Risk stratification and response to therapy in patients with pulmonary arterial hypertension and comorbidities: A COMPERA analysis

Publikation: Beitrag in FachzeitschriftForschungsartikelBeigetragenBegutachtung

Beitragende

  • Stephan Rosenkranz - , Universität zu Köln (Autor:in)
  • Christine Pausch - , Technische Universität Dresden (Autor:in)
  • John G. Coghlan - , Royal Free London NHS Foundation Trust (Autor:in)
  • Doerte Huscher - , Charité – Universitätsmedizin Berlin (Autor:in)
  • David Pittrow - , Technische Universität Dresden, Medizinische Fakultät Carl Gustav Carus Dresden, Institut für Klinische Pharmakologie (Autor:in)
  • Ekkehard Grünig - , Universität Heidelberg (Autor:in)
  • Gerd Staehler - , SLK-Kliniken Heilbronn GmbH (Autor:in)
  • Carmine Dario Vizza - , University of Rome La Sapienza (Autor:in)
  • Henning Gall - , Universities of Giessen and Marburg Lung Center (UGMLC), Deutsche Zentrum für Lungenforschung (DZL) - Standort München (Autor:in)
  • Oliver Distler - , Universität Zürich (Autor:in)
  • Marion Delcroix - , KU Leuven (Autor:in)
  • Hossain A. Ghofrani - , Universities of Giessen and Marburg Lung Center (UGMLC), Deutsche Zentrum für Lungenforschung (DZL) - Standort München, Imperial College London (Autor:in)
  • Ralf Ewert - , Ernst-Moritz-Arndt-Universität Greifswald (Autor:in)
  • Hans Joachim Kabitz - , Klinikum Konstanz (Autor:in)
  • Dirk Skowasch - , Universität Bonn (Autor:in)
  • Juergen Behr - , Ludwig-Maximilians-Universität München (LMU), Helmholtz Zentrum München - Deutsches Forschungszentrum für Gesundheit und Umwelt (Autor:in)
  • Katrin Milger - , Ludwig-Maximilians-Universität München (LMU) (Autor:in)
  • Michael Halank - , Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus Dresden (Autor:in)
  • Heinrike Wilkens - , Universität des Saarlandes (Autor:in)
  • Hans Jürgen Seyfarth - , Universität Leipzig (Autor:in)
  • Matthias Held - , Medical Mission Hospital (Autor:in)
  • Laura Scelsi - , IRCCS Fondazione Policlinico San Matteo - Pavia (Autor:in)
  • Claus Neurohr - , Robert Bosch Krankenhaus Stuttgart (Autor:in)
  • Anton Vonk-Noordegraaf - , Vrije Universiteit Amsterdam (VU) (Autor:in)
  • Silvia Ulrich - , Universität Zürich (Autor:in)
  • Hans Klose - , Universität Hamburg (Autor:in)
  • Martin Claussen - , Fachabteilung Pneumologie (Autor:in)
  • Stephan Eisenmann - , Martin-Luther-Universität Halle-Wittenberg (Autor:in)
  • Kai Helge Schmidt - , Johannes Gutenberg-Universität Mainz (Autor:in)
  • Bjoern Andrew Remppis - , Herz- und Gefäßzentrum Bad Bevensen (Autor:in)
  • Andris Skride - , Riga Stradins University (Autor:in)
  • Elena Jureviciene - , Vilnius University (Autor:in)
  • Lina Gumbiene - , Vilnius University (Autor:in)
  • Skaidrius Miliauskas - , Lithuanian University of Health Sciences (Autor:in)
  • Judith Löffler-Ragg - , Medizinische Universität Innsbruck (Autor:in)
  • Tobias J. Lange - , Universität Regensburg (Autor:in)
  • Karen M. Olsson - , Deutsche Zentrum für Lungenforschung (DZL) - Standort München, Medizinische Hochschule Hannover (MHH) (Autor:in)
  • Marius M. Hoeper - , Deutsche Zentrum für Lungenforschung (DZL) - Standort München, Medizinische Hochschule Hannover (MHH) (Autor:in)
  • Christian Opitz - , German Red Cross (Autor:in)

Abstract

Background: A diagnosis of idiopathic pulmonary arterial hypertension (IPAH) is frequently made in elderly patients who present with comorbidities, especially hypertension, coronary heart disease, diabetes mellitus, and obesity. It is unknown to what extent the presence of these comorbidities affects the response to PAH therapies and whether risk stratification predicts outcome in patients with comorbidities. Methods: We assessed the database of COMPERA, a European pulmonary hypertension registry, to determine changes after initiation of PAH therapy in WHO functional class (FC), 6-minute walking distance (6MWD), brain natriuretic peptide (BNP) or N-terminal fragment of probrain natriuretic peptide (NT-pro-BNP), and mortality risk assessed by a 4-strata model in patients with IPAH and no comorbidities, 1-2 comorbidities and 3-4 comorbidities. Results: The analysis was based on 1,120 IPAH patients (n = 208 [19%] without comorbidities, n = 641 [57%] with 1-2 comorbidities, and n = 271 [24%] with 3-4 comorbidities). Improvements in FC, 6MWD, BNP/NT-pro-BNP, and mortality risk from baseline to first follow-up were significantly larger in patients with no comorbidities than in patients with comorbidities, while they were not significantly different in patients with 1-2 and 3-4 comorbidities. The 4-strata risk tool predicted survival in patients without comorbidities as well as in patients with 1-2 or 3-4 comorbidities. Conclusions: Our data suggest that patients with IPAH and comorbidities benefit from PAH medication with improvements in FC, 6MWD, BNP/NT-pro-BNP, and mortality risk, albeit to a lesser extent than patients without comorbidities. The 4-strata risk tool predicted outcome in patients with IPAH irrespective of the presence of comorbidities.

Details

OriginalspracheEnglisch
Seiten (von - bis)102-114
Seitenumfang13
FachzeitschriftJournal of Heart and Lung Transplantation
Jahrgang42
Ausgabenummer1
PublikationsstatusVeröffentlicht - Jan. 2023
Peer-Review-StatusJa

Externe IDs

PubMed 36333206

Schlagworte

Ziele für nachhaltige Entwicklung

Schlagwörter

  • 4-strata approach, comorbidities, kt, mortality, pulmonary arterial hypertension, risk, Peptide Fragments, Follow-Up Studies, Risk Assessment, Humans, Pulmonary Arterial Hypertension/drug therapy, Familial Primary Pulmonary Hypertension, Hypertension, Pulmonary, Natriuretic Peptide, Brain, Aged