Gong et al reported prognostic factors for a patient with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). These can help to identify a patient who may require more aggressive management. The authors are from Capital Medical University, China-Japan Friendship Hospital, and Key Laboratory of Respiratory and Pulmonary Circulation Disorders in Beijing, China.
Patient selection: inoperable chronic thromboembolic pulmonary hypertension (CTEPH)
Criteria for CTEPH:
(1) mean pulmonary artery pressure >= 25 mm Hg
(2) pulmonary artery wedge pressure < 15 mm Hg
(3) chronic thromboemboli in pulmonary artery (on V-P lung scan, CT angiography, etc)
(4) exclusion of other types of pulmonary hypertension
Features of inoperable CTEPH:
(1) predominant distal pulmonary arteriopathy
(2) imbalance between severity of pulmonary hypertension and morphologic lesion
(3) pulmonary vascular resistance > 1,500 dyn•s•cm^(-5)
(4) older age and severe comorbidities
Outcome: overall survival
Parameters:
(1) serum total bilirubin in µmol/L
(2) 6-minute walking distance in meters (6MWD)
Predictors of worse survival:
(1) serum total bilirubin >= 23.7 µmol/L (HR 4.76)
(2) shorter 6 MWD (HR 0.994; survivors 260 to 470 m; non-survivors 165 to 309 m)
The 5-year cumulative survival was 78% for low serum total bilirubin and 17% for high.
A 6MWD < 260 m is poor; a 6MWD 260 to 309 m is fair; a 6MWD > 309 m is good.
