Chest
Clinical InvestigationsBosentan Improves Exercise Tolerance and Tei Index in Patients With Pulmonary Hypertension and Prostanoid Therapy
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Patients
Sixteen consecutive patients treated with prostanoids for a minimum of 12 months (Table 1) were included in this prospective, nonrandomized, open-label study. Patients were included when progressive pulmonary hypertension was noted despite prostanoid treatment. Progression of disease was defined as follows: (1) a decline of > 15% in 6MWD compared with the individual best value, (2) a decline in cardiac index to < 2 L/min/m2, and/or (3) a failure to increase in cardiac index to > 2 L/min/m2
6MWD
Figure 1 depicts the results of the 6MWD test. A significant increase in the walking distance was apparent at 6 months after initiation of combination therapy. This improvement was still maintained at the maximum time of follow-up. The increase in the 6MWD was 42.5 ± 66 m at 6 months and 44.6 ± 66 m at the maximum time of follow-up. Six months after initiation of combination therapy the 6MWD was improved in 11 patients (minimum, 16 m; maximum, 196 m), unchanged in 1 patient, and reduced in 4
Discussion
Our findings demonstrate that the addition of the dual endothelin receptor antagonist bosentan to prostanoid therapy significantly improves 6MWD as an indication of increased exercise tolerance and Tei index as an echocardiographic parameter summarizing RV function, in patients with progressive PAH and pulmonary hypertension due to chronic thromboembolic hypertension and due to interstitial lung disease. Several studies14, 15, 16 have demonstrated that bosentan therapy alone is effective in
Conclusion
The present study reports our experience of additional bosentan therapy in patients with progressive pulmonary hypertension despite maximally tolerated prostanoid therapy. The addition of bosentan resulted in a significant improvement of exercise capacity and RV function. This improvement was observed in patients with both PAH and those with pulmonary hypertension of other causes and was maintained for a mean follow-up period of 13.5 months.
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