Prognostic Value of Pulmonary Hypertension in Ambulatory Patients With Non-Ischemic Dilated Cardiomyopathy

Hirashiki, Akihiro; Kondo, Takahisa; Adachi, Shiro; Nakano, Yoshihisa; Shimazu, Shuzo; Shimizu, Sakayu; Morimoto, Ryo; Okumura, Takahiro; Murohara, Toyoaki

doi:10.1253/circj.cj-13-1120

Cited by 18 publications

(17 citation statements)

References 32 publications

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“…However, other studies have reported no difference between C-pcPH and I-pcPH in clinical outcome [14, 15]. Such discrepancies might be due to a small absolute value of DPG, which could easily be the cause of a measurement error [11].…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Arterial Capacitance Predicts Cardiac Events in Pulmonary Hypertension Due to Left Heart Disease

Sugimoto¹,

Yoshihisa²,

Nakazato³

et al. 2016

PLoS ONE

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BackgroundAlthough pulmonary hypertension due to left heart disease (LHD-PH) accounts for the largest proportion of pulmonary hypertension, few reports on the epidemiological analysis of LHD-PH exist. Recently, pulmonary arterial capacitance (PAC) has attracted attention as a possible factor of right ventricular afterload along with pulmonary vascular resistance. We therefore investigated the clinical significance of PAC in LHD-PH.MethodsThe subject consisted of 252 LHD-PH patients (145 men, mean age 63.4 ± 14.7 years) diagnosed by right heart catheterization. PAC was estimated by the ratio between stroke volume and pulmonary arterial pulse pressure. Patients were classified into four groups according to the PAC (1st quartile was 0.74 to 1.76 ml/mmHg, the 2nd quartile 1.77 to 2.53 ml/mmHg, the 3rd quartile 2.54 to 3.59 ml/mmHg, and the 4th quartile 3.61 to 12.14 ml/mmHg). The end-points were defined as rehospitalization due to worsening heart failure and/or cardiac death. The Cox proportional hazard regression model was used to determine what variables were associated with cardiac events.ResultsThe patients in the 1st quartile had the lowest cardiac index and stroke volume index, and the highest mean pulmonary arterial pressure, mean pulmonary capillary wedge pressure, and pulmonary vascular resistance compared with the 2nd, 3rd, and 4th quartiles. Fifty-four patients experienced cardiac events during the follow-up period (median 943 days). The event-free rate of the 1st quartile was significantly lower than that of the 3rd and 4th quartiles (66.7% vs 82.5% [3rd quartile], P = 0.008; and 92.1% [4th quartile], P < 0.001). The Cox hazard analysis revealed that PAC was significantly associated with cardiac events (HR 0.556, 95% CI 0.424–0.730, P < 0.001).ConclusionPAC is useful in the prediction of cardiac event risk in LHD-PH patients.

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Section: Discussionmentioning

confidence: 99%

Pulmonary Arterial Capacitance Predicts Cardiac Events in Pulmonary Hypertension Due to Left Heart Disease

Sugimoto¹,

Yoshihisa²,

Nakazato³

et al. 2016

PLoS ONE

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“…Although the non-ischemic cardiomyopathy population is reported to be somewhat younger than ischemic cardiomyopathy patients, 38) we must study elderly patients in the future. 4) We used LVEF to test the efficacy of carvedilol, but it would be better if we can directly assess hard endpoints such as death or cardiovascular event rate.…”

Section: Discussionmentioning

confidence: 99%

High Dose <i>β</i>-Blocker Therapy Triggers Additional Reverse Remodeling in Patients With Idiopathic Non-Ischemic Cardiomyopathy

et al. 2016

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SummaryCarvedilol has established its evidence to improve prognosis and facilitate left ventricular reverse remodeling (LVRR) in heart failure patients with reduced left ventricular ejection fraction (LVEF), and many studies have supported its dose-dependency. However, there are few studies demonstrating the effect of high dose carvedilol in Japan. We enrolled 23 patients with idiopathic non-ischemic cardiomyopathy, in whom LVEF remained 45% or less despite 20 mg/ day of carvedilol therapy for > 3 months. After high dose (40 mg/day) carvedilol therapy for > 3 months, LVEF improved (+9.1%, P = 0.002), and LV end-diastolic diameter (LVDd) and LV end-systolic diameter (LVDs) reduced (-4.6 and -6.9 mm, respectively, P < 0.05) compared with the baseline data. Finally, 17 patients achieved LVRR after the high dose, when LVRR was defined as 1) those with final EF > 45%, and 2) those with final EF < 45% but who attained increases in LVEF > 10%, or LVEF > 5% with a decrease in LV end-diastolic dimension index (LVDDI) > 5%. Baseline predictors for LVRR after high dose carvedilol were the change rates of log B-type natriuretic peptide (BNP), LVDd, and LVDs from the time of pre-carvedilol introduction to enrollment (P < 0.05, respectively). In conclusion, high dose carvedilol triggered additional LVRR in patients with idiopathic non-ischemic cardiomyopathy and the change rates of log BNP, LVDd, and LVDs at 20 mg carvedilol may be predictors for the additional LVRR at high dose. (Int Heart J 2016; 57: 717-724) Key words: Carvedilol, Heart failure, Ejection fraction β -Blockers (BBs) have established the evidence to improve the prognosis of chronic heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF), [1][2][3] and are recommended as one of the first line drugs in all HF guidelines. 4,5) Among the 3 BBs that have been shown to be effective in systolic HF, ie, carvedilol, bisoprolol, and metoprolol succinate, carvedilol has been used the most all over the world. [6][7][8] The approved maximal dose is 20 mg/day in Japan, whereas its standard dose in the United States and Europe is 50 mg/day. HF guidelines from the US 4) and Europe 5) state that BBs should be titrated as much as tolerated. However, a post-marketing surveillance study in Japanese HF patients reported that carvedilol was then prescribed at approximately 7.2 mg/day on average. 9) Similarly, the mean dosage of carvedilol was 25 mg/day, ie, half of the target dose in Europe in the SHIFT study.10) As such, BBs are underused in terms of their dosage in real-world clinical practice.When a new drug is introduced into Japan, approximately the half dose of that in Western countries has often been adopted as the maximal dose for Japanese simply because of their smaller average build. In most Japanese clinical trials, the protocols set the target dose of any medications relatively low. This was also the case for carvedilol. However, probably because of the Westernization of Japanese dietary habits, the improvement in the average build is q...

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“…4 Hirashiki et al showed that there were no differences between reactive and passive PH in the incidence of cardiac events, although the sample size was small. 5 The problem is that TPG and PVR are affected by cardiac output, 28 whereas DPG is less sensitive to this effect. Gerges et al showed that DPG ≥7 mmHg identified high-risk patients with reactive PH (PH due to LHD and TPG >12 mmHg) on Kaplan-Meier analysis and that DPG was associated with more severe pulmonary vascular remodeling on histological analysis.…”

Section: Study Limitationsmentioning

confidence: 99%

Prognostic Factors for Survival in Pulmonary Hypertension Due to Left Heart Disease

Yamabe

Dohi

Fujisaki

et al. 2016

Circ J

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Prognostic Value of Pulmonary Hypertension in Ambulatory Patients With Non-Ischemic Dilated Cardiomyopathy

Cited by 18 publications

References 32 publications

Pulmonary Arterial Capacitance Predicts Cardiac Events in Pulmonary Hypertension Due to Left Heart Disease

Pulmonary Arterial Capacitance Predicts Cardiac Events in Pulmonary Hypertension Due to Left Heart Disease

High Dose <i>β</i>-Blocker Therapy Triggers Additional Reverse Remodeling in Patients With Idiopathic Non-Ischemic Cardiomyopathy

Prognostic Factors for Survival in Pulmonary Hypertension Due to Left Heart Disease

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