Chapman T H, Wilde M, Sheth A, Madden B P
St Georges Hospital, Blackshaw Road, Tooting, London, UK.
Vascul Pharmacol. 2009 Aug-Sep;51(2-3):90-5. doi: 10.1016/j.vph.2009.04.002. Epub 2009 Apr 20.
Sildenafil is of benefit to selected patients with pulmonary hypertension due to parenchymal lung or cardiac disease. We present data from patients with secondary pulmonary hypertension, comparing their right heart catheter results and six minute walking distance to time on treatment.
25 patients with symptomatic secondary pulmonary hypertension received sildenafil 50 mg tds in a 5-year period. Underlying causes were chronic inoperable thromboembolic disease (11), COPD (6), interstitial lung disease (5) and valvular heart disease (3). Their cardio-pulmonary haemodynamics were measured with right heart catheterization prior to treatment, post-treatment at 2, 6 and 12 months and subsequently depending upon clinical need. Six-minute walk distance was also measured.
Patient age range was 40 to 83 (median 70.5) years. Time of treatment to latest right heart catheter was 2 to 60 (median 17) months and 8 to 61 (median 34) months to clinic follow-up or death. There was a significant reduction in six-minute walk distance from baseline to long term (>12 months) follow-up (p=0.002). Pulmonary vascular resistance was significantly reduced from baseline to 12 months (p=0.049). The mean pulmonary arterial (PA) pressure was significantly reduced at long-term follow-up (p=0.009). 20 patients had an improved PA pressure with treatment. In those with a worsening PA pressure, two had an improvement in cardiac output and six minute walk distance, two had stable cardiac output at 20 and 21 months, and one had measurements taken during a significant illness. Three patients, who had a reduction in PA pressure, subsequently died of progression of underlying illness at 8 months, from myocardial infarction at 34 months, and from aspergillus pneumonia at 59 months.
Long-term use of sildenafil in patients with secondary forms of pulmonary hypertension is associated with a sustained improvement in cardio-pulmonary haemodynamics. Lack of improvement may be attributed to other factors apart from treatment failure, such as underlying disease progression or unrelated concurrent illness at time of assessment.
西地那非对因实质性肺部或心脏疾病导致的肺动脉高压的特定患者有益。我们展示了继发性肺动脉高压患者的数据，比较了他们的右心导管检查结果以及治疗期间的六分钟步行距离。
25例有症状的继发性肺动脉高压患者在5年期间接受了每日三次、每次50毫克的西地那非治疗。潜在病因包括慢性不可手术的血栓栓塞性疾病（11例）、慢性阻塞性肺疾病（6例）、间质性肺疾病（5例）和心脏瓣膜病（3例）。在治疗前、治疗后2个月、6个月和12个月以及随后根据临床需要，通过右心导管检查测量他们的心肺血流动力学。还测量了六分钟步行距离。
患者年龄范围为40至83岁（中位数70.5岁）。到最近一次右心导管检查的治疗时间为2至60个月（中位数17个月），到临床随访或死亡的时间为8至61个月（中位数34个月）。从基线到长期（>12个月）随访，六分钟步行距离显著缩短（p=0.002）。从基线到12个月，肺血管阻力显著降低（p=0.049）。长期随访时平均肺动脉压显著降低（p=0.009）。20例患者治疗后肺动脉压有所改善。在肺动脉压恶化的患者中，2例心输出量和六分钟步行距离有所改善，2例在20和21个月时心输出量稳定，1例在患重病期间进行了测量。3例肺动脉压降低的患者随后分别在8个月时因基础疾病进展死亡、34个月时因心肌梗死死亡、59个月时因曲霉菌性肺炎死亡。
长期使用西地那非治疗继发性肺动脉高压患者可使心肺血流动力学持续改善。改善不佳可能归因于除治疗失败之外的其他因素，如基础疾病进展或评估时无关的并发疾病。
