Author + information
- Serdar Kucukoglu,
- Cihangir Kaymaz,
- Gul Sagin Saylam,
- Serdar Kula,
- Dursun Alehan,
- Atif Akcevin,
- Alpay Celiker,
- Sertac Cicek,
- Mehmet Gungor Kaya and
- Lale Tokgozoglu
The definition of WHO functional class (FC) is mainly based on the semi-quantitative evaluation of exertion capacity and clinical symptoms, and therefore lacks objectivity in its use for PAH associated with congenital heart disease (APAH-CHD). To overcome this limitation, we explored a quantitative definition of FC based on the 6MWD in patients with APAH-CHD.
Data from patients with APAH-CHD (mean PAP >25 mmHg, PCWP ≤15 mmHg, and PVRI >3 Wood units.m2), who were included into THALES Registry, and whose FC and 6MWD data were available, were analysed. FC was correlated with 4 pre-specified quartiles (qt) of 6MWD: qt1>450 m; qt2 374-450 m; qt3 301- 374 m; and qt4<301 m. All results are expressed as means + standard deviations. Comparisons between subgroups were performed by using Mann-Whitney U test. The correlation coefficients and their significance were calculated using the Pearson test.
194 patients were included in this analysis (M/F: 95/99, mean age 24.5 y +15.4 y). The mean 6MWD was 371 + 126 m. Pulmonary arterial systolic and mean pressures (PAPs, PAPm) were 99.9+27,1 and 65.3+20,4 mmHg, right atrial pressure (RAP) and PCWP were 9.41+3.41 and 11.16+3.34 mmHg, transpulmonary and transsystemic pressure gradients (TPPG, TSPG) were 55.4+19.9 and 75.9+18.0 mmHg, Qp/Qs and PVR/SVR ratios were 3.23+4.30 and 0.44+0.35, mixed venous, pulmonary arterial and systemic arterial O2 saturations (mVO2%, PAO2% and SAO2%) were 64.4+11.2%, 78.3+10.3% and 88.7+8.6%, respectively. The 6MWD stratified in 4 qt's showed a statistically significant correlation with FC (r= −0.68, p<0.0001) but not with age, gender, RAP, PCWP, Qp/Qs, PVR/SVR, mVO2%, PAO2%, SAO2%, platelet count, uric acid and C-reactive protein (p=NS). However, qt4 had a lower PAPm (65+19 mmHg vs 72+21 mmHg, p<0.05), TPPG (55+20 mmHg vs 62+20 mmHg, p<0.05) and TSPG (73+25 mmHg vs 81+18 mmHg, p<0,01) compared to qt2.
Categorization of APAH-CHD patients according to 6MWD-quartiles strongly correlates with the WHO FC but not with hemodynamic and other clinical parameters. However, prognostic implications of this approach remain to be determined.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Pulmonary Hypertension: Right Ventricle / Congenital Heart Disease
Abstract Category: 27. Pulmonary Hypertension
Presentation Number: 1208-154
- 2013 American College of Cardiology Foundation