Effect Of Beraprost On Pulmonary Hypertension Due To Left Ventricular Systolic Dysfunction

Part 1 Clinical features of pulmonary hypertension due to left ventricular systolic dysfunctionObjective: pulmonary hypertension due to left ventricular systolic dysfunction(PH-HFr EF)is one of the types of pulmonary hypertension associated with left heart disease.It is common in clinic,and the prognosis is poor.In this study,we analyzed the clinical characteristics of PH-HFr EF patients and to explore the risk factors of PH-HFr EF.Methods: Consecutive PH-HFr EF patients were selected with systolic pulmonary artery pressure(s PAP)more than 40 mm Hg and left ventricular ejection fraction(EF)less than 45% by echocardiography.The same number of patients with HFr EF(s PAP(27)30mmhg and EF<45%)were choosed as control.The height and weight of the patients were measured,and the body mass index(BMI)was calculated.Other routine characteristics were recorded and statistical analysis was carried out.Results: 93 patients with PH-HFr EF were selected and 93 patients with simple HFr EF were choosed as control.LVEF in the two groups had no significant difference.Patients with PH-HFr EF had higher s PAP(49.1±10.1 vs 26.0±1.9 mm Hg,P<0.001)and left atrial diameter(43.6±7.8 vs 40.8±5.7 mm,P<0.05)than HFr EF pateints.The prevalence of diabetes in PH-HFr EF patients was significantly higher than that in HFr EF group(44.1% vs 26.9%,P<0.05),while BMI was significantly lower than in HFr EF group(23.7±4.0 vs 25.0±3.2 kg/m2,P<0.05).Multivariate logistic regression analysis revealed that diabetes(AOR=11.803,95% CI=1.862-26.241,P=0.017)and low BMI(AOR=0.608,95% CI=0.378-0.977,P=0.040)were independent predictors of pulmonary hypertension in patients with left heart failure.Conclusions: PH-HFr EF is associated with diabetes and body mass index.Diabetes and low BMI are independent predictors of pulmonary hypertension in patients with left heart failure.It is suggested that the "obesity paradox" may also exist in the PH-HFr EF patients.Part 2 Effect of beraprost on pulmonary hypertension due to left ventricular systolic dysfunctionObjective: Beraprost is mainly adapted to peripheral chronic arterial occlusive disease.However,the efficacy and safety of beraprost in patients with pulmonary hypertension(PH)due to left ventricular systolic dysfunction(PH-HFr EF)remains unknown.The primary objective of this study was to ascertain the effect of beraprost on PH-HFr EF.Methods: PH-HFr EF patients were selected and randomly divided into beraprost group(based on conventional therapy plus beraprost sodium 60 ug/day,20 ug tid,n=25)and control group(conventional treatment only,n=24).Echocardiography and 6 minute walking test were performed at 3,6,9,and 12 months after treatment,and s PAP,EF,and 6minutes walk distance(6MWD)were recorded.After 12 months follow-up,major adverse cardiovascular events(MACE)were recorded including cardiac death,non fatal myocardial infarction,heart failure readmission,atrial fibrillation.At the same time,the incidence of adverse events was recorded including shock,severe bleeding,and severe liver function damage.Results: Both the routine treatment and the addition of beraprost sodium can reduce the s PAP,increase the EF value and improve the 6MWD in PH-HFr EF patients.However,the degree and amplitude of s PAP reduction in the beraprost group were significantly higher than those in the control group at 6,9,and 12 months(P<0.05).Although there was no significant difference in the EF value between the beraprost group and the control group during the follow-up period,the amplitude of EF increased in the beraprost group at 6,9and 12 months was significantly higher than that in the control group(P<0.05).The improvement of 6MWD in beraprost group at 6 and 12 months was significantly higher than that in the control group(P<0.05),and the amplitude of improvement in 3,6,9,12 months was significantly higher than that in the control group(P<0.01).During the follow-up period,2 cases of heart failure readmission(control group)were improved and discharged after treatment,and 2 cases of new atrial fibrillation(1 cases in control group and 1 in beraprost group)were recovered successfully by amiodarone.No cardiac death and myocardial infarction occurred,and there was no significant difference in total MACE between the two groups.One patient had hematochezia who was treated with clopidogrel and aspirin after coronary stenting.Hemorrhoid was found,and tumorswere excluded by colonoscopy.Hematochezia recovered after 3 days of discontinuation of aspirin.There were no severe bleeding(cerebral hemorrhage,gastrointestinal bleeding,pulmonary hemorrhage,etc.),and severe impairment of liver function.There was no significant difference between the two groups of adverse events.Conclusions: On the basis of routine treatment,the addition of beraprost sodium can effectively reduce the s PAP,EF value and 6MWD of patients with PH-HFr EF,which is much better than the conventional treatment group.Moreover,there are no serious bleeding events and shock indicating the good safety.