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Continuous intravenous iloprost to revert treatment failure of first-line inhaled iloprost therapy in patients with idiopathic pulmonary arterial hypertension

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Summary

Aims

To describe the clinical and haemodynamic effects during the first 6 months of continuous intravenous iloprost treatment in patients with idiopathic pulmonary arterial hypertension (IPAH) and relevant disease progression despite continued mono therapy with aerosolized iloprost.

Methods and results

Twenty-four IPAH patients with clinical decompensation to NYHA class IV despite therapy with aerosolized iloprost and optimized conservative treatment were assessed clinically, haemodynamically and by cardiopulmonary exercise testing for at least 6 months. Upon switching from inhaled to intravenous iloprost all patients improved clinically (NYHA III) while pulmonary vascular resistance (PVR) and right atrial pressure decreased from 2386 ± 243 to 1381 ± 124 dyne ·s ·cm−5 and 12 ± 1 to 8.5 ± 1 mmHg, respectively (both p < 0.05). Despite this acute improvement haemodynamic (PVR increased from 1462±223 to 1978 ± 327 dyne ·s ·cm−5) and clinical (4 deaths, 4 transplantations) deterioration occurred with continued intravenous treatment during the following 6 months.

Conclusions

In the group of patients described in this report the clinical and haemodynamic deterioration occurring while on mono therapy with inhaled iloprost could be stopped by switching to continuous application of intravenous iloprost. However, with continued intravenous therapy only a subgroup of patients could clinically be stabilized and transplanted successfully.

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Authors and Affiliations

  1. Klinik für Innere Medizin B, Ernst-Moritz-Arndt Universität Greifswald, Löfflerstr. 23 a, 17487, Greifswald, Germany

    Ralf Ewert MD &  Stephan B. Felix MD

  2. Medizinische Klinik II — Kardiologie, DRK-Kliniken Berlin/Westend, Spandauer Damm 130, 14050, Berlin, Germany

    Christian F. Opitz MD

  3. Klinik für Innere Medizin II, Universität Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany

    Roland Wensel MD, PhD

  4. Klinik für Innere Medizin I, Universität Leipzig, Johannisallee 32, 04103, Leipzig, Germany

    Jörg Winkler MD

  5. Medizinische Klinik I, Universitätsklinikum Carl Gustav Carus der TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany

    Michael Halank MD

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  1. Ralf Ewert MD
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  2. Christian F. Opitz MD
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  3. Roland Wensel MD, PhD
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  4. Jörg Winkler MD
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  5. Michael Halank MD
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  6. Stephan B. Felix MD
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Correspondence to Ralf Ewert MD.

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Ewert, R., Opitz, C.F., Wensel, R. et al. Continuous intravenous iloprost to revert treatment failure of first-line inhaled iloprost therapy in patients with idiopathic pulmonary arterial hypertension. Clin Res Cardiol 96, 211–217 (2007). https://doi.org/10.1007/s00392-007-0490-3

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  • DOI: https://doi.org/10.1007/s00392-007-0490-3

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