Key result
Less vasoreactivity at follow-up RHC linked to ~13-fold higher all-cause mortality versus preserved vasoreactivity.
Why the study?
Acute vasoreactivity testing is performed during diagnostic RHC in PAH, but the prognostic importance of follow-up vasoreactivity testing after treatment was unknown.
Does less vasoreactivity (ΔmPAP ≥0 mmHg) at follow-up right heart catheterization predict all-cause mortality in patients with pulmonary arterial hypertension?
Cohort (n=36)
No
Does less vasoreactivity (ΔmPAP ≥0 mmHg) at follow-up right heart catheterization predict all-cause mortality in patients with pulmonary arterial hypertension?
Loss of vasoreactivity (ΔmPAP ≥0 mmHg) at follow-up right heart catheterization is a strong independent predictor of long-term all-cause mortality in patients with pulmonary arterial hypertension.
Answers are grounded in this paper and cite their sources.
May refine PAH risk stratification via serial RHC; leaves open whether vasoreactivity changes should guide therapy.
BACKGROUND: Acute vasoreactivity test with inhaled nitric oxide (NO) is performed during diagnostic right heart catheterization (RHC) to identify patients with pulmonary arterial hypertension (PAH) who respond to calcium channel blockers. Our purpose was to investigate the prognostic importance of follow-up vasoreactivity test after treatment. METHODS: We retrospectively analyzed 36 PAH patients (mean age, 47 years; 61 % treatment-naïve), who underwent diagnostic and follow-up RHC and vasoreactivity tests at our center. The primary outcome was all-cause mortality. RESULTS: The median time between baseline and follow-up RHC was 9.7 months. Absolute change in mean pulmonary arterial pressure (ΔmPAP) during NO challenge was less pronounced after treatment, but there was great variability among patients. Overall cohort was dichotomized into two groups: preserved vasoreactivity (ΔmPAP ≤ -1 mmHg) and less vasoreactivity (ΔmPAP ≥0 mmHg) at follow-up RHC. Less vasoreactivity group had higher usage rate of endothelin receptor antagonists and parenteral prostacyclin analogues. During a median observation period of 6.3 years after follow-up RHC, 7 patients died, of which 6 showed less vasoreactivity at follow-up. Absolute ΔmPAP ≥0 at follow-up RHC was associated with all-cause mortality in univariable Cox regression analysis (hazard ratio, 8.728; 95 % confidence interval, 1.045-72.887; p = 0.045), whereas other hemodynamic parameters were not. Absolute ΔmPAP ≥0 at follow-up RHC was associated with all-cause mortality in multivariable Cox analysis adjusted for age and known PAH prognostic factors (HR, 12.814; 95 % CI, 1.088-150.891; p = 0.043). Kaplan-Meier survival analysis revealed a significantly worse survival of less vasoreactivity group compared to preserved vasoreactivity group (log-rank test, p = 0.016). CONCLUSIONS: Follow-up vasoreactivity test after treatment could contribute to the detection of high-risk subgroups who might need careful monitoring and referral for lung transplantation.
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Ishii et al. (2023) conducted a cohort in pulmonary arterial hypertension (n=36). Less vasoreactivity (ΔmPAP ≥0 mmHg) at follow-up RHC vs. Preserved vasoreactivity (ΔmPAP ≤ -1 mmHg) was evaluated on all-cause mortality (HR 12.814, 95% CI 1.088-150.891, p=0.043). Less vasoreactivity (ΔmPAP ≥0 mmHg) at follow-up RHC was associated with increased all-cause mortality compared to preserved vasoreactivity.
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