| Pulmonary vasoreactivity predicts long-term outcome in patients with Eisenmenger syndrome receiving bosentan therapy. | |
| | |
MedLine Citation:
|
PMID: 20668108 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND: Vasoreactivity testing is recommended in the management of pulmonary arterial hypertension (PAH), but its clinical relevance in congenital heart disease (CHD)-associated PAH has not been established. OBJECTIVE: To determine whether residual pulmonary vascular responsiveness to intravenous. epoprostenol is predictive of clinical outcome in patients with CHD-PAH and Eisenmenger syndrome. METHODS AND RESULTS: A diagnostic right heart catheterisation with reversibility testing using epoprostenol infusion was performed in 38 consecutive patients with CHD-PAH and Eisenmenger syndrome. Patients were treated with bosentan and were assessed every 3 months. Clinical worsening was defined as death from any cause, heart-lung or lung transplantation (or on the waiting list for this procedure), hospitalisation for PAH, or symptom exacerbation defined as a > or =20% decrease in the 6 min walking distance on two consecutive tests, an increase in WHO functional class, or worsening right heart failure. The mean follow-up was 33+/-17 months. Sixteen patients showed clinical worsening. Although they did not differ from the other patients in their baseline exercise capacity, haemodynamic characteristics and underlying CHD, pulmonary vascular resistance index (PVRi) was less reversible (DeltaPVRi 29+/-21 vs 52+/-14%, p=0.0003). At univariate analysis, systemic vascular resistance, PVRi and DeltaPVRi were significant predictors of clinical worsening. At multivariate Cox proportional hazards regression model, DeltaPVRi was found to be the only independent predictor of clinical worsening (HR=0.973, 95% CI 0.95 to 0.99; p=0.01). DeltaPVRi > or =25% had a positive and negative predictive value for clinical worsening of 100% and 75.9%, respectively. CONCLUSION: Pulmonary vasoreactivity is a significant predictor of clinical worsening in patients with CHD-PAH. |
| | |
Authors:
|
Michele D'Alto; Emanuele Romeo; Paola Argiento; Giuseppe Santoro; Berardo Sarubbi; Giampiero Gaio; Christian Mélot; Maria Giovanna Russo; Robert Naeije; Raffaele Calabrò |
Related Documents
:
|
9973698 - Severe barium sulfate aspirationinto the lung: clinical presentation, prognosis and the... 4056598 - Tuberculous laryngitis--a one year harvest. 15502498 - Biomarkers in pulmonary embolism. 15191918 - Enhanced monocyte chemoattractant protein-3/cc chemokine ligand-7 in usual interstitial... 1616188 - Preoperative irradiation and surgery for initially unresectable adenocarcinoma of the r... 23332588 - Atrial fibrillation and risk of stroke in dialysis patients. |
Publication Detail:
|
Type: Journal Article Date: 2010-07-28 |
Journal Detail:
|
Title: Heart (British Cardiac Society) Volume: 96 ISSN: 1468-201X ISO Abbreviation: Heart Publication Date: 2010 Sep |
Date Detail:
|
Created Date: 2010-09-03 Completed Date: 2010-10-28 Revised Date: 2013-06-18 |
Medline Journal Info:
|
Nlm Unique ID: 9602087 Medline TA: Heart Country: England |
Other Details:
|
Languages: eng Pagination: 1475-9 Citation Subset: AIM; IM |
Affiliation:
|
Second University of Naples, A.O. V. Monaldi, Naples, Italy. mic.dalto@tin.it |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adult Antihypertensive Agents / diagnostic use, therapeutic use* Cardiac Catheterization / methods Eisenmenger Complex / drug therapy*, physiopathology Epidemiologic Methods Epoprostenol / diagnostic use Exercise Tolerance / physiology Female Hemodynamics / physiology Humans Hypertension, Pulmonary / drug therapy*, physiopathology Male Middle Aged Prognosis Pulmonary Artery / physiopathology Sulfonamides / therapeutic use* Treatment Outcome Vascular Resistance / drug effects Young Adult |
| Chemical | |
Reg. No./Substance:
|
0/Antihypertensive Agents; 0/Sulfonamides; 35121-78-9/Epoprostenol; Q326023R30/bosentan |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Cardiac stem cell therapy: progress from the bench to bedside.
Next Document: Preeclampsia-related increase of interleukin-11 expression in human decidual cells.