Beneficial effects of riociguat on hemodynamic responses to exercise in CTEPH patients after balloon pulmonary angioplasty - A randomized controlled study
Beneficial effects of riociguat on hemodynamic responses to exercise in CTEPH patients after balloon pulmonary angioplasty - A randomized controlled study
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DOI：
10.1016/j.ijcha.2020.100579
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发表时间：
2020-08-01
影响因子：
2.9
通讯作者：
Shimokawa, Hiroaki
中科院分区：
文献类型：
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作者：
Aoki, Tatsuo;Sugimura, Koichiro;Shimokawa, Hiroaki
背景：尽管球囊肺血管成形术（BPA）可改善慢性血栓栓塞性肺动脉高压（CTEPH）患者的症状和肺血流动力学，但利奥西呱对BPA术后患者血流动力学和运动能力的影响仍有待阐明。
方法和结果：本研究是一项单中心、前瞻性、随机、开放标签试验。2015年11月至2018年11月，我们前瞻性地研究了21例CTEPH患者（年龄65±9岁，男/女 = 2/19），这些患者在未使用任何血管扩张剂的情况下接受BPA治疗后，平均肺动脉压（mPAP）<30 mmHg，血流动力学得到改善。我们使用自行车测力计在仰卧位休息和运动时进行血流动力学评估和呼气气体分析。在运动过程中进行右心导管检查后，根据年龄、性别和静息mPAP，采用最小化方法将他们随机分为两组：利奥西呱组（N = 10）和对照组（N = 11）。6个月后，两组的6分钟步行距离和心肺运动试验所评估的运动能力以及静息血流动力学参数相当。然而，与对照组相比，利奥西呱组在峰值负荷时的心输出量（CO）（6.0±1.7 - 7.4±1.6，P < 0.01）和肺血管阻力（4.8±1.8 - 3.2±0.7伍德单位，P = 0.02）显著改善。利奥西呱组线性化的mPAP - CO关系斜率显著降低[14.5（7.8，14.7）至6.41（5.1，11.4），P < 0.01]，而对照组无此变化。
结论：这些结果表明，即使在BPA改善血流动力学之后，利奥西呱对CTEPH患者运动时的血流动力学反应也具有有益作用。（C）2020作者。由爱思唯尔出版集团出版。
Background: Although balloon pulmonary angioplasty (BPA) improves symptoms and pulmonary hemodynamics in patients with chronic thromboembolic pulmonary hypertension (CTEPH), the effects of riociguat on hemodynamics and exercise capacity in patients after BPA remain to be elucidated.Methods and Results: This study was a single-center, prospective, randomized, open-label trial. From November 2015 to November 2018, we prospectively examined 21 patients with CTEPH (65 +/- 9 years old, M/F 2/19) who showed hemodynamic improvement with mean pulmonary arterial pressure (mPAP) < 30 mmHg after BPA without any vasodilators. We performed hemodynamic evaluation and expired gas analysis both at rest and during exercise in supine position using cycle ergometer. After right heart catheterization during exercise, they were randomly assigned to 2 groups with minimized method, using age, sex, and resting mPAP; riociguat (N = 10) and control (N = 11) groups. After 6 months, exercise capacity evaluated by 6-min walk distance and cardiopulmonary exercise testing, and resting hemodynamic parameters were comparable in both groups. However, cardiac output (CO) (6.0 +/- 1.7-7.4 +/- 1.6, P < 0.01) and pulmonary vascular resistance (4.8 +/- 1.8-3.2 +/- 0.7 Wood units, P = 0.02) at peak workload were significantly improved in the riociguat group as compared with the control group. The slope of linearized mPAP-CO relationship was significantly decreased in the riociguat group [14.5 (7.8, 14.7) to 6.41 (5.1, 11.4), P < 0.01] but not in the control group.Conclusions: These results indicate that riociguat exerts beneficial effects on hemodynamic response to exercise in CTEPH patients even after hemodynamic improvement by BPA. (C) 2020 The Author(s). Published by Elsevier B.V.