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. 2022 Nov 30;11(23):7136.
doi: 10.3390/jcm11237136.

Left Heart Disease Phenotype in Elderly Patients with Pulmonary Arterial Hypertension: Insights from the Italian PATRIARCA Registry

Matteo Toma  1 , Roberta Miceli  2 , Edoardo Bonsante  3 , Davide Colombo  4 , Marco Confalonieri  5 , Andrea Garascia  6 , Stefano Ghio  4 , Mariangela Lattanzio  7 , Carlo Maria Lombardi  8   9 , Giuseppe Paciocco  10 , Cristina Piccinino  11 , Irene Rota  12 , Caterina Santolamazza  6 , Laura Scelsi  4 , Piermario Scuri  13 , Davide Stolfo  14   15 , Antonella Vincenzi  16 , Lorenzo Volpiano  10 , Marco Vicenzi  12   17 , Pietro Ameri  1   18
Affiliations

Left Heart Disease Phenotype in Elderly Patients with Pulmonary Arterial Hypertension: Insights from the Italian PATRIARCA Registry

Matteo Toma et al. J Clin Med. .

Abstract

Pulmonary arterial hypertension (PAH) in the elderly is often associated with left heart disease (LHD), prompting concerns about the use of pulmonary vasodilators. The PATRIARCA registry enrolled ≥70 year-old PAH or chronic thromboembolic pulmonary hypertension (CTEPH) patients at 11 Italian centers from 1 December 2019 through 15 September 2022. After excluding those with CTEPH, post-capillary PH at the diagnostic right heart catheterization (RHC), and/or incomplete data, 23 (33%) of a total of 69 subjects met the criteria proposed in the AMBITION trial to suspect LHD. Diabetes [9 (39%) vs. 6 (13%), p = 0.01] and chronic kidney disease [14 (61%) vs. 12 (26%), p = 0.003] were more common, and the last RHC pulmonary artery wedge pressure [14 ± 5 vs. 10 ± 3 mmHg, p < 0.001] was higher and pulmonary vascular resistance [5.56 ± 3.31 vs. 8.30 ± 4.80, p = 0.02] was lower in LHD than non-LHD patients. However, PAH therapy was similar, with 13 (57%) and 23 (50%) subjects, respectively, taking two oral drugs. PAH medication patterns remained comparable between LHD and non-LHD patients also when the former [37, 54%] were identified by atrial fibrillation and echocardiographic features of LHD, in addition to the AMBITION criteria. In this real-world snapshot, elderly PAH patients were treated with pulmonary vasodilators, including combinations, despite a remarkable prevalence of a LHD phenotype.

Keywords: comorbidity; elderly; left heart disease; pulmonary hypertension; vasodilator.

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Conflict of interest statement

P.A. had speaker and/or advisor fees from Janssen and MSD outside the scope of the submitted work.

Figures

Figure 1
Figure 1
Flow-chart depicting the selection process of the study sample. PAH, pulmonary arterial hypertension; CTEPH, chronic thromboembolic pulmonary hypertension; PH, pulmonary hypertension; LHD, Left heart disease.
Figure 2
Figure 2
Number of patients with and without a left heart disease (LHD) phenotype according to main and secondary analysis criteria.
See this image and copyright information in PMC

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