Sildenafil in heart transplant candidates with pulmonary hypertension.
BACKGROUND
Severe pulmonary hypertension is a usual contraindication to heart transplantation. A few studies have found that sildenafil has a favourable effect on haemodynamic variables in patients with severe left ventricular systolic dysfunction.


OBJECTIVE
To report our clinical experience of sildenafil in patients with left ventricular systolic dysfunction and severe pulmonary hypertension.


METHODS
All patients underwent echocardiography, radionuclide angiography, a cardiopulmonary exercise test and right heart catheterization before and after treatment with sildenafil. All patients were clinically stable and were receiving maximal tolerated doses of recommended drugs.


RESULTS
We included 18 patients, with a mean±standard deviation age of 47±13 years. After a median of 8.7 months (interquartile range, 4.4-13.5 months) on sildenafil, there was a significant improvement in New York Heart Association classification (P=0.02) and mean right ventricular ejection fraction (from 26±7% to 30±9%; P=0.008), with a decrease in the VE/VCO2 slope (from 52±11 to 44±11; P=0.009) and in pulmonary vascular resistance (from 5.3±1.9 Wood units to 3.3±1.8 Wood units; P=0.01). During follow-up, three patients had urgent heart transplantation, two had non-urgent transplantation and six had left ventricular assist device implantation. All patients with pulmonary vascular resistance<3 Wood units after sildenafil were alive, compared with four in the other subgroup (44% survival).


CONCLUSIONS
In patients with pulmonary hypertension related to left ventricular systolic dysfunction, sildenafil seems to improve cardiac haemodynamics.
Pôle cardio-vasculaire et pulmonaire, clinique de cardiologie, CHRU de Lille, boulevard Prof.-J.-Leclercq, 59037 Lille cedex, France; Inserm U744, institut Pasteur de Lille, université de Lille 2, Lille, France. Electronic address: pascal.degroote@chru-lille.fr.
Pascal
P
de Groote
Pôle cardio-vasculaire et pulmonaire, clinique de cardiologie, CHRU de Lille, boulevard Prof.-J.-Leclercq, 59037 Lille cedex, France.
Ciham
C
El Asri
Pôle cardio-vasculaire et pulmonaire, clinique de cardiologie, CHRU de Lille, boulevard Prof.-J.-Leclercq, 59037 Lille cedex, France; Inserm U744, institut Pasteur de Lille, université de Lille 2, Lille, France.
Marie
M
Fertin
Pôle d'anesthésie réanimation, clinique d'anesthésie-réanimation cardio-thoracique, CHRU de Lille, Lille, France.
Céline
C
Goéminne
Pôle cardio-vasculaire et pulmonaire, clinique de chirurgie cardio-vasculaire, CHRU de Lille, Lille, France; Faculté de médecine de Lille, université de Lille 2, Lille, France.
André
A
Vincentelli
Pôle d'anesthésie réanimation, clinique d'anesthésie-réanimation cardio-thoracique, CHRU de Lille, Lille, France; Faculté de médecine de Lille, université de Lille 2, Lille, France.
Emmanuel
E
Robin
Pôle cardio-vasculaire et pulmonaire, clinique de cardiologie, CHRU de Lille, boulevard Prof.-J.-Leclercq, 59037 Lille cedex, France.
Anju
A
Duva-Pentiah
Pôle cardio-vasculaire et pulmonaire, clinique de cardiologie, CHRU de Lille, boulevard Prof.-J.-Leclercq, 59037 Lille cedex, France; Inserm U744, institut Pasteur de Lille, université de Lille 2, Lille, France; Faculté de médecine de Lille, université de Lille 2, Lille, France.
Nicolas
N
Lamblin
D000328:Adult; D006328:Cardiac Catheterization; D002317:Cardiovascular Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004280:Dobutamine / Q000627:therapeutic use; D004341:Drug Evaluation; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation; D006439:Hemodynamics; D065386:Historically Controlled Study; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D000068677:Sildenafil Citrate / Q000494:pharmacology / Q000627:therapeutic use*; D013318:Stroke Volume / Q000187:drug effects; D013599:Systole; D014463:Ultrasonography; D014665:Vasodilator Agents / Q000494:pharmacology / Q000627:therapeutic use*; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D014850:Waiting Lists
D002317:Cardiovascular Agents; D014665:Vasodilator Agents; D004280:Dobutamine; D000068677:Sildenafil Citrate
Cardiac transplantation; Hypertension pulmonaire; Insuffisance cardiaque systolique; Pulmonary hypertension; Sildenafil; Sildénafil; Systolic heart failure; Transplantation cardiaque