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Original Research: Pulmonary Vascular Disease |

Demographics and Outcomes of Patients Diagnosed With Pulmonary Hypertension With Pulmonary Capillary Wedge Pressures 16 to 18 mm HgPAH and Nonconforming Elevated Wedge Pressures: Insights From the REVEAL Registry

Adaani E. Frost, MD, FCCP; Harrison W. Farber, MD, FCCP; Robyn J. Barst, MD, FCCP; Dave P. Miller, MS; C. Gregory Elliott, MD, FCCP; and Michael D. McGoon, MD
Author and Funding Information

From the Baylor College of Medicine (Dr Frost), Houston, TX; Boston University School of Medicine (Dr Farber), Boston, MA; Columbia University College of Physicians and Surgeons (Dr Barst), New York, NY; ICON Late Phase & Outcomes Research (Mr Miller), San Francisco, CA; Intermountain Medical Center and the University of Utah (Dr Elliott), Murray, UT; and Mayo Clinic (Dr McGoon), Rochester, MN.

Correspondence to: Adaani E. Frost, MD, FCCP, Baylor College of Medicine, 6620 Main St, Ste 1225, Houston, TX 77030; e-mail: frost@bcm.tmc.edu


Funding/Support: Preparation of this manuscript was supported by Actelion Pharmaceuticals US, Inc. Funding for the REVEAL Registry is provided by Actelion Pharmaceuticals US, Inc.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(1):185-195. doi:10.1378/chest.11-1387
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Background:  The Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management (REVEAL Registry) is a multicenter, US-based, observational study of patients diagnosed with group 1 pulmonary hypertension enrolled consecutively from March 2006 to December 2009. Of 3,128 patients in this analysis, inclusion criteria permitted enrollment of 268 patients with mean pulmonary capillary wedge pressure (PCWP) 16 to 18 mm Hg at diagnostic right-sided heart catheterization (RHC) (above currently accepted pulmonary arterial hypertension [PAH] diagnostic criteria). This study compared the demographics and outcomes of those 268 patients with an elevated mean PCWP to patients with a mean PCWP ≤ 15 mm Hg.

Methods:  Demographic characteristics and outcomes were compared for patients with mean PCWP ≤ 12, 13 to 15, and 16 to 18 mm Hg at diagnostic and follow-up RHC.

Results:  At diagnostic RHC, patients with PCWP 16 to18 mm Hg were older, had more severe hemodynamic impairments, and were more likely to be obese and have other comorbidities than patients with PCWP ≤ 15 mm Hg. There were no clinically relevant differences in 5-year survival rates from diagnostic RHC regardless of PCWP at diagnosis (≤15 mm Hg vs 16-18 mm Hg, P = .07). Two-year survival rates of 108 patients with PAH whose PCWP increased to ≥ 19 mm Hg (regardless of PCWP at diagnosis) were significantly lower than that of patients with PAH with PCWP ≤ 18 mm Hg at subsequent RHC.

Conclusion:  Patients with PCWP 16 to 18 mm Hg who were diagnosed and treated for PAH were older, heavier, and more likely to have comorbidities associated with left ventricular diastolic dysfunction at diagnosis than those with PCWP ≤ 15 mm Hg. Five-year survival rates were similarly low for all PCWP subgroups.

Trial registry:  ClinicalTrials.gov; No.: NCT00370214; URL: www.clinicaltrials.gov

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