Role of Vasodilator Testing in Pulmonary Hypertension

Sharma, Abhishek; Obiagwu, Chukwudi; Mezue, Kenechukwu; Garg, Aakash; Mukherjee, Debabrata; Haythe, Jennifer; Shetty, Vijay

doi:10.1016/j.pcad.2015.09.006

Cited by 19 publications

(19 citation statements)

References 42 publications

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“…With the assistance of a respiratory therapist, the patient is administered 40 ppm of nitric oxide with 100% oxygen through a mask (the literature has reported doses up to 80 ppm). 11 , 12 Hemodynamic measurements are made at baseline and after 5 to 10 minutes of continuous inhaled nitric oxide.…”

Section: Pulmonary Vasoreactivity Testing During Right Heart Catheterizationmentioning

confidence: 99%

“…As an alternative, epoprostenol can be infused intravenously starting at 2 ng/kg/min and is increased by 2 ng/kg/min every 10 to 15 minutes until a maximum dose of 12 ng/kg/min is reached. 11 Side effects are more commonly encountered with epoprostenol and include flushing, headache, nausea/vomiting, and hypotension. It is cheaper than inhaled nitric oxide.…”

Section: Pulmonary Vasoreactivity Testing During Right Heart Catheterizationmentioning

confidence: 99%

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Under Pressure: Right Heart Catheterization and Provocative Testing for Diagnosing Pulmonary Hypertension

Tea

Hussain

2021

Methodist DeBakey Cardiovascular Journal

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Pulmonary hypertension (PH) is a heterogenous disorder involving multiple pathophysiological processes that ultimately affect the vasculature within the lungs. Right heart catheterization (RHC) continues to be the benchmark for diagnosing PH. The use of provocation techniques during RHC can help sub-characterize the type of PH and thus assist in developing appropriate treatment strategies for the management of each PH subtype. This review examines proven and novel approaches for evaluating the pulmonary vasculature during RHC and aspires to provide an accurate, clinically relevant framework for using RHC to diagnose and manage PH. Further improvement in standardized protocols will help optimize the application of RHC in patients with PH.

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Section: Pulmonary Vasoreactivity Testing During Right Heart Catheterizationmentioning

confidence: 99%

Section: Pulmonary Vasoreactivity Testing During Right Heart Catheterizationmentioning

confidence: 99%

Under Pressure: Right Heart Catheterization and Provocative Testing for Diagnosing Pulmonary Hypertension

Tea

Hussain

2021

Methodist DeBakey Cardiovascular Journal

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“…Inhaled NO has been the drug of choice for vasoreactivity testing due to its short half‐life, minimal systemic effects, and reduced costs. Nevertheless, there is no consensus on a specific agent or protocol 5 and inodilators such as milrinone 6 or levosimendan 7 that act both at the pulmonary vasculature and at the myocardium can be valuable alternatives.…”

Section: Introductionmentioning

confidence: 99%

Comparison of levosimendan, NO, and inhaled iloprost for pulmonary hypertension reversibility assessment in heart transplant candidates

et al. 2021

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Aims Assessing reversibility of pulmonary vascular changes through vasoreactivity testing (VRT) optimizes end-stage heart failure patient selection for heart transplant. All efforts should be made to unload the left ventricle and reduce pulmonary vascular resistance to effectively exclude irreversible pulmonary hypertension. Methods and results We reviewed our centre's cardiac transplant registry database (2009-2017) for VRT and compared haemodynamic responses with 40 ppm inhaled NO (n = 14), 14-17 μg inhaled iloprost (n = 7), and 24 h 0.1 μg/kg/min intravenous levosimendan (n = 14). Response to levosimendan was assessed by repeat right heart catheterization within 72 h. Baseline clinical and haemodynamic features were similar between groups. VRT was well tolerated in all patients. All drugs effectively reduced pulmonary artery pressures and transpulmonary gradient while increasing cardiac index, although levosimendan had a greater impact on cardiac index increase (P = 0.036). Levosimendan was the only drug that reduced pulmonary artery wedge pressure (P = 0.004) and central venous pressures (P < 0.001) and increased both left and right ventricular stroke work indexes (P = 0.020 and P = 0.042, respectively) and cardiac power index (P < 0.001) compared with NO and iloprost. Right ventricular end-diastolic pressures and central venous pressure were only decreased by levosimendan. The rate of positive responses (≥10 mmHg decrease or final mean pulmonary artery pressure ≤40 mmHg with increased/unaltered cardiac index) was lower with inhaled iloprost (14%) than with either levosimendan or NO (71% and 64%, respectively; P < 0.05). Conclusions Levosimendan may be a safe and effective alternative for pulmonary hypertension reversibility assessment or a valuable pre-test medical optimization tool in end-stage heart failure patient assessment for heart transplantation offering extended haemodynamic benefits. Whether it increases the rate of positive responses or allows a better selection of candidates to heart transplantation remains to be established.

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“…While the use of long-term pulmonary vasodilators in these cohorts is common, the assessment of pulmonary circulation and its reactivity to pulmonary vasodilators before administration may enable risk stratification. Performed with cardiac catheterization (CATH) support, it is a standard approach in many institutions (Abman et al, 2015;Douwes et al, 2016;Sharma et al, 2016). A decline in pulmonary artery (PA) pressure and pulmonary vascular resistance (PVR) indicates a reactive component to PH (Khemani et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

Assessing pulmonary circulation in severe bronchopulmonary dysplasia using functional echocardiography

et al. 2021

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Role of Vasodilator Testing in Pulmonary Hypertension

Cited by 19 publications

References 42 publications

Under Pressure: Right Heart Catheterization and Provocative Testing for Diagnosing Pulmonary Hypertension

Under Pressure: Right Heart Catheterization and Provocative Testing for Diagnosing Pulmonary Hypertension

Comparison of levosimendan, NO, and inhaled iloprost for pulmonary hypertension reversibility assessment in heart transplant candidates

Assessing pulmonary circulation in severe bronchopulmonary dysplasia using functional echocardiography

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