Jacqueline T DesJardin1, Nicholas A Kolaitis2, Noah Kime3, Richard A Kronmal3, Raymond L Benza4, Jean M Elwing5, Matthew R Lammi6, John W McConnell7, Kenneth W Presberg8, Jeffrey S Sager9, Oksana A Shlobin10, Teresa De Marco2. 1. Department of Medicine, University of California, San Francisco, San Francisco, California. Electronic address: jacqueline.desjardin@ucsf.edu. 2. Department of Medicine, University of California, San Francisco, San Francisco, California. 3. Department of Biostatistics, University of Washington, Seattle, Washington. 4. Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, Pennsylvania. 5. Department of Medicine, University of Cincinnati, Cincinnati, Ohio. 6. Comprehensive Pulmonary Hypertension Center - University Medical Center, Louisiana State University, New Orleans, Louisiana. 7. Kentuckiana Pulmonary Associates, Louisville, Kentucky. 8. Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. 9. Cottage Health Pulmonary Hypertension Center, Cottage Health, Santa Barbara, California. 10. Inova Fairfax Medical Center, Inova Medical Group, Falls Church, Virginia.
Abstract
BACKGROUND: The age of patients with pulmonary arterial hypertension (PAH) has increased, with registries now reporting mean ages of 50 to 65 years old. Limited data exist on age-related differences in hemodynamic and functional assessments in PAH. METHODS: Adults with PAH in the Pulmonary Hypertension Association Registry were divided into 3 groups (18-50, 51-65, and >65 years old). Analysis of variance and chi-square testing were used to assess for baseline differences. Linear regression was used to examine the association of age with continuous hemodynamic and functional variables. RESULTS: A total of 769 patients with mean age of 56 ± 16 years were included. Older patients had more connective tissue disease-associated PAH and less drug-associated PAH. In linear regression models, each year of increased age was associated with shorter 6-minute walk distance (-3.37 meters; 95% CI, -3.97 to -2.76), lower mean pulmonary arterial pressure (-0.21 mm Hg; 95% CI, -0.27 to -0.15), and lower pulmonary vascular resistance (-0.06 Wood units; 95% CI, -0.09 to -0.04). Pulmonary arterial compliance, cardiac index, right ventricular stroke work index, and percent predicted 6-minute walk distance were unrelated to age; resistance-compliance time was negatively related to age (-3 milliseconds per year; 95% CI, -4 to -2). CONCLUSIONS: Relative to their pulmonary vascular resistance, older patients have lower pulmonary artery compliance and worse right ventricular performance. Based on these findings, we suspect that age influences right ventricular loading conditions and the response of the right ventricle to increased afterload. Published by Elsevier Inc.
BACKGROUND: The age of patients with pulmonary arterial hypertension (PAH) has increased, with registries now reporting mean ages of 50 to 65 years old. Limited data exist on age-related differences in hemodynamic and functional assessments in PAH. METHODS: Adults with PAH in the Pulmonary Hypertension Association Registry were divided into 3 groups (18-50, 51-65, and >65 years old). Analysis of variance and chi-square testing were used to assess for baseline differences. Linear regression was used to examine the association of age with continuous hemodynamic and functional variables. RESULTS: A total of 769 patients with mean age of 56 ± 16 years were included. Older patients had more connective tissue disease-associated PAH and less drug-associated PAH. In linear regression models, each year of increased age was associated with shorter 6-minute walk distance (-3.37 meters; 95% CI, -3.97 to -2.76), lower mean pulmonary arterial pressure (-0.21 mm Hg; 95% CI, -0.27 to -0.15), and lower pulmonary vascular resistance (-0.06 Wood units; 95% CI, -0.09 to -0.04). Pulmonary arterial compliance, cardiac index, right ventricular stroke work index, and percent predicted 6-minute walk distance were unrelated to age; resistance-compliance time was negatively related to age (-3 milliseconds per year; 95% CI, -4 to -2). CONCLUSIONS: Relative to their pulmonary vascular resistance, older patients have lower pulmonary artery compliance and worse right ventricular performance. Based on these findings, we suspect that age influences right ventricular loading conditions and the response of the right ventricle to increased afterload. Published by Elsevier Inc.
Authors: Nicholas A Kolaitis; Roham T Zamanian; Vinicio A de Jesus Perez; David B Badesch; Raymond L Benza; Charles D Burger; Murali M Chakinala; Jean M Elwing; Jeremy Feldman; Matthew R Lammi; Stephen C Mathai; John W McConnell; Kenneth W Presberg; Jeffrey C Robinson; Jeffrey Sager; Oksana A Shlobin; Marc A Simon; Steven M Kawut; David V Glidden; Jonathan P Singer; Teresa De Marco Journal: Ann Am Thorac Soc Date: 2021-04
Authors: Jasleen Minhas; Sai Prasanna Narasimmal; Todd M Bull; Teresa De Marco; John Wesley McConnell; Matthew R Lammi; Thenappan Thenappan; Jeremy P Feldman; Jeffrey S Sager; David B Badesch; John J Ryan; Daniel C Grinnan; Dianne Zwicke; Evelyn M Horn; Jean M Elwing; John E Moss; Michael Eggert; Oksana A Shlobin; Robert P Frantz; Sonja D Bartolome; Stephen C Mathai; Sula Mazimba; Steven C Pugliese; Nadine Al-Naamani Journal: Pulm Circ Date: 2021-10-14 Impact factor: 2.886