Echocardiographic Evaluation of Initial Ambrisentan Plus Phosphodiesterase Type 5 Inhibitor on Right Ventricular Pulmonary Artery Coupling in Severe Pulmonary Arterial Hypertension Patients

Abstract

Introductionambrisentan and phosphodiesterase type 5 inhibitor (PDE5i) have been approved for treating patients with pulmonary arterial hypertension (PAH). Echocardiographic right ventricular pulmonary artery coupling (RVPAC) has been shown to be a valid non-invasive and alternative measurement method to assess the predicted outcomes in PAH patients. The aim of this study was to study the effect and clinical correlates of initial ambrisentan plus PDE5i combination therapy on RVPAC in patients with severe PAH.Method and ResultsWe retrospectively studied and analyzed comprehensive clinical data, hemodynamics, and echocardiography in 27 patients with severe PAH before and after 6 months of initial combination therapy. Compared with the baseline, significant improvements in RVPAC ratios were observed, including RVFAC/PASP (0.31 ± 0.10 vs. 0.44 ± 0.15%/mmHg, p < 0.001), TAPSE/PASP (0.15 ± 0.05 vs. 0.21 ± 0.06 mm/mmHg, p = 0.001), S’/PASP (0.10 ± 0.03 vs. 0.14 ± 0.05 cm/s∙mmHg, p = 0.001), and RVSV/RVESV (0.79 ± 0.22 vs. 1.02 ± 0.20, p < 0.001). Functional status indices [World Health Organization functional classifications (WHO-FC) and 6 min walk distance (6MWD) and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels] showed significant improvements. Right heart catheterization (RHC) evaluations for hemodynamic measurements between baseline and the 6–12 month follow-up were sPAP (96 ± 22 vs. 86 ± 24 mmHg, p = 0.002), mPAP (64 ± 18 vs. 56 ± 17 mmHg, p < 0.001) and TPVR (17.3 ± 6.7 vs. 12.1 ± 5.4 WU, p = 0.001). Simultaneously, significant associations between RVPAC ratios and NT-proBNP levels and WHO-FC and 6MWD were observed.ConclusionAmbrisentan plus PDE-5i combination therapy resulted in a significant improvement in RVPAC in severe PAH. Importantly, RVPAC parameters correlated with known prognostic markers of PAH.

Selexipag-based triple combination therapy improves prognosis in Chinese pulmonary arterial hypertension patients

“…Although right ventricular diameter and TAPSE improved significantly, the trend in decreasing RA area did not reach statistical significance. Several other studies have also demonstrated that changes in right heart structure and function lagged behind NT-proBNP levels and exercise ability (24,25). A recently published meta-analysis indicates that the improvement in RV systolic function appeared as long as 6 months and in the right atrial area, 12 months, after initiation of targeted therapy in PAH patients (26).…”

Potential impact of specific therapy on pregnant women with pulmonary arterial hypertension without cardiac shunt: a descriptive study in northern China

“…Multiple studies have revealed that NT-proBNP shows a faster response to PAH-specific therapies than that of other measurements of cardiac function (such as RV contractility and RV end-diastolic volume). [21–24] This phenomenon suggests that an adequate treatment duration of PAH-specific therapy may lead to better outcomes in patients with PAH during pregnancy.…”

“…In all 85 patients, C-section was performed, with only 9.4% of which performed for therapeutic abortion. Compared with the untreated group, the treated group comprised older individuals (31 [26, 33] years vs. 27 [24,31] years; P = 0.029) with higher sPAP (98 [78, 105] mm Hg vs. 73 [59, 88] mm Hg; P < 0.001) and larger RV diameter (32 [27, 37] mm vs. 28 [23,33] mm; P = 0.010). Although no significant difference was detected, the treated group comprised a higher proportion of patients under general anesthesia and those classified as WHO-FC III/IV (worse cardiac FC).…”