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Clinical Perspective of Pulmonary Arterial Hypertension (PAH) in the Elderly: A Single Center Study
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A2113 - Clinical Perspective of Pulmonary Arterial Hypertension (PAH) in the Elderly: A Single Center Study
Author Block: A. Iftikhar1, N. Rothbard2, M. Cheema3, M. Chhetry1, S. Sahni2; 1Pulmonary and Critical care, New york Presbyterian Queens, Flushing, NY, United States, 2Touro College of Osteopathic Medicine, Harlem, NY, United States, 3NYPQ, Flushing, NY, United States.
Introduction: Pulmonary arterial hypertension (PAH) (WHO Group I) is a rare and devastating disease characterized by progressive increases in pulmonary arterial pressure and pulmonary vascular resistance which eventually leads to right ventricular failure and death. It may be idiopathic in nature or associated with other systemic conditions and is thought to most commonly effect women, the majority of childbearing age. Due to disease recognition and readily available advanced diagnostic modalities, PAH in the elderly population is being increasingly diagnosed creating unique clinical challenges. We decided to study the elderly PAH population at our institution.
Material and methods: We conducted a retrospective chart review at the New York Presbyterian Hospital Queens in which all patients who underwent a right heart catheterization (RHC) from 2013 to 2016 were analyzed. PAH was defined in accordance to the latest guidelines (mean pulmonary artery pressure (mPAP) ≥25mmHg and pulmonary capillary wedge pressure (PCWP) ≤ 15mmHg in absence of any other causes of pulmonary hypertension (PH) (Galie et al. 2015). Only patients who underwent their first RHC above the age of 65 were considered for the study. Demographics, comorbidities, pulmonary hemodynamics, and other diagnostic criteria were analyzed.
Results: A total of 465 patients were identified who underwent their foremost RHC after the age of ≥65. There was a total of 27 patients who met the study criteria. 5 of these patients were excluded due to possible secondary causes of Pulmonary HTN. 22 patients, 7 (31.8%) males and 15 (68.2%) females with a mean age of 77.3±8.82 were considered for the study. The most common co-morbities were hyperlipidemia found in 16 (72.7%), hypertension in 15 (68.2%), diabetes mellitus type II in 8 (36.4%). Echocardiography revealed a left ventricular ejection fraction of 56.1 and an estimated mPAP of 54.5±9.4 mmHg. RHC revealed a mPAP was found to be 31.8±6.3 mmHg, PCWP was 11.6±2.6 mmHg, right atrial pressure was 6.9±2.8 mmHg and cardiac index was 2.46 ± 0.51 L/min/m2.
Conclusions: Diagnosed of PAH in the elderly population may not be as uncommon as previously thought. A high clinical suspicion is required for early diagnosis as initiation of disease specific pharmacotherapy is imperative. Special consideration needs to be placed on this population as there is a greater number of comorbidities and the possibility of drug interactions in the setting of polypharmacy. Further prospective studies need to be conducted to analyze this subset of “non-traditional” PAH patients.
Author Block: A. Iftikhar1, N. Rothbard2, M. Cheema3, M. Chhetry1, S. Sahni2; 1Pulmonary and Critical care, New york Presbyterian Queens, Flushing, NY, United States, 2Touro College of Osteopathic Medicine, Harlem, NY, United States, 3NYPQ, Flushing, NY, United States.
Introduction: Pulmonary arterial hypertension (PAH) (WHO Group I) is a rare and devastating disease characterized by progressive increases in pulmonary arterial pressure and pulmonary vascular resistance which eventually leads to right ventricular failure and death. It may be idiopathic in nature or associated with other systemic conditions and is thought to most commonly effect women, the majority of childbearing age. Due to disease recognition and readily available advanced diagnostic modalities, PAH in the elderly population is being increasingly diagnosed creating unique clinical challenges. We decided to study the elderly PAH population at our institution.
Material and methods: We conducted a retrospective chart review at the New York Presbyterian Hospital Queens in which all patients who underwent a right heart catheterization (RHC) from 2013 to 2016 were analyzed. PAH was defined in accordance to the latest guidelines (mean pulmonary artery pressure (mPAP) ≥25mmHg and pulmonary capillary wedge pressure (PCWP) ≤ 15mmHg in absence of any other causes of pulmonary hypertension (PH) (Galie et al. 2015). Only patients who underwent their first RHC above the age of 65 were considered for the study. Demographics, comorbidities, pulmonary hemodynamics, and other diagnostic criteria were analyzed.
Results: A total of 465 patients were identified who underwent their foremost RHC after the age of ≥65. There was a total of 27 patients who met the study criteria. 5 of these patients were excluded due to possible secondary causes of Pulmonary HTN. 22 patients, 7 (31.8%) males and 15 (68.2%) females with a mean age of 77.3±8.82 were considered for the study. The most common co-morbities were hyperlipidemia found in 16 (72.7%), hypertension in 15 (68.2%), diabetes mellitus type II in 8 (36.4%). Echocardiography revealed a left ventricular ejection fraction of 56.1 and an estimated mPAP of 54.5±9.4 mmHg. RHC revealed a mPAP was found to be 31.8±6.3 mmHg, PCWP was 11.6±2.6 mmHg, right atrial pressure was 6.9±2.8 mmHg and cardiac index was 2.46 ± 0.51 L/min/m2.
Conclusions: Diagnosed of PAH in the elderly population may not be as uncommon as previously thought. A high clinical suspicion is required for early diagnosis as initiation of disease specific pharmacotherapy is imperative. Special consideration needs to be placed on this population as there is a greater number of comorbidities and the possibility of drug interactions in the setting of polypharmacy. Further prospective studies need to be conducted to analyze this subset of “non-traditional” PAH patients.
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