Bajwa Abubakr A, Qureshi Tauseef, Shujaat Adil, Seeram Vandana, Jones Lisa M, Al-Saffar Farah, Cury James D
Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Jacksonville, FL, USA
Division of Pulmonary, Critical Care and Sleep Medicine, University of Southern California, la mirada, CA, USA.
J Cardiovasc Pharmacol Ther. 2015 Jul;20(4):395-400. doi: 10.1177/1074248414568195. Epub 2015 Jan 21.
Combination therapy is commonly used for pulmonary arterial hypertension (PAH) treatment. We aimed to identify factors that may predict the need for future combination therapy.
We conducted a retrospective chart review of consecutive patients with PAH in an aim to describe baseline clinical, echocardiogram, and hemodynamic characteristics of patients who eventually required combination therapy during the course of their disease and compared them to the ones who were maintained on monotherapy.
The monotherapy group was followed for an average of 31.8 ± 18.8 months and the combination therapy group was followed for an average of 28.7 ± 13.6 months. Among the 71 patients analyzed, a significantly higher number of patients who eventually required combination therapy belonged to World Health Organization functional class 3 (45% vs 37%) and 4 (23% vs 0) at baseline, compared with those on monotherapy (P < .05). Combination group also had a higher Registry to Evaluate Early And Long-term PAH Disease Management (REVEAL) PAH risk score at presentation. End of 6-minute walk test (6MWT), oxygen saturation (Spo 2) was also lower in the combination therapy group, 86% ± 8% versus 91% ± 7% (P < .05). Patients who eventually required combination therapy were more frequently noticed to have right ventricular enlargement, right atrial enlargement, and had a higher resting estimated right ventricular systolic pressure (RVSP). Right heart catheterization-derived hemodynamics data at baseline showed that the combination therapy group had a higher mean pulmonary artery (PA) pressure, lower pulmonary capillary wedge pressure, lower cardiac output, and higher pulmonary vascular resistance (PVR). On univariate analysis, only PVR ≥300 dyne·s/cm(5), mean PA pressure of ≥40 mm Hg, estimated RVSP ≥ 60 mm Hg, PAH risk score ≥ 10, and end of 6MWT saturation of ≤ 90% were of significance.
Patients with PAH who require combination therapy in the course of their disease have worse hemodynamics, PAH risk score, functional class, and end of 6MWT oxygen saturation at the time of presentation compared to patients maintained on monotherapy.
联合治疗常用于肺动脉高压（PAH）的治疗。我们旨在确定可能预测未来联合治疗需求的因素。
我们对连续性PAH患者进行了回顾性病历审查，目的是描述在疾病过程中最终需要联合治疗的患者的基线临床、超声心动图和血流动力学特征，并将其与接受单药治疗的患者进行比较。
单药治疗组平均随访31.8±18.8个月，联合治疗组平均随访28.7±13.6个月。在分析的71例患者中，与接受单药治疗的患者相比，最终需要联合治疗的患者在基线时属于世界卫生组织功能分级3级（45%对37%）和4级（23%对0）的人数明显更多（P<0.05）。联合治疗组在就诊时的肺动脉高压早期和长期疾病管理注册（REVEAL）PAH风险评分也更高。在6分钟步行试验（6MWT）结束时，联合治疗组的氧饱和度（Spo₂）也更低，分别为86%±8%和91%±7%（P<0.05）。最终需要联合治疗的患者更常出现右心室扩大、右心房扩大，且静息时估计右心室收缩压（RVSP）更高。基线时右心导管检查得出的血流动力学数据显示，联合治疗组的平均肺动脉（PA）压更高，肺毛细血管楔压更低，心输出量更低，肺血管阻力（PVR）更高。单因素分析显示，只有PVR≥300达因·秒/厘米⁵、平均PA压≥40毫米汞柱、估计RVSP≥60毫米汞柱、PAH风险评分≥10以及6MWT结束时饱和度≤90%具有统计学意义。
与接受单药治疗的患者相比，在疾病过程中需要联合治疗的PAH患者在就诊时的血流动力学、PAH风险评分、功能分级以及6MWT结束时的氧饱和度更差。
