The aim – to analyze the results of the 3-month experience of the regional program developed to provide medical care for the patients with pulmonary hypertension (PH) in Lviv region (Ukraine).
Material and methods. Since December 2015 until April 2016 18 patients with idiopathic and associated forms of pulmonary arterial hypertension (PAH) (n=12, 66.7 %) and Eisenmenger syndrome (n=6, 33.3 %) who have been previously treated with generic sildenafil were enrolled into the regional program. Mean age of the patients was 36.1±11.9 years, female/male ratio was 3.5:1. Mean pulmonary artery pressure by right heart catheterization was 62±14 mm Hg and pulmonary vascular resistance 13.6±5.4 WU. The majority of patients (61.1 %) presented with the signs of functional class (FC) III while FC II was diagnosed in seven (38.9 %) cases. During participation in the program sildenafil monotherapy was prescribed to eight (44.4 %) patients, combination with iloprost to ten (55.6 %) participants. Treatment efficacy was monitored by the change in 6-minute walk test and parameters of pulmonary hemodynamics and right ventrivular function were assessed by echocardiography.
Results. At the time patients were included into the program the mean duration of disease for all participants was 59 (30; 124) months. Subjects with Eisenmenger syndrome had lower SaO2 and higher tricuspid valve pressure gradient (TVPG), while PAH subjects presented with larger right atrium area and slightly larger right ventricle diameter and lower TAPSE. After three months of treatment self-reported improvement of symptoms was accompanied by increase in 6-minute walk test (from 374 to 392 m), decrease in heart rate (89±14 to 74±12 beats per minute) with mild increase in SaO2 (from 89.8±9.3 % to 93.8±4.5 %) in all patients. Echocardiographic evaluation demonstrated slight decrease in TVPG (from 71.1±17.9 to 69.9±17.9 mm Hg), which was accompanied by moderate decrease in the area of the right atrium (from 29.4±10.4 to 28.8±10.4 cm2) and increase in right ventrivular diameter, especially, in the PAH group.
Conclusions. Use of the original sildenafil or its combination with inhaled iloprost in prevalent PH patients with the history of irregular or generic treatment was accompanied by increase in tolerance to physical load but did not provide significant improvement of pulmonary hemodynamics or right ventricular performance assessed by echocardiography.