SESSION TITLE: Predictors of Outcomes in PAH
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Tuesday, October 27, 2015 at 08:45 AM - 10:00 AM
PURPOSE: The clinical impact of pulmonary capillary wedge pressure (PCWP) on long-term mortality among patients with pulmonary arterial hypertension (PAH) has been incompletely reported, particularly in relation to concomitant treprostinil administration.
METHODS: We studied a cohort of 743 patients with PAH treated with parenteral treprostinil therapy. Long-term all-cause mortality was compared in patients with baseline mean PCWP < 12mmHg and PCWP > 12mmHg over 4-year follow-up.
RESULTS: Of the 743 patients studied, 513 patients (69.0%) had a baseline mean PCWP < 12mmHg while 230 patients (31.0%) had a baseline mean PCWP > 12mmHg. Age (44.5 vs 45.2 years, p=0.811), gender (males: 20.5% vs 25.7%, p=0.641), and race were similar between both groups. Etiology of PAH was also similar between patients with PCWP < 12mmHg and PCWP > 12mmHg respectively [Idiopathic PAH: 53.6% vs 59.1%; congenital systemic-to-pulmonary shunts: 17.8% vs 17.0%; systemic sclerosis: 7.4% vs 5.7%; systemic lupus erythematosus: 5.1% vs 3.0%; thromboembolic disease: 4.3% vs 5.7%; limited sclerosis: 3.9% vs 2.6%; mixed connective tissue disease: 3.3% vs 3.5%; porto pulmonary hypertension: 3.3% vs 3.5%; collagen vascular disease: 0.4% vs 0.0%; p=0.610]. Rates of NYHA Functional Class III and IV (III: 76.8% vs 81.3%; IV: 8.2% vs 7.4%; p=0.348) as well as 6-minute walk distance (324 vs 319 meters, p=0.371) did not differ between both groups. Baseline right heart pressures demonstrated similar cardiac output (4.0 vs 4.1 liters/min, p=0.574) and pulmonary vascular resistance (14.1 vs 14.0 Wood units, p=0.201). Patients with PCWP > 12mmHg had higher mean pulmonary artery pressures (62.0 vs 57.9mmHg, p<0.001) and higher baseline mean PCWP (13.6 vs 7.7 mmHg, p<0.001). All-cause mortality was similar in patients with PCWP > 12mmHg at 1 year [HR 1.012, p=0.961] and at 4 years [HR 1.069, p=0.712]when compared to patients with PCWP < 12mmHg. Kaplan-Meier curve demonstrated no difference in mortality over 4 years (log-rank p=0.711). In multivariate analysis, no significant difference was noted with respect to all-cause mortality at 1 year [HR 0.995, p=0.984] and 4 years [HR 1.02, p=0.905].
CONCLUSIONS: In this study, patients with PAH receiving concomitant parenteral treprostinil, mean PCWP was not associated with long-term all-cause mortality. Further studies examining prognostic indicators in patients with PAH optimized on guideline-based therapies are warranted.
CLINICAL IMPLICATIONS: PCWP is not predictive of Intermediate/long-term mortality in patients with PAH.
DISCLOSURE: Paul Strachan: Grant monies (from industry related sources): United Therapeutics, Actelion, Intermune, Consultant fee, speaker bureau, advisory committee, etc.: United Therapeutics, Gilead, Genetech, Shareholder: Pfizer The following authors have nothing to disclose: Jignesh Patel
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