Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Kaemmerer, AS; Gorenflo, M; Huscher, D; Pittrow, D; Ewert, P; Pausch, C; Delcroix, M; Ghofrani, HA; Hoeper, MM; Kozlik-Feldmann, R; Skride, A; Stähler, G; Vizza, CD; Jureviciene, E; Jancauskaite, D; Gumbiene, L; Ewert, R; Dähnert, I; Held, M; Halank, M; Skowasch, D; Klose, H; Wilkens, H; Milger, K; Jux, C; Koestenberger, M; Scelsi, L; Brunnemer, E; Hofbeck, M; Ulrich, S; Vonk, Noordegraaf, A; Lange, TJ; Bruch, L; Konstantinides, S; Claussen, M; Löffler-Ragg, J; Wirtz, H; Apitz, C; Neidenbach, R; Freilinger, S; Nemes, A; Opitz, C; Grünig, E; Rosenkranz, S.
Medical treatment of pulmonary hypertension in adults with congenital heart disease: updated and extended results from the International COMPERA-CHD Registry.
Cardiovasc Diagn Ther. 2021; 11(6): 1255-1268.
Doi: 10.21037/cdt-21-351
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- Co-Autor*innen der Med Uni Graz
- Koestenberger Martin
- Milger-Kneidinger Katrin
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- Abstract:
- BACKGROUND: Pulmonary arterial hypertension (PAH) is common in congenital heart disease (CHD). Because clinical-trial data on PAH associated with CHD (PAH-CHD) remain limited, registry data on the long-term course are essential. This analysis aimed to update information from the COMPERA-CHD registry on management strategies based on real-world data. METHODS: The prospective international pulmonary hypertension registry COMPERA has since 2007 enrolled more than 10,000 patients. COMPERA-CHD is a sub-registry for patients with PAH-CHD. RESULTS: A total of 769 patients with PAH-CHD from 62 specialized centers in 12 countries were included into COMPERA-CHD from January 2007 through September 2020. At the last follow-up in 09/2020, patients [mean age 45.3±16.8 years; 512 (66%) female] had either post-tricuspid shunts (n=359; 46.7%), pre-tricuspid shunts (n=249; 32.4%), complex CHD (n=132; 17.2%), congenital left heart or aortic valve or aortic disease (n=9; 1.3%), or miscellaneous CHD (n=20; 2.6%). The mean 6-minute walking distance was 369±121 m, and 28.2%, 56.0%, and 3.8% were in WHO functional class I/II, III or IV, respectively (12.0% unknown). Compared with the previously published COMPERA-CHD data, after 21 months of follow-up, the number of included PAH-CHD patients increased by 91 (13.4%). Within this group the number of Eisenmenger patients rose by 39 (16.3%), the number of "Non-Eisenmenger PAH" patients by 45 (26.9%). Currently, among the 674 patients from the PAH-CHD group with at least one follow-up, 450 (66.8%) received endothelin receptor antagonists (ERA), 416 (61.7%) PDE-5 inhibitors, 85 (12.6%) prostacyclin analogues, and 36 (5.3%) the sGC stimulator riociguat. While at first inclusion in the COMPERA-CHD registry, treatment was predominantly monotherapy (69.3%), this has shifted to favoring combination therapy in the current group (53%). For the first time, the nature, frequency, and treatment of significant comorbidities requiring supportive care and medication are described. CONCLUSIONS: Analyzing "real life data" from the international COMPERA-CHD registry, we present a comprehensive overview about current management modalities and treatment concepts in PAH-CHD. There was an trend towards more aggressive treatment strategies and combination therapies. In the future, particular attention must be directed to the "Non-Eisenmenger PAH" group and to patients with complex CHD, including Fontan patients. TRIAL REGISTRATION: www.clinicaltrials.gov, study identifier: Clinicaltrials.gov NCT01347216.
- Find related publications in this database (Keywords)
- Congenital heart disease (CHD)
- Eisenmenger syndrome
- pulmonary hypertension
- registry
- targeted treatment