Abstract
Introduction or backgrounds: To distinguish between pulmonary arterial hypertension and pulmonary hypertension associated with left heart disease (PH-LHD), a fluid filling challenge can be useful during right heart catheterization (RHC). Conversely, nitric oxide is used as a vasodilator agent in heart transplant candidates to evaluate the reversibility of pulmonary vascular resistance.
Aims and objectives: The aim of this study was to assess pulmonary vasoreactivity to sublingual glyceryl trinitrate, a nitric oxide donor, in patients with PH-LHD.
Methods: We identified patients with PH-LHD defined as mPAP ≥ 25 mmHg and PCWP > 15 mmHg. Sublingual glyceryl trinitrate (0.150 mg) was administered during RHC.
Results: We studied 29 patients with a mean age of 66 ± 11 years. Echocardiographic findings were consistent with heart failure with preserved ejection fraction in most of the cases. At baseline, mean mPAP was 40 ± 9 mmHg, mean PCWP was 21 ± 5 mmHg, mean transpulmonary gradient (TPG) was 18.5 ± 8 mmHg and mean diastolic pressure gradient (DPG) was 3 ± 6 mmHg. After sublingual glyceryl trinitrate administration, mean mPAP decreased to 29 ± 11 mmHg (- 11 ± 5 mmHg, p < 0.001), mean PCWP decreased to 15 ± 5 mmHg (-7 ± 4 mmHg, p < 0.001). There was also a significant decrease of mean TGP (-4 ± 4 mmHg, p < 0.001). Mean DPG remained unchanged
Conclusion: Sublingual glyceryl trinitrate challenge is a simple method to assess PH-LHD.
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