Iloprost for pulmonary vasodilator testing in idiopathic pulmonary arterial hypertension
Open Access
- 12 February 2009
- journal article
- Published by European Respiratory Society (ERS) in European Respiratory Journal
- Vol. 33 (6), 1354-1360
- https://doi.org/10.1183/09031936.00169608
Abstract
The aim of this study was to confirm the utility of aerosolised iloprost for identifying long-term responders to calcium channel blockers (CCBs) in patients with idiopathic pulmonary arterial hypertension (IPAH). While undergoing right heart catheterisation, 74 patients with IPAH sequentially received incremental infusions of adenosine and aerosolised iloprost. The effects of the two vasodilators on haemodynamic parameters were recorded. All acute responders identified by aerosolised iloprost were subsequently treated with high doses of a CCB and were re-evaluated after 12 months. Both adenosine and iloprost produced significant decreases in mean pulmonary arterial pressure and pulmonary vascular resistance, and significant increases in cardiac index. Adverse effects were experienced by 35 out of the 74 patients with adenosine, but by only two with iloprost. Aerosolised iloprost identified more acute responders than infused adenosine (10 versus eight, respectively) according to the criteria recommended in recent consensus guidelines. Nine responders identified by iloprost were followed-up after 12 months of high-dose CCB therapy. Five had normal or near-normal haemodynamics and a World Health Organization functional classification of I or II after 12 months. Aerosolised iloprost is an appropriate new agent to identify long-term responders to CCBs in patients with IPAH. It is as effective in this regard as infused adenosine but is better tolerated.Keywords
This publication has 20 references indexed in Scilit:
- Prostacyclin therapies for the treatment of pulmonary arterial hypertensionEuropean Respiratory Journal, 2008
- Complications of Right Heart Catheterization Procedures in Patients With Pulmonary Hypertension in Experienced CentersJournal of the American College of Cardiology, 2006
- Long-Term Response to Calcium Channel Blockers in Idiopathic Pulmonary Arterial HypertensionCirculation, 2005
- Inhaled IloprostDrugs, 2004
- Bosentan Therapy for Pulmonary Arterial HypertensionNew England Journal of Medicine, 2002
- Inhaled nitric oxide in primary pulmonary hypertensionJournal of the American College of Cardiology, 1998
- A Comparison of Continuous Intravenous Epoprostenol (Prostacyclin) with Conventional Therapy for Primary Pulmonary HypertensionNew England Journal of Medicine, 1996
- Role of pharmacologic tests in the treatment of primary pulmonary hypertensionThe American Journal of Cardiology, 1995
- The Effect of High Doses of Calcium-Channel Blockers on Survival in Primary Pulmonary HypertensionNew England Journal of Medicine, 1992
- The cardiac effects of adenosineProgress in Cardiovascular Diseases, 1989