15 February 2020 by Mauricio Orozco-Levi

Dyspnea in patients with pulmonary hypertension is not a good predictor of disease severity: the experience of the “Colombian Network of Pulmonary Hypertension”

Introduction: Pulmonary Hypertension (PH) is a severe hemodynamic disorder in which multiple variables have been associated with severity and prognosis of patients. In the clinical arena, symptoms of dyspnea, functional class and exercise capacity (walking or cycloergometry test variables) are commonly used to classify patients in low, medium or high risk mortality categories. Nevertheless, our clinical perception within the Colombian Network of Pulmonary Hypertension (HAPred.co) suggests that symptoms reported by patients of the Andean region could not linearly reflect the severity of the disease.

Aim: To assess the potential association between objective functional variables (hemodynamic and exercise date) with dyspnea or peripheral (legs) symptoms in patients with an incident diagnosis of group 1 and group 4 HP and living in the Andean region of Colombia.

Methods: The information of all the patients (n=503) identified within the Colombian Network of Pulmonary Hypertension (HAPred.co) was included in the analysis. The network is a multidisciplinary and multicenter trade union initiative that consolidates and analyzes the information of patients with hemodynamically confirmed diagnosis of PH, with special emphasis on Groups 1 and 4 of the disease. Correlation analyses (linear and non-linear) were performed between functional variables at rest (pressures, resistances and cardiac output in right catheterization) and symptoms in various clinical evaluations.
Results: To date we have included in the analysis 503 adult patients (50±17 years, 74% women), with diagnosis of PH group 1 and group 4. The elapsed time between beginning of symptoms and diagnosis was 29 months (median 12 months, 10 patients with more than 5 years). A total of 67 patients had the diagnosis of PH group 1, the other group 4. In 78% of patients, one or more comorbidities exist. The functional class (NYHA) showed no linear correlation with age, BMI, echocardiographic, or pulmonary catheterization variables recorded at the time of diagnosis or the values at the last follow-up visit (p=ns, r2≤0.1).

Conclusions: In patients living in the Colombian Andean region, the functional class does not have a linear correlation with the severity of the hemodynamic variables during pulmonary catheterization. These results highlight the importance of objective evaluations in patients with PH of group 1 and 4, since subjective variables (symptoms) at diagnosis or follow-up can drastically underestimate the degree of cardiac functional impairment.

Supported in part by Unrestricted BAYER grant HAPred.co, 2019.

Key Contributors

Mauricio Orozco-Levi, Melissa Mogollón, Javier Fajardo, Alba Ramírez-Sarmiento, Rafael Conde, Héctor Ortega, Manuel Pacheco, Alejandro Londoño, and the HAPred.co Network Investigators. Servicio de Neumología, Centro para el Cuidado de la Salud Respiratoria, Hospital Internacional de Colombia. Santander, Colombia. Universidad de Santander, Colombia. Universidad Industrial de Santander (UIS), Bucaramanga, Colombia. IPS Respiremos, Pereira, Colombia. Clínica CardioVid, Medellín, Colombia. Fundación Neumológica Colombiana, Bogotá, Colombia.

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