Outcome of mean pulmonary arterial pressure-based intensive treatment for patients with pulmonary arterial hypertension

Yoichi Sugiyama; Hiromi Matsubara; Hiroto Shimokawahara; Aiko Ogawa

doi:10.1016/j.jjcc.2022.04.003

Outcome of mean pulmonary arterial pressure-based intensive treatment for patients with pulmonary arterial hypertension

J Cardiol. 2022 Nov;80(5):432-440. doi: 10.1016/j.jjcc.2022.04.003. Epub 2022 May 12.

Authors

Yoichi Sugiyama¹, Hiromi Matsubara², Hiroto Shimokawahara¹, Aiko Ogawa³

Affiliations

¹ Department of Cardiology, National Hospital Organization Okayama Medical Center, Okayama, Japan.
² Department of Cardiology, National Hospital Organization Okayama Medical Center, Okayama, Japan; Department of Clinical Science, National Hospital Organization Okayama Medical Center, Okayama, Japan.
³ Department of Clinical Science, National Hospital Organization Okayama Medical Center, Okayama, Japan. Electronic address: aiko-oky@umin.ac.jp.

PMID: 35570097
DOI: 10.1016/j.jjcc.2022.04.003

Abstract

Background: Mean pulmonary arterial pressure (mPAP) has not been recognized as a therapeutic target for pulmonary arterial hypertension (PAH). However, previous reports demonstrated that the survival of patients with some types of pulmonary hypertension was associated with mPAP. Therefore, we treated all subsets of PAH patients with the aim of lowering mPAP and evaluated the efficacy of the treatment algorithm.

Method: From September 2014 to August 2019, 43 consecutive patients with PAH on treatment <3 months on referral were enrolled in this study. They were treated according to our treatment algorithm mainly based on World Health Organization functional class, mPAP, and percent predicted diffusing capacity of the lung for carbon monoxide. The therapeutic goal was the achievement of mPAP <40 mmHg at follow-up. We evaluated clinical parameters, survival rate, and its determinants. Survival analyses were conducted using the Kaplan-Meier method and the relationship between all-cause death and selected variables was analyzed using the Cox proportional hazards model for mortality.

Results: mPAP significantly improved at the last follow-up [45 (35-55) mmHg to 24 (19-30) mmHg, p < 0.05], and the therapeutic goal was achieved in 37 patients (86%). The 5-year survival rate of all patients was 90.7%. The survival rate of patients who achieved the therapeutic goal (3- and 5-year survival: 97.3%) was significantly better than that of the patients who did not achieve the therapeutic goal (3-year survival: 50.0%, p < 0.05). The 5-year survival rates of the patients were the same among different treatment regimens (p = 0.985). mPAP <40 mmHg at follow-up was the independent predictor of survival.

Conclusions: Lowering mPAP resulted in favorable outcomes in all subsets of PAH patients, making it a therapeutic goal.

Keywords: Hemodynamics; Prostacyclin; Pulmonary hypertension; Survival; Treatment algorithm.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Arterial Pressure
Carbon Monoxide
Familial Primary Pulmonary Hypertension
Hemodynamics
Humans
Hypertension, Pulmonary* / etiology
Pulmonary Arterial Hypertension* / drug therapy

Substances

Carbon Monoxide