VasoREACTivity Testing With Intravenous SILdenafil in Patients With Precapillary Pulmonary Hypertension

Kerckhoff Heart Center10 enrolled

Overview

Sildenafil is a selective pulmonary vasodilator; in patients with a special kind of pulmonary hypertension it is approved for treatment. The trial seeks to find out, whether the acute response to this treatment (= vasoreactivity testing) given intravenously is effective and allows prediction of therapy success during a following oral treatment.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Pulmonary Hypertension Associated With Connective Tissue Disease

Interventions

SildenafilDRUG

oral Sildenafil 3 x 20 mg for 90 days

Eligibility

Sex: ALLMin age: 18 YearsMax age: 80 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Precapillary pulmonary hypertension associated with connective tissue disease * resting mean pressure in the pulmonary artery of \> 24 mmHg * resting mean pulmonary capillary wedge pressure (PCWP) of \< 16 mmHg * age 18 to 80 years * women of childbearing potential must have a negative pregnancy test (ß-HCG in urine) and must use effective methods of contraception * women must not be breastfeeding * ability to understand and sign the informed consent, correctly signed informed consent Exclusion Criteria: * pretreatment with Sildenafil * contraindications for Sildenafil treatment: * known intolerance to Sildenafil, * optic neuropathy (NAION), * known hereditary retina disease, * need of nitrate therapy * advanced liver cirrhosis - CHILD C * severely reduced renal function with GFR \< 30 ml/min/1,73 m² * stroke or myocardial infarction within the last 6 months

Locations (1)

Kerckhoff Heart Center

Bad Nauheim, Germany

Outcomes

Primary Outcomes

efficacy of Sildenafil I.V. for vasoreactivity testing

Right heart catheterisation with comprehensive hemodynamic measurements (pressures in RA, RV, PA, PCW position; cardiac index (CI) by thermodilution; oxygen saturation in the PA; the same under exercise conditions) is performed. In case of precapillary pulmonary hypertension, Sildenafil is given I.V. and acute tolerability, safety and efficacy on hemodynamic parameters are registrated. Successful vasoreactivity testing is defined by lowering the mean PA pressure by 10 mmHg or more, lowering it below 40 mmHg and maintaining / rising of the CI. Safety is mainly defined by lack of a substantial effect of the study drug on systemic blood pressure.

Time frame: 1.5 hours

Secondary Outcomes

clinical efficacy of sildenafil per os predicted by testing it intravenously in the course of oral therapy

Complete hemodynamic and functional assessment after 90 days of oral Sildenafil therapy (same protocol as before except vasoreactivity testing). Hemodynamic parameters which characterize successful oral therapy are mainly mean PA-pressure (decrease), pulmonary vascular resistance (decrease) and cardiac index (increase) - at rest and exercise. Functional improvement is further characterized by exercise capacity (cardiopulmonary exercise testing: improvement of V´O2 peak by ≥ 1 ml/min/kg), fall of NTproBNP, improvement of echocardiographic parameters of right ventricular function (TAPSE, S´, RV-FAC). Evaluation, if positive initial vasoreactivity testing results in successful oral therapy as defined above.

Time frame: 90 days

Data from ClinicalTrials.gov

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