RESUMO
BACKGROUND: Severe pulmonary hypertension is a usual contraindication to heart transplantation. A few studies have found that sildenafil has a favourable effect on haemodynamic variables in patients with severe left ventricular systolic dysfunction. AIM: To report our clinical experience of sildenafil in patients with left ventricular systolic dysfunction and severe pulmonary hypertension. METHODS: All patients underwent echocardiography, radionuclide angiography, a cardiopulmonary exercise test and right heart catheterization before and after treatment with sildenafil. All patients were clinically stable and were receiving maximal tolerated doses of recommended drugs. RESULTS: We included 18 patients, with a mean±standard deviation age of 47±13 years. After a median of 8.7 months (interquartile range, 4.4-13.5 months) on sildenafil, there was a significant improvement in New York Heart Association classification (P=0.02) and mean right ventricular ejection fraction (from 26±7% to 30±9%; P=0.008), with a decrease in the VE/VCO2 slope (from 52±11 to 44±11; P=0.009) and in pulmonary vascular resistance (from 5.3±1.9 Wood units to 3.3±1.8 Wood units; P=0.01). During follow-up, three patients had urgent heart transplantation, two had non-urgent transplantation and six had left ventricular assist device implantation. All patients with pulmonary vascular resistance<3 Wood units after sildenafil were alive, compared with four in the other subgroup (44% survival). CONCLUSION: In patients with pulmonary hypertension related to left ventricular systolic dysfunction, sildenafil seems to improve cardiac haemodynamics.
