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Induction and Phenotyping of Acute Right Heart Failure in a Large Animal Model of Chronic Thromboembolic Pulmonary Hypertension
Published on: March 17, 2022
Improved survival in medically treated chronic thromboembolic pulmonary hypertension
Rintaro Nishimura1, Nobuhiro Tanabe, Toshihiko Sugiura
1Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan. rintaro09281980@yahoo.co.jp
Insights
Modern oral therapy (mod Tx) significantly improves survival rates for medically treated patients with chronic thromboembolic pulmonary hypertension (CTEPH). This finding highlights the benefit of mod Tx in managing inoperable CTEPH cases.
Area of Science:
- Cardiology
- Pulmonology
- Medical Therapy
Background:
- Surgical indications for chronic thromboembolic pulmonary hypertension (CTEPH) have evolved, with recognition of peripheral CTEPH and advancements in surgical techniques.
- Modern oral therapies (mod Tx), including bosentan and sildenafil, are used for inoperable CTEPH, but their impact on survival is not well-established.
Purpose of the Study:
- To evaluate the survival rates of medically treated patients with CTEPH.
- To investigate the prognostic factors influencing survival in CTEPH, particularly the role of modern oral therapy (mod Tx).
Main Methods:
- Retrospective analysis of 202 CTEPH patients diagnosed between 1986 and 2010.
- Stratification of survival rates by diagnosis date and comparison between patients receiving mod Tx and those not.
- Multivariate analysis to identify predictors of better outcomes in medically treated CTEPH patients.
Main Results:
- Patients diagnosed more recently (2005-2010) showed significantly better survival rates compared to earlier groups.
- Medically treated CTEPH patients receiving mod Tx had a 5-year survival rate of 88.9%, compared to 60.2% for those not on mod Tx.
- Multivariate analysis identified mod Tx, lower pulmonary vascular resistance (PVR), and absence of comorbidity as significant predictors of improved survival.
Conclusions:
- Medically treated CTEPH patients demonstrate improved survival rates.
- The utilization of modern oral therapy (mod Tx) is a significant contributing factor to the enhanced survival observed in CTEPH patients.
Background:
The surgical indication for chronic thromboembolic pulmonary hypertension (CTEPH) has been modified due to recognition of peripheral type CTEPH and changes in surgical methods and skill. Bosentan and sildenafil are used as modern oral therapy (mod Tx) in patients with inoperable CTEPH, although it remains unknown whether they have positive effects on survival.
Methods And Results:
A total of 202 patients were diagnosed with CTEPH at Chiba University Hospital between 1986 and 2010, 100 of whom underwent pulmonary endarterectomy. Seven medically treated patients with pulmonary vascular resistance (PVR) ≤ 300 dyn·s·cm(-5) were regarded as having mild disease. Survival rate was stratified by date of diagnosis (group 1, 1986-1998; group 2, 1999-2004; group 3, 2005-2010), and prognostic factors in the remaining 95 medically treated patients were investigated. Group 3 included the most patients treated with mod Tx (group 1, 9.1%; group 2, 24.2%; group 3, 65.0%) and had significantly better survival than either group 1 or 2 (5-year survival: group 1, 54.6%; group 2, 69.7%; group 3, 87.3%). Patients receiving mod Tx had significantly better survival than those not on mod Tx (5-year survival: 88.9% vs. 60.2%). Multivariate analysis showed that mod Tx, lower PVR, and lack of comorbidity were significant predictors of better outcome.
Conclusions:
Medically treated patients with CTEPH had a better survival rate, and the use of mod Tx contributed to improved survival.
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