Pulmonary hypertension (PH) is a disease characterized by pulmonary pressure overload and right ventricular (RV) dysfunction. The TREPAR study is an analytical study that evaluates the impact of prolonged subcutaneous treprostinil(TS) use on right heart chamber remodeling and prognosis.

Objective: To evaluate the baseline characteristics of the population selected for subcutaneous Treprostinil treatment in Latin America in our TREPAR-PH study.

Materials and Methods: A multicenter, prospective, non-interventional study was conducted in Argentina and Colombia, which included patients with Pulmonary  

Arterial Hypertension PAH Groups I and PH IV treated with TS (prevalent or incident <12 months) with a follow-up of up to 48 months. Baseline assessment included clinical data, a 6-minute walk test (6MWT), echocardiographic parameters, and hemodynamic data. Monitoring data were collected every 6 months. In this sub study, base line data were analyzed. Qualitative variables are expressed as a percentage (%), and quantitative variables as mean or median with standard deviation or interquartile range, respectively.

Results: 102 patients were included, and 94 were included in the final analysis. The majority were women (86%),  with a mean age of 46.7 years. PAH group I (93.5%) was the most frequent etiology, which was idiopathic (57%), and group IV (6.5%). Most patients presented functional class III (62.4%), heart failure (HF) in 54%, and syncope in 25%. TC6M was 381 meters (RI 246-494) and Pro BNP 1267 (327-2260) pg/mL. Hemodynamic parameters: right atrial pressure 10.2 (5), mean pulmonary pressure 58.5 (16.8), cardiac index 2.2 (1.8 -2.6), pulmonary vascular resistance 17.1 (12 -20), and IVS 26 ml (21 -32). Echocardiographic findings demonstrate a left ventricular ejection fraction 61% (6%), baseline right ventricular diameter 50.4 mm (6.9), right ventricular area33.6 mm (7.9), RV function impairment 97%, right atrial area 26.7 cm (6.7), tricuspid regurgitation velocity (TRV) 4.3 m/s (0.98), TAPSE/SPAP ratio 0.20 (0.07), right ventricular free wall strain rate 13% (4.1) and pericardial effusion 36%. Baseline medical treatment furosemide in 62% and  spironolactone in 53%. Regarding the specific treatment strategy, monotherapy was used in 10.6%, dual combination therapy 78%, and triple therapy in 10.6%. According to the REVEAL 2.0 average risk stratification, 35% of patients were classified as high risk, 23% as intermediate risk, and 41% as low risk. Table 1 shows the regional differences between Argentina and Colombia.

Conclusions: The TREPAR-HP study demonstrated a high prevalence of advanced CF, negative right ventricular (RV) remodeling, systolic deterioration of RV function, and severe hemodynamic compromise at the start of subcutaneous Treprostinil treatment in Latin America. These data highlight the late implementation of parenteral prostaglandins in our region and the heterogeneity of the analyzed population, even within Latin America.

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