TY - JOUR
T1 - Echocardiographic predictors of an adverse response to a nifedipine trial in primary pulmonary hypertension
T2 - Diminished left ventricular size and leftward ventricular septal bowing
AU - Ricciardi, Mark J.
AU - Bossone, Eduardo
AU - Bach, David S.
AU - Armstrong, William F.
AU - Rubenfire, Melvyn
PY - 1999
Y1 - 1999
N2 - Background: The clinical course in primary pulmonary hypertension (PPH) is improved by calcium channel blocker therapy in those with a favorable hemodynamic response during a trial of high-dose oral nifedipine. Although trials of nifedipine are performed only in patients who demonstrate pulmonary vasodilator reserve to short-acting agents, this response does not predict the safely of nifedipine treatment, which can result in severe first-dose hypotension and death. Study objectives: To identify echocardiographic parameters that predict first-dose nifedipine-induced hypotension in patients with PPH. Methods: The pretrial echocardiograms of 23 consecutive PPH patients (mean age, 42.3 ± 13 years; 77% female) undergoing evaluation of pulmonary vasodilator reserve with nifedipine were analyzed. Patients were classified as those who suffered first-dose nifedipine hypotension (group 1) and those who did not (group 2). Echocardiographic measures of chamber size and septal geometry in the two groups were compared. Results: Five measures reflecting diminished left ventricular (LV) size and leftward ventricular septal bowing were found to be associated with nifedipine hypotension: LV transverse diameter in systole (LVDs; p = 0.007), LV transverse diameter in diastole (LVDd; p = 0.05), LV area in systole (LVAs; p = 0.009), LV area in diastole (LVAd; p = 0.03), the ratio of RV to LVAs (p = 0.02), and leftward ventricular septal bowing (p = 0.01). The LV dimensions found to best predict nifedipine-induced hypotension were LVDs < 2.7 cm, LVDd < 4.0 cm, LVAs < 15.5 cm2, and LVAd < 20.0 cm2. Conclusions: Readily available echocardiographic parameters in patients with PPH are predictive of nifedipine-induced hypotension, and can be used to select patients in whom a trial of nifedipine should be avoided.
AB - Background: The clinical course in primary pulmonary hypertension (PPH) is improved by calcium channel blocker therapy in those with a favorable hemodynamic response during a trial of high-dose oral nifedipine. Although trials of nifedipine are performed only in patients who demonstrate pulmonary vasodilator reserve to short-acting agents, this response does not predict the safely of nifedipine treatment, which can result in severe first-dose hypotension and death. Study objectives: To identify echocardiographic parameters that predict first-dose nifedipine-induced hypotension in patients with PPH. Methods: The pretrial echocardiograms of 23 consecutive PPH patients (mean age, 42.3 ± 13 years; 77% female) undergoing evaluation of pulmonary vasodilator reserve with nifedipine were analyzed. Patients were classified as those who suffered first-dose nifedipine hypotension (group 1) and those who did not (group 2). Echocardiographic measures of chamber size and septal geometry in the two groups were compared. Results: Five measures reflecting diminished left ventricular (LV) size and leftward ventricular septal bowing were found to be associated with nifedipine hypotension: LV transverse diameter in systole (LVDs; p = 0.007), LV transverse diameter in diastole (LVDd; p = 0.05), LV area in systole (LVAs; p = 0.009), LV area in diastole (LVAd; p = 0.03), the ratio of RV to LVAs (p = 0.02), and leftward ventricular septal bowing (p = 0.01). The LV dimensions found to best predict nifedipine-induced hypotension were LVDs < 2.7 cm, LVDd < 4.0 cm, LVAs < 15.5 cm2, and LVAd < 20.0 cm2. Conclusions: Readily available echocardiographic parameters in patients with PPH are predictive of nifedipine-induced hypotension, and can be used to select patients in whom a trial of nifedipine should be avoided.
KW - Echocardiography
KW - Hypotension
KW - Nifedipine
KW - Primary pulmonary hypertension
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U2 - 10.1378/chest.116.5.1218
DO - 10.1378/chest.116.5.1218
M3 - Article
C2 - 10559078
AN - SCOPUS:0032742559
VL - 116
SP - 1218
EP - 1223
JO - Diseases of the chest
JF - Diseases of the chest
SN - 0012-3692
IS - 5
ER -