Impact of pulmonary arteriovenous malformations on respiratory-related quality of life in patients with hereditary haemorrhagic telangiectasia

PLoS One. 2014 Mar 6;9(3):e90937. doi: 10.1371/journal.pone.0090937. eCollection 2014.

Abstract

Fifteen to fifty percent of patients with hereditary haemorrhagic telangiectasia have pulmonary arteriovenous malformations. The objective of this study was to measure the effect of the presence of pulmonary arteriovenous malformations and of their embolisation on respiratory-related quality of life (QoL). We prospectively recruited patients with a diagnosis of hereditary haemorrhagic telangiectasia based on the Curaçao criteria and/or the identification of a pathogenic mutation. Respiratory-related quality of life was measured using the Saint George's Respiratory Questionnaire (SGRQ). Patients who underwent embolisation of pulmonary arteriovenous malformations completed the questionnaire before and 6-12 mo after the procedure. The 56 participants were divided into three groups: no pulmonary arteriovenous malformation (group A, n = 10), small pulmonary arteriovenous malformations not accessible to embolotherapy (group B, n = 19), and large pulmonary arteriovenous malformations accessible to embolotherapy (group C, n = 27). The SGRQ score was significantly higher in group C compared to the other groups, indicating a worse respiratory-specific QoL. There was no significant difference between groups A and B. Among the 17 patients who underwent an embolisation, the SGRQ score decreased significantly after the procedure, to a value similar to that in patients without pulmonary arteriovenous malformation. Our results indicate that the presence of large but not small pulmonary arteriovenous malformations negatively affects the respiratory-related quality of life and that embolisation of pulmonary arteriovenous malformations normalizes the respiratory-related quality of life.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Arteriovenous Fistula / complications
  • Arteriovenous Fistula / physiopathology
  • Arteriovenous Fistula / psychology*
  • Arteriovenous Fistula / surgery
  • Embolization, Therapeutic*
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Pulmonary Artery / abnormalities*
  • Pulmonary Artery / physiopathology
  • Pulmonary Artery / surgery
  • Pulmonary Veins / abnormalities*
  • Pulmonary Veins / physiopathology
  • Pulmonary Veins / surgery
  • Quality of Life*
  • Respiration
  • Severity of Illness Index
  • Surveys and Questionnaires
  • Telangiectasia, Hereditary Hemorrhagic / complications
  • Telangiectasia, Hereditary Hemorrhagic / physiopathology
  • Telangiectasia, Hereditary Hemorrhagic / psychology*
  • Telangiectasia, Hereditary Hemorrhagic / surgery

Supplementary concepts

  • Pulmonary Arteriovenous Fistulas

Grants and funding

This work received financial support from the French HHT patient association, AMRO-France HHT (Association Maladie Rendu-Osler). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.