Hemodynamic Effects of Aerosolized Iloprost in Pulmonary Hypertension at Rest and During Exercise

Blumberg, Friedrich C.; Riegger, G.; Pfeifer, Michael

doi:10.1378/chest.121.5.1566

Cited by 47 publications

(43 citation statements)

References 20 publications

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“…Compared with 6MWD, pulmonary haemodynamic values during mild-tomoderate exercise in the supine position may be less affected by peripheral muscle weakness [24], increased dead-space ventilation and dynamic lung hyperinflation [25]. Exercise and change from rest to exercise of cardiac index reflected disease severity more accurately than did cardiac index at rest alone [14,15,26]. Change in cardiac index from rest to exercise may be a useful end-point for clinical research and may help to guide treatment decisions in the individual patient.…”

Section: Discussionmentioning

confidence: 99%

“…Exercise stress in patients with PAH tests the ability of the diseased heart to increase its output and the pulmonary arterial system to respond to an increased flow. Previous studies [14,15] have shown that the effect of prostacyclin analogues on exercise pulmonary haemodynamics was obvious although changes in resting measurements were undetectable.…”

Section: Introductionmentioning

confidence: 92%

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Prognostic value of exercise pulmonary haemodynamics in pulmonary arterial hypertension

Chaouat

Sitbon

Mercy

et al. 2014

European Respiratory Journal

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The aim of the study was to investigate the prognostic value of right heart catheterisation variables measured during exercise.55 incident patients with idiopathic, familial or anorexigen-associated pulmonary arterial hypertension (PAH) underwent right heart catheterisation at rest and during exercise and 6-min walk testing before PAH treatment initiation. Patients were treated according to recommendations within the next 2 weeks. Right heart catheterisation was repeated 3-5 months into the PAH treatment in 20 patients.Exercise cardiac index decreased gradually as New York Heart Association (NYHA) functional class increased whereas cardiac index at rest was not significantly different across NYHA groups. Baseline 6-min walk distance correlated significantly with exercise and change in cardiac index from rest to exercise (r50.414 and r50.481, respectively; p,0.01). Change in 6-min walk distance from baseline to 3-5 months under PAH treatment was highly correlated with change in exercise cardiac index (r50.746, p,0.001). The most significant baseline covariates associated with survival were change in systolic pulmonary artery pressure from rest to exercise and exercise cardiac index (hazard ratio 0.56 (95% CI 0.37-0.86) and 0.14 (95% CI 0.05-0.43), respectively).Change in pulmonary haemodynamics during exercise is an important tool for assessing disease severity and may help devise optimal treat-to-target strategies. @ERSpublications Exercise cardiac index correlated with exercise capacity and was associated with long-term survival in PAH

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 92%

Prognostic value of exercise pulmonary haemodynamics in pulmonary arterial hypertension

Chaouat

Sitbon

Mercy

et al. 2014

European Respiratory Journal

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“…12 Recent studies have begun to clarify the clinical correlates of exercise-induced PH. 11,12 Invasive and noninvasive studies have accumulated, showing that the slope of linearized mPAP-CO relationships should not exceed 3 mm Hg·L Table 6, [9][10][11][12]16,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] ). This corresponds to the former definition of exercise-induced PH (mPAP >30 mm Hg) provided that CO remains <10 L/min or total pulmonary resistance (mPAP/CO) at maximum exercise is <3 Wood units.…”

Section: Physiology Of the Pulmonary Circulation At Rest And During Ementioning

confidence: 99%

Pulmonary Vascular Hemodynamic Response to Exercise in Cardiopulmonary Diseases

et al. 2013

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“…In order to avoid acute haemodynamic effects, especially as a result of treatment with iloprost and beraprost, all patients had to observe an interval of o2 h between the last intake of any medication and the exercise test [22,23]. Right heart catheter examinations were performed in all patients within the 6 months prior to bosentan therapy (while the patients were already receiving prostanoid treatment) but catheter studies were not used to assess the effects of combination treatment.…”

Section: Efficacymentioning

confidence: 99%

Bosentan treatment in patients with primary pulmonary hypertension receiving nonparenteral prostanoids

Hoeper¹,

Taha²,

Bekjarova³

et al. 2003

European Respiratory Journal

182

114

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Primary pulmonary hypertension (PPH) is a life-threatening disease. Nonparenteral prostanoids, i.e. aerosolised iloprost or oral beraprost sodium show beneficial therapeutic effects but are not sufficiently active in all patients with this devastating disease. The purpose of the present study was to determine whether the endothelin-receptor antagonist bosentan is safe and effective in patients with PPH already receiving nonparenteral prostanoids.The effect of bosentan as add-on medication was studied in 20 patients with PPH, who received either inhaled iloprost (n=9) or oral beraprost (n=11) for a median period of 16¡13 months, by means of the 6-min walk test and cardiopulmonary exercise testing.After 3 months of administration of bosentan in addition to prostanoids, the walking distance in the 6-min walk test increased by 58¡43 m. Cardiopulmonary exercise testing revealed an increase in maximal oxygen consumption from 11.0¡2.3 to 13.8¡3.6 mL?kg -1 ?min -1 accompanied by significant improvements in anaerobic threshold, oxygen pulse and minute ventilation/carbon dioxide production slope. Peak systolic blood pressure increased from 120¡17 to 139¡21 mmHg. Combination treatment was well tolerated by all patients.It is concluded that the addition of the endothelin-receptor antagonist bosentan to inhaled iloprost or oral beraprost therapy appears to be safe for patients with primary pulmonary hypertension, resulting in a marked increase in exercise capacity. Therefore, rigorous studies should address whether combination treatment is more effective than either therapeutic intervention alone.

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Hemodynamic Effects of Aerosolized Iloprost in Pulmonary Hypertension at Rest and During Exercise

Cited by 47 publications

References 20 publications

Prognostic value of exercise pulmonary haemodynamics in pulmonary arterial hypertension

Prognostic value of exercise pulmonary haemodynamics in pulmonary arterial hypertension

Pulmonary Vascular Hemodynamic Response to Exercise in Cardiopulmonary Diseases

Bosentan treatment in patients with primary pulmonary hypertension receiving nonparenteral prostanoids

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