Prognostic value of follow-up vasoreactivity test in pulmonary arterial hypertension

Satoshi Ishii; Masaru Hatano; Hisataka Maki; Shun Minatsuki; Akihito Saito; Hiroki Yagi; Mai Shimbo; Katsura Soma; Genri Numata; Takayuki Fujiwara; Norifumi Takeda; Issei Komuro

doi:10.1016/j.jjcc.2023.01.005

Prognostic value of follow-up vasoreactivity test in pulmonary arterial hypertension

J Cardiol. 2023 Jul;82(1):69-75. doi: 10.1016/j.jjcc.2023.01.005. Epub 2023 Jan 20.

Authors

Affiliations

¹ Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan.
² Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan; Department of Advanced Medical Center for Heart Failure, The University of Tokyo Hospital, Tokyo, Japan. Electronic address: hatanoma@pg8.so-net.ne.jp.
³ Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan; Department of Cardiovascular Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan.
⁴ Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan; Department of Computational Diagnostic Radiology and Preventive Medicine, The University of Tokyo Hospital, Tokyo, Japan.

PMID: 36682710
DOI: 10.1016/j.jjcc.2023.01.005

Abstract

Background: Acute vasoreactivity test with inhaled nitric oxide (NO) is performed during diagnostic right heart catheterization (RHC) to identify patients with pulmonary arterial hypertension (PAH) who respond to calcium channel blockers. Our purpose was to investigate the prognostic importance of follow-up vasoreactivity test after treatment.

Methods: We retrospectively analyzed 36 PAH patients (mean age, 47 years; 61 % treatment-naïve), who underwent diagnostic and follow-up RHC and vasoreactivity tests at our center. The primary outcome was all-cause mortality.

Results: The median time between baseline and follow-up RHC was 9.7 months. Absolute change in mean pulmonary arterial pressure (ΔmPAP) during NO challenge was less pronounced after treatment, but there was great variability among patients. Overall cohort was dichotomized into two groups: preserved vasoreactivity (ΔmPAP ≤ -1 mmHg) and less vasoreactivity (ΔmPAP ≥0 mmHg) at follow-up RHC. Less vasoreactivity group had higher usage rate of endothelin receptor antagonists and parenteral prostacyclin analogues. During a median observation period of 6.3 years after follow-up RHC, 7 patients died, of which 6 showed less vasoreactivity at follow-up. Absolute ΔmPAP ≥0 at follow-up RHC was associated with all-cause mortality in univariable Cox regression analysis (hazard ratio, 8.728; 95 % confidence interval, 1.045-72.887; p = 0.045), whereas other hemodynamic parameters were not. Absolute ΔmPAP ≥0 at follow-up RHC was associated with all-cause mortality in multivariable Cox analysis adjusted for age and known PAH prognostic factors (HR, 12.814; 95 % CI, 1.088-150.891; p = 0.043). Kaplan-Meier survival analysis revealed a significantly worse survival of less vasoreactivity group compared to preserved vasoreactivity group (log-rank test, p = 0.016).

Conclusions: Follow-up vasoreactivity test after treatment could contribute to the detection of high-risk subgroups who might need careful monitoring and referral for lung transplantation.

Keywords: Inhaled nitric oxide; Right heart catheterization; Vasoresponsiveness.

MeSH terms

Cardiac Catheterization / adverse effects
Follow-Up Studies
Humans
Hypertension, Pulmonary*
Middle Aged
Prognosis
Pulmonary Arterial Hypertension* / diagnosis
Pulmonary Arterial Hypertension* / drug therapy
Retrospective Studies