ABSTRACT
<p><b>OBJECTIVE</b>To evaluate the therapy efficacy of iloprost combined with low dose tadalafil in adult congenital heart disease (CHD) patients with severe pulmonary arterial hypertension (PAH).</p><p><b>METHODS</b>Adult CHD patients with severe PAH were included and divided into the sequential combination therapy group [iloprost: 10 µg/inhalation, 6 times per day for 6 months, and then add oral tadalafil (5 mg/d) till 12 months, n = 32] and upfront combination therapy group [iloprost: 10 µg/inhalation, 6 times per day combined with oral tadalafil (5 mg) for 12 months, n = 36]. Data on 6 min walking test (6MWT), Borg dyspnea score, oxygen saturation measurement, WHO classification, and cardiac catheterization were obtained at baseline, 6 and 12 months.</p><p><b>RESULTS</b>Seventy-two patients were enrolled in the study and 68 patients completed the study. Pulmonary vascular resistance (PVR) was significantly reduced in the sequential combination therapy group[ (12.96 ± 6.48 ) Wood U vs. (16.94 ± 8.11) Wood U, P < 0.05] and in the upfront combination therapy group [(12.45 ± 7.32) Wood U vs. (16.73 ± 9.28) Wood U, P < 0.05] while pulmonary blood flow [(6.77 ± 3.17) L/min vs. (5.08 ± 2.36) L/min, P < 0.05; (6.95 ± 3.32) L/min vs. (5.03 ± 2.32) L/min, P < 0.05], the 6 MWD were significantly increased [(458 ± 59) m vs. (427 ± 65) m, P < 0.05; (494 ± 59) m vs. (436 ± 62) m, P < 0.01], the Borg dyspnea score (2.04 ± 0.72 vs. 2.52 ± 0.79, P < 0.05; 1.72 ± 0.73 vs. 2.51 ± 0.77, P < 0.01) was significantly improved in both groups at 6 months compared to baseline levels. In the upfront combination therapy group, venous oxygen saturation [(68.4 ± 9.3)% vs. (62.9 ± 9.5)%, P < 0.05] and systemic oxygen saturation during exercise[ (87.2 ± 9.7)% vs. (83.1 ± 15.6)%, P < 0.05]at 6 months were also significantly improved compared to baseline. At month 12, significantly lowered pulmonary artery pressure, PVR, Rp/Rs and increased pulmonary blood flow and cardiac index were evidenced in both groups compared to baseline.</p><p><b>CONCLUSION</b>Iloprost combined with low dose tadalafil regimen can effectively reduce PVR, increase 6MWD, and improve cardiopulmonary function in adults CHD patients with severe PAH. Compared with the sequential therapy regimen, the upfront combination therapy regimen can more rapidly improve the clinical symptoms of patients.</p>
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Carbolines , Therapeutic Uses , Follow-Up Studies , Heart Defects, Congenital , Drug Therapy , Hypertension, Pulmonary , Drug Therapy , Iloprost , Therapeutic Uses , Tadalafil , Treatment OutcomeABSTRACT
OBJECTIVE: To compare the acute hemodynamic effects of aerosolized iloprost and inhaled nitric oxide (NO) in adult congenital heart disease (CHD) patients with severe pulmonary arterial hypertension (PAH). METHODS: One hundred and eighty five adult CHDs with severe PAH were nonrandomized into two groups (iloprost, n=127; NO, n=58). Various hemodynamic parameters were measured before and after iloprost or NO inhalation. RESULTS: Iloprost and NO inhalation resulted in significant reductions in pulmonary arterial pressure (from 110.6±21.8 mmHg to 105.5±22.3 mmHg, p<0.05; from 113.1±18.7 mmHg to 107.2±19.9 mmHg, p<0.05, respectively) and pulmonary vascular resistance (PVR) (from 13.4±8.3 Wood units to 9.6±6.4 Wood units, p<0.01; from 13.7±7.1 Wood units to 9.3±4.9 Wood units, p<0.01, respectively) and increases in pulmonary blood flow (from 6.7±3.3 L/min to 9.4±5.8 L/min, p<0.05; from 6.6±3.1 L/min to 9.6±5.9 L/min, p<0.01, respectively) and the Qp/Qs ratio (from 1.5±0.8 to 2.1±1.4, p<0.01; from 1.5±0.8 to 2.0±1.3, p<0.01, respectively). When the effects of inhaled iloprost and NO were compared, similar reductions in pulmonary arterial pressure and pulmonary vascular resistance were observed. Aerosolized iloprost and inhaled nitric oxide (iNO) were generally well tolerated and no patient experienced any side effects during inhalation. CONCLUSION: Aerosolized iloprost can be effectively and safely used and might be an alternative to NO for testing pulmonary vascular reactivity and treating severe PAH in adult CHD patients.
Subject(s)
Heart Defects, Congenital/drug therapy , Hemodynamics/drug effects , Hypertension, Pulmonary/drug therapy , Iloprost/administration & dosage , Nitric Oxide/administration & dosage , Administration, Inhalation , Adolescent , Adult , Aerosols , Aged , Familial Primary Pulmonary Hypertension , Female , Heart Defects, Congenital/epidemiology , Heart Defects, Congenital/physiopathology , Hemodynamics/physiology , Humans , Hypertension, Pulmonary/epidemiology , Hypertension, Pulmonary/physiopathology , Male , Middle Aged , Severity of Illness Index , Young AdultABSTRACT
Objective To determine the nutrients contents in muscle of Culter erythropterus and evaluate its nutritive value. Method The nutrients composition was analysed by general method. Results The contents of moisture, crude protein, total fat, total sugar and ash were 78.29%, 18.31%, 0.97%, 1.18% and 1.17%, respectively. The total amount of AA, EAA, NEAA and FTAA was 71.93%, 31.61%, 40.32% and 25.57%, respectively. 26 kinds of FA were identified. There were 6 kinds of SFA, 20 kinds of UFA. The contents of SFA, MUFA and PUFA were 26.26%, 29.61% and 39.91%, respectively. The contents of DG, TG, FFA, Cho and PL were 3.69%, 11.71%, 23.60%, 0.54% and 60.46%, respectively. Conclusion The crude protein and PUFA were high in muscle of Culter erythropterus. It was beneficial for health to eat it regularly.
