Acute Vasoreactivity Testing With Nicardipine in Patients With Pulmonary Arterial Hypertension

Yukihiro Saito; Kazufumi Nakamura; Katsumasa Miyaji; Satoshi Akagi; Hiroki Mizoguchi; Aiko Ogawa; Soichiro Fuke; Hideki Fujio; Takahiko Kiyooka; Satoshi Nagase; Kunihisa Kohno; Hiroshi Morita; Kengo F Kusano; Hiromi Matsubara; Tohru Ohe; Hiroshi Ito

doi:10.1254/jphs.12114FP

Full Paper

Acute Vasoreactivity Testing With Nicardipine in Patients With Pulmonary Arterial Hypertension

Yukihiro Saito, Kazufumi Nakamura, Katsumasa Miyaji, Satoshi Akagi, Hiroki Mizoguchi, Aiko Ogawa, Soichiro Fuke, Hideki Fujio, Takahiko Kiyooka, Satoshi Nagase, Kunihisa Kohno, Hiroshi Morita, Kengo F Kusano, Hiromi Matsubara, Tohru Ohe, Hiroshi Ito

Author information

Yukihiro Saito
Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
Kazufumi Nakamura
Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
Katsumasa Miyaji
Division of Cardiology, National Hospital Organization, Okayama Medical Center, Japan
Satoshi Akagi
Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
Hiroki Mizoguchi
Division of Cardiology, National Hospital Organization, Okayama Medical Center, Japan
Aiko Ogawa
Division of Cardiology, National Hospital Organization, Okayama Medical Center, Japan
Soichiro Fuke
Department of Cardiology, Japanese Red Cross Okayama Hospital, Japan
Hideki Fujio
Department of Cardiology, Japanese Red Cross Society Himeji Hospital, Japan
Takahiko Kiyooka
Division of Cardiology, Tokai University Oiso Hospital, Japan
Satoshi Nagase
Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
Kunihisa Kohno
Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
Hiroshi Morita
Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
Kengo F Kusano
Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
Hiromi Matsubara
Division of Cardiology, National Hospital Organization, Okayama Medical Center, Japan
Tohru Ohe
Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
Hiroshi Ito
Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan

Keywords: calcium-channel blocker, acute vasoreactivity testing, pulmonary arterial hypertension

JOURNAL FREE ACCESS

2012 Volume 120 Issue 3 Pages 206-212

DOI https://doi.org/10.1254/jphs.12114FP

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Abstract

Acute vasoreactivity testing for patients with pulmonary arterial hypertension (PAH) has been reported to be useful to identify patients with sustained beneficial response to oral calcium-channel blockers (CCBs), but there is a risk of exacerbation during the testing with oral CCBs. Therefore, we developed a testing method utilizing intravenous nicardipine, a short-acting CCB, and examined the safety and usefulness of acute vasoreactivity testing with nicardipine in PAH patients. Acute vasoreactivity testing with nicardipine was performed in 65 PAH patients. Nicardipine was administered by short-time continuous infusion (1 μg·kg⁻¹·min⁻¹ for 5 min and 2 μg·kg⁻¹·min⁻¹ for 5 min) followed by bolus injection (5 μg/kg). Hemodynamic responses were continuously measured using a right heart catheter. Acute responders were defined as patients who showed a decrease in mean pulmonary artery pressure of at least 10 mmHg to an absolute level below 40 mmHg with preserved or increased cardiac output. Two acute responders and sixty-three non-acute responders were identified. There was no hemodynamic instability requiring additional inotropic agents or death during the testing. Acute responders had good responses to long-term oral CCBs. The acute vasoreactivity testing with nicardipine might be safe and useful for identifying CCB responders in PAH patients.

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