Abstract 10662: Ranolazine as Treatment of Pulmonary Hypertension Associated With Heart Failure With Preserved Ejcetion Fraction
The finding of an elevated pulmonary arterial pressure (PAP) on echocardiography is common; if further evaluated, a large and rapidly growing proportion of these individuals will have pulmonary venous hypertension, increasingly from LV diastolic dysfunction (heart failure with preserved ejection fraction; HFpEF). Among these patients, pulmonary hypertension (PH) is a poor prognostic indicator. While extensive data exist for treatment of WHO Group 1 PH (PAH), there are little data on treatment of WHO Group 2 PH. Ranolazine has been shown to improve diastolic function in animals; however, there is no information about its use in patients with PH associated with diastolic dysfunction. In this 6 month, open-label pilot study of 10 patients, we investigated ranolazine as treatment for PH associated with HFpEF. Eligibility for inclusion included: age 21-75; NYHA/WHO FC II-III; 6MWD >150m and <450m; LVEF>50% and no significant valvular disease by echocardiography; mPAP>25mmHg, PCWP >18mmHg and <30mmHg, and pulmonary artery diastolic pressure (PADP)-PCWP gradient <10 by RHC. Evaluations included: FC, 6MWD, Borg dyspnea index (BDI), BNP, troponin, echocardiography, cardiac MRI (CMRI) and invasive hemodynamics at baseline and after 6mo of ranolazine (1000mg bid). Participants were: 80% female; with an average age 63 and BMI 41.6; 100% were hypertensive; 80% were diabetic; 80% were dyslipidemic. After 6mo of ranolazine, there were significant improvements in FC (50% improved from III to II), 6MWD (+33m; 286m to 319m), mPAP (39mmHg to 23mmHg), and PCWP (22mmHg to 13mmHg). BDI, BNP, troponin, and echocardiographic parameters did not change significantly. One patient had symptomatic bradyarrhythmia (leading to discontinuation). Four subjects have continued ranolazine for 1y; improvements in FC and 6MW have been maintained. These preliminary observations suggest that ranolazine may be a promising treatment for PH associated with HFpEF.
- © 2013 by American Heart Association, Inc.