Clinical study: systemic and pulmonary hypertension
Effects of the oral endothelin-receptorantagonist bosentan on echocardiographicand doppler measures in patients with pulmonary arterial hypertension

https://doi.org/10.1016/S0735-1097(03)00121-9Get rights and content
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Abstract

Objectives

The purpose of this study was to investigate the effects of bosentan (125 or 250 mg twice daily) on echocardiographic and Doppler variables in 85 patients with World Health Organization class III or IV pulmonary arterial hypertension (PAH).

Background

Bosentan, an orally active dual endothelin-receptor antagonist, improves symptoms, exercise capacity, and hemodynamics in patients with PAH.

Methods

Patients had primary pulmonary hypertension (84%) or PAH associated with connective tissue disease. Of these, 29 patients received placebo and 56 received bosentan (1:2 randomization). Six-minute walk tests and echocardiograms were performed at baseline and after 16 weeks of treatment.

Results

Baseline characteristics were similar in the placebo and bosentan groups, and echocardiographic and Doppler findings were consistent with marked abnormalities of right ventricular (RV) and left ventricular (LV) structure and function that were due to PAH. The treatment effect on 6-min walking distance was 37 m in favor of bosentan (p = 0.036). Treatment effects of bosentan compared with placebo on other parameters were as follows: Doppler-derived cardiac index = +0.4 l/min/m2(p = 0.007), LV early diastolic filling velocity = +10.5 cm/s (p = 0.003), LV end-diastolic area = +4.2 cm2(p = 0.003), LV systolic eccentricity index = −0.12 (p = 0.047), RV end-systolic area = −2.3 cm2(p = 0.057), RV:LV diastolic areas ratio = −0.64 (p = 0.007), Doppler RV index = −0.06 (p = 0.03), and percentage of patients with an improvement in pericardial effusion score = 17% (p = 0.05).

Conclusions

Bosentan improves RV systolic function and LV early diastolic filling and leads to a decrease in RV dilation and an increase in LV size in patients with PAH.

Keywords

BREATHE-1
Bosentan Randomized trial of Endothelin Antagonist Therapy for pulmonary hypertension
LV
left ventricle/ventricular
PAH
pulmonary arterial hypertension
PPH
primary pulmonary hypertension
RV
right ventricle/ventricular
WHO
World Health Organization

Cited by (0)

This study was supported by Actelion Pharmaceuticals Ltd., Allschwil, Switzerland.