701
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De Castro S, Cavarretta E, Milan A, Caselli S, Di Angelantonio E, Vizza Carmine D, Lucchetti D, Patel A, Kuvin J, Pandian NG. ORIGINAL INVESTIGATIONS: Usefulness of Tricuspid Annular Velocity in Identifying Global RV Dysfunction in Patients with Primary Pulmonary Hypertension: A Comparison with 3D Echo-Derived Right Ventricular Ejection Fraction. Echocardiography 2009; 25:289-93. [DOI: 10.1111/j.1540-8175.2007.00587.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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702
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Pande S, Agarwal SK, Dhir U, Chaudhary A, Kumar S, Agarwal V. Pulmonary arterial hypertension in rheumatic mitral stenosis: does it affect right ventricular function and outcome after mitral valve replacement? Interact Cardiovasc Thorac Surg 2009; 9:421-5. [PMID: 19497952 DOI: 10.1510/icvts.2009.206607] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Right ventricular function affects the outcome in valvular heart disease but less is known about the relation between indices of dysfunction and outcome. Seventy patients undergoing mitral valve replacement between April 2007 and April 2008 for predominant rheumatic mitral stenosis were included in the study. Two groups were formed based on right ventricular systolic pressure (RVSP), <or=40 mmHg (group I, n=16) and >41 mmHg (group II, n=54). Right ventricle (RV) function indices were studied by echocardiography. RVSP reduced significantly in group II (P=0.0001) but not in group I. Brain natriuretic peptide (BNP) was raised in all cases and reduced significantly postoperatively. Tricuspid annular plane excursion, myocardial performance index, RV descent and tricuspid valve annular shortening (TV shortening) conformed to RV dysfunction in both groups, and did not change significantly postoperatively. Regression analysis for outcome revealed TV shortening as the only significant factor (P=0.03). Receiver operating characteristic of TV shortening and adverse outcome showed worse outcome with TV shortening of <11%. RV dysfunction was observed in all cases irrespective of RVSP. TV shortening of <11% was associated with adverse outcome. Postoperative fall in BNP levels may indicate a trend towards recovery.
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Affiliation(s)
- Shantanu Pande
- Department of Cardiovascular and Thoracic Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
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703
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McLaughlin VV, Badesch DB, Delcroix M, Fleming TR, Gaine SP, Galiè N, Gibbs JSR, Kim NH, Oudiz RJ, Peacock A, Provencher S, Sitbon O, Tapson VF, Seeger W. End Points and Clinical Trial Design in Pulmonary Arterial Hypertension. J Am Coll Cardiol 2009; 54:S97-S107. [DOI: 10.1016/j.jacc.2009.04.007] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Accepted: 04/15/2009] [Indexed: 01/23/2023]
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704
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Koestenberger M, Ravekes W, Everett AD, Stueger HP, Heinzl B, Gamillscheg A, Cvirn G, Boysen A, Fandl A, Nagel B. Right Ventricular Function in Infants, Children and Adolescents: Reference Values of the Tricuspid Annular Plane Systolic Excursion (TAPSE) in 640 Healthy Patients and Calculation of z Score Values. J Am Soc Echocardiogr 2009; 22:715-9. [DOI: 10.1016/j.echo.2009.03.026] [Citation(s) in RCA: 221] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Indexed: 02/08/2023]
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705
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Fayssoil A, Abasse S, Nardi O. Analyse échocardio-graphique du ventricule droit. Med Sci (Paris) 2009; 25:513-8. [DOI: 10.1051/medsci/2009255513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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706
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Pamidi S, Mehta S. Six-minute walk test in scleroderma-associated pulmonary arterial hypertension: are we counting what counts? J Rheumatol 2009; 36:216-8. [PMID: 19208554 DOI: 10.3899/jrheum.081243] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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707
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Fisher MR, Forfia PR, Chamera E, Housten-Harris T, Champion HC, Girgis RE, Corretti MC, Hassoun PM. Accuracy of Doppler echocardiography in the hemodynamic assessment of pulmonary hypertension. Am J Respir Crit Care Med 2009; 179:615-21. [PMID: 19164700 PMCID: PMC2720125 DOI: 10.1164/rccm.200811-1691oc] [Citation(s) in RCA: 682] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Accepted: 01/21/2009] [Indexed: 01/06/2023] Open
Abstract
RATIONALE Transthoracic Doppler echocardiography is recommended for screening for the presence of pulmonary hypertension (PH). However, some recent studies have suggested that Doppler echocardiographic pulmonary artery pressure estimates may frequently be inaccurate. OBJECTIVES Evaluate the accuracy of Doppler echocardiography for estimating pulmonary artery pressure and cardiac output. METHODS We conducted a prospective study on patients with various forms of PH who underwent comprehensive Doppler echocardiography within 1 hour of a clinically indicated right-heart catheterization to compare noninvasive hemodynamic estimates with invasively measured values. MEASUREMENTS AND MAIN RESULTS A total of 65 patients completed the study protocol. Using Bland-Altman analytic methods, the bias for the echocardiographic estimates of the pulmonary artery systolic pressure was -0.6 mm Hg with 95% limits of agreement ranging from +38.8 to -40.0 mm Hg. Doppler echocardiography was inaccurate (defined as being greater than +/-10 mm Hg of the invasive measurement) in 48% of cases. Overestimation and underestimation of pulmonary artery systolic pressure by Doppler echocardiography occurred with a similar frequency (16 vs. 15 instances, respectively). The magnitude of pressure underestimation was greater than overestimation (-30 +/- 16 vs. +19 +/- 11 mm Hg; P = 0.03); underestimates by Doppler also led more often to misclassification of the severity of the PH. For cardiac output measurement, the bias was -0.1 L/min with 95% limits of agreement ranging from +2.2 to -2.4 L/min. CONCLUSIONS Doppler echocardiography may frequently be inaccurate in estimating pulmonary artery pressure and cardiac output in patients being evaluated for PH.
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Affiliation(s)
- Micah R Fisher
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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708
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Maeder MT, Leet A, Ross A, Esmore D, Kaye DM. Changes in Right Ventricular Function During Continuous-low Left Ventricular Assist Device Support. J Heart Lung Transplant 2009; 28:360-6. [DOI: 10.1016/j.healun.2009.01.007] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Revised: 11/25/2008] [Accepted: 01/14/2009] [Indexed: 11/16/2022] Open
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709
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Shah SJ. Genetics of systemic sclerosis-associated pulmonary arterial hypertension: Recent progress and current concepts. Curr Rheumatol Rep 2009; 11:89-96. [DOI: 10.1007/s11926-009-0013-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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710
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Novel quantitative echocardiographic parameters in acute PE. J Thromb Thrombolysis 2009; 28:506-12. [DOI: 10.1007/s11239-009-0322-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 02/23/2009] [Indexed: 11/26/2022]
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711
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Mulder BJM, van der Wall EE. Tetralogy of Fallot: in good shape? Int J Cardiovasc Imaging 2008; 25:271-5. [PMID: 19085086 DOI: 10.1007/s10554-008-9399-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Accepted: 11/25/2008] [Indexed: 11/29/2022]
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712
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Mathai SC, Hassoun PM. The Role of Echocardiography in the Diagnosis and Assessment of Pulmonary Hypertension. ACTA ACUST UNITED AC 2008. [DOI: 10.21693/1933-088x-7.4.379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Stephen C. Mathai
- Johns Hopkins University School of Medicine, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Baltimore, MD
| | - Paul M. Hassoun
- Johns Hopkins University School of Medicine, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Baltimore, MD
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713
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Abstract
The primary challenge in the care of the patient with advanced pulmonary arterial hypertension (PAH) is right ventricular dysfunction with concomitant right heart failure. Right heart function is closely tied to survival in this disease, and there is a growing interest in the study of this unique structure. While echocardiography and cardiac magnetic resonance (CMR) have augmented our ability to image the right ventricle (RV), the primary means of assessing right heart function remains right heart catheterisation. Several of the currently available treatments for PAH have been shown to have effects on the RV, not just the pulmonary vasculature, and, in future, therapies aimed at optimizing right ventricular function may allow better outcomes in this challenging disease. New directions in right ventricular assessment including measurement of pulmonary vascular impedance and more widespread availability of CMR may allow greater knowledge about this little studied, yet highly important, right side of the heart.
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Affiliation(s)
- A R Hemnes
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
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714
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715
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Kalogeropoulos AP, Georgiopoulou VV, Howell S, Pernetz MA, Fisher MR, Lerakis S, Martin RP. Evaluation of Right Intraventricular Dyssynchrony by Two-Dimensional Strain Echocardiography in Patients With Pulmonary Arterial Hypertension. J Am Soc Echocardiogr 2008; 21:1028-34. [DOI: 10.1016/j.echo.2008.05.005] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Indexed: 10/21/2022]
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716
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Doppler Myocardial Imaging for Early Detection of Right Ventricular Dysfunction in Patients With Pulmonary Hypertension. J Am Soc Echocardiogr 2008; 21:1035-41. [DOI: 10.1016/j.echo.2008.07.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2008] [Indexed: 11/19/2022]
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717
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Nathan SD, Shlobin OA, Barnett SD, Saggar R, Belperio JA, Ross DJ, Ahmad S, Saggar R, Libre E, Lynch JP, Zisman DA. Right ventricular systolic pressure by echocardiography as a predictor of pulmonary hypertension in idiopathic pulmonary fibrosis. Respir Med 2008; 102:1305-10. [PMID: 18619825 DOI: 10.1016/j.rmed.2008.03.022] [Citation(s) in RCA: 154] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Revised: 03/08/2008] [Accepted: 03/26/2008] [Indexed: 11/18/2022]
Abstract
RATIONALE Pulmonary hypertension (PH) commonly complicates the course of patients with idiopathic pulmonary fibrosis (IPF). It has a significant impact on outcomes and is, therefore, important to detect. OBJECTIVES We sought to characterize the accuracy and performance characteristics of the right ventricular systolic pressure (RVSP) as estimated by echocardiography (ECHO) alone and in conjunction with physiologic indices in predicting the presence of PH in IPF patients. METHODS Cross-sectional study of IPF patients from two large tertiary centers in whom both ECHO and right-heart catheterization (RHC) were available. MEASUREMENTS AND MAIN RESULTS There were 110 patients with available ECHOs and RHCs. Estimates of RVSP were reported in 60 of these patients (54.5%) of whom 22 (36.6%) had PH, while 16 of the 50 patients without RVSP estimate (32%) had PH. Twenty-four of 60 (40%) ECHOs accurately reflected the pulmonary arterial systolic pressure as measured by RHC. An optimal RVSP threshold for the screening of PH could not be detected. When assessed in combination with various thresholds of PFT and 6-minute walk test (6MWT) parameters, the performance characteristics of the RVSP were slightly improved. CONCLUSION The RVSP is not an accurate test for the assessment of PH in IPF patients. Awareness of the various combinations of threshold values for RVSP with and without PFT and 6MWT might nonetheless assist clinicians in risk stratifying IPF patients for the presence of PH.
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718
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Abstract
Significant advances in the treatment of pulmonary arterial hypertension (PAH) have occurred over the last 10 years, starting with the approval of epoprostenol in 1998. Subsequently, multiple additional medications have received approval, including a subcutaneous prostacyclin, an inhaled prostacyclin, and oral medications in 2 separate classes. Over this same period, the classification of pulmonary hypertension has been revised with changes including the substitution of the term idiopathic for primary PAH and an expanded list of conditions felt to be associated with the development of PAH. Long-term follow-up studies have provided better information on prognosis and expected outcomes with treatment, with particularly valuable data on reassessment of prognosis after treatment with epoprostenol. Combination therapy is more frequently being used, and limited data on novel therapies such as stem cell transplantation have been published. The purpose of this review is to describe the current state of evidence for the diagnosis, prognosis, and treatment of the patient with PAH.
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719
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Abstract
The heart is one of the major organs involved in scleroderma, the involvement of which can be manifested by myocardial disease, conduction system abnormalities, arrhythmias, or pericardial disease. Additionally, scleroderma renal crisis and pulmonary hypertension lead to significant cardiac dysfunction secondary to damage in the kidney and lung. This article summarizes the types and mechanism of abnormalities in the heart in scleroderma. The concept of cardiac dysfunction in scleroderma and other rheumatologic conditions has received new interest with the advent of newer noninvasive imaging techniques, as well as the interest in detecting subclinical disease. With this increased interest in cardiac manifestations in scleroderma comes the realization that long-term studies are needed to better assess the appropriate screening and treatment in this patient population.
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720
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Forfia PR, Mathai SC, Fisher MR, Housten-Harris T, Hemnes AR, Champion HC, Girgis RE, Hassoun PM. Hyponatremia predicts right heart failure and poor survival in pulmonary arterial hypertension. Am J Respir Crit Care Med 2008; 177:1364-9. [PMID: 18356560 DOI: 10.1164/rccm.200712-1876oc] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Hyponatremia is associated with decompensated heart failure and poor prognosis in patients with left ventricular systolic dysfunction. OBJECTIVES We sought to determine if hyponatremia is associated with right heart failure and worse prognosis in patients with pulmonary arterial hypertension (PAH). METHODS We prospectively followed 40 patients with PAH and examined the relationship between serum sodium and right heart function as well as survival. MEASUREMENTS AND MAIN RESULTS Subjects with hyponatremia (Na < or = 136 mEq/L) were more symptomatic (11/13 World Health Organization [WHO] class III/IV vs. 12/27 WHO class III/IV; P = 0.02), had more peripheral edema (69 vs. 26%; P = 0.009), and had higher hospitalization rates (85 vs. 41%; P = 0.009) than normonatremic subjects. Hyponatremic subjects had higher right atrial pressure (14 +/- 6 vs. 9 +/- 3 mm Hg; P < 0.001), lower stroke volume index (21 +/- 7 vs. 32 +/- 10 ml/m(2); P < 0.01), larger right ventricular:left ventricular area ratio (1.8 +/- 0.4 vs. 1.3 +/- 0.4; P < 0.001), and lower tricuspid annular plane systolic excursion (1.4 +/- 0.3 vs. 2.0 +/- 0.6 cm; P = 0.001), despite similar mean pulmonary artery pressure (49 +/- 10 vs. 47 +/- 12 mm Hg; P = 0.60). The 1- and 2-year survival estimates were 93% (95% confidence interval [CI], 73-98%) and 85% (95% CI, 65-94%), and 38% (95% CI, 14-63%) and 15% (95% CI, 2-39%) for normonatremic and hyponatremic subjects, respectively (log-rank chi(2) = 25.19, P < 0.001). The unadjusted risk of death (hazard ratio) in hyponatremic compared with normonatremic subjects was 10.16 (95% CI, 3.42-30.10, P < 0.001). Hyponatremia predicted outcome after adjusting for WHO class, diuretic use, as well as right atrial pressure and cardiac index. CONCLUSIONS Hyponatremia is strongly associated with right heart failure and poor survival in PAH.
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Affiliation(s)
- Paul R Forfia
- Cardiovascular Division, Heart Failure/Transplant Program, University of Pennsylvania School of Medicine, 3400 Spruce Street, 6 Penn Tower, Philadelphia, PA 19104, USA.
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721
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Driscoll JA, Chakinala MM. Medical therapy for pulmonary arterial hypertension. Expert Opin Pharmacother 2008; 9:65-81. [PMID: 18076339 DOI: 10.1517/14656566.9.1.65] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Recent advances in the understanding of pulmonary arterial hypertension have led to new therapeutic options, although the disease remains incurable and continues to cause substantial morbidity and mortality. Disease-specific therapies have been approved for use in the US, including epoprostenol and its various analogs, endothelin receptor antagonists, and phosphodiesterase 5 inhibitors. The use of combination therapy with agents from more than one of these drug classes is becoming increasingly common, although guidelines establishing optimal combinations are lacking. Meanwhile, potential future therapeutic options are actively being pursued.
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Affiliation(s)
- James A Driscoll
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, 660 South Euclid, Campus Box 8052, Saint Louis, Missouri 63110, USA
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722
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Ramani GV, Edelman K, López-Candales A. Standard measures of right ventricular function assessment in adult patients with acute sickle cell crises. Int J Cardiol 2007; 132:448-50. [PMID: 18068240 DOI: 10.1016/j.ijcard.2007.08.099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Accepted: 08/10/2007] [Indexed: 11/18/2022]
Abstract
Chronic sickle cell (SC) disease is known to cause pulmonary hypertension (PH) which eventually affects right as well as left ventricular function. However, the acute effects of SC crisis on right ventricular (RV) function in adults have not been well described. Our echocardiography database was queried for patients followed in the outpatient hematology clinic, who were admitted with SC crises, and had an inpatient echocardiogram. Comparisons of RV fractional area change (RVFAC) and tricuspid annular peak systolic excursion (TAPSE) were then made to a group of healthy patients and a group with mild PH. TAPSE was normal in patients with SC disease (3.05+/-0.56). However, the SC patients had significantly larger RV's compared to controls and mild PH patients (31.33+/-7.23 cm(2) vs. 19.07+/-4.49 cm(2) and 21.51+/-6.07 cm(2), respectively, P<0.0001). RVFAC was reduced in SC patients, and was comparable to patients with mild PH (46+/-9% vs. 49 +/-14%, P=0.4). We found no correlation between hemoglobin level (8.1+/-2.5 g) and RVFAC, TAPSE, or PH severity. We found that adult patients admitted with SC crises have frequent dilatation of the RV with an abnormal reduction in RVFAC, despite normal TAPSE values. Therefore, caution should be exercised in using TAPSE to estimate RV function in this patient population.
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723
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Abraham TP, Dimaano VL, Liang HY. Role of Tissue Doppler and Strain Echocardiography in Current Clinical Practice. Circulation 2007; 116:2597-609. [PMID: 18040039 DOI: 10.1161/circulationaha.106.647172] [Citation(s) in RCA: 226] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
| | | | - Hsin-Yueh Liang
- From the Division of Cardiology, Johns Hopkins University, Baltimore, Md
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724
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Lamia B, Teboul JL, Monnet X, Richard C, Chemla D. Relationship between the tricuspid annular plane systolic excursion and right and left ventricular function in critically ill patients. Intensive Care Med 2007; 33:2143-9. [PMID: 17928992 DOI: 10.1007/s00134-007-0881-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Accepted: 09/09/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Echocardiographic recording of the tricuspid annular plane systolic excursion (TAPSE) has been recommended for assessing right ventricular function in cardiac patients. The ability of TAPSE to reflect right ventricular function at baseline and to monitor acute changes in right ventricular function was tested in critically ill patients. DESIGN Prospective study. SETTING A 24-bed medical intensive care unit. PATIENTS Eighty-six patients admitted for acute respiratory failure, circulatory failure, or coma. INTERVENTIONS In 40 patients, the examination was repeated after volume expansion (n = 15), passive leg raising (n = 5), or dobutamine infusion (n = 20). MEASUREMENTS AND RESULTS The right ventricular fractional area change, TAPSE, the left ventricular ejection fraction, and the ratio of right to left ventricular end-diastolic area were measured using Doppler echocardiography. In the overall population, TAPSE (19+/-5 mm) was positively related to left ventricular ejection fraction (r2 = 0.31, p < 0.001) and right ventricular fractional area change and was negatively related to age and to the ratio of right to left ventricular end-diastolic area. Multivariate analysis indicated that only left ventricular ejection fraction and age were independently related to TAPSE (multiple r2 = 0.36, p < 0.001). Following dynamic interventions, the changes in TAPSE were linearly related to changes in left ventricular ejection fraction (r2 = 0.65, p < 0.01) but notto changes in the right ventricular fractional area change. CONCLUSIONS Unexpectedly, TAPSE was more strongly related to left ventricular ejection fraction than to indices of right ventricular function in critically ill patients. The potential interest of TAPSE as a dynamic marker of left ventricular systolic function deserves further study.
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Affiliation(s)
- Bouchra Lamia
- AP-HP, Service de Réanimation Médicale, 94275 Le Kremlin-Bicêtre, France
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725
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726
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Reichenberger F, Kohstall MG, Seeger T, Olschewski H, Grimminger F, Seeger W, Ghofrani HA. Effect of sildenafil on hypoxia-induced changes in pulmonary circulation and right ventricular function. Respir Physiol Neurobiol 2007; 159:196-201. [PMID: 17851140 DOI: 10.1016/j.resp.2007.07.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2007] [Revised: 07/17/2007] [Accepted: 07/19/2007] [Indexed: 01/12/2023]
Abstract
Hypoxia leads to pulmonary vasoconstriction in healthy men. However, the consequences on right ventricular function are not known. The effects of hypoxia on systolic pulmonary artery pressure (sPAP) and right ventricular function index (TEI) were assessed by Doppler echocardiography. Fourteen members of a Mount Everest expedition were monitored during acute hypoxic challenge at sea level, environmental hypoxia exposure at altitudes of 3440 m and 5245 m and 2 weeks after return to sea level. Subjects received either placebo or 50mg sildenafil in a double-blind randomised cross-over design. Under normoxia at baseline, mean sPAP was 17.1(S.E.M. 1.3) mm Hg, and TEI was 0.13(0.004). Both increased during acute hypoxia: sPAP 29.6(2.6) mm Hg, and TEI 0.35(0.06) (each p<0.01). At 5245 m sPAP was 29.1(1.7) and TEI was 0.43(0.05) in the placebo group, while in the sildenafil group, both sPAP and TEI were reduced to 22(1.5) mm Hg and 0.23(0.03) (each p<0.005), respectively. We conclude that in healthy individuals, exposure to acute hypoxia and sojourns at high altitude result in a small but significant increase in sPAP accompanied by an impairment of right ventricular function. Sildenafil significantly decreases sPAP and improves right ventricular function.
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Affiliation(s)
- Frank Reichenberger
- Pulmonary Vascular Diseases Unit, University of Giessen Lung Center (UGLC), University Hospital Giessen, Germany.
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727
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Mahmud M, Champion HC. Right ventricular failure complicating heart failure: pathophysiology, significance, and management strategies. Curr Cardiol Rep 2007; 9:200-8. [PMID: 17470333 DOI: 10.1007/bf02938351] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Right heart failure most commonly results from the complication of left heart failure (systolic or nonsystolic dysfunction) or pulmonary hypertension. Over the past decade, greater attention has been paid to the role of right ventricular failure in the morbidity and mortality associated with cardiomyopathy and pulmonary hypertension. The right ventricle is distinct from the left ventricle not only in its spatial localization, but also in its response to increased afterload and signaling mechanisms. This article discusses the role of right ventricular failure in the setting of heart failure as well as the clinical diagnosis and management of right ventricular failure.
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Affiliation(s)
- Mobusher Mahmud
- Division of Cardiology, Department of Medicine, Johns Hopkins University, 720 Rutland Avenue, Ross 850, Baltimore, MD 21205, USA
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728
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Rosenkranz S. Pulmonary hypertension: current diagnosis and treatment. Clin Res Cardiol 2007; 96:527-41. [PMID: 17534570 DOI: 10.1007/s00392-007-0526-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2006] [Accepted: 03/19/2007] [Indexed: 12/21/2022]
Abstract
Pulmonary hypertension (PH) is a devastating disease that - if untreated - is characterized by a poor prognosis. According to the current classification (Venice, 2003), pulmonary arterial hypertension (PAH) is distinguished from other forms of PH. Recent advances in drug therapy have led to a dramatic improvement of medical care particularly in patients with PAH. Hence, early establishment of the diagnosis appears increasingly important. This review article gives an overview on the definition, classification, pathophysiology, and clinical presentation of various forms of PH. Furthermore, it summarizes the recommended diagnostic work-up and the current treatment options particularly in PAH, with special emphasis on prostanoids, endothelin receptor antagonists (ERAs), and phosphopdiesterase type 5 (PDE5) inhibitors such as sildenafil. Finally, novel developments are being discussed which currently represent an exciting field of research.
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Affiliation(s)
- Stephan Rosenkranz
- Klinik III für Innere Medizin, Universität zu Köln, Kerpener Str. 62, 50924, Köln, Germany.
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729
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Snow JL, Kawut SM. Surrogate end points in pulmonary arterial hypertension: assessing the response to therapy. Clin Chest Med 2007; 28:75-89, viii. [PMID: 17338929 PMCID: PMC1868503 DOI: 10.1016/j.ccm.2006.11.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Recent discoveries in the disease pathophysiology of pulmonary arterial hypertension have been translated into effective therapies tested in clinical trials. The studies have focused on surrogate and intermediate end points, thought to reflect quantity and quality of life, respectively. The authors present the necessary requirements for establishing the reliability and validity of such end points before they may be used dependably. The authors also review the available data, strengths, and weaknesses of potential end points in pulmonary arterial hypertension.
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Affiliation(s)
- Jennifer L. Snow
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Steven M. Kawut
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
- Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY
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Abstract
Progress in understanding the basic biology and the development of new therapies for pulmonary arterial hypertension have led to improvements in survival. This article reviews clinically important changes in the classification of the pulmonary hypertensive diseases, as well as the epidemiology of various forms of pulmonary hypertension. The risk factors for the development of pulmonary arterial hypertension, prognostic markers, and the effects of current therapies on survival are discussed.
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Affiliation(s)
- Darren B Taichman
- University of Pennsylvania School of Medicine, Penn Presbyterian Medical Center, 51 North 39th Street, 441 PHI Building, Philadelphia, PA 19104, USA.
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