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Pulmonary Arterial Hypertension in the Elderly-Clinical Characteristics and Long-Term Survival

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Abstract

Background

Recent registries describe a significant prevalence of pulmonary arterial hypertension (PAH) in the elderly, but little is known of their characteristics. We aimed to examine the features and prognostic factors of long-term survival in elderly (≥65 years) PAH patients.

Methods

Clinical, echocardiographic, angiographic, hemodynamic, treatments, and survival data were reviewed in consecutive patients over the course of 20 years. Elderly PAH patients (n = 47) were compared to younger PAH patients (n = 107).

Results

At presentation, elderly patients were more likely to have hypertension, diabetes, dyslipidemia, coronary disease, and PAH associated with scleroderma (42.6 vs. 24.3 %; p = 0.02) than younger patients. Prior to PAH therapy, elderly patients had better right ventricular myocardial performance index (RV-MPI; 0.48 ± 0.20 vs. 0.62 ± 0.23, p = 0.006) and lower mean pulmonary arterial pressure (PAP; 45.0 ± 11.1 vs. 49.2 ± 11.8 mmHg, p = 0.04). Elderly patients were treated less often with epoprostenol (8.5 vs. 29 %, p = 0.006) or trepostinil (8.5 vs. 23.4 %, p = 0.04). The 1, 3, and 5 year survival rates of elderly patients were estimated to be 76.4, 50.5, and 37.6 %, respectively. In comparison, younger patients had survival estimates of 92.2, 74.2 and 64.0 % (p = 0.002). Baseline right atrial pressure, mean PAP, cardiac index, and RV-MPI were associated with survival in elderly patients; however in these patients, survival was not affected by any PAH subgroup or age (per year) by itself.

Conclusions

The diagnosis of PAH in elderly patients is associated with poorer survival which is in part explained by a greater vulnerability to the hemodynamic disturbances of PAH.

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Acknowledgments

This study was supported in part by the Bank of Montreal Center for the Study of Heart Disease in Women at the Jewish General Hospital and the Demitrios Banousis Family Foundation. Dr. Shimony was supported by the Azrieli Foundation and by a Susan Raymer Cardiology Fellowship Grant. Dr. Fox was supported in part by the William Pencer Family Foundation.

Conflict of Interest

None for all authors.

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Authors and Affiliations

  1. Center for Pulmonary Vascular Disease and Divisions of Cardiology and Respirology, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, QC, Canada

    Avi Shimony, Benjamin D. Fox, Jonathan Afilalo, Lawrence G. Rudski, Andrew Hirsch & David Langleben

  2. Division of Cardiology, Jewish General Hospital, 3755 Cote Ste. Catherine, Room E-206, Montreal, QC, H3T 1E2, Canada

    David Langleben

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  1. Avi Shimony
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  2. Benjamin D. Fox
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  3. Jonathan Afilalo
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  4. Lawrence G. Rudski
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  5. Andrew Hirsch
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  6. David Langleben
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Correspondence to David Langleben.

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Shimony, A., Fox, B.D., Afilalo, J. et al. Pulmonary Arterial Hypertension in the Elderly-Clinical Characteristics and Long-Term Survival. Lung 190, 645–649 (2012). https://doi.org/10.1007/s00408-012-9425-5

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  • DOI: https://doi.org/10.1007/s00408-012-9425-5

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