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Torres-Castro R, Hinojosa W, Martínez-Meñaca A, Sala Llinas E, Jiménez Arjona J, Rueda Soriano J, Aurtenetxe A, Barberà JA, Escribano-Subías P, Blanco I. Epidemiology of supplemental oxygen in patients with pulmonary hypertension. Respirology 2024. [PMID: 39210654 DOI: 10.1111/resp.14821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 08/13/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND AND OBJECTIVE Patients with pulmonary hypertension (PH) may present with hypoxaemia at rest or during daily activities. There is no epidemiological data on the prescription of long-term oxygen therapy (LTOT) in patients with PH. The study sought to analyse the prevalence and incidence of LTOT prescription among patients with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) in Spain and to determine predictors for this prescription. METHODS A retrospective analysis was performed from the Spanish Registry of Pulmonary Arterial Hypertension (REHAP). Collected data included demographics and anthropometric measurements, functional class (FC), arterial blood gases, pulmonary function tests, haemodynamic measurements, six-minute walking distance (6MWD) and LTOT prescription. In addition, we assessed the prevalence and incidence of LTOT prescription by PH group and subtype and potential predictors for LTOT initiation in the first 5 years after diagnosis. RESULTS We analysed 4533 patients (69.9% PAH and 30.1% CTEPH), mostly female (64.5%), with a mean age of 53.0 ± 18.3 years. The prevalence of LTOT was 19.3% for all patients. The incidence of LTOT prescriptions decreased from 5.6% to 1.6% between 2010 and 2019, respectively. Predictors for LTOT prescription, excluding those that represent the indication for oxygen therapy were: FC (HR: 1.813), 6MWD (HR: 1.002), mean pulmonary arterial pressure (mPAP) (HR: 1.014), cardiac index (CI) (HR: 1.253), pulmonary vascular resistance (PVR) (HR: 1.023) and diffusing capacity of carbon monoxide (DLCO) (HR: 1.294). CONCLUSION The prevalence of LTOT in PAH and CTEPH patients is close to 20%. FC, 6MWD, mPAP, CI, PVR and DLCO were predictors for LTOT prescription.
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Affiliation(s)
- Rodrigo Torres-Castro
- Department of Pulmonary Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), University of Barcelona, Barcelona, Spain
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Williams Hinojosa
- Pulmonary Hypertension Unit, Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Amaya Martínez-Meñaca
- Department of Pneumology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
- Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain
- ERN-LUNG (European Reference Network on Rare Respiratory Diseases), Spain
| | - Ernest Sala Llinas
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Department of Pneumology, Hospital Universitario Son Espases, Balearic Islands, Spain
- Institut d'Investigació Sanitària Illes Balears (IdISBa), Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | - Joaquín Rueda Soriano
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Agueda Aurtenetxe
- Depatrment of Pneumology, Hospital Universitario Basurto, Bilbao, Spain
| | - Joan Albert Barberà
- Department of Pulmonary Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), University of Barcelona, Barcelona, Spain
- ERN-LUNG (European Reference Network on Rare Respiratory Diseases), Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Pilar Escribano-Subías
- Pulmonary Hypertension Unit, Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
- ERN-LUNG (European Reference Network on Rare Respiratory Diseases), Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Instituto de investigación del Hospital 12 de Octubre ( i+12), Madrid, Spain
| | - Isabel Blanco
- Department of Pulmonary Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), University of Barcelona, Barcelona, Spain
- ERN-LUNG (European Reference Network on Rare Respiratory Diseases), Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
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Nagata J, Sekine A, Tanabe N, Taniguchi Y, Ishida K, Shiko Y, Sakao S, Tatsumi K, Suzuki T. Mixed venous oxygen tension is a crucial prognostic factor in pulmonary hypertension: a retrospective cohort study. BMC Pulm Med 2022; 22:282. [PMID: 35858889 PMCID: PMC9301830 DOI: 10.1186/s12890-022-02073-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 07/12/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The prognostic value of mixed venous oxygen tension (PvO2) at pulmonary hypertension diagnosis treated with selective pulmonary vasodilators remains unclear. This study sought to investigate the association of PvO2 with long-term prognosis in pulmonary arterial hypertension (PAH) and medically treated chronic thromboembolic pulmonary hypertension (CTEPH) and to identify the distinct mechanisms influencing tissue hypoxia in patients with CTEPH or PAH. METHODS We retrospectively analyzed data from 138 (age: 50.2 ± 16.6 years, 81.9% women) and 268 (age: 57.4 ± 13.1 years, 72.8% women) patients with PAH and CTEPH, respectively, diagnosed at our institution from 1983 to 2018. We analyzed the survival rates of patients with/without tissue hypoxia (PvO2 < 35 mmHg) and identified their prognostic factors based on the pulmonary hypertension risk stratification guidelines. RESULTS Survival was significantly poorer in patients with tissue hypoxia than in those without it for PAH (P = 0.001) and CTEPH (P = 0.017) treated with selective pulmonary vasodilators. In patients with PAH, PvO2 more strongly correlated with prognosis than other hemodynamic prognostic factors regardless of selective pulmonary vasodilators usage. PvO2 was the only significant prognostic factor in patients with CTEPH treated with pulmonary hypertension medication. Patients with CTEPH experiencing tissue hypoxia exhibited significantly poorer survival than those in the intervention group (P < 0.001). PvO2 more strongly correlated with the cardiac index (CI) than the alveolar-arterial oxygen gradient (A-aDO2) in PAH; whereas in CTEPH, PvO2 was more strongly correlated with A-aDO2 than with CI. CONCLUSIONS PvO2 may represent a crucial prognostic factor for pulmonary hypertension. The prognostic impact of tissue hypoxia affects different aspects of PAH and CTEPH, thereby reflecting their distinct pathogenesis.
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Affiliation(s)
- Jun Nagata
- Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
- Department of Respirology, Chibaken Saiseikai Narashino Hospital, Narashino, 275-8580, Japan
| | - Ayumi Sekine
- Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan.
| | - Nobuhiro Tanabe
- Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
- Department of Respirology, Chibaken Saiseikai Narashino Hospital, Narashino, 275-8580, Japan
| | - Yu Taniguchi
- Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Keiichi Ishida
- Department of Cardiovascular Surgery, Eastern Chiba Medical Center, Togane, 283-8686, Japan
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, 260-8670, Japan
| | - Seiichiro Sakao
- Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
| | - Takuji Suzuki
- Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
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Tanabe N, Kumamaru H, Tamura Y, Taniguchi H, Emoto N, Yamada Y, Nishiyama O, Tsujino I, Kuraishi H, Nishimura Y, Kimura H, Inoue Y, Morio Y, Nakatsumi Y, Satoh T, Hanaoka M, Kusaka K, Sumitani M, Handa T, Sakao S, Kimura T, Kondoh Y, Nakayama K, Tanaka K, Ohira H, Nishimura M, Miyata H, Tatsumi K. Multi-Institutional Prospective Cohort Study of Patients With Pulmonary Hypertension Associated With Respiratory Diseases. Circ J 2021; 85:333-342. [PMID: 33536399 DOI: 10.1253/circj.cj-20-0939] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND There is limited evidence for pulmonary arterial hypertension (PAH)-targeted therapy in patients with pulmonary hypertension associated with respiratory disease (R-PH). Therefore, we conducted a multicenter prospective study of patients with R-PH to examine real-world characteristics of responders by evaluating demographics, treatment backgrounds, and prognosis.Methods and Results:Among the 281 patients with R-PH included in this study, there was a treatment-naïve cohort of 183 patients with normal pulmonary arterial wedge pressure and 1 of 4 major diseases (chronic obstructive pulmonary diseases, interstitial pneumonia [IP], IP with connective tissue disease, or combined pulmonary fibrosis with emphysema); 43% of patients had mild ventilatory impairment (MVI), whereas 52% had a severe form of PH. 68% received PAH-targeted therapies (mainly phosphodiesterase-5 inhibitors). Among patients with MVI, those treated initially (i.e., within 2 months of the first right heart catheterization) had better survival than patients not treated initially (3-year survival 70.6% vs. 34.2%; P=0.01); there was no significant difference in survival in the group with severe ventilatory impairment (49.6% vs. 32.1%; P=0.38). Responders to PAH-targeted therapy were more prevalent in the group with MVI. CONCLUSIONS This first Japanese registry of R-PH showed that a high proportion of patients with MVI (PAH phenotype) had better survival if they received initial treatment with PAH-targeted therapies. Responders were predominant in the group with MVI.
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Affiliation(s)
- Nobuhiro Tanabe
- Department of Respirology, Graduate School of Medicine, Chiba University.,Pulmonary Hypertension Center, Saiseikai Narashino Hospital
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo
| | - Yuichi Tamura
- Pulmonary Hypertension Center, International University of Health and Welfare Mita Hospital
| | | | - Noriaki Emoto
- Department of Clinical Pharmacy, Kobe Pharmaceutical University
| | - Yoshihito Yamada
- Department of Chest Medicine, Japan Railway Tokyo General Hospital
| | - Osamu Nishiyama
- Department of Respiratory Medicine and Allergology, Faculty of Medicine, Kindai University
| | - Ichizo Tsujino
- First Department of Medicine, Hokkaido University Hospital
| | | | - Yoshihiro Nishimura
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Hiroshi Kimura
- Department of Advanced Medicine for Pulmonary Circulation and Respiratory Failure and Department of Respiratory Medicine, Nippon Medical School Graduate School of Medicine.,Department of Respiratory Medicine, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA).,Second Department of Internal Medicine, Nara Medical University
| | - Yoshikazu Inoue
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center
| | - Yoshiteru Morio
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine.,Center for Pulmonary Diseases and Respiratory Disease Division, National Hospital Organization Tokyo National Hospital
| | | | - Toru Satoh
- Division of Cardiology Department of Medicine, Kyorin University Hospital
| | - Masayuki Hanaoka
- First Department of Medicine, Shinshu University School of Medicine
| | - Kei Kusaka
- Center for Pulmonary Diseases and Respiratory Disease Division, National Hospital Organization Tokyo National Hospital
| | | | - Tomohiro Handa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University
| | - Seiicihiro Sakao
- Department of Respirology, Graduate School of Medicine, Chiba University
| | - Tomoki Kimura
- Department of Respiratory Medicine and Allergy, Tosei General Hospital
| | - Yasuhiro Kondoh
- Department of Respiratory Medicine and Allergy, Tosei General Hospital
| | - Kazuhiko Nakayama
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Kensuke Tanaka
- Department of Chest Medicine, Japan Railway Tokyo General Hospital
| | - Hiroshi Ohira
- First Department of Medicine, Hokkaido University Hospital
| | | | - Hiroaki Miyata
- Department of Health Policy and Management, Keio University School of Medicine
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University
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Abstract
Pulmonary hypertension (PH) is a condition of raised pulmonary artery pressure (PAP), which may be secondary to a number of causes, one of which is sleep disordered breathing (SDB). When PH complicates SDB, it carries a significant burden of morbidity and mortality due to the risk of progression to right ventricular failure over time. This narrative review will cover the definition and classification of PH, and explore the epidemiology of PH in SDB. The mechanisms by which the two conditions are linked will be reviewed. Repetitive hypoxia with or without hypercapnia alongside frequent arousals can result in important metabolic and pulmonary vascular consequences for the left and right heart. MEDLINE was used to search for all relevant articles and abstracts published from January 1960 to October 2019 inclusive (in all languages). Current best practice in the investigation and management of PH complicating SDB will be reviewed. Important diagnostic investigations and when to consider and screen further for PH in patients with SDB will be discussed. Optimal disease management must include control of SDB with therapy. Additional treatment options will be reviewed. Areas for further research will be highlighted.
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Affiliation(s)
| | | | - Marino Philip
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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