Page 101 - Assessing right ventricular function and the pulmonary circulation in pulmonary hypertension Onno Anthonius Spruijt

Treatment response
As can be appreciated from Table 2, the DLCO<42% group received more double-therapy, more prostacyclin monotherapy and less endothelin receptor antagonist or phosphodiesterase type 5 inhibitor mono therapy. Interestingly, a significantly higher percentage of patients switched from monotherapy to combination therapy in the severely reduced DLCO group (table 3).
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Mono ERA/PDE5i (%)
Mono PGI2 (%)
Double: ERA+PDE5i (%) Double: PGI2 +ERA/PDE5i (%) Triple (%)
DLCO <43% 26.7 26.7 40.0 5.7
0
0
DLCO 43-62% DLCO>62% 41.9 52.8 7.0 11.1 37.2 22.2
p-value
<0.001 <0.001 <0.05 <0.05 <0.01 <0.01
Calcium antagonist (%)
Table 2: Pulmonary arterial hypertension specific medication during follow-up. ERA = endothelin receptor antagonist; PGI2 = prostacyclin; PDE5i = phosphodiesterase type 5 inhibitor.
2.3 0 2.3 8.3 9.3 5.6
DLCO 43-62% DLCO>62%
20.0 11.1 <0.01
All groups showed a decrease in mPAP and pulmonary vascular resistance (PVR), an increase in cardiac index (CI) and no change in pulmonary arterial wedge pressure (PAWP) and heart rate (HR) from baseline to follow-up (figure 2).
Cardiac responses are depicted in figure 3. Both groups showed no change in left ventricular end- systolic volume index (LVESVI). Delta left ventricular end-diastolic volume index (LVEDVI) and delta left ventricular ejection fraction (LVEF) did not differ between the three groups. Delta RVEDVI, RVESVI and RVEF were similar between severely reduced DLCO group, the moderately reduced group and the group with a preserved DLCO.
DLCO <43% 32.0
0
0
p-value
Mono to combi therapy (%)
Mono to triple therapy (%)
Combi to triple therapy (%)
Table 3: Treatment changes during follow-up (changes after an unsatisfactory response to previous treatment, hemodynamic or clinical worsening).
0 2.8 0.05 2.5 2.8 0.22
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