Comparison between two drugs on the hemodynamic evaluation of pulmonary hypertension prior to heart transplantation.
BACKGROUND
Invasive estimation of pulmonary pressure is part of the usual protocol prior to heart transplantation. The aim of this study was to compare the results of 2 different vasodilators, nitric oxide (NO) and prostacyclin, in an acute vasodilator test (AVT) for patients with pulmonary venous hypertension.


METHODS
From January 2000 to December 2006, 94 right-sided heart catheterizations were performed in our center within pretransplantation evaluations. AVT was performed if the mean pulmonary artery pressure (mPAP) >35 mm Hg or if the pulmonary vascular resistance (PVR) was >4 Wood units (WU). Epoprostenol was administered to 40 patients, NO to 6 patients, and both agents to 8 patients.


RESULTS
A significant decrease in both mPAP and PVR was shown with maximum doses of epoprostenol, with an average variation of 8.96 mm Hg in mPAP (P < .001) and 3.26 WU in PVR (P < .001). An increased cardiac output (CO) was observed with epoprostenol, with a mean difference of 1.9 L/min (P < .001) at maximum compared with baseline doses. A tendency for the mPAP and PVR to decrease was also observed with maximum NO doses, with mean decreases of mPAP and PVR of 5.62 mm Hg and 1.14 WU, respectively. A tendency for CO to decrease was observed with NO (0.75 L/min; P = .039).


CONCLUSIONS
In our experience, NO is the best drug for AVT due to its pulmonary tree selectivity. A study with epoprostenol was complementary; both drugs can be used in these patients prior to heart transplantation.
Mogollón Jiménez
M V
MV
Cardiology Service, Virgen del Rocio Hospital, Seville, Spain. mvmogjim@hotmail.com
Escoresca Ortega
A M
AM
Hinojosa Pérez
R
R
Lage Gallé
E
E
Herruzo Avilés
A
A
Sobrino Márquez
M
M
Frutos López
M
M
Romero Rodríguez
N
N
Pérez de la Yglesia
R
R
Martínez Martínez
A
A
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D011464:Epoprostenol / Q000627:therapeutic use*; D005260:Female; D016027:Heart Transplantation / Q000502:physiology*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000627:therapeutic use*; D011300:Preoperative Care; D011651:Pulmonary Artery / Q000187:drug effects / Q000502:physiology / Q000503:physiopathology; D012189:Retrospective Studies; D014655:Vascular Resistance / Q000187:drug effects; D014665:Vasodilator Agents / Q000627:therapeutic use*
D000959:Antihypertensive Agents; D014665:Vasodilator Agents; D009569:Nitric Oxide; D011464:Epoprostenol