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Emami Meybodi M, Bamarinejad A, Bamarinejad F, Abhari AP, Fakhrolmobasheri M, Khosravi Larijani F, Nasiri S, Shafie D. Prognostic Implication of Preprocedural Pulmonary Hypertension in Patients with Severe Aortic Valve Stenosis Undergoing Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-analysis. Cardiol Rev 2024:00045415-990000000-00200. [PMID: 38285645 DOI: 10.1097/crd.0000000000000583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
Pulmonary hypertension (PH) is a common comorbidity in patients with aortic stenosis (AS) who are candidates for transcatheter aortic valve implantation (TAVI). Herein, we sought to elucidate the prognostic value of preprocedural PH on the early and late mortality after TAVI. The Cochrane Library, Scopus, PubMed, Web of Science, Embase, and ProQuest were screened using a predefined search query. We considered odds ratios (ORs) as the measure of effect. Meta-regression analysis was applied to investigate the potential impact of baseline characteristics on the outcomes. Egger's and Begg's tests were used to assess the publication bias. Thirty-three studies comprising 34 datasets representing 68,435 patients were included in the analysis. Regardless of the definition and severity of PH, pooled data analysis indicated that preprocedural PH was associated with higher cardiac and overall 30-day [OR, 1.45 (1.15-1.82) and OR, 1.75 (1.42-2.17), respectively], and 1-year mortality [OR, 1.63 (1.35-1.96) and OR, 1.59 (1.38-1.82), respectively]. Meta-regression analysis demonstrated that older age, higher New York Heart Association function class, history of hypertension, diabetes, and lower left ventricular ejection fraction were predictors of higher mortality rate following TAVI. Moreover, we found that preprocedural PH is significantly associated with higher in-hospital mortality and 30-day acute kidney injury. Our results demonstrated that preprocedural PH is associated with higher early and late cardiac and overall mortality following TAVI; however, this finding is limited regarding the considerable inconsistency in the definition of PH and PH severity among studies.
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Affiliation(s)
- Mahmood Emami Meybodi
- From the Department of Cardiology, Afshar Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Atefe Bamarinejad
- Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fateme Bamarinejad
- Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amir Parsa Abhari
- Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Fakhrolmobasheri
- Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Shidrokh Nasiri
- Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Davood Shafie
- Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Albani S, Zilio F, Scicchitano P, Musella F, Ceriello L, Marini M, Gori M, Khoury G, D'Andrea A, Campana M, Iannopollo G, Fortuni F, Ciliberti G, Gabrielli D, Oliva F, Colivicchi F. Comprehensive diagnostic workup in patients with suspected heart failure and preserved ejection fraction. Hellenic J Cardiol 2024; 75:60-73. [PMID: 37743019 DOI: 10.1016/j.hjc.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/30/2023] [Accepted: 09/19/2023] [Indexed: 09/26/2023] Open
Abstract
Diagnosis of heart failure with preserved ejection fraction (HFpEF) can be challenging and it could require different tests, some of which are affected by limited availability. Nowadays, considering that new therapies are available for HFpEF and related conditions, a prompt and correct diagnosis is relevant. However, the diagnostic role of biomarker level, imaging tools, score-based algorithms and invasive evaluation, should be based on the strengths and weaknesses of each test. The aim of this review is to help the clinician in diagnosing HFpEF, overcoming the diagnostic uncertainty and disentangling among the different underlying causes, in order to properly treat this kind of patient.
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Affiliation(s)
- Stefano Albani
- Division of Cardiology, U. Parini Hospital, Aosta, Italy; Cardiovascular Institute Paris Sud, Massy, France
| | - Filippo Zilio
- Department of Cardiology, Santa Chiara Hospital, Trento, Italy.
| | | | - Francesca Musella
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Cardiology Department, Santa Maria Delle Grazie Hospital, Naples, Italy
| | - Laura Ceriello
- Cardiology Department, Ospedale Civile G. Mazzini, Teramo, Italy
| | - Marco Marini
- Cardiology and Coronary Care Unit, Marche University Hospital, Ancona, Italy
| | - Mauro Gori
- Division of Cardiology, Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Antonello D'Andrea
- Department of Cardiology, Umberto I Hospital, Nocera Inferiore, Salerno and Luigi Vanvitelli University, Italy
| | | | - Gianmarco Iannopollo
- Department of Cardiology, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
| | - Federico Fortuni
- Department of Cardiology, San Giovanni Battista Hospital, Foligno, Italy; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Giuseppe Ciliberti
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy
| | - Domenico Gabrielli
- Cardio-Toraco-Vascular Department, San Camillo-Forlanini Hospital, Rome, Italy; Heart Care Foundation, Florence, Italy
| | - Fabrizio Oliva
- Cardiologia 1, A. De Gasperis Cardicocenter, ASST Niguarda, Milan, Italy
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Unit, San Filippo Neri Hospital, Rome, Italy
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D'Alto M, Liccardo B, Di Maio M, Del Giudice C, Romeo E, Argiento P, Renon F, Vergara A, Di Vilio A, Caiazza E, Bossone E, Rea G, D'Andrea A, Gargani L, Golino P, Naeije R. Lung Ultrasound, Echocardiography, and Fluid Challenge for the Differential Diagnosis of Pulmonary Hypertension. J Am Soc Echocardiogr 2023; 36:1181-1189. [PMID: 37544385 DOI: 10.1016/j.echo.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVES The differential diagnosis between pulmonary arterial hypertension (PAH) and postcapillary pulmonary hypertension (PH) in heart failure with preserved ejection fraction (HFpEF) is sometimes difficult despite guidelines-derived standardized step-by-step diagnostic algorithms. We therefore explored the added value of lung ultrasound to a previously validated echocardiographic score of right heart catheterization measurements. METHODS Patients referred for PH underwent a right heart catheterization, echocardiography, and lung ultrasound before and after rapid infusion of 7 mL/kg of saline. A 7-point echocardiographic score based on cardiac chamber dimensions and estimates of filling pressures was implemented for the prediction of precapillary PH. Pulmonary congestion was identified by lung ultrasound B lines. RESULTS The study enrolled 70 patients with PAH and 77 patients with HFpEF. The PAH patients had a higher echocardiographic score (3.5 ± 1.8 vs 1.6 ± 1.5; P < .001). The HFpEF patients had more B lines both before (8.1 ± 4.2 vs 5.1 ± 3.0; P < .001) and after fluid challenge (14.6 ± 5.4 vs 7.6 ± 3.5; P < .001) and a more important increase (Δ) of B lines after fluid challenge (6.5 ± 2.9 vs 2.5 ± 1.6; P < .001). The sensitivity and specificity of the echocardiographic score (cutoff ≥2) alone for PAH were 0.91 and 0.49, respectively (area under the curve of 0.78). The best diagnostic improvement was observed with addition of ΔB lines + E/e' post-fluid challenge to the echocardiographic score, with a significant increase of the area under the curve (0.98) and (with a cutoff given by the presence of echo score ≥2, ΔB lines <4 and E/e' post < 11) a sensitivity of 0.90 (95% CI, 0.83; 0.97) and specificity of 0.84 (95% CI, 0.76; 0.93). CONCLUSIONS Lung ultrasound combined with echocardiography at baseline and after fluid challenge has an incremental value for the differential diagnosis between PAH and PH-HFpEF.
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Affiliation(s)
- Michele D'Alto
- Department of Cardiology, University of Campania "L. Vanvitelli"-Monaldi Hospital, Naples, Italy.
| | - Biagio Liccardo
- Department of Cardiology, University of Campania "L. Vanvitelli"-Monaldi Hospital, Naples, Italy
| | - Marco Di Maio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Carmen Del Giudice
- Department of Cardiology, University of Campania "L. Vanvitelli"-Monaldi Hospital, Naples, Italy
| | - Emanuele Romeo
- Department of Cardiology, University of Campania "L. Vanvitelli"-Monaldi Hospital, Naples, Italy
| | - Paola Argiento
- Department of Cardiology, University of Campania "L. Vanvitelli"-Monaldi Hospital, Naples, Italy
| | - Francesca Renon
- Department of Cardiology, University of Campania "L. Vanvitelli"-Monaldi Hospital, Naples, Italy
| | - Andrea Vergara
- Department of Cardiology, University of Campania "L. Vanvitelli"-Monaldi Hospital, Naples, Italy
| | - Alessandro Di Vilio
- Department of Cardiology, University of Campania "L. Vanvitelli"-Monaldi Hospital, Naples, Italy
| | - Eleonora Caiazza
- Department of Cardiology, University of Campania "L. Vanvitelli"-Monaldi Hospital, Naples, Italy
| | - Eduardo Bossone
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Gaetano Rea
- Radiology Unit, Monaldi Hospital, Naples, Italy
| | - Antonello D'Andrea
- Unit of Cardiology and Intensive Coronary Care, "Umberto I" Hospital, Nocera Inferiore, Italy
| | - Luna Gargani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Paolo Golino
- Department of Cardiology, University of Campania "L. Vanvitelli"-Monaldi Hospital, Naples, Italy
| | - Robert Naeije
- Department of Pathophysiology, Free University of Bruxelles, Bruxelles, Belgium
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Pistelli L, Piccione MC, Parisi F, Di Bella G, Micari A, Vetta G, Parlavecchio A, Molinero AE, Savio AL, Zito C. Rapid Onset Idiopathic Pulmonary Hypertension: A Case Report with a Review of Echocardiographic Parameters. J Cardiovasc Echogr 2023; 33:43-48. [PMID: 37426715 PMCID: PMC10328131 DOI: 10.4103/jcecho.jcecho_13_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/18/2023] [Indexed: 07/11/2023] Open
Abstract
Pulmonary hypertension (PHT) is an emerging issue. The prognosis in PHT is usually poor, independently from the etiology, with progressive right ventricle failure. Despite right Heart Catheterism is the gold standard for diagnosis of PHT, echocardiography provides important information about prognosis and is helpful in both follow-up and first evaluation of PHT patients, showing a good correlation with invasively measured parameters by right heart catheterization. However, it is important to understand the limits of this method, particularly in some settings, where transthoracic echocardiography has shown a lack of accuracy. In this case report we documented a case of rapid onset (3 months) idiopathic PHT and we provided a critical analysis of echocardiographic role in PHT.
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Affiliation(s)
- Lorenzo Pistelli
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Maurizio Cusmà Piccione
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Francesca Parisi
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Gianluca Di Bella
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Antonio Micari
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Giampaolo Vetta
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Antonio Parlavecchio
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Agustin Ezequiel Molinero
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Armando Lo Savio
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Concetta Zito
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
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Non-Invasive Estimation of Right Atrial Pressure Using a Semi-Automated Echocardiographic Tool for Inferior Vena Cava Edge-Tracking. J Clin Med 2022; 11:jcm11123257. [PMID: 35743330 PMCID: PMC9224556 DOI: 10.3390/jcm11123257] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/01/2022] [Accepted: 06/03/2022] [Indexed: 12/07/2022] Open
Abstract
The non-invasive estimation of right atrial pressure (RAP) would be a key advancement in several clinical scenarios, in which the knowledge of central venous filling pressure is vital for patients’ management. The echocardiographic estimation of RAP proposed by Guidelines, based on inferior vena cava (IVC) size and respirophasic collapsibility, is exposed to operator and patient dependent variability. We propose novel methods, based on semi-automated edge-tracking of IVC size and cardiac collapsibility (cardiac caval index—CCI), tested in a monocentric retrospective cohort of patients undergoing echocardiography and right heart catheterization (RHC) within 24 h in condition of clinical and therapeutic stability (170 patients, age 64 ± 14, male 45%, with pulmonary arterial hypertension, heart failure, valvular heart disease, dyspnea, or other pathologies). IVC size and CCI were integrated with other standard echocardiographic features, selected by backward feature selection and included in a linear model (LM) and a support vector machine (SVM), which were cross-validated. Three RAP classes (low < 5 mmHg, intermediate 5−10 mmHg and high > 10 mmHg) were generated and RHC values used as comparator. LM and SVM showed a higher accuracy than Guidelines (63%, 71%, and 61% for LM, SVM, and Guidelines, respectively), promoting the integration of IVC and echocardiographic features for an improved non-invasive estimation of RAP.
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