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HEMODYNAMIC EFFECTS OF PHOSHODIESTERASE-5 INHIBITOR IN PATIENTS WITH CHRONIC HEART FAILURE: ASSESSMENT BY ECHOCARDIOGRAPHY
E691 JACC March 12, 2013 Volume 61, Issue 10
Heart Failure Hemodynamic Effects of Phoshodiesterase-5 Inhibitor in Patients with Chronic Heart Failure: Assessment by Echocardiography Poster Contributions Poster Sessions, Expo North Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Novel and Standard Pharmacological Therapies in Heart Failure: Which Treatment for Which Patient Abstract Category: 15. Heart Failure: Clinical Presentation Number: 1221-292 Authors: Daisuke Morisawa, Shinichi Hirotani, Eri Manabe, Masataka Sugahara, Miho Fukui, Tomotaka Ando, Tohru Masuyama, Department of Internal Medicine, Cardiovascular Division, Hyogo College of Medicine, Nishinomiya, Japan Background: Phosphodiesterase type 5 (PDE-5) inhibitors are used to treat pulmonary hypertension. The vasodilation effects of PDE-5 inhibitor give hemodynamic influences to pulmonary and systemic circulation. Some previous studies reported the effect of PDE-5 inhibitor in patients with chronic heart failure (CHF), however, those studies did not evaluate echocardiographic parameters in detail. Therefore, in this study, we examined the mechanism by which the administration of sildenafil, a PDE-5 inhibitor, to patients with chronic heart failure gives influences in various echocardiographic parameters. Methods: Fourteen patients with CHF were enrolled in this study. We performed echocardiography before and one hour after 20 mg oral administration of sildenafil. We compared the echocardiographic parameters before and after administration. Results: The mean age and left ventricular (LV) ejection fraction were 70.3 years and 50.5%, and the mean tricuspid regurgitation peak gradient was 30mmHg. There were no significant differences in blood pressure and heart rate between pre- and post-administration of sildenafil. However, pulmonary vascular resistance significantly decreased from 2.46±0.68 wood to 2.19±0.62 wood, and right ventricular (RV) outflow tract (RVOT) velocity time integral (VTI) was significantly increase from 12.1±4.5cm to 13.5±5.1cm. Similarly, LVOT VTI tended to increase from 16.1±4.8cm to 16.6±4.3cm, but this failed to be statistically significant. LV Tei index significantly improved from 0.54±0.18 to 0.47±0.20. RV Tei index and tricuspid annular plane systolic excursion tended to improve from 0.42±0.25 to 0.34±0.25 and from 13.9±6.6 to 15.5±7.3; however, these were not statistically significant. Conclusions: In the CHF patient without severe pulmonary hypertension, sildenafil improves their hemodynamics via improvement of pulmonary circulation.
Heart Failure Hemodynamic Effects of Phoshodiesterase-5 Inhibitor in Patients with Chronic Heart Failure: Assessment by Echocardiography Poster Contributions Poster Sessions, Expo North Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Novel and Standard Pharmacological Therapies in Heart Failure: Which Treatment for Which Patient Abstract Category: 15. Heart Failure: Clinical Presentation Number: 1221-292 Authors: Daisuke Morisawa, Shinichi Hirotani, Eri Manabe, Masataka Sugahara, Miho Fukui, Tomotaka Ando, Tohru Masuyama, Department of Internal Medicine, Cardiovascular Division, Hyogo College of Medicine, Nishinomiya, Japan Background: Phosphodiesterase type 5 (PDE-5) inhibitors are used to treat pulmonary hypertension. The vasodilation effects of PDE-5 inhibitor give hemodynamic influences to pulmonary and systemic circulation. Some previous studies reported the effect of PDE-5 inhibitor in patients with chronic heart failure (CHF), however, those studies did not evaluate echocardiographic parameters in detail. Therefore, in this study, we examined the mechanism by which the administration of sildenafil, a PDE-5 inhibitor, to patients with chronic heart failure gives influences in various echocardiographic parameters. Methods: Fourteen patients with CHF were enrolled in this study. We performed echocardiography before and one hour after 20 mg oral administration of sildenafil. We compared the echocardiographic parameters before and after administration. Results: The mean age and left ventricular (LV) ejection fraction were 70.3 years and 50.5%, and the mean tricuspid regurgitation peak gradient was 30mmHg. There were no significant differences in blood pressure and heart rate between pre- and post-administration of sildenafil. However, pulmonary vascular resistance significantly decreased from 2.46±0.68 wood to 2.19±0.62 wood, and right ventricular (RV) outflow tract (RVOT) velocity time integral (VTI) was significantly increase from 12.1±4.5cm to 13.5±5.1cm. Similarly, LVOT VTI tended to increase from 16.1±4.8cm to 16.6±4.3cm, but this failed to be statistically significant. LV Tei index significantly improved from 0.54±0.18 to 0.47±0.20. RV Tei index and tricuspid annular plane systolic excursion tended to improve from 0.42±0.25 to 0.34±0.25 and from 13.9±6.6 to 15.5±7.3; however, these were not statistically significant. Conclusions: In the CHF patient without severe pulmonary hypertension, sildenafil improves their hemodynamics via improvement of pulmonary circulation.