Pneumologie 2019; 73(S 01)
DOI: 10.1055/s-0039-1678191
Posterbegehung (P15) – Sektion Kardiorespiratorische Interaktion
Kardiorespiratorische Interaktionen: Pulmonale Hypertonie
Georg Thieme Verlag KG Stuttgart · New York

Right ventricular size and function under riociguat in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension (the RIVER study)

B Egenlauf
1   Centre for Pulmonary Hypertension, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany, Translational Lung Research Center Heidelberg (Tlrc), Member of the German Center for Lung Research (Dzl)
,
AM Marra
2   Centre for Pulmonary Hypertension at the Thoraxclinic, University Hospital Heidelberg, Heidelberg, Germany, Translational Lung Research Center Heidelberg (Tlrc), Member of the German Center for Lung Research (Dzl); Irccs Sdn, Naples Italy
,
S Harutyunova
1   Centre for Pulmonary Hypertension, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany, Translational Lung Research Center Heidelberg (Tlrc), Member of the German Center for Lung Research (Dzl)
,
M Halank
3   Department of Internal Medicine I, Pneumology, University Hospital Dresden, Germany
,
N Benjamin
1   Centre for Pulmonary Hypertension, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany, Translational Lung Research Center Heidelberg (Tlrc), Member of the German Center for Lung Research (Dzl)
,
E Bossone
4   Cardiology Division, A. Cardarelli Hospital, Naples, Italy
,
A Cittadini
5   Department of Translational Medical Sciences, “federico” University, Naples, Italy
,
C Eichstaedt
6   Centre for Pulmonary Hypertension, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (Tlrc), Member of the German Center for Lung Research (Dzl); Institute of Human Genetics, University Hospital Heidelberg
,
C Fischer
7   Institute of Human Genetics, University Hospital Heidelberg, Heidelberg, Germany
,
H Gall
8   Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (Ugmlc), Member of the German Center for Lung Research (Dzl), Giessen, Germany
,
HA Ghofrani
8   Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (Ugmlc), Member of the German Center for Lung Research (Dzl), Giessen, Germany
,
MM Hoeper
9   Department of Respiratory Medicine, Member of the German Center for Lung Research (Dzl), Hannover Medical School, Germany
,
TJ Lange
10   Department of Internal Medicine II, Division of Pneumology, University Medical Center Regensburg, Germany
,
KM Olsson
9   Department of Respiratory Medicine, Member of the German Center for Lung Research (Dzl), Hannover Medical School, Germany
,
E Grünig
1   Centre for Pulmonary Hypertension, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany, Translational Lung Research Center Heidelberg (Tlrc), Member of the German Center for Lung Research (Dzl)
› Author Affiliations
Further Information

Publication History

Publication Date:
19 February 2019 (online)

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    Background Riociguat is a soluble guanylate cyclase stimulator approved for pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTPEH). The objective of this study was to evaluate right heart size and function assessed by echocardiography during long term treatment with riociguat.

    Methods Patients who started riociguat treatment (1.0 – 2.5 mg tid) within the trials phase II, PATENT, PATENTplus, EAS, CHEST and continued treatment for 3 – 12 months were included in this study. Echocardiography was analysed off-line at baseline, after 3, 6 and 12 months by investigators who were blinded to clinical data. Last and baseline observation carried forward method (LOCF, BOCF) were performed as sensitivity analysis.

    Results Seventy-one patients (45% PAH, 55% CTEPH; 53.5% female; 60 ± 13years, mean pulmonary arterial pressure 46 ± 10 mmHg, mean PVR 700 ± 282dynes·sec·cm-5) were included. After 6 months, RA and RV area, RV thickness tricuspid regurgitation velocity showed a significant reduction. After 12 months, patients receiving riociguat therapy showed a significant reduction in right atrial (−2.6 ± 4.4 cm2, 95% CI −3.84, −1.33; p < 0.001, n = 49) and right ventricular (RV) area (−3.5 ± 5.2 cm2, 95% CI −5.1, −1.9; p < 0.001; n = 44), RV thickness (−0.76 ± 2.2 mm, 95% CI −1.55, 0.03), and a significant increase in TAPSE (2.95 ± 4.78 mm, 95% CI 1.52, 4.39) and RV fractional area change (8.12 ± 8.87 mm, 95% CI 4.61, 11.62).

    Both LOCF and BOCF showed similar results but lower effect sizes.

    Conclusion Patients under long-term treatment with riociguat show significantly reduced right heart size and improved RV function in PAH and CTEPH. Further controlled prospective studies are needed to confirm these results.


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