title: Pulmonary acceleration time to optimize the timing of lung transplant in cystic fibrosis.
abstract: Pulmonary hypertension (PH) may affect survival in cystic fibrosis (CF) and can be assessed on echocardiographic measurement of the pulmonary acceleration time (PAT). The study aimed at evaluating PAT as a tool to optimize timing of lung transplant in CF patients. Prospective multicenter longitudinal study of patients with forced expiratory volume in 1 second (FEV1) ≤60% predicted. Echocardiography, spirometry and nocturnal oximetry were obtained as part of the routine evaluation. We included 67 patients (mean FEV1 42±12% predicted), among whom 8 underwent lung transplantation during the mean follow-up of 19±6 months. No patients died. PAT was determined in all patients and correlated negatively with systolic pulmonary artery pressure (sPAP, r=-0.36, P=0.01). Patients in the lowest PAT tertile (<101 ms) had lower FEV1 and worse nocturnal oxygen saturation, and they were more often on the lung transplant waiting list compared to patients in the other tertiles. Kaplan-Meier curves showed a shorter time to lung transplantation in the lowest PAT tertile (P<0.001) but not in patients with sPAP>35 mmHg. By multivariate analysis, FEV(1)and nocturnal desaturation were the main determinants of reduced PAT. A PAT<101 ms reduction is a promising tool for timing of lung transplantation in CF.
authors.affiliation: Department of Cardiology, AP-HP, Henri Mondor Hospital, Créteil, France.
authors.forename: Thibaud
authors.initials: T
authors.lastname: Damy
authors.forename: Pierre-Régis
authors.initials: PR
authors.lastname: Burgel
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Pepin
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Boelle
authors.forename: Claire
authors.initials: C
authors.lastname: Cracowski
authors.forename: Marlène
authors.initials: M
authors.lastname: Murris-Espin
authors.forename: Raphaele
authors.initials: R
authors.lastname: Nove-Josserand
authors.forename: Nathalie
authors.initials: N
authors.lastname: Stremler
authors.forename: Tabassome
authors.initials: T
authors.lastname: Simon
authors.forename: Serge
authors.initials: S
authors.lastname: Adnot
authors.forename: Brigitte
authors.initials: B
authors.lastname: Fauroux