Features of clinical, functional and hemodynamics profile, medical treatment and prognosis evaluation in patients with inoperable chronic thromboembolic pulmonary hypertension and idiopathic pulmonary arterial hypertension according to the Russian registry


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Abstract

Aim: to perform the complex analysis of clinical, functional, hemodynamics profile in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) compared to the idiopathic pulmonary arterial hypertension (IPAH) group at the time of diagnosis verification according to the Russian registry, and to evaluate the features of medical therapy and it’s influence on prognosis in these patients. Materials and methods. In the retrospective study 193 patients with IPAH and 130 patients with inoperable CTEPH older than 18 years were included. All included patients were the participants of Russian registry (www.medibase.pro) in 15 Russian expert centers during the period from 01.01.2012 to 31.12.2018 year. The diagnosis was verified according to the algorithm, reflected in the Russian guidelines on diagnosis and treatment of PH and CTEPH (2016 year). The comparison analysis of clinical, functional, hemodynamics parameters in patients with IPAH and inoperable CTEPH was made. Results. The status of 193 patients with IPAH (32 male and 162 female) and 130 patients with inoperable CTEPH - (40 male and 90 female) was analyzed during the study. The CTEPH patients were older compared to the IPAH patients: 52.2 [41.1; 60.6] and 36.5 [26.8; 36.5] years, respectively. The median period since symptom occurrence till CTEPH verification was 1.08 [0.2; 3.1] years, in IPAH patients - 2.01 [0.6; 4.2] years. More than 80% of inoperable CTEPH patients had III and IV functional class (FC) according to the World Health Organization classification at the time of diagnosis verification versus 61% of IPAH patients. According to echocardiography the level of mean pulmonary arterial pressure was comparable in two groups of PH patients. However in inoperable CTEPH patients the right atrial area was larger. The significantly higher value of mean pulmonary arterial pressure and lower value oxygen saturation of arterial blood according to the right heart catheterization were revealed. The 5-year survival in CTEPH patients, receiving initial dual combination therapy in 75% cases (in 40% - combination of riociguat and iloprost ) was 93% versus 86.5% in patients with IPAH. Conclusion: It was revealed, that inoperable CTEPH patients were significantly older with severe functional and hemodynamics status at the time of diagnosis verification, although with higher level of 5-year survival compared to the IPAH patients according to the Russian registry.

About the authors

I E Chazova

National Medical Research Center of Cardiology, Myasnikov Scientific Research Institute of Clinical Cardiology, Department of Pulmonary Hypertension and Heart Diseases

акад. РАН, проф., д.м.н., директор Института клинической кардиологии, руководитель отд. гипертонии НИИ клинической кардиологии им. А.Л. Мясникова ФГБУ «НМИЦ кардиологии» Минздрава России Moscow, Russia

Z S Valieva

National Medical Research Center of Cardiology, Myasnikov Scientific Research Institute of Clinical Cardiology, Department of Pulmonary Hypertension and Heart Diseases

Email: v.zarina.v@gmail.com
к.м.н., н.с. отд. легочной гипертензии и заболеваний сердца НИИ клинической кардиологии им. А.Л. Мясникова ФГБУ «НМИЦ кардиологии» Минздрава России Moscow, Russia

S N Nakonechnikov

National Medical Research Center of Cardiology, Myasnikov Scientific Research Institute of Clinical Cardiology, Department of Pulmonary Hypertension and Heart Diseases

д.м.н., генеральный директор РМОАГ, проф. каф. кардиологии фак-та ДПО Российского национального исследовательского медицинского университета им. Н.И. Пирогова Moscow, Russia

I N Taran

National Medical Research Center of Cardiology, Myasnikov Scientific Research Institute of Clinical Cardiology, Department of Pulmonary Hypertension and Heart Diseases; Scientific Research Institute for Complex Issues of Cardiovascular Diseases, Department of Multifocal Atherosclerosis, laboratory of rehabilitation

аспирант отд. легочной гипертензии и заболеваний сердца НИИ клинической кардиологии им. А.Л. Мясникова ФГБУ «НМИЦ кардиологии» Минздрава России; м.н.с. лаб. реабилитации отд. мультифокального атеросклероза ФГБНУ «НИИ комплексных проблем сердечно-сосудистых заболеваний», Кемерово Moscow, Russia

T V Martynyuk

National Medical Research Center of Cardiology, Myasnikov Scientific Research Institute of Clinical Cardiology, Department of Pulmonary Hypertension and Heart Diseases

д.м.н., руководитель отд. легочной гипертензии и заболеваний сердца НИИ клинической кардиологии им. А.Л. Мясникова ФГБУ «НМИЦ кардиологии» Минздрава России; проф. каф. кардиологии фак-та ДПО Российского национального исследовательского медицинского университета им. Н.И. Пирогова Moscow, Russia

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