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NCT Number: NCT03863990

Study Performed at Various Medical Centers to Learn More About Survival and Expected Course of Pulmonary Arterial Hypertension, a Type of High Blood Pressure in the Lungs Related to the Narrowing of the Small Blood Vessels in the Lungs

In this study researchers want to learn more about Pulmonary Arterial Hypertension, a type of high blood pressure in the lungs related to the narrowing of the small blood vessels in the lungs (group 1 according to WHO classification). Goal of the study is to describe the signs and risk factors of the illness at study start and the chances of survival.

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Key information

Age range

18 year and older

Sex eligibility

All sexes

Study type

Observational

Primary location

Many facilities

Multiple Locations, Argentina

About this study

The primary objective of the study is to describe baseline clinical characteristics and overall survival in a cohort of patients with pulmonary arterial hypertension (PAH) of WHO functional class I in Argentina.

Secondary objectives are to study the discriminatory ability of the risk assessment tool presented in the European Society of Cardiology and European Respiratory Society (ESC/ERS) 2015 guidelines and to explore the potential prognostic advantage of a low-risk profile at follow-up as treatment goal.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Consecutive newly diagnosed patients by Right heart catheterization (RHC) from 01-Jan-2012 to 31-Dec-2017, belonging to one of the following of Group 1 PAH subgroups: Idiopathic (IPAH), or Heritable (HPAH), or Drug or toxin induced, or Associated (APAH) with one of the following: Connective tissue disease; Congenital heart disease with simple systemic to pulmonary shunt at least 1 year after surgical repair; Portal Hypertension or HIV infection.
  • Diagnosis of PAH by RHC exhibiting a mean pulmonary artery pressure (MPAP) ≥ 25 mmHg and a pulmonary artery wedge pressure (PAWP) ≤15 mmHg at normal or reduced cardiac output, according to European Society of Cardiology and European Respiratory Society (ESC/ERS) 2009 guidelines or MPAP ≥ 25 mmHg and a PAWP ≤15 mmHg and a pulmonary vascular resistance (PVR) > 3 WU according to ESC/ERS 2015 guidelines.
  • Patients with at least one year documented follow up or that have died or received transplant before 1 year of follow up after baseline RHC and that have initiated treatment with a PAH-targeted medication.

Exclusion criteria

  • Patients with severe concomitant left heart disease (left ventricular ejection fraction <35%).
  • Patients with restrictive lung disease (Forced vital capacity (FVC) <60% predicted) other than connective tissue disease or obstructive lung disease (forced expiratory volume (FEV) <60% predicted, with FEV1/FVC<70%).
  • Clinical or radiological evidence of Pulmo-Veno-Occlusive Disease (PVOD) or Pulmonary Capillary Haemangiomatosis (PCH).
  • Hypertrophic obstructive cardiomyopathy.
  • Severe proven or suspected coronary artery disease.
  • Congenital or acquired valvular or myocardial disease if clinically significant apart from tricuspid valvular insufficiency due to pulmonary hypertension.
  • Underlying medical disorders at baseline with an anticipated life expectancy below 2 years (e.g. active cancer disease with localized and/or metastasized tumor mass) or Clinical relevant hepatic dysfunction (Child-Pugh B and C) or Renal insufficiency (glomerular filtration rate <30 mL/min).
  • Diagnosis of a pulmonary hypertension from WHO groups 2, 3, 4 or 5.

Treatment and study plan

PAH medication

Drug

Any PAH-targeted medication

Primary outcomes

  1. Age at baseline

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  2. Sex

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  3. Ethnicity

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  4. Descriptive analysis of comorbidities at baseline

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  5. PAH-subgroup at baseline as assessed by physician

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

    PAH-subgroups may be idiopathic, heritable, drug- or toxin-induced, or associated PAH (with CTD or HIV or portopulmonary hypertension or repaired congenital heart disease).

  6. Right atrial pressure at baseline by right heart catheterization hemodynamics

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  7. Pulmonary artery pressure at baseline by right heart catheterization hemodynamics

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  8. Pulmonary vascular resistance at baseline by right heart catheterization hemodynamics

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  9. Pulmonary artery wedge pressure (PAWP) at baseline by right heart catheterization hemodynamics

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  10. Cardiac Index (CI) at baseline by right heart catheterization hemodynamics

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  11. Mixed venous oxygen saturation (SvO2) at baseline by right heart catheterization hemodynamics

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  12. Pulmonary vasoreactivity at baseline by pulmonary artery pressure

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

    Yes / No - variable

  13. Peak oxygen consumption by cardiopulmonary exercise test at baseline

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  14. Right atrial area at baseline by echocardiography

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  15. Pericardial effusion at baseline by echocardiography

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

    Patients may have no, mild, moderate or severe pericardial effusion.

  16. Right ventricular function at baseline by echocardiography

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

    Patients may have a normal, mild, moderate and severe right ventricular function.

  17. Tricuspid annular plane systolic excursion (TAPSE) at baseline by echocardiography

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  18. Pulmonary artery systolic pressure at baseline by echocardiography

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  19. Left ventricular ejection fraction at baseline by echocardiography

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  20. 6-minute walking distance at baseline

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  21. Pulmonary hypertension functional class according to WHO classification at baseline

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

    Four functional classes ranging from Class I (Pulmonary hypertension without limited physical activity) to Class IV (Pulmonary hypertension with strongly limited physical activity).

  22. Time from onset of diagnostic symptoms to PAH-diagnosis

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  23. Symptoms progression at baseline assessed by physician

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

    Patient may display no, a slow or rapid progression of symptoms.

  24. Syncope frequency at baseline

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

    No, occasional or repeated syncope

  25. Systolic blood pressure at baseline

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  26. Heart rate at baseline

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  27. Body weight at baseline

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  28. Body height at baseline

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  29. Body mass index at baseline

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  30. Concentration of diagnostic markers for heart failure in blood at baseline

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

    Used diagnostic marker are either Brain natriuretic Peptide (BNP) or N-terminal pro b-type Natriuretic Peptide (NT-proBNP).

  31. Drug class of supportive PAH treatment

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

    Supportive treatments for PAH are assigned to four drug classes: diuretics, anticoagulants, oxygen and other.

  32. Drug class of PAH-treatment after diagnosis

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

    PAH-treatments are assigned to six drug classes: endothelin receptor antagonists (ERA), PDE5 inhibitors, prostanoides, prostacyclin receptor agonists, soluble guanylate cyclase (sGC) stimulants and calcium blockers.

  33. PAH risk status at baseline according to ESC/ERS 2015 guidelines

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

    Patients may have a low, intermediate or high risk for PAH according to the European Society of Cardiology and European Respiratory Society 2015 guidelines.

  34. Overall survival rate

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  35. Time from diagnosis to death from any cause

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

Secondary outcomes

  1. Right atrial pressure at follow-up by right heart catheterization hemodynamics

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  2. Pulmonary artery pressure at follow-up by right heart catheterization hemodynamics

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  3. Pulmonary vascular resistance at follow-up by right heart catheterization hemodynamics

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  4. Pulmonary artery wedge pressure (PAWP) at follow-up by right heart catheterization hemodynamics

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  5. Cardiac Index (CI) at follow-up by right heart catheterization hemodynamics

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  6. Mixed venous oxygen saturation (SvO2) at follow-up by right heart catheterization hemodynamics

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  7. Peak oxygen consumption by cardiopulmonary exercise test at follow-up

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  8. Right atrial area at follow-up by echocardiography

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  9. Pericardial effusion at follow-up by echocardiography

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  10. Right ventricular function at follow-up by echocardiography

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  11. Tricuspid annular plane systolic excursion (TAPSE) at follow-up by echocardiography

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  12. Pulmonary artery systolic pressure at follow-up by echocardiography

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  13. Left ventricular ejection fraction at follow-up by echocardiography

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  14. 6-minute walking distance at follow-up

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  15. Pulmonary hypertension functional class according to WHO classification at baseline

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

    Four functional classes ranging from Class I (Pulmonary hypertension without limited physical activity) to Class IV (Pulmonary hypertension with strongly limited physical activity).

  16. Symptoms progression at follow-up

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  17. Syncope frequency at follow-up

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  18. Concentration of diagnostic markers for heart failure in blood at follow-up

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

    Used diagnostic marker are either Brain natriuretic Peptide (BNP) or N-terminal pro b-type Natriuretic Peptide (NT-proBNP).

  19. PAH risk status at follow-up according to ESC/ERS 2015 guidelines

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

    Patients may have low, intermediate and high risk for PAH according to the European Society of Cardiology and European Respiratory Society 2015 guidelines.

  20. Cause of death

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  21. Time from diagnosis to death from any cause

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  22. Pulmonary transplant

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

    Yes or No

  23. Time from diagnosis to pulmonary transplant

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  24. Time from diagnosis to first hospitalization due to PAH-progression

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  25. Number of hospitalizations per year due to PAH-progression

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  26. Proportion of patients with low PAH risk

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

    Risk status is assessed according to the Society of Cardiology and European Respiratory Society (ESC/ERS) 2015 guidelines.

  27. Proportion of patients with intermediate+high PAH risk

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

    Risk status is assessed according to the Society of Cardiology and European Respiratory Society (ESC/ERS) 2015 guidelines.

  28. Survival rate of patients with low risk for PAH

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  29. Survival rate of patients with intermediate or high risk for PAH

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

  30. PAH risk status of patients without transplant being alive at the date of latest medical records according to ESC/ERS 2015 guidelines

    Time frame: Retrospective analysis of data from 01-Jan-2012 to 31-Dec-2018

    Patients may have low, intermediate and high risk for PAH according to the European Society of Cardiology and European Respiratory Society 2015 guidelines.

Sponsors and collaborators

Lead sponsor

Bayer

Industry

Registry information

Official study title

Survival and Prognostic Factors in Pulmonary Arterial Hypertension. A Multicenter Observational Registry (START)

Acronym: START

Important dates

Study start
2019
Primary completion
2020
Study completion
2020
First posted
Mar 5, 2019
Registry last updated
May 4, 2021

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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