Experience of Epoprostenol Infusion in Patients With Right Heart Failure Secondary to Pulmonary Hypertension

Abstract

SESSION TITLE: Pulmonary Vascular Disease I SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM PURPOSE: To describe the clinical characteristics of patients undergoing to Epoprostenol therapy for the treatment of right heart failure secondary to pulmonary hypertension. METHODS: Retrospective cohort of patients admitted to the emergency room because of right heart failure secondary to pulmonary hypertension between jan 2011 to oct 2015. Adults older than 18 y with epoprostenol infusión during the index hospitalization where included. Data were extracted from the pulmonary hypertension registry (SHIP) of a high complexity institution in Cali, Colombia. RESULTS: Thirty-one patients with pulmonary hypertension and right heart failure were included of whom 77% were women. The average age was 44.5 y. The most common cause of pulmonary hypertension was congenital heart disease (25.8%), followed by idiopathic and chronic thromboembolic disease, both with 22.5% (7/31). The average mean pulmonary arterial pressure was 62.0mmHg (SD ± 18.6) and pulmonary wedge pressure 18.5 (SD ± 11.8). The most common symptom was dyspnea in 48.3% (n = 15) and 30/31 have NYHA III/IV (96.7%). On physical examination, 12 patients (38.7%) had edema of lower limbs, 6(19.3%) jugular ingurgitation and 6 (19.3%) pulmonary edema. The median NT proBNP was 2451 pg/ml, PO2 59 mmHg and PCO2 was 32 mmHg. 16.1% of patients had hemoglobin ≤12g/dl and only one patient had hyponatremia (3.2%). The ejection fraction of the left ventricle was 59.55 ± 15%. There were an average of 302 hours of infusion of Epoprostenol (interquartile range [IQR] 158-687) and the maximum tolerated dose achieved was 7.65 ± 2,78ng/k/min. There were 7 early deaths related to pulmonary hypertension (22.5%). Only 4 patients (12.9%) required ambulatory infusion pump Epoprostenol. CONCLUSIONS: Epoprostenol was useful for the management of right heart failure in patients with pulmonary hypertension, however mortality remains to be high because of de underlying disease. CLINICAL IMPLICATIONS: The Epoprostenol is a synthetic prostacyclin administered by continuous infusion, was the first approved therapy for the management of severe pulmonary hypertension, currently there are a lot of alternatives for long-term management before deciding to establish Epoprostenol, but this drug is still a very good alternative for the management of acute right failure patient who subsequently other medicines are established1. In our series they continued with Epoprostenol 4 patients on an outpatient basis.