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(Chest. 2002;121:1566-1571.)
© 2002 American College of Chest Physicians

Hemodynamic Effects of Aerosolized Iloprost in Pulmonary Hypertension at Rest and During Exercise*

Friedrich C. Blumberg, MD; Günter A. J. Riegger, MD and Michael Pfeifer, MD

* From the Department of Internal Medicine II, University of Regensburg, Regensburg, Germany.

Correspondence to: Friedrich C. Blumberg, MD, Department of Internal Medicine II, University of Regensburg, 93042 Regensburg, Germany; e-mail: friedrich.blumberg{at}klinik.uni-regensburg.de

Study objectives: Aerosolized iloprost, a stable prostacyclin analog, improves functional capacity even in patients with pulmonary hypertension who did not show a vigorous hemodynamic response after iloprost inhalation at rest. We therefore speculated that aerosolized iloprost elicits more beneficial effects on pulmonary hemodynamics during exercise than at rest.

Design and setting: A prospective, open, uncontrolled study at a university hospital.

Patients: Sixteen patients with primary or secondary pulmonary hypertension.

Interventions: Right-heart catheterization at rest and during exercise before and after the inhalation iloprost, 14 to 28 µg.

Results: Before iloprost treatment, exercise increased mean (± SD) pulmonary artery pressure (PAPm) from 45 ± 8 to 70 ± 13 mm Hg, cardiac output from 3.7 ± 1.0 to 5.8 ± 2.4 L/min, and pulmonary vascular resistance (PVR) from 904 ± 322 to 1,013 ± 432 dyne·s·cm-5 (each p < 0.05). After recovery, iloprost reduced PAPm from 44 ± 8 to 41 ± 6 mm Hg, increased cardiac output from 3.7 ± 1.0 to 4.9 ± 1.4 L/min, and lowered PVR from 902 ± 350 to 636 ± 248 dyne·s·cm-5 (each p < 0.05). During exercise after iloprost, PAPm increased to 57 ± 8 mm Hg, cardiac output to 7.0 ± 3.0 L/min, and PVR to 673 ± 279 dyne·s·cm-5 (each p < 0.05 vs first exercise test). Systemic BP was not altered significantly by iloprost treatment during exercise.

Conclusions: Aerosolized iloprost treatment exerts more favorable effects on pulmonary hemodynamics during exercise than at rest. These findings explain the functional improvement observed in patients with pulmonary hypertension who show only a moderate pulmonary vasodilatory response during iloprost inhalation at rest. Whether these beneficial effects have prognostic significance needs to be elucidated by further study.

Key Words: exercise test • hypertension • prostaglandins • pulmonary




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