Pulmonary arterial hypertension (PAH) in the elderly is often associated with left heart disease (LHD), prompting concerns about the use of pulmonary vasodilators. The PATRIARCA registry enrolled >= 70 year-old PAH or chronic thromboembolic pulmonary hypertension (CTEPH) patients at 11 Italian centers from 1 December 2019 through 15 September 2022. After excluding those with CTEPH, post-capillary PH at the diagnostic right heart catheterization (RHC), and/or incomplete data, 23 (33%) of a total of 69 subjects met the criteria proposed in the AMBITION trial to suspect LHD. Diabetes [9 (39%) vs. 6 (13%), p = 0.01] and chronic kidney disease [14 (61%) vs. 12 (26%), p = 0.003] were more common, and the last RHC pulmonary artery wedge pressure [14 +/- 5 vs. 10 +/- 3 mmHg, p < 0.001] was higher and pulmonary vascular resistance [5.56 +/- 3.31 vs. 8.30 +/- 4.80, p = 0.02] was lower in LHD than non-LHD patients. However, PAH therapy was similar, with 13 (57%) and 23 (50%) subjects, respectively, taking two oral drugs. PAH medication patterns remained comparable between LHD and non-LHD patients also when the former [37, 54%] were identified by atrial fibrillation and echocardiographic features of LHD, in addition to the AMBITION criteria. In this real-world snapshot, elderly PAH patients were treated with pulmonary vasodilators, including combinations, despite a remarkable prevalence of a LHD phenotype.

Left Heart Disease Phenotype in Elderly Patients with Pulmonary Arterial Hypertension: Insights from the Italian PATRIARCA Registry / M. Toma, R. Miceli, E. Bonsante, D. Colombo, M. Confalonieri, A. Garascia, S. Ghio, M. Lattanzio, C.M. Lombardi, G. Paciocco, C. Piccinino, I. Rota, C. Santolamazza, L. Scelsi, P. Scuri, D. Stolfo, A. Vincenzi, L. Volpiano, M. Vicenzi, P. Ameri. - In: JOURNAL OF CLINICAL MEDICINE. - ISSN 2077-0383. - 11:23(2022 Nov 30), pp. 7136.1-7136.10. [10.3390/jcm11237136]

Left Heart Disease Phenotype in Elderly Patients with Pulmonary Arterial Hypertension: Insights from the Italian PATRIARCA Registry

M. Vicenzi
Penultimo
;
2022

Abstract

Pulmonary arterial hypertension (PAH) in the elderly is often associated with left heart disease (LHD), prompting concerns about the use of pulmonary vasodilators. The PATRIARCA registry enrolled >= 70 year-old PAH or chronic thromboembolic pulmonary hypertension (CTEPH) patients at 11 Italian centers from 1 December 2019 through 15 September 2022. After excluding those with CTEPH, post-capillary PH at the diagnostic right heart catheterization (RHC), and/or incomplete data, 23 (33%) of a total of 69 subjects met the criteria proposed in the AMBITION trial to suspect LHD. Diabetes [9 (39%) vs. 6 (13%), p = 0.01] and chronic kidney disease [14 (61%) vs. 12 (26%), p = 0.003] were more common, and the last RHC pulmonary artery wedge pressure [14 +/- 5 vs. 10 +/- 3 mmHg, p < 0.001] was higher and pulmonary vascular resistance [5.56 +/- 3.31 vs. 8.30 +/- 4.80, p = 0.02] was lower in LHD than non-LHD patients. However, PAH therapy was similar, with 13 (57%) and 23 (50%) subjects, respectively, taking two oral drugs. PAH medication patterns remained comparable between LHD and non-LHD patients also when the former [37, 54%] were identified by atrial fibrillation and echocardiographic features of LHD, in addition to the AMBITION criteria. In this real-world snapshot, elderly PAH patients were treated with pulmonary vasodilators, including combinations, despite a remarkable prevalence of a LHD phenotype.
comorbidity; elderly; left heart disease; pulmonary hypertension; vasodilator
Settore MED/11 - Malattie dell'Apparato Cardiovascolare
30-nov-2022
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/995709
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