New York Heart Association class and pulmonary artery pressure as prognostic factors of interstitial lung disease survival

OBJECTIVE: The aim of this study was to evaluate New York Heart Associ-ation (NYHA) class and systolic pulmonary ar-tery pressure (sPAP) as survival predictors in major interstitial lung diseases (ILD) including idiopathic pulmonary fibrosis (IPF), non-spe-cific interstitial pneumonia (NSIP) and hyper-sensitivity pneumonitis (HP) and in other ILD like granulomatosis with polyangiitis (GPA). PATIENTS AND METHODS: We analyzed survival, NYHA class, sPAP, and Octreoscan uptake index (UI) in 104 ILD patients (59 IPF, 19 NSIP, 10 HP and 16 GPA; median age 60.5 years) all referred to a single centre.RESULTS: Median survival was 68 months, with 1-and 2-year survival of 91% and 78%, re-spectively. Survival was lower among IPF and NSIP vs. HP and GPA patients (p=0.01). NY -HA class 3-4 was more frequent among IPF (76.3%) vs. NSIP patients (31.6%; p<0.001). HP and GPA had NYHA class 1-2. NYHA class was negatively associated with survival (class 1=90.3 months vs. class 3=18.3 months and class 4=5.1 months; p=0.001). sPAP was >55 mmHg in 76.3% of patients with IPF and 35-55 mmHg in 63.2% of patients with NSIP. Patients with HP and GPA had sPAP < 55 mmHg. Among patients with IPF, NYHA and sPAP were neg-atively associated with survival (p<0.01) both showed a parallel trend. High-resolution com-puted tomography and survival were worse among IPF and NSIP vs. HP and GPA patients (p<0.001). Octreoscan UI was <10, 10-12, and >12 in IPF, NSIP, HP and GPA, respectively. Oc-treoscan UI was negatively associated with survival (p=0.002).CONCLUSIONS: NYHA class and sPAP are comparable ILD survival predictors. NYHA class is correlated with worse prognosis for IPF and NSIP vs. HP and GPA patients.