Open AccessThe Effects of Pulmonary Vasodilating Agents on Right Ventricular Parameters in Severe Group 3 Pulmonary Hypertension: A Pilot Study
Author(s) -
Sato Takahiro,
Tsujino Ichizo,
Sugimoto Ayako,
Nakaya Toshitaka,
Watanabe Taku,
Ohira Hiroshi,
Suzuki Masaru,
Konno Satoshi,
OyamaManabe Noriko,
Nishimura Masaharu
Publication year - 2016
Publication title -
pulmonary circulation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.791
H-Index - 40
ISSN - 2045-8940
DOI - 10.1086/688712
Subject(s) - medicine , pulmonary hypertension , cardiology , sildenafil , vascular resistance , vasodilation , ejection fraction , cardiac index , lung , cardiac catheterization , blood pressure , cardiac output , heart failure
Pulmonary arterial hypertension (PAH)–approved vasodilators improve right ventricular (RV) function in patients with PAH. However, whether PAH‐approved drugs ameliorate RV morphology and function in lung disease–associated pulmonary hypertension (lung‐PH) remains unclear. We aimed to prospectively evaluate the changes in RV volume and ejection fraction (RVEF) in 14 consecutive severe lung‐PH patients treated with PAH‐approved vasodilators. Severe lung‐PH was defined as a mean pulmonary arterial pressure (MPAP) of ≥35 mmHg or an MPAP of ≥25 mmHg with a cardiac index (L/min/m 2 ) of <2. Right heart catheterization and cardiac magnetic resonance (CMR) imaging were performed at baseline and at 3 months after starting sildenafil with or without other PAH‐approved drugs. Follow‐up was conducted at 3 months in 11 participants; compared with baseline values, MPAP and pulmonary vascular resistance (PVR) decreased by 18% and 37%, respectively. Baseline CMR imaging revealed an elevated RV end‐diastolic volume index (RVEDVI; mL/m 2 ) of 117.5 ± 35.9 and a below‐average RVEF of 25.2% ± 7.2%; after 3 months, RVEDVI decreased by 23.7% ( P = 0.0061) and RVEF increased by 32.9% ( P = 0.0165). Among the 11 patients, 3 were thought to be a stable and homogenous subset in terms of background lung disease and medical management administered. These 3 patients exhibited similar ameliorations in PVR and RVEF, compared with the other 8 patients. PAH‐approved drug treatment may improve RV dilatation and systolic function among patients with severe lung‐PH. This study was approved by University Hospital Medical Information Network Clinical Trials Registry (UMIN‐CTR) on September 1, 2013 (UMIN000011541).