Kimura Mai, Tamura Yuichi, Takei Makoto, Yamamoto Tsunehisa, Ono Tomohiko, Kuwana Masataka, Fukuda Keiichi, Satoh Toru
Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
Department of Rheumatology, Nippon Medical School, Tokyo, Japan.
PLoS One. 2015 Apr 6;10(4):e0121894. doi: 10.1371/journal.pone.0121894. eCollection 2015.
Intravenous infusion (IVI) of epoprostenol is an effective treatment for patients with advanced pulmonary arterial hypertension (PAH). However, there is no widely accepted standard method for initiating the IVI therapy. This study evaluated the hemodynamic improvements achieved with IVI epoprostenol to determine the optimal protocol for treatment initiation.
We retrospectively analyzed 42 consecutive PAH patients who underwent IVI epoprostenol in Keio University Hospital from 2001 to 2013. The study group comprised 30 women with a mean age of 34.3 ± 1.9 years. The etiology of PAH was idiopathic or heritable PAH (I/HPAH) in 38 cases, PAH associated with connective tissue disease in 3, and Eissenmenger's syndrome in the remaining case. We divided the patients into rapid- and slow-initiation therapy groups according to the cumulative epoprostenol dose administered during the first 180 days, and compared the hemodynamic changes between the groups. The median cumulative doses were 6142 ± 165 μg/kg and 3998 ± 132 μg/kg epoprostenol, respectively. While there were no significant differences in mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR), or cardiac index (CI) between the groups before the IVI epoprostenol therapy, the rapid-initiation therapy group achieved significant improvements in these hemodynamic data compared with the slow-initiation therapy group (P < 0.005) at the follow-up right-heart catheterization (RHC).
Rapid initiation of IVI epoprostenol therapy achieved the optimal hemodynamic improvements in patients with severe PAH.
静脉输注依前列醇是治疗晚期肺动脉高压（PAH）患者的有效方法。然而，目前尚无广泛接受的静脉输注治疗起始标准方法。本研究评估了静脉输注依前列醇所实现的血流动力学改善情况，以确定治疗起始的最佳方案。
我们回顾性分析了2001年至2013年在庆应义塾大学医院接受静脉输注依前列醇治疗的42例连续性PAH患者。研究组包括30名女性，平均年龄为34.3±1.9岁。PAH的病因包括38例特发性或遗传性PAH（I/HPAH）、3例与结缔组织病相关的PAH以及1例艾森曼格综合征。我们根据前180天内给予的依前列醇累积剂量将患者分为快速起始治疗组和缓慢起始治疗组，并比较两组之间的血流动力学变化。依前列醇的中位累积剂量分别为6142±165μg/kg和3998±132μg/kg。在静脉输注依前列醇治疗前，两组之间的平均肺动脉压（mPAP）、肺血管阻力（PVR）或心脏指数（CI）无显著差异，但在随访右心导管检查（RHC）时，快速起始治疗组在这些血流动力学数据方面与缓慢起始治疗组相比有显著改善（P<0.005）。
快速起始静脉输注依前列醇治疗可使重度PAH患者实现最佳的血流动力学改善。
