Nitric Oxide Versus Prostaglandin E1 for Reduction of Pulmonary Hypertension in Heart Transplant Candidates

Radovančević, Branislav; Vrtovec, Bojan; Thomas, Cynthia D.; Croitoru, Mihai; Myers, Timothy J.; Radovancevic, Rajko; Khan, Tehreen; Massin, Edward K.; Frazier, O.H.

doi:10.1016/j.healun.2004.04.016

Cited by 27 publications

(21 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…At present, there is also no clear consensus on the best drug available to reverse PH clinically (even during pharmacological tests): inotropes (dobutamine, enoximone and milrinone) and vasodilators (nitroglycerin, sodium nitroprusside, nitric oxide and prostacyclin,) have been used [12][13][14][15][16]. Vasodilators are mostly used but the risk of systemic hypotension in end-stage HF patients, who are candidates for LVAD support, is real.…”

Section: Discussionmentioning

confidence: 99%

“…Presently, the optimal drug for the pharmacological test is still being discussed and the pulmonary haemodynamic parameters to predict outcome after HTx have not been well defined: mPAP, PVR and TPG are the most used, but no clear consensus is present about their real predictive value. There are several protocols for the diagnosis and treatment of PH secondary to HF, but conflicting data still exist [12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Left ventricular assist device or heart transplantation: impact of transpulmonary gradient and pulmonary vascular resistance on decision making☆

Mikus

Stepanenko

Krabatsch

et al. 2011

European Journal of Cardio-Thoracic Surgery

View full text Add to dashboard Cite

Transpulmonary gradient and pulmonary vascular resistance, but not mean pulmonary arterial pressure, are predictive parameters for successful heart transplantation in cases of severe postcapillary pulmonary hypertension. When no significant decrease in pulmonary vascular resistance and transpulmonary gradient after 3-4 days of pharmacological therapy is observed, mechanical circulatory support is the only option to bridge end-stage heart failure patients to heart transplantation. Survival after heart transplantation is strictly related to the reversibility of pulmonary vascular resistance and transpulmonary gradient before assist implantation, but not related to mean pulmonary artery pressure.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Left ventricular assist device or heart transplantation: impact of transpulmonary gradient and pulmonary vascular resistance on decision making☆

Mikus

Stepanenko

Krabatsch

et al. 2011

European Journal of Cardio-Thoracic Surgery

View full text Add to dashboard Cite

show abstract

“…There were 4 non-responders to PGE 1 , who responded to NO, and 4 non-responders to NO, who responded to PGE 1 . 24 As PGE 1 was documented as one of the most effective PVR-lowering agents, comparison of the effectiveness of different drugs was not adressed in the present study.…”

Section: Drugs For Reversibility Testingmentioning

confidence: 90%

“…Inhaled nitric oxide (NO) offers the potential advantage of a complete lack of systemic hypotensive effects. 17,18,24 However, it does not reduce or may even increase the pulmonary capillary wedge pressure. This may be dangerous in left ventricular failure because of the risk of pulmonary overflow and edema.…”

Section: Drugs For Reversibility Testingmentioning

confidence: 99%

“…8,13 Inotropic agents, such as dobutamine or enoximone, and vasodilating agents, such as nitroglycerin, nitroprusside, adenosine, sitaxsentan (an endothelin receptor blocker), prostglandin I 2 , prostaglandin E 1 and inhaled nitric oxide, have been evaluated in studies with small numbers of patients. 11,[15][16][17][18][19][20][21][22][23][24] At present, there is no clear consensus on the best agent available, but nitric oxide and prostaglandin E 1 appear to be the most promising. 18,20,24 Because there is a lack of a guideline-recommended, standardized protocol for pre-transplant reversibility testing of elevated PVR, and a lack of any prospective study evaluating the effectiveness of a potent vasodilator for reversibility of PVR in a large group of heart transplant candidates, the Working Group on Thoracic Organ Transplantation of the German Society of Cardiology designed and performed the PROPHET study.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Prostaglandin E1 Testing in Heart Failure–associated Pulmonary Hypertension Enables Transplantation: The PROPHET Study

Scheidt

Costard-Jaeckle

Stempfle³

et al. 2006

The Journal of Heart and Lung Transplantation

View full text Add to dashboard Cite

Haemodynamic effects and potential clinical implications of inhaled nitric oxide during right heart catheterization in heart transplant candidates

et al. 2020

View full text Add to dashboard Cite

Aims Right heart catheterization (RHC) is indicated in all candidates for heart transplantation (HT). An acute vasodilator challenge is recommended for those with pulmonary hypertension (PH) to assess its reversibility. The effects of inhaled nitric oxide (iNO) on pulmonary and systemic haemodynamics have been reported only in small series. Our purpose was to describe the response to iNO in a larger population and its potential clinical implications. Methods and results From 210 RHC procedures performed between 2010 and 2019, vasodilator challenge with iNO was used in 108 patients, of which 66 had advanced heart failure undergoing assessment for HT (55±11 years old; 74.2% male gender; 43.9% ischaemic cardiomyopathy; left ventricular ejection fraction 28.4 ± 11,4%; and peak VO2 12.1 ± 3.0 mL/kg/min). iNO was administered through a tight-fitting facial mask regardless of baseline pulmonary pressures. Clinical endpoints (allcause mortality and acute right heart failure) were assessed according to baseline haemodynamic findings over the available follow-up period. There were no side effects from iNO administration. Typical response consisted of a reduction in pulmonary vascular resistance, consequent to an increase in left ventricular filling pressures, no significant change in mean pulmonary artery pressure (resulting in a lower mean transpulmonary gradient) and a mild increase in cardiac ouput. Pulmonary arterial compliance increased significantly, whereas systemic vascular resistance was only mildly affected. In five cases (7.6%), pulmonary vascular resistance increased paradoxically. All-cause mortality and post-HT right heart failure events were overall low and similar in patients without PH or reversible PH. Conclusions Vasodilator challenge with iNO is safe in advanced heart failure patients undergoing RHC prior to HT listing. It produces a reasonably predictable haemodynamic response, which occurs predominantly at the pulmonary circulation level. Clinical implications of iNO-induced reversibility may be relevant, but further systematic validation is warranted in larger cohorts.

show abstract

Nitric Oxide Versus Prostaglandin E1 for Reduction of Pulmonary Hypertension in Heart Transplant Candidates

Cited by 27 publications

References 18 publications

Left ventricular assist device or heart transplantation: impact of transpulmonary gradient and pulmonary vascular resistance on decision making☆

Left ventricular assist device or heart transplantation: impact of transpulmonary gradient and pulmonary vascular resistance on decision making☆

Prostaglandin E1 Testing in Heart Failure–associated Pulmonary Hypertension Enables Transplantation: The PROPHET Study

Haemodynamic effects and potential clinical implications of inhaled nitric oxide during right heart catheterization in heart transplant candidates

Contact Info

Product

Resources

About