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Pulmonary hypertension in patients with pulmonary fibrosis awaiting lung transplant

¹ Pulmonary and Critical Care Medicine Section, Washington Hospital Center, ³ Dept of Pulmonary and Critical Care Medicine, Walter Reed Army Medical Center, Washington, DC, ² United Network for Organ Sharing, Richmond, and ⁴ INOVA Transplant Center, Fairfax Inova Hospital, Falls Church, VA, USA.

CORRESPONDENCE: A. F. Shorr, Pulmonary and Critical Care Medicine Section, Washington Hospital Center, Room 2A-38D, 110 Irving St, NW, Washington DC 20010, USA. Fax: 1 2022910386. E-mail: afshorr{at}dnamail.com

Keywords: Epidemiology, haemodynamics, idiopathic pulmonary fibrosis, pulmonary hypertension

Received: August 16, 2006
Accepted June 25, 2007

Pulmonary hypertension (PH) may complicate idiopathic pulmonary fibrosis (IPF) but the prevalence of PH in IPF remains undefined. The present authors sought to describe the prevalence of PH in IPF.

The lung transplant registry for the USA (January 1995 to June 2004) was analysed and IPF patients who had undergone right heart catheterisation (RHC) were identified. PH was defined as a mean pulmonary arterial pressure (_pa) 25 mmHg and severe PH as a _pa >40 mmHg. Independent factors associated with PH were determined.

Of the 3,457 persons listed, 2,525 (73.0%) had undergone RHC. PH affected 46.1% of subjects; 9% had severe PH. Variables independently associated with mild-to-moderate PH were as follows: need for oxygen, pulmonary capillary wedge pressure (P_pcw) and forced expiratory volume in one second (FEV₁). Independent factors related to severe PH included the following: carbon dioxide tension, age, FEV₁, P_pcw, need for oxygen and ethnicity. A sensitivity analysis in subjects with P_pcw <15 mmHg did not appreciably alter the present findings.

Pulmonary hypertension is common in idiopathic pulmonary fibrosis patients awaiting lung transplant, but the elevations in mean pulmonary arterial pressure are moderate. Lung volumes alone do not explain the pulmonary hypertension. Given the prevalence of pulmonary hypertension and its relationship with surrogate markers for quality of life (e.g. activities of daily living), future trials of therapies for this may be warranted.

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