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Published online before print August 9, 2007, 10.1183/09031936.00039007
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Eur Respir J 2007; 30:922-927
Copyright ©ERS Journals Ltd 2007

Long-term treatment with sildenafil in chronic thromboembolic pulmonary hypertension

F. Reichenberger1, R. Voswinckel1, B. Enke1, M. Rutsch1, E. El Fechtali1, T. Schmehl1, H. Olschewski2, R. Schermuly1, N. Weissmann1, H. A. Ghofrani1, F. Grimminger1, E. Mayer3 and W. Seeger1

1 University of Giessen Lung Centre, Dept of Internal Medicine, Giessen University Hospital, Giessen, 3 Dept of Cardiothoracic Surgery, Mainz University Hospital, Mainz, Germany. 2 Division of Pulmonology, University Clinic for Internal Medicine, Graz Medical University, Graz, Austria.

CORRESPONDENCE: F. Reichenberger, University of Giessen Lung Centre, University Hospital Giessen, Klinikstrasse 36, 35392 Giessen, Germany. Fax: 49 6419942599. E-mail: Frank.Reichenberger{at}innere.med.uni-giessen.de

Keywords: Chronic thromboembolism, pulmonary hypertension, sildenafil

Received: April 2, 2007
Accepted July 25, 2007

For chronic thromboembolic pulmonary hypertension not amenable to pulmonary endarterectomy, effective medical therapy is desired.

In an open-label uncontrolled clinical trial, 104 patients (mean±SEM age 62±11 yrs) with inoperable chronic thromboembolic pulmonary hypertension were treated with 50 mg sildenafil t.i.d. At baseline, patients had severe pulmonary hypertension (pulmonary vascular resistance 863±38 dyn·s·cm–5) and a 6-min walking distance of 310±11 m. Eight patients were in World Health Organization functional class II, 76 in class III and 20 in class IV.

After 3 months’ treatment, there was significant haemodynamic improvement, with reduction of pulmonary vascular resistance to 759±62 dyn·s·cm–5. The 6-min walking distance increased significantly to 361±15 m after 3 months’ treatment, and to 366±18 m after 12 months’ treatment. A subset of 67 patients received a single dose of 50 mg sildenafil during initial right heart catheterisation. The acute haemodynamic effect of this was not predictive of long-term outcome.

In this large series of patients with inoperable chronic thromboembolic pulmonary hypertension, open-label treatment with sildenafil led to significant long-term functional improvement. The acute effect of sildenafil may not predict the long-term outcome of therapy.




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