1
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Natarajan RK, Rodgers N, Narasimhan S, Ambrose M, Rothman A, Shyne M, Evans M, Aggarwal V. Invasive haemodynamics predict outcomes in paediatric pulmonary artery hypertension. Cardiol Young 2024:1-8. [PMID: 38572557 DOI: 10.1017/s1047951124000647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
BACKGROUND Invasive haemodynamics are often performed for initiating and guiding pulmonary artery hypertension therapy. Little is known about the predictive value of invasive haemodynamic indices for long-term outcomes in children with pulmonary artery hypertension. We aimed to evaluate invasive haemodynamic data to help predict outcomes in paediatric pulmonary artery hypertension. METHODS Patients with pulmonary artery hypertension who underwent cardiac catheterisation (2006-2019) at a single centre were included. Invasive haemodynamic data from the first cardiac catheterisation and clinical outcomes were reviewed. The combined adverse outcome was defined as pericardial effusion (due to right ventricle failure), creation of a shunt for pulmonary artery hypertension (atrial septal defect or reverse Pott's shunt), lung transplant, or death. RESULTS Among 46 patients with a median [interquartile range (IQR)] age of 13.2 [4.1-44.7] months, 76% had CHD. Median mean pulmonary artery pressure was 37 [28-52] mmHg and indexed pulmonary vascular resistance was 6.2 [3.6-10] Woods units × m2. Median pulmonary artery pulsatility index was 4.0 [3.0-4.7] and right ventricular stroke work index was 915 [715-1734] mmHg mL/m2. After a median follow-up of 2.4 years, nine patients had a combined adverse outcome (two had a pericardial effusion, one underwent atrial level shunt, one underwent reverse Pott's shunt, and six died). Patients with an adverse outcome had higher systolic and mean pulmonary artery pressures, higher diastolic and transpulmonary pressure gradients, higher indexed pulmonary vascular resistance, higher pulmonary artery elastance, and higher right ventricular stroke work index (p < 0.05 each). CONCLUSION Invasive haemodynamics (especially mean pulmonary artery pressure and diastolic pressure gradient) obtained at first cardiac catheterisation in children with pulmonary artery hypertension predicts outcomes.
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Affiliation(s)
| | - Nathan Rodgers
- Division of Pediatric Cardiology, University of Minnesota, Minneapolis, MN, USA
| | - Shanti Narasimhan
- Division of Pediatric Cardiology, University of Minnesota, Minneapolis, MN, USA
| | - Matthew Ambrose
- Division of Pediatric Cardiology, University of Minnesota, Minneapolis, MN, USA
| | - Abraham Rothman
- Children's Heart Center of Nevada, UNLV School of Medicine, Las Vegas, NV, USA
| | - Michael Shyne
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - Michael Evans
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - Varun Aggarwal
- Division of Pediatric Cardiology, University of Minnesota, Minneapolis, MN, USA
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2
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Walker M, Moore H, Ataya A, Pham A, Corris PA, Laubenbacher R, Bryant AJ. A perfectly imperfect engine: Utilizing the digital twin paradigm in pulmonary hypertension. Pulm Circ 2024; 14:e12392. [PMID: 38933181 PMCID: PMC11199193 DOI: 10.1002/pul2.12392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/08/2024] [Accepted: 05/16/2024] [Indexed: 06/28/2024] Open
Abstract
Pulmonary hypertension (PH) is a severe medical condition with a number of treatment options, the majority of which are introduced without consideration of the underlying mechanisms driving it within an individual and thus a lack of tailored approach to treatment. The one exception is a patient presenting with apparent pulmonary arterial hypertension and shown to have vaso-responsive disease, whose clinical course and prognosis is significantly improved by high dose calcium channel blockers. PH is however characterized by a relative abundance of available data from patient cohorts, ranging from molecular data characterizing gene and protein expression in different tissues to physiological data at the organ level and clinical information. Integrating available data with mechanistic information at the different scales into computational models suggests an approach to a more personalized treatment of the disease using model-based optimization of interventions for individual patients. That is, constructing digital twins of the disease, customized to a patient, promises to be a key technology for personalized medicine, with the aim of optimizing use of existing treatments and developing novel interventions, such as new drugs. This article presents a perspective on this approach in the context of a review of existing computational models for different aspects of the disease, and it lays out a roadmap for a path to realizing it.
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Affiliation(s)
- Melody Walker
- University of Florida College of MedicineGainesvilleFloridaUSA
| | - Helen Moore
- University of Florida College of MedicineGainesvilleFloridaUSA
| | - Ali Ataya
- University of Florida College of MedicineGainesvilleFloridaUSA
| | - Ann Pham
- University of Florida College of MedicineGainesvilleFloridaUSA
| | - Paul A. Corris
- The Faculty of Medical Sciences Newcastle UniversityNewcastle upon TyneUK
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3
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Hahn RT, Lawlor MK, Davidson CJ, Badhwar V, Sannino A, Spitzer E, Lurz P, Lindman BR, Topilsky Y, Baron SJ, Chadderdon S, Khalique OK, Tang GHL, Taramasso M, Grayburn PA, Badano L, Leipsic J, Lindenfeld J, Windecker S, Vemulapalli S, Redfors B, Alu MC, Cohen DJ, Rodés-Cabau J, Ailawadi G, Mack M, Ben-Yehuda O, Leon MB, Hausleiter J. Tricuspid Valve Academic Research Consortium Definitions for Tricuspid Regurgitation and Trial Endpoints. Eur Heart J 2023; 44:4508-4532. [PMID: 37793121 PMCID: PMC10645050 DOI: 10.1093/eurheartj/ehad653] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/12/2023] [Accepted: 08/08/2023] [Indexed: 10/06/2023] Open
Abstract
Interest in the pathophysiology, etiology, management, and outcomes of patients with tricuspid regurgitation (TR) has grown in the wake of multiple natural history studies showing progressively worse outcomes associated with increasing TR severity, even after adjusting for multiple comorbidities. Historically, isolated tricuspid valve surgery has been associated with high in-hospital mortality rates, leading to the development of transcatheter treatment options. The aim of this first Tricuspid Valve Academic Research Consortium document is to standardize definitions of disease etiology and severity, as well as endpoints for trials that aim to address the gaps in our knowledge related to identification and management of patients with TR. Standardizing endpoints for trials should provide consistency and enable meaningful comparisons between clinical trials. A second Tricuspid Valve Academic Research Consortium document will focus on further defining trial endpoints and will discuss trial design options.
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Affiliation(s)
- Rebecca T Hahn
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
- Cardiovascular Research Foundation, New York, New York,USA
| | - Matthew K Lawlor
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Charles J Davidson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Anna Sannino
- Baylor Research Institute, The Heart Hospital Baylor Plano, Plano, Texas, USA
- Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, Naples, Italy
| | - Ernest Spitzer
- Cardialysis, Rotterdam, the Netherlands
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Philipp Lurz
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Brian R Lindman
- Structural Heart and Valve Center, Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Suzanne J Baron
- Division of Cardiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
- Baim Institute of Clinical Research, Boston, Massachusetts, USA
| | - Scott Chadderdon
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Omar K Khalique
- Division of Cardiology, Saint Francis Hospital and Catholic Health, Roslyn, New York, USA
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York, USA
| | - Maurizio Taramasso
- Herzzentrum Hirslanden Zürich, Zürich, Switzerland
- University of Zürich, Zürich, Switzerland
| | - Paul A Grayburn
- Baylor Scott and White Heart and Vascular Hospital at Plano, Plano, Texas, USA
| | - Luigi Badano
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Jonathon Leipsic
- Department of Radiology and Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - JoAnn Lindenfeld
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephan Windecker
- Department of Cardiology, University Cardiovascular Center, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Bjorn Redfors
- Cardiovascular Research Foundation, New York, New York,USA
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria C Alu
- Cardiovascular Research Foundation, New York, New York,USA
| | - David J Cohen
- Cardiovascular Research Foundation, New York, New York,USA
- Division of Cardiology, Saint Francis Hospital and Catholic Health, Roslyn, New York, USA
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael Mack
- Baylor Scott and White Health, Dallas, Texas, USA
| | - Ori Ben-Yehuda
- Cardiovascular Research Foundation, New York, New York,USA
- University of California-San Diego, San Diego, California, USA
| | - Martin B Leon
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
- Cardiovascular Research Foundation, New York, New York,USA
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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4
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Hahn RT, Lawlor MK, Davidson CJ, Badhwar V, Sannino A, Spitzer E, Lurz P, Lindman BR, Topilsky Y, Baron SJ, Chadderdon S, Khalique OK, Tang GHL, Taramasso M, Grayburn PA, Badano L, Leipsic J, Lindenfeld J, Windecker S, Vemulapalli S, Redfors B, Alu MC, Cohen DJ, Rodés-Cabau J, Ailawadi G, Mack M, Ben-Yehuda O, Leon MB, Hausleiter J. Tricuspid Valve Academic Research Consortium Definitions for Tricuspid Regurgitation and Trial Endpoints. Ann Thorac Surg 2023; 116:908-932. [PMID: 37804270 DOI: 10.1016/j.athoracsur.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 10/09/2023]
Abstract
Interest in the pathophysiology, etiology, management, and outcomes of patients with tricuspid regurgitation (TR) has grown in the wake of multiple natural history studies showing progressively worse outcomes associated with increasing TR severity, even after adjusting for multiple comorbidities. Historically, isolated tricuspid valve surgery has been associated with high in-hospital mortality rates, leading to the development of transcatheter treatment options. The aim of this first Tricuspid Valve Academic Research Consortium document is to standardize definitions of disease etiology and severity, as well as endpoints for trials that aim to address the gaps in our knowledge related to identification and management of patients with TR. Standardizing endpoints for trials should provide consistency and enable meaningful comparisons between clinical trials. A second Tricuspid Valve Academic Research Consortium document will focus on further defining trial endpoints and will discuss trial design options.
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Affiliation(s)
- Rebecca T Hahn
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York.
| | - Matthew K Lawlor
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York
| | | | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
| | - Anna Sannino
- Baylor Research Institute, The Heart Hospital Baylor Plano, Plano, Texas; Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Ernest Spitzer
- Cardialysis, Rotterdam, the Netherlands; Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Philipp Lurz
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Brian R Lindman
- Structural Heart and Valve Center, Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Suzanne J Baron
- Division of Cardiology, Lahey Hospital and Medical Center, Burlington, Massachusetts; Baim Institute of Clinical Research, Boston, Massachusetts
| | - Scott Chadderdon
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Omar K Khalique
- Division of Cardiology, Saint Francis Hospital and Catholic Health, Roslyn, New York
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York
| | - Maurizio Taramasso
- Herzzentrum Hirslanden Zürich, Zürich, Switzerland; University of Zürich, Zürich, Switzerland
| | - Paul A Grayburn
- Baylor Scott and White Heart and Vascular Hospital at Plano, Plano, Texas
| | - Luigi Badano
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy; Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Jonathon Leipsic
- Department of Radiology and Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - JoAnn Lindenfeld
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Stephan Windecker
- Department of Cardiology, University Cardiovascular Center, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Durham, North Carolina; Duke University School of Medicine, Durham, North Carolina
| | - Bjorn Redfors
- Cardiovascular Research Foundation, New York, New York; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria C Alu
- Cardiovascular Research Foundation, New York, New York
| | - David J Cohen
- Cardiovascular Research Foundation, New York, New York; Division of Cardiology, Saint Francis Hospital and Catholic Health, Roslyn, New York
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Ori Ben-Yehuda
- Cardiovascular Research Foundation, New York, New York; University of California-San Diego, San Diego, California
| | - Martin B Leon
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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5
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Hahn RT, Lawlor MK, Davidson CJ, Badhwar V, Sannino A, Spitzer E, Lurz P, Lindman BR, Topilsky Y, Baron SJ, Chadderdon S, Khalique OK, Tang GHL, Taramasso M, Grayburn PA, Badano L, Leipsic J, Lindenfeld J, Windecker S, Vemulapalli S, Redfors B, Alu MC, Cohen DJ, Rodés-Cabau J, Ailawadi G, Mack M, Ben-Yehuda O, Leon MB, Hausleiter J. Tricuspid Valve Academic Research Consortium Definitions for Tricuspid Regurgitation and Trial Endpoints. J Am Coll Cardiol 2023; 82:1711-1735. [PMID: 37804294 DOI: 10.1016/j.jacc.2023.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/12/2023] [Accepted: 08/08/2023] [Indexed: 10/09/2023]
Abstract
Interest in the pathophysiology, etiology, management, and outcomes of patients with tricuspid regurgitation (TR) has grown in the wake of multiple natural history studies showing progressively worse outcomes associated with increasing TR severity, even after adjusting for multiple comorbidities. Historically, isolated tricuspid valve surgery has been associated with high in-hospital mortality rates, leading to the development of transcatheter treatment options. The aim of this first Tricuspid Valve Academic Research Consortium document is to standardize definitions of disease etiology and severity, as well as endpoints for trials that aim to address the gaps in our knowledge related to identification and management of patients with TR. Standardizing endpoints for trials should provide consistency and enable meaningful comparisons between clinical trials. A second Tricuspid Valve Academic Research Consortium document will focus on further defining trial endpoints and will discuss trial design options.
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Affiliation(s)
- Rebecca T Hahn
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA.
| | - Matthew K Lawlor
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Charles J Davidson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Anna Sannino
- Baylor Research Institute, The Heart Hospital Baylor Plano, Plano, Texas, USA; Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, Naples, Italy. https://twitter.com/AnnaSannino198
| | - Ernest Spitzer
- Cardialysis, Rotterdam, the Netherlands; Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Philipp Lurz
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Brian R Lindman
- Structural Heart and Valve Center, Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Suzanne J Baron
- Division of Cardiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA; Baim Institute of Clinical Research, Boston, Massachusetts, USA
| | - Scott Chadderdon
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA. https://twitter.com/PDXHeartValveMD
| | - Omar K Khalique
- Division of Cardiology, Saint Francis Hospital and Catholic Health, Roslyn, New York, USA
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York, USA
| | - Maurizio Taramasso
- Herzzentrum Hirslanden Zürich, Zürich, Switzerland; University of Zürich, Zürich, Switzerland
| | - Paul A Grayburn
- Baylor Scott and White Heart and Vascular Hospital at Plano, Plano, Texas, USA
| | - Luigi Badano
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy; Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Jonathon Leipsic
- Department of Radiology and Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - JoAnn Lindenfeld
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephan Windecker
- Department of Cardiology, University Cardiovascular Center, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA
| | - Bjorn Redfors
- Cardiovascular Research Foundation, New York, New York, USA; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria C Alu
- Cardiovascular Research Foundation, New York, New York, USA
| | - David J Cohen
- Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, Saint Francis Hospital and Catholic Health, Roslyn, New York, USA
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael Mack
- Baylor Scott and White Health, Dallas, Texas, USA
| | - Ori Ben-Yehuda
- Cardiovascular Research Foundation, New York, New York, USA; University of California-San Diego, San Diego, California, USA. https://twitter.com/oribenyehuda
| | - Martin B Leon
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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6
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Stubbe B, Halank M, Seyfarth HJ, Obst A, Desole S, Opitz CF, Ewert R. [Risk Stratification in Patients with Pulmonary Arterial Hypertension under Treatment - Results of Four German Centers]. Pneumologie 2022; 76:330-339. [PMID: 35373311 DOI: 10.1055/a-1740-3377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Risk stratification plays an essential role in the management of patients with pulmonary arterial hypertension (PAH). According to the current European guidelines the expected 1-year risk of mortality for PAH patients can be categorized as low, intermediate, or high, based on clinical, non-invasive and hemodynamic data.Data from 131 patients with incident PAH (age 64 ± 14) and frequent comorbidities (in 66.4 %) treated between 2016 and 2018 at 4 German PH centers were analyzed. At baseline, most patients were classified as intermediate risk (76 %), 13.8 % as high risk and only 9.9 % as low risk.During follow-up while on treatment after 12 ± 3 months (range 9-16 months) 64.9 % were still classified as intermediate risk (76 %), 14.4 % as high risk and 20.7 % as low risk.Survival at 12 and 24 months was 96 % and 82 % in the intermediate risk group, while only 89 % and 51 % of the high risk patients were alive at these time points. In contrast, all patients in the low risk category were alive at 24 months.Despite the availability of various treatment options for patients with PAH even in specialized centers only a minority of patients can be stabilized in the low risk group associated with a good outcome.
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Affiliation(s)
- Beate Stubbe
- University Medicine Greifswald, Internal Medicine B, Pneumology, Greifswald
| | - Michael Halank
- Internal Medicine, Pneumology, University Hospital Dresden, Dresden, Germany
| | | | - Anne Obst
- University Medicine Greifswald, Internal Medicine B, Pneumology, Greifswald
| | - Susanna Desole
- University Medicine Greifswald, Internal Medicine B, Pneumology, Greifswald
| | | | - Ralf Ewert
- University Medicine Greifswald, Internal Medicine B, Pneumology, Greifswald
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7
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Yang S, Yang Y, Zhang Y, Kuang T, Gong J, Li J, Li Y, Wang J, Guo X, Miao R. Haemodynamic effects of riociguat in CTEPH and PAH: a 10-year observational study. ERJ Open Res 2021; 7:00082-2021. [PMID: 34513985 PMCID: PMC8419318 DOI: 10.1183/23120541.00082-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/28/2021] [Indexed: 11/24/2022] Open
Abstract
Background Long-term treatment with riociguat has been shown to enhance exercise capacity in patients with pulmonary arterial hypertension (PAH) and inoperable or persistent/recurrent chronic thromboembolic pulmonary hypertension (CTEPH). This study sought to evaluate the long-term haemodynamic effects of riociguat in patients with PAH and inoperable CTEPH. Methods During this single-centre long-term observational study, riociguat was administered at a three-times-daily dose of up to 2.5 mg. The primary outcome was pulmonary vascular resistance (PVR). The secondary outcomes included mean pulmonary arterial pressure (PAP), cardiac index, mortality, clinical worsening events, 6-min walk distance (6MWD) and World Health Organization functional class (WHO FC). Results 37 patients (CTEPH n=19; PAH n=18) were included. The median follow-up period was 96 months. The survival estimates for all the patients at 1/3/5/8 years were 0.97/0.86/0.72/0.61, without significant differences between patients with CTEPH and PAH. At the final data cut-off, PVR decreased (1232±462 dyn·s·cm–5versus 835±348 dyn·s·cm–5, p<0.001), cardiac index increased (1.7±0.4 L·min−1·m−2versus 2.4±0.5 L·min−1·m−2, p<0.001), 6MWD increased by 43.1±59.6 m, and WHO FC improved/stabilised/worsened in 40%/35%/25% of patients versus baseline. Improvement in PAP was not shown. Compared with patients in WHO FC I/II and III/IV at baseline, the 8-year clinical worsening-free survival estimates were 0.51 versus 0.19 (p=0.026). Conclusions Riociguat improved PVR and cardiac index for up to 8 years, but not PAP. WHO FC may have certain predictive value for the long-term prognosis. In patients with PAH and inoperable CTEPH, riociguat improved pulmonary vascular resistance and cardiac index for 8 years, but not pulmonary arterial pressure. World Health Organization functional class may have predictive value for long-term prognosis.https://bit.ly/3dTf4ft
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Affiliation(s)
- Suqiao Yang
- Dept of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Respiratory Medicine, Beijing, China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China
| | - Yuanhua Yang
- Dept of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Respiratory Medicine, Beijing, China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China
| | - Yixiao Zhang
- Dept of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Respiratory Medicine, Beijing, China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China
| | - Tuguang Kuang
- Dept of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Respiratory Medicine, Beijing, China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China
| | - Juanni Gong
- Dept of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Respiratory Medicine, Beijing, China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China
| | - Jifeng Li
- Dept of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Respiratory Medicine, Beijing, China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China
| | - Yidan Li
- Dept of Echocardiography, Heart Centre, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jianfeng Wang
- Dept of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiaojuan Guo
- Dept of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Ran Miao
- Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China.,Medical Research Centre, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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8
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Highland KB, Crawford R, Classi P, Morrison R, Doward L, Nelsen AC, Castillo H, Mathai SC, DuBrock HM. Development of the Pulmonary Hypertension Functional Classification Self-Report: a patient version adapted from the World Health Organization Functional Classification measure. Health Qual Life Outcomes 2021; 19:202. [PMID: 34429110 PMCID: PMC8386063 DOI: 10.1186/s12955-021-01782-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 04/28/2021] [Indexed: 11/19/2022] Open
Abstract
Background Pulmonary arterial hypertension (PAH) is characterized by progressive limitations on physical activity, right heart failure, and premature death. The World Health Organization functional classification (WHO-FC) is a clinician-rated assessment used widely to assess PAH severity and functioning, but no equivalent patient-reported version of PAH symptoms and activity limitations exists. We developed a version of the WHO-FC for self-completion by patients: the Pulmonary Hypertension Functional Classification Self-Report (PH-FC-SR). Methods Semistructured interviews were conducted with three health care providers (HCPs) via telephone to inform development of the draft PH-FC-SR. Two rounds of semi-structured interviews were conducted with 14 US patients with a self-reported PAH diagnosis via telephone/online to elicit concepts and iteratively refine the PH-FC-SR. Results HCPs reported that the WHO-FC was a useful tool for evaluating patients’ PAH severity over time and for making treatment decisions but acknowledged that use of the measure is subjective. Patients in round 1 interviews (n = 6) reported PAH symptoms, including shortness of breath (n = 6), fatigue (n = 5), syncope (n = 5), chest pains (n = 3), and dizziness (n = 3). Round 1 patients identified challenges with the original WHO-FC, including comprehensibility of clinical terms and overlapping descriptions of class II and III, and preferred the Draft 1 PH-FC-SR over the original WHO-FC. After minor changes were made to Draft 2, round 2 interviews (n = 8) confirmed patients understood the PH-FC-SR class descriptions, interpreting them consistently. Conclusions The HCP and patient interviews identified and confirmed certain limitations inherent within the clinician-rated WHO-FC, including subjective assessment and overlapping definitions for class II and III. The PH-FC-SR includes patient-appropriate language, symptoms, and physical activity impacts relevant to patients with PAH. Future research is recommended to validate the PH-FC-SR and explore its correlation with the physician-assessed WHO-FC and other outcomes.
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Affiliation(s)
| | - Rebecca Crawford
- RTI Health Solutions, The Pavilion, Towers Business Park, Wilmslow Road, Didsbury, Manchester, M20 2LS, UK.
| | | | - Ross Morrison
- RTI Health Solutions, The Pavilion, Towers Business Park, Wilmslow Road, Didsbury, Manchester, M20 2LS, UK
| | - Lynda Doward
- RTI Health Solutions, The Pavilion, Towers Business Park, Wilmslow Road, Didsbury, Manchester, M20 2LS, UK
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9
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Affiliation(s)
- Peter V. Dicpinigaitis
- Albert Einstein College of Medicine and Montefiore Medical Center, 1825 Eastchester Road, Bronx, NY 10461 USA
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10
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Myocardial deformation assessment in patients with precapillary pulmonary hypertension: A cardiac magnetic resonance study. Diagn Interv Imaging 2020; 102:153-161. [PMID: 32917553 DOI: 10.1016/j.diii.2020.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/01/2020] [Accepted: 08/03/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE The purpose of this study was to investigate right atrial and ventricular strain parameters on cardiac magnetic resonance (CMR) in patients with precapillary pulmonary hypertension (PPH) and whether they can aid in the assessment of PPH prognosis. MATERIALS AND METHODS Adult patients with groups 1 and 4 PPH were invited to participate in the study. Age- and sex-matched healthy volunteers were also recruited as controls. At baseline, patients underwent clinical examination, N-terminal pro-B-type natriuretic peptide measurement and CMR with feature tracking post-processing (CMR-FT). Healthy controls underwent only CMR-FT. The study's primary endpoint was clinical failure, defined as death, hospitalization or demonstrable clinical deterioration during follow-up. Patients who were unable to perform 6-minute walking test due to musculoskeletal disorders were excluded from the study. RESULTS Thirty-six patients (8 men, 28 women; mean age, 50.6±13.8 [SD] years [range: 18.6-78.5years]) and 12 healthy control subjects (5 mean, 7 women; mean age, 40.6±13.5 [SD] years [range: 23.1-64.4years]) were recruited. Right ventricular global longitudinal strain (GLS) was significantly impaired in PPH patients (-20.2±5.3 [SD] % [range: -28.8 to -9.1%] vs. -28.4±3.1% [-33.7 to -22.7%] respectively, P<0.001). The right atrial GLS was significantly impaired in PPH compared to healthy controls (-19.9±4.5% [range: -28.6 to -3.6%] vs. -26.5±4.2% [range: -32.8 to -15.8%] respectively) (P<0.001). Clinical failure occurred in 19 (19/36, 53%) of patients. Right ventricular GLS predicted clinical failure most reliably among CMR parameters (-22.6±3.8 [SD] % [range: -27.6 to -12.7%] for patients without clinical failure vs. -18±5.6 [SD] % [range: -28.8 to -9.1%] for patients with clinical failure; hazard ratio [HR]=1.85; P=0.007; area under the AUC curve=0.75). Lower absolute right atrial GLS was significantly associated with clinical failure (-22.7±3.0 [SD] % [range: -28.6 to -17.7%] for patients without clinical failure vs. -16.9±5.8 [SD] % [range: -24.2 to -3.6%] for patients with clinical failure) (HR=1.53; P=0.035). CONCLUSION CMR feature tracking-derived myocardial strain parameters of both the right atrium and ventricle can assist clinicians in the prognosis of PPH.
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