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Beneficial effects of riociguat on hemodynamic responses to exercise in CTEPH patients after balloon pulmonary angioplasty – A randomized controlled study

BACKGROUND: Although balloon pulmonary angioplasty (BPA) improves symptoms and pulmonary hemodynamics in patients with chronic thromboembolic pulmonary hypertension (CTEPH), the effects of riociguat on hemodynamics and exercise capacity in patients after BPA remain to be elucidated. METHODS AND RESU...

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Autores principales: Aoki, Tatsuo, Sugimura, Koichiro, Terui, Yosuke, Tatebe, Shunsuke, Fukui, Shigefumi, Miura, Masanobu, Yamamoto, Saori, Yaoita, Nobuhiro, Suzuki, Hideaki, Sato, Haruka, Kozu, Katsuya, Konno, Ryo, Miyata, Satoshi, Nochioka, Kotaro, Satoh, Kimio, Shimokawa, Hiroaki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356201/
https://www.ncbi.nlm.nih.gov/pubmed/32685661
http://dx.doi.org/10.1016/j.ijcha.2020.100579
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author Aoki, Tatsuo
Sugimura, Koichiro
Terui, Yosuke
Tatebe, Shunsuke
Fukui, Shigefumi
Miura, Masanobu
Yamamoto, Saori
Yaoita, Nobuhiro
Suzuki, Hideaki
Sato, Haruka
Kozu, Katsuya
Konno, Ryo
Miyata, Satoshi
Nochioka, Kotaro
Satoh, Kimio
Shimokawa, Hiroaki
author_facet Aoki, Tatsuo
Sugimura, Koichiro
Terui, Yosuke
Tatebe, Shunsuke
Fukui, Shigefumi
Miura, Masanobu
Yamamoto, Saori
Yaoita, Nobuhiro
Suzuki, Hideaki
Sato, Haruka
Kozu, Katsuya
Konno, Ryo
Miyata, Satoshi
Nochioka, Kotaro
Satoh, Kimio
Shimokawa, Hiroaki
author_sort Aoki, Tatsuo
collection PubMed
description BACKGROUND: Although balloon pulmonary angioplasty (BPA) improves symptoms and pulmonary hemodynamics in patients with chronic thromboembolic pulmonary hypertension (CTEPH), the effects of riociguat on hemodynamics and exercise capacity in patients after BPA remain to be elucidated. METHODS AND RESULTS: This study was a single-center, prospective, randomized, open-label trial. From November 2015 to November 2018, we prospectively examined 21 patients with CTEPH (65 ± 9 years old, M/F 2/19) who showed hemodynamic improvement with mean pulmonary arterial pressure (mPAP) < 30 mmHg after BPA without any vasodilators. We performed hemodynamic evaluation and expired gas analysis both at rest and during exercise in supine position using cycle ergometer. After right heart catheterization during exercise, they were randomly assigned to 2 groups with minimized method, using age, sex, and resting mPAP; riociguat (N = 10) and control (N = 11) groups. After 6 months, exercise capacity evaluated by 6-min walk distance and cardiopulmonary exercise testing, and resting hemodynamic parameters were comparable in both groups. However, cardiac output (CO) (6.0 ± 1.7–7.4 ± 1.6, P < 0.01) and pulmonary vascular resistance (4.8 ± 1.8–3.2 ± 0.7 Wood units, P = 0.02) at peak workload were significantly improved in the riociguat group as compared with the control group. The slope of linearized mPAP-CO relationship was significantly decreased in the riociguat group [14.5 (7.8, 14.7) to 6.41 (5.1, 11.4), P < 0.01] but not in the control group. CONCLUSIONS: These results indicate that riociguat exerts beneficial effects on hemodynamic response to exercise in CTEPH patients even after hemodynamic improvement by BPA.
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spelling pubmed-73562012020-07-17 Beneficial effects of riociguat on hemodynamic responses to exercise in CTEPH patients after balloon pulmonary angioplasty – A randomized controlled study Aoki, Tatsuo Sugimura, Koichiro Terui, Yosuke Tatebe, Shunsuke Fukui, Shigefumi Miura, Masanobu Yamamoto, Saori Yaoita, Nobuhiro Suzuki, Hideaki Sato, Haruka Kozu, Katsuya Konno, Ryo Miyata, Satoshi Nochioka, Kotaro Satoh, Kimio Shimokawa, Hiroaki Int J Cardiol Heart Vasc Original Paper BACKGROUND: Although balloon pulmonary angioplasty (BPA) improves symptoms and pulmonary hemodynamics in patients with chronic thromboembolic pulmonary hypertension (CTEPH), the effects of riociguat on hemodynamics and exercise capacity in patients after BPA remain to be elucidated. METHODS AND RESULTS: This study was a single-center, prospective, randomized, open-label trial. From November 2015 to November 2018, we prospectively examined 21 patients with CTEPH (65 ± 9 years old, M/F 2/19) who showed hemodynamic improvement with mean pulmonary arterial pressure (mPAP) < 30 mmHg after BPA without any vasodilators. We performed hemodynamic evaluation and expired gas analysis both at rest and during exercise in supine position using cycle ergometer. After right heart catheterization during exercise, they were randomly assigned to 2 groups with minimized method, using age, sex, and resting mPAP; riociguat (N = 10) and control (N = 11) groups. After 6 months, exercise capacity evaluated by 6-min walk distance and cardiopulmonary exercise testing, and resting hemodynamic parameters were comparable in both groups. However, cardiac output (CO) (6.0 ± 1.7–7.4 ± 1.6, P < 0.01) and pulmonary vascular resistance (4.8 ± 1.8–3.2 ± 0.7 Wood units, P = 0.02) at peak workload were significantly improved in the riociguat group as compared with the control group. The slope of linearized mPAP-CO relationship was significantly decreased in the riociguat group [14.5 (7.8, 14.7) to 6.41 (5.1, 11.4), P < 0.01] but not in the control group. CONCLUSIONS: These results indicate that riociguat exerts beneficial effects on hemodynamic response to exercise in CTEPH patients even after hemodynamic improvement by BPA. Elsevier 2020-07-10 /pmc/articles/PMC7356201/ /pubmed/32685661 http://dx.doi.org/10.1016/j.ijcha.2020.100579 Text en © 2020 The Author(s) http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Paper
Aoki, Tatsuo
Sugimura, Koichiro
Terui, Yosuke
Tatebe, Shunsuke
Fukui, Shigefumi
Miura, Masanobu
Yamamoto, Saori
Yaoita, Nobuhiro
Suzuki, Hideaki
Sato, Haruka
Kozu, Katsuya
Konno, Ryo
Miyata, Satoshi
Nochioka, Kotaro
Satoh, Kimio
Shimokawa, Hiroaki
Beneficial effects of riociguat on hemodynamic responses to exercise in CTEPH patients after balloon pulmonary angioplasty – A randomized controlled study
title Beneficial effects of riociguat on hemodynamic responses to exercise in CTEPH patients after balloon pulmonary angioplasty – A randomized controlled study
title_full Beneficial effects of riociguat on hemodynamic responses to exercise in CTEPH patients after balloon pulmonary angioplasty – A randomized controlled study
title_fullStr Beneficial effects of riociguat on hemodynamic responses to exercise in CTEPH patients after balloon pulmonary angioplasty – A randomized controlled study
title_full_unstemmed Beneficial effects of riociguat on hemodynamic responses to exercise in CTEPH patients after balloon pulmonary angioplasty – A randomized controlled study
title_short Beneficial effects of riociguat on hemodynamic responses to exercise in CTEPH patients after balloon pulmonary angioplasty – A randomized controlled study
title_sort beneficial effects of riociguat on hemodynamic responses to exercise in cteph patients after balloon pulmonary angioplasty – a randomized controlled study
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356201/
https://www.ncbi.nlm.nih.gov/pubmed/32685661
http://dx.doi.org/10.1016/j.ijcha.2020.100579
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