Elderly Patients with Idiopathic Pulmonary Hypertension: Clinical Characteristics, Survival, and Risk Stratification in a Single-Center Prospective Registry
Introduction: The predictive value of the risk stratification scales in elderly patients with IPAH might differ from that in younger patients. It is unknown whether young and older IPAH patients have the same survival dependence on PAH-specific therapy numbers. The aim of this study was to evaluate...
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MDPI AG
2024-02-01
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| Online Access: | https://www.mdpi.com/2075-1729/14/2/259 |
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| author | Natalia Goncharova Kirill Lapshin Aelita Berezina Maria Simakova Alexandr Marichev Irina Zlobina Narek Marukyan Kirill Malikov Alexandra Aseeva Vadim Zaitsev Olga Moiseeva |
| author_facet | Natalia Goncharova Kirill Lapshin Aelita Berezina Maria Simakova Alexandr Marichev Irina Zlobina Narek Marukyan Kirill Malikov Alexandra Aseeva Vadim Zaitsev Olga Moiseeva |
| author_sort | Natalia Goncharova |
| collection | DOAJ |
| description | Introduction: The predictive value of the risk stratification scales in elderly patients with IPAH might differ from that in younger patients. It is unknown whether young and older IPAH patients have the same survival dependence on PAH-specific therapy numbers. The aim of this study was to evaluate the prognostic relevance of risk stratification scales and PAH medication numbers in elderly IPAH patients in comparison with young IPAH patients. Materials and methods: A total of 119 patients from a prospective single-center PAH registry were divided into group I < 60 years old (n = 89) and group II ≥ 60 years old (n = 30). ESC/ERS, REVEAL, and REVEAL 2.0 risk stratification scores were assessed at baseline, as well as H2FpEF score and survival at follow-up. Results: During a mean follow-up period of 2.9 years (1.63; 6.0), 42 (35.3%) patients died; at 1, 2, 3, 5, 7, and 10 years, survival was 95%, 88.6%, 78.5%, 61.7%, 48.5%, and 33.7%, respectively. No survival differences were observed between the two groups, despite the use of monotherapy in the elderly patients. The best predictive REVEAL value in elderly patients (IPAH patients ≥ 60 years) was AUC 0.73 (0.56–0.91), <i>p</i> = 0.03; and in patients with LHD comorbidities in the entire cohort, it was AUC 0.73 (0.59–0.87), <i>p</i> < 0.009. Factors independently associated with death in the entire cohort were CKD (<i>p</i> = 0.01, HR 0.2), the right-to-left ventricle dimension ratio (<i>p</i> = 0.0047, HR 5.97), and NT-proBNP > 1400 pg/mL (<i>p</i> = 0.008, HR 3.18). Conclusion: Risk stratification in the elderly IPAH patients requires a fundamentally different approach than that of younger patients, taking into account the initial limitations in physical performance and comorbidities that interfere with current assessment scores. The REVEAL score reliably stratifies patients at any age and LHD comorbidities. The initial monotherapy seems to be reasonable in patients over 60 years. Selection tools for initial combination PAH therapy in older IPAH patients with comorbidities need to be validated in prospective observational studies. |
| first_indexed | 2024-03-07T22:23:52Z |
| format | Article |
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| issn | 2075-1729 |
| language | English |
| last_indexed | 2024-03-07T22:23:52Z |
| publishDate | 2024-02-01 |
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| spelling | doaj.art-83c7fc453f504dc491c8dbc7fd9d49cb2024-02-23T15:24:47ZengMDPI AGLife2075-17292024-02-0114225910.3390/life14020259Elderly Patients with Idiopathic Pulmonary Hypertension: Clinical Characteristics, Survival, and Risk Stratification in a Single-Center Prospective RegistryNatalia Goncharova0Kirill Lapshin1Aelita Berezina2Maria Simakova3Alexandr Marichev4Irina Zlobina5Narek Marukyan6Kirill Malikov7Alexandra Aseeva8Vadim Zaitsev9Olga Moiseeva10Almazov National Medical Research Centre, Ministry of Health of Russia, Saint Petersburg 197341, RussiaAlmazov National Medical Research Centre, Ministry of Health of Russia, Saint Petersburg 197341, RussiaAlmazov National Medical Research Centre, Ministry of Health of Russia, Saint Petersburg 197341, RussiaAlmazov National Medical Research Centre, Ministry of Health of Russia, Saint Petersburg 197341, RussiaAlmazov National Medical Research Centre, Ministry of Health of Russia, Saint Petersburg 197341, RussiaAlmazov National Medical Research Centre, Ministry of Health of Russia, Saint Petersburg 197341, RussiaAlmazov National Medical Research Centre, Ministry of Health of Russia, Saint Petersburg 197341, RussiaAlmazov National Medical Research Centre, Ministry of Health of Russia, Saint Petersburg 197341, RussiaAlmazov National Medical Research Centre, Ministry of Health of Russia, Saint Petersburg 197341, RussiaAlmazov National Medical Research Centre, Ministry of Health of Russia, Saint Petersburg 197341, RussiaAlmazov National Medical Research Centre, Ministry of Health of Russia, Saint Petersburg 197341, RussiaIntroduction: The predictive value of the risk stratification scales in elderly patients with IPAH might differ from that in younger patients. It is unknown whether young and older IPAH patients have the same survival dependence on PAH-specific therapy numbers. The aim of this study was to evaluate the prognostic relevance of risk stratification scales and PAH medication numbers in elderly IPAH patients in comparison with young IPAH patients. Materials and methods: A total of 119 patients from a prospective single-center PAH registry were divided into group I < 60 years old (n = 89) and group II ≥ 60 years old (n = 30). ESC/ERS, REVEAL, and REVEAL 2.0 risk stratification scores were assessed at baseline, as well as H2FpEF score and survival at follow-up. Results: During a mean follow-up period of 2.9 years (1.63; 6.0), 42 (35.3%) patients died; at 1, 2, 3, 5, 7, and 10 years, survival was 95%, 88.6%, 78.5%, 61.7%, 48.5%, and 33.7%, respectively. No survival differences were observed between the two groups, despite the use of monotherapy in the elderly patients. The best predictive REVEAL value in elderly patients (IPAH patients ≥ 60 years) was AUC 0.73 (0.56–0.91), <i>p</i> = 0.03; and in patients with LHD comorbidities in the entire cohort, it was AUC 0.73 (0.59–0.87), <i>p</i> < 0.009. Factors independently associated with death in the entire cohort were CKD (<i>p</i> = 0.01, HR 0.2), the right-to-left ventricle dimension ratio (<i>p</i> = 0.0047, HR 5.97), and NT-proBNP > 1400 pg/mL (<i>p</i> = 0.008, HR 3.18). Conclusion: Risk stratification in the elderly IPAH patients requires a fundamentally different approach than that of younger patients, taking into account the initial limitations in physical performance and comorbidities that interfere with current assessment scores. The REVEAL score reliably stratifies patients at any age and LHD comorbidities. The initial monotherapy seems to be reasonable in patients over 60 years. Selection tools for initial combination PAH therapy in older IPAH patients with comorbidities need to be validated in prospective observational studies.https://www.mdpi.com/2075-1729/14/2/259idiopathic pulmonary arterial hypertensioncomorbiditiessurvivalrisk stratification |
| spellingShingle | Natalia Goncharova Kirill Lapshin Aelita Berezina Maria Simakova Alexandr Marichev Irina Zlobina Narek Marukyan Kirill Malikov Alexandra Aseeva Vadim Zaitsev Olga Moiseeva Elderly Patients with Idiopathic Pulmonary Hypertension: Clinical Characteristics, Survival, and Risk Stratification in a Single-Center Prospective Registry Life idiopathic pulmonary arterial hypertension comorbidities survival risk stratification |
| title | Elderly Patients with Idiopathic Pulmonary Hypertension: Clinical Characteristics, Survival, and Risk Stratification in a Single-Center Prospective Registry |
| title_full | Elderly Patients with Idiopathic Pulmonary Hypertension: Clinical Characteristics, Survival, and Risk Stratification in a Single-Center Prospective Registry |
| title_fullStr | Elderly Patients with Idiopathic Pulmonary Hypertension: Clinical Characteristics, Survival, and Risk Stratification in a Single-Center Prospective Registry |
| title_full_unstemmed | Elderly Patients with Idiopathic Pulmonary Hypertension: Clinical Characteristics, Survival, and Risk Stratification in a Single-Center Prospective Registry |
| title_short | Elderly Patients with Idiopathic Pulmonary Hypertension: Clinical Characteristics, Survival, and Risk Stratification in a Single-Center Prospective Registry |
| title_sort | elderly patients with idiopathic pulmonary hypertension clinical characteristics survival and risk stratification in a single center prospective registry |
| topic | idiopathic pulmonary arterial hypertension comorbidities survival risk stratification |
| url | https://www.mdpi.com/2075-1729/14/2/259 |
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