title: Pulmonary hypertension as a prognostic indicator at the initial evaluation in idiopathic pulmonary fibrosis.
abstract: BACKGROUND
  The impact of pulmonary hypertension (PH) on survival has been demonstrated in severe cases with idiopathic pulmonary fibrosis (IPF) who were referred for transplantation. However, whether PH is a predictor of survival remains unclear in milder cases.
  
  
  OBJECTIVE
  To evaluate the survival impact of pulmonary artery pressure measured during the initial evaluation in patients with IPF.
  
  
  METHODS
  We retrospectively analyzed the initial evaluation data of 101 consecutive IPF patients undergoing right heart catheterization. Patients evaluated with supplemental oxygen were excluded. Predictors of 5-year survival were analyzed using the Cox proportional model.
  
  
  RESULTS
  The mean forced vital capacity (FVC) % predicted, diffusing capacity of the lung for carbon monoxide (DLCO) % predicted, and mean pulmonary artery pressure (MPAP) were 70.2 ± 20.1%, 47.9 ± 19.5%, and 19.2 ± 6.5 mm Hg, respectively. A univariate Cox proportional hazard model showed that the body mass index, %FVC, %DLCO, baseline PaO2, modified Medical Research Council score, 6-min walk distance, and lowest SpO2 of the 6-min walk test were significantly predictive of survival. The MPAP and pulmonary vascular resistance of right heart catheterization were also significant. With stepwise, multivariate Cox proportional analysis, MPAP (HR = 1.064; 95% CI 1.015-1.116, p = 0.010) and %FVC (HR = 0.965, 95% CI 0.949-0.982, p < 0.001) were independent determinants of survival. Analysis of the receiver operating curve revealed MPAP >20 mm Hg to be optimal for predicting the prognosis.
  
  
  CONCLUSIONS
  Higher MPAP and lower %FVC at the initial evaluation were significant independent prognostic factors of IPF. The current results suggested the importance of the initial evaluation of PH for patients with IPF.
authors.affiliation: Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Motohiro
authors.initials: M
authors.lastname: Kimura
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Taniguchi
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kondoh
authors.forename: Tomoki
authors.initials: T
authors.lastname: Kimura
authors.forename: Kensuke
authors.initials: K
authors.lastname: Kataoka
authors.forename: Osamu
authors.initials: O
authors.lastname: Nishiyama
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Aso
authors.forename: Koji
authors.initials: K
authors.lastname: Sakamoto
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Hasegawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization; D005080:Exercise Test; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D054990:Idiopathic Pulmonary Fibrosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011651:Pulmonary Artery / Q000503:physiopathology*; D012129:Respiratory Function Tests; D012189:Retrospective Studies