Subaortic Obstruction after Sildenafil in a Patient with Hypertrophic Cardiomyopathy

Stauffer, Jean‐Christophe; Ruiz, Vincent; Morard, J.-D.

doi:10.1056/nejm199908263410916

Cited by 39 publications

(14 citation statements)

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“…1 The management of ED in men with HCM remains controversial, since phosphodiesterase 5 (PDE5) inhibitors can theoretically increase the left ventricular outflow tract (LVOT) pressure gradient (PG) to which HCM patients are particularly sensitive, and which may not be detected at rest. 2 This report demonstrates the novel use of serial provocation imaging studies aimed at comparing the peak LVOT PG during the initiation and dose titration of PDE5 inhibitors.…”

Section: Introductionmentioning

confidence: 92%

Stress Imaging in Men with Hypertrophic Cardiomyopathy and Erectile Dysfunction

KonecnyTomas

NehraAjay

Pellikka

et al. 2013

Journal of Men's Health

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Background: The management of erectile dysfunction in men with hypertrophic cardiomyopathy remains controversial, since phosphodiesterase 5 inhibitors can theoretically increase left ventricular outflow tract pressure gradient (PG), yet this increase may not be detected at rest. Case Description: Two hemodynamic supine bike stress tests with transthoracic echocardiography were performed on two subsequent mornings in a 65-year-old man with hypertrophic cardiomyopathy and episodes of presyncope. The patient was instructed to take Tadalafil before the first stress test, and Tadalafil and Vardenafil before the second stress test. Results: The left ventricular outflow tract PG recorded by continuous-wave Doppler in the transapical view increased between rest and peak exercise: DPG on Tadalafil = +37 mmHg; DPG on Tadalafil and Vardenafil = +124 mmHg. Conclusion: This report demonstrates a novel use of serial provocation imaging studies aimed at comparing left ventricular PGs at peak stress during the initiation and dose titration of phosphodiesterase 5 inhibitors. Further studies are needed to develop an evidence-guided algorithm for safe implementation of therapies for erectile dysfunction in this most common inherited cardiomyopathy.

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Section: Introductionmentioning

confidence: 92%

Stress Imaging in Men with Hypertrophic Cardiomyopathy and Erectile Dysfunction

KonecnyTomas

NehraAjay

Pellikka

et al. 2013

Journal of Men's Health

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“…However, in a report of a hypertrophic cardiomyopathy patient, Holter monitoring for 24 h before treatment with sildenafil revealed 255 ventricular premature beats and no episode of ventricular tachycardia. After treatment with sildenafil, Holter monitoring revealed 1210 ventricular premature beats and six episodes of unsustained ventricular tachycardia [241] . This pro-arrhythmic effect of sildenafil needs to be further characterized.…”

Section: Clinical Applications Of Pde5 Inhibitorsmentioning

confidence: 99%

Pivotal effects of phosphodiesterase inhibitors on myocyte contractility and viability in normal and ischemic hearts

Rao

2008

Acta Pharmacol Sin

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Phosphodiesterases (PDEs) are enzymes that degrade cellular cAMP and cGMP and are thus essential for regulating the cyclic nucleotides. At least 11 families of PDEs have been identified, each with a distinctive structure, activity, expression, and tissue distribution. The PDE type-3, -4, and -5 (PDE3, PDE4, PDE5) are localized to specific regions of the cardiomyocyte, such as the sarcoplasmic reticulum and Z-disc, where they are likely to influence cAMP/cGMP signaling to the end effectors of contractility. Several PDE inhibitors exhibit remarkable hemodynamic and inotropic properties that may be valuable to clinical practice. In particular, PDE3 inhibitors have potent cardiotonic effects that can be used for short-term inotropic support, especially in situations where adrenergic stimulation is insufficient. Most relevant to this review, PDE inhibitors have also been found to have cytoprotective effects in the heart. For example, PDE3 inhibitors have been shown to be cardioprotective when given before ischemic attack, whereas PDE5 inhibitors, which include three widely used erectile dysfunction drugs (sildenafil, vardenafil and tadalafil), can induce remarkable cardioprotection when administered either prior to ischemia or upon reperfusion. This article provides an overview of the current laboratory and clinical evidence, as well as the cellular mechanisms by which the inhibitors of PDE3, PDE4 and PDE5 exert their beneficial effects on normal and ischemic hearts. It seems that PDE inhibitors hold great promise as clinically applicable agents that can improve cardiac performance and cell survival under critical situations, such as ischemic heart attack, cardiopulmonary bypass surgery, and heart failure.

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“…Because of its selectivity for PDE-5 over PDE-3, tadalafil appears less likely to cause cardiovascular-related problems noted with sildenafil use. [35][36][37][38] The phosphodiesterase-type 11 (PDE-11) enzyme is distributed throughout the body, including the skeletal muscles, pituitary gland, pancreas, and heart. 39,40 Tadalafil exhibits only 5 times greater selectivity for PDE-5 versus PDE-11, and musculoskeletal effects (ie, back pain and myalgia) associated with this drug may be related to its potent inhibition of PDE-11.…”

Section: Safety Informationmentioning

confidence: 99%

Advances in the Treatment of Erectile Dysfunction: A Focus on Tadalafil

Norwood

Eraikhuemen

Larose-Pierre

et al. 2004

Journal of Pharmacy Practice

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Erectile dysfunction (ED) affects more than 150 million men and their partners throughout the world. Sildenafil, the first oral phosphodiesterase-type 5 (PDE-5) inhibitor approved for the treatment of ED, has led to the discovery of 2 more products in this class, with tadalafil being the latest. Tadalafil has proven to be well tolerated in various clinical studies and has demonstrated effectiveness in men with mild to severe ED, regardless of severity, etiology, or age. One major characteristic that may distinguish tadalafil from other oral PDE-5 inhibitors is its extensive duration of effect. Tadalafil has a therapeutic duration of up to 36 hours that may allow patients to engage in sexual activity at their own convenience rather than in a limited time period. This, along with other clinical and practical advantages, should make tadalafil an attractive alternative to currently available treatments options. This article summarizes the pharmacology, pharmacokinetics, adverse effects, and clinical efficacy of tadalafil.

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Subaortic Obstruction after Sildenafil in a Patient with Hypertrophic Cardiomyopathy

Cited by 39 publications

References 1 publication

Stress Imaging in Men with Hypertrophic Cardiomyopathy and Erectile Dysfunction

Stress Imaging in Men with Hypertrophic Cardiomyopathy and Erectile Dysfunction

Pivotal effects of phosphodiesterase inhibitors on myocyte contractility and viability in normal and ischemic hearts

Advances in the Treatment of Erectile Dysfunction: A Focus on Tadalafil

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