title: Haemodynamic effects of riociguat in inoperable/recurrent chronic thromboembolic pulmonary hypertension.
abstract: We compared the haemodynamic effects of riociguat in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) or persistent/recurrent CTEPH after pulmonary endarterectomy in the Chronic Thromboembolic Pulmonary Hypertension Soluble Guanylate Cyclase-Stimulator Trial 1 study.
  
  
  
  Patients with inoperable or persistent/recurrent CTEPH (n=261; mean± SD age 59±14 years; 66% women) were randomised to riociguat (up to 2.5 mg three times daily) or placebo. Haemodynamic parameters were assessed at baseline and week 16.
  
  
  
  Riociguat decreased pulmonary vascular resistance (PVR) in inoperable (n=189; least-squares mean difference: -285 dyn s/cm5(95% CI -357 to -213); p<0.0001) and persistent/recurrent (n=72; -131 dyn s/cm5(95% CI -214 to -48); p=0.0025) patients. Cardiac index improved in inoperable patients by a least-squares mean difference of +0.6 L/min/m2(95% CI 0.4 to 0.7; p<0.0001), while in persistent/recurrent patients the change was +0.2 L/min/m2(95% CI -0.1 to 0.5; p=0.17). Mean pulmonary artery pressure decreased in inoperable and persistent/recurrent patients(-4.7 mm Hg (95% CI -6.9 to -2.6; p<0.0001 and -4.8 mm Hg (-8.2 to -1.5; p=0.0055), respectively). For all patients, changes in 6 min walk distance correlated with changes in PVR (r=-0.29 (95% CI -0.41 to -0.17); p<0.0001) and cardiac index (r=0.23 (95% CI 0.10 to 0.35); p=0.0004).
  
  
  
  Riociguat improved haemodynamics in patients with inoperable CTEPH or persistent/recurrent CTEPH.
  
  
  
  NCT00855465.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of California, San Diego, La Jolla, California, USA.
authors.forename: Nick H
authors.initials: NH
authors.lastname: Kim
authors.affiliation: Division of Cardiothoracic Surgery, Foundation "I.R.C.C.S. Policlinico San Matteo", University of Pavia School of Medicine, Pavia, Italy.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: D'Armini
authors.affiliation: University of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany.|German Center of Lung Research (DZL), Giessen, Germany.
authors.forename: Friedrich
authors.initials: F
authors.lastname: Grimminger
authors.affiliation: Center for Pulmonary Hypertension, Thoraxclinic, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Ekkehard
authors.initials: E
authors.lastname: Grünig
authors.affiliation: German Center of Lung Research (DZL), Giessen, Germany.|Clinic for Respiratory Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: Marius M
authors.initials: MM
authors.lastname: Hoeper
authors.affiliation: Clinical Department of Cardiology and Angiology, First Faculty of Medicine and General Teaching Hospital, Prague, Czech Republic.
authors.forename: Pavel
authors.initials: P
authors.lastname: Jansa
authors.affiliation: Kerckhoff Heart and Lung Center, Bad Nauheim, Germany.
authors.forename: Eckhard
authors.initials: E
authors.lastname: Mayer
authors.affiliation: Division of Pulmonary Diseases, Ludwig Maximilians University, Munich, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Neurohr
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Service de Pneumologie, Hôpital Bicêtre, Université Paris-Sud, Laboratoire d'Excellence en Recherche sur le Médicament et Innovation Thérapeutique, and Institut National de la Santé et de la Recherche Médicale Unité 999, Le Kremlin-Bicêtre, France.
authors.forename: Gérald
authors.initials: G
authors.lastname: Simonneau
authors.affiliation: Department of Pulmonary Circulation and Thromboembolic Diseases, Medical Center of Postgraduate Education, Europejskie Centrum Zdrowia Otwock, Otwock, Poland.
authors.forename: Adam
authors.initials: A
authors.lastname: Torbicki
authors.affiliation: Department of Respiratory Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao Yang Hospital, Capital Medical University, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Wang
authors.affiliation: Global Clinical Development, Bayer Pharma AG, Wuppertal, Germany.
authors.forename: Arno
authors.initials: A
authors.lastname: Fritsch
authors.affiliation: Global Clinical Development, Bayer Pharma AG, Wuppertal, Germany.
authors.forename: Neil
authors.initials: N
authors.lastname: Davie
authors.affiliation: University of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany.|German Center of Lung Research (DZL), Giessen, Germany.|Department of Medicine, Imperial College London, London, UK.
authors.forename: Hossein-Ardeschir
authors.initials: HA
authors.lastname: Ghofrani
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D062186:Arterial Pressure / Q000187:drug effects*; D002908:Chronic Disease; D004311:Double-Blind Method; D004691:Endarterectomy; D017079:Exercise Tolerance / Q000187:drug effects; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D016018:Least-Squares Analysis; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000187:drug effects* / Q000503:physiopathology; D011655:Pulmonary Embolism / Q000150:complications* / Q000175:diagnosis; D011720:Pyrazoles / Q000009:adverse effects / Q000627:therapeutic use*; D011743:Pyrimidines / Q000009:adverse effects / Q000627:therapeutic use*; D020127:Recovery of Function; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome; D014655:Vascular Resistance / Q000187:drug effects*; D000070857:Walk Test
chemical_list: D000959:Antihypertensive Agents; D011720:Pyrazoles; D011743:Pyrimidines; C542595:riociguat