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Comparison of intravenous sildenafil with inhaled nitric oxide for acute vasodilator testing in pulmonary arterial hypertension

Acute vasodilator testing (AVT) identifies acute responders for initiation of calcium channel blockers in pulmonary arterial hypertension (PAH) and operability in congenital heart disease (CHD). We sought to determine the feasibility of intravenous sildenafil (ivS) as an alternative to inhaled nitri...

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Autores principales: Kumar, Shine, Memon, Danish, Raj, Manu, Sen, Amitabh C., Jayasankar, Jessin P., Leeladharan, Sreelakshmi P., Sudhakar, Abish, Kumar, Raman K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9791914/
https://www.ncbi.nlm.nih.gov/pubmed/36583117
http://dx.doi.org/10.1002/pul2.12180
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author Kumar, Shine
Memon, Danish
Raj, Manu
Sen, Amitabh C.
Jayasankar, Jessin P.
Leeladharan, Sreelakshmi P.
Sudhakar, Abish
Kumar, Raman K.
author_facet Kumar, Shine
Memon, Danish
Raj, Manu
Sen, Amitabh C.
Jayasankar, Jessin P.
Leeladharan, Sreelakshmi P.
Sudhakar, Abish
Kumar, Raman K.
author_sort Kumar, Shine
collection PubMed
description Acute vasodilator testing (AVT) identifies acute responders for initiation of calcium channel blockers in pulmonary arterial hypertension (PAH) and operability in congenital heart disease (CHD). We sought to determine the feasibility of intravenous sildenafil (ivS) as an alternative to inhaled nitric oxide (iNO) in AVT. All patients with PAH undergoing cardiac catheterization for AVT (November 2015 to December 2020) were prospectively enrolled. Hemodynamic data were obtained at baseline, with iNO 20 ppm and ivS (0.25 mg/kg for children and 10 mg for adults). We studied 44 patients with a mean age of 20.5 ± 14.4 years (27 [61%] females and 20 [45%] children). There were 17 (38.6%) patients in the CHD group for operability assessment and 27 patients in non‐CHD group (idiopathic pulmonary arterial hypertension—16 [36.3%], residual PAH after shunt closure—7 [15.9%], and 2 cases [4.5%] each of familial PAH and portopulmonary hypertension). There was an excellent intraclass correlation for mean pulmonary artery pressures (0.903, 95% confidence interval, CI: 0.809–0.949, p < 0.001), mean aortic pressures (0.745, 95% CI: 0.552–0.858, p < 0.001), pulmonary vascular resistance index (0.920, 95% CI: 0.858–0.956, p < 0.001), systemic vascular resistance (SVR) index (0.828, 95% CI: 0.706–0.902, p < 0.001), and the ratio of pulmonary and SVR indices (0.857, 95% CI: 0.752–0.919, p < 0.001) between the two agents. There were two responders, both in non‐CHD group, and were identified by iNO and ivS. The hemodynamic effects of ivS show excellent correlation with iNO and could be a potential alternative agent for identifying acute responders during AVT.
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spelling pubmed-97919142022-12-28 Comparison of intravenous sildenafil with inhaled nitric oxide for acute vasodilator testing in pulmonary arterial hypertension Kumar, Shine Memon, Danish Raj, Manu Sen, Amitabh C. Jayasankar, Jessin P. Leeladharan, Sreelakshmi P. Sudhakar, Abish Kumar, Raman K. Pulm Circ Research Articles Acute vasodilator testing (AVT) identifies acute responders for initiation of calcium channel blockers in pulmonary arterial hypertension (PAH) and operability in congenital heart disease (CHD). We sought to determine the feasibility of intravenous sildenafil (ivS) as an alternative to inhaled nitric oxide (iNO) in AVT. All patients with PAH undergoing cardiac catheterization for AVT (November 2015 to December 2020) were prospectively enrolled. Hemodynamic data were obtained at baseline, with iNO 20 ppm and ivS (0.25 mg/kg for children and 10 mg for adults). We studied 44 patients with a mean age of 20.5 ± 14.4 years (27 [61%] females and 20 [45%] children). There were 17 (38.6%) patients in the CHD group for operability assessment and 27 patients in non‐CHD group (idiopathic pulmonary arterial hypertension—16 [36.3%], residual PAH after shunt closure—7 [15.9%], and 2 cases [4.5%] each of familial PAH and portopulmonary hypertension). There was an excellent intraclass correlation for mean pulmonary artery pressures (0.903, 95% confidence interval, CI: 0.809–0.949, p < 0.001), mean aortic pressures (0.745, 95% CI: 0.552–0.858, p < 0.001), pulmonary vascular resistance index (0.920, 95% CI: 0.858–0.956, p < 0.001), systemic vascular resistance (SVR) index (0.828, 95% CI: 0.706–0.902, p < 0.001), and the ratio of pulmonary and SVR indices (0.857, 95% CI: 0.752–0.919, p < 0.001) between the two agents. There were two responders, both in non‐CHD group, and were identified by iNO and ivS. The hemodynamic effects of ivS show excellent correlation with iNO and could be a potential alternative agent for identifying acute responders during AVT. John Wiley and Sons Inc. 2022-10-01 /pmc/articles/PMC9791914/ /pubmed/36583117 http://dx.doi.org/10.1002/pul2.12180 Text en © 2022 The Authors. Pulmonary Circulation published by John Wiley & Sons Ltd on behalf of Pulmonary Vascular Research Institute. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Research Articles
Kumar, Shine
Memon, Danish
Raj, Manu
Sen, Amitabh C.
Jayasankar, Jessin P.
Leeladharan, Sreelakshmi P.
Sudhakar, Abish
Kumar, Raman K.
Comparison of intravenous sildenafil with inhaled nitric oxide for acute vasodilator testing in pulmonary arterial hypertension
title Comparison of intravenous sildenafil with inhaled nitric oxide for acute vasodilator testing in pulmonary arterial hypertension
title_full Comparison of intravenous sildenafil with inhaled nitric oxide for acute vasodilator testing in pulmonary arterial hypertension
title_fullStr Comparison of intravenous sildenafil with inhaled nitric oxide for acute vasodilator testing in pulmonary arterial hypertension
title_full_unstemmed Comparison of intravenous sildenafil with inhaled nitric oxide for acute vasodilator testing in pulmonary arterial hypertension
title_short Comparison of intravenous sildenafil with inhaled nitric oxide for acute vasodilator testing in pulmonary arterial hypertension
title_sort comparison of intravenous sildenafil with inhaled nitric oxide for acute vasodilator testing in pulmonary arterial hypertension
topic Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9791914/
https://www.ncbi.nlm.nih.gov/pubmed/36583117
http://dx.doi.org/10.1002/pul2.12180
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