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Prognostic impact of follow-up pulmonary vascular resistance in pulmonary arterial hypertension

OBJECTIVE: Pulmonary arterial hypertension (PAH), caused by pulmonary artery remodelling and increased pulmonary vascular resistance (PVR) due to an unknown mechanism, is an intractable disease with a poor prognosis. The recent development of PAH-specific treatment medications may allow for higher P...

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Autores principales: Suzuki, Sho, Asano, Ryotaro, Aoki, Tatsuo, Nakayama, Sayuri, Ueda, Jin, Tsuji, Akihiro, Noguchi, Teruo, Ogo, Takeshi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9185661/
https://www.ncbi.nlm.nih.gov/pubmed/35675988
http://dx.doi.org/10.1136/openhrt-2022-002054
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author Suzuki, Sho
Asano, Ryotaro
Aoki, Tatsuo
Nakayama, Sayuri
Ueda, Jin
Tsuji, Akihiro
Noguchi, Teruo
Ogo, Takeshi
author_facet Suzuki, Sho
Asano, Ryotaro
Aoki, Tatsuo
Nakayama, Sayuri
Ueda, Jin
Tsuji, Akihiro
Noguchi, Teruo
Ogo, Takeshi
author_sort Suzuki, Sho
collection PubMed
description OBJECTIVE: Pulmonary arterial hypertension (PAH), caused by pulmonary artery remodelling and increased pulmonary vascular resistance (PVR) due to an unknown mechanism, is an intractable disease with a poor prognosis. The recent development of PAH-specific treatment medications may allow for higher PVR reduction than previously achieved. This study aimed to identify the prognostic significance of follow-up PVR levels achieved shortly after the initiation of targeted treatment in patients with idiopathic/heritable pulmonary arterial hypertension (I/H-PAH). METHODS: We analysed the data of all patients with I/H-PAH admitted to our hospital between 1998 and 2019. We collected data at baseline and during the first invasive haemodynamic evaluation. The primary outcome was death or lung transplantation. RESULTS: Of the 133 treatment-naïve patients enrolled in this study, 47 experienced adverse events during a median follow-up period of 6.4 (IQR 3.5–11.5) years. The median time interval to first follow-up from diagnosis was 162 (IQR 117–253) days. Incidence of the primary outcome was significantly lower in patients who achieved low PVR at follow-up. Of risk factors evaluated at follow-up, the multivariate Cox regression analysis revealed PVR as an independent predictor of the primary outcome (HR 1.103, 95% CI 1.029 to 1.183; p=0.006). The results were consistent across risk profiles according to the simplified risk stratification recommended by the European Society of Cardiology and European Respiratory Society guidelines. CONCLUSION: Follow-up PVR was an independent predictor of transplant-free survival in patients with I/H-PAH. Evaluation of haemodynamic status shortly after initiating treatment may help predict long-term prognosis.
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spelling pubmed-91856612022-06-16 Prognostic impact of follow-up pulmonary vascular resistance in pulmonary arterial hypertension Suzuki, Sho Asano, Ryotaro Aoki, Tatsuo Nakayama, Sayuri Ueda, Jin Tsuji, Akihiro Noguchi, Teruo Ogo, Takeshi Open Heart Pulmonary Vascular Disease OBJECTIVE: Pulmonary arterial hypertension (PAH), caused by pulmonary artery remodelling and increased pulmonary vascular resistance (PVR) due to an unknown mechanism, is an intractable disease with a poor prognosis. The recent development of PAH-specific treatment medications may allow for higher PVR reduction than previously achieved. This study aimed to identify the prognostic significance of follow-up PVR levels achieved shortly after the initiation of targeted treatment in patients with idiopathic/heritable pulmonary arterial hypertension (I/H-PAH). METHODS: We analysed the data of all patients with I/H-PAH admitted to our hospital between 1998 and 2019. We collected data at baseline and during the first invasive haemodynamic evaluation. The primary outcome was death or lung transplantation. RESULTS: Of the 133 treatment-naïve patients enrolled in this study, 47 experienced adverse events during a median follow-up period of 6.4 (IQR 3.5–11.5) years. The median time interval to first follow-up from diagnosis was 162 (IQR 117–253) days. Incidence of the primary outcome was significantly lower in patients who achieved low PVR at follow-up. Of risk factors evaluated at follow-up, the multivariate Cox regression analysis revealed PVR as an independent predictor of the primary outcome (HR 1.103, 95% CI 1.029 to 1.183; p=0.006). The results were consistent across risk profiles according to the simplified risk stratification recommended by the European Society of Cardiology and European Respiratory Society guidelines. CONCLUSION: Follow-up PVR was an independent predictor of transplant-free survival in patients with I/H-PAH. Evaluation of haemodynamic status shortly after initiating treatment may help predict long-term prognosis. BMJ Publishing Group 2022-06-08 /pmc/articles/PMC9185661/ /pubmed/35675988 http://dx.doi.org/10.1136/openhrt-2022-002054 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Pulmonary Vascular Disease
Suzuki, Sho
Asano, Ryotaro
Aoki, Tatsuo
Nakayama, Sayuri
Ueda, Jin
Tsuji, Akihiro
Noguchi, Teruo
Ogo, Takeshi
Prognostic impact of follow-up pulmonary vascular resistance in pulmonary arterial hypertension
title Prognostic impact of follow-up pulmonary vascular resistance in pulmonary arterial hypertension
title_full Prognostic impact of follow-up pulmonary vascular resistance in pulmonary arterial hypertension
title_fullStr Prognostic impact of follow-up pulmonary vascular resistance in pulmonary arterial hypertension
title_full_unstemmed Prognostic impact of follow-up pulmonary vascular resistance in pulmonary arterial hypertension
title_short Prognostic impact of follow-up pulmonary vascular resistance in pulmonary arterial hypertension
title_sort prognostic impact of follow-up pulmonary vascular resistance in pulmonary arterial hypertension
topic Pulmonary Vascular Disease
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9185661/
https://www.ncbi.nlm.nih.gov/pubmed/35675988
http://dx.doi.org/10.1136/openhrt-2022-002054
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