Chronic Thromboembolic Pulmonary Hypertension in Females: Clinical Features and Survival
Abstract
:1. Introduction
2. Methods
2.1. Study Cohort
2.2. CTEPH Diagnosis
- PH confirmed by right heart catheterization (mean pulmonary arterial pressure (mPAP) > 25 mm Hg, pulmonary vascular resistance (PVR) > 3 Wood units, and pulmonary arterial wedge pressure (PAWP) < 15 mm Hg at rest);
- At least 3 months of effective anticoagulation;
- Other factors that may lead to pulmonary vascular lesions, such as arteritis, Takayasu’s disease, pulmonary artery sarcoma, fibrosing mediastinitis, pulmonary sarcoidosis, or schistosomiasis were excluded.
2.3. Statistical Analysis
3. Results
3.1. Clinical Features
3.2. Long-Term Survival and Risk Factors for All-Cause Death
3.3. Sensitive Analysis
3.4. Discussion
4. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variables | All Female Patients (n = 160) | Survival (n = 138) | Non-Survival (n = 22) | p Value |
---|---|---|---|---|
Characteristics | ||||
Age | 54.7 ± 13.8 | 54.6 ± 13.8 | 55.7 ± 13.8 | 0.716 |
BMI (kg/m2) | 23.6 ± 3.3 | 23.7 ± 3.2 | 22.9 ± 3.6 | 0.269 |
History of VTE | 113 (70.6) | 101 (73.2) | 12 (54.6) | 0.075 |
Time from first symptom to diagnosis (months) | 24.4 [9.1, 60.78] | 24.3 [9.1, 58.8] | 35.0 [9.6, 66.7] | 0.321 |
WHO FC III/IV | 108 (67.5) | 92 (66.7) | 16 (72.7) | 0.573 |
6MWD (m) | 377 [342, 442] | 384 [342, 442] | 342.0 [253, 442] | 0.037 |
Hemodynamics | ||||
Systolic PAP (mmHg) | 84.7 ± 23.6 | 84.2 ± 24.0 | 87.5 ± 21.2 | 0.542 |
Diastolic PAP (mmHg) | 31.0 [25.5, 36.5] | 31.0 [25.0, 36.0] | 31.0 [26.0, 39.0] | 0.661 |
mean PAP (mmHg) | 50.6 ± 13.0 | 50.2 ± 13.2 | 53.0 ± 11.6 | 0.361 |
mean RAP (mmHg) | 7.0 [4.0, 10.0] | 6.0 [4.0, 10.0] | 7.5 [5.0, 11.0] | 0.141 |
PAWP (mmHg) | 10.0 [8.0, 12.0] | 10.0 [7.0, 11.0] | 10.0 [9.0, 12.0] | 0.119 |
PVR (Wood units) | 9.68 [6.81, 12.66] | 9.40 [6.79, 12.35] | 11.70 [6.89, 15.00] | 0.136 |
CO (L/min) | 4.32 [3.69, 4.96] | 4.34 [3.70, 5.03] | 4.01 [3.00, 4.90] | 0.135 |
CI (L/(min.m2) | 2.47 [2.14, 2.90] | 2.47 [2.18, 2.91] | 2.39 [1.80, 2.72] | 0.161 |
Svo2 (%) | 61.1 [56.9, 65.9] | 61.6 [58.1, 66.2] | 56.9 [43.3, 65.5] | 0.022 |
Laboratory tests | ||||
HGB (g/L) | 143.0 [129.0, 155.0] | 144.5 [131.0, 158.0] | 129.5 [114.0, 146.0] | 0.013 |
PLT (×109) | 199.0 [162.0, 258.5] | 199.5 [162.0, 263.0] | 194.5 [167.0, 234.0] | 0.431 |
NT-proBNP (ng/mL) | 1318 [350, 2867] | 1208 [310, 2782] | 2109 [765, 4312] | 0.095 |
D-dimer (μg/mL) | 0.42 [0.22, 0.82] | 0.42 [0.23, 0.77] | 0.45 [0.22, 1.20] | 0.338 |
ALT (IU/L) | 20.0 [13.0, 35.0] | 21.0 [14.0, 35.0] | 17.0 [12.0, 35.0] | 0.715 |
AST (IU/L) | 24.0 [19.0, 31.0] | 24.0 [20.0, 31.0] | 22.0 [19.0, 31.0] | 0.625 |
TB (μmol/L) | 18.07 [12.90, 27.57] | 18.14 [12.67, 26.30] | 18.00 [15.90, 32.60] | 0.455 |
DB (μmol/L) | 3.90 [2.87, 7.40] | 3.90 [2.87, 7.40] | 4.30 [2.90, 7.40] | >0.999 |
Creatinine (μmol/L) | 70.15 [61.00, 80.07] | 70.75 [61.60, 80.07] | 68.50 [57.06, 79.20] | 0.347 |
Uric acid (μmol/L) | 381.4 [301.1, 465.5] | 386.8 [314.2, 460.3] | 335.3 [284.0, 554.0] | 0.690 |
Sao2 (%) | 89.4 [86.6, 92.5] | 89.4 [86.8, 92.5] | 89.6 [84.5, 92.1] | 0.818 |
Comorbidities | ||||
Thrombophilia | 8 (5.0) | 7 (5.1) | 1 (4.6) | >0.999 |
APS | 12 (7.5) | 11 (8.0) | 1 (4.6) | >0.999 |
CHD | 6 (3.8) | 4 (2.9) | 2 (9.1) | 0.192 |
DM | 4 (2.5) | 3 (2.2) | 1 (4.6) | 0.450 |
Hypertension | 37 (23.1) | 33 (23.9) | 4 (18.2) | 0.554 |
Cancer | 3 (1.9) | 2 (1.5) | 1 (4.6) | 0.360 |
Anemia | 14 (8.8) | 9 (6.5) | 5 (22.7) | 0.027 |
Targeted drug at diagnosis | 0.287 | |||
No drugs | 8 (5.0) | 8 (5.8) | 0 (0.0) | |
Monotherapy | 54 (33.8) | 44 (31.9) | 10 (45.5) | |
Combination therapy | 98 (61.3) | 86 (62.3) | 12 (54.5) | |
Main treatment modality | 0.001 | |||
Targeted drug | 49 (30.6) | 35 (25.4) | 14 (63.6) | |
PEA | 46 (28.8) | 42 (30.4) | 4 (18.2) | |
BPA | 65 (40.6) | 61 (44.2) | 4 (18.2) | |
Anticoagulants | 0.897 | |||
Warfarin | 55 (34.6) | 48 (34.8) | 7 (33.3) | |
NOAC | 104 (65.4) | 90 (65.2) | 14 (66.7) |
Variables | HR | 95% CI | p Value |
---|---|---|---|
Age | 1.01 | 0.97–1.05 | 0.741 |
BMI (kg/m2) | 0.92 | 0.78–1.09 | 0.339 |
6MWD/20 (m) | 0.97 | 0.90–1.05 | 0.415 |
Svo2 (%) | 0.97 | 0.92–1.03 | 0.288 |
NT-proBNP/500 (ng/mL) | 1.09 | 1.00–1.18 | 0.053 |
Cancer | 5.17 | 0.55–48.43 | 0.150 |
Anemia | 5.56 | 1.61–19.22 | 0.007 |
Targeted drug | Ref | Ref | |
PEA | 0.26 | 0.07–0.97 | 0.044 |
BPA | 0.14 | 0.04–0.57 | 0.006 |
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Wu, Y.; Hu, S.; Yan, X.-X.; Peng, F.-H.; Tan, J.-S.; Guo, T.-T.; Gao, X.; Hua, L. Chronic Thromboembolic Pulmonary Hypertension in Females: Clinical Features and Survival. J. Cardiovasc. Dev. Dis. 2022, 9, 308. https://doi.org/10.3390/jcdd9090308
Wu Y, Hu S, Yan X-X, Peng F-H, Tan J-S, Guo T-T, Gao X, Hua L. Chronic Thromboembolic Pulmonary Hypertension in Females: Clinical Features and Survival. Journal of Cardiovascular Development and Disease. 2022; 9(9):308. https://doi.org/10.3390/jcdd9090308
Chicago/Turabian StyleWu, Yan, Song Hu, Xin-Xin Yan, Fu-Hua Peng, Jiang-Shan Tan, Ting-Ting Guo, Xin Gao, and Lu Hua. 2022. "Chronic Thromboembolic Pulmonary Hypertension in Females: Clinical Features and Survival" Journal of Cardiovascular Development and Disease 9, no. 9: 308. https://doi.org/10.3390/jcdd9090308