Zusammenfassung
BackgroundThe number of elderly patients diagnosed with idiopathic pulmonary arterial hypertension (IPAH) is increasing. A 6-min walk distance (6MWD) >380m on therapy is associated with improved survival in IPAH. As exercise capacity is naturally decreasing with age, treatment goals for elderly patients might be different from those established for younger patients. MethodsConsecutive adult ...
Zusammenfassung
BackgroundThe number of elderly patients diagnosed with idiopathic pulmonary arterial hypertension (IPAH) is increasing. A 6-min walk distance (6MWD) >380m on therapy is associated with improved survival in IPAH. As exercise capacity is naturally decreasing with age, treatment goals for elderly patients might be different from those established for younger patients. MethodsConsecutive adult patients diagnosed with IPAH between 1/2005 and 7/2012 were retrospectively included. We analysed the prognostic value of 6MWD targets (in metres and % predicted) with respect to age at diagnosis. ResultsThe mean (SD) 6MWD in 23 patients aged >65years at diagnosis compared with 22 younger patients was significantly lower at baseline (262 +/- 69 vs. 356 +/- 128m; p=0.011) and first follow up (310 +/- 75 vs. 377 +/- 137m; p=0.045), while the corresponding % predicted values were similar (62 +/- 16% vs. 63 +/- 21%; p=0.854, and 74 +/- 16% vs. 68 +/- 21%; p=0.267). The established treatment target of >380m 6MWD was met by only 13% of elderly compared with 46% of younger patients (p=0.016), while the corresponding 6MWD of 78% predicted was exceeded by similar proportions (48% and 46%, respectively; p=0.873). Survival of patients walking >380m or 78% predicted on first follow up was significantly better compared with patients not exceeding the respective threshold (100% vs. 72% and 95% vs. 67% at the end of follow up, respectively; p<0.05 each). ConclusionExpression of the 6MWD target as % predicted equalises age-related differences and has similar prognostic power compared with absolute values in patients with IPAH. As elderly patients are less likely to reach the absolute 6MWD threshold, the use of % predicted could be helpful in their individual assessment and adaption of targeted therapy.
Altmetric