Factors Associated with Ineffectiveness of Sildenafil Treatment in Patients with End-Stage Heart Failure and Elevated Pulmonary Vascular Resistance
Introduction: Elevated pulmonary vascular resistance (PVR) unresponsive to vasodilator treatment is a marker of heart failure (HF) severity, and an important predictor of poor results of heart transplantation (HT). Objective: We sought to analyze factors associated with ineffectiveness of sildenafil...
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MDPI AG
2020-11-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/9/11/3539 |
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| author | Wioletta Szczurek Mariusz Gąsior Michał Skrzypek Ewa Romuk Bożena Szyguła-Jurkiewicz |
| author_facet | Wioletta Szczurek Mariusz Gąsior Michał Skrzypek Ewa Romuk Bożena Szyguła-Jurkiewicz |
| author_sort | Wioletta Szczurek |
| collection | DOAJ |
| description | Introduction: Elevated pulmonary vascular resistance (PVR) unresponsive to vasodilator treatment is a marker of heart failure (HF) severity, and an important predictor of poor results of heart transplantation (HT). Objective: We sought to analyze factors associated with ineffectiveness of sildenafil treatment in end-stage HF patients with elevated PVR with particular emphasis placed on tenascin-C (TNC) serum concentrations. Patients and Methods: The study is an analysis of 132 end-stage HF patients referred for HT evaluation in the Cardiology Department between 2015 and 2018. TNC was measured by sandwich enzyme-linked immunosorbent assay (Human TNC, SunRedBio Technology, Shanghai, China). The endpoint was PVR > 3 Wood units after the six-month sildenafil therapy. Results: The median age was 58 years, and 90.2% were men. PVR >3 Wood units after 6 months of sildenafil treatment were found in 36.6% patients. The multivariable logistic regression analysis confirmed that TNC (OR = 1.004 (1.002–1.006), <i>p</i> = 0.0003), fibrinogen (OR= 1.019 (1.005–1.033), <i>p</i> = 0.085), creatinine (OR =1.025 (1.004–1.047), <i>p</i> = 0.0223) and right ventricular end-diastolic dimension (RVEDd) (OR = 1.279 (1.074–1.525), <i>p</i> = 0.0059) were independently associated with resistance to sildenafil treatment. Area under the ROC curves indicated an acceptable power of TNC (0.9680 (0.9444–0.9916)), fibrinogen (0.8187 (0.7456–0.8917)) and RVEDd (0.7577 (0.6723–0.8431)), as well as poor strength of creatinine (0.6025 (0.4981–0.7070)) for ineffectiveness of sildenafil treatment. Conclusions: Higher concentrations of TNC, fibrinogen and creatinine, as well as a larger RVEDd are independently associated with the ineffectiveness of sildenafil treatment. TNC has the strongest predictive power, sensitivity and specificity for evaluation of resistance to sildenafil treatment. |
| first_indexed | 2024-03-10T15:07:59Z |
| format | Article |
| id | doaj.art-60ca173242cf4a4f82dcc3b82991dc30 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T15:07:59Z |
| publishDate | 2020-11-01 |
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| spelling | doaj.art-60ca173242cf4a4f82dcc3b82991dc302023-11-20T19:33:07ZengMDPI AGJournal of Clinical Medicine2077-03832020-11-01911353910.3390/jcm9113539Factors Associated with Ineffectiveness of Sildenafil Treatment in Patients with End-Stage Heart Failure and Elevated Pulmonary Vascular ResistanceWioletta Szczurek0Mariusz Gąsior1Michał Skrzypek2Ewa Romuk3Bożena Szyguła-Jurkiewicz4Silesian Center for Heart Diseases in Zabrze, 41-800 Zabrze, Poland3rd Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, PolandDepartment of Biostatistics, School of Public Health in Bytom, Medical University of Silesia, 40-055 Katowice, PolandDepartment of Biochemistry, School of Medicine with the Division of Dentistry, Medical University of Silesia, 41-800 Zabrze, Poland3rd Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, PolandIntroduction: Elevated pulmonary vascular resistance (PVR) unresponsive to vasodilator treatment is a marker of heart failure (HF) severity, and an important predictor of poor results of heart transplantation (HT). Objective: We sought to analyze factors associated with ineffectiveness of sildenafil treatment in end-stage HF patients with elevated PVR with particular emphasis placed on tenascin-C (TNC) serum concentrations. Patients and Methods: The study is an analysis of 132 end-stage HF patients referred for HT evaluation in the Cardiology Department between 2015 and 2018. TNC was measured by sandwich enzyme-linked immunosorbent assay (Human TNC, SunRedBio Technology, Shanghai, China). The endpoint was PVR > 3 Wood units after the six-month sildenafil therapy. Results: The median age was 58 years, and 90.2% were men. PVR >3 Wood units after 6 months of sildenafil treatment were found in 36.6% patients. The multivariable logistic regression analysis confirmed that TNC (OR = 1.004 (1.002–1.006), <i>p</i> = 0.0003), fibrinogen (OR= 1.019 (1.005–1.033), <i>p</i> = 0.085), creatinine (OR =1.025 (1.004–1.047), <i>p</i> = 0.0223) and right ventricular end-diastolic dimension (RVEDd) (OR = 1.279 (1.074–1.525), <i>p</i> = 0.0059) were independently associated with resistance to sildenafil treatment. Area under the ROC curves indicated an acceptable power of TNC (0.9680 (0.9444–0.9916)), fibrinogen (0.8187 (0.7456–0.8917)) and RVEDd (0.7577 (0.6723–0.8431)), as well as poor strength of creatinine (0.6025 (0.4981–0.7070)) for ineffectiveness of sildenafil treatment. Conclusions: Higher concentrations of TNC, fibrinogen and creatinine, as well as a larger RVEDd are independently associated with the ineffectiveness of sildenafil treatment. TNC has the strongest predictive power, sensitivity and specificity for evaluation of resistance to sildenafil treatment.https://www.mdpi.com/2077-0383/9/11/3539end-stage heart failurepulmonary vascular resistancesildenafilfactor |
| spellingShingle | Wioletta Szczurek Mariusz Gąsior Michał Skrzypek Ewa Romuk Bożena Szyguła-Jurkiewicz Factors Associated with Ineffectiveness of Sildenafil Treatment in Patients with End-Stage Heart Failure and Elevated Pulmonary Vascular Resistance Journal of Clinical Medicine end-stage heart failure pulmonary vascular resistance sildenafil factor |
| title | Factors Associated with Ineffectiveness of Sildenafil Treatment in Patients with End-Stage Heart Failure and Elevated Pulmonary Vascular Resistance |
| title_full | Factors Associated with Ineffectiveness of Sildenafil Treatment in Patients with End-Stage Heart Failure and Elevated Pulmonary Vascular Resistance |
| title_fullStr | Factors Associated with Ineffectiveness of Sildenafil Treatment in Patients with End-Stage Heart Failure and Elevated Pulmonary Vascular Resistance |
| title_full_unstemmed | Factors Associated with Ineffectiveness of Sildenafil Treatment in Patients with End-Stage Heart Failure and Elevated Pulmonary Vascular Resistance |
| title_short | Factors Associated with Ineffectiveness of Sildenafil Treatment in Patients with End-Stage Heart Failure and Elevated Pulmonary Vascular Resistance |
| title_sort | factors associated with ineffectiveness of sildenafil treatment in patients with end stage heart failure and elevated pulmonary vascular resistance |
| topic | end-stage heart failure pulmonary vascular resistance sildenafil factor |
| url | https://www.mdpi.com/2077-0383/9/11/3539 |
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