Impact of post-capillary pulmonary hypertension on mortality in interstitial lung disease |
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| Authors: | Ryo Teramachi Hiroyuki Taniguchi Yasuhiro Kondoh Tomoki Kimura Kensuke Kataoka Toshiki Yokoyama Taiki Furukawa Mitsuaki Yagi Koji Sakamoto Naozumi Hashimoto Yoshinori Hasegawa |
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| Affiliation: | 1. Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan;2. Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan;3. Department of Medical IT Center, Nagoya University Hospital, Nagoya, Aichi, Japan;4. Department of Respiratory Medicine, National Hospital Organization, Higashinagoya National Hospital, Nagoya, Aichi, Japan;5. National Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan;1. Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medicaland Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata-shi, Niigata, 951-8510, Japan;2. Division of Urology, Department of Regenerative & Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata-shi, Niigata, 951-8510, Japan;1. Department of Pulmonary Medicine, Hakodate Goryoukaku Hospital, Hokkaido, Japan;2. Department of Pulmonary Medicine, Hakodate General Hospital, Hokkaido, Japan;3. Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan;1. Department of Respiratory Medicine, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan;2. Department of Pathology, The University of Tokyo Hospital, Tokyo, Japan;3. Division of Pathology, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan;1. Department of Respiratory Medicine, Kyoto University, Graduate School of Medicine, Kyoto, Japan;2. Terada Clinic, Respiratory Medicine and General Practice, Himeji, Hyogo, Japan;3. Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan;1. Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan;2. Nakajima Medical Clinic, 1-8-3 Mikagenakamachi, Higashinada-ku, Kobe, 658-0054, Japan;3. I&H Co.,Ltd, 1-7-20, Mikagenakamachi, Higashinada-ku, Kobe, 658-0054, Japan;1. Department of Internal Medicine, Division of Medical Oncology & Respiratory Medicine, Shimane University, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan;2. Department of Respiratory Medicine, Hiroshima Prefectural Hospital, 1-5-54 Ujina-Kanda, Minami-ku, Hiroshima, 734-8530, Japan;3. Department of Pulmonary Medicine, Sendai Kousei Hospital, 4-15 Aoba-ku, Sendai, Miyagi, 980-0873, Japan;4. Department of Pharmacy, Shimane University Hospital, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan;5. Department of Respiratory Disease, Hiroshima Red Cross Hospital & Atomic-Bomb Survivors Hospital, 1-9-6 Naka-ku, Hiroshima, 730-8619, Japan;6. Department of Respiratory Internal Medicine, Hiroshima University Hospital, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8551, Japan;7. Department of Respiratory Medicine and Allergology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku-shi, Kochi, 783-8505, Japan;8. Department of Pharmacology, School of Pharmaceutical Sciences at Fukuoka International University of Health and Welfare, 137-1 Enokizu, Okawa, Fukuoka, 831-8501, Japan |
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| Abstract: | BackgroundPulmonary hypertension (PH) influences mortality in patients with interstitial lung disease (ILD). Almost all studies on patients with ILD, have focused on the clinical impact of pre-capillary PH on survival. Therefore, little is known about the influence of post-capillary PH. We aimed to assess the prevalence of post-capillary PH and its clinical impact on survival in patients with ILD, followed by comparison with pre-capillary PH.MethodsThis retrospective study enrolled 1152 patients with ILD who were diagnosed with PH using right heart catheterization between May 2007 and December 2015. We analyzed the demographics and composite outcomes (defined as death from any cause or lung transplantation) of patients with post-capillary PH and compared them with patients with pre-capillary PH.ResultsThirty-two (20%) of the 157 patients with ILD-PH were diagnosed with post-capillary PH. Patients with post-capillary PH had significantly lower modified Medical Research Council scores, higher diffusion capacity for carbon monoxide, higher resting PaO2, lower pulmonary vascular resistance (PVR), and higher lowest oxygen saturation during the 6-min walk test compared to those with pre-capillary PH. Cardiovascular diseases were associated with a higher risk of mortality in patients with post-capillary PH. Multivariate Cox proportional hazards analysis demonstrated no significant difference between the composite outcomes in pre-capillary and post-capillary PH, while PVR and the ILD Gender-Age-Physiology Index were significantly associated with the composite outcome.ConclusionsWe found that approximately one-fifth of patients with ILD-PH were diagnosed with post-capillary PH, and that PVR and not post-capillary PH was associated with mortality. |
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