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Causes of Pulmonary Hypertension in the Elderly

Causes of Pulmonary Hypertension in the Elderly

Authors :
Anna R. Hemnes
John H. Newman
Meredith E. Pugh
Lakshmi Sivarajan
Ivan M. Robbins
Li Wang
Source :
Chest. 146:159-166
Publication Year :
2014
Publisher :
Elsevier BV, 2014.

Abstract

BACKGROUND Pulmonary hypertension (PH) is common in elderly patients, but a detailed analysis of the causes of PH in the elderly has not been performed. We hypothesized that pulmonary arterial hypertension (PAH) is rare in elderly patients and sought to describe the characteristics of these patients at a large referral center. METHODS Clinical and hemodynamic data were collected on consecutive patients ≥ 65 years of age referred for evaluation of PH. The subtype of PH was determined after standard evaluation using the World Health Organization (WHO) classification. Patients with PH not meeting criteria for PAH with "out-of-proportion" PH related to group 2 or group 3 disease were classified as "other/mixed PH." A model using age, presence of connective tissue disease, and left atrial size was developed to predict the probability of PAH diagnosis. RESULTS Two hundred forty-six elderly patients were evaluated (mean age, 72.9 ± 5.5 years, 78% women); 36 had PAH (15%). Idiopathic PAH was rare (four patients, 1.6%). WHO group 2 PH was the most frequent diagnosis (n = 70, 28% of cohort); mixed/other PH (n = 43, 17%) and WHO group 3 PH (n = 34, 14%) were also common diagnoses. Connective tissue disease strongly predicted PAH diagnosis (OR, 27.2; 95% CI, 9.5-77.6). CONCLUSIONS PAH is an uncommon cause of PH in elderly patients, most frequently associated with connective tissue disease. WHO group 2 PH and mixed disease are common, highlighting a need for careful phenotyping of elderly patients with PH prior to initiating PAH therapy.

Details

ISSN :
00123692
Volume :
146
Database :
OpenAIRE
Journal :
Chest
Accession number :
edsair.doi.dedup.....ffd790d59323a4cc57f80dd91673b9e7
Full Text :
https://doi.org/10.1378/chest.13-1900