Change of right heart size and function by long-term therapy with riociguat in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension

INTERNATIONAL JOURNAL OF CARDIOLOGY

卷:195

Article

Marra, Alberto M.^1,2  Egenlauf, Benjamin¹  Ehlken, Nicola¹  Fischer, Christine³  Eichstaedt, Christina¹  Nagel, Christian¹  Bossone, Eduardo^4,5  Cittadini, Antonio²  Halank, Michael⁶  Gall, Henning⁷  Olsson, Karen M.⁸  Lange, Tobias J.⁹  Gruenig, Ekkehard¹ 

[1] Heidelberg Univ, Pulm Hypertens Ctr, Thoraxclin, D-69126 Heidelberg, Germany

[2] Univ Naples Federico II, Sch Med, Dept Translat Med Sci, Internal Med Sect, Naples, Italy

[3] Univ Heidelberg Hosp, Inst Human Genet, Heidelberg, Germany

[4] Univ Salerno, Cava De Tirreni & Amalfi Coast Hosp, Heart Dept, Div Cardiol, Salerno, Italy

[5] IRCCS Policlin San Donato, Milan, Italy

[6] Tech Univ Dresden, Univ Hosp, Med Clin 1, Dresden, Germany

[7] Univ Giessen, Lung Ctr, Dept Pneumol, Giessen, Germany

[8] Hannover Med Sch, Dept Resp Med, Hannover, Germany

[9] Univ Med Ctr Wurzburg, Internal Med 2, Wurzburg, Germany

关键词: Riociguat;    Pulmonary arterial hypertension;    Chronic thromboembolic pulmonary hypertension;    Right atrium;    Right ventricle;   

DOI  :  10.1016/j.ijcard.2015.05.105

来源: Elsevier

【 摘 要 】

Background: Riociguat is a soluble guanylate cyclase stimulator approved for pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). The objective of this study was to evaluate the change of right heart size and function assessed by echocardiography during long-term treatment with riociguat. Methods: We assessed patients who started riociguat treatment (1.0-2.5 mg tid) within the trials PATENT, PATENTplus, EAS and CHEST and continued for 3-12 months. Echocardiography, 6-minute walking distance (6MWD) and further clinical parameters were analyzed at baseline, after 3, 6 and 12 months. Right heart catheterization was performed at baseline and after 3 months. For missing data we performed the last and baseline observation carried forward (LOCF, BOCF) method as sensitivity analyses. Results: Thirty-nine patients (21 PAH, 18 CTEPH, mean pulmonary arterial pressure 43 +/- 2 mm Hg, PVR 600 +/- 43 dyn*s*cm(-5), 56.4% treatment-naive) were included. Mean right ventricular (RV) area significantly decreased after 3 (-2.1 +/- 3.9 cm(2), equals-7.4 +/- 15.3%, p = 0.002), 6 (-4.2 +/- 3.2 cm(2), equals - 16.1 +/- 11.5%, p < 0.001) and 12 months (-5.9 +/- 4.6 cm(2), equals-22.1 +/- 14.2%, p < 0.001) compared to baseline. Right atrial area significantly decreased after 12 months (-3.5 +/- 4.1 cm(2), equals-16.8 +/- 19.2%, p < 0.001) and TAPSE significantly improved after 6 (+ 2 +/- 4.7, equals 12 +/- 25.8%, p = 0.025) and 12 months (+ 3.6 +/- 5.4, equals 21.0 +/- 29.6%, p = 0.002). Furthermore, RV wall thickness and 6MWD significantly improved after 3, 6 and 12 months (p < 0.05). Invasive hemodynamics significantly improved after 3 months. Both LOCF and BOCF showed similar significance and lower effect sizes. Conclusion: Long-term treatment with riociguat significantly reduced right heart size and improved RV function in PAH and CTEPH. Further prospective studies are needed to confirm these results. (C) 2015 The Authors. Published by Elsevier Ireland Ltd.

【 授权许可】

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