Clinical phenotypes and survival of precapillary pulmonary hypertension in systemic sclerosis

David Launay, David Montani, Paul M. Hassoun, Vincent Cottin, Jérôme Le Pavec, Pierre Clerson, Olivier Sitbon, Xavier Jaïs, Laurent Savale, Jason Weatherald, Vincent Sobanski, Stephen C. Mathai, Majid Shafiq, Jean François Cordier, Eric Hachulla, Gérald Simonneau, Marc Humbert

Research output: Contribution to journalArticlepeer-review

Abstract

Pre-capillary pulmonary hypertension (PH) in systemic sclerosis (SSc) is a heterogeneous condition with an overall bad prognosis. The objective of this study was to identify and characterize homogeneous phenotypes by a cluster analysis in SSc patients with PH. Patients were identified from two prospective cohorts from the US and France. Clinical, pulmonary function, high-resolution chest tomography, hemodynamic and survival data were extracted. We performed cluster analysis using the k-means method and compared survival between clusters using Cox regression analysis. Cluster analysis of 200 patients identified four homogenous phenotypes. Cluster C1 included patients with mild to moderate risk pulmonary arterial hypertension (PAH) with limited or no interstitial lung disease (ILD) and low DLCO with a 3-year survival of 81.5% (95% CI: 71.4–88.2). C2 had pre-capillary PH due to extensive ILD and worse 3-year survival compared to C1 (adjusted hazard ratio [HR] 3.14; 95% CI 1.66–5.94; p = 0.0004). C3 had severe PAH and a trend towards worse survival (HR 2.53; 95% CI 0.99–6.49; p = 0.052). Cluster C4 and C1 were similar with no difference in survival (HR 0.65; 95% CI 0.19–2.27, p = 0.507) but with a higher DLCO in C4. PH in SSc can be characterized into distinct clusters that differ in prognosis.

Original languageEnglish (US)
Article numbere0197112
JournalPloS one
Volume13
Issue number5
DOIs
StatePublished - May 2018

ASJC Scopus subject areas

  • General

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