Kubota Kayoko, Miyanaga Sunao, Akao Mitsumasa, Mitsuyoshi Kokoro, Iwatani Noriko, Higo Kenjuro, Ohishi Mitsuru
Departments of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
Departments of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
J Cardiol. 2024 Jun;83(6):365-370. doi: 10.1016/j.jjcc.2023.08.004. Epub 2023 Aug 12.
Currently, pulmonary hypertension-targeted therapy has been shown to improve the survival of patients with pulmonary artery hypertension (PAH). However, the importance of early diagnosis has not been investigated. Therefore, this study aimed to investigate whether a delayed diagnosis of PAH is associated with its prognosis.
A total of 66 consecutive untreated patients were diagnosed with PAH from January 2008 to December 2021 at the Kagoshima University Hospital. The time from symptom onset to diagnosis correlated with brain natriuretic peptide levels (p < 0.001), right ventricle (RV) Tei index (p < 0.001), and the tricuspid annular plane systolic excursion/systolic pulmonary artery pressure ratio (p = 0.003). These findings suggest that in patients with PAH, RV function declines with increasing time from symptom onset to diagnosis. Furthermore, older patients with PAH appeared to have a longer time from symptom onset to diagnosis. Next, patients were divided into delayed diagnosis (>3 months) and early diagnosis (≤3 months) groups based on the time from symptom onset to diagnosis. Patients were categorized into three groups according to the European Society of Cardiology (or the European Respiratory Society) risk stratification guidelines. Patients diagnosed with PAH within 3 months of symptom onset were significantly in the low- or intermediate-risk groups (p < 0.001). A Kaplan-Meier analysis revealed that the cumulative event-free rate was significantly lower (p < 0.01) in the delayed diagnosis group than in the early diagnosis group. A delayed diagnosis was significantly associated with a worse outcome than an early diagnosis, after adjusting for different sets of confounding factors.
A delayed PAH diagnosis is associated with a poor prognosis. Early diagnosis of PAH may lead to a low-risk treatment. Furthermore, older patients need more careful screening for PAH.
目前，肺动脉高压靶向治疗已被证明可提高肺动脉高压（PAH）患者的生存率。然而，早期诊断的重要性尚未得到研究。因此，本研究旨在调查PAH延迟诊断是否与其预后相关。
2008年1月至2021年12月期间，鹿儿岛大学医院共有66例未经治疗的连续患者被诊断为PAH。从症状出现到诊断的时间与脑钠肽水平（p<0.001）、右心室（RV）Tei指数（p<0.001）以及三尖瓣环平面收缩期位移/收缩期肺动脉压比值（p=0.003）相关。这些发现表明，在PAH患者中，从症状出现到诊断的时间越长，RV功能下降越明显。此外，PAH老年患者从症状出现到诊断的时间似乎更长。接下来，根据从症状出现到诊断的时间，将患者分为延迟诊断组（>3个月）和早期诊断组（≤3个月）。根据欧洲心脏病学会（或欧洲呼吸学会）风险分层指南，将患者分为三组。症状出现后3个月内诊断为PAH的患者显著处于低风险或中风险组（p<0.001）。Kaplan-Meier分析显示，延迟诊断组的累积无事件发生率显著低于早期诊断组（p<0.01）。在调整了不同的混杂因素后，延迟诊断与比早期诊断更差的结果显著相关。
PAH延迟诊断与不良预后相关。PAH的早期诊断可能导致低风险治疗。此外，老年患者需要更仔细地筛查PAH。
