Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, European Health Centre Otwock, Centre of Postgraduate Medical Education, Poland.
Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, European Health Centre Otwock, Centre of Postgraduate Medical Education, Poland.
Int J Cardiol. 2018 Oct 15;269:283-288. doi: 10.1016/j.ijcard.2018.07.015. Epub 2018 Jul 3.
This study evaluated the incremental effect of riociguat on pulmonary hemodynamics in patients with inoperative or persistent chronic thromboembolic pulmonary hypertension (CTEPH) treated previously with sildenafil.
The retrospective study included 28 patients diagnosed with CTEPH who were ineligible for surgical treatment due to distal thrombi location or who suffered from persistent CTEPH after pulmonary endarterectomy and who were treated with sildenafil at a dose of 25 mg TID for a minimum of 3 months. Sildenafil was subsequently discontinued, and riociguat therapy was started with gradually increasing doses. Right heart catheterization was performed and WHO functional class (FC) was assessed in each patient at three time points: before starting sildenafil therapy (baseline), before the transition to riociguat, and after 3 to 6 months of therapy with riociguat.
Compared to baseline, the use of sildenafil and riociguat significantly decreased pulmonary vascular resistance (PVR) (10.47 ± 3.56 vs. 7.81 ± 3.58 Wood units, p < 0.001) and mean pulmonary arterial pressure (PAP) (54.1 ± 11.6 vs. 46.1 ± 13.2 mm Hg; p < 0.001) while increasing cardiac output (CO) (4.31 ± 0.88 vs. 4.85 ± 0.87 L/min; p = 0.007). Switching from sildenafil to riociguat reduced PVR by 14% (p = 0.005) and the mean PAP by 6% (p = 0.03) while increasing CO by 11% (p = 0,002). The number of patients with WHO FC III and IV symptoms decreased from 71,4% to 57,1% (p = 0,02) after the change from sildenafil to riociguat.
Replacing sildenafil with riociguat in patients with inoperable or persistent CTEPH may improve pulmonary hemodynamics and FC.
本研究评估了 riociguat 在先前接受西地那非治疗的手术不可行或持续性慢性血栓栓塞性肺动脉高压（CTEPH）患者中的肺血流动力学的附加效应。
这项回顾性研究纳入了 28 名被诊断为 CTEPH 的患者，由于远端血栓位置或肺动脉内膜剥脱术后持续性 CTEPH，他们不适合手术治疗，这些患者接受了西地那非治疗，剂量为 25mg TID，至少治疗 3 个月。随后停止使用西地那非，开始用逐渐增加剂量的 riociguat 进行治疗。在三个时间点对每个患者进行右心导管检查和世界卫生组织（WHO）功能分级（FC）评估：开始西地那非治疗前（基线）、转换为 riociguat 前和 riociguat 治疗 3 至 6 个月后。
与基线相比，使用西地那非和 riociguat 可显著降低肺血管阻力（PVR）（10.47±3.56 对 7.81±3.58 Wood 单位，p＜0.001）和平均肺动脉压（PAP）（54.1±11.6 对 46.1±13.2mmHg；p＜0.001），同时增加心输出量（CO）（4.31±0.88 对 4.85±0.87L/min；p=0.007）。从西地那非转换为 riociguat 可使 PVR 降低 14%（p=0.005），平均 PAP 降低 6%（p=0.03），CO 增加 11%（p=0.002）。从西地那非转换为 riociguat 后，WHO FC III 和 IV 级症状的患者数量从 71.4%降至 57.1%（p=0.02）。
在不可手术或持续性 CTEPH 患者中，用 riociguat 替代西地那非可能改善肺血流动力学和 FC。
