Author + information
- Cihangir Kaymaz,
- Ibrahim Halil Tanboga,
- Ozgur Y. Akbal,
- Hacer Ceren Tokgoz,
- Fatih Yilmaz,
- Aykun Hakgor,
- Nertila Poci,
- Canan Elif Yildiz,
- Sevim Turkday,
- Tugba Aktemur,
- Durmus Demir,
- Seda Tanyeri and
- Nihal Ozdemir
Background: Due to lacking randomized data, intravenous iloprost (iv ILO) has not been registered for use in patients (pts) with pulmonary hypertension (PH). In this single-center study, we aimed to present our data derived from the off-label, short-term, in-hospital use of iv ILO in clinical worsening episodes (CWs) of PH.
Methods: Study group comprised 481 pts (Female 61.5%, age49.2±18.2 years) with PH. Idiopathic pulmonary arterial hypertension, PAH associated with congenital heart disease and connective-tissue disease were noted in 102, 166 and 25 patients and other PAH, combined pre and post-capillary PH, Group 3 and Group 4 PH were noted in 9, 15, 56, and 108 pts, respectively.
Results: Baseline FC was II in 12.1%, III in 52.5% and IV in 34.6% of pts. Median 6MWD was 279 m (180-360m) and serum BNP was 341 (85-902) pg/mL at diagnosis and 187 (38.9%) pts were treatment-naive (TN). The systolic and mean PA pressures were 87.9±31.6 and 54.4±22.0 mm Hg and mean pulmonary and systemic vascular resistance (PVR, SVR) were 9.32±6.64 and 21.8±8.59 Wood U, respectively. Median follow-up was 12.6 months. Overall 587 CWs of PH (2.14 per pt,1 to 16) were noted in 274 pts (56.9%). The background mono, dual and triple targeted treatments (TT) were noted in 94.3%, 5.3% and 0.5% of the CWs of non-TN pts, respectively. In-hospital use of iv ILO added on non-parenteral TTs was the treatment of choice in 258 CWs in 190 pts, and mean duration of iv ILO treatment and dosage per day were1.8 days (1- 5 days) and 420 (234-692) mg/per day, respectively. The use of iv ILO resulted in significant improvements in WHO FC (p<0,0001), 6MWD (p<0,0001), and serum BNP levels (p<0,0001) regardless of the background TTs or clinical groups. Survival rates at 1,3, 5 and 9-years were 80%, 69%, 57% and 40%, respectively. Multivariate analysis revealed that baseline FC, PVR and presence of any CW predicted mortality while TN vs non-TN status and need for iv ILO at index hospitalization predicted future CWs.
Conclusions: Short-term use of iv ILO improved FC, 6MWD, BNP levels in CWs of precapillary PH, regardless of the prior TTs. In addition to baseline FC and PVR, CWs predict PH survival, and index CW requiring iv ILO is also indicative of subsequent CWs.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Understanding Pulmonary Vascular Disease: From Bench to Bedside
Abstract Category: 35. Pulmonary Hypertension and Pulmonary Thrombo-embolic Disease
Presentation Number: 1181-005
- 2017 American College of Cardiology Foundation