التفاصيل البيبلوغرافية
| العنوان: |
Prognostic value of follow-up vasoreactivity test in pulmonary arterial hypertension. |
| المؤلفون: |
Ishii, Satoshi, Hatano, Masaru, Maki, Hisataka, Minatsuki, Shun, Saito, Akihito, Yagi, Hiroki, Shimbo, Mai, Soma, Katsura, Numata, Genri, Fujiwara, Takayuki, Takeda, Norifumi, Komuro, Issei |
| المصدر: |
Journal of Cardiology; Jul2023, Vol. 82 Issue 1, p69-75, 7p |
| مستخلص: |
Acute vasoreactivity test with inhaled nitric oxide (NO) is performed during diagnostic right heart catheterization (RHC) to identify patients with pulmonary arterial hypertension (PAH) who respond to calcium channel blockers. Our purpose was to investigate the prognostic importance of follow-up vasoreactivity test after treatment. We retrospectively analyzed 36 PAH patients (mean age, 47 years; 61 % treatment-naïve), who underwent diagnostic and follow-up RHC and vasoreactivity tests at our center. The primary outcome was all-cause mortality. The median time between baseline and follow-up RHC was 9.7 months. Absolute change in mean pulmonary arterial pressure (ΔmPAP) during NO challenge was less pronounced after treatment, but there was great variability among patients. Overall cohort was dichotomized into two groups: preserved vasoreactivity (ΔmPAP ≤ −1 mmHg) and less vasoreactivity (ΔmPAP ≥0 mmHg) at follow-up RHC. Less vasoreactivity group had higher usage rate of endothelin receptor antagonists and parenteral prostacyclin analogues. During a median observation period of 6.3 years after follow-up RHC, 7 patients died, of which 6 showed less vasoreactivity at follow-up. Absolute ΔmPAP ≥0 at follow-up RHC was associated with all-cause mortality in univariable Cox regression analysis (hazard ratio, 8.728; 95 % confidence interval, 1.045–72.887; p = 0.045), whereas other hemodynamic parameters were not. Absolute ΔmPAP ≥0 at follow-up RHC was associated with all-cause mortality in multivariable Cox analysis adjusted for age and known PAH prognostic factors (HR, 12.814; 95 % CI, 1.088–150.891; p = 0.043). Kaplan-Meier survival analysis revealed a significantly worse survival of less vasoreactivity group compared to preserved vasoreactivity group (log-rank test, p = 0.016). Follow-up vasoreactivity test after treatment could contribute to the detection of high-risk subgroups who might need careful monitoring and referral for lung transplantation. [Display omitted] • Vasoreactivity test is recommended at initial assessment of pulmonary arterial hypertension. • Prognostic meaning of follow-up test with inhaled nitric oxide is unknown. • Vasoreactivity was less pronounced after treatment with variability among patients. • Patients with less vasoreactivity at follow-up showed poorer survival. • Follow-up vasoreactivity test could provide prognostic information. [ABSTRACT FROM AUTHOR] |
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