Anna Sandqvist1, Dan Henrohn2, Hanna Egeröd2, Mikael Hedeland3,4, Lisa Wernroth5, Ulf Bondesson3,4, Jörn Schneede6, Gerhard Wikström2. 1. Department of Pharmacology and Clinical Neuroscience, Division of Clinical Pharmacology, Umeå University, Umeå, Sweden. anna.sandqvist@umu.se. 2. Department of Medical Sciences, Uppsala University, Uppsala, Sweden. 3. Department of Chemistry, National Veterinary Institute (SVA), Uppsala, Sweden. 4. Department of Medicinal Chemistry, Division of Analytical Pharmaceutical Chemistry, Uppsala University, Uppsala, Sweden. 5. Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden. 6. Department of Pharmacology and Clinical Neuroscience, Division of Clinical Pharmacology, Umeå University, Umeå, Sweden.
Abstract
PURPOSE: Acute vasodilator testing is recommended in patients with pulmonary arterial hypertension to identify individuals who may benefit from long-term treatment with oral calcium channel blockers. The aim of this study was to investigate the use of vardenafil in acute vasoreactivity testing compared to adenosine. METHODS: A total of 20 patients eligible for right heart catheterisation were enrolled. Acute vasoreactivity testing was carried out with intravenous (iv) adenosine (n = 18) followed by oral vardenafil (n = 20). Haemodynamic responses were recorded at baseline and after 60 min (vardenafil). Responders were defined according to consensus guideline criteria. RESULTS: Both vardenafil and adenosine significantly decreased mean pulmonary arterial pressure (mPAP, p < 0.001 and p = 0.026, respectively) and pulmonary vascular resistance (p < 0.001 and p > 0.001, respectively), and significantly increased cardiac output (p = 0.001 and p = 0.005, respectively). Vardenafil reduced mPAP more than adenosine (p = 0.044), while adenosine resulted in higher responses of cardiac index (p = 0.009) and pulmonary arterial oxygen saturation (p = 0.042). Acute adverse reactions were common with adenosine, while no side effects were observed after a single oral dose vardenafil. Vardenafil identified five responders (out of 20), while adenosine identified three responders (out of 18). During a 7-year follow-up, vardenafil responders had significantly lower NT-proBNP levels compared to non-responders. CONCLUSIONS: Vardenafil may be safely used for acute vasoreactivity testing in patients with PH. A single oral dose of vardenafil is better tolerated than iv adenosine and may identify additional responders who could benefit from long-term vasodilator treatment.
PURPOSE: Acute vasodilator testing is recommended in patients with pulmonary arterial hypertension to identify individuals who may benefit from long-term treatment with oral calcium channel blockers. The aim of this study was to investigate the use of vardenafil in acute vasoreactivity testing compared to adenosine. METHODS: A total of 20 patients eligible for right heart catheterisation were enrolled. Acute vasoreactivity testing was carried out with intravenous (iv) adenosine (n = 18) followed by oral vardenafil (n = 20). Haemodynamic responses were recorded at baseline and after 60 min (vardenafil). Responders were defined according to consensus guideline criteria. RESULTS: Both vardenafil and adenosine significantly decreased mean pulmonary arterial pressure (mPAP, p < 0.001 and p = 0.026, respectively) and pulmonary vascular resistance (p < 0.001 and p > 0.001, respectively), and significantly increased cardiac output (p = 0.001 and p = 0.005, respectively). Vardenafil reduced mPAP more than adenosine (p = 0.044), while adenosine resulted in higher responses of cardiac index (p = 0.009) and pulmonary arterial oxygen saturation (p = 0.042). Acute adverse reactions were common with adenosine, while no side effects were observed after a single oral dose vardenafil. Vardenafil identified five responders (out of 20), while adenosine identified three responders (out of 18). During a 7-year follow-up, vardenafil responders had significantly lower NT-proBNP levels compared to non-responders. CONCLUSIONS:Vardenafil may be safely used for acute vasoreactivity testing in patients with PH. A single oral dose of vardenafil is better tolerated than iv adenosine and may identify additional responders who could benefit from long-term vasodilator treatment.
Authors: Anna Fijalkowska; Marcin Kurzyna; Adam Torbicki; Grzegorz Szewczyk; Michal Florczyk; Piotr Pruszczyk; Monika Szturmowicz Journal: Chest Date: 2006-05 Impact factor: 9.410
Authors: A M Sandqvist; D Henrohn; J Schneede; M Hedeland; H C Egeröd; U G Bondesson; B G Wikström Journal: Eur J Clin Pharmacol Date: 2012-06-26 Impact factor: 2.953
Authors: Jan T Kielstein; Stefanie M Bode-Böger; Gerrit Hesse; Jens Martens-Lobenhoffer; Attila Takacs; Danilo Fliser; Marius M Hoeper Journal: Arterioscler Thromb Vasc Biol Date: 2005-04-28 Impact factor: 8.311
Authors: Nazzareno Galiè; Marius M Hoeper; Marc Humbert; Adam Torbicki; Jean-Luc Vachiery; Joan Albert Barbera; Maurice Beghetti; Paul Corris; Sean Gaine; J Simon Gibbs; Miguel Angel Gomez-Sanchez; Guillaume Jondeau; Walter Klepetko; Christian Opitz; Andrew Peacock; Lewis Rubin; Michael Zellweger; Gerald Simonneau Journal: Eur Heart J Date: 2009-08-27 Impact factor: 29.983
Authors: Hossein A Ghofrani; Robert Voswinckel; Frank Reichenberger; Horst Olschewski; Peter Haredza; Burcu Karadaş; Ralph T Schermuly; Norbert Weissmann; Werner Seeger; Friedrich Grimminger Journal: J Am Coll Cardiol Date: 2004-10-06 Impact factor: 24.094