Subject(s)
Heart Failure/diagnosis , Heart Failure/therapy , Acute Disease , Brazil , Chronic Disease , Heart Failure/mortality , Humans , Risk FactorsABSTRACT
BACKGROUND: Pulmonary hypertension is associated with a worse prognosis after cardiac transplantation. The pulmonary hypertension reversibility test with sodium nitroprusside (SNP) is associated with a high rate of systemic arterial hypotension, ventricular dysfunction of the transplanted graft and high rates of disqualification from transplantation. OBJECTIVE: This study was aimed at comparing the effects of sildenafil (SIL) and SNP on hemodynamic, neurohormonal and echocardiographic variables during the pulmonary reversibility test. METHODS: The patients underwent simultaneously right cardiac catheterization, echocardiography, BNP measurement, and venous blood gas analysis before and after receiving either SNP (1 - 2 µg/kg/min) or SIL (100 mg, single dose). RESULTS: Both drugs reduced pulmonary hypertension, but SNP caused a significant systemic hypotension (mean blood pressure - MBP: 85.2 vs. 69.8 mm Hg; p < 0.001). Both drugs reduced cardiac dimensions and improved left cardiac function (SNP: 23.5 vs. 24.8%, p = 0.02; SIL: 23.8 vs. 26%, p < 0.001) and right cardiac function (SIL: 6.57 ± 2.08 vs. 8.11 ± 1.81 cm/s, p = 0.002; SNP: 6.64 ± 1.51 vs. 7.72 ± 1.44 cm/s, p = 0.003), measured through left ventricular ejection fraction and tissue Doppler, respectively. Sildenafil, contrary to SNP, improved venous oxygen saturation, measured on venous blood gas analysis. CONCLUSION: Sildenafil and SNP are vasodilators that significantly reduce pulmonary hypertension and cardiac geometry, in addition to improving biventricular function. Sodium nitroprusside, contrary to SIL, was associated with systemic arterial hypotension and worsening of venous oxygen saturation.
Subject(s)
Hemodynamics/drug effects , Hypertension, Pulmonary/drug therapy , Hypotension/chemically induced , Nitroprusside/therapeutic use , Piperazines/therapeutic use , Sulfones/therapeutic use , Vasodilator Agents/therapeutic use , Blood Pressure/drug effects , Blood Pressure/radiation effects , Female , Hemodynamics/physiology , Humans , Hypertension, Pulmonary/physiopathology , Hypotension/drug therapy , Male , Middle Aged , Nitroprusside/adverse effects , Preoperative Care , Purines/therapeutic use , Sildenafil Citrate , Vascular Resistance/drug effects , Vascular Resistance/physiology , Vasodilator Agents/adverse effects , Ventricular Function/drug effectsABSTRACT
BACKGROUND: Sleep apneas are frequent in patients with heart failure (HF). Estimate of the pre-beta blocker age (BB) point out to 45% of central apneas in these patients. OBJECTIVE: Assess the influence of BB in central apneas and their interference in the quality of sleep and life of patients with heart failure. METHODS: 65 patients with heart failure underwent diagnostic polysomnography. Polysomnography have been assessed according to the use or not of BB. On the day of examination, the patients answered the Minnesota questionnaire for quality of life with HF. After 6 and 12 months from the polysomnography date, all patients were contacted by phone, in order to repeat the Minnesota questionnaire. RESULTS: The prevalence of sleep apnea (IAH > 15/h) hit 46.1% in the total population, however, central sleep apnea was identified in 18.4% of patients. The use of BB, in a multivariate analysis, was the only predictor of a minor index of central apnea and hypopnea (IAH) (p=0.002), greater saturation (p=0.02) and smaller average desaturation of oxygen (p=0.03). Additionally, the use of BB could predict a better quality of life after 6 and 12 months (p=0.002 and 0.001 respectively) and a smaller number admissions in these periods (p=0.001 and p=0.05 respectively). CONCLUSION: The use BB reduced the rate of central sleep apnea in total population, if we compare to literature data. Additionally, the BB improved parameters of quality of sleep and life of patients with heart failure.
Subject(s)
Adrenergic beta-Antagonists/therapeutic use , Heart Failure/drug therapy , Quality of Life , Sleep Apnea, Central/epidemiology , Sleep Apnea, Central/prevention & control , Brazil/epidemiology , Female , Heart Failure/metabolism , Humans , Male , Middle Aged , Multivariate Analysis , Sleep Apnea, Central/pathology , Statistics, NonparametricABSTRACT
BACKGROUND: Pulmonary hypertension (PH) is a factor of poor prognosis in the postoperative period of heart transplant (HT) and thus, the study of the degree of reversibility to vasodilators is mandatory during the preoperative assessment. OBJECTIVE: To evaluate the pulmonary and systemic hemodynamic effects of sildenafil as a vasodilator during the PH reversibility test in patients that are candidates to HT. METHODS: Patients awaiting HT were submitted to the measurement of systemic and pulmonary hemodynamic variables before and after the administration of a single sublingual dose of 100 mg of sildenafil during right heart catheterization. RESULTS: Fourteen patients (age: 47+/-12 years, 71.4% men) with advanced heart failure Ejection Fraction (EF) 25 +/- 7%, Functional Class (FC - NYHA) FC III - 6 and FC IV - 8, were evaluated in this study. The acute administration of sildenafil showed to be effective in decreasing the systolic (62.4 +/- 12.1 vs 51.5 +/- 9.6 mmHg, CI=95%, p<0.05) and mean (40.7 +/- 7.3 vs 33.8 +/- 7.6 mmHg, CI=95%, p <0.05) pressures of the pulmonary artery. There was also a significant decrease in the pulmonary (4.2 +/- 3 vs 2.0 +/- 0.9 uWood, CI=95%, p<0.05) and systemic vascular resistance (22.9 +/- 6.8 vs 18.6 +/- 4.1 Wood, CI=95%, p<0.05), associated to an increase in the cardiac output (3.28 +/- 0.79 vs 4.12 +/-1.12 uWood, CI=95%, p<0.05) without, however, significantly interfering in the systemic arterial pressure (87.8 +/- 8.2 vs 83.6 +/- 9.1 mmHg, CI=95%, p=0.3). CONCLUSION: The sublingual administration of sildenafil is an effective and safe alternative as a vasodilator during the PH reversibility test in patients with heart failure and awaiting a HT.
