Comparison of intravenous sildenafil with inhaled nitric oxide for acute vasodilator testing in pulmonary arterial hypertension
Abstract 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 inha...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-10-01
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| Series: | Pulmonary Circulation |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/pul2.12180 |
| _version_ | 1828085474936225792 |
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| author | Shine Kumar Danish Memon Manu Raj Amitabh C. Sen Jessin P. Jayasankar Sreelakshmi P. Leeladharan Abish Sudhakar Raman K. Kumar |
| author_facet | Shine Kumar Danish Memon Manu Raj Amitabh C. Sen Jessin P. Jayasankar Sreelakshmi P. Leeladharan Abish Sudhakar Raman K. Kumar |
| author_sort | Shine Kumar |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-04-11T04:40:37Z |
| format | Article |
| id | doaj.art-d916ba36cb5a40bb8bb519d3e70a93b7 |
| institution | Directory Open Access Journal |
| issn | 2045-8940 |
| language | English |
| last_indexed | 2024-04-11T04:40:37Z |
| publishDate | 2022-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Pulmonary Circulation |
| spelling | doaj.art-d916ba36cb5a40bb8bb519d3e70a93b72022-12-28T07:32:41ZengWileyPulmonary Circulation2045-89402022-10-01124n/an/a10.1002/pul2.12180Comparison of intravenous sildenafil with inhaled nitric oxide for acute vasodilator testing in pulmonary arterial hypertensionShine Kumar0Danish Memon1Manu Raj2Amitabh C. Sen3Jessin P. Jayasankar4Sreelakshmi P. Leeladharan5Abish Sudhakar6Raman K. Kumar7Department of Pediatric Cardiology, Pulmonary Hypertension Clinic, Amrita Institute of Medical Sciences Amrita Vishwa Vidyapeetham University Kochi Kerala IndiaDepartment of Pediatric Cardiology, Pulmonary Hypertension Clinic, Amrita Institute of Medical Sciences Amrita Vishwa Vidyapeetham University Kochi Kerala IndiaDepartment of Pediatrics and Health Sciences Research, Amrita Institute of Medical Sciences Amrita Vishwa Vidyapeetham University Kochi Kerala IndiaDepartment of Cardiac Anesthesiology Sultan Qaboos University Hospital Muscat OmanDepartment of Cardiac Anesthesiology, Amrita Institute of Medical Sciences Amrita Vishwa Vidyapeetham University Kochi Kerala IndiaDepartment of Cardiac Anesthesiology, Amrita Institute of Medical Sciences Amrita Vishwa Vidyapeetham University Kochi Kerala IndiaDepartment of Pediatric Cardiology, Pulmonary Hypertension Clinic, Amrita Institute of Medical Sciences Amrita Vishwa Vidyapeetham University Kochi Kerala IndiaDepartment of Pediatric Cardiology, Pulmonary Hypertension Clinic, Amrita Institute of Medical Sciences Amrita Vishwa Vidyapeetham University Kochi Kerala IndiaAbstract 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.https://doi.org/10.1002/pul2.12180acute vasodilator testcardiac catheterizationnitric oxidepulmonary hypertensionsildenafil |
| spellingShingle | Shine Kumar Danish Memon Manu Raj Amitabh C. Sen Jessin P. Jayasankar Sreelakshmi P. Leeladharan Abish Sudhakar Raman K. Kumar Comparison of intravenous sildenafil with inhaled nitric oxide for acute vasodilator testing in pulmonary arterial hypertension Pulmonary Circulation acute vasodilator test cardiac catheterization nitric oxide pulmonary hypertension sildenafil |
| 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 | acute vasodilator test cardiac catheterization nitric oxide pulmonary hypertension sildenafil |
| url | https://doi.org/10.1002/pul2.12180 |
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