Original ArticleImmediate and Long-term Hemodynamic and Clinical Effects of Sildenafil in Patients With Pulmonary Arterial Hypertension Receiving Vasodilator Therapy
Section snippets
PATIENTS AND METHODS
The treatment regimens of 13 patients with PAH, managed by the Pulmonary Hypertension Clinic at the Mayo Clinic in Rochester, Minn, were modified empirically between November 1, 2000, and August 31, 2001, to include sildenafil. This study is a retrospective review of these patients. Sildenafil was used to augment treatment efficacy or permit down-titration of medications associated with adverse effects, expense, and/or inconvenience. All patients had undergone recent transthoracic
Patient Characteristics
The medical records of 13 patients were reviewed (Table 1). The mean ± SEM age was 55.1±9.8 years; 10 patients were women. Eleven patients had primary PAH, as defined by World Health Organization criteria. One patient had chronic thromboembolic pulmonary hypertension supported by history and prior ventilation-perfusion images, and 1 patient had portopulmonary hypertension attributed to primary sclerosing cholangitis. Of the 13 patients, 2 were in NYHA class I, 4 were in NYHA class II, and 7
DISCUSSION
During the past decade, there have been substantial advances in the understanding and management of PAH. Unfortunately, limited efficacy, adverse effects, and high costs often characterize current therapies. The goal of this study was to determine the short-term and long-term effects of sildenafil when added to the existing medical regimen of patients with PAH.
The addition of sildenafil significantly improved CO, mPAP, PASP, and PVR 1 to 2 hours after administration of the highest-tolerated
CONCLUSION
Oral sildenafil has an immediate pulmonary vasodilator effect in patients already treated with vasodilators for pulmonary hypertension. However, its effect on functional status and right heart function during longer-term administration in this small group was unsubstantial. Because of the simplicity of administration and apparent relative safety of sildenafil, it is a potentially attractive option as adjunctive therapy to current treatment strategies if a sufficient level of efficacy were
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