The role of exercise right heart catheterization to guide pulmonary hypertension therapy in older adults
Abstract The spectrum of patients referred for suspected pulmonary arterial hypertension (PAH) includes a population with clinical features suggestive of pulmonary hypertension due to left heart disease (PH‐LHD). Even after right heart catheterization (RHC) performed at rest, it can be a challenge t...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-07-01
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| Series: | Pulmonary Circulation |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/pul2.12103 |
| _version_ | 1811205258432479232 |
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| author | Susanna Mak Shimon Kolker Natasha R. Girdharry Robert F. Bentley Felipe H. Valle Vikram Gurtu K. H. Mok Jakov Moric John Thenganatt John T. Granton |
| author_facet | Susanna Mak Shimon Kolker Natasha R. Girdharry Robert F. Bentley Felipe H. Valle Vikram Gurtu K. H. Mok Jakov Moric John Thenganatt John T. Granton |
| author_sort | Susanna Mak |
| collection | DOAJ |
| description | Abstract The spectrum of patients referred for suspected pulmonary arterial hypertension (PAH) includes a population with clinical features suggestive of pulmonary hypertension due to left heart disease (PH‐LHD). Even after right heart catheterization (RHC) performed at rest, it can be a challenge to identify patients who will clearly benefit from PAH drug therapy. Therefore, the objective of this study was to evaluate the role of exercise RHC to influence decisions regarding prescription of PAH drug therapy in this population. A retrospective cohort study was conducted of older adults with risk factors for PH‐LHD and suspected PH referred for exercise RHC. One year follow‐up was conducted to record clinical outcomes, all changes in PAH drug therapy, and changes in patient‐reported quality of life. The final cohort included 61 patients, mean age of 69 ± 10; 44% and 34% had a history of coronary artery disease and atrial fibrillation respectively. Exercise changed the proportional breakdown of hemodynamic diagnoses from 36% No PH, 44% PAH, and 20% PH‐LHD at rest to 15% No PH, 36% PAH, and 49% PH‐LHD. Although a significant proportion of patients were reclassified as PH‐LHD, there was an overall increase in the proportion of patients receiving PAH drug therapy, particularly for those with PAH confirmed by exercise RHC. A total of 11 PAH drug prescriptions were employed before exercise RHC increasing to 24 after (p = 0.002). Patients receiving PAH therapy demonstrated significant improvement in self‐reported quality of life. Exercise RHC appeared to influence selection of PAH drug therapy. |
| first_indexed | 2024-04-12T03:27:39Z |
| format | Article |
| id | doaj.art-d14415638e8a436cb8eaee9947615d4c |
| institution | Directory Open Access Journal |
| issn | 2045-8940 |
| language | English |
| last_indexed | 2024-04-12T03:27:39Z |
| publishDate | 2022-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Pulmonary Circulation |
| spelling | doaj.art-d14415638e8a436cb8eaee9947615d4c2022-12-22T03:49:37ZengWileyPulmonary Circulation2045-89402022-07-01123n/an/a10.1002/pul2.12103The role of exercise right heart catheterization to guide pulmonary hypertension therapy in older adultsSusanna Mak0Shimon Kolker1Natasha R. Girdharry2Robert F. Bentley3Felipe H. Valle4Vikram Gurtu5K. H. Mok6Jakov Moric7John Thenganatt8John T. Granton9Department of Medicine, Sinai Health/University Health Network University of Toronto Toronto CanadaClalit Health Tel Aviv IsraelDepartment of Medicine, Sinai Health/University Health Network University of Toronto Toronto CanadaFaculty of Kinesiology and Physical Education University of Toronto Toronto CanadaHospital de Clinicas de Porto Alegre Porto Alegre BrasilDepartment of Medicine, Sinai Health/University Health Network University of Toronto Toronto CanadaDepartment of Medicine, Sinai Health/University Health Network University of Toronto Toronto CanadaDepartment of Medicine, Sinai Health/University Health Network University of Toronto Toronto CanadaDepartment of Medicine, Sinai Health/University Health Network University of Toronto Toronto CanadaDepartment of Medicine, Sinai Health/University Health Network University of Toronto Toronto CanadaAbstract The spectrum of patients referred for suspected pulmonary arterial hypertension (PAH) includes a population with clinical features suggestive of pulmonary hypertension due to left heart disease (PH‐LHD). Even after right heart catheterization (RHC) performed at rest, it can be a challenge to identify patients who will clearly benefit from PAH drug therapy. Therefore, the objective of this study was to evaluate the role of exercise RHC to influence decisions regarding prescription of PAH drug therapy in this population. A retrospective cohort study was conducted of older adults with risk factors for PH‐LHD and suspected PH referred for exercise RHC. One year follow‐up was conducted to record clinical outcomes, all changes in PAH drug therapy, and changes in patient‐reported quality of life. The final cohort included 61 patients, mean age of 69 ± 10; 44% and 34% had a history of coronary artery disease and atrial fibrillation respectively. Exercise changed the proportional breakdown of hemodynamic diagnoses from 36% No PH, 44% PAH, and 20% PH‐LHD at rest to 15% No PH, 36% PAH, and 49% PH‐LHD. Although a significant proportion of patients were reclassified as PH‐LHD, there was an overall increase in the proportion of patients receiving PAH drug therapy, particularly for those with PAH confirmed by exercise RHC. A total of 11 PAH drug prescriptions were employed before exercise RHC increasing to 24 after (p = 0.002). Patients receiving PAH therapy demonstrated significant improvement in self‐reported quality of life. Exercise RHC appeared to influence selection of PAH drug therapy.https://doi.org/10.1002/pul2.12103hemodynamicstreatment |
| spellingShingle | Susanna Mak Shimon Kolker Natasha R. Girdharry Robert F. Bentley Felipe H. Valle Vikram Gurtu K. H. Mok Jakov Moric John Thenganatt John T. Granton The role of exercise right heart catheterization to guide pulmonary hypertension therapy in older adults Pulmonary Circulation hemodynamics treatment |
| title | The role of exercise right heart catheterization to guide pulmonary hypertension therapy in older adults |
| title_full | The role of exercise right heart catheterization to guide pulmonary hypertension therapy in older adults |
| title_fullStr | The role of exercise right heart catheterization to guide pulmonary hypertension therapy in older adults |
| title_full_unstemmed | The role of exercise right heart catheterization to guide pulmonary hypertension therapy in older adults |
| title_short | The role of exercise right heart catheterization to guide pulmonary hypertension therapy in older adults |
| title_sort | role of exercise right heart catheterization to guide pulmonary hypertension therapy in older adults |
| topic | hemodynamics treatment |
| url | https://doi.org/10.1002/pul2.12103 |
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