Therapeutic Potential of Sildenafil in Patients with Chronic Heart Failure after Cardiac Surgery
Radwa Ahmed Mohamed Korany;
Abstract
The aim of this study was to evaluate the role of sildenafil therapy in the treatment of chronic heart failure following cardiac surgery in patients who are not responding to the usual anti-failure treatment.
This was a prospective paired single-institution study conducted on 26 patients with refractory heart failure after cardiac surgery who were recruited from the echocardiography clinic at El Demerdash Hospital – Ain Shams University, on an outpatient’s basis.
All patients were included into one group and evaluated before and after sildenafil administration (with the usual anti-failure treatment which consisted of Digoxin, captopril, diuretic). The study was consisted of a 1 week screening phase and a 12 weeks treatment phase, followed by evaluation and analysis.
Each eligible patient was submitted to a baseline evaluation during the 1-week screening phase at the beginning of the study (which includes: patient’s data, history taking, clinical examination, functional class determination, echocardiographic examination). At the treatment phase, patients were followed-up every 4 weeks and for an entire period of 12 weeks. All the patients were submitted at each visit to clinical examination, functional class determination, echocardiographic examination, and data were collected with observation and recording for any adverse events, hospital admission or mortality.
Majority of clinical parameters of heart failure emphasized the clinical superiority of sildenafil therapy. Sildenafil significantly decreases heart failure symptoms, with significant improvement in NHYA class after 1, 2 and 3 months.There was no significant change in heart rate, while there was a significant reduction insystolic blood pressure, diastolic and mean blood pressures.
Left ventricular internal diastolic diameter and end diastolic volume showed no significant changes, while left ventricular internal systolic diameter and end systolic volume showed significant decreases after 1, 2 and 3 months.
Ejection fraction, fractional shortening and cardiac output showed significant increases after 1, 2 and 3 months, while stroke volume showed no significant change during the treatment course.Right ventricular pressure and pulmonary hypertension showed significant decreases after 1, 2 and 3 months.
Overall adverse events were mild (hypotension and headache) and did not require treatment interruption. Readmission to hospital and mortality reported cases were not associated to sildenafil therapy.
Conclusion:
This study adds important information about the effects of sildenafil after 12 weeks treatment protocol for refractory heart failure due to cardiac surgery in patients already receiving guideline-based treatment for chronic heart failure. We demonstrated that sildenafil use improves symptoms of heart failure, NYHA class and quality of life, hemodynamic and echocardiographic parameters. No reported serious adverse effects requiring discontinuation of sildenafil.
Recommendations:
It is recommended to conduct larger scale multi-center trials to confirm these promising findings.
This was a prospective paired single-institution study conducted on 26 patients with refractory heart failure after cardiac surgery who were recruited from the echocardiography clinic at El Demerdash Hospital – Ain Shams University, on an outpatient’s basis.
All patients were included into one group and evaluated before and after sildenafil administration (with the usual anti-failure treatment which consisted of Digoxin, captopril, diuretic). The study was consisted of a 1 week screening phase and a 12 weeks treatment phase, followed by evaluation and analysis.
Each eligible patient was submitted to a baseline evaluation during the 1-week screening phase at the beginning of the study (which includes: patient’s data, history taking, clinical examination, functional class determination, echocardiographic examination). At the treatment phase, patients were followed-up every 4 weeks and for an entire period of 12 weeks. All the patients were submitted at each visit to clinical examination, functional class determination, echocardiographic examination, and data were collected with observation and recording for any adverse events, hospital admission or mortality.
Majority of clinical parameters of heart failure emphasized the clinical superiority of sildenafil therapy. Sildenafil significantly decreases heart failure symptoms, with significant improvement in NHYA class after 1, 2 and 3 months.There was no significant change in heart rate, while there was a significant reduction insystolic blood pressure, diastolic and mean blood pressures.
Left ventricular internal diastolic diameter and end diastolic volume showed no significant changes, while left ventricular internal systolic diameter and end systolic volume showed significant decreases after 1, 2 and 3 months.
Ejection fraction, fractional shortening and cardiac output showed significant increases after 1, 2 and 3 months, while stroke volume showed no significant change during the treatment course.Right ventricular pressure and pulmonary hypertension showed significant decreases after 1, 2 and 3 months.
Overall adverse events were mild (hypotension and headache) and did not require treatment interruption. Readmission to hospital and mortality reported cases were not associated to sildenafil therapy.
Conclusion:
This study adds important information about the effects of sildenafil after 12 weeks treatment protocol for refractory heart failure due to cardiac surgery in patients already receiving guideline-based treatment for chronic heart failure. We demonstrated that sildenafil use improves symptoms of heart failure, NYHA class and quality of life, hemodynamic and echocardiographic parameters. No reported serious adverse effects requiring discontinuation of sildenafil.
Recommendations:
It is recommended to conduct larger scale multi-center trials to confirm these promising findings.
Other data
| Title | Therapeutic Potential of Sildenafil in Patients with Chronic Heart Failure after Cardiac Surgery | Other Titles | التأثير العلاجى المحتمل لعقار السيلدينافيل لمرضى فشل القلب المزمن بعد عمليات جراحة القلب | Authors | Radwa Ahmed Mohamed Korany | Issue Date | 2015 |
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