Evaluation of the effect of early treatment for collagen associated borderline pulmonary arterial hypertension

Research Project

Project/Area Number	17K09552
Research Category	Grant-in-Aid for Scientific Research (C)
Allocation Type	Multi-year Fund
Section	一般
Research Field	Cardiovascular medicine
Research Institution	Mie University
Principal Investigator	Yamada Norikazu 三重大学, 医学系研究科, リサーチアソシエイト (60303731)
Project Period (FY)	2017-04-01 – 2020-03-31
Project Status	Completed (Fiscal Year 2019)
Budget Amount *help	¥3,640,000 (Direct Cost: ¥2,800,000、Indirect Cost: ¥840,000) Fiscal Year 2019: ¥1,170,000 (Direct Cost: ¥900,000、Indirect Cost: ¥270,000) Fiscal Year 2018: ¥1,170,000 (Direct Cost: ¥900,000、Indirect Cost: ¥270,000) Fiscal Year 2017: ¥1,300,000 (Direct Cost: ¥1,000,000、Indirect Cost: ¥300,000)
Keywords	肺高血圧症 / 早期治療介入 / 運動負荷 / 薬物治療 / 運動負荷試験 / 循環器・高血圧 / 肺循環
Outline of Final Research Achievements	Pulmonary arterial hypertension associated with connective tissue disease (CTD-PAH) is a rapidly progressive disorder and has a poor prognosis.　The purpose of this study is to investigate the effectiveness of early pharmacological intervention in borderline PAH. We performed right heart catheterization (RHC) during exercise in 31 patients with borderline CTD-PAH. Comparison of hemodynamic data between medication group and non-medication group was evaluated by follow-up RHC during exercise performed after 2 years. ΔMPAP (mmHg) (MPAP at maximal exercise - MPAP at rest) /ΔCO (CO at maximal exercise - CO at rest) significantly improved in medication group, but tended to worsen in non-medication group. Early pharmacological intervention might have the potential to prevent the pulmonary vascular remodeling for EIPAH with CTD.
Academic Significance and Societal Importance of the Research Achievements	右心カテーテルを留置したうえでの運動負荷時の各種血行動態指標の変化を2年間にわたり経年的に観察することで、肺動脈性肺高血圧症の中でも特に予後が悪く、息切れなど症状が発現した後では肺血管拡張薬の有効性も乏しいとされる膠原病関連肺動脈性肺高血圧症に対して、早期から薬物治療介入を行うことが病態進展を抑制できる可能性が示唆されたことは非常に意義深い。単一施設で行ったため、対象例数が限られており、さらに多施設共同研究が望まれる。