Cardiac MRI Metrics Help Stratify Mortality Risk in Pulmonary Arterial Hypertension - Pulmonology Advisor

Cardiac MRI Metrics Help Stratify Mortality Risk in Pulmonary Arterial Hypertension - Pulmonology Advisor
Cardiopulmonary Exercise Testing Plus Screening Algorithm Useful in SSc-Related Pulmonary Hypertension - Rheumatology Advisor
Bayer Announces Recipients of the Pulmonary Hypertension Accelerated Bayer (PHAB) Awards at CHEST Annual Meeting 2019 - PRNewswire
30 Days of PH: Advocacy - Pulmonary Hypertension News

Posted: 06 Nov 2019 03:30 AM PST

In patients with pulmonary arterial hypertension (PAH), cardiac magnetic resonance imaging (MRI) metrics are capable of identifying individuals at low risk for 1-year mortality, making cardiac MRI an effective additive risk stratification tool in this population, according to study results published in the American Journal of Respiratory and Critical Care Medicine.

The ASPIRE (Assessing the Spectrum of Pulmonary Hypertension Identified at a Referral Centre) cardiac MRI database was used to identify consecutive patients with PAH (n=438) undergoing cardiac MRI between April 2012 and March 2017. After imaging, operators who were blinded to patient diagnoses and cardiac catheter results analyzed imaging. Investigators identified thresholds in a discovery cohort, which were then assessed in a test cohort.

Cardiac MRI parameters were evaluated in the discovery cohort for their associated risk for 1-year mortality. Both univariate and multivariate analyses of demographics, hemodynamics, and MRI parameters were performed among the whole cohort. To determine whether cardiac MRI could be an additional risk stratification tool, the researchers also calculated the REVEAL 2.0 Risk Score and number of low-risk criteria by the French Pulmonary Hypertension Registry in the incident population. Electronic data from the National Health Service Personal Demographics Service provided mortality data.

A total of 63% of patients were stratified as low risk (<5%) of 1-year mortality, using a right ventricular end systolic volume index percentage predicted threshold of 227%. A left ventricular end diastolic volume index of 58 mL/m² was also capable of identifying 34% of patients at low risk for 1-year mortality. Several right ventricular ejection fraction (RVEF) thresholds were also established for identifying 1-year mortality risk.

An RVEF of >54% identified 21% of patients as low risk, an RVEF of 37% to 54% identified 43% of patients as intermediate risk, and an RVEF of <37% identified 36% of patients as high risk. The use of right ventricular end systolic volume index percent predicted improved risk stratification for 1-year mortality when used with the REVEAL 2.0 risk score calculator or a modified French Pulmonary Hypertension registry approach.

Limitations of the study included the relatively small sample size, as well as the lack of external validation of the MRI metrics for predicting 1-year mortality in patients with PAH.

The findings from this study provide clinical relevance for the care of the patients with PAH, the researchers wrote, as the "[i]dentification and maintenance of a low-risk status remains the goal of current treatment strategies."

Reference

Lewis RA, Johns CS, Cogliano M, et al. Identification of cardiac MRI thresholds for risk stratification in pulmonary arterial hypertension [published online October 24, 2019]. Am J Respir Crit Care Med. doi:10.1164/rccm.201909-1771OC

Topics:

Pulmonary Arterial Hypertension Pulmonary Hypertension

Cardiopulmonary Exercise Testing Plus Screening Algorithm Useful in SSc-Related Pulmonary Hypertension - Rheumatology Advisor

Posted: 06 Nov 2019 08:00 AM PST

Cardiopulmonary exercise testing in combination with the DETECT algorithm may be a useful tool in screening patients with systemic sclerosis (SSc) for pulmonary arterial hypertension, according to results of a report published in Rheumatology.

Consecutive adult patients with SSc were screened using the DETECT algorithm between June 2017 and February 2019. Pulmonary function tests were performed and blood samples were collected according to the DETECT approach.

In total, 314 patients with SSc were screened and 96 met the DETECT entry criteria. Of these patients, 76 passed DETECT step 1, and 54 passed step 2; these patients were referred for cardiopulmonary exercise testing and right-heart catheterization.

Overall, 42.6% of patients had precapillary pulmonary hypertension; 5.5% had postcapillary pulmonary hypertension. Pulmonary arterial hypertension was identified in 31.5% of patients, according to the European Society of Cardiology/European Respiratory Society 2015 guidelines. High-resolution computed tomography scans identified interstitial lung disease in 7 patients, 4 of whom had mild cases and 3 of whom had intermediate cases.

Investigators found that minute ventilation to carbon dioxide production (VE/VCO₂) at the first ventilatory threshold had a sensitivity of 1.0 in 63% of models, a median sensitivity of 1.0 (range, 0.857-1.000), and a specificity of 0.833 (range, 0.769-0.882). Positive predictive and negative predictive values were 0.7 and 1.0 (ranges, 0.6-0.8 and 0.923-1.000), respectively. The sensitivity of the VE/VCO₂ slope was 1.0 in 87% of models, with a median sensitivity of 1.0, a specificity of 0.778, a positive predictive value of 0.636, and a negative predictive value of 1.0.

When considering precapillary pulmonary hypertension, the investigators found that the VE/VCO₂ at the first ventilatory threshold had a sensitivity of 1.0, a specificity of 0.455, a positive predictive value of 0.571, and a negative predictive value of 1.0 with perfect sensitivity in 63.1% of models. In addition, the VE/VCO₂ slope had a sensitivity of 1.0, a specificity of 0.714, a positive predictive value of 0.714, and a negative predictive value of 1.0, with a maximum sensitivity in 63.7% of models.

No other cardiopulmonary exercise testing or echocardiographic variables had a substantial effect on DETECT performance.

Study limitations included the small sample size and lack of external population; researchers were unable to test the generalizability of their approach.

"[Cardiopulmonary exercise testing] appears to be a promising, noninvasive tool in the screening workup for SSc-related pulmonary hypertension," the researchers concluded.

Reference

Santaniello A, Casella R, Vicenzi M, et al. Cardiopulmonary exercise testing in a combined screening approach to individuate pulmonary arterial hypertension in systemic sclerosis [published online October 21, 2019]. Rheumatology. doi:10.1093/rheumatology/kez473

Topics:

Pulmonary Hypertension Scleroderma Systemic Sclerosis

Bayer Announces Recipients of the Pulmonary Hypertension Accelerated Bayer (PHAB) Awards at CHEST Annual Meeting 2019 - PRNewswire

Posted: 21 Oct 2019 12:00 AM PDT

WHIPPANY, N.J., Oct. 21, 2019 /PRNewswire/ -- Bayer today announced recipients of the inaugural Pulmonary Hypertension Accelerated Bayer (PHAB) Awards, a U.S.-based research grant program created to support clinical research in pulmonary hypertension (PH), with a focus on pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). The recipients will receive a combined total of $1 million in grants over a two-year period, making the PHAB Awards one of the largest industry-funded grant programs focused on PAH and CTEPH in the U.S. The eight award recipients were formally announced at a ceremony during the American College of Chest Physicians (CHEST) Annual Meeting in New Orleans on Sunday, October 20, 2019.

"Supporting a new generation of researchers is imperative to ensure we continue the progress that has been made during the past decade in pulmonary hypertension and its related conditions," said Aleksandra Vlajnic, M.D., Senior Vice President & Head Medical Affairs Americas at Bayer. "Our hope is that the PHAB Awards program will encourage researchers to think creatively about solving the significant treatment and patient care challenges that remain, knowing Bayer is committed to providing the support needed to help bring those ideas to fruition. We want to congratulate all of the applicants on their winning proposals."

The recipients are:

Andrew J. Bryant, M.D., Assistant Professor of Medicine, University of Florida College of Medicine, Gainesville, FL will study the uncertain relationship between myeloid cells (or bone-marrow derived cells), circadian rhythm and PH and apply this knowledge to evaluate the use of existing treatments for patients with PH.
Francisco Contijoch, Ph.D., Assistant Professor, University of California at San Diego, San Diego, CA will study the effectiveness of different imaging modalities to determine if pre-operative, imaging-based prediction of surgical disease level could be utilized to assess risk-benefit of pulmonary thromboendarterectomy (PTE) surgery.
Michael Insel, M.D., Pulmonary Critical Care Fellow, University of Arizona Department of Medicine, Tucson, AZ will study the different causes of shortness of breath in patients who have suffered a pulmonary embolism using invasive cardiopulmonary exercise testing.
Sonia Jasuja, M.D., Fellow Physician, David Geffen School of Medicine at UCLA, Los Angeles, CA will study the use of impedance cardiography, a non-invasive technology measuring cardiac output and stroke volume, to assess risk and response to treatment in patients with PAH or CTEPH.
Manreet Kanwar, M.D., Associate Professor, Allegheny General Hospital, Pittsburgh, PA will study the role of medical therapy, in treating patients with chronic thromboembolic disease (CTED), who have symptoms of shortness of breath, to help understand progression between CTED and CTEPH and evaluate treatment options.
Lea Ann Matura, Ph.D., Associate Professor, School of Nursing, University of Pennsylvania, PA will study alternative treatments, such as Cognitive Behavioral Therapy and Bright Light Therapy, to improve symptoms of PAH, including insomnia, fatigue and physical activity levels.
Yogesh Reddy, M.D., M.Sc., Instructor of Medicine, Mayo Clinic, Rochester, MN will study the prevalence of atypical PAH in elderly patients, as well as their response to therapy using invasive exercise hemodynamic testing.
Maria Trivieri, M.D., Ph.D., Assistant Professor, Icahn School of Medicine at Mount Sinai, New York, NY will work to develop a new in-vitro way to generate human species-specific, and even patient-specific stem cells, to examine the underlying mechanisms of vascular pathogenesis to advance disease understanding, to make greater inroads in the treatment of PAH.

The PHAB Awards recipients were selected by an independent Grants Review Committee, consisting of the following eminent PH leaders:

William Auger, M.D., Temple University Medical Center, Philadelphia, PA
Raymond L. Benza, M.D., FACC, FCCP, Temple University School of Medicine, Cardiovascular Institute, Allegheny Health Network, Pittsburgh, PA
Hunter Champion M.D., Ph.D., Southeastern Cardiology, Columbus, GA
Rajan Saggar, M.D., Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, CA
Roxana Sulica, M.D., NYU Langone Medical Center, Beth Israel Medical Center, New York, NY
Aaron Waxman, M.D., Ph.D., Brigham and Women's Hospital, Pulmonary Vascular Disease Program, Boston, MA
Melisa Wilson, APRN, ACNP-BC, Florida Hospital Orlando, Center for Pulmonary Hypertension and Cardiovascular Disease, Orlando, FL

"I would like to thank and recognize the Grants Review Committee for their time and commitment, and the PH community in the U.S. for their overwhelming response to the inaugural PHAB Awards," said Sameer Bansilal, M.D., M.S., Medical Director, U.S. Medical Affairs at Bayer. "We look forward to an even greater response next year and encourage eligible applicants to start thinking about submitting their research proposals."

The PHAB Award eligibility, review and category criteria were modeled after the National Institutes of Health (NIH) system; entries were graded on significance, investigator(s), innovation, approach, and environment.

For more information on the PHAB Awards visit: https://www.phab-awards.com/awards/ or e-mail PHAB.awards@bayer.com.

Grants were made on the merits of the research, and research must be posted on ClinicalTrials.gov. Every effort should be made to publish or present study outcomes. If the research is not conducted the grant must be returned.

About Pulmonary Arterial Hypertension (PAH)
Pulmonary Arterial Hypertension (PAH, WHO Group 1) is defined by elevated pressure in the arteries going from the right side of the heart to the lungs. Typical symptoms of PAH include shortness of breath on exertion, fatigue, weakness, chest pain and syncope. PAH is caused by abnormalities in the walls of the pulmonary arteries.^1,2

About Chronic Thromboembolic Pulmonary Hypertension (CTEPH)
Chronic Thromboembolic Pulmonary Hypertension (CTEPH, WHO Group 4) is a progressive type of pulmonary hypertension, in which it is believed that thromboembolic occlusion (organized blood clots) of pulmonary vessels gradually lead to an increased blood pressure in the pulmonary arteries, resulting in an overload of the right heart.^3,4 CTEPH may evolve after prior episodes of acute pulmonary embolism, but the pathogenesis is not yet completely understood. The standard and potentially curative treatment for CTEPH is pulmonary thromboendarterectomy (PTE), a surgical procedure in which the blood vessels of the lungs are cleared of clot and scar material.^5,6 However, a considerable number of patients with CTEPH (20%-40%) are not operable and in up to 35 percent of patients, the disease persists or reoccurs after PTE.⁷

About Bayer
Bayer is a global enterprise with core competencies in the life science fields of health care and nutrition. Its products and services are designed to benefit people by supporting efforts to overcome the major challenges presented by a growing and aging global population. At the same time, the Group aims to increase its earning power and create value through innovation and growth. Bayer is committed to the principles of sustainable development, and the Bayer brand stands for trust, reliability and quality throughout the world. In fiscal 2018, the Group employed around 117,000 people and had sales of 39.6 billion euros. Capital expenditures amounted to 2.6 billion euros, R&D expenses to 5.2 billion euros. For more information, go to www.bayer.us.

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Forward-Looking Statements
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References:
¹ Galie et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart. 2016;37:67–119.
²American Lung Association. Pulmonary Hypertension. Accessed November 22, 2017. http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/pulmonary-hypertension.
³ Piazza G and Goldhaber SZ. Chronic thromboembolic pulmonary hypertension. N Engl J Med. 2011; 364: 351-360.
⁴ Simonneau G et al. Updated Clinical Classification of Pulmonary Hypertension. Journal of the American College of Cardiology. 2013; 62(25):
⁵ D'Armini M. Diagnostic advances and opportunities in chronic thromboembolic pulmonary hypertension. Eur Respir Rev. 2015; 24: 253–262.
⁶ Kim et al. Chronic thromboembolic pulmonary hypertension. J Am Coll Cardiol. 2013; 62: D92-9.
⁷ Mathai et al. Quality of life in patients with chronic thromboembolic pulmonary hypertension. Eur Respir J. 2016 Aug; 48(2): 526–537.

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