Sildenafil vs. sodium before nitroprusside for the pulmonary hypertension reversibility test before cardiac transplantation

Arq Bras Cardiol. 2012 Sep;99(3):848-56. doi: 10.1590/s0066-782x2012005000076. Epub 2012 Aug 16.
[Article in English, Portuguese]

Abstract

Background: Pulmonary hypertension is associated with a worse prognosis after cardiac transplantation. The pulmonary hypertension reversibility test with sodium nitroprusside (SNP) is associated with a high rate of systemic arterial hypotension, ventricular dysfunction of the transplanted graft and high rates of disqualification from transplantation.

Objective: This study was aimed at comparing the effects of sildenafil (SIL) and SNP on hemodynamic, neurohormonal and echocardiographic variables during the pulmonary reversibility test.

Methods: The patients underwent simultaneously right cardiac catheterization, echocardiography, BNP measurement, and venous blood gas analysis before and after receiving either SNP (1 - 2 µg/kg/min) or SIL (100 mg, single dose).

Results: Both drugs reduced pulmonary hypertension, but SNP caused a significant systemic hypotension (mean blood pressure - MBP: 85.2 vs. 69.8 mm Hg; p < 0.001). Both drugs reduced cardiac dimensions and improved left cardiac function (SNP: 23.5 vs. 24.8%, p = 0.02; SIL: 23.8 vs. 26%, p < 0.001) and right cardiac function (SIL: 6.57 ± 2.08 vs. 8.11 ± 1.81 cm/s, p = 0.002; SNP: 6.64 ± 1.51 vs. 7.72 ± 1.44 cm/s, p = 0.003), measured through left ventricular ejection fraction and tissue Doppler, respectively. Sildenafil, contrary to SNP, improved venous oxygen saturation, measured on venous blood gas analysis.

Conclusion: Sildenafil and SNP are vasodilators that significantly reduce pulmonary hypertension and cardiac geometry, in addition to improving biventricular function. Sodium nitroprusside, contrary to SIL, was associated with systemic arterial hypotension and worsening of venous oxygen saturation.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Blood Pressure / drug effects
  • Blood Pressure / radiation effects
  • Female
  • Hemodynamics / drug effects*
  • Hemodynamics / physiology
  • Humans
  • Hypertension, Pulmonary / drug therapy*
  • Hypertension, Pulmonary / physiopathology
  • Hypotension / chemically induced*
  • Hypotension / drug therapy
  • Male
  • Middle Aged
  • Nitroprusside / adverse effects
  • Nitroprusside / therapeutic use*
  • Piperazines / therapeutic use*
  • Preoperative Care
  • Purines / therapeutic use
  • Sildenafil Citrate
  • Sulfones / therapeutic use*
  • Vascular Resistance / drug effects
  • Vascular Resistance / physiology
  • Vasodilator Agents / adverse effects
  • Vasodilator Agents / therapeutic use*
  • Ventricular Function / drug effects

Substances

  • Piperazines
  • Purines
  • Sulfones
  • Vasodilator Agents
  • Nitroprusside
  • Sildenafil Citrate