Document Detail


Improved outcomes in medically and surgically treated chronic thromboembolic pulmonary hypertension.
MedLine Citation:
PMID:  18292468     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
RATIONALE: The management of chronic thromboembolic pulmonary hypertension (CTEPH) has changed over recent years with the growth of pulmonary endarterectomy surgery and the availability of disease-modifying therapies.
OBJECTIVES: To investigate the prognosis of CTEPH in a national setting during recent years.
METHODS: All incident cases diagnosed in one of the five pulmonary hypertension centers in the United Kingdom between January 2001 and June 2006 were identified prospectively. Information regarding baseline characteristics, treatment, and follow-up was subsequently collected from hospital records.
MEASUREMENTS AND MAIN RESULTS: A total of 469 patients received a diagnosis, of whom 148 (32%) had distal, nonsurgical disease. One- and three-year survival from diagnosis was 82 and 70% for patients with nonsurgical disease and 88 and 76% for those treated surgically (P = 0.023). Initial functional improvement in patients with nonsurgical disease was noted but did not persist at 2 years. Significant functional and hemodynamic improvements were seen in surgically treated patients with an increase in six-minute-walk distance of 105 m (P < 0.001) at 3 months. Five-year survival from surgery in the 35% of patients who survived to 3 months but had persistent pulmonary hypertension was 94%.
CONCLUSIONS: The prognosis in nonsurgical disease has improved. We have confirmed the previously described good outcome in surgically treated disease. However, we have also demonstrated that the long-term prognosis for patients who have persistent pulmonary hypertension at 3 months after surgery is good. The observed improvements in outcome during the modern treatment era reinforce the importance of identifying patients with this increasingly treatable condition.
Authors:
Robin Condliffe; David G Kiely; J Simon R Gibbs; Paul A Corris; Andrew J Peacock; David P Jenkins; Denise Hodgkins; Kim Goldsmith; Rodney J Hughes; Karen Sheares; Steven S L Tsui; Iain J Armstrong; Chantal Torpy; Rachel Crackett; Christopher M Carlin; Clare Das; J Gerry Coghlan; Joanna Pepke-Zaba
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2008-02-21
Journal Detail:
Title:  American journal of respiratory and critical care medicine     Volume:  177     ISSN:  1535-4970     ISO Abbreviation:  Am. J. Respir. Crit. Care Med.     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-05-07     Completed Date:  2008-05-21     Revised Date:  2014-02-19    
Medline Journal Info:
Nlm Unique ID:  9421642     Medline TA:  Am J Respir Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1122-7     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Antihypertensive Agents / therapeutic use*
Chronic Disease
Cohort Studies
Endarterectomy / rehabilitation*
Exercise Test
Exercise Tolerance / drug effects
Female
Great Britain / epidemiology
Humans
Hypertension, Pulmonary / drug therapy*,  mortality,  surgery*
Male
Middle Aged
Platelet Aggregation Inhibitors / therapeutic use*
Pulmonary Artery / pathology,  surgery
Pulmonary Circulation
Retrospective Studies
Survival Analysis
Thromboembolism / complications,  mortality
Treatment Outcome
Grant Support
ID/Acronym/Agency:
MC_U105232027//Medical Research Council
Chemical
Reg. No./Substance:
0/Antihypertensive Agents; 0/Platelet Aggregation Inhibitors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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