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Long-term Inhaled Nitric Oxide Plus Phosphodiesterase 5 Inhibitors for Severe Pulmonary Hypertension

医学 肺动脉高压 血管阻力 内科学 一氧化氮 心脏病学 心脏指数 肺功能测试 利钠肽 肺动脉 麻醉 血压 心输出量 心力衰竭
作者
Gregorio Pérez-Peñate,Gabriel Juliá-Serdà,Nazario Ojeda-Betancort,Antonio García-Quintana,J. M. Pulido‐Duque,Aurelio Rodríguez‐Pérez,Pedro Cabrera-Navarro,Miguel Ángel Gómez‐Sánchez
出处
期刊:Journal of Heart and Lung Transplantation [Elsevier]
卷期号:27 (12): 1326-1332 被引量:18
标识
DOI:10.1016/j.healun.2008.08.007
摘要

Background Inhaled nitric oxide (iNO) is a potent pulmonary vasodilator, but therapeutic experience in patients with severe pulmonary hypertension is scarce. Methods Eleven patients with severe pulmonary hypertension, 6 due to pulmonary arterial hypertension and 4 due to chronic thromboembolic disease, were selected for iNO therapy. A phosphodiesterase type 5 inhibitor (PDE5i) was added in cases of clinical worsening. In this study we evaluate the clinical effectiveness and safety of long-term treatment with iNO either alone or combined with a PDE5i. Results After 1 month of iNO administration, improvements were observed in World Health Organization functional class, Borg scale (p = 0.003), brain natriuretic peptide levels (p = 0.002) and 6-minute walk test (p = 0.003). After 6 months of treatment, 7 patients had clinical deterioration that was reversed upon adding a PDE5i. One of these patients died in Month 8 and another underwent pulmonary transplantation in Month 9. The clinical condition of the remaining 9 patients was unchanged after 1 year. A second right catheterization showed improvement in mean pulmonary arterial pressure (66 ± 15 mm Hg to 56 ± 18 mm Hg; p = 0.01), pulmonary vascular resistance (1,234 ± 380 dyn/s/cm5 to 911 ± 410 dyn/s/cm5; p = 0.008) and cardiac index (2.0 ± 0.4 liters/min/m2 to 2.5 ± 0.4 liters/min/m2; p = 0.04). There was no significant increase in methemoglobin, no worsening of pulmonary function and no sudden withdrawal syndrome. Conclusions We suggest that iNO therapy alone or in combination with a PDE5i could be a therapeutic alternative for severe pulmonary hypertension. Inhaled nitric oxide (iNO) is a potent pulmonary vasodilator, but therapeutic experience in patients with severe pulmonary hypertension is scarce. Eleven patients with severe pulmonary hypertension, 6 due to pulmonary arterial hypertension and 4 due to chronic thromboembolic disease, were selected for iNO therapy. A phosphodiesterase type 5 inhibitor (PDE5i) was added in cases of clinical worsening. In this study we evaluate the clinical effectiveness and safety of long-term treatment with iNO either alone or combined with a PDE5i. After 1 month of iNO administration, improvements were observed in World Health Organization functional class, Borg scale (p = 0.003), brain natriuretic peptide levels (p = 0.002) and 6-minute walk test (p = 0.003). After 6 months of treatment, 7 patients had clinical deterioration that was reversed upon adding a PDE5i. One of these patients died in Month 8 and another underwent pulmonary transplantation in Month 9. The clinical condition of the remaining 9 patients was unchanged after 1 year. A second right catheterization showed improvement in mean pulmonary arterial pressure (66 ± 15 mm Hg to 56 ± 18 mm Hg; p = 0.01), pulmonary vascular resistance (1,234 ± 380 dyn/s/cm5 to 911 ± 410 dyn/s/cm5; p = 0.008) and cardiac index (2.0 ± 0.4 liters/min/m2 to 2.5 ± 0.4 liters/min/m2; p = 0.04). There was no significant increase in methemoglobin, no worsening of pulmonary function and no sudden withdrawal syndrome. We suggest that iNO therapy alone or in combination with a PDE5i could be a therapeutic alternative for severe pulmonary hypertension.
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