title: The Clinical Significance of HbA1c in Operable Chronic Thromboembolic Pulmonary Hypertension.
abstract: BACKGROUND
  Glycosylated hemoglobin A1c (HbA1c) has been proposed as an independent predictor of long-term prognosis in pulmonary arterial hypertension. However, the clinical relevance of HbA1c in patients with operable chronic thromboembolic pulmonary hypertension (CTEPH) remains unknown. The aim of the present study was to investigate the clinical significance of HbA1c as a biomarker in CTEPH.
  
  
  METHODS
  Prospectively, 102 patients underwent pulmonary endarterectomy (PEA) in our national referral center between March 2013 and March 2014, of which after exclusion 45 patients were analyzed. HbA1c- levels, hemodynamic and exercise parameters were analyzed prior and one-year post-PEA.
  
  
  RESULTS
  45 patients (BMI: 27.3 ± 6.0 kg/m2; age: 62.7 ± 12.3 years) with a mean pulmonary arterial pressure (mPAP) of 43.6 ± 9.4 mmHg, a pulmonary vascular resistance (PVR) of 712.1 ± 520.4 dyn*s/cm5, a cardiac index (CI) of 2.4 ± 0.5 l/min/m2 and a mean HbA1c-level of 39.8 ± 5.6 mmol/mol were included. One-year post-PEA pulmonary hemodynamic and functional status significantly improved in our cohort. Baseline HbA1c-levels were significantly associated with CI, right atrial pressure, peak oxygen uptake and the change of 6-minute walking distance using linear regression analysis. However, using logistic regression analysis baseline HbA1c-levels were not significantly associated with residual post-PEA PH.
  
  
  CONCLUSIONS
  This is the first prospective study to describe an association of HbA1c-levels with pulmonary hemodynamics and exercise capacity in operable CTEPH patients. Our preliminary results indicate that in these patients impaired glucose metabolism as assessed by HbA1c is of clinical significance. However, HbA1c failed as a predictor of the hemodynamic outcome one-year post-PEA.
authors.affiliation: Department of Pneumology, Kerckhoff Heart, Rheuma and Thoracic Center, Bad Nauheim, Germany.|Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany.
authors.forename: Manuel Jonas
authors.initials: MJ
authors.lastname: Richter
authors.affiliation: Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany.|Medical Clinic V, University of Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research, Munich, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Milger
authors.affiliation: Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany.
authors.forename: Sarah
authors.initials: S
authors.lastname: Haase
authors.affiliation: Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany.
authors.forename: Natascha
authors.initials: N
authors.lastname: Sommer
authors.affiliation: Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany.
authors.forename: Khodr
authors.initials: K
authors.lastname: Tello
authors.affiliation: Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Seeger
authors.affiliation: Department of Thoracic Surgery, Kerckhoff Heart, Rheuma and Thoracic Center, Bad Nauheim, Germany.
authors.forename: Eckhard
authors.initials: E
authors.lastname: Mayer
authors.affiliation: Department of Thoracic Surgery, Kerckhoff Heart, Rheuma and Thoracic Center, Bad Nauheim, Germany.
authors.forename: Christoph Benjamin
authors.initials: CB
authors.lastname: Wiedenroth
authors.affiliation: Department of Pneumology, Kerckhoff Heart, Rheuma and Thoracic Center, Bad Nauheim, Germany.|Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany.
authors.forename: Friedrich
authors.initials: F
authors.lastname: Grimminger
authors.affiliation: TransMIT Project Division for Health Services Research and Consulting, THM University of Applied Science, Giessen, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: George
authors.affiliation: Department of Pneumology, Kerckhoff Heart, Rheuma and Thoracic Center, Bad Nauheim, Germany.|Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany.
authors.forename: Hossein Ardeschir
authors.initials: HA
authors.lastname: Ghofrani
authors.affiliation: TransMIT Project Division for Health Services Research and Consulting, THM University of Applied Science, Giessen, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Guth
authors.affiliation: Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany.
authors.forename: Henning
authors.initials: H
authors.lastname: Gall
mesh_terms: D000368:Aged; D062186:Arterial Pressure; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D015331:Cohort Studies; D004691:Endarterectomy; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D007118:Immunoassay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000032:analysis; D010446:Peptide Fragments / Q000032:analysis; D011379:Prognosis; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000503:physiopathology
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; D020097:Natriuretic Peptide, Brain; D010446:Peptide Fragments; C517652:hemoglobin A1c protein, human; C109794:pro-brain natriuretic peptide (1-76)