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J Heart Lung Transplant. 2012 Apr;31(4):364-72. doi: 10.1016/j.healun.2011.12.011. Epub 2012 Jan 29.

Prognostic factors in severe pulmonary hypertension patients who need parenteral prostanoid therapy: the impact of late referral.

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1
Department of Cardiovascular and Respiratory Science, I School of Medicine, University of Rome Sapienza, Policlinico Umberto I.

Abstract

BACKGROUND:

Oral drugs have made the treatment of pulmonary hypertension (PH) feasible in non-expert centers, which could delay patient access to prostanoid therapy.

METHODS:

Fifty-seven consecutive patients with precapillary PH received a prostanoid in our center. Data at prostanoid initiation included modality of center referral, medical history, New York Heart Association [NYHA] class, exercise capacity, echocardiographic parameters, and hemodynamics.

RESULTS:

Overall survival at 1, 2, and 3 years was 85%, 69%, 55%, respectively. Non-survivors had worse NYHA class III/IV (17/12) than survivors (27/1; p < 0.01) and exercise capacity on 6-minute-walk distance (254 ± 114 vs 354 ± 91 meters; p < 0.01). Non-survivors were more frequently referred on oral therapy (83% vs 36%; p < 0.01) and had a higher rate of urgent prostanoid treatment (69% vs 17%; p < 0.0001). Multivariate analysis (hazard ratio [95% confidence interval]) found the independent prognostic factors were urgent prostanoid therapy (2.0 [1.1-3.9]) and NYHA class (3.5 [1.5-8.2]). Survivors had a significant response to prostanoid, improving NYHA class from 2.8 ± 0.4 to 2.3 ± 0.5 (p = 0.002), 6-minute walk distance from 354 ± 91 to 426 ± 82 meters (p = 0.0001), and pulmonary hemodynamics (pulmonary artery pressure from 56 ± 13 to 44 ± 18 mm Hg [p < 0.05]; cardiac index from 2.0 ± 1.2 to 3.1 ± 1.2 liters/min/m(2) [p = 0.002], and pulmonary vascular resistance from 17 ± 10 to 8 ± 6 WU [p = 0.001]).

CONCLUSIONS:

Referral of patients on oral treatment to a tertiary PH center is delayed and significantly affects prognosis.

PMID:
22289484
DOI:
10.1016/j.healun.2011.12.011
[Indexed for MEDLINE]
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