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Original Research |

Ventricular diastolic pressure ratio as a marker of treatment response in pulmonary hypertension

Arun Jose, MD; Christopher S. King, MD; Oksana A. Shlobin, MD; Joseph M. Kiernan, MD; Nicolas A. Cossa, MD; A.Whitney Brown; Steven D. Nathan, MD
Author and Funding Information

Disclosures

AJ, CSK, JMK, NAC, and AWB have no disclosures. OAS served as a consultant and is on the speakers’ bureau for Actelion, United Therapeutics, and Bayer. SDN serves as a consultant and is on the speakers’ bureau for Bayer, Gilead, and United Therapeutics. He also receives research funding from Bayer, Gilead, and United Therapeutics.

1Pulmonary, Critical Care and Sleep Medicine Division, The George Washington University MFA, Washington, District of Columbia

2Advanced Lung Disease and Transplant Program, Inova Heart and Vascular Institute, Inova Fairfax Hospital, Falls Church, Virginia

3Cardiovascular Disease and Interventional Cardiology Program, Inova Heart and Vascular Institute, Inova Fairfax Hospital, Falls Church, Virginia


Copyright 2017, . All Rights Reserved.


Chest. 2017. doi:10.1016/j.chest.2017.05.008
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Abstract

Background  Pulmonary hypertension (PH) is diagnosed and classified through right heart catheterization (RHC), with a number of hemodynamic markers used to help guide treatment decisions. These markers may not reflect the complex remodeling of the right ventricle or the interplay between ventricles, and struggle to predict treatment response. This study investigates the use of a novel marker; the ratio of left to right ventricular end-diastolic pressures (LVEDP/RVEDP), in predicting treatment outcomes in a cohort of PH patients.

Methods  We performed a retrospective analysis of PH patients at INOVA Fairfax Hospital Advanced Lung Disease Program with simultaneous left- and right-heart catheterization. The primary endpoint was the time to clinical improvement, defined by an improvement in distance walked on the 6MWT of greater than 35 meters in a year without interceding hospitalization for worsening PH or need for additional PH therapy.

Results  A total of 51 patients were included in the final analysis, of which 21 (41.2%) had a salutary treatment effect with a mean improvement in the 6MWT of 75 meters. Treatment responders were more likely to have a lower LVEDP/RVEDP ratio (1.08 vs 1.62, p=0.051). This association persisted in the final multivariate regression model after adjustment for age, gender, and controlling for severity of pulmonary hypertension (OR 0.17, 95% confidence interval 0.03-0.65, p=0.024).

Conclusion  The LVEDP/RVEDP ratio is a novel marker for therapeutic response in PH patients treated with pulmonary vasodilator medications, and may offer robust predictive value independent of existing markers of disease severity.


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