@article {GergesP4072, author = {Christian Gerges and Mario Gerges and Yi Zhou and Diana Lam and Marie Lang and Irene Lang}, title = {Hemodynamic correlates of right ventricular afterload and pulmonary artery pulsatility under treatment with prostacyclin: Retrospective analysis of changes from baseline in pulmonary arterial hypertension}, volume = {42}, number = {Suppl 57}, elocation-id = {P4072}, year = {2013}, publisher = {European Respiratory Society}, abstract = {PURPOSE: Survival in pulmonary arterial hypertension (PAH) is significantly dependent on right ventricular (RV) function. We characterized the change from baseline in hemodynamic correlates of RV afterload that reflects the arterial load to steady flow (pulmonary vascular resistance [PVR]) and parameters of oscillatory load, including pulmonary arterial compliance (PAC) and pulmonary valve resistance (ZVA).METHODS: Parameters of RV afterload were analyzed in a prospective data base of 933 PAH patients receiving treprostinil or placebo.RESULTS: Within 12 weeks of treatment parameters of oscillatory load did not change, while PVR was significantly reduced in patients on treprostinil compared to placebo (Mean, [95\%C.I.]: -2.6WU [-4.2, -1.0]). ROC analysis revealed that PVR has to be reduced by at least 3WU to achieve an improvement in ZVA, (area under the curve [AUC]: 0.84), whereas an increase in PAC is already reached after a reduction of 1WU (AUC: 0.90). However, only baseline PVR (p\<0.001) and ZVA (p\<0.001) were predictors of survival/freedom of lung transplantation. Patients with improved PAC and ZVA had a larger reduction in afterload (ΔmPAP (mmHg): -3{\textpm}7.8, -3.6{\textpm}7.7; ΔPVR (WU): -3.1{\textpm}4.5, -3.0{\textpm}4.6) than patients with worsened PAC and ZVA (ΔmPAP (mmHg): 2.2{\textpm}8.1, 2.2{\textpm}8.2; ΔPVR (WU): 2.5{\textpm}4.5; 2.1{\textpm}4.7).CONCLUSION: PVR is the key steady flow parameter that is changed under treatment with treprostinil, while parameters of pulsatility did not change significantly over 12 weeks. Baseline PVR (p\<0.001) and ZVA (p\<0.001) were predictors of survival/freedom of lung transplantation.}, issn = {0903-1936}, URL = {https://erj.ersjournals.com/content/42/Suppl_57/P4072}, eprint = {https://erj.ersjournals.com/content/42/Suppl_57/P4072.full.pdf}, journal = {European Respiratory Journal} }