Copyright © 2003 by the European Society of Cardiology.
Assessment of the vasodilator response in primary pulmonary hypertension
Comparing prostacyclin and iloprost administered by either infusion or inhalation
a Department of Cardiology, DRK-Kliniken Westend, Medizinische Klinik II, Spandauer Damm 130,14050 Berlin, Germany
b Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum, Berlin, Germany
c Department of Chemistry, Humboldt University, Berlin, Germany
Received February 11, 2002;
accepted April 17, 2002
* Corresponding author. Tel.: +49-30-3035-4305; fax: +49-30-3035-4309
c.opitz{at}drk-kliniken-bln.de
Aims To directly compare the differential effects of oxygen, prostacyclin and iloprost (aerosolized and intravenous) in primary pulmonary hypertension.
Methods and results Twenty-one patients with severe primary pulmonary hypertension underwent right heart catheterization following oxygen inhalation, inhalation of aerosolized iloprost, intravenous prostacyclin or intravenous iloprost. The stability of the iloprost solution was tested for up to 4 weeks. Oxygen slightly decreased pulmonary vascular resistance. Intravenous prostacyclin (7.2±3.4ngkg–1min–1) reduced pulmonary (1772±844 vs 1325±615dynscm–5, 
) and systemic vascular resistance, and arterial and right atrial pressure, while cardiac output increased. Iloprost inhalation diminished pulmonary (1813±827 vs 1323±614dynscm–5, ) and systemic vascular resistance, and pulmonary artery (58±12 vs 50±12mmHg,) and right atrial pressure, while cardiac output increased. With intravenous iloprost (1.2±0.5ngkg–1min–1, 
) a decrease in pulmonary (2202±529 vs 1515±356dynscm–5, 
) and systemic vascular resistance and right atrialpressure occurred while cardiac output increased. Iloprost solution remained stable for 33 days while losing <10% (4°C) of its active drug concentration.
Conclusions Intravenous iloprost and prostacyclin have very similar haemodynamic profiles. In contrast, only inhaled iloprost exerted selective pulmonary vasodilation, reducing pulmonary vascular resistance and pulmonary artery pressure withoutsystemic vasodilation. The longer half-life and extended stability despite lower costs render iloprost an attractive alternative to chronic prostacyclin treatment in primary pulmonary hypertension.
Key Words: Pulmonary hypertension • Prostaglandin • Prostacyclin • Inhaled iloprost
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