The impact of ambrisentan and tadalafil upfront combination therapy on cardiac function in scleroderma associated pulmonary arterial hypertension patients: cardiac magnetic resonance feature tracking study

Takahiro Sato; Bharath Ambale-Venkatesh; Joao A.C. Lima; Stefan L. Zimmerman; Ryan J. Tedford; Tomoki Fujii; Olivia L. Hulme; Erica H. Pullins; Celia P. Corona-Villalobos; Roham T. Zamanian; Omar A. Minai; Reda E. Girgis; Kelly Chin; Rubina Khair; Rachel L. Damico; Todd M. Kolb; Stephen C. Mathai; Paul M. Hassoun

doi:10.1177/2045893217748307

Pulmonary Circulation (Feb 2018)

The impact of ambrisentan and tadalafil upfront combination therapy on cardiac function in scleroderma associated pulmonary arterial hypertension patients: cardiac magnetic resonance feature tracking study

Takahiro Sato,
Bharath Ambale-Venkatesh,
Joao A.C. Lima,
Stefan L. Zimmerman,
Ryan J. Tedford,
Tomoki Fujii,
Olivia L. Hulme,
Erica H. Pullins,
Celia P. Corona-Villalobos,
Roham T. Zamanian,
Omar A. Minai,
Reda E. Girgis,
Kelly Chin,
Rubina Khair,
Rachel L. Damico,
Todd M. Kolb,
Stephen C. Mathai,
Paul M. Hassoun

Affiliations

Takahiro Sato: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Bharath Ambale-Venkatesh: Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Joao A.C. Lima: Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Stefan L. Zimmerman: Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Ryan J. Tedford: Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Tomoki Fujii: Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Olivia L. Hulme: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Erica H. Pullins: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Celia P. Corona-Villalobos: Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Roham T. Zamanian: Division of Pulmonary & Critical Care Medicine, Stanford University School of Medicine, Stanford, CA, USA
Omar A. Minai: Division of Pulmonary and Critical Care Medicine, The Cleveland Clinic, Cleveland, OH, USA
Reda E. Girgis: Division of Pulmonary Medicine, Spectrum Health/Michigan State University, Grand Rapids, MI, USA
Kelly Chin: Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
Rubina Khair: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Rachel L. Damico: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Todd M. Kolb: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Stephen C. Mathai: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Paul M. Hassoun: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

DOI: https://doi.org/10.1177/2045893217748307
Journal volume & issue: Vol. 8

Abstract

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The aim of this study was to evaluate the effect of upfront combination therapy with ambrisentan and tadalafil on left ventricular (LV) and right ventricular (RV) function in patients with systemic sclerosis-associated pulmonary arterial hypertension (SSc-PAH). LV and RV peak longitudinal and circumferential strain and strain rate (SR), which consisted of peak systolic SR (SRs), peak early diastolic SR (SRe), and peak atrial-diastolic SR (SRa) were analyzed using cardiac magnetic resonance imaging (CMRI) data from the recently published ATPAHSS-O trial (ambrisentan and tadalafil upfront combination therapy in SSc-PAH). Twenty-one patients completed the study protocol. Measures of RV systolic function (RV free wall [RVFW] peak longitudinal strain [pLS], RVFW peak longitudinal SRs [pLSRs]) and RV diastolic function (RVFW peak longitudinal SRa [pLSRa], RVFW peak circumferential SRe) were improved after treatment. LV systolic function (LV peak global longitudinal strain [pGLS]) and diastolic function (LV peak global longitudinal SRe [pGLSRe]) were also significantly improved at follow-up. Increased 6-min walk distance was significantly correlated with RVFW pLS and pLSRs, while the decrease in N-terminal pro-brain natriuretic peptide was correlated with LV pGLS. Increased cardiac index was associated with improved LV pGLSRe, and reduction in mean right atrial pressure was correlated with improved RVFW pLS and pLSRa. Combination therapy was associated with a significant improvement in both RV and LV function as assessed by CMR-derived strain and SR. Importantly, the improvement in RV and LV strain and SR correlated with improvements in known prognostic markers of PAH. (Approved by clinicaltrials.gov [NCT01042158] before patient recruitment.)

Published in Pulmonary Circulation

ISSN: 2045-8940 (Online)
Publisher: Wiley
Country of publisher: United Kingdom
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system; Medicine: Internal medicine: Specialties of internal medicine: Diseases of the respiratory system
Website: https://onlinelibrary.wiley.com/journal/20458940

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