Abstract
Background: In pulmonary arterial hypertension increased HbA1c-levels reflect disease severity and have been identified as negative prognostic factors. HbA1c and their association with disease severity in operable chronic thromboembolic pulmonary hypertension (CTEPH) are unknown.
Methods: HbA1c, hemodynamic and exercise parameters were prospectively analyzed in CTEPH before pulmonary endarterectomy (PEA). Using published criteria (American Diabetes Association), a HbA1c (International Federation of Clinical Chemistry and Laboratory Medicine (IFCC)) < 40.9 mmol/mol was defined normal, 41 to 47.9 mmol/mol as glucose intolerance, and > 48 mmol/mol as manifest diabetes mellitus. All values are means ± standard deviation.
Results: In 63 patients (BMI: 27.6 ± 5.6 kg/m2; age: 61 ± 12 years) with CTEPH (mean pulmonary arterial pressure :43.2 ± 11.2 mmHg, pulmonary vascular resistance: 662 ± 318 dyn*s/cm5, cardiac index (CI): 2.3 ± 0.6 l/min/m2, WHO Functional Class: 3.0 ± 0.6 and peak VO2: 12.1 ± 3.9 l/min/kg) the HbA1c-level was 40.5 ± 6.5 mmol/mol. Diabetes mellitus was observed in 9 patients (14 %) with a HbA1c-level of 53.6 ± 4.8 mmol/mol, whereas 22 patients (35 %) had glucose intolerance (HbA1c: 43.5 ± 1.9 mmol/mol). In univariate linear regression analysis elevated HbA1c-levels were associated with a reduced CI (r= -0.4, p= 0.001) and reduced peak VO2 (r= -0.35, p= 0.005). Multivariate linear regression analysis including age, gender and BMI as covariates, confirmed HbA1c as independently correlated with CI (r= -0.4, p= 0.002) and peak VO2 (r= -0.35, p= 0.02).
Conclusions: In operable CTEPH diabetes mellitus and glucose intolerance assessed via HbA1c are common and associated with disease severity.
- © 2014 ERS