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Novel disease mechanisms in pulmonary arterial hypertension
S100 Change in diastolic pulmonary artery pressure (3 months post surgery compared to pre-surgery value) as a long-term prognostic parameter in patients treated with pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension
  1. G C Hagan,
  2. C Treacy,
  3. K Sheares,
  4. D P Jenkins,
  5. J PepkeZaba,
  6. A Kacprzak
  1. Papworth Hospital, PapworthEverard, UK

Abstract

Introduction The definitive treatment for chronic thromboembolic pulmonary hypertension is pulmonary endarterectomy (PEA). Some patients are left with residual pulmonary hypertension after the surgery. We analysed post-PEA haemodynamics to assess their impact on long-term survival.

Methods We analysed systolic(sPAP), diastolic(dPAP) and mean(mPAP) pulmonary artery pressures, pulmonary vascular resistance (PVR) and changes (Δ) in these parameters measured at right heart catheterisation from pre-PEA to 3 months post PEA in 251 patients who underwent PEA in our centre in years 2000–2009. We assessed their usefulness as survival predictors using receiver operating characteristic (ROC) curves for 56 patients who completed at least 6 years follow-up. Eight of them died during this period, 48 survived. Subsequently, on the basis of ROC, we identified a cut-off value for change in diastolic pulmonary artery pressure (ΔdPAP), the parameter which had the biggest area under the curve (AUC). We divided the whole study population according to that value and performed Kaplan–Meier survival analysis.

Results AUCs were as follows: sPAP (0.57), ΔsPAP(0.7), dPAP(0.72), ΔdPAP(0.76), mPAP(0.66), ΔmPAP (0.71), PVR(0.65), ΔPVR(0.73). We chose 24.5 mm Hg as a cut-off value for change in dPAP. It was characterised by 100% specificity and 41.9% sensitivity in predicting death within 6 years post-PEA. Kaplan–Meier survival analysis (with time zero taken at time of right heart catheter 3 months post-PEA) for the whole group showed that patients with ΔdPAP>24.5 mm Hg had significantly better survival rates in comparison to patients with ΔdPAP<24.5 mm Hg (p=0.03)—Abstract S100 Figure 1. 13 of 59 patients with ΔdPAP>24.5 mm Hg still had pulmonary hypertension 3 months post-PEA. The overall 5-year survival of the whole group was 80.8%.

Abstract S100 Figure 1

Survival of ΔdPAP 24.5 mm Hg (From 3 months post PEA).

Conclusions 3 months post-PEA dPAP and ΔdPAP from pre-PEA values appeared to be the best survival predictor. The advantage of utilising dPAP is that it is a directly measured value and less susceptible to error then derived PVR.

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