Background: Elevated pulmonary vascular resistance (PVR) is a risk factor for early right ventricular failure and poor prognosis after heart transplantation (HT) as well as an indication for treatment with vasodilators. The aim of the study was to determine the relationship between the baseline values of the modified Model for End-Stage Liver Disease (modMELD) score and the presence of elevated PVR in patients with advanced heart failure (HF) after 6 months of sildenafil treatment.
Materials and methods: The study was a retrospective review of 86 adult patients with end-stage HF who were evaluated for HT at our institution between 2015 and 2017. All patients had reversible PVR according to right heart catheterization. They all received sildenafil therapy in the maximum tolerated doses. Before the inclusion of sildenafil, the modMELD scores were calculated based on the serum bilirubin, creatinine, and albumin levels. The study's endpoint was PVR >3 Wood units after 6 months of sildenafil therapy.
Results: The median age of the patients was 57 (50-63) years, and 91.9% of them were men. Elevated PVR values (>3 Wood units) after 6 months of sildenafil treatment were found in 36 patients (42%). The area under the ROC curve (AUC) for modMELD was 0.848 (95% CI: 0.768-0.929). The cutoff point for modMELD (>11.1) had a sensitivity of 97% and a specificity of 68%.
Conclusions: The modMELD score may be a useful indicator of the ineffectiveness of sildenafil treatment in patients with advanced HF evaluated for HT.
Published by Elsevier Inc.