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Kosyakovsky LB, Liu EE, Wang JK, Myers L, Parekh JK, Knauss H, Lewis GD, Malhotra R, Nayor M, Robbins JM, Gerszten RE, Hamburg NM, McNeill JN, Lau ES, Ho JE. Uncovering Unrecognized Heart Failure With Preserved Ejection Fraction Among Individuals With Obesity and Dyspnea. Circ Heart Fail 2024; 17:e011366. [PMID: 38742409 PMCID: PMC11214582 DOI: 10.1161/circheartfailure.123.011366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/18/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Although heart failure with preserved ejection fraction (HFpEF) has become the predominant heart failure subtype, it remains clinically under-recognized. HFpEF diagnosis is particularly challenging in the setting of obesity given the limitations of natriuretic peptides and resting echocardiography. We examined invasive and noninvasive HFpEF diagnostic criteria among individuals with obesity and dyspnea without known cardiovascular disease to determine the prevalence of hemodynamic HFpEF in the community. METHODS Research volunteers with dyspnea and obesity underwent resting echocardiography; participants with possible pulmonary hypertension qualified for invasive cardiopulmonary exercise testing. HFpEF was defined using rest or exercise pulmonary capillary wedge pressure criteria (≥15 mm Hg or Δpulmonary capillary wedge pressure/Δcardiac output slope, >2.0 mm Hg·L-1·min-1). RESULTS Among n=78 participants (age, 53±13 years; 65% women; body mass index, 37.3±6.8 kg/m2), 40 (51%) met echocardiographic criteria to undergo invasive cardiopulmonary exercise testing. In total, 24 participants (60% among the cardiopulmonary exercise testing group, 31% among the total sample) were diagnosed with HFpEF by rest or exercise pulmonary capillary wedge pressure (n=12) or exercise criteria (n=12). There were no differences in NT-proBNP (N-terminal pro-B-type natriuretic peptide; 79 [62-104] versus 73 [57-121] pg/mL) or resting echocardiography (mitral E/e' ratio, 9.1±3.1 versus 8.0±2.7) among those with versus without HFpEF (P>0.05 for all). Distributions of HFpEF diagnostic scores were similar, with the majority classified as intermediate risk (100% versus 93.75% [H2FPEF] and 87.5% versus 68.75% [HFA-PEFF (Heart Failure Association Pretest assessment, echocardiography and natriuretic peptide, functional testing, and final etiology)] in those with versus without HFpEF). CONCLUSIONS Among adults with obesity and dyspnea without known cardiovascular disease, at least a third had clinically unrecognized HFpEF uncovered on invasive cardiopulmonary exercise testing. Clinical, biomarker, resting echocardiography, and diagnostic scores were similar among those with and without HFpEF. These results suggest clinical underdiagnosis of HFpEF among individuals with obesity and dyspnea and highlight limitations of noninvasive testing in the identification of HFpEF.
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Affiliation(s)
- Leah B. Kosyakovsky
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Elizabeth E. Liu
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jessica K. Wang
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Lisa Myers
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Juhi K Parekh
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Hanna Knauss
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Gregory D. Lewis
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Rajeev Malhotra
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Matthew Nayor
- Sections of Cardiology and Preventive Medicine and Epidemiology, Division of Internal Medicine, Boston University School of Medicine, Boston, MA
| | - Jeremy M. Robbins
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Robert E. Gerszten
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Naomi M. Hamburg
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Jenna N. McNeill
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Emily S. Lau
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Jennifer E. Ho
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Kadoglou NPE, Khattab E, Velidakis N, Gkougkoudi E, Myrianthefs MM. The Role of Echocardiography in the Diagnosis and Prognosis of Pulmonary Hypertension. J Pers Med 2024; 14:474. [PMID: 38793056 PMCID: PMC11122427 DOI: 10.3390/jpm14050474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024] Open
Abstract
The right heart catheterisation constitutes the gold standard for pulmonary hypertension (PH) diagnosis. However, echocardiography remains a reliable, non-invasive, inexpensive, convenient, and easily reproducible modality not only for the preliminary screening of PH but also for PH prognosis. The aim of this review is to describe a cluster of echocardiographic parameters for the detection and prognosis of PH and analyse the challenges of echocardiography implementation in patients with suspected or established PH. The most important echocardiographic index is the calculation of pulmonary arterial systolic pressure (PASP) through the tricuspid regurgitation (TR). It has shown high correlation with invasive measurement of pulmonary pressure, but several drawbacks have questioned its accuracy. Besides this, the right ventricular outflow track acceleration time (RVOT-AT) has been proposed for PH diagnosis. A plethora of echocardiographic indices: right atrial area, pericardial effusion, the tricuspid annular plane systolic excursion (TAPSE), the TAPSE/PASP ratio, tricuspid annular systolic velocity (s'), can reflect the severity and prognosis of PH. Recent advances in echocardiography with 3-dimensional right ventricular (RV) ejection fraction, RV free wall strain and right atrial strain may further assist the prognosis of PH.
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Affiliation(s)
- Nikolaos P. E. Kadoglou
- Medical School, University of Cyprus, 215/6 Old Road Lefkosias-Lemesou, Aglatzia, Nicosia 2029, Cyprus; (E.K.); (N.V.); (E.G.)
- Cardiology Department, Nicosia General Hospital, Lemesou 215, Strovolos, Nicosia 2029, Cyprus;
| | - Elina Khattab
- Medical School, University of Cyprus, 215/6 Old Road Lefkosias-Lemesou, Aglatzia, Nicosia 2029, Cyprus; (E.K.); (N.V.); (E.G.)
- Cardiology Department, Nicosia General Hospital, Lemesou 215, Strovolos, Nicosia 2029, Cyprus;
| | - Nikolaos Velidakis
- Medical School, University of Cyprus, 215/6 Old Road Lefkosias-Lemesou, Aglatzia, Nicosia 2029, Cyprus; (E.K.); (N.V.); (E.G.)
| | - Evaggelia Gkougkoudi
- Medical School, University of Cyprus, 215/6 Old Road Lefkosias-Lemesou, Aglatzia, Nicosia 2029, Cyprus; (E.K.); (N.V.); (E.G.)
| | - Michael M. Myrianthefs
- Cardiology Department, Nicosia General Hospital, Lemesou 215, Strovolos, Nicosia 2029, Cyprus;
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3
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Liu J, Fang G, Lan C, Qiu C, Yao L, Zhang Q, Hu J, Zhang Y, Yang Y, Zhang Y. Forsythoside B Mitigates Monocrotaline-Induced Pulmonary Arterial Hypertension via Blocking the NF-κB Signaling Pathway to Attenuate Vascular Remodeling. Drug Des Devel Ther 2024; 18:767-780. [PMID: 38495631 PMCID: PMC10942864 DOI: 10.2147/dddt.s444605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/24/2024] [Indexed: 03/19/2024] Open
Abstract
Purpose Pulmonary arterial hypertension (PAH) is a devastating disease with little effective treatment. The proliferation of pulmonary artery smooth muscle cells (PASMCs) induced by the nuclear factor-κB (NF-κB) signaling activation plays a pivotal role in the pathogenesis of PAH. Forsythoside B (FTS•B) possesses inhibitory effect on NF-κB signaling pathway. The present study aims to explore the effects and mechanisms of FTS•B in PAH. Methods Sprague-Dawley rats received monocrotaline (MCT) intraperitoneal injection to establish PAH model, and FTS•B was co-treated after MCT injection. Right ventricular hypertrophy and pulmonary artery pressure were measured by echocardiography and right heart catheterization, respectively. Histological alterations were detected by H&E staining and immunohistochemistry. FTS•B's role in PASMC proliferation and migration were evaluated by CCK-8 and wound healing assay. To investigate the underlying mechanisms, Western blotting, immunofluorescence staining and ELISA were conducted. The NF-κB activator PMA was used to investigate the role of NF-κB in FTS•B's protective effects against PAH. Results FTS•B markedly alleviated MCT-induced vascular remodeling and pulmonary artery pressure, and improved right ventricular hypertrophy and survival. FTS•B also reversed PDGF-BB-induced PASMC proliferation and migration, decreased PCNA and CyclinD1 expression in vitro. The elevated levels of IL-1β and IL-6 caused by MCT were decreased by FTS•B. Mechanistically, MCT-triggered phosphorylation of p65, IκBα, IKKα and IKKβ was blunted by FTS•B. FTS•B also reversed MCT-induced nuclear translocation of p65. However, all these protective effects were blocked by PMA-mediated NF-κB activation. Conclusion FTS•B effectively attenuates PAH by suppressing the NF-κB signaling pathway to attenuate vascular remodeling. FTS•B might be a promising drug candidate with clinical translational potential for the treatment of PAH.
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Affiliation(s)
- Jiying Liu
- Department of Cardiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, People’s Republic of China
- Department of Cardiology, General Hospital of Western Theater Command, Chengdu, Sichuan, 610083, People’s Republic of China
- Department of Cardiology, The Third People’s Hospital of Yibin, Yibin, Sichuan, 644000, People’s Republic of China
| | - Guangyao Fang
- Department of Cardiology, General Hospital of Western Theater Command, Chengdu, Sichuan, 610083, People’s Republic of China
- College of Medicine, Southwest Jiaotong University, Chengdu, Sichuan, 610083, People’s Republic of China
| | - Cong Lan
- Department of Cardiology, General Hospital of Western Theater Command, Chengdu, Sichuan, 610083, People’s Republic of China
| | - Chenming Qiu
- Department of Burn and Plastic Surgery, General Hospital of Western Theater Command, Chengdu, Sichuan, 610083, People’s Republic of China
| | - Li Yao
- Department of Cardiology, General Hospital of Western Theater Command, Chengdu, Sichuan, 610083, People’s Republic of China
| | - Qian Zhang
- Department of Cardiology, General Hospital of Western Theater Command, Chengdu, Sichuan, 610083, People’s Republic of China
| | - Jingtang Hu
- Department of Cardiology, General Hospital of Western Theater Command, Chengdu, Sichuan, 610083, People’s Republic of China
| | - Yaolei Zhang
- Basic Medical Laboratory, General Hospital of Western Theater Command, Chengdu, Sichuan, 610083, People’s Republic of China
| | - Yongjian Yang
- Department of Cardiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, People’s Republic of China
- Department of Cardiology, General Hospital of Western Theater Command, Chengdu, Sichuan, 610083, People’s Republic of China
| | - Yan Zhang
- Department of Cardiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, People’s Republic of China
- Department of Cardiology, General Hospital of Western Theater Command, Chengdu, Sichuan, 610083, People’s Republic of China
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Gu H, Azukaitis K, Doyon A, Erdem S, Ranchin B, Harambat J, Lugani F, Boguslavskyi A, Cansick J, Finlay E, Gilbert R, Kerecuk L, Lunn A, Maxwell H, Morgan H, Shenoy M, Shroff R, Subramaniam P, Tizard J, Tse Y, Simpson J, Chowienczyk P, Schaefer F, Sinha MD. Decline in Left Ventricular Early Systolic Function with Worsening Kidney Function in Children with Chronic Kidney Disease: Insights from the 4C and HOT-KID Studies. J Am Soc Echocardiogr 2024; 37:356-363.e1. [PMID: 37993063 DOI: 10.1016/j.echo.2023.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/27/2023] [Accepted: 11/08/2023] [Indexed: 11/24/2023]
Abstract
INTRODUCTION Adults with childhood-onset chronic kidney disease (CKD) have an increased risk of cardiovascular disease. First-phase ejection fraction (EF1), a novel measure of early systolic function, may be a more sensitive marker of left ventricular dysfunction than other markers in children with CKD. OBJECTIVE To examine whether EF1 is reduced in children with CKD. METHODS Children from the 4C and HOT-KID studies were stratified according to estimated glomerular filtration rate (eGFR). The EF1 was calculated from the fraction of left ventricular (LV) volume ejected up to the time of peak aortic flow velocity. RESULTS The EF1 was measured in children ages 10.9 ± 3.7 (mean ± SD) years, 312 with CKD and 63 healthy controls. The EF1 was lower, while overall ejection fraction was similar, in those with CKD compared with controls and decreased across stages of CKD (29.3% ± 3.7%, 23.5% ± 4.5%, 19.8% ± 4.0%, 18.5% ± 5.1%, and 16.7% ± 6.6% in controls, CKD 1, 2, 3, and ≥ 4, respectively, P < .001). The relationship of EF1 to eGFR persisted after adjustment for relevant confounders (P < .001). The effect size for association of measures of LV structure or function with eGFR (SD change per unit change in eGFR) was greater for EF1 (β = 0.365, P < .001) than for other measures: LV mass index (β = -0.311), relative wall thickness (β = -0.223), E/e' (β = -0.147), and e' (β = 0.141) after adjustment for confounders in children with CKD. CONCLUSIONS Children with CKD exhibit a marked and progressive decline in EF1 with falling eGFR. This suggests that EF1 is a more sensitive marker of LV dysfunction when compared to other structural or functional measures and that early LV systolic function is a key feature in the pathophysiology of cardiac dysfunction in CKD.
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Affiliation(s)
- Haotian Gu
- King's College London British Heart Foundation Centre, London, United Kingdom
| | - Karolis Azukaitis
- Clinic of Pediatrics, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Anke Doyon
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Sevcan Erdem
- Department of Pediatric Cardiology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Bruno Ranchin
- Pediatric Nephrology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université de Lyon, Lyon, France
| | - Jerome Harambat
- Pediatric Nephrology Unit, Department of Pediatrics, Centre de Référence Maladies Rénales Rares, Bordeaux University Hospital, Bordeaux, France
| | - Francesca Lugani
- Division of Nephrology, Dialysis, Transplantation, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Andrii Boguslavskyi
- King's College London British Heart Foundation Centre, London, United Kingdom
| | - Janette Cansick
- Department of Paediatrics, Medway Maritime Hospital, Medway, United Kingdom
| | - Eric Finlay
- Department of Paediatric Nephrology, Leeds General Infirmary, Leeds, United Kingdom
| | - Rodney Gilbert
- Department of Paediatric Nephrology, Southampton General Hospital, Southampton, United Kingdom
| | - Larissa Kerecuk
- Department of Paediatric Nephrology, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Andrew Lunn
- Department of Paediatric Nephrology, Nottingham University Hospital NHS Trust, Nottingham, United Kingdom
| | - Heather Maxwell
- Department of Paediatric Nephrology, Royal Hospital for Children, Glasgow, United Kingdom
| | - Henry Morgan
- Department of Paediatric Nephrology, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Mohan Shenoy
- Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Rukshana Shroff
- Department of Paediatric Nephrology, UCL Great Ormond Street Hospital and Institute of Child Health, London, United Kingdom
| | - Pushpa Subramaniam
- Department of Paediatrics, St Georges Hospital, Tooting, London, United Kingdom
| | - Jane Tizard
- Department of Paediatric Nephrology, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Yincent Tse
- Department of Paediatric Nephrology, Great North Children's Hospital, Newcastle Upon Tyne, United Kingdom
| | - John Simpson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, United Kingdom
| | - Phil Chowienczyk
- King's College London British Heart Foundation Centre, London, United Kingdom
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Manish D Sinha
- King's College London British Heart Foundation Centre, London, United Kingdom; Department of Paediatric Nephrology, Evelina London Children's Hospital, London, United Kingdom.
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Deboever N, Eapen GA, Casal RF, Durand JB, Eisenberg MA, Feldman H, May C, Ali Z, Rice DC, Mehran RJ. Endobronchial ultrasound: A novel screening test for pulmonary hypertension prior to major pulmonary surgery. JTCVS Tech 2024; 23:146-153. [PMID: 38352000 PMCID: PMC10859667 DOI: 10.1016/j.xjtc.2023.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/19/2023] [Accepted: 10/25/2023] [Indexed: 02/16/2024] Open
Abstract
Objectives Pulmonary hypertension (PH) is an important physiologic variable in the assessment of patients undergoing major thoracic operations but all too often neglected because of the need for right heart catheterization (RHC) due to the inaccuracy of transthoracic echocardiography. Patients with lung cancer often require endobronchial ultrasound (EBUS) as part of the staging of the cancer. We sought to investigate whether EBUS can be used to screen these patients for PH. Methods Patients undergoing a major thoracic operation requiring EBUS for staging were included prospectively in the study. All patients had also a RHC (gold standard). We aimed to compare the pulmonary artery pressure measurements by EBUS with the RHC values. Results A total of 20 patients were enrolled in the study. The prevalence of abnormal pulmonary artery pressure was 65% based on RHC. All patients underwent measurement of the pulmonary vascular acceleration time (PVAT) by EBUS with no adverse events. Linear regression analysis comparing PVAT and RHC showed a correlation (r = -0.059, -0.010 to -0.018, P = .007). A receiver operator characteristic curve (area under the curve = 0.736) was used to find the optimal PVAT threshold (140 milliseconds) to predict PH; this was used to calculate a positive and negative likelihood ratio following a positive diagnosis of 2.154 and 0.538, respectively. Conclusions EBUS interrogation of pulmonary artery hemodynamic is safe and feasible. EBUS may be used as a screening test for PH in high-risk individuals.
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Affiliation(s)
- Nathaniel Deboever
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - George A. Eapen
- Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Roberto F. Casal
- Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Jean-Bernard Durand
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Michael A. Eisenberg
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Hope Feldman
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Celestino May
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Zohra Ali
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - David C. Rice
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Reza J. Mehran
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
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6
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Lui JK, Gillmeyer KR, Sangani RA, Smyth RJ, Gopal DM, Trojanowski MA, Bujor AM, Soylemez Wiener R, LaValley MP, Klings ES. A Clinical Decision Tool for Risk Stratifying Patients with Systemic Sclerosis-Related Pulmonary Hypertension. Lung 2023; 201:565-569. [PMID: 37957388 PMCID: PMC11037922 DOI: 10.1007/s00408-023-00646-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/20/2023] [Indexed: 11/15/2023]
Abstract
We devised a scoring system to identify patients with systemic sclerosis (SSc) at risk for pulmonary hypertension (PH) and predict all-cause mortality. Using 7 variables obtained via pulmonary function testing, echocardiography, and computed tomographic chest imaging, we applied the score to a retrospective cohort of 117 patients with SSc. There were 60 (51.3%) who were diagnosed with PH by right heart catheterization. Using a scoring threshold ≥ 0, our decision tool predicted PH with a sensitivity, specificity, and accuracy of 0.87 (95% CI 0.75, 0.94), 0.74 (95% CI 0.60, 0.84), and 0.80 (95% CI 0.72, 0.87), respectively. When adjusted for age at PH diagnosis, sex, and receipt of pulmonary arterial vasodilators, each one-point score increase was associated with an adjusted HR of 1.19 (95% CI 1.05, 1.34) for all-cause mortality. With further validation in external cohorts, our simplified clinical decision tool may better streamline earlier detection of PH in SSc.
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Affiliation(s)
- Justin K Lui
- The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, 72 East Concord Street, R‑304, Boston, MA, 02118, USA.
| | - Kari R Gillmeyer
- The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, 72 East Concord Street, R‑304, Boston, MA, 02118, USA
| | - Ruchika A Sangani
- The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, 72 East Concord Street, R‑304, Boston, MA, 02118, USA
| | - Robert J Smyth
- The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, 72 East Concord Street, R‑304, Boston, MA, 02118, USA
| | - Deepa M Gopal
- Section of Cardiovascular Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Marcin A Trojanowski
- Section of Rheumatology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Andreea M Bujor
- Section of Rheumatology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Renda Soylemez Wiener
- The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, 72 East Concord Street, R‑304, Boston, MA, 02118, USA
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA, USA
| | - Michael P LaValley
- Section of Rheumatology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Elizabeth S Klings
- The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, 72 East Concord Street, R‑304, Boston, MA, 02118, USA
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7
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Landzberg MJ, Daniels CJ, Forfia P, McLaughlin VV, Bell Lynum KS, Selej M, Opotowsky AR. Timely PAH Identification in Adults With Repaired Congenital Heart Disease? The ACHD-QuERI Registry Insights. JACC. ADVANCES 2023; 2:100649. [PMID: 38938704 PMCID: PMC11198110 DOI: 10.1016/j.jacadv.2023.100649] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/06/2023] [Accepted: 08/08/2023] [Indexed: 06/29/2024]
Abstract
Background The Quality Enhancement Research Initiative (QuERI) in adults with congenital heart disease (ACHD) was developed to improve detection of pulmonary arterial hypertension (PAH) after repair of systemic-to-pulmonary arterial shunt lesions. Objectives This study sought to standardize use of accepted criteria for PAH diagnosis and evaluate utility in at-risk patients with ACHD. Methods Patients ≥18 years of age with ACHD repaired ≥1 year before enrollment and with additional risk factors for developing PAH were eligible. History, physical examination, electrocardiogram, transthoracic echocardiogram, World Health Organization functional class, and 6-minute walk distance were evaluated at baseline and yearly for 3 years. Pop-up reminders of patient-specific evidence-based recommendations for PAH detection appeared during data entry. Results Among 217 eligible patients, mean age (enrollment) was 44.0 ± 15.9 years, 72.3% were women, and 82.0% were World Health Organization functional class I. Electrocardiogram was performed in >80% and TTE in >70% of patients annually; capture of required transthoracic echocardiography (TTE) measures and alignment between study- and core-center interpretation improved over time, with more frequent assessment of pulmonary arterial flow acceleration time and documentation of right ventricular outflow tract Doppler notching. Approximately 40% of patients had ≥2 high-risk features for PAH on TTE, but only 7% (6/82) underwent right heart catheterization (RHC). Using current definitions, 2 patients were confirmed by RHC to have a diagnosis of PAH (maximum follow-up 3 years). Conclusions A structured protocol may improve screening for patients with repaired ACHD at risk of developing PAH. RHC may be underutilized in patients with ACHD with TTE findings suggestive of PAH. (Adult Congenital Heart Disease Registry [QuERI]; NCT01659411).
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Affiliation(s)
- Michael J. Landzberg
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Curt J. Daniels
- The Ohio State University College of Medicine and Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Paul Forfia
- Temple University Hospital, Philadelphia, Pennsylvania, USA
| | | | | | - Mona Selej
- Actelion Pharmaceuticals US, Inc, South San Francisco, California, USA
| | - Alexander R. Opotowsky
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Heart Institute, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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8
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Jervan Ø, Dhayyat A, Gleditsch J, Haukeland-Parker S, Tavoly M, Klok FA, Rashid D, Stavem K, Ghanima W, Steine K. Demographic, clinical, and echocardiographic factors associated with residual perfusion defects beyond six months after pulmonary embolism. Thromb Res 2023; 229:7-14. [PMID: 37356172 DOI: 10.1016/j.thromres.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/22/2023] [Accepted: 06/04/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Residual perfusion defects (RPD) after pulmonary embolism (PE) are common. PRIMARY AIM This study aimed to determine the prevalence of RPD in a cohort diagnosed with PE 6-72 months earlier, and to determine demographic, clinical, and echocardiographic variables associated with RPD. METHODS Patients aged 18-75 years with prior PE, confirmed by computed tomography pulmonary angiography 6-72 months earlier, were included. Participants (N = 286) completed a diagnostic work-up consisting of transthoracic echocardiography and ventilation/perfusion scintigraphy. Demographic, clinical, and echocardiographic characteristics between participants with RPD and those without RPD were explored in univariate analyses using t-test or Mann-Whitney U test. Multiple logistic regression analysis was used to assess the association between selected variables and RPD. RESULTS RPD were detected in 72/286 patients (25.2 %, 95 % CI:20.5 %-30.5 %). Greater tricuspid annular plane systolic excursion (TAPSE) (adjusted odds ratio (aOR) 1.10, 95 % CI:1.00-1.21, p = 0.048) at echocardiographic follow-up, greater thrombotic burden at diagnosis, as assessed by mean bilateral proximal extension of the clot (MBPEC) score 3-4 (aOR 2.08, 95 % CI:1.06-4.06, p = 0.032), and unprovoked PE (aOR 2.25, 95 % CI:1.13-4.48, p = 0.021) were independently associated with increased risk of RPD, whereas increased pulmonary artery acceleration time was associated with a lower risk of RPD (aOR 0.72, 95 % CI:0.62-0.83, p < 0.001, per 10 ms). Dyspnoea was not associated with RPD. CONCLUSION RPD were common after PE. Reduced pulmonary artery acceleration time and greater TAPSE on echocardiography at follow-up, greater thrombotic burden at diagnosis, and unprovoked PE were associated with RPD.
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Affiliation(s)
- Øyvind Jervan
- Department of Cardiology, Østfold Hospital, Kalnes, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Adam Dhayyat
- Department of Cardiology, Østfold Hospital, Kalnes, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jostein Gleditsch
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Radiology, Østfold Hospital, Kalnes, Norway
| | - Stacey Haukeland-Parker
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Physical Medicine and Rehabilitation, Østfold Hospital, Kalnes, Norway
| | - Mazdak Tavoly
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Frederikus A Klok
- Department of Medicine - Thrombosis and hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Diyar Rashid
- Department of Radiology, Østfold Hospital, Kalnes, Norway
| | - Knut Stavem
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway; Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Waleed Ghanima
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Medicine, Østfold Hospital, Kalnes, Norway; Department of Hematology, Oslo University Hospital, Oslo, Norway
| | - Kjetil Steine
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
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9
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Louw E, Baines N, Maarman G, Osman M, Sigwadhi L, Irusen E, Koegelenberg C, Doubell A, Nathan S, Channick R, Allwood B. The prevalence of pulmonary hypertension after successful tuberculosis treatment in a community sample of adult patients. Pulm Circ 2023; 13:e12184. [PMID: 36699148 PMCID: PMC9852678 DOI: 10.1002/pul2.12184] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 12/15/2022] [Accepted: 12/26/2022] [Indexed: 01/06/2023] Open
Abstract
There are an estimated 155 million survivors of tuberculosis (TB). Clinical experience suggests that post tuberculosis lung disease (PTLD) is an important cause of Group 3 pulmonary hypertension (PH). However, TB is not listed as a cause of PH in most guidelines. A cross-sectional, community-based study was conducted in nonhealthcare seeking adults who had successfully completed TB treatment. Subjects underwent questionnaires, spirometry, a 6-min walk distance test (6MWD) and transthoracic echocardiography (TTE). Screen probable PH was defined on TTE as an estimated pulmonary artery peak systolic pressure (PASP) of ≥40 mmHg. One hundred adults (71 males) were enrolled, with a mean age of 42 years (SD 13.8 years) and a median of one TB episode (interquartile range: 1-2). Co-morbidities included hypertension (21%), diabetes (16%), human immunodeficiency virus (10%) and asthma/COPD (5%). Only 25% had no residual symptoms after TB. Probable PH was found in 9%, while 7% had borderline raised PASP values (PASP 35-40 mmHg). An association was found between PH and the number of previous TB episodes, with each additional episode of TB increasing the odds of PH-postTB 2.13-fold (confidence interval [CI]: 1.17-3.88; p = 0.013). All of those found to have PH were smokers or ex-smokers yielding an unadjusted odds ratio for PH-postTB of 3.67 (95% CI: 0.77-17.46). There was no statistical difference in spirometry or 6MWD, between those with and without PH. Neither symptoms nor co-morbidities demonstrated significant association with PH. PH after TB was a common finding in this community-based population. Further research is needed to confirm and determine the significance of these findings.
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Affiliation(s)
- Elizabeth Louw
- Division of Pulmonology, Department of MedicineStellenbosch University & Tygerberg HospitalCape TownSouth Africa
| | - Nicola Baines
- Division of Pulmonology, Department of MedicineStellenbosch University & Tygerberg HospitalCape TownSouth Africa
| | - Gerald Maarman
- Division of Medical Physiology, Department of Biomedical Sciences, CARMA: Centre for Cardio‐Metabolic Research in Africa, Faculty of Medicine & Health SciencesStellenbosch UniversityStellenboschSouth Africa
| | - Muhammad Osman
- Department of Paediatrics and Child Health, Desmond Tutu TB CentreStellenbosch UniversityCape TownSouth Africa,Public Health, School of Human SciencesUniversity of GreenwichLondonUK
| | - Lovemore Sigwadhi
- Division of Epidemiology and BiostatisticsStellenbosch UniversityStellenboschSouth Africa,Division of StatisticsBiomedical Research and Training Institute, ZimbabweHarareZimbabwe
| | - Elvis Irusen
- Division of Pulmonology, Department of MedicineStellenbosch University & Tygerberg HospitalCape TownSouth Africa
| | - Coenraad Koegelenberg
- Division of Pulmonology, Department of MedicineStellenbosch University & Tygerberg HospitalCape TownSouth Africa
| | - Anton Doubell
- Division of Cardiology, Department of MedicineStellenbosch University & Tygerberg HospitalCape TownSouth Africa
| | - Steven Nathan
- The Advanced Lung Disease and Transplant ProgramInova Fairfax HospitalFalls ChurchVirginiaUSA
| | - Richard Channick
- Pulmonary and Critical Care DivisionDavid Geffen School of MedicineLos AngelesCaliforniaUSA
| | - Brian Allwood
- Division of Pulmonology, Department of MedicineStellenbosch University & Tygerberg HospitalCape TownSouth Africa
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10
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Bartnik A, Pepke-Zaba J, Hoole SP, White P, Garbi M, Coghlan JG, Taghavi F, Tsui S, Weir-McCall J. Right ventricular-pulmonary artery coupling in chronic thromboembolic pulmonary hypertension. Heart 2022; 109:898-904. [PMID: 36549680 DOI: 10.1136/heartjnl-2022-321770] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Chronic thromboembolic pulmonary hypertension occurs in a proportion of patients with prior acute pulmonary embolism and is characterised by breathlessness, persistently raised pulmonary pressures and right heart failure. Surgical pulmonary endarterectomy (PEA) offers significant prognostic and symptomatic benefits for patients with proximal disease distribution. For those with inoperable disease, management options include balloon pulmonary angioplasty (BPA) and medical therapy. Current clinical practice relies on the evaluation of pulmonary haemodynamics to assess disease severity, timing of and response to treatment. However, pulmonary haemodynamics correlate poorly with patient symptoms, which are influenced by right ventricular tolerance of the increased afterload. How best to manage symptomatic patients with chronic thromboembolic pulmonary disease (CTEPD) in the absence of pulmonary hypertension is not resolved.Right ventricular-pulmonary artery coupling (RV-PAC) describes the energy transfer within the whole cardiopulmonary unit. Thus, it can identify the earliest signs of decompensation even before pulmonary hypertension is overt. Invasive measurement of coupling using pressure volume loop technology is well established in research settings. The development of efficient and less invasive measurement methods has revived interest in coupling as a viable clinical tool. Significant improvement in RV-PAC has been demonstrated after both PEA and BPA. Further studies are required to understand its clinical utility and prognostic value, in particular, its potential to guide management in patients with CTEPD. Finally, given the reported differences in coupling between sexes in pulmonary arterial hypertension, further work is required to understand the applicability of proposed thresholds for decoupling in therapeutic decision making.
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Affiliation(s)
- Aleksandra Bartnik
- Radiology, Royal Papworth Hospital, Cambridge, UK .,University of Cambridge, Cambridge, UK.,Surgery, Royal Papworth Hospital, Cambridge, UK
| | - Joanna Pepke-Zaba
- Pulmonary Vascular Disease Unit, Royal Papworth Hospital, Cambridge, UK
| | | | - Paul White
- Medical Physics and Clinical Engineering, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Medical Technology Research Centre, Anglia Ruskin University, Cambridge, UK
| | | | | | | | - Steven Tsui
- Surgery, Royal Papworth Hospital, Cambridge, UK
| | - Jonathan Weir-McCall
- Radiology, Royal Papworth Hospital, Cambridge, UK.,University of Cambridge, Cambridge, UK
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11
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Dammassa V, Corradi F, Colombo CNJ, Mojoli F, Price S, Tavazzi G. Pulmonary artery acceleration time accuracy for systolic pulmonary artery pressure estimation in critically ill patients. Ultrasound J 2022; 14:26. [PMID: 35723841 PMCID: PMC9209611 DOI: 10.1186/s13089-022-00276-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/08/2022] [Indexed: 11/21/2022] Open
Abstract
Background Estimation of pulmonary pressures is of key importance in acute cardiovascular and respiratory failure. Pulmonary artery acceleration time (PAAT) has emerged as reliable parameter for the estimation of systolic pulmonary artery pressure (sPAP) in cardiological population with preserved right ventricular function. We sought to find whether PAAT correlates with sPAP in critically ill patients with and without right ventricular (RV) systolic dysfunction. Methods Observational study. We measured sPAP using continuous-wave Doppler analysis of tricuspid regurgitation velocity peak method and we assessed the validity of PAAT in estimating sPAP in patients admitted to adult intensive care unit (ICU) for acute cardiovascular and respiratory failure. Results We enrolled 236 patients admitted to cardiothoracic ICU for cardiovascular and respiratory failure (respectively: 129, 54.7% and 107, 45.3%). 114 (48.3%) had preserved RV systolic function (defined as TAPSE ≥ 17 mm), whilst 122 (51.7%) had RV systolic impairment (defined as TAPSE < 17 mm). A weak inverse correlation between PAAT and sPAP (ρ–0.189, p 0.0035) was observed in overall population, which was confirmed in those with preserved RV systolic PAAT and sPAP (ρ–0.361, p 0.0001). In patients with impaired RV systolic function no statistically significant correlation between PAAT and sPAP was demonstrated (p 0.2737). Adjusting PAAT values for log10, heart rate and RV ejection time did not modify the abovementioned correlations. Conclusions PAAT measurement to derive sPAP is not reliable in cardiothoracic critically ill patients, particularly in the coexistence of RV systolic impairment.
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12
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Woo JL, DiLorenzo MP, Rosenzweig E, Pasumarti N, Villeda GV, Berman-Rosenzweig E, Krishnan U. Correlation Between Right Ventricular Echocardiography Measurements and Functional Capacity in Patients With Pulmonary Arterial Hypertension. Tex Heart Inst J 2022; 49:488231. [PMID: 36350291 PMCID: PMC9809095 DOI: 10.14503/thij-21-7719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Accelerometry is an emerging option for real-time evaluation of functional capacity in patients with pulmonary arterial hypertension (PAH). This prospective pilot study assesses the relationship between functional capacity by accelerometry and right ventricular measurements on echocardiography for this high-risk cohort. METHODS Patients with PAH were prospectively enrolled and underwent 6-Minute Walk Test and cardiopulmonary exercise testing. They were given a Fitbit, which collected steps and sedentary time per day. Echocardiographic data included right ventricular global longitudinal, free wall, and septal strain; tricuspid regurgitant peak velocity; tricuspid annular plane systolic excursion; tricuspid annular plane systolic velocity; right ventricular myocardial performance index; and pulmonary artery acceleration time. Pairwise correlations were performed. RESULTS The final analysis included 22 patients aged 13 to 59 years. Tricuspid regurgitant peak velocity had a negative correlation with 6-Minute Walk Test (r = -0.58, P = .02), peak oxygen consumption on exercise testing (r = -0.56, P = .03), and average daily steps on accelerometry (r = -0.59, P = .03), but a positive correlation with median sedentary time on accelerometry (r = 0.64, P = .02). Pulmonary artery acceleration time positively correlated with peak oxygen consumption on exercise testing (r = 0.64, P = .002). There was no correlation between right ventricular strain measurements and functional capacity testing. CONCLUSION In this pilot study, tricuspid regurgitant jet and pulmonary artery acceleration time were the echocardiographic variables that correlated most with accelerometry data. With further echocardiographic validation, accelerometry can be a useful, noninvasive, and cost-effective tool to monitor disease progression in patients with PAH.
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Affiliation(s)
- Joyce L. Woo
- Department of Pediatrics, Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael P. DiLorenzo
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Medical Center, New York, New York
| | - Eliana Rosenzweig
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Medical Center, New York, New York
| | - Nikhil Pasumarti
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Medical Center, New York, New York
| | | | - Erika Berman-Rosenzweig
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Medical Center, New York, New York
| | - Usha Krishnan
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Medical Center, New York, New York
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13
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Arrebola-Moreno AL, Casuso RA, Bejder J, Bonne TC, Breenfeldt Andersen A, Aragón-Vela J, Nordsborg NB, Huertas JR. Does Hypoxia and Stress Erythropoiesis Compromise Cardiac Function in Healthy Adults? A Randomized Trial. SPORTS MEDICINE - OPEN 2022; 8:137. [PMID: 36334130 PMCID: PMC9637068 DOI: 10.1186/s40798-022-00531-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 10/20/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To investigate whether recombinant human erythropoietin (rHuEPO) injections during an altitude training camp impact heart function. METHODS Thirty (12 women) moderately trained subjects stayed at 2320 m altitude for 4 weeks while training. Subjects were randomized to placebo (isotonic saline) or rHuEPO (20 IU/kg body weight) i.v. injections. Transthoracic echocardiography imaging was acquired 3 days after arrival to altitude and prior to the first placebo or rHuEPO injection as well as one day after the last rHuEPO injection three weeks later. RESULTS rHuEPO did not alter cardiovascular morphology parameters, systolic or diastolic function. In the placebo group, altitude exposure improved left ventricle (LV) systolic function due to an increased twist angle but rHuEPO had no additional effects. Pulmonary arterial systolic pressure was unaffected in either group. Notably, rHuEPO hampered LV untwist rate without affecting LV early filling. CONCLUSION rHuEPO provided during mild altitude exposure does not cause any major effects on heart function. The observed alteration in LV untwist induced by rHuEPO is unlikely to have a meaningful clinical effect. Trial Registration Registered on www. CLINICALTRIALS gov (NCT04227665).
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Affiliation(s)
| | - Rafael A. Casuso
- grid.4489.10000000121678994Department of Physiology, Institute of Nutrition and Food Technology, University of Granada, Granada, Spain ,grid.449008.10000 0004 1795 4150Department of Health Sciences, Universidad Loyola Andalucía, Sevilla, Spain
| | - Jacob Bejder
- grid.5254.60000 0001 0674 042XDepartment of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, Denmark
| | - Thomas Christian Bonne
- grid.5254.60000 0001 0674 042XDepartment of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, Denmark
| | - Andreas Breenfeldt Andersen
- grid.5254.60000 0001 0674 042XDepartment of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, Denmark
| | - Jerónimo Aragón-Vela
- grid.4489.10000000121678994Department of Physiology, Institute of Nutrition and Food Technology, University of Granada, Granada, Spain
| | - Nikolai B. Nordsborg
- grid.5254.60000 0001 0674 042XDepartment of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, Denmark
| | - Jesús R. Huertas
- grid.4489.10000000121678994Department of Physiology, Institute of Nutrition and Food Technology, University of Granada, Granada, Spain
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14
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Bowcock EM, Gerhardy B, Huang S, Orde S. Right ventricular outflow tract Doppler flow analysis and pulmonary arterial coupling by transthoracic echocardiography in sepsis: a retrospective exploratory study. Crit Care 2022; 26:303. [PMID: 36192793 PMCID: PMC9527734 DOI: 10.1186/s13054-022-04160-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 09/07/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Right ventricular (RV) and pulmonary vascular dysfunction appear to be common in sepsis. RV performance is frequently assessed in isolation, yet its close relationship to afterload means combined analysis with right ventricular outflow tract (RVOT) Doppler and RV-pulmonary arterial (RV-PA) coupling may be more informative than standard assessment techniques. Data on feasibility and utility of these parameters in sepsis are lacking and were explored in this study. METHODS This is a retrospective study over a 3-year period of one-hundred and thirty-one patients admitted to ICU with sepsis who underwent transthoracic echocardiography (TTE) with RVOT pulsed wave Doppler. RVOT Doppler flow and RV-PA coupling was evaluated alongside standard measurements of RV systolic function and pulmonary pressures. RVOT Doppler analysis included assessment of pulmonary artery acceleration time (PAAT), velocity time integral and presence of notching. RV-PA coupling was assessed using tricuspid annular planar systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) ratio. RESULTS PAAT was measurable in 106 (81%) patients, and TAPSE/PASP was measurable in 77 (73%). Seventy-three (69%) patients had a PAAT of ≤ 100 ms suggesting raised pulmonary vascular resistance (PVR) is common. RVOT flow notching occurred in 15 (14%) of patients. TRV was unable to be assessed in 24 (23%) patients where measurement of PAAT was possible. RV dysfunction (RVD) was present in 28 (26%), 26 (25%) and 36 (34%) patients if subjective assessment, TAPSE < 17 mm and RV dilatation definitions were used, respectively. There was a trend towards shorter PAAT with increasing severity of RVD. RV-PA uncoupling defined as a TAPSE/PASP < 0.31 mm/mmHg was present in 15 (19%) patients. As RV dilatation increased the RV-PA coupling ratio decreased independent of LV systolic function, whereas TAPSE appeared to be more susceptible to changes in LV systolic function. CONCLUSION Raised PVR and RV-PA uncoupling is seen in a significant proportion of patients with sepsis. Non-invasive assessment with TTE is feasible. The role of these parameters in assisting improved definitions of RVD, as well as their therapeutic and prognostic utility against standard parameters, deserves further investigation.
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Affiliation(s)
- Emma Maria Bowcock
- grid.1013.30000 0004 1936 834XIntensive Care Medicine and Respiratory Medicine, Intensive Care Unit, Nepean Hospital, The University of Sydney, Derby Street, Penrith, Sydney, 2747 Australia
| | - Benjamin Gerhardy
- grid.1013.30000 0004 1936 834XIntensive Care Medicine and Respiratory Medicine, Intensive Care Unit, Nepean Hospital, The University of Sydney, Derby Street, Penrith, Sydney, 2747 Australia
| | - Stephen Huang
- grid.1013.30000 0004 1936 834XIntensive Care Medicine and Respiratory Medicine, Intensive Care Unit, Nepean Hospital, The University of Sydney, Derby Street, Penrith, Sydney, 2747 Australia
| | - Sam Orde
- grid.1013.30000 0004 1936 834XIntensive Care Medicine and Respiratory Medicine, Intensive Care Unit, Nepean Hospital, The University of Sydney, Derby Street, Penrith, Sydney, 2747 Australia
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15
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Clinical Analysis of Fetal Lung Development Index and Pregnancy Outcome in Pregnant Women with Gestational Diabetes Mellitus with Satisfactory Blood Glucose Control. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:5777804. [PMID: 36262988 PMCID: PMC9553484 DOI: 10.1155/2022/5777804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/28/2022] [Accepted: 08/24/2022] [Indexed: 01/26/2023]
Abstract
Objective To explore the regularity of fetal lung development of pregnant women with gestational diabetes mellitus (GDM) with satisfactory blood glucose control and the clinical analysis with pregnancy outcome. Methods 120 GDM pregnant women with satisfactory blood glucose control (GDM group) and 200 normal pregnant women undergoing prenatal examination (Control group) from 31 to 38 + 6 weeks of gestation were included. The two groups of pregnant women were divided into 8 time periods according to the gestational age, respectively. The parameters of Doppler flow velocity curve of fetal main pulmonary artery, diameter lines of fetal lung development, mode of delivery, neonatal weight, neonatal asphyxia, neonatal respiratory distress syndrome (NRDS), and neonatal pneumonia were, respectively, compared and analyzed between the two groups. Results Acceleration time (AT) and AT/ejection time (AT/ET) were positively correlated with gestational age, and AT/ET showed stronger correlation than AT, while no significant difference in AT and AT/ET between the two groups (P > 0.05). There was a positive correlation between the diameter of fetal lung development and gestational age, but there was no significant difference between the two groups (P > 0.05). In addition, there was no significant difference between the two groups in fetal delivery mode, neonatal weight, neonatal asphyxia, NRDS, and neonatal pneumonia (P > 0.05). Conclusion AT/ET may be a potential index to evaluate fetal lung maturity. There was no difference in fetal lung development and neonatal birth outcome between pregnant women with satisfactory GDM blood glucose control and the normal pregnant women. The pregnancy of GDM pregnant women lasts until the end of 37∼38 weeks, and the neonatal incidence rate is decreased. The key is to manipulate the blood glucose in the normal range.
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16
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Cao N, Aikeremu N, Shi WY, Tang XC, Gao RJ, Kong LJY, Zhang JR, Qin WJ, Zhang AM, Ma KT, Li L, Si JQ. Inhibition of KIR2.1 decreases pulmonary artery smooth muscle cell proliferation and migration. Int J Mol Med 2022; 50:119. [PMID: 35856410 PMCID: PMC9354699 DOI: 10.3892/ijmm.2022.5175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/28/2022] [Indexed: 11/22/2022] Open
Abstract
The investigation of effective therapeutic drugs for pulmonary hypertension (PH) is critical. KIR2.1 plays crucial roles in regulating cell proliferation and migration, and vascular remodeling. However, researchers have not yet clearly determined whether KIR2.1 participates in the proliferation and migration of pulmonary artery smooth muscle cells (PASMCs) and its role in pulmonary vascular remodeling (PVR) also remains elusive. The present study aimed to examine whether KIR2.1 alters PASMC proliferation and migration, and participates in PVR, as well as to explore its mechanisms of action. For the in vivo experiment, a PH model was established by intraperitoneally injecting Sprague-Dawley rats monocrotaline (MCT). Hematoxylin and eosin staining revealed evidence of PVR in the rats with PH. Immunofluorescence staining and western blot analysis revealed increased levels of the KIR2.1, osteopontin (OPN) and proliferating cell nuclear antigen (PCNA) proteins in pulmonary blood vessels and lung tissues following exposure to MCT, and the TGF-β1/SMAD2/3 signaling pathway was activated. For the in vitro experiments, the KIR2.1 inhibitor, ML133, or the TGF-β1/SMAD2/3 signaling pathway blocker, SB431542, were used to pre-treat human PASMCs (HPASMCs) for 24 h, and the cells were then treated with platelet-derived growth factor (PDGF)-BB for 24 h. Scratch and Transwell assays revealed that PDGF-BB promoted cell proliferation and migration. Immunofluorescence staining and western blot analysis demonstrated that PDGF-BB upregulated OPN and PCNA expression, and activated the TGF-β1/SMAD2/3 signaling pathway. ML133 reversed the proliferation and migration induced by PDGF-BB, inhibited the expression of OPN and PCNA, inhibited the TGF-β1/SMAD2/3 signaling pathway, and reduced the proliferation and migration of HPASMCs. SB431542 pre-treatment also reduced cell proliferation and migration; however, it did not affect KIR2.1 expression. On the whole, the results of the present study demonstrate that KIR2.1 regulates the TGF-β1/SMAD2/3 signaling pathway and the expression of OPN and PCNA proteins, thereby regulating the proliferation and migration of PASMCs and participating in PVR.
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Affiliation(s)
- Nan Cao
- Department of Physiology, Shihezi University Medical College, Shihezi, Xinjiang 832002, P.R. China
| | - Nigala Aikeremu
- Department of Physiology, Shihezi University Medical College, Shihezi, Xinjiang 832002, P.R. China
| | - Wen-Yan Shi
- Department of Physiology, Shihezi University Medical College, Shihezi, Xinjiang 832002, P.R. China
| | - Xue-Chun Tang
- Department of Physiology, Shihezi University Medical College, Shihezi, Xinjiang 832002, P.R. China
| | - Rui-Juan Gao
- Department of Physiology, Shihezi University Medical College, Shihezi, Xinjiang 832002, P.R. China
| | - Liang-Jing-Yuan Kong
- Department of Physiology, Shihezi University Medical College, Shihezi, Xinjiang 832002, P.R. China
| | - Jing-Rong Zhang
- Department of Physiology, Shihezi University Medical College, Shihezi, Xinjiang 832002, P.R. China
| | - Wen-Juan Qin
- Department of Ultrasound, the First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang 832002, P.R. China
| | - Ai-Mei Zhang
- Department of Cardiology, the First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang 832002, P.R. China
| | - Ke-Tao Ma
- Department of Physiology, Shihezi University Medical College, Shihezi, Xinjiang 832002, P.R. China
| | - Li Li
- Department of Physiology, Jiaxing University Medical College, Jiaxing, Zhejiang 314001, P.R. China
| | - Jun-Qiang Si
- Department of Physiology, Shihezi University Medical College, Shihezi, Xinjiang 832002, P.R. China
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17
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Trittmann JK, Almazroue H, Nelin LD, Shaffer TA, Celestine CR, Green HW, Malbrue RA. PATET ratio by Doppler echocardiography: noninvasive detection of pediatric pulmonary arterial hypertension. Pediatr Res 2022; 92:631-636. [PMID: 34795389 PMCID: PMC9114166 DOI: 10.1038/s41390-021-01840-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 10/09/2021] [Accepted: 10/28/2021] [Indexed: 11/12/2022]
Abstract
Pulmonary artery acceleration time (PAT) and PAT: ejection time (PATET) ratio are echocardiographic measurements of pulmonary arterial hypertension (PAH). These noninvasive quantitative measurements are ideal to follow longitudinally through the clinical course of PAH, especially as it relates to the need for and/or response to treatment. This review article focuses on the current literature of PATET measurement for infants and children as it relates to the shortening of the PATET ratio in PAH. At the same time, further development of PATET as an outcome measure for PAH in preclinical models, particularly mice, such that the field can move forward to human clinical studies that are both safe and effective. Here, we present what is known about PATET in infants and children and discuss what is known in preclinical models with particular emphasis on neonatal mouse models. In both animal models and human disease, PATET allows for longitudinal measurements in the same individual, leading to more precise determinations of disease/model progression and/or response to therapy. IMPACT: PATET ratio is a quantitative measurement by a noninvasive technique, Doppler echocardiography, providing clinicians a more precise/accurate, safe, and longitudinal assessment of pediatric PAH. We present a brief history/state of the art of PATET ratio to predict PAH in adults, children, infants, and fetuses, as well as in small animal models of PAH. In a preliminary study, PATET shortened by 18% during acute hypoxic exposure compared to pre-hypoxia. Studies are needed to establish PATET, especially in mouse models of disease, such as bronchopulmonary, as a routine measure of PAH.
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Affiliation(s)
- Jennifer K. Trittmann
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH,Department of Pediatrics, The Ohio State University, College of Medicine, Columbus, OH,Jennifer K. Trittmann, MD, MPH, Center for Perinatal Research, Abigail Wexner Research Institute at, Nationwide Children’s Hospital and, The Ohio State University, College of Medicine, Columbus, OH, USA,
| | - Hanadi Almazroue
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
| | - Leif D. Nelin
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH,Department of Pediatrics, The Ohio State University, College of Medicine, Columbus, OH
| | - Terri A. Shaffer
- Animal Resources Core, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
| | - Charanda R. Celestine
- Louisiana State University, School of Veterinary Medicine, Department of Veterinary Clinical Sciences, Baton Rouge, LA, USA
| | - Henry W. Green
- Louisiana State University, School of Veterinary Medicine, Department of Veterinary Clinical Sciences, Baton Rouge, LA, USA
| | - Raphael A. Malbrue
- Animal Resources Core, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH,The Ohio State University, College of Veterinary Medicine, Columbus, OH
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18
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Tai C, Hsieh A, Moon-Grady AJ, Keller RL, Teitel D, Nawaytou HM. Pulmonary artery acceleration time in young children is determined by heart rate and transpulmonary gradient but not by pulmonary blood flow: A simultaneous echocardiography-cardiac catheterization study. Echocardiography 2022; 39:895-905. [PMID: 35690918 DOI: 10.1111/echo.15397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 04/06/2022] [Accepted: 05/21/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Pulmonary artery acceleration time (PAAT) is considered useful for the non-invasive evaluation of pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR). PAAT is dependent on PAP, PVR, pulmonary artery compliance, stroke volume, and heart rate. Its relative dependency on these determinants may differ between young and older children, raising uncertainty regarding its utility in young children. We aim to identify the primary determinants of the PAAT in children less than 36 months undergoing cardiac catheterization and its utility for the diagnosis of elevated PVR. METHODS We prospectively studied 42 children undergoing cardiac catheterization and simultaneous echocardiography. We determined the correlations of PAAT to the above-mentioned determinants and evaluated receiver operator characteristic (ROC) curves for diagnosis of PVR indexed to body surface area (PVRi) ≥3 Wu*m2 . RESULTS Median age was 11.5 (IQR 5.2, 21.2) months. Moderate correlations were found between PAAT and mean PAP (R = -.66, p < .001), PVRi (R = -.54, p = .004), pulmonary artery compliance (R = .65, p < .001), transpulmonary gradient (R = -.67, p < .001), stroke volume (R = .61, p = .002), and heart rate (R = -.63, p < .001). In multivariate regression modeling, only transpulmonary gradient and heart rate were independent determinants of PAAT. PAAT ≤77 msec had acceptable utility for diagnosing PVRi ≥ 3 Wu*m2 (AUC .8 [.64, .95], n = 36), low sensitivity (59%), and excellent specificity (94%). CONCLUSION Transpulmonary gradient and heart rate, but not pulmonary blood flow, are important determinants of PAAT in children <36 months undergoing cardiac catheterization. PAAT has low sensitivity for diagnosing elevated PVRi, therefore, should not be solely relied upon in screening for elevated PVRi in young children.
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Affiliation(s)
- Christiana Tai
- Department of Pediatrics, University of California, San Francisco, California, USA
| | - Anyir Hsieh
- Department of Pediatrics, University of California, San Francisco, California, USA
| | - Anita J Moon-Grady
- Department of Pediatrics, University of California, San Francisco, California, USA
| | - Roberta L Keller
- Department of Pediatrics, University of California, San Francisco, California, USA
| | - David Teitel
- Department of Pediatrics, University of California, San Francisco, California, USA
| | - Hythem M Nawaytou
- Department of Pediatrics, University of California, San Francisco, California, USA
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19
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Fernando RJ, Johnson SD, Richardson K. Intraoperative Transesophageal Echocardiographic Detection of a Gerbode Defect in a Patient Referred for Aortic Valve Endocarditis: A Case Report. Semin Cardiothorac Vasc Anesth 2022; 26:245-252. [PMID: 35412867 DOI: 10.1177/10892532221080920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This clinical challenge discusses a case in which a patient was referred for aortic valve repair or replacement due to severe aortic regurgitation from infective endocarditis. In addition to discovering a previously unknown tricuspid valve vegetation, the intraoperative echocardiographic evaluation was instrumental in revealing an undiagnosed Gerbode defect. The flow through this Gerbode defect was previously mistaken for tricuspid regurgitation, and the patient was misdiagnosed as exhibiting severe pulmonary hypertension. This case highlights the importance of reviewing preoperative echocardiographic imaging, as well as diligence in completing a thorough intraoperative transesophageal echocardiographic exam prior to cardiopulmonary bypass. In addition, while flow typically occurs in Gerbode defects during systole, this case demonstrates that flow can also occur during diastole, which was most likely due to the severe aortic regurgitation. Fortunately, the patient was able to undergo successful treatment for the unexpected sequalae of the infective endocarditis, including repair of the Gerbode defect, tricuspid valve repair, and aortic valve and root replacement. Importantly, the incorrect diagnosis of severe pulmonary hypertension was removed.
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Affiliation(s)
- Rohesh J Fernando
- Department of Anesthesiology, Cardiothoracic Division, 12279Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Sean D Johnson
- Department of Anesthesiology, Cardiothoracic Division, 12279Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Karl Richardson
- Department of Cardiology, 12279Wake Forest School of Medicine, Winston Salem, NC, USA
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20
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Suciu LM, Giesinger RE, Mărginean C, Muntean M, Cucerea M, Făgărășan A, McNamara P. Comparative evaluation of echocardiography indices during the transition to extrauterine life between small and appropriate for gestational age infants. Front Pediatr 2022; 10:1045242. [PMID: 36727000 PMCID: PMC9884809 DOI: 10.3389/fped.2022.1045242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/30/2022] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES To study changes in heart function and hemodynamics during the transitional period in small for gestational (SGA) infants and appropriate (AGA) healthier counterparts. DESIGN A hospital based prospective observational study was performed at a perinatal center. Echocardiograms were performed on the first postnatal day and again at 48 h age. Term SGA infants were compared with those AGA newborns matched for the GA and mode of delivery. RESULTS Eighteen SGA infants were compared with 18 AGA infants [gestation 38 ± 1.5 vs. 38 ± 1.2 weeks, p > 0.05 and birthweight 2331 ± 345 vs. 3332 ± 405 grams, p < 0.05, respectively]. Maternal weight and body mass index was higher among non-affected pregnancies, 61% infants were born vaginally, and no differences in cord blood pH at birth were noted. SGA infants had higher systolic and mean blood pressure at both time points, lower indices of right ventricular (RV) performance [TAPSE (tricuspid annular peak systolic excursion) 7.4 ± 2.8 vs. 9.3 ± 0.7 on day 1, 7.2 ± 2.8 vs. 9.2 ± 0.5 on day 2, p = 0.001], lower pulmonary acceleration time (PAAT) suggestive of elevated pulmonary vascular resistance [56.4 ± 10.5 vs. 65.7 ± 13.2 on day 1, 61.4 ± 12.5 vs. 71.5 ± 15.7 on day 2, p = 0.01] and higher left ventricular (LV) ejection fraction [62.1 ± 7.8 vs. 54.9 ± 5.5 on day 1, 61.9 ± 7.6 vs. 55.8 ± 4.9 on day 2, p = 0.003]. CONCLUSIONS SGA infants had evidence of higher pulmonary vascular resistance, and lower RV performance during the postnatal transition. The relevance and impact of these changes to hemodynamic disease states during the postnatal transition requires prospective investigation.
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Affiliation(s)
- Laura Mihaela Suciu
- Department of Pediatrics, University of Medicine Pharmacy Science and Technology George Emil Palade of Târgu Mureș, Târgu Mureș, Romania
| | - Regan E Giesinger
- Division of Neonatology, Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa, IA, United States
| | - Claudiu Mărginean
- Department of Obstetrics and Gynecology, University of Medicine Pharmacy Science and Technology George Emil Palade of Târgu Mureș, Târgu Mureș, Romania
| | - Mihai Muntean
- Department of Obstetrics and Gynecology, University of Medicine Pharmacy Science and Technology George Emil Palade of Târgu Mureș, Târgu Mureș, Romania
| | - Manuela Cucerea
- Department of Pediatrics, University of Medicine Pharmacy Science and Technology George Emil Palade of Târgu Mureș, Târgu Mureș, Romania
| | - Amalia Făgărășan
- Department of Pediatrics, University of Medicine Pharmacy Science and Technology George Emil Palade of Târgu Mureș, Târgu Mureș, Romania
| | - Patrick McNamara
- Division of Neonatology, Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa, IA, United States
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21
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Radvansky BM, Shah R, Feinman J, Augoustides JG, Kiers A, Younger J, Sanders J, Knott VH, Fernando RJ. Pulmonary Hypertension in Pregnancy: A Positive Outcome with a Multidisciplinary Team and Individualized Treatment Plan. J Cardiothorac Vasc Anesth 2022; 36:3403-3413. [DOI: 10.1053/j.jvca.2021.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 11/11/2022]
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22
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Hon SM, Alpizar-Rivas RM, Farber HW. Pulmonary Arterial Hypertension in Patients Infected with the Human Immunodeficiency Virus. Cardiol Clin 2021; 40:45-54. [PMID: 34809916 DOI: 10.1016/j.ccl.2021.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
It is important to recognize and treat human immunodeficiency virus-associated pulmonary arterial hypertension (HIV-PAH) because of the associated morbidity and mortality. With the introduction of antiretroviral therapies (ART), improved survival has changed the focus of treatment management from immunodeficiency-related opportunistic infections to chronic cardiovascular complications, including HIV-PAH. The 2018 6th World Symposium of Pulmonary Hypertension recommended a revised definition of PAH that might result in a greater number of patients with HIV-PAH; however, the implication of this change is not yet clear. Here, we review the current literature on the diagnosis, management, and outcomes of patients with HIV-PAH.
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Affiliation(s)
- Stephanie M Hon
- Division of Pulmonary, Critical Care, and Sleep Medicine, Tufts Medical Center, 800 Washington Street, Box 257, Boston, MA 02111, USA.
| | - Rodolfo M Alpizar-Rivas
- Division of Infectious Diseases, University of Rochester Medical Center, 601 Elmwood Avenue, Box 689, Rochester, NY 14642, USA
| | - Harrison W Farber
- Division of Pulmonary, Critical Care, and Sleep Medicine, Tufts Medical Center, 800 Washington Street, Box 257, Boston, MA 02111, USA
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23
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Taieb P, Szekely Y, Lupu L, Ghantous E, Borohovitz A, Sadon S, Lichter Y, Ben-Gal Y, Banai A, Hochstadt A, Merdler I, Sapir O, Granot Y, Laufer-Perl M, Banai S, Topilsky Y. Risk prediction in patients with COVID-19 based on haemodynamic assessment of left and right ventricular function. Eur Heart J Cardiovasc Imaging 2021; 22:1241-1254. [PMID: 34453517 DOI: 10.1093/ehjci/jeab169] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 08/12/2021] [Indexed: 12/13/2022] Open
Abstract
AIMS Cardiovascular involvement is common in COVID-19. We sought to describe the haemodynamic profiles of hospitalized COVID-19 patients and determine their association with mortality. METHODS AND RESULTS Consecutive hospitalized patients diagnosed with COVID-19 infection underwent clinical evaluation using the Modified Early Warning Score (MEWS) and a full non-invasive echocardiographic haemodynamic evaluation, irrespective of clinical indication, as part of a prospective predefined protocol. Patients were stratified based on filling pressure and output into four groups. Multivariable Cox-Hazard analyses determined the association between haemodynamic parameters with mortality. Among 531 consecutive patients, 44% of patients had normal left ventricular (LV) and right ventricular (RV) haemodynamic status. In contrast to LV haemodynamic parameters, RV parameters worsened with higher MEWS stage. While RV parameters did not have incremental risk prediction value above MEWS, LV stroke volume index, E/e' ratio, and LV stroke work index were all independent predictors of outcome, particularly in severe disease. Patients with LV or RV with high filling pressure and low output had the worse outcome, and patients with normal haemodynamics had the best (P < 0.0001). CONCLUSION In hospitalized patients with COVID-19, almost half have normal left and right haemodynamics at presentation. RV but not LV haemodynamics are related to easily obtainable clinical parameters. LV but not RV haemodynamics are independent predictors of mortality, mostly in patients with severe disease.
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Affiliation(s)
- Philippe Taieb
- Division of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Weizmann 6, Tel Aviv 6423919, Israel
| | - Yishay Szekely
- Division of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Weizmann 6, Tel Aviv 6423919, Israel
| | - Lior Lupu
- Division of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Weizmann 6, Tel Aviv 6423919, Israel
| | - Eihab Ghantous
- Division of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Weizmann 6, Tel Aviv 6423919, Israel
| | - Ariel Borohovitz
- Division of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Weizmann 6, Tel Aviv 6423919, Israel
| | - Sapir Sadon
- Division of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Weizmann 6, Tel Aviv 6423919, Israel
| | - Yael Lichter
- Division of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Weizmann 6, Tel Aviv 6423919, Israel
| | - Yanai Ben-Gal
- Division of Anesthesia, Pain and Intensive Care, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Weizmann 6, Tel Aviv 6423919, Israel
| | - Ariel Banai
- Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Weizmann 6, Tel Aviv 6423919, Israel
| | - Aviram Hochstadt
- Division of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Weizmann 6, Tel Aviv 6423919, Israel
| | - Ilan Merdler
- Division of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Weizmann 6, Tel Aviv 6423919, Israel
| | - Orly Sapir
- Division of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Weizmann 6, Tel Aviv 6423919, Israel
| | - Yoav Granot
- Division of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Weizmann 6, Tel Aviv 6423919, Israel
| | - Michal Laufer-Perl
- Division of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Weizmann 6, Tel Aviv 6423919, Israel
| | - Shmuel Banai
- Division of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Weizmann 6, Tel Aviv 6423919, Israel
| | - Yan Topilsky
- Division of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Weizmann 6, Tel Aviv 6423919, Israel
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24
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Lammers AE, Apitz C, Michel-Behnke I, Koestenberger M. A guide to echocardiographic assessment in children and adolescents with pulmonary hypertension. Cardiovasc Diagn Ther 2021; 11:1160-1177. [PMID: 34527541 DOI: 10.21037/cdt-21-119] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/23/2021] [Indexed: 12/14/2022]
Abstract
While the current definition of pulmonary hypertension (PH) is still based on haemodynamic variables, transthoracic echocardiography is the most important diagnostic clinical tool for the first assessment and evaluation of a patient, in whom PH is suspected. In addition, it is the most important clinical modality in long term follow-up and the utility of echocardiography has widely been demonstrated in patients with PH. Echocardiography not only reveals the underlying cardiac morphology and diagnosis of any associated cardiac defects. In most patients with PH right ventricular (RV) pressure estimation is feasible. In addition, ventricular systolic and diastolic function, as well as ventricular-ventricular interactions of both ventricles can be assessed by using echocardiography. Maximizing the use of echocardiography by reporting several measures to gain information and quantitatively describe the parameters, that are linked to prognosis, seem particularly appealing in these children, in whom other advanced imaging modalities requiring anaesthesia is associated with a considerable risk. Herein we provide a practical approach and a concise and clinically applicable echocardiographic guidance and present basic variables, which should be obtained at any assessment. Moreover, we present additional advanced echocardiographic measures, that can be applied in a research or clinical setting when progressive PH needs a deeper insight to assess heart function, estimation of pulmonary artery pressures among others, by echocardiography. Finally, clinically relevant studies in view of the prognostic properties with a focus on the most important echocardiographic variables in pediatric PH are summarized.
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Affiliation(s)
- Astrid E Lammers
- Pediatric Cardiology and Adult Congenital Heart Disease, University Hospital Münster, Münster, Germany
| | - Christian Apitz
- Pediatric Cardiology, University Children's Hospital Ulm, Ulm, Germany
| | - Ina Michel-Behnke
- Division of Pediatric Cardiology, University Hospital for Children and Adolescents, Pediatric Heart Centre Vienna, Medical University Vienna, Vienna, Austria
| | - Martin Koestenberger
- Division of Pediatric Cardiology and Pediatrics, Medical University Graz, Graz, Austria
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25
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Wang L, Zhang F, Li J, Liu Z, Kou Y, Song Y, Xu H, Wang H, Wang Y. Using pulmonary artery acceleration time to evaluate pulmonary hemodynamic changes on preterm infants with respiratory distress syndrome. Transl Pediatr 2021; 10:2287-2297. [PMID: 34733669 PMCID: PMC8506067 DOI: 10.21037/tp-21-341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/17/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Pulmonary artery acceleration time (PAAT) is a reliable and non-invasive method for assessing pulmonary hemodynamics. To date, few studies have used PAAT to assess preterm infants, especially those with respiratory distress syndrome (RDS). This study aimed to assess changes in PAAT among preterm infants with RDS undergoing pulmonary surfactant (PS) therapy or not, and determine its potential effects on the pulmonary vascular disease (PVD) outcomes of preterm infants with RDS in the late postnatal period. METHODS The risk of RDS was reviewed in 62 preterm infants with a gestational age of 26-31 weeks. The infants receiving PS therapy were allocated to the PS group, and the others were allocated to the control group. PAAT, right ventricular ejection time (RVET), and other ultrasonic parameters at 3 different time points after birth were studied and compared. RESULTS Infants in the PS group had a significantly lower PAAT (52.7±5.9 vs. 59.6±8.7; P=0.001) and PAAT/RVET (0.30±0.03 vs. 0.33±0.03; P=0.001) than those in the control group at 36 weeks postmenstrual age (PMA). No significant increases in PAAT/RVET were detected at 3 different times for the PS group (P=0.117), but both PAAT and PAAT/RVET increased significantly with time after birth in the control group (P<0.001). CONCLUSIONS Preterm infants with RDS might still have PVD in the late postnatal period and thus require long-term follow-up observation. PAAT appears to be a reliable non-invasive screening measure for evaluating pulmonary hemodynamics in preterm infants with RDS and late PVD.
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Affiliation(s)
- Liling Wang
- Department of Pediatric Cardiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Pediatrics, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Fengjuan Zhang
- Department of Pediatrics, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Jiahui Li
- Department of Pediatrics, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Zhijie Liu
- Department of Pediatrics, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Yan Kou
- Department of Pediatrics, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Yanting Song
- Department of Pediatrics, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Haiyan Xu
- Department of Pediatrics, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Haiyan Wang
- Department of Medical Ultrasound, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Yulin Wang
- Department of Pediatric Cardiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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26
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Topyła-Putowska W, Tomaszewski M, Wysokiński A, Tomaszewski A. Echocardiography in Pulmonary Arterial Hypertension: Comprehensive Evaluation and Technical Considerations. J Clin Med 2021; 10:jcm10153229. [PMID: 34362015 PMCID: PMC8348437 DOI: 10.3390/jcm10153229] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/18/2021] [Accepted: 07/20/2021] [Indexed: 12/21/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a rare, progressive disease in which there is a persistent, abnormal increase in pulmonary artery pressure. Symptoms of pulmonary hypertension are nonspecific and mainly associated with progressive right ventricular failure. The diagnosis of PAH is a multistep process and often requires the skillful use of several tests. The gold standard for the diagnosis of PAH is hemodynamic testing. Echocardiography currently plays an important role in the diagnostic algorithm of PAH as it is minimally invasive and readily available. Moreover, many echocardiographic parameters are closely related to pulmonary hemodynamics. It allows assessment of the right heart′s structure and function, estimation of the pressure in the right ventricle, right atrium, and pulmonary trunk, and exclusion of other causes of elevated pulmonary bed pressure. Echocardiographic techniques are constantly evolving, and recently, measurements made using new techniques, especially 3D visualization, have become increasingly important. In echocardiographic assessment, it is crucial to know current guidelines and new reports that organize the methodology and allow standardization of the examination. This review aims to discuss the different echocardiographic techniques used to evaluate patients with PAH.
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27
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Harrod KK, Rogers JL, Feinstein JA, Marsden AL, Schiavazzi DE. Predictive Modeling of Secondary Pulmonary Hypertension in Left Ventricular Diastolic Dysfunction. Front Physiol 2021; 12:666915. [PMID: 34276397 PMCID: PMC8281259 DOI: 10.3389/fphys.2021.666915] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/16/2021] [Indexed: 12/03/2022] Open
Abstract
Diastolic dysfunction is a common pathology occurring in about one third of patients affected by heart failure. This condition may not be associated with a marked decrease in cardiac output or systemic pressure and therefore is more difficult to diagnose than its systolic counterpart. Compromised relaxation or increased stiffness of the left ventricle induces an increase in the upstream pulmonary pressures, and is classified as secondary or group II pulmonary hypertension (2018 Nice classification). This may result in an increase in the right ventricular afterload leading to right ventricular failure. Elevated pulmonary pressures are therefore an important clinical indicator of diastolic heart failure (sometimes referred to as heart failure with preserved ejection fraction, HFpEF), showing significant correlation with associated mortality. However, accurate measurements of this quantity are typically obtained through invasive catheterization and after the onset of symptoms. In this study, we use the hemodynamic consistency of a differential-algebraic circulation model to predict pulmonary pressures in adult patients from other, possibly non-invasive, clinical data. We investigate several aspects of the problem, including the ability of model outputs to represent a sufficiently wide pathologic spectrum, the identifiability of the model's parameters, and the accuracy of the predicted pulmonary pressures. We also find that a classifier using the assimilated model parameters as features is free from the problem of missing data and is able to detect pulmonary hypertension with sufficiently high accuracy. For a cohort of 82 patients suffering from various degrees of heart failure severity, we show that systolic, diastolic, and wedge pulmonary pressures can be estimated on average within 8, 6, and 6 mmHg, respectively. We also show that, in general, increased data availability leads to improved predictions.
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Affiliation(s)
- Karlyn K Harrod
- Department of Applied and Computational Mathematics and Statistics, University of Notre Dame, Notre Dame, IN, United States
| | - Jeffrey L Rogers
- Department of Digital Health, T.J. Watson Research Center, International Business Machines Corporation, Yorktown Heights, NY, United States
| | - Jeffrey A Feinstein
- Department of Pediatrics and Bioengineering, Stanford University, Stanford, CA, United States
| | - Alison L Marsden
- Department of Pediatrics, Bioengineering and Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, United States
| | - Daniele E Schiavazzi
- Department of Applied and Computational Mathematics and Statistics, University of Notre Dame, Notre Dame, IN, United States
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28
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Sengeløv M, Biering-Sørensen T. Noninvasive Hemodynamic Evaluation at Rest in Heart Failure with Preserved Ejection Fraction. Heart Fail Clin 2021; 17:423-434. [PMID: 34051974 DOI: 10.1016/j.hfc.2021.02.006] [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: 11/30/2022]
Abstract
Noninvasive cardiac imaging by transthoracic echocardiography is among the first-line assessments in evaluation of heart failure patients with preserved ejection fraction (HFpEF). Although systolic function seems preserved by conventional measurers, important information is found through examination of the heart's hemodynamic profile through Doppler and novel echocardiographic measures. These measures aid in establishing the diagnosis of HFpEF and provide valuable prognostic information. Targets of interest include the left ventricle diastolic function, atrial structure and function, and right ventricular function including pulmonary pressures. Contemporary assessments of the hemodynamic profile attainable through echocardiography in HFpEF at rest are reviewed and future directions outlined.
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Affiliation(s)
- Morten Sengeløv
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hjertemedicinsk Forskning 2, Gentofte Hospital, Gentofte Hospitalsvej 8, 3. sal, Post 835, 2900 Hellerup, Copenhagen, Denmark; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hjertemedicinsk Forskning 2, Gentofte Hospital, Gentofte Hospitalsvej 8, 3. sal, Post 835, 2900 Hellerup, Copenhagen, Denmark; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, Copenhagen, Denmark.
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29
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Rysz S, Al-Saadi J, Sjöström A, Farm M, Campoccia Jalde F, Plattén M, Eriksson H, Klein M, Vargas-Paris R, Nyrén S, Abdula G, Ouellette R, Granberg T, Jonsson Fagerlund M, Lundberg J. COVID-19 pathophysiology may be driven by an imbalance in the renin-angiotensin-aldosterone system. Nat Commun 2021; 12:2417. [PMID: 33893295 PMCID: PMC8065208 DOI: 10.1038/s41467-021-22713-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 03/23/2021] [Indexed: 12/13/2022] Open
Abstract
SARS-CoV-2 uses ACE2, an inhibitor of the Renin-Angiotensin-Aldosterone System (RAAS), for cellular entry. Studies indicate that RAAS imbalance worsens the prognosis in COVID-19. We present a consecutive retrospective COVID-19 cohort with findings of frequent pulmonary thromboembolism (17%), high pulmonary artery pressure (60%) and lung MRI perfusion disturbances. We demonstrate, in swine, that infusing angiotensin II or blocking ACE2 induces increased pulmonary artery pressure, reduces blood oxygenation, increases coagulation, disturbs lung perfusion, induces diffuse alveolar damage, and acute tubular necrosis compared to control animals. We further demonstrate that this imbalanced state can be ameliorated by infusion of an angiotensin receptor blocker and low-molecular-weight heparin. In this work, we show that a pathophysiological state in swine induced by RAAS imbalance shares several features with the clinical COVID-19 presentation. Therefore, we propose that severe COVID-19 could partially be driven by a RAAS imbalance.
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Affiliation(s)
- Susanne Rysz
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Jonathan Al-Saadi
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anna Sjöström
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Chemistry, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Farm
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Chemistry, Karolinska University Hospital, Stockholm, Sweden
| | - Francesca Campoccia Jalde
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Michael Plattén
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Helen Eriksson
- Department of Sociology, Stockholm University Demography Unit, Stockholm University, Stockholm, Sweden
| | - Margareta Klein
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Radiology Huddinge, Karolinska University Hospital, Stockholm, Sweden
| | - Roberto Vargas-Paris
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Radiology Solna, Karolinska University Hospital, Stockholm, Sweden
| | - Sven Nyrén
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Radiology Solna, Karolinska University Hospital, Stockholm, Sweden
| | - Goran Abdula
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Russell Ouellette
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Tobias Granberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Malin Jonsson Fagerlund
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Johan Lundberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.
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30
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COVID-19 pathophysiology may be driven by an imbalance in the renin-angiotensin-aldosterone system. Nat Commun 2021; 12:2417. [PMID: 33893295 PMCID: PMC8065208 DOI: 10.1038/s41467-021-22713-z|] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
SARS-CoV-2 uses ACE2, an inhibitor of the Renin-Angiotensin-Aldosterone System (RAAS), for cellular entry. Studies indicate that RAAS imbalance worsens the prognosis in COVID-19. We present a consecutive retrospective COVID-19 cohort with findings of frequent pulmonary thromboembolism (17%), high pulmonary artery pressure (60%) and lung MRI perfusion disturbances. We demonstrate, in swine, that infusing angiotensin II or blocking ACE2 induces increased pulmonary artery pressure, reduces blood oxygenation, increases coagulation, disturbs lung perfusion, induces diffuse alveolar damage, and acute tubular necrosis compared to control animals. We further demonstrate that this imbalanced state can be ameliorated by infusion of an angiotensin receptor blocker and low-molecular-weight heparin. In this work, we show that a pathophysiological state in swine induced by RAAS imbalance shares several features with the clinical COVID-19 presentation. Therefore, we propose that severe COVID-19 could partially be driven by a RAAS imbalance.
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31
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Gall H, Yogeswaran A, Fuge J, Sommer N, Grimminger F, Seeger W, Olsson KM, Hoeper MM, Richter MJ, Tello K, Ghofrani HA. Validity of echocardiographic tricuspid regurgitation gradient to screen for new definition of pulmonary hypertension. EClinicalMedicine 2021; 34:100822. [PMID: 33997731 PMCID: PMC8102717 DOI: 10.1016/j.eclinm.2021.100822] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Currently an echocardiographic threshold for the tricuspid regurgitation gradient (TRG) of > 31 mmHg is recommended for screening for pulmonary hypertension (PH). Invasively diagnosed PH was recently redefined as mean pulmonary arterial pressure (mPAP) > 20 mmHg instead of ≥ 25 mmHg. We investigated the ability of TRG to screen for the new PH-definition. METHODS Retrospective assessment of echocardiography and right heart catheterisation data from 1572 patients entering the Giessen PH-Registry during 2008-2018. Accuracy of different TRG thresholds and other echocardiographic parameters was evaluated using receiver operating characteristic curves. FINDINGS 1264 patients fulfilled the new PH-definition. Positive (PPV) and negative predictive values and accuracy of TRG > 46 mmHg were 95%, 39%, and 73%, respectively, for the new PH-definition. Lowering the TRG cut-off to 31 mmHg and below worsened PPV to ≤ 89%. The PPV of TRG for pre-capillary PH (mPAP > 20 mmHg and pulmonary vascular resistance ≥ 3 Wood Units) was ≤ 85%. In patients with TRG ≤ 46 mmHg, tricuspid annular plane systolic excursion/TRG and TRG/right ventricular outflow tract acceleration time were superior to TRG in screening for newly defined pre-capillary PH. INTERPRETATION In patients with suspected PH referred to a tertiary care centre, the PPV of TRG to meet the new PH-definition depended strongly on the TRG cut-off used. Our data do not support lowering the TRG cut-off. Combining TRG with other echocardiographic parameters might improve the validity of echocardiographic screening for PH.
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Affiliation(s)
- Henning Gall
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Centre (UGMLC, Member of the German Centre for Lung Research (DZL), Klinikstrasse 32, 35392, Germany
- Cardio-Pulmonary Institute (CPI), Giessen , Germany
| | - Athiththan Yogeswaran
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Centre (UGMLC, Member of the German Centre for Lung Research (DZL), Klinikstrasse 32, 35392, Germany
- Cardio-Pulmonary Institute (CPI), Giessen , Germany
| | - Jan Fuge
- Department of Respiratory Medicine, Hannover Medical School, Member of the German Centre for Lung Research (DZL/BREATH), Germany
| | - Natascha Sommer
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Centre (UGMLC, Member of the German Centre for Lung Research (DZL), Klinikstrasse 32, 35392, Germany
- Cardio-Pulmonary Institute (CPI), Giessen , Germany
| | - Friedrich Grimminger
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Centre (UGMLC, Member of the German Centre for Lung Research (DZL), Klinikstrasse 32, 35392, Germany
- Cardio-Pulmonary Institute (CPI), Giessen , Germany
- Institute for Lung Health (ILH), Giessen, Germany
| | - Werner Seeger
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Centre (UGMLC, Member of the German Centre for Lung Research (DZL), Klinikstrasse 32, 35392, Germany
- Cardio-Pulmonary Institute (CPI), Giessen , Germany
- Institute for Lung Health (ILH), Giessen, Germany
| | - Karen M. Olsson
- Department of Respiratory Medicine, Hannover Medical School, Member of the German Centre for Lung Research (DZL/BREATH), Germany
| | - Marius M. Hoeper
- Department of Respiratory Medicine, Hannover Medical School, Member of the German Centre for Lung Research (DZL/BREATH), Germany
| | - Manuel J. Richter
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Centre (UGMLC, Member of the German Centre for Lung Research (DZL), Klinikstrasse 32, 35392, Germany
- Cardio-Pulmonary Institute (CPI), Giessen , Germany
| | - Khodr Tello
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Centre (UGMLC, Member of the German Centre for Lung Research (DZL), Klinikstrasse 32, 35392, Germany
- Cardio-Pulmonary Institute (CPI), Giessen , Germany
| | - Hossein Ardeschir Ghofrani
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Centre (UGMLC, Member of the German Centre for Lung Research (DZL), Klinikstrasse 32, 35392, Germany
- Cardio-Pulmonary Institute (CPI), Giessen , Germany
- Department of Medicine, Imperial College London, United Kingdom
- Corresponding author at: Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Centre (UGMLC, Member of the German Centre for Lung Research (DZL), Klinikstrasse 32, 35392, Germany.
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Thomas L, Baczynski M, Deshpande P, Kharrat A, Joye S, Zhu F, Ibarra-Rios D, Shah PS, Mertens L, Jankov RP, Ye XY, Neary E, Ting J, Castaldo M, Levy P, Smith A, El-Khuffash AF, Giesinger RE, McNamara PJ, Weisz DE, Jain A. Multicentre prospective observational study exploring the predictive value of functional echocardiographic indices for early identification of preterm neonates at risk of developing chronic pulmonary hypertension secondary to chronic neonatal lung disease. BMJ Open 2021; 11:e044924. [PMID: 33789855 PMCID: PMC8016080 DOI: 10.1136/bmjopen-2020-044924] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Although chronic pulmonary hypertension (cPH) secondary to chronic neonatal lung disease is associated with increased mortality and respiratory and neurodevelopmental morbidities, late diagnosis (typically ≥36 weeks postmenstrual age, PMA) and the use of qualitative echocardiographic diagnostic criterion (flat interventricular septum in systole) remain significant limitations in clinical care. Our objective in this study is to evaluate the utility of relevant quantitative echocardiographic indices to identify cPH in preterm neonates, early in postnatal course and to develop a diagnostic test based on the best combination of markers. METHODS AND ANALYSIS In this ongoing international prospective multicentre observational diagnostic accuracy study, we aim to recruit 350 neonates born <27 weeks PMA and/or birth weight <1000 g and perform echocardiograms in the third week of age and at 32 weeks PMA (early diagnostic assessments, EDA) in addition to the standard diagnostic assessment (SDA) for cPH at 36 weeks PMA. Predefined echocardiographic markers under investigation will be measured at each EDA and examined to create a scoring system to identify neonates who subsequently meet the primary outcome of cPH/death at SDA. Diagnostic test characteristics will be defined for each EDA. Pulmonary artery acceleration time and tricuspid annular plane systolic excursion are the primary markers of interest. ETHICS AND DISSEMINATION Ethics approval has been received by the Mount Sinai Hospital Research Ethics Board (REB) (#16-0111-E), Sunnybrook Health Sciences Centre REB (#228-2016), NHS Health Research Authority (IRAS 266498), University of Iowa Human Subjects Office/Institutional Review Board (201903736), Rotunda Hospital Research and Ethics Committee (REC-2019-008), and UBC Children's and Women's REB (H19-02738), and is under review at Boston Children's Hospital Institutional Review Board. Study results will be disseminated to participating families in lay format, presented to the scientific community at paediatric and critical care conferences and published in relevant peer-reviewed journals. TRAIL REGISTRATION NUMBER NCT04402645.
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Affiliation(s)
- Laura Thomas
- Paediatrics, Sinai Health System, Toronto, Ontario, Canada
- Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Poorva Deshpande
- Paediatrics, Sinai Health System, Toronto, Ontario, Canada
- Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Ashraf Kharrat
- Paediatrics, Sinai Health System, Toronto, Ontario, Canada
- Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Sébastien Joye
- Clinic of Neonatology, Lausanne University Hospital, Lausanne, Switzerland
| | - Faith Zhu
- Paediatrics, Sinai Health System, Toronto, Ontario, Canada
| | - Daniel Ibarra-Rios
- Neonatology, Hospital Infantil de Mexico Federico Gomez, Mexico City, Mexico
| | - Prakesh S Shah
- Paediatrics, Sinai Health System, Toronto, Ontario, Canada
- Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Luc Mertens
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Robert P Jankov
- Division of Neonatology, Department of Paediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Xiang Y Ye
- MiCare Research Centre, Sinai Health System, Toronto, Ontario, Canada
| | - Elaine Neary
- Neonatology, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | - Joseph Ting
- Neonatology, The University of British Columbia, Vancouver, Ontario, Canada
| | - Michael Castaldo
- Neonatology, The University of British Columbia, Vancouver, Ontario, Canada
| | - Philip Levy
- Boston Children's Hospital Department of Pediatrics, Boston, Massachusetts, USA
- Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Regan E Giesinger
- Pediatrics, The University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Patrick J McNamara
- Pediatrics, The University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Dany E Weisz
- Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Amish Jain
- Paediatrics, Sinai Health System, Toronto, Ontario, Canada
- Paediatrics, University of Toronto, Toronto, Ontario, Canada
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33
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Alerhand S, Sundaram T, Gottlieb M. What are the echocardiographic findings of acute right ventricular strain that suggest pulmonary embolism? Anaesth Crit Care Pain Med 2021; 40:100852. [PMID: 33781986 DOI: 10.1016/j.accpm.2021.100852] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/24/2020] [Accepted: 01/13/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Pulmonary embolism (PE) is a potentially fatal disease encountered in the hospital setting. Prompt diagnosis and management can improve outcomes and survival. Unfortunately, a PE may be difficult to diagnose in a timely manner. Point-of-care ultrasound (POCUS) can assist in the evaluation for suspected PE by assessing for acute right ventricular strain. Physicians should thus be aware of these echocardiographic findings. OBJECTIVE This manuscript will review ten echocardiographic findings of right ventricular strain that may suggest a diagnosis of PE. It will provide a description of each finding along with the associated pathophysiology. It will also summarize the literature for the diagnostic utility of echocardiography for this indication, while providing reference parameters where applicable. Along with labeled images and video clips, the review will then illustrate how to evaluate for each of the ten findings, while offering pearls and pitfalls in this bedside evaluation. DISCUSSION The ten echocardiographic findings of right ventricular strain are: increased right ventricle: left ventricle size ratio, abnormal septal motion, McConnell's sign, tricuspid regurgitation, elevated pulmonary artery systolic pressure, decreased tricuspid annular plane systolic excursion, decreased S', pulmonary artery mid-systolic notching, 60/60 sign, and speckle tracking demonstrating decreased right ventricular free wall strain. CONCLUSIONS Physicians must recognize and understand the echocardiographic findings and associated pathophysiology of right ventricular strain. In the proper clinical context, these findings can point toward a diagnosis of PE and thereby lead to earlier initiation of directed management.
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Affiliation(s)
- Stephen Alerhand
- Department of Emergency Medicine, Rutgers New Jersey Medical School, 150 Bergen Street, Newark, NJ 07103, USA.
| | - Tina Sundaram
- Department of Emergency Medicine, Rush University Medical Center, 1750 W. Harrison Street, Kellogg Suite 108, Chicago, IL 60612, USA
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, 1750 W. Harrison Street, Kellogg Suite 108, Chicago, IL 60612, USA
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34
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Churchill TW, Petek BJ, Wasfy MM, Guseh JS, Weiner RB, Singh TK, Schmied C, O'Malley H, Chiampas G, Baggish AL. Cardiac Structure and Function in Elite Female and Male Soccer Players. JAMA Cardiol 2021; 6:316-325. [PMID: 33263734 DOI: 10.1001/jamacardio.2020.6088] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Importance Population-specific normative data are essential for the evaluation of competitive athletes. At present, there are limited data defining normal electrocardiographic (ECG) and echocardiographic values among elite US soccer players. Objective To describe ECG and echocardiographic findings in healthy elite US soccer players. Design, Setting, and Participants This cross-sectional study analyzed Fédération Internationale de Football Association-mandated screening sessions performed at US Soccer National Team training locations from January 2015 to December 2019. US women's and men's national team soccer players undergoing mandated cardiovascular screening were included. Main Outcomes and Measures Normal training-related and abnormal ECG findings were reported using the International Recommendations for Electrocardiographic Interpretation in Athletes. Echocardiographic measurements of structural and functional parameters relevant to cardiovascular remodeling were assessed relative to American Society of Echocardiography guideline-defined normal ranges. Results A total of 238 athletes (122 [51%] female; mean [SD] age, 20 [4] years; age range, 15-40 years) were included. Male athletes demonstrated a higher prevalence of normal training-related ECG findings, while female athletes were more likely to have abnormal ECG patterns (14 [11%] vs 0 in male cohort), largely accounted for by abnormal T-wave inversions. Echocardiography revealed no pathologic findings meeting criteria for sport restriction, but athletes frequently exceeded normal ranges for structural cardiac parameters responsive to exercise-induced remodeling including body surface area-indexed left ventricular (LV) mass (58 of 113 female athletes [51%] and 67 of 114 male athletes [59%]), indexed LV volume (89 of 115 female athletes [77%] and 76 of 111 male athletes [68%]), and LV wall thickness (37 of 122 female athletes [30%] and 47 of 116 male athletes [41%]). Age-stratified analysis revealed age-dependent increases in LV wall thickness, mass, and volumes among female athletes and LV wall thickness and mass among male athletes. Conclusions and Relevance These data represent the first set of comprehensive normative values for elite US soccer players and one of the largest sport-specific echocardiographic remodeling studies in female athletes. Abnormal ECG findings were more common in female athletes, while both female and male athletes frequently exceeded clinical normality cut points for remodeling-associated echocardiographic parameters.
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Affiliation(s)
- Timothy W Churchill
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston.,Echocardiography Laboratory, Massachusetts General Hospital, Boston
| | - Bradley J Petek
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston
| | - Meagan M Wasfy
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston.,Echocardiography Laboratory, Massachusetts General Hospital, Boston
| | - James S Guseh
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston
| | - Rory B Weiner
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston.,Echocardiography Laboratory, Massachusetts General Hospital, Boston
| | | | | | | | - George Chiampas
- United States Soccer Federation, Chicago, Illinois.,Feinberg School of Medicine, Department of Emergency Medicine, Northwestern University, Evanston, Illinois
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston.,Echocardiography Laboratory, Massachusetts General Hospital, Boston.,United States Soccer Federation, Chicago, Illinois
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Gual-Capllonch F, Lupón J, Bancu I, Graterol F, Ferrer-Sistach E, Teis A, Santiago-Vacas E, Vallejo N, Juncà G, Bayes-Genis A. Preload dependence of pulmonary haemodynamics and right ventricular performance. Clin Res Cardiol 2021; 110:591-600. [PMID: 33624153 DOI: 10.1007/s00392-021-01820-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/08/2021] [Indexed: 11/25/2022]
Abstract
AIMS Systolic pulmonary artery pressure (SPAP) and right heart adaptation in relation to pre-existing preload are often disregarded. To determine volume-related changes in the pulmonary-right ventricle (RV) unit and the preload dependence of its components, we analysed pulmonary haemodynamics and right ventricular performance, taking advantage of the plasma volume removal associated to haemodialysis (HD). METHODS AND RESULTS Fifty-three stable patients on chronic HD with LVEF > 50% and without heart failure were recruited (mean age 63.0 ± 12.4 years; 31.2% women; hypertension in 89% and diabetes in 53%) and evaluated just before and after HD (mean ultrafiltration volume 2.4 ± 0.7 l). SPAP from both times were available in 39 patients. After HD, SPAP decreased (42.2 ± 12.6 to 33.7 ± 11.6 mmHg, p < 0.001) without modification of non-invasive pulmonary vascular resistance (1.75 ± 0.44 to 1.75 ± 0.40 eWU, p = 0.94). Age and drop in the E/e' ratio were the variables associated with greater reduction in PASP (p = 0.022 and p = 0.049, respectively). A significant reduction of right chamber sizes was observed, along with a diminution in measures of RV contractility, excluding RV longitudinal strain. Functional tricuspid regurgitation (FTR) diminution was observed in 26% of patients, occurring in every case with more than mild FTR. On multivariate analyses, left atrial size was the only predictor of pulmonary hypertension (defined as SPAP > 40 mmHg) (OR 1.29 (1.07-1.56), p = 0.006). CONCLUSION Rapid volemic changes may affect FTR grading, RV size and contractility, with RV longitudinal strain being less variable than conventional parameters. SPAP decreases after HD, and this reduction is related to age and greater diminution of the E/e' ratio.
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Affiliation(s)
- Francisco Gual-Capllonch
- Heart Institute. Hospital Universitari Germans Trias I Pujol, Carretera de Canyet s/n 08916, Badalona, Barcelona, Spain.
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Josep Lupón
- Heart Institute. Hospital Universitari Germans Trias I Pujol, Carretera de Canyet s/n 08916, Badalona, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Ioana Bancu
- Nefrology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Fredzzia Graterol
- Nefrology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Elena Ferrer-Sistach
- Heart Institute. Hospital Universitari Germans Trias I Pujol, Carretera de Canyet s/n 08916, Badalona, Barcelona, Spain
| | - Albert Teis
- Heart Institute. Hospital Universitari Germans Trias I Pujol, Carretera de Canyet s/n 08916, Badalona, Barcelona, Spain
| | - Evelyn Santiago-Vacas
- Heart Institute. Hospital Universitari Germans Trias I Pujol, Carretera de Canyet s/n 08916, Badalona, Barcelona, Spain
| | - Nuria Vallejo
- Heart Institute. Hospital Universitari Germans Trias I Pujol, Carretera de Canyet s/n 08916, Badalona, Barcelona, Spain
| | - Gladys Juncà
- Heart Institute. Hospital Universitari Germans Trias I Pujol, Carretera de Canyet s/n 08916, Badalona, Barcelona, Spain
| | - Antoni Bayes-Genis
- Heart Institute. Hospital Universitari Germans Trias I Pujol, Carretera de Canyet s/n 08916, Badalona, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
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36
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Guliyeva A, Cakir E, Yazan H, AlShadfan L, Sharifov R, Temur HO, Karaarslan U, Yozgat CY, Erenberk U, Yakut K, Yozgat Y. Assessment of Right Heart Functions in Children with Mild Cystic Fibrosis. KLINISCHE PADIATRIE 2021; 233:231-236. [PMID: 33601431 DOI: 10.1055/a-1341-1698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) is a multisystemic disease that prevalently involves the lungs. Hypoxemia occurs due to the existing of progressive damage to the pulmonary parenchyma and pulmonary vessels. The condition may cause systolic and diastolic dysfunction to the right ventricle due to the effects of high pulmonary artery systolic pressure (PASP). The study aimed to determine echocardiographic alterations in PASP, right ventricle (RV) anatomy, and functions in mild CF children. MATERIALS AND METHODS RV anatomy, systolic, and diastolic functions were evaluated with conventional echocardiographic measurements. Estimated PASP was used measured with new echocardiographic modalities, including pulmonary artery acceleration time (PAAT), right ventricular ejection time (RVET), and their ratio (PAAT/RVET). The obtained echocardiographic data were statistically compared between the patient group and the control group. RESULTS The study consisted of 30 pediatric patients with mild CF and 30 healthy children with similar demographics. In patient group, conventional parameters disclosed differences in RV anatomy, both systolic and diastolic functions of RV compared with the healthy group. We did not compare the patient group with published standard data because of the wide range variability. However, new echocardiographic parameters showed notable increase in pulmonary artery pressure compared with values of control group and published standard data (p<0.001). CONCLUSION Elevated PASP, RV failure, and Cor pulmonale usually begin early in children with mild CF. In addition to routine echocardiographic measurements to evaluate RV, we recommend the use of new echocardiographic modalities for routine examinations and in the follow up of children with mild CF.
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Affiliation(s)
- Aynur Guliyeva
- Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Erkan Cakir
- Pediatric Pulmonology, Bezmialem Vakif University, Istanbul, Turkey
| | - Hakan Yazan
- Pediatric Pulmonology, Bezmialem Vakif University, Istanbul, Turkey
| | - Lina AlShadfan
- Pediatric Pulmonology, Bezmialem Vakif University, Istanbul, Turkey
| | | | | | - Utku Karaarslan
- Pediatric Intensive Care Unit, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | | | - Ufuk Erenberk
- Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Kahraman Yakut
- Pediatric Cardiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Yilmaz Yozgat
- Pediatric Cardiology, Bezmialem Vakif University, Istanbul, Turkey
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F Zaky A, Froelich M, Meers B, Sturdivant AB, Densmore R, Subramaniam A, Carter T, Tita AN, Matalon S, Jilling T. Noninvasive Assessment of Right Ventricle Function and Pulmonary Artery Pressure Using Transthoracic Echocardiography in Women With Pre-Eclampsia: An Exploratory Study. Cureus 2021; 13:e13419. [PMID: 33763315 PMCID: PMC7980723 DOI: 10.7759/cureus.13419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background and objective Pre-eclampsia (PEC) is associated with the release of anti-angiogenic factors that are incriminated in raising systemic and pulmonary vascular resistance (PVR). Compared to the left heart and systemic circulation, much less attention has been paid to the right heart and pulmonary circulation in patients with PEC. We used transthoracic echocardiography (TTE) to estimate pulmonary artery (PA) pressure and right ventricular (RV) function in women with PEC. Materials and methods We conducted a case-control study at a tertiary care academic center. Ten early PEC (<34-week gestation) and nine late PEC (≥34-week gestation) patients with 11 early and 10 late gestational age-matched controls were enrolled. Two-dimensional TTE was performed on all patients. The estimated mean PA pressure (eMPAP) was calculated based on PA acceleration time (PAAT). PVR was estimated from eMPAP and RV cardiac output (RV CO). RV myocardial performance index (RV MPI), tricuspid annular plane systolic excursion (TAPSE), tissue tricuspid annular displacement (TTAD), and lateral tricuspid annular tissue peak systolic velocity (S’) were measured. Results Compared to early controls, in early PEC, the eMPAP and estimated PVR (ePVR) were elevated, PAAT was reduced, RV MPI was increased, TTAD was reduced, and TAPSE and TV S’ were unchanged. Compared to late controls, in late PEC, the eMPAP and ePVR were elevated, PAAT was reduced, and RV MPI was increased, while TAPSE, TTAD, and TV S’ were unchanged. Conclusions In a sample of women with PEC, early PEC was found to be associated with increased eMPAP and ePVR and subclinical decrement of RV function as assessed by TTE. TTE may be a useful noninvasive screening tool for early detection of pulmonary hypertension and RV dysfunction in PEC. An adequately powered longitudinal study is needed to determine the implications of these findings on long-term outcomes.
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Affiliation(s)
- Ahmed F Zaky
- Anesthesiology, University of Alabama at Birmingham, Birmingham, USA
| | - Michael Froelich
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, USA
| | - Brad Meers
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Adam B Sturdivant
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, USA
| | | | - Akila Subramaniam
- Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, USA
| | - Tekuila Carter
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Alan N Tita
- Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, USA
| | - Sadis Matalon
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Tamas Jilling
- Pediatrics, University of Alabama at Birmingham, Birmingham, USA
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38
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Aashish A, Giridharan S, Karthikeyan S, Ganesh BA, Prasath PA. Assessment of Pulmonary Artery Pressures by Various Doppler Echocardiographic Parameters and its Correlation with Cardiac Catheterization in Patients with Pulmonary Hypertension. Heart Views 2021; 21:263-268. [PMID: 33986925 PMCID: PMC8104318 DOI: 10.4103/heartviews.heartviews_133_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 11/23/2020] [Indexed: 11/23/2022] Open
Abstract
Background: Measuring pulmonary artery pressures is a routine index in Doppler echocardiography to diagnose, risk stratify, and prognosticate patients with pulmonary hypertension (PH). There are numerous methods in use to measure it in routine clinical practice. Objective: The objective of this study was to assess the correlation between the commonly used Doppler-derived parameters such as tricuspid regurgitation (TR)-derived systolic pulmonary artery pressure (SPAP), pulmonary regurgitation (PR)-derived mean pulmonary artery pressure (MPAP), and right ventricular outflow tract acceleration time (RVOT AcT) with right heart catheterization (RHC) data which are the gold standard. Materials and Methods: In this analytical study, we prospectively measured echo and angiogram parameters such as TR-derived SPAP, PR-derived MPAP, and RVOT AcT and studied its association with RHC data of thirty patients for a span of 2 years. Right ventricular AcT was also included in the study. Their relationship was displayed using Bland–Altman scatter plots. P < 0.05 was considered as statistically significant. Results: Although both TR-derived SPAP and PR-derived MPAP had a moderate correlation with RHC-acquired data, the agreement between them was poor. RVOT AcT showed a strong inverse correlation with invasive MPAP. Conclusion: Among the three Doppler methods that were assessed to measure pulmonary pressures, RVOT AcT had a strong correlation with MPAP. RVOT AcT of <80 ms had a high sensitivity to detect severe PH (defined as MPAP >45 mmHg). Hence, it is recommended to include AcT as a routine measure in the armamentarium of echocardiographic parameters used in patients with PH.
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Affiliation(s)
- Arumugam Aashish
- Department of Cardiology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - Srinivasan Giridharan
- Department of Cardiology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - Selvaraj Karthikeyan
- Department of Cardiology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | | | - Palamalai Arun Prasath
- Department of Cardiology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
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Bahrami HSZ, Pedersen FHG, Myhr KA, Møgelvang R, Hassager C. Feasibility, repeatability, and reproducibility of contemporary diastolic parameters and classification. Int J Cardiovasc Imaging 2021; 37:931-944. [PMID: 33394217 DOI: 10.1007/s10554-020-02069-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/09/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE To evaluate feasibility, time of acquisition, retest repeatability and reproducibility of echocardiographic indexes and classification algorithms of diastolic function. METHODS A total of 356 patients were examined before coronary artery bypass-grafting and/or aortic valve surgery. A subgroup of 50 was examined with 3 successive echocardiograms in conditions reflecting daily clinical practice. Diastolic parameters were obtained and analysed according to previous (2009) and current (2016) guidelines. Acquisition and analysis time, plus intra- and inter-observer variability were assessed. RESULTS Feasibility of diastolic parameters was between 93 and 99%, except the maximal tricuspid regurgitation velocity (TR Vmax) (65%). Mean acquisition and analysis time were highest for left atrial volumes (141 ± 24 s) in contrast to other parameters which were obtained in approximately one minute. Mean 368 and 360 s were needed to classify diastolic function according to the 2009 and 2016 algorithms, respectively (non-significant). Reproducibility was overall moderate (Pearson r = 0.62 to 0.87), with TR Vmax having the highest (r = 0.62) and mitral valve E/A ratio the lowest (r = 0.87) variation. The 2009 algorithm resulted in more indeterminate cases than the 2016 algorithm. Inter-examiner analysis resulted in reclassification of 20 vs. 8 patients using the 2009 and 2016 algorithms, respectively. CONCLUSION Diastolic parameters are highly feasible and moderately reproducible, except TR Vmax. The 2016 algorithm is more restrictive than the 2009 algorithm in classifying patients with advanced stages of diastolic dysfunction. Time of acquisition according to the two guidelines is not significantly different.
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Affiliation(s)
- Hashmat S Z Bahrami
- Department of Cardiology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
| | - Frederik H G Pedersen
- Department of Cardiology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Katrine A Myhr
- Department of Cardiology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Rasmus Møgelvang
- Department of Cardiology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Southern Denmark, Svendborg, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen Ø, Denmark
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen Ø, Denmark
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40
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Meinel K, Koestenberger M, Sallmon H, Hansmann G, Pieles GE. Echocardiography for the Assessment of Pulmonary Hypertension and Congenital Heart Disease in the Young. Diagnostics (Basel) 2020; 11:diagnostics11010049. [PMID: 33396225 PMCID: PMC7823322 DOI: 10.3390/diagnostics11010049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 12/18/2022] Open
Abstract
While invasive assessment of hemodynamics and testing of acute vasoreactivity in the catheterization laboratory is the gold standard for diagnosing pulmonary hypertension (PH) and pulmonary vascular disease (PVD) in children, transthoracic echocardiography (TTE) serves as the initial diagnostic tool. International guidelines suggest several key echocardiographic variables and indices for the screening studies when PH is suspected. However, due to the complex anatomy and special physiological considerations, these may not apply to patients with congenital heart disease (CHD). Misinterpretation of TTE variables can lead to delayed diagnosis and therapy, with fatal consequences, or–on the other hand-unnecessary invasive diagnostic procedures that have relevant risks, especially in the pediatric age group. We herein provide an overview of the echocardiographic workup of children and adolescents with PH with a special focus on children with CHD, such as ventricular/atrial septal defects, tetralogy of Fallot or univentricular physiology. In addition, we address the use of echocardiography as a tool to assess eligibility for exercise and sports, a major determinant of quality of life and outcome in patients with PH associated with CHD.
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Affiliation(s)
- Katharina Meinel
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, 8036 Graz, Austria; (K.M.); (M.K.)
- European Pediatric Pulmonary Vascular Disease Network, 13125 Berlin, Germany; (H.S.); (G.H.)
| | - Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, 8036 Graz, Austria; (K.M.); (M.K.)
- European Pediatric Pulmonary Vascular Disease Network, 13125 Berlin, Germany; (H.S.); (G.H.)
| | - Hannes Sallmon
- European Pediatric Pulmonary Vascular Disease Network, 13125 Berlin, Germany; (H.S.); (G.H.)
- Department of Pediatric Cardiology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin (DHZB), 13353 Berlin, Germany
| | - Georg Hansmann
- European Pediatric Pulmonary Vascular Disease Network, 13125 Berlin, Germany; (H.S.); (G.H.)
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, 30625 Hannover, Germany
| | - Guido E. Pieles
- European Pediatric Pulmonary Vascular Disease Network, 13125 Berlin, Germany; (H.S.); (G.H.)
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Centre, Congenital Heart Unit, Bristol Royal Hospital for Children and Bristol Heart Institute, Bristol BS2 8HW, UK
- Institute of Sport Exercise and Health (ISEH), University College London, London W1T 7HA, UK
- Correspondence:
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41
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Wierzbowska-Drabik K, Picano E, Bossone E, Ciampi Q, Lipiec P, Kasprzak JD. The feasibility and clinical implication of tricuspid regurgitant velocity and pulmonary flow acceleration time evaluation for pulmonary pressure assessment during exercise stress echocardiography. Eur Heart J Cardiovasc Imaging 2020; 20:1027-1034. [PMID: 30824900 DOI: 10.1093/ehjci/jez029] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 02/13/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS Echocardiography can estimate pulmonary arterial pressure (PAP) from tricuspid regurgitation velocity (TRV) or acceleration time (ACT) of pulmonary flow. We assessed the feasibility of TRV and ACT measurements during exercise stress echocardiography (ESE) and their correlation in all stages of ESE. METHODS AND RESULTS We performed ESE in 102 subjects [mean age 49 ± 17 years, 50 females, 39 healthy, 30 with cardiovascular risk factors, and 33 with pulmonary hypertension (PH)] referred for the assessment of exercise tolerance and ischaemia exclusion. ESE was performed on cycloergometer with the load increasing by 25 W for each 2 min. Assessment of TRV with continuous wave and ACT with pulsed Doppler were attempted in 306 time points: at rest, peak exercise, and recovery. In 20 PH patients we evaluated the correlations of TRV and ACT with invasively measured PAP. The success rate was 183/306 for TRV and 304/306 for ACT (feasibility: 60 vs. 99%, P < 0.0001). There was a close correlation between TRV and ACT: r = 0.787, P < 0.001 and ACT at peak ≤67 ms showed 94% specificity for elevated systolic PAP detection. Moreover, TRV and ACT at peak exercise reflected better that resting data the invasive systolic PAP and mean PAP with r = 0.76, P = 0.0004 and r = -0.67, P = 0.0018, respectively. CONCLUSION ACT is closely correlated with and substantially more feasible than TRV during ESE and inclusion of both parameters (TRACT approach) expands the possibility of PAP assessment, especially at exercise when TRV feasibility is the lowest but correlation with invasive PAP seems to increase.
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Affiliation(s)
- Karina Wierzbowska-Drabik
- Department of Cardiology, Medical University of Lodz, Bieganski Hospital, Ul. Kniaziewicza 1/5, 91-347 Lodz, Poland
| | - Eugenio Picano
- Institute of Clinical Physiology, National Council Research, Via Giuseppe Moruzzi 1, Pisa 56124, Italy
| | - Eduardo Bossone
- Echo-Lab, Division of Cardiology, Internal Medicine Department, AORN A. Cardarelli Hospital, Via A. Cardarelli 9, 80131 Naples, Italy
| | - Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, Viale Principe di Napoli, 12, 82100 Benevento, Italy
| | - Piotr Lipiec
- Department of Cardiology, Medical University of Lodz, Bieganski Hospital, Ul. Kniaziewicza 1/5, 91-347 Lodz, Poland
| | - Jarosław Damian Kasprzak
- Department of Cardiology, Medical University of Lodz, Bieganski Hospital, Ul. Kniaziewicza 1/5, 91-347 Lodz, Poland
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42
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Truong U, Meinel K, Haddad F, Koestenberger M, Carlsen J, Ivy D, Jone PN. Update on noninvasive imaging of right ventricle dysfunction in pulmonary hypertension. Cardiovasc Diagn Ther 2020; 10:1604-1624. [PMID: 33224776 DOI: 10.21037/cdt-20-272] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Pulmonary hypertension (PH) is a progressive disease affecting patients across the life span. The pathophysiology primarily involves the pulmonary vasculature and right ventricle (RV), but eventually affects the left ventricular (LV) function as well. Safe, accurate imaging modalities are critical for diagnosis, serial monitoring, and tailored therapy. While cardiac catheterization remains the conventional modality for establishing diagnosis and serial monitoring, noninvasive imaging has gained considerable momentum in providing accurate assessment of the entire RV-pulmonary axis. In this state-of-the-art review, we will discuss the most recent developments in echocardiography, magnetic resonance imaging, and computed tomography in PH evaluation from pediatric to adult population.
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Affiliation(s)
- Uyen Truong
- Division of Pediatric Cardiology, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Katharina Meinel
- Division of Pediatric Cardiology, Medical University of Graz, Graz, Austria
| | - Francois Haddad
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | | | - Jørn Carlsen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dunbar Ivy
- Division of Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Pei-Ni Jone
- Division of Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
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43
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Gürsel G, Özdemir U, Güney T, Karaarslan N, Tekin Ö, Öztürk B. The usefulness of subxiphoid view in the evaluation of acceleration time and pulmonary hypertension in ICU patients. Echocardiography 2020; 37:1345-1352. [PMID: 32789889 DOI: 10.1111/echo.14822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/24/2020] [Accepted: 07/24/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pulmonary hypertension (PHT) is very frequent in ICUs. Estimation of systolic pulmonary artery pressure (PASP) by using tricuspid regurgitation velocity (TRV) is impossible in 25% of patients. However, it may be possible to estimate PHT in these patients by obtaining subxiphoid imaging of short axis (SX-SAX) and measuring pulmonary artery diameter (PAD) and right ventricular outflow tract (RVOT) acceleration time (AT). We first aimed to compare the values of AT and PAD measured at the parasternal short axis view (PSAX) and SX-SAX and then to compare AT measurements obtained in the RVOT and pulmonary artery (PA) in ICU patients. METHODS This prospective observational study was conducted in a 7-bed ICU of a tertiary academic teaching hospital. Measurements of TRV, PAD, and AT in parasternal and subxiphoid SAX were obtained. AT was measured in RVOT and PA locations. We measured other echocardiographic signs of PHT to assess the probability of PHT in addition to TRV measurements. RESULTS The study consisted of 61 patients. TRV was measured in 85% of the patients, and SX-SAX was visualized in 78%. The probability of PHT was high (49%) in this study population. There were agreement and no proportional bias between the measurements of PAD and AT at both SX-SAX and PSAX. Measurements of AT in the RVOT and PA were similar, as well. CONCLUSION These results suggested that measurements of AT in the PSAX and SX-SAX and RVOT and PA were similar in the ICU patients.
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Affiliation(s)
- Gül Gürsel
- Department of Pulmonary Critical Care Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - Uğur Özdemir
- Division of Critical Care Medicine, Department of Internal Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - Tuba Güney
- Division of Critical Care Medicine, Department of Neurology, Gazi University School of Medicine, Ankara, Turkey
| | - Nur Karaarslan
- Division of Critical Care Medicine, Department of Anesthesiology, Gazi University School of Medicine, Ankara, Turkey
| | - Ömer Tekin
- Division of Critical Care Medicine, Department of Internal Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - Burcu Öztürk
- Department of Pulmonary Critical Care Medicine, Gazi University School of Medicine, Ankara, Turkey
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Gopal DM, Ayalon N, Wang YC, Siwik D, Sverdlov A, Donohue C, Perez A, Downing J, Apovian C, Silva V, Panagia M, Kolachalama V, Ho JE, Liang CS, Gokce N, Colucci WS. Galectin-3 Is Associated With Stage B Metabolic Heart Disease and Pulmonary Hypertension in Young Obese Patients. J Am Heart Assoc 2020; 8:e011100. [PMID: 30929550 PMCID: PMC6509711 DOI: 10.1161/jaha.118.011100] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Obesity is a precursor to heart failure with preserved ejection fraction. Biomarkers that identify preclinical metabolic heart disease (MHD) in young obese patients would help identify high‐risk individuals for heart failure prevention strategies. We assessed the predictive value of GAL3 (galectin–3), FSTL3 (follistatin‐like 3 peptide), and NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) to identify stage B MHD in young obese participants free of clinically evident cardiovascular disease. Methods and Results Asymptomatic obese patients (n=250) and non‐obese controls (n=21) underwent echocardiographic cardiac phenotyping. Obese patients were classified as MHD positive (MHD‐POS; n=94) if they had abnormal diastolic function or left ventricular hypertrophy and had estimated pulmonary artery systolic pressure ≥35 mm Hg. Obese patients without such abnormalities were classified as MHD negative (MHD‐NEG; n=52). Serum biomarkers timed with echocardiography. MHD‐POS and MHD‐NEG individuals were similarly obese, but MHD‐POS patients were older, with more diabetes mellitus and metabolic syndrome. Right ventricular coupling was worse in MHD‐POS patients (P<0.001). GAL3 levels were higher in MHD‐POS versus MHD‐NEG patients (7.7±2.3 versus 6.3±1.9 ng/mL, respectively; P<0.001). Both GAL3 and FSTL3 levels correlated with diastolic dysfunction and increased pulmonary artery systolic pressure but not with left ventricular mass. In multivariate models including all 3 biomarkers, only GAL3 remained associated with MHD (odds ratio: 1.30; 95% CI, 1.01–1.68; P=0.04). Conclusions In young obese individuals without known cardiovascular disease, GAL3 is associated with the presence of preclinical MHD. GAL3 may be useful in screening for preclinical MHD and identifying individuals with increased risk of progression to obesity‐related heart failure with preserved ejection fraction.
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Affiliation(s)
- Deepa M Gopal
- 1 Cardiovascular Medicine Section Department of Medicine Boston University School of Medicine Boston MA
| | - Nir Ayalon
- 1 Cardiovascular Medicine Section Department of Medicine Boston University School of Medicine Boston MA
| | - Yi-Chih Wang
- 4 Cardiovascular Division Department of Internal Medicine National Taiwan University Hospital Taipei Taiwan
| | - Deborah Siwik
- 1 Cardiovascular Medicine Section Department of Medicine Boston University School of Medicine Boston MA
| | - Aaron Sverdlov
- 5 School of Medicine and Public Health University of Newcastle New South Wales Australia
| | | | - Alejandro Perez
- 1 Cardiovascular Medicine Section Department of Medicine Boston University School of Medicine Boston MA
| | - Jill Downing
- 1 Cardiovascular Medicine Section Department of Medicine Boston University School of Medicine Boston MA
| | - Caroline Apovian
- 2 Endocrinology Section Department of Medicine Boston University School of Medicine Boston MA
| | - Vanessa Silva
- 1 Cardiovascular Medicine Section Department of Medicine Boston University School of Medicine Boston MA
| | - Marcello Panagia
- 1 Cardiovascular Medicine Section Department of Medicine Boston University School of Medicine Boston MA
| | - Vijaya Kolachalama
- 3 Computational Biomedicine Department of Medicine Boston University School of Medicine Boston MA
| | - Jennifer E Ho
- 6 Division of Cardiology Department of Medicine Massachusetts General Hospital Boston MA
| | - Chang-Seng Liang
- 1 Cardiovascular Medicine Section Department of Medicine Boston University School of Medicine Boston MA
| | - Noyan Gokce
- 1 Cardiovascular Medicine Section Department of Medicine Boston University School of Medicine Boston MA
| | - Wilson S Colucci
- 1 Cardiovascular Medicine Section Department of Medicine Boston University School of Medicine Boston MA
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45
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Wierzbowska-Drabik K, Kasprzak JD, D Alto M, Ágoston G, Varga A, Ferrara F, Amor M, Ciampi Q, Bossone E, Picano E. Reduced pulmonary vascular reserve during stress echocardiography in confirmed pulmonary hypertension and patients at risk of overt pulmonary hypertension. Int J Cardiovasc Imaging 2020; 36:1831-1843. [PMID: 32462450 PMCID: PMC7497494 DOI: 10.1007/s10554-020-01897-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 05/21/2020] [Indexed: 12/19/2022]
Abstract
Noninvasive estimation of systolic pulmonary artery pressure (SPAP) during exercise stress echocardiography (ESE) is recommended for pulmonary hemodynamics evaluation but remains flow-dependent. Our aim was to assess the feasibility of pulmonary vascular reserve index (PVRI) estimation during ESE combining SPAP with cardiac output (CO) or exercise-time and compare its value in three group of patients: with invasively confirmed pulmonary hypertension (PH), at risk of PH development (PH risk) mainly with systemic sclerosis and in controls (C) without clinical risk factors for PH, age-matched with PH risk patients. We performed semisupine ESE in 171 subjects: 31 PH, 61 PH at risk and 50 controls as well as in 29 young, healthy normals. Rest and stress assessment included: tricuspid regurgitant flow velocity (TRV), pulmonary acceleration time (ACT), CO (Doppler-estimated). SPAP was calculated from TRV or ACT when TRV was not available. We estimated PVRI based on CO (peak CO/SPAP*0.1) or exercise-time (ESE time/SPAP*0.1). During stress, TRV was measurable in 44% patients ACT in 77%, either one in 95%. PVRI was feasible in 65% subjects with CO and 95% with exercise-time (p < 0.0001). PVRI was lower in PH compared to controls both for CO-based PVRI (group 1 = 1.0 ± 0.95 vs group 3 = 4.28 ± 2.3, p < 0.0001) or time-based PVRI estimation (0.66 ± 0.39 vs 3.95 ± 2.26, p < 0.0001). The proposed criteria for PH detection were for CO-based PVRI ≤ 1.29 and ESE-time based PVRI ≤ 1.0 and for PH risk ≤ 1.9 and ≤ 1.7 respectively. Noninvasive estimation of PVRI can be obtained in near all patients during ESE, without contrast administration, integrating TRV with ACT for SPAP assessment and using exercise time as a proxy of CO. These indices allow for comparison of pulmonary vascular dynamics in patients with varied exercise tolerance and clinical status.
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Affiliation(s)
| | - Jarosław D Kasprzak
- I Department and Chair of Cardiology, Medical University of Lodz, Bieganski Hospital, Lodz, Poland
| | - Michele D Alto
- Department of Cardiology, University "L. Vanvitelli"- AORN dei Colli - Monaldi Hospital, Naples, Italy
| | - Gergely Ágoston
- Department of Family Medicine, University of Szeged, Tisza Lajos krt. 109, Szeged, 6725, Hungary
| | - Albert Varga
- Department of Family Medicine, University of Szeged, Tisza Lajos krt. 109, Szeged, 6725, Hungary
| | - Francesco Ferrara
- Cardiology Division, Heart Department, University Hospital of Salerno, "Cava de' Tirreni and Amalfi Coast" Hospital, Salerno, Italy
| | - Miguel Amor
- Cardiology Department, Ramos Mejia Hospital, Buenos Aires, Argentina
| | - Quirino Ciampi
- Division of Cardiology, Fatebenefratelli Hospital, Benevento, Italy
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Spyropoulos F, Vitali SH, Touma M, Rose CD, Petty CR, Levy P, Kourembanas S, Christou H. Echocardiographic markers of pulmonary hemodynamics and right ventricular hypertrophy in rat models of pulmonary hypertension. Pulm Circ 2020; 10:2045894020910976. [PMID: 32537128 PMCID: PMC7268140 DOI: 10.1177/2045894020910976] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/11/2020] [Indexed: 01/05/2023] Open
Abstract
Echocardiography is the gold standard non-invasive technique to diagnose
pulmonary hypertension. It is also an important modality used to monitor disease
progression and response to treatment in patients with pulmonary hypertension.
Surprisingly, only few studies have been conducted to validate and standardize
echocardiographic parameters in experimental animal models of pulmonary
hypertension. We sought to define cut-off values for both invasive and
non-invasive measures of pulmonary hemodynamics and right ventricular
hypertrophy that would reliably diagnose pulmonary hypertension in three
different rat models. The study was designed in two phases: (1) a
derivation phase to establish the cut-off values for
invasive measures of right ventricular systolic pressure, Fulton's index (right
ventricular weight/left ventricle + septum weight), right ventricular to body
weight ratio, and non-invasive echocardiographic measures of pulmonary arterial
acceleration time, pulmonary arterial acceleration time to ejection time ratio
and right ventricular wall thickness in diastole in the hypoxic and
monocrotaline rat models of pulmonary hypertension and (2) a validation
phase to test the performance of the cut-off values in predicting
pulmonary hypertension in an independent cohort of rats with
Sugen/hypoxia-induced pulmonary hypertension. Our study demonstrates that right
ventricular systolic pressure ≥35.5 mmHg and Fulton's Index ≥0.34 are highly
sensitive (>94%) and specific (>91%) cut-offs to distinguish animals with
pulmonary hypertension from controls. When pulmonary arterial acceleration
time/ejection time and right ventricular wall thickness in diastole were both
measured, a result of either pulmonary arterial acceleration time/ejection time
≤0.25 or right ventricular wall thickness in diastole ≥1.03 mm detected right
ventricular systolic pressure ≥35.5 mmHg or Fulton's Index ≥0.34 with a
sensitivity of 88% and specificity of 100%. With properly validated non-invasive
echocardiography measures of right ventricular performance in rats that
accurately predict invasive measures of pulmonary hemodynamics, future studies
can now utilize these markers to test the efficacy of different treatments with
preclinical therapeutic modeling.
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Affiliation(s)
- Fotios Spyropoulos
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Sally H Vitali
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Marlin Touma
- University of California at Los Angeles, Los Angeles, CA, USA
| | - Chase D Rose
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Carter R Petty
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA
| | - Philip Levy
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | | | - Helen Christou
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
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47
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Krishnan M, Barnett CF. Advances in the diagnosis and treatment of HIV-associated pulmonary arterial hypertension. Expert Opin Orphan Drugs 2020. [DOI: 10.1080/21678707.2020.1770080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Mrinalini Krishnan
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Department of Cardiology, Division of Advanced Heart Failure, Washington, D.C, USA
| | - Christopher F. Barnett
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Department of Cardiology, Division of Advanced Heart Failure, Washington, D.C, USA
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Abstract
The emergency room is a principal entrance for the initial management of patients with acute heart failure. Echocardiography may be performed by cardiologists and noncardiologists in the emergency room. Echocardiographic studies require effective technical skills and precise diagnostic knowledge. This article contributes to physicians in the emergency room, general practitioners in training, and medical staff who engage in emergency medicine. This article emphasized the role of echocardiography in light of pathophysiology of acute heart failure in the emergency room and refining the clinical workflow by integrating conventional and innovative knowledge for the initial management of acute heart failure.
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Affiliation(s)
- Masataka Sugahara
- JCHO Hoshigaoka Medical Center, 4-8-1 Hoshigaoka, Hirakata, Osaka 573-8511, Japan
| | - Tohru Masuyama
- JCHO Hoshigaoka Medical Center, 4-8-1 Hoshigaoka, Hirakata, Osaka 573-8511, Japan.
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49
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González‐Tajuelo R, de la Fuente‐Fernández M, Morales‐Cano D, Muñoz‐Callejas A, González‐Sánchez E, Silván J, Serrador JM, Cadenas S, Barreira B, Espartero‐Santos M, Gamallo C, Vicente‐Rabaneda EF, Castañeda S, Pérez‐Vizcaíno F, Cogolludo Á, Jiménez‐Borreguero LJ, Urzainqui A. Spontaneous Pulmonary Hypertension Associated With Systemic Sclerosis in P-Selectin Glycoprotein Ligand 1-Deficient Mice. Arthritis Rheumatol 2020; 72:477-487. [PMID: 31509349 PMCID: PMC7065124 DOI: 10.1002/art.41100] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 09/03/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Pulmonary arterial hypertension (PAH), one of the major complications of systemic sclerosis (SSc), is a rare disease with unknown etiopathogenesis and noncurative treatments. As mice deficient in P-selectin glycoprotein ligand 1 (PSGL-1) develop a spontaneous SSc-like syndrome, we undertook this study to analyze whether they develop PAH and to examine the molecular mechanisms involved. METHODS Doppler echocardiography was used to estimate pulmonary pressure, immunohistochemistry was used to assess vascular remodeling, and myography of dissected pulmonary artery rings was used to analyze vascular reactivity. Angiotensin II (Ang II) levels were quantified by enzyme-linked immunosorbent assay, and Western blotting was used to measure Ang II type 1 receptor (AT1 R), AT2 R, endothelial cell nitric oxide synthase (eNOS), and phosphorylated eNOS expression in lung lysates. Flow cytometry allowed us to determine cytokine production by immune cells and NO production by endothelial cells. In all cases, there were 4-8 mice per experimental group. RESULTS PSGL-1-/- mice showed lung vessel wall remodeling and a reduced mean ± SD expression of pulmonary AT2 R (expression ratio [relative to β-actin] in female mice age >18 months: wild-type mice 0.799 ± 0.508 versus knockout mice 0.346 ± 0.229). With aging, female PSGL-1-/- mice had impaired up-regulation of estrogen receptor α (ERα) and developed lung vascular endothelial dysfunction coinciding with an increase in mean ± SEM pulmonary Ang II levels (wild-type 48.70 ± 5.13 pg/gm lung tissue versus knockout 78.02 ± 28.09 pg/gm lung tissue) and a decrease in eNOS phosphorylation, leading to reduced endothelial NO production. These events led to a reduction in the pulmonary artery acceleration time:ejection time ratio in 33% of aged female PSGL-1-/- mice, indicating pulmonary hypertension. Importantly, we found expanded populations of interferon-γ-producing PSGL-1-/- T cells and B cells and a reduced presence of regulatory T cells. CONCLUSION The absence of PSGL-1 induces a reduction in Treg cells, NO production, and ERα expression and causes an increase in Ang II in the lungs of female mice, favoring the development of PAH.
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Affiliation(s)
- Rafael González‐Tajuelo
- Fundación de Investigación Biomédica‐Hospital de la PrincesaIIS‐Princesa, Servicio de InmunlogíaMadridSpain
| | | | - Daniel Morales‐Cano
- University Complutense of Madrid School of Medicine and Ciber Enfermedades RespiratoriasMadridSpain
| | - Antonio Muñoz‐Callejas
- Fundación de Investigación Biomédica‐Hospital de la PrincesaIIS‐Princesa, Servicio de InmunlogíaMadridSpain
| | - Elena González‐Sánchez
- Fundación de Investigación Biomédica‐Hospital de la PrincesaIIS‐Princesa, Servicio de InmunlogíaMadridSpain
| | - Javier Silván
- Fundación de Investigación Biomédica‐Hospital de la PrincesaIIS‐Princesa, Servicio de InmunlogíaMadridSpain
| | - Juan Manuel Serrador
- Centro de Biología Molecular Severo Ochoa (CBMSO) and Instituto de Física Teórica CSIC/Universidad Autónoma de Madrid (UAM)MadridSpain
| | - Susana Cadenas
- Fundación de Investigación Biomédica‐Hospital de la PrincesaIIS‐Princesa, and CBMSO, CSIC‐UAMMadridSpain
| | - Bianca Barreira
- University Complutense of Madrid School of Medicine and Ciber Enfermedades RespiratoriasMadridSpain
| | - Marina Espartero‐Santos
- Fundación de Investigación Biomédica‐Hospital de la PrincesaIIS‐Princesa, Servicio de InmunlogíaMadridSpain
| | - Carlos Gamallo
- Fundación de Investigación Biomédica‐Hospital de la PrincesaIIS‐Princesa, Servicio de InmunlogíaMadridSpain
| | - Esther F. Vicente‐Rabaneda
- Fundación de Investigación Biomédica‐Hospital de la PrincesaIIS‐Princesa, Servicio de InmunlogíaMadridSpain
| | - Santos Castañeda
- Fundación de Investigación Biomédica‐Hospital de la PrincesaIIS‐Princesa, and Catedra UAM‐ROCHEMadridSpain
| | - Francisco Pérez‐Vizcaíno
- University Complutense of Madrid School of Medicine and Ciber Enfermedades RespiratoriasMadridSpain
| | - Ángel Cogolludo
- University Complutense of Madrid School of Medicine and Ciber Enfermedades RespiratoriasMadridSpain
| | | | - Ana Urzainqui
- Fundación de Investigación Biomédica‐Hospital de la PrincesaIIS‐Princesa, Servicio de InmunlogíaMadridSpain
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50
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Mohammad Nijres B, Bokowski J, Mubayed L, Jafri SH, Davis AT, Abdulla RI. Utility of Pulmonary Artery Acceleration Time to Estimate Systolic Pulmonary Artery Pressure in Neonates and Young Infants. Pediatr Cardiol 2020; 41:265-271. [PMID: 31707489 PMCID: PMC7223795 DOI: 10.1007/s00246-019-02251-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 11/02/2019] [Indexed: 02/08/2023]
Abstract
Transthoracic echocardiogram (TTE) is commonly used to screen for pulmonary hypertension (PHTN) in neonates and young infants. However, in the absence of sufficient tricuspid regurgitation (TR), a ventricular septal defect (VSD), or a patent ductus arteriosus (PDA), the estimation of systolic pulmonary artery pressure (SPAP) becomes challenging. Pulmonary artery acceleration time (PAAT) is an alternate parameter that is easy to obtain in almost all patients and does not require the presence of tricuspid valvar regurgitation or an anatomical cardiac defect. We sought to examine the correlation of PAAT with estimated SPAP by TTE and create an equation to estimate the SPAP using PAAT. We performed a retrospective review of TTEs performed on neonates and young infants (4 months of age or younger) at our institution between April 2017 and December 2018, along with the corresponding medical records. We included TTEs that provided estimation for SPAP and at least one PAAT measurement. During the study period, 138 TTEs performed on 82 patients met the inclusion criteria. Strong correlation was delineated between PAAT and SPAP estimated by the maximum velocity of tricuspid valve regurgitation Doppler, correlation coefficient (r) = - 0.83. Moderate correlation was detected between PAAT and SPAP estimated by PDA Doppler, r = - 0.66. Utilizing the following equation "SPAP = 82.6 - 0.58 × PAAT + RA mean pressure", PAAT can be used to estimate SPAP in neonates and young infants. PAAT can be used as an alternative to TR jet to assess SPAP when the latter is absent or insufficient. Further studies are needed to verify the accuracy of this equation.
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Affiliation(s)
- Bassel Mohammad Nijres
- Section of Pediatric Cardiology, Department of Pediatrics, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL, 60612, USA. .,Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, Legacy Tower (MC E 1920), Houston, TX, USA.
| | - John Bokowski
- grid.240684.c0000 0001 0705 3621Section of Pediatric Cardiology, Department of Pediatrics, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL 60612 USA
| | - Lamya Mubayed
- grid.240684.c0000 0001 0705 3621Section of Pediatric Cardiology, Department of Pediatrics, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL 60612 USA
| | - Sabih H. Jafri
- grid.240684.c0000 0001 0705 3621Section of Pediatric Cardiology, Department of Pediatrics, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL 60612 USA ,grid.413561.40000 0000 9881 9161Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH 45219 USA
| | - Alan T. Davis
- grid.430538.90000 0004 0450 5903Spectrum Health OME Scholarly Activity Support, 945 Ottawa Ave. NW, Grand Rapids, MI 49503 USA
| | - Ra-id Abdulla
- grid.240684.c0000 0001 0705 3621Section of Pediatric Cardiology, Department of Pediatrics, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL 60612 USA ,grid.413808.60000 0004 0388 2248Section of Pediatric Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL 60611 USA
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