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Oral PAH Specific Therapy is Safe and Efficacious in Octagenerians

Demir Baykal

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Conference: 2012 International PHA Conference and Scientific Sessions

Release Date: 06.22.2012

Presentation Type: Abstracts

Demir Baykal, MD, FACC, FASE

Gwinnett Consultants in Cardiology, Lawrenceville GA

BACKGROUNDPrevalence of Pulmonary hypertension and possibly PAH increases with age. The average age of the patients enrolled in major oral therapy trials is around 50. There is not adequate published safety and efficacy data for any form of PAH specific therapy in elderly.

METHODSWe report our experience on 5 octogenarian ,all with WHO group1,class 3-4PAH patients (4 idiopathic,1 familial). In all 5 silent left heart and lung disease have been vigorously excluded using echocardiography with tissue Doppler, right and left heart catheterization,high resolution CT chest. 2 were oxygen dependent at the time of diagnosis.All 5 were treated with background therapy including diuretics, 3 with anticoagulants. Combination therapy with ERAs (Tracleer) and PD5 inhibitors(Adcirca) were initiated in 3, ERAs only were initiated in 2.

 Age

Mean PAP,mmHg

PVR W.U.

PCWP,

mmHg

LVEDP,

mmHg

LVEF,%

Mitral E/E’

Systolic

PAP, mmHg

NYHA CLASS

82

55

7

14

16

48

8

85

4

85

45

6.5

11

13

46

9

73

3

80

43

5.6

14

15

44

8

75

3

83

39

4.2

15

16

52

10

65

3

80

44

4.6

15

18

47

11

68

4

Table 1 (Baseline)

RESULTSAt 12 weeks none of the 5 had clinical deterioration, the 2 group 4 patients improved to group 3 ,1 of the group 3 improved to class 2,the 2 others in class 3 remained same. Clinical improvements were noted in 1 class 4 and class 3 patient as early as 2 weeks. There were no significant LFT changes ,ERA was stopped in 1 class 4 patient due to leg edema with continued improvement on PD5 inhibitor.At 12 weeks RHC was done in only 2, echocardiogram with tissue doppler were performed in all 5.

 Age

Mean PAP,mmHg

PVR W.U.

PCWP,

mmHg

LVEDP,

mmhg

LVEF,%

Mitral E/E’

Systolic

PAP,mmHg

NYHA CLASS

82

47

5.8

15

16

52

8

65

3

85

 

 

 

 

48

9

58

3

80

35

4.5

12

15

47

8

61

2

83

 

 

 

 

55

10

45

3

80

 

 

 

 

50

11

47

3

Table 2 (12 weeks follow up)

CONCLUSIONPAH specific oral therapy is safe and conducive to hemodynamic and functional improvement in elderly. Natural course of elderly PAH may be more indolent with less progression and surprisingly favorable and early response to therapy.