Hirashiki Akihiro, Kondo Takahisa, Adachi Shiro, Nakano Yoshihisa, Kamimura Yoshihiro, Shimokata Shigetake, Okumura Naoki, Shimizu Atsuya, Washimi Yukihiko, Arai Hidenori, Murohara Toyoaki
Department of Cardiology, Nagoya University Graduate School of Medicine Nagoya Japan.
Department of Cardiology, National Center for Geriatrics and Gerontology Obu Japan.
Circ Rep. 2019 Jun 2;1(7):303-311. doi: 10.1253/circrep.CR-19-0047.
Many treatment options are available for pulmonary arterial hypertension (PAH), but specific recommendations for long-term treatment are unavailable. We compared prognosis in PAH patients receiving goal-oriented, sequential combination therapy evaluated using cardiopulmonary exercise testing (CPX) parameters or conventional empiric therapy. The Goal-Oriented Therapy Evaluated by Cardiopulmonary Exercise Testing for Pulmonary Arterial Hypertension (GOOD EYE) study was a multicenter, retrospective/prospective study in which a total of 129 patients with newly diagnosed PAH were enrolled (goal-oriented sequential combination therapy, n=42; conventional empiric therapy, n=87). Patients in the goal-oriented therapy group received sequential combination therapy, the efficacy of which was regularly evaluated using CPX parameters. Patients in the conventional empiric therapy group received conventional empiric therapy. The primary endpoint was cardiovascular death. In the goal-oriented therapy group, plasma brain natriuretic peptide, mean pulmonary arterial pressure, pulmonary vascular resistance, and 6-min walk test were significantly improved at 12 months compared with baseline. Survival in the goal-oriented therapy group at 1, 2, and 3 years (97.6%, 95.2%, and 86.0%, respectively) tended to be higher than that in the conventional empiric therapy group (P=0.082). Goal-oriented sequential combination therapy evaluated using CPX parameters may be associated with a favorable prognosis compared with conventional empiric therapy in patients with newly diagnosed PAH.
肺动脉高压（PAH）有多种治疗选择，但长期治疗的具体建议尚不明确。我们比较了接受以目标为导向的序贯联合治疗（根据心肺运动试验[CPX]参数评估）或传统经验性治疗的PAH患者的预后。“通过心肺运动试验评估肺动脉高压的目标导向治疗（GOOD EYE）”研究是一项多中心、回顾性/前瞻性研究，共纳入129例新诊断的PAH患者（目标导向序贯联合治疗组，n = 42；传统经验性治疗组，n = 87）。目标导向治疗组的患者接受序贯联合治疗，并定期根据CPX参数评估其疗效。传统经验性治疗组的患者接受传统经验性治疗。主要终点是心血管死亡。与基线相比，目标导向治疗组在12个月时血浆脑钠肽、平均肺动脉压、肺血管阻力和6分钟步行试验均有显著改善。目标导向治疗组1年、2年和3年的生存率（分别为97.6%、95.2%和86.）倾向于高于传统经验性治疗组（P = 0.082）。与传统经验性治疗相比，根据CPX参数评估的目标导向序贯联合治疗可能与新诊断的PAH患者的良好预后相关。
