Korean Circ J.  2007 Jun;37(6):265-270. 10.4070/kcj.2007.37.6.265.

Clinical Characteristics and Prognostic Factors of Patients with Severe Pulmonary Hypertension

• Lee WS
• Kim KH
• Jeong DH
• Lee KH
• Hong SN
• Park HW
• Kim JH
• Ahn YK
• Jeong MH
• Cho JG
• Park JC

• KMID: 1825860
• DOI: http://doi.org/10.4070/kcj.2007.37.6.265

Abstract

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate the clinical characteristics and predictors of the prognosis for patients with severe pulmonary hypertension (PHT).
SUBJECTS AND METHODS
A total of 169 patients with severe PHT (systolic pulmonary arterial pressure > or =70 mmHg by Doppler echocardiogram) were divided into two groups according to the mortality during 2.8+/-2.2 year clinical follow-up period: group I (moribund group, 34 patients, 60.0+/-15.7 years, 18 males) and group II (survived group, 135 patients, 57.2+/-16.9 years, 65 males). The clinical, electrocardiographic and echocardiographic variables were analyzed.
RESULTS
The three most common etiologies were valvular heart disease (VHD)(n=55: 32.9%), pulmonary thromboembolism (n=29: 17.2%) and ischemic cardiomyopathy (n=17: 10.1%). The common presenting clinical symptoms were dyspnea on exertion, leg edema, cough and chest discomfort. Among the variables, the WHO functional classification at presentation [95% confidence interval (CI) 2.065-221.168, p=0.010], atrial fibrillation (AF)(95% CI 1.014-10.161, p=0.041) and the left ventricular ejection fraction (LVEF)(95% CI 1.011-4.545, p=0.047) were significantly associated with the prognosis. CONSLUSION: VHD was the most common cause of severe PHT. The WHO functional classification at presentation, the presence of AF and low LVEF at presentation were the significant predictors of mortality for patients with severe PHT.

Keyword

Hypertension; pulmonary; Prognosis

MeSH Terms

Arterial Pressure
Atrial Fibrillation
Cardiomyopathies
Classification
Cough
Dyspnea
Echocardiography
Edema
Electrocardiography
Follow-Up Studies
Heart Valve Diseases
Humans
Hypertension
Hypertension, Pulmonary*
Leg
Mortality
Prognosis
Pulmonary Embolism
Stroke Volume
Thorax

Reference

1. Zipes DP, Libby P, Bonow RO, Braunwald E. Braunwald's Heart Disease. 2005. 7th ed. Philadelphia: Saunders;1807–1842.

2. Boyce PD, Waxman AB. Pulmonary hypertension: work in progress. J Nucl Cardiol. 2003. 10:413–423.

3. Kawut SM, Palevsky HI. Surrogate end points for pulmonary arterial hypertension. Am Heart J. 2004. 148:559–565.

4. Sims JM. What's new in pulmonary artery hypertension. Dimens Crit Care Nurs. 2003. 22:167–170.

5. Simonneau G, Galie N, Rubin LJ, et al. Clinical classification of pulmonary hypertension. J Am Coll Cardiol. 2004. 43:5S–12S.

6. Humbert M, Sitbon O, Simonneau G. Treatment of pulmonary arterial hypertension. N Engl J Med. 2004. 351:1425–1436.

7. Chakinala MM. Changing the prognosis of pulmonary arterial hypertension: impact of medical therapy. Semin Respir Crit Care Med. 2005. 26:409–416.

8. Gibbs JS, Higenbottam TW. Recommendations on the management of pulmonary hypertension in clinical practice. Heart. 2001. 86:Suppl I. I1–I13.

9. Torbicki A, Kurzyna M. Pulmonary arterial hypertension: evaluation of the newly diagnosed patient. Semin Respir Crit Care Med. 2005. 26:372–378.

10. Humbert M, Nunes H, Sitbon O, Parent F, Herve P, Simonneau G. Risk factors for pulmonary arterial hypertension. Clin Chest Med. 2001. 22:459–475.

11. Chung SM, Kim SH, Ryu KH, et al. Impact of pulmonary hypertension on the regional right ventricular strain. Korean Circ J. 2006. 36:578–582.

12. Lee WD, Kim DS, Lee JH, et al. A clinical review of primary pulmonary hypertension. Korean Circ J. 2003. 33:507–512.

13. Moloney ED, Evans TW. Pathophysiology and pharmacological treatment of pulmonary hypertension in acute respiratory distress syndrome. Eur Respir J. 2003. 21:720–727.

14. Yock PG, Popp RL. Noninvasive estimation of right ventricular systolic pressure by Doppler ultrasound in patients with tricuspid regurgitation. Circulation. 1984. 70:657–662.

15. Reynolds T. The Echocardiographer's Pocket Reference. 1993. 1st ed. Phoenix: Arizona Heart Institute;152–160.

16. Peterson KL, Nicod P. Catheterization and angiography in pulmonary hypertension. Cardiac Catheterization: Methods, Diagnosis and Therapy. 1997. 1st ed. Philadelphia: Saunders;401–414.

17. Huszar RJ. Basic Dysrhythmias. 2002. 3rd ed. St. Louis: Mosby.

18. Oh JK, Seward JB, Tajik AJ. The Echo Manual. 1999. 2nd ed. Philadelphia: Lippincott Williams & Wilkins.

19. Kwak MH, Oh JH, Jeong JO, et al. Role of echocardiography as a screening test in patients with suspected pulmonary embolism. Korean Circ J. 2001. 31:500–506.

20. de Perrot M, Granton J, Fadel E. Pulmonary hypertension after pulmonary emboli: an underrecognized condition. CMAJ. 2006. 174:1706.

21. Dartevelle P, Fadel E, Mussot S, et al. Chronic thromboembolic pulmonary hypertension. Eur Respir J. 2004. 23:637–648.

22. Fedullo PF, Kerr KM, Auger WR, Jamieson SW, Kapelanski DP. Chronic thromboembolic pulmonary hypertension. Semin Respir Crit Care Med. 2000. 21:563–574.

23. Schreiber J, Schreiber C, Kachel R, Bittner H. Thromboembolic pulmonary hypertension. Pneumologie. 2007. 61:123–124.

24. Roig Figueroa V, Herrero Perez A, de la Torre Ferrera N, Hernandez Garcia E, Aller Alvarez JL, Para Cabello J. Iloprost for chronic thromboembolic pulmonary hypertension. Arch Bronconeumol. 2004. 40:326–328.

25. Rubin LJ. Therapy of pulmonary hypertension: the evolution from vasodilators to antiproliferative agents. Am J Respir Crit Care Med. 2002. 166:1308–1309.

26. Hrometz SL, Shields KM. Sildenafil citrate for the treatment of pulmonary hypertension. Drugs Today. 2006. 42:771–784.

27. Jacobs A, Preston IR, Gomberg-Maitland M. Endothelin receptor antagonism in pulmonary arterial hypertension: a role for selective ET (A) inhibition? Curr Med Res Opin. 2006. 22:2567–2574.

28. McLaughlin VV, Sitbon O, Badesch DB, et al. Survival with firstline bosentan in patients with primary pulmonary hypertension. Eur Respir J. 2005. 25:244–249.

29. Stiebellehner L, Petkov V, Vonbank K, et al. Long-term treatment with oral sidelnafil in addition to continuous IV epoprostenol in patients with pulmonary arterial hypertension. Chest. 2003. 123:1293–1295.

30. Olsson LG, Swedberg K, Ducharme A, et al. Atrial fibrillation and risk of clinical events in chronic heart failure with and without left ventricular systolic dysfunction. J Am Coll Cardiol. 2006. 47:1997–2004.