Roberto Badagliacca1, Amresh Raina2, Stefano Ghio3, Michele D'Alto4, Marco Confalonieri5, Michele Correale6, Marco Corda7, Giuseppe Paciocco8, Carlo Lombardi9, Massimiliano Mulè10, Roberto Poscia11, Laura Scelsi3, Paola Argiento4, Susanna Sciomer11, Raymond L Benza2, Carmine Dario Vizza11. 1. Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, Rome, Italy. Electronic address: roberto.badagliacca@uniroma1.it. 2. Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA. 3. Department of Cardiology, Fondazione IRCCS Policlinico San Matteo-University of Pavia, Pavia, Pavia, Italy. 4. Department of Cardiology, Monaldi Hospital-Second University of Naples, Naples, Italy. 5. Pneumology Unit, Ospedali Riuniti di Trieste, Trieste, Italy. 6. Cardiologia-UTIC Universitaria Ospedali Riuniti di Foggia, Foggia, Italy. 7. Azienda Ospedaliera "G. Brotzu" San Michele, Cagliari, Italy. 8. Dipartimento Cardio-Toraco-Vascolare, Clinica Pneumologica, Azienda Ospedaliera San Gerardo, Monza, Italy. 9. Cardiologia, Università degli studi di Brescia, Brescia, Italy. 10. Ferrarotto Hospital, Catania, Italy. 11. Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, Rome, Italy.
Abstract
BACKGROUND: In idiopathic pulmonary arterial hypertension (IPAH) treatment goals include improving right ventricular (RV) function, hemodynamics and symptoms to move patients to a low-risk category for adverse clinical outcomes. No data are available on the effect of upfront combination therapy on RV improvement as compared with monotherapy. The aim of this study was to evaluate echocardiographic RV morphology and function in patients affected by IPAH and treated with different strategies. METHODS: Sixty-nine consecutive, treatment-naive IPAH patients treated with first-line upfront combination therapy at 10 centers were retrospectively evaluated and compared with 2 matched cohorts treated with monotherapy after short-term follow-up. Evaluation included clinical, hemodynamic and echocardiographic parameters. RESULTS: At 155 ± 65 days after baseline evaluation, patients in the oral+prostanoid group (Group 1) had the most clinical and hemodynamic improvement compared with the double oral group (Group 2), the oral monotherapy group (Group 3) and the prostanoid monotherapy group (Group 4). The more extensive reduction of pulmonary vascular resistance in Groups 1, 2 and 4 was associated with significant improvement in all RV echocardiographic parameters compared with Group 3. Considering the number of patients who reached the target goals suggested by established guidelines, 8 of 27 (29.6%) and 7 of 42 (16.7%) patients in Groups 1 and 2, respectively, achieved low-risk status, as compared with 2 of 69 (2.8%) and 6 of 27 (22.2%) in Groups 3 and 4, respectively. CONCLUSIONS: In advanced treatment-naive IPAH patients, an upfront combination therapy strategy seems to significantly improve hemodynamics and RV morphology and function compared with oral monotherapy. The most significant results seem to be achieved with prostanoids plus oral drug, whereas the use of the double oral combination and prostanoids as monotherapy seem to produce similar results.
BACKGROUND: In idiopathic pulmonary arterial hypertension (IPAH) treatment goals include improving right ventricular (RV) function, hemodynamics and symptoms to move patients to a low-risk category for adverse clinical outcomes. No data are available on the effect of upfront combination therapy on RV improvement as compared with monotherapy. The aim of this study was to evaluate echocardiographic RV morphology and function in patients affected by IPAH and treated with different strategies. METHODS: Sixty-nine consecutive, treatment-naive IPAH patients treated with first-line upfront combination therapy at 10 centers were retrospectively evaluated and compared with 2 matched cohorts treated with monotherapy after short-term follow-up. Evaluation included clinical, hemodynamic and echocardiographic parameters. RESULTS: At 155 ± 65 days after baseline evaluation, patients in the oral+prostanoid group (Group 1) had the most clinical and hemodynamic improvement compared with the double oral group (Group 2), the oral monotherapy group (Group 3) and the prostanoid monotherapy group (Group 4). The more extensive reduction of pulmonary vascular resistance in Groups 1, 2 and 4 was associated with significant improvement in all RV echocardiographic parameters compared with Group 3. Considering the number of patients who reached the target goals suggested by established guidelines, 8 of 27 (29.6%) and 7 of 42 (16.7%) patients in Groups 1 and 2, respectively, achieved low-risk status, as compared with 2 of 69 (2.8%) and 6 of 27 (22.2%) in Groups 3 and 4, respectively. CONCLUSIONS: In advanced treatment-naive IPAH patients, an upfront combination therapy strategy seems to significantly improve hemodynamics and RV morphology and function compared with oral monotherapy. The most significant results seem to be achieved with prostanoids plus oral drug, whereas the use of the double oral combination and prostanoids as monotherapy seem to produce similar results.
Authors: Rebecca R Vanderpool; Kendall S Hunter; Michael Insel; Joe G N Garcia; Edward J Bedrick; Ryan J Tedford; Franz P Rischard Journal: Chest Date: 2021-10-09 Impact factor: 10.262
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Authors: Pavel Jansa; Samuel Heller; Michal Svoboda; Michal Pad'our; David Ambrož; Vladimír Dytrych; Michal Širanec; Tomáš Kovárník; Marián Felšőci; Martin Hutyra; Aleš Linhart; Jaroslav Lindner; Michael Aschermann Journal: J Clin Med Date: 2020-11-09 Impact factor: 4.241