Hemodynamic Effects of Epoprostenol in Patients With Systemic Sclerosis and Pulmonary Hypertension

To determine the cause of pulmonaryhypertension (PH) in systemic sclerosis (SSc) patients since PH canoccur because of pulmonary arteriopathy, pulmonary parenchymaldestruction, and left ventricular cardiac dysfunction. Consecutive case series in a universityhospital. Nine SSc patients with PH (meanp...

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Vydáno v:	Chest Ročník 118; číslo 4; s. 1077 - 1082
Hlavní autoři:	Strange, Charlie, Bolster, Marcy, Mazur, Joe, Taylor, Marian, Gossage, James R., Silver, Richard
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	Northbrook, IL Elsevier Inc 01.10.2000 American College of Chest Physicians
Témata:	Adult Antihypertensive Agents - administration & dosage Biological and medical sciences Cardiac Catheterization Cardiac Output - drug effects Drug dosages Drug therapy Drug withdrawal Echocardiography, Doppler Edema epoprostenol Epoprostenol - administration & dosage Female Hemodynamics Hemodynamics - drug effects Humans Hypertension, Pulmonary - diagnostic imaging Hypertension, Pulmonary - drug therapy Hypertension, Pulmonary - etiology Hypertension, Pulmonary - physiopathology Infusions, Intravenous interstitial lung disease Intubation Lung diseases Male Medical sciences Middle Aged Patients Pharmacology. Drug treatments Pulmonary arteries Pulmonary hypertension Pulmonary Wedge Pressure - drug effects Raynaud disease Respiratory system Scleroderma Scleroderma, Systemic - complications Scleroderma, Systemic - diagnostic imaging Scleroderma, Systemic - drug therapy Scleroderma, Systemic - physiopathology Spirometry systemic sclerosis Total Lung Capacity Veins & arteries Ventilation ILD SSc systemic sclerosis interstitial lung disease epoprostenol pulmonary hypertension PAOP PH HRCT TLC dcSSc PVR Human Immunopathology Connective tissue disease Skin disease Prostaglandin I2 Respiratory disease Arachidonic acid derivatives Treatment efficiency Cardiovascular disease Autoimmune disease Exploration Pulmonary artery Pulmonary hypertension Epoprostenol Chemotherapy Treatment Vascular resistance Systemic disease Complication Hemodynamics Scleroderma
ISSN:	0012-3692, 1931-3543
On-line přístup:	Získat plný text
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Popis
Shrnutí:	To determine the cause of pulmonaryhypertension (PH) in systemic sclerosis (SSc) patients since PH canoccur because of pulmonary arteriopathy, pulmonary parenchymaldestruction, and left ventricular cardiac dysfunction. Consecutive case series in a universityhospital. Nine SSc patients with PH (meanpulmonary artery pressure, 41 mm Hg), with (n = 6) or without(n = 3) concomitant interstitial lung disease (ILD). Acute infusion of epoprostenol was begun at 2ng/kg/min and was titrated upward at a rate of 2 ng/kg/min every 30 minuntil symptomatic complications developed or pulmonary artery vascularresistance (PVR) was reduced by 50%. Eightof nine patients demonstrated a reduction of ≥ 20% in PVR, suggesting that vasoreactivity is common despite the presence of significant ILD. A single patient had no response to infusion withunchanged hemodynamics and oxygenation. One patient developed hypoxemiaas cardiac output increased, suggesting a worsening of ventilation/perfusion matching or the presence of an anatomicshunt. Acute pulmonary edema developed in one patient at aninfusion rate of 6 ng/kg/min. The results of cardiac catheterizationsuggested that pulmonary edema was caused by SSc heart disease. SSc patients with ILD have diverse andsometimes multiple causes of PH that can be determined by short-termepoprostenol infusion. Beneficial effects can be obtained fromepoprostenol despite extensive ILD.
Bibliografie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 ObjectType-Article-2 ObjectType-Feature-1 content type line 23
ISSN:	0012-3692 1931-3543
DOI:	10.1378/chest.118.4.1077