Chronic Lung Disease, Pulmonary Hypertension
Conditions
Brief summary
Prospective observational study to determine if the PVD-B65 risk score for one-year mortality in patients with chronic lung disease and pulmonary hypertension (CLD-PH) can accurately risk stratify these patients and successfully predict one-year mortality from time of pulmonary hypertension diagnosis. PVD-B65 risk score was developed in a retrospective cohort of patients with CLD-PH, utilizing the presence of pulmonary fibrosis without emphysema, pulmonary vascular resistance (PVR) \> 5 woods units (WU), 6-minute walk distance (6MWD) \< 150 meters, B-natriuretic type peptide (BNP) \> 200 pg/mL or N-terminal pro-natriuretic type peptide (NT-proBNP) \> 300 pg/dL, and age \> 65 years as the score components.
Detailed description
Objectives: Primary objective: Prospectively validate the PVD-B65 risk score in patients newly diagnosed with or referred to our center with chronic lung disease and pulmonary hypertension by assigning a PVD-B65 score at time of diagnosis and/or referral and following one-year mortality outcome. Secondary objectives: * Assess whether the risk severity assigned from the PVD-B65 score in patients newly diagnosed with or referred to our center with chronic lung disease and pulmonary hypertension can predict clinical worsening. * Assess whether optimal treatment in line with standard of care of both chronic lung disease and pulmonary hypertension can modify the initial risk severity assigned from the PVD-B65 score and in turn influence survival outcomes. Primary endpoint: One-year outcome of mortality vs. lung transplantation vs. alive without lung transplantation Secondary endpoints 1. Composite endpoint of clinical worsening defined as hospitalization for respiratory failure, worsening oxygen requirement, intensification of pulmonary vasodilator therapy from initial treatment 2. Change in PH markers (mPAP, PVR, cardiac output, cardiac index via RHC; PASP via TTE, pulmonary artery diameter and pulmonary artery to aorta ratio on CT chest) 3. Change in lung function (FEV1, FVC), 6MWD, and DLCO 4. Change in PVD-B65 score and associated risk severity through duration of study
Interventions
DIAGNOSTIC_TESTObservational Study
* assignment of PVD-B65 score derived from standard of care testing * no therapeutic intervention or other treatment
Sponsors
Temple University
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 99 Years
Inclusion criteria
* Eligibility criteria 1. Adult patients ≥ 18 years of age with chronic lung disease diagnosed via CT chest and/or PFT data and pre-capillary pulmonary hypertension diagnosed via right-heart catheterization (RHC, mPAP \> 20 mmHg, PVR \> 2 WU, and PCWP ≤ 15 mmHg) 1. Chronic lung disease diagnoses will include: COPD, IPF, other pulmonary fibrosis, non-fibrotic ILD, combined pulmonary fibrosis and emphysema, and advanced pulmonary sarcoidosis with parenchymal involvement 2. PFT criteria will include an FEV1/FVC \< 0.70 for the diagnosis of COPD 2. Willingness to make return visits and be available by telephone for the duration of the study. 3. Ability to participate in necessary testing, including ambulatory testing
Exclusion criteria
*
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Prediction of one year mortality | One year | death (yes or no) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Clinical worsening | one year | Composite endpoint defined as having had hospitalization for respiratory failure, worsening oxygen requirement in L/min, or intensification of pulmonary vasodilator therapy from initial treatment |
| Change in PH severity via RHC | Assessed every 6 months for one year | PVR in Woods units via RHC |
| Change in PH severity via TTE | Assessed every 3 months for one year | Estimated PASP in mmHg |
| Change in functional status | Assessed every 3 months for one year | 6 minute walk distance in meters |
| Change in PVD-B65 score and associated risk severity through duration of study | Every 3 months for one year | PVD-B65 risk score (absolute numeric value) calculated throughout study as described above |
Countries
United States
Contacts
Primary ContactShameek Gayen, MD
Outcome results
None listed