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Prognostic and pathophysiological marker for patients with chronic thromboembolic pulmonary hypertension: Usefulness of diffusing capacity for carbon monoxide at diagnosis
Author(s) -
Suda Rika,
Tanabe Nobuhiro,
Ishida Keiichi,
Kato Fumiaki,
Urushibara Takashi,
Sekine Ayumi,
Nishimura Rintaro,
Jujo Takayuki,
Sugiura Toshihiko,
Shigeta Ayako,
Sakao Seiichiro,
Tatsumi Koichiro
Publication year - 2017
Publication title -
respirology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.857
H-Index - 85
eISSN - 1440-1843
pISSN - 1323-7799
DOI - 10.1111/resp.12883
Subject(s) - medicine , pathophysiology , chronic thromboembolic pulmonary hypertension , cardiology , pulmonary hypertension , diffusing capacity , angioplasty , retrospective cohort study , cohort , copd , lung , gastroenterology , lung function
Background and objective Chronic thromboembolic pulmonary hypertension ( CTEPH ) is a progressive disease in some patients, despite improved treatments. Microvasculopathy has been implicated in the poor outcomes of patients with CTEPH . A reduction in the diffusing capacity for carbon monoxide ( DL CO ) was previously suggested to indicate microvasculopathy in CTEPH patients; therefore, we assessed DL CO /alveolar ventilation ( DL CO / V A ) as a prognostic and pathophysiological marker in CTEPH . Methods We performed a retrospective cohort study of 214 CTEPH patients consecutively diagnosed between 1986 and 2011. After exclusion of 24 patients because of missing DL CO data or severe obstructive impairment, the mortality rates of medically treated patients classified with normal or decreased DL CO values were compared, and prognostic factors were determined. The relationship between long‐term surgical outcomes and DL CO / V A was also investigated. Results Ninety‐one inoperable patients were treated medically, two of whom underwent balloon pulmonary angioplasty. Ninety‐nine underwent pulmonary endarterectomy. The 5‐year survival rate of medically treated patients was significantly lower in patients with decreased DL CO / V A than in those with normal values (61.4% vs 90.4%, P = 0.017). Decreased preoperative DL CO / V A was associated with a smaller percent decrease in post‐operative pulmonary vascular resistance, but not with the extent of proximal thrombi; these results may support our hypothesis that DL CO reflects microvascular involvement. Conclusion Decreased DL CO / V A was associated with poor outcomes of medically treated CTEPH patients; and may be useful for identifying high‐risk patients, potentially leading to earlier and more appropriate interventions.