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Heart, Lung and Circulation

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Acute Vasoreactivity Testing and Outcomes in Pulmonary Arterial Hypertension: A Call for Increased Testing - 28/02/23

Doi : 10.1016/j.hlc.2022.09.005 
Sahan Chandrasekara, MBBS a, Edmund M. Lau, MBBS, PhD b, James Anderson, MBBS c, Nicholas Collins, MBBS d, Rachael Cordina, MBBS, PhD e, Carolyn Corrigan, BSN f, Nathan Dwyer, MBBS, PhD g, John Feenstra, MBBS h, Mark Horrigan, MBBS i, Anne Keogh, MD f, Eugene Kotlyar, MD f, Melanie Lavender, MBChB j, Tanya McWilliams, MD, PhD k, Bronwen Rhodes, MBBS l, Peter Steele, MBBS m, Geoff Strange, PhD n, o, Vivek Thakkar, MD p, Robert Weintraub, MBBS q, Helen Whitford, MBBS a, Kenneth Whyte, MD k, Trevor Williams, MD a, Jeremy Wrobel, MBBS, PhD r, Dominic T. Keating, MD a, ⁎
on behalf of the

PHSANZ Registry

a Department of Respiratory Medicine, The Alfred Hospital, and Central Clinical School, Monash University, Melbourne, Vic, Australia 
b Sydney Medical School, University of Sydney, Sydney, NSW, Australia 
c Respiratory Department, Sunshine Coast University Hospital, Birtinya, Qld, Australia 
d Department of Cardiology, John Hunter Hospital, Newcastle, NSW, Australia 
e Department of Cardiology, Royal Prince Alfred Hospital, and Heart Research Institute, Sydney, NSW, Australia 
f Heart and Lung Transplant Unit, St Vincent's Hospital, Sydney, NSW, Australia 
g Department of Cardiology, Royal Hobart Hospital, Hobart, Tas, Australia 
h Queensland Lung Transplant Service, Prince Charles Hospital, Brisbane, Qld, Australia 
i The Austin Hospital, Melbourne, Vic, Australia 
j Advanced Lung Disease Unit, Fiona Stanley Hospital, Perth, WA, Australia 
k Greenlane Clinical Centre, Auckland City Hospital, Auckland, New Zealand 
l Department of Respiratory Medicine, Christchurch Hospital, Christchurch, New Zealand 
m Department of Cardiovascular Services, Royal Adelaide Hospital, Adelaide, SA, Australia 
n School of Medicine, University of Notre Dame, Fremantle, WA, Australia 
o Pulmonary Hypertension Society of Australia and New Zealand 
p Department of Clinical Medicine, Macquarie University, Sydney, NSW, Australia; Department of Rheumatology, Liverpool Hospital, Sydney, NSW, Australia 
q Royal Children's Hospital, Melbourne, Vic, Australia; Murdoch Children's Research Institute, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia 
r Advanced Lung Disease Unit, Fiona Stanley Hospital, Perth, WA, Australia; School of Medicine, University of Notre Dame, Fremantle, WA, Australia 

∗Corresponding author at: Alfred Hospital, Commercial Road, Melbourne, Vic, AustraliaAlfred HospitalCommercial RoadMelbourneVicAustralia

Abstract

Background

Pulmonary arterial hypertension (PAH) has a progressive, unremitting clinical course. Vasoreactivity testing (VdT) during right heart catheterisation (RHC) identifies a subgroup with excellent long-term response to calcium channel blockade (CCB). Reporting on these patients is limited. Established in 2011, the Pulmonary Hypertension Society of Australia and New Zealand (PHSANZ) registry offers the opportunity to assess the frequency of VdT during RHC, treatment and follow up of PAH patients.

Methods

Registry data from 3,972 PAH patients with index RHC revealed 1,194 VdT appropriate patients. Data was analysed in three groups: 1) VdT+CCB+: VdT positive, CCB treated; 2) VdT+CCB-: VdT positive, no CCB prescribed, 3) VdT-/noVdT: VdT negative, or VdT not tested. Data was reviewed for adherence to guidelines, clinical response (World Health Organization functional class [WHO FC], 6-minute-walk-distance [6MWD], RHC), and outcomes (survival or lung transplantation).

Results

Patients included had idiopathic (IPAH=1,087), heritable (HPAH=67) and drug or toxin-induced PAH (DPAH=40). A VdT was performed in 22% (268/1,194), with incomplete data in 26% (70/268); 28% (55/198) were VdT+. Analysis group allocation was: VdT+CCB+ (33/55), VdT+CCB- (22/55), VdT- (143)/noVdT (996). From patients with 1-year data VdT+CCB+ and VdT-/noVdT patients improved WHO FC, 6MWD and cardiac index (CI); VdT+CCB- data remained similar. Within the VdT+CCB+ group, 30% (10/33) were long-term CCB responders with a 100% 5-year survival; non-responders had a 61% survival at 5.4 years. Long-term responders were younger at diagnosis (40 yrs vs 54 yrs).

Conclusion

Use of VdT testing and documentation is poor in this contemporary patient cohort. Nonetheless, survival in VdT+CCB+ patients from the PHSANZ registry is excellent, supporting guidelines promoting VdT testing. Strategies to promote the use of VdT are warranted.

Le texte complet de cet article est disponible en PDF.

Keywords : Pulmonary hypertension, Calcium channel blockers, Right heart catheter, Right ventricular failure, Vasoreactivity testing


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© 2022  Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 32 - N° 2

P. 156-165 - février 2023 Retour au numéro
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