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Mean pulmonary arterial pressure as a prognostic indicator in connective tissue disease associated with interstitial lung disease: a retrospective cohort study.

Takahashi K, Taniguchi H, Ando M, Sakamoto K, Kondoh Y, Watanabe N, Kimura T, Kataoka K, Suzuki A, Ito S, Hasegawa Y - BMC Pulm Med (2016)

Bottom Line: We did not observe a significant difference in MPAP among various CTDs.A univariate Cox proportional hazard model showed that MPAP has a significant impact on survival, while the type of CTD did not contribute to survival in our cohort.A higher MPAP at the initial evaluation was a significant independent predictor of survival in CTD-ILD.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.

ABSTRACT

Background: Pulmonary hypertension (PH) can develop in connective tissue disease associated interstitial lung disease (CTD-ILD), and contributes to increased morbidity and mortality. However, except for systemic sclerosis and mixed connective tissue disease, the impact of mean pulmonary arterial pressure (MPAP) on survival in CTD-ILD has not been sufficiently elucidated. We hypothesized that pulmonary arterial pressure may be a prognostic factor in CTD-ILDs regardless of the kind of CTD.

Methods: We evaluated the survival impact of MPAP, which is measured using right heart catheterization, on survival of patients with CTD-ILD with various CTD backgrounds. We retrospectively analyzed data of consecutive CTD-ILD patients undergoing a pulmonary function test and right-heart-catheterization at the initial evaluation.

Results: We studied 74 patients (33 men and 41 women, mean age 62.8 ± 9.6, 24 with rheumatoid arthritis, 14 with systemic sclerosis, 14 with polymyositis/dermatomyositis, 11 with primary Sjögren's syndrome, and 11 with other diagnoses). Six patients exhibited pulmonary hypertension (MPAP ≥ 25 mmHg), and 16 (21.6 %) had mild elevation of MPAP (≥20 mmHg). The mean MPAP was 17.2 ± 5.5 mmHg. We did not observe a significant difference in MPAP among various CTDs. A univariate Cox proportional hazard model showed that MPAP has a significant impact on survival, while the type of CTD did not contribute to survival in our cohort. A multivariate Cox proportional hazard model showed MPAP (HR = 1.087; 95 % CI 1.008-1.172; p = 0.030) to be the sole independent determinant of survival.

Conclusions: Mild elevation of MPAP is relatively common in CTD-ILD patients with various CTD backgrounds. A higher MPAP at the initial evaluation was a significant independent predictor of survival in CTD-ILD. MPAP evaluation provides additional information on disease status and will help physicians predict mortality in CTD-ILD.

No MeSH data available.


Related in: MedlinePlus

Kaplan-Meier curves for survival according to MPAP. Survival curves of patients with MPAP ≥ 20 mmHg and MPAP < 20 mmHg were compared and tested with log-rank statistics (p = 0.023)
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Fig2: Kaplan-Meier curves for survival according to MPAP. Survival curves of patients with MPAP ≥ 20 mmHg and MPAP < 20 mmHg were compared and tested with log-rank statistics (p = 0.023)

Mentions: To evaluate the significance of mild elevation of MPAP with a cutoff point of 20 mmHg for survival, the following analysis was performed. As shown in Table 4, patients were stratified according to MPAP with the cutoff point of 20 mmHg, and their baseline characteristics and physiology were compared. Male sex and a history of smoking were more frequent in patients with MPAP ≥ 20 mmHg. Figure 2 shows a Kaplan-Meier curve that reveals significantly worse survival among patients whose MPAP was ≥ 20 mmHg than among those whose MPAP was < 20 mmHg (log-rank test p = 0.023).Table 4


Mean pulmonary arterial pressure as a prognostic indicator in connective tissue disease associated with interstitial lung disease: a retrospective cohort study.

Takahashi K, Taniguchi H, Ando M, Sakamoto K, Kondoh Y, Watanabe N, Kimura T, Kataoka K, Suzuki A, Ito S, Hasegawa Y - BMC Pulm Med (2016)

Kaplan-Meier curves for survival according to MPAP. Survival curves of patients with MPAP ≥ 20 mmHg and MPAP < 20 mmHg were compared and tested with log-rank statistics (p = 0.023)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4837628&req=5

Fig2: Kaplan-Meier curves for survival according to MPAP. Survival curves of patients with MPAP ≥ 20 mmHg and MPAP < 20 mmHg were compared and tested with log-rank statistics (p = 0.023)
Mentions: To evaluate the significance of mild elevation of MPAP with a cutoff point of 20 mmHg for survival, the following analysis was performed. As shown in Table 4, patients were stratified according to MPAP with the cutoff point of 20 mmHg, and their baseline characteristics and physiology were compared. Male sex and a history of smoking were more frequent in patients with MPAP ≥ 20 mmHg. Figure 2 shows a Kaplan-Meier curve that reveals significantly worse survival among patients whose MPAP was ≥ 20 mmHg than among those whose MPAP was < 20 mmHg (log-rank test p = 0.023).Table 4

Bottom Line: We did not observe a significant difference in MPAP among various CTDs.A univariate Cox proportional hazard model showed that MPAP has a significant impact on survival, while the type of CTD did not contribute to survival in our cohort.A higher MPAP at the initial evaluation was a significant independent predictor of survival in CTD-ILD.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.

ABSTRACT

Background: Pulmonary hypertension (PH) can develop in connective tissue disease associated interstitial lung disease (CTD-ILD), and contributes to increased morbidity and mortality. However, except for systemic sclerosis and mixed connective tissue disease, the impact of mean pulmonary arterial pressure (MPAP) on survival in CTD-ILD has not been sufficiently elucidated. We hypothesized that pulmonary arterial pressure may be a prognostic factor in CTD-ILDs regardless of the kind of CTD.

Methods: We evaluated the survival impact of MPAP, which is measured using right heart catheterization, on survival of patients with CTD-ILD with various CTD backgrounds. We retrospectively analyzed data of consecutive CTD-ILD patients undergoing a pulmonary function test and right-heart-catheterization at the initial evaluation.

Results: We studied 74 patients (33 men and 41 women, mean age 62.8 ± 9.6, 24 with rheumatoid arthritis, 14 with systemic sclerosis, 14 with polymyositis/dermatomyositis, 11 with primary Sjögren's syndrome, and 11 with other diagnoses). Six patients exhibited pulmonary hypertension (MPAP ≥ 25 mmHg), and 16 (21.6 %) had mild elevation of MPAP (≥20 mmHg). The mean MPAP was 17.2 ± 5.5 mmHg. We did not observe a significant difference in MPAP among various CTDs. A univariate Cox proportional hazard model showed that MPAP has a significant impact on survival, while the type of CTD did not contribute to survival in our cohort. A multivariate Cox proportional hazard model showed MPAP (HR = 1.087; 95 % CI 1.008-1.172; p = 0.030) to be the sole independent determinant of survival.

Conclusions: Mild elevation of MPAP is relatively common in CTD-ILD patients with various CTD backgrounds. A higher MPAP at the initial evaluation was a significant independent predictor of survival in CTD-ILD. MPAP evaluation provides additional information on disease status and will help physicians predict mortality in CTD-ILD.

No MeSH data available.


Related in: MedlinePlus