PMID- 22289484
OWN - NLM
STAT- MEDLINE
DCOM- 20120807
LR  - 20171116
IS  - 1557-3117 (Electronic)
IS  - 1053-2498 (Linking)
VI  - 31
IP  - 4
DP  - 2012 Apr
TI  - Prognostic factors in severe pulmonary hypertension patients who need parenteral 
      prostanoid therapy: the impact of late referral.
PG  - 364-72
LID - 10.1016/j.healun.2011.12.011 [doi]
AB  - BACKGROUND: Oral drugs have made the treatment of pulmonary hypertension (PH) 
      feasible in non-expert centers, which could delay patient access to prostanoid 
      therapy. METHODS: Fifty-seven consecutive patients with precapillary PH received 
      a prostanoid in our center. Data at prostanoid initiation included modality of 
      center referral, medical history, New York Heart Association [NYHA] class, 
      exercise capacity, echocardiographic parameters, and hemodynamics. RESULTS: 
      Overall survival at 1, 2, and 3 years was 85%, 69%, 55%, respectively. 
      Non-survivors had worse NYHA class III/IV (17/12) than survivors (27/1; p < 0.01) 
      and exercise capacity on 6-minute-walk distance (254 +/- 114 vs 354 +/- 91 meters; p 
      < 0.01). Non-survivors were more frequently referred on oral therapy (83% vs 36%; 
      p < 0.01) and had a higher rate of urgent prostanoid treatment (69% vs 17%; p < 
      0.0001). Multivariate analysis (hazard ratio [95% confidence interval]) found the 
      independent prognostic factors were urgent prostanoid therapy (2.0 [1.1-3.9]) and 
      NYHA class (3.5 [1.5-8.2]). Survivors had a significant response to prostanoid, 
      improving NYHA class from 2.8 +/- 0.4 to 2.3 +/- 0.5 (p = 0.002), 6-minute walk 
      distance from 354 +/- 91 to 426 +/- 82 meters (p = 0.0001), and pulmonary 
      hemodynamics (pulmonary artery pressure from 56 +/- 13 to 44 +/- 18 mm Hg [p < 0.05]; 
      cardiac index from 2.0 +/- 1.2 to 3.1 +/- 1.2 liters/min/m(2) [p = 0.002], and 
      pulmonary vascular resistance from 17 +/- 10 to 8 +/- 6 WU [p = 0.001]). CONCLUSIONS: 
      Referral of patients on oral treatment to a tertiary PH center is delayed and 
      significantly affects prognosis.
CI  - Copyright A(c) 2012 International Society for Heart and Lung Transplantation. 
      Published by Elsevier Inc. All rights reserved.
FAU - Badagliacca, Roberto
AU  - Badagliacca R
AD  - Department of Cardiovascular and Respiratory Science, I School of Medicine, 
      University of Rome Sapienza, Policlinico Umberto I.
FAU - Pezzuto, Beatrice
AU  - Pezzuto B
FAU - Poscia, Roberto
AU  - Poscia R
FAU - Mancone, Massimo
AU  - Mancone M
FAU - Papa, Silvia
AU  - Papa S
FAU - Marcon, Serena
AU  - Marcon S
FAU - Valli, Gabriele
AU  - Valli G
FAU - Sardella, Gennaro
AU  - Sardella G
FAU - Ferrante, Fabio
AU  - Ferrante F
FAU - Iacoboni, Carlo
AU  - Iacoboni C
FAU - Parola, Daniela
AU  - Parola D
FAU - Fedele, Francesco
AU  - Fedele F
FAU - Vizza, Carmine Dario
AU  - Vizza CD
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20120129
PL  - United States
TA  - J Heart Lung Transplant
JT  - The Journal of heart and lung transplantation : the official publication of the 
      International Society for Heart Transplantation
JID - 9102703
RN  - 0 (Prostaglandins)
RN  - DCR9Z582X0 (Epoprostenol)
RN  - RUM6K67ESG (treprostinil)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Epoprostenol/*analogs & derivatives/pharmacology/*therapeutic use
MH  - Female
MH  - Follow-Up Studies
MH  - Hemodynamics/drug effects/physiology
MH  - Humans
MH  - Hypertension, Pulmonary/*drug therapy/*mortality/physiopathology
MH  - Kaplan-Meier Estimate
MH  - Male
MH  - Middle Aged
MH  - Prognosis
MH  - Prostaglandins/pharmacology/*therapeutic use
MH  - *Referral and Consultation
MH  - Retrospective Studies
MH  - Survival Rate
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2012/02/01 06:00
MHDA- 2012/08/08 06:00
CRDT- 2012/02/01 06:00
PHST- 2011/08/17 00:00 [received]
PHST- 2011/10/26 00:00 [revised]
PHST- 2011/12/14 00:00 [accepted]
PHST- 2012/02/01 06:00 [entrez]
PHST- 2012/02/01 06:00 [pubmed]
PHST- 2012/08/08 06:00 [medline]
AID - S1053-2498(11)01260-5 [pii]
AID - 10.1016/j.healun.2011.12.011 [doi]
PST - ppublish
SO  - J Heart Lung Transplant. 2012 Apr;31(4):364-72. doi: 
      10.1016/j.healun.2011.12.011. Epub 2012 Jan 29.