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Chebib N, Cottin V, Taharo-Ag-Ralissoum M, Chuzeville M, Mornex JF. Epoprostenol discontinuation in patients with pulmonary arterial hypertension: a complex medical and social problem. Pulm Circ 2018; 8:2045893217753352. [PMID: 29283031 PMCID: PMC6022074 DOI: 10.1177/2045893217753352] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Nader Chebib
- Hospices Civils de Lyon, National Reference Center for Rare Pulmonary Diseases, Competence Center for Pulmonary Hypertension, Lyon, France
| | - Vincent Cottin
- Hospices Civils de Lyon, National Reference Center for Rare Pulmonary Diseases, Competence Center for Pulmonary Hypertension, Lyon, France
- Claude Bernard Lyon 1 University, University of Lyon, Lyon, France
| | - Martine Taharo-Ag-Ralissoum
- Hospices Civils de Lyon, National Reference Center for Rare Pulmonary Diseases, Competence Center for Pulmonary Hypertension, Lyon, France
| | - Michel Chuzeville
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Cardiogeriatrics Department, Lyon, France
| | - Jean-François Mornex
- Hospices Civils de Lyon, National Reference Center for Rare Pulmonary Diseases, Competence Center for Pulmonary Hypertension, Lyon, France
- Claude Bernard Lyon 1 University, University of Lyon, Lyon, France
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Girard A, Jouneau S, Chabanne C, Khouatra C, Lannes M, Traclet J, Turquier S, Delaval P, Cordier JF, Cottin V. Severe pulmonary hypertension associated with COPD: hemodynamic improvement with specific therapy. Respiration 2015; 90:220-8. [PMID: 26277885 DOI: 10.1159/000431380] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 05/12/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There is no recommendation for treating pulmonary hypertension (PH) when associated with chronic obstructive pulmonary disease (COPD). OBJECTIVE To evaluate the effect of PH-specific therapy in patients with COPD. METHODS All successive patients with severe PH [mean pulmonary arterial pressure (mPAP) ≥35 mm Hg] and COPD, who received specific PH medication and who underwent right heart catheterization at baseline and after 3-12 months of treatment, were analyzed from a prospective database. RESULTS Twenty-six patients were included with a median follow-up of 14 months. Mean forced expiratory volume in 1 s was 57 ± 20% of predicted, and mean forced expiratory volume in 1 s/forced vital capacity was 47 ± 12%. Dyspnea was New York Health Association classification stage (NYHA) II in 15%, NYHA III in 81% and NYHA IV in 4%. First-line treatments were endothelin receptor antagonists in 11 patients, phosphodiesterase-5 inhibitors in 11 patients, calcium blocker in 1 patient, combination therapy in 3 patients including 2 with a prostanoid. After 6 ± 3 months, pulmonary vascular resistance decreased from 8.5 ± 3 to 6.6 ± 2 Wood units (p < 0.001), with significant improvement of cardiac index from 2.44 ± 0.43 to 2.68 ± 0.63 liters × min × m-2 (p = 0.015) and mPAP from 48 ± 9 to 42 ± 10 mm Hg (p = 0.008). There was no significant difference in dyspnea, 6-min walking distance, echocardiographic parameters or N-terminal pro-brain natriuretic peptide levels. There was no significant difference in arterial oxygen saturation after 3-12 months of treatment. CONCLUSIONS Specific PH medications may improve hemodynamic parameters in COPD patients with severe PH. Appropriate prospective randomized studies are needed to evaluate the potential long-term clinical benefit of treatment.
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Affiliation(s)
- Anne Girard
- Service de Pneumologie, Centre de Compx00E9;tences des Maladies Pulmonaires Rares, Centre de Compx00E9;tences de l'Hypertension Pulmonaire, Universitx00E9; de Rennes 1, Rennes, France
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Courand PY, Pina Jomir G, Khouatra C, Scheiber C, Turquier S, Glérant JC, Mastroianni B, Gentil B, Blanchet-Legens AS, Dib A, Derumeaux G, Humbert M, Mornex JF, Cordier JF, Cottin V. Prognostic value of right ventricular ejection fraction in pulmonary arterial hypertension. Eur Respir J 2014; 45:139-49. [PMID: 25537560 DOI: 10.1183/09031936.00158014] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Right ventricle ejection fraction (RVEF) evaluated with magnetic resonance imaging is a strong determinant of patient outcomes in pulmonary arterial hypertension. We evaluated the prognostic value of RVEF assessed with conventional planar equilibrium radionuclide angiography at baseline and change 3-6 months after initiating pulmonary arterial hypertension-specific therapy. In a prospective cohort of newly diagnosed patients with idiopathic, heritable or anorexigen-associated pulmonary arterial hypertension, RVEF was measured at baseline (n=100) and 3-6 months after initiation of therapy (n=78). After a median follow-up of 4.1 years, 41 deaths occurred, including 35 from cardiovascular causes. Patients with a (median) baseline RVEF >25% had better survival than those with a RVEF <25% using Kaplan-Meier analysis (p=0.010). RVEF at baseline was an independent predictor of all-cause and cardiovascular mortality in adjusted Cox regression model (p=0.002 and p=0.007, respectively; HR 0.93 for both). Patients with stable or increased RVEF at 3-6 months had a trend for improved all-cause survival (HR 2.43, p=0.086) and had less cardiovascular mortality (HR 3.25, p=0.034) than those in whom RVEF decreased despite therapy. RVEF assessed with conventional planar equilibrium radionuclide angiography at baseline and change in RVEF 3-6 months after therapy initiation independently predict outcomes in patients with pulmonary arterial hypertension.
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Affiliation(s)
- Pierre-Yves Courand
- Dept of Cardiology, Hospices Civils de Lyon, Croix-Rousse Hospital, Lyon, France
| | - Géraldine Pina Jomir
- Dept of Nuclear Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - Chahéra Khouatra
- Dept of Respiratory Diseases, Hospices Civils de Lyon, Louis Pradel Hospital, Service de pneumologie - National Reference Centre for Rare Pulmonary Diseases, Regional Competence Center for Severe Pulmonary Arterial Hypertension, Lyon, France
| | - Christian Scheiber
- Dept of Nuclear Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - Ségolène Turquier
- Dept of Respiratory Physiology, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - Jean-Charles Glérant
- Dept of Respiratory Physiology, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - Bénédicte Mastroianni
- Dept of Respiratory Diseases, Hospices Civils de Lyon, Louis Pradel Hospital, Service de pneumologie - National Reference Centre for Rare Pulmonary Diseases, Regional Competence Center for Severe Pulmonary Arterial Hypertension, Lyon, France
| | - Béatrice Gentil
- Dept of Respiratory Diseases, Hospices Civils de Lyon, Louis Pradel Hospital, Service de pneumologie - National Reference Centre for Rare Pulmonary Diseases, Regional Competence Center for Severe Pulmonary Arterial Hypertension, Lyon, France
| | - Anne-Sophie Blanchet-Legens
- Dept of Respiratory Diseases, Hospices Civils de Lyon, Louis Pradel Hospital, Service de pneumologie - National Reference Centre for Rare Pulmonary Diseases, Regional Competence Center for Severe Pulmonary Arterial Hypertension, Lyon, France
| | - Alfred Dib
- Dept of Respiratory Diseases, Hospices Civils de Lyon, Louis Pradel Hospital, Service de pneumologie - National Reference Centre for Rare Pulmonary Diseases, Regional Competence Center for Severe Pulmonary Arterial Hypertension, Lyon, France. Claude Bernard University Lyon 1, INRA, UMR754 INRA-Vetagrosup EPHE IFR 128, Lyon, France
| | - Geneviève Derumeaux
- Dept of Echocardiography, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - Marc Humbert
- Univ. Paris-Sud, Le Kremlin-Bicêtre, France. AP-HP, Service de Pneumologie, DHU Thorax Innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France. INSERM U999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
| | - Jean-François Mornex
- Dept of Respiratory Diseases, Hospices Civils de Lyon, Louis Pradel Hospital, Service de pneumologie - National Reference Centre for Rare Pulmonary Diseases, Regional Competence Center for Severe Pulmonary Arterial Hypertension, Lyon, France. Claude Bernard University Lyon 1, INRA, UMR754 INRA-Vetagrosup EPHE IFR 128, Lyon, France
| | - Jean-François Cordier
- Dept of Respiratory Diseases, Hospices Civils de Lyon, Louis Pradel Hospital, Service de pneumologie - National Reference Centre for Rare Pulmonary Diseases, Regional Competence Center for Severe Pulmonary Arterial Hypertension, Lyon, France. Claude Bernard University Lyon 1, INRA, UMR754 INRA-Vetagrosup EPHE IFR 128, Lyon, France
| | - Vincent Cottin
- Dept of Respiratory Diseases, Hospices Civils de Lyon, Louis Pradel Hospital, Service de pneumologie - National Reference Centre for Rare Pulmonary Diseases, Regional Competence Center for Severe Pulmonary Arterial Hypertension, Lyon, France. Claude Bernard University Lyon 1, INRA, UMR754 INRA-Vetagrosup EPHE IFR 128, Lyon, France.
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Current epoprostenol use in patients with severe idiopathic, heritable or anorexigen-associated pulmonary arterial hypertension: Data from the French pulmonary hypertension registry. Int J Cardiol 2014; 172:561-7. [DOI: 10.1016/j.ijcard.2013.12.313] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 10/28/2013] [Accepted: 12/31/2013] [Indexed: 11/24/2022]
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[Pulmonary arterial hypertension in systemic lupus erythematosus]. Rev Med Interne 2011; 32:689-97. [PMID: 21376432 DOI: 10.1016/j.revmed.2011.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 12/17/2010] [Accepted: 01/04/2011] [Indexed: 11/20/2022]
Abstract
Pulmonary hypertension (PH) is a serious complication of connective tissue diseases. The prevalence of PH in systemic lupus erythematosus (SLE) ranges from 0.5 to 17.5%, depending on whether echocardiography or right heart catheterization is used as the gold standard for diagnosis. The recent guidelines for the diagnosis and treatment of pulmonary hypertension include several potential causes of PH in SLE, including: a primary vasculopathy similar to idiopathic pulmonary arterial hypertension (PAH); left heart diseases; post-thromboembolic disease; hypoxia and fibrosis resulting from interstitial lung disease; and the infrequent SLE-associated pulmonary veno-occlusive disease. The pathogenesis of PAH associated with lupus is yet unclear, but likely includes a role for the genetic background, the presence of antiphospholipid antibodies, and some level of endothelial dysfunction. The evolution of SLE-associated PH is highly variable and difficult to elicit because the published series have used heterogeneous inclusion criteria. Optimal therapeutic management of PAH associated with lupus is unclear because no dedicated randomized controlled trial is yet available. Treatment usually includes arterial pulmonary vasodilators and immunosuppressive agents when the patients have NYHA functional class II, III or IV dyspnea.
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Humbert M, Sitbon O, Chaouat A, Bertocchi M, Habib G, Gressin V, Yaïci A, Weitzenblum E, Cordier JF, Chabot F, Dromer C, Pison C, Reynaud-Gaubert M, Haloun A, Laurent M, Hachulla E, Cottin V, Degano B, Jaïs X, Montani D, Souza R, Simonneau G. Survival in patients with idiopathic, familial, and anorexigen-associated pulmonary arterial hypertension in the modern management era. Circulation 2010; 122:156-63. [PMID: 20585011 DOI: 10.1161/circulationaha.109.911818] [Citation(s) in RCA: 984] [Impact Index Per Article: 70.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Novel therapies have recently become available for pulmonary arterial hypertension. We conducted a study to characterize mortality in a multicenter prospective cohort of patients diagnosed with idiopathic, familial, or anorexigen-associated pulmonary arterial hypertension in the modern management era. METHODS AND RESULTS Between October 2002 and October 2003, 354 consecutive adult patients with idiopathic, familial, or anorexigen-associated pulmonary arterial hypertension (56 incident and 298 prevalent cases) were prospectively enrolled. Patients were followed up for 3 years, and survival rates were analyzed. For incident cases, estimated survival (95% confidence intervals [CIs]) at 1, 2, and 3 years was 85.7% (95% CI, 76.5 to 94.9), 69.6% (95% CI, 57.6 to 81.6), and 54.9% (95% CI, 41.8 to 68.0), respectively. In a combined analysis population (incident patients and prevalent patients diagnosed within 3 years before study entry; n=190), 1-, 2-, and 3-year survival estimates were 82.9% (95% CI, 72.4 to 95.0), 67.1% (95% CI, 57.1 to 78.8), and 58.2% (95% CI, 49.0 to 69.3), respectively. Individual survival analysis identified the following as significantly and positively associated with survival: female gender, New York Heart Association functional class I/II, greater 6-minute walk distance, lower right atrial pressure, and higher cardiac output. Multivariable analysis showed that being female, having a greater 6-minute walk distance, and exhibiting higher cardiac output were jointly significantly associated with improved survival. CONCLUSIONS In the modern management era, idiopathic, familial, and anorexigen-associated pulmonary arterial hypertension remains a progressive, fatal disease. Mortality is most closely associated with male gender, right ventricular hemodynamic function, and exercise limitation.
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Affiliation(s)
- Marc Humbert
- Service de Pneumologie et Réanimation Respiratoire, Faculté de Médecine, Hôpital Antoine Béclère, Assistance-Publique-Hôpitaux de Paris, Université Paris-Sud 11, 92140 Clamart, France.
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Burdy G, Dalban-Sillas B, Leclerc C, Bonnaventure F, Roullet Audy JC, Frileux P. [Financial analysis of a department of general surgery in a French hospital. The new "fee-for-service" reimbursement system results in a high deficit for emergency care]. ACTA ACUST UNITED AC 2009; 146:469-76. [PMID: 19833334 DOI: 10.1016/j.jchir.2009.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
GOAL The aim of this study was to perform a detailed analysis of income and expense in a department of general surgery in a French hospital under the new system of funding based on a "fee-for-service" principle. METHODS All hospital stays of year 2006 were analysed retrospectively. The conditions of admission (elective vs. emergency), the principal diagnosis, and surgical procedures were examined. We determined hospital costs and the reimbursement for every admission. RESULTS One thousand nine hundred and eighty-five hospitalizations generated an income of 8Meuros with a deficit of 1.3Meuros. The 775 elective admissions generated 50% of the income and 13% of the deficit (178,562euros). Seven hundred and forty-nine emergency admissions generated 45% of the income and 82% of deficit (1.1Meuros). Four hundred and sixty-one admissions for endoscopy generated 5% of the income and 5% of the deficit (67,249euros). Hospital stays of less than two days (the minimum duration of stay for total reimbursement) caused a loss of 122,624euros. Length of hospital stay below the lower limit caused a loss of 42,850euros. CONCLUSION Elective surgical activity in digestive surgery can generate a balanced budget provided the length of hospital stay is reduced to the minimum, sometimes to the detriment of patient comfort. Emergency admissions result in a large deficit between cost and reimbursement; this fact may lead hospitals to avoid emergency activity in the future unless appropriate remedial measures are taken.
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Affiliation(s)
- G Burdy
- Service de chirurgie digestive, hôpital Foch, 40, rue Worth, 92151 Suresnes cedex, France.
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Hachulla É, Launay D, Hatron PY. L’iloprost dans le traitement de la sclérodermie systémique. Presse Med 2008; 37:831-9. [DOI: 10.1016/j.lpm.2007.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2007] [Revised: 05/31/2007] [Accepted: 06/01/2007] [Indexed: 11/26/2022] Open
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Le Pavec J, Humbert M. Centres de référence “maladies rares respiratoires”. Presse Med 2007; 36:933-5. [PMID: 17442533 DOI: 10.1016/j.lpm.2007.03.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Accepted: 03/08/2007] [Indexed: 11/27/2022] Open
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Abstract
Pulmonary arterial hypertension (PAH) is a serious complication of systemic sclerosis (SSc) and a leading cause of death in patients with it. Recent publications suggest that a prevalence of 10-15% is likely. The prognosis remains poor compared to that of idiopathic PAH. WHO recommends annual echocardiography for PAH screening of patients with SSc. Right heart catheterization is necessary to confirm the diagnosis. Nevertheless, more than half of all SSc patients have symptoms classified as WHO functional class III or IV at diagnosis. Prostacyclin therapy, delivered via continuous intravenous infusion (epoprostenol), has been demonstrated to be effective in patients with severe PAH (both idiopathic and scleroderma-related). Prostacyclin analogs (such as treprostinil and iloprost) are other options. Bosentan is the first endothelin receptor antagonist approved in the EU for the treatment of PAH, both idiopathic and related to connective tissue diseases such as scleroderma, in patients in WHO functional class III. Sildenafil by its selective inhibition of phosphodiesterase type 5 is also effective against both types of PAH. It too is now approved in the EU for this purpose in patients in WHO functional class III, but we do not yet have any information about its long-term effects in scleroderma.
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Affiliation(s)
- David Launay
- Service de Médecine Interne, Centre National de Référence des Atteintes Vasculaires de la Sclérodermie, Hôpital Claude Huriez, CHRU, Lille
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Abstract
INTRODUCTION Porto-pulmonary hypertension (PoPH) is the association of pulmonary artery hypertension and portal hypertension. The diagnosis of PoPH is based on pulmonary haemodynamic criteria, obtained via right heart catheterisation, including an increase in mean pulmonary arterial pressure (> 25 mmHg) and in pulmonary vascular resistance (> 240 dyn.s.cm-5). STATE OF THE ART The exact pathophysiological mechanisms of PoPH are unknown. However, since PoPH has been reported in patients with non-hepatic portal hypertension, the factor that determines the development must be portal hypertension rather than liver disease per se. Moreover, no simple relationship has been identified between the degree of hepatic impairment and the severity of PoPH. The clinical presentation is non-specific with haemodynamic failure occurring at the end stage. As a consequence, screening by annual transthoracic echocardiography is highly recommended in potential liver transplant candidates. Therapy with prostacyclin analogues may partially relieve pulmonary arterial hypertension (PAH). Liver transplantation has an uncertain effect in PoPH and because PoPH is associated with a high perioperative mortality, moderate to severe PoPH remains a contraindication for liver transplantation. PERSPECTIVES AND CONCLUSIONS Recent advances in the management of PoPH have improved the prognosis. The safety and efficacy of oral endothelin receptor antagonists and oral phosphodiesterase inhibitors is currently under evaluation. A therapeutic approach utilising combinations of drugs should provide better long-term results.
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Affiliation(s)
- F Chabot
- Service des Maladies Respiratoires et Réanimation Respiratoire, CHU Nancy, Université Henri Poincaré, Nancy, France.
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Humbert M, Dartevelle P, Simonneau G. Actualités des maladies vasculaires pulmonaires. Presse Med 2005; 34:1413-5. [PMID: 16301972 DOI: 10.1016/s0755-4982(05)84202-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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