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Change in Diastolic Pulmonary Arterial Pressure (dPAP) Predicts Changes in Cardiac Index (CI) in Pulmonary Arterial Hypertension (PAH): Hemodynamic Data Analysis of the Initial Randomized Placebo-Cont

Francisco Soto


S. Girotra

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Conference: 2008 International PHA Conference and Scientific Sessions

Release Date: 06.20.2008

Presentation Type: Abstracts

Soto F.J., Girotra S.
Medical College of Wisconsin, Milwaukee, WI, USA

BACKGROUND: Based on the pathophysiology of PAH we postulate that dPAP may be a stronger prognostic variable than meanPAP.
METHODS/PURPOSE: We reviewed data from the 2001, 12-week bosentan-placebo-trial (32 PAH patients, 21 bosentan-11 placebo) to: 1.Compare therapy impact on dPAP vs mPAP; 2.Evaluate whether dPAP or mPAP changes correlate with changes in CI. 
RESULTS: Hemodynamic data on 21 bosentan and 9 placebo patients were available. Mean age was 52 for bosentan (81% women) vs 46 (100% women) for placebo. Etiology: 81% Idiopathic and 19% Scleroderma vs 91% and 9%, respectively. 

Demographics and Hemodynamic Data

 

Bosentan

Placebo

 

 

Baseline

12 weeks

Delta (p)

Baseline

12 weeks

Delta (p)

Delta Change Comparison (p)*

mPAP

(mm Hg)

52.7

51

-1.7 (0.13)

55.7

57.2

1.5 (0.35)

3.2 (0.10)

dPAP

(mm Hg)

35.6

31.7

-3.9 (0.006)

37.7

39.1

1.3 (0.19)

5.2 (0.01)

CI (L/min/m2)

2.39

2.84

0.44 (0.0005)

2.47

2.07

-0.39 (0.053)

0.84 (0.0002)

*compares bosentan and placebo groups

Change in Diastolic Pulmonary Arterial Pressure (dPAP) Predicts Changes in Cardiac Index (CI) in Pul

COMMENTS AND CONCLUSIONS: The 2001 study found a walk test improvement between groups of 76m favoring bosentan. Based on this plus the dPAP/CI correlation and the significant CI and dPAP changes we found, we propose that dPAP reduction may play an important role in the clinical improvement seen in patients treated for PAH.