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Thirty-year trends and outcome of isolated versus combined group 2 pulmonary hypertension after cardiac transplantation
AIM: To investigate the effect of the new definition of pulmonary hypertension (PH) and new pulmonary vascular resistance (PVR) thresholds on the prevalence, clinical characteristics, and events following cardiac transplantation (CTx) over 30 years. METHODS: Patients who underwent CTx between 1983 a...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9755656/ https://www.ncbi.nlm.nih.gov/pubmed/36531737 http://dx.doi.org/10.3389/fcvm.2022.841025 |
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author | Nasri, Amine Dupuis, Jocelyn Carrier, Michel Racine, Normand Parent, Marie-Claude Ducharme, Anique Fortier, Annik Hausermann, Leslie White, Michel Tremblay-Gravel, Maxime |
author_facet | Nasri, Amine Dupuis, Jocelyn Carrier, Michel Racine, Normand Parent, Marie-Claude Ducharme, Anique Fortier, Annik Hausermann, Leslie White, Michel Tremblay-Gravel, Maxime |
author_sort | Nasri, Amine |
collection | PubMed |
description | AIM: To investigate the effect of the new definition of pulmonary hypertension (PH) and new pulmonary vascular resistance (PVR) thresholds on the prevalence, clinical characteristics, and events following cardiac transplantation (CTx) over 30 years. METHODS: Patients who underwent CTx between 1983 and 2014 for whom invasive hemodynamic data was available were analyzed (n = 342). Patients transplanted between 1983 and 1998 were classified as early era and those transplanted between 1999 and 2014 were classified as recent era. Group 2 PH was diagnosed in the presence of a mean pulmonary artery pressure (mPAP) > 20 mmHg and pulmonary capillary wedge pressure (PCWP) > 15 mmHg. Isolated post capillary PH (Ipc-PH) was defined as PVR ≤ 2 wood units and combined pre and post capillary PH (Cpc-PH) was defined PVR > 2 wood units. Moderate to severe PH was defined as mPAP ≥ 35 mmHg. The primary outcome was 30-day mortality and long-term mortality according to type and severity of PH. Proportions were analyzed using the chi-square test, and survival analyses were performed using Kaplan-Meier curves and compared using the logrank test. RESULTS: The prevalence of PH in patients transplanted in the early era was 89.1%, whilst 84.2% of patients transplanted in the recent era had PH (p = 0.3914). There was no difference in the prevalence of a pre-capillary component according to era (p = 0.4001), but severe PH was more common in the early era (51.1% [early] vs 38.0% [recent] p = 0.0151). Thirty-day and long-term mortality were not significantly associated with severity or type of PH. There was a trend toward increased 30-day mortality in mild PH (10.1%), compared to no PH (4.4%) and moderate to severe PH (6.6%; p = 0.0653). Long-term mortality did not differ according to the severity of PH (p = 0.1480). There were no significant differences in 30-day or long-term mortality in IpcPH compared to CpcPH (p = 0.3974 vs p = 0.5767, respectively). CONCLUSION: Over 30 years, PH has remained very prevalent before CTx. The presence, severity, and type (pre- vs post-capillary) of PH is not significantly associated with short- or long-term mortality. |
format | Online Article Text |
id | pubmed-9755656 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-97556562022-12-17 Thirty-year trends and outcome of isolated versus combined group 2 pulmonary hypertension after cardiac transplantation Nasri, Amine Dupuis, Jocelyn Carrier, Michel Racine, Normand Parent, Marie-Claude Ducharme, Anique Fortier, Annik Hausermann, Leslie White, Michel Tremblay-Gravel, Maxime Front Cardiovasc Med Cardiovascular Medicine AIM: To investigate the effect of the new definition of pulmonary hypertension (PH) and new pulmonary vascular resistance (PVR) thresholds on the prevalence, clinical characteristics, and events following cardiac transplantation (CTx) over 30 years. METHODS: Patients who underwent CTx between 1983 and 2014 for whom invasive hemodynamic data was available were analyzed (n = 342). Patients transplanted between 1983 and 1998 were classified as early era and those transplanted between 1999 and 2014 were classified as recent era. Group 2 PH was diagnosed in the presence of a mean pulmonary artery pressure (mPAP) > 20 mmHg and pulmonary capillary wedge pressure (PCWP) > 15 mmHg. Isolated post capillary PH (Ipc-PH) was defined as PVR ≤ 2 wood units and combined pre and post capillary PH (Cpc-PH) was defined PVR > 2 wood units. Moderate to severe PH was defined as mPAP ≥ 35 mmHg. The primary outcome was 30-day mortality and long-term mortality according to type and severity of PH. Proportions were analyzed using the chi-square test, and survival analyses were performed using Kaplan-Meier curves and compared using the logrank test. RESULTS: The prevalence of PH in patients transplanted in the early era was 89.1%, whilst 84.2% of patients transplanted in the recent era had PH (p = 0.3914). There was no difference in the prevalence of a pre-capillary component according to era (p = 0.4001), but severe PH was more common in the early era (51.1% [early] vs 38.0% [recent] p = 0.0151). Thirty-day and long-term mortality were not significantly associated with severity or type of PH. There was a trend toward increased 30-day mortality in mild PH (10.1%), compared to no PH (4.4%) and moderate to severe PH (6.6%; p = 0.0653). Long-term mortality did not differ according to the severity of PH (p = 0.1480). There were no significant differences in 30-day or long-term mortality in IpcPH compared to CpcPH (p = 0.3974 vs p = 0.5767, respectively). CONCLUSION: Over 30 years, PH has remained very prevalent before CTx. The presence, severity, and type (pre- vs post-capillary) of PH is not significantly associated with short- or long-term mortality. Frontiers Media S.A. 2022-12-02 /pmc/articles/PMC9755656/ /pubmed/36531737 http://dx.doi.org/10.3389/fcvm.2022.841025 Text en Copyright © 2022 Nasri, Dupuis, Carrier, Racine, Parent, Ducharme, Fortier, Hausermann, White and Tremblay-Gravel. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Cardiovascular Medicine Nasri, Amine Dupuis, Jocelyn Carrier, Michel Racine, Normand Parent, Marie-Claude Ducharme, Anique Fortier, Annik Hausermann, Leslie White, Michel Tremblay-Gravel, Maxime Thirty-year trends and outcome of isolated versus combined group 2 pulmonary hypertension after cardiac transplantation |
title | Thirty-year trends and outcome of isolated versus combined group 2 pulmonary hypertension after cardiac transplantation |
title_full | Thirty-year trends and outcome of isolated versus combined group 2 pulmonary hypertension after cardiac transplantation |
title_fullStr | Thirty-year trends and outcome of isolated versus combined group 2 pulmonary hypertension after cardiac transplantation |
title_full_unstemmed | Thirty-year trends and outcome of isolated versus combined group 2 pulmonary hypertension after cardiac transplantation |
title_short | Thirty-year trends and outcome of isolated versus combined group 2 pulmonary hypertension after cardiac transplantation |
title_sort | thirty-year trends and outcome of isolated versus combined group 2 pulmonary hypertension after cardiac transplantation |
topic | Cardiovascular Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9755656/ https://www.ncbi.nlm.nih.gov/pubmed/36531737 http://dx.doi.org/10.3389/fcvm.2022.841025 |
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