Cardiovascular medicine
Treatment with epoprostenol reverts nitric oxide
non-responsiveness in patients with primary pulmonary hypertension
R Zieschea, V Petkova, K Wittmanna, J Kopatschkaa, L Stiebellehnera, P Schenka, P Germannb, G Röderb, R Ullrichb, L H Blocka
a Department of
Internal Medicine IV, University of Vienna Medical School, Währinger
Gürtel 18-20, A-1090 Vienna, Austria, b Department of
Anesthesiology and General Intensive Care, University of Vienna Medical
School
Correspondence to: Dr Ziesche email: rolf.ziesche{at}akh-wien.ac.at
Accepted 11 October
1999
OBJECTIVE
To assess whether long term treatment with
epoprostenol might restore primary non-responsiveness to nitric oxide
(NO) in patients with primary pulmonary hypertension.
METHODSSeven patients with primary pulmonary
hypertension receiving intravenous epoprostenol continuously because of
failure of NO to influence pulmonary haemodynamics during initial
testing were followed over a period of 13-29 months. Afterwards, acute
vascular reactivity towards NO was tested again during right heart catheterisation.
RESULTSAdministration of NO after continuous
epoprostenol treatment for a mean period of 18 months improved arterial
oxygen saturation (p < 0.01) and cardiac index (p < 0.05), and
decreased mean pulmonary artery pressure (p < 0.01) and total
pulmonary vascular resistance (p < 0.01) in patients previously
unresponsive to NO.
CONCLUSIONSLong term treatment with epoprostenol reverts
initial refractoriness to NO in patients with primary pulmonary
hypertension. Thus the addition of NO to epoprostenol treatment might
cause further improvement in the course of the disease.
Keywords: primary pulmonary hypertension; epoprostenol; vascular reactivity
© 2000 by Heart
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