Journal article

Publication year: 2015

Pages: 19-26

Journal: International Journal of Cardiology

Volume number: 195

ISSN: 0167-5273

eISSN: 1874-1754

Open access status: Hybrid

DOI Link: https://doi.org/10.1016/j.ijcard.2015.05.105

Publisher: Elsevier

Abstract: 

Background: Riociguat is a soluble guanylate cyclase stimulator approved for pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). The objective of this study was to evaluate the change of right heart size and function assessed by echocardiography during long-term treatment with riociguat.

Methods: We assessed patients who started riociguat treatment (1.0-2.5 mg tid) within the trials PATENT, PATENTplus, EAS and CHEST and continued for 3-12 months. Echocardiography, 6-minute walking distance (6MWD) and further clinical parameters were analyzed at baseline, after 3, 6 and 12 months. Right heart catheterization was performed at baseline and after 3 months. For missing data we performed the last and baseline observation carried forward (LOCF, BOCF) method as sensitivity analyses.

Results: Thirty-nine patients (21 PAH, 18 CTEPH, mean pulmonary arterial pressure 43 +/- 2 mm Hg, PVR 600 +/- 43 dyn*s*cm(-5), 56.4% treatment-naive) were included. Mean right ventricular (RV) area significantly decreased after 3 (-2.1 +/- 3.9 cm(2), equals-7.4 +/- 15.3%, p = 0.002), 6 (-4.2 +/- 3.2 cm(2), equals - 16.1 +/- 11.5%, p < 0.001) and 12 months (-5.9 +/- 4.6 cm(2), equals-22.1 +/- 14.2%, p < 0.001) compared to baseline. Right atrial area significantly decreased after 12 months (-3.5 +/- 4.1 cm(2), equals-16.8 +/- 19.2%, p < 0.001) and TAPSE significantly improved after 6 (+ 2 +/- 4.7, equals 12 +/- 25.8%, p = 0.025) and 12 months (+ 3.6 +/- 5.4, equals 21.0 +/- 29.6%, p = 0.002). Furthermore, RV wall thickness and 6MWD significantly improved after 3, 6 and 12 months (p < 0.05). Invasive hemodynamics significantly improved after 3 months. Both LOCF and BOCF showed similar significance and lower effect sizes.

Conclusion: Long-term treatment with riociguat significantly reduced right heart size and improved RV function in PAH and CTEPH. Further prospective studies are needed to confirm these results. (C) 2015 The Authors. Published by Elsevier Ireland Ltd.

Harvard Citation style: Marra, A., Egenlauf, B., Ehlken, N., Fischer, C., Eichstaedt, C., Nagel, C., et al. (2015) Change of right heart size and function by long-term therapy with riociguat in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension, International Journal of Cardiology, 195, pp. 19-26. https://doi.org/10.1016/j.ijcard.2015.05.105

APA Citation style: Marra, A., Egenlauf, B., Ehlken, N., Fischer, C., Eichstaedt, C., Nagel, C., Bossone, E., Cittadini, A., Halank, M., Gall, H., Olsson, K., Lange, T., & Gruenig, E. (2015). Change of right heart size and function by long-term therapy with riociguat in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. International Journal of Cardiology. 195, 19-26. https://doi.org/10.1016/j.ijcard.2015.05.105