Unexplained pulmonary hypertension in elderly patients

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Abstract

Background: Idiopathic pulmonary arterial hypertension (IPAH) preferentially affects young women. However, a subset of patients with IPAH is elderly. Our objective was to compare elderly (age ≥ 65 years) vs younger persons with unexplained pulmonary hypertension (PH) and a presumptive diagnosis of IPAH. Methods: Clinical, echocardiographic, hemodynamic, and survival data were collected on consecutive patients with suspected IPAH after evaluation in a large tertiary center PH clinic. Results: Of 197 patients (mean age ± SD, 52 ± 16 years; 80% female), 48 patients (24%) were elderly. Elderly and younger patients had similar symptom severity, systolic pulmonary artery (PA) pressure (82.7 ± 20.3 mm Hg vs 86.9 ± 18.8 mm Hg, respectively; p = 0.21), and severity of right ventricular enlargement and dysfunction. Elderly patients had higher pulmonary capillary wedge pressure (PCWP) [15.3 ± 7.3 mm Hg vs 11.1 ± 5.3 mm Hg; p < 0.0001] and more frequently failed (56%) to meet hemodynamic criteria for IPAH (PH with PCWP < 15 mm Hg) than did younger patients (19%). Elderly patients also had higher systemic systolic (p < 0.0001) and pulse (p < 0.0001) pressures and more cardiovascular disease. Among those patients with normal PCWP, elderly patients had worse survival than young patients (p = 0.007). Among those patients with elevated PCWP, elderly patients had lower PA pressures (p = 0.04) and better survival (p = 0.02). Conclusions: Elderly patients with clinically suspected IPAH often fail to meet hemodynamic criteria for IPAH due to elevated PCWP. Studies to define the proper diagnostic strategy and the safety and efficacy of pulmonary vasodilators in elderly patients with unexplained PH are needed.

Original languageEnglish (US)
Pages (from-to)94-100
Number of pages7
JournalChest
Volume131
Issue number1
DOIs
StatePublished - Jan 2007

Fingerprint

Pulmonary Hypertension
Pulmonary Wedge Pressure
Hemodynamics
Pressure
Pulmonary Artery
Survival
Right Ventricular Dysfunction
Familial Primary Pulmonary Hypertension
Vasodilator Agents
Pulse
Cardiovascular Diseases

Keywords

  • Diastolic heart failure
  • Idiopathic pulmonary arterial hypertension
  • Pulmonary capillary wedge pressure
  • Ventricular interdependence

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Unexplained pulmonary hypertension in elderly patients. / Shapiro, Brian P; McGoon, Michael D.; Redfield, Margaret May.

In: Chest, Vol. 131, No. 1, 01.2007, p. 94-100.

Research output: Contribution to journalArticle

Shapiro, Brian P ; McGoon, Michael D. ; Redfield, Margaret May. / Unexplained pulmonary hypertension in elderly patients. In: Chest. 2007 ; Vol. 131, No. 1. pp. 94-100.
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abstract = "Background: Idiopathic pulmonary arterial hypertension (IPAH) preferentially affects young women. However, a subset of patients with IPAH is elderly. Our objective was to compare elderly (age ≥ 65 years) vs younger persons with unexplained pulmonary hypertension (PH) and a presumptive diagnosis of IPAH. Methods: Clinical, echocardiographic, hemodynamic, and survival data were collected on consecutive patients with suspected IPAH after evaluation in a large tertiary center PH clinic. Results: Of 197 patients (mean age ± SD, 52 ± 16 years; 80{\%} female), 48 patients (24{\%}) were elderly. Elderly and younger patients had similar symptom severity, systolic pulmonary artery (PA) pressure (82.7 ± 20.3 mm Hg vs 86.9 ± 18.8 mm Hg, respectively; p = 0.21), and severity of right ventricular enlargement and dysfunction. Elderly patients had higher pulmonary capillary wedge pressure (PCWP) [15.3 ± 7.3 mm Hg vs 11.1 ± 5.3 mm Hg; p < 0.0001] and more frequently failed (56{\%}) to meet hemodynamic criteria for IPAH (PH with PCWP < 15 mm Hg) than did younger patients (19{\%}). Elderly patients also had higher systemic systolic (p < 0.0001) and pulse (p < 0.0001) pressures and more cardiovascular disease. Among those patients with normal PCWP, elderly patients had worse survival than young patients (p = 0.007). Among those patients with elevated PCWP, elderly patients had lower PA pressures (p = 0.04) and better survival (p = 0.02). Conclusions: Elderly patients with clinically suspected IPAH often fail to meet hemodynamic criteria for IPAH due to elevated PCWP. Studies to define the proper diagnostic strategy and the safety and efficacy of pulmonary vasodilators in elderly patients with unexplained PH are needed.",
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AB - Background: Idiopathic pulmonary arterial hypertension (IPAH) preferentially affects young women. However, a subset of patients with IPAH is elderly. Our objective was to compare elderly (age ≥ 65 years) vs younger persons with unexplained pulmonary hypertension (PH) and a presumptive diagnosis of IPAH. Methods: Clinical, echocardiographic, hemodynamic, and survival data were collected on consecutive patients with suspected IPAH after evaluation in a large tertiary center PH clinic. Results: Of 197 patients (mean age ± SD, 52 ± 16 years; 80% female), 48 patients (24%) were elderly. Elderly and younger patients had similar symptom severity, systolic pulmonary artery (PA) pressure (82.7 ± 20.3 mm Hg vs 86.9 ± 18.8 mm Hg, respectively; p = 0.21), and severity of right ventricular enlargement and dysfunction. Elderly patients had higher pulmonary capillary wedge pressure (PCWP) [15.3 ± 7.3 mm Hg vs 11.1 ± 5.3 mm Hg; p < 0.0001] and more frequently failed (56%) to meet hemodynamic criteria for IPAH (PH with PCWP < 15 mm Hg) than did younger patients (19%). Elderly patients also had higher systemic systolic (p < 0.0001) and pulse (p < 0.0001) pressures and more cardiovascular disease. Among those patients with normal PCWP, elderly patients had worse survival than young patients (p = 0.007). Among those patients with elevated PCWP, elderly patients had lower PA pressures (p = 0.04) and better survival (p = 0.02). Conclusions: Elderly patients with clinically suspected IPAH often fail to meet hemodynamic criteria for IPAH due to elevated PCWP. Studies to define the proper diagnostic strategy and the safety and efficacy of pulmonary vasodilators in elderly patients with unexplained PH are needed.

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