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Pulmonary Vascular Disease |

Diffusing Lung Capacity Reveals Phenotypical Complexity in Pulmonary Hypertension

Navitha Ramesh, MD; David Nesheim, MD; Michael Lau, MD; Jason Filopei, MD; Michael Bergman, MD; Sarun Thomas, DO; Roxana Sulica, MD; Albert Miller, MD
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Mount Sinai Beth Israel, Chesterfield, NJ


Chest. 2015;148(4_MeetingAbstracts):941A. doi:10.1378/chest.2279213
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Abstract

SESSION TITLE: Pulmonary Arterial Hypertension Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Classification of pulmonary hypertension (PH) is based on predisposing conditions and hemodynamic characteristics, with pathogenetic and therapeutic implications. Multiple phenotypes of PH and comorbidities may complicate the diagnosis. Carbon monoxide diffusing lung capacity (DLCO) reflects the alveolar and microvascular integrity and is a diagnostic marker that may distinguish between various phenotypes of PH. We sought to determine if there is a significant difference in the DLCO in patients belonging to different WHO classes of PH.

METHODS: Design: Retrospective analysis. Setting: PH Program in an academic hospital. Subjects: Patients with PH confirmed by right heart catheterization who have had pulmonary function testing within the last two years. Records were reviewed for demographic data, etiology of PH, and DLCO.

RESULTS: We have identified 169 consecutive patients (71% women) classified in group I (n=71), group II (n=36), group III (n=11), group IV (n=5), and group V (n=12, of which 75% had sarcoidosis). For Group I PAH patients mean (±SD) DLCO was 54% (19). There was no statistically significant difference in the DLCO between Group I PH and Group II PH (54% vs. 56%; p=0.59), Group I PH and Group III PH (54% vs. 51%; p=0.69) and Group I and Group IV (54% vs. 47%; p=0.42). However there was a statistically significant difference in the DLCO between Group I and Group V (54% vs. 41.8%; p=0.04).

CONCLUSIONS: There is no statistically significant difference in the DLCO within the different groups of PH, except the significantly lower DLCO in sarcoidosis. At least in certain PH patients from Groups II-V the alveolar/microvascular integrity is more significantly disrupted than currently appreciated. This is particularly intriguing in patients in group II (PH due to left heart disease). The lower DLCO in patients with sarcoidosis is suggestive of more complex interactions between the microvascular and lung parenchymal changes.

CLINICAL IMPLICATIONS: The search for markers that better define PH phenotypes may help in patient selection for future therapeutic trials.

DISCLOSURE: The following authors have nothing to disclose: Navitha Ramesh, David Nesheim, Michael Lau, Jason Filopei, Michael Bergman, Sarun Thomas, Roxana Sulica, Albert Miller

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