Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany.
Department of Thoracic- and Cardiovascular Surgery, West German Heart and Vascular Center, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany.
ESC Heart Fail. 2023 Aug;10(4):2728-2733. doi: 10.1002/ehf2.14366. Epub 2023 Apr 13.
Phosphodiesterase-5 inhibitors (PDE5I) are frequently implemented after left ventricular assist device (LVAD) implantation to improve haemodynamics in patients with early postoperative right ventricular (RV) failure. It is unknown if long-term PED5I therapy beyond the early post-operative period provides any clinical benefit in stable outpatients, who have recovered from post-operative RV failure under univentricular device support. This study aimed to investigate the impact of PDE5I discontinuation on RV function and cardiopulmonary exercise capacity in patients on durable LVAD support.
We enrolled 31 clinically stable LVAD recipients on long-term oral PDE5I therapy. The mean age was 53 years, and 90% were male. Patients discontinued PDE5I and underwent cardiopulmonary exercise testing, echocardiography, LVAD interrogation, and biomarker analysis at baseline and 4 weeks after PDE5I withdrawal. At 4 weeks, no significant changes were observed in echocardiographic indices of RV morphology and function but an increase in peak tricuspid regurgitation velocity (2.1 vs. 2.4 m/s, P = 0.01). Peak oxygen consumption (11.4 vs. 11.8 mL/min/kg, P = 0.52), minute ventilation/carbon dioxide production slope (33 vs. 35, P = 0.56), N-terminal pro-brain natriuretic peptide (1455 vs. 1399 pg/mL, P = 0.55), flow and power readings of the device, and quality of life (Kansas City Cardiomyopathy Questionnaire score 78.3% vs. 77.5%, P = 0.62) exhibited no significant changes. We observed an increase in 6-min walking distance (346 vs. 364 m, P = 0.03). Two patients were hospitalized for non-cardiac reasons (subtherapeutic INR, driveline infection). No patient was hospitalized for cardiac decompensation.
In LVAD patients with a history of early post-operative RV failure, discontinuation of long-term PDE5I therapy was not associated with deterioration of RV function, exercise capacity, and quality of life. PDE5I should be critically evaluated until more evidence regarding the net clinical benefit of this pharmacologic intervention becomes available.
磷酸二酯酶-5 抑制剂（PDE5I）常用于左心室辅助装置（LVAD）植入术后，以改善术后早期右心室（RV）衰竭患者的血液动力学。尚不清楚在接受单心室装置支持并从术后 RV 衰竭中恢复的稳定门诊患者中，长期应用 PDE5I 治疗是否能提供任何临床益处。本研究旨在探讨 PDE5I 停药对长期接受 LVAD 支持的患者 RV 功能和心肺运动能力的影响。
我们纳入了 31 例长期口服 PDE5I 治疗的临床稳定的 LVAD 受者。平均年龄为 53 岁，90%为男性。患者停用 PDE5I 并在基线和 PDE5I 停药 4 周时进行心肺运动试验、超声心动图、LVAD 检查和生物标志物分析。4 周时，RV 形态和功能的超声心动图指标无明显变化，但峰值三尖瓣反流速度增加（2.1 对 2.4m/s，P=0.01）。峰值耗氧量（11.4 对 11.8mL/min/kg，P=0.52）、分钟通气量/二氧化碳产量斜率（33 对 35，P=0.56）、N 末端脑钠肽前体（1455 对 1399pg/mL，P=0.55）、装置的流量和功率读数以及生活质量（堪萨斯城心肌病问卷评分 78.3%对 77.5%，P=0.62）无明显变化。我们观察到 6 分钟步行距离增加（346 对 364m，P=0.03）。2 例患者因非心脏原因住院（治疗性 INR、导线感染）。无患者因心脏失代偿而住院。
在 LVAD 患者中，有术后早期 RV 衰竭病史者，长期 PDE5I 治疗的停药与 RV 功能、运动能力和生活质量的恶化无关。在获得这种药物干预的净临床获益的更多证据之前，应仔细评估 PDE5I 的应用。
