(Circulation. 2000;101:2388.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Effects of Iloprost Inhalation on Exercise Capacity and Ventilatory Efficiency in Patients With Primary Pulmonary Hypertension
From Humboldt University Berlin (C.F.O., L.B., F.X.K.) and Deutsches Herzzentrum Berlin (R.W., R.E.), Germany.
Correspondence to Franz X. Kleber, MD, Humboldt University Berlin, Department of Internal Medicine, Unfall-Krankenhaus Berlin, Warener Straße 7, 12683 Berlin, Germany. E-mail franz-xaverk{at}ukb.de
Background—The continuous infusion of prostacyclin has been shown to improve exercise capacity and survival in patients with primary pulmonary hypertension (PPH). Inhalation of iloprost, a stable analog of prostacyclin, might be an alternative therapy for PPH, selectively acting on the pulmonary vascular bed through ventilation-matched alveolar deposition of the drug. We investigated the short-term effects of iloprost inhalation on exercise capacity and gas exchange in patients with PPH.
Methods and Results—In 11 patients with PPH, we performed 2
consecutive cardiopulmonary exercise tests before and after the
inhalation of 17 µg of iloprost. Patients had marked
pulmonary hypertension (mean pulmonary artery pressure
65 mm Hg), and inhalation resulted in a decrease in
pulmonary vascular resistance (1509 versus 1175 dyne ·
s-1 · cm-5, P<0.05).
Arterial blood gases remained unchanged
(PaO2 69.3 versus 66.8 mm Hg;
PaCO2 29.6 versus 28.8 mm Hg). Iloprost
significantly (P<0.05) improved exercise duration (379
versus 438 seconds), peak oxygen uptake (12.8 versus 14.2 mL ·
kg-1 · min-1), and
E-versus-CO2 slope
(58 versus 51.4).
Conclusions—The present data show that iloprost inhalation exerts pulmonary vasodilatation and improves symptoms and exercise capacity in patients with PPH. The data also suggest that iloprost inhalation is a suitable treatment for PPH. Whether these effects are maintained during long-term treatment and are paralleled by improvement in prognosis remains to be determined.
Key Words: iloprost • pulmonary heart disease • hypertension, pulmonary • exercise • lung
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