title: Persistence of complex vascular lesions despite prolonged prostacyclin therapy of pulmonary arterial hypertension.
abstract: OBJECTIVE
  Continuous infusion of prostacyclin analogues improves survival in advanced pulmonary arterial hypertension. In addition to its vasodilatory effects, prostacyclin has the potential to decrease inflammation, thrombosis, and smooth muscle proliferation. The aim of this retrospective study was to determine whether pathological data support the ability of prostanoids to prevent progression of vascular disease.
  
  
  RESULTS
  Twenty-two autopsied patients with World Health Organization category 1 pulmonary arterial hypertension (primarily idiopathic and connective tissue disease-associated) were divided into those who received long-term prostacyclin (n = 12, PG-long, mean treatment 3.9 years) and those who received 0-1 month of prostacyclin (n = 10, PG-short). Surprisingly, PG-long patients had larger plexiform lesions (P < 0.05), with no decrease in medial and intimal thicknesses as compared with PG-short patients. Plexiform lesion size and density increased with increasing treatment time. Also, PG-long patients had fewer platelet thrombi and more frequent acute diffuse alveolar haemorrhage. Quantification of macrophages and T cells revealed no differences in inflammatory infiltrates.
  
  
  CONCLUSIONS
  Although long-term prostacyclin therapy may have an antithrombotic effect in addition to its vasodilatory actions, it was not associated with the prevention of advanced vascular lesions. The mechanism by which prostacyclin analogues improve survival in pulmonary arterial hypertension remains uncertain.
authors: Department of PathologySection of Cardiology, Department of Medicine, University of Chicago, Chicago, IL, USA.
authors: Jennifer E
authors: JE
authors: Pogoriler
authors: Stuart
authors: S
authors: Rich
authors: Stephen L
authors: SL
authors: Archer
authors: Aliya N
authors: AN
authors: Husain
mesh_terms: D000328:Adult; D000368:Aged; D001344:Autopsy; D002675:Child, Preschool; D011464:Epoprostenol / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D011464:Epoprostenol