Echocardiographic Evaluation of Initial Ambrisentan Plus Phosphodiesterase Type 5 Inhibitor on Right Ventricular Pulmonary Artery Coupling in Severe Pulmonary Arterial Hypertension Patients

被引：8
作者：
Lan, Wei-Fang [1 ]
Deng, Yan [1 ]
Wei, Bin [2 ]
Huang, Kai [2 ]
Dai, Ping [1 ]
Xie, Shan-Shan [1 ]
Wu, Dan-dan [1 ]
机构：
[1] Guangxi Med Univ, Affiliated Hosp 1, Dept Ultrasound, Nanning, Peoples R China
[2] Guangxi Med Univ, Affiliated Hosp 1, Dept Cardiol, Nanning, Peoples R China
来源：
FRONTIERS IN CARDIOVASCULAR MEDICINE | 2022年 / 9卷
基金：
中国国家自然科学基金;
关键词：
pulmonary arterial hypertension; right ventricular pulmonary arterial coupling; echocardiography; combination therapy; right ventricular remodeling; EUROPEAN ASSOCIATION; COMBINATION THERAPY; AMERICAN SOCIETY; RIGHT HEART; EPIDEMIOLOGY; ADULTS;
D O I：
10.3389/fcvm.2022.843606
中图分类号：
R5 [内科学];
学科分类号：
1002 ; 100201 ;
摘要：
Introductionambrisentan and phosphodiesterase type 5 inhibitor (PDE5i) have been approved for treating patients with pulmonary arterial hypertension (PAH). Echocardiographic right ventricular pulmonary artery coupling (RVPAC) has been shown to be a valid non-invasive and alternative measurement method to assess the predicted outcomes in PAH patients. The aim of this study was to study the effect and clinical correlates of initial ambrisentan plus PDE5i combination therapy on RVPAC in patients with severe PAH. Method and ResultsWe retrospectively studied and analyzed comprehensive clinical data, hemodynamics, and echocardiography in 27 patients with severe PAH before and after 6 months of initial combination therapy. Compared with the baseline, significant improvements in RVPAC ratios were observed, including RVFAC/PASP (0.31 +/- 0.10 vs. 0.44 +/- 0.15%/mmHg, p < 0.001), TAPSE/PASP (0.15 +/- 0.05 vs. 0.21 +/- 0.06 mm/mmHg, p = 0.001), S'/PASP (0.10 +/- 0.03 vs. 0.14 +/- 0.05 cm/s center dot mmHg, p = 0.001), and RVSV/RVESV (0.79 +/- 0.22 vs. 1.02 +/- 0.20, p < 0.001). Functional status indices [World Health Organization functional classifications (WHO-FC) and 6 min walk distance (6MWD) and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels] showed significant improvements. Right heart catheterization (RHC) evaluations for hemodynamic measurements between baseline and the 6-12 month follow-up were sPAP (96 +/- 22 vs. 86 +/- 24 mmHg, p = 0.002), mPAP (64 +/- 18 vs. 56 +/- 17 mmHg, p < 0.001) and TPVR (17.3 +/- 6.7 vs. 12.1 +/- 5.4 WU, p = 0.001). Simultaneously, significant associations between RVPAC ratios and NT-proBNP levels and WHO-FC and 6MWD were observed. ConclusionAmbrisentan plus PDE-5i combination therapy resulted in a significant improvement in RVPAC in severe PAH. Importantly, RVPAC parameters correlated with known prognostic markers of PAH.
引用
收藏
页数：11
相关论文
共 42 条
[31]   Initial dual oral combination therapy in pulmonary arterial hypertension [J].
Sitbon, Olivier ;
Sattler, Caroline ;
Bertoletti, Laurent ;
Savale, Laurent ;
Cottin, Vincent ;
Jais, Xavier ;
De Groote, Pascal ;
Chaouat, Ari ;
Chabannes, Celine ;
Bergot, Emmanuel ;
Bouvaist, Helene ;
Dauphin, Claire ;
Bourdin, Arnaud ;
Bauer, Fabrice ;
Montani, David ;
Humbert, Marc ;
Simonneau, Gerald .
EUROPEAN RESPIRATORY JOURNAL, 2016, 47 (06) :1727-1736
[32]   Upfront triple combination therapy in pulmonary arterial hypertension: a pilot study [J].
Sitbon, Olivier ;
Jais, Xavier ;
Savale, Laurent ;
Cottin, Vincent ;
Bergot, Emmanuel ;
Macari, Elise Artaud ;
Bouvaist, Helene ;
Dauphin, Claire ;
Picard, Francois ;
Bulifon, Sophie ;
Montani, David ;
Humbert, Marc ;
Simonneau, Gerald .
EUROPEAN RESPIRATORY JOURNAL, 2014, 43 (06) :1691-1697
[33]   Initial Riociguat Monotherapy and Transition from Sildenafil to Riociguat in Patients with Idiopathic Pulmonary Arterial Hypertension: Influence on Right Heart Remodeling and Right Ventricular-Pulmonary Arterial Coupling [J].
Taran, Irina N. ;
Belevskaya, Anna A. ;
Saidova, Marina A. ;
Martynyuk, Tamila V. ;
Chazova, Irina E. .
LUNG, 2018, 196 (06) :745-753
[34]   Validation of the Tricuspid Annular Plane Systolic Excursion/Systolic Pulmonary Artery Pressure Ratio for the Assessment of Right Ventricular-Arterial Coupling in Severe Pulmonary Hypertension [J].
Tello, Khodr ;
Wan, Jun ;
Dalmer, Antonia ;
Vanderpool, Rebecca ;
Ghofrani, Hossein A. ;
Naeije, Robert ;
Roller, Fritz ;
Mohajerani, Emad ;
Seeger, Werner ;
Herberg, Ulrike ;
Sommer, Natascha ;
Gall, Henning ;
Richter, Manuel J. .
CIRCULATION-CARDIOVASCULAR IMAGING, 2019, 12 (09)
[35]   Reserve of Right Ventricular-Arterial Coupling in the Setting of Chronic Overload [J].
Tello, Khodr ;
Dalmer, Antonia ;
Axmann, Jens ;
Vanderpool, Rebecca ;
Ghofrani, Hossein A. ;
Naeije, Robert ;
Roller, Fritz ;
Seeger, Werner ;
Sommer, Natascha ;
Wilhelm, Jochen ;
Gall, Henning ;
Richter, Manuel J. .
CIRCULATION-HEART FAILURE, 2019, 12 (01) :e005512
[36]   Relevance of the TAPSE/PASP ratio in pulmonary arterial hypertension [J].
Tello, Khodr ;
Axmann, Jens ;
Ghofrani, Hossein A. ;
Naeije, Robert ;
Narcin, Newroz ;
Rieth, Andreas ;
Seeger, Werner ;
Gall, Henning ;
Richter, Manuel J. .
INTERNATIONAL JOURNAL OF CARDIOLOGY, 2018, 266 :229-235
[37]   Pulmonary arterial hypertension: pathogenesis and clinical management [J].
Thenappan, Thenappan ;
Ormiston, Mark L. ;
Ryan, John J. ;
Archer, Stephen L. .
BMJ-BRITISH MEDICAL JOURNAL, 2018, 360
[38]   Upfront combination therapy reduces right ventricular volumes in pulmonary arterial hypertension [J].
van de Veerdonk, Marielle C. ;
in t Veld, Anna E. Huis ;
Marcus, J. Tim ;
Westerhof, Nico ;
Heymans, Martijn W. ;
Bogaard, Harm-Jan ;
Vonk-Noordegraaf, Anton .
EUROPEAN RESPIRATORY JOURNAL, 2017, 49 (06)
[39]   RV-pulmonary arterial coupling predicts outcome in patients referred for pulmonary hypertension [J].
Vanderpool, Rebecca R. ;
Pinsky, Michael R. ;
Naeije, Robert ;
Deible, Christopher ;
Kosaraju, Vijaya ;
Bunner, Cheryl ;
Mathier, Michael A. ;
Lacomis, Joan ;
Champion, Hunter C. ;
Simon, Marc A. .
HEART, 2015, 101 (01) :37-43
[40]   Hemodynamic Effects of Pulmonary Arterial Hypertension Specific Therapy in Patients With Heart Failure With Preserved Ejection Fraction and With Combined Post- and Precapillay Pulmonary Hypertension [J].
Veld, Anna E. Huis In't ;
Oosterveer, Frank P. T. ;
De Man, Frances S. ;
Marcus, J. Tim ;
Nossent, Esther J. ;
Boonstra, Anco ;
Van Rossum, A. C. ;
Noordegraaf, Anton Vonk ;
Bogaard, Harm Jan ;
Handoko, M. Louis .
JOURNAL OF CARDIAC FAILURE, 2020, 26 (01) :26-34
12345