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Pulmonary arterial hypertension associated with fenfluramine exposure: report of 109 cases

¹ Université Pains-Sud, UPRES-EA 2705 Pneumology Dept and French National Reference Centre for Pulmonary Hypertension, Antoine Béclère Hospital, Clamart and, and ² Laboratory of Oncogenetics and Molecular Angiogenetics, Federation of Genetics, Pitié-Salpêtrière Hospital Group, Pierre and Marie Curie University, Paris, France.

CORRESPONDENCE: M. Humbert, Centre des Maladies Vasculaires Pulmonaires, UPRES EA 2705, Service de Pneumologie et Réanimation Respiratoire, Hôpital Antoine Béclère, Assistance Publique – Hôpitaux de Paris, Université Paris-Sud., 157 rue de la Porte de Trivaux, 92140 Clamart, Paris, France. Fax: 33 146303824. E-mail: marc.humbert{at}abc.aphp.fr

Keywords: Bone morphogenetic protein receptor type 2, fenfluramine derivatives, idiopathic pulmonary arterial hypertension, pulmonary arterial hypertension, survival

Received: August 11, 2007
Accepted October 9, 2007

The aim of the present study was to describe a large cohort of fenfluramine-associated pulmonary arterial hypertension (fen-PAH) and its possible prognostic markers.

The records of all patients with a diagnosis of fen-PAH evaluated at the present authors’ centre from 1986–2004 were retrospectively studied. Baseline clinical and haemodynamic data were collected, as well as survival times.

The median duration of fenfluramine exposure was 6 months, with a median of 4.5 yrs between exposure and onset of symptoms. Nine (22.5%) out of 40 patients evaluated resulted positive for the presence of germline bone morphogenetic protein receptor (BMPR) type 2 mutations. In these patients, the duration of exposure to fenfluramine was significantly lower than in patients without mutation. The median survival was 6.4 yrs, without significant difference between fen-PAH and a control group of idiopathic and familial pulmonary arterial hypertension patients referred to the present authors’ centre during the same time frame and treated identically. Duration of fenfluramine exposure showed no relation to survival, while cardiac index was the only independent predictor of multivariate analysis.

Fenfluramine-associated pulmonary arterial hypertension shares clinical, functional, haemodynamic and genetic features with idiopathic pulmonary arterial hypertension, as well as overall survival rates. Therefore, the present authors conclude that fenfluramine exposure characterises a potent trigger for pulmonary arterial hypertension without influencing its clinical course.

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