Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MA.
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.
Chest. 2024 Jun;165(6):1493-1504. doi: 10.1016/j.chest.2024.02.009. Epub 2024 Feb 12.
Health-related quality of life (HRQOL) is frequently impaired in pulmonary arterial hypertension. However, little is known about HRQOL in other forms of pulmonary hypertension (PH).
Does HRQOL vary across groups of the World Symposium on Pulmonary Hypertension (WSPH) classification system?
This cross-sectional study included patients with PH from the Pulmonary Vascular Disease Phenomics (PVDOMICS) cohort study. HRQOL was assessed by using emPHasis-10 (e-10), the 36-item Medical Outcomes Study Short Form survey (physical component score [PCS] and mental component score), and the Minnesota Living with Heart Failure Questionnaire. Pearson correlations between HRQOL and demographic, physiologic, and imaging characteristics within each WSPH group were tested. Multivariable linear regressions compared HRQOL across WSPH groups, adjusting for demographic characteristics, disease prevalence, functional class, and hemodynamics. Cox proportional hazards models were used to assess associations between HRQOL and survival across WSPH groups.
Among 691 patients with PH, HRQOL correlated with functional class and 6-min walk distance but not hemodynamics. HRQOL was severely depressed across WSPH groups for all measures except the 36-item Medical Outcomes Study Short Form survey mental component score. Compared with Group 1 participants, Group 2 participants had significantly worse HRQOL (e-10 score, 29 vs 24 [P = .001]; PCS, 32.9 ± 8 vs 38.4 ± 10 [P < .0001]; and Minnesota Living with Heart Failure Questionnaire score, 50 vs 38 [P = .003]). Group 3 participants similarly had a worse e-10 score (31 vs 24; P < .0001) and PCS (33.3 ± 9 vs 38.4 ± 10; P < .0001) compared with Group 1 participants, which persisted in multivariable models (P < .05). HRQOL was associated in adjusted models with survival across Groups 1, 2, and 3.
HRQOL was depressed in PH and particularly in Groups 2 and 3 despite less severe hemodynamics. HRQOL is associated with functional capacity, but the severity of hemodynamic disease poorly estimates the impact of PH on patients' lives. Further studies are needed to better identify predictors and treatments to improve HRQOL across the spectrum of PH.
健康相关生活质量（HRQOL）在肺动脉高压中经常受损。然而，对于其他形式的肺动脉高压（PH）的 HRQOL 知之甚少。
HRQOL 是否在世界肺动脉高压研讨会（WSPH）分类系统的组间存在差异？
本横断面研究纳入了来自肺血管疾病表型学（PVDOMICS）队列研究的 PH 患者。使用 emPHasis-10（e-10）、36 项医疗结果研究短表（身体成分评分[PCS]和精神成分评分）和明尼苏达州心力衰竭生活质量问卷评估 HRQOL。在每个 WSPH 组内，测试 HRQOL 与人口统计学、生理和影像学特征之间的 Pearson 相关性。多变量线性回归比较了 WSPH 组之间的 HRQOL，调整了人口统计学特征、疾病流行率、功能分类和血液动力学。Cox 比例风险模型用于评估 WSPH 组之间的 HRQOL 与生存之间的关联。
在 691 名 PH 患者中，HRQOL 与功能分类和 6 分钟步行距离相关，但与血液动力学无关。除了 36 项医疗结果研究短表精神成分评分外，WSPH 组的 HRQOL 均严重受损。与第 1 组参与者相比，第 2 组参与者的 HRQOL 明显更差（e-10 评分，29 对 24 [P =.001]；PCS，32.9 ± 8 对 38.4 ± 10 [P <.0001]；明尼苏达州心力衰竭生活质量问卷评分，50 对 38 [P =.003]）。第 3 组参与者的 e-10 评分（31 对 24；P <.0001）和 PCS（33.3 ± 9 对 38.4 ± 10；P <.0001）也明显差于第 1 组参与者，这在多变量模型中仍然存在（P <.05）。在调整模型中，HRQOL 与第 1、2 和 3 组的生存相关。
PH 患者的 HRQOL 下降，尤其是第 2 和第 3 组，尽管血液动力学疾病较轻。HRQOL 与功能能力相关，但血液动力学疾病的严重程度并不能很好地估计 PH 对患者生活的影响。需要进一步研究以更好地确定预测因素和治疗方法，以改善 PH 谱中患者的 HRQOL。
