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European Journal of Echocardiography Advance Access originally published online on November 28, 2008
European Journal of Echocardiography 2009 10(3):433-438; doi:10.1093/ejechocard/jen308
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org.

Duration of right ventricular contraction predicts the efficacy of bosentan treatment in patients with pulmonary hypertension

Mariëlle G.J. Duffels1,2,*, Maxim Hardziyenka1,2, Sulaiman Surie3, Rianne H.A.C.M de Bruin-Bon1, Elke S. Hoendermis4, Arie P.J. van Dijk5, Berto J. Bouma1, Hanno L. Tan1, Rolf M.F. Berger6, Paul Bresser3 and Barbara J.M. Mulder1,7

1 Department of Cardiology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
2 Interuniversity Cardiology, Institute of the Netherlands (ICIN), The Netherlands
3 Department of Pulmonology, Academic Medical Center, Amsterdam, The Netherlands
4 Department of Cardiology, University Medical Center Groningen, The Netherlands
5 Department of Cardiology, University Medical Center Nijmegen, The Netherlands
6 Department of Paediatric Cardiology, University Medical Center Groningen, The Netherlands
7 Department of Cardiology, University Medical Center Utrecht, The Netherlands

Received 8 August 2008; accepted after revision 4 November 2008; online publish-ahead-of-print 28 November 2008.

* Corresponding author. Tel: +31 20 5662193; fax: +31 20 5666809. E-mail address: b.j.mulder{at}amc.uva.nl


  Abstract

Aims: In patients with pulmonary hypertension (PH), elevated endothelin-1 levels are associated with prolonged duration of right ventricular (RV) contraction, which induces leftward ventricular septal bowing with impaired left diastolic filling. We hypothesized that baseline RV contraction duration predicts efficacy of endothelin receptor antagonist, bosentan.

Methods and results: Eighteen PH patients (age 57, range 35–79 years, 33% male) received bosentan. Six minute walk distance (6-MWD) and echocardiography were performed at baseline and after 1 year follow-up. After 1 year of treatment, 6-MWD increased (mean 60 ± 41 m) in 67% of patients (responders). Baseline RV contraction duration was longer in responders, compared with non-responders (612 ± 66 vs. 514 ± 23 ms; P < 0.01). A baseline RV contraction duration >550 ms was associated with improved 6-MWD (sensitivity 83%, specificity 83%; P < 0.01).

Conclusion: An improvement of 6-MWD during bosentan treatment was associated with a decrease in RV contraction duration and could be predicted by a baseline RV contraction duration >550 ms.

Keywords: Pulmonary hypertension; Congenital heart disease; Chronic thromboembolic pulmonary hypertension; Echocardiography; Bosentan treatment


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