Study on the clinical efficacy of specific phosphodiesterase inhibitor in patients with pulmonary hypertension due to left heart disease

Abstract

Pulmonary hypertension due to left heart disease (PH-LHD) is caused by left ventricular (LV) systolic and/or diastolic dysfunction and left heart valve disease. LV diseases lead to left ventricular filling pressure increases, pulmonary venous obstruction and pulmonary venous pressure increases, and thus to secondary PH. Exercise tolerance is lower and fatality rates are higher in patients with PH-LHD than those in subjects with normal pulmonary arterial pressure. In spite of the progress in the study of the mechanisms of PH-LHD in recent years, no specific treatment is currently available. The efficacy and safety of targeted therapies for pulmonary arterial hypertension remain to be fully established. In the present study, PH-LHD patients were treated with milrinone injection. It was concluded that milrinone significantly reduces pulmonary artery systolic pressure (PASP) in patients with PH-LHD, and significantly improves the cardiac structure, cardiac function and biochemical indexes. PASP was significantly correlated with the left atrial diameter, LV end diastolic diameter, LV ejection fraction, tricuspid annular plane systolic excursion, right ventricular fractional area change, N-terminal pro-B-type natriuretic peptide and hypersensitive C-reactive protein.

Animal models of pulmonary hypertension due to left heart disease

“…Nevertheless, therapeutic agents directly targeting patients with PH‐LHD are not available. Although there have been some studies supporting the treatment of PH‐LHD with targeted drugs for PAH, none has been applied to clinical treatment of PH‐LHD 5–16 . Effective treatments for LHD do not seem to improve PH‐LHD, 17 because PH‐LHD is divided hemodynamically into pure postcapillary PH and combined pre‐ and postcapillary PH 18,19 .…”

Role of per-operative milrinone on pulmonary hypertension having mitral valve replacement.

“…6 Mitral stenosis results in increase in left atrial pressures causing reversible increase in pulmonary arterial pressures 7 Immediately after MVR, pulmonary arterial pressure does not usually regress completely and persist in about 75% of patients having pre-operation severe pulmonary hypertension 8 Milrinone is a phosphodiesterase inhibitor which is commonly used in such patients during weaning from cardiopulmonary bypass, to reduce the pulmonary vascular resistance 9 Milrinone reduces biventricular filling pressures and afterload by systemic and pulmonary vasodilation. 10,11,12 with no significant effect on patients heart rate 13 The aim of this study is to determine the effect of perioperative milrinone on postoperative pulmonary hypertension after mitral valve replacement surgery. After institutional ethical review committee approval informed consent was taken.…”

Outcome of preoperative oral sildenafil in patients with pulmonary hypertension after mitral valve replacement.

“…Increase in pulmonary vascular resistance due to mitral valve disease with pulmonary hypertension leads to right ventricular failure and mortality. 1,2 Pulmonary hypertension is defined as an increase of the mean pulmonary arterial pressure more than 25mmHg at rest. 3,4 Pulmonary hypertension affects all patients having mitral valve disease.…”