title: Changes in exercise capacity and cardiac performance in a series of patients with Eisenmenger's syndrome transitioned from selective to dual endothelin receptor antagonist.
abstract: BACKGROUND
  Differences in clinical effects between selective and dual endothelin (ET) receptor antagonists (ERA) in patients with pulmonary arterial hypertension (PAH) are currently unknown. We aimed to assess prospectively how transition from selective (sitaxsentan) to dual (bosentan) ERA affected exercise capacity and cardiocirculatory performance in patients with Eisenmenger's syndrome.
  
  
  METHODS
  A series of seven stable patients with Eisenmenger's syndrome aged 40.0 (30.0-56.0) years old treated with sitaxsentan were assessed before and three months after transition to bosentan. Six minute walk test and magnetic resonance to assess LV and RV mass, volume and ejection fraction, and pulmonary flow, and laboratory tests were performed.
  
  
  RESULTS
  We observed an increase in LV mass [96.5 (66.0-116.0) vs. 123.0 (93.0-146.0)g; p=0.03], LV ejection fraction [55.0 (44.0-63.0) vs. 65.0 (58.0-70.0)%; p=0.02)], and pulmonary flow [64 (53.0-71.0) vs. 69.0 (55.0-84.0)ml/beat; p=0.046]. This was accompanied by an increase of oxygen saturation, elongation of 6MWD [435.0 (378.0-482.3) vs. 474 (405.0-534.7); p=0.02], decrease of NTproBNP level and increase of ET-1 level.
  
  
  CONCLUSIONS
  Three month follow-up of stable patients with Eisenmenger's syndrome transitioned from sitaxsentan to bosentan revealed improvement of exercise capacity despite significant elevation of ET-1 level. Concurrent increase of LV ejection fraction and pulmonary flow might have contributed to these favourable effects.
authors: John Paul II Hospital in Krakow, Department of Cardiac and Vascular Diseases, Pradnicka 80, 31-202 Krakow, Poland. gkopec@szpitaljp2.krakow.pl
authors: Grzegorz
authors: G
authors: Kopeć
authors: Anna
authors: A
authors: Tyrka
authors: Tomasz
authors: T
authors: Miszalski-Jamka
authors: Tomasz
authors: T
authors: Mikołajczyk
authors: Marcin
authors: M
authors: Waligóra
authors: Tomasz
authors: T
authors: Guzik
authors: Piotr
authors: P
authors: Podolec
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D000077300:Bosentan; D004541:Eisenmenger Complex / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D065128:Endothelin Receptor Antagonists; D019332:Endothelin-1 / Q000097:blood; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007555:Isoxazoles / Q000008:administration & dosage*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D013318:Stroke Volume / Q000187:drug effects; D013449:Sulfonamides / Q000008:administration & dosage*; D013876:Thiophenes / Q000008:administration & dosage*
chemical_list: D000959:Antihypertensive Agents; D065128:Endothelin Receptor Antagonists; D019332:Endothelin-1; D007555:Isoxazoles; D010446:Peptide Fragments; D013449:Sulfonamides; D013876:Thiophenes; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; C106276:sitaxsentan; D000077300:Bosentan