Influence of various therapeutic strategies on right ventricular morphology, function and hemodynamics in pulmonary arterial hypertension

Badagliacca, Roberto; Raina, Amresh; Ghio, Stefano; D′Alto, Michele; Confalonieri, Marco; Correale, Michele; Corda, Marco; Paciocco, Giuseppe; Lombardi, Carlo; Mulè, Massimiliano; Poscia, Roberto; Scelsi, Laura; Argiento, Paola; Sciomer, Susanna; Benza, Raymond L.; Vizza, Carmine Dario

doi:10.1016/j.healun.2017.08.009

Cited by 53 publications

(53 citation statements)

References 35 publications

(34 reference statements)

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“…Our findings are aligned with those from previous randomised controlled trials and real-world studies where haemodynamic and functional improvement was observed following initial ERA and PDE5i combination therapy [1,[8][9][10][11][12]. Safety and tolerability were generally consistent with previous data for macitentan in combination with PDE5i [5,6,13].…”

Section: To the Editorsupporting

confidence: 90%

Initial combination therapy of macitentan and tadalafil in pulmonary arterial hypertension

et al. 2020

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Section: To the Editorsupporting

confidence: 90%

Initial combination therapy of macitentan and tadalafil in pulmonary arterial hypertension

et al. 2020

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“…Right ventricular function is a critical outcome determinant in patients with PH. An association between RV function and survival has already been described in patients with PAH treated with specific therapy [21][22][23]. We speculate that this could be also applicable for CTEPH patients treated with BPA.…”

Section: Effect Of Bpa On Clinical Outcomesupporting

confidence: 59%

Balloon Pulmonary Angioplasty in Patients with Chronic Thromboembolic Pulmonary Hypertension: Impact on Clinical and Hemodynamic Parameters, Quality of Life and Risk Profile

Jansa

Heller

Svoboda

et al. 2020

JCM

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Balloon pulmonary angioplasty (BPA) is a novel treatment option for patients with chronic thromboembolic pulmonary hypertension (CTEPH) who are not eligible for pulmonary endarterectomy (PEA) or suffer from persistent pulmonary hypertension after PEA. The aim of this study was to evaluate the real-life efficacy and safety of BPA in a consecutive group of patients who were diagnosed and treated in the national referral center for CTEPH in the Czech Republic. Here we report data from 160 BPA procedures performed in 64 patients. Efficacy analysis was performed in the subgroup of 25 patients who completed BPA series. Significant improvements were observed in New York Heart Association functional class (4% to 79% in I/II, p < 0.001), 6 min walking test distance (+54.3 m, p < 0.001), risk profile (15.8% to 68.5% with presence of 2/3 low risk criteria, p < 0.001), pulmonary artery mean pressure (−18%, p < 0.001), pulmonary vascular resistance (−32%, p < 0.001), stroke volume (+17%, p = 0.011) and quality of life (+37% in assessment of overall health status by a patient, p < 0.001). We observed 1 fatal periprocedural complication (1.6% of all 64 patients) and 19 BPA-related non-fatal complications (11.9% of all 160 interventions) that predominantly included hemoptysis (10.0% of all sessions). Overall survival at 12 months was 94.6%.

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“…this context, it is noteworthy that previous observational studies have shown a much more impressive therapeutic response when the intravenous prostacyclin therapy was initiated in treatment-naïve patients as part of an upfront combination regimen. 22,23 In contrast, late initiation of intravenous prostacyclin therapy was an independent predictor of a poor outcome in a series from Italy. 24 Taken together, these observations favor early initiation of intravenous therapy, but further studies are needed to better determine when this treatment should be initiated and which patients benefit most.…”

Section: Discussionmentioning

confidence: 86%

Intravenous treprostinil as an add-on therapy in patients with pulmonary arterial hypertension

Olsson

Richter

Kamp

et al. 2019

The Journal of Heart and Lung Transplantation

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BACKGROUND: In patients with pulmonary arterial hypertension who have an insufficient response to oral or inhaled therapies, current guidelines recommend the use of parenteral prostacyclin analogues, although the efficacy of this approach is unknown. METHODS: This retrospective multicenter study evaluated patients with pulmonary arterial hypertension who received intravenous treprostinil as an add-on therapy. The risk at baseline and follow-up (6−12 months after the initiation of treprostinil) was classified as low, intermediate, or high according to current recommendations. The outcome was measured as transplant-free survival after the initiation of treprostinil therapy. RESULTS: A total of 126 patients were analyzed, almost all of them pre-treated with combinations of other pulmonary arterial hypertension medications. Before the initiation of intravenous treprostinil, 2 (2%) patients had a low-risk profile; 100 (79%), an intermediate-risk profile; and 24 (19%), a highrisk profile. At follow-up, 24 (19%) patients were classified as low-risk. These patients had a 5-year transplant-free survival rate >90%. In contrast, patients who remained at intermediate or high risk had transplant-free survival rates of 76%, 43%, and 28% at 1, 3, and 5 years, respectively. Failure to reach a low risk at follow-up was an independent predictor of transplant-free survival (hazard ratio, 9.25; 95% confidence interval, 1.20−71.60; p = 0.033 1). CONCLUSIONS: Risk assessment at 6−12 months after the initiation of add-on intravenous treprostinil in patients with an insufficient response to nonparenteral treatments allows the prediction of transplantfree survival over the ensuing years. Achieving a low-risk profile is associated with excellent outcomes, whereas mortality is high in patients who remain at intermediate or high risk.

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Influence of various therapeutic strategies on right ventricular morphology, function and hemodynamics in pulmonary arterial hypertension

Cited by 53 publications

References 35 publications

Initial combination therapy of macitentan and tadalafil in pulmonary arterial hypertension

Initial combination therapy of macitentan and tadalafil in pulmonary arterial hypertension

Balloon Pulmonary Angioplasty in Patients with Chronic Thromboembolic Pulmonary Hypertension: Impact on Clinical and Hemodynamic Parameters, Quality of Life and Risk Profile

Intravenous treprostinil as an add-on therapy in patients with pulmonary arterial hypertension

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