PMID- 30777406
OWN - NLM
STAT- MEDLINE
DCOM- 20191230
LR  - 20191230
IS  - 1874-1754 (Electronic)
IS  - 0167-5273 (Linking)
VI  - 283
DP  - 2019 May 15
TI  - Therapeutic potential of phosphodiesterase type 5 inhibitors in heart failure 
      with preserved ejection fraction and combined post- and pre-capillary pulmonary 
      hypertension.
PG  - 152-158
LID - S0167-5273(18)35398-1 [pii]
LID - 10.1016/j.ijcard.2018.12.078 [doi]
AB  - OBJECTIVE: Heart failure with preserved ejection fraction (HFpEF) is frequently 
      associated with pulmonary hypertension (PH), which substantially impacts 
      survival. Based on pulmonary vascular resistance (PVR) and the diastolic pressure 
      gradient (DPG), current guidelines distinguish between isolated post-capillary PH 
      (IpcPH) and combined post- and pre-capillary PH (CpcPH). However, the therapeutic 
      consequences of this sub-classification remain entirely unclear. We specifically 
      investigated the efficacy and safety of PDE5i in patients with HFpEF and CpcPH. 
      METHODS: In 40 hemodynamically precisely characterized patients with HFpEF and 
      Cpc-PH who were treated with a PDE5i for at least 12 months, the therapeutic 
      effect on 6-minute walk distance (6MWD), WHO functional class (FC), NTproBNP 
      levels, right ventricular function, and hospitalization rates was evaluated. 
      RESULTS: Patients' mean age was 73 +/- 9 years, and comorbidities were frequent 
      (78% hypertension, 58% atrial fibrillation, 35% diabetes). Initially, 38 patients 
      (95%) were in WHO-FC III and 2 patients (5%) in WHO-FC II. Prior to PDE5i 
      initiation, mean PAPm was 46.2 +/- 10.3 mmHg, PAWP 21.2 +/- 4.7 mmHg, DPG 
      5.5 +/- 7.2 mmHg, and PVR 6.2 +/- 3.0 WU. After 12 months of PDE5i therapy, the 6MWD 
      increased from initially 277 +/- 17 to 340 +/- 18 m (p < 0.001), and the proportion 
      of patients in WHO-FC I/II increased from 5% to 37.5%. NTproBNP levels decreased 
      by 33% (p = 0.004), and TAPSE improved from 16.8 +/- 0.7 mm at baseline to 
      18.2 +/- 0.6 mm (p = 0.01). The rate of HF-associated hospitalizations was 
      substantially lower in the 12 months post PDE5i initiation compared to the prior 
      12 months. The DPG had no impact on the response to therapy. No deaths occurred, 
      and typical side effects of PDE5i were observed. CONCLUSION: These data indicate 
      that at least a subset of precisely characterized patients with HFpEF and CpcPH 
      who tolerate PDE5i may benefit from targeted therapy. A randomized study in this 
      particular sub-population is warranted.
CI  - Copyright (c) 2018. Published by Elsevier B.V.
FAU - Kramer, Tilmann
AU  - Kramer T
AD  - Klinik III fur Innere Medizin, Herzzentrum der Universitat zu Koln, Germany.
FAU - Dumitrescu, Daniel
AU  - Dumitrescu D
AD  - Klinik III fur Innere Medizin, Herzzentrum der Universitat zu Koln, Germany.
FAU - Gerhardt, Felix
AU  - Gerhardt F
AD  - Klinik III fur Innere Medizin, Herzzentrum der Universitat zu Koln, Germany.
FAU - Orlova, Kristina
AU  - Orlova K
AD  - Klinik III fur Innere Medizin, Herzzentrum der Universitat zu Koln, Germany.
FAU - Ten Freyhaus, Henrik
AU  - Ten Freyhaus H
AD  - Klinik III fur Innere Medizin, Herzzentrum der Universitat zu Koln, Germany; 
      Cologne Cardiovascular Research Center (CCRC), Heart Center at the University of 
      Cologne, Germany.
FAU - Hellmich, Martin
AU  - Hellmich M
AD  - Institut fur Medizinische Statistik, Informatik und Epidemiologie (IMSIE), 
      Universitat zu Koln, Germany.
FAU - Baldus, Stephan
AU  - Baldus S
AD  - Klinik III fur Innere Medizin, Herzzentrum der Universitat zu Koln, Germany; 
      Cologne Cardiovascular Research Center (CCRC), Heart Center at the University of 
      Cologne, Germany.
FAU - Rosenkranz, Stephan
AU  - Rosenkranz S
AD  - Klinik III fur Innere Medizin, Herzzentrum der Universitat zu Koln, Germany; 
      Cologne Cardiovascular Research Center (CCRC), Heart Center at the University of 
      Cologne, Germany. Electronic address: stephan.rosenkranz@uk-koeln.de.
LA  - eng
PT  - Journal Article
DEP - 20190104
PL  - Netherlands
TA  - Int J Cardiol
JT  - International journal of cardiology
JID - 8200291
RN  - 0 (Phosphodiesterase 5 Inhibitors)
RN  - 742SXX0ICT (Tadalafil)
SB  - IM
CIN - Int J Cardiol. 2019 Aug 1;288:132-134. PMID: 30917897
MH  - Aged
MH  - Cardiac Catheterization
MH  - Echocardiography
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Failure/complications/*drug therapy/physiopathology
MH  - Heart Ventricles/diagnostic imaging/physiopathology
MH  - Humans
MH  - Hypertension, Pulmonary/*drug therapy/etiology/physiopathology
MH  - Male
MH  - Phosphodiesterase 5 Inhibitors/therapeutic use
MH  - Retrospective Studies
MH  - Stroke Volume/*physiology
MH  - Tadalafil/*therapeutic use
MH  - Time Factors
MH  - Treatment Outcome
MH  - Vascular Resistance/*physiology
MH  - Ventricular Function, Right/physiology
OTO - NOTNLM
OT  - Diastolic pressure gradient (DPG)
OT  - Heart failure with preserved ejection fraction (HFpEF)
OT  - Phosphodiesterase type 5 inhibitor (PDE5i)
OT  - Pulmonary artery compliance (PAC)
OT  - Pulmonary hypertension (PH)
OT  - Pulmonary vascular resistance (PVR)
EDAT- 2019/02/20 06:00
MHDA- 2019/12/31 06:00
CRDT- 2019/02/20 06:00
PHST- 2018/09/03 00:00 [received]
PHST- 2018/12/04 00:00 [revised]
PHST- 2018/12/28 00:00 [accepted]
PHST- 2019/02/20 06:00 [pubmed]
PHST- 2019/12/31 06:00 [medline]
PHST- 2019/02/20 06:00 [entrez]
AID - S0167-5273(18)35398-1 [pii]
AID - 10.1016/j.ijcard.2018.12.078 [doi]
PST - ppublish
SO  - Int J Cardiol. 2019 May 15;283:152-158. doi: 10.1016/j.ijcard.2018.12.078. Epub 
      2019 Jan 4.