Pulmonary Arterial Hypertension in the Elderly-Clinical Characteristics and Long-Term Survival
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Pulmonary Arterial Hypertension in the Elderly-Clinical Characteristics and Long-Term Survival Avi Shimony • Benjamin D. Fox • Jonathan Afilalo Lawrence G. Rudski • Andrew Hirsch • David Langleben
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Received: 27 April 2012 / Accepted: 22 September 2012 / Published online: 11 October 2012 Ó Springer Science+Business Media New York 2012
Abstract Background Recent registries describe a significant prevalence of pulmonary arterial hypertension (PAH) in the elderly, but little is known of their characteristics. We aimed to examine the features and prognostic factors of long-term survival in elderly (C65 years) PAH patients. Methods Clinical, echocardiographic, angiographic, hemodynamic, treatments, and survival data were reviewed in consecutive patients over the course of 20 years. Elderly PAH patients (n = 47) were compared to younger PAH patients (n = 107). Results At presentation, elderly patients were more likely to have hypertension, diabetes, dyslipidemia, coronary disease, and PAH associated with scleroderma (42.6 vs. 24.3 %; p = 0.02) than younger patients. Prior to PAH therapy, elderly patients had better right ventricular myocardial performance index (RV-MPI; 0.48 ± 0.20 vs. 0.62 ± 0.23, p = 0.006) and lower mean pulmonary arterial pressure (PAP; 45.0 ± 11.1 vs. 49.2 ± 11.8 mmHg, p = 0.04). Elderly patients were treated less often with epoprostenol (8.5 vs. 29 %, p = 0.006) or trepostinil (8.5 vs. 23.4 %, p = 0.04). The 1, 3, and 5 year survival rates of elderly patients were estimated to be 76.4, 50.5, and
A. Shimony B. D. Fox J. Afilalo L. G. Rudski A. Hirsch D. Langleben Center for Pulmonary Vascular Disease and Divisions of Cardiology and Respirology, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, QC, Canada D. Langleben (&) Division of Cardiology, Jewish General Hospital, 3755 Cote Ste. Catherine, Room E-206, Montreal, QC H3T 1E2, Canada e-mail: [email protected]
37.6 %, respectively. In comparison, younger patients had survival estimates of 92.2, 74.2 and 64.0 % (p = 0.002). Baseline right atrial pressure, mean PAP, cardiac index, and RV-MPI were associated with survival in elderly patients; however in these patients, survival was not affected by any PAH subgroup or age (per year) by itself. Conclusions The diagnosis of PAH in elderly patients is associated with poorer survival which is in part explained by a greater vulnerability to the hemodynamic disturbances of PAH. Keywords Elderly Pulmonary arterial hypertension Mortality Survival
Introduction Pulmonary arterial hypertension (PAH) is a disease characterized by a progressive increase in pulmonary vascular resistance (PVR), leading to right heart failure and death [1–4]. PAH was previously considered as an illness that affects mostly the young, but it is also increasingly recognized in the elderly [5–10]. Notably, little is known of their characteristics. In addition, it is uncertain whether their survival is influenced by a function of PAH progression, poor right ventricul
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