ABSTRACT
The effect of nitrates was monitored in 16 patients with precapillary, and in 12 patients with postcapillary pulmonary hypertension (PH). The patients had haemodynamic examination on acute administration of 10 mg of isosorbide nitrate (ID) in infusion and after 2-month therapy with 120 mg of isosorbide dinitrate retard daily. Acute ID administration decreased filling pressure of both ventricles, pulmonary and aortic pressure, pulmonary and systemic resistance and increased blood flow. No significant difference was found between the two types of PH. Long-term administration resulted in a statistically significant decrease in filling pressure (in both ventricles) and pulmonary pressure, even though the decrease was less pronounced than those seen following acute administration. Again, no statistical differences were noted between the two types of PH. While acute administration of nitrates decreases both preload and afterload, chronic administration decreases only preload. The implications of this finding for therapeutic practice are discussed.
Subject(s)
Hypertension, Pulmonary/drug therapy , Isosorbide Dinitrate/administration & dosage , Lung Diseases, Obstructive/drug therapy , Pulmonary Wedge Pressure/drug effects , Cardiomyopathy, Dilated/drug therapy , Coronary Disease/drug therapy , Delayed-Action Preparations , Drug Administration Schedule , Humans , Vascular Resistance/drug effectsABSTRACT
The effect of isosorbide dinitrate (ID) on the development of pulmonary hypertension (PH) has been examined in 18 patients with idiopathic diffuse interstitial lung fibrosis (IDILF) during two years of treatment. All patients responded favourably to acutely administered ID by a decrease in pulmonary vascular resistance (PVR) by 38 +/- 13% and of the pulmonary arterial pressure (PAP) by 35 +/- 11%. Two years ID therapy led to sustained haemodynamic improvement in patients in whom blood gases were stable PAP was reduced from 38 +/- 5 to 30 +/- 6 mmHg and PVR from 483 +/- 197 to 364 +/- 175 dyne s cm-5. No haemodynamic changes were noted in the subjects with progressive hypoxaemia whereas steady deterioration of central haemodynamics was recorded in those patients who died during the follow-up. It is concluded that some patients with IDILF and PH may benefit from long-term ID treatment, but that the outcome of this treatment cannot be reliably predicted from the results of the initial first ID administration.
Subject(s)
Hypertension, Pulmonary/drug therapy , Isosorbide Dinitrate/therapeutic use , Pulmonary Fibrosis/physiopathology , Adult , Female , Follow-Up Studies , Hemodynamics/drug effects , Humans , Hypertension, Pulmonary/etiology , Hypertension, Pulmonary/physiopathology , Isosorbide Dinitrate/administration & dosage , Male , Middle Aged , Oxygen/blood , Pulmonary Circulation/drug effects , Pulmonary Fibrosis/complications , Time FactorsABSTRACT
Fifty-six patients with kryptogenic fibrosing alveolitis were followed up during 6.3 years (from 1.5 to 19.3 years) after their first functional examination including cardiac catheterization. Twenty-two out of 56 patients died during the follow-up. The significance of individual functional tests as predictors of the survival was evaluated by means of actuarial survival probability curves. Four variables were predictive for nonsurvival: a mean pulmonary arterial pressure exceeding 30 mmHg, a vital capacity of 60% of the predicted value or lower, a CO diffusing capacity at rest less than 40% of the predicted value, an age at first symptoms over 30 years. Other variables were not significantly predictive for a given time of follow-up. A simple prognostic score derived from predictive variables was able to separate the subgroup of patients with unfavourable short-term prognosis. Among significantly predictive variables, a resting pulmonary arterial pressure over 30 mmHg appears to be the most important.
Subject(s)
Pulmonary Fibrosis/physiopathology , Adult , Female , Follow-Up Studies , Humans , Hypertension, Pulmonary/etiology , Male , Middle Aged , Prognosis , Pulmonary Alveoli , Pulmonary Fibrosis/complications , Respiratory Function TestsABSTRACT
Values characterizing the central haemodynamics in patients with cryptogenic fibrosing alveolitis tend to vary considerably in the individual subjects over the years, but the long-term average indicates a trend towards a gradual deterioration. In most patients, the development of pulmonary hypertension is rather slow, amounting to 0.712 kPa (1.3 mmHg) per year on the average. This development is due both to the increase of the transpulmonary driving pressure gradient and to an increase in the pulmonary artery wedge pressure.
