1
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Lepsy N, Dering MR, Fuge J, Meltendorf T, Hoeper MM, Heitland I, Kamp JC, Park DH, Richter MJ, Gall H, Ghofrani HA, Ellermeier D, Kulla HD, Olsson KM, Kahl KG. Childhood Maltreatment, Mental Well-Being, and Healthy Lifestyle in Patients With Chronic Thromboembolic Pulmonary Hypertension. Front Psychiatry 2022; 13:821468. [PMID: 35280158 PMCID: PMC8908105 DOI: 10.3389/fpsyt.2022.821468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/31/2022] [Indexed: 01/29/2023] Open
Abstract
Introduction Chronic thromboembolic pulmonary hypertension (CTEPH) is a potentially life-threatening condition associated with high morbidity and mortality. However, advances in medical, surgical and interventional treatment have markedly improved the outcome of patients with CTEPH. Additional factors potentially influencing quality of life (QoL) and outcome in CTEPH are yet to be defined. Child maltreatment is a major risk factor for unfavorable behavioral, mental as well as physical health outcomes and has been associated with decreased QoL. To date, no study assessed the impact of childhood trauma in patients with CTEPH. Methods Patients with CTEPH were invited to complete the Childhood Trauma Questionnaire (CTQ). Data were compared to prevalence data from the German population. Mental well-being was assessed using the Hospital Anxiety and Depression Scale (HADS) and quality of life was measured using the WHO Quality of Life Questionnaire (WHOQOL). Furthermore, lifestyle factors and physical health parameters were studied.Logistic regression analysis was used to investigate a possible impact of child maltreatment on markers of disease severity. Results One-hundred and seven patients with CTEPH completed the CTQ. These patients reported higher rates of emotional abuse and physical abuse and emotional neglect compared to the German population while rates of physical neglect and sexual abuse did not differ between patients and German population with prevalence of 20.6% for emotional abuse, 20% for physical abuse, 22% for emotional neglect, 46% for physical neglect, and 6% for sexual abuse in patients with CTEPH. Higher CTQ scores were associated with anxiety symptoms as well as negatively associated with QoL. No direct impact of childhood trauma on CTEPH severity was found. Conclusion We found a higher rate of child maltreatment in patients with CTEPH in comparison to the German population. Correlations suggest moderate associations between CTQ scores and mental health and QoL. Child maltreatment had no significant impact on disease severity. Further investigation on proper interventions to support affected patients is needed.
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Affiliation(s)
- Nicole Lepsy
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Madelaine-Rachel Dering
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Jan Fuge
- Department of Respiratory Medicine, Hannover Medical School, German Center for Lung Research (DZL/BREATH), Hannover, Germany
| | - Tanja Meltendorf
- Department of Respiratory Medicine, Hannover Medical School, German Center for Lung Research (DZL/BREATH), Hannover, Germany
| | - Marius M. Hoeper
- Department of Respiratory Medicine, Hannover Medical School, German Center for Lung Research (DZL/BREATH), Hannover, Germany
| | - Ivo Heitland
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Jan C. Kamp
- Department of Respiratory Medicine, Hannover Medical School, German Center for Lung Research (DZL/BREATH), Hannover, Germany
| | - Da-Hee Park
- Department of Respiratory Medicine, Hannover Medical School, German Center for Lung Research (DZL/BREATH), Hannover, Germany
| | - Manuel J. Richter
- Department of Internal Medicine, German Center for Lung Research (DZL), Justus Liebig University Giessen, Universities of Gießen and Marburg Lung Center, Giessen, Germany
| | - Henning Gall
- Department of Internal Medicine, German Center for Lung Research (DZL), Justus Liebig University Giessen, Universities of Gießen and Marburg Lung Center, Giessen, Germany
| | - Hossein A. Ghofrani
- Department of Internal Medicine, German Center for Lung Research (DZL), Justus Liebig University Giessen, Universities of Gießen and Marburg Lung Center, Giessen, Germany
- Department of Pneumology, Kerckhoff Heart, Rheuma and Thoracic Center, German Center for Lung Research, Universities of Giessen and Marburg Lung Center, Bad Nauheim, Germany
| | | | | | - Karen M. Olsson
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
- Department of Respiratory Medicine, Hannover Medical School, German Center for Lung Research (DZL/BREATH), Hannover, Germany
| | - Kai G. Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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Bai X, Ruan L. A case report of primary pulmonary artery intimal sarcoma. Eur J Med Res 2021; 26:89. [PMID: 34372932 PMCID: PMC8351160 DOI: 10.1186/s40001-021-00568-w] [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: 06/29/2021] [Accepted: 07/09/2021] [Indexed: 11/30/2022] Open
Abstract
Background Pulmonary artery intimal sarcoma (PAS) is a very rare disease, its prevalence is about 0.001–0.003%. PAS is often misdiagnosed as acute or chronic pulmonary thromboembolism due to its clinical presentation and radiological findings. Thus, early diagnosis is very crucial and may improve patient outcome. Case presentation Here, we report a case in a Chinese male where the symptom presentation was episodes of shortness of breath. Transthoracic echocardiography showed a solid mass in the pulmonary valve orifice, which was demonstrated to be a pulmonary artery intimal sarcoma diagnosed by histopathology. In this case, the initial differential diagnosis included pulmonary embolism. Because the initial symptom of primary pulmonary artery sarcoma is extremely similar to the pulmonary embolism, half of them may be misdiagnosed as pulmonary embolism. Imaging studies are very helpful. Ultrasound and CT are the best due to their resolution and ability to assess the relationship of the mass with the surrounding structures. The final diagnosis is mostly made after surgical excision and this is the most effective treatment. At the same time, radiotherapy and chemotherapy after surgery is also an adjuvant treatment. Conclusion We report a very rare case of pulmonary artery intimal sarcoma. Due to late diagnosis and delayed treatment in this case, the patient displayed a poor prognostic. Early diagnosis and right treatment can improve the prognosis of PAS and optimize overall health.
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Affiliation(s)
- Xiaofang Bai
- The Department of Ultrasound Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, 710061, Shaanxi, China
| | - Litao Ruan
- The Department of Ultrasound Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, 710061, Shaanxi, China.
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3
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Chronisch thromboembolische pulmonale Hypertonie. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2020. [DOI: 10.1007/s00398-019-00356-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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4
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Kriechbaum SD, Wiedenroth CB, Hesse ML, Ajnwojner R, Keller T, Sebastian Wolter J, Haas M, Roller FC, Breithecker A, Rieth AJ, Guth S, Rolf A, Hamm CW, Mayer E, Liebetrau C. Development of renal function during staged balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary hypertension. Scandinavian Journal of Clinical and Laboratory Investigation 2019; 79:268-275. [PMID: 30987470 DOI: 10.1080/00365513.2019.1601765] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Balloon pulmonary angioplasty (BPA), for chronic thromboembolic pulmonary hypertension, improves pulmonary and systemic hemodynamics. The kidney might benefit from this effect. However, staged BPA therapy comes along with repetitive administration of contrast agent. This study examined the overall effect of BPA therapy on renal function. This study included consecutive patients who underwent BPA treatment and completed a 6-month follow-up between March 2014 and March 2017. Biomarker-based evaluation of renal function was performed at baseline, consecutively prior to and after each BPA and at 6-month follow-up. The 51 patients underwent an average of 5 (±2) BPA sessions. In this course, patients received 133 (±48; 21-300) mL of contrast agent per session and 691 (±24; 240-1410) mL during the whole sequence. Acute kidney injury occurred after 6 (2.3%) procedures. The creatinine [80.1 (IQR 67.8-96.8) µmol/L vs. 77.4 (IQR 66.9-91.5) µmol/L, p = .02] and urea level [13.7 (IQR10.7-16.6) mmol/L vs. 12.5 (IQR 10.0-15.5) mmol/L, p = .02] decreased from baseline to the 6-month follow-up. The estimated glomerular filtration rate (eGFR) [79 (IQR 59-94) mL/min/m2 vs. 79.6 (IQR 67.1-95.0) mL/min/m2, p = .11] did not change. The Chronic kidney disease (CKD) stages at baseline were: G1:15; G2:23; G3a:10; G3b:2; G4:1; G5:0. Among patients with a CKD-stage ≥2, analysis revealed an increase of eGFR, decrease of creatinine and urea from baseline to 6-month follow-up. Among those patients, the baseline-CKD-stage improved in 14 (41.2%) patients. BPA therapy improves pulmonary and systemic hemodynamics, with positive effects on renal function. Repetitive administration of contrast agent seems not to be harmful regarding renal function.
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Affiliation(s)
- Steffen D Kriechbaum
- a Department of Cardiology , Kerckhoff Heart and Thorax Center , Bad Nauheim , Germany.,b German Center for Cardiovascular Research (DZHK), Partner Site , RhineMain Frankfurt am Main , Germany
| | - Christoph B Wiedenroth
- c Department of Thoracic Surgery , Kerckhoff Heart and Thorax Center , Bad Nauheim , Germany
| | - Maura L Hesse
- a Department of Cardiology , Kerckhoff Heart and Thorax Center , Bad Nauheim , Germany.,b German Center for Cardiovascular Research (DZHK), Partner Site , RhineMain Frankfurt am Main , Germany
| | - Ruth Ajnwojner
- a Department of Cardiology , Kerckhoff Heart and Thorax Center , Bad Nauheim , Germany.,b German Center for Cardiovascular Research (DZHK), Partner Site , RhineMain Frankfurt am Main , Germany
| | | | - Jan Sebastian Wolter
- a Department of Cardiology , Kerckhoff Heart and Thorax Center , Bad Nauheim , Germany.,b German Center for Cardiovascular Research (DZHK), Partner Site , RhineMain Frankfurt am Main , Germany
| | - Moritz Haas
- a Department of Cardiology , Kerckhoff Heart and Thorax Center , Bad Nauheim , Germany.,b German Center for Cardiovascular Research (DZHK), Partner Site , RhineMain Frankfurt am Main , Germany
| | - Fritz C Roller
- d Department of Radiology , Justus Liebig University Giessen , Giessen , Germany
| | - Andreas Breithecker
- e Department of Radiology , Gesundheitszentrum Wetterau , Bad Nauheim , Germany
| | - Andreas J Rieth
- a Department of Cardiology , Kerckhoff Heart and Thorax Center , Bad Nauheim , Germany.,b German Center for Cardiovascular Research (DZHK), Partner Site , RhineMain Frankfurt am Main , Germany
| | - Stefan Guth
- c Department of Thoracic Surgery , Kerckhoff Heart and Thorax Center , Bad Nauheim , Germany
| | - Andreas Rolf
- a Department of Cardiology , Kerckhoff Heart and Thorax Center , Bad Nauheim , Germany.,f Medical Clinic I Division of Cardiology , Justus Liebig University Giessen , Giessen , Germany
| | - Christian W Hamm
- a Department of Cardiology , Kerckhoff Heart and Thorax Center , Bad Nauheim , Germany.,f Medical Clinic I Division of Cardiology , Justus Liebig University Giessen , Giessen , Germany
| | - Eckhard Mayer
- c Department of Thoracic Surgery , Kerckhoff Heart and Thorax Center , Bad Nauheim , Germany
| | - Christoph Liebetrau
- a Department of Cardiology , Kerckhoff Heart and Thorax Center , Bad Nauheim , Germany.,f Medical Clinic I Division of Cardiology , Justus Liebig University Giessen , Giessen , Germany
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5
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Berlier C, Schwarz EI, Saxer S, Lichtblau M, Ulrich S. Real-Life Experience with Selexipag as an Add-On Therapy to Oral Combination Therapy in Patients with Pulmonary Arterial or Distal Chronic Thromboembolic Pulmonary Hypertension: A Retrospective Analysis. Lung 2019; 197:353-360. [PMID: 30963265 DOI: 10.1007/s00408-019-00222-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 03/25/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Patients with pulmonary arterial hypertension (PAH) and distal chronic thromboembolic pulmonary hypertension (CTEPH) who still reveal risk factors of worse prognosis on double combination therapy may benefit from add-on therapy with the novel oral selective prostacyclin receptor agonist selexipag. METHODS We reviewed all patients with PAH/distal CTEPH in the Zurich cohort who received selexipag as add-on to oral combination therapy and retrieved New York Heart Association (NYHA) functional class, 6-min walk distance (6MWD), NT-pro-BNP, quality of life questionnaires (CAMPHOR and EuroQoL), tricuspid pressure gradient (TPG) by echocardiography and cardiopulmonary exercise test parameters (power output and oxygen uptake). RESULTS Twenty-three patients with PAH/CTEPH (20/3), 14 females, median (quartiles) age 56 (46; 66) years received an oral triple therapy containing selexipag at a median dose of 2000 (1600; 3100) mcg during 221 (113; 359) days. The following parameters were stabilized from baseline to last FU: 6MWD (440 (420; 490) to 464 (420; 526) m), NYHA class (three to two), NT-pro-BNP (326 (167; 1725) to 568 (135; 1856) ng/l), TPG, power output, and oxygen uptake. Quality of life reflected by the CAMPHOR and EuroQoL improved. CONCLUSIONS Early initiation of triple oral combination therapy including selexipag in PAH/CTEPH with intermediate risk factor profile may help to stabilize functional class, exercise performance, and pulmonary hemodynamics in a real-life setting and potentially improves quality of life. Whether these beneficial effects can be truly attributed to the addition of selexipag should be addressed in future randomized controlled trials.
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Affiliation(s)
- Charlotte Berlier
- Clinic of Pulmonology, University Hospital of Zurich, Zurich, Switzerland
| | - Esther I Schwarz
- Clinic of Pulmonology, University Hospital of Zurich, Zurich, Switzerland
| | - Stéphanie Saxer
- Clinic of Pulmonology, University Hospital of Zurich, Zurich, Switzerland
| | - Mona Lichtblau
- Clinic of Pulmonology, University Hospital of Zurich, Zurich, Switzerland
| | - Silvia Ulrich
- Clinic of Pulmonology, University Hospital of Zurich, Zurich, Switzerland. .,Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.
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6
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Abstract
The vast majority of tricuspid valve regurgitations are of low degree without prognostic relevance in healthy individuals; however, morbidity and mortality increase with the degree of regurgitation, which can be secondary to either primary (structural) or secondary (functional) alterations of the valve. Due to the frequent lack of symptoms, echocardiographic examinations should be annually performed in patients with higher degree (at least moderate) tricuspid valve regurgitation, in particular in the presence of risk factors. Individual therapeutic management strategies should consider the etiology of the tricuspid valve regurgitation, the degree of regurgitation, the valve pathology and the risk-to-benefit ratio of the envisaged therapeutic procedure. Medicinal treatment options for tricuspid valve regurgitation are limited and generalized recommendations cannot be provided due to the lack of conclusive clinical trials. Symptomatic therapeutic measures encompass especially (loop) diuretics for the reduction of preload and afterload of the right ventricle. Pharmaceutical reduction of the heart rate should be avoided in patients with right heart insufficiency. While symptomatic therapeutic measures are often associated with only moderate effects, the most effective therapy of tricuspid valve regurgitation consists in the treatment of underlying illnesses, in most cases pulmonary hypertension due to pulmonary arterial hypertension (PAH), left heart disease or acute pulmonary embolism. Based on a number of published clinical studies and licensing of new drugs, treatment options for patients with PAH and heart failure with reduced ejection fraction (HFrEF) have substantially improved during the past years allowing for a differentiated, individualized management.
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Affiliation(s)
- M Lankeit
- Medizinische Klinik mit Schwerpunkt Kardiologie, Campus Virchow-Klinikum (CVK), Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland. .,Centrum für Thrombose und Hämostase (CTH), Universitätsmedizin Mainz, Mainz, Deutschland. .,Standort Berlin, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Deutschland.
| | - K Keller
- Centrum für Thrombose und Hämostase (CTH), Universitätsmedizin Mainz, Mainz, Deutschland
| | - C Tschöpe
- Medizinische Klinik mit Schwerpunkt Kardiologie, Campus Virchow-Klinikum (CVK), Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.,Standort Berlin, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Deutschland.,Berlin-Brandenburger Centrum für Regenerative Therapien (BCRT), Berlin, Deutschland
| | - B Pieske
- Medizinische Klinik mit Schwerpunkt Kardiologie, Campus Virchow-Klinikum (CVK), Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.,Standort Berlin, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Deutschland.,Deutsches Herzzentrum Berlin (DHZB), Berlin, Deutschland
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7
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Kriechbaum SD, Wiedenroth CB, Keller T, Wolter JS, Ajnwojner R, Peters K, Haas MA, Roller FC, Breithecker A, Rieth AJ, Guth S, Rolf A, Bandorski D, Hamm CW, Mayer E, Liebetrau C. Dynamics of high-sensitivity cardiac troponin T during therapy with balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension. PLoS One 2018; 13:e0204683. [PMID: 30252896 PMCID: PMC6155553 DOI: 10.1371/journal.pone.0204683] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 09/12/2018] [Indexed: 01/05/2023] Open
Abstract
Aims Balloon pulmonary angioplasty (BPA) is an interventional treatment modality for inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Therapy monitoring, based on non-invasive biomarkers, is a clinical challenge. This post-hoc study aimed to assess dynamics of high-sensitivity cardiac troponin T (hs-cTnT) as a marker for myocardial damage and its relation to N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels as a marker for cardiac wall stress. Methods and results This study included 51 consecutive patients who underwent BPA treatment and completed a 6-month follow-up (6-MFU) between 3/2014 and 3/2017. Biomarker measurement was performed consecutively prior to each BPA and at 6-MFU. In total, the 51 patients underwent an average of 5 BPA procedures. The 6-month survival rate was 96.1%. The baseline (BL) meanPAP (39.5±12.1mmHg) and PVR (515.8±219.2dyn×sec×cm-5) decreased significantly within the 6-MFU (meanPAP: 32.6±12.6mmHg, P<0.001; PVR: 396.9±182.6dyn×sec×cm-5, P<0.001). At BL, the median hs-cTnT level was 11 (IQR 6–16) ng/L and the median NT-proBNP level was 820 (IQR 153–1872) ng/L. The levels of both biomarkers decreased steadily after every BPA, showing the first significant difference after the first procedure. Within the 6-MFU, hs-cTnT levels (7 [IQR 5–12] ng/L; P<0.001) and NT-proBNP levels (159 [IQR 84–464] ng/l; P<0.001) continued to decrease. The hs-cTnT levels correlated with the PVR (rrs = 0.42; p = 0.005), the meanPAP (rrs = 0.32; p = 0.029) and the NT-proBNP (rrs = 0.51; p<0.001) levels at BL. Conclusion Non-invasive biomarker measurement provides valuable evidence for the decreasing impairment of myocardial function and structure during BPA therapy. Changes in hs-cTNT levels are suggestive for a reduction in ongoing myocardial damage.
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Affiliation(s)
- Steffen D. Kriechbaum
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Frankfurt am Main, Germany
- * E-mail:
| | | | - Till Keller
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Frankfurt am Main, Germany
| | - Jan Sebastian Wolter
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Frankfurt am Main, Germany
| | - Ruth Ajnwojner
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Frankfurt am Main, Germany
| | - Karina Peters
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Frankfurt am Main, Germany
| | - Moritz A. Haas
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Frankfurt am Main, Germany
| | - Fritz C. Roller
- Justus Liebig University Giessen, Department of Radiology, Giessen, Germany
| | | | - Andreas J. Rieth
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Frankfurt am Main, Germany
| | - Stefan Guth
- Kerckhoff Heart and Thorax Center, Department of Thoracic Surgery, Bad Nauheim, Germany
| | - Andreas Rolf
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Frankfurt am Main, Germany
- Justus Liebig University Giessen, Medical Clinic I, Division of Cardiology, Giessen, Germany
| | - Dirk Bandorski
- Justus Liebig University of Giessen, Department of Internal Medicine, Division of Pulmonology, Giessen, Germany
| | - Christian W. Hamm
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Frankfurt am Main, Germany
- Justus Liebig University Giessen, Medical Clinic I, Division of Cardiology, Giessen, Germany
| | - Eckhard Mayer
- Kerckhoff Heart and Thorax Center, Department of Thoracic Surgery, Bad Nauheim, Germany
| | - Christoph Liebetrau
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Frankfurt am Main, Germany
- Justus Liebig University Giessen, Medical Clinic I, Division of Cardiology, Giessen, Germany
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8
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[Heart or lung? : Diagnostics and management of unclear exertional dyspnea]. Herz 2018; 43:567-582. [PMID: 30027500 DOI: 10.1007/s00059-018-4730-2] [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: 10/28/2022]
Abstract
Exertional dyspnea is a nonspecific symptom with a variety of underlying causes. It can be challenging to differentiate a beginning cardiac disease from a pulmonary disease or from deconditioning alone. In the presence of obesity, the overall assessment is even more difficult. Rare diseases, such as pulmonary hypertension with dyspnea on exertion as the cardinal symptom are usually diagnosed late in the course of disease. The starting point of a successful evaluation is a thorough patient history. The combination of symptoms, clinical signs and findings leads to a preferred differential diagnosis. Readily available basic findings, such as physical examination, electrocardiogram (ECG), spirometry and laboratory tests help with the diagnosis. For unexplained causes, extended diagnostics such as echocardiography, blood gas analysis and finally special examinations are available. Cardiopulmonary exercise testing (CPET) and exercise echocardiography as well as right heart catheterization at rest and during exercise in the hands of experienced physicians allow an exact differentiation.
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9
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Held M, Joa F, Wilkens H. [Pulmonary embolism]. MMW Fortschr Med 2018; 160:48-56. [PMID: 29582315 DOI: 10.1007/s15006-018-0010-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Matthias Held
- Klinikum Würzburg Mitte, Standort Missioklinik, Innere Medizin, Pneumologie und Beatmungsmedizin, Onkologie und Umweltmedizin, Zentrum für pulmonale Hypertonie und Lungengefäßkrankheiten, Salvatorstraße 7, D-97074, Würzburg, Deutschland.
| | - Franziska Joa
- Zentrum für pulmonale Hypertonie und Lungengefäßkrankheiten, Würzburg, Deutschland
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10
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Wiedenroth CB, Olsson KM, Guth S, Breithecker A, Haas M, Kamp JC, Fuge J, Hinrichs JB, Roller F, Hamm CW, Mayer E, Ghofrani HA, Meyer BC, Liebetrau C. Balloon pulmonary angioplasty for inoperable patients with chronic thromboembolic disease. Pulm Circ 2017; 8:2045893217753122. [PMID: 29283044 PMCID: PMC5798689 DOI: 10.1177/2045893217753122] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Symptomatic patients with residual pulmonary perfusion defects or vascular lesions but no pulmonary hypertension at rest are diagnosed with chronic thromboembolic disease (CTED). Balloon pulmonary angioplasty (BPA) is an emerging treatment for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH), but data regarding the safety and efficacy of BPA in patients with CTED are lacking. We report a prospective series of ten consecutive patients with CTED who underwent 35 BPA interventions (median of four per patient) at two German institutions. All patients underwent a comprehensive diagnostic workup at baseline and 24 weeks after their last intervention. BPA was safe, with one pulmonary vascular injury and subsequent self-limiting pulmonary bleeding as the only complication (2.9% of the interventions, 10% of the patients). After the procedures, World Health Organization functional class, 6-min walking distance, pulmonary vascular resistance, and pulmonary arterial compliance improved, and NT-proBNP concentrations declined in 9/10 patients. BPA may be a new treatment option for carefully selected patients with CTED. A larger, prospective, international registry is required to confirm these results.
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Affiliation(s)
| | - Karen M Olsson
- 2 214619 Department of Respiratory Medicine and German Centre for Lung Research (DZL/BREATH), Hannover Medical School, Hannover, Germany
| | - Stefan Guth
- 1 14990 Kerckhoff Clinic, Department of Thoracic Surgery, Bad Nauheim, Germany
| | - Andreas Breithecker
- 3 Gesundheitszentrum Wetterau, Department of Radiology, Bad Nauheim, Germany
| | - Moritz Haas
- 4 Kerckhoff Clinic, Department of Cardiology, Bad Nauheim, Germany and German Center for Cardiovascular Research (DZHK), partner site RheinMain, Frankfurt am Main, Germany
| | - Jan-Christopher Kamp
- 2 214619 Department of Respiratory Medicine and German Centre for Lung Research (DZL/BREATH), Hannover Medical School, Hannover, Germany
| | - Jan Fuge
- 2 214619 Department of Respiratory Medicine and German Centre for Lung Research (DZL/BREATH), Hannover Medical School, Hannover, Germany
| | - Jan B Hinrichs
- 5 Department of Diagnostic and Interventional Radiology and German Centre for Lung Research (DZL/BREATH), Hannover Medical School, Hannover, Germany
| | - Fritz Roller
- 6 University of Giessen, Department of Radiology, Giessen, Germany
| | - Christian W Hamm
- 4 Kerckhoff Clinic, Department of Cardiology, Bad Nauheim, Germany and German Center for Cardiovascular Research (DZHK), partner site RheinMain, Frankfurt am Main, Germany.,7 University of Giessen, Department of Internal Medicine I, Division of Cardiology, Giessen, Germany
| | - Eckhard Mayer
- 1 14990 Kerckhoff Clinic, Department of Thoracic Surgery, Bad Nauheim, Germany
| | - Hossein A Ghofrani
- 8 Kerckhoff Clinic, Department of Pulmonology, Bad Nauheim, Germany.,9 Universities of Giessen and Marburg Lung Center (UGML), Giessen, Germany.,10 Department of Medicine, Imperial College London, London, UK
| | - Bernhard C Meyer
- 5 Department of Diagnostic and Interventional Radiology and German Centre for Lung Research (DZL/BREATH), Hannover Medical School, Hannover, Germany
| | - Christoph Liebetrau
- 4 Kerckhoff Clinic, Department of Cardiology, Bad Nauheim, Germany and German Center for Cardiovascular Research (DZHK), partner site RheinMain, Frankfurt am Main, Germany.,7 University of Giessen, Department of Internal Medicine I, Division of Cardiology, Giessen, Germany
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