Journal of Rare Cardiovascular Diseases

The key point in the diagnostic algorithm for pulmonary hypertension plays the pulmonary reactivity testing, the agent most frequently used in the test is inhaled nitric oxide (iNO). Various dosages of iNO were used in acute vasoreactivity testing so far, so we aimed to determine the most effective dose of iNO administered in the acute vasoreactivity testing. Ten consecutive patients was enrolled to the open label study. To assess the most effective dose of iNO increasing concentrations of iNO: 10 ppm, 20 ppm and 30 ppm were administered. In the study statistically significant reduction in mean pulmonary artery pressure after each dose of iNO as compared to baseline was found. There were no significant differences in mean pulmonary artery pressure between subsequent iNO doses (10 ppm vs. 20 ppm, 20 ppm vs. 30 ppm). Statistically significant reduction of systolic pulmonary artery pressure after iNO at the dose of 20 ppm as compared to a dose of 10 ppm was observed. No significant side effects during iNO administration were observed. We concluded that the dose of inhaled nitric oxide used in the acute vasoreactivity testing should not exceed 20 ppm, it is effective and safe dose.

PAH; reactive pulmonary hypertension; iNO; right heart catheterization

Nazzareno G, Marius MH, Humbert M, et al. Guidelines for the diagnosis and treatment of pulmonary hypertension. The Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J 2009; 30: 2493–2537.

Rich S, Kaufmann E, Levy P, et al. The effect of high doses of calcium channel blockers on survival in primary pulmonary hypertension. N Engl J Med 1992; 327: 76–81.

Świerad M, Maruszewski M, Zakliczyński M et al. Odwracalność nadciśnienia płucnego – kiedy i w jaki sposób to oceniać, jak interpretować. Kardiochir Torakochir Pol 2007; 4:79–82.

Stobierska-Dzierżek B, Awad H, Michler RE. The evolving management of acute right-sided heart failure in cardiac transplant recipients. J Am Coll Cardiol 2001; 38: 923–931.

Mehra MR, Kobashigawa J, Starling R, et al. Listing criteria for heart transplantation: International Society for Heart and Lung Transplantation guidelines for the care of cardiac transplant candidates–2006, J Heart Lung Transplant 2006; 25: 1024–1042.

Griffits MJ, Evans T. Inhaled nitric oxide therapy in adults. N Engl J Med 2005; 353: 2683–2695.

Budts W, Van Pelt N, Gillyns H, et al. Residual pulmonary vasoreactivity to inhaled nitric oxide in patients with severe obstructive pulmonary hypertension and Eisenmenger syndrome. Heart 2001; 86: 553–558.

Krasuski RA, Warner JJ, Wang A, et al. Inhaled nitric oxide selectively dilates pulmonary vasculature in adult patients with pulmonary hypertension, irrespective of etiology. J Am Coll Cardiol 2000; 36: 2204–2211.

Hayward CS, Kelly RP., Macdonald PS. Inhaled nitric oxide in cardiology practice. Cardiovasc Res 1999; 43: 628–638.

Shah AM, Vallance P, Harrison D. NO in the cardiovascular system. Cardiovasc Res 1999; 43: 507–8.

Chen EP, Bittner HB, Davis RD, et al. Hemodynamic and inotropic effects of nitric oxide in pulmonary hypertension. J Surg Res 1997; 69: 288–94.

Sitbon O, Brenot F, Denjean A, et al. Inhaled nitric oxide as a screening vasodilator agent in primary pulmonary hypertension. A dose-response study and comparison with prostacyclin. Am J Respir Crit Care Med 1995; 151: 384–389.