Effects of the oral endothelin-receptor antagonist bosentan on echocardiographic and Doppler measures in patients with pulmonary arterial hypertension

被引:270
作者
Galiè, N
Hinderliter, AL
Torbicki, A
Fourme, T
Simonneau, G
Pulido, T
Espinola-Zavaleta, N
Rocchi, G
Manes, A
Frantz, R
Kurzyna, M
Nagueh, SF
Barst, R
Channick, R
Dujardin, K
Kronenberg, A
Leconte, I
Rainisio, M
Rubin, L
机构
[1] Univ Bologna, Ist Cardiol, I-40138 Bologna, Italy
[2] Univ N Carolina, Dept Med, Chapel Hill, NC 27515 USA
[3] Inst TB & Lung Dis, Dept Chest Med, Warsaw, Poland
[4] Univ Paris Sud, Div Pulm & Crit Care Med, Paris, France
[5] Inst Nacl Cardiol, Mexico City, DF, Mexico
[6] Mayo Clin, Dept Cardiol, Rochester, MN USA
[7] Baylor Coll Med, Houston, TX 77030 USA
[8] Methodist Hosp, Houston, TX 77030 USA
[9] Columbia Univ, Coll Phys & Surg, Dept Pediat, New York, NY 10027 USA
[10] Univ Calif San Diego, Div Pulm & Crit Care Med, San Diego, CA 92103 USA
[11] Univ Hosp Gasthuisberg, Dept Cardiol, B-3000 Louvain, Belgium
[12] Actel Ltd, Allschwil, Switzerland
关键词
D O I
10.1016/S0735-1097(03)00121-9
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES The purpose of this study was to investigate the effects of bosentan (125 or 250 mg twice daily) on echocardiographic and Doppler variables in 85 patients with World Health Organization class III or IV pulmonary arterial hypertension (PAH). BACKGROUND Bosentan, an orally active dual endothelin-receptor antagonist, improves symptoms, exercise capacity, and hemodynamics in patients with PAH. METHODS Patients had primary pulmonary hypertension (84%) or PAH associated with connective tissue disease. Of these, 29 patients received placebo and 56 received bosentan (1:2 randomization). Six-minute walk tests and echocardiograms were performed at baseline and after 16 weeks of treatment. RESULTS Baseline characteristics were similar in the placebo and bosentan groups, and echocardiographic and Doppler findings were consistent with marked abnormalities of right ventricular (RV) and left ventricular (LV) structure and function that were due to PAH. The treatment effect on 6-min walking distance was 37 in in favor of bosentan (p = 0.036). Treatment effects of bosentan compared with placebo on other parameters were as follows: Doppler-derived cardiac index = +0.4 1/min/m(2) (p = 0.007), LV early diastolic filling velocity = +10.5 cm/s (p = 0.003), LV end-diastolic area = +4.2 cm(2) (p = 0.003), LV systolic eccentricity index = -0.12 (p = 0.047), RV end-systolic area = -2.3 cm(2) (p = 0.057), RV.LV diastolic areas ratio = -0.64 (p = 0.007), Doppler RV index = -0.06 (p = 0.03), and percentage of patients with an,improvement in pericardial. effusion score = 17% (p = 0.05). CONCLUSIONS Bosentan improves RV systolic function and LV early diastolic filling and leads to a decrease in RV dilation and an increase in LV size in patients with PAH. (C) 2003 by the American College of Cardiology Foundation.
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页码:1380 / 1386
页数:7
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