PMID- 32933828
OWN - NLM
STAT- MEDLINE
DCOM- 20210928
LR  - 20210928
IS  - 1557-3117 (Electronic)
IS  - 1053-2498 (Linking)
VI  - 39
IP  - 12
DP  - 2020 Dec
TI  - Hemodynamics and risk assessment 2 years after the initiation of upfront 
      ambrisentan‒tadalafil in pulmonary arterial hypertension.
PG  - 1389-1397
LID - S1053-2498(20)31706-X [pii]
LID - 10.1016/j.healun.2020.08.016 [doi]
AB  - BACKGROUND: Upfront combination therapy with ambrisentan and tadalafil has been 
      reported to improve the condition of patients with pulmonary arterial 
      hypertension (PAH) more than with either drug alone. However, little is known 
      about the long-term associated changes in hemodynamics and risk assessment 
      scores. METHODS: This was a multicenter, retrospective analysis of clinical data 
      in 106 patients with newly diagnosed PAH. Clinical evaluations, including 
      demographics, medical history, World Health Organization (WHO) functional class 
      (FC) and 6-minute walk distance (6MWD), right heart catheterization, and Registry 
      to Evaluate Early and Long-Term PAH Disease Management (REVEAL) risk score 2.0, 
      were assessed over 48 months of ambrisentan‒tadalafil therapy. RESULTS: At 
      baseline, 9 patients (9%) showed a low (<7), 48 patients (45%) showed an 
      intermediate (7-8), and 49 patients (46%) showed a high (>8) REVEAL risk score. 
      At a median follow-up of 2 years, 45 patients (43%) showed a low, 47 patients 
      (44%) showed an intermediate, and 14 patients (13%) showed a high REVEAL score, 
      along with improvements in WHO FC, 6MWD and a decrease in mean pulmonary artery 
      pressure and N-terminal pro brain natriuretic peptide (all p < 0.001). Pulmonary 
      vascular resistance (PVR) decreased by 37% from 11.5 +/- 6.5 to 7.2 +/- 4.1 Wood 
      units (p < 0.001). A total of 61 patients (57%) remained in intermediate-risk or 
      high-risk categories. Low-risk patients had either a decrease in PVR of >50% or a 
      stroke volume within the limits of normal. CONCLUSIONS: Initial combination 
      therapy with ambrisentan and tadalafil in PAH improves the REVEAL risk score in 
      proportion to decreased PVR and preserved stroke volume but still insufficiently 
      so in approximately 50% of the patients.
CI  - Copyright (c) 2020 International Society for Heart and Lung Transplantation. 
      Published by Elsevier Inc. All rights reserved.
FAU - D'Alto, Michele
AU  - D'Alto M
AD  - Department of Cardiology, Monaldi Hospital, "L. Vanvitelli" University, Naples, 
      Italy; Italian Pulmonary Hypertension Network (iPHnet), Italy. Electronic 
      address: mic.dalto@tin.it.
FAU - Badagliacca, Roberto
AU  - Badagliacca R
AD  - Italian Pulmonary Hypertension Network (iPHnet), Italy; Department of Cardiology, 
      La Sapienza University, Rome, Italy.
FAU - Lo Giudice, Francesco
AU  - Lo Giudice F
AD  - Italian Pulmonary Hypertension Network (iPHnet), Italy; National Heart 
      and Lung Institute, Faculty of Medicine, Imperial College London, London, United 
      Kingdom.
FAU - Argiento, Paola
AU  - Argiento P
AD  - Department of Cardiology, Monaldi Hospital, "L. Vanvitelli" University, Naples, 
      Italy; Italian Pulmonary Hypertension Network (iPHnet), Italy.
FAU - Casu, Gavino
AU  - Casu G
AD  - Italian Pulmonary Hypertension Network (iPHnet), Italy; Department of Cardiology, 
      Ospedale San Francesco, Nuoro, Italy.
FAU - Corda, Marco
AU  - Corda M
AD  - Italian Pulmonary Hypertension Network (iPHnet), Italy; Department of Cardiology, 
      Ospedale Brotzu, Cagliari, Italy.
FAU - Correale, Michele
AU  - Correale M
AD  - Italian Pulmonary Hypertension Network (iPHnet), Italy; Department of Cardiology, 
      Ospedali Riuniti University Hospital, Foggia, Italy.
FAU - Ghio, Stefano
AU  - Ghio S
AD  - Italian Pulmonary Hypertension Network (iPHnet), Italy; Department of Cardiology, 
      Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
FAU - Greco, Alessandra
AU  - Greco A
AD  - Italian Pulmonary Hypertension Network (iPHnet), Italy; Department of Cardiology, 
      Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
FAU - Lattanzio, Mariangela
AU  - Lattanzio M
AD  - Italian Pulmonary Hypertension Network (iPHnet), Italy; Department of 
      Cardiovascular Disease, Fondazione Macchi ASST Sette Laghi, University of 
      Insubria, Varese, Italy.
FAU - Mercurio, Valentina
AU  - Mercurio V
AD  - Italian Pulmonary Hypertension Network (iPHnet), Italy; Department of 
      Translational Medical Sciences, Federico II University, Naples, Italy.
FAU - Paciocco, Giuseppe
AU  - Paciocco G
AD  - Italian Pulmonary Hypertension Network (iPHnet), Italy; Department of 
      Pulmonology, University of Milano-Bicocca, Monza, Italy.
FAU - Papa, Silvia
AU  - Papa S
AD  - Italian Pulmonary Hypertension Network (iPHnet), Italy; Department of Cardiology, 
      La Sapienza University, Rome, Italy.
FAU - Prediletto, Renato
AU  - Prediletto R
AD  - Italian Pulmonary Hypertension Network (iPHnet), Italy; Department of 
      Pulmonology, CNR Tuscany Region Gabriele Monasterio Foundation and Institute of 
      Clinical Physiology, Pisa, Italy.
FAU - Romeo, Emanuele
AU  - Romeo E
AD  - Department of Cardiology, Monaldi Hospital, "L. Vanvitelli" University, Naples, 
      Italy; Italian Pulmonary Hypertension Network (iPHnet), Italy.
FAU - Russo, Maria Giovanna
AU  - Russo MG
AD  - Department of Cardiology, Monaldi Hospital, "L. Vanvitelli" University, Naples, 
      Italy.
FAU - Tayar, Alessandro
AU  - Tayar A
AD  - National Heart and Lung Institute, Faculty of Medicine, Imperial College London, 
      London, United Kingdom.
FAU - Vitulo, Patrizio
AU  - Vitulo P
AD  - Italian Pulmonary Hypertension Network (iPHnet), Italy; Cardiothoracic and 
      transplant Department, IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad 
      Alta Specializzazione (ISMETT), Palermo, Italy.
FAU - Vizza, Carmine Dario
AU  - Vizza CD
AD  - Italian Pulmonary Hypertension Network (iPHnet), Italy; Department of Cardiology, 
      La Sapienza University, Rome, Italy.
FAU - Golino, Paolo
AU  - Golino P
AD  - Department of Cardiology, Monaldi Hospital, "L. Vanvitelli" University, Naples, 
      Italy.
FAU - Naeije, Robert
AU  - Naeije R
AD  - Department of Pathophysiology, Free University of Brussels, Brussels, Belgium.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20200828
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  - 0 (Phenylpropionates)
RN  - 0 (Pyridazines)
RN  - 0 (Vasodilator Agents)
RN  - 742SXX0ICT (Tadalafil)
RN  - HW6NV07QEC (ambrisentan)
SB  - IM
MH  - Antihypertensive Agents/therapeutic use
MH  - Drug Therapy, Combination
MH  - Female
MH  - Follow-Up Studies
MH  - Hemodynamics/drug effects/*physiology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Phenylpropionates/*therapeutic use
MH  - Pulmonary Arterial Hypertension/drug therapy/*physiopathology
MH  - Pyridazines/*therapeutic use
MH  - Retrospective Studies
MH  - Risk Assessment/*methods
MH  - Tadalafil/*therapeutic use
MH  - Time Factors
MH  - Treatment Outcome
MH  - Vasodilator Agents/therapeutic use
OTO - NOTNLM
OT  - European risk score
OT  - REVEAL risk score
OT  - combination therapy
OT  - prognosis
OT  - pulmonary arterial hypertension
OT  - risk assessment
COIS- Disclosure statement M.D.A., R.B., C.D.V., S.G. received fees for participating 
      in advisory boards and received benefits (travel and accommodation for scientific 
      meetings) from Actelion, Bayer, Dompe, Ferrer, GlaxoSmithKline, and Merck Sharp & 
      Dohme. P.A. received fees for participating in advisory boards and received 
      benefits (travel and accommodation for scientific meetings) from Actelion, Dompe, 
      GlaxoSmithKline, and Merck Sharp & Dohme. G.C. received fees for participating in 
      advisory boards and received benefits (travel and accommodation for scientific 
      meetings) from Actelion, Bayer, Dompe, Merck Sharp & Dohme, Boehringer Ingelheim, 
      AstraZeneca, Boston Scient, Servier, Sanofi, Amgen, and Novartis. M.C. received 
      grants for advisory board by GlaxoSmithKline and Janssen. R.P. received 
      economical support for advisory boards and travel and accommodation for 
      scientific meetings from Actelion, GlaxoSmithKline, and Bayer. E.R. received fees 
      for participating in advisory boards and received benefits (travel and 
      accommodation for scientific meetings) from Actelion, Dompe, GlaxoSmithKline, and 
      Merck Sharp & Dohme. V.M. received a research fellowship grant from the European 
      Respiratory Society. R.N. has relationships with AOP Orphan Pharmaceuticals, 
      Actelion, Reata Pharmaceuticals, Lung Biotechnology Corporation, and United 
      Therapeutics. The remaining authors have no conflict of interest to disclose.
EDAT- 2020/09/17 06:00
MHDA- 2021/09/29 06:00
CRDT- 2020/09/16 05:31
PHST- 2020/04/16 00:00 [received]
PHST- 2020/08/26 00:00 [revised]
PHST- 2020/08/26 00:00 [accepted]
PHST- 2020/09/17 06:00 [pubmed]
PHST- 2021/09/29 06:00 [medline]
PHST- 2020/09/16 05:31 [entrez]
AID - S1053-2498(20)31706-X [pii]
AID - 10.1016/j.healun.2020.08.016 [doi]
PST - ppublish
SO  - J Heart Lung Transplant. 2020 Dec;39(12):1389-1397. doi: 
      10.1016/j.healun.2020.08.016. Epub 2020 Aug 28.