Outcome of mean pulmonary arterial pressure-based intensive treatment for patients with pulmonary arterial hypertension
Outcome of mean pulmonary arterial pressure-based intensive treatment for patients with pulmonary arterial hypertension
复制标题
基于平均肺动脉压的肺动脉高压患者强化治疗的结果
DOI：
10.1016/j.jjcc.2022.04.003
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发表时间：
2022
影响因子：
2.5
通讯作者：
Ogawa Aiko
中科院分区：
文献类型：
--
作者：
Sugiyama Yoichi;Matsubara Hiromi;Shimokawahara Hiroto;Ogawa Aiko
背景：平均肺动脉压（mPAP）尚未被认为是肺动脉高压（PAH）的治疗靶点。然而，先前的报道表明，某些类型的肺动脉高压患者的生存与mPAP相关。因此，我们以降低mPAP为目的对PAH患者的所有亚群进行治疗，并评估治疗算法的疗效。方法2014年9月至2019年8月，连续43例经转诊治疗<3 个月的PAH患者入组。他们根据我们的治疗算法进行治疗，主要基于世界卫生组织功能分类、mPAP和预测肺一氧化碳弥散能力的百分比。治疗目标是随访时达到mPAP <40 mmHg。我们评估了临床参数、生存率及其决定因素。使用Kaplan-Meier法进行生存分析，使用Cox死亡率比例风险模型分析全因死亡与选定变量之间的关系。结果末次随访时pap明显改善[45 (35-55)mmHg ~ 24 (19-30) mmHg,p< 0.05]，37例（86%）患者达到治疗目的。所有患者5年生存率为90.7%。达到治疗目标的患者生存率（3年、5年生存率：97.3%）明显优于未达到治疗目标的患者生存率（3年生存率：50.0%,p< 0.05）。不同治疗方案患者5年生存率差异无统计学意义（p= 0.985）。随访时mPAP <40 mmHg是生存的独立预测因子。结论减缓mPAP对所有亚群PAH患者均有良好的预后，使其成为治疗目标。
BackgroundMean pulmonary arterial pressure (mPAP) has not been recognized as a therapeutic target for pulmonary arterial hypertension (PAH). However, previous reports demonstrated that the survival of patients with some types of pulmonary hypertension was associated with mPAP. Therefore, we treated all subsets of PAH patients with the aim of lowering mPAP and evaluated the efficacy of the treatment algorithm.MethodFrom September 2014 to August 2019, 43 consecutive patients with PAH on treatment <3 months on referral were enrolled in this study. They were treated according to our treatment algorithm mainly based on World Health Organization functional class, mPAP, and percent predicted diffusing capacity of the lung for carbon monoxide. The therapeutic goal was the achievement of mPAP <40 mmHg at follow-up. We evaluated clinical parameters, survival rate, and its determinants. Survival analyses were conducted using the Kaplan-Meier method and the relationship between all-cause death and selected variables was analyzed using the Cox proportional hazards model for mortality.ResultsmPAP significantly improved at the last follow-up [45 (35–55) mmHg to 24 (19–30) mmHg,p< 0.05], and the therapeutic goal was achieved in 37 patients (86%). The 5-year survival rate of all patients was 90.7%. The survival rate of patients who achieved the therapeutic goal (3- and 5-year survival: 97.3%) was significantly better than that of the patients who did not achieve the therapeutic goal (3-year survival: 50.0%,p< 0.05). The 5-year survival rates of the patients were the same among different treatment regimens (p= 0.985). mPAP <40 mmHg at follow-up was the independent predictor of survival.ConclusionsLowering mPAP resulted in favorable outcomes in all subsets of PAH patients, making it a therapeutic goal.