Does combination therapy work in chronic thromboembolic pulmonary hypertension?

Autor: J. C. Kelder, R.J. Snijder, Johannes J. Mager, M.C.J. van Thor, M.C. Post
Jazyk: angličtina
Rok vydání: 2020
Předmět:
lcsh:Diseases of the circulatory (Cardiovascular) system
Survival
HR
hazards regression
mPAP
mean pulmonary arterial pressure
Cardiac index
Chronic thromboembolic pulmonary hypertension
Hemodynamics
030204 cardiovascular system & hematology
Gastroenterology
NT-proBNP
N-terminal pro brain natriuretic peptide
0302 clinical medicine
Combination strategy
030212 general & internal medicine
CTEPH
chronic thromboembolic pulmonary hypertension
CT
computed tomography
medicine.anatomical_structure
COPD
chronic obstructive lung disease
Baseline characteristics
FC
functional class
RAP
right atrial pressure
Erratum
PAH
pulmonary arterial hypertension
Cardiology and Cardiovascular Medicine
medicine.medical_specialty
Combination therapy
BPA
balloon pulmonary angioplasty
PEA
pulmonary endarterectomy
CO
cardiac output
PH
pulmonary hypertension
PVR
pulmonary vascular resistance
WHO
World Health Organization
03 medical and health sciences
medicine.artery
Internal medicine
medicine
CI
cardiac index
ERA(s)
endothelin receptor antagonist(s)
IQR
interquartile range
Original Paper
6MWD
6-minute walking distance
business.industry
Monotherapy
lcsh:RC666-701
Pulmonary artery
Vascular resistance
business
SD
standard deviation
RHC
right heart catheterisation
Zdroj: International Journal of Cardiology. Heart & Vasculature
International Journal of Cardiology: Heart & Vasculature, Vol 29, Iss, Pp 100544-(2020)
Int J Cardiol Heart Vasc
ISSN: 2352-9067
Popis: Highlights • Long-term overall survival of CTEPH patients receiving PH-specific medial therapy is very reasonable. • Despite worse baseline characteristics at baseline, combination therapy showed similar survival as monotherapy. • Combination therapy strategy showed no difference in survival outcome.
Objective The current experience with combination therapy in chronic thromboembolic pulmonary hypertension (CTEPH) is limited. We present the first survival results up to 5 years for dual combination therapy versus monotherapy in CTEPH. Methods All consecutive, non-operated CTEPH or residual PH after pulmonary endarterectomy patients treated with PH-specific medical therapy between January 2002 and November 2019 were included. We report and compare survival between monotherapy and (upfront or sequential) dual combination therapy until five years after medication initiation. Results In total, 183 patients (mean age 65 ± 14 years, 60% female, 66% WHO FC III/IV, 86% non-operated) were included, of which 83 patients received monotherapy and 100 patients received dual combination therapy. At baseline, patients receiving combination therapy had a higher NT-proBNP (p = 0.02) mean pulmonary artery pressure (p = 0.0001) and pulmonary vascular resistance (p = 0.02), while cardiac index was lower (p = 0.03). Total follow-up duration was 3.3 ± 1.8 years, during which 31 (17%) patients died. Estimated 1-, 3- and 5-year survival for monotherapy were 99%, 92% and 79%, respectively. For combination therapy percentages were 98%, 89% and 70%, respectively. Survival did not significantly differ between both groups (p = 0.22). Conclusion Survival up to 5 years for patients treated with combination therapy, regardless of the combination strategy, was similar as patients with monotherapy, despite worse clinical and haemodynamic baseline characteristics.
Databáze: OpenAIRE
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