Continuous intravenous iloprost to revert treatment failure of first-line inhaled iloprost therapy in patients with idiopathic pulmonary arterial hypertension.
OBJECTIVE
To describe the clinical and haemodynamic effects during the first 6 months of continuous intravenous iloprost treatment in patients with idiopathic pulmonary arterial hypertension (IPAH) and relevant disease progression despite continued mono therapy with aerosolized iloprost.


RESULTS
Twenty-four IPAH patients with clinical decompensation to NYHA class IV despite therapy with aerosolized iloprost and optimized conservative treatment were assessed clinically, haemodynamically and by cardiopulmonary exercise testing for at least 6 months. Upon switching from inhaled to intravenous iloprost all patients improved clinically (NYHA III) while pulmonary vascular resistance (PVR) and right atrial pressure decreased from 2386 +/- 243 to 1381 +/- 124 dyne .s .cm(-5) and 12 +/- 1 to 8.5 +/- 1 mmHg, respectively (both p < 0.05). Despite this acute improvement haemodynamic (PVR increased from 1462+/-223 to 1978 +/- 327 dyne .s .cm(-5)) and clinical (4 deaths, 4 transplantations) deterioration occurred with continued intravenous treatment during the following 6 months.


CONCLUSIONS
In the group of patients described in this report the clinical and haemodynamic deterioration occurring while on mono therapy with inhaled iloprost could be stopped by switching to continuous application of intravenous iloprost. However, with continued intravenous therapy only a subgroup of patients could clinically be stabilized and transplanted successfully.
Ewert
Ralf
R
Klinik für Innere Medizin B, Ernst-Moritz-Arndt Universität Greifswald, Greifswald, Germany. ewert@uni-greifswald.de
Opitz
Christian F
CF
Wensel
Roland
R
Winkler
Jörg
J
Halank
Michael
M
Felix
Stephan B
SB
D000280:Administration, Inhalation; D000328:Adult; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D017079:Exercise Tolerance / Q000187:drug effects; D005260:Female; D005858:Germany / Q000453:epidemiology; D006325:Heart Atria / Q000187:drug effects; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D016285:Iloprost / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000187:drug effects* / Q000503:physiopathology; D012720:Severity of Illness Index; D017211:Treatment Failure; D014655:Vascular Resistance / Q000187:drug effects; D014665:Vasodilator Agents / Q000008:administration & dosage*
D000959:Antihypertensive Agents; D014665:Vasodilator Agents; D016285:Iloprost