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Published on: October 22, 2014
Hemodynamic effects of sildenafil in men with severe coronary artery disease
H C Herrmann1, G Chang, B D Klugherz
1Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia 19104, USA. herrmann@mail.med.upenn.edu
Insights
Sildenafil (100 mg) showed no adverse cardiovascular effects in men with severe coronary artery disease. This study assessed its hemodynamic impact on coronary blood flow in patients undergoing revascularization.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
Background:
- Cardiovascular effects of sildenafil are crucial due to common cardiac disease in men with erectile dysfunction.
- Serious cardiac events have been reported with sildenafil use.
Purpose of the Study:
- To assess the systemic, pulmonary, and coronary hemodynamic effects of oral sildenafil (100 mg).
- To evaluate sildenafil's impact on coronary blood flow and reserve in patients with severe coronary artery disease.
Main Methods:
- 14 men (mean age 61 years) with severe coronary artery stenosis (>70%) undergoing revascularization were studied.
- Doppler guidewire assessed coronary blood flow velocity and reserve before and after oral sildenafil (100 mg) administration.
- Maximal hyperemia was induced with intracoronary adenosine to assess flow reserve.
Main Results:
- Sildenafil caused minimal (<10%) decreases in systemic and pulmonary arterial pressures.
- No significant changes were observed in heart rate, cardiac output, or coronary blood flow parameters.
- Coronary flow reserve increased by approximately 13% after sildenafil administration (P=0.003).
Conclusions:
- Oral sildenafil (100 mg) did not produce adverse cardiovascular effects in men with severe coronary artery disease.
- The drug did not negatively impact coronary hemodynamics or flow reserve in this patient group.
Background:
The cardiovascular effects of sildenafil are important because of the frequent presence of underlying cardiac disease in men with erectile dysfunction and reports indicating serious cardiac events temporally associated with the use of this drug.
Methods:
We assessed the systemic, pulmonary, and coronary hemodynamic effects of oral sildenafil (100 mg) in 14 men (mean [+/-SD] age, 61+/-11 years) with severe stenosis of at least one coronary artery (stenosis of >70 percent of the vessel diameter) who were scheduled to undergo percutaneous coronary revascularization. Blood-flow velocity and flow reserve were assessed with a Doppler guidewire in 25 coronary arteries, including 13 severely diseased arteries (mean stenosis, 78+/-7 percent) and 12 arteries without stenosis, used as a reference; maximal hyperemia was induced (to assess flow reserve) with the intracoronary administration of adenosine both before and after sildenafil.
Results:
Oral sildenafil produced only small decreases (<10 percent) in systemic arterial and pulmonary arterial pressures, and it had no effect on pulmonary-capillary wedge pressure, right atrial pressure, heart rate, or cardiac output. There were no significant changes in average peak coronary flow velocity, coronary-artery diameter, volumetric coronary blood flow, or coronary vascular resistance. Coronary flow reserve at base line was lower in the stenosed arteries (1.26+/-0.26) than in the reference arteries (2.19+/-0.44) and increased about 13 percent in both groups of arteries combined after the administration of sildenafil (from 1.70+/-0.59 to 1.92+/-0.72, P=0.003). The ratio of coronary flow reserve in coronary arteries with stenosis to that in the reference arteries (0.57+/-0.14) was not affected by sildenafil.
Conclusions:
No adverse cardiovascular effects of oral sildenafil were detected in men with severe coronary artery disease.
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