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Original research
Mild elevation of pulmonary vascular resistance predicts mortality regardless of mean pulmonary artery pressure in mild interstitial lung disease
  1. Tomonori Sato1,
  2. Taiki Furukawa1,2,
  3. Ryo Teramachi1,2,
  4. Jun Fukihara3,
  5. Yasuhiko Yamano3,
  6. Toshiki Yokoyama3,
  7. Toshiaki Matsuda3,
  8. Kensuke Kataoka3,
  9. Tomoki Kimura3,
  10. Koji Sakamoto1,
  11. Makoto Ishii1,
  12. Yasuhiro Kondoh3
  1. 1Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
  2. 2Medical IT Center, Nagoya University Hospital, Nagoya, Japan
  3. 3Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
  1. Correspondence to Dr Yasuhiro Kondoh, Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, 489-8642, Japan; kondoh{at}tosei.or.jp

Abstract

Background Pulmonary hypertension (PH) is defined by elevated mean pulmonary arterial pressure (MPAP), and elevated pulmonary vascular resistance (PVR) reflects pulmonary vascular abnormalities. The clinical significance of non-severe PH in patients with various interstitial lung diseases (ILDs) has not been fully elucidated. We aimed to investigate the clinical significance of MPAP and PVR for mortality in patients with newly diagnosed ILD.

Methods We retrospectively analysed consecutive patients with ILD at initial evaluations that included right heart catheterisation from 2007 to 2018. These patients were classified by MPAP and PVR using the 2022 the European Society of Cardiology (ESC)/the European Respiratory Society (ERS) guidelines for PH. The clinical significance of MPAP and PVR for mortality was analysed.

Results Among 854 patients, 167 (19.6%) had MPAP>20 mm Hg. The proportion of patients with PVR>2 Wood units (WU) among those with MPAP≤20 mm Hg, 20<MPAP<25 mm Hg, and ≥25 mm Hg were 26.2%, 60.4% and 86.4%, respectively. In Cox proportional hazards analyses with adjustment for ILD–Gender, Age and Physiology Index, PVR but not MPAP was associated with a higher mortality rate (HR 1.37, 95% CI 1.23 to 1.52, p<0.0001; HR 0.98, 95% CI 0.96 to 1.01, p=0.1671, respectively). PVR>2 WU was associated with a higher mortality rate (HR 1.61, 95% CI 1.28 to 2.02, p<0.0001) even in a group with MPAP≤20 mm Hg.

Conclusions Mild elevation of PVR was associated with a higher mortality rate in patients with newly diagnosed ILD, even in those with MPAP≤20 mm Hg.

  • Interstitial Fibrosis
  • Idiopathic pulmonary fibrosis
  • Primary Pulmonary Hypertension
  • Systemic disease and lungs

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • TS, TF and RT contributed equally.

  • Contributors TS, TF, RT and YK designed the study. TS, TF, RT, YY, JF and KK collected the data. TS, TF and RT performed the data analysis. TS, TF, RT, TY, TM, KK, TK, KS and MI contributed to data interpretation. TS, TF, RT and YK wrote the original manuscript. All authors contributed to revisions of the manuscript, provided final approval of the version to be published and agree to be accountable for all aspects of the work. YK is responsible for the overall content as the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests YK reports consulting fees from Asahi Kasei Pharma Corporation, Boehringer Ingelheim, Chugai Pharmaceutical, Healios K.K., Janssen Pharmaceutical KK, Shionogi and Taiho Pharmaceutical and lecture fees from Asahi Kasei Pharma Corporation, Bristol Myers Squibb, Boehringer Ingelheim, Eisai, Janssen Pharmaceutical KK, KYORIN Pharmaceutical, Mitsubishi Tanabe Pharma, NIPPON SHINYAKU, Novartis Pharma KK, Shionogi and Teijin Pharma outside the submitted work. TK reports lecture fees from GlaxoSmithKline KK outside the submitted work. KK reports lecture fees from Nippon Boehringer Ingelheim outside the submitted work. The other authors have nothing to disclose.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.