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 new insights in pharmacological treatment, patents with pulmonary arterial hypertension (PAH) still have a considerably reduced life expectancy.
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.
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.
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.
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).
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.
Future prospective studies are needed to identify the most appropriate therapeutic strategies in this subset population.