Thenappan Thenappan, Al-Naamani Nadine, Ghio Stefano, Ghofrani Hossein-Ardeschir, Hassoun Paul M, Pritzker Marc, Torbicki Adam, Nikkho Sylvia, Busse Dennis, Preston Ioana R
Division of Cardiology, University of Minnesota, Minneapolis, MN, USA.
Pulmonary, Critical Care and Sleep Division, University of Pennsylvania, Philadelphia, PA, USA.
Pulm Circ. 2020 Nov 20;10(4):2045894020963836. doi: 10.1177/2045894020963836. eCollection 2020 Oct-Dec.
Pulmonary arterial compliance is a measure of the pulsatile afterload of the right ventricle. Lower pulmonary arterial compliance is associated with reduced right ventricular function and worse prognosis in pulmonary hypertension. The effect of pulmonary vasodilators on pulmonary arterial compliance has not been evaluated in detail in pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension. In this post hoc analysis of patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension in the PATENT and CHEST studies, we evaluated the change in pulmonary arterial compliance with riociguat versus placebo. Association of pulmonary arterial compliance with clinical outcomes was assessed using Kaplan-Meier and Cox proportional hazards analyses. Compared with placebo, riociguat significantly improved pulmonary arterial compliance in patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension. Pulmonary arterial compliance at baseline was associated with survival and clinical worsening-free survival in pulmonary arterial hypertension but only with clinical worsening-free survival in chronic thromboembolic pulmonary hypertension. In patients with pulmonary arterial hypertension, pulmonary arterial compliance at follow-up ≥1.6 mL/mmHg was associated with better outcomes than pulmonary arterial compliance <1.6 mL/mmHg. In patients with chronic thromboembolic pulmonary hypertension, pulmonary arterial compliance at follow-up did not predict outcomes. Cox proportional hazards analyses showed no association between change in pulmonary arterial compliance and outcomes in patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension. In conclusion, riociguat improved pulmonary arterial compliance in patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension. Pulmonary arterial compliance at baseline or follow-up, rather than change in pulmonary arterial compliance, is of prognostic importance for outcomes.
肺动脉顺应性是衡量右心室搏动后负荷的指标。肺动脉顺应性降低与右心室功能减退及肺动脉高压患者预后较差相关。肺动脉高压或慢性血栓栓塞性肺动脉高压患者中，肺血管扩张剂对肺动脉顺应性的影响尚未得到详细评估。在PATENT和CHEST研究中对肺动脉高压和慢性血栓栓塞性肺动脉高压患者进行的这项事后分析中，我们评估了利奥西呱与安慰剂相比对肺动脉顺应性的影响。使用Kaplan-Meier和Cox比例风险分析评估肺动脉顺应性与临床结局的相关性。与安慰剂相比，利奥西呱显著改善了肺动脉高压或慢性血栓栓塞性肺动脉高压患者的肺动脉顺应性。基线时的肺动脉顺应性与肺动脉高压患者的生存率和无临床恶化生存率相关，但仅与慢性血栓栓塞性肺动脉高压患者的无临床恶化生存率相关。在肺动脉高压患者中，随访时肺动脉顺应性≥1.6 mL/mmHg的患者比肺动脉顺应性<1.6 mL/mmHg的患者预后更好。在慢性血栓栓塞性肺动脉高压患者中，随访时的肺动脉顺应性不能预测结局。Cox比例风险分析显示，肺动脉高压或慢性血栓栓塞性肺动脉高压患者的肺动脉顺应性变化与结局之间无相关性。总之，利奥西呱改善了肺动脉高压或慢性血栓栓塞性肺动脉高压患者的肺动脉顺应性。对于结局而言，基线或随访时的肺动脉顺应性而非肺动脉顺应性的变化具有预后重要性。
