Some patients with advanced heart failure (HF) develop significant pre-capillary pulmonary hypertension (PH) that affects survival and therapeutic choices. Beneficial effects of short-term oral sildenafil on pulmonary hemodynamics have been recently reported. The aim of our study was to examine the long-term effects of sildenafil therapy and the relation between its acute and chronic hemodynamic effects in a group of HF patients with PH.
Ten patients with advanced HF (age 50.7 ± 9.6, all males, 70% CAD etiology) and severe PH on stable optimal medical therapy were prospectively recruited. Patients underwent right heart catheterization using SG catheter (Corodyn, Braun) at baseline and 1hour after oral 40 mg sildenafil dose. Right heart cath was repeated after 24 weeks of sildenafil (3x40 mg p.o.) therapy, after withholding the morning dose at the day of testing.
Sildenafil reduced PVR, TPG, PA wedge pressure and increased CO both acutely and chronically (table 1). 24w therapy was well tolerated, no patient experienced HF decompensation or death. The only non-response was observed in restrictive cardiomyopathy. The magnitude of acute and chronic effects was similar, although a trend to lower reduction was observed for PVR and TPG at 24w. Correlation between Δ of TPG or PVR at 1H and 24W were not significant (r=0.33 and −0.21).
After 24-week long therapy with sildenafil, only minute decrement of hemodynamic benefits was observed in comparison to acute administration. Weak correlation between acute and chronic changes of TPG and PVR suggests limited role of acute testing for individual prediction of long-term response to sildenafil.
Sildenafil had sustained benefical effects on pulmonary hemodynamics in patients with advanced heart failure and PH.
Hikmet Al-Hiti, No Financial Disclosure Information; No Product/Research Disclosure Information