PMID- 17403477
OWN - NLM
STAT- MEDLINE
DCOM- 20070419
LR  - 20131121
IS  - 1557-3117 (Electronic)
IS  - 1053-2498 (Linking)
VI  - 26
IP  - 4
DP  - 2007 Apr
TI  - Intravenous epoprostenol in inoperable chronic thromboembolic pulmonary 
      hypertension.
PG  - 357-62
AB  - BACKGROUND: Pulmonary thromboendarterectomy may be a cure for patients with 
      chronic thromboembolic pulmonary hypertension (CTEPH) with proximal obstruction. 
      Conversely, short-term prognosis is poor for inoperable CTEPH patients with 
      distal obstruction. Vascular remodeling lesions can be found in lungs of patients 
      with CTEPH. Little is known about epoprostenol therapy in inoperable distal CTEPH 
      patients. METHODS: We conducted a retrospective analysis of 27 consecutive 
      patients with inoperable distal CTEPH, who were in New York Heart Association 
      Functional Class (NYHA FC) III (n = 20) or IV (n = 7) and treated with long-term 
      intravenous epoprostenol. RESULTS: Before epoprostenol initiation (baseline), 
      6-minute walk distance (6MWD) was 265 +/- 117 m, right atrial pressure 13 +/- 5 
      mm Hg, mean pulmonary artery pressure (mPAP) 56 +/- 9 mm Hg, cardiac index (CI) 
      1.9 +/- 0.3 liters/min/m2, total pulmonary resistance (TPR) 29.3 +/- 7.0 U/m2 and 
      mixed venous oxygen saturation 52 +/- 8%. After 3 months of epoprostenol (n = 23; 
      mean epoprostenol dose 16 +/- 2 ng/kg/min), NYHA FC improved by one class in 11 
      of 23 patients, 6MWD increased by 66 m (p < 0.0001), and hemodynamics also 
      improved (mPAP: 51 +/- 8 mm Hg, p = 0.001; CI: 2.3 +/- 0.4 liters/min/m2, p = 
      0.0003; TPR: 23.0 +/- 5.0 U/m2, p < 0.0001). At last evaluation (n = 18; 20 +/- 8 
      months), mean dose of epoprostenol was 30 +/- 8 ng/kg/min, NYHA FC was improved 
      in 9 of 18 patients and there was sustained improvement in 6MWD (+46 m, p = 0.03) 
      and hemodynamic parameters. Survival at 1, 2 and 3 years was 73%, 59% and 41%, 
      respectively. CONCLUSIONS: Long-term treatment with intravenous epoprostenol 
      improves exercise capacity and hemodynamic parameters in patients with inoperable 
      distal CTEPH. Epoprostenol may be used as bridge therapy in CTEPH patients 
      awaiting lung transplantation.
FAU - Cabrol, Segolene
AU  - Cabrol S
AD  - Centre des Maladies Vasculaires Pulmonaires (UPRES EA 2705), Service de 
      Pneumologie et Reanimation, AP-HP, Universite Paris-Sud, Hopital Antoine Beclere, 
      Clamart, France.
FAU - Souza, Rogerio
AU  - Souza R
FAU - Jais, Xavier
AU  - Jais X
FAU - Fadel, Elie
AU  - Fadel E
FAU - Ali, Ratiba Haddad Si
AU  - Ali RH
FAU - Humbert, Marc
AU  - Humbert M
FAU - Dartevelle, Philippe
AU  - Dartevelle P
FAU - Simonneau, Gerald
AU  - Simonneau G
FAU - Sitbon, Olivier
AU  - Sitbon O
LA  - eng
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 (Antihypertensive Agents)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - DCR9Z582X0 (Epoprostenol)
SB  - IM
CIN - J Heart Lung Transplant. 2007 Dec;26(12):1346-7. PMID: 18096491
MH  - Adult
MH  - Antihypertensive Agents/*administration & dosage/adverse effects/therapeutic use
MH  - Cardiac Output
MH  - Chronic Disease
MH  - Drug Administration Schedule
MH  - Epoprostenol/*administration & dosage/adverse effects/therapeutic use
MH  - Female
MH  - Humans
MH  - Hypertension, Pulmonary/*drug therapy/*etiology/physiopathology/surgery
MH  - Injections, Intravenous
MH  - Kaplan-Meier Estimate
MH  - Lung Transplantation
MH  - Male
MH  - Middle Aged
MH  - Physical Endurance
MH  - Platelet Aggregation Inhibitors/*administration & dosage/adverse 
      effects/therapeutic use
MH  - Retrospective Studies
MH  - Thromboembolism/*complications/*drug therapy
MH  - Vascular Resistance
EDAT- 2007/04/04 09:00
MHDA- 2007/04/20 09:00
CRDT- 2007/04/04 09:00
PHST- 2006/04/26 00:00 [received]
PHST- 2006/10/11 00:00 [revised]
PHST- 2006/12/12 00:00 [accepted]
PHST- 2007/04/04 09:00 [pubmed]
PHST- 2007/04/20 09:00 [medline]
PHST- 2007/04/04 09:00 [entrez]
AID - S1053-2498(06)01487-2 [pii]
AID - 10.1016/j.healun.2006.12.014 [doi]
PST - ppublish
SO  - J Heart Lung Transplant. 2007 Apr;26(4):357-62. doi: 
      10.1016/j.healun.2006.12.014.