Therapy with sildenafil in a patient with pulmonary hypertension associated with end‑stage left ventricular failure (RCD code: II‑1B.1)

Magdalena Nowacka, Grzegorz Kopeć, Piotr Podolec

Full Text:



In the last decade the great progress was made in the therapy of pulmonary arterial hypertension (PAH). Unfortunately, there is still lack of evidence-based data how to manage with pulmonary hypertension due to left heart diseases (PH-LHD). Approximately 60% of  patients with heart failure with reduced ejection fraction (HFREF) develop PH-LHD and this condition is associated with a very poor prognosis. We report the case of 51-year-old man with a history of myocardial infarction, with HFREF who was previously disqualified from heart transplantation (HTX) due to PH. We added sildenafil (20 mg t.i.d.) to the standard therapy of HFREF in this patient. After 3 months of treatment with sildenafil we observed improvement in hemodynamic parameters, right and left ventricle performance as well as exercise capacity. Although we demonstrated the benefit of treatment with sildenafil in so called “no option” patients, further randomized trials are needed to confirm the advantage of sildenafil therapy in patients with PH due to HFREF. JRCD 2014; 1 (8): 27–31


phosphodiesterase type 5, reduced ejection fraction, pulmonary wedge pressure


Hoeper MM, Barbera JA, Channick RN, et al. Diagnosis, assessment, and treatment of non-pulmonary arterial hypertension pulmonary hypertension. Am Coll Cardiol 2009; 54(1 Suppl): S85–96.

Galie N, Hoeper MM, Humbert M, et al. Guidelines for the diagnosis and treatment of pulmonary hypertension. The Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J 2009; 30: 2493–2537.

Ghio S, Gavazzi A, Campana C. Independent and additive prognostic value of right ventricular systolic function and pulmonary artery pressure in patients with chronic heart failure. J Am Coll Cardiol 2001; 37: 183–188.

Butler J, Chomsky DB, Wilson JR. Pulmonary hypertension and exercise intolerance in patients with heart failure. J Am Coll Cardiol. 1999; 34: 1802–1806.

Baker BJ, Wilen MM, Boyd CM, et al. Relation of right ventricular ejection fraction to exercise capacity in chronic left ventricular failure. Am J Cardiol. 1984; 54: 596–599.

De Groote P, Millaire A, Foucher-Hossein C, et al. Right ventricular ejection fraction is an independent predictor of survival in patients with moderate heart failure. J Am Coll Cardiol. 1998; 32: 948–954.

Meluzin J, Spinarova L, Hude P, et al. Combined right ventricular systolic and diastolic dysfunction represents a strong determinant of poor prognosis in patients with symptomatic heart failure. Int J Cardiol. 2005; 105: 164–173.

Paulus WJ, Tschope C, Sanderson JE. How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J 2007; 28: 2539–2550.

Chang PP, Longenecker JC, Wang NY, et al. Mild vs severe pulmonary hypertension before heart transplantation: different effects on posttransplantation pulmonary hypertension and mortality. J Heart Lung Transplant 2005; 24: 998 –10 07.

Sitbon O, Humbert M, Jais X, et al. Long-term response to calcium channel blockers in idiopathic pulmonary arterial hypertension. Circulation 2005; 111: 3105 –3111.

Nowacka M, Kopec G., Stepniewski J, Podolec P. Nitric oxide vs Sildenafil for pulmonary artery reactivity testing in heart transplantation candidates. Journal of Rare Cardiovascular Diseases 2012; 1: 7–9.

McMurray JJ, Adamopoulos S, Anker SD, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 2012; 33: 1787–1847.

Dalen JE, Matloff JM, Evans GL. Early reduction of pulmonary vascular resistance after mitral valve replacement. N Engl J Med 1967; 277: 387–394.

Califf RM, Adams KF, McKenna WJ, et al. A randomized controlled trial of epoprostenol therapy for severe congestive heart failure: The Flolan International Randomized Survival Trial (FIRST). Am Heart J. 1997; 134: 44–54.

Packer M. Multicentre, double-blind, placebo-controlled study of long-term endothelin blockade with bosentan in chronic heart failure – results of the REACH-1 trial. Circulation (Suppl.) 1998; 98: I–3.

Kalra PR, Moon JC, Coats AJ. Do results of the ENABLE (Endothelin Antagonist Bosentan for Lowering Cardiac Events in Heart Failure) study spell the end for non-selective endothelin antagonism in heart failure? Int J Cardiol 2002; 85: 195–197.

Lewis GD, Shah R, Shahzad K, et al. Sildenafil improves exercise capacity and quality of life in patients with systolic heart failure and secondary pulmonary hypertension. Circulation 2007; 116: 1555–1562.

Guazzi M, Vicenzi M, Arena R, Guazzi MD. PDE5 inhibition with sildenafil improves left ventricular diastolic function, cardiac geometry, and clinical status in patients with stable systolic heart failure: results of a 1-year, prospective, randomized, placebo-controlled study. Circ Heart Fail. 2011; 4:8–17.

Guazzi M, Samaja M, Arena R, et al. Long-Term Use of Sildenafil in the Therapeutic Management of Heart Failure. J Am Coll Cardiol. 2007; 50: 2136–2144.

Lepore JJ, Maroo A, Bigatello LM, et al. Hemodynamic effects of sildenafil in patients with congestive heart failure and pulmonary hypertension. Chest 2005; 127: 1647–1653.

Alaeddini J, Uber PA, Park MH, et al. Efficacy and safety of sildenafil in the evaluation of pulmonary hypertension in severe heart failure. Am J Cardiol. 2004; 94: 1475–1477.

Amin A, Mahmoudi E, Navid H, Chitsazan M. Is chronic sildenafil therapy safe and clinically beneficial in patients with systolic heart failure? Congest Heart Fail. 2013; 19: 99–103.

Hirata K., Adji A., Vlachopoulos C., O’Rourke M.F. Effect of sildenafil on cardiac performance in patients with heart failure. Am J Cardiol. 2005; 96: 1436–1440.

Borlaug BA, Melenovsky V, Marhin T, et al. Sildenafil inhibits beta-adrenergic-stimulated cardiac contractility in humans. Circulation 2005; 112: 2642–2649.

Zhang M, Takimoto E, Hsu S, et al. Myocardial remodeling is controlled by myocyte-targeted gene regulation of phosphodiesterase type 5. J Am Coll Cardiol 2010; 56: 2021–2030.

Butler J, Stankewicz MA, Wu J. Pre-transplant rversible pulmonary hypertension predicts higher risk for mortality after cardiac transplantation. J Heart Lung Transplant 2005; 24: 170–177.

Katz SD, Balidemaj K, Homma S, et al. Acute type 5 phosphodiesterase inhibition with sildenafil enhances flow-mediated vasodilation in patients with chronic heart failure. J Am Coll Cardiol. 2000; 36: 845–851.

Martin J, Siegenthaler MP, Friesewinkel O, et al. Implantable left ventricular assist device for treatment of pulmonary hypertension in candidates for orthotopic heart transplantation-a preliminary study. Eur J Cardiothorac Surg. 2004; 25: 971–977.

Mikus E, Stepanenko A, Krabatsch T, et al. Reversibility of fixed pulmonary hypertension in left ventricular assist device support recipients. Eur J Cardiothorac Surg. 2011; 40: 971–977.

Rose EA, Gelijns AC, Moskowitz AJ, et al. Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med 2001; 345: 1435–1443.

Kavarana MN, Pessin-Minsley MS, Urtecho J, et al. Right ventricular dysfunction and organ failure in left ventricular assist device recipients: a continuing problem. Ann Thorac Surg. 2002; 73: 745–750.



  • There are currently no refbacks.
Journal of Rare Cardiovascular Diseases (JRCD)
John Paul II Hospital in Kraków, 80 Prądnicka Str., 31-202 Kraków, Poland
Phone: +48 (12) 614 33 99, +48 (12) 614 34 88 Fax: +48 (12) 614 34 88
Published by SoftQ sp. z o.o.
ul. Oleandry 2, 30-063 Kraków, Poland
Phone: +48 (12) 444 1650 Fax: +48 (12) 444 1659