What is the clinical evidence from this study?

Study design: Observational. Population: Pulmonary hypertension due to left heart disease (PH-LHD) (n=18). Intervention: Inhaled nitric oxide (iNO) vs. Baseline (pre-intervention). Primary outcome: Change in pulmonary vascular resistance (PVR) in Wood Units (p=<0.001).

What question did this study set out to answer?

To evaluate the effectiveness of inhaled nitric oxide during acute vasodilator challenge for predicting pulmonary hemodynamic reversibility in candidates for heart transplantation with PH-LHD.

April 1, 2026Open Access

Utility of Acute Vasodilator Challenge with Inhaled Nitric Oxide to Predict Pulmonary Hemodynamic Reversibility in Patients with Pulmonary Hypertension due to Left Heart Disease Referred for Heart Transplantation

Q: What are the key findings of this study?

Acute vasodilator challenge with inhaled nitric oxide significantly reduced pulmonary vascular resistance from 5.2 to 2.9 Wood Units in patients with pulmonary hypertension due to left heart disease.

Q: What question did this study set out to answer?

To evaluate the effectiveness of inhaled nitric oxide during acute vasodilator challenge for predicting pulmonary hemodynamic reversibility in candidates for heart transplantation with PH-LHD.

Key Result

Acute vasodilator challenge with inhaled nitric oxide significantly reduced pulmonary vascular resistance from 5.2 to 2.9 Wood Units in patients with pulmonary hypertension due to left heart disease.

Key Points

To evaluate the effectiveness of inhaled nitric oxide during acute vasodilator challenge for predicting pulmonary hemodynamic reversibility in candidates for heart transplantation with PH-LHD.
Conducted an acute vasodilator challenge with inhaled nitric oxide on heart transplant candidates with pulmonary hypertension due to left heart disease.
Monitored pulmonary hemodynamics during the intervention to assess reversibility.
Compared results against traditional vasodilators like nitroprusside and milrinone.
Inhaled nitric oxide was found to be a safe alternative for evaluating vasodilatory response.
Patients showing significant pulmonary hemodynamic improvement with iNO were more likely to have better post-transplant outcomes.
Greater mortality rates were noted in patients without reversibility in hemodynamics.

Study Design

Type

Observational (n=18)

Multicenter

Structured PICO

Does acute vasodilator challenge with inhaled nitric oxide safely assess pulmonary hemodynamic reversibility and predict post-LVAD response in patients with PH-LHD referred for heart transplantation?

Population

Patients with pulmonary hypertension due to left heart disease (PH-LHD) referred for heart transplantation, mean age 41.4 years, 83.3% male.

Intervention

Acute vasodilator challenge (AVC) with inhaled nitric oxide (iNO) at 20 ppm continuously for 10 minutes.

Outcome

Hemodynamic changes (mPAP, PVR, PAWP, CI) and safety of AVC with iNO.surrogate

Acute vasodilator challenge with inhaled nitric oxide safely evaluates pulmonary vascular resistance reversibility and its dynamic changes correlate with post-LVAD hemodynamic improvements in patients with PH-LHD.

Main Result

Absolute Event Rate: 2.9% vs 5.2%

p-value: p=<0.001

Limitations

Retrospective, single-center study
Small cohort size
Various heart failure etiologies
Potential selection bias
Data collected prior to widespread use of SGLT2 inhibitors and ARNIs

Abstract

Pulmonary hypertension due to left heart disease (PH-LHD) in heart transplantation (HTx) candidates is associated with increased post-transplant mortality. Although guidelines recommend acute vasodilator challenge (AVC) with nitroprusside or milrinone, the safety and utility of inhaled nitric oxide (iNO) for AVC in this setting remain unclear.

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