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