Usefulness of Intravenous Adenosine in Idiopathic Pulmonary Arterial Hypertension as a Screening Agent for Identifying Long-Term Responders to Calcium Channel Blockers - 30/05/12
Résumé |
Although intravenous adenosine is recommended for acute vasodilator testing in patients with pulmonary hypertension, long-term outcomes in acute responders treated with calcium channel blockers (CCBs) who are identified by adenosine remain unknown. In this study, the value of adenosine for identifying long-term responders to CCBs was investigated in patients with idiopathic pulmonary arterial hypertension (IPAH). All acute responders were subsequently treated with high-dose CCB monotherapy, and 6-minute walk distances, hemodynamic data, and World Health Organization functional classifications were followed. Nine of 104 patients exhibited an acute response with intravenous adenosine (8.7%, 95% confidence interval 3.2 to 14.2). After 12 months of follow-up, all acute responders were still alive; however, only 6 patients showed sustained hemodynamic improvement (5.8%, 95% confidence interval 2 to 13). Three patients had failed CCB monotherapy and bosentan was added to their treatment. Mean tolerated dose of intravenous adenosine was 142 ± 49 μg/kg/min. No life-threatening adverse events were observed and only 2 patients of the nonresponders exhibited a 20% decrease in mean systemic arterial pressure. In nonresponders, 1- and 3-year survival rates were 89% and 75%, respectively. In conclusion, acute vasodilator testing with intravenous adenosine was safe and able to screen responders to CCB therapy in patients with IPAH. Long-term CCB responders accounted for about 5.8% of patients with IPAH.
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The study was sponsored in part by the Program for the Shanghai Outstanding Academic Leader, Grant 10SG25 from the “Dawn” Program of the Shanghai Education Committee, and Grant 2009150 from the Shanghai Municipal Health Bureau Projects, Shanghai, China. Dr. Jing has relationships with drug companies including Actelion, Allschwil, Swizerland, Bayer Schering, Berlin, Germany, Pfizer, New York, and United Therapeutics, Maryland, in addition to being an investigator in trials involving these companies; relationships include consultancy service and membership of scientific advisory boards. |
Vol 109 - N° 12
P. 1801-1806 - juin 2012 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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