(Circulation. 1997;95:1479-1486.)
© 1997 American Heart Association, Inc.
Articles |
Effects of Long-term Infusion of Prostacyclin (Epoprostenol) on Echocardiographic Measures of Right Ventricular Structure and Function in Primary Pulmonary Hypertension
From the Departments of Medicine (A.L.H., P.W.W.), Pediatrics (W.A.L.), and Biostatistics (G.K., S.L.), University of North Carolina, Chapel Hill; Department of Pediatrics (R.J.B.), College of Physicians and Surgeons, Columbia University, New York, NY; Departments of Medicine, University of Illinois at Chicago (S.R.); University of Maryland (L.J.R.), Baltimore; University of Colorado Health Sciences Center (D.B.B., B.M.G.), Denver; Mayo Clinic Medical Center (M.D.M.), Rochester, Minn; Duke University Medical Center (V.F.T.), Durham, NC; University of Alabama (R.C.B.), Birmingham; Harbor-UCLA Medical Center (B.H.B.), Torrance, Calif; Cedars Sinai Medical Center (S.K.K.), Los Angeles, Calif; Sir Mortimer B. Davis Jewish General Hospital (D.L.), McGill University, Montreal, Quebec, Canada; Baylor College of Medicine (C.A.K.), Houston, Tex; and Presbyterian-University Hospital (S.M., B.F.U.), University of Pittsburgh, Pa; GlaxoWellcome Inc (L.M.C., M.M.J., S.D.B.), Research Triangle Park, NC; and Cato Research, Ltd (J.W.C.), Research Triangle Park, NC.
Background Right heart failure is an important cause of morbidity and mortality in primary pulmonary hypertension. In a recent prospective, randomized study of severely symptomatic patients, treatment with prostacyclin (epoprostenol) produced improvements in hemodynamics, quality of life, and survival. This article describes the echocardiographic characteristics of participants in this trial; the relationships of echocardiographic variables to hemodynamic parameters, exercise capacity, and quality of life; and the echocardiographic changes associated with prostacyclin therapy.
Methods and Results The 81 patients enrolled in this multicenter trial were randomized to treatment with a long-term infusion of prostacyclin in addition to conventional therapy (n=41) or conventional therapy alone (n=40) for 12 weeks. Echocardiograms and assessments of hemodynamics, exercise capacity, and quality of life were performed before and after the treatment phase. On baseline evaluation, patients had marked right ventricular dilatation and dysfunction, abnormal septal curvature, and significant tricuspid regurgitation with a high regurgitant velocity. Pericardial effusions were common. More pronounced abnormalities in right heart structure and function were associated with higher pulmonary arterial and mean right atrial pressures, lower cardiac index, and impaired exercise capacity but had no predictable relationship to quality-of-life indicators. The 12-week infusion of prostacyclin had beneficial effects on right ventricular size, curvature of the interventricular septum, and maximal tricuspid regurgitant jet velocity.
Conclusions The echocardiographic manifestations of severe primary pulmonary hypertension reflect abnormalities in hemodynamics and exercise capacity. Prostacyclin has beneficial effects on right heart structure and function that may contribute to the clinical improvement and prolonged survival observed with this drug.
Key Words: hypertension, pulmonary • heart failure • prostacyclin
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