Intensification of diuretic therapy in pulmonary hypertension - a retrospective evaluation of hemodynamic and...

Diuretics are first-line medication in the management of volume overload in pulmonary hypertension (PH). Their impact on the hemodynamic and functional parameters has not been studied. This study analyzes the impact of intensified diuretic therapy on patients deterioration.

The retrospective analysis included 38 patients who were divided into Group 1 (n ​= ​24, no change in the equivalent diuretic dose or treatment without diuretics) and Group 2 (n ​= ​14, increase in the equivalent diuretic dose). Measurements at baseline and after 6 months included echocardiographic parameters, 6-min walk test distance (6MWTd), and N-terminal prohormone of brain natriuretic peptide (NT-proBNP).

In the initial assessment of the studied parameters, Group 2 had a significantly greater inferior vena cava diameter (IVCd) and right ventricle internal diameter in diastole (RVIDd), trends towards greater right atrium area (RAA), lower tricuspid annular plane systolic excursion (TAPSE), and greater NT-proBNP values compared to Group 1. Over the 6-month follow-up period, Group 1 had a significant increase in IVCd, systolic pulmonary artery pressure (sPAP), significant decrease in TAPSE/sPAP ratio and trends towards increased mean pulmonary artery pressure (mPAP) and 6MWTd values. Group 2, on the other hand, had no significant worsening, which reflects a stabilizing impact of intensified diuretic therapy.

Intensified diuretic therapy in patients with PH and fluid overload appears to stabilize exercise capacity and prevent deterioration of cardiac function over a 6-month period.