PURPOSE: Sildenafil is found to improve exercise capacity and haemodynamics in selected patients with pulmonary hypertension. We present data from patients with severe PH, following their 6-minute walking distance, right ventricule pressure measured by cardiac ultrasound, Borg dyspnea score and NYHA class.
METHODS: Over 8-year period we commenced 40 patients on sildenafil 25-50 mg tds, NYHA class II-IV, with various etiology of pulmonary hypertension (30 patients with PAH; which included 19 patients with IPAH, 5 with connective tissue disease, 5 with congenital heart disease, 1 with PH associated with anorexigen intake; 8 patients with CTEPH, 1 patient with PH due to COPD and 1 patient with PH due to hematologic malignancy) were followed for mean od 17.3 months (range, 1 to 72 months). Long-term efficacy was assesed by 6-min walking distance (6MWD), NYHA class, Borg dyspnea score, and right ventricule pressure measeured by cardiac ultrasound. Clinical events were monitored to asses time to disease progression.
RESULTS: Rigth ventricule pressure was reduced from 97.45 mmHg before treatment to 90.5 mmHg after 12 months of treatment (p<0.05). 6MWD increased from 316 m to 375m after 3 month, then further to 384m at 6 months and further to 407m after 12 months of treatment(p<0.05). Eleven patients (79% of all failures) had failure of treatment after 3 months, additional two after 6 months and one more after 12 months of treatment. Therapy is still ongoing in 26 patients, and in 19 patient is longer than 12 months. In those patients with prolonged benefit, mean duration of treatment is 33.2 months (range 12 to 72 months). In patients with prolonged benefit we noticed improvements in Borgy dyspnea score and NYHA class.
CONCLUSION: Long-term use of sildenafil in patients with severe pulmonary hypertension of various etiologies is associated with a sustained improvement in exercise capacity and right venticule pressure. Most of the treatment failures were noticed after first three months of treatment.
CLINICAL IMPLICATIONS: Prolonged use of sildenafil can be of benefit in selecetd patients with PH.
DISCLOSURE: Marko Jakopovic, No Financial Disclosure Information; No Product/Research Disclosure Information