Sodium Nitroprusside in Patients With Mixed Pulmonary Hypertension and Left Heart Disease: Hemodynamic Predictors of Response and Prognostic Implications

Pulmonary artery pulsatility index: physiological basis and clinical application

“…Dupont and colleagues reported median PAC in patients with advanced heart failure of 2.5 (1.60–3.96) mL/mmHg . In our previous study of patients with higher PAWP and severe pulmonary hypertension due to left heart disease, PAC was 1.29 ± 0.4 mL/mmHg, and significantly higher in responders compared to non‐responders to sodium nitroprusside (1.44 ± 0.09 vs. 1.03 ± 0.09 mL/mmHg) …”

“…10 In our previous study of patients with higher PAWP and severe pulmonary hypertension due to left heart disease, PAC was 1.29 ± 0.4 mL/mmHg, and significantly higher in responders compared to non-responders to sodium nitroprusside (1.44 ± 0.09 vs. 1.03 ± 0.09 mL/mmHg). 17 Right atrial pressure is a function of cardiac and venous return function, expressed graphically as the point of intersection between the cardiac function and venous return curves. The cardiac function curve shifts downwards with reduction in contractility and/or increase in afterload.…”

Prognostic Power of Pulmonary Arterial Compliance Is Boosted by a Hemodynamic Unloading Test With Glyceryl Trinitrate in Heart Failure Patients With Post-capillary Pulmonary Hypertension

“…In a study by Al-Naamani et al ( 25 ) VRT did not predict outcome in 73 patients with PH and heart failure with preserved LVEF. Lim et al ( 26 ) described an association of PVR reduction (at least 20%) with survival, and baseline PAC was associated with survival in 98 patients with “mixed” PH. To the best of our knowledge, however, our study is the first to demonstrate a prognostic value of VRT in post-capillary PH independent of the “CpcPH” definition and a predefined, albeit arbitrary definition of “response.”…”

Management of pulmonary hypertension from left heart disease in candidates for orthotopic heart transplantation

“…Intravenous agents such as nitroglycerin and nitroprusside, both exogenous NO donors, are commonly used in the acute setting to assess reversibility of PH-LHD and as a bridge therapy to more definitive treatments (17,27,28). In a study of 33 patients with PH secondary to end-stage HF, the use of nesiritide, a synthetic B-type natriuretic peptide, during hospitalization for HF significantly reduced PCWP by 31% and mPAP by 15.6% compared to pretreatment (29).…”