1
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Singh I, Waxman AB. The casting of invasive cardiopulmonary exercise testing: towards a common goal. Eur Respir J 2024; 64:2400783. [PMID: 38991723 DOI: 10.1183/13993003.00783-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 07/13/2024]
Affiliation(s)
- Inderjit Singh
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine and Yale New Haven Hospital, New Haven, CT, USA
| | - Aaron B Waxman
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
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2
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Miller E, Sampson CU, Desai AA, Karnes JH. Differential drug response in pulmonary arterial hypertension: The potential for precision medicine. Pulm Circ 2023; 13:e12304. [PMID: 37927610 PMCID: PMC10621006 DOI: 10.1002/pul2.12304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/05/2023] [Accepted: 10/11/2023] [Indexed: 11/07/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) is a rare, complex, and deadly cardiopulmonary disease. It is characterized by changes in endothelial cell function and smooth muscle cell proliferation in the pulmonary arteries, causing persistent vasoconstriction, resulting in right heart hypertrophy and failure. There are multiple drug classes specific to PAH treatment, but variation between patients may impact treatment response. A small subset of patients is responsive to pulmonary vasodilators and can be treated with calcium channel blockers, which would be deleterious if prescribed to a typical PAH patient. Little is known about the underlying cause of this important difference in vasoresponsive PAH patients. Sex, race/ethnicity, and pharmacogenomics may also factor into efficacy and safety of PAH-specific drugs. Research has indicated that endothelin receptor antagonists may be more effective in women and there have been some minor differences found in certain races and ethnicities, but these findings are muddled by the impact of socioeconomic factors and a lack of representation of non-White patients in clinical trials. Genetic variants in genes such as CYP3A5, CYP2C9, PTGIS, PTGIR, GNG2, CHST3, and CHST13 may influence the efficacy and safety of certain PAH-specific drugs. PAH research faces many challenges, but there is potential for new methodologies to glean new insights into PAH development and treatment.
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Affiliation(s)
- Elise Miller
- Department of Pharmacy Practice and ScienceUniversity of Arizona R. Ken Coit College of PharmacyTucsonArizonaUSA
| | - Chinwuwanuju Ugo‐Obi Sampson
- Department of Pharmacy Practice and ScienceUniversity of Arizona R. Ken Coit College of PharmacyTucsonArizonaUSA
| | - Ankit A. Desai
- Department of MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Jason H. Karnes
- Department of Pharmacy Practice and ScienceUniversity of Arizona R. Ken Coit College of PharmacyTucsonArizonaUSA
- Department of Biomedical InformaticsVanderbilt University School of MedicineNashvilleTennesseeUSA
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3
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Gillmeyer KR, Rinne ST, Qian SX, Maron BA, Johnson SW, Klings ES, Wiener RS. Socioeconomically disadvantaged veterans experience treatment delays for pulmonary arterial hypertension. Pulm Circ 2022; 12:e12171. [PMID: 36568691 PMCID: PMC9768567 DOI: 10.1002/pul2.12171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 12/09/2022] Open
Abstract
Prompt initiation of therapy after pulmonary arterial hypertension (PAH) diagnosis is critical to improve outcomes; yet delays in PAH treatment are common. Prior research demonstrates that individuals with PAH belonging to socially disadvantaged groups experience worse clinical outcomes. Whether these poor outcomes are mediated by delays in care or other factors is incompletely understood. We sought to examine the association between race/ethnicity and socioeconomic status and time-to-PAH treatment. We conducted a retrospective cohort study of Veterans diagnosed with incident PAH between 2006 and 2019 and treated with PAH therapy. Our outcome was time-to-PAH treatment. Our primary exposures were race/ethnicity, annual household income, health insurance status, education, and housing insecurity. We calculated time-to-treatment using multivariable mixed-effects Cox proportional hazard models. Of 1827 Veterans with PAH, 27% were Black, 4% were Hispanic, 22.1% had an income < $20,000, 53.3% lacked non-VA insurance, 25.5% had <high school education, and 3.9% had housing insecurity. Median time-to-treatment was 114 days (interquartile range [IQR] 21-336). Our multivariable models demonstrated increased time-to-treatment among patients with lower household income (hazard ratio [HR] 0.74, 95% confidence interval [CI] 0.60-0.91 for < $20,000 vs. ≥ $100,000) and those without non-VA insurance (HR 0.90, 95% CI 0.82-1.00). Race/ethnicity, education, and housing insecurity were not associated with time-to-treatment. Veterans with PAH experienced substantial and potentially harmful treatment delays, with median time-to-treatment of 16 weeks after diagnosis. Those with lower income and those without non-VA health insurance experienced even greater treatment delays. Additional research is urgently needed to develop interventions to improve timely PAH treatment and mitigate economic disparities in treatment.
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Affiliation(s)
- Kari R. Gillmeyer
- The Pulmonary CenterBoston University School of MedicineBostonMassachusettsUSA,Center for Healthcare Organization & Implementation ResearchVA Bedford Healthcare System and VA Boston Healthcare SystemBedford and BostonMassachusettsUSA
| | - Seppo T. Rinne
- The Pulmonary CenterBoston University School of MedicineBostonMassachusettsUSA,Center for Healthcare Organization & Implementation ResearchVA Bedford Healthcare System and VA Boston Healthcare SystemBedford and BostonMassachusettsUSA
| | - Shirley X. Qian
- Center for Healthcare Organization & Implementation ResearchVA Bedford Healthcare System and VA Boston Healthcare SystemBedford and BostonMassachusettsUSA,VA Boston Healthcare SystemBostonMassachusettsUSA
| | - Bradley A. Maron
- Department of CardiologyVA Boston Healthcare SystemBostonMassachusettsUSA,Division of Cardiovascular MedicineBrigham and Women's HospitalBostonMassachusettsUSA
| | - Shelsey W. Johnson
- The Pulmonary CenterBoston University School of MedicineBostonMassachusettsUSA,Center for Healthcare Organization & Implementation ResearchVA Bedford Healthcare System and VA Boston Healthcare SystemBedford and BostonMassachusettsUSA
| | - Elizabeth S. Klings
- The Pulmonary CenterBoston University School of MedicineBostonMassachusettsUSA
| | - Renda S. Wiener
- The Pulmonary CenterBoston University School of MedicineBostonMassachusettsUSA,Center for Healthcare Organization & Implementation ResearchVA Bedford Healthcare System and VA Boston Healthcare SystemBedford and BostonMassachusettsUSA
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4
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Murthy S, Benza R. The Evolution of Risk Assessment in Pulmonary Arterial Hypertension. Methodist Debakey Cardiovasc J 2021; 17:134-144. [PMID: 34326933 PMCID: PMC8298117 DOI: 10.14797/lrpr7655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 11/08/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a chronic debilitating disease that
carries an unacceptably high morbidity and mortality rate despite improved
survival with modern therapies. The combination of several modifiable and
nonmodifiable variables yields a robust risk assessment across various available
clinical calculators. The role of risk calculation is integral to managing PAH
and aids in the timely referral to expert centers and potentially lung
transplantation. Studies are ongoing to determine the role of risk calculators
in the framework of clinical trials and to elucidate novel markers of high risk
in PAH.
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Affiliation(s)
| | - Raymond Benza
- Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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5
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Sprecher VP, Didden EM, Swerdel JN, Muller A. Evaluation of code-based algorithms to identify pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension patients in large administrative databases. Pulm Circ 2020; 10:2045894020961713. [PMID: 33240487 PMCID: PMC7675881 DOI: 10.1177/2045894020961713] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 09/05/2020] [Indexed: 01/27/2023] Open
Abstract
Large administrative healthcare (including insurance claims) databases are used
for various retrospective real-world evidence studies. However, in pulmonary
arterial hypertension and chronic thromboembolic pulmonary hypertension,
identifying patients retrospectively based on administrative codes remains
challenging, as it relies on code combinations (algorithms) and the accuracy for
patient identification of most of them is unknown. This study aimed to assess
the performance of various algorithms in correctly identifying patients with
pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension
in administrative databases. A systematic literature review was performed to
find publications detailing code-based algorithms used to identify pulmonary
arterial hypertension and chronic thromboembolic pulmonary hypertension
patients. PheValuator, a diagnostic predictive modelling tool, was applied to
three US claims databases, yielding models that estimated the probability of a
patient having the disease. These models were used to evaluate the performance
characteristics of selected pulmonary arterial hypertension and chronic
thromboembolic pulmonary hypertension algorithms. With increasing algorithm
complexity, average positive predictive value increased (pulmonary arterial
hypertension: 13.4–66.0%; chronic thromboembolic pulmonary hypertension:
10.3–75.1%) and average sensitivity decreased (pulmonary arterial hypertension:
61.5–2.7%; chronic thromboembolic pulmonary hypertension: 20.7–0.2%).
Specificities and negative predictive values were high (≥97.5%) for all
algorithms. Several of the algorithms performed well overall when considering
all of these four performance parameters, and all algorithms performed with
similar accuracy across the three claims databases studied, even though most
were designed for patient identification in a specific database. Therefore, it
is the objective of a study that will determine which algorithm may be most
suitable; one- or two-component algorithms are most inclusive and three- or
four-component algorithms identify most precise pulmonary arterial hypertension
or chronic thromboembolic pulmonary hypertension populations, respectively.
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Affiliation(s)
| | | | | | - Audrey Muller
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
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6
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National trends and inpatient outcomes of pulmonary arterial hypertension related hospitalizations – Analysis of the National Inpatient Sample Database. Int J Cardiol 2020; 319:131-138. [DOI: 10.1016/j.ijcard.2020.06.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/11/2020] [Accepted: 06/21/2020] [Indexed: 01/07/2023]
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7
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Medrek S, Sahay S, Zhao C, Selej M, Frost A. Impact of race on survival in pulmonary arterial hypertension: Results from the REVEAL registry. J Heart Lung Transplant 2020; 39:321-330. [PMID: 32067864 DOI: 10.1016/j.healun.2019.11.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/23/2019] [Accepted: 11/11/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Prior research has suggested that the prevalence and outcomes of pulmonary arterial hypertension (PAH) may vary by race or ethnicity. However, these studies have been limited by small sample size or methodological techniques relying on epidemiologic data. The purpose of this study is to evaluate the relationship between race/ethnicity and survival in a large U.S.-based prospective multicenter registry. METHODS Patients in the Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL), a 5-year observational study of Group 1 PAH, were categorized by race/ethnicity. Baseline hemodynamic characteristics, clinical characteristics, and medication use was described. The relationship between race/ethnicity and outcome was evaluated by Kaplan-Meier and Cox proportional hazards modeling techniques. Left-truncation analysis, which adjusted for time from diagnosis to study enrollment, was used to minimize the effect of survivor bias. RESULTS This analysis included 3,046 patients; 2,202 identified as white, 393 as black, 263 as Hispanic, 100 as Asian or Pacific Islander, and 88 as other. Unadjusted Kaplan-Meier survival analysis indicated that white patients had the lowest survival rates. After adjusting for variables of prognostic impact, race/ethnicity was no longer significantly associated with survival. Other results showed that black patients were more likely to have connective tissue disease-associated PAH, Hispanic patients were more likely to have portopulmonary hypertension, and Asian patients were more likely to have congenital heart disease-associated PAH. CONCLUSIONS Analysis of the REVEAL registry did not find race/ethnicity to be a significant predictor of mortality. This is the largest analysis to date evaluating the role of race/ethnicity on outcomes in PAH.
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Affiliation(s)
- Sarah Medrek
- Division of Pulmonary Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico.
| | - Sandeep Sahay
- Division of Pulmonary Critical Care Medicine, Weill Cornell Medical College, Houston Methodist Hospital, Houston, Texas
| | - Carol Zhao
- Actelion Pharmaceuticals United States of America, Inc/A Janssen Pharmaceutical Company of Johnson & Johnson, San Francisco, California
| | - Mona Selej
- Actelion Pharmaceuticals United States of America, Inc/A Janssen Pharmaceutical Company of Johnson & Johnson, San Francisco, California
| | - Adaani Frost
- Houston Methodist Hospital and Institute for Academic Medicine, Houston, Texas
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8
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Lakshmanan S, Jankowich M, Wu WC, Blackshear C, Abbasi S, Choudhary G. Gender Differences in Risk Factors Associated With Pulmonary Artery Systolic Pressure, Heart Failure, and Mortality in Blacks: Jackson Heart Study. J Am Heart Assoc 2020; 9:e013034. [PMID: 31902323 PMCID: PMC6988159 DOI: 10.1161/jaha.119.013034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Pulmonary hypertension is prevalent in black individuals, especially women. Elevated pulmonary artery systolic pressure (PASP) is associated with significant morbidity and mortality. Methods and Results We developed linear and proportional hazards models to examine potential gender‐related differences in risk factors for elevated PASP (estimated by transthoracic echocardiography) and PASP‐associated clinical outcomes (incident heart failure admissions and mortality) in JHS (Jackson Heart Study) participants. JHS is a prospective observational cohort study of heart disease in blacks from the Jackson, Mississippi, metropolitan area. The study cohort included participants with measurable transtricuspid gradients (n=3286) at the time of first/baseline examination, 2000–2004. The median age (interquartile range) of patients at baseline was 57.8 years (18.6 years) with 67.5% being women. The median PASP at baseline was higher in women (men: 26 mm Hg [interquartile range 8], women: 27 mm Hg [interquartile range 9]. In multivariate linear regression analyses with PASP, significant gender interactions were noted for age, chronic lung disease, pulse pressure, and obstructive spirometry. In exploratory analyses stratified by gender, body mass index, and obstructive and restrictive spirometry patterns were associated with PASP in women, and chronic lung disease was associated with PASP in men. Age and pulse pressure had stronger associations with PASP in women compared with men. There was a significant interaction between gender and PASP for heart failure admissions but not mortality. Conclusions Specific cardiopulmonary risk factors are associated with elevated PASP in women and men. Women with elevated PASP have a higher risk of incident heart failure admissions. Future research is needed to understand associated gender‐specific mechanisms that can help identify targeted prevention and management strategies for patients with elevated PASP.
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Affiliation(s)
- Suvasini Lakshmanan
- Division of Cardiology Providence VA Medical Center Providence RI.,Alpert Medical School of Brown University Providence RI
| | - Matthew Jankowich
- Alpert Medical School of Brown University Providence RI.,Division of Pulmonary, Critical Care and Sleep Medicine Providence VA Medical Center Providence RI
| | - Wen-Chih Wu
- Division of Cardiology Providence VA Medical Center Providence RI.,Alpert Medical School of Brown University Providence RI
| | - Chad Blackshear
- Department of Data Science University of Mississippi Jackson MS
| | - Siddique Abbasi
- Division of Cardiology Providence VA Medical Center Providence RI.,Alpert Medical School of Brown University Providence RI
| | - Gaurav Choudhary
- Division of Cardiology Providence VA Medical Center Providence RI.,Alpert Medical School of Brown University Providence RI
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9
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Papani R, Sharma G, Agarwal A, Callahan SJ, Chan WJ, Kuo YF, Shim YM, Mihalek AD, Duarte AG. Validation of claims-based algorithms for pulmonary arterial hypertension. Pulm Circ 2018; 8:2045894018759246. [PMID: 29480064 PMCID: PMC5833187 DOI: 10.1177/2045894018759246] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Administrative claims studies do not adequately distinguish pulmonary arterial hypertension (PAH) from other forms of pulmonary hypertension (PH). Our aim is to develop and validate a set of algorithms using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes and electronic medical records (EMR), to identify patients with PAH. From January 2012 to August 2015, the EMRs of patients with ICD-9-CM codes for PH with an outpatient visit at the University of Texas Medical Branch were reviewed. Patients were divided into PAH or non-PAH groups according to EMR encounter diagnosis. Patient demographics, echocardiography, right heart catheterization (RHC) results, and PAH-specific therapies were assessed. RHC measurements were reviewed to categorize cases as hemodynamically determined PAH or not PAH. Weighted sensitivity, specificity, and positive and negative predictive values were calculated for the developed algorithms. A logistic regression analysis was conducted to determine how well the algorithms performed. External validation was performed at the University of Virginia Health System. The cohort for the development algorithms consisted of 683 patients with PH, PAH group (n = 191) and non-PAH group (n = 492). A hemodynamic diagnosis of PAH determined by RHC was recorded in the PAH (26%) and non-PAH (3%) groups. The positive predictive value for the algorithm that included ICD-9-CM and PAH-specific medications was 66.9% and sensitivity was 28.2% with a c-statistic of 0.66. The positive predictive value for the EMR-based algorithm that included ICD-9-CM, EMR encounter diagnosis, echocardiography, RHC, and PAH-specific medication was 69.4% and a c-statistic of 0.87. A validation cohort of 177 patients with PH examined from August 2015 to August 2016 using EMR-based algorithms yielded a similar positive predictive value of 62.5%. In conclusion, claims-based algorithms that included ICD-9-CM codes, EMR encounter diagnosis, echocardiography, RHC, and PAH-specific medications better-identified patients with PAH than ICD-9-CM codes alone.
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Affiliation(s)
- Ravikanth Papani
- 1 Division of Pulmonary, Critical Care, and Sleep Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Gulshan Sharma
- 1 Division of Pulmonary, Critical Care, and Sleep Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Amitesh Agarwal
- 2 Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Sean J Callahan
- 3 Division of Pulmonary and Critical Care Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Winston J Chan
- 4 Office of Biostatistics, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Yong-Fang Kuo
- 4 Office of Biostatistics, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Yun M Shim
- 3 Division of Pulmonary and Critical Care Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Andrew D Mihalek
- 3 Division of Pulmonary and Critical Care Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Alexander G Duarte
- 1 Division of Pulmonary, Critical Care, and Sleep Medicine, University of Texas Medical Branch, Galveston, TX, USA
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10
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Yang BQ, Assad TR, O'Leary JM, Xu M, Halliday SJ, D'Amico RW, Farber-Eger EH, Wells QS, Hemnes AR, Brittain EL. Racial differences in patients referred for right heart catheterization and risk of pulmonary hypertension. Pulm Circ 2018; 8:2045894018764273. [PMID: 29480090 PMCID: PMC5858628 DOI: 10.1177/2045894018764273] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
African Americans (AA) have a higher incidence of pulmonary hypertension (PH) risk factors. Few studies have examined the racial differences in the prevalence and etiology of PH and direct comparison of invasive hemodynamics between AAs and Caucasians has rarely been reported. In this study, we examined whether racial differences exist in patients referred for right heart catheterization (RHC) and hypothesized that AA race is an independent risk factor for PH and is associated with increased adjusted mortality. We extracted data for AA and Caucasian patients who underwent RHC at Vanderbilt between 1998 and 2014. Clinical information was obtained from Vanderbilt's Synthetic Derivative, a de-identified mirror of our Electronic Medical Record. A total of 4576 patients were analyzed, including 586 (13%) AAs and 3990 (87%) Caucasians. AAs were younger than Caucasians by an average of eight years, but had more prevalent heart failure, features of metabolic syndrome, and higher creatinine. AAs also had higher mean pulmonary artery pressure and pulmonary vascular resistance. After adjusting for relevant co-morbidities, the AA race is associated with 41% increased risk of PH (odds ratio [OR] = 1.41, 95% confidence interval [CI] = 1.12–1.79). Among patients with PH, AA race is associated with 24% increased adjusted mortality (hazard ratio [HR] = 1.24, 95% CI = 1.09–1.45). AAs were younger but had more prevalent cardiometabolic and renal disease and worse pulmonary hemodynamics. The AA race is an independent risk factor for PH. Among patients with PH, the AA race is associated with increased adjusted mortality. Future studies should focus on delineating whether genetic or environmental factors contribute to PH risk in AAs.
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Affiliation(s)
- Bin Q Yang
- 1 12328 Vanderbilt University Medical Center, Department of Medicine, Nashville, TN, USA
| | - Tufik R Assad
- 2 12328 Vanderbilt University Medical Center, Division of Allergy, Pulmonary and Critical Care Medicine, Nashville, TN, USA
| | - Jared M O'Leary
- 3 12328 Vanderbilt University Medical Center, Division of Cardiovascular Medicine, Nashville, TN, USA
| | - Meng Xu
- 4 12328 Vanderbilt University Department of Biostatistics, Nashville, TN, USA
| | - Stephen J Halliday
- 2 12328 Vanderbilt University Medical Center, Division of Allergy, Pulmonary and Critical Care Medicine, Nashville, TN, USA
| | - Reid W D'Amico
- 5 12328 Vanderbilt University Department of Biomedical Engineering, Nashville, TN, USA
| | - Eric H Farber-Eger
- 3 12328 Vanderbilt University Medical Center, Division of Cardiovascular Medicine, Nashville, TN, USA
| | - Quinn S Wells
- 3 12328 Vanderbilt University Medical Center, Division of Cardiovascular Medicine, Nashville, TN, USA
| | - Anna R Hemnes
- 2 12328 Vanderbilt University Medical Center, Division of Allergy, Pulmonary and Critical Care Medicine, Nashville, TN, USA
| | - Evan L Brittain
- 3 12328 Vanderbilt University Medical Center, Division of Cardiovascular Medicine, Nashville, TN, USA
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11
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Ventetuolo CE, Hess E, Austin ED, Barón AE, Klinger JR, Lahm T, Maddox TM, Plomondon ME, Thompson L, Zamanian RT, Choudhary G, Maron BA. Sex-based differences in veterans with pulmonary hypertension: Results from the veterans affairs-clinical assessment reporting and tracking database. PLoS One 2017; 12:e0187734. [PMID: 29121097 PMCID: PMC5679554 DOI: 10.1371/journal.pone.0187734] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 08/29/2017] [Indexed: 11/22/2022] Open
Abstract
Women have an increased risk of pulmonary hypertension (PH) but better survival compared to men. Few studies have explored sex-based differences in population-based cohorts with PH. We sought to determine whether sex was associated with hemodynamics and survival in US veterans with PH (mean pulmonary artery pressure [mPAP] ≥ 25 mm Hg) from the Veterans Affairs Clinical Assessment, Reporting, and Tracking database. The relationship between sex and hemodynamics was assessed with multivariable linear mixed modeling. Cox proportional hazards models were used to compare survival by sex for those with PH and precapillary PH (mPAP ≥ 25 mm Hg, pulmonary artery wedge pressure [PAWP] ≤ 15 mm Hg and pulmonary vascular resistance [PVR] > 3 Wood units) respectively. The study population included 15,464 veterans with PH, 516 (3%) of whom were women; 1,942 patients (13%) had precapillary PH, of whom 120 (6%) were women. Among those with PH, women had higher PVR and pulmonary artery pulse pressure, and lower right atrial pressure and PAWP (all p <0.001) compared with men. There were no significant differences in hemodynamics according to sex in veterans with precapillary PH. Women with PH had 18% greater survival compared to men with PH (adjusted HR 0.82, 95% CI 0.69-0.97, p = 0.020). Similarly, women with precapillary PH were 29% more likely to survive as compared to men with PH (adjusted HR 0.71, 95% CI 0.52-0.98, p = 0.040). In conclusion, female veterans with PH have better survival than males despite higher pulmonary afterload.
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Affiliation(s)
- Corey E. Ventetuolo
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, United States of America
| | - Edward Hess
- Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado, United States of America
| | - Eric D. Austin
- Division of Pediatric Pulmonary, Allergy, and Immunology, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Anna E. Barón
- Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado, United States of America
| | - James R. Klinger
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Tim Lahm
- Division of Pulmonary, Critical Care, Occupational and Sleep Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
- Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana, United States of America
| | - Thomas M. Maddox
- Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado, United States of America
| | - Mary E. Plomondon
- Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado, United States of America
| | - Lauren Thompson
- University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Roham T. Zamanian
- Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, Stanford, California, United States of America
| | - Gaurav Choudhary
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
- Providence Veterans Affairs Medical Center, Providence, Rhode Island, United States of America
| | - Bradley A. Maron
- Boston Veterans Affairs Healthcare System, Boston, Massachusetts, United States of America
- Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
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12
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Talwar A, Garcia JGN, Tsai H, Moreno M, Lahm T, Zamanian RT, Machado R, Kawut SM, Selej M, Mathai S, D'Anna LH, Sahni S, Rodriquez EJ, Channick R, Fagan K, Gray M, Armstrong J, Rodriguez Lopez J, de Jesus Perez V. Health Disparities in Patients with Pulmonary Arterial Hypertension: A Blueprint for Action. An Official American Thoracic Society Statement. Am J Respir Crit Care Med 2017; 196:e32-e47. [PMID: 29028375 DOI: 10.1164/rccm.201709-1821st] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Health disparities have a major impact in the quality of life and clinical care received by minorities in the United States. Pulmonary arterial hypertension (PAH) is a rare cardiopulmonary disorder that affects children and adults and that, if untreated, results in premature death. The impact of health disparities in the diagnosis, treatment, and clinical outcome of patients with PAH has not been systematically investigated. OBJECTIVES The specific goals of this research statement were to conduct a critical review of the literature concerning health disparities in PAH, identify major research gaps and prioritize direction for future research. METHODS Literature searches from multiple reference databases were performed using medical subject headings and text words for pulmonary hypertension and health disparities. Members of the committee discussed the evidence and provided recommendations for future research. RESULTS Few studies were found discussing the impact of health disparities in PAH. Using recent research statements focused on health disparities, the group identified six major study topics that would help address the contribution of health disparities to PAH. Representative studies in each topic were discussed and specific recommendations were made by the group concerning the most urgent questions to address in future research studies. CONCLUSIONS At present, there are few studies that address health disparities in PAH. Given the potential adverse impact of health disparities, we recommend that research efforts be undertaken to address the topics discussed in the document. Awareness of health disparities will likely improve advocacy efforts, public health policy and the quality of care of vulnerable populations with PAH.
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Al-Naamani N, Paulus JK, Roberts KE, Pauciulo MW, Lutz K, Nichols WC, Kawut SM. Racial and ethnic differences in pulmonary arterial hypertension. Pulm Circ 2017; 7:793-796. [PMID: 28849992 PMCID: PMC5703127 DOI: 10.1177/2045893217732213] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This study explores the racial and ethnic differences in presentation, severity, and treatment of patients with pulmonary arterial hypertension (PAH) in a large multicenter registry. African American and Hispanic patients are more likely to present with associated PAH compared to non-Hispanic whites. Hispanic patients with PAH were less likely to be treated with PAH-specific medications compared to non-Hispanic whites.
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Affiliation(s)
- Nadine Al-Naamani
- 1 14640 Pulmonary, Allergy and Critical Care Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jessica K Paulus
- 2 Institute for Clinical Research and Health Policy Studies, Department of Medicine, Tufts Medical Center, Boston, MA, USA
| | - Kari E Roberts
- 3 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Tufts Medical Center, Boston, MA, USA
| | - Michael W Pauciulo
- 4 Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Katie Lutz
- 4 Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - William C Nichols
- 4 Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Steven M Kawut
- 1 14640 Pulmonary, Allergy and Critical Care Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Maron BA, Hess E, Maddox TM, Opotowsky AR, Tedford RJ, Lahm T, Joynt KE, Kass DJ, Stephens T, Stanislawski MA, Swenson ER, Goldstein RH, Leopold JA, Zamanian RT, Elwing JM, Plomondon ME, Grunwald GK, Barón AE, Rumsfeld JS, Choudhary G. Association of Borderline Pulmonary Hypertension With Mortality and Hospitalization in a Large Patient Cohort: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program. Circulation 2016; 133:1240-8. [PMID: 26873944 PMCID: PMC4811678 DOI: 10.1161/circulationaha.115.020207] [Citation(s) in RCA: 252] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 02/08/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pulmonary hypertension (PH) is associated with increased morbidity across the cardiopulmonary disease spectrum. Based primarily on expert consensus opinion, PH is defined by a mean pulmonary artery pressure (mPAP) ≥25 mm Hg. Although mPAP levels below this threshold are common among populations at risk for PH, the relevance of mPAP <25 mm Hg to clinical outcome is unknown. METHODS AND RESULTS We analyzed retrospectively all US veterans undergoing right heart catheterization (2007-2012) in the Veterans Affairs healthcare system (n=21,727; 908-day median follow-up). Cox proportional hazards models were used to evaluate the association between mPAP and outcomes of all-cause mortality and hospitalization, adjusted for clinical covariates. When treating mPAP as a continuous variable, the mortality hazard increased beginning at 19 mm Hg (hazard ratio [HR]=1.183; 95% confidence interval [CI], 1.004-1.393) relative to 10 mm Hg. Therefore, patients were stratified into 3 groups: (1) referent (≤18 mm Hg; n=4,207); (2) borderline PH (19-24 mm Hg; n=5,030); and (3) PH (≥25 mm Hg; n=12,490). The adjusted mortality hazard was increased for borderline PH (HR=1.23; 95% CI, 1.12-1.36; P<0.0001) and PH (HR=2.16; 95% CI, 1.96-2.38; P<0.0001) compared with the referent group. The adjusted hazard for hospitalization was also increased in borderline PH (HR=1.07; 95% CI, 1.01-1.12; P=0.0149) and PH (HR=1.15; 95% CI, 1.09-1.22; P<0.0001). The borderline PH cohort remained at increased risk for mortality after excluding the following high-risk subgroups: (1) patients with pulmonary artery wedge pressure >15 mm Hg; (2) pulmonary vascular resistance ≥3.0 Wood units; or (3) inpatient status at the time of right heart catheterization. CONCLUSIONS These data illustrate a continuum of risk according to mPAP level and that borderline PH is associated with increased mortality and hospitalization. Future investigations are needed to test the generalizability of our findings to other populations and study the effect of treatment on outcome in borderline PH.
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Affiliation(s)
- Bradley A Maron
- From Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.).
| | - Edward Hess
- From Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.)
| | - Thomas M Maddox
- From Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.)
| | - Alexander R Opotowsky
- From Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.)
| | - Ryan J Tedford
- From Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.)
| | - Tim Lahm
- From Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.)
| | - Karen E Joynt
- From Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.)
| | - Daniel J Kass
- From Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.)
| | - Thomas Stephens
- From Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.)
| | - Maggie A Stanislawski
- From Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.)
| | - Erik R Swenson
- From Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.)
| | - Ronald H Goldstein
- From Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.)
| | - Jane A Leopold
- From Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.)
| | - Roham T Zamanian
- From Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.)
| | - Jean M Elwing
- From Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.)
| | - Mary E Plomondon
- From Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.)
| | - Gary K Grunwald
- From Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.)
| | - Anna E Barón
- From Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.)
| | - John S Rumsfeld
- From Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.)
| | - Gaurav Choudhary
- From Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.)
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Rusiecki J, Rao Y, Cleveland J, Rhinehart Z, Champion HC, Mathier MA. Sex and menopause differences in response to tadalafil: 6-minute walk distance and time to clinical worsening. Pulm Circ 2015; 5:701-6. [PMID: 26697177 DOI: 10.1086/683829] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) is a female-predominant disease, but there are little data on treatment response by sex and menopausal status. In this retrospective analysis of the Pulmonary Arterial Hypertension and Response to Tadalafil (PHIRST) randomized clinical trial, we assessed treatment response between the sexes by examining change in 6-minute walk distance (6MWD) and time to clinical worsening (TCW). We examined the effect of menopausal status on the same treatment measures. 6MWD was recorded before and after 16 weeks of treatment with tadalafil or placebo in the PHIRST study cohort of 340 subjects (264 females, 76 males). A univariate analysis was used to assess the effect of sex on change in 6MWD and TCW. Multivariate linear regression and Cox proportional hazards models were built for 6MWD and TCW, respectively. Women were subdivided by age as a surrogate for menopausal status. The linear trend test and the log-rank test were performed on change in 6MWD and TCW by age. For tadalafil-treated patients, a significant difference in change in 6MWD by sex (mean: 48.6 m for males vs. 34.7 m for females; P = 0.01) was found, but it was not significant in multivariate analysis (P = 0.08). There was a trend toward a female age-dependent effect in change in 6MWD; the premenopausal group showed the greatest improvement. A significant sex- or age-dependent effect on TCW was not present. In conclusion, this retrospective analysis of the PHIRST trial suggests that men and premenopausal women may experience greater functional improvement when treated with tadalafil than older women, but there was no consistent sex or menopausal effect on TCW.
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Affiliation(s)
- Jennifer Rusiecki
- Pulmonary Allergy and Critical Care Medicine, Heart and Vascular Institute, Vascular Medicine Institute, University of Pittsburgh/University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Youlan Rao
- United Therapeutics, Research Triangle Park, North Carolina, USA
| | - Jody Cleveland
- United Therapeutics, Research Triangle Park, North Carolina, USA
| | - Zachary Rhinehart
- Pulmonary Allergy and Critical Care Medicine, Heart and Vascular Institute, Vascular Medicine Institute, University of Pittsburgh/University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Hunter C Champion
- Pulmonary Allergy and Critical Care Medicine, Heart and Vascular Institute, Vascular Medicine Institute, University of Pittsburgh/University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michael A Mathier
- Pulmonary Allergy and Critical Care Medicine, Heart and Vascular Institute, Vascular Medicine Institute, University of Pittsburgh/University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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16
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Ventetuolo CE, Mitra N, Wan F, Manichaikul A, Barr RG, Johnson C, Bluemke DA, Lima JAC, Tandri H, Ouyang P, Kawut SM. Oestradiol metabolism and androgen receptor genotypes are associated with right ventricular function. Eur Respir J 2015; 47:553-63. [PMID: 26647441 DOI: 10.1183/13993003.01083-2015] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 10/09/2015] [Indexed: 11/05/2022]
Abstract
Sex hormones are linked to right ventricular (RV) function, but the relationship between genetic variation in these pathways and RV function is unknown.We performed a cross-sectional study of 2761 genotyped adults without cardiovascular disease. The relationships between RV measures and single nucleotide polymorphisms (SNPs) in 10 candidate genes were assessed. Urinary oestradiol (E2) metabolites produced by cytochrome P4501B1 (CYP1B1) and serum testosterone were measured in women and men respectively.In African-American (AA) women, the CYP1B1 SNP rs162561 was associated with RV ejection fraction (RVEF), such that each copy of the A allele was associated with a 2.0% increase in RVEF. Haplotype analysis revealed associations with RVEF in AA (global p<7.2×10(-6)) and white (global p=0.05) women. In white subjects, higher E2 metabolite levels were associated with significantly higher RVEF. In men, androgen receptors SNPs (rs1337080; rs5918764) were significantly associated with all RV measures and modified the relationship between testosterone and RVEF.Genetic variation in E2 metabolism and androgen signalling was associated with RV morphology in a sex-specific manner. The CYP1B1 SNP identified is in tight linkage disequilibrium with SNPs associated with pulmonary hypertension and oncogenesis, suggesting these pathways may underpin sexual dimorphism in RV failure.
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Affiliation(s)
- Corey E Ventetuolo
- Depts of Medicine and Health Services, Policy and Practice, Alpert Medical School of Brown University, Providence, RI, USA
| | - Nandita Mitra
- Dept of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Fei Wan
- Dept of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Ani Manichaikul
- Center for Public Health Genomics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - R Graham Barr
- Dept of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Craig Johnson
- Dept of Biostatistics, University of Washington, Seattle, WA, USA
| | - David A Bluemke
- Radiology and Imaging Sciences, National Institutes of Health/Clinical Center, National Institute for Biomedical Imaging and Bioengineering, Bethesda, MD, USA
| | - Joao A C Lima
- Dept of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Hari Tandri
- Dept of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Pamela Ouyang
- Dept of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Steven M Kawut
- Dept of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA Dept of Medicine, University of Pennsylvania, Philadelphia, PA, USA Penn Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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17
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Simaga B, Vicenzi M, Faoro V, Caravita S, Di Marco G, Forton K, Deboeck G, Lalande S, Naeije R. Pulmonary vascular function and exercise capacity in black sub-Saharan Africans. J Appl Physiol (1985) 2015. [DOI: 10.1152/japplphysiol.00466.2015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Sex and age affect the pulmonary circulation. Whether there may be racial differences in pulmonary vascular function is unknown. Thirty white European Caucasian subjects (15 women) and age and body-size matched 30 black sub-Saharan African subjects (15 women) underwent a cardiopulmonary exercise test and exercise stress echocardiography with measurements of pulmonary artery pressure (PAP) and cardiac output (CO). A pulmonary vascular distensibility coefficient α was mathematically determined from the natural curvilinearity of multipoint mean PAP (mPAP)-CO plots. Maximum oxygen uptake (V̇o2max) and workload were higher in the whites, while maximum respiratory exchange ratio and ventilatory equivalents for CO2 were the same. Pulmonary hemodynamics were not different at rest. Exercise was associated with a higher maximum total pulmonary vascular resistance, steeper mPAP-CO relationships, and lower α-coefficients in the blacks. These differences were entirely driven by higher slopes of mPAP-CO relationships (2.5 ± 0.7 vs. 1.4 ± 0.7 mmHg·l−1·min; P < 0.001) and lower α-coefficients (0.85 ± 0.33 vs. 1.35 ± 0.51%/mmHg; P < 0.01) in black men compared with white men. There were no differences in any of the hemodynamic variables between black and white women. In men only, the slopes of mPAP-CO relationships were inversely correlated to V̇o2max ( P < 0.01). Thus the pulmonary circulation is intrinsically less distensible in black sub-Saharan African men compared with white Caucasian Europeans men, and this is associated with a lower exercise capacity. This study did not identify racial differences in pulmonary vascular function in women.
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Affiliation(s)
- Bamodi Simaga
- Laboratory of Physiopathology, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
- Laboratory of Exercise Physiology, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - Marco Vicenzi
- Laboratory of Physiopathology, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
- Laboratory of Exercise Physiology, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - Vitalie Faoro
- Laboratory of Exercise Physiology, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - Sergio Caravita
- Departement of Cardiology, Erasmus University Hospital, Brussels, Belgium; and
| | - Giovanni Di Marco
- Departement of Cardiology, Erasmus University Hospital, Brussels, Belgium; and
| | - Kevin Forton
- Laboratory of Exercise Physiology, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - Gael Deboeck
- Laboratory of Exercise Physiology, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
- Departement of Cardiology, Erasmus University Hospital, Brussels, Belgium; and
| | - Sophie Lalande
- Departement of Kinesiology, University of Toledo, Toledo, Ohio
| | - Robert Naeije
- Laboratory of Physiopathology, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
- Laboratory of Exercise Physiology, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
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18
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George MG, Schieb LJ, Ayala C, Talwalkar A, Levant S. Pulmonary hypertension surveillance: United States, 2001 to 2010. Chest 2014; 146:476-495. [PMID: 24700091 PMCID: PMC4122278 DOI: 10.1378/chest.14-0527] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 03/05/2014] [Indexed: 12/03/2022] Open
Abstract
Pulmonary hypertension (PH) is an uncommon but progressive condition, and much of what we know about it comes from specialized disease registries. With expanding research into the diagnosis and treatment of PH, it is important to provide updated surveillance on the impact of this disease on hospitalizations and mortality. This study, which builds on previous PH surveillance of mortality and hospitalization, analyzed mortality data from the National Vital Statistics System and data from the National Hospital Discharge Survey between 2001 and 2010. PH deaths were identified using International Classification of Diseases, Tenth Revision codes I27.0, I27.2, I27.8, or I27.9 as any contributing cause of death on the death certificate. Hospital discharges associated with PH were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes 416.0, 416.8, or 416.9 as one of up to seven listed medical diagnoses. The decline in death rates associated with PH among men from 1980 to 2005 has reversed and now shows a significant increasing trend. Similarly, the death rates for women with PH have continued to increase significantly during the past decade. PH-associated mortality rates for those aged 85 years and older have accelerated compared with rates for younger age groups. There have been significant declines in PH-associated mortality rates for those with pulmonary embolism and emphysema. Rates of hospitalization for PH have increased significantly for both men and women during the past decade; for those aged 85 years and older, hospitalization rates have nearly doubled. Continued surveillance helps us understand and address the evolving trends in hospitalization and mortality associated with PH and PH-associated conditions, especially regarding sex, age, and race/ethnicity disparities.
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Affiliation(s)
- Mary G George
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Linda J Schieb
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Carma Ayala
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Anjali Talwalkar
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD
| | - Shaleah Levant
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD
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19
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Blanco I, Mathai S, Shafiq M, Boyce D, M Kolb T, Chami H, K Hummers L, Housten T, Chaisson N, L Zaiman A, M Wigley F, J Tedford R, A Kass D, Damico R, E Girgis R, M Hassoun P. Severity of systemic sclerosis-associated pulmonary arterial hypertension in African Americans. Medicine (Baltimore) 2014; 93:177-185. [PMID: 25181310 PMCID: PMC4602454 DOI: 10.1097/md.0000000000000032] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
African Americans (AA) with systemic sclerosis (SSc) have a worse prognosis compared to Americans of European descent (EA). We conducted the current study to test the hypothesis that AA patients with SSc have more severe disease and poorer outcomes compared to EA patients when afflicted with pulmonary arterial hypertension (PAH). We studied 160 consecutive SSc patients with PAH diagnosed by right heart catheterization, comparing demographics, hemodynamics, and outcomes between AA and EA patients. The cohort included 29 AA and 131 EA patients with similar baseline characteristics except for increased prevalence of diffuse SSc in AA. AA patients had worse functional class (FC) (80% FC III-IV vs 53%; p = 0.02), higher brain natriuretic peptide (NT-pro-BNP) (5729 ± 9730 pg/mL vs 1892 ± 2417 pg/mL; p = 0.02), more depressed right ventricular function, a trend toward lower 6-minute walk distance (263 ± 111 m vs 333 ± 110 m; p = 0.07), and worse hemodynamics (cardiac index 1.95 ± 0.58 L/min/m vs 2.62 ± 0.80 L/min/m; pulmonary vascular resistance 10.3 ± 6.2 WU vs 7.6 ± 5.0 WU; p < 0.05) compared with EA patients. Kaplan-Meier survival estimates for AA and EA patients, respectively, were 62% vs 73% at 2 years and 26% vs 44% at 5 years (p > 0.05). In conclusion, AA patients with SSc-PAH are more likely to have diffuse SSc and to present with significantly more severe PAH compared with EA patients. AA patients also appear to have poorer survival, though larger studies are needed to investigate this association definitively.
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MESH Headings
- Adult
- Black or African American
- Autoantibodies/blood
- Cardiac Catheterization/methods
- Echocardiography/methods
- Exercise Test/methods
- Familial Primary Pulmonary Hypertension
- Female
- Humans
- Hypertension, Pulmonary/blood
- Hypertension, Pulmonary/diagnosis
- Hypertension, Pulmonary/ethnology
- Hypertension, Pulmonary/etiology
- Hypertension, Pulmonary/physiopathology
- Kaplan-Meier Estimate
- Male
- Middle Aged
- Natriuretic Peptide, Brain/blood
- Outcome Assessment, Health Care
- Peptide Fragments/blood
- Prevalence
- Prognosis
- Scleroderma, Systemic/blood
- Scleroderma, Systemic/complications
- Scleroderma, Systemic/diagnosis
- Scleroderma, Systemic/ethnology
- Scleroderma, Systemic/physiopathology
- Severity of Illness Index
- United States/epidemiology
- Ventricular Dysfunction, Right/etiology
- Ventricular Dysfunction, Right/physiopathology
- White People
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Affiliation(s)
- Isabel Blanco
- Divisions of Pulmonary and Critical Care Medicine (IB, SCM, DB, TMK, HC, TH, NC, ALZ, RD, REG, PMH), General Internal Medicine (MS, FMW), Rheumatology (LKH), and Cardiology (RJT, DAK), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (IB), Barcelona, Spain; and Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES) (IB), Spain
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20
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Trends in pulmonary hypertension mortality and morbidity. Pulm Med 2014; 2014:105864. [PMID: 24991431 PMCID: PMC4060165 DOI: 10.1155/2014/105864] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 05/14/2014] [Indexed: 02/04/2023] Open
Abstract
CONTEXT Few reports have been published regarding surveillance data for pulmonary hypertension, a debilitating and often fatal condition. AIMS We report trends in pulmonary hypertension. SETTINGS AND DESIGN United States of America; vital statistics, hospital data. METHODS AND MATERIAL We used mortality data from the National Vital Statistics System (NVSS) for 1999-2008 and hospital discharge data from the National Hospital Discharge Survey (NHDS) for 1999-2009. STATISTICAL ANALYSIS USED We present age-standardized rates. Results. Since 1999, the numbers of deaths and hospitalizations as well as death rates and hospitalization rates for pulmonary hypertension have increased. In 1999 death rates were higher for men than for women; however, by 2002, no differences by gender remained because of the increasing death rates among women and the declining death rates among men; after 2003 death rates for women were higher than for men. Death rates throughout the reporting period 1999-2008 were higher for blacks than for whites. Hospitalization rates in women were 1.3-1.6 times higher than in men. CONCLUSIONS Pulmonary hypertension mortality and hospitalization numbers and rates increased from 1999 to 2008.
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21
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The contribution of depression to mortality among elderly with self-reported hypertension: analysis using a national representative longitudinal survey. J Hypertens 2012; 29:2084-90. [PMID: 21934532 DOI: 10.1097/hjh.0b013e32834b59ad] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Previous research has suggested that hypertension and depression are two of the important causes of mortality among the elderly. This study aims to test the contribution of depression to mortality among elderly with self-reported hypertension. METHODS This research used data from the Survey of Health and Living Status of the Middle Age and Elderly (SHLS) conducted by the Bureau of Health Promotion, Department of Health in Taiwan. The 1989, 1996, 1999, 2003, and 2007 waves were used. In total, 3736 respondents aged 60 or above were analyzed. Participants were grouped by status of hypertension and depression. The contribution of depression to mortality among elderly with self-reported hypertension was estimated using Cox proportional hazard model. Analyses were separated into younger elderly individuals (<70 years) and older elderly individuals (≥ 70 years). RESULTS In the full model, the hazard ratios for mortality for the groups of not hypertensive/depressed, hypertensive/not depressed, and hypertensive/depressed were 1.12 [95% confidence interval (CI) 0.98-1.28], 1.32 (95% CI 1.19-1.46), and 1.54 (95% CI 1.29-1.83), respectively, compared with the reference group of not hypertensive/not depressed. The pattern remained the similar after separating the participants into the two age groups. However, much higher hazard ratios were observed for the older cohort. CONCLUSION Depression contributes significantly to the hypertension-mortality relationship for the elderly. For the elderly, hypertension should be tackled along with depression in order to reduce the mortality associated with hypertension.
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22
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Gabler NB, French B, Strom BL, Liu Z, Palevsky HI, Taichman DB, Kawut SM, Halpern SD. Race and sex differences in response to endothelin receptor antagonists for pulmonary arterial hypertension. Chest 2011; 141:20-26. [PMID: 21940766 DOI: 10.1378/chest.11-0404] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Recently studied therapies for pulmonary arterial hypertension (PAH) have improved outcomes among populations of patients, but little is known about which patients are most likely to respond to specific treatments. Differences in endothelin-1 biology between sexes and between whites and blacks may lead to differences in patients' responses to treatment with endothelin receptor antagonists (ERAs). METHODS We conducted pooled analyses of deidentified, patient-level data from six randomized placebo-controlled trials of ERAs submitted to the US Food and Drug Administration to elucidate heterogeneity in treatment response. We estimated the interaction between treatment assignment (ERA vs placebo) and sex and between treatment and white or black race in terms of the change in 6-min walk distance from baseline to 12 weeks. RESULTS Trials included 1,130 participants with a mean age of 49 years; 21% were men, 74% were white, and 6% were black. The placebo-adjusted response to ERAs was 29.7 m (95% CI, 3.7-55.7 m) greater in women than in men (P = .03). The placebo-adjusted response was 42.2 m for whites and -1.4 m for blacks, a difference of 43.6 m (95% CI, -3.5-90.7 m) (P = .07). Similar results were found in sensitivity analyses and in secondary analyses using the outcome of absolute distance walked. CONCLUSIONS Women with PAH obtain greater responses to ERAs than do men, and whites may experience a greater treatment benefit than do blacks. This heterogeneity in treatment-response may reflect pathophysiologic differences between sexes and races or distinct disease phenotypes.
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Affiliation(s)
- Nicole B Gabler
- Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA
| | - Benjamin French
- Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA; Penn Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Brian L Strom
- Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA
| | - Ziyue Liu
- Department of Biostatistics, Indiana University-Purdue University Indianapolis, Indianapolis, IN
| | - Harold I Palevsky
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania, Philadelphia, PA; Penn Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Darren B Taichman
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania, Philadelphia, PA; Penn Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Steven M Kawut
- Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA; Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania, Philadelphia, PA; Penn Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Scott D Halpern
- Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA; Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania, Philadelphia, PA; Penn Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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23
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24
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Link J, Glazer C, Torres F, Chin K. International Classification of Diseases coding changes lead to profound declines in reported idiopathic pulmonary arterial hypertension mortality and hospitalizations: implications for database studies. Chest 2011; 139:497-504. [PMID: 20724737 PMCID: PMC3047288 DOI: 10.1378/chest.10-0837] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 07/22/2010] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Database studies have reported several associations between the diagnosis of idiopathic pulmonary arterial hypertension (IPAH) and mortality attributable to IPAH, including older age, black race, and diabetes. METHODS We investigated reported deaths and hospital discharges coded as IPAH and compared these with other forms of pulmonary hypertension. Three databases were used: the US National Center for Health Statistics database (1979-2006), queried for mortality data; the Nationwide Inpatient Sample database (1993-2007), queried for hospital discharge data; and the University of Texas Southwestern Hospital-Zale Lipshy discharge database (1999, 2002). RESULTS Marked increases in mortality attributable to IPAH and to pulmonary hypertension (all codes combined) generally were reported from 1979 until 2002 in the National Center for Health Statistics database. In 2003, reported IPAH mortality fell sharply while total pulmonary hypertension deaths increased. The Nationwide Inpatient Sample database showed a similar pattern of changes beginning approximately 2 years earlier. In both cases, the timing of these observations corresponded with changes made to the International Classification of Diseases (ICD) coding system in use for pulmonary hypertension in that particular database. Review of pulmonary hypertension discharge data from the University of Texas Southwestern Hospital-Zale Lipshy showed similar changes in diagnosis code use. CONCLUSIONS Sudden shifts in reported IPAH mortality and hospital discharges were seen in all databases, likely related to coding changes. These findings raise questions about the accuracy of pulmonary hypertension diagnosis codes. Studies based on International Classification of Diseases, Ninth Revision and International Classification of Diseases, 10th Revision codes may have inadvertently included patients with other forms of pulmonary hypertension and should be reevaluated in this context. Validation studies of the IPAH diagnosis code are needed, and changes to the ICD coding system should be considered.
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Affiliation(s)
- Jeffrey Link
- Department of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
| | - Craig Glazer
- Department of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Fernando Torres
- Department of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Kelly Chin
- Department of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX
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25
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Swiston JR, Johnson SR, Granton JT. Factors that prognosticate mortality in idiopathic pulmonary arterial hypertension: A systematic review of the literature. Respir Med 2010; 104:1588-607. [DOI: 10.1016/j.rmed.2010.08.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 07/28/2010] [Accepted: 08/09/2010] [Indexed: 10/19/2022]
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26
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Todd NW, Lavania S, Park MH, Iacono AT, Franks TJ, Galvin JR, Jeudy J, Britt EJ, Luzina IG, Hasday JD, Atamas SP. Variable prevalence of pulmonary hypertension in patients with advanced interstitial pneumonia. J Heart Lung Transplant 2010; 29:188-94. [PMID: 20113909 DOI: 10.1016/j.healun.2009.07.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Revised: 07/29/2009] [Accepted: 07/29/2009] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Pulmonary hypertension may occur in patients with interstitial pneumonia and is associated with increased mortality. We sought to determine the prevalence of pulmonary hypertension in sub-groups of patients with interstitial pneumonia and to investigate possible associations between pulmonary vascular hemodynamics and pulmonary function. METHODS The presence or absence of pulmonary hypertension was assessed in 70 patients with advanced interstitial pneumonia who underwent right heart catheterization. The associations of pulmonary hypertension with clinical characteristics and pulmonary function tests were analyzed. RESULTS The prevalence of pulmonary hypertension in patients with idiopathic interstitial pneumonia was 29% vs 64% in patients with connective tissue disease-interstitial pneumonia (p = 0.013). African American patients had a significantly higher prevalence of pulmonary hypertension in the entire study population (81% vs 22%, p < 0.001) and in the idiopathic interstitial pneumonia group (70% vs 19%, p < 0.01). Regression analyses revealed no association between mean pulmonary artery pressure (mPAP) and forced vital capacity or mPAP and diffusion capacity of the lung for carbon monoxide in the entire cohort or in sub-groups of patients. CONCLUSIONS African American patients and patients with connective tissue disease-interstitial pneumonia had a high prevalence of pulmonary hypertension. Non-African American patients with advanced idiopathic interstitial pneumonia (including idiopathic pulmonary fibrosis) had a low prevalence of pulmonary hypertension.
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Affiliation(s)
- Nevins W Todd
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.
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27
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Chung L, Liu J, Parsons L, Hassoun PM, McGoon M, Badesch DB, Miller DP, Nicolls MR, Zamanian RT. Characterization of connective tissue disease-associated pulmonary arterial hypertension from REVEAL: identifying systemic sclerosis as a unique phenotype. Chest 2010; 138:1383-94. [PMID: 20507945 DOI: 10.1378/chest.10-0260] [Citation(s) in RCA: 296] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND REVEAL (the Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management) is the largest US cohort of patients with pulmonary arterial hypertension (PAH) confirmed by right-sided heart catheterization (RHC), providing a more comprehensive subgroup characterization than previously possible. We used REVEAL to analyze the clinical features of patients with connective tissue disease-associated PAH (CTD-APAH). METHODS All newly and previously diagnosed patients with World Health Organization (WHO) group 1 PAH meeting RHC criteria at 54 US centers were consecutively enrolled. Cross-sectional and 1-year mortality and hospitalization analyses from time of enrollment compared CTD-APAH to idiopathic disease and systemic sclerosis (SSc) to systemic lupus erythematosus (SLE), mixed connective tissue disease (MCTD), and rheumatoid arthritis (RA). RESULTS Compared with patients with idiopathic disease (n = 1,251), patients with CTD-APAH (n = 641) had better hemodynamics and favorable right ventricular echocardiographic findings but a higher prevalence of pericardial effusions, lower 6-min walk distance (300.5 ± 118.0 vs 329.4 ± 134.7 m, P = .01), higher B-type natriuretic peptide (BNP) levels (432.8 ± 789.1 vs 245.6 ± 427.2 pg/mL, P < .0001), and lower diffusing capacity of carbon monoxide (Dlco) (44.9% ± 18.0% vs 63.6% ± 22.1% predicted, P < .0001). One-year survival and freedom from hospitalization were lower in the CTD-APAH group (86% vs 93%, P < .0001; 67% vs 73%, P = .03). Compared with patients with SSc-APAH (n = 399), those with other CTDs (SLE, n = 110; MCTD, n = 52; RA, n = 28) had similar hemodynamics; however, patients with SSc-APAH had the highest BNP levels (552.2 ± 977.8 pg/mL), lowest Dlco (41.2% ± 16.3% predicted), and poorest 1-year survival (82% vs 94% in SLE-APAH, 88% in MCTD-APAH, and 96% in RA-APAH). CONCLUSIONS Patients with SSc-APAH demonstrate a unique phenotype with the highest BNP levels, lowest Dlco, and poorest survival of all CTD-APAH subgroups. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT00370214; URL: clinicaltrials.gov.
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Affiliation(s)
- Lorinda Chung
- VA Palo Alto Health Care System, Palo Alto, CA 94304, USA.
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