老年肺动脉高压患者运动能力与血流动力学不匹配：台湾心脏病学会肺动脉高压注册研究（TAIPANS）的一项全国多中心研究
Exercise capacity-hemodynamics mismatch in elderly patients with pulmonary hypertension: A nationwide multicenter study from Taiwan Society of Cardiology Pulmonary Hypertension Registry (TAIPANS).
作者信息
Chen Chang-Ying, Mei-Tzu Wang, Sung Shih-Hsien, Wu Yih-Jer, Hsu Chih-Hsin, Ho Wan-Jing, Lin Yen-Hung, Liu Wei-Shin, Liu Ju-Chi, Kao Yung-Ta, Wu Wen-Shiann, Wu Chun-Hsien, Lei Meng-Huan, Chen Yu-Wei, Chen-Yu Chien, Chiu Yu-Wei, Dai Zen-Kong, Lin Tsung-Hsien, Lin Lin, Chung Cheng-Chih, Chung Chang-Min, Huang Sung-Hao, Cheng Chin-Chang, Wu Yen-Wen, Chao Ting-Hsing, Hwang Juey-Jen, Jia-Yin Hou Charles, Huang Wei-Chun
机构信息
Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
出版信息
Heliyon. 2024 Mar 11;10(6):e27537. doi: 10.1016/j.heliyon.2024.e27537. eCollection 2024 Mar 30.
BACKGROUND
Demographics of pulmonary hypertension (PH) has changed a lot over the past forty years. Several recent registries noted an increase in mean age of PH but only a few of them investigated the characteristics of elderly patients. Thus, we aimed to analyze the characteristics of PH in such a population in this study.
METHODS
This multicenter study enrolled patients diagnosed with PH in group 1, 3, 4, and 5 consecutively from January 1, 2019 to December 31, 2020. A total of 490 patients was included, and patients were divided into three groups by age (≤45 years, 45-65 years, and >65 years).
RESULTS
The mean age of PH patients diagnosed with PH was 55.3 ± 16.3 years of age. There was higher proportion of elderly patients classified as group 3 PH (≤45: 1.3, 45-65: 4.5, >65: 8.1 %; = 0.0206) and group 4 PH (≤45: 8.4, 45-65: 14.5, >65: 31.6 %; < 0.0001) than young patients. Elderly patients had shorter 6-min walking distance (6 MWD) (≤45 vs. >65, mean difference, 77.8 m [95% confidence interval (CI), 2.1-153.6 m]), lower mean pulmonary arterial pressure (mPAP) (≤45 vs. >65, mean difference, 10.8 mmHg [95% CI, 6.37-15.2 mmHg]), and higher pulmonary arterial wedge pressure (PAWP) (≤45 vs. 45-65, mean difference, -2.1 mmHg [95% CI, -3.9 to -0.3 mmHg]) compared to young patients. Elderly patients had a poorer exercise capacity despite lower mPAP level compared to young population, but they received combination therapy less frequently compared to young patients (triple therapy in group 1 PH, ≤45: 16.7, 45-65: 11.3, >65: 3.8 %; = 0.0005). Age older than 65 years was an independent predictor of high mortality for PH patients.
CONCLUSIONS
Elderly PH patients possess unique hemodynamic profiles and epidemiologic patterns. They had higher PAWP, lower mPAP, and received combination therapy less frequently. Moreover, ageing is a predictor of high mortality for PH patients. Exercise capacity-hemodynamics mismatch and inadequate treatment are noteworthy in the approach of elderly population with PH.
背景
在过去四十年中，肺动脉高压（PH）的人口统计学特征发生了很大变化。最近的几项登记研究指出，PH患者的平均年龄有所增加，但其中只有少数研究调查了老年患者的特征。因此，我们旨在分析本研究中这类人群的PH特征。
方法
这项多中心研究连续纳入了2019年1月1日至2020年12月31日期间诊断为1、3、4和5组PH的患者。共纳入490例患者，并根据年龄将患者分为三组（≤45岁、45 - 65岁和>65岁）。
结果
诊断为PH的患者平均年龄为55.3±16.3岁。与年轻患者相比 老年患者中3组PH（≤45岁：1.3%，45 - 65岁：4.5%，>65岁：8.1%；P = 0.0206）和4组PH（≤45岁：8.4%，45 - 65岁：14.5%，>65岁：31.6%；P < 0.0001）所占比例更高与年轻患者相比，老年患者的6分钟步行距离（6MWD）更短（≤45岁vs.>65岁，平均差值，77.8m[95%置信区间（CI），2.1 - 153.6m]），平均肺动脉压（mPAP）更低（≤45岁vs.>65岁，平均差值，10.8mmHg[95%CI，6.37 - 15.2mmHg]），肺动脉楔压（PAWP）更高（≤45岁vs.45 - 65岁，平均差值， - 2.1mmHg[95%CI， - 3.9至 - 0.3mmHg]）。尽管老年患者的mPAP水平低于年轻人群，但其运动能力较差，但与年轻患者相比，他们接受联合治疗的频率较低（1组PH中的三联疗法，≤45岁：16.7%，45 - 65岁：11.3%，>65岁：3.8%；P = 0.0005）。65岁以上是PH患者高死亡率的独立预测因素。
结论
老年PH患者具有独特的血流动力学特征和流行病学模式。他们的PAWP较高，mPAP较低，接受联合治疗的频率较低。此外，年龄增长是PH患者高死亡率的预测因素。在老年PH患者的治疗中，运动能力与血流动力学不匹配以及治疗不足值得关注。
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