Characterization of LV Strain Patterns in Mildly Elevated PCWP and PAH. (LV strain)
Hypertension, Pulmonary Artery, Ventricular Dysfunction, Left
About this trial
This is an interventional diagnostic trial for Hypertension, Pulmonary Artery focused on measuring Pulmonary Artery Hypertension, pulmonary capillary wedge pressure, sildenafil, echocardiography, left ventricular longitudinal wall strain, strain rate pre and post medical therapy, speckle tracking
Eligibility Criteria
Inclusion Criteria:
- Patients with New York Heart Association/World Health Organization(NYHA/WHO)functional class II-III
- Patients with mean pulmonary artery pressure >25 mmHg, pulmonary capillary wedge pressure >15 mmHg ≤18, and pulmonary vascular resistance >3 wood units
- Age >18 and <80
- Stable on antihypertensives and diuretics>3 months
- No evidence of active ischemic heart disease
- 6 minute walk distance >150 meters and <450 meters
Exclusion Criteria:
- - Left ventricular ejection fraction <50%
- Patients with significant restrictive lung disease (FVC<60% predicted) and/or significant obstructive lung disease (FEV1 <55% predicted) within 1 year of enrollment
- Poorly interpretable grey scale echocardiographic images
- Contraindications to right heart catheterization
- Nitroglycerin therapy
- Moderate-severe aortic and mitral valve abnormality
- Contraindications to submaximal exercise testing
Sites / Locations
- University of Arizona Medical Center
Arms of the Study
Arm 1
Experimental
sildenafil therapy
Subjects will have 2D-Echocardiogram measuring left ventricular strain and strain rate using speckle tracking techniques, have 6 minute walk test, World Health Organization functional class (I-IV)assignment, and BNP lab result at baseline and at 3 months. Subjects will be started on sildenafil at 20 mg by mouth three times per day at the baseline visit. Each individual will serve as his/her own control.