Prostacyclin pathway vasodilators in patients with chronic thromboembolic pulmonary hypertension (CTEPH): A systemic review and meta‐analysis of randomized controlled trials
Abstract Although surgical and interventional therapy has emerged as the primary treatment for patients with chronic thromboembolic pulmonary hypertension (CTEPH), there remains a subset of patients who need medication therapy. This study aimed to evaluate the efficacy and safety outcomes of prostac...
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| Format: | Article |
| Language: | English |
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Wiley
2024-10-01
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| Series: | Pulmonary Circulation |
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| Online Access: | https://doi.org/10.1002/pul2.70001 |
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| author | Weijun Li Xingxue Pang Jun Chen Xiaoxia Ren Huaibing Zhao Xu Wang Ning Zhao Dayi Hu Zhongyi Jin |
| author_facet | Weijun Li Xingxue Pang Jun Chen Xiaoxia Ren Huaibing Zhao Xu Wang Ning Zhao Dayi Hu Zhongyi Jin |
| author_sort | Weijun Li |
| collection | DOAJ |
| description | Abstract Although surgical and interventional therapy has emerged as the primary treatment for patients with chronic thromboembolic pulmonary hypertension (CTEPH), there remains a subset of patients who need medication therapy. This study aimed to evaluate the efficacy and safety outcomes of prostacyclin pathway vasodilators, providing further insight for clinical decision‐making. A literature search was conducted in PubMed, Embase, and CENTRAL databases from inception to December 2023. Literature screening and quality assessment were carried out with the Cochrane Risk of Bias Tool. Data analysis was conducted using RevMan 5.4 software. We included 6 randomized controlled trials with 387 patients. Prostacyclin pathway vasodilators demonstrated a significant improvement in PVR (−125.26 dynes·sec·cm−5, 95%CI: −219.29 to −31.23, Z = 2.61, and p < 0.009), RAP (−0.78 mmHg, 95%CI: −1.52 to −0.04, Z = 2.06, and p = 0.04), cardiac index (0.62, 95%CI: 0.54 to 0.69, Z = 16.13, and p < 0.00001), and the number of patients showing improvement in WHO functional class (3.86, 95%CI: 1,92 to 7.77, Z = 3.79, and p = 0.0002) compared to controls, moreover, a trend towards improvement was observed in mPAP, 6MWD, and NT‐proBNP. Regarding the safety endpoints, no significant difference was found in both groups in terms of serious adverse events and all‐cause deaths. The prostacyclin pathway vasodilators present therapeutic potential for CTEPH patients with inoperable or persistent/recurrent PH after PEA/BPA primarily characterized by distal small‐vessel and microvasculopathy. However, the current clinical evidence remains insufficient and controversial, necessitating further validation. |
| format | Article |
| id | doaj-art-a1136c7588b94e2bbd0bda8f8a59ef37 |
| institution | Kabale University |
| issn | 2045-8940 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Pulmonary Circulation |
| spelling | doaj-art-a1136c7588b94e2bbd0bda8f8a59ef372024-12-27T05:54:34ZengWileyPulmonary Circulation2045-89402024-10-01144n/an/a10.1002/pul2.70001Prostacyclin pathway vasodilators in patients with chronic thromboembolic pulmonary hypertension (CTEPH): A systemic review and meta‐analysis of randomized controlled trialsWeijun Li0Xingxue Pang1Jun Chen2Xiaoxia Ren3Huaibing Zhao4Xu Wang5Ning Zhao6Dayi Hu7Zhongyi Jin8Department of Cardiovascular Medicine, Dongzhimen Hospital Beijing University of Chinese Medicine Beijing People's Republic of ChinaDepartment of Cardiovascular Medicine, Dongzhimen Hospital Beijing University of Chinese Medicine Beijing People's Republic of ChinaCapital Medical University Beijing People's Republic of ChinaDepartment of Cardiovascular Medicine, Dongzhimen Hospital Beijing University of Chinese Medicine Beijing People's Republic of ChinaDepartment of Cardiovascular Medicine, Dongzhimen Hospital Beijing University of Chinese Medicine Beijing People's Republic of ChinaDepartment of Cardiovascular Medicine, Dongzhimen Hospital Beijing University of Chinese Medicine Beijing People's Republic of ChinaDepartment of Geriatrics Chui Yang Liu Hospital Affiliated to Tsinghua University Beijing People's Republic of ChinaDepartment of Cardiology Peking University People's Hospital Beijing People's Republic of ChinaDepartment of Cardiovascular Medicine, Dongzhimen Hospital Beijing University of Chinese Medicine Beijing People's Republic of ChinaAbstract Although surgical and interventional therapy has emerged as the primary treatment for patients with chronic thromboembolic pulmonary hypertension (CTEPH), there remains a subset of patients who need medication therapy. This study aimed to evaluate the efficacy and safety outcomes of prostacyclin pathway vasodilators, providing further insight for clinical decision‐making. A literature search was conducted in PubMed, Embase, and CENTRAL databases from inception to December 2023. Literature screening and quality assessment were carried out with the Cochrane Risk of Bias Tool. Data analysis was conducted using RevMan 5.4 software. We included 6 randomized controlled trials with 387 patients. Prostacyclin pathway vasodilators demonstrated a significant improvement in PVR (−125.26 dynes·sec·cm−5, 95%CI: −219.29 to −31.23, Z = 2.61, and p < 0.009), RAP (−0.78 mmHg, 95%CI: −1.52 to −0.04, Z = 2.06, and p = 0.04), cardiac index (0.62, 95%CI: 0.54 to 0.69, Z = 16.13, and p < 0.00001), and the number of patients showing improvement in WHO functional class (3.86, 95%CI: 1,92 to 7.77, Z = 3.79, and p = 0.0002) compared to controls, moreover, a trend towards improvement was observed in mPAP, 6MWD, and NT‐proBNP. Regarding the safety endpoints, no significant difference was found in both groups in terms of serious adverse events and all‐cause deaths. The prostacyclin pathway vasodilators present therapeutic potential for CTEPH patients with inoperable or persistent/recurrent PH after PEA/BPA primarily characterized by distal small‐vessel and microvasculopathy. However, the current clinical evidence remains insufficient and controversial, necessitating further validation.https://doi.org/10.1002/pul2.70001chronic thromboembolic pulmonary hypertensionprostacyclinpulmonary hypertension |
| spellingShingle | Weijun Li Xingxue Pang Jun Chen Xiaoxia Ren Huaibing Zhao Xu Wang Ning Zhao Dayi Hu Zhongyi Jin Prostacyclin pathway vasodilators in patients with chronic thromboembolic pulmonary hypertension (CTEPH): A systemic review and meta‐analysis of randomized controlled trials Pulmonary Circulation chronic thromboembolic pulmonary hypertension prostacyclin pulmonary hypertension |
| title | Prostacyclin pathway vasodilators in patients with chronic thromboembolic pulmonary hypertension (CTEPH): A systemic review and meta‐analysis of randomized controlled trials |
| title_full | Prostacyclin pathway vasodilators in patients with chronic thromboembolic pulmonary hypertension (CTEPH): A systemic review and meta‐analysis of randomized controlled trials |
| title_fullStr | Prostacyclin pathway vasodilators in patients with chronic thromboembolic pulmonary hypertension (CTEPH): A systemic review and meta‐analysis of randomized controlled trials |
| title_full_unstemmed | Prostacyclin pathway vasodilators in patients with chronic thromboembolic pulmonary hypertension (CTEPH): A systemic review and meta‐analysis of randomized controlled trials |
| title_short | Prostacyclin pathway vasodilators in patients with chronic thromboembolic pulmonary hypertension (CTEPH): A systemic review and meta‐analysis of randomized controlled trials |
| title_sort | prostacyclin pathway vasodilators in patients with chronic thromboembolic pulmonary hypertension cteph a systemic review and meta analysis of randomized controlled trials |
| topic | chronic thromboembolic pulmonary hypertension prostacyclin pulmonary hypertension |
| url | https://doi.org/10.1002/pul2.70001 |
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