RT Journal Article
SR Electronic
T1 Relevance of comorbidities on initial combination therapy in pulmonary arterial hypertension
JF ERJ Open Research
JO erjor
FD European Respiratory Society
SP 00298-2022
DO 10.1183/23120541.00298-2022
VO 8
IS 4
A1 Roberto Badagliacca
A1 Michele D'Alto
A1 Stefano Ghio
A1 Paola Argiento
A1 Natale Daniele Brunetti
A1 Gavino Casu
A1 Nadia Cedrone
A1 Marco Confalonieri
A1 Marco Corda
A1 Michele Correale
A1 Carlo D'Agostino
A1 Lucrezia De Michele
A1 Serena Di Marino
A1 Domenico Filomena
A1 Giuseppe Galgano
A1 Alessandra Greco
A1 Carlo Lombardi
A1 Giovanna Manzi
A1 Valentina Mercurio
A1 Massimiliano Mulè
A1 Giuseppe Paciocco
A1 Silvia Papa
A1 Emanuele Romeo
A1 Laura Scelsi
A1 Davide Stolfo
A1 Patrizio Vitulo
A1 Carmine Dario Vizza
A1 ,
YR 2022
UL http://openres.ersjournals.com/content/8/4/00298-2022.abstract
AB 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