Jacob Y Cao1, Kathryn M Wales1, Rachael Cordina1, Edmund M T Lau1, David S Celermajer2. 1. Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia. 2. Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia. Electronic address: David.Celermajer@health.nsw.gov.au.
Abstract
BACKGROUND: Pulmonary hypertension complicating left heart disease (PH-LHD) is the most common cause of PH. Off-label use of pulmonary arterial hypertension (PAH) medications for PH-LHD is prevalent, despite a lack of clinical data supporting their use. METHODS: A systematic review and meta-analysis was performed. Comprehensive search of all available literature to date identified ten randomised, placebo controlled trials comprising 439 treated (Phosphodiesterase 5 inhibitors: n = 206; guanylate cyclase stimulators: n = 132; endothelin receptor antagonists: n = 101) and 338 placebo patients. Random effects model was employed to assess outcomes in the treatment compared to the placebo control arm. RESULTS: The risks of all-cause mortality, cardiovascular mortality and worsening heart failure were numerically higher in the treated compared to the control group, although not statistically (all-cause mortality: RR = 1.97, 95% CI: 0.64-6.05, p = 0.24; cardiovascular mortality: RR = 2.01, 95% CI: 0.39-10.34, p = 0.4; worsening heart failure: RR = 1.23, 95% CI: 0.68-2.25, p = 0.49). Conversely, right heart hemodynamics improved numerically in the treated group, also without being significant (mean pulmonary artery pressure: MWD = -5.13 mm Hg, 95% CI: -13.2-2.9, p = 0.21; pulmonary vascular resistance: MWD = -0.87 WU, 95% CI: -1.75-0.1, p = 0.053). CONCLUSIONS: The current meta-analysis demonstrated that there is no current evidence to support the widespread use of PAH therapy in PH-LHD. On the basis of a numerically increased risk of clinical harm, these agents should not be prescribed in this setting, unless further evidence of benefit arises in the future.
BACKGROUND:Pulmonary hypertension complicating left heart disease (PH-LHD) is the most common cause of PH. Off-label use of pulmonary arterial hypertension (PAH) medications for PH-LHD is prevalent, despite a lack of clinical data supporting their use. METHODS: A systematic review and meta-analysis was performed. Comprehensive search of all available literature to date identified ten randomised, placebo controlled trials comprising 439 treated (Phosphodiesterase 5 inhibitors: n = 206; guanylate cyclase stimulators: n = 132; endothelin receptor antagonists: n = 101) and 338 placebo patients. Random effects model was employed to assess outcomes in the treatment compared to the placebo control arm. RESULTS: The risks of all-cause mortality, cardiovascular mortality and worsening heart failure were numerically higher in the treated compared to the control group, although not statistically (all-cause mortality: RR = 1.97, 95% CI: 0.64-6.05, p = 0.24; cardiovascular mortality: RR = 2.01, 95% CI: 0.39-10.34, p = 0.4; worsening heart failure: RR = 1.23, 95% CI: 0.68-2.25, p = 0.49). Conversely, right heart hemodynamics improved numerically in the treated group, also without being significant (mean pulmonary artery pressure: MWD = -5.13 mm Hg, 95% CI: -13.2-2.9, p = 0.21; pulmonary vascular resistance: MWD = -0.87 WU, 95% CI: -1.75-0.1, p = 0.053). CONCLUSIONS: The current meta-analysis demonstrated that there is no current evidence to support the widespread use of PAH therapy in PH-LHD. On the basis of a numerically increased risk of clinical harm, these agents should not be prescribed in this setting, unless further evidence of benefit arises in the future.
Authors: Nicholas Collins; Stuart Sugito; Allan Davies; Andrew Boyle; Aaron Sverdlov; John Attia; Simon Stewart; David Playford; Geoff Strange Journal: Pulm Circ Date: 2022-10-01 Impact factor: 2.886
Authors: Kari R Gillmeyer; Seppo T Rinne; Mark E Glickman; Kyung Min Lee; Qing Shao; Shirley X Qian; Elizabeth S Klings; Bradley A Maron; Joseph T Hanlon; Donald R Miller; Renda Soylemez Wiener Journal: Circ Cardiovasc Qual Outcomes Date: 2020-05-12