SESSION TITLE: DVT/PE/Pulmonary Hypertension Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM
PURPOSE: Combination therapy is commonly used for pulmonary arterial hypertension (PAH) treatment. There is increasing interest to evaluate the value of treating patients with combination therapy up front instead of staggering it.
METHODS: Retrospective chart review of PAH patients. Comparison of baseline clinical, echocardiogram and hemodynamics was made between patients that eventually required combination therapy versus ones that were maintained on monotherapy.
RESULTS: Seventy-one patients were analyzed with a mean follow up of 30 months. A total of 39 patients were maintained on monotherapy while 32 required combination therapy. Mean age was not different between the monotherapy and combination therapy groups at the time of diagnosis and/or initiation of treatment, 55 ± 3 years vs 50 ± 3 years. At presentation, a significantly higher number of patients that eventually required combination therapy belonged to WHO functional class 3 (45% vs 37%) and 4 (23% vs 0) compared with those on monotherapy (p=0.0006). There was no statistically significant difference in baseline heart rate, six minute walk distance (6MWT), Borg dyspnea index before or after 6MWT, FEV1/FVC ratio, diffusion capacity (DLCO), echocardiogram derived left ventricular size, left atrial size, left ventricular ejection fraction (LVEF) and right ventricular (RV) hypertrophy. Right heart catheterization derived hemodynamics data at baseline showed that the combination therapy group had a higher mean pulmonary artery (PA) pressure 45 ± 13 mmHg vs 33 ± 8 mmHg (p= <0.001), lower pulmonary capillary wedge pressure (PCWP) 11 ± 0.7 mmHg vs 13 ± 0.6 mmHg (p=0.0197), lower cardiac output (C.O.) 5.6 ± 2 L/min vs 7 ± 2 L/min (p=0.0299) and higher pulmonary vascular resistance (PVR) 256.5 ± 127 dyn·s/cm5 vs 549 ± 204.5 dyn·s/cm5 (p=< 0.001). There was no difference in the right atrial pressure.
CONCLUSIONS: PAH patients that require combination therapy in the course of their disease have worse hemodynamics and functional class at the time of presentation.
CLINICAL IMPLICATIONS: Larger studies are needed to identify patients at risk that potentially can be initiated on combination therapy up front.
DISCLOSURE: The following authors have nothing to disclose: Tauseef Qureshi, Adil Shujaat, Faisal Usman, Lisa Jones, James Cury, Avinash Ramdass, Abubakr Bajwa
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