This new study on pulmonary arterial hypertension (PAH) in women examines the common symptoms of different disease phenotypes to see where they overlap, and finally according to symptom clusters and features. defined symptom.
Ability to predict symptom exacerbation and disease outcome pulmonary artery hypertension (PAH) space may benefit from three symptom cluster phenotypes identified in new study was announced in pulmonary circulation.
The researchers had a mean age (SD) of 50.6 (17.8) years and were non-Hispanic white (51%), non-Hispanic black (32%), white (Hispanic) (10%), and Asian (10%). 7%) reported ethnicity. According to the World Health Organization (WHO) Group 1 criteria, the most common causes of PAH in the 60 women surveyed were idiopathic disease (38%), connective tissue disease (35%), and congenital heart disease. (12%). 45% had WHO functional class II disease and 47% had WHO functional class III disease.
The cross-sectional study population included the Pulmonary Arterial Hypertension Symptom Scale (PAHSS), Pittsburgh Sleep Quality Index (PSQI), Multidimensional Dyspnea Profile (MDP), Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function, and PROMIS Sleep Related. They also underwent several tests, including transthoracic echocardiography, phlebotomy, 6-minute walking distance, and actigraphy.
“Women with PAH experience multiple symptoms that compromise health-related quality of life (HRQOL), including dyspnea, fatigue, and sleep disturbances,” the study authors wrote. “The aim of this study was to define ‘symptoms’ by phenotypes of symptom clusters and characterize them as biomarkers, cardiac structure and function (echocardiography), functional capacity (6-minute walking distance), and HRQOL. was to compare between groups. “
They used the dyspnea, fatigue, and sleep disturbance variables to define each symptom cluster.
Overall, there was a significant correlation between dyspnea and fatigue (ρ = .638; P. < .001), dyspnea and sleep disturbance (ρ = .531; P. < .001), sleep disturbance and fatigue (ρ = .655; P. < .001).
Cluster analysis revealed that mild, moderate, and severe symptom groups were similar in age, reported race/ethnicity, and occurrence of PAH types. Their ages were 49.4 (21.2), 52.7 (15.8), and 50.0 (11.9) years, respectively. 50%, 55%, and 50% were Caucasian. The two most common PAH etiologies were idiopathic (39%, 35%, and 42%) and connective tissue disease (32%, 45%, and 25%).
However, the groups differed significantly in the following disease characteristics: WHO functional class (P. < .001), norepinephrine levels (P. = .029), right atrial pressure (P. = .001), physical function (P. < .001), sleep onset latency (P = .040), and HRQOL (P. < .001). Also, among the echocardiographic variables assessed, only right atrial pressure was associated with symptom cluster severity.
Worse HRQOL and self-reported levels of physical functioning were more common in moderate and severe phenotypes, elevated and levels of depression were more common in severe phenotypes, and NT-proBNP levels were moderate Significantly higher in severe and severe phenotypes, sleep onset latency was higher. Longest in severe phenotypes.
“Given the importance of symptoms for patients with PAH, our findings are important for future diagnostic, prognostic, clinical trials and treatment paradigms, even if our data require confirmation in larger cohorts.” “Screening patients to identify symptom cluster phenotypic memberships most suitable for symptom management interventions and adopting a ‘precision medicine’ approach to symptom management.” I can. “
Their findings stressed that future studies should focus on men, as their results may be limited by an all-female study population. It should also be validated in targeted large-scale longitudinal studies.
reference
Matura LA, Fargo JD, Boyle K, et al. Symptomatic phenotype of pulmonary arterial hypertension: PAH ‘symptoms’. palm circle Published online September 6, 2022. doi:10.1002/pul2.12135
