PURPOSE: Pulmonary hypertension (PH) is typically a disease of young women. The use of screening echocardiograms has increased the detection of PH in the elderly. We describe the demographics, an outcomes of bosentan treated PH patients (pts) [greater than or equal to] 60 years of age.
METHODS: Retrospective chart review of patients referred to the Henry Ford Hospital PH program over two years. Demographics, hemodynamics, 6 minute walk test (6MW), WHO class were recorded. Pts who completed at least 6 months of bosentan therapy followed by repeat right heart catheterization were included. Pts [greater than or equal to] 60 years old were compared to pts < 60 years old. Paired Student t-test was used for comparisons.
RESULTS: 62 pts [greater than or equal to] 60 (Grp 1)and 60 pts < 60 (Grp 2)had PH. Diastolic dysfunction (DD) (31%), connective tissue disease (CTD) (15%), IPAH (15%), CTEPH (13%), and pulmonary disease (PD) (13%) were causes of PH in Grp 1. CTD (19%), IPAH (17%), portopulmonary (13%), DD (12%), PD (7%) and CTEPH (10%)predominated in Grp 2. Bosentan was initiated in 19 pts (Age 71 [+ or -] 7)in Grp 1 and 10 pts (Age 47 [+ or -] 5)in Grp 2. 4 discontinuations (1 nausea, 3 refractory edema) occurred in Grp 1 while 1 discontinuation (transaminitis) happened in Grp 2.9 pts in grp 1 and 6 pts in grp 2 qualified for analysis. Overall 6MW increased from 249m to 307m and the change in 6MW distance between the groups was no different (69.8 [+ or -] 132 vs 41 [+ or -] 73m). WHO class fell significantly following treatment from 3.5 [+ or -] 0.6 to 2.4 [+ or -] 1.2 (p = 0.0016) which was most affected by grp 1 with a fall from 3.8 [+ or -] 0.4 to 2.2 [+ or -] 1.1 (p = 0.0017). Grp 2 was without change in WHO class (3.2 [+ or -] 0.8 to 2.7 [+ or -] 1.5). Hemodynamic measurements revealed overall improvement in mPAP (52 [+ or -] 12 to 47 [+ or -] 13mmHg) (p = 0.04) and PVR (12.2 [+ or -] 7 to 9.4 [+ or -] 4 WU) (p = 0.049).
CONCLUSION: Awareness of PH as a cause of dyspnea is increasing in the elderly. DD is the predominant cause, but IPAH, CTD and CTEPH represent 43% of PH patients [greater than or equal to] 60. Bosentan is effective in lowering WHO class, and is equivalent in changing pulmonary hemodynamics and walking distance when compared to younger pts.
CLINICAL IMPLICATIONS: IPAH, CTD and CTEPH should be suspected in the elderly PH patient. Bosentan is effective in this population.
DISCLOSURE: Maria Carillo, Consultant fee, speaker bureau, advisory committee, etc. Actelion
Maria Carrillo MD * Hector Cajigas MD Adam Greenbaum MD Kevin M. Chan MD Henry Ford Health Systems, Detroit, MI
COPYRIGHT 2005 American College of Chest Physicians
COPYRIGHT 2005 Gale Group
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