title: Clinical and hemodynamic profiles of elderly patients with pulmonary arterial hypertension: a single center, prospective study.
abstract: BACKGROUND
  Pulmonary arterial hypertension (PAH) was previously considered an illness that affects mostly the young, but now it is also increasingly recognized in the elderly. The aim of this study was to compare the features of elderly versus younger patients diagnosed with PAH, and to define the prognostic factors which affect their long-term survival.
  
  
  METHODS
  In this prospective, single center study, the clinical, echocardiographic, hemodynamic characteristics, and the outcomes of younger (18-65 years) and elderly (≥ 65 years) patients with definitive diagnosis of precapillary PAH were compared.
  
  
  RESULTS
  A total of 119 patients were analyzed in this study; 43 were elderly (mean age: 71.5 ± 5.5 years), while 76 were non-elderly (mean age 44.5 ± 15.2 years). During the mean follow-up duration of 26.8 ± 25.0 months, 43 deaths occurred, 17 of which were among the elderly group, with 28 among non-elderly group. Comparison of baseline parameters showed that 6 min walking distance, hemoglobin levels, pulmonary artery pressures and pulmonary vascular resistance were significantly lower; and estimated glomerular filtration rate, body mass index, E/e' and pulmonary capillary wedge pressure were significantly higher in the elderly group than in the younger group. Survival analysis demonstrated that the independent predictors of death were tricuspid plane annular systolic excursion (TAPSE; HR: 1.272, 95% CI: 1.079-1.499,P= 0.004) and uric acid (HR: 1.291, 95% CI: 1.042-1.600,P= 0.019) in the elderly group. In contrast, in the non-elderly group, higher brain natriuretic peptide (HR: 1.002, 95% CI: 1.001-1.004,P< 0.001) and higher right atrial pressure (HR: 1.128, 95% CI: 1.026-1.241,P= 0.013) values were the only parameters associated with mortality.
  
  
  CONCLUSIONS
  Our data suggest that elderly PAH patients have a unique clinical and hemodynamic profile, with totally different prognostic markers compared to younger PAH patients.
authors.affiliation: Department of Cardiology, School of Medicine, Dokuz Eylul University, Izmir, Turkey.
authors.forename: Ebru
authors.initials: E
authors.lastname: Ozpelit
authors.affiliation: Department of Cardiology, School of Medicine, Dokuz Eylul University, Izmir, Turkey.
authors.forename: Bahri
authors.initials: B
authors.lastname: Akdeniz
authors.affiliation: Department of Internal Medicine, Faculty of Nursing, Dokuz Eylul University, Izmir, Turkey.
authors.forename: Dilek
authors.initials: D
authors.lastname: Sezgin
authors.affiliation: Department of Chest Disease, School of Medicine, Dokuz Eylul University, Izmir, Turkey.
authors.forename: Can
authors.initials: C
authors.lastname: Sevinc
authors.affiliation: Department of Chest Disease, School of Medicine, Dokuz Eylul University, Izmir, Turkey.
authors.forename: Kemal Can
authors.initials: KC
authors.lastname: Tertemiz
authors.affiliation: Department of Cardiology, Medicalpark Hospital, Izmir, Turkey.
authors.forename: Mehmet Emre
authors.initials: ME
authors.lastname: Ozpelit
authors.affiliation: Department of Radiology, School of Medicine, Dokuz Eylul University, Izmir, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Baris
authors.affiliation: Department of Cardiology, School of Medicine, Dokuz Eylul University, Izmir, Turkey.
authors.forename: Nezihi
authors.initials: N
authors.lastname: Baris
keywords: Clinical characteristics; Prognosis; Pulmonary hypertension; The elderly