Hemodynamic effects of aerosolized iloprost in pulmonary hypertension at rest and during exercise.
OBJECTIVE
Aerosolized iloprost, a stable prostacyclin analog, improves functional capacity even in patients with pulmonary hypertension who did not show a vigorous hemodynamic response after iloprost inhalation at rest. We therefore speculated that aerosolized iloprost elicits more beneficial effects on pulmonary hemodynamics during exercise than at rest.


METHODS
A prospective, open, uncontrolled study at a university hospital.


METHODS
Sixteen patients with primary or secondary pulmonary hypertension.


METHODS
Right-heart catheterization at rest and during exercise before and after the inhalation iloprost, 14 to 28 microg.


RESULTS
Before iloprost treatment, exercise increased mean (+/- SD) pulmonary artery pressure (PAPm) from 45 +/- 8 to 70 +/- 13 mm Hg, cardiac output from 3.7 +/- 1.0 to 5.8 +/- 2.4 L/min, and pulmonary vascular resistance (PVR) from 904 +/- 322 to 1,013 +/- 432 dyne.s.cm(-5) (each p < 0.05). After recovery, iloprost reduced PAPm from 44 +/- 8 to 41 +/- 6 mm Hg, increased cardiac output from 3.7 +/- 1.0 to 4.9 +/- 1.4 L/min, and lowered PVR from 902 +/- 350 to 636 +/- 248 dyne x s x cm(-5) (each p < 0.05). During exercise after iloprost, PAPm increased to 57 +/- 8 mm Hg, cardiac output to 7.0 +/- 3.0 L/min, and PVR to 673 +/- 279 dyne x s x cm(-5) (each p < 0.05 vs first exercise test). Systemic BP was not altered significantly by iloprost treatment during exercise.


CONCLUSIONS
Aerosolized iloprost treatment exerts more favorable effects on pulmonary hemodynamics during exercise than at rest. These findings explain the functional improvement observed in patients with pulmonary hypertension who show only a moderate pulmonary vasodilatory response during iloprost inhalation at rest. Whether these beneficial effects have prognostic significance needs to be elucidated by further study.
Blumberg
Friedrich C
FC
Department of Internal Medicine II, University of Regensburg, Regensburg, Germany. friedrich.blumberg@klinik.uni-regensburg.de
Riegger
Günter A J
GA
Pfeifer
Michael
M
D000280:Administration, Inhalation; D000336:Aerosols; D001794:Blood Pressure / Q000187:drug effects; D006328:Cardiac Catheterization; D002302:Cardiac Output / Q000187:drug effects; D005080:Exercise Test; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000503:physiopathology; D016285:Iloprost / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011651:Pulmonary Artery; D011652:Pulmonary Circulation / Q000187:drug effects; D012146:Rest; D014655:Vascular Resistance / Q000187:drug effects; D014665:Vasodilator Agents / Q000008:administration & dosage*
D000336:Aerosols; D014665:Vasodilator Agents; D016285:Iloprost