Pulmonary hypertension in patients with moderate to severe hypersensitivity pneumonitis

Résumé fourni par la source

Hypersensitivity pneumonitis (HP) is characterized by a complex immunological reaction of the lung parenchyma that may lead to chronic interstitial lung disease (ILD). Pulmonary hypertension (PH) may aggravate the clinical picture. We aimed to assess the prevalence of PH in two independent HP cohorts including moderate and severe HP-ILD. We retrospectively analysed the data of HP patients with severe ILD undergoing lung transplantation (LuTX) (cohort 1) and invited HP patients undergoing pulmonary rehabilitation for a prospective clinical evaluation and screening for PH (cohort 2). HP diagnosis was set in multidisciplinary team in accordance to the newest guidelines. In cohort 1 (n= 63, age:55±9 yrs, 63% males, forced vital capacity (FVC): 40±15%pred.) echocardiographic estimation (n=34) of systolic pulmonary arterial pressure (sPAP) generally revealed elevated values (55±23 mmHg) and n=10 (29% of ECHO) had a high probability of PH (sPAP > 50mmHg). RHC was performed in n=27 (42%)cases (mean pulmonary arterial pressure (mPAP): 30±14 mmHg, pulmonary vascular resistance (PVR): 3.0±1.0 WU) of whom n=18 had PH (mPAP >20mmHg; 67% of RHC, 28% of all). In cohort 2 (n=96, age:63±11 yrs, 67% males, FVC: 99±20%pred.) echocardiography (n=88) revealed upper-normal sPAP values in most subjects (30±7mmHg) and n=1 (1% of ECHO) had a high probability of PH. Based on non-invasive probability of PH, RHC was performed in n=13 (14%) cases (mPAP: 20±6mmHg, PVR: 2.3±1.1 WU) and PH was confirmed in 5 patients (38% of RHC, 5% of all). PH is a frequent complication in patients with HP, but dependent on HP severity. While PH was more prevalence in severe cases, PH also occurred in patients with preserved pulmonary function.

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