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[Effects of urapidil by intravenous injection on pulmonary circulation and cardiac function in left ventricular
G Drobinski1, G Montalescot, J M Fossier
1Service de Cardiologie, CHU Pitié-Salpêtrière, Paris.
Insights
Urapidil significantly reduced pulmonary and systemic pressures in patients with secondary pulmonary hypertension. This vasodilator demonstrated a synergistic effect with existing treatments, improving hemodynamics for heart transplant candidates.
Area of Science:
- Cardiology
- Pharmacology
Context:
- Secondary pulmonary hypertension is a serious condition often seen in patients with advanced heart failure.
- Patients awaiting heart transplantation frequently have complex hemodynamic profiles requiring optimized management.
Purpose:
- To evaluate the hemodynamic effects of urapidil in patients with secondary pulmonary hypertension.
- To assess the potential synergistic action of urapidil with other vasodilators in this patient population.
Summary:
- Intravenous urapidil administration led to significant reductions in pulmonary arterial pressure and total pulmonary resistance.
- Systemic arterial resistance also decreased significantly, while cardiac output increased substantially.
- No adverse effects on left ventricular myocardial function were observed.
Impact:
- Urapidil demonstrates a beneficial hemodynamic profile in patients with congestive heart failure and secondary pulmonary hypertension.
- Its synergistic action with other vasodilators may aid in assessing pulmonary arteriolar vasodilatation reserves.
- Findings support urapidil's potential role in the hemodynamic management of heart transplant candidates.
Abstract:
The hemodynamic effects of urapidil were studied in 10 patients with secondary pulmonary hypertension investigated for the purpose of possible inclusion on a heart transplant waiting list. All patients gave their consent to participate. Nine patients had a dilated cardiomyopathy and 1 three-vessel coronary disease with diffuse hypokinesia. All were treated with digitalis, diuretics, converting enzyme inhibitors or calcium antagonists. Hemodynamic effects were measured 5 and 25 minutes after the slow intravenous injection of 50 mg of urapidil. Urapidil caused a significant decrease in pulmonary pressures (-20%) and total pulmonary resistance (-42.5%). The fall in systemic arterial resistance was of the same degree (41.5%). The fall in pulmonary arterial resistance was also significant (-26%). The increase in cardiac output was +35%, with no change in left ventricular myocardial function indices. Thus, in patients with congestive left ventricular failure and secondary pulmonary hypertension already treated with vasodilators, urapidil resulted in a hemodynamic improvement after intravenous administration, demonstrating a synergistic action with that of other vasodilators. This synergistic action could be used to test pulmonary arteriolar vasodilatation reserves during the hemodynamic assessment of patients in whom a heart transplant is contemplated.