0
Correspondence |

Is Pulmonary Hypertension Without Left Ventricular Dysfunction Associated With Poor Survival in Patients With Sarcoidosis or Is It Just a Factor of Advanced Disease Stage? FREE TO VIEW

Saadah Alrajab, MD, MPH; Firas Abu Baker, MD
Author and Funding Information

From the Department of Pulmonary and Critical Care Medicine (Dr Alrajab), Louisiana State University-Shreveport; and the Department of Internal Medicine (Dr Abu Baker), Virginia Tech Carilion School of Medicine.

Correspondence to: Saadah Alrajab, MD, MPH, Louisiana State University-Shreveport, Department of Pulmonary and Critical Care Medicine, 1501 Kings Hwy, Shreveport, LA 71130; e-mail: salraj@lsuhsc.edu


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(4):970. doi:10.1378/chest.10-2899
Text Size: A A A
Published online

To the Editor:

We read with great interest the article by Baughman and colleagues1 in a recent issue of CHEST (November 2010). The study concluded that pulmonary hypertension (PH) without left ventricular dysfunction (LVD) was associated with increased mortality in a population sample of patients with sarcoidosis. Although we strongly agree that patients with PH need to have right-sided heart catheterization for better classification and hence treatment strategy of PH, we have some reservations about the study.

The difference in the two main study groups, namely PH without LVD (PH/no LVD) and PH with LVD (PH/LVD) was barely significant, with a CI almost touching the null value. On the survival curve (Fig 4 in the study1) at 3 years, the CIs of the two groups were insignificant and overlapped (at the time when 23 of the 50 PH/no LVD and only 11 of the 20 PH/LVD were alive). This indicated that with a possibly severe PH stage and early death (within 3 years) the difference in mortality in the two groups was insignificant. The fact that increased pulmonary vascular resistance in the same study was an independent predictor of mortality regardless of the cause of PH may support this observation.

The study attempted to firmly stratify the relationship between the cause of PH in patients with sarcoidosis and increased mortality, with some adjustment in statistical analysis using Cox proportional hazards regression for important and known factors that are associated with increased mortality in this population, such as reduced diffusing capacity of the lung for carbon monoxide and home oxygen use. Other critical factors, such as 6-min walk distance and whether patients received treatment and the type of treatment, were not known or controlled for in the study population because of the retrospective nature of this study.

The question remains: Is PH without LVD the most important factor in predicting survival, or is it only one factor among many others indicating increased sarcoidosis disease severity and lung parenchymal destruction? In a future study, it might be of interest to calculate a score based on the diffusing capacity of the lung for carbon monoxide, FVC, home oxygen use, radiographic stage, PH without LVD, and 6-min walk distance and to test the relationship of these individual factors, as well as the total score, on survival. Many of those factors were not associated with increased mortality in this study but were significant factors in other studies.2-4

Baughman RP, Engel PJ, Taylor L, Lower EE. Survival in sarcoidosis-associated pulmonary hypertension: the importance of hemodynamic evaluation. Chest. 2010;1385:1078-1085. [CrossRef] [PubMed]
 
Baughman RP, Winget DB, Bowen EH, et al. Predicting respiratory failure in sarcoidosis patients. Sarcoidosis Vasc Diff Lung Dis. 1997;142:154-158
 
Baughman RP, Sparkman BK, Lower EE. Six-minute walk test and health status assessment in sarcoidosis. Chest. 2007;1321:207-213. [CrossRef] [PubMed]
 
Shorr AF, Davies DB, Nathan SD. Predicting mortality in patients with sarcoidosis awaiting lung transplantation. Chest. 2003;1243:922-928. [CrossRef] [PubMed]
 

Figures

Tables

References

Baughman RP, Engel PJ, Taylor L, Lower EE. Survival in sarcoidosis-associated pulmonary hypertension: the importance of hemodynamic evaluation. Chest. 2010;1385:1078-1085. [CrossRef] [PubMed]
 
Baughman RP, Winget DB, Bowen EH, et al. Predicting respiratory failure in sarcoidosis patients. Sarcoidosis Vasc Diff Lung Dis. 1997;142:154-158
 
Baughman RP, Sparkman BK, Lower EE. Six-minute walk test and health status assessment in sarcoidosis. Chest. 2007;1321:207-213. [CrossRef] [PubMed]
 
Shorr AF, Davies DB, Nathan SD. Predicting mortality in patients with sarcoidosis awaiting lung transplantation. Chest. 2003;1243:922-928. [CrossRef] [PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543