Acute vasoreactivity testing predicts outcome of idiopathic pulmonary arterial hypertension patients with a negative acute response

Yuanyuan Sun; Yuan Li; Xiangrui Meng; Rong Jiang; Qinhua Zhao; Lan Wang; Lingzi Shi; Cijun Luo; Hongling Qiu; Wenhui Wu; Jinling Li; Jing He; Jinming Liu; Ping Yuan; Sugang Gong

doi:10.21037/atm-20-7339

Acute vasoreactivity testing predicts outcome of idiopathic pulmonary arterial hypertension patients with a negative acute response

Ann Transl Med. 2020 Dec;8(24):1650. doi: 10.21037/atm-20-7339.

Authors

Yuanyuan Sun¹, Yuan Li¹, Xiangrui Meng², Rong Jiang¹, Qinhua Zhao¹, Lan Wang¹, Lingzi Shi³, Cijun Luo¹, Hongling Qiu¹, Wenhui Wu¹, Jinling Li¹, Jing He¹, Jinming Liu¹, Ping Yuan¹, Sugang Gong¹

Affiliations

¹ Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China.
² Institute of Bismuth Science, University of Shanghai for Science and Technology, China.
³ School of Clinical Medicine, Hebei Medical University, Shijiazhuang, China.

Abstract

Background: Acute vasoreactivity testing (AVT) during right heart catheterization (RHC) is performed in certain subsets of patients with pulmonary arterial hypertension (PAH) in order to identify those who benefit from calcium channel blockers. The present study aimed to investigate the prognostic value of pre-AVT, post-AVT, and changes in AVT (ΔAVT) parameters for idiopathic PAH (IPAH) patients with a negative acute response, and to identify sex differences that could be of prognostic value.

Methods: A total of 487 incident IPAH patients (171 males and 316 females) with a negative acute response to AVT were recruited from Shanghai Pulmonary Hospital between 2009 and 2018. Outcomes were predicted using the Kaplan-Meier curve and univariate/multivariate Cox regression analyses. All patients were followed up till January 2020, with outcome specified as all-cause mortality.

Results: Inhalation of iloprost aerosol improved the hemodynamic parameters for all patients. Post-PVR was decreased, and post-cardiac output (post-CO) and post-cardiac index (post-CI) were increased compared with pre-AVT parameters among males. Increased post- artery oxygen saturation (post-SaO₂) and decreased post-mean right atrium pressure (post-mRAP) were also observed in females. For all patients, pre-CO ≥3.25 L/min, post-mPAP <53 mmHg, and post-mixed venous oxygen saturation (post-SvO₂) ≤63% were parameters suggesting better prognosis. For males, patients with pre-PVR <12.47 Wood units, pre-SvO₂ ≥64%, and post-mean pulmonary artery pressure (post-mPAP) <51 mmHg had a better prognosis. For females, patients with ΔmPAP ≥-4 mmHg and ΔPVR ≥-0.25 Wood units had better outcomes.

Conclusions: AVT parameters, including pre-AVT, post-AVT and ΔAVT, have a more important prognostic value than currently used for identify a small subgroup of patients with PAH who are suitable for high-dose calcium channel blockers. Sex differences in AVT parameters suggest that sex should be taken into account in estimating prognosis.

Keywords: Idiopathic pulmonary arterial hypertension (IPAH); acute vasoreactivity testing (AVT); hemodynamics; prognosis; sex differences.