title: Marked hemodynamic improvements by high-dose epoprostenol therapy in patients with idiopathic pulmonary arterial hypertension.
abstract: BACKGROUND
  The appropriate dose range of epoprostenol is thought to be 25-40 ng · kg(-1) · min(-1) based on the results of previous studies showing that epoprostenol therapy reduced mean pulmonary artery pressure (mPAP) by 12-22% and pulmonary vascular resistance (PVR) by 32-53% compared with baseline values in patients with idiopathic pulmonary arterial hypertension (IPAH). However, the efficacy of treatment of IPAH patients with epoprostenol >40 ng · kg(-1) · min(-1) has not been determined and this was the aim of the present study.
  
  
  RESULTS
  The study group comprised 16 consecutive patients, none of whom died; 2 dropped out because they could not be titrated up as needed to the highest effective epoprostenol dose. Hemodynamics were evaluated in 14 IPAH patients who received high-dose epoprostenol monotherapy. The mean epoprostenol dosage was 107 ± 40 ng · kg(-1) · min(-1) (range, 54-190 ng · kg(-1) · min(-1)) and the mean duration of high-dose epoprostenol therapy was 1,355 ± 627 days (range, 582-2,410 days). Significant decreases from baseline values were seen in mPAP (from 66 ± 16 to 47 ± 12 mmHg, P<0.001) and PVR (from 21.6 ± 8.3 to 6.9 ± 2.9 Wood units, P<0.001). Compared with the baseline state, high-dose epoprostenol therapy reduced mPAP by 30% and PVR by 68%.
  
  
  CONCLUSIONS
  The present study suggests high-dose epoprostenol therapy is a new treatment strategy for IPAH.
authors.affiliation: Division of Cardiology, National Hospital Organization, Okayama Medical Center, Okayama, Japan. satoshi.akagi@gmail.com
authors.forename: Satoshi
authors.initials: S
authors.lastname: Akagi
authors.forename: Kazufumi
authors.initials: K
authors.lastname: Nakamura
authors.forename: Katsumasa
authors.initials: K
authors.lastname: Miyaji
authors.forename: Aiko
authors.initials: A
authors.lastname: Ogawa
authors.forename: Kengo Fukushima
authors.initials: KF
authors.lastname: Kusano
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ito
authors.forename: Hiromi
authors.initials: H
authors.lastname: Matsubara
mesh_terms: D000293:Adolescent; D000328:Adult; D000959:Antihypertensive Agents; D001794:Blood Pressure; D011464:Epoprostenol / Q000008:administration & dosage*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D020714:Maximum Tolerated Dose; D011651:Pulmonary Artery / Q000187:drug effects / Q000503:physiopathology; D014655:Vascular Resistance; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents; D011464:Epoprostenol