Changes in mean pulmonary artery pressure (mPAP) after treatment were significantly associated with adverse clinical events in patients with pulmonary arterial hypertension (R2 analog = 0.911).
Meta-Analysis (n=3,306)
Do changes in hemodynamic indices (mPAP, PVR, RAP, CI) after treatment predict clinical outcomes and mortality in patients with pulmonary arterial hypertension?
Treatment-induced changes in hemodynamic indices, particularly mPAP and PVR, are strong predictors of clinical events and mortality in patients with pulmonary arterial hypertension, suggesting their utility in guiding drug titration.
Effect estimate: β = 0.1794
p-value: p=0.0048
Abstract Background Hemodynamic assessment in patients with pulmonary arterial hypertension (PAH) is essential for risk stratification and pharmacological management. However, the prognostic value of the hemodynamic changes after treatment is less well established. Objectives We investigated the prognostic impacts of the changes in hemodynamic indices, including mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR), right atrial pressure (RAP), and cardiac output index (CI). We conducted this systematic review with meta-regression analysis on existing clinical trials. Methods We searched and identified all relevant randomized controlled trials from multiple databases. An analogous R 2 index was used to quantify the proportion of variance explained by each predictor in the association with PAH patients’ prognosis. A total of 21 trials and 3306 individuals were enrolled. Results The changes in mPAP, PVR, RAP, and CI were all significantly associated with the change in 6MWD (∆6MWD). The change in mPAP was with the highest explanatory power for ∆6MWD ( R 2 analog = 0.740). Additionally, the changes in mPAP, PVR, and CI were independently predictive of adverse clinical events. The change in mPAP had the highest explanatory power for the clinical events ( R 2 analog = 0.911). Furthermore, the change in PVR was with the highest explanatory power for total mortality of PAH patients ( R 2 analog = 0.612). Conclusion Hemodynamic changes after treatment, including mPAP, PVR, CI, and RAP, were significantly associated with adverse clinical events or mortality in treated PAH patients. It is recommended that further studies be conducted to evaluate the changes in hemodynamic indices to guide drug titration. Systematic review registration PROSPERO CRD42019125157
Sung et al. (2021) conducted a meta-analysis in Pulmonary arterial hypertension (n=3,306). PAH pharmacological therapies vs. Placebo or active control was evaluated on All adverse events (β = 0.1794, p=0.0048). Changes in mean pulmonary artery pressure (mPAP) after treatment were significantly associated with adverse clinical events in patients with pulmonary arterial hypertension (R2 analog = 0.911).