Heart 1998;80:151-155 ( August )

Long term intravenous prostaglandin (epoprostenol or iloprost) for treatment of severe pulmonary hypertension

T Higenbottam,^a A Y Butt,^b A McMahon,^b R Westerbeck,^c L Sharples^c

^a Section of Respiratory Medicine, Division of Clinical Sciences, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK, ^b Department of Respiratory Physiology, Papworth Hospital, Cambridge, UK, ^c Department of Research and Development, Papworth Hospital, Cambridge, and MRC Biostatistics Unit, Institute of Public Health, Cambridge, UK

Correspondence to: Professor T Higenbottam, Division of Clinical Sciences, Section of Respiratory Medicine, Floor F, The Medical School, University of Sheffield, Beech Hill Road, Sheffield S10 2RX, UK.

Accepted for publication 24 April 1998

ObjectiveTo investigate the relation between the severity of pulmonary hypertension and the outcome of medical treatment.
Methods98 patients with primary pulmonary hypertensionnine (6%) with systemic disease and pulmonary hypertension and 39 (27%) with thromboembolic pulmonary hypertensionreceived medical treatment and were followed between 1982 and 1995. They were given long term intravenous prostaglandin treatment (either epoprostenol (n = 61) or iloprost (n = 13)) or conventional treatment with oral anticoagulants (n = 24) with or without calcium channel blockers. Event-free survival was measured to death or transplant surgery, or pulmonary thromboendarterectomy.
ResultsPrognosis (hazard ratio) was affected by: New York Heart Association grade, 1.52 (95% confidence interval 1.11 to 2.09); mixed venous oxygen saturation (SvO₂%), 0.97 (0.95 to 0.98); cardiac index, 0.72 (0.49 to 1.06); mean right atrial pressure, 1.04 (1.01 to 1.07); and pulmonary vascular resistance, 1.02 (1.00 to 1.04). The median event-free survival time of patients with SvO₂ < 60% was 239 days (0 to 502) on conventional treatment (n = 22) and 585 days (300 to 870) on prostaglandin treatment (n = 42). No difference was seen in patients with SvO₂  60% between conventional treatment and prostaglandin treatment, survival being 1275 days (732 to 1818; (n = 48)) and 986 days (541 to 1431; n = 30)), respectively. Capacity for pulmonary vasodilatation did not predict outcome of treatment.
ConclusionsContinuous intravenous prostaglandins were more effective than anticoagulants, with or without calcium channel blockers, in prolonging survival in patients with right heart failure. In these patients a capacity to vasodilate did not predict outcome from medical treatment.

Keywords: prostacyclin;  iloprost;  pulmonary hypertension;  event-free survival

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© 1998 by Heart
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