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The Goal of the Epoprostenol Therapy in Patients with Pulmonary Arterial Hypertension

Toru Satoh

Masaharu Kataoka

Takumi Inami

Tsunehiko Shimura

Haruhisa Ishiguro

Satoru Yuzu

Kenichiro Matsushita

Toshiaka Satou

Kyoro Soejima

Konomi Sakata

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Conference: 2012 International PHA Conference and Scientific Sessions

Release Date: 06.22.2012

Presentation Type: Abstracts

Toru Satoh, Masaharu Kataoka, Takumi Inami, Tsunehiko Shimura, Haruhisa Ishiguro, Satoru Yuzu, Kenichiro Matsushita, Toshiaki Satou, Kyoro Soejima, Konomi Sakata, Hideo Yoshino

Division of Cardiology, Kyorin University School of Medicine, Tokyo, Japan

BACKGROUND: Pulmonary arterial hypertension (PAH) is still the disease with grave prognosis even under several new effective drugs. Among those drugs, epoprostenol(EPO) is considered the most potent and is increased in dosage according to poor responsiveness and improvement. In this study, to how much EPO should be increased in dosage in order to attain better prognosis was retrospectively investigated. 

METHODS: Forty six patients with idiopathic PAHand PH with connective tissue disease with ambulatory EPO therapy were enrolled in this study. The patients who were alive and have had EPO therapy more than 3 years were selected as the ‘alive group’. The ‘dead group’ only included the patients who died due to right heart failure. The hemodynamics, mixed-venous oxygen saturation (SvO2) and BNP before death in the ‘dead group’ and the most recent data in the ‘alive group’ were analyzed using Cox regression analysis to know which variable was most related to death, implying that avoiding this variable leads to good prognosis.

RESULTSThe overall 5-year survival rate was 73% and the 10-year 46%. The lower SvO2contributed to death the most (p=0.002) and the higher mPA the second(p=0.03).The cut-off value of SvO2was around 70% and that of mPA was 40 mmHg. The 5-year survival rate of 28 patients with the last SvO2 more than 70% was 96% and the 10-year 89%. The 5-year survival of 18 with SvO2 less than 70% was 61% and the 10-year 16%.

CONCLUSIONS: Epoprostenol should be increased until SvO2 surpasses 70% to get good prognosis in patients with PAH.