PMID- 17097500 OWN - NLM STAT- MEDLINE DCOM- 20061219 LR - 20151119 IS - 1557-3117 (Electronic) IS - 1053-2498 (Linking) VI - 25 IP - 11 DP - 2006 Nov TI - Efficacy of sildenafil as a rescue therapy for patients with severe pulmonary arterial hypertension and given long-term treatment with prostanoids: 2-year experience. PG - 1353-7 AB - BACKGROUND: Both prostanoids and sildenafil are effective treatments for severe pulmonary arterial hypertension (PAH). The combined use of these drugs to maximize the clinical benefit is an emerging treatment option. This study describes a 2-year experience with adjunct sildenafil as a rescue therapy for patients with severe PAH treated long term with prostanoids and who showed clinical deterioration or onset of heart failure. METHODS: Twenty patients (11 men, 9 women; mean age 42 +/- 11 years) with severe PAH, who showed clinical or functional worsening despite ongoing treatment with prostanoids (8 subcutaneous, 7 intravenous, 5 inhaled), were started on adjunct oral sildenafil. New York Heart Association (NYHA) functional class, 6-minute walking test, signs of right ventricular failure and echocardiography were assessed before and after 1 and 2 years of combined therapy. RESULTS: There was a significant improvement of NYHA functional class and signs of right heart failure after 1- and 2-year follow-up. Patients showed a mean increase in 6-minute walking distance of 79 m and 105 m after 1 and 2 years of adjunct sildenafil, respectively. Two patients died during follow-up. The echocardiographic parameters showed a significant reduction of right ventricular end-diastolic diameter and left ventricular diastolic eccentricity index. No serious side effects related to sildenafil were observed. CONCLUSIONS: Adjunct sildenafil to long-term prostacyclin therapy in patients with severe PAH provided sustained clinical stabilization and an improved clinical situation, exercise capacity and echocardiographic parameters of right ventricular function. The beneficial effects were strong and lasted >24 months. FAU - Ruiz, Maria Jose AU - Ruiz MJ AD - Department of Cardiology, Hospital 12 de Octubre, Madrid, Spain. majorcardio@yahoo.es FAU - Escribano, Pilar AU - Escribano P FAU - Delgado, Juan F AU - Delgado JF FAU - Jimenez, Carmen AU - Jimenez C FAU - Tello, Rocio AU - Tello R FAU - Gomez, M Angel AU - Gomez MA FAU - de la Calzada, C Saenz AU - de la Calzada CS LA - eng PT - Clinical Trial PT - Journal Article PL - United States TA - J Heart Lung Transplant JT - The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation JID - 9102703 RN - 0 (Piperazines) RN - 0 (Prostaglandins) RN - 0 (Purines) RN - 0 (Sulfones) RN - 0 (Vasodilator Agents) RN - BW9B0ZE037 (Sildenafil Citrate) SB - IM MH - Adult MH - Blood Pressure/drug effects/physiology MH - Drug Administration Schedule MH - Drug Therapy, Combination MH - Echocardiography MH - Exercise Tolerance/drug effects/physiology MH - Female MH - Humans MH - Hypertension, Pulmonary/*drug therapy/pathology MH - Longitudinal Studies MH - Male MH - Middle Aged MH - New York MH - Piperazines/pharmacology/*therapeutic use MH - Prostaglandins/pharmacology/*therapeutic use MH - Purines MH - Sildenafil Citrate MH - Stroke Volume/drug effects/physiology MH - Sulfones MH - Vasodilator Agents/pharmacology/*therapeutic use MH - Ventricular Dysfunction, Right/pathology/physiopathology EDAT- 2006/11/14 09:00 MHDA- 2006/12/21 09:00 CRDT- 2006/11/14 09:00 PHST- 2006/04/12 00:00 [received] PHST- 2006/07/26 00:00 [revised] PHST- 2006/09/11 00:00 [accepted] PHST- 2006/11/14 09:00 [pubmed] PHST- 2006/12/21 09:00 [medline] PHST- 2006/11/14 09:00 [entrez] AID - S1053-2498(06)00654-1 [pii] AID - 10.1016/j.healun.2006.09.016 [doi] PST - ppublish SO - J Heart Lung Transplant. 2006 Nov;25(11):1353-7. doi: 10.1016/j.healun.2006.09.016.