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The Journal of Cardiovascular Surgery 2012 December;53(6):817-20


lingua: Inglese

Pulmonary hypertension is associated with higher mortality in cystic fibrosis patients awaiting lung transplantation

Venuta F. 1, Tonelli A. R. 2, Anile M. 1, Diso D. 1, De Giacomo T. 1, Ruberto F. 2, Russo E. 1, Rolla M. 4, Quattrucci S. 4, Rendina E. A. 1, Li Phd N. 5, Coloni G. F. 1

1 Department of Thoracic Surgery, La Sapienza University of Rome, Rome, Italy; 2 Division of Pulmonary, Critical Care and Sleep Medicine Department of Internal Medicine, University of Florida, Gainesville, FL, USA; 3 Intensive Care Unit; La Sapienza University of Rome, Rome, Italy; 4 Cystic Fibrosis Unit, La Sapienza University of Rome, Rome, Italy; 5 Biostatistics Core, Samuel Oschin Comprehensive Cancer Institutem, Cedars-Sinai Medical Center, Los Angeles, CA, USA


AIM: Pulmonary hypertension (PH) is frequently found in patients with advanced parenchymal lung diseases. In advanced stages, cystic fibrosis (CF) patients can develop PH and eventually cor pulmonale. Little is known about the prevalence of PH in CF patients and its impact on outcome.
METHODS: We retrospectively studied a large cohort of CF patients evaluated for lung transplantation between 1995 and 2010. All the patients underwent right heart catheterization as part of the evaluation. We included 179 unique consecutive adult CF patients. Age was 24±9 years and 45.8% were women.
RESULTS: Eighty-seven patients were transplanted (48.6%) and 65 died (36.3%) while waiting for LT. By right heart catheterization, 38.5% of the patients had PH (mean ≥25 mm Hg). PaCO2 (P=0.045) and forced vital capacity (P=0.023) were independent predictors of PH in CF patients. The median survival (free of lung transplantation) was 13.4 months. After adjusting for several covariates, the presence of PH significantly increased mortality (hazard ratio, HR) (P<0.001). Pulmonary vascular resistance was associated with mortality (P=0.03). When both PH and PVR were included in the model, only PH predicted mortality.
CONCLUSION: Pulmonary hypertension of mild degree is frequently found in CF patients with advanced lung disease and its presence significantly worsens survival.

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