Sildenafil vs. sodium before nitroprusside for the pulmonary hypertension reversibility test before cardiac transplantation.
BACKGROUND
Pulmonary hypertension is associated with a worse prognosis after cardiac transplantation. The pulmonary hypertension reversibility test with sodium nitroprusside (SNP) is associated with a high rate of systemic arterial hypotension, ventricular dysfunction of the transplanted graft and high rates of disqualification from transplantation.


OBJECTIVE
This study was aimed at comparing the effects of sildenafil (SIL) and SNP on hemodynamic, neurohormonal and echocardiographic variables during the pulmonary reversibility test.


METHODS
The patients underwent simultaneously right cardiac catheterization, echocardiography, BNP measurement, and venous blood gas analysis before and after receiving either SNP (1 - 2 µg/kg/min) or SIL (100 mg, single dose).


RESULTS
Both drugs reduced pulmonary hypertension, but SNP caused a significant systemic hypotension (mean blood pressure - MBP: 85.2 vs. 69.8 mm Hg; p < 0.001). Both drugs reduced cardiac dimensions and improved left cardiac function (SNP: 23.5 vs. 24.8%, p = 0.02; SIL: 23.8 vs. 26%, p < 0.001) and right cardiac function (SIL: 6.57 ± 2.08 vs. 8.11 ± 1.81 cm/s, p = 0.002; SNP: 6.64 ± 1.51 vs. 7.72 ± 1.44 cm/s, p = 0.003), measured through left ventricular ejection fraction and tissue Doppler, respectively. Sildenafil, contrary to SNP, improved venous oxygen saturation, measured on venous blood gas analysis.


CONCLUSIONS
Sildenafil and SNP are vasodilators that significantly reduce pulmonary hypertension and cardiac geometry, in addition to improving biventricular function. Sodium nitroprusside, contrary to SIL, was associated with systemic arterial hypotension and worsening of venous oxygen saturation.
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil. affreitasjr@cardiol.br
Aguinaldo Figueiredo
AF
Freitas
Fernando
F
Bacal
José de Lima
Jde L
Oliveira Júnior
Alfredo Inácio
AI
Fiorelli
Ronaldo Honorato
RH
Santos
Luiz Felipe Pinho
LF
Moreira
Christiano Pereira
CP
Silva
Sandrigo
S
Mangini
Jeane Mike
JM
Tsutsui
Edimar Alcides
EA
Bocchi
D001794:Blood Pressure / Q000187:drug effects / Q000528:radiation effects; D005260:Female; D006439:Hemodynamics / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000503:physiopathology; D007022:Hypotension / Q000139:chemically induced* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009599:Nitroprusside / Q000009:adverse effects / Q000627:therapeutic use*; D010879:Piperazines / Q000627:therapeutic use*; D011300:Preoperative Care; D011687:Purines / Q000627:therapeutic use; D000068677:Sildenafil Citrate; D013450:Sulfones / Q000627:therapeutic use*; D014655:Vascular Resistance / Q000187:drug effects / Q000502:physiology; D014665:Vasodilator Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016276:Ventricular Function / Q000187:drug effects
D010879:Piperazines; D011687:Purines; D013450:Sulfones; D014665:Vasodilator Agents; D009599:Nitroprusside; D000068677:Sildenafil Citrate