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Pulmonary venous occlusion and death in pulmonary arterial hypertension: survival analyses using radiographic surrogates.

Takeda Y, Takeda Y, Yamamoto K, Tomimoto S, Tani T, Narita H, Ohte N, Kimura G - BMC Pulm Med (2011)

Bottom Line: Thickening of the interlobular septa, centrilobular ground-glass attenuation, and mediastinal adenopathy were found in 37.8%, 24.3%, and 16.2% of patients, respectively.The statistical significance of these relationships was independent of the cause of PAH and plasma concentration of brain natriuretic peptide.The results of this study imply that obstruction of the pulmonary veins is associated with an increased risk of death in patients with PAH.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. takeday@med.nagoya-cu.ac.jp

ABSTRACT

Background: Recent studies find that a considerable number of patients with pulmonary arterial hypertension (PAH) develop fibrous obstruction of the pulmonary veins. Such obstruction more commonly accompanies connective tissue disorder (CTD)-associated PAH than idiopathic PAH. However, few researchers have gauged the risk of death involving obstruction of the pulmonary veins.

Methods: Thirty-seven patients with PAH were enrolled (18 patients, idiopathic PAH; 19 patients, CTD-associated PAH). The patients were 49 ± 18 years and had a World Health Organization functional class of 3.2 ± 0.6. Thickening of the interlobular septa, centrilobular ground-glass attenuation, and mediastinal adenopathy were surrogates for obstruction of the pulmonary veins, and were detected by a 16-row multidetector computed tomography scanner.

Results: The follow-up period was 714 ± 552 days. Fifteen deaths occurred. Thickening of the interlobular septa, centrilobular ground-glass attenuation, and mediastinal adenopathy were found in 37.8%, 24.3%, and 16.2% of patients, respectively. Cox proportional hazard analysis revealed an increased risk of death with each radiographic surrogate (mediastinal adenopathy: p < 0.0001, hazard ratio = 13.9; thickening of interlobular septa: p < 0.001, hazard ratio = 12.0; ground-glass attenuation: p = 0.02, hazard ratio = 3.7). The statistical significance of these relationships was independent of the cause of PAH and plasma concentration of brain natriuretic peptide.

Conclusions: The results of this study imply that obstruction of the pulmonary veins is associated with an increased risk of death in patients with PAH.

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Related in: MedlinePlus

Kaplan-Meier survival curves of the patients showing the comparison between the presence and lack of ground-glass attenuation and between idiopathic and connective-tissue-disorder-associated pulmonary arterial hypertension.
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Figure 4: Kaplan-Meier survival curves of the patients showing the comparison between the presence and lack of ground-glass attenuation and between idiopathic and connective-tissue-disorder-associated pulmonary arterial hypertension.

Mentions: The presence of centrilobular ground-glass attenuation was also associated with an increased risk of death, although the effect with this surrogate was somewhat milder than with the other surrogates (p = 0.02, hazard ratio [95%CI] = 3.7 [1.2 - 11.1]). Adding the causes of PAH to the covariate had little impact on the relationship between this surrogate and the risk of death (attenuation: p = 0.02, hazard ratio [95%CI] = 3.6 [1.2 - 10.8]; the causes of PAH: p = 0.24); the survival curves were somewhat close in patients with ground glass attenuation regardless the cause of PAH, although this is less clear than with the other two surrogates (Figure 4). Despite the relationship between this surrogate and the elevation of plasma BNP level did not reach the statistical significance, Cox proportional analysis was performed by adding plasma concentration of BNP to the covariates. The analysis again showed that ground-glass attenuation was associated with a seriously increased mortality rate independently of the BNP concentration (attenuation: p = 0.016, hazard ratio [95%CI] = 4.8 [1.3 - 16.9]; BNP: p < 0.001; hazard ratio [95%CI] = 2.7 [1.6 - 4.5]; the causes of PAH: p = 0.15).


Pulmonary venous occlusion and death in pulmonary arterial hypertension: survival analyses using radiographic surrogates.

Takeda Y, Takeda Y, Yamamoto K, Tomimoto S, Tani T, Narita H, Ohte N, Kimura G - BMC Pulm Med (2011)

Kaplan-Meier survival curves of the patients showing the comparison between the presence and lack of ground-glass attenuation and between idiopathic and connective-tissue-disorder-associated pulmonary arterial hypertension.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3198760&req=5

Figure 4: Kaplan-Meier survival curves of the patients showing the comparison between the presence and lack of ground-glass attenuation and between idiopathic and connective-tissue-disorder-associated pulmonary arterial hypertension.
Mentions: The presence of centrilobular ground-glass attenuation was also associated with an increased risk of death, although the effect with this surrogate was somewhat milder than with the other surrogates (p = 0.02, hazard ratio [95%CI] = 3.7 [1.2 - 11.1]). Adding the causes of PAH to the covariate had little impact on the relationship between this surrogate and the risk of death (attenuation: p = 0.02, hazard ratio [95%CI] = 3.6 [1.2 - 10.8]; the causes of PAH: p = 0.24); the survival curves were somewhat close in patients with ground glass attenuation regardless the cause of PAH, although this is less clear than with the other two surrogates (Figure 4). Despite the relationship between this surrogate and the elevation of plasma BNP level did not reach the statistical significance, Cox proportional analysis was performed by adding plasma concentration of BNP to the covariates. The analysis again showed that ground-glass attenuation was associated with a seriously increased mortality rate independently of the BNP concentration (attenuation: p = 0.016, hazard ratio [95%CI] = 4.8 [1.3 - 16.9]; BNP: p < 0.001; hazard ratio [95%CI] = 2.7 [1.6 - 4.5]; the causes of PAH: p = 0.15).

Bottom Line: Thickening of the interlobular septa, centrilobular ground-glass attenuation, and mediastinal adenopathy were found in 37.8%, 24.3%, and 16.2% of patients, respectively.The statistical significance of these relationships was independent of the cause of PAH and plasma concentration of brain natriuretic peptide.The results of this study imply that obstruction of the pulmonary veins is associated with an increased risk of death in patients with PAH.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. takeday@med.nagoya-cu.ac.jp

ABSTRACT

Background: Recent studies find that a considerable number of patients with pulmonary arterial hypertension (PAH) develop fibrous obstruction of the pulmonary veins. Such obstruction more commonly accompanies connective tissue disorder (CTD)-associated PAH than idiopathic PAH. However, few researchers have gauged the risk of death involving obstruction of the pulmonary veins.

Methods: Thirty-seven patients with PAH were enrolled (18 patients, idiopathic PAH; 19 patients, CTD-associated PAH). The patients were 49 ± 18 years and had a World Health Organization functional class of 3.2 ± 0.6. Thickening of the interlobular septa, centrilobular ground-glass attenuation, and mediastinal adenopathy were surrogates for obstruction of the pulmonary veins, and were detected by a 16-row multidetector computed tomography scanner.

Results: The follow-up period was 714 ± 552 days. Fifteen deaths occurred. Thickening of the interlobular septa, centrilobular ground-glass attenuation, and mediastinal adenopathy were found in 37.8%, 24.3%, and 16.2% of patients, respectively. Cox proportional hazard analysis revealed an increased risk of death with each radiographic surrogate (mediastinal adenopathy: p < 0.0001, hazard ratio = 13.9; thickening of interlobular septa: p < 0.001, hazard ratio = 12.0; ground-glass attenuation: p = 0.02, hazard ratio = 3.7). The statistical significance of these relationships was independent of the cause of PAH and plasma concentration of brain natriuretic peptide.

Conclusions: The results of this study imply that obstruction of the pulmonary veins is associated with an increased risk of death in patients with PAH.

Show MeSH
Related in: MedlinePlus