title: The effects of pulmonary vasodilating agents on right ventricular parameters in severe group 3 pulmonary hypertension: a pilot study.
abstract: Pulmonary arterial hypertension (PAH)-approved vasodilators improve right ventricular (RV) function in patients with PAH. However, whether PAH-approved drugs ameliorate RV morphology and function in lung disease-associated pulmonary hypertension (lung-PH) remains unclear. We aimed to prospectively evaluate the changes in RV volume and ejection fraction (RVEF) in 14 consecutive severe lung-PH patients treated with PAH-approved vasodilators. Severe lung-PH was defined as a mean pulmonary arterial pressure (MPAP) of ≥35 mmHg or an MPAP of ≥25 mmHg with a cardiac index (L/min/m2) of <2. Right heart catheterization and cardiac magnetic resonance (CMR) imaging were performed at baseline and at 3 months after starting sildenafil with or without other PAH-approved drugs. Follow-up was conducted at 3 months in 11 participants; compared with baseline values, MPAP and pulmonary vascular resistance (PVR) decreased by 18% and 37%, respectively. Baseline CMR imaging revealed an elevated RV end-diastolic volume index (RVEDVI; mL/m2) of 117.5 ± 35.9 and a below-average RVEF of 25.2% ± 7.2%; after 3 months, RVEDVI decreased by 23.7% (P= 0.0061) and RVEF increased by 32.9% (P= 0.0165). Among the 11 patients, 3 were thought to be a stable and homogenous subset in terms of background lung disease and medical management administered. These 3 patients exhibited similar ameliorations in PVR and RVEF, compared with the other 8 patients. PAH-approved drug treatment may improve RV dilatation and systolic function among patients with severe lung-PH. This study was approved by University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) on September 1, 2013 (UMIN000011541).
authors.affiliation: Division of Respiratory Medicine, Department of Internal Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Sato
authors.affiliation: Division of Respiratory Medicine, Department of Internal Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Ichizo
authors.initials: I
authors.lastname: Tsujino
authors.affiliation: Division of Respiratory Medicine, Department of Internal Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Ayako
authors.initials: A
authors.lastname: Sugimoto
authors.affiliation: Division of Respiratory Medicine, Department of Internal Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Nakaya
authors.affiliation: Division of Respiratory Medicine, Department of Internal Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Taku
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Division of Respiratory Medicine, Department of Internal Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ohira
authors.affiliation: Division of Respiratory Medicine, Department of Internal Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Suzuki
authors.affiliation: Division of Respiratory Medicine, Department of Internal Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Konno
authors.affiliation: Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Oyama-Manabe
authors.affiliation: Division of Respiratory Medicine, Department of Internal Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Masaharu
authors.initials: M
authors.lastname: Nishimura
keywords: arterial pressure; hypertension; magnetic resonance imaging; vasodilating agents; ventricular function