Changes in hemodynamic indices such as mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR), cardiac output index (CI), and right atrial pressure (RAP) following treatment are significantly associated with adverse clinical events or mortality in patients with pulmonary arterial hypertension (PAH), according to a new study published in the journal Systematic Reviews.
Shih-Hsien Sung, MD, and the coauthors of the study recommend that further studies be conducted to further evaluate the hemodynamic changes in order to guide drug titration.
Risk stratification is essential in the management of PAH, and hemodynamic changes can help stratify risk and pharmacologically manage the disease. However, their prognostic value following treatment is less well-known.
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A team of researchers from Taiwan led by Hao-Min Cheng, MD, conducted a systematic review with meta-regression analysis on existing clinical trials to investigate the impact of hemodynamic changes on the prognosis of PAH.
They searched the literature and identified 21 randomized controlled trials that enrolled 3306 people. They found that mPAP, PVR, CI, and RAP changes were all significantly associated with the change in the 6-Minute Walk Distance (6MWD), which reflects aerobic capacity and endurance.
The highest explanatory power for the change in the 6MWD and for clinical events was the change in mPAP. Moreover, mPAP, PVR, and CI changes were independent predictive factors of adverse clinical events.
Finally, the change in PVR was with the highest explanatory power for total mortality.
PAH is a rare and progressive disease characterized by the narrowing and thickening of the pulmonary arteries leading to increased resistance to blood flow and blood pressure, which eventually leads to right ventricular failure if left untreated. The progression of the disease is usually characterized by increasing mPAP, PVR, and RAP, and decreasing CI.
Sung SH, Yeh WY, Chiang CE, et al. The prognostic significance of the alterations of pulmonary hemodynamics in patients with pulmonary arterial hypertension: a meta-regression analysis of randomized controlled trials. Syst Rev. 2021;10:284. doi:10.1186/s13643-021-01816-0