Younger age at initiation of subcutaneous treprostinil is associated with better response in pediatric Group 1 pulmonary arterial hypertension.

Autor: Kochanski JJ; Department of Pediatrics (Cardiology) Stanford University School of Medicine Palo Alto California USA., Feinstein JA; Department of Pediatrics (Cardiology) Stanford University School of Medicine Palo Alto California USA., Ogawa M; Department of Pediatrics (Cardiology) Stanford University School of Medicine Palo Alto California USA., Ritter V; Stanford University School of Medicine Quantitative Sciences Unit Palo Alto California USA., Hopper RK; Department of Pediatrics (Cardiology) Stanford University School of Medicine Palo Alto California USA., Adamson GT; Department of Pediatrics (Cardiology) Stanford University School of Medicine Palo Alto California USA.
Jazyk: angličtina
Zdroj: Pulmonary circulation [Pulm Circ] 2024 Feb 12; Vol. 14 (1), pp. e12328. Date of Electronic Publication: 2024 Feb 12 (Print Publication: 2024).
DOI: 10.1002/pul2.12328
Abstrakt: Children with severe Group 1 pulmonary arterial hypertension (PAH) have an unpredictable response to subcutaneous treprostinil (TRE) therapy, which may be influenced by age, disease severity, or other unknown variables at time of initiation. In this retrospective single-center cohort study, we hypothesized that younger age at TRE initiation, early hemodynamic response (a decrease in pulmonary vascular resistance by ≥30% at follow-up catheterization), and less severe baseline hemodynamics (Rp:Rs < 1.1) would each be associated with better clinical outcomes. In 40 pediatric patients with Group I PAH aged 17 days-18 years treated with subcutaneous TRE, younger age (cut-off of 6-years of age, AUC 0.824) at TRE initiation was associated with superior 5-year freedom from adverse events (94% vs. 39%, p  = 0.002), better WHO functional class (I or II: 88% vs. 39% p  = 0.003), and better echocardiographic indices of right ventricular function at most recent follow-up. Neither early hemodynamic response nor less severe baseline hemodynamics were associated with better outcomes. Patients who did not have a significant early hemodynamic response to TRE by first follow-up catheterization were unlikely to show subsequent improvement in PVRi (1/8, 13%). These findings may help clinicians counsel families and guide clinical decision making regarding the timing of advanced therapies.
Competing Interests: The authors declare no conflict of interest.
(© 2024 The Authors. Pulmonary Circulation published by John Wiley & Sons Ltd on behalf of Pulmonary Vascular Research Institute.)
Databáze: MEDLINE
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