Takeda et al identified a number of prognostic factors for patients with pulmonary arterial hypertension (PAH). A patient with severe heart failure may develop a cholestatic picture as a result of hepatic involvement. The authors are from Nagoya City University in Japan.


Patient selection: PAH without additional liver disease


Laboratory testing was performed in patients after a 3 month period free from hospitalization and without change in functional class, treatment or vital signs.


Hyperbilirubinemia (defined as a serum total bilirubin > 1.2 mg/dL or > 20.6 µmol/L) was found to be a significant predictor of mortality during the followup period (up to 3 years).


Additional prognostic factors:

(1) higher functional class (WHO functional class)

(2) high plasma concentration of brain natriuretic peptide (BNP)


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