学術雑誌論文 The effects of pulmonary vasodilating agents on right ventricular parameters in severe group 3 pulmonary hypertension : a pilot study

Sato, Takahiro  ,  Tsujino, Ichizo  ,  Sugimoto, Ayako  ,  Nakaya, Toshitaka  ,  Watanabe, Taku  ,  Ohira, Hiroshi  ,  Suzuki, Masaru  ,  Konno, Satoshi  ,  Oyama-Manabe, Noriko  ,  Nishimura, Masaharu

6 ( 4 )  , pp.524 - 531 , 2016-12-01 , University of Chicago Press
ISSN:2045-8932
内容記述
Pulmonary arterial hypertension (PAH)-approved vasodilators improve right ventricular (RV) function in patients with PAH. However, whether PAH-approved drugs ameliorate RV morphology and function in lung disease-associated pulmonary hypertension (lung-PH) remains unclear. We aimed to prospectively evaluate the changes in RV volume and ejection fraction (RVEF) in 14 consecutive severe lung-PH patients treated with PAH-approved vasodilators. Severe lung-PH was defined as a mean pulmonary arterial pressure (MPAP) of ≥35 mmHg or an MPAP of ≥25 mmHg with a cardiac index (L/min/m2) of <2. Right heart catheterization and cardiac magnetic resonance (CMR) imaging were performed at baseline and at 3 months after starting sildenafil with or without other PAH-approved drugs. Follow-up was conducted at 3 months in 11 participants; compared with baseline values, MPAP and pulmonary vascular resistance (PVR) decreased by 18% and 37%, respectively. Baseline CMR imaging revealed an elevated RV end-diastolic volume index (RVEDVI; mL/m2) of 117.5 ± 35.9 and a below-average RVEF of 25.2% ± 7.2%; after 3 months, RVEDVI decreased by 23.7% (P = 0.0061) and RVEF increased by 32.9% (P = 0.0165). Among the 11 patients, 3 were thought to be a stable and homogenous subset in terms of background lung disease and medical management administered. These 3 patients exhibited similar ameliorations in PVR and RVEF, compared with the other 8 patients. PAH-approved drug treatment may improve RV dilatation and systolic function among patients with severe lung-PH. This study was approved by University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) on September 1, 2013 (UMIN000011541).
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https://eprints.lib.hokudai.ac.jp/dspace/bitstream/2115/67743/1/688712.pdf

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