Beneficial effects of riociguat on hemodynamic responses to exercise in CTEPH patients after balloon pulmonary angioplasty – A randomized controlled study

Aoki, Tatsuo; Sugimura, Koichiro; Terui, Yosuke; Tatebe, Shunsuke; Fukui, Shigefumi; Miura, Masanobu; Yamamoto, Shozo; Yaoita, Nobuhiro; Suzuki, Hideaki; Sato, Haruka; Kozu, Katsuya; Konno, Ryo; Miyata, Satoshi; Nochioka, Kotaro; Satoh, Kimio; Shimokawa, Hiroaki

doi:10.1016/j.ijcha.2020.100579

Cited by 11 publications

(8 citation statements)

References 29 publications

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“…Improvement in RV haemodynamic parameters was also seen in a study of 21 patients with CTEPH who had experienced haemodynamic improvement after BPA and had subsequently received riociguat or standard of care [ 40 ]. Significant improvements were seen in CO and PVR during exercise in those who received riociguat compared with controls.…”

Section: Effect Of Riociguat On Rv Function In Clinical Studiesmentioning

confidence: 94%

Riociguat and the right ventricle in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension

et al. 2022

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Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are progressive diseases that can lead to right heart failure and death. Right ventricular dysfunction, hypertrophy and maladaptive remodelling are consequences of increased right ventricular (RV) afterload in PAH and CTEPH and are indicative of long-term outcomes. Because RV failure is the main cause of morbidity and mortality in PAH and CTEPH, successful treatments should lead to improvements in RV parameters. Riociguat is a soluble guanylate cyclase stimulator approved for the treatment of PAH and inoperable or persistent/recurrent CTEPH after pulmonary endarterectomy. This review examines the current evidence showing the effect of riociguat on the right ventricle, with particular focus on remodelling, function and structural parameters in preclinical models and patients with PAH or CTEPH.

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Section: Effect Of Riociguat On Rv Function In Clinical Studiesmentioning

confidence: 94%

Riociguat and the right ventricle in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension

et al. 2022

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“…Despite the beneficial effect of riociguat in Ex-PH patients after BPA, 18 there is little evidence regarding the usefulness of PH-targeted drugs for CTEPD without PH. Because of the nature of microarteriopathy, there could be a possible efficacy of PH-targeted drugs in Ex-PH in CTEPD patients without PH.…”

Section: Effectiveness and Safety Of Bpa For Ctepd With Mild Ph And W...mentioning

confidence: 99%

Efficacy of Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Disease Patients with Exercise Pulmonary Hypertension

Naka,

Inami,

Takeuchi

et al. 2024

Preprint

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BackgroundThe efficacy of balloon pulmonary angioplasty (BPA) for chronic thromboembolic pulmonary disease (CTEPD) with or mild pulmonary hypertension (PH) or without PH remains unknown. Exercise pulmonary hypertension (Ex-PH) is associated with impaired exercise capacity and ventilatory efficiency, even under normalized pulmonary hemodynamics at rest. We hypothesized that patients with Ex-PH and/or hypoxemia would be candidates for BPA. We aimed to verify the prevalence and clinical profiles of Ex-PH and the effect of BPA on oxygenation and Ex-PH in patients with CTEPD with mean pulmonary arterial pressure (mPAP) < 25 mmHg.MethodsWe retrospectively reviewed 29 patients with CTEPD and mPAP < 25 mmHg at rest, who had undergone a cardiopulmonary exercise test with right heart catheterization (median age, 65 years; 38% male). Patients were divided into two groups: Ex-PH, defined as a cardiac output slope (mPAP/CO slope) > 3.0, and non-Ex-PH.ResultsOverall, six patients had mild PH (mPAP: 21–24 mmHg), and 16 and 13 were assigned to the Ex-PH and Non-Ex-PH groups, respectively. There were no significant differences in the clinical parameters, including hemodynamics at rest, blood gas analysis, and 6-minute walk distance, between the Ex-PH and Non-Ex-PH groups. Among the 16 patients with Ex-PH and/or long-term oxygen therapy (LTOT), BPA improved the World Health Organization-functional class (WHO-FC) and PaO2in association with a decrease in the mPAP/CO slope. All nine patients discontinued LTOT after BPA. No significant complications were observed during each BPA session.ConclusionsEx-PH was common among patients with CTEPD and mPAP < 25 mmHg. BPA can improve symptoms, oxygenation, and exercise hemodynamics in patients with CTEPD and Ex-PH and/or hypoxemia.What is Known?BPA has been recommended for patients with non-operable CTEPH.Although there is still a small body of evidence, BPA for patients with CTEPD with mild PH (mPAP < 25 mmHg) or without PH can safely improve symptoms.The prevalence of Ex-PH in CTEPD patients with or without PH is unknown.What the Study Adds?Approximately 50% of CTEPD patients with mild PH or without PH had Ex-PH.In patients with CTEPD with mPAP < 25 mmHg, BPA improves exercising hemodynamics, such as the mPAP/CO slope, which could be a parameter to determine the indication for BPA.Graphical Abstract.The distribution of exercise pulmonary hypertension (Ex-PH) in patients with chronic thromboembolic pulmonary disease (CTEPD) with mild pulmonary hypertension (PH) or without PH, and efficacy of balloon pulmonary angioplasty (BPA) for CTEPD with Ex-PH and/or hypoxemia. Blue person symbols mean Ex-PH, and white person symbols mean non-Ex-PH.

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“…A prospective single center European study showed that improvements in pulmonary hemodynamics at rest and during exercise, in quality of life, and in exercise capacity were observed six months after balloon pulmonary angioplasty, and WHO functional class improved in 78% of patients [23]. Some data suggest that riociguat exerts beneficial effects on hemodynamic response to exercise in CTEPH patients on top of hemodynamic improvement by BPA [70].…”

Section: Balloon Pulmonary Angioplasty Efficacymentioning

confidence: 99%

Update on balloon pulmonary angioplasty for treatment of chronic thromboembolic pulmonary hypertension

Lang¹

2022

Current Opinion in Pulmonary Medicine

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Purpose of reviewTo provide an update on balloon pulmonary angioplasty (BPA) for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH), a pulmonary vascular disease that is characterized by fibro-thrombotic material mechanically obliterating major pulmonary arteries, resulting in increased pulmonary vascular resistance (PVR), progressive pulmonary hypertension (PH) combined with a microscopic pulmonary vasculopathy [1▪▪], right ventricular (RV) failure [2] and premature death.Recent findingsData from a most recent CTEPH European registry (2015 and 2016) suggest significantly improved survival [3▪] of CTEPH patients compared with survival in the eighties [4], or with data from 2007 and 2009 [5]. Pulmonary endarterectomy (PEA) is still the gold-standard therapy for CTEPH [6,7]. However, only around two thirds of all CTEPH patients are amenable to surgery [3▪,5]. Patients not suitable for PEA and treated conservatively have a poor prognosis [8]. BPA may have a role for this particular group of patients. [9–11]. Currently, BPA programs are available in many countries, with excellent results at expert centers [12–15,16▪,17,18▪▪]. Based on recent data, BPA seems to have a greater impact on symptomatic and hemodynamic improvement than medical therapy with riociguat alone [15].SummaryThe evidence favoring BPA is growing, but there is still a lack of published controlled trials. In addition, treatment concepts including indication, technical performance, use of PH-targeted medication, and the concept of follow-up vary between centers. In addition, there is a significant learning curve impacting outcomes [13]. The data from the International BPA registry will provide answers for some of the open questions.

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Beneficial effects of riociguat on hemodynamic responses to exercise in CTEPH patients after balloon pulmonary angioplasty – A randomized controlled study

Cited by 11 publications

References 29 publications

Riociguat and the right ventricle in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension

Riociguat and the right ventricle in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension

Efficacy of Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Disease Patients with Exercise Pulmonary Hypertension

Update on balloon pulmonary angioplasty for treatment of chronic thromboembolic pulmonary hypertension

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