Pulmonary venous occlusion and death in pulmonary arterial hypertension: survival analyses using radiographic surrogates

BMC Pulmonary Medicine

Research Article

Shigehiro Tomimoto¹  Koji Yamamoto¹  Yutaka Takeda¹  Tomomitsu Tani¹  Nobuyuki Ohte¹  Genjiro Kimura¹  Yasuko Takeda²  Hitomi Narita³ 

[1] Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan;Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan;Department of Cardiology, Nagoya City Rehabilitation Center, Nagoya, Japan;Department of Cardiology, Nagoya City Rehabilitation Center, Nagoya, Japan;

关键词: Pulmonary Arterial Hypertension;    Pulmonary Vein;    Brain Natriuretic Peptide;    Idiopathic Pulmonary Arterial Hypertension;    Pulmonary Arterial Hypertension Patient;   

DOI  :  10.1186/1471-2466-11-47

 received in 2010-11-20, accepted in 2011-10-06,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundRecent studies find that a considerable number of patients with pulmonary arterial hypertension (PAH) develop fibrous obstruction of the pulmonary veins. Such obstruction more commonly accompanies connective tissue disorder (CTD)-associated PAH than idiopathic PAH. However, few researchers have gauged the risk of death involving obstruction of the pulmonary veins.MethodsThirty-seven patients with PAH were enrolled (18 patients, idiopathic PAH; 19 patients, CTD-associated PAH). The patients were 49 ± 18 years and had a World Health Organization functional class of 3.2 ± 0.6. Thickening of the interlobular septa, centrilobular ground-glass attenuation, and mediastinal adenopathy were surrogates for obstruction of the pulmonary veins, and were detected by a 16-row multidetector computed tomography scanner.ResultsThe follow-up period was 714 ± 552 days. Fifteen deaths occurred. Thickening of the interlobular septa, centrilobular ground-glass attenuation, and mediastinal adenopathy were found in 37.8%, 24.3%, and 16.2% of patients, respectively. Cox proportional hazard analysis revealed an increased risk of death with each radiographic surrogate (mediastinal adenopathy: p < 0.0001, hazard ratio = 13.9; thickening of interlobular septa: p < 0.001, hazard ratio = 12.0; ground-glass attenuation: p = 0.02, hazard ratio = 3.7). The statistical significance of these relationships was independent of the cause of PAH and plasma concentration of brain natriuretic peptide.ConclusionsThe results of this study imply that obstruction of the pulmonary veins is associated with an increased risk of death in patients with PAH.

【 授权许可】

CC BY   
© Takeda et al; licensee BioMed Central Ltd. 2011