Continuous intravenous infusion of prostaglandin E1 improves myocardial perfusion reserve in patients with ischemic heart disease assessed by positron emission tomography: a pilot study

Abstract

Recent investigation has demonstrated that prostaglandin E(1) (PGE(1)) therapy increased capillary density in explanted hearts. Dynamic (13)N-ammonia positron emission tomography (PET) is reliable for non-invasive measurement of myocardial blood flow and myocardial perfusion reserve (MPR). The aim of this study was to investigate the effects of PGE(1) therapy during 4weeks on reduction of myocardial perfusion abnormalities and increase of MPR in the patients with ischemic heart disease. In this double-blind, placebo-controlled trial, we randomly assigned 11 patients who had symptomatic heart failure and documented myocardial ischemia to 4weeks intravenous infusion of PGE(1) (2.5ng/kg/min; 8 patients, age 60±13years) or saline (3 patients, age 57±13years). Dynamic (13)N-ammonia PET scans at rest and during adenosine stress were obtained at baseline and 12weeks after treatment completion. Quantitative size/severity of perfusion defects and MPR change from baseline to follow-up PET were determined using a 17-segment model. Compared with the control group, baseline MPR in the PGE(1) group was significantly lower (1.96±0.78 vs. 2.71±0.73; P<0.001). MPR significantly improved 12weeks after completion of PGE(1) infusion (1.96±0.78 to 2.16±0.77; P<0.001). In contrast, MPR declined significantly in the placebo group (2.71±0.73 to 2.01±0.58, P<0.001). Four weeks of PGE(1) infusion sustained MPR improvement in patients with ischemic heart disease. This may be an attractive therapeutic approach for no-option patients with severe ischemic cardiomyopathy.