Pulmonary vascular resistance as a potential marker of reactive pulmonary hypertension reduction following sildenafil therapy in patients disqualified from orthotopic heart transplantation
| Autor: | Marek Gierlotka, Michał Zakliczyński, Agata Duszańska, Jarosław Wasilewski |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Cardiac Catheterization medicine.medical_specialty Sildenafil Hypertension Pulmonary Vasodilator Agents medicine.medical_treatment PH reduction Sildenafil Citrate Pulmonary hypertension 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Interquartile range Internal medicine medicine Humans 030212 general & internal medicine Retrospective Studies Heart transplantation business.industry Vasoreactivity test General Medicine Middle Aged medicine.disease medicine.anatomical_structure chemistry 030220 oncology & carcinogenesis Heart failure Vascular resistance Cardiology Heart Transplantation Female Vascular Resistance business Biomarkers |
| Zdroj: | Advances in Medical Sciences. 65:298-303 |
| ISSN: | 1896-1126 |
| DOI: | 10.1016/j.advms.2020.04.002 |
| Popis: | Purpose:We sought to determine the predictors of restoration of heart transplantation (HTx) candidacy in pa-tients with systolic heart failure (HF) and reactive fixed pulmonary hypertension (RFPH) defined as pulmonaryvascular resistance (PVR) > 2.5 Wood units (WU), transpulmonary gradient (TPG) > 12 mmHg or ≤2.5 WUwith systolic arterial pressure ≤85 mmHg during vasoreactivity test, following sildenafil therapy.Material and methods:Between2007and20181136patientswereevaluatedatourdepartmentascandidatesforHTx. Thirty-five of them, who presented with systolic HF and were not eligible for HTx due to RFPH, wereincluded in the study (31 men aged 55.1 ± 7.4 years). In all the patients sildenafil was introduced and up-titrated to a maximal tolerated dose in addition to optimal medical therapy. Patients were assessed at 3–6months intervals.Results:During median 11 months (interquartile range 6–18 months) reduction of RFPH enabling qualificationfor HTx was observed in 62.9% patients. Higher baseline PVR (OR 0.32; 95% CI (0.14–0.74) p < 0.001), pul-monary artery systolic pressure (PASP) (OR 0.94, 95% CI (0.88–0.99) p = 0.05), mean artery pulmonarypressure (mPAP) (OR 0.87, 95% CI (0.77–0.98) p = 0.02) and TPG (OR 082, 95% CI (0.70–0.96) p = 0.003)were negative predictors of RFPH reduction with sildenafil therapy. In multivariable analysis, lower PVR(p = 0.02) was identified as an independent predictor of RFPH reduction following sildenafil therapy.Conclusion:Sildenafiltherapy cansupport PHreduction in systolic HFpatients uneligible for HTxdue to RFPH.Lower baseline PVR was identified as an independent predictor of PH reversibility with sildenafil enablingrestoration of HTx candidacy. |
| Databáze: | OpenAIRE |
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