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Renal effects of vasodilators in acute heart failure

World Journal of Cardiovascular Diseases 2013年第2期3卷 8-17页

作者： Mattia A. E. Valente Adriaan A. Voors Department of Cardiology University Medical Center Groningen Groningen The Netherlands

Vasodilator therapy is common in acute heart failure (AHF) patients, although evidence for morbidity and mortality benefits is limited for many of these drugs. AHF is frequently accompanied by renal dysfunction, which is a strong, independent predictor for poor prognosis. Several hemodynamic and neurohormonal effects of vasodilators—including preload and afterload reduction, activation or inhibition of neurohormonal and inflammatory cascades—have the potential to modulate cardiorenal interaction and impact renal function. However, the effect of vasodilators on renal function in acute heart failure is often poorly described. In this review, we provide an overview of the known cardiorenal effects of traditional and novel vasodilators in patients with acute heart failure.

关键词： Heart Failure vasodilators Cardiorenal Syndrome Renal Function

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Management of acute heart failure-Is there a paradigm shift around the corner?

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World Journal of Cardiovascular Diseases 2013年第2期3卷 1-7页

作者： C. Pater, T. Severin Novartis Pharma AG Basel Switzerland

It has become increasingly apparent that the looming epidemic of heart failure calls for systematic treatment approaches tailored to the needs of individual patient phenotypes. Although chronic heart failure (CHF) therapies are continuously evolving based on the increasing understanding of the involved etiology, acute heart failure (AHF) therapies are still based on hemodynamic improvements and symptom alleviation. Guidelines on AHF management have highlighted that the currently administered AHF therapies lack evidence and have raised concerns on the safety and efficacy of some of the hitherto accepted treatment modalities. Additionally, the high mortality and morbidity rates associated with the current AHF therapies also add to the imperative need to revisit AHF management. The last decade has witnessed a paradigm shift in the way we define and diagnose AHF. Apart from it being recognized as a distinct clinical entity, research has also led to new data on the pathophysiological changes associated with AHF. These developments along with the limited short- and long-term effects of currently used therapies may herald a paradigm shift in the way we plan and deliver management strategies to treat the pathological progression of heart failure.

关键词： Acute Heart Failure Hemodynamic Clinical and Residual Congestion vasodilators Diuretics Management Strategies

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<i>In Vitro</i>Characterisation of Pharmacological Effect of Prostacyclin Analogues in Comparison to Phosphodiesterase Inhibitors on Small Human Pulmonary Vessels

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World Journal of Cardiovascular Surgery 2017年第11期7卷 131-142页

作者： Azar Hussain Robert Bennett Zaheer Tahir Ahmed Habib Michael Cowen Mubarak Chaudhry Mahmoud Loubani Alyn Morice Department of Cardiothoracic Surgery Castle Hill Hospital Cottingham UK Department of Respiratory Medicine Castle Hill Hospital Cottingham UK

Background and Aim of Study: The phosphodiesterase inhibitors (Sildenafil and Milrinone), Nitric Oxide donor Sodium Nitroprusside (SNP) and prostacyclin analogs are commonly used pulmonary vasodilators to treat pulmonary hypertension. In the past few years, we have used human pulmonary artery rings in vitro to evaluate pulmonary vascular resistance. The main objective of the current study is to document the pharmacological impact of clinically used prostacyclin analogs on the human pulmonary system in parallel with phosphodiesterase inhibitors and SNP. Methods: The study used human pulmonary artery rings of internal diameter of 2 - 4 mm and length of 2 mm. These were extracted from patients with lung resections. These rings were then mounted on a multiwire myograph, and changes in isometric tension were noted. Then, concentration response curves were constructed to Sildenafil (Sd), Milrinone (Mil), Sodium Nitroprusside (SNP), Epoprostenol (Ep), Iloprost (Ip) and Treprostinil (Tp). Results: 52 pulmonary artery rings were used in these experiments. Sildenafil, Milrinone, SNP, Epoprostenol, Iloprost and Treprostinil caused a concentration-dependent vasodilation in small human pulmonary arteries (pEC50: 5.97 ± 0.22, 5.99 ± 0.12, 7.64 ± 0.08, 7.53 ± 0.14, 8.84 ± 0.15 and 9.48 ± 0.13 respectively, n = 8 to 12). The efficacy for the same was in the order: Tp = Ip > Ep > Mil > SNP > Sd. The potency varied in the order: Tp > Ip > SNP > Ep > Mil > Sd. Conclusion: This research showed the efficacy as well as the potency of SNP and phosphodiesterase inhibitors and prostacyclin analogs on the human pulmonary vasculature. Treprostinil and Iloprost exhibited maximum relaxation. However, Sildenafil and SNP showed lesser impact. These effects need to be considered for clinical studies for enhanced patient outcomes.

关键词： Pulmonary Artery Rings Human vasodilators In Vitro Pulmonary Hypertension Study

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Isolated Patent Ductus Arteriosus in an Elderly Female, Aged 65 Years—A Case Report

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Case Reports in Clinical Medicine 2018年第5期7卷 352-379页

作者： Ramachandran Muthiah Zion Hospital Azhagiamandapam Kanyakumari District India

Aim: To report a case of longer-lived patent ductus arteriosus with features of pulmonary arterial hypertension up to the age of 65 years in an elderly woman. Introduction: The clinical recognition of patent ductus arteriosus with severe pulmonary hypertension is difficult. Only 60% of adults presented with a continuous murmur in a recent series. Asymptomatic patent ductus arteriosus tolerated for many years and may not require closure. Case Report: A 65 years old female presented with dyspnea had signs of pulmonary arterial hypertension with enlarged pulmonary artery and its branches, atrial fibrillation along with a continuous murmur in the left second intercostal space. Echocardiography revealed a 13 mm size patent ductus arteriosus and a bidirectional with predominant left-to-right shunt. Patient was managed conservatively and symptoms got improved with medical therapy. Conclusion: Treatment of patent ductus arteriosus in the setting of pulmonary hypertension is challenging. Early repair can mitigate the development of pulmonary hypertension and reverse vasculopathy in more advanced disease. Maternal aspirin ingestion should be avoided in pregnancy since it causes constriction of fetal ductus.

关键词： Adult Ductus Pulmonary Hypertension Pulmonary vasodilators Transcatheter Closure Wright Technique

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