Non-invasive estimation of pulmonary arterial hypertension in chronic obstructive pulmonary disease

Quantitative Analysis of Right Atrial Functions by 2D-Speckle Tracking Echocardiography During Healthy Pregnancy

BACKGROUND

The role of speckle tracking in the assessment of right atrial (RA) deformation parameters has not been investigated yet. The purpose of this article is to establish the effects of normal pregnancy on RA mechanical changes obtained by 2-dimensional speckle-tracking echocardiography.

METHODOLOGY

A total of 49 healthy pregnant women were included in the study. All participants were followed for each trimester and postpartum period, encompassing standard assessments of both RA and ventricular functions, as well as measurements of RA global peak atrial longitudinal strain (RA-Global-PALS) and RA global peak atrial contraction strain (RA-Global-PACS). Additionally, the RA segments were individually evaluated with respect to strain parameters.

RESULTS

During pregnancy, the increased volume load resulted in elevated RA reservoir function, as indicated by RA-Global-PALS, and increased contraction parameter, as indicated by RA-Global-PACS. These changes were within physiological limits and reversible. Segmental analysis of the right atrium showed similar findings for regional PACS and PALS parameters.

CONCLUSION

In this study, we established normal RA deformation parameters for healthy pregnancies. These data will aid in discerning various measures of RA phasic function in cardiovascular and systemic conditions among normal pregnant women. Moreover, they may offer insights into potential cardiac pathologies that may arise during the pregnancy.

The Significance of Elevated Brain Natriuretic Peptide Levels in Chronic Obstructive Pulmonary Disease

We investigated the clinical significance of brain natriuretic peptide (BNP), a cardiac hormone, in chronic obstructive pulmonary disease (COPD). Subjects were 38 patients with stable COPD, of whom 20 had cor pulmonale (CP), and 22 were healthy individuals. Plasma BNP levels were measured and pulmonary arterial pressure (PAP) was estimated by echocardiography. Arterial blood gas analysis, forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were also recorded. BNP levels of patients with COPD were higher than those of controls (48.2 ± 37.5 and 9.3 ± 3.0 pg/ml). Patients with CP had a higher mean BNP level with respect to those without CP (73.9 ± 35.8 and 21.0 ± 10.2 pg/ml, respectively). BNP levels correlated with PAP ( r = 0.68), partial arterial oxygen pressure ( r = −0.70), FEV1 ( r = −0.65) and FVC ( r = −0.52). We have concluded that BNP determination has a role in the diagnosis of CP in patients with COPD.

Relationship between obstructive sleep apnea-specific symptoms and cardiac function before and after adenotonsillectomy in children with adenotonsillar hypertrophy

OBJECTIVE

The aim of our study was to investigate subclinical cardiac disturbances in patients with symptoms due to adenotonsillar hypertrophy (ATH) and the impact of adenotonsillectomy (AT) using conventional and novel echocardiographic measures.

MATERIAL AND METHODS

Thirty patients with grade 3 or 4 ATH (mean age: 7.86 ± 3.83 years; 10 females) and 30 healthy, age- and sex-matched volunteers (mean age, 8 ± 2.77; 14 females) were enrolled in the study. In addition to conventional two-dimensional and Doppler echocardiographic parameters, tissue Doppler parameters, including myocardial performance indices (MPIs) of both the right (RV) and left ventricle (LV), were studied. The severity of obstructive sleep apnea (OSA) was determined using the OSA-18 health quality questionnaire. The OSA-18 questionnaire and echocardiographic examination were repeated after AT in patients with ATH.

RESULTS

The total OSA-18 scores for the control, preoperative, and postoperative groups were 39.56 ± 19.98, 80.63 ± 22.32, and 44.10 ± 20.31, respectively. Conventional parameters were not different among the groups. The mean pulmonary artery pressure estimated using the Mahan formula was increased in the ATH group compared with that in the control group (21.72 ± 4.25 vs. 12.43 ± 3.83, respectively; p<0.001) and significantly improved after AT (21.72 ± 4.25 vs. 16.09 ± 4.53; p<0.001). The RV MPI was significantly different between the control and ATH groups (0.322 ± 0.052 vs. 0.383 ± 0.079, respectively; p=0.001). Both the LV and RV MPI significantly improved (0.515 ± 0.066 vs. 0.434 ± 0.052, p<0.001; and 0.383 ± 0.079 vs. 0.316 ± 0.058, p=0.018, respectively) after surgery for ATH.

CONCLUSIONS

Our study revealed that the patients with OSA-specific symptoms due to ATH had higher pulmonary artery pressure and impaired RV function according to novel echocardiographic parameters. Surgery for ATH seems to have an important effect on both LV and RV function.

Tissue Doppler Evaluation of Tricuspid Annulus for Estimation of Pulmonary Artery Pressure in Patients with COPD

Because transthoracic echocardiography is an inexpensive, easy, and reproducible method, it is the most commonly used noninvasive diagnostic tool to determine pulmonary artery pressure (PAP). Tissue Doppler imaging (TDI) emerged as a new echocardiographic method that can be applied in various clinical conditions. In our study we aimed to evaluate the relationship between tricuspid lateral annulus TDI parameters and pulmonary artery systolic pressure (PASP) as estimated by continuous wave Doppler in patients with chronic obstructive pulmonary disease (COPD). A total of 51 (42 men, mean age: 62.3 +/- 8.2 years) patients with clinically stable COPD were included in the study. The tricuspid annular systolic myocardial velocity (Sm), velocity time integral of Sm (SmVTI), early (Em) and late (Am) peak diastolic myocardial velocities, and myocardial isovolumic relaxation time (IVRTm) were acquired as well as two-dimensional (2-D) and conventional Doppler data. When compared with values of patients without pulmonary hypertension (PHT), Sm, SmVTI, Em, and Em/Am values were found to be lower and IVRTm values higher in patients with PHT. When all the patients were analyzed, there was a significant negative correlation between PASP and Sm and SmVTI (r = -0.82, p < 0.001 and r = -0.84, p < 0.001, respectively). Sm velocity < or = 12 cm/s had a sensitivity of 85% and a specificity of 93.3% for predicting PASP > 40 mmHg. SmVTI < or = 2.5 cm had a sensitivity of 85.7% and a specificity of 90% for detecting PHT. In our study, there was significant negative correlation between tricuspid lateral annular Sm and SmVTI values and PASP in patients with stable COPD irrespective of the presence of PHT. Tricuspid annular Sm and SmVTI had very good level sensitivity and specificity for predicting PHT. In conclusion, it might be suggested that in cases where noninvasive PASP measurement is not possible, TDI can be used as an alternative and reliable method to assess PAP.

A Novel Echocardiographic Doppler Method for Estimation of Pulmonary Arterial Pressures

BACKGROUND

Current noninvasive methods for estimating diastolic and mean pulmonary artery pressures (PAp) in children are cumbersome and have limited accuracy. We hypothesized that systolic PAp correlates with diastolic and mean PAp, and that this correlation can be used to estimate diastolic and mean PAp from Doppler flow data.

METHODS

We recorded PAp in 112 patients 30 years or younger catheterized for heart failure, heart transplant, pulmonary hypertension, or congenital heart disease. We derived the relationship of systolic PAp to diastolic and mean PAp. We then applied these relations to systolic PAp measured by tricuspid regurgitation (TR) Doppler flow in a subset of 17 patients with pulmonary hypertension to predict mean and diastolic PAp, and correlated the results.

RESULTS

An excellent linear relation was found between systolic PAp and both the diastolic and mean PAp measured at cardiac catheterization (r = 0.95, P < .0001; r = 0.98, P < .0001, respectively). The calculated diastolic PAp calculated from TR Doppler correlated well with invasive data (31 +/- 13 vs 30 +/- 11 mm Hg, respectively, not significant; r = 0.85, P < .0001) and surpassed existing methods that are based on pulmonary regurgitation for predicting diastolic PAp. Similarly, mean PAp calculated from TR Doppler flow correlated well with invasive data (r = 0.86, P < .0001).

CONCLUSION

A strong linear relationship between systolic and diastolic PAp allows for easy and accurate noninvasive estimation of diastolic and mean PAp from TR Doppler flow.

Burkholderia cepacia is associated with pulmonary hypertension and increased mortality among cystic fibrosis patients

The aim of the study was to evaluate the impact of Burkholderia cepacia on cardiovascular status and mortality in cystic fibrosis. Seven patients infected with B. cepacia were matched with 31 patients not infected with this organism for gender, age, height, weight, genotype, and percent predicted forced expiratory volume in one second, partial arterial oxygen pressure, and pancreatic sufficiency status. The pulmonary artery systolic pressure, as assessed by transthoracic echocardiography, was significantly higher in patients infected with B. cepacia (61.3 +/- 17.2 mm Hg) than in controls (37.3 +/- 13.9 mm Hg; P = 0.02), and the mean acceleration time was significantly lower (77 +/- 33 ms versus 108 +/- 25 ms; P = 0.02). The 6-month mortality was significantly higher in patients infected with B. cepacia (57% versus 16%; P = 0.02). Six of the seven patients infected with B. cepacia harbored the same ribotype (genomovar II, B. multivorans). Pulmonary hypertension was significantly more frequent in patients infected by B. cepacia and could contribute to the increased mortality rate.

Pulmonary hypertension in patients with chronic obstructive pulmonary disease: recent advances in pathophysiology and management

In patients with chronic obstructive pulmonary disease (COPD), pulmonary hypertension (PH) is associated with a worse prognosis. Recently, information has been increasing concerning the cellular and molecular aspects of the pathophysiology of PH in COPD. The most striking finding is the role of vascular endothelial cells and endogenous mediators released by these cells. Endothelial cell-dependent relaxation is impaired in COPD patients with PH. Moreover, vascular remodelling in these patients is mainly responsible for irreversible PH in advanced COPD. Smoking cessation will slow down the progression of the disease process and may prevent the development of PH in COPD. The timing of initiation of long-term oxygen therapy is important for the effective management of PH in COPD. Research on therapeutic agents for the effective treatment of PH is still needed in the management aspect of patients with COPD. This review focuses on the recent advances in our understanding of the pathophysiology and treatment of PH in COPD.