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Clinical Trial
. 2011 Oct;17(10):813-8.
doi: 10.1016/j.cardfail.2011.05.012. Epub 2011 Jul 8.

Inhaled iloprost for patients with precapillary pulmonary hypertension and right-side heart failure

Amadea M Martischnig  1 , Alexander Tichy, Mariam Nikfardjam, Gottfried Heinz, Irene M Lang, Diana Bonderman
Affiliations
Clinical Trial

Inhaled iloprost for patients with precapillary pulmonary hypertension and right-side heart failure

Amadea M Martischnig et al. J Card Fail. 2011 Oct.

Abstract

Background: Pulmonary hypertension (PH) can lead to right-side heart failure (RHF) and death. There are no therapeutic recommendations for patients experiencing acute RHF in the course of PH. This study aimed to examine the safety and efficacy of inhaled iloprost in patients with precapillary PH and RHF.

Methods and results: Between October 2007 and December 2008, 7 patients with precapillary PH and RHF were enrolled. Per protocol, iloprost was inhaled hourly for a minimum of 12 hours during a 24-hour period. The starting dose of 2.5 μg was increased hourly by 2.5 μg as long as the increases were tolerated. Safety and efficacy were determined by continuous invasive monitoring of systemic and pulmonary hemodynamic parameters. Systemic pressures remained stable during inhalation (66.1 ± 6.9 mm Hg at baseline and 69.1 ± 6.4 mm Hg immediately after inhalation therapy, P = 0.48). Cardiac index increased from 2.4 ± 0.7 L/min/m(2) to 2.9 ± 0.9 L/min/m(2) (P = .008). Pulmonary vascular resistance decreased from 634.6 ± 218.3 dyn·s·cm(-5) to 489.6 ± 173.8 dyn·s·cm(-5) (P = .044), and N-terminal B-type natriuretic peptide levels decreased from 13,591 ± 10,939 pg/mL to 9,944 ± 8,569 pg/mL (P = .051).

Conclusion: Blood pressure-guided hourly inhalation of iloprost may offer a safe and effective strategy for the treatment of PH patients with RHF.

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Figures

Fig. 1
Fig. 1
Individual up-titrations and cumulative doses of inhaled iloprost. Each horizontal block represents a patient, numbers within lanes show doses of iloprost in μg at given time points.
Fig. 2
Fig. 2
Percentage change from baseline in safety endpoints. After the final iloprost inhalation, there were no relevant changes from baseline in arterial oxygen saturation (sO2) or mean arterial pressure (mAP).
Fig. 3
Fig. 3
Percentage change from baseline in efficacy endpoints. After the final iloprost inhalation, there were significant improvements in pulmonary vascular resistance (PVR) and cardiac index (CI). The drop in N-terminal B-type natriuretic peptide (NT-proBNP) reached borderline significance. Statistically significant differences are marked with an asterisk. mPAP, mean pulmonary arterial pressure; MVS, mixed venous oxygen saturation.
Fig. 4
Fig. 4
Changes in mean PVR according to mean iloprost dose. Numbers on the x axis refer to inhalation time points. “Last” denotes the final inhalation. White bars represent mean pulmonary vascular resistance (PVR) before inhalation; gray bars show mean PVR after inhalation. Asterisks indicate a significant decrease from baseline in PVR (P < .05).
See this image and copyright information in PMC

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