Risk Reduction and Hemodynamics with Initial Combination Therapy in Pulmonary Arterial Hypertension
Risk Reduction and Hemodynamics with Initial Combination Therapy in Pulmonary Arterial Hypertension
复制标题
DOI：
10.1164/rccm.202004-1006oc
复制
发表时间：
2021-02-15
影响因子：
24.7
通讯作者：
Vizza, Carmine Dario
中科院分区：
文献类型：
--
作者：
Badagliacca, Roberto;D'Alto, Michele;Vizza, Carmine Dario
理由：建议对肺动脉高压 (PAH) 进行初始口服药物组合，但这种方法对降低风险和肺血管阻力 (PVR) 的影响尚不清楚。目的：检验预先接受口服药物组合治疗的 PAH 患者的 PVR 降低可确定低风险状态的假设。方法：该研究纳入了 181 名初治 PAH 患者（81% 为特发性），并进行了随访首次联合使用内皮素受体拮抗剂 + 磷酸二酯酶 5 抑制剂药物，并根据欧洲指南和登记处评估早期和长期 PAH 疾病管理评分进行临床评估和风险评估后 6 个月（四分位距，144-363 天）进行心导管检查。测量和主要结果：初始联合治疗改善了功能等级和 6 分钟步行距离，并将 PVR 平均降低了 35%（中位数为 40%）。三分之一的患者 PVR 下降
Rationale: An initial oral combination of drugs is being recommended in pulmonary arterial hypertension (PAH), but the effects of this approach on risk reduction and pulmonary vascular resistance (PVR) are not known.Objectives: To test the hypothesis that a low-risk status would be determined by the reduction of PVR in patients with PAH treated upfront with a combination of oral drugs.Methods: The study enrolled 181 treatment-naive patients with PAH (81% idiopathic) with a follow-up right heart catheterization at 6 months (interquartile range, 144-363 d) after the initial combination of endothelin receptor antagonist + phosphodiesterase-5 inhibitor drugs and clinical evaluation and risk assessments by European guidelines and Registry to Evaluate Early and Long-Term PAH Disease Management scores.Measurements and Main Results: Initial combination therapy improved functional class and 6-minute-walk distance and decreased PVR by an average of 35% (median, 40%). One-third of the patients had a decrease in PVR