title: Haemodynamics, exercise capacity and clinical events in pulmonary arterial hypertension.
abstract: The purpose of this study was to clarify whether changes in cardiopulmonary haemodynamics induced by pharmacological therapy correlate with exercise capacity and clinical events in patients with pulmonary arterial hypertension. 16 randomised trials including 2353 patients, followed up for 16.4±10.6 weeks, measuring cardiopulmonary haemodynamics by right heart catheterisation and reporting clinical events were included. Meta-analysis and meta-regression analysis were performed to assess the effects of treatments on clinical events and the relationship between haemodynamic changes (pulmonary artery pressure, pulmonary vascular resistance, cardiac index and right atrial pressure) and clinical events. Treatments significantly reduced all-cause death (OR 0.5, 95% CI 0.3-0.7; p<0.01), hospitalisation for pulmonary arterial hypertension (OR 0.4, 95% CI 0.2-0.7; p<0.01), initiation of rescue therapy (OR 0.3, 95% CI 0.2-0.6; p<0.01) and the composite outcome (OR 0.3, 95% CI 0.3-0.5; p<0.01). No relationship was found between changes of haemodynamic parameters and clinical events, whereas changes of cardiac index and pulmonary vascular resistance significantly correlated with changes in the 6-min walking distance (r = 0.64, p = 0.03; r = -0.55, p = 0.04, respectively). In patients with pulmonary arterial hypertension, improvements of cardiopulmonary haemodynamics observed in randomised clinical trials correlate with exercise capacity changes but do not predict clinical events in a short-term follow-up.
authors.affiliation: Dept of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Savarese
authors.forename: Francesca
authors.initials: F
authors.lastname: Musella
authors.forename: Carmen
authors.initials: C
authors.lastname: D'Amore
authors.forename: Teresa
authors.initials: T
authors.lastname: Losco
authors.forename: Caterina
authors.initials: C
authors.lastname: Marciano
authors.forename: Paola
authors.initials: P
authors.lastname: Gargiulo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rengo
authors.forename: Santo
authors.initials: S
authors.lastname: Dellegrottaglie
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bossone
authors.forename: Dario
authors.initials: D
authors.lastname: Leosco
authors.forename: Pasquale
authors.initials: P
authors.lastname: Perrone-Filardi
mesh_terms: D001549:Benzamides / Q000627:therapeutic use; D065128:Endothelin Receptor Antagonists; D011464:Epoprostenol / Q000031:analogs & derivatives; D015444:Exercise; D017079:Exercise Tolerance; D065627:Familial Primary Pulmonary Hypertension; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy / Q000503:physiopathology*; D000068877:Imatinib Mesylate; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use; D010879:Piperazines / Q000627:therapeutic use; D011743:Pyrimidines / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D016896:Treatment Outcome; D016138:Walking
chemical_list: D001549:Benzamides; D065128:Endothelin Receptor Antagonists; D058986:Phosphodiesterase 5 Inhibitors; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate; D011464:Epoprostenol