Right ventricular size and function under riociguat in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension (the RIVER study)

Marra, Alberto M. and Halank, Michael and Benjamin, Nicola and Bossone, Eduardo and Cittadini, Antonio and Eichstaedt, Christina A. and Egenlauf, Benjamin and Harutyunova, Satenik and Fischer, Christine and Gall, Henning and Ghofrani, Hossein Ardeschir and Hoeper, Marius M. and Lange, Tobias J. and Olsson, Karen M. and Klose, Hans and Gruenig, Ekkehard (2018) Right ventricular size and function under riociguat in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension (the RIVER study). RESPIRATORY RESEARCH, 19: 258. ISSN 1465-993X, 1465-9921

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Abstract

BackgroundRiociguat is a soluble guanylate cyclase stimulator approved for pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTPEH). The objective of this study was to evaluate right heart size and function assessed by echocardiography during long term treatment with riociguat.MethodsPatients who started riociguat treatment (1.0-2.5mg tid) within the trials phase II, PATENT, PATENTplus, EAS, CHEST and continued treatment for 3-12months were included in this study. Echocardiography was analysed off-line at baseline, after 3, 6 and 12months by investigators who were blinded to clinical data. Last and baseline observation carried forward method (LOCF, BOCF) were performed as sensitivity analysis.ResultsSeventy-one patients (45% PAH, 55% CTEPH; 53.5% female; 6013years, mean pulmonary arterial pressure 4610mmHg, mean PVR 700 +/- 282dynes<bold>seccm</bold>-5) were included. After 6months, RA and RV area, RV thickness tricuspid regurgitation velocity showed a significant reduction. After 12months, patients receiving riociguat therapy showed a significant reduction in right atrial (-2.6 +/- 4.4cm2, 95% CI -3.84, -1.33; p<0.001, n=49) and right ventricular (RV) area (-3.5 +/- 5.2cm2, 95% CI -5.1, -1.9; p<0.001; n=44), RV thickness (-0.76 +/- 2.2mm, 95% CI -1.55, 0.03; n=32), and a significant increase in TAPSE (2.95 +/- 4.78mm, 95% CI 1.52, 4.39; n=45) and RV fractional area change (8.12 +/- 8.87mm, 95% CI 4.61, 11.62; n=27).Both LOCF and BOCF showed similar results but lower effect sizes.Conclusion Patients under long-term treatment with riociguat show significantly reduced right heart size and improved RV function in PAH and CTEPH. Further controlled prospective studies are needed to confirm these results.

Item Type: Article
Uncontrolled Keywords: ECHOCARDIOGRAPHIC-ASSESSMENT; RIGHT HEART; GUIDELINES; DIAGNOSIS; OUTCOMES; ADULTS; Pulmonary hypertension; Pulmonary arterial hypertension; Chronic thromboembolic pulmonary hypertension; Riociguat; Soluble guanylate cyclase stimulator; Right atrial area; Right heart size; Right ventricular function; Echocardiography
Subjects: 600 Technology > 610 Medical sciences Medicine
Divisions: Medicine > Lehrstuhl für Innere Medizin II
Depositing User: Dr. Gernot Deinzer
Date Deposited: 04 Oct 2019 06:02
Last Modified: 07 Oct 2019 06:13
URI: https://pred.uni-regensburg.de/id/eprint/13344

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