US EPA

2267617 

Journal Article 

Abstract 

Comparison of acute hemodynamic effects of inhaled nitric oxide (iNO) and inhaled epoprostenol (iEPO) in patients with pulmonary arterial hypertension (PAH) 

Shah, AM; Siddiqui, F; Preston, IR; Brennan, J; Roberts, K; Howard, W; Hill, NS 

2010 

Yes 

American Journal of Respiratory and Critical Care Medicine
ISSN: 1073-449X
EISSN: 1535-4970 

181 

A3382 

English 

10.1164/ajrccm-conference.2010.181.1_MeetingAbstracts.A3382 

WOS:000208771002492 

is part of a larger document 3452678 Proceedings of the American Thoracic Society 2010 International Conference, May 14-19, 2010, New Orleans

Objective: To compare acute hemodynamic effects of inhaled nitric oxide (iNO) and inhaled epoprostenol (iEPO) alone and in combination, in patients with Pulmonary Arterial Hypertension (PAH).

Design: Prospective, randomized, double blind study.

Setting: University hospital catheterization laboratory.

Participants: Eighteen treatment-naïve patients undergoing right heart catheterization for PAH at a tertiary referral center.

Interventions: Consecutive patients who underwent elective right heart catherizations (RHCs) [mean PA pressure (mPAP) ≥ 25 mm Hg, PA wedge ≤ 18 mmHg] with acute vasodilator responses to iNO (20ppm) alone, iEPO (50ng/kg/min) alone and the combination were assessed in a double-blind, randomized fashion. Hemodynamics were measured at baseline, after 10 minutes’ administration of each vasodilator and after a 20 minute washout period between each vasodilator agent. Patients were maintained on the same FiO2 throughout.

Results: Eighteen patients (F: M=12:6), with a mean age of 67 years underwent RHC as described above. Two patients had normal hemodynamics and were excluded. WHO Classification of enrolled patients was: Group I = 6, Group II = 7, and 1 each in Groups III, IV and V. Only 1 patient had a positive acute vasodilator response, as defined by current guidelines. Table 1 shows mPAP and pulmonary vascular resistance (PVR) responses to vasodilators. Changes in PVR in response to iNO and iEPO had a significant positive correlation in Groups’ I, IV and V (combined in Figure 1) and in Group II (r^2 = 0.89, p = 0.005). Changes in mPAP in response to iNO and iEPO had no significant positive correlation. The combination of iNO and iEPO did not have an additive effect over each agent alone.

Conclusion: In this small cohort of pulmonary hypertension patients, acute vasodilator challenge with iNO and iEPO produced similar vasodilator responses, while the combination did not have additive effects. 

American Thoracic Society 2010 International Conference 

New Orleans, LA 

May 14-19, 2010