Chest
Treatment of Severe Pulmonary Hypertension Secondary to Connective Tissue Diseases With Continuous IV Epoprostenol (Prostacyclin)
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MATERIALS AND METHODS
Twelve patients with severe pulmonary hypertension secondary to systemic lupus erythematosous (n=4), systemic sclerosis (n=4), mixed CTD (n=3), and primary Sjogren's syndrome (n=l) entered this study. The diagnosis of pulmonary hypertension was established by right heart catheterization. Secondary causes of pulmonary hypertension other than CTD were eliminated by perfusion lung scanning and/or pulmonary angiography, lung function testing, and echocardiography. Patients were in NYHA functional
RESULTS
All patients were evaluated at baseline and 6 weeks after initiation of continuous IV epoprostenol therapy (Table 1). Baseline NYHA functional class was III or IV in all patients. At 6 weeks, functional class improved in nine patients, worsened in one, and was unchanged in two.
Before continuous IV epoprostenol therapy, baseline values (mean±SEM) for unencouraged 6-min walk test, mPAP, CI, PVR, and SvO2 were 253±45 m, 52±2 mm Hg, 1.95±0.12 L/min/m2, 28.1±2.5 U/m2, and 48±4%, respectively. Six
DISCUSSION
The present open monocenter uncontrolled study suggests that continuous IV epoprostenol infusion can produce significant hemodynamic and symptomatic responses in severe pulmonary hypertension refractory to conventional medical therapy occurring in patients with CTD. In our patient population, corticosteroids and immunosuppressants have been unable to control or prevent the occurrence of severe pulmonary hypertension, and all patients presented with NYHA functional class III or IV despite
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Efficacy of combined medication of nifedipine and magnesium sulfate on gestational hypertension and the effect on PAPP-A, VEGF, NO, Hcy and vWF
2019, Saudi Journal of Biological SciencesCitation Excerpt :Spasm in small arteries triggers oxidative stress, giving rise to the release of superoxide radical and inflammatory cytokines, which gains the possibility to aggravate the vascular endothelial injuries (Golding, 2008; McLaughlin et al., 2008). Humbert et al. (2008) reported increased PAPP-A level in gestational hypertension patients, and that PAPP-A is positively correlated with the severity, with a potential of indicator in monitoring the gestational hypertension. In this study, patients in the observation group, after treatment, had a significant reduction in PAPP-A level (p < 0.05), which shows that magnesium sulfate in combination with nifedipine can decrease the PAPP-A level, thereby alleviating the endothelial injury and improving the pregnancy outcome.
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2019, Clinics in Chest MedicineCitation Excerpt :Bosentan has been evaluated in 157 patients with inoperable CTEPH or persistent/recurrent PH after PTE over 16 weeks; the primary endpoint of a decrease in PVR and an increase in the 6-minute walk distance was not met.85,86 In cases of severe CTEPH in APLAS patients, continuous intravenous prostacyclin infusion with a pump has been used.87,88 Cyclophosphamide has been tried as a treatment for APL antibody-associated PH, with success in individual cases.89
WHO Group 1 pulmonary arterial hypertension: Current and investigative therapies
2012, Progress in Cardiovascular DiseasesPulmonary Hypertension in Systemic Sclerosis
2011, Seminars in Arthritis and RheumatismCitation Excerpt :Both PAPm and PVR decreased significantly with epoprostenol infusion, with a concomitant increase in cardiac output. Following this, an open-label uncontrolled study suggested that continuous IV epoprostenol infusion can produce significant hemodynamic and symptomatic responses in severe pulmonary hypertension associated with CTD that is refractory to conventional medical therapy (98). Similar results were found in another study of 16 SSc-PH patients who manifest favorable short-term and long-term hemodynamic responses to epoprostenol, and it was also well tolerated (99).
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2010, Respiratory Medicine CMECitation Excerpt :The prevalence of pulmonary veno-occlusive disease may be increased in patients with PAH-CTD,102 so extra care is required to exclude evidence of this condition when starting vasodilator therapy. Patients with PAH-CTD treated with IV epoprostenol have shown improvements in functional class, 6MWD, and haemodynamics in short term open-label studies.103–105 Longer-term studies of IV prostacyclin and inhaled iloprost have suggested clinical and haemodynamic benefits in PAH-CTD and SSc.106,107
This study has been supported in part by a grant from Laboratoire Glaxo Wellcome.