Acute Vasoreactivity Testing and Outcomes in Pulmonary Arterial Hypertension: A Call for Increased Testing.

Humans Calcium Channel Blockers / therapeutic use Pulmonary Arterial Hypertension / therapy Familial Primary Pulmonary Hypertension Hypertension, Pulmonary / therapy Cardiac Catheterization
Calcium channel blockers Pulmonary hypertension Right heart catheter Right ventricular failure Vasoreactivity testing

Journal

Heart, lung & circulation
ISSN: 1444-2892
Titre abrégé: Heart Lung Circ
Pays: Australia
ID NLM: 100963739

Informations de publication

Date de publication:
Feb 2023
Historique:
received: 27 01 2022
revised: 14 08 2022
accepted: 01 09 2022
pubmed: 13 12 2022
medline: 7 3 2023
entrez: 12 12 2022
Statut: ppublish

Résumé

Pulmonary arterial hypertension (PAH) has a progressive, unremitting clinical course. Vasoreactivity testing (VdT) during right heart catheterisation (RHC) identifies a subgroup with excellent long-term response to calcium channel blockade (CCB). Reporting on these patients is limited. Established in 2011, the Pulmonary Hypertension Society of Australia and New Zealand (PHSANZ) registry offers the opportunity to assess the frequency of VdT during RHC, treatment and follow up of PAH patients. Registry data from 3,972 PAH patients with index RHC revealed 1,194 VdT appropriate patients. Data was analysed in three groups: 1) VdT+CCB+: VdT positive, CCB treated; 2) VdT+CCB-: VdT positive, no CCB prescribed, 3) VdT-/noVdT: VdT negative, or VdT not tested. Data was reviewed for adherence to guidelines, clinical response (World Health Organization functional class [WHO FC], 6-minute-walk-distance [6MWD], RHC), and outcomes (survival or lung transplantation). Patients included had idiopathic (IPAH=1,087), heritable (HPAH=67) and drug or toxin-induced PAH (DPAH=40). A VdT was performed in 22% (268/1,194), with incomplete data in 26% (70/268); 28% (55/198) were VdT+. Analysis group allocation was: VdT+CCB+ (33/55), VdT+CCB- (22/55), VdT- (143)/noVdT (996). From patients with 1-year data VdT+CCB+ and VdT-/noVdT patients improved WHO FC, 6MWD and cardiac index (CI); VdT+CCB- data remained similar. Within the VdT+CCB+ group, 30% (10/33) were long-term CCB responders with a 100% 5-year survival; non-responders had a 61% survival at 5.4 years. Long-term responders were younger at diagnosis (40 yrs vs 54 yrs). Use of VdT testing and documentation is poor in this contemporary patient cohort. Nonetheless, survival in VdT+CCB+ patients from the PHSANZ registry is excellent, supporting guidelines promoting VdT testing. Strategies to promote the use of VdT are warranted.

Sections du résumé

BACKGROUND BACKGROUND
Pulmonary arterial hypertension (PAH) has a progressive, unremitting clinical course. Vasoreactivity testing (VdT) during right heart catheterisation (RHC) identifies a subgroup with excellent long-term response to calcium channel blockade (CCB). Reporting on these patients is limited. Established in 2011, the Pulmonary Hypertension Society of Australia and New Zealand (PHSANZ) registry offers the opportunity to assess the frequency of VdT during RHC, treatment and follow up of PAH patients.
METHODS METHODS
Registry data from 3,972 PAH patients with index RHC revealed 1,194 VdT appropriate patients. Data was analysed in three groups: 1) VdT+CCB+: VdT positive, CCB treated; 2) VdT+CCB-: VdT positive, no CCB prescribed, 3) VdT-/noVdT: VdT negative, or VdT not tested. Data was reviewed for adherence to guidelines, clinical response (World Health Organization functional class [WHO FC], 6-minute-walk-distance [6MWD], RHC), and outcomes (survival or lung transplantation).
RESULTS RESULTS
Patients included had idiopathic (IPAH=1,087), heritable (HPAH=67) and drug or toxin-induced PAH (DPAH=40). A VdT was performed in 22% (268/1,194), with incomplete data in 26% (70/268); 28% (55/198) were VdT+. Analysis group allocation was: VdT+CCB+ (33/55), VdT+CCB- (22/55), VdT- (143)/noVdT (996). From patients with 1-year data VdT+CCB+ and VdT-/noVdT patients improved WHO FC, 6MWD and cardiac index (CI); VdT+CCB- data remained similar. Within the VdT+CCB+ group, 30% (10/33) were long-term CCB responders with a 100% 5-year survival; non-responders had a 61% survival at 5.4 years. Long-term responders were younger at diagnosis (40 yrs vs 54 yrs).
CONCLUSION CONCLUSIONS
Use of VdT testing and documentation is poor in this contemporary patient cohort. Nonetheless, survival in VdT+CCB+ patients from the PHSANZ registry is excellent, supporting guidelines promoting VdT testing. Strategies to promote the use of VdT are warranted.

Identifiants

DOI: 10.1016/j.hlc.2022.09.005 PMID: 36503731
pubmed: 36503731
pii: S1443-9506(22)01098-8
doi: 10.1016/j.hlc.2022.09.005
pii:
doi:

Substances chimiques

Calcium Channel Blockers 0

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

156-165

Informations de copyright

Copyright © 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Auteurs

Sahan Chandrasekara (S)

Department of Respiratory Medicine, The Alfred Hospital, and Central Clinical School, Monash University, Melbourne, Vic, Australia.

Edmund M Lau (EM)

Sydney Medical School, University of Sydney, Sydney, NSW, Australia.

James Anderson (J)

Respiratory Department, Sunshine Coast University Hospital, Birtinya, Qld, Australia.

Nicholas Collins (N)

Department of Cardiology, John Hunter Hospital, Newcastle, NSW, Australia.

Rachael Cordina (R)

Department of Cardiology, Royal Prince Alfred Hospital, and Heart Research Institute, Sydney, NSW, Australia.

Carolyn Corrigan (C)

Heart and Lung Transplant Unit, St Vincent's Hospital, Sydney, NSW, Australia.

Nathan Dwyer (N)

Department of Cardiology, Royal Hobart Hospital, Hobart, Tas, Australia.

John Feenstra (J)

Queensland Lung Transplant Service, Prince Charles Hospital, Brisbane, Qld, Australia.

Mark Horrigan (M)

The Austin Hospital, Melbourne, Vic, Australia.

Anne Keogh (A)

Heart and Lung Transplant Unit, St Vincent's Hospital, Sydney, NSW, Australia.

Eugene Kotlyar (E)

Heart and Lung Transplant Unit, St Vincent's Hospital, Sydney, NSW, Australia.

Melanie Lavender (M)

Advanced Lung Disease Unit, Fiona Stanley Hospital, Perth, WA, Australia.

Tanya McWilliams (T)

Greenlane Clinical Centre, Auckland City Hospital, Auckland, New Zealand.

Bronwen Rhodes (B)

Department of Respiratory Medicine, Christchurch Hospital, Christchurch, New Zealand.

Peter Steele (P)

Department of Cardiovascular Services, Royal Adelaide Hospital, Adelaide, SA, Australia.

Geoff Strange (G)

School of Medicine, University of Notre Dame, Fremantle, WA, Australia; Pulmonary Hypertension Society of Australia and New Zealand.

Vivek Thakkar (V)

Department of Clinical Medicine, Macquarie University, Sydney, NSW, Australia; Department of Rheumatology, Liverpool Hospital, Sydney, NSW, Australia.

Robert Weintraub (R)

Royal Children's Hospital, Melbourne, Vic, Australia; Murdoch Children's Research Institute, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia.

Helen Whitford (H)

Department of Respiratory Medicine, The Alfred Hospital, and Central Clinical School, Monash University, Melbourne, Vic, Australia.

Kenneth Whyte (K)

Greenlane Clinical Centre, Auckland City Hospital, Auckland, New Zealand.

Trevor Williams (T)

Department of Respiratory Medicine, The Alfred Hospital, and Central Clinical School, Monash University, Melbourne, Vic, Australia.

Jeremy Wrobel (J)

Advanced Lung Disease Unit, Fiona Stanley Hospital, Perth, WA, Australia; School of Medicine, University of Notre Dame, Fremantle, WA, Australia.

Dominic T Keating (DT)

Department of Respiratory Medicine, The Alfred Hospital, and Central Clinical School, Monash University, Melbourne, Vic, Australia. Electronic address: D.Keating@alfred.org.au.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Acute Vasoreactivity Testing and Outcomes in...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents cardiovasculaires › Inhibiteurs des canaux calciques › Acute Vasoreactivity Testing and Outcomes in...
questionsmedicales.fr › Maladies de l'appareil respiratoire › Maladies pulmonaires › Hypertension artérielle pulmonaire › Acute Vasoreactivity Testing and Outcomes in...
questionsmedicales.fr › Maladies de l'appareil respiratoire › Maladies pulmonaires › Hypertension artérielle pulmonaire primitive familiale › Acute Vasoreactivity Testing and Outcomes in...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Hypertension artérielle › Hypertension pulmonaire › Acute Vasoreactivity Testing and Outcomes in...
questionsmedicales.fr › Techniques d'investigation › Cathétérisme › Cathétérisme cardiaque › Acute Vasoreactivity Testing and Outcomes in...