Marked hemodynamic improvements by high-dose epoprostenol therapy in patients with idiopathic pulmonary arterial hypertension.
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.
Akagi
Satoshi
S
Division of Cardiology, National Hospital Organization, Okayama Medical Center, Okayama, Japan. satoshi.akagi@gmail.com
Nakamura
Kazufumi
K
Miyaji
Katsumasa
K
Ogawa
Aiko
A
Kusano
Kengo Fukushima
KF
Ito
Hiroshi
H
Matsubara
Hiromi
H
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
D000959:Antihypertensive Agents; D011464:Epoprostenol