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HbA(1c) in pulmonary arterial hypertension: A marker of prognostic relevance?
MedLine Citation:
PMID:  22975101     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: Patients with pulmonary arterial hypertension (PAH) exhibit impaired glucose metabolism and increased insulin resistance. The clinical consequences of these metabolic changes are not known.
METHODS: We assessed HbA(1c) levels in 115 patients newly diagnosed with PAH (79 females and 36 males; mean age 49.2 years; idiopathic n = 67, collagen vascular disease n = 16, congenital heart defect n = 19, pulmonary veno-occlusive disease n = 8, portopulmonary n = 5). No patients had diabetes or were receiving anti-diabetic medication or systemic steroids. After initiation of pulmonary vasoactive treatment, patients remained in long-term follow-up.
RESULTS: Initially, patients were in an advanced stage of disease (mean pulmonary arterial pressure 53 ± 18 mm Hg, cardiac index 2.3 ± 0.8 liters/min/m(2)) with a 6-minute-walk distance of 337 ± 123 meters, and in NYHA Functional Class 3.0 ± 0.7. The HbA(1c) was 5.73 ± 0.75%. A moderate but statistically significant positive correlation was observed between HbA(1c) levels and BNP (r(p) = 0.41, p = 0.014), but no correlation was found with hemodynamics or 6-minute-walk distance. The 5-year survival rate for the entire group was 68%. Kaplan-Meier analysis and multivariate Cox proportional hazard models correcting for demographic and clinical covariates revealed that patients with HbA(1c) <5.7% had a significantly better 5-year survival compared with those having higher initial values (85.1% vs 55.9%; log rank p = 0.002). HbA(1c) was a predictor of all-cause mortality with a hazard ratio of 2.23 (95% CI 1.06 to 4.70; p = 0.034) per 1-unit increase of HbA(1c).
CONCLUSIONS: In patients with pulmonary arterial hypertension, the HbA(1c) level at time of diagnosis is an independent predictor of long-term prognosis.
Authors:
Michael J Belly; Henning Tiede; Rory E Morty; Richard Schulz; Robert Voswinckel; Christian Tanislav; Horst Olschewski; Hossein A Ghofrani; Werner Seeger; Frank Reichenberger
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation     Volume:  31     ISSN:  1557-3117     ISO Abbreviation:  J. Heart Lung Transplant.     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-09-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9102703     Medline TA:  J Heart Lung Transplant     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1109-14     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Internal Medicine, University of Giessen Lung Center, Giessen, Germany.
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