Marked Hemodynamic Improvements by High-Dose Epoprostenol Therapy in Patients With Idiopathic Pulmonary Arterial Hypertension

作者：Akagi Satoshi; Nakamura Kazufumi; Miyaji Katsumasa; Ogawa Aiko; Kusano Kengo Fukushima; Ito Hiroshi; Matsubara Hiromi^*

来源：Circulation Journal, 2010, 74(10): 2200-2205.

DOI：10.1253/circj.CJ-10-0190

• Epoprostenol
• Idiopathic pulmonary arterial hypertension
• Prostacyclin

Background: The appropriate dose range of epoprostenol is thought to be 25-40ng.kg(-1).min(-1) based on the results of previous studies showing that epoprostenol therapy reduced mean pulmonary artery pressure (mPAP) by 12-22% and pulmonary vascular resistance (PVR) by 32-53% compared with baseline values in patients with idiopathic pulmonary arterial hypertension (IPAH). However, the efficacy of treatment of IPAH patients with epoprostenol >40ng.kg(-1).min(-1) has not been determined and this was the aim of the present study.
Methods and Results: The study group comprised 16 consecutive patients, none of whom died; 2 dropped out because they could not be titrated up as needed to the highest effective epoprostenol dose. Hemodynamics were evaluated in 14 IPAH patients who received high-dose epoprostenol monotherapy. The mean epoprostenol dosage was 107 +/- 40ng.kg(-1).min(-1) (range, 54-190ng.kg(-1).min(-1)) and the mean duration of high-dose epoprostenol therapy was 1,355 +/- 627 days (range, 582-2,410 days). Significant decreases from baseline values were seen in mPAP (from 66 +/- 16 to 47 +/- 12mmHg, P<0.001) and PVR (from 21.6 +/- 8.3 to 6.9 +/- 2.9 Wood units, P<0.001). Compared with the baseline state, high-dose epoprostenol therapy reduced mPAP by 30% and PVR by 68%.
Conclusions: The present study suggests high-dose epoprostenol therapy is a new treatment strategy for IPAH. (Circ J 2010; 74: 2200-2205)

• 出版日期2010-10