title: Effect of bosentan on pulmonary hypertension secondary to systolic heart failure.
abstract: OBJECTIVE
  The dual endothelin receptor antagonist bosentan improves pulmonary vascular resistance (PVR) in patients with primary pulmonary hypertension (PH). The effects of bosentan on secondary PH due to systolic heart failure (HF) are not well defined. This study evaluates the effect and tolerability of bosentan in patients with PH secondary to HF.
  
  
  METHODS
  Seventeen adult HF patients with PH and New York Heart Association class III-IV symptoms were treated with bosentan, 62.5 mg twice daily, for 1 month, which was gradually increased to 125 mg twice daily thereafter. Right heart catheterization (RHC), a clinical evaluation and echocardiographic measurements were performed at baseline and at 4 ± 3 (mean ± SD) months of follow-up. Response to bosentan was defined as an improvement in clinical, echocardiographic and RHC parameters.
  
  
  RESULTS
  Six patients did not complete the study (therapy was discontinued due to hypotension, elevated liver enzymes or acute decompensation of HF), 11 patients completed the follow-up; 9 patients responded to therapy. Systemic arterial pressures, pulmonary pressures, PVR and the transpulmonary gradient significantly decreased compared with baseline levels in 9 responders (p = 0.05, 0.05, 0.01 and 0.004, respectively), and 4 became eligible for heart transplantation and 3 for left ventricular assist device implantation.
  
  
  CONCLUSIONS
  Bosentan decreased pulmonary pressures and PVR in the majority of patients with PH secondary to systolic HF, thereby allowing them to be considered candidates for heart transplantation.
authors.affiliation: Departments of Cardiovascular Diseases, University of Siena, Siena, Italy.
authors.forename: Margherita
authors.initials: M
authors.lastname: Padeletti
authors.forename: Maria
authors.initials: M
authors.lastname: Caputo
authors.forename: Valerio
authors.initials: V
authors.lastname: Zacà
authors.forename: Charilos
authors.initials: C
authors.lastname: Tsioulpas
authors.forename: Sonia
authors.initials: S
authors.lastname: Bernazzali
authors.forename: Sergio
authors.initials: S
authors.lastname: Mondillo
authors.forename: Massimo
authors.initials: M
authors.lastname: Maccherini
authors.forename: Sanja
authors.initials: S
authors.lastname: Jelic
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D000077300:Bosentan; D006328:Cardiac Catheterization / Q000379:methods; D004452:Echocardiography; D065128:Endothelin Receptor Antagonists; D005260:Female; D005500:Follow-Up Studies; D054143:Heart Failure, Systolic / Q000150:complications*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D013449:Sulfonamides / Q000627:therapeutic use*; D016896:Treatment Outcome; D014655:Vascular Resistance / Q000187:drug effects
chemical_list: D000959:Antihypertensive Agents; D065128:Endothelin Receptor Antagonists; D013449:Sulfonamides; D000077300:Bosentan