Long-term effects of epoprostenol on the pulmonary vasculature in idiopathic pulmonary arterial hypertension

Stuart Rich*, Jennifer Pogoriler, Aliya N. Husain, Peter T. Toth, Mardi Gomberg-Maitland, Stephen L. Archer

*Corresponding author for this work

Research output: Contribution to journalArticle

84 Scopus citations

Abstract

The current treatment of pulmonary arterial hypertension (PAH) uses vasodilator drugs. Although they improve symptoms associated with PAH, their chronic effects on the pulmonary vasculature and the right ventricle (RV) in humans remain unknown. We report the autopsy findings from a patient with idiopathic PAH treated with epoprostenol successfully for 18 years. The patient died of colon cancer. The pulmonary vasculature surprisingly showed extensive changes of a proliferative vasculopathy. Immunohistochemical studies confirmed ongoing cellular proliferation. Studies of the RV demonstrated concentric hypertrophy with seemingly preserved contractility. The myocardium shifted to glycolytic metabolism. Although the long-term use of epoprostenol contributed to the patient's increased survival, it did not prevent progression of the underlying vascular disease. Remarkably, the RV was able to sustain a normal cardiac output in the face of advanced vascular pathology. The mechanisms by which the RV adapts to chronic PAH need further study.

Original languageEnglish (US)
Pages (from-to)1234-1239
Number of pages6
JournalCHEST
Volume138
Issue number5
DOIs
StatePublished - Nov 1 2010

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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    Rich, S., Pogoriler, J., Husain, A. N., Toth, P. T., Gomberg-Maitland, M., & Archer, S. L. (2010). Long-term effects of epoprostenol on the pulmonary vasculature in idiopathic pulmonary arterial hypertension. CHEST, 138(5), 1234-1239. https://doi.org/10.1378/chest.09-2815