worse outcome than those with PH-COPD (p = 0.015), and borderline worse outcome than patients with PH-ILD (p = 0.050), Figure. 48 of 94 patients were diagnosed with severe PH-RESP, defined at mPAP≥40 mmHg. WHO functional class (p = 0.036), TLCO (p = 0.019), RVEF (p = 0.033) were significant independent predictors of outcome in patients with severe PH-RESP. Conclusion Patients with severe PH-RESP have a dire clinical outcome. RVEF is an independent predictor of adverse outcome in these patients and may be a powerful biomarker for use in clinical trials of targeted therapy in patients with pulmonary hypertension associated with lung disease, particularly given the unreliable performance of echocardiography in patients with advanced lung disease.
Background The incidence of malignant pleural effusions (MPE) is increasing and overall prognosis remains poor. In-dwelling pleural catheters (IPCs) relieve symptoms, but increase the risk of pleural infection. We reviewed survival times of cases of pleural infection in patients with IPCs for MPE from 6 UK centres. Methods Baseline data were collected for all IPC insertions from 1/1/05 to 31/1/14. Survival times were analysed by underlying tumour. Results were compared with national data, and with data from a cohort of 789 patients with MPE (the LENT cohort). LENT scores were used to calculate individual predicted life expectancy, which was compared with actual survival. Results Of 672 IPCs inserted across 6 centres during the study period, 25 patients (3.6%) experienced pleural infection. 19/25 were male,median age 69 (range 35-79). 12/25 had mesothelioma, 8/25 lung cancer, 3/25 breast cancer, 1/25 lymphoma and 1/25 thyroid cancer. 18/25 had a performance status of 0-1, and 19/25 received oncological treatment.Survival with MPE and pleural infection compared favourably with the LENT cohort (see figure 1). Median survival with mesothelioma and pleural infection was 753 days (95% confidence interval 446-1089) compared with 339 days in the LENT cohort (95% CI 267-442) and less than 365 days in nationally reported data. Patients with lung cancer and pleural infection also outlived their LENT counterparts; median survival of 138 days (95% CI 62-479) versus 74 days (95% CI 60-90). Patients with breast cancer had similar survival times (167 vs 192 days). LENT scores were calculated where possible. 9/13 (69%) outlived their predicted life expectancy. 16/25 (64%) developed infection within 90 days of IPC insertion. There was no difference in survival times between patients with early and late infection (p = 0.6). Discussion In this series of patients with IPCs, pleural infection was associated with longer survival with mesothelioma and lung cancer, but not breast cancer. Most patients experienced early infection, suggesting this result isn't simply a result of higher infection rates in patients who survive longer with an IPC in situ. We propose that pleural infection stimulates a local immune response, which acts against tumour. Further studies are planned to investigate this hypothesis further. Introduction The management and follow-up of pulmonary embolism (PE) is delivered by various specialities resulting in both under and over investigation for suspected chronic thromboembolic pulmonary hypertension (CTEPH). To standardise our approach to long-term PE management a "one-stop" clinic was established in Sheffield in March 2010 to review all patients approximately 3 months after their presentation with acute PE. The aim of this study was to evaluate the incidence and severity of CTEPH identified from a one-stop clinic using an investigative strategy based on careful clinical assessment Methods Consecutive patients attending the one-stop PE clinic following hospital admission with acute PE were identified. During the on...
IntroductionChronic thromboembolic pulmonary hypertension (CTEPH) is commonly associated with a history of venous thromboembolism. Pulmonary endarterectomy (PEA) offers a potential cure in surgically accessible disease. However, a significant proportion of patients with CTEPH may not undergo surgery due to various reasons including disease distribution, comorbidities and patient choice This group of patients have previously been considered to have a poor outcome although an international registry has recently reported on improved medium term outcomes in this patient population.Aims and objectivesTo compare long term survival of patients with CTEPH undergoing pulmonary endarterectomy (CTEPH-surgical-operated), surgically accessible disease not undergoing pulmonary endarterectomy (CTEPH-surgical-not-operated), surgically inaccessible disease (CTEPH-non-surgical).MethodsData was retrieved from hospital records and departmental database for consecutive, treatment-naïve patients with CTEPH diagnosed between 1st January 2001 and 30th November 2014 and followed up till 30th November 2015 at the Sheffield Pulmonary Vascular Disease Unit and collected in the ASPIRE registry. Patients with suspected CTEPH undergo systematic evaluation but formal pulmonary angiography is only performed when other imaging modalities such as CTPA, MR imaging and nuclear medicine imaging are non-diagnostic.Results592 patients, mean age (± standard deviation), 65 ± 22 years, mean pulmonary arterial pressure 48 ± 13 mmHg and median pulmonary vascular resistance 480 ± 463 dynes/sec/cm-5 were identified and followed for 4.3 ± 3.2 years. 5 year survival was significantly (p < 0.001) better in CTEPH-surgical-operated (n = 279) at 82.9 ± 3.1% compared to CTEPH-surgical-not-operated (n = 206) at 44.4 ± 5% (66.7 ± 9.1% patient choice, 39.4 ± 6% comorbidities) and 53.4 ± 5.8% in CTEPH-non-surgical (n = 107). Only 4% of the patients in our study were investigated with conventional pulmonary angiography.The median time to PEA surgery from diagnosis was 10.2 months and did not affect long term survival (p = 0.52).ConclusionsFor operable patients with CTEPH pulmonary endarterectomy is associated with an excellent long term outcome, the long-term survival of patients with surgical disease who decline surgery is significantly better than historically reported and that a non-invasive multimodality imaging approach can be used to assess patients with suspected CTEPH. Furthermore there is no time from diagnosis to surgery which predicts outcome.Abstract P28 Figure 1Kaplan-Meier estimates survival from date of diagnosis in CTEPH, surgical, operated, CTEPH, surgical, not-operated and CTEPH, non-surgical patients,log-rank test, p < 0.001
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