SESSION TYPE: DVT/PE/Pulmonary Hypertension Posters I
PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM
PURPOSE: Despite significant advances in therapy over the last 2 decades, pulmonary arterial hypertension (PAH) remains a progressive and fatal condition. While Phosphodiesterase-5 inhibitors (PDE5-I) and endothelin receptor antagonists (ERAs) are approved for patients with World Health Organization Functional Class [WHO FC] II-IV, previous studies have only included patients with severe pulmonary arterial hypertension (mean pulmonary artery pressure [PAP] > 45 mmHg). No previous trial has specifically evaluated patients with moderate disease by PAP criteria (mean PAP > 35 mmHg and ≤ 45 mmHg), regardless of WHO FC. Given the progressive nature of this condition, and its significant association with morbidity and mortality, it may be beneficial to initiate therapy in patients with more moderate PAH prior to progression to more severe disease.
METHODS: We conducted a retrospective analysis of patients with moderate PAH (mean PAP between 35 and 45 mmHg) who were on PDE5-I and/or ERAs to assess whether these therapies are associated with improved functional status as measured by 6 minute walk distance (6MWD). We reviewed the records of all patients seen at our pulmonary hypertension clinic between January 1, 2005 and December 31, 2011 with moderate PAH. Twenty-one patients who had an initial 6MWD prior to the initiation of PDE5-I (either sildenafil or tadafil) or ERA therapy (either bosentan or ambrisentan) and at least one follow-up after 6 months of therapy were included.
RESULTS: At follow-up ≥ 6months after the initiation of PDE5-I and/or ERA therapy, 6MWD improved by 56.2 meters (mean 6MWD 275.7±27.0 vs. 331.9±22.1, p=0.02).
CONCLUSIONS: PDE5-I and ERA therapy in patients with moderate PAH is associated with significant improvement in 6MWD after at least 6 months of therapy.
CLINICAL IMPLICATIONS: Given the progressive nature of PAH, those with more moderate disease may stand to benefit from therapy before further clinical decline ensues. These data respresent a preliminary evaluation, and given the results, one that warrants further prospective study.
DISCLOSURE: Ronald Zolty: Consultant fee, speaker bureau, advisory committee, etc.: Actellion, Consultant fee, speaker bureau, advisory committee, etc.: Gilead
The following authors have nothing to disclose: Thiago Jabuonski, Jeremy Mazurek
No Product/Research Disclosure InformationJacobi Medical Center, Bronx, NY