The Right Ventricle Explains Sex Differences in Survival in Idiopathic Pulmonary Arterial Hypertension

被引:177
作者
Jacobs, Wouter [1 ,4 ]
van de Veerdonk, Marielle C. [1 ]
Trip, Pia [1 ]
de Man, Frances [1 ]
Heymans, Martijn W. [2 ]
Marcus, Johannes T. [3 ]
Kawut, Steven M. [5 ]
Bogaard, Harm-Jan [1 ]
Boonstra, Anco [1 ]
Noordegraaf, Anton Vonk [1 ]
机构
[1] Vrije Univ Amsterdam, Med Ctr, Dept Pulmonol, NL-1007 MB Amsterdam, Netherlands
[2] Vrije Univ Amsterdam, Med Ctr, Dept Epidemiol & Biostat, NL-1007 MB Amsterdam, Netherlands
[3] Vrije Univ Amsterdam, Med Ctr, Dept Phys & Med Technol, NL-1007 MB Amsterdam, Netherlands
[4] Martini Hosp, Dept Pulmonol, Groningen, Netherlands
[5] Univ Penn, Perelman Sch Med, Dept Med, Philadelphia, PA 19104 USA
基金
美国国家卫生研究院;
关键词
HEART-FAILURE; NT-PROBNP; MASS; DYSFUNCTION; DIAGNOSIS; DISEASE; PREDICTION; MANAGEMENT; GEOMETRY; HORMONES;
D O I
10.1378/chest.13-1291
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background: Male sex is an independent predictor of worse survival in pulmonary arterial hypertension (PAH). This finding might be explained by more severe pulmonary vascular disease, worse right ventricular (RV) function, or different response to therapy. The aim of this study was to investigate the underlying cause of sex differences in survival in patients treated for PAH. Methods: This was a retrospective cohort study of 101 patients with PAH (82 idiopathic, 15 heritable, four anorexigen associated) who were diagnosed at VU University Medical Centre between February 1999 and January 2011 and underwent right-sided heart catheterization and cardiac MRI to assess RV function. Change in pulmonary vascular resistance (PVR) was taken as a measure of treatment response in the pulmonary vasculature, whereas change in RV ejection fraction (RVEF) was used to assess RV response to therapy. Results: PVR and RVEF were comparable between men and women at baseline; however, male patients had a worse transplant-free survival compared with female patients (P =.002). Although male and female patients showed a similar reduction in PVR after 1 year, RVEF improved in female patients, whereas it deteriorated in male patients. In a mediator analysis, after correcting for confounders, 39.0% of the difference in transplant- free survival between men and women was mediated through changes in RVEF after initiating PAH medical therapies. Conclusions: This study suggests that differences in RVEF response with initiation of medical therapy in idiopathic PAH explain a significant portion of the worse survival seen in men.
引用
收藏
页码:1230 / 1236
页数:7
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