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Mora-Cuesta VM, Martínez-Meñaca A, González-Fernández Á, Iturbe-Fernández D, Tello-Mena S, Izquierdo-Cuervo S, Fernández-Rozas S, Alonso-Lecue P, Cifrián-Martínez JM. The impact of time from ILD diagnosis to referral to the transplant center on the probability of inclusion in the transplant waiting list. Heart Lung 2024; 67:92-99. [PMID: 38735159 DOI: 10.1016/j.hrtlng.2024.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Lung transplant is a therapeutic option for patients with progressive interstitial lung disease (ILD). OBJECTIVES The objective of this study was to determine whether time from ILD diagnosis to referral to a transplant center influences the probability of being included in the transplant waiting list. METHODS We performed a retrospective cohort study including all ILD patients evaluated as lung transplantation (LT) candidates at a lung transplant center between 01/01/2017 and 31/12/2022. The primary endpoint was the probability of being included in the lung transplant waiting list according to the time elapsed from diagnosis to referral to the transplant center. RESULTS A total of 843 lung transplant requests were received, of which 367 (43.5%) were associated with ILD. Thirteen patients were excluded because they did not attend the first visit, whereas another 11 were excluded because some information was missing. As a result, our final sample was composed of 343 patients. The median time from diagnosis to referral was 29.4 (10.9 - 61.1) months. The overall probability of inclusion in the waiting list was 29.7%. By time from diagnosis to referral, the probability of inclusion in the waiting list was 48.1% for the patients referred 〈 6 months from diagnosis; 27.5% for patients referred 6 to 24 months from diagnosis; and 25.8% for patients referred 〉 24 months from diagnosis (p = 0.007). CONCLUSIONS Early referral to a lung transplant center seemed to increase the probability of being included in the lung transplant waiting list. Further research is needed in this topic.
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Affiliation(s)
- Víctor M Mora-Cuesta
- Respiratory Department, Lung Transplant Unit, ERN-LUNG (European Reference Network on Rare Respiratory Diseases), Marqués de Valdecilla University Hospital, Avda. Valdecilla s/n. 39008, Santander, Spain.
| | - Amaya Martínez-Meñaca
- Respiratory Department. ERN-LUNG (European Reference Network on Rare Respiratory Diseases), Marqués de Valdecilla University Hospital, Spain
| | | | - David Iturbe-Fernández
- Respiratory Department, Lung Transplant Unit, ERN-LUNG (European Reference Network on Rare Respiratory Diseases), Marqués de Valdecilla University Hospital, Avda. Valdecilla s/n. 39008, Santander, Spain
| | - Sandra Tello-Mena
- Respiratory Department, Lung Transplant Unit, ERN-LUNG (European Reference Network on Rare Respiratory Diseases), Marqués de Valdecilla University Hospital, Avda. Valdecilla s/n. 39008, Santander, Spain
| | - Sheila Izquierdo-Cuervo
- Respiratory Department, Lung Transplant Unit, ERN-LUNG (European Reference Network on Rare Respiratory Diseases), Marqués de Valdecilla University Hospital, Avda. Valdecilla s/n. 39008, Santander, Spain
| | - Sonia Fernández-Rozas
- Respiratory Department. ERN-LUNG (European Reference Network on Rare Respiratory Diseases), Marqués de Valdecilla University Hospital, Spain
| | | | - José M Cifrián-Martínez
- Respiratory Department, Lung Transplant Unit, ERN-LUNG (European Reference Network on Rare Respiratory Diseases), Marqués de Valdecilla University Hospital, Avda. Valdecilla s/n. 39008, Santander, Spain
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Mora-Cuesta VM, Martínez-Meñaca A, Iturbe-Fernández D, Tello-Mena S, Izquierdo-Cuervo S, García-Camarero T, Gil-Ongay A, Sánchez-Moreno L, Alonso-Lecue P, Naranjo-Gozalo S, Cifrián-Martínez JM. Impact of the New Definition of Pulmonary Hypertension on the Prevalence of Primary Graft Dysfunction in Lung Transplant Recipients. Heart Lung Circ 2024; 33:524-532. [PMID: 38429191 DOI: 10.1016/j.hlc.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 11/08/2023] [Accepted: 12/22/2023] [Indexed: 03/03/2024]
Abstract
BACKGROUND & AIM Pulmonary hypertension (PH) secondary to lung disease (Group-3 PH) is the second leading cause of PH. The role of PH as a risk factor for primary graft dysfunction (PGD) following lung transplant (LT) is controversial. OBJECTIVE To assess the impact that the new definition of PH had on the prevalence of PH in patients with advanced lung disease-candidate for LT, and its association with the occurrence of PGD. METHOD A retrospective study was performed in all patients undergoing cardiac catheterisation referred for consideration as candidates to LT in a centre between 1 January 2017 and 31 December 2022. The baseline and haemodynamic characteristics of patients were analysed, along with the occurrence of PGD and post-transplant course in those who ultimately underwent transplantation. RESULTS A total of 396 patients were included. Based on the new 2022 European Society of Cardiology/European Respiratory Society definitions, as many as 70.7% of patients met PH criteria. Since the introduction of the 2022 definition, a significant reduction was observed in the frequency of severe Group-3 PH (41.1% vs 10.3%; p<0.001), with respect to the 2015 definition. As many as 236 patients underwent transplantation. None of the variables associated with PH was identified as a risk factor for PGD. CONCLUSION The new classification did not have any impact on the prevalence of PGD after transplantation. These results exclude that any significant differences exist in the baseline characteristics or post-transplant course of patients with Group-3 PH vs unclassified PH.
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Affiliation(s)
- Víctor M Mora-Cuesta
- Respiratory Department, Lung Transplant Unit, Marqués de Valdecilla University Hospital, Santander, Spain; Department of Thoracic Surgery, Lung Transplant Unit, Marqués de Valdecilla University Hospital, Santander, Spain.
| | - Amaya Martínez-Meñaca
- Respiratory Department, Lung Transplant Unit, Marqués de Valdecilla University Hospital, Santander, Spain; Department of Thoracic Surgery, Lung Transplant Unit, Marqués de Valdecilla University Hospital, Santander, Spain
| | - David Iturbe-Fernández
- Respiratory Department, Lung Transplant Unit, Marqués de Valdecilla University Hospital, Santander, Spain; Department of Thoracic Surgery, Lung Transplant Unit, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Sandra Tello-Mena
- Respiratory Department, Lung Transplant Unit, Marqués de Valdecilla University Hospital, Santander, Spain; Department of Thoracic Surgery, Lung Transplant Unit, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Sheila Izquierdo-Cuervo
- Respiratory Department, Lung Transplant Unit, Marqués de Valdecilla University Hospital, Santander, Spain; Department of Thoracic Surgery, Lung Transplant Unit, Marqués de Valdecilla University Hospital, Santander, Spain
| | | | - Aritz Gil-Ongay
- Cardiology Department, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Laura Sánchez-Moreno
- Department of Thoracic Surgery, Lung Transplant Unit, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Pilar Alonso-Lecue
- Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, Santander, Spain
| | - Sara Naranjo-Gozalo
- Department of Thoracic Surgery, Lung Transplant Unit, Marqués de Valdecilla University Hospital, Santander, Spain
| | - José M Cifrián-Martínez
- Respiratory Department, Lung Transplant Unit, Marqués de Valdecilla University Hospital, Santander, Spain; Department of Thoracic Surgery, Lung Transplant Unit, Marqués de Valdecilla University Hospital, Santander, Spain
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Martínez-Meñaca A, Mora-Cuesta VM, Iturbe-Fernández D, Sáinz-Ezquerra Belmonte B, Fernández-Cavia G, Gallardo-Ruiz MJ. Quality of Life and the Cardiopulmonary Exercise Test in Pulmonary Arterial Hypertension Patients. Arch Bronconeumol 2024; 60:253-255. [PMID: 38402048 DOI: 10.1016/j.arbres.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 02/26/2024]
Affiliation(s)
- Amaya Martínez-Meñaca
- Marqués de Valdecilla University Hospital, Respiratory Department, Pulmonary Hypertension Unit, ERN-LUNG (European Reference Network on Rare Respiratory Diseases), Spain
| | - Víctor M Mora-Cuesta
- Marqués de Valdecilla University Hospital, Respiratory Department, Pulmonary Hypertension Unit, Lung Transplant Unit, ERN-LUNG (European Reference Network on Rare Respiratory Diseases), Spain.
| | - David Iturbe-Fernández
- Marqués de Valdecilla University Hospital, Respiratory Department, Pulmonary Hypertension Unit, Lung Transplant Unit, ERN-LUNG (European Reference Network on Rare Respiratory Diseases), Spain
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Martínez-Meñaca A, Cruz-Utrilla A, Mora-Cuesta VM, Luna-López R, Segura-de la Cal T, Flox-Camacho Á, Alonso-Lecue P, Escribano-Subias P, Cifrián-Martínez JM. Simplified risk stratification based on cardiopulmonary exercise test: A Spanish two-center experience. Pulm Circ 2024; 14:e12342. [PMID: 38414916 PMCID: PMC10897871 DOI: 10.1002/pul2.12342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/21/2023] [Accepted: 01/22/2024] [Indexed: 02/29/2024] Open
Abstract
A simplified 4-strata risk stratification approach based on three variables is widespread in pulmonary arterial hypertension (PAH) at follow-up. This study aimed to assess the impact of replacing the 6-min walk test (6MWT) with the peak 02 uptake evaluated by the cardiopulmonary exercise test (CPET) on risk stratification by this scale. We included 180 prevalent patients with PAH from two reference hospitals in Spain, followed up between 2006 and 2022. Patients were included if all the variables of interest were available within a 3-month period on the Spanish Registry of Pulmonary Arterial Hypertension (REHAP): functional class (FC); NT-proBNP; 6MWT; and CPET. The original 4-strata model (NT-proBNP, 6MWT, FC) identified most patients at low or intermediate-low risk (36.7% and 51.1%, respectively). Notably, the modified scale (NT-proBNP, CPET, FC) improved the identification of patients at intermediate-high risk up to 18.9%, and at high risk up to 1.1% in comparison with the previous 12.2% and 0.0% in the original scale. This new model increased the number of patients correctly classified into higher-risk strata (positive NRI of 0.06), as well as classified more patients without events in lower-risk strata (negative NRI of 0.04). The proposed score showed a slightly superior prognostic capacity compared with the original model (Harrel's C-index 0.717 vs. 0.709). Using O2 uptake instead of distance walked in the 6MWT improves the identification of high-risk patients using the 4-strata scale. This change could have relevant prognostic implications and lead to changes in the specific treatment of PAH.
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Affiliation(s)
- Amaya Martínez-Meñaca
- Respiratory Department, ERN-LUNG (European Reference Network on rare respiratory diseases), Instituto de Investigación Valdecilla (IDIVAL) Hospital Universitario Marqués de Valdecilla Santander Spain
| | - Alejandro Cruz-Utrilla
- Cardiology Department, ERN-LUNG (European Reference Network on rare respiratory diseases) Hospital Universitario Doce de Octubre Madrid Spain
| | - Víctor Manuel Mora-Cuesta
- Respiratory Department, ERN-LUNG (European Reference Network on rare respiratory diseases), Instituto de Investigación Valdecilla (IDIVAL) Hospital Universitario Marqués de Valdecilla Santander Spain
| | - Raquel Luna-López
- Cardiology Department, ERN-LUNG (European Reference Network on rare respiratory diseases) Hospital Universitario Doce de Octubre Madrid Spain
| | - Teresa Segura-de la Cal
- Cardiology Department, ERN-LUNG (European Reference Network on rare respiratory diseases) Hospital Universitario Doce de Octubre Madrid Spain
| | - Ángela Flox-Camacho
- Cardiology Department, ERN-LUNG (European Reference Network on rare respiratory diseases) Hospital Universitario Doce de Octubre Madrid Spain
| | | | - Pilar Escribano-Subias
- Cardiology Department, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III (ISCIII) Hospital Universitario Doce de Octubre Madrid Spain
- ERN-LUNG (European Reference Network on rare respiratory diseases), Facultad de Medicina Universidad Complutense de Madrid Madrid Spain
| | - José Manuel Cifrián-Martínez
- Respiratory Department, ERN-LUNG (European Reference Network on rare respiratory diseases), Instituto de Investigación Valdecilla (IDIVAL) Facultad de Medicina, Hospital Universitario Marqués de Valdecilla Universidad de Cantabria Santander Spain
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Cruz-Utrilla A, Pérez-Olivares C, Martínez-Meñaca A, López-Meseguer M, Escribano-Subias P. Phenotypes of idiopathic pulmonary arterial hypertension. Lancet Respir Med 2022; 10:e87. [PMID: 36179740 DOI: 10.1016/s2213-2600(22)00290-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/20/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Alejandro Cruz-Utrilla
- Pulmonary Hypertension Unit, European Reference Network for Rare Respiratory Diseases (ERN-Lung), Department of Cardiology, University Hospital October 12, 28041 Madrid, Spain.
| | | | - Amaya Martínez-Meñaca
- Department of Pulmonology, ERN-Lung, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Manuel López-Meseguer
- Department of Pulmonology, ERN-Lung, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Pilar Escribano-Subias
- Pulmonary Hypertension Unit, European Reference Network for Rare Respiratory Diseases (ERN-Lung), Department of Cardiology, University Hospital October 12, 28041 Madrid, Spain; CIBERCV, Madrid, Spain; Complutense University of Madrid, Madrid, Spain
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Martínez-Santos P, Velázquez-Martín MT, Barberá JA, Fernández Pérez C, López-Meseguer M, López-Reyes R, Martínez-Meñaca A, Lara-Padrón A, Domingo-Morera JA, Blanco I, Escribano-Subías P. Hipertensión pulmonar tromboembólica crónica en España: una década de cambio. Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2020.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Martínez-Santos P, Velázquez-Martín MT, Barberá JA, Fernández Pérez C, López-Meseguer M, López-Reyes R, Martínez-Meñaca A, Lara-Padrón A, Domingo-Morera JA, Blanco I, Escribano-Subías P. Chronic thromboembolic pulmonary hypertension in Spain: a decade of change. ACTA ACUST UNITED AC 2020; 74:384-392. [PMID: 32654945 DOI: 10.1016/j.rec.2020.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 05/25/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES Chronic thromboembolic pulmonary hypertension (CTEPH) treatment has evolved in the last decade. However, there is scarce information on the long-term impact of this progress in a real-life population at a national level. This study was designed to analyze the characteristics of CTEPH patients in Spain over the last decade. METHODS We prospectively collected epidemiological, clinical, and prognostic data from CTEPH patients consecutively included in the Spanish REHAP registry from January 1, 2007, to December 31, 2018. We evaluated differences over time, establishing 2013 as the reference date for analysis. Propensity scores for interventional treatment were calculated using a multivariable logistic regression model. RESULTS A total of 1019 patients were included; 659 (64.4%) were evaluated at a national CTEPH center. Overall, 350 patients (34.3%) were selected for surgery and 97 (9.6%) for percutaneous treatment. Patients diagnosed between 2007 and 2012 died more frequently than those diagnosed from 2013 onward (HR, 1.83; 95%CI, 1.07-3.15; P=.027). Within the subgroup of patients adjusted by propensity score, baseline pulmonary vascular resistance and the 6-minute walk test distance also determined the outcome (HR, 1.24; 95%CI, 1.15-1.33; P=.011; and HR, 0.93; 95%CI, 0.90-0.97; P=.001, respectively). High survival rates were found in patients who underwent an invasive procedure (pulmonary endarterectomy or balloon pulmonary angioplasty). CONCLUSIONS CTEPH diagnosis and prognosis have consistently improved in the last decade. Baseline disease severity determines the risk profile. Patients who undergo pulmonary endarterectomy or balloon pulmonary angioplasty have better outcomes.
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Affiliation(s)
- Paula Martínez-Santos
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain
| | | | - Joan Albert Barberá
- Servicio de Neumología, Hospital Clínic, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain; Servicio de Neumología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Manuel López-Meseguer
- Servicio de Neumología, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | | | - Amaya Martínez-Meñaca
- Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Antonio Lara-Padrón
- Servicio de Cardiología, Hospital Universitario de Canarias, Sta. Cruz de Tenerife, Spain
| | | | - Isabel Blanco
- Servicio de Neumología, Hospital Clínic, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Pilar Escribano-Subías
- Unidad de Hipertensión Pulmonar, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
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Prieto-Peña D, Martínez-Meñaca A, Calderón-Goercke M, Mora-Cuesta VM, Fernández-Rozas S, Iturbe-Fernández D, Gómez-Román JJ, Cifrián-Martínez JM, Castañeda S, Hernández JL, González-Gay MA, Blanco R. Long-term survival of lung transplantation for interstitial lung disease associated with connective tissue diseases: a study of 26 cases from a referral centre. Clin Exp Rheumatol 2020; 38:615-620. [PMID: 31694743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 07/22/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Interstitial lung disease (ILD) is a leading cause of mortality in patients with connective tissue diseases (CTD). Lung transplantation has become a viable option for patients with end-stage CTD-ILD. However, patients with CTD are often considered suboptimal candidates for lung transplantation because of concerns of worse outcomes. We assessed post-transplant survival of patients with CTD-ILD compared to patients with idiopathic pulmonary fibrosis (IPF). METHODS Medical records of patients who underwent lung transplantation for CTD-ILD at a single referral centre for lung transplantation in Northern Spain between 1998 and 2018 were reviewed. This cohort was compared with patients with IPF (group-matched for age ±3.3 years, transplant year and use of basiliximab induction previous to transplant). Cumulative survival rates after transplantation were estimated by the Kaplan-Meier method and compared between groups using the log-rank test. RESULTS We studied 26 patients with CTD-ILD and 26 patients with IPF. The underlying diseases of CTD-ILD patients were rheumatoid arthritis (n=9), scleroderma (n=6), Sjögren's syndrome (n=4), ANCA-associated vasculitis (n=3), anti-synthetase syndrome (n=2), and dermatomyositis, systemic lupus erythematosus (1 each). Baseline characteristics were similar in both groups. CTD-ILD patients experienced acute graft rejection less commonly than those with IPF (32.0% vs. 62.5%; p=0.032). However, a non-statistically significant increased frequency of chronic graft rejection was observed in CTD-ILD patients (20.0% vs. 8.3%; p=0.417). In this regard, the 5-year cumulative survival rates after transplantation was reduced in CTD-ILD (42.4% vs. 65.8%) but the difference did not achieve statistical significance (p=0.075). CONCLUSIONS Long-term post-transplant survival in Northern Spanish patients with CTD-ILD is reduced compared with IPF.
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Affiliation(s)
- Diana Prieto-Peña
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Amaya Martínez-Meñaca
- Pneumology Division, Hospital Universitario Marqués de Valdecilla, Molecular Imaging Group IDIVAL, Santander, Spain
| | - Mónica Calderón-Goercke
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Víctor M Mora-Cuesta
- Pneumology Division, Hospital Universitario Marqués de Valdecilla, Molecular Imaging Group IDIVAL, Santander, Spain
| | - Sonia Fernández-Rozas
- Pneumology Division, Hospital Universitario Marqués de Valdecilla, Molecular Imaging Group IDIVAL, Santander, Spain
| | - David Iturbe-Fernández
- Pneumology Division, Hospital Universitario Marqués de Valdecilla, Molecular Imaging Group IDIVAL, Santander, Spain
| | - José J Gómez-Román
- Pathology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Jose M Cifrián-Martínez
- Pneumology Division, Hospital Universitario Marqués de Valdecilla, Molecular Imaging Group IDIVAL, Santander, Spain
| | - Santos Castañeda
- Rheumatology Department, Hospital de la Princesa, IIS-Princesa, Cátedra UAM-Roche (EPID-Future), Universidad Autónoma de Madrid, Madrid, Spain
| | - Jose L Hernández
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Miguel A González-Gay
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marqués deValdecilla, IDIVAL, Santander; University of Cantabria, School of Medicine, Santander, Spain; and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Ricardo Blanco
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.
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Del Pozo R, Blanco I, Hernández-González I, López-Meseguer M, López-Reyes R, Lázaro-Salvador M, Elías-Hernández T, Álvarez-Vega P, Pérez-Peñate GM, Martínez-Meñaca A, Bedate P, Escribano-Subias P. Real-life experience of inhaled iloprost for patients with pulmonary arterial hypertension: Insights from the Spanish REHAP registry. Int J Cardiol 2018; 275:158-164. [PMID: 30316648 DOI: 10.1016/j.ijcard.2018.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 09/26/2018] [Accepted: 10/03/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION REHAP is a voluntary, observational Spanish registry of patients with pulmonary arterial hypertension. We analyzed the experience (use and effectiveness) with inhaled iloprost (inh-ILO) in real-life conditions during a 3-year period. METHODS Patients included were those with PAH ≥14 years recruited during 1998-2016 who had received inh-ILO. Variables were collected at the beginning of treatment (0 ± 3 months) and 12 ± 3/36 ± 6 months follow-up. Effectiveness was assessed in the intent-to-treat population as changes in functional class and/or physical performance and transplant-free survival from the beginning of treatment. Stopping inh-ILO-related survival was also assessed. Subanalyses included treatment strategy (first-line therapy -monotherapy or upfront combination- or sequential therapy) and risk of clinical worsening/death. RESULTS Inh-ILO was the most frequently used prostanoid in Spain, rendering 267 patients eligible for analysis. Median age was 54 years; 61% were WHO FC III. Sixty (23%) patients started inh-ILO as monotherapy, 27 (10%) as upfront combination and 180 (67%) sequentially. At 3-year follow-up significant clinical improvements were observed; however, transplant-free survival rate was 54%, being poorer in patients at high risk (63% vs. 85% in low risk patients; P < 0.001) and similar in the three treatment strategies. Only 25% patients remained on inh-ILO. Three-year after stopping inh-ILO-related survival rate was 24.7%. CONCLUSION Data from the REHAP collected during 3 years shows that inh-ILO has low effectiveness independently of the treatment strategy used, with a 3-year survival rate of 54% despite significant clinical improvements, probably due to the use in high-risk patients. Discontinuation rate was as high as 75%.
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Affiliation(s)
- Roberto Del Pozo
- Pulmonary Hypertension Unit, Pneumology Department of Hospital Universitario 12 de Octubre, Avenida de Córdoba s/n, 28041 Madrid, Spain
| | - Isabel Blanco
- Pulmonary Medicine Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Villarroel 170, 08036 Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Avenida de Monforte de Lemos 3-5, 28029 Madrid, Spain
| | - Ignacio Hernández-González
- Pulmonary Hypertension Unit, Cardiology Department of Hospital Universitario 12 de Octubre, Avenida de Córdoba s/n, 28041 Madrid, Spain
| | - Manuel López-Meseguer
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Avenida de Monforte de Lemos 3-5, 28029 Madrid, Spain; Pneumology Department of Hospital Universitario Vall d'Hebron, Paseo de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Raquel López-Reyes
- Pneumology Department of Hospital Universitari i Politècnic la Fe, Avinguda de Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - María Lázaro-Salvador
- Cardiology Department of Hospital Virgen de la Salud, Avenida de Barber 30, 45005 Toledo, Spain
| | - Teresa Elías-Hernández
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Avenida de Monforte de Lemos 3-5, 28029 Madrid, Spain; Medical-surgical Unit of Respiratory Diseases, Pneumology Department of Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), Avenida Manuel Siurot s/n, 41013 Sevilla, Spain
| | - Pablo Álvarez-Vega
- Pneumology Department of Complejo Asistencial Universitario de Salamanca (CAUSA), Montalvos 0, 37120 Doñinos de Salamanca, Salamanca, Spain
| | - Gregorio Miguel Pérez-Peñate
- Pulmonary Circulation Unit, Pneumology Department of Hospital Universitario de Gran Canaria Dr. Negrín, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Canarias, Spain
| | - Amaya Martínez-Meñaca
- Pneumology Department of Hospital Universitario Marqués de Valdecilla, Avenida Valdecilla 25, 39008 Santander, Cantabria, Spain
| | - Pedro Bedate
- Pneumology Department of Hospital Universitario Central de Asturias, Avenida de Roma s/n, 33011 Oviedo, Spain
| | - Pilar Escribano-Subias
- Pulmonary Hypertension Unit, Cardiology Department of Hospital Universitario 12 de Octubre, Avenida de Córdoba s/n, 28041 Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Avenida de Monforte de Lemos 3-5, 28029 Madrid, Spain.
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