Prevalence of acute vasoresponsiveness in patients with pulmonary hypertension: treatment implications.
OBJECTIVE
Pulmonary hypertension (PH) is a serious and often progressive disorder that results in right ventricular dysfunction. The general reported rate of patients who are responders is 10%-26%. More recently, using the current criteria, the rate of acute vasodilator response was as low as 6%. This study used the most current guidelines to assess the prevalence of acute vasoresponsiveness in patients with PH.


METHODS
A retrospective chart review of 618 patients seen in the PH clinic at the Mayo Clinic Jacksonville from 1991 to June 2008 was conducted. We assessed the prevalence of acute vasoresponsiveness in patients with PH who had undergone vasodilator trial with epoprostenol or nitric oxide, using the current accepted criteria.


RESULTS
One hundred and seventy-six patients who underwent a vasodilator trial that had complete hemodynamic data were identified. The average age was 61 +/- 14 years and most were women (67%). The PH was severe with most patients in the World Health Organization (WHO) functional class III-IV (82%), and an average mean pulmonary artery pressure of 48 +/- 11 mm Hg. Although the study group included all WHO diagnostic groups, 69% were diagnosed as Group I pulmonary arterial hypertension. We found an overall prevalence of response to acute vasodilator therapy to be 26%.


CONCLUSIONS
Using the most current criteria to identify acute responders to vasodilator therapy in PH patients, we found a slightly higher rate of "responders" than previously reported. Acute vasodilator testing identifies a clinically important group who may benefit from calcium channel blockers (CCBs), and this study confirms that a significant percentage of PH patients are acutely vasoresponsive.
Division of Pulmonary Medicine and Biostatistics Unit, Mayo Clinic Jacksonville, Jacksonville, FL 32224, USA. Arunthari.vichaya@mayo.edu
Vichaya
V
Arunthari
Michael G
MG
Heckman
Charles D
CD
Burger
D000208:Acute Disease; D006328:Cardiac Catheterization; D016001:Confidence Intervals; D011464:Epoprostenol / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000009:adverse effects* / Q000627:therapeutic use; D015995:Prevalence; D011651:Pulmonary Artery / Q000187:drug effects / Q000503:physiopathology; D012189:Retrospective Studies; D014664:Vasodilation / Q000187:drug effects*; D014665:Vasodilator Agents / Q000009:adverse effects* / Q000627:therapeutic use
D014665:Vasodilator Agents; D009569:Nitric Oxide; D011464:Epoprostenol