Author + information
- Cihangir Kaymaz,
- Ozgur Akbal,
- Fatih Yilmaz,
- Hacer Ceren Tokgoz,
- Ibrahim Halil Tanboga,
- Aykun Hakgor,
- Canan Elif Yildiz,
- Sevim Turkday,
- Nertila Poci,
- Tugba Aktemur,
- Durmus Demir,
- Seda Tanyeri and
- Nihal Ozdemir
Background: Although diastolic pulmonary gradient (DPG) has been proposed as a novel hemodynamic measure (HM) in the definition of combined pre and post-capillary pulmonary hypertension (PH), its prognostic value remains to be determined. In this analysis, we evaluated the prognostic value of DPG together with baseline functional class (FC), six-minute walk distance (6MWD), plasma brain natriuretic peptide (BNP), uric acid (UA), C-reactive protein (CRP) and HMs for PH survival (SV).
Methods: 481 pts (Female 61.5%, age 49.2±18.2 years) with PH were included into the study. Subgroups were as follows: Idiopathic Pulmonary Arterial Hypertension (IPAH) in 102, PAH associated with congenital heart disease (APAH-CHD) in 166, PAH associated with connective-tissue disease (APAH-CTD) in 25, other PAH in 9, combined pre and post-capillary PH in 15, Group 3 PH in 56 and Group 4 in 108 pts.
Results: At index admission 38.9% of pts were treatment-naive (TN). FC was II in 12.1%, III in 52.5% and IV in 34.6% of pts. Median 6MWD was 279 (180-360) m and serum BNP was 341 (85-902) pg/mL at diagnosis. Systolic and mean pulmonary arterial pressures were 87.9±31.6 and 54.4±22.0 mmHg, and mean pulmonary and systemic vascular resistance (PVR, SVR) and PVR/SVR ratio were 9.32±6.64 Wood Unit (WU), 21.8±8.59 WU and 0.44±0.32, respectively. DPG showed strong correlation to PVR (r=0.731, p<0.001). Median follow-up was 12.6 months, and 587 clinical worsening episodes (CWs) of PH were noted in 274 pts (2.14 per pt,1 to 16). Background mono, dual and triple targeted treatments (TT) were noted in 94.3%, 5.3% and 0.5% of the CWs in non-TN pts, respectively. The 1, 3, 5 and 9-year survival rates were 80 %, 69 %, 57 % and 40%, respectively. Although APAH-CHD was associated with a lower mortality as compared to APAH-CTD and IPAH (p=0.009), SV was comparable among the PH groups (p>0.05). In multivariate analysis, baseline FC, PVR, and CWs, but not age, sex, baseline or follow-up 6MWD, BNP, UA, CRP, DPG and PVR/SVR ratio were found to predict SV.
Conclusions: Baseline FC and PVR, and history of CWs, but not other clinical, biochemical, TT characteristics or HMs including DPG seem to predict SV in pts with PH.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Predicting the Future: Observations and Discoveries From Registries and Databases
Abstract Category: 35. Pulmonary Hypertension and Pulmonary Thrombo-embolic Disease
Presentation Number: 1230-005
- 2017 American College of Cardiology Foundation