血液动力学是肺动脉高血压的替代终点吗?
Corey E Ventetuolo1, Nicole B Gabler1, Jason S Fritz1
1From the Division of Pulmonary, Critical Care and Sleep, Department of Medicine (C.E.V., J.R.K.) and Department of Health Services, Policy, and Practice (C.E.V.), Alpert Medical School of Brown University, Providence, RI; Center for Clinical Epidemiology and Biostatistics (N.B.G., S.D.H., S.M.K.), Department of Medicine (J.S.F., K.A.S., H.I.P., S.D.H., S.M.K.), Penn Cardiovascular Institute (S.D.H., S.M.K.), and Leonard Davis Institute of Health Economics (S.D.H.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
12周血液动力学改善仅部分解释了肺动脉高血压 (PAH) 早期临床事件的治疗益处. 静止血液动力学不是短期PAH结果的有效替代品.
科学领域:
- 心脏病学 心脏病学
- 肺部医学 肺部医学
- 临床试验 临床试验
背景情况:
- 血液动力学反应经常在肺动脉高血压 (PAH) 试验和实践中进行评估.
- 然而,它作为PAH临床事件的替代终点的验证一直缺乏.
研究的目的:
- 确定12周治疗诱导的血液动力学变化是否解释了PAH治疗和早期临床事件之间的关系.
- 评估静止血液动力学在短期PAH试验中的替代终点的有效性.
主要方法:
- 对4项随机,安慰剂对照试验的患者一级综合分析,涉及1119名PAH受试者.
- 评估治疗对血液动力学值 (右心房压,肺动脉压,肺血管阻力,心脏输出/指数) 的影响及其与临床事件的关联.
主要成果:
- 与安慰剂相比,活性PAH治疗显著改善了血液动力学参数.
- 血液动力学变化与临床事件风险相关,但仅占整体治疗效果的1.2%至13.9%.
- 积极治疗减半了临床事件的几率 (P<0.001).
结论:
- 12周治疗诱导的血液动力学变化只能部分解释治疗对PAH早期临床事件的影响.
- 在PAH试验中,静止血液动力学不是短期临床事件的有效代用终点.
相关概念视频
Treatment for Pulmonary Arterial Hypertension: Endothelin Receptor Antagonists
ETs are synthesized through a complex sequence of enzymatic steps, primarily involving an enzyme referred to as endothelin-converting enzyme...
Treatment for Pulmonary Arterial Hypertension: Prostacyclin Receptor Agonists
These agonists bind to the IPR receptor situated on the plasma membrane of the pulmonary artery smooth muscle cells. This binding triggers a cascade of reactions known as the GS-AC-cAMP-PKA pathway. This pathway results in the relaxation of smooth muscle...
Pulmonary Hypertension: Classification and Pathogenesis
There are various classifications for PH, each relating to different underlying causes and also...
Treatment for Pulmonary Arterial Hypertension: Phosphodiesterase Inhibitors
Among the PDE5 inhibitors, sildenafil (Revatio) stands out as a competitive and selective inhibitor. It operates by elevating cellular levels of cGMP and augmenting signaling through the cGMP-PKG pathway, promoting vasodilation. Upon oral...
Treatment for Pulmonary Arterial Hypertension: Receptor Tyrosine Kinase Inhibitors and Calcium Channel Blockers
TKIs, such as imatinib (Gleevec), are particularly effective in tackling the growth and mitogenic factors that become upregulated in PAH patients. These factors contribute to the...
Heart Failure Drugs: Inhibitors of Renin-Angiotensin System


