Stefano Barco1, Frederikus A Klok1,2, Stavros V Konstantinides1,3, Philippe Dartevelle4, Elie Fadel5, David Jenkins6, Nick H Kim7, Michael Madani8, Hiromi Matsubara9, Eckhard Mayer10, Joanna Pepke-Zaba11, Gérald Simonneau12, Marion Delcroix13, Irene M Lang14. 1. Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University, Mainz, Germany. 2. Department of Medicine - Thrombosis & Hemostasis, Leiden University Medical Center, Leiden, the Netherlands. 3. Department of Cardiology, Democritus University of Thrace, University General Hospital, Alexandroupolis, Greece. 4. Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, Paris-Sud University, Paris, France. 5. Faculté de Médecine, University Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France. 6. Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK. 7. Division of Pulmonary and Critical Care Medicine, University of California, San Diego, CA, USA. 8. Division of Cardiovascular and Thoracic Surgery, University of California, San Diego, CA, USA. 9. Department of Clinical Science, National Hospital Organization Okayama Medical Center, Okayama, Japan. 10. Kerckhoff Heart and Lung Center, Bad Nauheim, Germany. 11. Pulmonary Vascular Disease Unit, Papworth Hospital, Cambridge, UK. 12. Assistance Publique-Hôpitaux de Paris, Service de Pneumologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France. 13. Department of Pneumology, University Hospitals Leuven, Leuven, Belgium. 14. Department of Internal Medicine II, Division of Cardiology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.
Abstract
BACKGROUND: Women are more susceptible than men to several forms of pulmonary hypertension, but have better survival. Sparse data are available on chronic thromboembolic pulmonary hypertension (CTEPH). METHODS: We investigated sex-specific differences in the clinical presentation of CTEPH, performance of pulmonary endarterectomy (PEA), and survival. RESULTS: Women constituted one-half of the study population of the European CTEPH registry (N = 679) and were characterized by a lower prevalence of some cardiovascular risk factors, including prior acute coronary syndrome, smoking habit, and chronic obstructive pulmonary disease, but more prevalent obesity, cancer, and thyroid diseases. The median age was 62 (interquartile ratio, 50-73) years in women and 63 (interquartile ratio, 53-70) in men. Women underwent PEA less often than men (54% vs 65%), especially at low-volume centers (48% vs 61%), and were exposed to fewer additional cardiac procedures, notably coronary artery bypass graft surgery (0.5% vs 9.5%). The prevalence of specific reasons for not being operated, including patient's refusal and the proportion of proximal vs distal lesions, did not differ between sexes. A total of 57 (17.0%) deaths in women and 70 (20.7%) in men were recorded over long-term follow-up. Female sex was positively associated with long-term survival (adjusted hazard ratio, 0.66; 95% confidence interval, 0.46-0.94). Short-term mortality was identical in the two groups. CONCLUSIONS: Women with CTEPH underwent PEA less frequently than men, especially at low-volume centers. Furthermore, they had a lower prevalence of cardiovascular risk factors and were less often exposed to additional cardiac surgery procedures. Women had better long-term survival.
BACKGROUND:Women are more susceptible than men to several forms of pulmonary hypertension, but have better survival. Sparse data are available on chronic thromboembolic pulmonary hypertension (CTEPH). METHODS: We investigated sex-specific differences in the clinical presentation of CTEPH, performance of pulmonary endarterectomy (PEA), and survival. RESULTS:Women constituted one-half of the study population of the European CTEPH registry (N = 679) and were characterized by a lower prevalence of some cardiovascular risk factors, including prior acute coronary syndrome, smoking habit, and chronic obstructive pulmonary disease, but more prevalent obesity, cancer, and thyroid diseases. The median age was 62 (interquartile ratio, 50-73) years in women and 63 (interquartile ratio, 53-70) in men. Women underwent PEA less often than men (54% vs 65%), especially at low-volume centers (48% vs 61%), and were exposed to fewer additional cardiac procedures, notably coronary artery bypass graft surgery (0.5% vs 9.5%). The prevalence of specific reasons for not being operated, including patient's refusal and the proportion of proximal vs distal lesions, did not differ between sexes. A total of 57 (17.0%) deaths in women and 70 (20.7%) in men were recorded over long-term follow-up. Female sex was positively associated with long-term survival (adjusted hazard ratio, 0.66; 95% confidence interval, 0.46-0.94). Short-term mortality was identical in the two groups. CONCLUSIONS:Women with CTEPH underwent PEA less frequently than men, especially at low-volume centers. Furthermore, they had a lower prevalence of cardiovascular risk factors and were less often exposed to additional cardiac surgery procedures. Women had better long-term survival.
Authors: Pavel Jansa; David Ambrož; Matyáš Kuhn; Vladimír Dytrych; Michael Aschermann; Vladimír Černý; Virginie Gressin; Samuel Heller; Jan Kunstýř; Michal Širanec; Ci Song; Aleš Linhart; Jaroslav Lindner; Audrey Muller Journal: Pulm Circ Date: 2022-03-28 Impact factor: 2.886