Does the inhaled nitric oxide pulmonary vasodilation test predict the therapeutic response in pulmonary hypertension associated with chronic respiratory diseases?

Résumé fourni par la source

Background. Pulmonary hypertension (PH) is a common complication in patients with chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD), being one of the most aggravating prognostic factors. Methods. Prospective study of patients referred to the Multidisciplinary Pulmonary Vascular Unit of the Hospital Dr. Negrín diagnosed with group III PH by catheterisation. The aim of the study is to evaluate the vasodilator capacity with inhaled nitric oxide (inhNO) 20ppm in patients of group III PH, hemodynamic characteristics and its implications. Patients with pulmonary vascular resistance (PVR) >5UW were included. The test was considered positive if PVR decreased by at least 20% and PaO2 was not reduced by more than 20%. Results. From a series of 72 patients, a total of 30 patients were selected, 19 with COPD, 9 with ILD, 2 with obstructive sleep apnea. Mean age was 72±7, mostly male (63%). After treatment, patients with positive inhNO vasodilation test showed improvement in functional class compared to those with negative test and in NT-proBNP levels (723±688 vs 2498±2912pg/mL respectively; p=0.035). Only patients with positive inhNO vasodilation test improved TM6M after treatment (233±75 vs 314±92m, p=0.001). Vasoreactive patients had longer survival than non-vasoreactive patients at 1 year (100% vs 55% respectively), 3 years (75% vs 33% respectively) and 5 years (62.5% vs 22% respectively); p=0.017. Conclusions. Among patients with severe PH associated with respiratory disease, the presence of positive vasoreactivity test with inhNO predicts a better therapeutic response in terms of survival.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.