Efficacy and safety of sildenafil in the evaluation of pulmonary hypertension in severe heart failure

ACCF/AHA 2009 Expert Consensus Document on Pulmonary Hypertension

“…186,187 An acute study has shown that sildenafil administration improved peak VO 2 , reduced VE/VCO 2 slope, and produced pulmonary vasodilatation during rest and exercise in patients with heart failure and PH. 188 In addition, sildenafil treatment for 12 weeks improved exercise capacity and quality of life in patients with systolic heart failure and PH, compared with placebo-treated patients.…”

Pulmonary Hypertension in Heart Failure Preserved Ejection Fraction

“…These studies may challenge this scenario based on some At variance with other pulmonary vasodilators, evidence is accumulating that inhibition of phosphodiesterase-5 (PDE5), the isoenzyme that breaks down cGMP to its inactive form, may be an effective and well-tolerated tool for targeting the pulmonary vasculature and unloading the RV in left-sided PH. 53 This is suggested by multiple observations made in patients with left-sided PH of various pathogenesis and severity, with acute [54][55][56][57] and long-term administration [58][59][60][61] of sildenafil. Intriguingly, the benefits of PDE5 inhibitors compared with other classes of pulmonary vasodilators stand on the pulmonary vascular selectivity of PDE5 expression in lung microvessels both in physiological and, even more, pathological conditions, avoiding the untoward systemic hypotensive effect that is typical of other pulmonary vasodilating agents, such as prostanoids and ERAs.…”

Pulmonary hypertension in left heart disease

“…In patients with HFREF and PH, there is evidence of both acute (single dose of 50 mg) efficacy and safety of sildenafil in the evaluation of PH in severe heart failure [83,84] and is effective and well tolerated in longer term trials [85][86][87]. 12 weeks of treatment with sildenafil significantly reduced PVR and increased cardiac output with exercise compared with placebo, without altering Ppcw or mean Ppa, heart rate or systemic vascular resistance [86].…”