TY - JOUR T1 - Relevance of comorbidities on initial combination therapy in pulmonary arterial hypertension JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00298-2022 VL - 8 IS - 4 SP - 00298-2022 AU - Roberto Badagliacca AU - Michele D'Alto AU - Stefano Ghio AU - Paola Argiento AU - Natale Daniele Brunetti AU - Gavino Casu AU - Nadia Cedrone AU - Marco Confalonieri AU - Marco Corda AU - Michele Correale AU - Carlo D'Agostino AU - Lucrezia De Michele AU - Serena Di Marino AU - Domenico Filomena AU - Giuseppe Galgano AU - Alessandra Greco AU - Carlo Lombardi AU - Giovanna Manzi AU - Valentina Mercurio AU - Massimiliano Mulè AU - Giuseppe Paciocco AU - Silvia Papa AU - Emanuele Romeo AU - Laura Scelsi AU - Davide Stolfo AU - Patrizio Vitulo AU - Carmine Dario Vizza A2 - , Y1 - 2022/10/01 UR - http://openres.ersjournals.com/content/8/4/00298-2022.abstract N2 - Rationale Demographic characteristics of pulmonary arterial hypertension (PAH) patients have changed over time, but the effects of cardiovascular risk factors on risk status and pulmonary vascular resistance (PVR) reduction with initial oral combination therapy are not known. Therefore, we tested the relevance of cardiovascular comorbidities in this setting.Methods The study enrolled 181 treatment-naive PAH patients with a 6-month (IQR 144–363 days) right heart catheterisation and risk assessment after initial oral combination therapy.Results Group A included 96 (53.0%) patients without cardiac comorbidities; Group B included 54 (29.8%) patients with one cardiac comorbidity; Group C included 31 (17.1%) patients with two cardiac comorbidities or more. Group C patients were older with a balanced sex distribution. There was a significant difference in PVR reduction moving from the absence to one or at least two cardiac comorbidities, respectively: median −45.0%, −30.3%, −24.3%. A European Respiratory Society/European Society of Cardiology low-risk status was present at first follow-up in 50 (52.0%) patients in Group A, 19 (35.1%) in Group B and 9 (29.0%) in Group C; a REVEAL 2.0 low-risk status was present at first follow-up in 41 (42.0%) patients in Group A, 15 (27.7%) in Group B and 7 (22.6%) in Group C. Group A patients were 2.3 times more likely to achieve/maintain a low-risk status compared with Group B and C (OR 2.27, 95% CI 1.15–4.54, p=0.02). No significant difference was observed between patients with non-cardiac comorbidities and those without comorbidities.Conclusion Initial oral combination therapy seems associated with a less effective response for patients with cardiovascular comorbidities compared with the others, related to the magnitude of treatment-induced decrease in PVR.In patients with pulmonary arterial hypertension, initial oral combination therapy is associated with a less effective response for those with cardiovascular comorbidities, related to the magnitude of treatment-induced decrease in PVR. https://bit.ly/3QB0Gd5 ER -