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• W2061792189 abstract "Prostacyclin therapy is an effective treatment for severe pulmonary hypertension. Sildenafil, a selective phosphodiesterase type 5 inhibitor, induces selective vasodilatation of the pulmonary vessels. A synergistic effect has been described for these two drugs. The aim of this study was to evaluate the efficacy and safety of sildenafil as rescue therapy in patients with severe pulmonary hypertension on chronic treatment with prostacyclin whose clinical or functional course was unsatisfactory. Observational study of 11 patients (7 men, 4 women, mean age 42 [8] years) diagnosed as having severe idiopathic pulmonary hypertension, who were receiving chronic prostacyclin therapy. Sildenafil was started after a worsening of their clinical or functional status. Baseline, 3-month and 12-month follow-up evaluations were based on functional status (NYHA functional class and 6-minute walking test), the presence of decompensated right heart failure and echocardiogram. Seven of the 11 patients showed significant improvements in exercise capacity (distance walked in 6 minutes) at 3 (+25 m) and 12 months' follow-up (+36 m). Improvements in functional class were seen, and heart failure disappeared. No significant adverse effects of sildenafil were detected. The echocardiographic parameters showed a significant reduction in right ventricular end-diastolic diameter and left ventricular diastolic eccentricity index. One patient died after 4 months of follow-up from sudden cardiac death. The addition of oral sildenafil to chronic prostacyclin treatment in patients with severe pulmonary hypertension improved functional capacity and reduced episodes of decompensated right heart failure, with good tolerance and no significant adverse effects. La prostaciclina es un tratamiento eficaz en la hipertensión arterial pulmonar severa. El sildenafilo, un inhibidor selectivo de la fosfodiesterasa (PDE) tipo 5, produce vasodilatación selectiva de los vasos pulmonares, y se ha descrito un efecto sinérgico con la prostaciclina. El objetivo es analizar la eficacia y seguridad del sildenafilo como terapia de rescate en pacientes con hipertensión pulmonar (HTP) en tratamiento crónico con prostaciclina que presentan mala evolución clínica y funcional. Estudio observacional de 11 pacientes (7 varones, edad 42 ± 8 años) con hipertensión pulmonar idiopática (HTPI) en tratamiento crónico con prostaciclina. Se asoció sildenafilo oral cuando presentaban deterioro clínico o funcional. Basalmente, a los 3 y los 12 meses de tratamiento combinado, se evaluó la capacidad funcional (clase funcional [CF] de la New York Heart Association [NYHA] y prueba de los 6 min), la pre-sencia de insuficiencia cardíaca derecha (ICD) descom-pensada y se realizó un ecocardiograma. Se produjo una mejoría significativa de la capacidad de esfuerzo, con incremento de la distancia recorrida en 6 min a los 3 y los 12 meses (+25 y +36 m, respectivamente), mejoría de la CF y desaparición de la insuficiencia cardíaca en 7 de los 11 pacientes. No se observaron efectos adversos significativos. El ecocardiograma mostró una reducción significativa del diámetro diastólico del ventrículo derecho y del índice de excentricidad diastólico del ventrículo izquierdo. Un paciente falleció (muerte súbita) a los 4 meses. La adición de sildenafilo al tratamiento crónico con prostaciclina en pacientes con HTP severa mejoró la capacidad funcional y disminuyó los episodios de ICD descompensada, con buena tolerancia al medicamento y sin efectos adversos graves." @default.
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• W2061792189 date "2004-10-01" @default.
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• W2061792189 title "Efficacy of Oral Sildenafil as Rescue Therapy in Patients With Severe Pulmonary Arterial Hypertension Chronically Treated With Prostacyclin. Long-Term Results" @default.
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• W2061792189 doi "https://doi.org/10.1016/s1885-5857(06)60473-8" @default.
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