TY - JOUR
T1 - Assessment of survival in patients with primary pulmonary hypertension
T2 - Importance of cardiopulmonary exercise testing
AU - Wensel, Roland
AU - Opitz, Christian F.
AU - Anker, Stefan D.
AU - Winkler, Jrg
AU - Höffken, Gert
AU - Kleber, Franz X.
AU - Sharma, Rakesh
AU - Hummel, Manfred
AU - Hetzer, Roland
AU - Ewert, Ralf
PY - 2002/7/16
Y1 - 2002/7/16
N2 - Background - Primary pulmonary hypertension (PPH) is a life-threatening disease. Prognostic assessment is an important factor in determining medical treatment and lung transplantation. Whether cardiopulmonary exercise testing data predict survival has not been reported previously. Methods and Results - We studied 86 patients with PPH (58 female, age 46±2 years, median NYHA class III) between 1996 and 2001 who were followed up in a tertiary referral center. Right heart catheterization was performed and serum uric acid levels were measured in all patients. Seventy patients were able to undergo exercise testing. At the start of the study, the average pulmonary artery pressure was 60±2 mm Hg, average pulmonary vascular resistance was 1664±81 dyne · s · cm-5, average serum uric acid level was 7.5±0.35 mg/dL, and average peak oxygen uptake during exercise (peak V̇O2) was 11.2 ± 0.5 mL · kg-1 · min-1. During follow-up (mean: 567±48 days), 28 patients died and 16 underwent lung transplantation (1-year cumulative event-free survival: 68%; 95% CI 58 to 78). The strongest predictors of impaired survival were low peak V̇O2 (PO2 ≥ 10.4 mL · kg-1 · min-1 and peak SBP ≥ 120 mm Hg (ie, 2 risk factors) had poor survival rates at 12 months (23%), whereas patients with 1 or none of these risk factors had better survival rates (79% and 97%, respectively). Conclusions - Peak V̇O2 and peak SBP are independent and strong predictors of survival in PPH patients. Hemodynamic parameters, although also accurate predictors, provide no independent prognostic information.
AB - Background - Primary pulmonary hypertension (PPH) is a life-threatening disease. Prognostic assessment is an important factor in determining medical treatment and lung transplantation. Whether cardiopulmonary exercise testing data predict survival has not been reported previously. Methods and Results - We studied 86 patients with PPH (58 female, age 46±2 years, median NYHA class III) between 1996 and 2001 who were followed up in a tertiary referral center. Right heart catheterization was performed and serum uric acid levels were measured in all patients. Seventy patients were able to undergo exercise testing. At the start of the study, the average pulmonary artery pressure was 60±2 mm Hg, average pulmonary vascular resistance was 1664±81 dyne · s · cm-5, average serum uric acid level was 7.5±0.35 mg/dL, and average peak oxygen uptake during exercise (peak V̇O2) was 11.2 ± 0.5 mL · kg-1 · min-1. During follow-up (mean: 567±48 days), 28 patients died and 16 underwent lung transplantation (1-year cumulative event-free survival: 68%; 95% CI 58 to 78). The strongest predictors of impaired survival were low peak V̇O2 (PO2 ≥ 10.4 mL · kg-1 · min-1 and peak SBP ≥ 120 mm Hg (ie, 2 risk factors) had poor survival rates at 12 months (23%), whereas patients with 1 or none of these risk factors had better survival rates (79% and 97%, respectively). Conclusions - Peak V̇O2 and peak SBP are independent and strong predictors of survival in PPH patients. Hemodynamic parameters, although also accurate predictors, provide no independent prognostic information.
KW - Exercise
KW - Prognosis
KW - Pulmonary heart disease
KW - Risk factors
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U2 - 10.1161/01.CIR.0000022687.18568.2A
DO - 10.1161/01.CIR.0000022687.18568.2A
M3 - Article
C2 - 12119247
AN - SCOPUS:0037118681
VL - 106
SP - 319
EP - 324
JO - Circulation
JF - Circulation
SN - 0009-7322
IS - 3
ER -