舌下含服西地那非对心力衰竭患者肺动脉高压的影响。

Impact of sublingual sildenafil on pulmonary hypertension in patients with heart failure.

作者信息

Freitas Aguinaldo Figueiredo de, Bacal Fernando, Oliveira José de Lima, Santos Ronaldo Honorato Barros, Moreira Luiz Felipe Pinho, Silva Christiano Pereira, Mangini Sandrigo, Carneiro Rodrigo Moreno Dias, Fiorelli Alfredo Inácio, Bocchi Edimar Alcides

机构信息

Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.

出版信息

Arq Bras Cardiol. 2009 Feb;92(2):116-26. doi: 10.1590/s0066-782x2009000200008.

DOI:10.1590/s0066-782x2009000200008

PMID:19360244

Abstract

BACKGROUND

Pulmonary hypertension (PH) is a factor of poor prognosis in the postoperative period of heart transplant (HT) and thus, the study of the degree of reversibility to vasodilators is mandatory during the preoperative assessment.

OBJECTIVE

To evaluate the pulmonary and systemic hemodynamic effects of sildenafil as a vasodilator during the PH reversibility test in patients that are candidates to HT.

METHODS

Patients awaiting HT were submitted to the measurement of systemic and pulmonary hemodynamic variables before and after the administration of a single sublingual dose of 100 mg of sildenafil during right heart catheterization.

RESULTS

Fourteen patients (age: 47+/-12 years, 71.4% men) with advanced heart failure Ejection Fraction (EF) 25 +/- 7%, Functional Class (FC - NYHA) FC III - 6 and FC IV - 8, were evaluated in this study. The acute administration of sildenafil showed to be effective in decreasing the systolic (62.4 +/- 12.1 vs 51.5 +/- 9.6 mmHg, CI=95%, p<0.05) and mean (40.7 +/- 7.3 vs 33.8 +/- 7.6 mmHg, CI=95%, p <0.05) pressures of the pulmonary artery. There was also a significant decrease in the pulmonary (4.2 +/- 3 vs 2.0 +/- 0.9 uWood, CI=95%, p<0.05) and systemic vascular resistance (22.9 +/- 6.8 vs 18.6 +/- 4.1 Wood, CI=95%, p<0.05), associated to an increase in the cardiac output (3.28 +/- 0.79 vs 4.12 +/-1.12 uWood, CI=95%, p<0.05) without, however, significantly interfering in the systemic arterial pressure (87.8 +/- 8.2 vs 83.6 +/- 9.1 mmHg, CI=95%, p=0.3).

CONCLUSION

The sublingual administration of sildenafil is an effective and safe alternative as a vasodilator during the PH reversibility test in patients with heart failure and awaiting a HT.

摘要

背景

肺动脉高压（PH）是心脏移植（HT）术后预后不良的一个因素，因此，在术前评估期间必须研究对血管扩张剂的可逆程度。

目的

评估西地那非作为血管扩张剂在HT候选患者的PH可逆性试验期间对肺和全身血流动力学的影响。

方法

等待HT的患者在右心导管插入术期间接受单次舌下含服100mg西地那非前后的全身和肺血流动力学变量测量。

结果

本研究评估了14例患者（年龄：47±12岁，71.4%为男性），这些患者患有晚期心力衰竭，射血分数（EF）为25±7%，功能分级（FC - NYHA）为FC III - 6例和FC IV - 8例。急性给予西地那非显示可有效降低肺动脉的收缩压（62.4±12.1 vs 51.5±9.6 mmHg，CI = 95%，p<0.05）和平均压（40.7±7.3 vs 33.8±7.6 mmHg，CI = 95%，p<0.05）。肺血管阻力（4.2±3 vs 2.0±0.9 uWood，CI = 95%，p<0.05）和全身血管阻力（22.9±6.8 vs 18.6±4.1 Wood，CI = 95%，p<0.05）也显著降低，同时心输出量增加（3.28±0.79 vs 4.12±1.12 uWood，CI = 95%，p<0.05），然而，对体动脉压无显著影响（87.8±8.2 vs 83.6±9.1 mmHg，CI = 95%，p = 0.3）。