Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Mar 9, 2022; 11(2): 85-91
Published online Mar 9, 2022. doi: 10.5492/wjccm.v11.i2.85
Treatment with neurohormonal inhibitors and prognostic outcome in pulmonary arterial hypertension with risk factors for left heart disease
Riccardo Scagliola, Claudio Brunelli, Manrico Balbi
Riccardo Scagliola, Claudio Brunelli, Manrico Balbi, Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova 16132, Genova, Italy
Author contributions: Scagliola R and Balbi M contributed to the conception and design of the study and acquired and interpreted the data; Brunelli C and Balbi M analyzed the data; Scagliola R drafted the manuscript; All authors contributed equally to the critical revision, editing and approval of the final version of the manuscript.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board committee at the University of Genoa, Italy.
Informed consent statement: Due to the retrospective design, written informed consent to participate in the study was not applicable.
Conflict-of-interest statement: None to be declared.
Data sharing statement: The present data are anonymized, with no risk of identification.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Riccardo Scagliola, MD, Doctor, Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi No. 10, Genova 16132, Genova, Italy. risca88@live.it
Received: April 7, 2021
Peer-review started: April 7, 2021
First decision: July 27, 2021
Revised: September 4, 2021
Accepted: February 25, 2022
Article in press: February 25, 2022
Published online: March 9, 2022
Abstract
BACKGROUND

Despite major advances in pharmacologic treatment, patients with pulmonary arterial hypertension (PAH) still have a considerably reduced life expectancy. In this context, chronic hyperactivity of the neurohormonal axis has been shown to be detrimental in PAH, thus providing novel insights on the role of neurohormonal blockade as a potential therapeutic target.

AIM

To evaluate the application and prognostic effect of neurohormonal inhibitors (NEUi) in a single-center sample of patients with idiopathic PAH and risk factors for left heart disease.

METHODS

We analyzed data retrospectively collected from our register of right heart catheterizations performed consecutively from January 1, 2005 to October 31, 2018. Patients on beta-blocker, angiotensin-converting enzyme inhibitor, angiotensin receptor blocker or mineralocorticoid receptor antagonist at the time of right heart catheterization were classified as NEUi users and compared to NEUi non-recipients.

RESULTS

Complete data were available for 57 PAH subjects: 27 of those (47.4%) were taking at least one NEUi at the time of right heart catheterization and were compared with the remaining 36 NEUi non-recipients. NEUi users were older and had a higher cardiovascular risk profile compared to non-recipients. Additionally, NEUi non-users had a higher probability of dying during the course of follow-up than NEUi recipients (56.7% vs 25.9%, log-rank P = 0.020).

CONCLUSION

The above data highlighted a subgroup of patients with PAH and comorbidities for left heart disease in which NEUi use has shown to be associated with improved survival. Future prospective studies are needed to identify the most appropriate therapeutic strategies in this subset population.

Keywords: Pulmonary arterial hypertension, Left heart disease, Neurohormonal inhibitors, Prognostic outcome, Right heart catheterization, Pharmacological treatment

Core Tip: In this observational study we underscored an increase in risk predictors for left heart disease among patients with idiopathic pulmonary arterial hypertension. Data were retrospectively collected from a single-center sample of patients with idiopathic pulmonary arterial hypertension who underwent right heart catheterization from January 1, 2005 to October 31, 2018. Among them, subjects treated with neurohormonal inhibitors showed a significantly better prognostic outcome during the course of follow-up as compared to neurohormonal inhibitor non-recipients.