Analysis of pulmonary hypertension patient survival after treatment in referral center (data of first Ukrainian register)

Abstract

The aims of the study were: (1) to evaluate the Ukrainian reality of survival in patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH); and (2) to determine predictors of death. A total of 281 patients were enrolled (52 [18.5%] with CTEPH, 229 [81.5%] with PAH). Long-term survival (Kaplan–Meier) and its predictors (Stepwise binary logistic regression and Cox’s proportional hazards analyses) were evaluated in adult patients with PH (diagnosed by right heart catheterization [RHC]) within a prospective registry at a single referral center in Kyiv, Ukraine. Follow-up period was up to 51 months. The Kaplan–Meier survival rate for the total cohort was 93.3%, 86.8%, and 81.5% at one, two, and three years, respectively. Survival was better in patients with congenital heart diseases (CHD) in comparison with idiopathic PAH (long rank P¼0.002), connective tissue diseases (CTD; long rank P¼0.001) and CTEPH (long rank P¼0.04). Univariate Cox’s predictors of death were: functional class IV (odds ratio [OR]¼4.94; 95% confidence interval [CI]¼2.12–11.48), presence of ascites (OR¼4.52; 95% CI¼2.21–9.24), PAH-CTD (OR¼3.07; 95% CI¼1.07–8.87), PAH-CHD (OR¼0.28; 95% CI¼0.11–0.68), HR on treatment>105 beats per min (OR¼7.85; 95% CI¼1.83–33.69), office systolic BP<100mmHg (OR¼2.78; 95% CI¼1.26–6.1), 6MWT on treatment<340m (OR¼3.47; 95% CI¼1.01–12.35), NT-proBNP>300pg/mL (OR¼4.98; 95% CI¼1.49–16.6), right atrium square>22cm2 (OR¼14.2; 95% CI¼1.92–104.89), right ventricular square in diastole (OR¼1.08; 95% CI¼1.03–1.14), right ventricular square in systole (OR¼1.08; 95% CI¼1.02–1.11), mean pressure in right atrium per each 1-mmHg increase (OR¼1.02; 95% CI¼1.02–1.19). In multivariate Cox regression analyses only presence of ascites, office systolic BP<100mmHg, CHD etiology of PH, and NT-proBNP>300pg/mL were associated with survival.