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2014 ; 146
(1
): 159-166
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Causes of pulmonary hypertension in the elderly
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Pugh ME
; Sivarajan L
; Wang L
; Robbins IM
; Newman JH
; Hemnes AR
Chest
2014[Jul]; 146
(1
): 159-166
PMID24480915
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BACKGROUND: Pulmonary hypertension (PH) is common in elderly patients, but a
detailed analysis of the causes of PH in the elderly has not been performed. We
hypothesized that pulmonary arterial hypertension (PAH) is rare in elderly
patients and sought to describe the characteristics of these patients at a large
referral center. METHODS: Clinical and hemodynamic data were collected on
consecutive patients ? 65 years of age referred for evaluation of PH. The subtype
of PH was determined after standard evaluation using the World Health
Organization (WHO) classification. Patients with PH not meeting criteria for PAH
with "out-of-proportion" PH related to group 2 or group 3 disease were classified
as "other/mixed PH." A model using age, presence of connective tissue disease,
and left atrial size was developed to predict the probability of PAH diagnosis.
RESULTS: Two hundred forty-six elderly patients were evaluated (mean age, 72.9 ±
5.5 years, 78% women); 36 had PAH (15%). Idiopathic PAH was rare (four patients,
1.6%). WHO group 2 PH was the most frequent diagnosis (n = 70, 28% of cohort);
mixed/other PH (n = 43, 17%) and WHO group 3 PH (n = 34, 14%) were also common
diagnoses. Connective tissue disease strongly predicted PAH diagnosis (OR, 27.2;
95% CI, 9.5-77.6). CONCLUSIONS: PAH is an uncommon cause of PH in elderly
patients, most frequently associated with connective tissue disease. WHO group 2
PH and mixed disease are common, highlighting a need for careful phenotyping of
elderly patients with PH prior to initiating PAH therapy.
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