No effect of epoprostenol on right ventricular diameter in patients with acute pulmonary embolism: a randomized controlled trial.
BACKGROUND
Right ventricular dilatation in the setting of acute pulmonary embolism is associated with an adverse prognosis. Treatment with a pulmonary vasodilator has never been studied systematically. We evaluated the effect of epoprostenol on right ventricular diameter and function in patients with acute pulmonary embolism and right ventricular dilatation.


METHODS
In a randomized, single-blind study, 14 patients with acute pulmonary embolism received epoprostenol or placebo infusion for 24 hours on top of conventional treatment. Effects on right ventricular end-diastolic diameter, systolic pulmonary artery pressure, right ventricle fractional area change and tricuspid annular plane systolic excursion were assessed by serial echocardiography. Furthermore Troponin T and NT-proBNP were measured serially.


RESULTS
Compared to placebo, epoprostenol was associated with a relative change from baseline in right ventricular end-diastolic diameter of +2% after 2.5 hours and -8% after 24 hours. Epoprostenol did not have a significant effect on systolic pulmonary artery pressure, right ventricular fractional area change and tricuspid annular plane systolic excursion, nor on biochemical parameters.


CONCLUSIONS
In patients with acute pulmonary embolism and right ventricular overload, treatment with epoprostenol did not improve right ventricular dilatation or any other measured variables of right ventricular overload.


BACKGROUND



BACKGROUND
URL: NCT01014156Medical ethical committee: Medisch-ethische toetsingscommissie (METc) from the VUmc (free university medical centre).
Kooter
Albertus J
AJ
Department of Internal Medicine, VU University Medical Center, Amsterdam, the Netherlands. jkooter@vumc.nl
Ijzerman
Richard G
RG
Kamp
Otto
O
Boonstra
Anco B
AB
Smulders
Yvo M
YM
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000494:pharmacology*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D015150:Echocardiography, Doppler; D011464:Epoprostenol / Q000009:adverse effects / Q000494:pharmacology*; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000473:pathology*; D006801:Humans; D017380:Hypertrophy, Right Ventricular / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D016037:Single-Blind Method; D020107:Troponin T / Q000097:blood; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology
D000959:Antihypertensive Agents; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D011464:Epoprostenol