About choosing a vasodilator for vasoreactivity tests in heart transplant candidates

Abstract

The purpose of our prospective, consistent, non-randomized study was to analyze the results of vasoreactivity tests (VRT) performed with nitric oxide (NO) or inhaled Iloprost in heart transplant candidates. 72 VRTs were done in 58 candidates for heart transplantation. All patients had heart failure III-IV NYHA and pulmonary hypertension (PH) with pulmonary vascular resistance (PVR) over 2.5 WU. 43 patients received NO, 80 ppm for 20 min. 29 patients inhaled 20 g of Iloprost (Ventavis, Bayer). Hemodynamic parameters were measured at baseline, 20 min after NO inhalation and 15 min following the completion of Iloprost inhalation. There were no between-group differences in the severity of patient's condition and baseline hemodynamic indicators. Both vasodilators caused statistically significant reduction in mean PAP: in the NO group it dropped (p = 0.002), in the Iloprost group the mean PAP decreased (p<0.0001). A more than 20% decrease in PAP was recorded in 13 cases (30.2%) in the NO group and in 16 cases (55.2%) in the Iloprost group (p = 0.03). A more than 20% decrease in PVR was noted in 24 cases (55.8%) in the NO group and in 24 cases (82.8%) in the Iloprost group (p<0.02). We found some differences in the effect of NO and Iloprost on LV efficiency. There were no changes in the stroke volume index (SVI) in the NO group, while inhaled Iloprost increased SVI (p<0.001). A probable cause of the increase in LV efficiency might have been the reduction of total peripheral vascular resistance (p<0.0001). There were no differences in SVI during NO inhala-tion. It should be noted in conclusion that Iloprost is more effective in decreasing mean PAP and PVR in heart transplant candidates. Inhaled Iloprost causes favorable changes in preload and afterload of the impaired LV and increases its performance.

Keywords

• ТРАНСПЛАНТАЦИЯ СЕРДЦА
• ЛЕГОЧНАЯ ГИПЕРТЕНЗИЯ
• ОКСИД АЗОТА
• ИЛОПРОСТ