Chronic Thromboembolic Pulmonary Hypertension
Conditions
Keywords
Chronic Thromboembolic Pulmonary Hypertension, Riociguat, Right heart function
Brief summary
Riociguat and balloon pulmonary angioplasty (BPA) are established standard-of-care interventions for inoperable chronic thromboembolic pulmonary hypertension (CTEPH) with comparable evidence levels. However, the optimal combined treatment strategy remains unclear. Specifically, there is no consensus on whether riociguat should be continued long-term after achieving hemodynamic stability with BPA. Additionally, the long-term effects of riociguat discontinuation on right ventricular (RV) structure and function remain poorly characterized, particularly due to the lack of comprehensive noninvasive evaluations integrating cardiac magnetic resonance (CMR) and echocardiography. This prospective study aims to determine the hemodynamic impact of riociguat discontinuation in inoperable CTEPH patients who have achieved BPA treatment endpoints using right heart catheterization (RHC). Evaluate RV remodeling and functional changes after riociguat cessation through multimodal noninvasive imaging (CMR, echocardiography). Assess safety outcomes and identify potential rebound pulmonary hypertension or decompensated RV dysfunction associated with riociguat withdrawal.
Interventions
DRUGRiociguat
On the basis of the comprehensive treatment in line with the guidelines, including conventional diuresis, anticoagulation, oxygen inhalation, etc., continue oral administration of riociguat for treatment.
DRUGRoutine Treatment
On the basis of the comprehensive treatment in line with the guidelines, including conventional diuresis, anticoagulation, oxygen inhalation, etc, and stop taking riociguat
Sponsors
China-Japan Friendship Hospital
Beijing Anzhen Hospital
Suqiao Yang
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥18 years old * CTEPH was diagnosed and one of the following three factors was met: Pulmonary endarterectomy was technically impossible; Pulmonary endarterectomy is technically feasible, but the risk-benefit ratio is poor; Residual/recurrent pulmonary hypertension after pulmonary endarterectomy * Subjects had been treated with BPA and had received a stable dose of riociguat for ≥12 weeks * mPAP \< 30mmHg * Male subjects and female subjects of reproductive age are required to use effective contraception for at least 28 days after signing the informed consent form. Male subjects are not allowed to donate sperm and female subjects are not allowed to breastfeed. * Subjects voluntarily sign written informed consent
Exclusion criteria
* Severe hepatic and renal insufficiency (Child-Pugh Grade C/creatinine clearance \< 30ml/min·1.73m²) * The presence of severe infectious disease or severe bleeding tendency * Combined with pulmonary hypertension of other types than CTEPH * Other pulmonary hypertension targeting drugs are being used * The expected survival time with cancer or other diseases is less than 6 months * Pregnancy, lactation * Subjects are currently participating in an interventional clinical trial * In the investigator's judgment, a subject's medical abnormality, physical condition, or medical history may affect his or her ability to participate in or complete the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change from Baseline in the Cardiac Output at 6 Months. | Baseline and 6-month follow-up | Cardiac Output was measured by right heart catheterization. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change from Baseline in the Pulmonary Vascular Resistance at 6 Months. | Baseline and 6-month follow-up | Pulmonary Vascular Resistance was measured by right heart catheterization. |
| Change from Baseline in the concentration of NT-proBNP at 6 Months. | Baseline and 6-month follow-up | The concentration of NTproBNP in serum was detected in pg/ml |
| Change from Baseline in the 6-minute walking distance at 6 Months. | Baseline, 3-month follow-up, and 6-month follow-up | 6-minute walking distance was measured by 6-minute walking test |
| All-cause mortality | From the baseline to the completion follow-up,an average of 6 months | Observe and record All-cause mortality |
| Combined incidence of all-cause death, re-hospitalization or disability/incapacity events due to clinical exacerbation of pulmonary hypertension | From the baseline to the completion follow-up,an average of 6 months | Observe and record All-cause mortality, clinical exacerbation of pulmonary hypertension leading to re-hospitalization or disability/incapacity |
Countries
China
Contacts
Primary ContactSuqiao Yang
Outcome results
None listed