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
ARTICLE HIGHLIGHTS
Research background

Despite new insights in pharmacological treatment, patents with pulmonary arterial hypertension (PAH) still have a considerably reduced life expectancy.

Research motivation

Chronic hyperactivity of the neurohormonal axis has been shown to be detrimental in PAH, thus providing novel insights on the role of neurohormonal inhibitors (NEUi) as a new potential therapeutic target.

Research objectives

To assess the use and prognostic impact of NEUi in a single-center cohort of subjects with idiopathic PAH and risk factors for left heart disease.

Research methods

This was a single-center, retrospective observational study, involving 57 subjects with idiopathic PAH, confirmed by right heart catheterization. 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.

Research results

NEUi users were significantly older (67.6 ± 11.9 years vs 60.1 ± 14.5 years, P = 0.039), had a higher body mass index (25.9 ± 4.4 vs 23.5 ± 3.5, P = 0.025), a lower estimated glomerular filtration rate (58.7 ± 22.7 mL/min/1.73 m2vs 73.7 ± 24.7 mL/min/1.73 m2, P = 0.022) and more frequent systemic arterial hypertension (74.1% vs 40.0%, P = 0.020) and smoking habits (51.9% vs 20.0%, P = 0.025) compared to non-recipients. Mortality rate was significantly higher among NEUi non-users than in NEUi users (56.7% vs 25.9%, P = 0.038). NEUi non-users were more likely to die over the course of follow-up (log-rank P = 0.020).

Research conclusions

Our analysis highlighted a subset of patients with PAH and cardiovascular comorbidities in which NEUi use has been shown to be associated with improved survival.

Research perspectives

Future prospective studies are needed to identify the most appropriate therapeutic strategies in this subset population.