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Becerra-Muñoz VM, Gómez Sáenz JT, Escribano Subías P. The importance of data in Pulmonary Arterial Hypertension: from international registries to Machine Learning. Med Clin (Barc) 2024; 162:591-598. [PMID: 38383269 DOI: 10.1016/j.medcli.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 02/23/2024]
Abstract
Real-world registries have been critical to building the scientific knowledge of rare diseases, including Pulmonary Arterial Hypertension (PAH). In the past 4 decades, a considerable number of registries on this condition have allowed to improve the pathology and its subgroupś definition, to advance in the understanding of its pathophysiology, to elaborate prognostic scales and to check the transferability of the results from clinical trials to clinical practice. However, in a moment where a huge amount of data from multiple sources is available, they are not always taken into account by the registries. For that reason, Machine Learning (ML) offer a unique opportunity to manage all these data and, finally, to obtain tools that may help to get an earlier diagnose, to help to deduce the prognosis and, in the end, to advance in Personalized Medicine. Thus, we present a narrative revision with the aims of, in one hand, summing up the aspects in which data extraction is important in rare diseases -focusing on the knowledge gained from PAH real-world registries- and, on the other hand, describing some of the achievements and the potential use of the ML techniques on PAH.
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Affiliation(s)
- Víctor Manuel Becerra-Muñoz
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, España; Servicio de Cardiología, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España; Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Málaga, España.
| | - José Tomás Gómez Sáenz
- Centro de Salud de Nájera, La Rioja, España; Sociedad Española de Médicos de Atención Primaria (SEMERGEN), Madrid, España
| | - Pilar Escribano Subías
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, España; Hospital Universitario 12 de Octubre, Madrid, España
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Luna-Lopez R, Segura de la Cal T, Sarnago Cebada F, Martin de Miguel I, Hinojosa W, Cruz-Utrilla A, Velazquez MT, Delgado JF, Mendoza A, Arribas Ynsaurriaga F, Escribano-Subías P. Triple vasodilator therapy in pulmonary arterial hypertension associated with congenital heart disease. Heart 2024; 110:346-352. [PMID: 37903556 DOI: 10.1136/heartjnl-2023-323015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/03/2023] [Indexed: 11/01/2023] Open
Abstract
OBJECTIVE This study assessed the long-term effects of triple therapy with prostanoids on patients with pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD), as there is limited information on the safety and efficacy of this treatment approach. METHODS A retrospective cohort study was conducted on patients with PAH-CHD who were actively followed up at our centre. All patients were already receiving dual combination therapy at maximum doses. Clinical characteristics, including functional class (FC), 6-minute walking test distance (6MWTD) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, were documented before initiating triple therapy and annually for a 2-year follow-up period. RESULTS A total of 60 patients were included in the study, with a median age of 41 years and 68% being women. Of these, 32 had Eisenmenger syndrome, 9 had coincidental shunts, 18 had postoperative PAH and 1 had a significant left-to-right shunt. After 1 year of triple combination initiation, a significant improvement in 6MWTD was observed (406 vs 450; p=0.0027), which was maintained at the 2-year follow-up. FC improved in 79% of patients at 1 year and remained stable in 76% at 2 years. NT-proBNP levels decreased significantly by 2 years, with an average reduction of 199 ng/L. Side effects were experienced by 33.3% of patients but were mostly mild and manageable. Subgroup analysis showed greater benefits in patients without Eisenmenger syndrome and those with pre-tricuspid defects. CONCLUSIONS Triple therapy with prostanoids is safe and effective for patients with PAH-CHD, improving FC, 6MWTD and NT-proBNP levels over 2 years. The treatment is particularly beneficial for patients with pre-tricuspid defects and non-Eisenmenger PAH-CHD.
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Affiliation(s)
- Raquel Luna-Lopez
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), Madrid, Spain
- Pulmonary Hyertension Unit, Department of Cardiology. Hospital Universitario 12 de Octubre, Hospital Universitario 12 de Octubre, Madrid, Spain
- Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Teresa Segura de la Cal
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), Madrid, Spain
- Pulmonary Hyertension Unit, Department of Cardiology. Hospital Universitario 12 de Octubre, Hospital Universitario 12 de Octubre, Madrid, Spain
- Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Fernando Sarnago Cebada
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), Madrid, Spain
- Pulmonary Hyertension Unit, Department of Cardiology. Hospital Universitario 12 de Octubre, Hospital Universitario 12 de Octubre, Madrid, Spain
- Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBERCV, Madrid, Spain
| | - Irene Martin de Miguel
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), Madrid, Spain
- Pulmonary Hyertension Unit, Department of Cardiology. Hospital Universitario 12 de Octubre, Hospital Universitario 12 de Octubre, Madrid, Spain
- Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Williams Hinojosa
- Pulmonary Hyertension Unit, Department of Cardiology. Hospital Universitario 12 de Octubre, Hospital Universitario 12 de Octubre, Madrid, Spain
- Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Alejandro Cruz-Utrilla
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), Madrid, Spain
- Pulmonary Hyertension Unit, Department of Cardiology. Hospital Universitario 12 de Octubre, Hospital Universitario 12 de Octubre, Madrid, Spain
- Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Maria Teresa Velazquez
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), Madrid, Spain
- Pulmonary Hyertension Unit, Department of Cardiology. Hospital Universitario 12 de Octubre, Hospital Universitario 12 de Octubre, Madrid, Spain
- Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBERCV, Madrid, Spain
| | - Juan F Delgado
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), Madrid, Spain
- Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBERCV, Madrid, Spain
| | - Alberto Mendoza
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
- Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Fernando Arribas Ynsaurriaga
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), Madrid, Spain
- Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBERCV, Madrid, Spain
| | - Pilar Escribano-Subías
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), Madrid, Spain
- Pulmonary Hyertension Unit, Department of Cardiology. Hospital Universitario 12 de Octubre, Hospital Universitario 12 de Octubre, Madrid, Spain
- Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBERCV, Madrid, Spain
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Del Pozo R, Blanco I, López-Meseguer M, Escribano-Subías P, Cruz Utrilla A. Effectiveness and persistence with selexipag in pulmonary arterial hypertension in the real-life setting. Eur J Intern Med 2023; 111:140-142. [PMID: 36720652 DOI: 10.1016/j.ejim.2023.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023]
Affiliation(s)
- R Del Pozo
- Pneumology Department, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - I Blanco
- Pneumology Department, Pulmonary Hypertension Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - M López-Meseguer
- Pneumology Depatrment, Hospital Universitario Vall d´Hebrón, Barcelona, Spain
| | - P Escribano-Subías
- Pulmonary Hypertension Unit, Cardiology Department, Hospital Universitario 12 de Octubre, Complutense University, Avenida de Andalucía S/N. 28041 Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
| | - A Cruz Utrilla
- Pulmonary Hypertension Unit, Cardiology Department, Hospital Universitario 12 de Octubre, Complutense University, Avenida de Andalucía S/N. 28041 Madrid, Madrid, Spain
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Zhang H, Kan J, Zhang C, Yang Z, Gu H, Fan F, Gu H, Wang Q, Zhang J, Xie D, Zhang G, Guo X, Yin Y, Chen SL. Long-term mortality after pulmonary artery denervation stratified by baseline functional class in patients with pulmonary arterial hypertension: Long-term mortality after PADN stratified by functional class. ASIAINTERVENTION 2022; 8:58-68. [PMID: 35350791 PMCID: PMC8922462 DOI: 10.4244/aij-d-21-00033] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/23/2021] [Indexed: 06/14/2023]
Abstract
AIMS This study aimed to assess the long-term effects of pulmonary artery denervation (PADN) on mortality in patients with pulmonary arterial hypertension (PAH). METHODS AND RESULTS Between March 2012 and March 2018, a total of 120 patients with PAH, who underwent PADN treatment and were prospectively followed up, were analysed. Patients were classified into World Health Organization (WHO) Functional Class I and II (FC 1-2; n=46) and Functional Class III and IV (FC 3-4; n=74) according to their FC prior to PADN. The primary endpoint was lung transplantation-free mortality until March 2021. The secondary endpoint was a change in the six-minute walk distance (6MWD). During the median of 4.8 years of follow-up, 23 (19.2%) patients died, predominantly from the FC 3-4 group (25.7%), compared to 8.7% in the FC 1-2 group (p=0.034). The mortality rate at one year (2.2% vs 12.2%, p=0.087) and three years (6.5% vs 17.6%, p=0.102) was numerically low in the FC 1-2 group versus the FC 3-4 group, respectively. The median net increase of 6MWD was +29 m in the FC 1-2 group, compared to +60.5 m in the FC 3-4 group (p=0.037). CONCLUSIONS PADN results in significant improvements in survival at long-term follow-up, especially in patients with PAH in FC 3-4. This study was the continuation of the PADN-1 study which was registered at URL: http://www.chictr.trc.com.cn. Unique identifier: chiCTR-ONC-12002085.
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Affiliation(s)
- Han Zhang
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jing Kan
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Caojing Zhang
- Guangdong Provincial Peoples Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangzhou, China
| | - Zhenweng Yang
- General Hospital of Tianjin Medical University, Tianjin, China
| | - Heping Gu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fenling Fan
- First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hong Gu
- Beijing Anzhen Hospital, Beijing, China
| | - Qiguang Wang
- General Hospital of Northern Theater Command, Shenyang, China
| | - Juan Zhang
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Dujiang Xie
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | | | - Xiaomei Guo
- Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yuehui Yin
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shao-Liang Chen
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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Küçükoğlu MS, Hanta İ, Akdeniz B, Güllülü S, Atahan E, Sayın T, Okumuş G, Önen ZP, Yokuşoğlu M, Baygül A. Clinical efficacy, safety, tolerability, and survival outcome of long-term inhaled iloprost treatment in the management of pulmonary arterial hypertension: Data from prospective multicenter observational OPTION study. Anatol J Cardiol 2021; 25:721-732. [PMID: 34622787 PMCID: PMC8504660 DOI: 10.5152/anatoljcardiol.2021.03009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate clinical efficacy, safety and tolerability of long-term inhaled iloprost treatment in the daily practice for the management of pulmonary arterial hypertension (PAH). METHODS A total of 115 patients with PAH on inhaled iloprost treatment were included. New York Heart Association (NYHA) functional class, brain natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, and 6-minute walk distance (6MWD) were recorded at baseline and at 3rd to 24th month visits. Safety and tolerability of iloprost treatment were also evaluated during follow-up, as were the survival, clinical worsening, and the related risk factors. RESULTS The treatment was associated with an increase in the percentage NYHA functional class II (from 0.0% at enrolment to 36.2% at 24th month visit) patients but no significant difference was noted in 6MWD values. Clinical worsening was observed in 63.5% patients, while survival rate was 69.6%. NT-proBNP levels were significantly higher in non-survivors than in survivors (p=0.042). Cox regression analysis revealed the association of female sex [odds ratio (OR)=0.318; 95% confidence interval (CI), 0.128-0.792; p=0.014] and scleroderma-related PAH (OR=0.347; 95% CI, 0.140-0.860; p=0.022) with significantly lower risk (3.14 fold and 2.88 fold, respectively) of mortality. CONCLUSION Our findings indicate favorable efficacy, safety, and tolerability of long-term iloprost treatment in the management of PAH, whereas improved NYHA functional class was not accompanied with a significant change in 6MWD values. Patient age was a risk factor for clinical worsening, while female sex, scleroderma subtype, and lower NT-proBNP levels were associated with significantly lower mortality risk.
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Affiliation(s)
| | - İsmail Hanta
- Department of Chest Diseases, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Bahri Akdeniz
- Department of Cardiology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Sümeyye Güllülü
- Department of Cardiology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Ersan Atahan
- Department of Chest Diseases, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Tamer Sayın
- Department of Cardiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Gülfer Okumuş
- Department of Chest Diseases, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Zeynep Pınar Önen
- Department of Chest Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Yokuşoğlu
- Department of Cardiology, Gulhane Military Medical Academy, Ankara, Turkey
| | - Arzu Baygül
- Department of Biostatistics, Koc University School of Medicine, Istanbul, Turkey
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Cristo Ropero MJ, Cruz-Utrilla A, Escribano-Subias MP. Epoprostenol for the treatment of pulmonary arterial hypertension. Expert Rev Clin Pharmacol 2021; 14:1005-1013. [PMID: 34030557 DOI: 10.1080/17512433.2021.1929925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Introduction: Pulmonary arterial hypertension (PAH) is a rare, progressive, and severe disease. Since the first demonstration of survival benefit of intravenous epoprostenol in monotherapy in 1996, prostanoids remain the cornerstone for PAH patients at high risk. This review is essential to understand the current situation of this drug among all the therapeutic possibilities concerning this entity.Areas covered: The aim of this article is to review the pharmacological properties of epoprostenol and to update its clinical evidence in different specific clinical scenarios. A deep literature search was carried out on the MEDLINE database for published literature before March 2021.Expert opinion: Epoprostenol is still the best treatment option for high-risk PAH patients. Nevertheless, there are many unsolved questions: drug dosing, its use in combination therapy with other pulmonary vasodilators, and the utility in PAH associated with connective tissue disease, congenital heart disease, or pulmonary veno-occlusive disease are only a few examples. Its safety and efficacy are supported by clinical trials, observational work, and experience, both as monotherapy and in combination therapy. Epoprostenol should be considered a destination treatment in high-risk patients and not only as a bridge to pulmonary transplantation. However, it remains underused in clinical practice.
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Affiliation(s)
- María José Cristo Ropero
- Pulmonary Hypertension Unit, Cardiology Department, Hospital Universitario 12 De Octubre, Madrid, Spain
| | - Alejandro Cruz-Utrilla
- Pulmonary Hypertension Unit, Cardiology Department, Hospital Universitario 12 De Octubre, Madrid, Spain
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Lazaro Salvador M, Quezada Loaiza CA, Rodríguez Padial L, Barberá JA, López-Meseguer M, López-Reyes R, Sala-Llinas E, Alcolea S, Blanco I, Escribano-Subías P. Portopulmonary hypertension: prognosis and management in the current treatment era - results from the REHAP registry. Intern Med J 2021; 51:355-365. [PMID: 31943676 DOI: 10.1111/imj.14751] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 01/03/2020] [Accepted: 01/07/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Portopulmonary hypertension (PoPH) is a rare condition with poorer survival compared to idiopathic/familial pulmonary arterial hypertension (IPAH/FPAH). AIMS To compare the characteristics, survival, prognostic factors and management of PoPH and IPAH/FPAH patients and to assess the impact of treatment on survival of PoPH patients. METHODS Analysis of data of prevalent and incident PoPH patients enrolled in the Spanish registry of PAH (REHAP) from January 1998 to December 2017 and comparison with IPAH/FPAH patients. Variables analysed: patient and disease (PAH and liver) characteristics, first-line PAH-targeted therapy, causes of death, prognostic factors and survival (according to aetiology and treatment in PoPH patients). RESULTS Compared to IPAH/FPAH patients (n = 678), patients with PoPH (n = 237) were predominantly men, older and had better functional class and higher prevalence of ascites. Haemodynamics were better. Biomarkers for heart failure were worse. Age- and sex-adjusted 5-year survival rate from diagnosis was 49.3% for PoPH patients and 68.7% for IPAH patients (P < 0.001). Treated PoPH had better survival than non-treated. PAH- and liver-related causes accounted for 30.2% and 24.7% of deaths in PoPH patients. PoPH patients were less likely to receive first-line PAH-targeted therapy and this was associated with greater mortality. Increasing age, worse exercise capacity and ascites were independent prognostic factors of poorer survival; first-line oral monotherapy was associated with improved survival. Eight (3.4%) PoPH patients underwent liver transplantation. CONCLUSIONS PoPH patients are undertreated and show poorer survival than IPAH/FPAH patients. First-line treatment with PAH-targeted therapy was associated with better survival. Presence of ascites was a predictor of mortality.
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Affiliation(s)
| | | | | | - Joan A Barberá
- Pulmonary Medicine Department, Hospital Clínic de Barcelona/Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Manuel López-Meseguer
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Pneumology Department, Hospital Universitario Vall d'Hebrón, Barcelona, Spain
| | - Raquel López-Reyes
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Ernest Sala-Llinas
- Pneumology Department, Hospital Universitario Son Espases, Islas Baleares, Spain
| | - Sergio Alcolea
- Pneumology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Isabel Blanco
- Pulmonary Medicine Department, Hospital Clínic de Barcelona/Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Pilar Escribano-Subías
- Pulmonary Hypertension Unit, Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Instituto de Salud Carlos III, Madrid, Spain
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Liu K, Wang H, Yu SJ, Tu GW, Luo Z. Inhaled pulmonary vasodilators: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:597. [PMID: 33987295 PMCID: PMC8105872 DOI: 10.21037/atm-20-4895] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/30/2020] [Indexed: 02/05/2023]
Abstract
Pulmonary hypertension (PH) is a severe disease that affects people of all ages. It can occur as an idiopathic disorder at birth or as part of a variety of cardiovascular and pulmonary disorders. Inhaled pulmonary vasodilators (IPV) can reduce pulmonary vascular resistance (PVR) and improve RV function with minimal systemic effects. IPV includes inhaled nitric oxide (iNO), inhaled aerosolized prostacyclin, or analogs, including epoprostenol, iloprost, treprostinil, and other vasodilators. In addition to pulmonary vasodilating effects, IPV can also be used to improve oxygenation, reduce inflammation, and protect cell. Off-label use of IPV is common in daily clinical practice. However, evidence supporting the inhalational administration of these medications is limited, inconclusive, and controversial regarding their safety and efficacy. We conducted a search for relevant papers published up to May 2020 in four databases: PubMed, Google Scholar, EMBASE and Web of Science. This review demonstrates that the clinical using and updated evidence of IPV. iNO is widely used in neonates, pediatrics, and adults with different cardiopulmonary diseases. The limitations of iNO include high cost, flat dose-response, risk of significant rebound PH after withdrawal, and the requirement of complex technology for monitoring. The literature suggests that inhaled aerosolized epoprostenol, iloprost, treprostinil and others such as milrinone and levosimendan may be similar to iNO. More research of IPV is needed to determine acceptable inclusion criteria, long-term outcomes, and management strategies including time, dose, and duration.
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Affiliation(s)
- Kai Liu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Huan Wang
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shen-Ji Yu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guo-Wei Tu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhe Luo
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Critical Care Med, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
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Characterization of Patients with Pulmonary Arterial Hypertension: Data from the Polish Registry of Pulmonary Hypertension (BNP-PL). J Clin Med 2020; 9:jcm9010173. [PMID: 31936377 PMCID: PMC7019268 DOI: 10.3390/jcm9010173] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 12/21/2019] [Accepted: 01/03/2020] [Indexed: 12/21/2022] Open
Abstract
Current knowledge of pulmonary arterial hypertension (PAH) epidemiology is based mainly on data from Western populations, and therefore we aimed to characterize a large group of Caucasian PAH adults of Central-Eastern European origin. We analyzed data of incident and prevalent PAH adults enrolled in a prospective national registry involving all Polish PAH centers. The estimated prevalence and annual incidence of PAH were 30.8/mln adults and 5.2/mln adults, respectively and they were the highest in females ≥65 years old. The most frequent type of PAH was idiopathic (n = 444; 46%) followed by PAH associated with congenital heart diseases (CHD-PAH, n = 356; 36.7%), and PAH associated with connective tissue disease (CTD-PAH, n = 132; 13.6%). At enrollment, most incident cases (71.9%) were at intermediate mortality risk and the prevalent cases had most of their risk factors in the intermediate or high risk range. The use of triple combination therapy was rare (4.7%). A high prevalence of PAH among older population confirms the changing demographics of PAH found in the Western countries. In contrast, we found: a female predominance across all age groups, a high proportion of patients with CHD-PAH as compared to patients with CTD-PAH and a low use of triple combination therapy.
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Improving Survival in Patients with Pulmonary Arterial Hypertension: Focus on Intravenous Epoprostenol. Am J Cardiovasc Drugs 2019; 19:99-105. [PMID: 30671881 DOI: 10.1007/s40256-018-00319-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Pulmonary arterial hypertension represents a devastating disease, causing progressive increase of pulmonary vascular resistance leading to right ventricular dysfunction and death. Therapeutic management has rapidly advanced in recent years due to improved understanding of pathophysiology and new drugs have been developed; however, survival remains poor. Oral agents as phosphodiesterase type V inhibitors, the soluble guanylyl cyclase stimulator riociguat, the prostacyclin receptor agonist selexipag and the endothelin receptor antagonists have each achieved evidence-based validation and are recommended for pulmonary arterial hypertension. Initial oral monotherapy or combination therapy is recommended for patients with low or intermediate risk according to each patient's risk stratification. Intravenous epoprostenol is a synthetic prostacyclin and the first drug approved for the disease. Although it represents the only treatment shown to reduce mortality, it is underused. Survival rates for patients treated with oral combination drug therapies are lower than those for patients treated with initial combination therapies including intravenous epoprostenol. This raises the interesting question of whether intermediate risk pulmonary arterial hypertension patients should be routinely introduced to therapies including intravenous epoprostenol rather than combination oral therapies.
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