Zhang Xiang, Zhang Xueming, Wang Saihua, Luo Jun, Zhao Zhihong, Zheng Changzhu, Shen Jieyan
Shanghai Zhoupu Hospital, Shanghai, China.
Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Can Respir J. 2018 Mar 26;2018:3148259. doi: 10.1155/2018/3148259. eCollection 2018.
Pulmonary hypertension due to left ventricular heart failure with preserved ejection fraction (PH-HFpEF) is an increasingly medical problem. The aim of the study was to evaluate the clinical efficacy of fasudil on PH-HFpEF elderly patients and to figure out the subtype of PH-HFpEF which may be the therapeutic object of fasudil.
58 PH-HFpEF elderly patients were enrolled. Patients were diagnosed with passive pulmonary hypertension (PPH) or reactive pulmonary hypertension (RPH) by right heart catheterization and all receiving Rho kinase inhibitor fasudil for 2 weeks. The endpoint includes changes in SpO2, NT-pro BNP, cardiac functional classification, and echocardiography measurements after 2 weeks treatment.
The course of disease in the RPH group was longer than the PPH group ( < 0.05). Cardiac output was found to be worse in the RPH group than the PPH group ( < 0.01). Besides, the RPH group demonstrated a greater transpulmonary pressure gradient (TPG) and pulmonary vascular resistance (PVR) than the PPH group ( < 0.01 for both) as well as pulmonary arterial systolic pressure (PASP) and mean pulmonary arterial pressure (mPAP) ( < 0.01 for both), which fits the feature of RPH. After treatment of fasudil, in RPH group, PASP significantly decreased ( < 0.01) with decreased E/E' and increased E/A ( < 0.05 for both), indicating that pulmonary haemodynamics and cardiac diastolic function were ameliorated, but the measurements in the PPH group had no significant changes. NT-pro BNP and 6 MWD of both groups were improved ( < 0.05). The total effective rate of the RPH group was 74.29%, which was higher than 47.83% of the PPH group ( < 0.05).
The Rho kinase inhibitor fasudil can improve pulmonary and left ventricular haemodynamics in patients with PH-HFpEF. The total effective rate was higher in the RPH group. Fasudil may be a promising targeted drug for the RPH in PH-HFpEF patients. This trial is registered with ChiCTR-INR-16009511.
射血分数保留的左心室心力衰竭所致肺动脉高压（PH-HFpEF）是一个日益严重的医学问题。本研究的目的是评估法舒地尔对老年PH-HFpEF患者的临床疗效，并确定可能是法舒地尔治疗对象的PH-HFpEF亚型。
纳入58例老年PH-HFpEF患者。通过右心导管检查诊断为被动性肺动脉高压（PPH）或反应性肺动脉高压（RPH），所有患者均接受Rho激酶抑制剂法舒地尔治疗2周。观察终点包括治疗2周后SpO2、NT-pro BNP、心功能分级及超声心动图测量值的变化。
RPH组病程长于PPH组（P<0.05）。RPH组心输出量低于PPH组（P<0.01）。此外，RPH组的跨肺压梯度（TPG）和肺血管阻力（PVR）高于PPH组（均P<0.01），肺动脉收缩压（PASP）和平均肺动脉压（mPAP）也高于PPH组（均P<0.01），符合RPH的特征。法舒地尔治疗后，RPH组PASP显著降低（P<0.01），E/E'降低，E/A升高（均P<0.05），提示肺血流动力学和心脏舒张功能改善，但PPH组测量值无明显变化。两组的NT-pro BNP和6分钟步行距离（6 MWD）均有改善（P<0.05）。RPH组总有效率为74.29%，高于PPH组的47.83%（P<0.05）。
Rho激酶抑制剂法舒地尔可改善PH-HFpEF患者的肺和左心室血流动力学。RPH组总有效率更高。法舒地尔可能是PH-HFpEF患者RPH的一种有前景的靶向药物。本试验已在中国临床试验注册中心注册，注册号为ChiCTR-INR-16009511。
