Exercise capacity-hemodynamics mismatch in elderly patients with pulmonary hypertension: A nationwide multicenter study from Taiwan Society of Cardiology Pulmonary Hypertension Registry (TAIPANS)
Chang-Ying Chen,
Wang Mei-Tzu,
Shih-Hsien Sung,
Yih-Jer Wu,
Chih-Hsin Hsu,
Wan-Jing Ho,
Yen-Hung Lin,
Wei-Shin Liu,
Ju-Chi Liu,
Yung-Ta Kao,
Wen-Shiann Wu,
Chun-Hsien Wu,
Meng-Huan Lei,
Yu-Wei Chen,
Chien Chen-Yu,
Yu-Wei Chiu,
Zen-Kong Dai,
Tsung-Hsien Lin,
Lin Lin,
Cheng-Chih Chung,
Chang-Min Chung,
Sung-Hao Huang,
Chin-Chang Cheng,
Yen-Wen Wu,
Ting-Hsing Chao,
Juey-Jen Hwang,
Charles Jia-Yin Hou,
Wei-Chun Huang
Affiliations
Chang-Ying Chen
Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Wang Mei-Tzu
Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
Shih-Hsien Sung
School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan
Yih-Jer Wu
Department of Medicine, MacKay Medical College, New Taipei, Taiwan; Cardiovascular Center, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
Chih-Hsin Hsu
Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Wan-Jing Ho
Department of Cardiology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
Yen-Hung Lin
Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
Wei-Shin Liu
Division of Cardiology, Tzu-Chi General Hospital, Hualien, Taiwan
Ju-Chi Liu
Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
Yung-Ta Kao
Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taiwan
Wen-Shiann Wu
Department of Cardiology, Chi-Mei Medical Center, Tainan, Taiwan
Chun-Hsien Wu
Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
Meng-Huan Lei
Cardiovascular Center, Lo-Tung Poh-Ai Hospital, YI-Lan, Taiwan
Yu-Wei Chen
Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
Chien Chen-Yu
Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
Yu-Wei Chiu
Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Computer Science and Engineering, Yuan Ze University, Taoyuan, Taiwan
Zen-Kong Dai
Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
Tsung-Hsien Lin
Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan; Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
Lin Lin
Cardiovascular Center, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan
Cheng-Chih Chung
Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taiwan; Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
Chang-Min Chung
Division of Cardiology, Department of Internal Medicine, Chiayi Chang Gung Medical Foundation, Chiayi County, Taiwan; Medical Department, Chiayi Chang Gung Medical Foundation, Chiayi County, Taiwan
Sung-Hao Huang
Division of Cardiology, National Yang Ming Chiao Tung University Hospital, Yi-Lan, Taiwan
Chin-Chang Cheng
Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan
Yen-Wen Wu
School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan; Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Graduate Institute of Medicine, Yuan Ze University, Taoyuan, Taiwan
Ting-Hsing Chao
Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Juey-Jen Hwang
Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
Charles Jia-Yin Hou
Department of Medicine, MacKay Medical College, New Taipei, Taiwan
Wei-Chun Huang
Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan; Graduate Institute of Medicine, Yuan Ze University, Taoyuan, Taiwan; National Sun Yat-sen University, Kaohsiung, Taiwan; Corresponding author. Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st 27 Rd., Zuoying Dist., Kaohsiung City, 813, Taiwan.
Background: Demographics of pulmonary hypertension (PH) has changed a lot over the past forty years. Several recent registries noted an increase in mean age of PH but only a few of them investigated the characteristics of elderly patients. Thus, we aimed to analyze the characteristics of PH in such a population in this study. Methods: This multicenter study enrolled patients diagnosed with PH in group 1, 3, 4, and 5 consecutively from January 1, 2019 to December 31, 2020. A total of 490 patients was included, and patients were divided into three groups by age (≤45 years, 45–65 years, and >65 years). Results: The mean age of PH patients diagnosed with PH was 55.3 ± 16.3 years of age. There was higher proportion of elderly patients classified as group 3 PH (≤45: 1.3, 45–65: 4.5, >65: 8.1 %; p = 0.0206) and group 4 PH (≤45: 8.4, 45–65: 14.5, >65: 31.6 %; p 65, mean difference, 77.8 m [95% confidence interval (CI), 2.1–153.6 m]), lower mean pulmonary arterial pressure (mPAP) (≤45 vs. >65, mean difference, 10.8 mmHg [95% CI, 6.37–15.2 mmHg]), and higher pulmonary arterial wedge pressure (PAWP) (≤45 vs. 45–65, mean difference, −2.1 mmHg [95% CI, −3.9 to −0.3 mmHg]) compared to young patients. Elderly patients had a poorer exercise capacity despite lower mPAP level compared to young population, but they received combination therapy less frequently compared to young patients (triple therapy in group 1 PH, ≤45: 16.7, 45–65: 11.3, >65: 3.8 %; p = 0.0005). Age older than 65 years was an independent predictor of high mortality for PH patients. Conclusions: Elderly PH patients possess unique hemodynamic profiles and epidemiologic patterns. They had higher PAWP, lower mPAP, and received combination therapy less frequently. Moreover, ageing is a predictor of high mortality for PH patients. Exercise capacity-hemodynamics mismatch and inadequate treatment are noteworthy in the approach of elderly population with PH.
