Hemodynamics of Obliterative Pulmonary Hypertension With the Acute Vasodilator Test

Objective:To study the hemodynamics of obliterative pulmonary hypertension including chronic thromboembolic pulmonary hypertension(CTEPH)and primary(idiopathic)pulmonary hypertension(PPH)with the acute vasodilator test of western medicine and traditional herbal medicine.Methods:We studied 115 eligible patients with obliterative pulmonary hypertension including 46 CTEPH and 69 PPH in 1980s.We observed the hemodynamic characters of the right heart,and performed the acute vasodilator test as follows:Pure oxygen inhalation in 49 patients,Nifedipine 20mg for sublingual administration in 21 patients,and Ligustrajine 80mg for intravenous administration in 18 patients.Results:There were 82.60%(95/115)of diagnosed patients suffered from moderate or severe pulmonary hypertension(mPAP40mmHg,1 mmHg=0.133 kPa),and 56.52%(65/115)of them combined with right heart failure.In PPH group,the patients' heart rate,pulmonary arterial pressure(systolic,diastolic and the mean pressure),and cardiac index were higher than those in CTEPH group(P0.05～0.001),however,the systemic blood pressure was higher in CTEPH group(P0.05).There were 76%(37/49)of patients with oxygen inhalation showed decreased pulmonary arterial pressure,while 7 cases showed paradoxical elevation of pulmonary arterial pressure and 5 of them from CTEPH group.Nifedipine decreased the systemic circulation resistance,increased the cardiac index and slightly reduced pulmonary vascular resistance,only 19%(4/21)of them had pulmonary vascular dilation and some patients suffered from obvious side effect.Ligustrajine had weak effect for reducing the pressure of pulmonary circulation and meanwhile with the mild side effect.Conclusion:The majority of patients with obliterative pulmonary hypertension suffered from moderate or severe pulmonary hypertension as being diagnosed in 1980s,and therefore,their prognosis was not ideal.With the acute vasodilator test,Nifedipine caused obvious side effect and not a good choice in clinical practice,while Ligustrajine showed no real effect for reducing the pressure of pulmonary circulation.