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01.09.2009 | Original article | Ausgabe 9/2009

Netherlands Heart Journal 9/2009

Long-term efficacy of bosentan in inoperable chronic thromboembolic pulmonary hypertension

Zeitschrift:
Netherlands Heart Journal > Ausgabe 9/2009
Autoren:
M. C. Post, H. W. M. Plokker, J. C. Kelder, R. J. Snijder
Wichtige Hinweise
Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands
Department of Pulmonology, St Antonius Hospital, Nieuwegein, the Netherlands
M.C. Post Department of Cardiology, St Antonius Hospital, PO Box 2500, 3430 EM Nieuwegein, the Netherlands

Abstract

Background. Inoperable chronic thromboembolic pulmonary hypertension (CTEPH) is associated with a poor survival.
Objectives. To evaluate the long-term response to a dual endothelin receptor antagonist in patients with inoperable CTEPH.
Methods. All consecutive 18 patients (mean age 63±14 years) treated with bosentan for symptomatic inoperable CTEPH were included. Efficacy was evaluated by the log value of serum levels of N-terminal-pro brain natriuretic peptide (log NTpro BNP), New York Heart Association functional class (NYHA), and the six-minute walk test (6-MWT). All follow-up data (median 31 months) were compared with baseline and divided into: short-term (<12 months), mid-term (between 12 and 24 months), and long-term follow-up (>24 months).
Results. At baseline, 15 patients were in NYHA class III and three in NYHA class IV, mean log NT-pro BNP level was 7.2±1.4 log pg/ml, and mean 6-MWT distance was 404±125 m. During short-term follow-up (n=18), the NYHA class improved (p=0.001), 6-MWT distance increased by 33 m (p=0.03), and log NT-pro BNP decreased to 6.9±1.4 log pg/ml (p=0.007). During mid-term follow-up (n=17), the NYHA class improved (p<0.001), the mean 6-MWT distance increased by 41 m (p=0.01), and log NT-pro BNP was 6.9±1.4 log pg/ml (p=0.31). During late followup (n=14) the NYHA class was still improved (p=0.03), the 6-MWT distance decreased by 9 m (p=0.73), and log NT-pro BNP was 7.1±1.5 log pg/ml (p=0.91). The overall four year survival rate was 88%.
Conclusion: Bosentan seems to be effective during long-term treatment in patients with inoperable CTEPH. (Neth Heart J 2009;17:329–33).

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