Table 2. Effect of pulmonary arterial hypertension (PAH) therapies on remodelling of the right heart, as assessed by noninvasive tests
TherapyPatientsConventional end-pointsSurrogate end-points
cMRI
    Epoprostenol [83]11 PAH↑ 6MWD↑ RVSV
↓ PVR↑ CO
↔ RVEDV
↔ RV mass
pa
    Bosentan [116]16 PAH↑ 6MWD↔ RVEF
↑ CI↔ RVEDV
↓ PVR↔ RVSV
    Bosentan/sildenafil [117]26 PAH (IPAH and CTD-APAH)↑ 6MWD↓ RV mass
↑ CI↓ LVSEI
    Bosentan and sildenafil [118]9 IPAH↑ 6MWD↑ RVEF
3 CTD-APAH↑ CI↓ RV mass
2 CHD-APAH↔ RVEDV
1 HIV-APAH↔ LVEDV
↓ RVEDV/LVEDV ratio
↔ RVSV index
    Ambisertan [119]11 IPAH↑ 6MWD↑ RVEF
1 drug-induced PAH↓ PVR↔ RVEDV
↔ RV mass
    Sildenafil [120]4 IPAH↑ 6MWD↓ RV mass
1 CHD-APAH↓ PVR
Echocardiography
    Epoprostenol [121]9 IPAH↓ NYHA FC↓ RV dilatation
1 CTD-APAH↓ TRV
2 CHD-APAHPpa,syst/PVVTI
4 PPH↔ RVMPI
1 CTEPH
2 sarcoid
1 IPF
    Bosentan [122]48 IPAH↑ 6MWD↑ CI
7 CTD-APAH↓ NYHA FC↑ LVED filling velocity
1 other PAH↑ LVED area
↓ LVSEI
↓ RVES area
↓ RV:LV diastolic areas
↓ Pericardial effusion score
    Bosentan [123]13 CTD-APAH↑ 6MWD↓ RVSP
pa
    Sildenafil [124]11 PAH↔ NYHA FC↔ RVSP
1 CTEPH↔ 6MWD↔ Tei index
1 PPH
    Epoprostenol/treprostinil s.c./inhaled iloprost plus sildenafil [125]13 IPAH↓ NYHA FC↓ RVES diameter
6 toxic oil PAH↓ Right heart failure↓ LVDEI
1 HIV-APAH↑ 6MWD
    Epoprostenol [126]41 IPAHNA↓ RVED area
↓ LVDEI
↓ LVSEI
↔ Pericardial effusion score
↓ Maximal TRV
    Beraprost/inhaled iloprost/iloprost i.v. plus bosentan [127]10 IPAH↑ 6MWD↓ Tei index
6 other PAH↑ 6MWD
Biomarkers
    Bosentan [128]18 CTD-APAH↔ WHO class III↓ NO
↑ 6MWD↓ sCD40L
↑ P-selectin
    Bosentan and sildenafil [118]9 IPAH↑ 6MWD↓ NT-proBNP
3 CTD-APAH
2 CHD-APAH
1 HIV-APAH
    Bosentan/sildenafil [117]26 PAH (IPAH and CTD-APAH)↑ 6MWD↓ BNP
↑ CI
  • cMRI: cardiac magnetic resonance imaging; IPAH: idiopathic PAH/primary pulmonary hypertension; CTD-APAH: PAH associated with connective tissue disease; CHD-APAH: PAH associated with congenital heart disease; PPH: portopulmonary hypertension; CTEPH: chronic thromboembolic pulmonary hypertension; IPF: idiopathic pulmonary fibrosis; 6MWD: 6-min walk distance; PVR: pulmonary vascular resistance; CI: cardiac index; NYHA FC: New York Heart Association functional class; NA: not applicable; WHO: World Health Organization; RV: right ventricular; RVSV: RV stroke volume; CO: cardiac output; RVEDV: RV end-diastolic volume; pa: mean pulmonary artery pressure; RVEF: RV ejection fraction; LV: left ventricular; LVSEI: LV systolic eccentricity index; LVEDV: LV end-diastolic volume; TRV: tricuspid regurgitation jet velocity; Ppa,syst: pulmonary artery systolic pressure; PVVTI: pulmonary valve velocity time integral; RVMPI: RV myocardial performance index; LVED: LV end-diastolic; RVES: RV end-systolic; RVSP: RV systolic pressure; LVDEI: LV diastolic eccentricity index; RVED: RV end-diastolic; NO: nitric oxide; sCD40L: human soluble CD40 ligand; BNP: brain natriuretic peptide; NT-proBNP: N-terminal pro-BNP.