Acute Vasoreactivity Testing and Outcomes in Pulmonary Arterial Hypertension: A Call for Increased Testing

Sahan Chandrasekara; Edmund M Lau; James Anderson; Nicholas Collins; Rachael Cordina; Carolyn Corrigan; Nathan Dwyer; John Feenstra; Mark Horrigan; Anne Keogh; Eugene Kotlyar; Melanie Lavender; Tanya McWilliams; Bronwen Rhodes; Peter Steele; Geoff Strange; Vivek Thakkar; Robert Weintraub; Helen Whitford; Kenneth Whyte; Trevor Williams; Jeremy Wrobel; Dominic T Keating; PHSANZ Registry

doi:10.1016/j.hlc.2022.09.005

Acute Vasoreactivity Testing and Outcomes in Pulmonary Arterial Hypertension: A Call for Increased Testing

Heart Lung Circ. 2023 Feb;32(2):156-165. doi: 10.1016/j.hlc.2022.09.005. Epub 2022 Dec 8.

Authors

Sahan Chandrasekara¹, Edmund M Lau², James Anderson³, Nicholas Collins⁴, Rachael Cordina⁵, Carolyn Corrigan⁶, Nathan Dwyer⁷, John Feenstra⁸, Mark Horrigan⁹, Anne Keogh⁶, Eugene Kotlyar⁶, Melanie Lavender¹⁰, Tanya McWilliams¹¹, Bronwen Rhodes¹², Peter Steele¹³, Geoff Strange¹⁴, Vivek Thakkar¹⁵, Robert Weintraub¹⁶, Helen Whitford¹, Kenneth Whyte¹¹, Trevor Williams¹, Jeremy Wrobel¹⁷, Dominic T Keating¹⁸; PHSANZ Registry

Affiliations

¹ Department of Respiratory Medicine, The Alfred Hospital, and Central Clinical School, Monash University, Melbourne, Vic, Australia.
² Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
³ Respiratory Department, Sunshine Coast University Hospital, Birtinya, Qld, Australia.
⁴ Department of Cardiology, John Hunter Hospital, Newcastle, NSW, Australia.
⁵ Department of Cardiology, Royal Prince Alfred Hospital, and Heart Research Institute, Sydney, NSW, Australia.
⁶ Heart and Lung Transplant Unit, St Vincent's Hospital, Sydney, NSW, Australia.
⁷ Department of Cardiology, Royal Hobart Hospital, Hobart, Tas, Australia.
⁸ Queensland Lung Transplant Service, Prince Charles Hospital, Brisbane, Qld, Australia.
⁹ The Austin Hospital, Melbourne, Vic, Australia.
¹⁰ Advanced Lung Disease Unit, Fiona Stanley Hospital, Perth, WA, Australia.
¹¹ Greenlane Clinical Centre, Auckland City Hospital, Auckland, New Zealand.
¹² Department of Respiratory Medicine, Christchurch Hospital, Christchurch, New Zealand.
¹³ Department of Cardiovascular Services, Royal Adelaide Hospital, Adelaide, SA, Australia.
¹⁴ School of Medicine, University of Notre Dame, Fremantle, WA, Australia; Pulmonary Hypertension Society of Australia and New Zealand.
¹⁵ Department of Clinical Medicine, Macquarie University, Sydney, NSW, Australia; Department of Rheumatology, Liverpool Hospital, Sydney, NSW, Australia.
¹⁶ Royal Children's Hospital, Melbourne, Vic, Australia; Murdoch Children's Research Institute, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia.
¹⁷ Advanced Lung Disease Unit, Fiona Stanley Hospital, Perth, WA, Australia; School of Medicine, University of Notre Dame, Fremantle, WA, Australia.
¹⁸ Department of Respiratory Medicine, The Alfred Hospital, and Central Clinical School, Monash University, Melbourne, Vic, Australia. Electronic address: D.Keating@alfred.org.au.

PMID: 36503731
DOI: 10.1016/j.hlc.2022.09.005

Abstract

Background: Pulmonary arterial hypertension (PAH) has a progressive, unremitting clinical course. Vasoreactivity testing (VdT) during right heart catheterisation (RHC) identifies a subgroup with excellent long-term response to calcium channel blockade (CCB). Reporting on these patients is limited. Established in 2011, the Pulmonary Hypertension Society of Australia and New Zealand (PHSANZ) registry offers the opportunity to assess the frequency of VdT during RHC, treatment and follow up of PAH patients.

Methods: Registry data from 3,972 PAH patients with index RHC revealed 1,194 VdT appropriate patients. Data was analysed in three groups: 1) VdT+CCB+: VdT positive, CCB treated; 2) VdT+CCB-: VdT positive, no CCB prescribed, 3) VdT-/noVdT: VdT negative, or VdT not tested. Data was reviewed for adherence to guidelines, clinical response (World Health Organization functional class [WHO FC], 6-minute-walk-distance [6MWD], RHC), and outcomes (survival or lung transplantation).

Results: Patients included had idiopathic (IPAH=1,087), heritable (HPAH=67) and drug or toxin-induced PAH (DPAH=40). A VdT was performed in 22% (268/1,194), with incomplete data in 26% (70/268); 28% (55/198) were VdT+. Analysis group allocation was: VdT+CCB+ (33/55), VdT+CCB- (22/55), VdT- (143)/noVdT (996). From patients with 1-year data VdT+CCB+ and VdT-/noVdT patients improved WHO FC, 6MWD and cardiac index (CI); VdT+CCB- data remained similar. Within the VdT+CCB+ group, 30% (10/33) were long-term CCB responders with a 100% 5-year survival; non-responders had a 61% survival at 5.4 years. Long-term responders were younger at diagnosis (40 yrs vs 54 yrs).

Conclusion: Use of VdT testing and documentation is poor in this contemporary patient cohort. Nonetheless, survival in VdT+CCB+ patients from the PHSANZ registry is excellent, supporting guidelines promoting VdT testing. Strategies to promote the use of VdT are warranted.

Keywords: Calcium channel blockers; Pulmonary hypertension; Right heart catheter; Right ventricular failure; Vasoreactivity testing.

Copyright © 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

MeSH terms

Calcium Channel Blockers / therapeutic use
Cardiac Catheterization
Familial Primary Pulmonary Hypertension
Humans
Hypertension, Pulmonary* / drug therapy
Hypertension, Pulmonary* / therapy
Pulmonary Arterial Hypertension* / drug therapy
Pulmonary Arterial Hypertension* / therapy

Substances

Calcium Channel Blockers