Hemodynamic, functional, and clinical responses to pulmonary artery denervation in patients with pulmonary arterial hypertension of different causes: phase II results from the Pulmonary Artery Denervation-1 study.
Hemodynamic, functional, and clinical responses to pulmonary artery denervation in patients with pulmonary arterial hypertension of different causes: phase II results from the Pulmonary Artery Denervation-1 study.
复制标题
DOI：
10.1161/circinterventions.115.002837
复制
发表时间：
2015-11
期刊：
影响因子：
--
通讯作者：
Stone GW
中科院分区：
文献类型：
--
作者：
Chen SL;Zhang H;Xie DJ;Zhang J;Zhou L;Rothman AM;Stone GW
肺动脉高压（PAH）的发病机制是多因素的。对肺动脉去神经支配（PADN）治疗特发性PAH的疗效进行了评价。本研究旨在分析不同原因的PAH患者对PADN的血流动力学、功能和临床反应。2012年4月至2014年4月，连续66例经PADN治疗的静息平均肺动脉压≥25 mm Hg的患者进行前瞻性随访。PADN手术后停用靶药。在PADN随访后1年内反复测量血流动力学反应和6分钟步行距离。临床终点为1年随访中pah相关事件的发生。无padn相关并发症。94%的患者获得了血流动力学成功（定义为在PADN后平均肺动脉压至少降低10%），24小时内收缩期肺动脉压和平均肺动脉压分别平均绝对降低- 10 mm Hg和- 7 mm Hg。PADN后6分钟步行距离平均增加量为94 m。10例患者（15%）发生了更严重的PAH相关事件，主要是由PAH恶化引起的（12%）。全因死亡8例（12%），与多环芳烃相关死亡6例（9%）。PADN治疗PAH是安全可行的。PADN手术与血流动力学功能、运动能力和心功能的显著改善以及PADN治疗后1年pah相关事件和死亡的发生率降低相关。需要进一步的随机研究来证实PADN对PAH的疗效。URL: http://www.chictr.trc.com.cn。唯一标识符：chiCTR-ONC-12002085。
The mechanisms underlying pulmonary arterial hypertension (PAH) are multifactorial. The efficacy of pulmonary artery denervation (PADN) for idiopathic PAH treatment has been evaluated. This study aimed to analyze the hemodynamic, functional, and clinical responses to PADN in patients with PAH of different causes. Between April 2012 and April 2014, 66 consecutive patients with a resting mean pulmonary arterial pressure ≥25 mm Hg treated with PADN were prospectively followed up. Target drugs were discontinued after the PADN procedure. Hemodynamic response and 6-minute walk distance were repeatedly measured within the 1 year post PADN follow-up. The clinical end point was the occurrence of PAH-related events at the 1-year follow-up. There were no PADN-related complications. Hemodynamic success (defined as the reduction in mean pulmonary arterial pressure by a minimal 10% post PADN) was achieved in 94% of all patients, with a mean absolute reduction in systolic pulmonary arterial pressure and mean pulmonary arterial pressure within 24 hours of −10 mm Hg and −7 mm Hg, respectively. The average increment in 6-minute walk distance after PADN was 94 m. Worse PAH-related events occurred in 10 patients (15%), mostly driven by the worsening of PAH (12%). There were 8 (12%) all-cause deaths, with 6 (9%) PAH-related deaths. PADN was safe and feasible for the treatment of PAH. The PADN procedure was associated with significant improvements in hemodynamic function, exercise capacity, and cardiac function and with less frequent PAH-related events and death at 1 year after PADN treatment. Further randomized studies are required to confirm the efficacy of PADN for PAH. URL: http://www.chictr.trc.com.cn. Unique identifier: chiCTR-ONC-12002085.