Pulmonary arterial hypertension (PAH) is a common finding in patients with significant valvular heart disease. Currently, inhaled Nitric Oxide (iNO) is frequently used to rapidly reduce the pulmonary artery pressures in this population. Although intravenous epoprostenol (EPO) is efficacious in treating PAH, we examined the efficacy of inhaled EPO (iEPO) in the treatment of PAH.
We retrospectively collected data by chart review of patients who were treated with iEPO at our institution, from July 2008 through April 2009. Eighty-seven patients treated with iEPO [63.5% male (n = 54), mean age 66.7 ± 13.12 years, mean BMI 31.3 ± 8.48] were studied to evaluate the effectiveness of treatment. Pre and post mean PAP and CI were compared using two-sample paired t-test, respectively (two-tailed), when the hemodynamic data was available.
Of all the patients, 72 (82.8%) underwent valve surgeries, seven (8.1%) had LVAD, and two (2.3%) had cardiac transplants. iEPO was used as adjunctive therapy in six (6.7%) medical patients. No adverse effects associated with this form of therapy were observed. Hemodynamic parameters were statistically significant, as seen in the table below. The average daily cost of inhaled EPO was $19/hr, while iNO cost $132/hr.
iEPO demonstrated excellent clinical and hemodynamic response, and it was well tolerated in this critically ill subgroup of patients. It was a cost-effective alternative to iNO, with a net savings greater than $750,000.
Based on this preliminary subset population analysis, iEPO may be efficacious in wider clinical settings for patients with PAH. Further studies are needed in this regard to guide therapy.
Dianne Zwicke, No Financial Disclosure Information; No Product/Research Disclosure Information