Predictors of mortality in inoperable chronic thromboembolic pulmonary hypertension
Received 19 August 2008; accepted 18 January 2009. published online 23 February 2009.
Summary
Introduction
Recent studies suggest that medically treated patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) have an improved prognosis. However, only limited data are available concerning predictors of mortality in these patients. The aim of this study was to assess, and to identify, predictors of the long-term outcome of inoperable CTEPH patients.
Methods
We analysed 84 inoperable CTEPH patients referred to our centre between 1999 and 2008. During follow-up (mean 32months), 17 patients died and one underwent a lung transplantation. The 1-, 3- and 5-year survival rates were 93, 78 and 68%, respectively. Univariate analysis demonstrated that 6-min walking distance (6MWD), mean pulmonary artery pressure (mPAP), right atrial pressure (RAP) and pulmonary vascular resistance (PVR) were predictive factors for survival. In the multivariate analysis only 6MWD was independently related to poor survival (hazard ratio 0.995; 95% CI, 0.991–0.998; P=0.003). Kaplan–Meier curves showed that patients with an mPAP>40mmHg, PVR>584dyn s cm−5 and RAP>12mmHg had a very poor prognosis.
Conclusions
Haemodynamic parameters (mPAP, RAP, PVR) and the 6MWD at baseline are predictive factors for mortality of medically treated inoperable CTEPH patients. A subgroup of these patients with good prognostic factors, defined by their haemodynamics and clinical measures, have an improved long-term survival and outcome.
aDepartment of Pulmonary Diseases, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
bDepartment of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
cClinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
Corresponding author. Department of Pulmonary Diseases, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. Tel.: +31 204444327; fax: +31 204444328.
ABSTRACT