Key result
Positive acute vasodilator response in IPAH is linked to ~33% higher 5-year survival versus non-responders.
Why the study?
Identification of a vasoreactive subset of Korean IPAH patients and their clinical characteristics and prognosis was needed.
Does a positive acute response to vasodilator testing predict better survival in Korean patients with idiopathic pulmonary arterial hypertension?
Cohort (n=60)
No
Does a positive acute response to vasodilator testing predict better survival in Korean patients with idiopathic pulmonary arterial hypertension?
Absolute Event Rate: 88% vs 55%
p-value: p=0.029
Korean IPAH patients with vasoreactivity to inhaled nitric oxide have significantly better baseline hemodynamics and long-term survival compared to non-responders.
Supports vasoreactivity as a prognostic marker in Korean IPAH; extends prior evidence but leaves open whether testing should guide therapy.
We aimed to identify a vasoreactive subset of patients with idiopathic pulmonary arterial hypertension (IPAH) in Korea and to show their clinical characteristics and prognosis. Data on patients who were diagnosed with IPAH at Asan Medical Center between January 1994 and March 2013 were retrospectively collected. Acute vasodilator testing was performed with inhaled nitric oxide during diagnostic right heart catheterization. A positive acute response was defined as a reduction in mean pulmonary arterial pressure (PAP) ≥10 mmHg to an absolute level of mean PAP <40 mmHg without a decrease in cardiac output. Among a total of 60 IPAH patients included for analysis, 9 (15%) showed a positive acute response to acute vasodilator testing. Acute responders showed significantly lower peak velocity of a tricuspid regurgitation jet on echocardiography (4.1±0.3 m/s vs. 4.6±0.6 m/s; P=0.01) and significantly lower mean PAP hemodynamically (47±10 mmHg vs. 63±17 mmHg; P=0.003) than non-responders at baseline. The survival rate of acute responders was 88% at 1, 3, 5, and 10 yr, respectively, which was significantly higher than that of non-responders (85%, 71%, 55%, and 40%, respectively; P=0.029). In conclusion, Korean IPAH patients with vasoreactivity showed better baseline hemodynamic features and survival than those without vasoreactivity.
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Ahn et al. (2014) conducted a cohort in Idiopathic pulmonary arterial hypertension (IPAH) (n=60). Positive acute response to vasodilator testing (vasoreactivity) vs. Non-responders (no vasoreactivity) was evaluated on 5-year survival rate (p=0.029). Korean IPAH patients with a positive acute response to vasodilator testing had a significantly higher 5-year survival rate (88%) compared to non-responders (55%, P=0.029).
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