Abstract: Slide Presentations |


Maria Carrillo, MD*; Hector Cajigas, MD; Adam Greenbaum, MD; Kevin M. Chan, MD
Author and Funding Information

Henry Ford Health Systems, Detroit, MI


Chest. 2005;128(4_MeetingAbstracts):175S-b-176S. doi:10.1378/chest.128.4_MeetingAbstracts.175S-b
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PURPOSE:  Pulmonary hypertension (PH) is typically a disease of young women. The use of screening echocardiograms has increased the detection of PH in the elderly. We describe the demographics, and outcomes of bosentan treated PH patients(pts) ≥ 60 years of age.

METHODS:  Retrospective chart review of patients referred to the Henry Ford Hospital PH program over two years. Demographics, hemodynamics, 6 minute walk test (6MW), WHO class were recorded. Pts who completed at least 6 months of bosentan therapy followed by repeat right heart catheterization were included. Pts ≥ 60 years old were compared to pts < 60 years old. Paired Student t-test was used for comparisons.

RESULTS:  62 pts ≥ 60 (Grp 1)and 60 pts < 60 (Grp 2)had PH. Diastolic dysfunction(DD)(31%), connective tissue disease(CTD) (15%), IPAH(15%), CTEPH(13%), and pulmonary disease(PD)(13%)were causes of PH in Grp 1. CTD(19%), IPAH(17%), portopulmonary(13%), DD(12%), PD(7%)and CTEPH(10%)predominated in Grp 2. Bosentan was initiated in 19 pts(Age 71±7)in Grp 1 and 10 pts(Age 47±5)in Grp 2. 4 discontinuations(1 nausea, 3 refractory edema)occurred in Grp 1 while 1 discontinuation(transaminitis)happened in Grp 2. 9 pts in grp 1 and 6 pts in grp 2 qualified for analysis. Overall 6MW increased from 249m to 307m and the change in 6MW distance between the groups was no different(69.8±132 vs 41±73m). WHO class fell significantly following treatment from 3.5±0.6 to 2.4±1.2(p=0.0016)which was most affected by grp 1 with a fall from 3.8±0.4 to 2.2±1.1(p=0.0017). Grp 2 was without change in WHO class(3.2±0.8 to 2.7±1.5). Hemodynamic measurements revealed overall improvement in mPAP(52±12 to 47±13mmHg)(p=0.04) and PVR(12.2±7 to 9.4±4 WU)(p=0.049).

CONCLUSION:  Awareness of PH as a cause of dyspnea is increasing in the elderly. DD is the predominant cause, but IPAH, CTD and CTEPH represent 43% of PH patients ≥60. Bosentan is effective in lowering WHO class, and is equivalent in changing pulmonary hemodynamics and walking distance when compared to younger pts.

CLINICAL IMPLICATIONS:  IPAH, CTD and CTEPH should be suspected in the elderly PH patient. Bosentan is effective in this population.

DISCLOSURE:  Maria Carrillo, Consultant fee, speaker bureau, advisory committee, etc. Actelion6MW (m)Δ6MW after bosentan (m)WHO ClassWHO Class after bosentanMPAP (mmHg)MPAP after bosentan(mmHg)PVR(WU)PVR after bosentan(WU)Grp 1 (N=9)232±12269.8±1323.8±0.42.2±1.1*50.8±1045.0±3.811.9±5.69.2±2.7Grp 2 (N=6)275.8±10141±733.2±0.82.7±1.555±1650±2212.9±8.99.8±6.9Total249±11258±1103.5±0.62.4±1.2*52±1247±13*12.2±79.4±4**

p≤0.05 compared to baseline

Tuesday, November 1, 2005

10:30 AM - 12:00 PM




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