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PIIINP Is Associated With Worse Health Related Quality of Life in Pulmonary Arterial Hypertension FREE TO VIEW

Emilio Tameez; Zeenat Safdar, MD; Danielle Guffey, MS; Charles Minard, PhD; Mark Entman, MD
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Baylor College of Medicine, Houston, TX

Chest. 2014;146(4_MeetingAbstracts):855A. doi:10.1378/chest.1994977
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SESSION TITLE: Pulmonary Hypertension (Poster Discussion)

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: The goal of this study was to investigate the relationship between peripherally measurable collagen metabolism biomarkers and health related quality of life (HRQoL) in PAH patients.

METHODS: We prospectively enrolled 68 stable idiopathic, anorexigen-associated, and hereditary PAH subjects and 37 healthy controls with similar distributions of age and gender. Serum samples were analyzed for N-terminal propeptide of type III procollagen (PIIINP), c-terminal telopeptide of collagen type I (CITP), matrix metalloproteinase 9 (MMP-9) and tissue inhibitor of metalloproteinase 1 (TIMP-1). The Minnesota Living with Heart Failure (MLWHF), EQ-5D-3L (EQ-5D) and Short Form (SF-36) general health survey were administered at the time of blood draw. Univariate and multivariable linear regression models were used to assess associations between variables.

RESULTS: Mean age of PAH patients and controls were similar (45±15 and 49±14 years respectively, mean±SD, p=0.18). The six-minute walk distance, Borg dyspnea score, WHO functional class, presence of edema, brain naturiectic peptide were all significantly different between controls and PAH patients (p<0.01 for all). CITP, PIIINP, MMP9, and TIMP1 levels, and all HRQoL domains were significantly different between controls and PAH patients (p<0.001 for each). PIIINP levels in particular were significantly associated with MLWHF physical (coef=1.63, and p=0.02), SF-36 physical (coef=-2.62, p=0.007), and EQ-5D aggregate (coef=0.21, p=0.03) scores also correlated well with PIIINP. An ROC curve analysis was conducted with moderate and severe versus mild PAH, using PIIINP as the predictor variable. Our result show that for each unit (1 µg/ml) increase in PIIINP, the odds increased by 1.62 (95% CI=1.06, 2.48 and p=0.025) and PIIINP cutoff value that gave the highest sensitivity and specificity is 4.64 µg/ml, with a sensitivity of 59.6% and a specificity of 60.0%.

CONCLUSIONS: HRQoL is an important part of the patient health assessment. Lower PIIINP levels were associated with better quality of life domains, in particular those specific to PAH, suggesting that PIIINP levels may be a useful tool in clinical assessment of PAH patients.

CLINICAL IMPLICATIONS: PIIINP levels may be a useful tool in clinical assessment of PAH patients.

DISCLOSURE: The following authors have nothing to disclose: Emilio Tameez, Zeenat Safdar, Danielle Guffey, Charles Minard, Mark Entman

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