Pulmonary Hypertension Associated With Connective Tissue Disease
Conditions
Keywords
vasoreactivity testing, Sildenafil, precapillary pulmonary hypertension, connective tissue disease, mean pressure in the pulmonary artery 25 mmHg or more, mean pulmonary capillary wedge pressure below 16 mmHg
Brief summary
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.
Interventions
DRUGSildenafil
oral Sildenafil 3 x 20 mg for 90 days
Sponsors
Pfizer
Kerckhoff Heart Center
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| efficacy of Sildenafil I.V. for vasoreactivity testing | 1.5 hours | 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. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| clinical efficacy of sildenafil per os predicted by testing it intravenously in the course of oral therapy | 90 days | 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. |
Countries
Germany
Outcome results
None listed