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          Institute: MPI für Herz- und Lungenforschung (W. G. Kerckhoff Institut)     Collection: Yearbook 2016     Display Documents



ID: 723955.0, MPI für Herz- und Lungenforschung (W. G. Kerckhoff Institut) / Yearbook 2016
Sildenafil versus nitric oxide for acute vasodilator testing in pulmonary arterial hypertension
Authors:Milger, K.; Felix, J. F.; Voswinckel, R.; Sommer, N.; Franco, O. H.; Grimminger, F.; Reichenberger, F.; Seeger, W.; Ghofrani, H. A.; Gall, H.
Date of Publication (YYYY-MM-DD):2015-06
Title of Journal:Pulm Circ
Volume:5
Issue / Number:2
Start Page:305
End Page:312
Audience:Not Specified
Abstract / Description:Vasoreactivity testing with inhaled NO is recommended for pulmonary arterial hypertension (PAH) because of its therapeutic and prognostic value. Sildenafil has acute pulmonary vasodilating properties, but its diagnostic and prognostic impact in PAH is unknown. Our objective was to compare acute vasodilating responses to sildenafil and those to NO during right heart catheterization and also their prognostic values in patients with PAH. Ninety-nine patients with idiopathic PAH and 99 with associated PAH underwent vasoreactivity testing with NO and sildenafil. Only mild adverse effects of sildenafil, in the form of hypotension, were observed, at a rate of 4.5%. The acute responder rate was 8.1% for NO and 11.6% for sildenafil. The NO-induced response in mean pulmonary arterial pressure and cardiac output correlated with the response to sildenafil. Thirteen patients were long-term responders to calcium channel blockers (CCBs), and 3 of them were correctly identified by acute vasoreactivity test with both drugs. The specificity of the vasoreactivity test for identifying long-term CCB responders was 88.9% for NO and 85.1% for sildenafil testing. A trend toward better survival was found in sildenafil and NO responders, compared with nonresponders. Use of sildenafil for vasoreactivity testing is safe. Sildenafil may be useful as alternative vasoreactivity-testing agent, identifying the same number of long-term CCB responders as NO. However, NO seems to be a more ideal testing drug because of its pharmacologic properties. Moreover, sildenafil vasoreactivity testing might contribute to an improved estimate of prognosis among patients with PAH.
Free Keywords:nitric oxide; pulmonary arterial hypertension; sildenafil; vasoreactivity testing
External Publication Status:published
Document Type:Article
Communicated by:n.n.
Affiliations:MPI für physiologische und klinische Forschung
External Affiliations:Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands. University of Giessen and Marburg Lung Center, Giessen, Germany, member of the German Center for Lung Research (DZL) ; Department of Internal Medicine, Health Center Wetterau, Friedberg, Germany. University of Giessen and Marburg Lung Center, Giessen, Germany, member of the German Center for Lung Research (DZL). University of Giessen and Marburg Lung Center, Giessen, Germany, member of the German Center for Lung Research (DZL) ; Comprehensive Pneumology Center, Munich, Germany, member of the German Center for Lung Research (DZL) ; Asklepios Klinik Gauting, Gauting, Germany. University of Giessen and Marburg Lung Center, Giessen, Germany, member of the German Center for Lung Research (DZL) ; Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands.
Identifiers:ISSN:2045-8932 (Print) 2045-8932 (Linking) %R 10.1086/680355
URL:http://www.ncbi.nlm.nih.gov/pubmed/26064455
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