Abstract
Background:
Current treatment goals in patients with pulmonary arterial hypertension (PAH), correlating with long-term outcome are WHO functional class (FC) I or II, hemodynamic assessment with right atrial pressure (RA) < 8 mmHg and cardiac index > 2.5 l/min/m², 6-min walk distance (6-MWD) >380 m and BNP within normal limits.
Methods:
We performed a retrospective analysis of 76 consecutive patients with PAH class I (49 female, age 52.7 ± 19.0 years , WHO FC II-IV) were followed up for 5.6 ± 4.4 years.
All patients were started on monotherapy (PDE-5-inhibitors, ERA, prostacyclines p.i.) and follow up assessment including right heart catheterization was performed after 6.8 ± 3.9 months.
Baseline characteristics were as follows: mean pulmonary-artery pressure was 51.8±13.2 mmHg, RA 8.8±5.0 mmHg, BNP 322.2±398.0 ng/l, 6-MWD 364.5±120.4 m.
During follow-up 21 patients died (27.6%).
For the survival analysis was performed using the Kaplan-Meier method. Ap-value < 0,05 was considered statistically significant.
Results:
Survival analysis revealed a significant better survival in patients reaching FC class I or II (p=0,012), BNP within normal limits (p=0,001) and 6-MWD >380m (p=0,007). Hemodynamic parameters were not significantly correlated with survival (p>0,05).
At baseline 5 patients (6,6%) and under therapy 18 patients (23,7%) reached FC class I or II.
42 patients (55,3%) under therapy in comparison to 30 patients (39,5%) at baseline reached an 6-MWD > 380m.
25 patients (32,9%) without and 29 patients with monotherapy (38,2%) reached BNP values within normal limits.
Conclusions:
Our data suggest that reaching predefined therapeutic goals in PH patients improves overall long-term survival.
- © 2014 ERS