Impact of Parenteral Prostanoids in Pulmonary Arterial Hypertension: The Relevance of Timing

Figures

• 

  Figure 1. Distribution of decreases in pulmonary vascular resistance after 12 months of initial combination therapy. Abbreviation: PVR: pulmonary vascular resistance.

• 

  Figure 2. Correlation between changes in PVR and maximum dosage of parenteral prostanoids achieved at follow-up. Yellow circles indicate double upfront strategy including prostanoid plus one oral drug (Group 1); orange circles indicate triple upfront strategy including parenteral prostanoid plus double oral drug (Group 2); blue circles indicate add-on strategy including parenteral prostanoid after oral drugs (Group 3). Markedly, the upfront strategy including prostanoids is independently associated with reduction in PVR compared with an add-on strategy. The up-titration to higher dosage of prostanoid is more important for the add-on strategy and upfront with one oral drug strategy compared with the triple upfront. Abbreviation: PVR: pulmonary vascular resistance.

• 

  Figure 3. Correlation between changes in RVEDA and PVR at follow-up. Yellow circles indicate double upfront strategy including prostanoid plus one oral drug (Group 1); orange circles indicate triple upfront strategy including parenteral prostanoid plus double oral drug (Group 2); blue circles indicate add-on strategy including parenteral prostanoid after oral drugs (Group 3). Markedly more reverse remodeling in relation to more a important decrease in PVR was observed in patients treated with upfront combination therapy including prostanoid. Abbreviation: RVEDA: right ventricular end-diastolic area; PVR: pulmonary vascular resistance.

• 

  Figure 4. Correlation between RVEDA and RVFAC at follow-up. Yellow circles indicate double upfront strategy including prostanoid plus one oral drug (Group 1); orange circles indicate triple upfront strategy including parenteral prostanoid plus double oral drug (Group 2); blue circles indicate add-on strategy including parenteral prostanoid after oral drugs (Group 3). Markedly better recovery of RVFAC in relation to more important decrease in RVEDA was observed in patients treated with upfront combination therapy including prostanoid. Abbreviation: RVEDA: right ventricular end-diastolic area; RVFAC: right ventricular fractional area change.