Transition from selexipag to oral treprostinil in a patient with pulmonary arterial hypertension

Prostacyclins are the mainstay treatment for patients with severe pulmonary arterial hypertension. This case highlights the transition from selexipag to oral treprostinil. Our patient improved both subjectively and objectively. Cardiac output and index, as measured by the echocardiogram, improved 12% and 7.7%, respectively. Invasive hemodynamic data revealed greater improvements: cardiac output improved by 25% and cardiac index by 28%. Mixed venous oxygen saturation improved from 65% to 71%. A possible explanation is that selexipag has a maximal dose, whereas there is no recommended maximum dose of oral treprostinil. Another theory is oral treprostinil has higher affinity to the IP receptor, though selexipag has a higher specificity. However, there are no bio-equivalency data, and data comparing pharmacodynamics of both drugs are lacking. Furthermore, no head-to-head trials comparing these agents exist.

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Agreement of Central Venous Saturation and Mixed Venous Oxygen Saturation in Patients With Pulmonary Arterial Hypertension After Cardiac Surgery

Heart Lung and Circulation ◽

10.1016/j.hlc.2018.04.168 ◽

2018 ◽

Vol 27 ◽

pp. S560-S561

Author(s):

Shuai Hu ◽

Zhi-Yan Han ◽

Xiao-Jian Wang ◽

Yi Sun ◽

Dian-Yuan Li

Keyword(s):

Cardiac Surgery ◽

Pulmonary Arterial Hypertension ◽

Arterial Hypertension ◽

Oxygen Saturation ◽

Mixed Venous Oxygen Saturation ◽

Central Venous ◽

Venous Oxygen Saturation ◽

Central Venous Saturation ◽

Pulmonary Arterial ◽

Mixed Venous

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Different Prognostic Implications of Cardiac Index and Mixed Venous Oxygen Saturation in Idiopathic and Heritable Pulmonary Arterial Hypertension

10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a6797 ◽

2019 ◽

Author(s):

A. Almoushref ◽

T. Naal ◽

B. Abuhalimeh ◽

R.A. Dweik ◽

G.A. Heresi ◽

...

Keyword(s):

Pulmonary Arterial Hypertension ◽

Cardiac Index ◽

Arterial Hypertension ◽

Oxygen Saturation ◽

Mixed Venous Oxygen Saturation ◽

Venous Oxygen Saturation ◽

Pulmonary Arterial ◽

Prognostic Implications ◽

Heritable Pulmonary Arterial Hypertension ◽

Mixed Venous

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Mixed Venous Oxygen Saturation Is a Better Prognosticator Than Cardiac Index in Pulmonary Arterial Hypertension

CHEST Journal ◽

10.1016/j.chest.2020.06.053 ◽

2020 ◽

Vol 158 (6) ◽

pp. 2546-2555 ◽

Cited By ~ 2

Author(s):

Ghaleb Khirfan ◽

Allaa Almoushref ◽

Tawfeq Naal ◽

Batool Abuhalimeh ◽

Raed A. Dweik ◽

...

Keyword(s):

Pulmonary Arterial Hypertension ◽

Cardiac Index ◽

Arterial Hypertension ◽

Oxygen Saturation ◽

Mixed Venous Oxygen Saturation ◽

Venous Oxygen Saturation ◽

Pulmonary Arterial ◽

Mixed Venous

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A modelling study of atrial septostomy for pulmonary arterial hypertension, and its effect on the state of tissue oxygenation and systemic blood flow

Cardiology in the Young ◽

10.1017/s1047951109991855 ◽

2010 ◽

Vol 20 (1) ◽

pp. 25-32 ◽

Cited By ~ 13

Author(s):

Gerhard-Paul Diller ◽

Astrid E. Lammers ◽

Sheila G. Haworth ◽

Konstantinos Dimopoulos ◽

Graham Derrick ◽

...

Keyword(s):

Cardiac Output ◽

Pulmonary Arterial Hypertension ◽

Arterial Hypertension ◽

Right Ventricular ◽

Tissue Oxygenation ◽

Arterial Blood ◽

Atrial Septostomy ◽

Pulmonary Arterial ◽

Mixed Venous ◽

Content Of Oxygen

AbstractAtrial septostomy is performed in patients with severe pulmonary arterial hypertension, and has been shown to improve symptoms, quality of life and survival. Despite recognized clinical benefits, the underlying pathophysiologic mechanisms are poorly understood. We aimed to assess the effects of right-to-left shunting on arterial delivery of oxygen, mixed venous content of oxygen, and systemic cardiac output in patients with pulmonary arterial hypertension and a fixed flow of blood to the lungs. We formulated equations defining the mandatory relationship between physiologic variables and delivery of oxygen in patients with right-to-left shunting. Using calculus and computer modelling, we considered the simultaneous effects of right-to-left shunting on physiologies with different pulmonary flows, total metabolic rates, and capacities for carrying oxygen. Our study indicates that, when the flow of blood to the lungs is fixed, increasing right-to-left shunting improves systemic cardiac output, arterial blood pressure, and arterial delivery of oxygen. In contrast, the mixed venous content of oxygen, which mirrors the average state of tissue oxygenation, remains unchanged. Our model suggests that increasing the volume of right-to-left shunting cannot compensate for right ventricular failure. Atrial septostomy in the setting of pulmonary arterial hypertension, therefore, increases the arterial delivery of oxygen, but the mixed systemic saturation of oxygen, arguably the most important index of tissue oxygenation, stays constant. Our data suggest that the clinically observed beneficial effects of atrial septostomy are the result of improved flow of blood rather than augmented tissue oxygenation, provided that right ventricular function is adequate.

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