PMID- 21531577
OWN - NLM
STAT- MEDLINE
DCOM- 20120126
LR  - 20220311
IS  - 1557-3117 (Electronic)
IS  - 1053-2498 (Linking)
VI  - 30
IP  - 9
DP  - 2011 Sep
TI  - Prognostic factors associated with increased survival in patients with pulmonary 
      arterial hypertension treated with subcutaneous treprostinil in randomized, 
      placebo-controlled trials.
PG  - 982-9
LID - 10.1016/j.healun.2011.03.011 [doi]
AB  - BACKGROUND: Because of the challenges associated with conducting large survival 
      studies of patients with pulmonary arterial hypertension (PAH), we analyzed the 
      surrogate markers predictive of long-term survival in a large cohort of patients 
      treated with subcutaneous treprostinil. METHODS: A retrospective review was 
      conducted using data from a total of 811 patients with New York Heart Association 
      Functional Class (NYHA FC) II to IV PAH, who were treated with subcutaneous 
      treprostinil. Patient baseline disease and on-treatment parameters were analyzed 
      by uni- and multivariate analyses for predictive value of 3-year survival with 
      PAH. RESULTS: Among the baseline disease-related factors analyzed, there was a 
      significantly higher risk of death (p < 0.001) associated with connective tissue 
      disease-associated PAH relative to idiopathic PAH (hazard ratio for death [HR] 
      1.93), NYHA FC IV vs III (HR 2.31), pulmonary vascular resistance index (PVRI) 
      >30 vs </=16 mm Hg/liter/min/m(2) (HR 2.44) and mixed venous oxygen saturation 
      (SVO(2)) </=55% vs >55%. The 6-minute walk distance (6MWD) of </=295 m after 12 weeks 
      of treprostinil treatment was associated with reduced survival at 3 years (58%). 
      A >/=20-m increase from baseline in 6MWD was associated with greater survival (80%) 
      vs smaller walk increments (69%; p = 0.039). Treprostinil dose of >/=40 ng/kg/min 
      (p < 0.001) and every 10-ng/kg/min dose increase (p = 0.009) resulted in improved 
      long-term survival. In a multivariate analysis, only SVO(2), 6MWD and 
      treprostinil dose were significant on-treatment predictors (p < 0.02) of 
      survival. CONCLUSIONS: Disease etiology, baseline factors (NYHA FC, PVRI and 
      SVO(2)) and on-treatment factors (6MWD, SVO(2) and treprostinil dose) were 
      predictors of survival in this study and may be used to aid in treatment 
      optimization.
CI  - Copyright (c) 2011 International Society for Heart and Lung Transplantation. 
      Published by Elsevier Inc. All rights reserved.
FAU - Benza, Raymond L
AU  - Benza RL
AD  - Division of Cardiovascular Diseases, Allegheny General Hospital, Pittsburgh, 
      Pennsylvania 15212, USA. rbenza@wpahs.org
FAU - Gomberg-Maitland, Mardi
AU  - Gomberg-Maitland M
FAU - Naeije, Robert
AU  - Naeije R
FAU - Arneson, Carl P
AU  - Arneson CP
FAU - Lang, Irene M
AU  - Lang IM
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20110504
PL  - United States
TA  - J Heart Lung Transplant
JT  - The Journal of heart and lung transplantation : the official publication of the 
      International Society for Heart Transplantation
JID - 9102703
RN  - 0 (Antihypertensive Agents)
RN  - DCR9Z582X0 (Epoprostenol)
RN  - RUM6K67ESG (treprostinil)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Antihypertensive Agents/administration & dosage/*therapeutic use
MH  - Child
MH  - Child, Preschool
MH  - Dose-Response Relationship, Drug
MH  - Epoprostenol/administration & dosage/*analogs & derivatives/therapeutic use
MH  - Familial Primary Pulmonary Hypertension
MH  - Female
MH  - Humans
MH  - Hypertension, Pulmonary/diagnosis/*drug therapy/*mortality
MH  - Injections, Subcutaneous
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Prognosis
MH  - Retrospective Studies
MH  - Survival Rate
MH  - Treatment Outcome
MH  - Vascular Resistance/physiology
MH  - Young Adult
EDAT- 2011/05/03 06:00
MHDA- 2012/01/27 06:00
CRDT- 2011/05/03 06:00
PHST- 2010/09/30 00:00 [received]
PHST- 2011/03/02 00:00 [revised]
PHST- 2011/03/06 00:00 [accepted]
PHST- 2011/05/03 06:00 [entrez]
PHST- 2011/05/03 06:00 [pubmed]
PHST- 2012/01/27 06:00 [medline]
AID - S1053-2498(11)00873-4 [pii]
AID - 10.1016/j.healun.2011.03.011 [doi]
PST - ppublish
SO  - J Heart Lung Transplant. 2011 Sep;30(9):982-9. doi: 10.1016/j.healun.2011.03.011. 
      Epub 2011 May 4.