Chest
Clinical InvestigationsBosentan Therapy for Inoperable Chronic Thromboembolic Pulmonary Hypertension
Section snippets
Setting
The present study was conducted at the Pulmonary Hypertension Unit of the Medical University of Vienna between July 2003 and December 2004. PEA is a long-term successful treatment option of CTEPH, and this treatment is, in Austria, offered only at the Medical University of Vienna.
Diagnostic Procedures
All patients were referred for exertional or resting dyspnea. The diagnosis of CTEPH was established by chest radiography, transthoracic and transesophageal echocardiography with Doppler imaging, pulmonary function
Patients
Patient baseline characteristics are shown in Table 1. Of the 33 patients who received a diagnosis of CTEPH at our center within the inclusion period, 16 patients (7 men and 9 women) were found to be inoperable. Mean age was 70 ± 13 years. Baseline hemodynamic data were as follows: mean cardiac index, 2.4 ± 0.5 L/min/m2; mean PVR, 712 ± 213 dyne/s−1/cm−5; mean mixed venous saturation, 61 ± 9%; and mean pulmonary arterial pressure, 52 ± 10 mm Hg. None of the patients had elevated liver enzymes
Discussion
Our study suggests a beneficial effect of the oral dual ET receptor antagonist bosentan in patients with inoperable CTEPH. Currently, no specific randomized trial-based therapeutic recommendations exist for this patient population. The pathogenesis of CTEPH is still unclear, but it is widely accepted that the disease is determined by thromboembolic obliteration triggering an abnormal process of vascular remodeling due to a variety of factors, such as shear stress, pressure, inflammation, and
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This research was supported by the Austrian fellowship grant FWFS9406-B11-MED (to Dr. Lang), the Osterreichischer Herzfonds, the Osterreichischer Selbsthilfeverein Lungenhochdruck, and the Ludwig Boltzmann Institute for Cardiovascular Research.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).