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Article

Left Heart Disease Phenotype in Elderly Patients with Pulmonary Arterial Hypertension: Insights from the Italian PATRIARCA Registry

by
Matteo Toma
1,
Roberta Miceli
2,
Edoardo Bonsante
3,
Davide Colombo
4,
Marco Confalonieri
5,
Andrea Garascia
6,
Stefano Ghio
4,
Mariangela Lattanzio
7,
Carlo Maria Lombardi
8,9,
Giuseppe Paciocco
10,
Cristina Piccinino
11,
Irene Rota
12,
Caterina Santolamazza
6,
Laura Scelsi
4,
Piermario Scuri
13,
Davide Stolfo
14,15,
Antonella Vincenzi
16,
Lorenzo Volpiano
10,
Marco Vicenzi
12,17 and
Pietro Ameri
1,18,*
1
Cardiovascular Disease Unit, Cardiac, Vascular, and Thoracic Department, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genova, Italy
2
Cardiovascular Disease Unit, Ente Ospedaliero Ospedali Galliera, Mura delle Cappuccine 14, 16128 Genova, Italy
3
Cardiology Unit, Ospedale di Bolzano, 39100 Bolzano, Italy
4
Cardiology Unit, Fondazione IRCCS Policlinico San Matteo Pavia, 27100 Pavia, Italy
5
Department of Pulmonology, University Hospital of Cattinara, Strada di Fiume 447, 34149 Trieste, Italy
6
De Gasperis Cardio Center, Niguarda Hospital, 20162 Milano, Italy
7
Cardiology Unit, Department of Heart and Vessels, Ospedale di Circolo & Fondazione Macchi, 21100 Varese, Italy
8
Cardiology Unit, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
9
Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, 25123 Brescia, Italy
10
Pulmonary Unit, Cardio-Thoracic and Vascular Department, Milano Bicocca University, San Gerardo Hospital, 20126 Milano, Italy
11
Division of Cardiology, “Maggiore della Carità” Hospital, Corso Mazzini 18, 28100 Novara, Italy
12
Cardiovascular Disease Unit, Internal Medicine Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
13
Cardiology Unit, Cardiovascular Department, ASST- Ospedale Papa Giovanni XXIII, 24127 Bergamo, Italy
14
Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University Hospital of Trieste, 34129 Trieste, Italy
15
Division of Cardiology, Department of Medicine, Karolinska Institutet, 17177 Stockholm, Sweden
16
Department of Cardiology, San Gerardo Hospital, 20900 Monza, Italy
17
Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milano, Italy
18
Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
 
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Author to whom correspondence should be addressed.
J. Clin. Med. 2022, 11(23), 7136; https://doi.org/10.3390/jcm11237136
Submission received: 30 October 2022 / Revised: 14 November 2022 / Accepted: 28 November 2022 / Published: 30 November 2022
(This article belongs to the Special Issue Pulmonary Arterial Hypertension: Old Drugs and New Treatment Strategies)
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Abstract

Pulmonary arterial hypertension (PAH) in the elderly is often associated with left heart disease (LHD), prompting concerns about the use of pulmonary vasodilators. The PATRIARCA registry enrolled ≥70 year-old PAH or chronic thromboembolic pulmonary hypertension (CTEPH) patients at 11 Italian centers from 1 December 2019 through 15 September 2022. After excluding those with CTEPH, post-capillary PH at the diagnostic right heart catheterization (RHC), and/or incomplete data, 23 (33%) of a total of 69 subjects met the criteria proposed in the AMBITION trial to suspect LHD. Diabetes [9 (39%) vs. 6 (13%), p = 0.01] and chronic kidney disease [14 (61%) vs. 12 (26%), p = 0.003] were more common, and the last RHC pulmonary artery wedge pressure [14 ± 5 vs. 10 ± 3 mmHg, p < 0.001] was higher and pulmonary vascular resistance [5.56 ± 3.31 vs. 8.30 ± 4.80, p = 0.02] was lower in LHD than non-LHD patients. However, PAH therapy was similar, with 13 (57%) and 23 (50%) subjects, respectively, taking two oral drugs. PAH medication patterns remained comparable between LHD and non-LHD patients also when the former [37, 54%] were identified by atrial fibrillation and echocardiographic features of LHD, in addition to the AMBITION criteria. In this real-world snapshot, elderly PAH patients were treated with pulmonary vasodilators, including combinations, despite a remarkable prevalence of a LHD phenotype.
Keywords: pulmonary hypertension; elderly; left heart disease; comorbidity; vasodilator pulmonary hypertension; elderly; left heart disease; comorbidity; vasodilator

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MDPI and ACS Style

Toma, M.; Miceli, R.; Bonsante, E.; Colombo, D.; Confalonieri, M.; Garascia, A.; Ghio, S.; Lattanzio, M.; Lombardi, C.M.; Paciocco, G.; et al. Left Heart Disease Phenotype in Elderly Patients with Pulmonary Arterial Hypertension: Insights from the Italian PATRIARCA Registry. J. Clin. Med. 2022, 11, 7136. https://doi.org/10.3390/jcm11237136

AMA Style

Toma M, Miceli R, Bonsante E, Colombo D, Confalonieri M, Garascia A, Ghio S, Lattanzio M, Lombardi CM, Paciocco G, et al. Left Heart Disease Phenotype in Elderly Patients with Pulmonary Arterial Hypertension: Insights from the Italian PATRIARCA Registry. Journal of Clinical Medicine. 2022; 11(23):7136. https://doi.org/10.3390/jcm11237136

Chicago/Turabian Style

Toma, Matteo, Roberta Miceli, Edoardo Bonsante, Davide Colombo, Marco Confalonieri, Andrea Garascia, Stefano Ghio, Mariangela Lattanzio, Carlo Maria Lombardi, Giuseppe Paciocco, and et al. 2022. "Left Heart Disease Phenotype in Elderly Patients with Pulmonary Arterial Hypertension: Insights from the Italian PATRIARCA Registry" Journal of Clinical Medicine 11, no. 23: 7136. https://doi.org/10.3390/jcm11237136

APA Style

Toma, M., Miceli, R., Bonsante, E., Colombo, D., Confalonieri, M., Garascia, A., Ghio, S., Lattanzio, M., Lombardi, C. M., Paciocco, G., Piccinino, C., Rota, I., Santolamazza, C., Scelsi, L., Scuri, P., Stolfo, D., Vincenzi, A., Volpiano, L., Vicenzi, M., & Ameri, P. (2022). Left Heart Disease Phenotype in Elderly Patients with Pulmonary Arterial Hypertension: Insights from the Italian PATRIARCA Registry. Journal of Clinical Medicine, 11(23), 7136. https://doi.org/10.3390/jcm11237136

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