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

doi:10.1016/j.heliyon.2024.e27537

Exercise capacity-hemodynamics mismatch in elderly patients with pulmonary hypertension: A nationwide multicenter study from Taiwan Society of Cardiology Pulmonary Hypertension Registry (TAIPANS)

Heliyon. 2024 Mar 11;10(6):e27537. doi: 10.1016/j.heliyon.2024.e27537. eCollection 2024 Mar 30.

Authors

Chang-Ying Chen^{1

2}, Wang Mei-Tzu^{1

3}, Shih-Hsien Sung^{3

4}, Yih-Jer Wu^{5

6}, Chih-Hsin Hsu², Wan-Jing Ho⁷, Yen-Hung Lin⁸, Wei-Shin Liu⁹, Ju-Chi Liu^{10

11

12}, Yung-Ta Kao^{11

12

13}, Wen-Shiann Wu¹⁴, Chun-Hsien Wu¹⁵, Meng-Huan Lei¹⁶, Yu-Wei Chen^{17

18

19}, Chien Chen-Yu²⁰, Yu-Wei Chiu^{21

22}, Zen-Kong Dai^{23

24

25}, Tsung-Hsien Lin^{24

26

27}, Lin Lin²⁸, Cheng-Chih Chung^{11

13

29}, Chang-Min Chung^{30

31}, Sung-Hao Huang³², Chin-Chang Cheng^{1

33}, Yen-Wen Wu^{3

21

34}, Ting-Hsing Chao², Juey-Jen Hwang⁸, Charles Jia-Yin Hou⁵, Wei-Chun Huang^{1

3

34

35}

Affiliations

¹ Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
² Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
³ School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan.
⁴ Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan.
⁵ Department of Medicine, MacKay Medical College, New Taipei, Taiwan.
⁶ Cardiovascular Center, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.
⁷ Department of Cardiology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
⁸ Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan.
⁹ Division of Cardiology, Tzu-Chi General Hospital, Hualien, Taiwan.
¹⁰ Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
¹¹ Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan.
¹² Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
¹³ Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taiwan.
¹⁴ Department of Cardiology, Chi-Mei Medical Center, Tainan, Taiwan.
¹⁵ Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
¹⁶ Cardiovascular Center, Lo-Tung Poh-Ai Hospital, YI-Lan, Taiwan.
¹⁷ Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.
¹⁸ Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
¹⁹ Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
²⁰ Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.
²¹ Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
²² Department of Computer Science and Engineering, Yuan Ze University, Taoyuan, Taiwan.
²³ Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
²⁴ Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
²⁵ Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
²⁶ Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan.
²⁷ Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
²⁸ Cardiovascular Center, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan.
²⁹ Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
³⁰ Division of Cardiology, Department of Internal Medicine, Chiayi Chang Gung Medical Foundation, Chiayi County, Taiwan.
³¹ Medical Department, Chiayi Chang Gung Medical Foundation, Chiayi County, Taiwan.
³² Division of Cardiology, National Yang Ming Chiao Tung University Hospital, Yi-Lan, Taiwan.
³³ Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan.
³⁴ Graduate Institute of Medicine, Yuan Ze University, Taoyuan, Taiwan.
³⁵ National Sun Yat-sen University, Kaohsiung, Taiwan.

Abstract

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 < 0.0001) than young patients. Elderly patients had shorter 6-min walking distance (6 MWD) (≤45 vs. >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.

Keywords: Elderly; Hemodynamic; Pulmonary hypertension.