Riociguat Improves Pulmonary Hemodynamics in Patients with Inoperable Chronic Thromboembolic Pulmonary Hypertension

New progress in diagnosis and treatment of pulmonary arterial hypertension

Pulmonary arterial hypertension (PAH) is a progressive disease. Although great progress has been made in its diagnosis and treatment in recent years, its mortality rate is still very significant. The pathophysiology and pathogenesis of PAH are complex and involve endothelial dysfunction, chronic inflammation, smooth muscle cell proliferation, pulmonary arteriole occlusion, antiapoptosis and pulmonary vascular remodeling. These factors will accelerate the progression of the disease, leading to poor prognosis. Therefore, accurate etiological diagnosis, treatment and prognosis judgment are particularly important. Here, we systematically review the pathophysiology, diagnosis, genetics, prognosis and treatment of PAH.

[The achievements of the modern specific therapy of pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension: focus on the stimulator of soluble guanylate cyclase riociguat]

Currently, treatment of pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) is focused on three signaling pathways: the NO pathway, the endothelin pathway, and the prostacyclin pathway. Riociguat is the only representative of stimulators of the soluble guanylate cyclase (sGC) class that is approved for the treatment of PAH and inoperable and persistent/recurrent CTEPH. The review presents data from clinical trials showing a positive effect of riociguat on the functional and hemodynamic profile of patients with PAH and CTEPH. In recent years there has been much discussion about the possibility of optimizing therapy by switching to drugs that affect a single pathogenesis target. Thus, sGC stimulants have obvious advantages over phosphodiesterase type 5 (PDE-5) inhibitors, including the ability of riociguat to exert pharmacological effects (due to a NO-independent mechanism of action) even in conditions of reduced NO production. Switching from PDE-5 to riociguat may be safe and appropriate, according to clinical trials presented in the review. In accordance with the guidelines for the diagnosis and treatment of pulmonary hypertension of the Eurasian Association of cardiologists from 2019, this strategy is approved when PDE5 therapy is ineffective in patients with PAH FC III (WHO).

Imaging of Chronic Thromboembolic Disease

Acute pulmonary embolism (PE) is a leading cause of cardiovascular morbidity. The most common long-term complication of acute PE is chronic thromboembolic disease, a heterogenous entity which ranges from asymptomatic imaging sequelae to persistent symptoms. Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare disease that can develop in this population and represents the only treatable type of pulmonary hypertension. Recognition of the characteristic findings of chronic pulmonary embolism and CTEPH provides not only diagnostic information, but is also crucial for guiding therapy. The present state-of-the-art review focuses on the multimodality imaging features of chronic pulmonary embolism. Detailed description and illustrations of relevant imaging findings will be demonstrated for ventilation/perfusion (V/Q) scan, CT scan and Dual-Energy CT and MRI and features that distinguish chronic PE from common imaging mimics.