Sex Differences in Chronic Thromboembolic Pulmonary Hypertension. Treatment Options over Time in a National Referral Center

Abstract

(1) Background: Clinical presentation, disease distribution, or treatment received may provide insights into the reasons contributing to sex differences in chronic thromboembolic pulmonary hypertension (CTEPH). (2) Methods: We evaluated 453 patients (56% women) between 2007–2019. Data was collected from REHAP (Registro Español de Hipertensión Arterial Pulmonar) registry. Two time periods were selected to evaluate the influence of new treatments over time. (3) Results: Women were older. Baseline functional class was worse, and distance walked shorter in women compared with men. Women had higher pulmonary vascular resistances. Despite this, pulmonary endarterectomy (PEA) was carried out in more men, and women received more frequently pulmonary vasodilators exclusively. The 2014–2019 interval was associated with a better survival only among women. Interestingly, women had a more distal disease during this second period of time. (4) Conclusions: Even though women were older, and received invasive treatments less frequently, mortality was similar in both sexes. The introduction of balloon pulmonary angioplasty and the improvement of pulmonary endarterectomy, especially during the last years, could be associated with a survival benefit among women.

Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension: a clinical consensus statement of the ESC working group on pulmonary circulation and right ventricular function

“…Sex differences in the treatment of CTEPH have been evaluated in few studies. 32 , 33 PEA was performed more frequently in men while more females were classified as inoperable. 34 Women have more frequently distal technically inaccessible disease 35 and tend to reject PEA, 36 although mortality was similar between both sexes.…”

Balloon pulmonary angioplasty can be an effective and safe therapeutic option in non-surgical elderly patients

“…Furthermore, futility in elderly patients is another potential issue, since comorbidities and physical deconditioning may partly explain their functional class, which would continue to remain suboptimal after BPA therapy as a result of these comorbidities. The female predominance in our cohort indicated a higher degree of fragility and possible futility of BPA therapy since older women are often weaker and more fragile ( 13 ). Taking these factors into consideration, we think that a significant functional improvement defined by WHO FC 1 or 2 could be a potentially sufficient aim, especially in a population of elderly patients like ours.…”

“…mm balloon without inflation through a subtotal stenosis. fragility and possible futility of BPA therapy since older women are often weaker and more fragile (13). Taking these factors into consideration, we think that a significant functional improvement defined by WHO FC 1 or 2 could be a potentially sufficient aim, especially in a population of elderly patients like ours.…”

Pulmonary Hypertension: Current Diagnosis, Approach and Treatment at the Dawn of the New European Guidelines

“…The Special Issue also includes three important publications related to a national referral center in Spain and the Hellenic national registry, all related to chronic thromboembolic pulmonary hypertension (CTEPH): Cruz-Utrilla et al, report on sex-related differences in CTEPH; data are provided via the Spanish registry REHAP, but are related to one center only. In total, 453 patients were evaluated between 2007–2019, revealing among others that female patients had worse functional, exercise-related, and PVR profiles than men, but more pulmonary endarterectomy (PEA) surgical procedures were performed in the latter [ 12 ]. The authors report a better survival only in women between 2014–2019, that might be related to the introduction of balloon pulmonary angioplasty (BPA) and the improvement in the performed PEAs [ 12 ].…”

“…In total, 453 patients were evaluated between 2007–2019, revealing among others that female patients had worse functional, exercise-related, and PVR profiles than men, but more pulmonary endarterectomy (PEA) surgical procedures were performed in the latter [ 12 ]. The authors report a better survival only in women between 2014–2019, that might be related to the introduction of balloon pulmonary angioplasty (BPA) and the improvement in the performed PEAs [ 12 ]. The remaining two articles present data from the Hellenic nationwide pulmonary hypertension registry (HOPE).…”