Marked Hemodynamic Improvements by High-Dose Epoprostenol Therapy in Patients With Idiopathic Pulmonary Arterial Hypertension

Akagi, Satoshi; Nakamura, Kazufumi; Miyaji, Kohei; Ogawa, Aiko; Kusano, Kengo; Ito, Hiroshi; Matsubara, Hiromi

doi:10.1253/circj.cj-10-0190

Cited by 61 publications

(55 citation statements)

References 20 publications

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“…It is noteworthy, that all the algorithms mentioned above recommend not more than moderate doses of the drug to be administered chronically while there are data supporting higher doses and also more aggressive dose-escalation. It was already reported, that treatment with 100 ng/kg/min of epoprostenol for an average of almost 4 years in patients with IPAH/HPAH was associated with a pronounced reduction in mean PAP and PVR by 29% and 68%, respectively [23]. Although this was a retrospective analysis of a single center experience, it provided for the first time an insight into the potency, effectiveness and tolerance of high doses of epoprostenol.…”

Section: Epoprostenol As the Key Drug To Decrease Pulmonary Artery Prmentioning

confidence: 87%

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Pulmonary artery pressure matters – how to efficiently improve survival in pulmonary arterial hypertension (RCD code: II‐1A.1)

Matsubara

Błaszczak

Podolec

et al. 2017

Journal of Rare Cardiovascular Diseases

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Please cite this article: Matsubara H, Blaszczak P, Podolec P, et al. Pulmonary artery pressure matters -how to efficiently improve survival in pulmonary arterial hypertension. AbstractPulmonary arterial hypertension is a disease characterized by poor prognosis despite treatment. Even in a modern era of pharmacotherapy there is a strong need to further improve survival of patients. The current therapeutic strategies do not offer a real break-through in terms of reducing mortality. In a search for better efficacy of treatment we discuss a strategy based on lowering pulmonary artery pressure as much as possible with epoprostenol in monotherapy or in combination. Epoprostenol with bosentan is an effective tool in achieving this goal. A rapid up-titration regardless of maximum epoprostenol dose achieved gives additional long-term benefit. Practical issues related to such modality of treatment are also discussed. JRCD 2017; 3 (4): 110-115

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Section: Epoprostenol As the Key Drug To Decrease Pulmonary Artery Prmentioning

confidence: 87%

“…Patients should be advised to avoid exercise. Exactly this strategy was implemented in cohorts of patients described herein [27,23,26].…”

Section: Lowering Pap To Improve Survivalmentioning

confidence: 99%

Pulmonary artery pressure matters – how to efficiently improve survival in pulmonary arterial hypertension (RCD code: II‐1A.1)

Matsubara

Błaszczak

Podolec

et al. 2017

Journal of Rare Cardiovascular Diseases

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“…Baseline hemodynamic evaluations were performed in all patients with RHC as previously described (1,20). Baseline hemodynamic measurements included heart rate (HR), BP, right atrial pressure (RAP), mean PAP, PCWP, and CO determined by the Fick method.…”

Section: Baseline Evaluationmentioning

confidence: 99%

“…Pulmonary arterial hypertension (PAH) is a condition characterized by elevated mean pulmonary artery pressure (PAP), and the prognosis is poor in most cases (1,2). Although we and other investigators have reported that a small proportion of patients with PAH respond to long-term calcium-channel blockers (CCBs) and have a better prognosis (3 -6), the empiric use of CCBs in PAH is not recommended because of the risk of exacerbation (7,8).…”

Section: Introductionmentioning

confidence: 99%

Acute Vasoreactivity Testing With Nicardipine in Patients With Pulmonary Arterial Hypertension

Saito¹,

Nakamura²,

Miyaji³

et al. 2012

J Pharmacol Sci

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Abstract. Acute vasoreactivity testing for patients with pulmonary arterial hypertension (PAH) has been reported to be useful to identify patients with sustained beneficial response to oral calcium-channel blockers (CCBs), but there is a risk of exacerbation during the testing with oral CCBs. Therefore, we developed a testing method utilizing intravenous nicardipine, a short-acting CCB, and examined the safety and usefulness of acute vasoreactivity testing with nicardipine in PAH patients. Acute vasoreactivity testing with nicardipine was performed in 65 PAH patients. Nicardipine was administered by short-time continuous infusion (1 μg·kg ·min−1 for 5 min) followed by bolus injection (5 μg/kg). Hemodynamic responses were continuously measured using a right heart catheter. Acute responders were defined as patients who showed a decrease in mean pulmonary artery pressure of at least 10 mmHg to an absolute level below 40 mmHg with preserved or increased cardiac output. Two acute responders and sixty-three non-acute responders were identified. There was no hemodynamic instability requiring additional inotropic agents or death during the testing. Acute responders had good responses to long-term oral CCBs. The acute vasoreactivity testing with nicardipine might be safe and useful for identifying CCB responders in PAH patients.

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“…12 They reported that 14 patients with PAH in NYHA functional class III or IV were treated with high-dose (>40 ng · kg -1 · min -1 ) EPO (107±40 (range 54-190) ng · kg -1 · min -1 ) for 1,355±627 days, and that mPA decreased from 66±16 to 47± 12 mmHg, PVR from 21.6±8.3 to 6.9±2.9 Wood units, and more importantly, all the patients survived for a period of 3.7 years.…”

Section: Article P 2200mentioning

confidence: 99%

Dose-Dependent Reduction in Pulmonary Vascular Resistance With Epoprostenol in Pulmonary Arterial Hypertension

Homma

2010

Circ J

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Marked Hemodynamic Improvements by High-Dose Epoprostenol Therapy in Patients With Idiopathic Pulmonary Arterial Hypertension

Cited by 61 publications

References 20 publications

Pulmonary artery pressure matters – how to efficiently improve survival in pulmonary arterial hypertension (RCD code: II‐1A.1)

Pulmonary artery pressure matters – how to efficiently improve survival in pulmonary arterial hypertension (RCD code: II‐1A.1)

Acute Vasoreactivity Testing With Nicardipine in Patients With Pulmonary Arterial Hypertension

Dose-Dependent Reduction in Pulmonary Vascular Resistance With Epoprostenol in Pulmonary Arterial Hypertension

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