scholarly journals Upfront combination therapy reduces right ventricular volumes in pulmonary arterial hypertension

2017 ◽  
Vol 49 (6) ◽  
pp. 1700007 ◽  
Author(s):  
Mariëlle C. van de Veerdonk ◽  
Anna E. Huis in t Veld ◽  
J. Tim Marcus ◽  
Nico Westerhof ◽  
Martijn W. Heymans ◽  
...  
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Combination Therapy ◽  
Arterial Hypertension ◽  
Right Ventricular ◽  
Therapy Group ◽  
Heart Association ◽  
Wall Stress ◽  
Combination Therapy Group ◽  
Pulmonary Arterial ◽  
The Impact

In pulmonary arterial hypertension (PAH), upfront combination therapy is associated with better clinical outcomes and a greater reduction in N-terminal pro-brain natriuretic peptide (NT-proBNP) than monotherapy. NT-proBNP levels reflect right ventricular (RV) wall stress, which increases when the right ventricle dilates. This study explored the impact of upfront combination therapy on RV volumes compared with monotherapy in PAH patients.This retrospective study involved 80 incident PAH patients (New York Heart Association class II and III) who were treated with upfront combination therapy (n=35) (i.e. endothelin receptor antagonists (ERAs) plus phosphodiesterase-5-inhibitors (PDE5Is)) or monotherapy (n=45) (i.e. either ERAs or PDE5Is). All patients underwent right-sided heart catheterisation and cardiac magnetic resonance imaging at baseline and after 1-year follow-up.Combination therapy resulted in more significant reductions in pulmonary vascular resistance and pulmonary pressures than monotherapy. NT-proBNP was decreased by ∼77% in the combination therapy group compared with a ∼51% reduction after monotherapy (p<0.001). RV volumes and calculated RV wall stress improved after combination therapy (both p<0.001) but remained unchanged after monotherapy (both p=NS). RV ejection fraction improved more in the combination therapy group than in the monotherapy group (p<0.001).In PAH patients, upfront combination therapy was associated with improved RV volumes.

scholarly journals Addition of Sildenafil in Patients with Pulmonary Arterial Hypertension with Inadequate Response to Bosentan Monotherapy

2008 ◽  
Vol 15 (8) ◽  
pp. 427-430 ◽  
Author(s):  
Nancy R Porhownik ◽  
Hassan Al-Sharif ◽  
Zoheir Bshouty
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Combination Therapy ◽  
Arterial Hypertension ◽  
Exercise Tolerance ◽  
Nyha Class ◽  
Heart Association ◽  
Functional Class ◽  
Inadequate Response ◽  
Nyha Classification ◽  
Pulmonary Arterial

BACKGROUND: Pulmonary arterial hypertension (PAH) remains a progressive disease despite improvement when using one of three medication classes: prostanoids, endothelin receptor antagonists or phosphodiesterase-5 inhibitors. Combination therapy has been proposed for patients with unsatisfactory response to monotherapy.OBJECTIVES: To examine the effect of adding sildenafil to bosentan on 6 min walk distance (6MWD) and New York Heart Association (NYHA) classification in patients with PAH who achieved inadequate improvement with bosentan monotherapy.METHODS: Patients with idiopathic PAH or connective tissue disease-associated PAH, and who had either self-reported inadequate improvement in exercise tolerance or a decline in 6MWD after initial improvement, were included in the study (n=10). Data on 6MWD and NYHA class at baseline (before initiation of bosentan), three and six months after baseline, second baseline (before initiation of combination therapy with sildenafil), and three and six months after second baseline were analyzed for any changes.RESULTS: Mean time from initiation of bosentan monotherapy to initiation of combination therapy was 558 days (range 150 to 900 days). Six months after initiation of bosentan, 6MWD increased by 57.2 m above the baseline of 314.4 m. Six months after combination therapy, 6MWD was 62.80 m higher than the baseline before initiation of combination therapy of 339 m (P<0.02). The overall increase in 6MWD six months after combination therapy was higher than the first baseline by 87.4 m (P not significant). NYHA functional class did not improve with combination therapy in all patients.DISCUSSION: Initiating combination therapy in patients who achieve an inadequate improvement in exercise tolerance with mono-therapy may result in further improvement in exercise tolerance.

scholarly journals Initial dual oral combination therapy in pulmonary arterial hypertension

2016 ◽  
Vol 47 (6) ◽  
pp. 1727-1736 ◽  
Author(s):  
Olivier Sitbon ◽  
Caroline Sattler ◽  
Laurent Bertoletti ◽  
Laurent Savale ◽  
Vincent Cottin ◽  
...  
Keyword(s):  
New York ◽  
Pulmonary Arterial Hypertension ◽  
Combination Therapy ◽  
Arterial Hypertension ◽  
Single Agent ◽  
Survival Rates ◽  
Heart Association ◽  
Functional Class ◽  
Class Iii ◽  
Pulmonary Arterial

Treatment for pulmonary arterial hypertension (PAH) has been underpinned by single-agent therapy to which concomitant drugs are added sequentially when pre-defined treatment goals are not met.This retrospective analysis of real-world clinical data in 97 patients with newly diagnosed PAH (86% in New York Heart Association functional class III−IV) explored initial dual oral combination treatment with bosentan plus sildenafil (n=61), bosentan plus tadalafil (n=17), ambrisentan plus tadalafil (n=11) or ambrisentan plus sildenafil (n=8).All regimens were associated with significant improvements in functional class, exercise capacity, dyspnoea and haemodynamic indices after 4 months of therapy. Over a median follow-up period of 30 months, 75 (82%) patients were still alive, 53 (71%) of whom received only dual oral combination therapy. Overall survival rates were 97%, 94% and 83% at 1, 2 and 3 years, respectively, and 96%, 94% and 84%, respectively, for the patients with idiopathic PAH, heritable PAH and anorexigen-induced PAH. Expected survival rates calculated from the French equation for the latter were 86%, 75% and 66% at 1, 2 and 3 years, respectively.Initial combination of oral PAH-targeted medications may offer clinical benefits, especially in PAH patients with severe haemodynamic impairment.

Right Ventricular End-Diastolic Wall Stress Predicts Survival in Patients With Pulmonary Arterial Hypertension

CHEST Journal ◽  
2013 ◽  
Vol 144 (4) ◽  
pp. 869A
Author(s):  
Karima Addetia ◽  
Alex Zhai ◽  
Aaron Leong ◽  
Amal Bessissow ◽  
Avi Shimony ◽  
...  
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Right Ventricular ◽  
Wall Stress ◽  
Pulmonary Arterial

scholarly journals Right ventricular dyssynchrony: from load-independent right ventricular function to wall stress in severe pulmonary arterial hypertension

2020 ◽  
Vol 10 (2) ◽  
pp. 204589402092575
Author(s):  
Manuel J. Richter ◽  
Roberto Badagliacca ◽  
Jun Wan ◽  
Rebecca Vanderpool ◽  
Antonia Dalmer ◽  
...  
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Right Ventricular ◽  
Diastolic Function ◽  
Ventricular Function ◽  
Right Ventricular Function ◽  
Wall Stress ◽  
Ventricular Dyssynchrony ◽  
Pulmonary Arterial ◽  
Severe Pulmonary Arterial Hypertension

Right ventricular (RV) dyssynchrony has been related to outcome in pulmonary arterial hypertension. Prospectively, we performed echocardiography with measurement of right ventricular dyssynchrony and pressure–volume loop catheterization in 27 pulmonary arterial hypertension patients. Afterload and diastolic function emerged as determinates of wall stress, which results in dyssynchrony.

Sign in / Sign up

Export Citation Format

Share Document