0
Pulmonary Vascular Disease |

Patient Outcomes in Pulmonary Arterial Hypertension With Nonclassic Response to Acute Vasodilator Testing

Stephen Halliday, MD; Anna Hemnes, MD; Ivan Robbins, MD; Evan Brittain, MD
Author and Funding Information

Vanderbilt University Medical Center, Nashville, TN


Chest. 2013;144(4_MeetingAbstracts):870A. doi:10.1378/chest.1705071
Text Size: A A A
Published online

Abstract

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: A classic response to acute vasodilator testing (drop of > 10mmHg in mean pulmonary artery pressure [mPAP] to absolute value of < 40mmHg) confers an excellent prognosis in patients with idiopathic pulmonary arterial hypertension (IPAH) treated with calcium channel blockers (CCB). Little is known about vasodilator responsiveness (VR) in other types of PAH, or about outcomes in PAH patients with a significant but non-classic decrease in mPAP. We hypothesized that VR occurs in non-idiopathic PAH and ‘non-classic’ VR in PAH patients portends a better prognosis than no VR.

METHODS: Acute VR testing with nitric oxide was performed on 157 consecutive patients referred for PH evaluation. Significant but non-classic response was defined as decrease in mPAP > 10mmHg to greater than 40mmHg with preserved cardiac output. Demographics, six minute walk distance (6MWD), and NYHA class were assessed at baseline and the first clinic visit after VR testing.

RESULTS: Thirty-five (22%) patients had a decrease in mPAP > 10mmHg, twenty-one (13%) of whom had a classic response. Among patients with a classic response, 13 (68%) had familial or idiopathic PAH (F/IPAH) and 8 (32%) had connective tissue disease- associated (CTD-PAH). Fourteen (9%) patients had a non-classic response to NO (delta mPAP -15.3±5.2mmHg), consisting of 6 with F/IPAH, 4 with CTD-PAH, 2 with PAH related to congenital heart disease, and 2 with miscellaneous causes. There was no difference in age, gender, or distribution of PAH sub-type between non-classic responders and patients with no response to NO (n = 122). Non-classic responders had similar but non-significant changes in both 6MWD (32±58 m, p = 0.23) and NYHA class (-0.05±0.6, p = 0.80) whereas both improved in non-responders (22±91m, p = 0.04 and -.3±0.6, p <0.001, respectively).

CONCLUSIONS: Patients with non-idiopathic PAH may have a significant VR to NO. There was no improvement in exercise capacity or functional status in patients with a significant but non-classic response to acute VR testing.

CLINICAL IMPLICATIONS: Vasodilator responsive PAH may occur in non-idiopathic PAH, however non-classic VR is not associated with improved patient outcomes compared with non-responsive PAH.

DISCLOSURE: The following authors have nothing to disclose: Stephen Halliday, Anna Hemnes, Ivan Robbins, Evan Brittain

No Product/Research Disclosure Information


Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543