Li Jing-Hui, Zhang Hong-Da, Wang Zhen-Zhen, Lu Qing-Qing, Li Dong, Lian Tian-Yu, Lv Zi-Chao, Jiang Xin, Wu Yan, Ye Jue, Zhao Shihua, Yang Zhenwen
The Key Lab of Pulmonary Vascular Medicine and FuWai Hospital, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Tianjin Medical University General Hospital, Tianjin, China.
Front Pharmacol. 2019 Jan 21;9:1550. doi: 10.3389/fphar.2018.01550. eCollection 2018.
Right ventricle (RV) function is among the most important prognostic factors for pulmonary arterial hypertension (PAH) patients. Inhaled iloprost, an inhaled member of the prostacyclin family, is effective for the treatment of severe PAH and acute RV failure. However, the acute effects of iloprost on RV physiology have not been thoroughly explored in the past. This prospective study involved 69 incident PAH patients, including 23 idiopathic PAH (IPAH) patients, 26 patients with PAH associated with connective tissue disease (CTD-PAH) and 20 with PAH associated with congenital heart disease (CHD-PAH). All patients underwent both right heart catheterization and cardiac magnetic resonance imaging at baseline and 20 min after 5 μg iloprost inhalation. Acute iloprost inhalation reduced PVR from 13 ± 7 to 10 ± 6 Wood U ( < 0.001), increased RV ejection fraction (RVEF) from 31 ± 11 to 35 ± 12 % ( < 0.001), increased RV stroke volume from 53 ± 21 to 57 ± 22 ml ( < 0.001) and decreased RV end-diastolic volume from 179 ± 67 to 172 ± 69 ml ( < 0.001). Acute iloprost inhalation-induced RVEF improvement was correlated with the degree of PVR reduction ( < 0.001) in IPAH patients, but not in CTD-PAH or CHD-PAH patients. Acute iloprost inhalation improved RVEF, RV stroke volume and decreased RV volume in IPAH and CTD-PAH patients. Iloprost-induced RVEF increase was proportional to PVR reduction in IPAH patients, but not in CTD-PAH or CHD-PAH patients.
右心室（RV）功能是肺动脉高压（PAH）患者最重要的预后因素之一。吸入性伊洛前列素是前列环素家族的吸入性药物，对治疗重度PAH和急性右心室衰竭有效。然而，过去尚未对伊洛前列素对右心室生理功能的急性影响进行全面研究。这项前瞻性研究纳入了69例新发PAH患者，包括23例特发性PAH（IPAH）患者、26例结缔组织病相关性PAH（CTD-PAH）患者和20例先天性心脏病相关性PAH（CHD-PAH）患者。所有患者在基线时以及吸入5μg伊洛前列素20分钟后均接受了右心导管检查和心脏磁共振成像。急性吸入伊洛前列素使肺血管阻力（PVR）从13±7 Wood单位降至10±6 Wood单位（<0.001），右心室射血分数（RVEF）从31±11%增至35±12%（<0.001），右心室每搏输出量从53±21 ml增至57±22 ml（<0.001），右心室舒张末期容积从179±67 ml降至172±69 ml（<0.001）。急性吸入伊洛前列素引起的RVEF改善与IPAH患者PVR降低程度相关（<0.001），但在CTD-PAH或CHD-PAH患者中无此相关性。急性吸入伊洛前列素可改善IPAH和CTD-PAH患者的RVEF、右心室每搏输出量并减少右心室容积。伊洛前列素引起的RVEF增加在IPAH患者中与PVR降低成比例，但在CTD-PAH或CHD-PAH患者中并非如此。
