Influence of various therapeutic strategies on right ventricular morphology, function and hemodynamics in pulmonary arterial hypertension

Roberto Badagliacca, Amresh Raina, Stefano Ghio, Michele D'Alto, Marco Confalonieri, Michele Correale, Marco Corda, Giuseppe Paciocco, Carlo Lombardi, Massimiliano Mulè, Roberto Poscia, Laura Scelsi, Paola Argiento, Susanna Sciomer, Raymond L Benza, Carmine Dario Vizza

Research output: Contribution to journalArticle

Abstract

BACKGROUND: In idiopathic pulmonary arterial hypertension (IPAH) treatment goals include improving right ventricular (RV) function, hemodynamics and symptoms to move patients to a low-risk category for adverse clinical outcomes. No data are available on the effect of upfront combination therapy on RV improvement as compared with monotherapy. The aim of this study was to evaluate echocardiographic RV morphology and function in patients affected by IPAH and treated with different strategies.

METHODS: Sixty-nine consecutive, treatment-naive IPAH patients treated with first-line upfront combination therapy at 10 centers were retrospectively evaluated and compared with 2 matched cohorts treated with monotherapy after short-term follow-up. Evaluation included clinical, hemodynamic and echocardiographic parameters.

RESULTS: At 155 ± 65 days after baseline evaluation, patients in the oral+prostanoid group (Group 1) had the most clinical and hemodynamic improvement compared with the double oral group (Group 2), the oral monotherapy group (Group 3) and the prostanoid monotherapy group (Group 4). The more extensive reduction of pulmonary vascular resistance in Groups 1, 2 and 4 was associated with significant improvement in all RV echocardiographic parameters compared with Group 3. Considering the number of patients who reached the target goals suggested by established guidelines, 8 of 27 (29.6%) and 7 of 42 (16.7%) patients in Groups 1 and 2, respectively, achieved low-risk status, as compared with 2 of 69 (2.8%) and 6 of 27 (22.2%) in Groups 3 and 4, respectively.

CONCLUSIONS: In advanced treatment-naive IPAH patients, an upfront combination therapy strategy seems to significantly improve hemodynamics and RV morphology and function compared with oral monotherapy. The most significant results seem to be achieved with prostanoids plus oral drug, whereas the use of the double oral combination and prostanoids as monotherapy seem to produce similar results.

Original languageEnglish
Pages (from-to)365-375
Number of pages11
JournalJournal of Heart and Lung Transplantation
Volume37
Issue number3
DOIs
Publication statusPublished - Mar 2018

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Right Ventricular Function
Pulmonary Hypertension
Hemodynamics
Prostaglandins
Therapeutics
Vascular Resistance
Guidelines
Familial Primary Pulmonary Hypertension
Pharmaceutical Preparations

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Influence of various therapeutic strategies on right ventricular morphology, function and hemodynamics in pulmonary arterial hypertension. / Badagliacca, Roberto; Raina, Amresh; Ghio, Stefano; D'Alto, Michele; Confalonieri, Marco; Correale, Michele; Corda, Marco; Paciocco, Giuseppe; Lombardi, Carlo; Mulè, Massimiliano; Poscia, Roberto; Scelsi, Laura; Argiento, Paola; Sciomer, Susanna; Benza, Raymond L; Vizza, Carmine Dario.

In: Journal of Heart and Lung Transplantation, Vol. 37, No. 3, 03.2018, p. 365-375.

Research output: Contribution to journalArticle

Badagliacca, R, Raina, A, Ghio, S, D'Alto, M, Confalonieri, M, Correale, M, Corda, M, Paciocco, G, Lombardi, C, Mulè, M, Poscia, R, Scelsi, L, Argiento, P, Sciomer, S, Benza, RL & Vizza, CD 2018, 'Influence of various therapeutic strategies on right ventricular morphology, function and hemodynamics in pulmonary arterial hypertension', Journal of Heart and Lung Transplantation, vol. 37, no. 3, pp. 365-375. https://doi.org/10.1016/j.healun.2017.08.009
Badagliacca, Roberto ; Raina, Amresh ; Ghio, Stefano ; D'Alto, Michele ; Confalonieri, Marco ; Correale, Michele ; Corda, Marco ; Paciocco, Giuseppe ; Lombardi, Carlo ; Mulè, Massimiliano ; Poscia, Roberto ; Scelsi, Laura ; Argiento, Paola ; Sciomer, Susanna ; Benza, Raymond L ; Vizza, Carmine Dario. / Influence of various therapeutic strategies on right ventricular morphology, function and hemodynamics in pulmonary arterial hypertension. In: Journal of Heart and Lung Transplantation. 2018 ; Vol. 37, No. 3. pp. 365-375.
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title = "Influence of various therapeutic strategies on right ventricular morphology, function and hemodynamics in pulmonary arterial hypertension",
abstract = "BACKGROUND: In idiopathic pulmonary arterial hypertension (IPAH) treatment goals include improving right ventricular (RV) function, hemodynamics and symptoms to move patients to a low-risk category for adverse clinical outcomes. No data are available on the effect of upfront combination therapy on RV improvement as compared with monotherapy. The aim of this study was to evaluate echocardiographic RV morphology and function in patients affected by IPAH and treated with different strategies.METHODS: Sixty-nine consecutive, treatment-naive IPAH patients treated with first-line upfront combination therapy at 10 centers were retrospectively evaluated and compared with 2 matched cohorts treated with monotherapy after short-term follow-up. Evaluation included clinical, hemodynamic and echocardiographic parameters.RESULTS: At 155 ± 65 days after baseline evaluation, patients in the oral+prostanoid group (Group 1) had the most clinical and hemodynamic improvement compared with the double oral group (Group 2), the oral monotherapy group (Group 3) and the prostanoid monotherapy group (Group 4). The more extensive reduction of pulmonary vascular resistance in Groups 1, 2 and 4 was associated with significant improvement in all RV echocardiographic parameters compared with Group 3. Considering the number of patients who reached the target goals suggested by established guidelines, 8 of 27 (29.6{\%}) and 7 of 42 (16.7{\%}) patients in Groups 1 and 2, respectively, achieved low-risk status, as compared with 2 of 69 (2.8{\%}) and 6 of 27 (22.2{\%}) in Groups 3 and 4, respectively.CONCLUSIONS: In advanced treatment-naive IPAH patients, an upfront combination therapy strategy seems to significantly improve hemodynamics and RV morphology and function compared with oral monotherapy. The most significant results seem to be achieved with prostanoids plus oral drug, whereas the use of the double oral combination and prostanoids as monotherapy seem to produce similar results.",
author = "Roberto Badagliacca and Amresh Raina and Stefano Ghio and Michele D'Alto and Marco Confalonieri and Michele Correale and Marco Corda and Giuseppe Paciocco and Carlo Lombardi and Massimiliano Mul{\`e} and Roberto Poscia and Laura Scelsi and Paola Argiento and Susanna Sciomer and Benza, {Raymond L} and Vizza, {Carmine Dario}",
note = "Copyright {\circledC} 2018 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.",
year = "2018",
month = "3",
doi = "10.1016/j.healun.2017.08.009",
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TY - JOUR

T1 - Influence of various therapeutic strategies on right ventricular morphology, function and hemodynamics in pulmonary arterial hypertension

AU - Badagliacca, Roberto

AU - Raina, Amresh

AU - Ghio, Stefano

AU - D'Alto, Michele

AU - Confalonieri, Marco

AU - Correale, Michele

AU - Corda, Marco

AU - Paciocco, Giuseppe

AU - Lombardi, Carlo

AU - Mulè, Massimiliano

AU - Poscia, Roberto

AU - Scelsi, Laura

AU - Argiento, Paola

AU - Sciomer, Susanna

AU - Benza, Raymond L

AU - Vizza, Carmine Dario

N1 - Copyright © 2018 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

PY - 2018/3

Y1 - 2018/3

N2 - BACKGROUND: In idiopathic pulmonary arterial hypertension (IPAH) treatment goals include improving right ventricular (RV) function, hemodynamics and symptoms to move patients to a low-risk category for adverse clinical outcomes. No data are available on the effect of upfront combination therapy on RV improvement as compared with monotherapy. The aim of this study was to evaluate echocardiographic RV morphology and function in patients affected by IPAH and treated with different strategies.METHODS: Sixty-nine consecutive, treatment-naive IPAH patients treated with first-line upfront combination therapy at 10 centers were retrospectively evaluated and compared with 2 matched cohorts treated with monotherapy after short-term follow-up. Evaluation included clinical, hemodynamic and echocardiographic parameters.RESULTS: At 155 ± 65 days after baseline evaluation, patients in the oral+prostanoid group (Group 1) had the most clinical and hemodynamic improvement compared with the double oral group (Group 2), the oral monotherapy group (Group 3) and the prostanoid monotherapy group (Group 4). The more extensive reduction of pulmonary vascular resistance in Groups 1, 2 and 4 was associated with significant improvement in all RV echocardiographic parameters compared with Group 3. Considering the number of patients who reached the target goals suggested by established guidelines, 8 of 27 (29.6%) and 7 of 42 (16.7%) patients in Groups 1 and 2, respectively, achieved low-risk status, as compared with 2 of 69 (2.8%) and 6 of 27 (22.2%) in Groups 3 and 4, respectively.CONCLUSIONS: In advanced treatment-naive IPAH patients, an upfront combination therapy strategy seems to significantly improve hemodynamics and RV morphology and function compared with oral monotherapy. The most significant results seem to be achieved with prostanoids plus oral drug, whereas the use of the double oral combination and prostanoids as monotherapy seem to produce similar results.

AB - BACKGROUND: In idiopathic pulmonary arterial hypertension (IPAH) treatment goals include improving right ventricular (RV) function, hemodynamics and symptoms to move patients to a low-risk category for adverse clinical outcomes. No data are available on the effect of upfront combination therapy on RV improvement as compared with monotherapy. The aim of this study was to evaluate echocardiographic RV morphology and function in patients affected by IPAH and treated with different strategies.METHODS: Sixty-nine consecutive, treatment-naive IPAH patients treated with first-line upfront combination therapy at 10 centers were retrospectively evaluated and compared with 2 matched cohorts treated with monotherapy after short-term follow-up. Evaluation included clinical, hemodynamic and echocardiographic parameters.RESULTS: At 155 ± 65 days after baseline evaluation, patients in the oral+prostanoid group (Group 1) had the most clinical and hemodynamic improvement compared with the double oral group (Group 2), the oral monotherapy group (Group 3) and the prostanoid monotherapy group (Group 4). The more extensive reduction of pulmonary vascular resistance in Groups 1, 2 and 4 was associated with significant improvement in all RV echocardiographic parameters compared with Group 3. Considering the number of patients who reached the target goals suggested by established guidelines, 8 of 27 (29.6%) and 7 of 42 (16.7%) patients in Groups 1 and 2, respectively, achieved low-risk status, as compared with 2 of 69 (2.8%) and 6 of 27 (22.2%) in Groups 3 and 4, respectively.CONCLUSIONS: In advanced treatment-naive IPAH patients, an upfront combination therapy strategy seems to significantly improve hemodynamics and RV morphology and function compared with oral monotherapy. The most significant results seem to be achieved with prostanoids plus oral drug, whereas the use of the double oral combination and prostanoids as monotherapy seem to produce similar results.

U2 - 10.1016/j.healun.2017.08.009

DO - 10.1016/j.healun.2017.08.009

M3 - Article

C2 - 28912026

VL - 37

SP - 365

EP - 375

JO - Journal of Heart and Lung Transplantation

JF - Journal of Heart and Lung Transplantation

SN - 1053-2498

IS - 3

ER -