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El Embaby DAES. Assessment of pulmonary hypertension by cardiac MRI and right sided heart catheter in COPD patients. JOURNAL OF LUNG, PULMONARY & RESPIRATORY RESEARCH 2023; 10:5-9. [DOI: 10.15406/jlprr.2023.10.00292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Background: Pulmonary hypertension (PH) is a progressive disorder characterized by abnormally elevated blood pressure of the pulmonary circulation which results, over time, from extensive vascular remodeling and increased pulmonary vascular resistance (PVR). Recent advances in cMRI technology have led to the development of techniques for noninvasive assessment of the morphology of the right side of the heart to be correlated to the hemodynamic parameters collected by RHC which is still the golden standard technique of PH diagnosis. Aim: To assess the role of Cardiac MRI in severe COPD patients with pulmonary artery pressure more than 35 mmHg as evaluated by Echocardiography and right sided cardiac catheterization. Patients and methods: The current study was conducted upon 20 patients with moderate or severe chronic obstructive pulmonary disease (COPD) by spirometry according to GOLD 2022 criteria who had been assessed for severe pulmonary hypertension with Pulmonary Artery Pressure more than 35 mmHg by cardiac Magnetic resonance imaging (cMRI) and right sided heart catheter (RHC). They were recruited from the outpatient clinic and department of chest specialized hospital Kobry Elkobba Armed Forces. Results: Twenty patients included in the study were 90% males, mean age about 64.50 ± 7.94 years old with mean smoking duration 33.89 ±7.03 years and 45% with co-morbidities. Spirometry done for all studied cases included FEV1/FVC, FEV1 and FVC parameters with mean range 43.40 ± 5.17, 38.90 ± 8.60, 79.45 ± 16.59 respectively. The descriptive data of HRCT showed 60% of the patients with emphysema while the rest showed mixed emphysema and ILD. V/Q scan study was positive in 4 patients which represented 20% of the patients whose all included in group B (mPA > 43.5 mmHg). All studied COPD patients who showed severe PHT by a measurement of mPAP > 35 mmHg by RHC with normal PCW pressure underwent cMRI study to assess right ventricular structure and morphology. Conclusion: Cardiac MRI showed a great rule in the evaluation of the morphological changes associated with the condition of COPDPH in the right side of the heart which should affect its functions. The cardiac MRI is not the best tool in assessment of the right side of the heart in COPD patients due to many causes like the difficulty of holding breaths with COPDPH patients during the maneuver to snap accurate clear shots of the heart, the hypoxia in those patients which makes the maneuver more difficult, the associated co-morbidities may interfere with completing the maneuver like the chronic kidney disease that prohibit the use of gadolinium dye and other co-morbidities like morbid obesity that will not allow the patient to get through the MRI
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Zhang L, Liu Y, Zhao S, Wang Z, Zhang M, Zhang S, Wang X, Zhang S, Zhang W, Hao L, Jiao G. The Incidence and Prevalence of Pulmonary Hypertension in the COPD Population: A Systematic Review and Meta-Analysis. Int J Chron Obstruct Pulmon Dis 2022; 17:1365-1379. [PMID: 35711174 PMCID: PMC9196913 DOI: 10.2147/copd.s359873] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 04/30/2022] [Indexed: 12/22/2022] Open
Abstract
Purpose Chronic obstructive pulmonary disease (COPD)-related pulmonary hypertension (PH) is one of the most common comorbidities of COPD, and often leads to a worse prognosis. Although the estimated prevalence and risk factors of COPD-related PH have been widely reported, these results have not been well integrated. This study aimed to review the worldwide incidence and prevalence of COPD-related PH and explore possible factors affecting its prevalence. Patients and Methods We searched four electronic databases (Web of Science, Embase, Cochrane, and MEDLINE) to identify all observational studies on the prevalence of COPD-related PH from database creation until July 20, 2021. Eligibility screening, quality assessment, and data extraction of the retrieved studies were independently conducted by two reviewers. Meta-analyses were performed to determine the prevalence of PH in the COPD population. Random-effects meta-regression model analyses were conducted to investigate the sources of heterogeneity. Results Altogether, 38 articles were included in the meta-analyses. The pooled prevalence was 39.2% (95% CI: 34.0–44.4, I2 = 97.6%) for COPD-related PH. Subgroup analyses showed that the prevalence of PH increased with COPD severity, where the majority (30.2%) had mild PH and the minority had severe PH (7.2%). Furthermore, we found a significant regional difference in the prevalence of COPD-related PH (P = 0.000), which was the highest in Africa (64.0%) and the lowest in Europe (30.4%). However, stratified studies on other factors involving mean age, sex, enrolment time, participant recruitment settings, and PH diagnostic methods showed no significant differences in prevalence (P >0.05). Conclusion The global incidence of PH in the COPD population is very high, and there are significant regional and international variations. Patients with COPD should be screened for PH and contributing risk factors to reduce the burden on individuals and society.
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Affiliation(s)
- Limin Zhang
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, People's Republic of China
| | - Yujia Liu
- College of Traditional Chinese Medicine, Liaoning University of Traditional Chinese Medicine, Shenyang, Liaoning, 110032, People's Republic of China
| | - Shuai Zhao
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, People's Republic of China
| | - Zhen Wang
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, People's Republic of China
| | - Miaomiao Zhang
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, People's Republic of China
| | - Su Zhang
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, People's Republic of China
| | - Xinzhuo Wang
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, People's Republic of China
| | - Shuang Zhang
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, People's Republic of China
| | - Wenyan Zhang
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, People's Republic of China
| | - Liying Hao
- Department of Pharmaceutical Pharmacology and Toxicology, China Medical University, Shenyang, Liaoning, 110000, People's Republic of China
| | - Guangyu Jiao
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, People's Republic of China
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Wang N, Guo Z, Gong X, Kang S, Cui Z, Yuan Y. A Nomogram for Predicting the Risk of Pulmonary Hypertension for Patients with Chronic Obstructive Pulmonary Disease. Int J Gen Med 2022; 15:5751-5762. [PMID: 35770051 PMCID: PMC9234502 DOI: 10.2147/ijgm.s363035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 06/14/2022] [Indexed: 12/29/2022] Open
Abstract
Background Pulmonary hypertension (PH) is a life-threatening complication of chronic obstructive pulmonary disease (COPD). Timely diagnosis of PH in COPD patients is vital to achieve proper treatment; however, there is no algorithm to identify those at high risk. We aimed to develop a predictive model for PH in patients with COPD that provides individualized risk estimates. Methods A total of 527 patients with COPD who were admitted to our hospital between May 2019 and December 2020 were retrospectively enrolled in this study. Using echocardiographic results as a standard, patients were stratified into a moderate- or high-PH probability group and a low-PH probability group. They were randomly grouped into either the training set (n = 368 patients) or validation set (n = 159 patients) in a ratio of 7:3. We utilized the least absolute shrinkage and selection operator (LASSO) regression model to select the feature variables. The characteristic variables selected in the LASSO regression were analyzed using multivariable logistic regression to construct the predictive model. The predictive model was displayed using a nomogram. We used the receiver operating characteristic curve, calibration curve, and clinical decision curve analysis (DCA) to evaluate model performance, and internal validation was assessed. Results The predictive factors included in the prediction model were Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage, emphysema, PaCO2, NT-pro-BNP, red blood cell (RBC) distribution width-standard deviation (RDW-SD), and neutrophil/lymphocyte ratio (NLR). The predictive model yielded an area under the curve (AUC) of 0.770 (95% confidence interval [CI], 0.719–0.820); in the internal validation, the AUC was 0.741 (95% CI, 0.659–0.823). The predictive model was well calibrated, and the DCA showed that the proposed nomogram had strong clinical applicability. Conclusion This study showed that a simple nomogram could be used to calculate the risk of PH in patients with COPD which can be useful for the individualized clinical management of COPD patients who may be occur with PH. Further studies need to be confirmed by larger sample sizes and validated in the stable COPD population.
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Affiliation(s)
- Ning Wang
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, Hengshui People’s Hospital, Hengshui, People’s Republic of China
| | - Zhenjiang Guo
- Department of Gastrointestinal Surgery, Hengshui People’s Hospital, Hengshui, People’s Republic of China
| | - Xiaowei Gong
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
| | - Shiwei Kang
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
| | - Zhaobo Cui
- Department of Respiratory and Critical Care Medicine, Hengshui People’s Hospital, Hengshui, People’s Republic of China
| | - Yadong Yuan
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
- Correspondence: Yadong Yuan, Department of Respiratory and Critical Care Medicine, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Shijiazhuang, Hebei, 050000, People’s Republic of China, Tel/Fax +86-311-66003989, Email
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Wernhart S, Hedderich J. Prediction of pulmonary hypertension in older adults based on vital capacity and systolic pulmonary artery pressure. JRSM Cardiovasc Dis 2020; 9:2048004020973834. [PMID: 33240494 PMCID: PMC7672752 DOI: 10.1177/2048004020973834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/25/2020] [Indexed: 11/20/2022] Open
Abstract
Objective Right heart catheterization (RHC) is associated with a higher procedural risk in older adults, but non-invasive estimation of pulmonary hypertension (PH) is a challenge. We aimed to elaborate a non-invasive prediction model to estimate PH. Methods and design We retrospectively analysed 134 older adults (70.0 years ±12.3; 44.9% males) who reported to our clinic with unclear dyspnea between 01/2015 and 01/2020 and had received RHC as a part of their diagnostic workup. Lung function testing, analysis of blood gas samples, 6 min walk distance and echocardiography were performed within 24 hours of RHC. Main outcome measures In a stepwise statistical approach by using an in/exclusion algorithm (using the AIC criterion) we analysed non-invasive parameters to test their value in predicting PH (defined as mean pulmonary artery pressure, PAmean, >25mmHg). Discrimination capability of the final model was measured by the AUC (area under curve) from an ROC (receiver operating characteristics) analysis. Results We yielded a sensitivity of 87.2% and a specificity of 62.5% in a combinatorial logistical model with systolic pulmonary artery pressure (sPAP) and forced vital capacity (VCmax), the discrimination index was 86.7%. The odds ratios for an increase of 10 mmHg of sPAP were 2.99 (2.08–4.65) and 1.86 (1.11–3.21) for a 1 l decrease in VCmax. On their own, VCmax proved to be specific (83.3%), while sPAP was a sensitive (79.1%) predictor for PH. Conclusions We provide a combinatorial model to predict PH from sPAP and VCmax in older adults, which may help to avoid invasive procedures.
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Affiliation(s)
- Simon Wernhart
- Department of Cardiology, Fachkrankenhaus Kloster Grafschaft, Schmallenberg, Germany.,West German Heart- and Vascular Center, Department of Cardiology and Vascular Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Jürgen Hedderich
- Medistat-Biomedical Statistics, Medistat GmbH, Kronshagen, Germany
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Nakayama S, Chubachi S, Sakurai K, Irie H, Tsutsumi A, Hashiguchi M, Itabashi Y, Murata M, Nakamura H, Asano K, Fukunaga K. Characteristics of Chronic Obstructive Pulmonary Disease Patients with Pulmonary Hypertension Assessed by Echocardiography in a Three-Year Observational Cohort Study. Int J Chron Obstruct Pulmon Dis 2020; 15:487-499. [PMID: 32184586 PMCID: PMC7060780 DOI: 10.2147/copd.s230952] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 02/14/2020] [Indexed: 01/25/2023] Open
Abstract
Background Pulmonary hypertension (PH) is a major comorbidity of chronic obstructive pulmonary disease (COPD). However, the association of PH detected by echocardiography and COPD-related outcome in longitudinal follow-up has not been elucidated. In this study, we aimed to investigate the relationship between clinical characteristics of COPD patients with PH detected by echocardiography and various outcome parameters such as COPD exacerbation and health status over a three-year observation period. Methods In this observational study, we analyzed patients with COPD who underwent chest computed tomography and echocardiography at baseline (n = 183). Results The prevalence of PH was 21.9% (40 patients). The median estimated systolic pulmonary artery pressure in patients with PH was 38.8 mmHg. COPD patients with PH were older, had a lower body mass index, scored worse in the COPD Assessment Test and St. George's Respiratory Questionnaire, and exhibited a lower diffusing capacity of the lung for carbon monoxide in comparison to patients without PH. In computed tomography images, the percentages of low-attenuation areas (LAA%) and interstitial abnormalities were higher in COPD patients with PH than in those without PH. Higher values for LAA% (LAA ≥ 30%) and interstitial abnormalities independently increased the risk of PH. The ratio of main pulmonary diameter to aortic artery diameter was significantly correlated with estimated systolic pulmonary artery pressure. In the follow-up analysis, the frequency of exacerbations in three years was significantly higher in patients with PH compared to patients without PH. Conclusion In this study, we identified the clinical characteristics of COPD patients with PH detected by echocardiography. The presence of PH assessed by echocardiography was related to future COPD exacerbations and closely related to radiographical emphysema.
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Affiliation(s)
- Shingo Nakayama
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo160-8582, Japan
| | - Shotaro Chubachi
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo160-8582, Japan
| | - Kaori Sakurai
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo160-8582, Japan
| | - Hidehiro Irie
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo160-8582, Japan
| | - Akihiro Tsutsumi
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo160-8582, Japan
| | - Mizuha Hashiguchi
- Division of Pulmonary Medicine, Keiyu Hospital, Yokohama, Kanagawa220-0012, Japan
| | - Yuji Itabashi
- Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Mitsushige Murata
- Center for Preventive Medicine, Keio University School of Medicine, Tokyo160-8582, Japan
| | - Hidetoshi Nakamura
- Division of Pulmonary Medicine, Saitama Medical University Hospital, Saitama350-0495, Japan
| | - Koichiro Asano
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Isehara-Shi, Kanagawa259-1193, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo160-8582, Japan
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El-Shabrawy M, Eldamanhory AS. Study of cardiovascular diseases in hospitalized AECOPD patients. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2017. [DOI: 10.1016/j.ejcdt.2016.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Hilde JM, Skjørten I, Hansteen V, Melsom MN, Atar D, Hisdal J, Humerfelt S, Steine K. Assessment of Right Ventricular Afterload in COPD. COPD 2016; 13:176-85. [PMID: 26914261 DOI: 10.3109/15412555.2015.1057275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND We aimed to study whether pulmonary hypertension (PH) and elevated pulmonary vascular resistance (PVR) could be predicted by conventional echo Doppler and novel tissue Doppler imaging (TDI) in a population of chronic obstructive pulmonary disease (COPD) free of LV disease and co-morbidities. METHODS Echocardiography and right heart catheterization was performed in 100 outpatients with COPD. By echocardiography the time-integral of the TDI index, right ventricular systolic velocity (RVSmVTI) and pulmonary acceleration-time (PAAcT) were measured and adjusted for heart rate. The COPD patients were randomly divided in a derivation (n = 50) and a validation cohort (n = 50). RESULTS PH (mean pulmonary artery pressure (mPAP) ≥ 25mmHg) and elevated PVR ≥ 2Wood unit (WU) were predicted by satisfactory area under the curve for RVSmVTI of 0.93 and 0.93 and for PAAcT of 0.96 and 0.96, respectively. Both echo indices were 100% feasible, contrasting 84% feasibility for parameters relying on contrast enhanced tricuspid-regurgitation. RVSmVTI and PAAcT showed best correlations to invasive measured mPAP, but less so to PVR. PAAcT was accurate in 90- and 78% and RVSmVTI in 90- and 84% in the calculation of mPAP and PVR, respectively. CONCLUSIONS Heart rate adjusted-PAAcT and RVSmVTI are simple and reproducible methods that correlate well with pulmonary artery pressure and PVR and showed high accuracy in detecting PH and increased PVR in patients with COPD. Taken into account the high feasibility of these two echo indices, they should be considered in the echocardiographic assessment of COPD patients.
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Affiliation(s)
- Janne Mykland Hilde
- a 1 Department of Cardiology, Oslo University Hospital , Aker , Norway.,e 5 Faculty of Medicine, Institute of Clinical Sciences, University of Oslo , Aker , Norway
| | - Ingunn Skjørten
- b 2 Department of Pulmonary Medicine, Oslo University Hospital , Aker , Norway.,e 5 Faculty of Medicine, Institute of Clinical Sciences, University of Oslo , Aker , Norway
| | - Viggo Hansteen
- a 1 Department of Cardiology, Oslo University Hospital , Aker , Norway
| | | | - Dan Atar
- d 4 Department of Cardiology, Oslo University Hospital , Ullevål , Norway.,e 5 Faculty of Medicine, Institute of Clinical Sciences, University of Oslo , Aker , Norway
| | - Jonny Hisdal
- e 5 Faculty of Medicine, Institute of Clinical Sciences, University of Oslo , Aker , Norway.,f 6 Section of Vascular Investigations, Oslo University Hospital , Aker , Norway
| | - Sjur Humerfelt
- b 2 Department of Pulmonary Medicine, Oslo University Hospital , Aker , Norway
| | - Kjetil Steine
- e 5 Faculty of Medicine, Institute of Clinical Sciences, University of Oslo , Aker , Norway.,g 7 Department of Cardiology, Akershus University Hospital , Lorenskog , Norway
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Farrag M, Elfattah NA, Younis MA. Demographic and clinical characteristics of pulmonary hypertension cases and the awareness of the disease among chest physicians in Abassia Chest Hospital. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2016. [DOI: 10.1016/j.ejcdt.2015.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Detection of right sided heart changes and pulmonary hypertension in COPD patients. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2015. [DOI: 10.1016/j.ejcdt.2014.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Abstract
Pulmonary hypertension may complicate the course of patients with many forms of advanced lung disease. The cause is likely multifactorial with pathogenic pathways both common and unique to the specific disease entities. The occurrence of pulmonary hypertension is associated with worse outcomes, but whether this is an adaptive or maladaptive phenomenon remains unknown. The treatment of pulmonary hypertension with vasoactive medications in lung disease remains unproved. Specific disease phenotypes that might benefit, and those in which such therapies might be deleterious, remain to be determined.
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Affiliation(s)
- Steven D Nathan
- Advanced Lung Disease and Transplant Program, Department of Medicine, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA.
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Abstract
Right ventricular (RV) dysfunction arises in chronic lung disease when chronic hypoxemia and disruption of pulmonary vascular beds increase ventricular afterload. RV dysfunction is defined by hypertrophy with preserved myocardial contractility and cardiac output. RV hypertrophy seems to be a common complication of chronic and advanced lung disease. RV failure is rare, except during acute exacerbations of chronic lung disease or when multiple comorbidities are present. Treatment is targeted at correcting hypoxia and improving pulmonary gas exchange and mechanics. There are no data supporting the use of pulmonary hypertension-specific therapies for patients with RV dysfunction secondary to chronic lung disease.
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Affiliation(s)
- Todd M. Kolb
- Post-Doctoral Fellow, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Paul M. Hassoun
- Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University
- Director, Pulmonary Hypertension Program, Johns Hopkins University, Baltimore, Maryland
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