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Peer-reviewedCC BY 4.0Frontiers in Cardiovascular Medicine

Pulmonary vasoreactive reserve in patients with idiopathic pulmonary arterial hypertension: characteristics and clinical significance

  • Natalia Goncharova1
  • Kirill Lapshin1
  • Aelita Berezina1
  • Artem Isakov2
  • Aleksandra Vatian2
  • Anton Ryzhkov1
  • Irina Zlobina1
  • Zaneta Matakaeva1
  • Elizaveta Korobchenko1
  • Olga Moiseeva1
  1. 1Almazov National Medical Research Center Ministry of Health of Russia
  2. 2Information Technologies, Mechanics and Optics University
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Abstract

Introduction: We hypothesized that differences in pulmonary hemodynamics during acute vasoreactive testing (AVT), beyond the conventional Sitbon criteria, may be described as pulmonary vasoreactive reserve (VRR) that could be used to assess disease severity and prognosis in idiopathic pulmonary arterial hypertension (IPAH) patients. The study aimed to evaluate the clinical significance of VRR in patients with IPAH.

Methods: Ninety adult IPAH patients (40.4 ± 14.6 years, 14.3% males) from a prospective single-center PAH registry were divided into three groups based on mean pulmonary artery pressure (mPAP) decrease during AVT: Group I ( n = 25): ΔmPAP > 30%; Group II ( n = 13): ΔmPAP 15%–30%; and Group III ( n = 52): ΔmPAP < 15%. A comparison was performed between the standard model of survival prediction using the 2022 European Society of Cardiology/European Respiratory Society (ESC/ERS) three-strata risk stratification scale and the experimental model with ΔmPAP grading.

Results: The absolute value of ΔmPAP was 21 mmHg (14; 28) in Group I, 11 mmHg (10; 12) in Group II, and only 2.5 mm Hg (1; 4.5) in Group III. The Δ%mPAP significantly differed in low-, intermediate-, and high-risk 2022 ESC/ERS three-strata categories (32.4 (12.3; 42.2) vs. 12.9 (3.01; 28.2) vs. 4.8% (1.8; 8.9), p = 0.0009). Significant association was revealed between the Δ%mPAP and pulmonary artery compliance ( r = 0.30; p = 0.0045), pulmonary artery distensibility ( r = 0.37, p = 0.0058), and cardiopulmonary exercise test parameters. During a follow-up of 2.32 years (1.04; 4.06), 17 (18.8%) patients died. The survival rate was 93%, 83%, 78%, 62%, and 55% at 1, 3, 5, 7, and 10 years, respectively. The degree of Δ%mPAP [heart rate (HR) 5.99 (1.37–26.2), p = 0.017], N-terminal pro-brain-type natriuretic peptide > 1,100 pg/mL [HR 8.1 (1.67–39.2), p = 0.009], and the number of PAH-specific drugs [HR 0.07 (0.018–0.3), p = 0.0003] were considered independent predictors of survival. The inclusion of Δ%mPAP slightly improved prognostic value for the 2022 ESC/ERS three-strata risk stratification scale in comparison with the standard 2022 ESC/ERS three-strata approach (mean absolute percentage error, MAPE = 9.66%; C-index = 0.7552742616033755 vs. MAPE = 9.82%; C-index = 0.7510548523206751).

Conclusion: The assessment of VRR may warrant further investigation as an additional marker of the disease severity and prognosis in IPAH patients.

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Cite

BibTeXRIS
BibTeX
@article{goncharova2026pulmonary,
  title = {{Pulmonary vasoreactive reserve in patients with idiopathic pulmonary arterial hypertension: characteristics and clinical significance}},
  author = {Natalia Goncharova and Kirill Lapshin and Aelita Berezina and Artem Isakov and Aleksandra Vatian and Anton Ryzhkov and Irina Zlobina and Zaneta Matakaeva and Elizaveta Korobchenko and Olga Moiseeva},
  journal = {Frontiers in Cardiovascular Medicine},
  year = {2026},
  month = oct,
  doi = {10.3389/fcvm.2026.1893751},
  url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1893751/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Pulmonary vasoreactive reserve in patients with idiopathic pulmonary arterial hypertension: characteristics and clinical significance
AU  - Natalia Goncharova
AU  - Kirill Lapshin
AU  - Aelita Berezina
AU  - Artem Isakov
AU  - Aleksandra Vatian
AU  - Anton Ryzhkov
AU  - Irina Zlobina
AU  - Zaneta Matakaeva
AU  - Elizaveta Korobchenko
AU  - Olga Moiseeva
PY  - 2026
DA  - 2026/10/14
JO  - Frontiers in Cardiovascular Medicine
DO  - 10.3389/fcvm.2026.1893751
UR  - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1893751/full
AB  - Introduction: We hypothesized that differences in pulmonary hemodynamics during acute vasoreactive testing (AVT), beyond the conventional Sitbon criteria, may be described as pulmonary vasoreactive reserve (VRR) that could be used to assess disease severity and prognosis in idiopathic pulmonary arterial hypertension (IPAH) patients. The study aimed to evaluate the clinical significance of VRR in patients with IPAH.  Methods: Ninety adult IPAH patients (40.4 ± 14.6 years, 14.3% males) from a prospective single-center PAH registry were divided into three groups based on mean pulmonary artery pressure (mPAP) decrease during AVT: Group I ( n = 25): ΔmPAP > 30%; Group II ( n = 13): ΔmPAP 15%–30%; and Group III ( n = 52): ΔmPAP < 15%. A comparison was performed between the standard model of survival prediction using the 2022 European Society of Cardiology/European Respiratory Society (ESC/ERS) three-strata risk stratification scale and the experimental model with ΔmPAP grading.  Results: The absolute value of ΔmPAP was 21 mmHg (14; 28) in Group I, 11 mmHg (10; 12) in Group II, and only 2.5 mm Hg (1; 4.5) in Group III. The Δ%mPAP significantly differed in low-, intermediate-, and high-risk 2022 ESC/ERS three-strata categories (32.4 (12.3; 42.2) vs. 12.9 (3.01; 28.2) vs. 4.8% (1.8; 8.9), p = 0.0009). Significant association was revealed between the Δ%mPAP and pulmonary artery compliance ( r = 0.30; p = 0.0045), pulmonary artery distensibility ( r = 0.37, p = 0.0058), and cardiopulmonary exercise test parameters. During a follow-up of 2.32 years (1.04; 4.06), 17 (18.8%) patients died. The survival rate was 93%, 83%, 78%, 62%, and 55% at 1, 3, 5, 7, and 10 years, respectively. The degree of Δ%mPAP [heart rate (HR) 5.99 (1.37–26.2), p = 0.017], N-terminal pro-brain-type natriuretic peptide > 1,100 pg/mL [HR 8.1 (1.67–39.2), p = 0.009], and the number of PAH-specific drugs [HR 0.07 (0.018–0.3), p = 0.0003] were considered independent predictors of survival. The inclusion of Δ%mPAP slightly improved prognostic value for the 2022 ESC/ERS three-strata risk stratification scale in comparison with the standard 2022 ESC/ERS three-strata approach (mean absolute percentage error, MAPE = 9.66%; C-index = 0.7552742616033755 vs. MAPE = 9.82%; C-index = 0.7510548523206751).  Conclusion: The assessment of VRR may warrant further investigation as an additional marker of the disease severity and prognosis in IPAH patients.
SN  - 2297-055X
ER  -