mPAWP < 12 mm Hg and DPG > 20 mm Hg identify patients with pulmonary arterial hypertension who are likely to have significant hemodynamic improvement with prostacyclin treatment.
Meta-Analysis (n=4,904)
placebo-controlled
randomized
Yes
Does treprostinil improve hemodynamics in patients with pulmonary arterial hypertension defined by specific hemodynamic cutoffs?
mPAWP < 12 mm Hg and DPG > 20 mm Hg are effective hemodynamic thresholds to identify patients with pulmonary arterial hypertension who are likely to respond to prostacyclin therapy.
BackgroundHemodynamic differentiation between pulmonary arterial hypertension (PAH) and postcapillary pulmonary hypertension (PH) is important because treatment options are strikingly different for the two disease subsets. Whereas patients with PAH can be treated effectively with targeted therapies, their use in postcapillary PH is currently not recommended. Our aim was to establish an algorithm to identify patients who are likely to experience a significant hemodynamic treatment response.MethodsWe determined hemodynamic cutoffs to discriminate between idiopathic PAH and postcapillary PH in a large database of 4,363 stable patients undergoing first diagnostic right and left heart catheterizations. In a second step, we performed a patient-level pooled analysis of four randomized, placebo-controlled trials including 541 patients with PAH who received treprostinil or placebo, to validate hemodynamic cutoffs with regard to treatment response.ResultsReceiver operating characteristic analysis identified mean pulmonary arterial wedge pressure (mPAWP) 20 mm Hg or a combination of both had a significant placebo-corrected improvement in hemodynamics.ConclusionsmPAWP 20 mm Hg identify patients with PAH who are likely to have significant hemodynamic improvement with prostacyclin treatment. Hemodynamic differentiation between pulmonary arterial hypertension (PAH) and postcapillary pulmonary hypertension (PH) is important because treatment options are strikingly different for the two disease subsets. Whereas patients with PAH can be treated effectively with targeted therapies, their use in postcapillary PH is currently not recommended. Our aim was to establish an algorithm to identify patients who are likely to experience a significant hemodynamic treatment response. We determined hemodynamic cutoffs to discriminate between idiopathic PAH and postcapillary PH in a large database of 4,363 stable patients undergoing first diagnostic right and left heart catheterizations. In a second step, we performed a patient-level pooled analysis of four randomized, placebo-controlled trials including 541 patients with PAH who received treprostinil or placebo, to validate hemodynamic cutoffs with regard to treatment response. Receiver operating characteristic analysis identified mean pulmonary arterial wedge pressure (mPAWP) 20 mm Hg or a combination of both had a significant placebo-corrected improvement in hemodynamics. mPAWP 20 mm Hg identify patients with PAH who are likely to have significant hemodynamic improvement with prostacyclin treatment.
Gerges et al. (2015) conducted a meta-analysis in Pulmonary arterial hypertension and postcapillary pulmonary hypertension (n=4,904). Treprostinil vs. Placebo was evaluated on Hemodynamic discrimination between idiopathic PAH and postcapillary PH, and placebo-corrected improvement in hemodynamics. mPAWP < 12 mm Hg and DPG > 20 mm Hg identify patients with pulmonary arterial hypertension who are likely to have significant hemodynamic improvement with prostacyclin treatment.