1. Is Upfront Triple Combination Therapy in PAH "A Thing"?
Vallerie V. McLaughlin, MD, FACC, FAHA, FCCP
Kim A. Eagle, MD, Endowed Professor of Cardiovascular Medicine Director, Pulmonary Hypertension Program University of Michigan Health System Ann Arbor, Michigan, USA

2. Upfront Triple Combination Therapy: Pilot Study of the Effect on Hemodynamics
Upfront triple combo therapy: i.v. epoprostenol + bosentan + sildenafil
19 incident (i.e. newly diagnosed) patients with Idiopathic (n=9) or heritable (n=10) PAH
Mean age 39 ± 14 years (18–63)
NYHA FC III (n=8) or IV (n=11)
Severe hemodynamics: CI < 2.0 L/min/m2 or PVR > 1000 d.s.cm-5
Sitbon O, Jaîs X, Savale L, et al. Upfront triple combination therapy in pulmonary arterial hypertension: a pilot study. Eur Respir J. 2014;43:

3. Upfront Triple Combination Therapy: Effect on Hemodynamics
Prospective, observational analysis of idiopathic or heritable PAH patients (n = 19) treated with upfront combination therapy (epoprostenol, bosentan and sildenafil)
N=18
Baseline
4-month
Last visit (32 ± 19 months)
RAP (mmHg)
11.9 ± 5.2
4.9 ± 4.9*
5.2 ± 3.5*
mPAP (mmHg)
65.8 ± 13.7
45.7 ± 14.0*
44.4 ± 13.4*
PCWP (mmHg)
8.4 ± 3.5
6.7 ± 3.2
7.9 ± 2.8
CI (l/min/m2)
1.66 ± 0.35
3.49 ± 0.69*
3.64 ± 0.65*
PVR (d.s.cm-5)
1718 ± 627
564 ± 260*
492 ± 209*
Heart rate (bpm)
92.3 ± 10.7
83.9 ± 9.8*
79.9 ± 13.4*
Mean BP (mmHg)
92.1 ± 12.5
80.1 ± 11.7*
84.9 ± 19.4
SvO2 (%)
51.0 ± 8.5
69.7 ± 5.2*
72.2 ± 4.0*
*P <0.01 versus baseline
Sitbon O, Jaîs X, Savale L, et al. Upfront triple combination therapy in pulmonary arterial hypertension: a pilot study. Eur Respir J. 2014;43: