Iloprost and exercise haemodynamics in heart failure with preserved ejection fraction—the ILO‐HOPE randomised controlled trial

Abstract

AimsA dramatic increase in pulmonary capillary wedge pressure (PCWP) during exercise is observed in patients with heart failure with preserved ejection fraction (HFpEF). This study was designed to determine whether iloprost inhalation could improve exercise haemodynamics and cardiac reserve in patients with HFpEF.MethodsThirty‐four HFpEF patients were enrolled in this double‐blind, randomized, placebo‐controlled, parallel‐group trial. Patients received both cardiac catheterization and underwent expired gas analysis at rest, during exercise, and before and 10 minutes after treatment with either inhaled iloprost or placebo. The primary endpoint was decrease in exercise PCWP.ResultsAt baseline, enrolled patients showed an increase in PCWP during exercise (from 16 [range, 14–23] mmHg to 27 [21–36] mmHg; P < .0001). After iloprost inhalation, exercise PCWP was significantly reduced compared to placebo (adjusted mean: 20 [16–29] mmHg vs 23 [17–32] mmHg; P = .002). There was no difference for cardiac output reserve with exercise in the 2 groups (0.2 [−1.3–1.2] L/min vs –0.7 [−1.9–0.1] L/min; P = .099). Iloprost improved the pulmonary artery pressure flow relationships in HFpEF with exercise compared to placebo.ConclusionIloprost inhalation improved haemodynamic deficits during exercise in patients with HFpEF. Prospective trials testing long‐term iloprost therapy in this population are warranted.