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Outcomes of patients with decreased arterial oxyhaemoglobin saturation on pulmonary arterial hypertension drugs

2021; European Respiratory Society; Volume: 58; Issue: 5 Linguagem: Inglês

10.1183/13993003.04066-2020

1399-3003

Simon Valentin, Arnaud Maurac, Olivier Sitbon, Antoine Beurnier, E. Gomez, Anne Guillaumot, Laura Textoris, Renaud Fay, Laurent Savale, Xavier Jaïs, David Montani, François Picard, Jean‐François Mornex, Grégoire Prévôt, F. Chabot, Marc Humbert, Ari Chaouat,

Congenital Heart Disease Studies

Background Drugs approved for the treatment of pulmonary arterial hypertension (PAH) improve long-term outcomes. These drugs have pulmonary vasodilator properties which may potentially cause a decrease in arterial oxyhaemoglobin saturation ( S aO 2 ) in some patients. The present retrospective study of the French Pulmonary Hypertension Registry aimed to describe the clinical characteristics and outcomes of patients showing a ≥3% decrease in S aO 2 while treated with PAH drugs. Methods We reviewed 719 PAH patients. The exclusion criteria were PAH associated with congenital heart disease and PAH with overt features of venous/capillaries involvement. Results 173 (24%) patients had a ≥3% decrease in S aO 2 . At diagnosis, they were older with a lower diffusing capacity of the lung for carbon monoxide and a shorter 6-min walk distance compared with those who did not display a ≥3% decrease in S aO 2 . The percentage of patients meeting the European Society of Cardiology/European Respiratory Society (ESC/ERS) low-risk criteria at re-evaluation was significantly lower in those with a ≥3% decrease in S aO 2 and more patients started long-term oxygen therapy in this group (16% versus 5%; p<0.001). A ≥3% decrease in S aO 2 was associated with a poorer survival (hazard ratio 1.81, 95% CI 1.43–2.34; p<0.0001). In a multivariate Cox analysis, a ≥3% decrease in S aO 2 was a prognostic factor independent of age at diagnosis and ESC/ERS risk stratification at follow-up. Conclusions When treated with PAH drugs, a large subset of patients experience a ≥3% decrease in S aO 2 , which is associated with worse long-term outcomes and reduced survival.