title: Effects of the oral endothelin-receptor antagonist bosentan on echocardiographic and doppler measures in patients with pulmonary arterial hypertension.
abstract: OBJECTIVE
  The purpose of this study was to investigate the effects of bosentan (125 or 250 mg twice daily) on echocardiographic and Doppler variables in 85 patients with World Health Organization class III or IV pulmonary arterial hypertension (PAH).
  
  
  BACKGROUND
  Bosentan, an orally active dual endothelin-receptor antagonist, improves symptoms, exercise capacity, and hemodynamics in patients with PAH.
  
  
  METHODS
  Patients had primary pulmonary hypertension (84%) or PAH associated with connective tissue disease. Of these, 29 patients received placebo and 56 received bosentan (1:2 randomization). Six-minute walk tests and echocardiograms were performed at baseline and after 16 weeks of treatment.
  
  
  RESULTS
  Baseline characteristics were similar in the placebo and bosentan groups, and echocardiographic and Doppler findings were consistent with marked abnormalities of right ventricular (RV) and left ventricular (LV) structure and function that were due to PAH. The treatment effect on 6-min walking distance was 37 m in favor of bosentan (p = 0.036). Treatment effects of bosentan compared with placebo on other parameters were as follows: Doppler-derived cardiac index = +0.4 l/min/m(2) (p = 0.007), LV early diastolic filling velocity = +10.5 cm/s (p = 0.003), LV end-diastolic area = +4.2 cm(2) (p = 0.003), LV systolic eccentricity index = -0.12 (p = 0.047), RV end-systolic area = -2.3 cm(2) (p = 0.057), RV:LV diastolic areas ratio = -0.64 (p = 0.007), Doppler RV index = -0.06 (p = 0.03), and percentage of patients with an improvement in pericardial effusion score = 17% (p = 0.05).
  
  
  CONCLUSIONS
  Bosentan improves RV systolic function and LV early diastolic filling and leads to a decrease in RV dilation and an increase in LV size in patients with PAH.
authors.affiliation: Institute of Cardiology, University of Bologna, Italy. n.galie@bo.nettuno.it
authors.forename: Nazzareno
authors.initials: N
authors.lastname: Galiè
authors.forename: Alan L
authors.initials: AL
authors.lastname: Hinderliter
authors.forename: Adam
authors.initials: A
authors.lastname: Torbicki
authors.forename: Thierry
authors.initials: T
authors.lastname: Fourme
authors.forename: Gerald
authors.initials: G
authors.lastname: Simonneau
authors.forename: Tomas
authors.initials: T
authors.lastname: Pulido
authors.forename: Nilda
authors.initials: N
authors.lastname: Espinola-Zavaleta
authors.forename: Guido
authors.initials: G
authors.lastname: Rocchi
authors.forename: Alessandra
authors.initials: A
authors.lastname: Manes
authors.forename: Robert
authors.initials: R
authors.lastname: Frantz
authors.forename: Marcin
authors.initials: M
authors.lastname: Kurzyna
authors.forename: Sherif F
authors.initials: SF
authors.lastname: Nagueh
authors.forename: Robyn
authors.initials: R
authors.lastname: Barst
authors.forename: Richard
authors.initials: R
authors.lastname: Channick
authors.forename: Karl
authors.initials: K
authors.lastname: Dujardin
authors.forename: Andrew
authors.initials: A
authors.lastname: Kronenberg
authors.forename: Isabelle
authors.initials: I
authors.lastname: Leconte
authors.forename: Maurizio
authors.initials: M
authors.lastname: Rainisio
authors.forename: Lewis
authors.initials: L
authors.lastname: Rubin
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000494:pharmacology*; D000077300:Bosentan; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000139:chemically induced / Q000000981:diagnostic imaging; D017380:Hypertrophy, Right Ventricular / Q000000981:diagnostic imaging / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D013449:Sulfonamides / Q000008:administration & dosage / Q000494:pharmacology*; D016277:Ventricular Function, Left / Q000187:drug effects*; D016278:Ventricular Function, Right / Q000187:drug effects*
chemical_list: D000959:Antihypertensive Agents; D013449:Sulfonamides; D000077300:Bosentan