Chest
Clinical InvestigationsBosentan Therapy for Inoperable Chronic Thromboembolic Pulmonary Hypertension
Section snippets
Patient Selection
In order to ensure diagnostic accuracy and to prevent inclusion of patients with operable disease, this study was carried out at the three largest referral centers for surgical treatment of CTEPH in Germany. All patients underwent standardized assessment at the centers including ventilation/perfusion scanning, helical CT of the chest, and pulmonary angiography. The final decision to classify the patient as inoperable was made together with the surgeon in charge of the PEA program. Patients who
Results
Between September 2003 and June 2004, 19 patients were enrolled into this study. Four patients had persistent/recurrent pulmonary hypertension after previous PEA (1.5 years, 4 years, 5 years, and 6 years after surgery, respectively); the others had nonoperable CTEPH. The interval between diagnosis of CTEPH and study entry was > 3 months in all patients and was > 12 months in 10 patients. All patients had received adequate treatment with oral anticoagulants since diagnosis. Demographics,
Discussion
This open-label pilot trial, despite limited by its relatively small sample size and its uncontrolled design, shows that the dual endothelin receptor antagonist bosentan may have beneficial effects in selected patients with inoperable CTEPH. On first glance, it may seem counterintuitive to use a vasoactive treatment in a disease that is characterized by mechanical obstruction of pulmonary vessels. However, several lines of evidence suggest that, after the initializing event of single, multiple,
References (17)
- et al.
Long-term follow-up of patients with pulmonary thromboembolism: late prognosis and evolution of hemodynamic and respiratory data
Chest
(1982) - et al.
Prostacyclin therapy before pulmonary thromboendarterectomy in patients with chronic thromboembolic pulmonary hypertension
Chest
(2003) - et al.
Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism
N Engl J Med
(2004) - et al.
Chronic thromboembolic pulmonary hypertension
Eur Respir J
(2004) - et al.
Chronic thromboembolic pulmonary hypertension
N Engl J Med
(2001) - et al.
Pulmonary endarterectomy: experience and lessons learned in 1,500 cases
Ann Thorac Surg
(2003) - et al.
Interventional and surgical modalities of treatment for pulmonary arterial hypertension
J Am Coll Cardiol
(2004) - et al.
Do patients with primary pulmonary hypertension develop extensive central thrombi?
Circulation
(1995)
Cited by (0)
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).
The present study was funded by Actelion Pharmaceuticals, the manufacturer of bosentan.
Dr. Hoeper and Dr. Wilkens have received speaker's honorariums from Actelion Pharmaceuticals. Dr. Hoeper serves as an Advisory Board Member for Actelion Pharmaceuticals.