The effects of phosphodiesterase 5 inhibition on hemodynamics, functional status and survival in advanced heart failure and pulmonary hypertension: A case-control study

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• 作者：Adrian Reichenbach ; Hikmet Al-Hiti ; Ivan Malek ; Jan Pirk ; Eva Goncalvesova ; Josef Kautzner ; Vojtech Melenovsky
• 关键词：Heart failure ; Heart transplantation ; Pulmonary hypertension ; Sildenafil ; phosphodiesterase 5 ; Cardiac cachexia
• 刊名：International Journal of Cardiology
• 出版年：2013
• 出版时间：20 September, 2013
• 年：2013
• 卷：168
• 期：1
• 页码：60-65
• 全文大小：395 K

文摘

Background

The goal was to examine the hemodynamic and clinical effects of long-term therapy with PDE5 inhibitor sildenafil (SILD) in patients with advanced, pre-transplant heart failure (HF) and severe pulmonary hypertension (PH), in comparison to a similar control group (CON).

Methods

In this non-randomized, retrospective case-control study, 32 middle-aged patients (81 % males) with advanced systolic HF (80 %  ¡Ý NYHA III, 56 % ischemic) and severe pre-capillary PH (transpulmonary pressure gradient > 15 mm Hg) were studied before and after initiation of SILD (dose 73 ¡À 25 mg/day) and were compared to 15 CON patients, matched for key clinical characteristics (including PH severity, age and co-morbidities), not exposed to SILD. Changes at 3 months and the long-term outcome were compared between groups.

Results

SILD significantly reduced pulmonary vascular resistance (? 32 % vs. baseline), transpulmonary gradient (? 25 % ) and increased cardiac output (+ 15 % ) compared to controls, without affecting systemic or ventricular filling pressures. SILD-treated subjects experienced an improvement in NYHA class and had a steady body weight which contrasted with significant weight loss in the CON group (by ? 4.8 % , absolutely by 4.3 ¡À 6 kg). During follow-up (median 349 days from baseline), 60 % of patients underwent heart transplantation. Two patients in CON group had severe post-transplant failure of the right ventricle, none in SILD group. Overall pre- and peritransplant survival (censored 30 days after transplantation) was significantly better in SILD than CON group (93.7 vs 60 % , p = 0.0048).

Conclusions

In patients with advanced HF and severe PH, SILD therapy has beneficial effects on hemodynamics, clinical status, cardiac cachexia, and contributes to improved peri-transplant survival.