Open AccessBosentan Treatment Is Associated With Improvement of Right Ventricular Function and Remodeling in Chronic Thromboembolic Pulmonary Hypertension
Author(s) -
Surie Sulaiman,
Reesink Herre J.,
Marcus J. Tim,
van der Plas Mart N.,
Kloek Jaap J.,
VonkNoordegraaf Anton,
Bresser Paul
Publication year - 2013
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22197
Subject(s) - bosentan , medicine , cardiology , ejection fraction , pulmonary hypertension , ventricular remodeling , pulmonary artery , ventricle , endothelin receptor antagonist , cardiac magnetic resonance imaging , endothelin receptor , heart failure , magnetic resonance imaging , radiology , receptor
Background Medical pretreatment before pulmonary endarterectomy (PEA) can optimize right ventricular (RV) function and may improve postoperative outcome in high‐risk patients. Using cardiac magnetic resonance imaging (cMRI), we determined whether the dual endothelin‐1 antagonist bosentan improves RV function and remodeling in patients with chronic thromboembolic pulmonary hypertension (CTEPH) who waited for PEA. Hypothesis We hypothesized that medical therapy prior to PEA will be associated with improvements in RV remodeling and function. Methods In this pilot study, 15 operable CTEPH patients were randomly assigned to either bosentan (n = 8) or no bosentan (n = 7, control) for 16 weeks, next to “best standard of care.” Both before and after treatment, RV stroke volume index (RVSVI), RV ejection fraction (RVEF), RV mass, RV isovolumic relaxation time (rIVRT), leftward ventricular septal bowing (LVSB), and left ventricular ejection fraction (LVEF) were determined using cMRI. Results After 16 weeks, the change (Δ) from baseline (median [range]) in the studied cMRI parameters differed significantly between the bosentan group and the controls: Δ RVSVI: 6 [−4–11] vs 1 [−6–3] mL/m −2 ; Δ RVEF: 8 [−10–15] vs −4 [−7–5]%; Δ RV mass: −3 [−6–−2] vs 2 [−1–3] g/m −2 ; Δ rIVRT: −30 [−130–20] vs 10 [−30–30] msec; Δ LVSB: 0.03 [−0.03–0.13] vs −0.03[−0.08–0.04] cm −1 ; and Δ LVEF: 8 [−5–17] vs −2 [−14–2]% (all P < 0.05). The change from baseline in mean pulmonary artery pressure (−11 [−17–11] vs 5 [−6–21] mm Hg, P < 0.05) and 6‐minute walk distance (20 [3–88] vs −4 [−40–40] m, P < 0.05) also differed significantly. Conclusions In CTEPH, compared with control, treatment with bosentan for 16 weeks was associated with a significant improvement in cMRI parameters of RV function and remodelling.