Demographics and outcomes of patients diagnosed with pulmonary hypertension with pulmonary capillary wedge pressures 16 to 18 mm Hg: insights from the REVEAL Registry.
BACKGROUND
The Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management (REVEAL Registry) is a multicenter, US-based, observational study of patients diagnosed with group 1 pulmonary hypertension enrolled consecutively from March 2006 to December 2009. Of 3,128 patients in this analysis, inclusion criteria permitted enrollment of 268 patients with mean pulmonary capillary wedge pressure (PCWP) 16 to 18 mm Hg at diagnostic right-sided heart catheterization (RHC) (above currently accepted pulmonary arterial hypertension [PAH] diagnostic criteria). This study compared the demographics and outcomes of those 268 patients with an elevated mean PCWP to patients with a mean PCWP ≤ 15 mm Hg.


METHODS
Demographic characteristics and outcomes were compared for patients with mean PCWP ≤ 12, 13 to 15, and 16 to 18 mm Hg at diagnostic and follow-up RHC.


RESULTS
At diagnostic RHC, patients with PCWP 16 to 18 mm Hg were older, had more severe hemodynamic impairments, and were more likely to be obese and have other comorbidities than patients with PCWP ≤ 15 mm Hg. There were no clinically relevant differences in 5-year survival rates from diagnostic RHC regardless of PCWP at diagnosis (≤ 15 mm Hg vs 16-18 mm Hg, P = .07). Two-year survival rates of 108 patients with PAH whose PCWP increased to 19 mm Hg (regardless of PCWP at diagnosis) were significantly lower than that of patients with PAH with PCWP ≤ 18 mm Hg at subsequent RHC.


CONCLUSIONS
Patients with PCWP 16 to 18 mm Hg who were diagnosed and treated for PAH were older, heavier, and more likely to have comorbidities associated with left ventricular diastolic dysfunction at diagnosis than those with PCWP ≤ 15 mm Hg. Five-year survival rates were similarly low for all PCWP subgroups.


BACKGROUND
ClinicalTrials.gov; No.: NCT00370214; URL: www.clinicaltrials.gov
Baylor College of Medicine, Houston, TX. Electronic address: frost@bcm.tmc.edu.
Adaani E
AE
Frost
Boston University School of Medicine, Boston, MA.
Harrison W
HW
Farber
Columbia University College of Physicians and Surgeons, New York, NY.
Robyn J
RJ
Barst
ICON Late Phase & Outcomes Research, San Francisco, CA.
Dave P
DP
Miller
Intermountain Medical Center and the University of Utah, Murray, UT.
C Gregory
CG
Elliott
Mayo Clinic, Rochester, MN.
Michael D
MD
McGoon
D000328:Adult; D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D011379:Prognosis; D011669:Pulmonary Wedge Pressure; D012042:Registries; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology*