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Acute vasoreactivity testing predicts outcome of idiopathic pulmonary arterial hypertension patients with a negative acute response

BACKGROUND: Acute vasoreactivity testing (AVT) during right heart catheterization (RHC) is performed in certain subsets of patients with pulmonary arterial hypertension (PAH) in order to identify those who benefit from calcium channel blockers. The present study aimed to investigate the prognostic v...

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Autores principales: Sun, Yuanyuan, Li, Yuan, Meng, Xiangrui, Jiang, Rong, Zhao, Qinhua, Wang, Lan, Shi, Lingzi, Luo, Cijun, Qiu, Hongling, Wu, Wenhui, Li, Jinling, He, Jing, Liu, Jinming, Yuan, Ping, Gong, Sugang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7812225/
https://www.ncbi.nlm.nih.gov/pubmed/33490162
http://dx.doi.org/10.21037/atm-20-7339
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author Sun, Yuanyuan
Li, Yuan
Meng, Xiangrui
Jiang, Rong
Zhao, Qinhua
Wang, Lan
Shi, Lingzi
Luo, Cijun
Qiu, Hongling
Wu, Wenhui
Li, Jinling
He, Jing
Liu, Jinming
Yuan, Ping
Gong, Sugang
author_facet Sun, Yuanyuan
Li, Yuan
Meng, Xiangrui
Jiang, Rong
Zhao, Qinhua
Wang, Lan
Shi, Lingzi
Luo, Cijun
Qiu, Hongling
Wu, Wenhui
Li, Jinling
He, Jing
Liu, Jinming
Yuan, Ping
Gong, Sugang
author_sort Sun, Yuanyuan
collection PubMed
description BACKGROUND: Acute vasoreactivity testing (AVT) during right heart catheterization (RHC) is performed in certain subsets of patients with pulmonary arterial hypertension (PAH) in order to identify those who benefit from calcium channel blockers. The present study aimed to investigate the prognostic value of pre-AVT, post-AVT, and changes in AVT (ΔAVT) parameters for idiopathic PAH (IPAH) patients with a negative acute response, and to identify sex differences that could be of prognostic value. METHODS: A total of 487 incident IPAH patients (171 males and 316 females) with a negative acute response to AVT were recruited from Shanghai Pulmonary Hospital between 2009 and 2018. Outcomes were predicted using the Kaplan-Meier curve and univariate/multivariate Cox regression analyses. All patients were followed up till January 2020, with outcome specified as all-cause mortality. RESULTS: Inhalation of iloprost aerosol improved the hemodynamic parameters for all patients. Post-PVR was decreased, and post-cardiac output (post-CO) and post-cardiac index (post-CI) were increased compared with pre-AVT parameters among males. Increased post- artery oxygen saturation (post-SaO(2)) and decreased post-mean right atrium pressure (post-mRAP) were also observed in females. For all patients, pre-CO ≥3.25 L/min, post-mPAP <53 mmHg, and post-mixed venous oxygen saturation (post-SvO(2)) ≤63% were parameters suggesting better prognosis. For males, patients with pre-PVR <12.47 Wood units, pre-SvO(2) ≥64%, and post-mean pulmonary artery pressure (post-mPAP) <51 mmHg had a better prognosis. For females, patients with ΔmPAP ≥−4 mmHg and ΔPVR ≥−0.25 Wood units had better outcomes. CONCLUSIONS: AVT parameters, including pre-AVT, post-AVT and ΔAVT, have a more important prognostic value than currently used for identify a small subgroup of patients with PAH who are suitable for high-dose calcium channel blockers. Sex differences in AVT parameters suggest that sex should be taken into account in estimating prognosis.
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spelling pubmed-78122252021-01-22 Acute vasoreactivity testing predicts outcome of idiopathic pulmonary arterial hypertension patients with a negative acute response Sun, Yuanyuan Li, Yuan Meng, Xiangrui Jiang, Rong Zhao, Qinhua Wang, Lan Shi, Lingzi Luo, Cijun Qiu, Hongling Wu, Wenhui Li, Jinling He, Jing Liu, Jinming Yuan, Ping Gong, Sugang Ann Transl Med Original Article BACKGROUND: Acute vasoreactivity testing (AVT) during right heart catheterization (RHC) is performed in certain subsets of patients with pulmonary arterial hypertension (PAH) in order to identify those who benefit from calcium channel blockers. The present study aimed to investigate the prognostic value of pre-AVT, post-AVT, and changes in AVT (ΔAVT) parameters for idiopathic PAH (IPAH) patients with a negative acute response, and to identify sex differences that could be of prognostic value. METHODS: A total of 487 incident IPAH patients (171 males and 316 females) with a negative acute response to AVT were recruited from Shanghai Pulmonary Hospital between 2009 and 2018. Outcomes were predicted using the Kaplan-Meier curve and univariate/multivariate Cox regression analyses. All patients were followed up till January 2020, with outcome specified as all-cause mortality. RESULTS: Inhalation of iloprost aerosol improved the hemodynamic parameters for all patients. Post-PVR was decreased, and post-cardiac output (post-CO) and post-cardiac index (post-CI) were increased compared with pre-AVT parameters among males. Increased post- artery oxygen saturation (post-SaO(2)) and decreased post-mean right atrium pressure (post-mRAP) were also observed in females. For all patients, pre-CO ≥3.25 L/min, post-mPAP <53 mmHg, and post-mixed venous oxygen saturation (post-SvO(2)) ≤63% were parameters suggesting better prognosis. For males, patients with pre-PVR <12.47 Wood units, pre-SvO(2) ≥64%, and post-mean pulmonary artery pressure (post-mPAP) <51 mmHg had a better prognosis. For females, patients with ΔmPAP ≥−4 mmHg and ΔPVR ≥−0.25 Wood units had better outcomes. CONCLUSIONS: AVT parameters, including pre-AVT, post-AVT and ΔAVT, have a more important prognostic value than currently used for identify a small subgroup of patients with PAH who are suitable for high-dose calcium channel blockers. Sex differences in AVT parameters suggest that sex should be taken into account in estimating prognosis. AME Publishing Company 2020-12 /pmc/articles/PMC7812225/ /pubmed/33490162 http://dx.doi.org/10.21037/atm-20-7339 Text en 2020 Annals of Translational Medicine. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Original Article
Sun, Yuanyuan
Li, Yuan
Meng, Xiangrui
Jiang, Rong
Zhao, Qinhua
Wang, Lan
Shi, Lingzi
Luo, Cijun
Qiu, Hongling
Wu, Wenhui
Li, Jinling
He, Jing
Liu, Jinming
Yuan, Ping
Gong, Sugang
Acute vasoreactivity testing predicts outcome of idiopathic pulmonary arterial hypertension patients with a negative acute response
title Acute vasoreactivity testing predicts outcome of idiopathic pulmonary arterial hypertension patients with a negative acute response
title_full Acute vasoreactivity testing predicts outcome of idiopathic pulmonary arterial hypertension patients with a negative acute response
title_fullStr Acute vasoreactivity testing predicts outcome of idiopathic pulmonary arterial hypertension patients with a negative acute response
title_full_unstemmed Acute vasoreactivity testing predicts outcome of idiopathic pulmonary arterial hypertension patients with a negative acute response
title_short Acute vasoreactivity testing predicts outcome of idiopathic pulmonary arterial hypertension patients with a negative acute response
title_sort acute vasoreactivity testing predicts outcome of idiopathic pulmonary arterial hypertension patients with a negative acute response
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7812225/
https://www.ncbi.nlm.nih.gov/pubmed/33490162
http://dx.doi.org/10.21037/atm-20-7339
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