SESSION TYPE: Heart Failure
PRESENTED ON: Sunday, October 21, 2012 at 10:30 AM - 11:45 AM
PURPOSE: The goal was to examine the hemodynamic and clinical effects of long-term therapy with PDE5 inhibitor sildenafil (SILD) in patients with advanced, pre-transplant heart failure (HF) and severe pulmonary hypertension (PH),in comparison to a similar control group (CON).
METHODS: In this matched case-control study, 32 middle-aged patients (81% males) with advanced systolic HF (80%≥NYHA III, 56% ischemic) and severe pre-capillary PH (transpulmonary pressure gradient>15 mmHg) were studied before and after initiation of SILD (dose 73±25mg/day) and were compared to 15 CON patients, matched for key clinical characteristics (including PH severity, age and co-morbidities), not exposed to SILD. Changes at 3 months and the long-term outcome were compared between groups
RESULTS: SILD significantly reduced pulmonary vascular resistance (-32% vs. baseline), transpulmonary gradient (-25%) and increased cardiac output (+15%) compared to controls, without affecting systemic or ventricular filling pressures. SILD-treated subjects experienced an improvement in NYHA class and had a steady body weight which contrasted with significant weight loss in the CON group (by -4.8%, absolutely by 4.3±6 kg). During followup (median 914 days), overall survival was significantly better in the SILD than the CON group (85% vs. 56%, p=0.04). Sixty percent of patients underwent heart transplantation. Among them, two patients in the CON group had severe post-transplant failure of the right ventricle while none did in the SILD group.
CONCLUSIONS: In patients with advanced HF and severe PH, SILD therapy has beneficial effects on hemodynamics, clinical status, cardiac cachexia, and contributes to improved peritransplant survival
CLINICAL IMPLICATIONS: Therapy with PDE5 inhibitors in patients with advanced HF and severe PH has beneficial effect on hemodynamics, clinical status and body weight loss due to cardiac cachexia.
DISCLOSURE: The following authors have nothing to disclose: Hikmet Al-Hiti, Vojtech Melenovsky, Adrian Reichenbach, Ivan Malek, Jan Pirk, Eva Goncalvesova, Josef Kautzner
No Product/Research Disclosure InformationIKEM, Prague, Czech Republic