Key result
Elderly PAH patients with LHD phenotype receive similar pulmonary vasodilator therapy as non-LHD patients.
Why the study?
Pulmonary arterial hypertension in the elderly is often associated with left heart disease, prompting concerns about the use of pulmonary vasodilators.
Does the presence of a left heart disease phenotype alter the use of pulmonary vasodilators in elderly patients with pulmonary arterial hypertension?
Observational (n=69)
Yes
Does the presence of a left heart disease phenotype alter the use of pulmonary vasodilators in elderly patients with pulmonary arterial hypertension?
In real-world practice, elderly PAH patients frequently receive pulmonary vasodilator combinations regardless of whether they exhibit a left heart disease phenotype.
Similar dual oral vasodilator use in elderly PAH regardless of LHD phenotype should not yet change practice; leaves open whether phenotype should guide therapy.
Pulmonary arterial hypertension (PAH) in the elderly is often associated with left heart disease (LHD), prompting concerns about the use of pulmonary vasodilators. The PATRIARCA registry enrolled ≥70 year-old PAH or chronic thromboembolic pulmonary hypertension (CTEPH) patients at 11 Italian centers from 1 December 2019 through 15 September 2022. After excluding those with CTEPH, post-capillary PH at the diagnostic right heart catheterization (RHC), and/or incomplete data, 23 (33%) of a total of 69 subjects met the criteria proposed in the AMBITION trial to suspect LHD. Diabetes [9 (39%) vs. 6 (13%), p = 0.01] and chronic kidney disease [14 (61%) vs. 12 (26%), p = 0.003] were more common, and the last RHC pulmonary artery wedge pressure [14 ± 5 vs. 10 ± 3 mmHg, p < 0.001] was higher and pulmonary vascular resistance [5.56 ± 3.31 vs. 8.30 ± 4.80, p = 0.02] was lower in LHD than non-LHD patients. However, PAH therapy was similar, with 13 (57%) and 23 (50%) subjects, respectively, taking two oral drugs. PAH medication patterns remained comparable between LHD and non-LHD patients also when the former [37, 54%] were identified by atrial fibrillation and echocardiographic features of LHD, in addition to the AMBITION criteria. In this real-world snapshot, elderly PAH patients were treated with pulmonary vasodilators, including combinations, despite a remarkable prevalence of a LHD phenotype.
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Toma et al. (2022) conducted an observational in Pulmonary arterial hypertension (n=69). Left heart disease (LHD) phenotype vs. Non-LHD phenotype was evaluated on Use of two oral pulmonary vasodilator drugs. Elderly PAH patients with a left heart disease phenotype received similar pulmonary vasodilator therapy compared to non-LHD patients, with 57% vs 50% taking two oral drugs.
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