Changes in mean pulmonary artery pressure (mPAP) after treatment were significantly associated with changes in 6-minute walk distance (coefficient -7.1067, p<0.0001) and had the highest explanatory power for adverse clinical events (R2 analog=0.911).
Meta-Analysis (n=3,263)
Do changes in hemodynamic indices (mPAP, PVR, RAP, CI) after treatment predict changes in 6MWD and adverse clinical events in patients with pulmonary arterial hypertension?
Changes in hemodynamic parameters after treatment, particularly mean pulmonary artery pressure and pulmonary vascular resistance, are significantly associated with clinical outcomes and mortality in PAH patients, supporting their use in risk assessment.
Effect estimate: Coefficient -7.1067
p-value: p=<0.0001
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 20 trials and 3,263 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=0.739). 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 =0.594). 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. Trial registration number: PROSPERO; No.: CRD42019125157; URL: https://www.crd.york.ac.uk/PROSPERO/ (Date of registration: 14/03/2019)
Sung et al. (2021) conducted a meta-analysis in Pulmonary Arterial Hypertension (n=3,263). Changes in hemodynamic indices (mPAP, PVR, RAP, CI) was evaluated on Change in 6-minute walk distance (Δ6MWD) associated with change in mPAP (Coefficient -7.1067, p=<0.0001). Changes in mean pulmonary artery pressure (mPAP) after treatment were significantly associated with changes in 6-minute walk distance (coefficient -7.1067, p<0.0001) and had the highest explanatory power for adverse clinical events (R2 analog=0.911).