Hemodynamic Response to Oral Vasodilator Therapy in Systemic Sclerosis-Related Pulmonary Hypertension.

Autor: Lui JK; The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA. justin.lui@bmc.org.; Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA. justin.lui@bmc.org., Sangani RA; The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.; Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA., Gillmeyer KR; The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.; Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA., Vakhshoorzadeh J; Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA., Trojanowski MA; Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.; Section of Rheumatology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA., Bujor AM; Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.; Section of Rheumatology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA., Gopal DM; Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.; Section of Cardiovascular Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA., Wiener RS; The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.; Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.; Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA, USA., LaValley MP; Section of Rheumatology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.; Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA., Klings ES; The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.; Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
Jazyk: angličtina
Zdroj: Cardiovascular drugs and therapy [Cardiovasc Drugs Ther] 2024 Jun; Vol. 38 (3), pp. 651-656. Date of Electronic Publication: 2023 Jan 06.
DOI: 10.1007/s10557-022-07420-1
Abstrakt: Purpose: Although classified as group 1 pulmonary arterial hypertension (PAH), patients with systemic sclerosis-related pulmonary hypertension (SSc-PH) experience poorer clinical response to PAH therapy and increased mortality compared to those with idiopathic PAH. Due to heterogeneity in phenotypes, identifying patients likely to respond to therapy is challenging. The goal of this study was to determine clinical factors associated with hemodynamic response, defined by a > 20% reduction in pulmonary vascular resistance on repeat right heart catheterization.
Methods: We applied a time-to-event model using a retrospective cohort of 39 patients with precapillary SSc-PH, defined by a mean pulmonary artery pressure of ≥ 25 mmHg and pulmonary arterial wedge pressure (PAWP) ≤ 15 mmHg on right heart catheterization.
Results: Patients with PAWP ≤ 8 mmHg were nearly fourfold more likely to achieve a hemodynamic response compared to those with PAWP > 8 mmHg (HR 3.88; 95% CI: 1.20, 12.57); each 1 mmHg increase in PAWP was associated with a decreased hazard for hemodynamic response (HR 0.84; 95% CI: 0.70, 1.00).
Conclusion: In patients with precapillary SSc-PH, PAWP was associated with time to hemodynamic response, suggesting the importance of subclinical cardiac disease in determining hemodynamic response to oral vasodilator therapy.
(© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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