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Primary Pulmonary Hypertension In Israel^*

A National Survey

^* From the Pulmonary Institute (Dr. Appelbaum), Hadassah University Medical Center, Jerusalem, Israel; the Pulmonary Institute (Dr. Yigla), Rambam Medical Center, Haifa, Israel; the Pulmonary Institute (Dr. Reichart), Shiba Medical Center, Tel-Hashomer, Israel; the Pulmonary Institute (Drs. Kramer, Fink, and Bendayan), Rabin Medical Center, Petah-Tikvah, Israel; the Pulmonary Institute (Dr. Priel), Pulmonary Department, Wolfson Medical Center, Holon, Israel; the Pulmonary Institute (Dr. Schwartz), Ichilov Medical Center, Tel-Aviv, Israel; Haemek Medical Center (Dr. Richman), Afula, Israel; the Pulmonary Institute (Dr. Picard), Shaarey-zedek Medical Center, Jerusalem, Israel; the Epidemiology Department (Dr. Goldman), Hadassah University Medical Center, Jerusalem, Israel.

Correspondence to: Mordechai R. Kramer, MD, FCCP, Institute of Pulmonology, Rabin Medical Center, Petach Tikva, 49100 Israel; e-mail: pulm{at}netvision.net.il

Objectives: To characterize the incidence of patients with primary pulmonary hypertension (PPH) in Israel and their outcomes.

Methods: We have evaluated retrospectively all the patients in Israel in whom PPH was diagnosed between the years 1988 and 1997. We looked at medical history, hemodynamic data, pulmonary function and gas exchange, and demographic variables. Patients were followed up for survival until November 1997. Life table analysis and Kaplan-Meier statistics were used to estimate the overall survival distribution. Regression analysis was used to examine the relations between survival and selected variables.

Results: Overall, we found 44 patients with PPH. The estimated incidence of PPH in Israel is 1.4 new cases per year per million population. The mean (± SD) age at diagnosis was 43 ± 13 years. In the Jewish population, PPH was more frequent among immigrants from Europe and the United States. The mean interval from the onset of symptoms to diagnosis was 3 years (median, 2 years). The median survival time was 4 years. The 1-year, 3-year, and 5-year survival rates were 82%, 57%, and 43%, respectively. The major variables influencing the survival rate were the following: interval from symptom onset to diagnosis; and hemodynamic measurements (ie, mean pulmonary artery pressure, mean right atrial pressure, and cardiac index). In comparison to rates discerned from the National Institutes of Health registry data, the survival rate in Israel is somewhat better and prognosis is influenced by similar hemodynamic variables.

Conclusion: PPH is a rare and fatal disease in Israel. New therapeutic modalities such as prostacyclin therapy and lung transplantation may improve survival among patients with this malignant disease.

Key Words: lung transplantation • primary pulmonary hypertension • prostacyclin

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