Pulmonary Vascular Disease |

Effect of PAH Specific Therapy on Pulmonary Hemodynamics and 6 Minute Walk Distance in Chronic Thromboembolic Pulmonary Hypertension: A Meta-analysis FREE TO VIEW

Furqan Siddiqi, MD; Adil Shujaat, MD; Muhammad Faisal, MD; Abubakr Bajwa, MD
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University of Florida, Jacksonville, FL

Chest. 2015;148(4_MeetingAbstracts):958A. doi:10.1378/chest.2267146
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SESSION TITLE: Pulmonary Arterial Hypertension Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Pulmonary thromboendarterectomy (PEA) is the definitive treatment for chronic thromboembolic pulmonary hypertension (CTEPH). However, not all patients are surgical candidates and some may be left with residual pulmonary hypertension after PEA. Treatment options for such patients are limited. We sought to perform a literature search for randomized clinical trial (RCTs) of pulmonary arterial hypertension (PAH) specific therapy in CTEPH.

METHODS: We searched PUBMED for articles published between January 1996 and February 2015, using the terms “chronic thromboembolic pulmonary hypertension” AND “CTEPH” and applying the filters: English language, Humans and Clinical Trials. We also searched the abstracts of major scientific meetings. We included studies that met the following criteria: randomized, double-blind, placebo controlled, clinical trial AND PH confirmed by right heart catheterization, AND baseline and follow up 6MWD AND baseline and follow up pulmonary hemodynamic data. We used MetaAnalyst version Beta 3.13 and random effects model to perform the meta-analysis.

RESULTS: Five RCTs met our inclusion criteria. There was a total of 190 patients treated for 12-16 weeks with placebo or one of the three drug classes of PAH specific therapy: Riociguat (n= 173), Endothelin receptor antagonist (n= 86), and Phosphodiesterase 5 inhibitor (n= 9). Overall, the placebo corrected mean change in 6MWD was 25.8 meters (95%CI 6.7 to 44.4; p=0.150, I2 0.41, Q 6.74). The mean change in mean pulmonary artery pressure was -10.45 mmHg (95%CI -16.5 to -4.32; p=0.848, I2 0, Q 0.80) and change in pulmonary vascular resistance was -244.23 dynes.sec/cm5 (95%CI -274.5 to -173.9; p=0.479, I2 0, Q 2.47).

CONCLUSIONS: The use of PAH specific therapy in patients with CTEPH results in significant improvement in 6MWD and pulmonary hemodynamics.

CLINICAL IMPLICATIONS: PAH specific therapy can be beneficial in patients with residual or inoperable CTEPH.

DISCLOSURE: Abubakr Bajwa: University grant monies: UF health- jacksonville, Grant monies (from industry related sources): United theraputics investigator grant, Consultant fee, speaker bureau, advisory committee, etc.: UT, Gileac, Actleion The following authors have nothing to disclose: Furqan Siddiqi, Adil Shujaat, Muhammad Faisal

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