Synopsis: In the multicenter, double-blind, randomized controlled SIOVAC trial, researchers found that patients with persistent pulmonary hypertension (PH) despite correction of valvular heart disease treated with sildenafil had worse composite clinical outcomes and increased admissions for heart failure exacerbations. This trial adds to the list of previous studies of group 2 PH in which phosphodiesterase-5 (PDE-5) inhibitors did not show clinical benefit. However, the population studied in this trial was not representative of the subpopulation of patients, with the hemodynamic phenotype of combined postcapillary and precapillary pulmonary hypertension, otherwise deemed “PH out of proportion to associated left heart disease,” a subset of patients that has shown benefit from PDE-5 inhibitors in other studies. More investigation into the use of PDE-5 inhibitors in the treatment of pulmonary hypertension secondary to left heart disease with the combined postcapillary and precapillary pulmonary hypertension phenotype is needed.
Source: Bermejo J, Yotti R, Garcia-Orta R, et al. Sildenafil for improving outcomes in patients with corrected valvular heart disease and persistent pulmonary hypertension: a multicenter, double-blind, randomized clinical trial. Eur Heart J. 2017; ehx700, https://doi.org/10.1093/eurheartj/ehx700.