Clinical heart transplantationProstaglandin E1 Testing in Heart Failure–associated Pulmonary Hypertension Enables Transplantation: The PROPHET Study
Section snippets
Population
The study included 208 consecutive heart failure patients undergoing evaluation for potential listing for heart transplantation (Table 1). Patients dependent on intravenous inotropic support were excluded. The study was approved by the ethics committee of each participating study center. Written informed consent was given by each patient.
Right Heart Catheterization and Testing With PGE1
All 208 patients underwent right heart catheterization while under continuation of their pre-existing oral therapy (Table 1), which was not changed before and
Baseline Hemodynamics
The baseline hemodynamics of the entire population (n = 208) and the pre-defined patient cohorts without (n = 116) and with (n = 92) increased PVR >2.5 WU or TPG >12 mm Hg are given in Table 2.
PGE1 Testing
In the 92 patients tested with PGE1, PVR decreased from 4.1 ± 2.0 to 2.1 ± 1.1 WU (p < 0.01), and TPG from 14 ± 4.0 to 10 ± 3.0 mm Hg (p < 0.01). CO increased from 3.8 ± 1.0 to 5.0 ± 1.5 liters/min (p < 0.01). PAM decreased from 39 ± 9 to 29 ± 9 mm Hg (p < 0.01), and mean PCWP from 24 ± 7 to 19 ± 9 mm Hg (p
Effectiveness of PVR Reversibility Testing and Implications for Transplant Listing
This multicenter study demonstrates the reversibility of increased PVR with PGE1 in a large cohort of patients with severe left ventricular dysfunction being evaluated for orthotopic heart transplantion. At baseline, 92 of 208 patients (44%) exhibited a PVR >2.5 WU, and 37 of 208 (18%) a PVR >4.0 WU (a consensus cut-off value for ineligibility for heart transplant listing in Germany11). After PGE1 testing PVR remained >2.5 WU in only 22 of 208 patients (10.6%), and only 2 of 208 patients (1%)
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Cited by (35)
Pulmonary Hypertension in Left Heart Disease
2021, Clinics in Chest MedicineCitation Excerpt :Extensive literature has demonstrated, however, that if the PVR elevation is reversible, then transplantation can be performed successfully. This importantly indicates that not all precapillary PH in LH disease is from irreversible histologic remodeling.34–36 In contrast, among the subset of patients whose CpC PH is not acutely reversible with short-term hemodynamic optimization, further experience with chronic LVAD support and sustained LA pressure reduction has demonstrated reversibility of the precapillary component over time, resulting in subsequent successful transplantation.37
Pulmonary Hypertension and Heart Failure: A Dangerous Liaison
2018, Heart Failure ClinicsCitation Excerpt :The following discussion focuses on agents targeting the pulmonary vasculature, and it is less likely that these therapies could be effective to improve outcome in purely passive Group 2 PH. Many of these therapies also target abnormalities outside of the pulmonary vasculature and this may independently affect their efficacy (or lack thereof). Prostaglandins are powerful vasodilators that lead to consistent hemodynamic improvements in Group 1 PH. Small, short-term, nonrandomized studies suggested promising effects on hemodynamics in patients with severe left-sided PH.58–62 In patients post–cardiac surgery, inhaled prostacyclin decreased PVR by 29% and improved RV performance.63 During mitral valve surgery, inhaled iloprost was superior to intravenous nitroglycerin in preventing right ventricular failure during weaning from cardiopulmonary bypass.64,65
Sodium Nitroprusside in Patients with Mixed Pulmonary Hypertension and Left Heart Disease: Hemodynamic Predictors of Response and Prognostic Implications
2016, Journal of Cardiac FailureCitation Excerpt :The former may respond acutely to vasodilators, but resting TPG and PVR criteria have poor sensitivity and specificity for response to vasodilators. This is evident from several studies that have reported on the acute improvements in pulmonary hemodynamics with vasodilators in some patients despite TPG and PVR levels above the criteria for mixed PH.7–9 The criterion of DPG ≥ 7 mmHg has not been studied in relation to the response to vasodilators. Sodium nitroprusside (SNP) is a potent vasodilator that can acutely reduce left ventricular afterload, improve cardiac filling pressures, reduce mitral regurgitation, and increase cardiac output in patients with HF.10
Pulmonary hypertension in left heart disease: A review
2012, International Journal of CardiologyPulmonary hypertension: Hemodynamic evaluation. Updated Recommendations of the Cologne Consensus Conference 2011
2011, International Journal of CardiologyPulmonary Hypertension in Heart Failure
2010, Journal of Cardiac FailureCitation Excerpt :Furthermore, it produces a positive inotropic effect.56 Intravenous prostaglandin E1 have also safely and successfully lowered PVR and TPG in 99% of patients without any significant side effects.57 In the Muenster experience, all patients with PH experienced a successful reduction in PVR by using prostaglandin E1 or prostacyclin; their 30-day and 10-year survival rates after orthotopic cardiac transplantation were similar to patients without PH.58
Supported by Pharmacia-Upjohn (Nuernberg, Germany).