Catecholamine support at the initiation of epoprostenol therapy in pulmonary arterial hypertension

Satoshi Akagi, Aiko Ogawa, Katsumasa Miyaji, Kengo Kusano, Hiroshi Itoh, Hiromi Matsubaral

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Rationale: Epoprostenol is a first-line therapy for patients with pulmonary arterial hypertension (PAH) in World Health Organization functional class IV who often have low cardiac output and hypotension. However, initiation of epoprostenol can cause hemodynamic collapse in these vulnerable patients. Inotropic agent support may prevent the hemodynamic instability caused by initiation of epoprostenol; however, a protocol for supportive therapy has not been established. Objectives: To assess the reliability and prognostic effects of dobutamine and dopamine support at the initiation of epoprostenol therapy in patients with PAH. Methods: We initiated epoprostenol therapy in 71 patients with PAH. Hemodynamics at the initiation of epoprostenol were measured by right heart catheterization. We initiated dobutamine when a patient's mixed venous oxygen saturation was less than 60% or cardiac index was less than 2.0 L/min/m2 or when right ventricular failure was clinically suspected. We initiated dopamine when a patient's systolic blood pressure was less than 90 mm Hg or urine volume was less than 20 ml/h. Measurements and Main Results: At the initiation of epoprostenol, dobutamine and/or dopamine were required to support 46 patients according to protocol. Eight patients died during the hospitalization and one patient received a living-donor lobar lung transplant after the initiation of epoprostenol therapy. Neither inotropic agent was an independent risk factor for short-term mortality (dobutamine: hazard ratio, 1.63; 95% confidence interval, 0.33-8.11; dopamine: hazard ratio, 0.22; 95% confidence interval, 0.03-1.70). Sixty-two patients were discharged for home infusion of epoprostenol. Transplant-free survival rates at 5 years were 80.0% for patients who did not require inotropic support at the start of epoprostenol and 76.6% for patients with who did require dopamine and/or dobutamine support (P = 0.45). Conclusions: Temporary use of dobutamine and dopamine appears to be safe for hemodynamic support at the initiation of epoprostenol therapy for selected patients with PAH with low cardiac output and hypotension. The protocol presented here requires validation at other centers.

Original languageEnglish
Pages (from-to)719-727
Number of pages9
JournalAnnals of the American Thoracic Society
Volume11
Issue number5
DOIs
Publication statusPublished - 2014

Fingerprint

Epoprostenol
Pulmonary Hypertension
Catecholamines
Dobutamine
Dopamine
Therapeutics
Hemodynamics
Low Cardiac Output
Hypotension
Confidence Intervals
Blood Pressure
Transplants
Living Donors
Cardiac Catheterization
Hospitalization
Survival Rate
Urine

Keywords

  • Dobutamine
  • Dopamine
  • Heart failure
  • Right ventricle

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Medicine(all)

Cite this

Catecholamine support at the initiation of epoprostenol therapy in pulmonary arterial hypertension. / Akagi, Satoshi; Ogawa, Aiko; Miyaji, Katsumasa; Kusano, Kengo; Itoh, Hiroshi; Matsubaral, Hiromi.

In: Annals of the American Thoracic Society, Vol. 11, No. 5, 2014, p. 719-727.

Research output: Contribution to journalArticle

Akagi, Satoshi ; Ogawa, Aiko ; Miyaji, Katsumasa ; Kusano, Kengo ; Itoh, Hiroshi ; Matsubaral, Hiromi. / Catecholamine support at the initiation of epoprostenol therapy in pulmonary arterial hypertension. In: Annals of the American Thoracic Society. 2014 ; Vol. 11, No. 5. pp. 719-727.
@article{17bebb1383a6463c95cfbb53c1c4c553,
title = "Catecholamine support at the initiation of epoprostenol therapy in pulmonary arterial hypertension",
abstract = "Rationale: Epoprostenol is a first-line therapy for patients with pulmonary arterial hypertension (PAH) in World Health Organization functional class IV who often have low cardiac output and hypotension. However, initiation of epoprostenol can cause hemodynamic collapse in these vulnerable patients. Inotropic agent support may prevent the hemodynamic instability caused by initiation of epoprostenol; however, a protocol for supportive therapy has not been established. Objectives: To assess the reliability and prognostic effects of dobutamine and dopamine support at the initiation of epoprostenol therapy in patients with PAH. Methods: We initiated epoprostenol therapy in 71 patients with PAH. Hemodynamics at the initiation of epoprostenol were measured by right heart catheterization. We initiated dobutamine when a patient's mixed venous oxygen saturation was less than 60{\%} or cardiac index was less than 2.0 L/min/m2 or when right ventricular failure was clinically suspected. We initiated dopamine when a patient's systolic blood pressure was less than 90 mm Hg or urine volume was less than 20 ml/h. Measurements and Main Results: At the initiation of epoprostenol, dobutamine and/or dopamine were required to support 46 patients according to protocol. Eight patients died during the hospitalization and one patient received a living-donor lobar lung transplant after the initiation of epoprostenol therapy. Neither inotropic agent was an independent risk factor for short-term mortality (dobutamine: hazard ratio, 1.63; 95{\%} confidence interval, 0.33-8.11; dopamine: hazard ratio, 0.22; 95{\%} confidence interval, 0.03-1.70). Sixty-two patients were discharged for home infusion of epoprostenol. Transplant-free survival rates at 5 years were 80.0{\%} for patients who did not require inotropic support at the start of epoprostenol and 76.6{\%} for patients with who did require dopamine and/or dobutamine support (P = 0.45). Conclusions: Temporary use of dobutamine and dopamine appears to be safe for hemodynamic support at the initiation of epoprostenol therapy for selected patients with PAH with low cardiac output and hypotension. The protocol presented here requires validation at other centers.",
keywords = "Dobutamine, Dopamine, Heart failure, Right ventricle",
author = "Satoshi Akagi and Aiko Ogawa and Katsumasa Miyaji and Kengo Kusano and Hiroshi Itoh and Hiromi Matsubaral",
year = "2014",
doi = "10.1513/AnnalsATS.201308-268OC",
language = "English",
volume = "11",
pages = "719--727",
journal = "Annals of the American Thoracic Society",
issn = "2325-6621",
publisher = "American Thoracic Society",
number = "5",

}

TY - JOUR

T1 - Catecholamine support at the initiation of epoprostenol therapy in pulmonary arterial hypertension

AU - Akagi, Satoshi

AU - Ogawa, Aiko

AU - Miyaji, Katsumasa

AU - Kusano, Kengo

AU - Itoh, Hiroshi

AU - Matsubaral, Hiromi

PY - 2014

Y1 - 2014

N2 - Rationale: Epoprostenol is a first-line therapy for patients with pulmonary arterial hypertension (PAH) in World Health Organization functional class IV who often have low cardiac output and hypotension. However, initiation of epoprostenol can cause hemodynamic collapse in these vulnerable patients. Inotropic agent support may prevent the hemodynamic instability caused by initiation of epoprostenol; however, a protocol for supportive therapy has not been established. Objectives: To assess the reliability and prognostic effects of dobutamine and dopamine support at the initiation of epoprostenol therapy in patients with PAH. Methods: We initiated epoprostenol therapy in 71 patients with PAH. Hemodynamics at the initiation of epoprostenol were measured by right heart catheterization. We initiated dobutamine when a patient's mixed venous oxygen saturation was less than 60% or cardiac index was less than 2.0 L/min/m2 or when right ventricular failure was clinically suspected. We initiated dopamine when a patient's systolic blood pressure was less than 90 mm Hg or urine volume was less than 20 ml/h. Measurements and Main Results: At the initiation of epoprostenol, dobutamine and/or dopamine were required to support 46 patients according to protocol. Eight patients died during the hospitalization and one patient received a living-donor lobar lung transplant after the initiation of epoprostenol therapy. Neither inotropic agent was an independent risk factor for short-term mortality (dobutamine: hazard ratio, 1.63; 95% confidence interval, 0.33-8.11; dopamine: hazard ratio, 0.22; 95% confidence interval, 0.03-1.70). Sixty-two patients were discharged for home infusion of epoprostenol. Transplant-free survival rates at 5 years were 80.0% for patients who did not require inotropic support at the start of epoprostenol and 76.6% for patients with who did require dopamine and/or dobutamine support (P = 0.45). Conclusions: Temporary use of dobutamine and dopamine appears to be safe for hemodynamic support at the initiation of epoprostenol therapy for selected patients with PAH with low cardiac output and hypotension. The protocol presented here requires validation at other centers.

AB - Rationale: Epoprostenol is a first-line therapy for patients with pulmonary arterial hypertension (PAH) in World Health Organization functional class IV who often have low cardiac output and hypotension. However, initiation of epoprostenol can cause hemodynamic collapse in these vulnerable patients. Inotropic agent support may prevent the hemodynamic instability caused by initiation of epoprostenol; however, a protocol for supportive therapy has not been established. Objectives: To assess the reliability and prognostic effects of dobutamine and dopamine support at the initiation of epoprostenol therapy in patients with PAH. Methods: We initiated epoprostenol therapy in 71 patients with PAH. Hemodynamics at the initiation of epoprostenol were measured by right heart catheterization. We initiated dobutamine when a patient's mixed venous oxygen saturation was less than 60% or cardiac index was less than 2.0 L/min/m2 or when right ventricular failure was clinically suspected. We initiated dopamine when a patient's systolic blood pressure was less than 90 mm Hg or urine volume was less than 20 ml/h. Measurements and Main Results: At the initiation of epoprostenol, dobutamine and/or dopamine were required to support 46 patients according to protocol. Eight patients died during the hospitalization and one patient received a living-donor lobar lung transplant after the initiation of epoprostenol therapy. Neither inotropic agent was an independent risk factor for short-term mortality (dobutamine: hazard ratio, 1.63; 95% confidence interval, 0.33-8.11; dopamine: hazard ratio, 0.22; 95% confidence interval, 0.03-1.70). Sixty-two patients were discharged for home infusion of epoprostenol. Transplant-free survival rates at 5 years were 80.0% for patients who did not require inotropic support at the start of epoprostenol and 76.6% for patients with who did require dopamine and/or dobutamine support (P = 0.45). Conclusions: Temporary use of dobutamine and dopamine appears to be safe for hemodynamic support at the initiation of epoprostenol therapy for selected patients with PAH with low cardiac output and hypotension. The protocol presented here requires validation at other centers.

KW - Dobutamine

KW - Dopamine

KW - Heart failure

KW - Right ventricle

UR - http://www.scopus.com/inward/record.url?scp=84903585758&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84903585758&partnerID=8YFLogxK

U2 - 10.1513/AnnalsATS.201308-268OC

DO - 10.1513/AnnalsATS.201308-268OC

M3 - Article

VL - 11

SP - 719

EP - 727

JO - Annals of the American Thoracic Society

JF - Annals of the American Thoracic Society

SN - 2325-6621

IS - 5

ER -