Pulmonary arterial hypertension in critically ill elderly patients

Abstract

Objective:To assess the incidence, possible risk factors and prognosis of pulmonary arterial hypertension (PAH) in critically ill elderly patients.Methods:We selected 122 cases admitted to the ICU, ages 60–93 years old. An echocardiography examination was performed within four days after admission to the ICU. PAH is usually suspected if the patient’s pulmonary artery systolic pressure ≥ 40 mmHg. We collected echocardiography data, relevant clinical data and routine laboratory data; we then used a statistical method to analyze the risk factors for PAH in critically ill elderly patients and examined its impact on the prognosis.Results:Total 51 patients were diagnosed with PAH. The prevalence of critically ill elderly patients with PAH was 41.8%. The ANOVA analysis showed that if patients had COPD (P = 0.031) and/or respiratory failure (P = 0.021), they were more prone to PAH. An enlarged left atrium (P = 0.038) and/or right ventricle (P = 0.029), a declining left ventricle fractional shortening rate (P = 0.038), and an elevated amount of the brain natriuretic peptides (P = 0.046) were all associated with the occurrence of PAH. Multivariate regression analysis showed that the left atrial diameter (P = 0.045) was the risk factor in critically ill elderly patients with PAH. The 30-day mortality rate was 33.3% for elderly patients with PAH, which is statistically significant (P = 0.035) when compared with the mortality rate of patients with normal pulmonary artery pressure. Our multivariate regression analysis also showed that, for critically ill elderly patients admitted in the ICU, PAH (P = 0.039) is risk factor for increased mortality.Conclusions:A higher incidence of PAH occurs in critically ill elderly patients. PAH is more likely to occur in patients with an enlarged left atrium, and these problems adversely impact the prognosis.

Pulmonary Arterial Hypertension in the Elderly: Peculiar Features and Challenges for a Proper Phenotyping Approach

“…Compared to the younger patients without cardiovascular comorbidities, elderly subjects with PAH and risk predictors for LHD have shown to have a higher mortality risk and a worse prognostic outcome, as well as poorer exercise capacity and functional class, a weaker response to PAH-targeted treatment, and a higher rate of PAH drug discontinuation [ 1 , 13 , 14 , 66 ] ( Figure 2 ). The first plausible explanation seems to be attributable to the persistent delay in the diagnosis of PAH over time in this patient population, usually due to the longer duration of symptoms, which are commonly attributed to the older age and other more prevalent comorbidities, than suspecting a timely diagnosis of PAH [ 15 , 16 , 37 ]. Furthermore, the higher rate of associated cardiovascular comorbidities seems to also be actively involved in the worse clinical outcome and the weaker pharmacological response in patients with the PAH and LHD phenotype [ 17 , 28 ].…”