04 February 2019 by Agueda Aurtenetxe Perez

Chronic thromboembolic pulmonary hypertension. Observational study in referral unit

Purpose:

Chronic thromboembolic pulmonary hypertension (CTEPH) causes elevated pulmonary vascular resistance (PVR) due to incomplete resolution of pulmonary thromboemboli. The treatment of choice and curative strategy is pulmonary thromboendarterectomy (PTE) surgery, although inoperable patient has been proposed for angioplasty or medical treatment. Our purpose was to determine the treatment chosen and clinical outcomes of our patients with CTPEPH according to the age.

Methods:

This is an observational prospective cohort study of 482 patients diagnosed with CTEPH from our Pulmonary Hypertension Unit. All patients were evaluated by the multidisciplinary team of pulmonary arterial hypertension. We analysed patient baseline prognostic variables, rate of surgeries and procedures of angioplasty and survival. We classified our sample in two groups, first group was below 75 percentile regarding age (Group A ≤ 70 years) and the second one was above 70 years (Group B >70 years).

Results:

Out of 482 with CTEPH 25% were above 70 years (118 patients, group B). Patients in group B were women more frequent than in group A (70%Vs49%(p<0,001)) and had lower results in 6MWT (group A 391,45 ±120,73 Vs group B 311,8 ±103,16 (p <0,001)) and CO in hemodynamics (groupA 4,41±1,32 l/min Vs groupB 4,12±1,08 l/min (p<0,038). The rest of prognostic variables were similar between groups (A Vs B) NYHA III-IV (67,5% Vs 68,6% p=0,8); NTProBNP (1562 Vs 1889 (p=0,22)); RAP (9,41±4,74mmHg Vs 8,71±4,5mmHg (p = 0,25)); PVR (9,49 ±5,03 WU Vs 9,17±4,31WU p=0,55).Pulmonary thromboendarterectomy was performed more frequently in group A than in group B (57%Vs17,8% (p< 0,001)) whereas in group B the patients who underwent through angioplasty was higher comparing to group A (A15%VsB19% p= 0,269).
The survival at 1st, 3th and 5th year was 96%-92%-88% for GroupA, and 95%-86%-80% for GroupB.

Conclusions:

There was not a significant difference between both groups regarding prognostic assessment tools. However, patients in group A were more frequent to go through surgery whereas in group B the elected treatment was conservative therapy. The survival was higher in the group A. 

About the author


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Key Contributors

A. Aurtenetxe 1, C. Pérez-Olivares 1, P. Caravaca 1, N. Ochoa 1, M.J López-Gude 1 M.T. Velázquez 1, J.Cortina 1, S. Alonso 1, Escribano 1-2 : 1. University Hospital 12 de Octubre, Multidisciplinary Pulmonary Hpertension Unit, Madrid, Spain 2. University Hospital 12 de Octubre, CIBER Enfermedades Cardiovasculares, Madrid, Spain


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