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

Alejandro Cruz-Utrilla,Fernando Arribas Ynsaurriaga,Héctor Bueno,Javier De La Cruz-Bértolo,José Luis Pérez Vela,Miguel Calderón-Flores,José María Cortina,Pilar Escribano-Subias,Maite Velázquez,María José Cristo-Ropero,Yolanda Revilla Ostolaza,María Jesús López-Gude

doi:10.3390/jcm10184251

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.

Highlights

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare form of precapillary pulmonary hypertension (PH) characterized by the combination of both obstruction of the pulmonary circulation and microvascular dysfunction [1]
Our study population consisted of 453 patients with the diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH), of
Our study population consisted of 453 patients with the diagnosis of CTEPH, of whom whom 252 (55.6%) were women and 201 (44.4%) men

Summary

Introduction

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare form of precapillary pulmonary hypertension (PH) characterized by the combination of both obstruction of the pulmonary circulation and microvascular dysfunction [1]. Treatment of CTEPH has changed significantly during the last decade. The introduction of balloon pulmonary angioplasty (BPA) into clinical practice [5,6] and pulmonary vasodilators for inoperable cases [7,8,9,10] which represent approximately 50% of the total number of patients [11], has absolutely changed the therapeutic scenario. Specific comprehensive analyses of the patient phenotyping, clinical course, and prognosis in women with CTEPH are limited. The present study sought to assess sex-based differences in clinical characteristics, treatment, and outcomes over time in a large and unselected cohort of CTEPH patients followed in a single reference national center for the study of pulmonary hypertension between 2007 and 2019

Methods

Results

Discussion

Conclusion