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Acute hemodynamic effects of sildenafil in patients with idiopathic dilated cardiomyopathy

S Ramakrishnan1, Vineet Malik, G Karthikeyan

  • 1Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.

Indian Heart Journal
|March 12, 2009
PubMed

Insights

Sildenafil effectively reduced pulmonary artery pressures and pulmonary vascular resistance in patients with idiopathic dilated cardiomyopathy (IDCM). This phosphodiesterase-5 inhibitor demonstrated favorable vasodilation without adverse effects in this patient group.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Idiopathic dilated cardiomyopathy (IDCM) is characterized by impaired left ventricular function.
  • Sildenafil, a phosphodiesterase-5 inhibitor, is known to reduce pulmonary artery pressures (PAP) in idiopathic pulmonary hypertension.
  • Limited data exists on sildenafil's effects in unselected IDCM patients.

Purpose of the Study:

  • To evaluate the hemodynamic effects of a single oral dose of sildenafil in patients with IDCM.
  • To assess changes in pulmonary artery pressures, pulmonary vascular resistance, and systemic vascular resistance.

Main Methods:

  • Eleven patients with IDCM (left ventricular ejection fraction ≤40%, NYHA class II/III) received a single 50 mg oral dose of sildenafil.
  • Hemodynamic parameters were measured during right heart catheterization before and after sildenafil administration.

Main Results:

  • Sildenafil significantly decreased pulmonary artery systolic pressure (31.5 to 19.0 mmHg, p < 0.001) and pulmonary vascular resistance (3.0 to 1.6 dyne/s/m²/cm⁵, p = 0.01).
  • Systemic vascular resistance and pulmonary wedge capillary pressure also significantly decreased.
  • No significant changes were observed in heart rate, cardiac index, or the PVR/SVR ratio. No side effects were reported.

Conclusions:

  • Sildenafil induces favorable pulmonary and systemic vasodilation in stable IDCM patients.
  • It leads to a reduction in left ventricular filling pressures.
  • Further research is warranted to explore its therapeutic potential in IDCM.

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