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DOI: 10.1055/s-2005-862154
Effectiveness of Prostaglandin E1 versus Prostacyclin in evaluation of transplant candidates with elevated pulmonary vascular resistance
Background: Prostaglandin E1 (PGE1) and I2 (PGI2, Prostacyclin) have potential pulmonary vasodilatating properties and are both routinely used for pretransplant evaluation in patients with elevated pulmonary vascular resistance (PVR). However, a direct comparison of effectiveness in lowering PVR has not yet been evaluated.
Methods: Transplant candidates with both, PVR >2.5 WU and transpulmonary gradient (TPG) >12mmHg, were studied. 17 patients received PGE1, 21 PGI2 via a short-term protocol over 3 hours. Classifications were made in complete (PVR ≤2.5WU and TPG ≤12mmHg), partial (PVR ≤2.5WU or TPG ≤12mmHg) and non-responder. Complete responders underwent cardiac transplantation after a time-period of 141±86 days post evaluation and 1-month-mortality due to right ventricular failure (RHF) was determined.
Results: Age (50.8±9.9 vs. 53.7±11.0 years), PVR (329±89 vs. 293±78 WU), TPG (14.9±5.8 vs. 15.6±3.6mmHg), mean pulmonary artery pressure (MPAP, 38.7±7.9 vs. 39.2±10mmHg) and mean systemic arterial pressure (MAP, 82.7±12.9 vs. 87.1±9.0mmHg) were comparable in both groups pre-treatment. During treatment PVR, TPG and MPAP could be reduced to equivalent amounts in both groups (Table). However, MAP dropped to significant lower values following PGI2 treatment (p<0.05). In addition, 4 patients with PGI2 and only 1 patient with PGE1 did not respond in adequate reduction of PVR and TPG. 1-month-mortality following transplantation was higher in the PGI2-group.
|
# absolute change from pre- to post-treatment* p<0.05 vs. PGE1 |
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|
|
PGE1# |
PGI2# |
|
PVR, WU |
–2.0±1.5 |
–1.7±1.4 |
|
TPG, mmHg |
–5.0±6.6 |
–5.0±5.1 |
|
MPAP, mmHg |
–8.2±6.5 |
–9.2±6.2 |
|
MAP, mmHg |
–11.9±9.0 |
–20.4±11.2* |
|
|
|
|
|
Complete responder |
13 (77%) |
15 (71%) |
|
Partial responder |
3 (18%) |
2 (10%) |
|
Non-responder |
1 (6%) |
4 (19%) |
|
1-month-Mortality |
0 (0%) |
3 (20%) |
Conclusion: PGE1 and PGI2 are comparable in lowering PVR and TPG. However, disadvantages of PGI2 are a stronger systemic vasodilatating effect, a higher rate of non-responders and a trend towards increased mortality due to RHF. PGE1 should be preferred in evaluation transplant candidates.