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Treatment of patients with chronic thrombo­embolic pulmonary hypertension: focus on riociguat

Authors Smith Z, Makowski C, Awdish R

Received 27 February 2016

Accepted for publication 15 April 2016

Published 10 June 2016 Volume 2016:12 Pages 957—964

DOI https://doi.org/10.2147/TCRM.S80131

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Hoa Le

Peer reviewer comments 2

Editor who approved publication: Professor Garry Walsh

Zachary R Smith,1 Charles T Makowski,1 Rana L Awdish2

1Department of Pharmacy Services, 2Pulmonary and Critical Care Medicine Division, Henry Ford Hospital, Detroit, MI, USA

Abstract: Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease of the pulmonary vascular bed that is characterized by elevations in the mean pulmonary artery pressure in the setting of perfusion defects on ventilation–perfusion scan, and subsequently confirmed by pulmonary angiography. CTEPH, or World Health Organization (WHO) group 4 pulmonary hypertension, is a result of unresolved thromboembolic obstruction in the pulmonary arteries. Pulmonary endarterectomy (PEA) is the treatment of choice for CTEPH as it is a potentially curative therapy. However, up to one-third of patients are not candidates for the surgery, either due to distal and inaccessible nature of the lesions or comorbid conditions. Due to remodeling that occurs in nonobstructed pulmonary vessels, a portion of patients who have undergone PEA have residual CTEPH after the procedure, attributable to high shear stress prior to PEA. This phenomenon has led to the understanding of a so-called “two-compartment model” of CTEPH, opening the door to pharmacologic treatment strategies. In 2013, riociguat, a soluble guanylate cyclase stimulator, was approved in the US and Europe for the treatment of inoperable or persistent/recurrent CTEPH. This article reviews the current management of CTEPH with a focus on riociguat.

Keywords: riociguat, chronic thromboembolic pulmonary hypertension, pulmonary endarterectomy, pulmonary hypertension

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