Hemodynamics and risk assessment 2 years after the initiation of upfront ambrisentan-tadalafil in pulmonary arterial hypertension

被引:32
作者
D'Alto, Michele [1 ,2 ]
Badagliacca, Roberto [2 ,3 ]
Lo Giudice, Francesco [2 ,4 ]
Argiento, Paola [1 ,2 ]
Casu, Gavino [2 ,5 ]
Corda, Marco [2 ,6 ]
Correale, Michele [2 ,7 ]
Ghio, Stefano [2 ,8 ]
Greco, Alessandra [2 ,8 ]
Lattanzio, Mariangela [2 ,9 ]
Mercurio, Valentina [2 ,10 ]
Paciocco, Giuseppe [2 ,11 ]
Papa, Silvia [2 ,3 ]
Prediletto, Renato [2 ,12 ,13 ]
Romeo, Emanuele [1 ,2 ]
Russo, Maria Giovanna [1 ]
Tayar, Alessandro [4 ]
Vitulo, Patrizio [2 ,14 ]
Vizza, Carmine Dario [2 ,3 ]
Golino, Paolo [1 ]
Naeije, Robert [15 ]
机构
[1] L Vanvitelli Univ, Monaldi Hosp, Dept Cardiol, Naples, Italy
[2] Italian Pulm Hypertens Network iPHnet, Rome, Italy
[3] Univ Roma La Sapienza, Dept Cardiol, Rome, Italy
[4] Imperial Coll London, Fac Med, Natl Heart & Lung Inst, London, England
[5] Osped San Francesco, Dept Cardiol, Nuoro, Italy
[6] Osped Brotzu, Dept Cardiol, Cagliari, Italy
[7] Osped Riuniti Univ Hosp, Dept Cardiol, Foggia, Italy
[8] Fdn IRCCS Policlin San Matteo, Dept Cardiol, Pavia, Italy
[9] Univ Insubria, Fdn Macchi ASST Sette Laghi, Dept Cardiovasc Dis, Varese, Italy
[10] Univ Naples Federico II, Dept Translat Med Sci, Naples, Italy
[11] Univ Milano Bicocca, Dept Pulmonol, Monza, Italy
[12] CNR Tuscany Reg Gabriele Monasterio Fdn, Dept Pulmonol, Pisa, Italy
[13] Inst Clin Physiol, Dept Pulmonol, Pisa, Italy
[14] IRCCS Ist Mediterraneo & Trapianti & Terapie Alta, Cardiothorac & Transplant Dept, Palermo, Italy
[15] Free Univ Brussels, Dept Pathophysiol, Brussels, Belgium
关键词
pulmonary arterial hypertension; combination therapy; risk assessment; REVEAL risk score; European risk score; prognosis; COMBINATION THERAPY; PREDICTING SURVIVAL; SCORE CALCULATOR; MANAGEMENT; REGISTRY;
D O I
10.1016/j.healun.2020.08.016
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND: Upfront combination therapy with ambrisentan and tadalafil has been reported to improve the condition of patients with pulmonary arterial hypertension (PAH) more than with either drug alone. However, little is known about the long-term associated changes in hemodynamics and risk assessment scores. METHODS: This was a multicenter, retrospective analysis of clinical data in 106 patients with newly diagnosed PAH. Clinical evaluations, including demographics, medical history, World Health Organization (WHO) functional class (FC) and 6-minute walk distance (6MWD), right heart catheterization, and Registry to Evaluate Early and Long-Term PAH Disease Management (REVEAL) risk score 2.0, were assessed over 48 months of ambrisentan.tadalafil therapy. RESULTS: At baseline, 9 patients (9%) showed a low (< 7), 48 patients (45%) showed an intermediate (7-8), and 49 patients (46%) showed a high (> 8) REVEAL risk score. At a median follow-up of 2 years, 45 patients (43%) showed a low, 47 patients (44%) showed an intermediate, and 14 patients (13%) showed a high REVEAL score, along with improvements in WHO FC, 6MWD and a decrease in mean pulmonary artery pressure and N-terminal pro brain natriuretic peptide (all p < 0.001). Pulmonary vascular resistance (PVR) decreased by 37% from 11.5 +/- 6.5 to 7.2 +/- 4.1 Wood units (p < 0.001). A total of 61 patients (57%) remained in intermediate-risk or high-risk categories. Low-risk patients had either a decrease in PVR of > 50% or a stroke volume within the limits of normal. CONCLUSIONS: Initial combination therapy with ambrisentan and tadalafil in PAH improves the REVEAL risk score in proportion to decreased PVR and preserved stroke volume but still insufficiently so in approximately 50% of the patients. (C) 2020 International Society for Heart and Lung Transplantation. All rights reserved.
引用
收藏
页码:1389 / 1397
页数:9
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