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 Cura?ao 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.
References
[1]
Guttmacher AE, Marchuk DA, White RI Jr (1995) Hereditary hemorrhagic telangiectasia. N Engl J Med 333: 918–924. doi: 10.1056/nejm199510053331407
[2]
Shovlin Cl, Guttmacher AE, Buscarini E, Faughnan ME, Hyland RH, et al. (2000) Diagnostic criteria for hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber syndrome). Am J Med Genet 91: 66–67. doi: 10.1002/(sici)1096-8628(20000306)91:1<66::aid-ajmg12>3.0.co;2-p
[3]
Abdalla SA, Le Tarte M (2006) Hereditary haemorrhagic telangiectasia: current views on genetics and mechanisms of disease. J Med Genet 43: 97–110. doi: 10.1136/jmg.2005.030833
[4]
Faughnan ME, Palda VA, Garcia-Tsao G, Geisthoff UW, McDonald J, et al. (2011) International Guidelines for the diagnosis and management of Hereditary Hemorrhagic Telangiectasia. J Med Genet 48: 73–87. doi: 10.1136/jmg.2009.069013
[5]
Gossage JR, Kanj G (1998) Pulmonary arteriovenous malformations. Am J Respir Crit Care Med 158: 643–661. doi: 10.1164/ajrccm.158.2.9711041
[6]
Faughnan ME, Granton JT, Young LH (2009) The pulmonary vascular complications of hereditary hemorrhagic telangiectasia. Eur Respir J 33: 1186–1194. doi: 10.1183/09031936.00061308
[7]
Moussouttas M, Fayad P, Rosenblatt M, Hashimoto M, Pollak J, et al. (2000) Cerebral ischemia and neurologic manifestations. Neurology 55: 959–964. doi: 10.1212/wnl.55.7.959
[8]
Trerotola SO, Pyeritz RE (2010) PAVM embolisation: an update. Am J Roentgenol 195: 837–845. doi: 10.2214/ajr.10.5230
[9]
Lacombe P, Lagrange C, Beauchet A, El Hajjam M, Chinet T, et al. (2009) Diffuse Pulmonary Arteriovenous Malformations in Hereditary Hemorrhagic Telangiectasia: Long-term results of Embolization According to the Extent of Lung Involvement. Chest 135: 1031–1037. doi: 10.1378/chest.08-1794
[10]
Pasculli G, Resta F, Guastamacchia E, Di Gennaro L, Suppressa P, et al. (2004) Health-related quality of life in a rare disease: Hereditary hemorrhagic telangiectasia (HHT) or Rendu–Osler–Weber Disease. Qual Life Res 13: 1715–1723. doi: 10.1007/s11136-004-7865-y
[11]
Lennox PA, Hitchings AE, Lund VJ, Howard DJ (2005) The SF-36 health status questionnaire in assessing patients with epistaxis secondary to hereditary hemorrhagic telangiectasia. Am J Rhinol 19: 71–74.
[12]
Geisthoff UW, Heckmann K, D’Amelio R, Grunewald S, Knobber D, et al. (2007) Health-related quality of life in hereditary hemorrhagic telangiectasia. Otolaryngol Head Neck Surg 136: 726–733. doi: 10.1016/j.otohns.2006.12.019
[13]
Geirdal A?, Dheyauldeen S, Bachmann-Harildstad G, Heimdal K (2012) Quality of life in patients with hereditary hemorrhagic telangiectasia in Norway: A population-based study. Am J Med Genet Part A 158A: 1269–1278. doi: 10.1002/ajmg.a.35309
[14]
Pfister M, Zalaman IM, Blumenstock G, Mauz PS, Baumann I (2009) Impact of genotype and mutation type on health-related quality of life in patients with hereditary hemorrhagic telangiectasia. Acta Otolaryngol 129: 862–866. doi: 10.1080/00016480802468138
[15]
Jones PW, Quirk FH, Baveystock CM, Littlejohns P (1992) A self-complete measure of health status for chronic airflow limitation. The St. George’s Respiratory Questionnaire. Am Rev Respir Dis 145: 1321–1327. doi: 10.1164/ajrccm/145.6.1321
[16]
Jones PW (2002) Interpreting thresholds for a clinically significant change in health status in asthma and COPD. Eur Respir J 19: 398–404. doi: 10.1183/09031936.02.00063702
[17]
de Gussem EM, Snijder RJ, Disch FJ, Zanen P, Westermann CJ, et al. (2009) The effect of N-acetylcysteine on epistaxis and quality of life in patients with HHT: A pilot study. Rhinology 47: 85–88.
[18]
Karapantzos I, Tsimpiris N, Goulis DG, Van Hoecke H, Van Cauwenberge P, et al. (2005) Management of epistaxis in hereditary hemorrhagic telangiectasia by Nd:YAG laser and quality of life assessment using the HR-QoL questionnaire. Eur Arch Otorhinolaryngol 262: 830–833. doi: 10.1007/s00405-004-0911-0
[19]
Gupta S, Faughnan ME, Bayoumi AM (2009) Embolization for pulmonary arteriovenous malformation in hereditary haemorrhagic telangiectasia. A decision analysis. Chest 136: 849–858.
[20]
Velthuis S, Buscarini E, van Gent MWF, Gazzaniga P, Manfredi G, et al. (2013) Grade of pulmonary right-to-left shunt on contrast echocardiography and cerebral complications. A striking association. Chest 144: 542–548. doi: 10.1378/chest.12-1599
[21]
Nishiyama O, Taniguchi H, Kondoh Y, Kimura T, Ogawa T, et al. (2005) Health-related quality of life in patients with idiopathic pulmonary fibrosis. What is the main contributing factor? Respir Med 99: 408–414. doi: 10.1016/j.rmed.2004.09.005
[22]
Rubenfire M, Lippo G, Bodini BD, Blasi F, Allegra L, et al. (2009) Evaluating Health-Related Quality of Life, Work Ability, and Disability in Pulmonary Arterial Hypertension: An Unmet Need. Chest 136: 597–603. doi: 10.1378/chest.08-1260
[23]
Al-Shair K, Atherton GTW, Kennedy D, Powell G, Denning DW, et al. (2013) Validity and reliability of the St George’s respiratory questionnaire in assessing health status in patients with chronic pulmonary aspergillosis. Chest 144: 623–631. doi: 10.1378/chest.12-0014
[24]
Bouchet Ch, Guillemin F, Hoang Thi TH, Cornette A, Brian?on S (1996) Validation du questionnaire St Georges pour mesurer la qualité de vie chez les insuffisants respiratoires chroniques. Rev Mal Resp 13: 43–46.