Changes long term prognosis of 17 patients with pulmonary artery hypertension
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Date
2011
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SOC MEDICA SANTIAGO
Abstract
Background: Pulmonary artery hypertension (PAR) is a progressive disease with high mortality. Major advances had been made in the treatment of this condition during the last decade. Aim: To characterize the clinical evolution and mortality of a cohort of Chilean patients. Material and Methods: Seventeen patients with PAH diagnosed in the last 10 years in two Chilean hospitals were enrolled. Measurements at diagnosis included hemodynamic variables and 6-minute walk test. The patients were followed clinically for 3 years and the observed mortality was compared with that predicted by the prognostic equation proposed by the historic registry of the National Institutes of Health (NIH). Results: The mean age of patients was 45 years and 80% had an idiopathic PAH. The mean median pulmonary artery pressure was 57 +/- 15 mmHg, the cardiac index was 2.4 +/- 0.7 l/min/m(2) and the right atrial pressure was 12 +/- 8 mmHg. The 6-minute walk distance was 348 +/- 98 m. All patients received anticoagulants. Eighty two percent received ambrisentan, 12% received bosentan, 29% received iloprost and 24% sildenafil. At the end of follow-up only 3 patients had died, with an observed survival rate of 88, 82 and 82% at 1, 2 and 3 years, respectively. In contrast, the survival calculated according to the predictive formula of the NIH was 67, 56 and 45%, respectively. Among surviving patients, an improvement in exercise capacity was observed after one year (p < 0.05). Conclusions: The observed survival rate was significantly better than that estimated according to historical data. Furthermore, therapy was associated with an improvement in functional capacity after one year. This prognostic improvement is consistent with data of other contemporary registries published after the NIH Registry. (Rev Med Chile 2011; 139: 327-333).
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Keywords
Drug therapy, Hypertension, pulmonary, Survival rate, DOUBLE-BLIND, SURVIVAL, THERAPY, REGISTRY, TREPROSTINIL, PROSTACYCLIN, MULTICENTER, EFFICACY, INFUSION, BOSENTAN