Pulmonary vascular disease & thromboembolism
Sotatercept in Pulmonary Arterial Hypertension: Central, Hematologic, and Peripheral Mechanisms of Benefit
Main finding · Peak exercise mean PA pressure/COResult — go to the resultChange −2.1 mm Hg/L/min 95% CI −3.1 to −1.1Authors' conclusion
Sotatercept improves exercise tolerance in patients with PAH through multiple, previously unappreciated mechanisms beyond the pulmonary vasculature, including increased hemoglobin (driven in part by systemic decongestion with hemoconcentration), which along with enhanced RV-PA coupling and CO reserve increases skeletal muscle O2 delivery.
Study context
- Population
- Patients with PAH
- Participants
- 30 patients
- Comparison
- After vs before 24-week sotatercept
- Outcome
- Peak exercise mean PA pressure/CO
- Follow-up
- 24 weeks
Methodological detailssingle-arm, before-and-after (24-week sotatercept)
- Single-arm
- Before-and-after (24-week sotatercept)
Main finding
As reported in the abstract
Change
−2.1 mm Hg/L/min
95% CI −3.1 to −1.1
P = 0.0003
Further findings
Pulmonary vascular resistance, mean pulmonary artery (PA) pressure, right ventricular (RV) work
| Change (WU) (95% CI) | P value | ||
|---|---|---|---|
| SotaterceptPulmonary vascular resistance | −2.6 (−3.0 to −2.2) | P < 0.0001 | |
| −4−202Difference, WU (linear scale) |
| Change (mm Hg) (95% CI) | P value | ||
|---|---|---|---|
| SotaterceptMean PA pressure | −12.5 (−13.8 to −11.2) | P < 0.0001 | |
| −20−10010Difference, mm Hg (linear scale) |
| Change (kg-m/min) (95% CI) | P value | ||
|---|---|---|---|
| SotaterceptRV work | −1.1 (−1.4 to −0.9) | P < 0.0001 | |
| −2−101Difference, kg-m/min (linear scale) |
Resting cardiac output (CO)
| Change (L/min) (95% CI) | P value | ||
|---|---|---|---|
| Sotatercept | −0.58 (−0.85 to −0.32) | P < 0.0001 | |
| −1−0.500.5Difference, L/min (linear scale) |
| Outcome | Change (mL/dL) (95% CI) | P value |
|---|---|---|
| Oxygen delivery and uptakeArterial-femoral venous O2 content difference across phases | +1.1 (+0.7 to +1.4) | P < 0.0001 |
- Oxygen delivery and uptake — Increased convective oxygen delivery with exertion
- P = 0.002; interaction P = 0.018
Pulmonary vascular resistance, mean PA pressure, RV work
- Improved RV-PA coupling across rest and exercise
Systemic congestion
- Decrease in NT-proBNP
- P < 0.0001
- Decrease in right atrial pressure
- P = 0.04
- Decrease in blood volume
- P < 0.0001
Oxygen delivery and uptake
- Single-leg exercise performance improved
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
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