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

Roberto Badagliacca, Beatrice Pezzuto, Roberto Poscia, Massimo Mancone, Silvia Papa, Serena Marcon, Gabriele Valli, Gennaro Sardella, Fabio Ferrante, Carlo Iacoboni, Daniela Parola, Francesco Fedele, Carmine Dario Vizza

Research output: Contribution to journalArticle

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 [1.13.9]) and NYHA class (3.5 [1.58.2]). 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.

Original languageEnglish
Pages (from-to)364-372
Number of pages9
JournalJournal of Heart and Lung Transplantation
Volume31
Issue number4
DOIs
Publication statusPublished - Apr 2012

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Keywords

  • epoprostenol
  • prostanoids
  • pulmonary arterial hypertension
  • survival
  • treprostinil

ASJC Scopus subject areas

  • Transplantation
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

Badagliacca, R., Pezzuto, B., Poscia, R., Mancone, M., Papa, S., Marcon, S., Valli, G., Sardella, G., Ferrante, F., Iacoboni, C., Parola, D., Fedele, F., & Vizza, C. D. (2012). Prognostic factors in severe pulmonary hypertension patients who need parenteral prostanoid therapy: The impact of late referral. Journal of Heart and Lung Transplantation, 31(4), 364-372. https://doi.org/10.1016/j.healun.2011.12.011