الفهرس 
Pulmonary HypertensionOnly 14 pages are availabe for public view
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Abstract
Pulmonary hypertension is a syndrome resulting from restricted flow through the pulmonary arterial circulation resulting in increased pulmonary vascular circulation resistance and right heart failure (ACCF/AHA, 2009).
The therapy of pulmonary hypertension has evolved rapidly in the last 10 years from the use of non-selective vasodilators to drugs that specifically target pulmonary vasodilation, endothelial function and vascular remodeling. Sildenafil is a phosphodiestrase type 5 inhibitior that has an expanding role in the treatment of pulmonary hypertension (Barnett and Machado, 2006).
CPET is increasingly being used in a wide spectrum of clinical applications for the objective determination of functional capacity and impairment. The use of CPET in patient management is increasing with the understanding that resting pulmonary and cardiac function testing cannot reliably predict exercise performance and function capacity (ATS/ACCP, 2003).
The aim of this study was to evaluate the role of CPET in the assessment of patients with chronic pulmonary hypertension and in evaluating the effect of sildenafil as a modality of treatment in these cases.
The study was conducted upon thirty patients with pulmonary hypertension at Ain Shams University Hospital in the period between April 2008 and June 2010. The included patients (18 males and 12 females) had a mean age of 48.77 ± 14.3 yrs, 3 patients had primary pulmonary hypertension, whereas the remaining 27 patients had secondary pulmonary hypertension. The diagnosis of pulmonary hypertension was based upon; detailed history taking, thorough clinical examination as well as serial of investigations including resting TTE.
Before the onset of treatment with sildenafil therapy, all patients were subjected to: HRQoL (SF-36) questionnaire, CPET, simple spirometry, ABGs, TTE and all patients were classified according to the WHO functional classification.
Then all patients started twelve continuous weeks with sildenafil therapy at a dose of 0.5mg/kg/day after which the whole study population underwent reassessment by repeating the previously mentioned assessment tools done before sildenafil therapy.
The main results of this study were:
1- Significant improvement after sildenafil therapy regarding:
o RVSP.
o WHO functional classification.
o Ventilatory efficiency parameters of CPET.
o Total score as well as individual domains of (SF-36) questionnaire (except social functioning domain).
2- Significant improvement after sildenafil therapy among patients with bilharzial cor-pulmonale in regarding RVSP and CPET ventilatory efficiency parameters.
3- Non-significant improvement after sildenafil therapy among patients with pulmonary hypertension secondary to COPD, CTEPH and interstitial lung diseases regarding RVSP, CPET ventilatory parameters and ABGs parameters.
4- Significant positive statistical correlation between RVSP and both the slope of minute ventilation versus carbon dioxide production and the same slope at anaerobic threshold before and after treatment.
5- Significant negative statistical correlation between WHO functional classification and physical role, body pain, emotional role domains as well as total score of (SF-36) health questionnaire before treatment.
6- Significant negative statistical correlation between WHO functional classification and total score of (SF-36) health questionnaire as well as all individual domains (except social functioning domain) after treatment.
7- Highly significant negative statistical correlation between WHO functional classification and pH, PO2 and SO2, highly significant positive statistical correlation with PCO2 after treatment.
8- Significant negative statistical correlation between WHO functional classification and slope of minute ventilation versus carbon dioxide production and the same slope at anaerobic threshold after treatment.
9- Significant negative statistical correlation between WHO functional classification and FEV1, FVC, MMEF and FEV1/FVC after treatment.
from the present study it is concluded that:
1- CPET is a safe and non-invasive method for assessment of pulmonary hypertension.
2- Sildenafil can be used safely in treatment of pulmonary hypertension with good tolerability.
3- Sildenafil improves both right ventricle pressure and functional class of patients with pulmonary hypertension.
4- Sildenafil improves HRQoL among patients with pulmonary hypertension. These improvements were strongest in domains addressing the physical impact of health on daily activities and patients overall perception of health.
5- The determination of the effect of a drug on HRQoL is an essential component of evaluating its impact on clinical and health care outcomes for the patients.
6- Sildenafil improves exercise capacity.
7- Sildenafil did not improve patients with pulmonary hypertension secondary to COPD, CTEPH and interstitial lung diseases.
8- Sildenafil improves patients with bilharzial cor-pulmonale.