Pulmonary arterial hypertension in the elderly population

Abstract

Pulmonary arterial hypertension (PAH) was a disease predominantly affecting young females about 40 years ago; however, it has been increasingly diagnosed in elderly individuals. Few studies have investigated the features of elderly patients with PAH. This review provides an overview of the characteristics of elderly patients with PAH compared to young patients. The examination of the changing demographics of the population with PAH revealed that the mean age has increased over the years. In addition, the investigation into the diagnostic challenges in elderly patients with PAH revealed the difficulty in differentiating PAH from pulmonary hypertension secondary to diastolic heart failure. Moreover, it was noted that elderly patients underwent combination drug regimens less frequently and exhibited poorer treatment responses than young patients. Finally, it was found that elderly PAH patients experienced poorer survival than young patients. The differences among five survival prediction models and their applicability in predicting the prognosis of PAH patients are discussed.

Application of homocysteine as a non-invasive and effort-free measurements for risk assessment of patients with pulmonary hypertension

“…Surprisingly, a previous study reported that BNP or NT-proBNP had a 98% sensitivity for excluding high right atrial pressure (≥ 8 mmHg) and low cardiac index (< 2.5 L/min/m 2 ), and in circumstances of extreme low BNP (< 50 pg/mL) or NT-proBNP (< 300 pg/mL) level, hemodynamic measurements no longer had independent prognostic predictive values [ 14 ]. Moreover, COMPERA and the SPAHR registries demonstrated that the ability of mortality prediction is excellent even when only about a third of patients are followed up under the assessment of right heart catheterization [ 15 , 18 ]. Nevertheless, due to the complexity of pulmonary hypertension, any single biomarker is insufficient for the broad assessment of patients with different etiologies of pulmonary hypertension.…”

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

“…Many registries have been established to assess the characteristics of patients suffering from PH since 1980s. They demonstrated an increasing trend in the mean age of PH patients over the past forty years [ 3 ]. In the first registry of PH conducted by the National Institute of Health in the United States between 1981 and 1985, only 9% of patients were >60 years of age with a mean age of 36 years [ 4 ].…”

Neoadjuvant therapy

“…8,10,11 Dr. Wang’s current study used “60” years of age as cutoff value, many studies used “65” as watershed. 10,11…”

“…It is well-known that the elder population is associated with worse prognosis in almost all diseases, 9 even though it is not consistent to define what is the appropriate cutoff value for elder age. 8,10,11 Dr. Wang's current study used "60" years of age as cutoff value, many studies used "65" as watershed. 10,11 Second, it is relatively difficult to identify who have an impaired bone marrow function.…”

“…8,10,11 Dr. Wang's current study used "60" years of age as cutoff value, many studies used "65" as watershed. 10,11 Second, it is relatively difficult to identify who have an impaired bone marrow function. It is still absent of any marker to predict the hematological toxicity of the patients during the treatment accurately.…”