Published online Mar 9, 2022. doi: 10.5492/wjccm.v11.i2.85
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
Processing time: 329 Days and 7.7 Hours
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 neuroho
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.
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.
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).
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.
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.