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Comorbidity Burden in Chronic Thromboembolic Pulmonary Hypertension: Implications and Outcome
Burcak Kilickiran Avci1, Ibrahim Basarici2, Mehmet Akbulut3
1Department of Cardiology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul 34098, Turkey.
Insights
Comorbidities are common in chronic thromboembolic pulmonary hypertension (CTEPH) and affect patient health and treatment choices. Managing these conditions is crucial, especially for those undergoing pulmonary endarterectomy (PEA).
Area of Science:
- Cardiology
- Pulmonary Medicine
- Clinical Outcomes Research
Background:
- Comorbidities (coexisting conditions) complicate management and outcomes in chronic diseases.
- Chronic thromboembolic pulmonary hypertension (CTEPH) management is impacted by comorbidities, but their specific influence is understudied.
- Understanding comorbidity burden is essential for optimizing CTEPH patient care.
Purpose of the Study:
- To determine the prevalence and burden of comorbidities in CTEPH patients.
- To analyze associations between comorbidities and clinical presentation, treatment decisions, and survival.
- To stratify findings based on pulmonary endarterectomy (PEA) status.
Main Methods:
- Retrospective analysis of 187 CTEPH patients from eight centers (2009-2020).
- Identification and categorization of cardiovascular and non-cardiovascular comorbidities (0, 1-2, or ≥3).
- Assessment of comorbidity impact on six-minute walk distance (6MWD), hemodynamics, operability, and survival.
Main Results:
- 90% of CTEPH patients had comorbidities; 49% had ≥3.
- Comorbidities like hypertension and CKD correlated with lower 6MWD and worse hemodynamics.
- Comorbidities disqualified 39% of operable patients from PEA; ≥3 cardiovascular comorbidities worsened survival post-PEA.
- PEA surgery and baseline 6MWD independently predicted mortality.
Conclusions:
- High comorbidity burden is prevalent in CTEPH, affecting functional status, hemodynamics, and surgical eligibility.
- Comorbidities negatively impact long-term survival after PEA but are less prognostic in non-operated patients.
- Careful operability assessment and proactive comorbidity management are vital for CTEPH patients.
Abstract:
Background and Objectives: Comorbidities, the coexistence of additional conditions with a primary disease, are increasingly prevalent, complicating disease management and clinical outcomes. While CTEPH is a well-studied condition in terms of risk factors and outcomes, the specific impact of comorbidity burden on clinical presentation, treatment decisions, and survival remains insufficiently explored. This study aims to assess the prevalence and burden of comorbidities in CTEPH and to examine their associations with initial clinical characteristics, treatment allocation, and survival, stratified by pulmonary endarterectomy (PEA) status. Materials and Methods: We included 187 CTEPH patients from eight tertiary PH centers (2009-2020). Cardiovascular and non-cardiovascular comorbidities were identified and categorized as 0, 1-2, or ≥3. Their impact on baseline six-minute walk distance (6MWD), hemodynamic parameters, operability decision, and survival was assessed. Results: Comorbidities were prevalent (90%), with 49% of patients having three or more. Hypertension, diabetes, coronary artery disease, and chronic kidney disease (CKD) were associated with lower 6MWD. Hypertension, atrial fibrillation, left heart failure, and CKD were linked to elevated right atrial and pulmonary arterial wedge pressures. Comorbidities rendered 39% of anatomically operable patients ineligible for surgery. No single comorbidity predicted survival. Among PEA patients, those with ≥3 cardiovascular comorbidities had worse survival (p = 0.010). In contrast, the comorbidity burden did not impact survival in non-PEA patients. PEA surgery (HR 0.342, 95% CI 0.130-0.899, p = 0.030) and baseline 6MWD (HR 0.997, 95% CI 0.994-1.000, p = 0.036) were identified as independent predictors of mortality. Conclusions: A high comorbidity burden is common in CTEPH and influences functional status, hemodynamics, and operability decisions. It may worsen long-term outcomes after PEA but appears to be less prognostic in non-operated patients, where disease severity seems to be the primary determinant of outcomes. These findings underscore the importance of careful operability assessment and proactive comorbidity management.
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