Impact of Pulmonary Capillary Wedge Pressure on Long-Term Mortality in Patients With Pulmonary Arterial Hypertension Treated With Parenteral Trepostinil.

BACKGROUND: The clinical impact of pulmonary capillary wedge pressure (PCWP) on long-term mortality among patients with pulmonary arterial hypertension (PAH) has been incompletely reported, particularly in relation to concomitant treprostinil administration. The goal of this study was to assess the impact of PCWP on long-term mortality in PAH patients treated with parenteral treprostinil. METHODS: We studied a cohort of 743 patients with PAH treated with parenteral treprostinil therapy. The long-term all-cause mortality was compared in patients with baseline mean PCWP≤8mmHg, 811mmHg over 4-year follow-up. RESULTS: Of the 743 patients studied, 280 patients (37.7%) had a baseline mean PCWP ≤ 8mmHg, 233 patients (31.4%) had a mean PCWP of >8mmHg and ≤11mmHg, and 230 patients (31.0%) had a mean PCWP >11mmHg. While patients with higher PCWP had higher mean right atrial and PA pressures, no difference was noted in cardiac output and pulmonary vascular resistance (PVR). All-cause mortality was similar between patients with PCWP≤8mmHg, 811mmHg at 1 year (10.4% vs 9.9% vs 10.0%, p=0.980) and 4 years (16.8% vs 21.9% vs 19.2%, p=0.353) respectively. In multivariate analysis, PCWP was not independently predictive of 4-year all-cause mortality [HR 1.00, 95%CI 0.95-1.05, p=0.98 (permmHg)]. Predictors of 4-year mortality included older age [HR 1.02, 95%CI 1.00-1.03, p=0.0091 (per year)], non-​Caucasian race, and higher PVR [HR 1.06, 95% CI 1.04-1.08, p<0.0001 (per Woods Unit)]. CONCLUSIONS: In this study of patients with PAH receiving parenteral treprostinil, PCWP was not associated with long-term all-cause mortality. Further studies examining prognostic indicators in patients with PAH optimised on guideline-based therapies are warranted.

Simulating murder: the aversion to harmful action.

Diverse lines of evidence point to a basic human aversion to physically harming others. First, we demonstrate that unwillingness to endorse harm in a moral dilemma is predicted by individual differences in aversive reactivity, as indexed by peripheral vasoconstriction. Next, we tested the specific factors that elicit the aversive response to harm. Participants performed actions such as discharging a fake gun into the face of the experimenter, fully informed that the actions were pretend and harmless. These simulated harmful actions increased peripheral vasoconstriction significantly more than did witnessing pretend harmful actions or to performing metabolically matched nonharmful actions. This suggests that the aversion to harmful actions extends beyond empathic concern for victim harm. Together, these studies demonstrate a link between the body and moral decision-making processes.