Beneficial effects of riociguat on hemodynamic responses to exercise in CTEPH patients after balloon pulmonary angioplasty – A randomized controlled study. (August 2020)

• Record Type: Journal Article
• Authors: Aoki, Tatsuo; Sugimura, Koichiro; Terui, Yosuke; Tatebe, Shunsuke; Fukui, Shigefumi; Miura, Masanobu; Yamamoto, Saori; Yaoita, Nobuhiro; Suzuki, Hideaki; Sato, Haruka; Kozu, Katsuya; Konno, Ryo; Miyata, Satoshi; Nochioka, Kotaro; Satoh, Kimio; Shimokawa, Hiroaki
• Is Part Of: IJC heart & vasculature. Volume 29(2020)
• Publication Date: 2020-08
• Subjects: Chronic thromboembolic pulmonary hypertension -- Balloon pulmonary angioplasty -- Riociguat, exercise response; BPA Balloon pulmonary angioplasty -- BP Arterial blood pressure -- CI Cardiac index -- CO cardiac output -- CTEPH Chronic thromboembolic pulmonary hypertension -- HR heart rate -- mPAP mean pulmonary arterial pressure -- PAH pulmonary arterial hypertension -- PAWP pulmonary arterial wedge pressure -- PEA pulmonary endarterectomy -- PVR pulmonary vascular resistance -- RAP right atrial pressure -- RVEF right ventricular ejection fraction -- 6MWD 6-min walk distance; Cardiovascular system -- Diseases -- Periodicals; Cardiovascular system -- Pathophysiology -- Periodicals; 616.1005
• DOI: 10.1016/j.ijcha.2020.100579
• Languages: English
• ISSNs: 2352-9067

Abstract

Abstract: Background: Although balloon pulmonary angioplasty (BPA) improves symptoms and pulmonary hemodynamics in patients with chronic thromboembolic pulmonary hypertension (CTEPH), the effects of riociguat on hemodynamics and exercise capacity in patients after BPA remain to be elucidated. Methods and Results: This study was a single-center, prospective, randomized, open-label trial. From November 2015 to November 2018, we prospectively examined 21 patients with CTEPH (65 ± 9 years old, M/F 2/19) who showed hemodynamic improvement with mean pulmonary arterial pressure (mPAP) < 30 mmHg after BPA without any vasodilators. We performed hemodynamic evaluation and expired gas analysis both at rest and during exercise in supine position using cycle ergometer. After right heart catheterization during exercise, they were randomly assigned to 2 groups with minimized method, using age, sex, and resting mPAP; riociguat (N = 10) and control (N = 11) groups. After 6 months, exercise capacity evaluated by 6-min walk distance and cardiopulmonary exercise testing, and resting hemodynamic parameters were comparable in both groups. However, cardiac output (CO) (6.0 ± 1.7–7.4 ± 1.6, P < 0.01) and pulmonary vascular resistance (4.8 ± 1.8–3.2 ± 0.7 Wood units, P = 0.02) at peak workload were significantly improved in the riociguat group as compared with the control group. The slope of linearized mPAP-CO relationship was significantly decreased in the riociguat group [14.5 (7.8, 14.7) to 6.41 (5.1, 11.4), P < 0.01] but not in the control group. Conclusions: These results indicate that riociguat exerts beneficial effects on hemodynamic response to exercise in CTEPH patients even after hemodynamic improvement by BPA.