Survival in pulmonary arterial hypertension patients awaiting lung transplantation

Gomberg‐Maitland, Mardi; Glassner-Kolmin, Cherylanne; Watson, Sydeaka; Frantz, Robert P.; Park, Myung; Frost, Adaani E.; Benza, Raymond L.; Torres, Fernando

doi:10.1016/j.healun.2013.08.016

Cited by 42 publications

(31 citation statements)

References 24 publications

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“…Our findings agree with those of previous studies showing that the 6MWD is a significant predictor of mortality. 23,25,26 Furthermore, our findings agree that 150 feet is too low a cut-off to properly determine which candidates have an increased risk of waitlist mortality. 31,35 Through the use of ROC curves, we found that a cut-off of between 550 and 655 feet (for 30-day and 6-month mortality, respectively) is more optimal, depending on whether 30-day or 6-month mortality is used.…”

Section: Discussionsupporting

confidence: 59%

The utility of 6-minute walk distance in predicting waitlist mortality for lung transplant candidates

Castleberry

Mulvihill

Yerokun

et al. 2017

The Journal of Heart and Lung Transplantation

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BACKGROUND The lung allocation score (LAS) has led to improved organ allocation for transplant candidates. At present, the 6-minute walk distance (6MWD) is treated as a binary categorical variable of whether or not a candidate can walk more than 150 feet in 6 minutes. In this study, we tested the hypothesis that 6MWD is presently under-utilized with respect to discriminatory power, and that, as a continuous variable, could better prognosticate risk of waitlist mortality. METHODS A retrospective cohort analysis was performed using the Organ Procurement and Transplantation Network/United Network for Organ Sharing (OPTN/UNOS) transplant database. Candidates listed for isolated lung transplant between May 2005 and December 2011 were included. The population was stratified by 6MWD quartiles and unadjusted survival rates were estimated. Multivariable Cox proportional hazards modeling was used to assess the effect of 6MWD on risk of death. The Scientific Registry of Transplant Recipients (SRTR) Waitlist Risk Model was used to adjust for confounders. The optimal 6MWD for discriminative accuracy in predicting waitlist mortality was assessed by receiver-operating characteristic (ROC) curves. RESULTS Analysis was performed on 12,298 recipients. Recipients were segregated into quartiles by distance walked. Waitlist mortality decreased as 6MWD increased. In the multivariable model, significant variables included 6MWD, male gender, non-white ethnicity and restrictive lung diseases. ROC curves discriminated 6-month mortality was best at 655 feet. CONCLUSIONS The 6MWD is a significant predictor of waitlist mortality. A cut-off of 150 feet suboptimally identifies candidates with increased risk of mortality. A cut-off between 550 and 655 feet is more optimal if 6MWD is to be treated as a dichotomous variable. Utilization of the LAS as a continuous variable could further enhance predictive capabilities.

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Section: Discussionsupporting

confidence: 59%

The utility of 6-minute walk distance in predicting waitlist mortality for lung transplant candidates

Castleberry

Mulvihill

Yerokun

et al. 2017

The Journal of Heart and Lung Transplantation

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“…Despite increases in the general awareness and detection of PH, survival and outcomes remain poor across the spectrum of PH groups . Furthermore, risk assessment remains a challenge .…”

Section: Discussionmentioning

confidence: 99%

Right atrial to left atrial volume index ratio is associated with increased mortality in patients with pulmonary hypertension

et al. 2018

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Background Pulmonary hypertension (PH) is characterized by increased pulmonary vascular resistance leading to right heart failure. Elevated right atrial (RA) pressure reflects right ventricular (RV) pressure overload and is an established risk factor for mortality in PH. We hypothesized that PH patients with an increased ratio of RA to LA volume index (RAVI/LAVI), would have increased mortality. Methods We evaluated the association of RAVI/LAVI with mortality in 124 patients seen at a single academic center's PH clinic after adjusting for the REVEAL risk score, an established risk score in PH. LA and RA volume indices were measured in the four‐and two‐chamber views by two independent researchers. Multivariable logistic regression was used to model the independent association of RAVI/LAVI with survival. Results Among 124 patients (mean age 62 ± 12.7 years, 68.6% female), each unit increase in RAVI/LAVI was associated with a nearly twofold increase in mortality (OR: 1.91, 95% CI: 1.20–3.04). In a multivariable logistic regression, each unit increase in RAVI/LAVI was associated with a nearly twofold increase in mortality (OR: 1.73, 95% CI: 1.003–2.998). Furthermore, RAVI/LAVI in the highest quartile (>1.42) was significantly associated with elevated right atrial pressure (RAP) to pulmonary artery wedge pressure ratio (RAP/PAWP) (0.76 ± 0.41, P = 0.02) compared with the lowest quartile (<0.77), suggesting an interaction between invasive hemodynamic data, atrial structural changes, and mortality in PH. Conclusions Increased RAVI/LAVI in PH is associated with decreased survival and accounts for atrial structural remodeling related to invasive hemodynamics. These findings support further study of this index in predicting outcomes in PH.

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“…Malgré des progrès considérables, l'HTAP reste une maladie chronique pour laquelle on ne dispose pas de traitement curatif, avec toujours un risque d'échappement thérapeutique. Ainsi, dans une étude rétrospective évaluant le pronostic des malades porteurs d'HTAP en attente de TP, 4 facteurs étaient associés avec la survie à 1 an : la classe de dyspnée, la distance au TM6, les résultats du cathétérisme droit, et le débit d'oxygène au repos [37]. Par ailleurs, lorsqu'il existe des arguments pour une maladie veino-occlusive, il est habituellement recommandé d'orienter les malades vers la TP dès le diagnostic [27].…”

Section: Htapunclassified

Indications de la transplantation pulmonaire : sélection des candidats, critères d’inscription en liste d’attente, choix du type d’intervention

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Sénéchal

Philit

et al. 2016

Revue de Pneumologie Clinique

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Survival in pulmonary arterial hypertension patients awaiting lung transplantation

Cited by 42 publications

References 24 publications

The utility of 6-minute walk distance in predicting waitlist mortality for lung transplant candidates

The utility of 6-minute walk distance in predicting waitlist mortality for lung transplant candidates

Right atrial to left atrial volume index ratio is associated with increased mortality in patients with pulmonary hypertension

Indications de la transplantation pulmonaire : sélection des candidats, critères d’inscription en liste d’attente, choix du type d’intervention

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