Ficcion in the treatment of pulmonary hypertension. does reverse remodeing exist?
P V Paul Vargas, G Sorasio, S C N Silva Croome Nicolas, S J Soricetti Julieta, F M Figueroa Manuel, B E Besmalinoviich Ezequiel, V T Vanegas Tomas, C P Costas Pablo, F I Fernandez Ianina, M M Mercado Mariela, L D Lopez Daiana, P M Perez Maria, L A Lescano AdrianAbstract
Introduction
Pulmonary Hypertension (PH) is an entity with high mortality and morbidity. Few studies have evaluated reverse remodeling of the right heart chambers by echocardiography: right ventricle (RV); right atrium (RA); ventricle-arterial coupling, fractional area change, etc., in PH patients treated with dual or triple therapy, along with hemodynamic changes assessed by right heart catheterization during follow-up.
Objectives
Evaluate, using echocardiography and right heart catheterization, the structural and hemodynamic changes that occur in patients with PH undergoing one year of treatment.
Materials and methods
Multicenter, descriptive, prospective study that included patients with a diagnosis of PH confirmed by right heart catheterization (RHC) between January 2012 and March 2025. Demographic, clinical, and complementary study data (RHC, Doppler echocardiogram, 6-minute walk test [6MWT], laboratory tests) and implemented treatment were collected. Qualitative variables are expressed as percentages (%), and quantitative variables as mean or median with standard deviation (SD) or interquartile range (IQR) depending on the distribution. Student's t-test was used to analyze the different variables at 12 months.
Results
451 patients were included. Mean age of 62 ± 17 years and 66.44% female. Group I: 55.73%. 48% presented with advanced functional class (III/IV). Only 25% covered a distance greater than 440 meters. In relation with hemodynamic variables: 11.11% presented with a cardiac index (CI) less than 2 L/min*m² and 20.67% with a CI between 2 and 2.5 L/min*m². 86.89% had pulmonary vascular resistance >5 WU. Echocardiography showed right ventricular dilation and impaired systolic function in 62.14%. 53.67% were classified as intermediate risk and 18.26% as high risk. 64% received combination therapy and 22% received triple therapy. Regarding echocardiographic parameters it was observed: a 2.4% decrease in right ventricular diastolic diameter (p = 0.01); a 3.2% improvement in TASPE (p = 0.0016); a 2.9% improvement in ventriculo-arterial coupling (TAPSE/PSAP) (p = 0.0049); and a 3.7% increase in fractional area change (FAC) (p = 0.003). Regarding hemodynamic parameters: a 5.2% decrease in pulmonary vascular resistance (PVR) (p = 0.0000); and a 5.1% decrease in mean pulmonary pressure (p = 0.0000). Cardiac index (CI), stroke volume index and right atrial pressure index did not show a significant p-value (p: 0.09; p: 0.05; p: 0.07 respectively).
Conclusion
Patients with pulmonary hypertension treated in our setting present reverse remodeling of the right chamber structure (diastolic diameter of the right ventricle and fractional area change) and improved ventriculo-arterial coupling (TAPSE, TAPSE/PSAP), and a decrease in pulmonary vascular resistance and mean pulmonary arterial preassure at 12 months of treatment.For image description, please refer to the figure legend and surrounding text.