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Cannon JE, Su L, Kiely DG, Page K, Toshner M, Swietlik E, Treacy C, Ponnaberanam A, Condliffe R, Sheares K, Taboada D, Dunning J, Tsui S, Ng C, Gopalan D, Screaton N, Elliot C, Gibbs S, Howard L, Corris P, Lordan J, Johnson M, Peacock A, MacKenzie-Ross R, Schreiber B, Coghlan G, Dimopoulos K, Wort SJ, Gaine S, Moledina S, Jenkins DP, Pepke-Zaba J. Dynamic Risk Stratification of Patient Long-Term Outcome After Pulmonary Endarterectomy: Results From the United Kingdom National Cohort. Circulation 2016; 133:1761-71. [PMID: 27052413 DOI: 10.1161/circulationaha.115.019470] [Citation(s) in RCA: 281] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 03/18/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Chronic thromboembolic pulmonary hypertension results from incomplete resolution of pulmonary emboli. Pulmonary endarterectomy (PEA) is potentially curative, but residual pulmonary hypertension following surgery is common and its impact on long-term outcome is poorly understood. We wanted to identify factors correlated with poor long-term outcome after surgery and specifically define clinically relevant residual pulmonary hypertension post-PEA. METHODS AND RESULTS Eight hundred eighty consecutive patients (mean age, 57 years) underwent PEA for chronic thromboembolic pulmonary hypertension. Patients routinely underwent detailed reassessment with right heart catheterization and noninvasive testing at 3 to 6 months and annually thereafter with discharge if they were clinically stable at 3 to 5 years and did not require pulmonary vasodilator therapy. Cox regressions were used for survival (time-to-event) analyses. Overall survival was 86%, 84%, 79%, and 72% at 1, 3, 5, and 10 years for the whole cohort and 91% and 90% at 1 and 3 years for the recent half of the cohort. The majority of patient deaths after the perioperative period were not attributable to right ventricular failure (chronic thromboembolic pulmonary hypertension). At reassessment, a mean pulmonary artery pressure of ≥30 mm Hg correlated with the initiation of pulmonary vasodilator therapy post-PEA. A mean pulmonary artery pressure of ≥38 mm Hg and pulmonary vascular resistance ≥425 dynes·s(-1)·cm(-5) at reassessment correlated with worse long-term survival. CONCLUSIONS Our data confirm excellent long-term survival and maintenance of good functional status post-PEA. Hemodynamic assessment 3 to 6 months and 12 months post-PEA allows stratification of patients at higher risk of dying of chronic thromboembolic pulmonary hypertension and identifies a level of residual pulmonary hypertension that may guide the long-term management of patients postsurgery.
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Affiliation(s)
- John E Cannon
- From Papworth Hospital, Cambridge, United Kingdom (J.E.C., K.P., M.T., E.S., C.T., A. Ponnaberanam, K.S., D.T., J.D., S.T., C.N., N.S., D.P.T., J.P.-Z.); MRC Biostatistics Unit, Cambridge, United Kingdom (L.S.); Royal Hallamshire Hospital, Sheffield, United Kingdom (D.G.K., R.C., C.E.); Respiratory Medicine Department, University of Warmia and Mazury, Poland (E.S.); Hammersmith Hospital, London, United Kingdom (D.G., S. Gibbs, L.H.); Freeman Hospital, Newcastle, United Kingdom (P.C., J.L.); Golden Jubilee Hospital, Glasgow, United Kingdom (M.J., A. Peacock); Royal United Hospital, Bath, United Kingdom (R.M.-R.); Royal Free Hospital, London, United Kingdom (B.S., G.C.); Royal Brompton Hospital, London, United Kingdom (K.D., J.W.); Mater Misericordiae University Hospital, Dublin, Ireland (S. Gaine); and Great Ormond Street Hospital, London, United Kingdom (S.M.)
| | - Li Su
- From Papworth Hospital, Cambridge, United Kingdom (J.E.C., K.P., M.T., E.S., C.T., A. Ponnaberanam, K.S., D.T., J.D., S.T., C.N., N.S., D.P.T., J.P.-Z.); MRC Biostatistics Unit, Cambridge, United Kingdom (L.S.); Royal Hallamshire Hospital, Sheffield, United Kingdom (D.G.K., R.C., C.E.); Respiratory Medicine Department, University of Warmia and Mazury, Poland (E.S.); Hammersmith Hospital, London, United Kingdom (D.G., S. Gibbs, L.H.); Freeman Hospital, Newcastle, United Kingdom (P.C., J.L.); Golden Jubilee Hospital, Glasgow, United Kingdom (M.J., A. Peacock); Royal United Hospital, Bath, United Kingdom (R.M.-R.); Royal Free Hospital, London, United Kingdom (B.S., G.C.); Royal Brompton Hospital, London, United Kingdom (K.D., J.W.); Mater Misericordiae University Hospital, Dublin, Ireland (S. Gaine); and Great Ormond Street Hospital, London, United Kingdom (S.M.)
| | - David G Kiely
- From Papworth Hospital, Cambridge, United Kingdom (J.E.C., K.P., M.T., E.S., C.T., A. Ponnaberanam, K.S., D.T., J.D., S.T., C.N., N.S., D.P.T., J.P.-Z.); MRC Biostatistics Unit, Cambridge, United Kingdom (L.S.); Royal Hallamshire Hospital, Sheffield, United Kingdom (D.G.K., R.C., C.E.); Respiratory Medicine Department, University of Warmia and Mazury, Poland (E.S.); Hammersmith Hospital, London, United Kingdom (D.G., S. Gibbs, L.H.); Freeman Hospital, Newcastle, United Kingdom (P.C., J.L.); Golden Jubilee Hospital, Glasgow, United Kingdom (M.J., A. Peacock); Royal United Hospital, Bath, United Kingdom (R.M.-R.); Royal Free Hospital, London, United Kingdom (B.S., G.C.); Royal Brompton Hospital, London, United Kingdom (K.D., J.W.); Mater Misericordiae University Hospital, Dublin, Ireland (S. Gaine); and Great Ormond Street Hospital, London, United Kingdom (S.M.)
| | - Kathleen Page
- From Papworth Hospital, Cambridge, United Kingdom (J.E.C., K.P., M.T., E.S., C.T., A. Ponnaberanam, K.S., D.T., J.D., S.T., C.N., N.S., D.P.T., J.P.-Z.); MRC Biostatistics Unit, Cambridge, United Kingdom (L.S.); Royal Hallamshire Hospital, Sheffield, United Kingdom (D.G.K., R.C., C.E.); Respiratory Medicine Department, University of Warmia and Mazury, Poland (E.S.); Hammersmith Hospital, London, United Kingdom (D.G., S. Gibbs, L.H.); Freeman Hospital, Newcastle, United Kingdom (P.C., J.L.); Golden Jubilee Hospital, Glasgow, United Kingdom (M.J., A. Peacock); Royal United Hospital, Bath, United Kingdom (R.M.-R.); Royal Free Hospital, London, United Kingdom (B.S., G.C.); Royal Brompton Hospital, London, United Kingdom (K.D., J.W.); Mater Misericordiae University Hospital, Dublin, Ireland (S. Gaine); and Great Ormond Street Hospital, London, United Kingdom (S.M.)
| | - Mark Toshner
- From Papworth Hospital, Cambridge, United Kingdom (J.E.C., K.P., M.T., E.S., C.T., A. Ponnaberanam, K.S., D.T., J.D., S.T., C.N., N.S., D.P.T., J.P.-Z.); MRC Biostatistics Unit, Cambridge, United Kingdom (L.S.); Royal Hallamshire Hospital, Sheffield, United Kingdom (D.G.K., R.C., C.E.); Respiratory Medicine Department, University of Warmia and Mazury, Poland (E.S.); Hammersmith Hospital, London, United Kingdom (D.G., S. Gibbs, L.H.); Freeman Hospital, Newcastle, United Kingdom (P.C., J.L.); Golden Jubilee Hospital, Glasgow, United Kingdom (M.J., A. Peacock); Royal United Hospital, Bath, United Kingdom (R.M.-R.); Royal Free Hospital, London, United Kingdom (B.S., G.C.); Royal Brompton Hospital, London, United Kingdom (K.D., J.W.); Mater Misericordiae University Hospital, Dublin, Ireland (S. Gaine); and Great Ormond Street Hospital, London, United Kingdom (S.M.)
| | - Emilia Swietlik
- From Papworth Hospital, Cambridge, United Kingdom (J.E.C., K.P., M.T., E.S., C.T., A. Ponnaberanam, K.S., D.T., J.D., S.T., C.N., N.S., D.P.T., J.P.-Z.); MRC Biostatistics Unit, Cambridge, United Kingdom (L.S.); Royal Hallamshire Hospital, Sheffield, United Kingdom (D.G.K., R.C., C.E.); Respiratory Medicine Department, University of Warmia and Mazury, Poland (E.S.); Hammersmith Hospital, London, United Kingdom (D.G., S. Gibbs, L.H.); Freeman Hospital, Newcastle, United Kingdom (P.C., J.L.); Golden Jubilee Hospital, Glasgow, United Kingdom (M.J., A. Peacock); Royal United Hospital, Bath, United Kingdom (R.M.-R.); Royal Free Hospital, London, United Kingdom (B.S., G.C.); Royal Brompton Hospital, London, United Kingdom (K.D., J.W.); Mater Misericordiae University Hospital, Dublin, Ireland (S. Gaine); and Great Ormond Street Hospital, London, United Kingdom (S.M.)
| | - Carmen Treacy
- From Papworth Hospital, Cambridge, United Kingdom (J.E.C., K.P., M.T., E.S., C.T., A. Ponnaberanam, K.S., D.T., J.D., S.T., C.N., N.S., D.P.T., J.P.-Z.); MRC Biostatistics Unit, Cambridge, United Kingdom (L.S.); Royal Hallamshire Hospital, Sheffield, United Kingdom (D.G.K., R.C., C.E.); Respiratory Medicine Department, University of Warmia and Mazury, Poland (E.S.); Hammersmith Hospital, London, United Kingdom (D.G., S. Gibbs, L.H.); Freeman Hospital, Newcastle, United Kingdom (P.C., J.L.); Golden Jubilee Hospital, Glasgow, United Kingdom (M.J., A. Peacock); Royal United Hospital, Bath, United Kingdom (R.M.-R.); Royal Free Hospital, London, United Kingdom (B.S., G.C.); Royal Brompton Hospital, London, United Kingdom (K.D., J.W.); Mater Misericordiae University Hospital, Dublin, Ireland (S. Gaine); and Great Ormond Street Hospital, London, United Kingdom (S.M.)
| | - Anie Ponnaberanam
- From Papworth Hospital, Cambridge, United Kingdom (J.E.C., K.P., M.T., E.S., C.T., A. Ponnaberanam, K.S., D.T., J.D., S.T., C.N., N.S., D.P.T., J.P.-Z.); MRC Biostatistics Unit, Cambridge, United Kingdom (L.S.); Royal Hallamshire Hospital, Sheffield, United Kingdom (D.G.K., R.C., C.E.); Respiratory Medicine Department, University of Warmia and Mazury, Poland (E.S.); Hammersmith Hospital, London, United Kingdom (D.G., S. Gibbs, L.H.); Freeman Hospital, Newcastle, United Kingdom (P.C., J.L.); Golden Jubilee Hospital, Glasgow, United Kingdom (M.J., A. Peacock); Royal United Hospital, Bath, United Kingdom (R.M.-R.); Royal Free Hospital, London, United Kingdom (B.S., G.C.); Royal Brompton Hospital, London, United Kingdom (K.D., J.W.); Mater Misericordiae University Hospital, Dublin, Ireland (S. Gaine); and Great Ormond Street Hospital, London, United Kingdom (S.M.)
| | - Robin Condliffe
- From Papworth Hospital, Cambridge, United Kingdom (J.E.C., K.P., M.T., E.S., C.T., A. Ponnaberanam, K.S., D.T., J.D., S.T., C.N., N.S., D.P.T., J.P.-Z.); MRC Biostatistics Unit, Cambridge, United Kingdom (L.S.); Royal Hallamshire Hospital, Sheffield, United Kingdom (D.G.K., R.C., C.E.); Respiratory Medicine Department, University of Warmia and Mazury, Poland (E.S.); Hammersmith Hospital, London, United Kingdom (D.G., S. Gibbs, L.H.); Freeman Hospital, Newcastle, United Kingdom (P.C., J.L.); Golden Jubilee Hospital, Glasgow, United Kingdom (M.J., A. Peacock); Royal United Hospital, Bath, United Kingdom (R.M.-R.); Royal Free Hospital, London, United Kingdom (B.S., G.C.); Royal Brompton Hospital, London, United Kingdom (K.D., J.W.); Mater Misericordiae University Hospital, Dublin, Ireland (S. Gaine); and Great Ormond Street Hospital, London, United Kingdom (S.M.)
| | - Karen Sheares
- From Papworth Hospital, Cambridge, United Kingdom (J.E.C., K.P., M.T., E.S., C.T., A. Ponnaberanam, K.S., D.T., J.D., S.T., C.N., N.S., D.P.T., J.P.-Z.); MRC Biostatistics Unit, Cambridge, United Kingdom (L.S.); Royal Hallamshire Hospital, Sheffield, United Kingdom (D.G.K., R.C., C.E.); Respiratory Medicine Department, University of Warmia and Mazury, Poland (E.S.); Hammersmith Hospital, London, United Kingdom (D.G., S. Gibbs, L.H.); Freeman Hospital, Newcastle, United Kingdom (P.C., J.L.); Golden Jubilee Hospital, Glasgow, United Kingdom (M.J., A. Peacock); Royal United Hospital, Bath, United Kingdom (R.M.-R.); Royal Free Hospital, London, United Kingdom (B.S., G.C.); Royal Brompton Hospital, London, United Kingdom (K.D., J.W.); Mater Misericordiae University Hospital, Dublin, Ireland (S. Gaine); and Great Ormond Street Hospital, London, United Kingdom (S.M.)
| | - Dolores Taboada
- From Papworth Hospital, Cambridge, United Kingdom (J.E.C., K.P., M.T., E.S., C.T., A. Ponnaberanam, K.S., D.T., J.D., S.T., C.N., N.S., D.P.T., J.P.-Z.); MRC Biostatistics Unit, Cambridge, United Kingdom (L.S.); Royal Hallamshire Hospital, Sheffield, United Kingdom (D.G.K., R.C., C.E.); Respiratory Medicine Department, University of Warmia and Mazury, Poland (E.S.); Hammersmith Hospital, London, United Kingdom (D.G., S. Gibbs, L.H.); Freeman Hospital, Newcastle, United Kingdom (P.C., J.L.); Golden Jubilee Hospital, Glasgow, United Kingdom (M.J., A. Peacock); Royal United Hospital, Bath, United Kingdom (R.M.-R.); Royal Free Hospital, London, United Kingdom (B.S., G.C.); Royal Brompton Hospital, London, United Kingdom (K.D., J.W.); Mater Misericordiae University Hospital, Dublin, Ireland (S. Gaine); and Great Ormond Street Hospital, London, United Kingdom (S.M.)
| | - John Dunning
- From Papworth Hospital, Cambridge, United Kingdom (J.E.C., K.P., M.T., E.S., C.T., A. Ponnaberanam, K.S., D.T., J.D., S.T., C.N., N.S., D.P.T., J.P.-Z.); MRC Biostatistics Unit, Cambridge, United Kingdom (L.S.); Royal Hallamshire Hospital, Sheffield, United Kingdom (D.G.K., R.C., C.E.); Respiratory Medicine Department, University of Warmia and Mazury, Poland (E.S.); Hammersmith Hospital, London, United Kingdom (D.G., S. Gibbs, L.H.); Freeman Hospital, Newcastle, United Kingdom (P.C., J.L.); Golden Jubilee Hospital, Glasgow, United Kingdom (M.J., A. Peacock); Royal United Hospital, Bath, United Kingdom (R.M.-R.); Royal Free Hospital, London, United Kingdom (B.S., G.C.); Royal Brompton Hospital, London, United Kingdom (K.D., J.W.); Mater Misericordiae University Hospital, Dublin, Ireland (S. Gaine); and Great Ormond Street Hospital, London, United Kingdom (S.M.)
| | - Steven Tsui
- From Papworth Hospital, Cambridge, United Kingdom (J.E.C., K.P., M.T., E.S., C.T., A. Ponnaberanam, K.S., D.T., J.D., S.T., C.N., N.S., D.P.T., J.P.-Z.); MRC Biostatistics Unit, Cambridge, United Kingdom (L.S.); Royal Hallamshire Hospital, Sheffield, United Kingdom (D.G.K., R.C., C.E.); Respiratory Medicine Department, University of Warmia and Mazury, Poland (E.S.); Hammersmith Hospital, London, United Kingdom (D.G., S. Gibbs, L.H.); Freeman Hospital, Newcastle, United Kingdom (P.C., J.L.); Golden Jubilee Hospital, Glasgow, United Kingdom (M.J., A. Peacock); Royal United Hospital, Bath, United Kingdom (R.M.-R.); Royal Free Hospital, London, United Kingdom (B.S., G.C.); Royal Brompton Hospital, London, United Kingdom (K.D., J.W.); Mater Misericordiae University Hospital, Dublin, Ireland (S. Gaine); and Great Ormond Street Hospital, London, United Kingdom (S.M.)
| | - Choo Ng
- From Papworth Hospital, Cambridge, United Kingdom (J.E.C., K.P., M.T., E.S., C.T., A. Ponnaberanam, K.S., D.T., J.D., S.T., C.N., N.S., D.P.T., J.P.-Z.); MRC Biostatistics Unit, Cambridge, United Kingdom (L.S.); Royal Hallamshire Hospital, Sheffield, United Kingdom (D.G.K., R.C., C.E.); Respiratory Medicine Department, University of Warmia and Mazury, Poland (E.S.); Hammersmith Hospital, London, United Kingdom (D.G., S. Gibbs, L.H.); Freeman Hospital, Newcastle, United Kingdom (P.C., J.L.); Golden Jubilee Hospital, Glasgow, United Kingdom (M.J., A. Peacock); Royal United Hospital, Bath, United Kingdom (R.M.-R.); Royal Free Hospital, London, United Kingdom (B.S., G.C.); Royal Brompton Hospital, London, United Kingdom (K.D., J.W.); Mater Misericordiae University Hospital, Dublin, Ireland (S. Gaine); and Great Ormond Street Hospital, London, United Kingdom (S.M.)
| | - Deepa Gopalan
- From Papworth Hospital, Cambridge, United Kingdom (J.E.C., K.P., M.T., E.S., C.T., A. Ponnaberanam, K.S., D.T., J.D., S.T., C.N., N.S., D.P.T., J.P.-Z.); MRC Biostatistics Unit, Cambridge, United Kingdom (L.S.); Royal Hallamshire Hospital, Sheffield, United Kingdom (D.G.K., R.C., C.E.); Respiratory Medicine Department, University of Warmia and Mazury, Poland (E.S.); Hammersmith Hospital, London, United Kingdom (D.G., S. Gibbs, L.H.); Freeman Hospital, Newcastle, United Kingdom (P.C., J.L.); Golden Jubilee Hospital, Glasgow, United Kingdom (M.J., A. Peacock); Royal United Hospital, Bath, United Kingdom (R.M.-R.); Royal Free Hospital, London, United Kingdom (B.S., G.C.); Royal Brompton Hospital, London, United Kingdom (K.D., J.W.); Mater Misericordiae University Hospital, Dublin, Ireland (S. Gaine); and Great Ormond Street Hospital, London, United Kingdom (S.M.)
| | - Nicholas Screaton
- From Papworth Hospital, Cambridge, United Kingdom (J.E.C., K.P., M.T., E.S., C.T., A. Ponnaberanam, K.S., D.T., J.D., S.T., C.N., N.S., D.P.T., J.P.-Z.); MRC Biostatistics Unit, Cambridge, United Kingdom (L.S.); Royal Hallamshire Hospital, Sheffield, United Kingdom (D.G.K., R.C., C.E.); Respiratory Medicine Department, University of Warmia and Mazury, Poland (E.S.); Hammersmith Hospital, London, United Kingdom (D.G., S. Gibbs, L.H.); Freeman Hospital, Newcastle, United Kingdom (P.C., J.L.); Golden Jubilee Hospital, Glasgow, United Kingdom (M.J., A. Peacock); Royal United Hospital, Bath, United Kingdom (R.M.-R.); Royal Free Hospital, London, United Kingdom (B.S., G.C.); Royal Brompton Hospital, London, United Kingdom (K.D., J.W.); Mater Misericordiae University Hospital, Dublin, Ireland (S. Gaine); and Great Ormond Street Hospital, London, United Kingdom (S.M.)
| | - Charlie Elliot
- From Papworth Hospital, Cambridge, United Kingdom (J.E.C., K.P., M.T., E.S., C.T., A. Ponnaberanam, K.S., D.T., J.D., S.T., C.N., N.S., D.P.T., J.P.-Z.); MRC Biostatistics Unit, Cambridge, United Kingdom (L.S.); Royal Hallamshire Hospital, Sheffield, United Kingdom (D.G.K., R.C., C.E.); Respiratory Medicine Department, University of Warmia and Mazury, Poland (E.S.); Hammersmith Hospital, London, United Kingdom (D.G., S. Gibbs, L.H.); Freeman Hospital, Newcastle, United Kingdom (P.C., J.L.); Golden Jubilee Hospital, Glasgow, United Kingdom (M.J., A. Peacock); Royal United Hospital, Bath, United Kingdom (R.M.-R.); Royal Free Hospital, London, United Kingdom (B.S., G.C.); Royal Brompton Hospital, London, United Kingdom (K.D., J.W.); Mater Misericordiae University Hospital, Dublin, Ireland (S. Gaine); and Great Ormond Street Hospital, London, United Kingdom (S.M.)
| | - Simon Gibbs
- From Papworth Hospital, Cambridge, United Kingdom (J.E.C., K.P., M.T., E.S., C.T., A. Ponnaberanam, K.S., D.T., J.D., S.T., C.N., N.S., D.P.T., J.P.-Z.); MRC Biostatistics Unit, Cambridge, United Kingdom (L.S.); Royal Hallamshire Hospital, Sheffield, United Kingdom (D.G.K., R.C., C.E.); Respiratory Medicine Department, University of Warmia and Mazury, Poland (E.S.); Hammersmith Hospital, London, United Kingdom (D.G., S. Gibbs, L.H.); Freeman Hospital, Newcastle, United Kingdom (P.C., J.L.); Golden Jubilee Hospital, Glasgow, United Kingdom (M.J., A. Peacock); Royal United Hospital, Bath, United Kingdom (R.M.-R.); Royal Free Hospital, London, United Kingdom (B.S., G.C.); Royal Brompton Hospital, London, United Kingdom (K.D., J.W.); Mater Misericordiae University Hospital, Dublin, Ireland (S. Gaine); and Great Ormond Street Hospital, London, United Kingdom (S.M.)
| | - Luke Howard
- From Papworth Hospital, Cambridge, United Kingdom (J.E.C., K.P., M.T., E.S., C.T., A. Ponnaberanam, K.S., D.T., J.D., S.T., C.N., N.S., D.P.T., J.P.-Z.); MRC Biostatistics Unit, Cambridge, United Kingdom (L.S.); Royal Hallamshire Hospital, Sheffield, United Kingdom (D.G.K., R.C., C.E.); Respiratory Medicine Department, University of Warmia and Mazury, Poland (E.S.); Hammersmith Hospital, London, United Kingdom (D.G., S. Gibbs, L.H.); Freeman Hospital, Newcastle, United Kingdom (P.C., J.L.); Golden Jubilee Hospital, Glasgow, United Kingdom (M.J., A. Peacock); Royal United Hospital, Bath, United Kingdom (R.M.-R.); Royal Free Hospital, London, United Kingdom (B.S., G.C.); Royal Brompton Hospital, London, United Kingdom (K.D., J.W.); Mater Misericordiae University Hospital, Dublin, Ireland (S. Gaine); and Great Ormond Street Hospital, London, United Kingdom (S.M.)
| | - Paul Corris
- From Papworth Hospital, Cambridge, United Kingdom (J.E.C., K.P., M.T., E.S., C.T., A. Ponnaberanam, K.S., D.T., J.D., S.T., C.N., N.S., D.P.T., J.P.-Z.); MRC Biostatistics Unit, Cambridge, United Kingdom (L.S.); Royal Hallamshire Hospital, Sheffield, United Kingdom (D.G.K., R.C., C.E.); Respiratory Medicine Department, University of Warmia and Mazury, Poland (E.S.); Hammersmith Hospital, London, United Kingdom (D.G., S. Gibbs, L.H.); Freeman Hospital, Newcastle, United Kingdom (P.C., J.L.); Golden Jubilee Hospital, Glasgow, United Kingdom (M.J., A. Peacock); Royal United Hospital, Bath, United Kingdom (R.M.-R.); Royal Free Hospital, London, United Kingdom (B.S., G.C.); Royal Brompton Hospital, London, United Kingdom (K.D., J.W.); Mater Misericordiae University Hospital, Dublin, Ireland (S. Gaine); and Great Ormond Street Hospital, London, United Kingdom (S.M.)
| | - James Lordan
- From Papworth Hospital, Cambridge, United Kingdom (J.E.C., K.P., M.T., E.S., C.T., A. Ponnaberanam, K.S., D.T., J.D., S.T., C.N., N.S., D.P.T., J.P.-Z.); MRC Biostatistics Unit, Cambridge, United Kingdom (L.S.); Royal Hallamshire Hospital, Sheffield, United Kingdom (D.G.K., R.C., C.E.); Respiratory Medicine Department, University of Warmia and Mazury, Poland (E.S.); Hammersmith Hospital, London, United Kingdom (D.G., S. Gibbs, L.H.); Freeman Hospital, Newcastle, United Kingdom (P.C., J.L.); Golden Jubilee Hospital, Glasgow, United Kingdom (M.J., A. Peacock); Royal United Hospital, Bath, United Kingdom (R.M.-R.); Royal Free Hospital, London, United Kingdom (B.S., G.C.); Royal Brompton Hospital, London, United Kingdom (K.D., J.W.); Mater Misericordiae University Hospital, Dublin, Ireland (S. Gaine); and Great Ormond Street Hospital, London, United Kingdom (S.M.)
| | - Martin Johnson
- From Papworth Hospital, Cambridge, United Kingdom (J.E.C., K.P., M.T., E.S., C.T., A. Ponnaberanam, K.S., D.T., J.D., S.T., C.N., N.S., D.P.T., J.P.-Z.); MRC Biostatistics Unit, Cambridge, United Kingdom (L.S.); Royal Hallamshire Hospital, Sheffield, United Kingdom (D.G.K., R.C., C.E.); Respiratory Medicine Department, University of Warmia and Mazury, Poland (E.S.); Hammersmith Hospital, London, United Kingdom (D.G., S. Gibbs, L.H.); Freeman Hospital, Newcastle, United Kingdom (P.C., J.L.); Golden Jubilee Hospital, Glasgow, United Kingdom (M.J., A. Peacock); Royal United Hospital, Bath, United Kingdom (R.M.-R.); Royal Free Hospital, London, United Kingdom (B.S., G.C.); Royal Brompton Hospital, London, United Kingdom (K.D., J.W.); Mater Misericordiae University Hospital, Dublin, Ireland (S. Gaine); and Great Ormond Street Hospital, London, United Kingdom (S.M.)
| | - Andrew Peacock
- From Papworth Hospital, Cambridge, United Kingdom (J.E.C., K.P., M.T., E.S., C.T., A. Ponnaberanam, K.S., D.T., J.D., S.T., C.N., N.S., D.P.T., J.P.-Z.); MRC Biostatistics Unit, Cambridge, United Kingdom (L.S.); Royal Hallamshire Hospital, Sheffield, United Kingdom (D.G.K., R.C., C.E.); Respiratory Medicine Department, University of Warmia and Mazury, Poland (E.S.); Hammersmith Hospital, London, United Kingdom (D.G., S. Gibbs, L.H.); Freeman Hospital, Newcastle, United Kingdom (P.C., J.L.); Golden Jubilee Hospital, Glasgow, United Kingdom (M.J., A. Peacock); Royal United Hospital, Bath, United Kingdom (R.M.-R.); Royal Free Hospital, London, United Kingdom (B.S., G.C.); Royal Brompton Hospital, London, United Kingdom (K.D., J.W.); Mater Misericordiae University Hospital, Dublin, Ireland (S. Gaine); and Great Ormond Street Hospital, London, United Kingdom (S.M.)
| | - Robert MacKenzie-Ross
- From Papworth Hospital, Cambridge, United Kingdom (J.E.C., K.P., M.T., E.S., C.T., A. Ponnaberanam, K.S., D.T., J.D., S.T., C.N., N.S., D.P.T., J.P.-Z.); MRC Biostatistics Unit, Cambridge, United Kingdom (L.S.); Royal Hallamshire Hospital, Sheffield, United Kingdom (D.G.K., R.C., C.E.); Respiratory Medicine Department, University of Warmia and Mazury, Poland (E.S.); Hammersmith Hospital, London, United Kingdom (D.G., S. Gibbs, L.H.); Freeman Hospital, Newcastle, United Kingdom (P.C., J.L.); Golden Jubilee Hospital, Glasgow, United Kingdom (M.J., A. Peacock); Royal United Hospital, Bath, United Kingdom (R.M.-R.); Royal Free Hospital, London, United Kingdom (B.S., G.C.); Royal Brompton Hospital, London, United Kingdom (K.D., J.W.); Mater Misericordiae University Hospital, Dublin, Ireland (S. Gaine); and Great Ormond Street Hospital, London, United Kingdom (S.M.)
| | - Benji Schreiber
- From Papworth Hospital, Cambridge, United Kingdom (J.E.C., K.P., M.T., E.S., C.T., A. Ponnaberanam, K.S., D.T., J.D., S.T., C.N., N.S., D.P.T., J.P.-Z.); MRC Biostatistics Unit, Cambridge, United Kingdom (L.S.); Royal Hallamshire Hospital, Sheffield, United Kingdom (D.G.K., R.C., C.E.); Respiratory Medicine Department, University of Warmia and Mazury, Poland (E.S.); Hammersmith Hospital, London, United Kingdom (D.G., S. Gibbs, L.H.); Freeman Hospital, Newcastle, United Kingdom (P.C., J.L.); Golden Jubilee Hospital, Glasgow, United Kingdom (M.J., A. Peacock); Royal United Hospital, Bath, United Kingdom (R.M.-R.); Royal Free Hospital, London, United Kingdom (B.S., G.C.); Royal Brompton Hospital, London, United Kingdom (K.D., J.W.); Mater Misericordiae University Hospital, Dublin, Ireland (S. Gaine); and Great Ormond Street Hospital, London, United Kingdom (S.M.)
| | - Gerry Coghlan
- From Papworth Hospital, Cambridge, United Kingdom (J.E.C., K.P., M.T., E.S., C.T., A. Ponnaberanam, K.S., D.T., J.D., S.T., C.N., N.S., D.P.T., J.P.-Z.); MRC Biostatistics Unit, Cambridge, United Kingdom (L.S.); Royal Hallamshire Hospital, Sheffield, United Kingdom (D.G.K., R.C., C.E.); Respiratory Medicine Department, University of Warmia and Mazury, Poland (E.S.); Hammersmith Hospital, London, United Kingdom (D.G., S. Gibbs, L.H.); Freeman Hospital, Newcastle, United Kingdom (P.C., J.L.); Golden Jubilee Hospital, Glasgow, United Kingdom (M.J., A. Peacock); Royal United Hospital, Bath, United Kingdom (R.M.-R.); Royal Free Hospital, London, United Kingdom (B.S., G.C.); Royal Brompton Hospital, London, United Kingdom (K.D., J.W.); Mater Misericordiae University Hospital, Dublin, Ireland (S. Gaine); and Great Ormond Street Hospital, London, United Kingdom (S.M.)
| | - Kostas Dimopoulos
- From Papworth Hospital, Cambridge, United Kingdom (J.E.C., K.P., M.T., E.S., C.T., A. Ponnaberanam, K.S., D.T., J.D., S.T., C.N., N.S., D.P.T., J.P.-Z.); MRC Biostatistics Unit, Cambridge, United Kingdom (L.S.); Royal Hallamshire Hospital, Sheffield, United Kingdom (D.G.K., R.C., C.E.); Respiratory Medicine Department, University of Warmia and Mazury, Poland (E.S.); Hammersmith Hospital, London, United Kingdom (D.G., S. Gibbs, L.H.); Freeman Hospital, Newcastle, United Kingdom (P.C., J.L.); Golden Jubilee Hospital, Glasgow, United Kingdom (M.J., A. Peacock); Royal United Hospital, Bath, United Kingdom (R.M.-R.); Royal Free Hospital, London, United Kingdom (B.S., G.C.); Royal Brompton Hospital, London, United Kingdom (K.D., J.W.); Mater Misericordiae University Hospital, Dublin, Ireland (S. Gaine); and Great Ormond Street Hospital, London, United Kingdom (S.M.)
| | - Stephen J Wort
- From Papworth Hospital, Cambridge, United Kingdom (J.E.C., K.P., M.T., E.S., C.T., A. Ponnaberanam, K.S., D.T., J.D., S.T., C.N., N.S., D.P.T., J.P.-Z.); MRC Biostatistics Unit, Cambridge, United Kingdom (L.S.); Royal Hallamshire Hospital, Sheffield, United Kingdom (D.G.K., R.C., C.E.); Respiratory Medicine Department, University of Warmia and Mazury, Poland (E.S.); Hammersmith Hospital, London, United Kingdom (D.G., S. Gibbs, L.H.); Freeman Hospital, Newcastle, United Kingdom (P.C., J.L.); Golden Jubilee Hospital, Glasgow, United Kingdom (M.J., A. Peacock); Royal United Hospital, Bath, United Kingdom (R.M.-R.); Royal Free Hospital, London, United Kingdom (B.S., G.C.); Royal Brompton Hospital, London, United Kingdom (K.D., J.W.); Mater Misericordiae University Hospital, Dublin, Ireland (S. Gaine); and Great Ormond Street Hospital, London, United Kingdom (S.M.)
| | - Sean Gaine
- From Papworth Hospital, Cambridge, United Kingdom (J.E.C., K.P., M.T., E.S., C.T., A. Ponnaberanam, K.S., D.T., J.D., S.T., C.N., N.S., D.P.T., J.P.-Z.); MRC Biostatistics Unit, Cambridge, United Kingdom (L.S.); Royal Hallamshire Hospital, Sheffield, United Kingdom (D.G.K., R.C., C.E.); Respiratory Medicine Department, University of Warmia and Mazury, Poland (E.S.); Hammersmith Hospital, London, United Kingdom (D.G., S. Gibbs, L.H.); Freeman Hospital, Newcastle, United Kingdom (P.C., J.L.); Golden Jubilee Hospital, Glasgow, United Kingdom (M.J., A. Peacock); Royal United Hospital, Bath, United Kingdom (R.M.-R.); Royal Free Hospital, London, United Kingdom (B.S., G.C.); Royal Brompton Hospital, London, United Kingdom (K.D., J.W.); Mater Misericordiae University Hospital, Dublin, Ireland (S. Gaine); and Great Ormond Street Hospital, London, United Kingdom (S.M.)
| | - Shahin Moledina
- From Papworth Hospital, Cambridge, United Kingdom (J.E.C., K.P., M.T., E.S., C.T., A. Ponnaberanam, K.S., D.T., J.D., S.T., C.N., N.S., D.P.T., J.P.-Z.); MRC Biostatistics Unit, Cambridge, United Kingdom (L.S.); Royal Hallamshire Hospital, Sheffield, United Kingdom (D.G.K., R.C., C.E.); Respiratory Medicine Department, University of Warmia and Mazury, Poland (E.S.); Hammersmith Hospital, London, United Kingdom (D.G., S. Gibbs, L.H.); Freeman Hospital, Newcastle, United Kingdom (P.C., J.L.); Golden Jubilee Hospital, Glasgow, United Kingdom (M.J., A. Peacock); Royal United Hospital, Bath, United Kingdom (R.M.-R.); Royal Free Hospital, London, United Kingdom (B.S., G.C.); Royal Brompton Hospital, London, United Kingdom (K.D., J.W.); Mater Misericordiae University Hospital, Dublin, Ireland (S. Gaine); and Great Ormond Street Hospital, London, United Kingdom (S.M.)
| | - David P Jenkins
- From Papworth Hospital, Cambridge, United Kingdom (J.E.C., K.P., M.T., E.S., C.T., A. Ponnaberanam, K.S., D.T., J.D., S.T., C.N., N.S., D.P.T., J.P.-Z.); MRC Biostatistics Unit, Cambridge, United Kingdom (L.S.); Royal Hallamshire Hospital, Sheffield, United Kingdom (D.G.K., R.C., C.E.); Respiratory Medicine Department, University of Warmia and Mazury, Poland (E.S.); Hammersmith Hospital, London, United Kingdom (D.G., S. Gibbs, L.H.); Freeman Hospital, Newcastle, United Kingdom (P.C., J.L.); Golden Jubilee Hospital, Glasgow, United Kingdom (M.J., A. Peacock); Royal United Hospital, Bath, United Kingdom (R.M.-R.); Royal Free Hospital, London, United Kingdom (B.S., G.C.); Royal Brompton Hospital, London, United Kingdom (K.D., J.W.); Mater Misericordiae University Hospital, Dublin, Ireland (S. Gaine); and Great Ormond Street Hospital, London, United Kingdom (S.M.)
| | - Joanna Pepke-Zaba
- From Papworth Hospital, Cambridge, United Kingdom (J.E.C., K.P., M.T., E.S., C.T., A. Ponnaberanam, K.S., D.T., J.D., S.T., C.N., N.S., D.P.T., J.P.-Z.); MRC Biostatistics Unit, Cambridge, United Kingdom (L.S.); Royal Hallamshire Hospital, Sheffield, United Kingdom (D.G.K., R.C., C.E.); Respiratory Medicine Department, University of Warmia and Mazury, Poland (E.S.); Hammersmith Hospital, London, United Kingdom (D.G., S. Gibbs, L.H.); Freeman Hospital, Newcastle, United Kingdom (P.C., J.L.); Golden Jubilee Hospital, Glasgow, United Kingdom (M.J., A. Peacock); Royal United Hospital, Bath, United Kingdom (R.M.-R.); Royal Free Hospital, London, United Kingdom (B.S., G.C.); Royal Brompton Hospital, London, United Kingdom (K.D., J.W.); Mater Misericordiae University Hospital, Dublin, Ireland (S. Gaine); and Great Ormond Street Hospital, London, United Kingdom (S.M.).
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