Primary Pulmonary Hypertension: Improved Long-Term Effects and Survival With Continuous Intravenous Epoprostenol Infusion

Objectives. This study sought to determine the long-term effects of continuous infusion of epoprostenol (epo) therapy on survival and pulmonary artery pressure in patients with primary pulmonary hypertension (PPH). Background. PPH is progressive disease for which there are few effective therapies. Methods. Patients with PPH and New York Heart Association functional class III or IV symptoms of congestive heart failure underwent right heart catheterization and Doppler-echocardiography to measure the maximal systolic pressure gradient between the right ventricle and right atrium (ΔP) and cardiac output (CO). Doppler-echocardiography and catheterization dat were compared. Patients were followed up long term with Doppler-echocardiography. Results. Of 69 patients who went on to receive epo, 18 were followed up for >330 days (range 330 to 700). During long-term follow-up, there was significant reduction in ΔP, which decreased from 84.1 ± 24.1 to 62.7 ± 18.2 (mean ± SD, p < 0.01). Kaplan-Meier plot of survival of our study patients demonstrated improved survival compared with that of historical control subjects. The 1-, 2- and 3-year survival rates for our patients were 80% (n = 36), 76% (n = 22) and 49% (n = 6) compared with 10- (88%, n = 31), 20- (56%, n = 27) and 30-month (47%, n = 17) survival rates in historical control subjects. Conclusions. Patients receiving continuous infusion of epo for treatment of PPH experience decrease in pulmonary artery pressure. Long-term follow-up of this single-center patient group demonstrated improved long-term survival during epo therapy compared with that in historical control subjects and confirms predicted improved outcomes based on shorter follow-up periods.