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Ferrero P, Krishnathasan K, Constantine A, Chessa M, Dimopoulos K. Pulmonary arterial hypertension in congenital heart disease. Heart 2024; 110:1145-1152. [PMID: 37963728 DOI: 10.1136/heartjnl-2023-322890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Affiliation(s)
- Paolo Ferrero
- Adult Congenital Heart Disease Unit, Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, Milan, Italy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart, Rome, Italy
| | - Kaushiga Krishnathasan
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Andrew Constantine
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Massimo Chessa
- Adult Congenital Heart Disease Unit, Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, Milan, Italy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart, Rome, Italy
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
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Valdeolmillos E, Foray C, Albenque G, Batteux C, Petit J, Lecerf F, Jaïs X, Sitbon O, Montani D, Savale L, Humbert M, Hascoët S. Percutaneous atrial septal defect closure in patients with pulmonary arterial hypertension. Eur Respir J 2024; 63:2301649. [PMID: 38754963 DOI: 10.1183/13993003.01649-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 03/04/2024] [Indexed: 05/18/2024]
Affiliation(s)
- Estibaliz Valdeolmillos
- Department of Congenital Heart Diseases, Centre de Référence Malformations, Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe, Hospitalier Paris-Saint Joseph, Paris, France
- Université Paris-Saclay, Faculty of Medicine, Le Kremin-Bicêtre, France
- Inserm UMR-S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Claire Foray
- Department of Congenital Heart Diseases, Centre de Référence Malformations, Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe, Hospitalier Paris-Saint Joseph, Paris, France
| | - Gregoire Albenque
- Department of Congenital Heart Diseases, Centre de Référence Malformations, Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe, Hospitalier Paris-Saint Joseph, Paris, France
- Université Paris-Saclay, Faculty of Medicine, Le Kremin-Bicêtre, France
- Inserm UMR-S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Clément Batteux
- Department of Congenital Heart Diseases, Centre de Référence Malformations, Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe, Hospitalier Paris-Saint Joseph, Paris, France
- Université Paris-Saclay, Faculty of Medicine, Le Kremin-Bicêtre, France
- Inserm UMR-S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Jerome Petit
- Department of Congenital Heart Diseases, Centre de Référence Malformations, Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe, Hospitalier Paris-Saint Joseph, Paris, France
| | - Florence Lecerf
- Research and Innovation Department, Marie Lannelongue Hospital, Paris Saclay University, Le Plessis-Robinson, France
| | - Xavier Jaïs
- Université Paris-Saclay, Faculty of Medicine, Le Kremin-Bicêtre, France
- Inserm UMR-S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
- Department of Respiratory and Intensive Care Medicine, Reference Centre for Pulmonary Hypertension, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Olivier Sitbon
- Université Paris-Saclay, Faculty of Medicine, Le Kremin-Bicêtre, France
- Inserm UMR-S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
- Department of Respiratory and Intensive Care Medicine, Reference Centre for Pulmonary Hypertension, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - David Montani
- Université Paris-Saclay, Faculty of Medicine, Le Kremin-Bicêtre, France
- Inserm UMR-S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
- Department of Respiratory and Intensive Care Medicine, Reference Centre for Pulmonary Hypertension, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Laurent Savale
- Université Paris-Saclay, Faculty of Medicine, Le Kremin-Bicêtre, France
- Inserm UMR-S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
- Department of Respiratory and Intensive Care Medicine, Reference Centre for Pulmonary Hypertension, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Marc Humbert
- Université Paris-Saclay, Faculty of Medicine, Le Kremin-Bicêtre, France
- Inserm UMR-S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
- Department of Respiratory and Intensive Care Medicine, Reference Centre for Pulmonary Hypertension, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Sébastien Hascoët
- Department of Congenital Heart Diseases, Centre de Référence Malformations, Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe, Hospitalier Paris-Saint Joseph, Paris, France
- Université Paris-Saclay, Faculty of Medicine, Le Kremin-Bicêtre, France
- Inserm UMR-S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
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Akagi S, Kasahara S, Akagi T, Ejiri K, Mitsuhashi T, Nakagawa K, Nakamura K, Ito H. Feasibility of Treat and Repair Strategy in Congenital Heart Defects With Pulmonary Arterial Hypertension. JACC. ADVANCES 2024; 3:100887. [PMID: 38939653 PMCID: PMC11198275 DOI: 10.1016/j.jacadv.2024.100887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 11/27/2023] [Accepted: 12/03/2023] [Indexed: 06/29/2024]
Abstract
Background A treatment strategy for congenital heart defects with moderate to severe pulmonary arterial hypertension (PAH) has not been established. Objectives The purpose of this study was to identify patients in whom a treat and repair strategy was considered and to examine pretreatment variables associated with successful defect repair. Methods Patients with atrial or ventricular septal defect and PAH (pulmonary vascular resistance [PVR] ≥ 5 Wood units) eligible for the treat and repair strategy were included. Hemodynamics among pretreatment, pre-repair, and post-defect repair were compared. Clinical outcomes in patients with or without defect repair were also compared. Clinical outcomes included all-cause death, hospitalization for worsening pulmonary hypertension, and lung transplantation. Results Among 25 eligible for the treat and repair strategy, 20 underwent successful repair (repaired group) and 5 did not have a repair (unrepaired group). In the repaired group, PVR significantly decreased from 9.6 ± 2.6 WU at pretreatment to 5.0 ± 3.4 pre-repair (ß coefficient -4.6 [95% CI: -5.9 to -3.3]). The pulmonary to systemic blood flow ratio (Qp/Qs) increased from 1.5 ± 0.6 at pretreatment to 2.4 ± 1.3 pre-repair (ß coefficient 0.9 [95% CI: 0.4-1.38]). In the unrepaired group, pretreatment PVR decreased with treatment; however, PVR remained elevated. Qp/Qs did not change between pretreatment and post-treatment. The repaired group had a better prognosis than the unrepaired group (HR 0.092 [95% CI: 0.009-0.905]). Pretreatment mean pulmonary artery pressure, PVR, Qp/Qs, and arterial oxygen saturations were associated with undergoing defect repair. Conclusions In this small cohort, a treat and repair strategy was successfully used in a significant proportion of the patients with congenital heart defects with moderate to severe PAH.
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Affiliation(s)
- Satoshi Akagi
- Department of Cardiovascular Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Teiji Akagi
- Cardiac Intensive Care Unit, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Kentaro Ejiri
- Department of Cardiovascular Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Toshiharu Mitsuhashi
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Zhang F, Lin D, Jin Q, Fan J, Chen D, Guan L, Pan W, Zhou D. Noninvasive Monitoring of Severe Pulmonary Artery Hypertension in Atrial Septal Defect Patients: Role of Serum Bilirubin Combined with Uric Acid. Rev Cardiovasc Med 2024; 25:50. [PMID: 39077349 PMCID: PMC11263178 DOI: 10.31083/j.rcm2502050] [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: 04/19/2023] [Revised: 08/28/2023] [Accepted: 09/27/2023] [Indexed: 07/31/2024] Open
Abstract
Background Atrial septal defect (ASD) patients commonly experience severe pulmonary arterial hypertension (SPAH), which is frequently associated with a poor prognosis. While serum bilirubin levels, indicative of liver function, are known predictors of right heart failure (RHF), their potential to differentiate SPAH in ASD patients is yet to be ascertained. The purpose of this study was to discover the potential correlations between serum bilirubin levels and ASD patients with SPAH. Methods In this cross-sectional study, 102 ASD patients admitted from December 2019 to November 2020 were enrolled and divided into two cohorts: those with SPAH and those without. Blood tests were conducted to measure serum direct bilirubin (DBIL), total bilirubin (TBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST), uric acid (UA) and N-terminal pro B-type natriuretic peptide (NT-proBNP). Additionally, all participants underwent transthoracic echocardiography, and invasive hemodynamic data were gathered through right heart catheterization. Results ASD patients with SPAH exhibited significantly elevated serum DBIL (5.2 ± 3.0 vs. 2.4 ± 1.5 µmol/L, p < 0.001) and TBIL (24.6 ± 20.7 vs. 10.1 ± 4.8 µmol/L, p < 0.001) levels in comparison to those without SPAH. However, ALT and AST levels remained comparable between the cohorts. Additionally, the SPAH cohort displayed higher serum UA (403.5 ± 131.6 vs. 317.8 ± 67.9 µmol/L, p < 0.001) and NT-proBNP levels. Serum DBIL levels, when analyzed independently of other variables, correlated with an increased risk of mean pulmonary arterial pressure (mPAP) in ASD patients ( β = 1.620, p = 0.010). A DBIL concentration of 2.15 mg/dL effectively differentiated ASD patients with SPAH from those without, with a sensitivity of 92.9% and a specificity of 51.4% (area under the curve [AUC]: 0.794, 95% confidence interval [CI]: 0.701-0.886, p < 0.001). Notably, the combination of DBIL and UA had a higher sensitivity of 92.9% and specificity of 71.6% (AUC: 0.874, 95% CI: 0.799-0.949, p < 0.001). Conclusions Elevated serum DBIL and TBIL levels in ASD patients with SPAH were correlated with poor cardiac function and heightened pulmonary artery pressure. The combination of DBIL and UA has emerged as a strong noninvasive predictor for SPAH in ASD patients, presenting a potentially novel therapeutic biomarker.
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Affiliation(s)
- Feng Zhang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, 200032 Shanghai, China
- Department of Cardiology, Jinshan Hospital, Fudan University, 201508 Shanghai, China
| | - Dawei Lin
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, 200032 Shanghai, China
| | - Qi Jin
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, 200032 Shanghai, China
| | - Jianing Fan
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, 200032 Shanghai, China
| | - Dandan Chen
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, 200032 Shanghai, China
| | - Lihua Guan
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, 200032 Shanghai, China
| | - Wenzhi Pan
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, 200032 Shanghai, China
| | - Daxin Zhou
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, 200032 Shanghai, China
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Cool CJ, Kamarullah W, Pranata R, Putra ICS, Khalid AF, Akbar MR, Setiabudiawan B, Rahayuningsih SE. A Meta-Analysis of Atrial Septal Defect Closure in Patients With Severe Pulmonary Hypertension: Is There a Room for Poking Holes Amid Debate? Curr Probl Cardiol 2024; 49:102121. [PMID: 37802163 DOI: 10.1016/j.cpcardiol.2023.102121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 09/30/2023] [Indexed: 10/08/2023]
Abstract
Severe pulmonary arterial hypertension (PAH) associated with atrial septal defect (ASD) poses a challenge to a closure of ASD, particularly severe PAH that persists even after pharmacological therapeutic strategy. Our study was aimed to evaluate this matter. A systematic literature search from several databases was conducted up until August 1st, 2023. A meta-analysis was undertaken on studies that reported hemodynamic measurements in ASD patients with severe PAH before and after closure. The primary objectives were the extent of improvement in all hemodynamic parameters following closure, and the secondary outcomes were major adverse cardiac events (MACEs) during follow-up. Our study comprised 10 studies with a total of 207 participants. Patients were divided into treat-and-repair and straight-to-repair groups based on the therapeutic strategy. Meta-analysis of all studies demonstrated significant improvement in mean pulmonary arterial pressure (mPAP), pulmonary vascular resistance (PVR), pulmonary vascular resistance index (PVRI), 6-minutes walking distance (6MWD), and lower prevalence of World Health Organization functional classes (WHO fc), particularly in the treat-and-repair strategy subgroup. Additionally, merely 4 of the 156 individuals died from cardiac causes, and only 1 required rehospitalization, indicating a low likelihood of MACEs arising. Our new findings support the notion that effective shunt closure can improve various hemodynamic parameters in carefully chosen patients with noncorrectable ASD-PAH. Further large and prospective observational studies are still warranted to validate these findings.
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Affiliation(s)
- Charlotte Johanna Cool
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia
| | | | - Raymond Pranata
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia
| | - Iwan Cahyo Santosa Putra
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia
| | - Achmad Fitrah Khalid
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia
| | - Mohammad Rizki Akbar
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia
| | - Budi Setiabudiawan
- Department of Child Health, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia
| | - Sri Endah Rahayuningsih
- Department of Child Health, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia.
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Mahmoud AK, Abbas MT, Kamel MA, Farina JM, Pereyra M, Scalia IG, Barry T, Chao CJ, Marcotte F, Ayoub C, Scott RL, Majdalany DS, Arsanjani R. Current Management and Future Directions for Pulmonary Arterial Hypertension Associated with Congenital Heart Disease. J Pers Med 2023; 14:5. [PMID: 38276220 PMCID: PMC10817644 DOI: 10.3390/jpm14010005] [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: 11/18/2023] [Revised: 12/12/2023] [Accepted: 12/16/2023] [Indexed: 01/27/2024] Open
Abstract
Current management of patients with congenital heart disease has increased their survival into adulthood. This is accompanied by potential cardiac complications, including pulmonary hypertension associated with congenital heart disease (PAH-CHD). PAH-CHD constitutes a challenging subgroup of pulmonary hypertension and requires expert management to improve quality of life and prognosis. Novel agents have shown a significant improvement in morbidity and mortality in patients with pulmonary arterial hypertension. However, the long-term effects of these medications on PAH-CHD patients remain somewhat uncertain, necessitating treatment plans largely founded on the clinical experience of the healthcare providers. The aim of this review is to summarize the current evidence and future perspectives regarding treatment strategies for PAH-CHD to help better guide management of this complex disease.
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Affiliation(s)
- Ahmed K. Mahmoud
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (A.K.M.)
| | - Mohammed Tiseer Abbas
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (A.K.M.)
| | - Moaz A. Kamel
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (A.K.M.)
| | - Juan M. Farina
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (A.K.M.)
| | - Milagros Pereyra
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (A.K.M.)
| | - Isabel G. Scalia
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (A.K.M.)
| | - Timothy Barry
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (A.K.M.)
| | - Chieh-Ju Chao
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Francois Marcotte
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (A.K.M.)
| | - Chadi Ayoub
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (A.K.M.)
| | - Robert L. Scott
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (A.K.M.)
| | - David S. Majdalany
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (A.K.M.)
| | - Reza Arsanjani
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (A.K.M.)
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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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Luo D, Zheng X, Yang Z, Li H, Fei H, Zhang C. Machine learning for clustering and postclosure outcome of adult CHD-PAH patients with borderline hemodynamics. J Heart Lung Transplant 2023; 42:1286-1297. [PMID: 37211333 DOI: 10.1016/j.healun.2023.05.003] [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: 09/14/2022] [Revised: 04/27/2023] [Accepted: 05/08/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND Patients with uncorrected isolated simple shunts associated pulmonary arterial hypertension (PAH) had increased mortality. Treatment strategies for borderline hemodynamics remain controversial. This study aims to investigate preclosure characteristics and its association with postclosure outcome in this group of patients. METHODS Adults with uncorrected isolated simple shunts associated PAH were included. Peak tricuspid regurgitation velocity<2.8 m/sec with normalized cardiac structures was defined as the favorable study outcome. We applied unsupervised and supervised machine learning for clustering analysis and model constructions. RESULTS Finally, 246 patients were included. During a median follow-up of 414days, 58.49% (62/106) of patients with pretricuspid shunts achieved favorable outcome while 32.22% (46/127) of patients with post-tricuspid shunts. In unsupervised learning, two clusters were identified in both types of shunts. Generally, the oxygen saturation, pulmonary blood flow, cardiac index, dimensions of the right and left atrium, were the major features that characterized the identified clusters. Specifically, mean right atrial pressure, right ventricular dimension, and right ventricular outflow tract helped differentiate clusters in pretricuspid shunts while age, aorta dimension, and systemic vascular resistance helped differentiate clusters for post-tricuspid shunts. Notably, cluster 1 had better postclosure outcome than cluster 2 (70.83% vs 32.55%, p < .001 for pretricuspid and 48.10% vs 16.67%, p < .001 for post-tricuspid). However, models constructed from supervised learning methods did not achieve good accuracy for predicting the postclosure outcome. CONCLUSIONS There were two main clusters in patients with borderline hemodynamics, in which one cluster had better postclosure outcome than the other.
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Affiliation(s)
- Dongling Luo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Xinpeng Zheng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Ziyang Yang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Hezhi Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Hongwen Fei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China.
| | - Caojin Zhang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China.
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9
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Kishi K, Jarutach J, Ooi YK, Wong NL, Che Mood M, Kandhavello G, Alwi M, Leong MC. High haemoglobin levels at the time of occlusion predict worse outcome for patients with patent ductus arteriosus and pulmonary hypertension. Cardiol Young 2023; 33:1359-1366. [PMID: 35950412 DOI: 10.1017/s104795112200244x] [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] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Current guidelines discourage shunt closure in patients with pulmonary vascular resistance index >8 Wood units x m2. The study examined the long-term outcome of patients over 15 years old, with pulmonary vascular resistance index >8 Wood units x m2 and patent ductus arteriosus. MATERIALS AND METHODS This was a multi-institutional, retrospective study involving all consecutive patients (>15 years old) with patent ductus arteriosus and severe pulmonary hypertension. Patients who had patent ductus arteriosus closure were divided into the Good (no death or hospital admissions due to worsening pulmonary hypertension) and the Poor Outcome groups and these groups were compared. RESULTS Thirty-seven patients [male: 9 (24.3%); mean age: 30.49 ± 9.56 years; median follow-up: 3 (IQR: 1.5,10) years] were included from four centers. Twenty-two patients who underwent patent ductus arteriosus closure, 15 (71.4%) had good outcomes while 7 (28.6%) had poor outcomes. Pulmonary vascular resistance index and pulmonary to systemic resistance ratio (Rp:Rs) were lower in the Good Outcome Group (14.35 ± 1.66 Wood units x m2 vs. 20.07 ± 2.44; p = 0.033 and 0.44 ± 0.16 vs. 1.08 ± 1.21; p = 0.042). Haemoglobin concentrations (<14.3 g/dL) were associated with good long-term outcomes in the Closed Group. CONCLUSIONS Patients with patent ductus arteriosus with severe pulmonary hypertension have a dismal outcome with or without closure. High haemoglobin levels at the time of occlusion predict a worse outcome for patients with patent ductus arteriosus and pulmonary hypertension.
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Affiliation(s)
- Kanta Kishi
- Division of Cardiology, Department of Paediatrics, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Jirayut Jarutach
- Division of Cardiology, Department of Paediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Yinn Khurn Ooi
- Paediatric Department, Cardiology Unit, Serdang Hospital, 43000 Serdang, Selangor, Malaysia
| | - Ngie Liong Wong
- Department of Cardiology, Sarawak General Hospital, Jalan Tun Ahmad Zaidi Adruce, Kuching 93596, Sarawak, Malaysia
| | - Marhisham Che Mood
- Paediatric & Congenital Heart Centre, Institut Jantung Negara (National Heart Institute), 145, Jalan Tun Razak, 50400 Kuala Lumpur, Malaysia
| | - Geetha Kandhavello
- Paediatric & Congenital Heart Centre, Institut Jantung Negara (National Heart Institute), 145, Jalan Tun Razak, 50400 Kuala Lumpur, Malaysia
| | - Mazeni Alwi
- Paediatric & Congenital Heart Centre, Institut Jantung Negara (National Heart Institute), 145, Jalan Tun Razak, 50400 Kuala Lumpur, Malaysia
| | - Ming Chern Leong
- Paediatric & Congenital Heart Centre, Institut Jantung Negara (National Heart Institute), 145, Jalan Tun Razak, 50400 Kuala Lumpur, Malaysia
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Xie F, Quan R, Zhang G, Tian H, Chen Y, Yu Z, Zhang C, Liu Y, Zhu X, Wu W, Zhu X, Yang Z, Gu Q, Xiong C, Han H, Cheng Y, He J, Wu Y. Characteristics, treatments and survival of pulmonary arterial hypertension associated with congenital heart disease in China: Insights from a national multicenter prospective registry. J Heart Lung Transplant 2023; 42:974-984. [PMID: 37002152 DOI: 10.1016/j.healun.2023.02.1494] [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: 08/31/2022] [Revised: 01/15/2023] [Accepted: 02/19/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND The purpose of this registry was to provide insights into the characteristics, treatments and survival of patients with PAH-CHD in China. METHODS Patients diagnosed with PAH-CHD were enrolled in this national multicenter prospective registry. Baseline and follow-up data on clinical characteristics, PAH-targeted treatments and survival were collected. RESULTS A total of 1060 PAH-CHD patients (mean age 31 years; 67.9% females) were included, with Eisenmenger syndrome (51.5%) being the most common form and atrial septal defects (37.3%) comprising the most frequent underlying defect. Approximately 33.0% of the patients were in World Health Organization functional class III to IV. The overall mean pulmonary arterial pressure and pulmonary vascular resistance were 67.1 (20.1) mm Hg and 1112.4 (705.9) dyn/s/cm5, respectively. PAH-targeted therapy was utilized in 826 patients (77.9%), and 203 patients (19.1%) received combination therapy. The estimated 1-, 3-, 5-, and 10-year survival rates of the overall cohort were 96.9%, 92.9%, 87.6% and 73.0%, respectively. Patients received combination therapy had significantly better survival than those with monotherapy (p = 0.016). NT-proBNP >1400 pg/ml, SvO2 ≤ 65% and Borg dyspnea index ≥ 3 and PAH-targeted therapy were independent predictors of mortality. Hemoglobin > 160g/L was a unique predictor for mortality in Eisenmenger syndrome. CONCLUSIONS Chinese PAH-CHD patients predominantly exhibit Eisenmenger syndrome and have significantly impaired exercise tolerance and right ventricular function at diagnosis, which are closely associated with long-term survival. PAH-targeted therapy including combination therapy showed a favorable effect on survival in PAH-CHD. The long-term survival of Chinese CHD-PAH patients remains to be improved.
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Affiliation(s)
- Feng Xie
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Ruilin Quan
- Department of Pulmonary Vascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Gangcheng Zhang
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China
| | - Hongyan Tian
- Department of Peripheral Vascular Diseases, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yucheng Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Zaixin Yu
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China
| | - Caojin Zhang
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yuhao Liu
- Heart Centre of Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Xianyang Zhu
- Department of Congenital Heart Disease, General Hospital of Northern Theater Command, Shenyang, China
| | - Weifeng Wu
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiulong Zhu
- Department of Cardiovascular Medicine, The People's Hospital of Gaozhou, Maoming, China
| | - Zhenwen Yang
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Qing Gu
- Department of Pulmonary Vascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Changming Xiong
- Department of Pulmonary Vascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Huijun Han
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Yingzhang Cheng
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jianguo He
- Department of Pulmonary Vascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Cardiovascular Disease, Beijing, China.
| | - Yanqing Wu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
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11
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Ladouceur M, Valdeolmillos E, Karsenty C, Hascoet S, Moceri P, Le Gloan L. Cardiac Drugs in ACHD Cardiovascular Medicine. J Cardiovasc Dev Dis 2023; 10:190. [PMID: 37233157 PMCID: PMC10219196 DOI: 10.3390/jcdd10050190] [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: 03/30/2023] [Revised: 04/17/2023] [Accepted: 04/21/2023] [Indexed: 05/27/2023] Open
Abstract
Adult congenital heart disease (ACHD) is a growing population that requires life-long care due to advances in pediatric care and surgical or catheter procedures. Despite this, drug therapy in ACHD remains largely empiric due to the lack of clinical data, and formalized guidelines on drug therapy are currently lacking. The aging ACHD population has led to an increase in late cardiovascular complications such as heart failure, arrhythmias, and pulmonary hypertension. Pharmacotherapy, with few exceptions, in ACHD is largely supportive, whereas significant structural abnormalities usually require interventional, surgical, or percutaneous treatment. Recent advances in ACHD have prolonged survival for these patients, but further research is needed to determine the most effective treatment options for these patients. A better understanding of the use of cardiac drugs in ACHD patients could lead to improved treatment outcomes and a better quality of life for these patients. This review aims to provide an overview of the current status of cardiac drugs in ACHD cardiovascular medicine, including the rationale, limited current evidence, and knowledge gaps in this growing area.
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Affiliation(s)
- Magalie Ladouceur
- Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, 75015 Paris, France
- Centre de Recherche Cardiovasculaire de Paris, INSERM U970, Université de Paris Cité, 75015 Paris, France
| | - Estibaliz Valdeolmillos
- Marie-Lannelongue Hospital, Paediatric and Congenital Cardiac Surgery Department, Centre de Référence des Malformations Cardiaques Congénitales Complexes M3C Groupe Hospitalier Saint-Joseph, Paris-Saclay University, 92350 Le Plessis Robinson, France
- UMRS 999, INSERM, Marie-Lannelongue Hospital, Paris-Saclay University, 92350 Le Plessis Robinson, France
| | - Clément Karsenty
- Pediatric and Congenital Cardiology, Children’s Hospital CHU Toulouse, 31300 Toulouse, France
- Institut des Maladies Métaboliques et Cardiovasculaires, Université de Toulouse, Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, 31300 Toulouse, France
| | - Sébastien Hascoet
- Marie-Lannelongue Hospital, Paediatric and Congenital Cardiac Surgery Department, Centre de Référence des Malformations Cardiaques Congénitales Complexes M3C Groupe Hospitalier Saint-Joseph, Paris-Saclay University, 92350 Le Plessis Robinson, France
- UMRS 999, INSERM, Marie-Lannelongue Hospital, Paris-Saclay University, 92350 Le Plessis Robinson, France
| | - Pamela Moceri
- UR2CA, Equipe CARRES, Faculté de Médecine, Université Côte d’Azur, 06000 Nice, France
| | - Laurianne Le Gloan
- Cardiologie Congénitale Adulte, Institut du Thorax, CHU de Nantes, 44000 Nantes, France
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12
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Characteristics of exercise intolerance in different subgroups of pulmonary arterial hypertension associated with congenital heart disease. Int J Cardiol 2023; 375:29-35. [PMID: 36565957 DOI: 10.1016/j.ijcard.2022.12.033] [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] [Received: 11/13/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Exercise intolerance is a major manifestation of pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD). We aimed to investigate the characteristics of exercise intolerance in different subgroups of PAH-CHD. METHODS We retrospectively enrolled 171 adult patients with PAH-CHD and 30 age and sex-matched healthy subjects and performed cardiopulmonary exercise testing. Gas exchange parameters, including peak oxygen uptake (peak V̇o2), anaerobic threshold, and the slope of ventilatory equivalent for carbon dioxide (V̇e/V̇co2 slope), were recorded. RESULTS The median age of patients at enrollment was 27.8 years, and 131 (76.6%) were female. Peak V̇o2 was reduced in patients compared to healthy controls (median, 14.8 ml/kg/min versus 26.9 ml/kg/min, p < 0.001). Of all 171 patients, 60 (35.1%) had Eisenmenger syndrome, 35 (20.5%) had PAH associated with systemic-to-pulmonary shunts (PAH-SP), 39 (22.8%) had PAH with small defects (PAH-SD), and 37 (21.6%) had PAH after cardiac defect correction (PAH-CD). Patients with Eisenmenger syndrome had the lowest peak V̇o2 (p = 0.003) and the highest V̇e/V̇co2 slope (p = 0.012), compared with other patients, representing the worst exercise capacity and ventilatory efficiency. Patients with PAH-SP had the best exercise capacity among the four groups, indicated by the highest peak V̇o2 (p = 0.003) compared with other patients. Peak V̇o2 was negatively correlated with pulmonary vascular resistance (r = -0.411, p < 0.001). CONCLUSIONS Exercise capacity was severely reduced in patients with PAH-CHD. Among the four subgroups, patients with Eisenmenger syndrome had the worst exercise capacity and ventilatory efficiency.
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13
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Zhao M, Liu J, Xin M, Yang K, Huang H, Zhang W, Zhang J, He S. Pulmonary arterial hypertension associated with congenital heart disease: An omics study. Front Cardiovasc Med 2023; 10:1037357. [PMID: 36970344 PMCID: PMC10036813 DOI: 10.3389/fcvm.2023.1037357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 02/24/2023] [Indexed: 03/12/2023] Open
Abstract
Pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD) is a severely progressive condition with uncertain physiological course. Hence, it has become increasingly relevant to clarify the specific mechanisms of molecular modification, which is crucial to identify more treatment strategies. With the rapid development of high-throughput sequencing, omics technology gives access to massive experimental data and advanced techniques for systems biology, permitting comprehensive assessment of disease occurrence and progression. In recent years, significant progress has been made in the study of PAH-CHD and omics. To provide a comprehensive description and promote further in-depth investigation of PAH-CHD, this review attempts to summarize the latest developments in genomics, transcriptomics, epigenomics, proteomics, metabolomics, and multi-omics integration.
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Affiliation(s)
- Maolin Zhao
- Department of Cardiovascular Surgery, Affiliated Hospital of Southwest Jiaotong University, General Hospital of Western Theater Command, Chengdu, China
| | - Jian Liu
- Department of Cardiovascular Surgery, Affiliated Hospital of Southwest Jiaotong University, General Hospital of Western Theater Command, Chengdu, China
| | - Mei Xin
- Department of Cardiovascular Surgery, Affiliated Hospital of Southwest Jiaotong University, General Hospital of Western Theater Command, Chengdu, China
| | - Ke Yang
- Department of Cardiovascular Surgery, Affiliated Hospital of Southwest Jiaotong University, General Hospital of Western Theater Command, Chengdu, China
| | - Honghao Huang
- Department of Cardiovascular Surgery, Affiliated Hospital of Southwest Jiaotong University, General Hospital of Western Theater Command, Chengdu, China
| | - Wenxin Zhang
- Department of Cardiovascular Surgery, Affiliated Hospital of Southwest Jiaotong University, General Hospital of Western Theater Command, Chengdu, China
| | - Jinbao Zhang
- Department of Cardiovascular Surgery, Affiliated Hospital of Southwest Jiaotong University, General Hospital of Western Theater Command, Chengdu, China
| | - Siyi He
- Department of Cardiovascular Surgery, Affiliated Hospital of Southwest Jiaotong University, General Hospital of Western Theater Command, Chengdu, China
- Correspondence: Siyi He
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14
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Fournier E, Selegny M, Amsallem M, Haddad F, Cohen S, Valdeolmillos E, Le Pavec J, Humbert M, Isorni MA, Azarine A, Sitbon O, Jais X, Savale L, Montani D, Fadel E, Zoghbi J, Belli E, Hascoët S. Evaluación multiparamétrica de la función ventricular derecha en la hipertensión arterial pulmonar asociada a cardiopatías congénitas. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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15
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Guo F, Chang RK, Detrano RC. Eisenmenger Syndrome Among Children with Unrepaired Congenital Heart Defects in Yunnan, China. Pediatr Cardiol 2022; 43:1848-1856. [PMID: 35522268 DOI: 10.1007/s00246-022-02922-z] [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] [Received: 02/02/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
Abstract
Eisenmenger syndrome is a life-threatening complication of congenital heart defects (CHD). Since Eisenmenger syndrome among children of repaired CHD is rare, very few studies have had the necessary data to investigate its distribution in children. The current study used data collected in rural China to investigate the prevalence of Eisenmenger syndrome in children with unrepaired CHD. Data were from the 2006 to 2016 patient medical records of China California Heart Watch, which is a traveling cardiology clinic in Yunnan Province, China. Patients were included if they (1) aged 18 or below, (2) had CHD(s), and (3) the defect was not repaired by the time of the clinic visit. The prevalence of Eisenmenger syndrome was calculated in each age and defect group. Using logistic regression models, we tested whether oxygen saturation, Down syndrome, sex, and age were significantly associated with Eisenmenger syndrome. Of the 1301 study participants, ventricular septum defect (VSD), atrial septal defect (ASD), and patent ductus arteriosus (PDA) were the most common CHD. About one-sixth of the patients had pulmonary hypertension and 1.5% had Eisenmenger syndrome. The percentages of Eisenmenger syndrome were 1.8% in VSD patients, 0 in ASD patients, and 0.9% in PDA patients. Patients in the age group between 15 and 18 years had the highest percentages of Eisenmenger syndrome (11.5%). Age and presence of Down syndrome were significantly associated with the presence of Eisenmenger syndrome. Our finding highlights the importance of early detection and correction of CHD.
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Affiliation(s)
- Fangqi Guo
- Susan and Henry Samueli College of Health Sciences, Program in Public Health, University of California Irvine, Irvine, CA, 92697, USA.
| | - Ruey-Kang Chang
- Division of Pediatric Cardiology, Harbor-UCLA Medical Center, Torrance, USA
| | - Robert C Detrano
- Susan and Henry Samueli College of Health Sciences, Program in Public Health, University of California Irvine, Irvine, CA, 92697, USA.,School of Medicine, Department of Radiological Sciences, University of California Irvine, Irvine, USA.,China California Heart Watch, Silverado, USA
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16
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Partial anomalous pulmonary venous return in adults: Insight into pulmonary hypertension. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2022.100426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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17
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Rogula S, Pomirski B, Czyżak N, Eyileten C, Postuła M, Szarpak Ł, Filipiak KJ, Kurzyna M, Jaguszewski M, Mazurek T, Grabowski M, Gąsecka A. Biomarker-based approach to determine etiology and severity of pulmonary hypertension: Focus on microRNA. Front Cardiovasc Med 2022; 9:980718. [PMID: 36277769 PMCID: PMC9582157 DOI: 10.3389/fcvm.2022.980718] [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: 06/28/2022] [Accepted: 09/12/2022] [Indexed: 11/25/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is characterized by remodeling of the pulmonary arteries, and defined by elevated pulmonary arterial pressure, measured during right heart catheterization. There are three main challenges to the diagnostic and therapeutic process of patients with PAH. First, it is difficult to differentiate particular PAH etiology. Second, invasive diagnostic is required to precisely determine the severity of PAH, and thus to qualify patients for an appropriate treatment. Third, the results of treatment of PAH are unpredictable and remain unsatisfactory. MicroRNAs (miRNAs) are small non-coding RNAs that regulate post transcriptional gene-expression. Their role as a prognostic, and diagnostic biomarkers in many different diseases have been studied in recent years. MiRNAs are promising novel biomarkers in PAH due to their activity in various molecular pathways and processes underlying PAH. Lack of biomarkers to differentiate between particular PAH etiology and evaluate the severity of PAH, as well as paucity of therapeutic targets in PAH open a new field for the possibility to use miRNAs in these applications. In our article, we discuss the potential of miRNAs use as diagnostic tools, prognostic biomarkers and therapeutic targets in PAH.
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Affiliation(s)
- Sylwester Rogula
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland,*Correspondence: Sylwester Rogula,
| | - Bartosz Pomirski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Norbert Czyżak
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Ceren Eyileten
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, Warsaw, Poland,Genomics Core Facility, Center of New Technologies (CeNT), University of Warsaw, Warsaw, Poland
| | - Marek Postuła
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, Warsaw, Poland
| | - Łukasz Szarpak
- Department of Outcomes Research, Maria Skłodowska-Curie Medical Academy in Warsaw, Warsaw, Poland
| | - Krzysztof J. Filipiak
- Institute of Clinical Sciences, Maria Skłodowska-Curie Medical Academy in Warsaw, Warsaw, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, Otwock, Poland
| | - Miłosz Jaguszewski
- 1st Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Tomasz Mazurek
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Grabowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Aleksandra Gąsecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
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18
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Mong DA, Guillerman RP, Weinman JP. Computed tomography evaluation of pediatric pulmonary hypertension. Pediatr Radiol 2022; 52:1888-1894. [PMID: 35648162 DOI: 10.1007/s00247-022-05385-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/25/2022] [Accepted: 04/22/2022] [Indexed: 10/18/2022]
Abstract
Although rare in the pediatric population, pulmonary hypertension is a significant cause of morbidity and mortality in affected individuals. In addition to evaluating potential causes and severity of parenchymal lung diseases, non-contrast high-resolution CT of the chest can aid in the diagnosis of heritable and acquired causes. In addition to evaluating parenchymal lung disease, CT angiography can help to confirm findings of pulmonary hypertension using criteria similar to echocardiography, and provide detailed assessment of the pulmonary vascularity in specific causes.
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Affiliation(s)
- David Andrew Mong
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E. 16th Ave., Aurora, CO, 80045, USA.
| | - R Paul Guillerman
- Department of Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Jason P Weinman
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E. 16th Ave., Aurora, CO, 80045, USA
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19
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Yao A, Inuzuka R, Mizuno A, Iwano H, Tatebe S, Tsukamoto Y, Sakamoto I, Watanabe H, Fukuda N, Takechi F, Adachi S, Akazawa Y, Kuwahara K, Dohi K, Ishizu T, Miyake M, Koitabashi N, Hasegawa-Tamba S, Sato S, Fujii T, Ehara E, Minamino T, Yamada H, Yamashita E, Kawamatsu N, Masuda K, Soma K, Shiraishi I, Nagai R, Niwa K. Status of adult outpatients with congenital heart disease in Japan: The Japanese Network of Cardiovascular Departments for Adult Congenital Heart Disease Registry. J Cardiol 2022; 80:525-531. [PMID: 35995687 DOI: 10.1016/j.jjcc.2022.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/04/2022] [Accepted: 07/01/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND The Japanese Network of Cardiovascular Departments for Adult Congenital Heart Disease (JNCVD-ACHD) was founded in 2011 for the lifelong care of adult patients with congenital heart disease (ACHD patients). This network maintains the first Japanese ACHD registry. METHODS AND RESULTS From 2011 to 2019, the JNCVD-ACHD registered 54 institutions providing specialized care for ACHD patients in 32 of the 47 prefectures in Japan. The registry collected data on the disease profile for 24,048 patients from 50 institutions and the patient characteristics for 9743 patients from 24 institutions. The most common ACHDs were atrial septal defect (20.5 %), ventricular septal defect (20.5 %), tetralogy of Fallot (12.9 %), and univentricular heart (UVH)/single ventricle (SV; 6.6 %). ACHD patients without biventricular repair accounted for 37.0 % of the population. Also examined were the serious anatomical and/or pathophysiological disorders such as pulmonary arterial hypertension (3.0 %) including Eisenmenger syndrome (1.2 %), systemic right ventricle under biventricular circulation (sRV-2VC; 2.8 %), and Fontan physiology (6.0 %). The sRV-2VC cases comprised congenitally corrected transposition of the great arteries without anatomical repair (61.9 %) and transposition of the great arteries with atrial switching surgery (38.1 %). The primary etiology (86.4 %) for Fontan physiology was UVH/SV. In addition, developmental/chromosomal/genetic disorders were heterotaxy syndromes (asplenia, 0.9 %; polysplenia, 0.7 %), trisomy 21 (4.0 %), 22q11.2 deletion (0.9 %), Turner syndrome (0.2 %), and Marfan syndrome (1.1 %). CONCLUSIONS Although the specific management of ACHD has systematically progressed in Japan, this approach is still evolving. For ideal ACHD care, the prospective goals for the JNCVD-ACHD are to create local networks and provide a resource for multicenter clinical trials to support evidence-based practice.
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Affiliation(s)
- Atsushi Yao
- Division for Health Service Promotion, the University of Tokyo, Bunkyo-ku, Tokyo, Japan.
| | - Ryo Inuzuka
- Pediatric Department, the University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Atsushi Mizuno
- Department of Cardiology, St. Luke's International Hospital, Choo-ku, Tokyo, Japan
| | - Hiroyuki Iwano
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Shunsuke Tatebe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yasumasa Tsukamoto
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Ichiro Sakamoto
- Department of Cardiovascular Medicine, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Hiroyuki Watanabe
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Akita, Akita, Japan
| | - Nobuyuki Fukuda
- Second Department of Internal Medicine, University of Toyama, Toyama, Toyama, Japan
| | - Fumie Takechi
- Department of Pediatrics, Chiba Cerebral and Cardiovascular Center, Ichihara, Chiba, Japan
| | - Shiro Adachi
- Department of Cardiology, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Yusuke Akazawa
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toonn, Ehime, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Tomoko Ishizu
- Division of Cardiology, University of Tsukuba, Tsukuba, Ibaragi, Japan
| | - Makoto Miyake
- Department of Cardiology, Tenri Hospital, Tenri, Nara, Japan
| | - Norimichi Koitabashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Saki Hasegawa-Tamba
- Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Seiichi Sato
- Division of Pediatric Cardiology, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Shimajiri-gun, Okinawa, Japan
| | - Takanari Fujii
- Pediatric Heart Disease and Adult Congenital Heart Disease Center, Showa University Hospital, Shinagawa-ku, Tokyo, Japan
| | - Eiji Ehara
- Department of Pediatric Cardiology, Osaka City General Hospital, Osaka, Osaka, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Hirotsugu Yamada
- Department of Community Medicine for Cardiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Eiji Yamashita
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan
| | - Naoto Kawamatsu
- Mito Saiseikai General Hospital, Department of Cardiology, Mito, Ibaragi, Japan
| | - Keita Masuda
- Department of Cardiology, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan
| | - Katsura Soma
- Cardiovascular Department, the University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Isao Shiraishi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Ryozo Nagai
- Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Koichiro Niwa
- Department of Cardiology, St. Luke's International Hospital, Choo-ku, Tokyo, Japan
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Cober ND, VandenBroek MM, Ormiston ML, Stewart DJ. Evolving Concepts in Endothelial Pathobiology of Pulmonary Arterial Hypertension. Hypertension 2022; 79:1580-1590. [PMID: 35582968 DOI: 10.1161/hypertensionaha.122.18261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Pulmonary arterial hypertension (PAH) is a deadly disease, characterized by increased vascular resistance, pulmonary arteriolar loss, and occlusive arterial remodeling, leading to eventual right heart failure. Evidence increasingly points to the pulmonary endothelium as a central actor in PAH. Endothelial cell apoptosis can result directly in distal lung arteriolar pruning and indirectly in the formation of complex and occlusive arterial lesions, reflecting an imbalance between endothelial injury and repair in the development and progression of PAH. Many of the mutations implicated in PAH are in genes, which are predominantly, or solely, expressed in endothelial cells, and the endothelium is a major target for therapeutic interventions to restore BMP signaling. We explore how arterial pruning can promote the emergence of occlusive arterial remodeling mediated by ongoing endothelial injury secondary to hemodynamic perturbation and pathological increases in luminal shear stress. The emerging role of endothelial cell senescence is discussed in the transition from reversible to irreversible arterial remodeling in advanced PAH, and we review the sometimes conflicting evidence that female sex hormones can both protect or promote vascular changes in disease. Finally, we explore the contribution of the endothelium to metabolic changes and the altered inflammatory and immune state in the PAH lung, focusing on the role of excessive TGFβ signaling. Given the complexity of the endothelial pathobiology of PAH, we anticipate that emerging technologies that allow the study of molecular events at a single cell level will provide answers to many of the questions raised in this review.
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Affiliation(s)
- Nicholas D Cober
- Ottawa Hospital Research Institute, ON, Canada (N.D.C., D.J.S.).,Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, ON, Canada (N.D.C., D.J.S.)
| | - M Martin VandenBroek
- Department of Medicine, Queen's University, Kingston, ON, Canada (M.M.V., M.L.O.)
| | - Mark L Ormiston
- Department of Medicine, Queen's University, Kingston, ON, Canada (M.M.V., M.L.O.).,Departments of Surgery, and Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada (M.L.O.)
| | - Duncan J Stewart
- Ottawa Hospital Research Institute, ON, Canada (N.D.C., D.J.S.).,Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, ON, Canada (N.D.C., D.J.S.)
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21
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Multiparametric evaluation of right ventricular function in pulmonary arterial hypertension associated with congenital heart disease. REVISTA ESPAÑOLA DE CARDIOLOGÍA (ENGLISH EDITION) 2022; 76:333-343. [PMID: 35940550 DOI: 10.1016/j.rec.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 07/27/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION AND OBJECTIVES Outcome in patients with congenital heart diseases and pulmonary arterial hypertension (PAH) is closely related to right ventricular (RV) function. Two-dimensional echocardiographic parameters, such as strain imaging or RV end-systolic remodeling index (RVESRI) have emerged to quantify RV function. METHODS We prospectively studied 30 patients aged 48±12 years with pretricuspid shunt and PAH and investigated the accuracy of multiple echocardiographic parameters of RV function (tricuspid annular plane systolic excursion, tricuspid annular peak systolic velocity, RV systolic-to-diastolic duration ratio, right atrial area, RV fractional area change, RV global longitudinal strain and RVESRI) to RV ejection fraction measured by cardiac magnetic resonance. RESULTS RV ejection fraction <45% was observed in 13 patients (43.3%). RV global longitudinal strain (ρ [Spearman's correlation coefficient]=-0.75; P=.001; R2=0.58; P=.001), right atrium area (ρ=-0.74; P <.0001; R2=0.56; P <.0001), RVESRI (ρ=-0.64; P <.0001; R2=0.47; P <.0001), systolic-to-diastolic duration ratio (ρ=-0.62; P=.0004; R2=0.47; P <.0001) and RV fractional area change (ρ=0.48; P=.01; R2=0.37; P <.0001) were correlated with RV ejection fraction. RV global longitudinal strain, RVESRI and right atrium area predicted RV ejection fraction <45% with the greatest area under curve (0.88; 95%CI, 0.71-1.00; 0.88; 95%CI, 0.76-1.00, and 0.89; 95%CI, 0.77-1.00, respectively). RV global longitudinal strain >-16%, RVESRI ≥ 1.7 and right atrial area ≥ 22 cm2 predicted RV ejection fraction <45% with a sensitivity and specificity of 87.5% and 85.7%; 76.9% and 88.3%; 92.3% and 82.4%, respectively. CONCLUSIONS RVESRI, right atrial area and RV global longitudinal strain are strong markers of RV dysfunction in patients with pretricuspid shunt and PAH.
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22
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Widenka KJ, Kosiorowska M, Jakob H, Pacini D, Hemmer W, Grabenwoeger M, Sioris T, Moritz A, Tsagakis K. Early and midterm results of frozen elephant trunk operation with Evita open stent-graft in patients with Marfan syndrome: results of a multicentre study. BMC Cardiovasc Disord 2022; 22:333. [PMID: 35883019 PMCID: PMC9317434 DOI: 10.1186/s12872-022-02777-5] [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: 03/23/2022] [Accepted: 06/13/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Endovascular treatment of patients with Marfan syndrome (MFS) is not recommended. Hybrid procedures such as frozen elephant trunk (FET), which combines stent-graft deployment with an integrated non-stented fabric graft for proximal grafting and suturing, have not been previously evaluated. The aim of this study was to assess the safety and feasibility of FET operation in patients with MFS. METHODS Patients enrolled in the International E-vita Open Registry (IEOR) who underwent FET procedure between January 2001 and February 2020 meeting Ghent criteria for MFS were included in the study. Early and midterm results were retrospectively analyzed. Preoperative, postoperative and follow-up computed tomography angiography scans were analysed. RESULTS We analyzed 37 patients [mean age 38 ± 11 years, 65% men]. Acute or chronic aortic dissection was present in 35 (95%) patients (14 and 21 patients respectively). Two (5%) patients had an aneurysm without dissection. Malperfusion syndrome was present in 4 patients. Twenty-nine (78%) patients had history of aortic surgical interventions. The 30-day and in-hospital mortality amounted to 8 and 14% respectively. False lumen exclusion was present in 73% in stented segment in last postoperative CT. The overall 5-year survival was 71% and freedom from reintervention downstream was 58% at 5 years. Of the nine patients who required reintervention for distal aortic disease, one patient died. CONCLUSIONS FET operation for patients with MFS can be performed with acceptable mortality and morbidity. In long-term follow-up no reinterventions on the aortic arch were required. FET allows for easier second stage operations providing platform for surgical and endovascular reinterventions.
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Affiliation(s)
- Kazimierz Jan Widenka
- Department of Cardiac Surgery, University of Rzeszow Poland, 60 Lwowska Street 60, 35-301, Rzeszow, Poland.
| | - Monika Kosiorowska
- Department of Cardiac Surgery, University of Rzeszow Poland, 60 Lwowska Street 60, 35-301, Rzeszow, Poland
| | - Heinz Jakob
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, Essen, Germany
| | - Davide Pacini
- Department of Cardiac Surgery, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Wolfgang Hemmer
- Department of Cardiac Surgery, Sana Cardiac Surgery Stuttgart GmbH, Stuttgart, Germany
| | | | - Thanos Sioris
- Tampere University Hospital Heart Center, Tampere, Finland
| | - Anton Moritz
- Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, Essen, Germany
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23
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The Treatment Strategy for the Atrial Septal Defect in the Presence of Severe Pulmonary Hypertension. Medicina (B Aires) 2022; 58:medicina58070892. [PMID: 35888611 PMCID: PMC9323680 DOI: 10.3390/medicina58070892] [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: 05/22/2022] [Revised: 06/16/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022] Open
Abstract
Atrial septal defect is one of the most common congenital heart diseases in adults. The defect often leads to volume overload in the right heart coupled with the potential risk of right heart failure and pulmonary arterial hypertension. These conditions lead to worsening in quality of life, decrease in physical capacity, and even to fatal outcomes. The main strategy for treatment of atrial septal defect is a transcatheter or surgical closure of the defect, but in patients with severe pulmonary arterial hypertension, it is recommended to manage pulmonary arterial hypertension and after that treat the defect invasively. This strategy is called “treat and repair” strategy. We present an illustrative case report of management and treatment of atrial septal defect, complicated with severe pulmonary arterial hypertension. In this case, surgical closure of the defect was contraindicated because of the high pulmonary vascular resistance. Therefore, the “treat and repair” strategy was approached. After specific medical treatment of pulmonary arterial hypertension, surgical closure of the defect was chosen and proven successful.
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24
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Predictors of pulmonary hypertension after atrial septal defect closure: Impact of atrial fibrillation. TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2022; 30:344-353. [PMID: 36303690 PMCID: PMC9580293 DOI: 10.5606/tgkdc.dergisi.2022.23639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/09/2022] [Indexed: 11/21/2022]
Abstract
Background
In this study, we aimed to evaluate the course of pulmonary artery systolic pressure, to identify factors associated with pulmonary arterial hypertension, and to determine the impact of atrial septal defect closure on clinical outcomes in long-term follow-up.
Methods
Between March 2008 and August 2020, a total of 547 adult patients (193 males, 354 females; median age: 37 years; range, 27.5 to 47 years) with secundum atrial septal defect were retrospectively analyzed. Of these patients, 304 underwent percutaneous defect closure and 243 underwent isolated surgical repairs. Pulmonary arterial hypertension was defined as a noninvasively estimated pulmonary artery systolic pressure of ≥40 mmHg at the final follow-up after atrial septal defect closure. Factors associated with pulmonary arterial hypertension were analyzed.
Results
Sixty-nine (12.6%) patients presented with pulmonary arterial hypertension at the final follow-up. A total of 35 (6.4%) patients had persistent atrial fibrillation before atrial septal defect closure, and 22 of these 35 patients had pulmonary arterial hypertension during long-term follow-up. Older age at the time of atrial septal defect closure (HR: 4.76; 95% CI: 2.68-8.44; p<0.001), the presence of persistent atrial fibrillation (HR: 2.18; 95% CI: 1.21-3.91; p=0.009), and greater right ventricular basal diameter (HR: 4.78; 95% CI: 2.57-8.84; p<0.001) were found to be associated with late pulmonary arterial hypertension.
Conclusion
The presence of persistent atrial fibrillation may be used to predict patients at higher risk for pulmonary arterial hypertension after atrial septal defect closure.
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25
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Zhou J. Synemin promotes pulmonary artery smooth muscle cell phenotypic switch in shunt-induced pulmonary arterial hypertension. ESC Heart Fail 2022; 9:3221-3231. [PMID: 35769011 DOI: 10.1002/ehf2.14048] [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: 03/07/2022] [Revised: 05/11/2022] [Accepted: 06/03/2022] [Indexed: 11/06/2022] Open
Abstract
AIMS Although considerable progress has been made in the diagnosis and treatment of congenital heart disease-associated pulmonary heart hypertension (CHD-PAH), the clinical prognosis and overall survival of patients with CHD-PAH remain poor. Therefore, the molecular pathogenesis of CHD-PAH requires further investigation. The intermediate filament protein synemin (SYN) is reported to modulate phenotypic alterations and varicose vein development, but there is little understanding of its exact functions in CHD-PAH. METHODS AND RESULTS SYN expression in the pulmonary arterioles of CHD-PAH patients and shunt-induced PAH rat models was evaluated using immunohistochemistry and western blot. Cell counts and Transwell migration assays were used to assess the effect of SYN on the proliferation and migration capability of human pulmonary smooth muscle cells (hPASMCs). Adeno-associated viruses (AAVs) have been used to suppress SYN expression in the pulmonary arterioles of rats. Such rats were further used to construct a shunt-induced PAH animal model to investigate the function of SYN in PAH and pulmonary vascular remodelling. Compared with the normal control group, SYN expression was found to be clearly up-regulated in the remodelled pulmonary arterioles of CHD-PAH and shunt-induced PAH rat models. In addition, SYN suppression increased the expression of hPASMC contractile-phenotype markers and decreased the expression of synthetic phenotype markers, in contrast to the control group. SYN suppression also dramatically attenuated the proliferation and migration capability of hPASMCs. Conversely, SYN overexpression promoted phenotypic switch, proliferation, and migration of hPASMCs, whereas these effects were notably alleviated by the protein kinase B (AKT) inhibitor MK-2206. Furthermore, we confirmed that SYN suppression mitigated PAH and pulmonary vascular remodelling induced by high blood flow in vivo. CONCLUSIONS Our findings indicated that SYN may represent a promising therapeutic target in the treatment of CHD-PAH.
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Affiliation(s)
- Jingjing Zhou
- Beijing Key Laboratory of Maternal-Fetal Medicine and Fetal Heart Disease & Echocardiography Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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26
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Gado AA, Hefnawy SM, Abdelrahim AM, Alberry MAWAA, Madkour MAEF. A randomized controlled comparison of three modes of ventilation during cardiopulmonary bypass on oxygenation in pediatric patients with pulmonary hypertension undergoing congenital heart surgeries. EGYPTIAN JOURNAL OF ANAESTHESIA 2022. [DOI: 10.1080/11101849.2022.2059952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Ahmed Ali Gado
- Anesthesia and Intensive Care Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Salwa Mohamed Hefnawy
- Anesthesia and Intensive Care Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Ashraf M Abdelrahim
- Anesthesia and Intensive Care Department, Faculty of Medicine, Cairo University, Giza, Egypt
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27
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Chiu S, Lu C, Lin M, Chen C, Wu M, Wang J. Pulmonary Hypertension in Adult Congenital Heart Disease in Asia: A Distinctive Feature of Complex Congenital Heart Disease. J Am Heart Assoc 2022; 11:e022596. [PMID: 35285668 PMCID: PMC9075472 DOI: 10.1161/jaha.121.022596] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background The epidemiology of pulmonary hypertension (PH) in patients with adult congenital heart disease in Western countries is already known. We investigate clinical characteristics of PH in adult congenital heart disease with emphasis on complex congenital heart disease (CHD) from an Asian cohort in Taiwan. Methods and Results All adult patients (aged >18 years) diagnosed with CHD between January 2007 and July 2018 qualified for the study. PH was determined by cardiac catheterization data or echocardiography reports. In accord with the World Symposia on Pulmonary Hypertension, CHD was further categorized as simple, severe, or complex CHD (including pulmonary atresia‐ventricular septal defect and single‐ventricle anomalies). There were 4301 patients (55.6% women), 15.7% with severe and 3.9% with complex CHD. The cumulative incidence of PH was 4.4% (95% CI, 3.8–5.0). Our multivariable regression model indicated 4.2‐fold mortality increase (95% CI, 3.0–5.9) in the presence of PH, with age, female sex, and severe or complex CHD linked to higher incidence of PH. Only 49% of patients received PH‐specific therapy. Five‐ and 10‐year survival rates of patients with PH (n=190) were 72.3% (95% CI, 65.1%–78.4%) and 58.8% (95% CI, 50.1%–66.5%), respectively. Survival rates in those with Eisenmenger syndrome, PH after defect correction, and complex CHD were similar. Low oxygen saturation and high uric acid levels were associated with increased mortality. Conclusions In this sizable Asian adult CHD cohort, the cumulative incidence of PH was aligned with that of Western countries. Mortality proved higher in patients with PH versus without PH. Although complex CHD carried greater risk of PH compared with other adult CHD subsets, survival rate was similar.
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Affiliation(s)
- Shuenn‐Nan Chiu
- Department of Pediatrics National Taiwan University Hospital and Medical CollegeNational Taiwan University Taipei Taiwan
| | - Chun‐Wei Lu
- Department of Pediatrics National Taiwan University Hospital and Medical CollegeNational Taiwan University Taipei Taiwan
| | - Ming‐Tai Lin
- Department of Pediatrics National Taiwan University Hospital and Medical CollegeNational Taiwan University Taipei Taiwan
| | - Chun‐An Chen
- Department of Pediatrics National Taiwan University Hospital and Medical CollegeNational Taiwan University Taipei Taiwan
| | - Mei‐Hwan Wu
- Department of Pediatrics National Taiwan University Hospital and Medical CollegeNational Taiwan University Taipei Taiwan
| | - Jou‐Kou Wang
- Department of Pediatrics National Taiwan University Hospital and Medical CollegeNational Taiwan University Taipei Taiwan
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28
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Akseer S, Abrahamyan L, Lee DS, Huszti E, Meier LM, Osten M, Benson L, Horlick E. Long-Term Outcomes in Adult Patients With Pulmonary Hypertension After Percutaneous Closure of Atrial Septal Defects. Circ Cardiovasc Interv 2021; 15:e011110. [PMID: 34911355 DOI: 10.1161/circinterventions.121.011110] [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: 11/16/2022]
Abstract
BACKGROUND Pulmonary hypertension (PH), recently redefined as mean pulmonary arterial pressure >20 mm Hg (PH20), may be observed in patients with atrial septal defects (ASD). We aimed to determine the effect of preprocedural PH20 status on outcomes among patients undergoing ASD closure. METHODS Study population was selected from a retrospective registry of adult patients who underwent percutaneous ASD closure from 1998 to 2016 from a single center and had right heart catheterizations during the procedure. The clinical registry was linked to administrative databases to capture short- and long-term outcomes. RESULTS We included a total of 632 ASD closure patients of whom 359 (56.8%) had PH20. The mean follow-up length was 7.6±4.6 years. Patients with PH20 were older (mean age 56.5 versus 43.1 years, P<0.001) and a higher prevalence of comorbidities including hypertension (54.3% versus 21.6%, P<0.001) and diabetes (18.1% versus 5.9%, P<0.001) than those without PH. In a Cox proportional hazards model after covariate adjustment, patients with PH had a significantly higher risk of developing major adverse cardiac and cerebrovascular events (heart failure, stroke, myocardial infarction, or cardiovascular mortality), with hazards ratio 2.45 (95% CI, 1.4-4.4). When applying the prior, mean pulmonary arterial pressure ≥25 mm Hg (PH25) cutoff, a significantly higher hazard of developing major adverse cardiac and cerebrovascular events was observed in PH versus non-PH patients. CONCLUSIONS ASD patients with PH undergoing closure suffer from more comorbidities and worse long-term major adverse cardiac and cerebrovascular events outcomes, compared with patients without PH. The use of the new PH20 definition potentially dilutes the effect of this serious condition on outcomes in this population.
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Affiliation(s)
- Selai Akseer
- Toronto General Hospital Research Institute, University Health Network (UHN), Ontario, Canada (S.A., L.A., D.S.L., E.H.).,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Ontario, Canada. (S.A., L.A., D.S.L., E.H.)
| | - Lusine Abrahamyan
- Toronto General Hospital Research Institute, University Health Network (UHN), Ontario, Canada (S.A., L.A., D.S.L., E.H.).,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Ontario, Canada. (S.A., L.A., D.S.L., E.H.)
| | - Douglas S Lee
- Toronto General Hospital Research Institute, University Health Network (UHN), Ontario, Canada (S.A., L.A., D.S.L., E.H.).,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Ontario, Canada. (S.A., L.A., D.S.L., E.H.).,ICES, Toronto, Ontario, Canada (D.S.L.)
| | - Ella Huszti
- Toronto General Hospital Research Institute, University Health Network (UHN), Ontario, Canada (S.A., L.A., D.S.L., E.H.).,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Ontario, Canada. (S.A., L.A., D.S.L., E.H.).,Biostatistics Research Unit, UHN, Toronto, Ontario, Canada (E.H.)
| | - Lukas M Meier
- Adult Congenital Heart Disease Program, University Heart Center, University Hospital Zurich, University of Zurich, Switzerland (L.M.M.)
| | - Mark Osten
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, UHN, Toronto, Ontario, Canada (M.O., E.H.)
| | - Lee Benson
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Ontario, Canada. (L.B.).,Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada (L.B.)
| | - Eric Horlick
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, UHN, Toronto, Ontario, Canada (M.O., E.H.)
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Chinawa JM, Chinawa AT, Ossai EN, Duru CO. Predictors of pulmonary hypertension among children with atrial septal defects (ASD). Libyan J Med 2021; 17:2007603. [PMID: 34813403 PMCID: PMC8635614 DOI: 10.1080/19932820.2021.2007603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction: Atrial septal defect (ASD) is a common congenital heart disease in children that uncommonly presents with pulmonary hypertension. Much is not known about the exact predictor of PAH in children with ASD. Objectives: This study aimed to determine the predictors of pulmonary hypertension in children with ASD. Patients and Methods: This was a descriptive analysis of children with ASD carried out in three different institutions over a five-year period. Data entry and analysis were done using IBM Statistical Package for Social Sciences (SPSS) statistical software, version 25. Results: The majority of the participants, 52.2%, had pulmonary hypertension and 62.5% of them occurred as mild pulmonary hypertension. There was a very weak positive correlation between pulmonary hypertension and the size of atrial septal defect, increases in size of atrial septal defect correlate with increases in pulmonary hypertension and this was found not to be statistically significant (n = 67, r = 0.193, p = 0.118). There was a positive correlation between the size of atrial septal defect and the age of participants in months, increases in age correlate with increases in size of atrial septal defect and this was found to be statistically significant (n = 67, r = 0.357, p = 0.003).The highest proportion of respondents who had pulmonary hypertension, 64.7%, was seen among children less than 1 year old while the least proportion, 27.3%, was within 1–5 years, and the difference in proportions was found to be statistically significant (χ2 = 8.187, p = 0.017). Conclusion: Pulmonary hypertension in children with ASD occur usually in the mild form. Age is the only strong predictor of PAH in children with isolated ASD.
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Affiliation(s)
- Josephat M Chinawa
- Professor and Pediatric Cardiologist, College of Medicine, Department of pediatrics, University of Nigeria/University of Nigeria Teaching Hospital (UNTH), Ituku- Ozalla, Enugu State, Nigeria
| | - Awoere T Chinawa
- Senior Lecturer, Department of Paediatrics and Child health, Niger Delta University Teaching Hospital, Nigeria
| | - Edmund N Ossai
- Senior Lecturer, Department of Community Medicine, College of Health Sciences, Ebonyi State University Abakaliki, Nigeria
| | - Chika O Duru
- Lecturer, Enugu state University Teaching hospital, Nigeria
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30
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Deng J. Clinical application of pulmonary vascular resistance in patients with pulmonary arterial hypertension. J Cardiothorac Surg 2021; 16:311. [PMID: 34670595 PMCID: PMC8527803 DOI: 10.1186/s13019-021-01696-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/11/2021] [Indexed: 12/03/2022] Open
Abstract
Pulmonary arterial hypertension is a type of malignant pulmonary vascular disease, which is mainly caused by the increase of pulmonary vascular resistance due to the pathological changes of the pulmonary arteriole itself, which eventually leads to right heart failure and death. As one of the diagnostic indicators of hemodynamics, pulmonary vascular resistance plays an irreplaceable role in the pathophysiology, diagnosis and treatment of pulmonary arterial hypertension. It provides more references for the evaluation of pulmonary arterial hypertension patients. This article summarizes the clinical application of pulmonary vascular resistance in patients with pulmonary arterial hypertension.
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Affiliation(s)
- Jianying Deng
- Department of Cardiovascular Surgery, Chongqing Kanghua Zhonglian Cardiovascular Hospital, 168# Haier Road, District of Jiangbei, Chongqing, 400015, China.
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31
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Huntgeburth M, Hohmann C, von Scheidt F, Meierhofer C. Überraschende Echobefunde als Erstdiagnose eines angeborenen Herzfehlers im Erwachsenenalter. AKTUELLE KARDIOLOGIE 2021. [DOI: 10.1055/a-1535-3115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ZusammenfassungAngeborene Herzfehler (AHF) werden teilweise erst im Erwachsenenalter diagnostiziert, entweder weil sie erst dann klinisch auffällig werden oder bei vorausgegangenen Untersuchungen übersehen wurden. Im Rahmen einer routinemäßigen transthorakalen Echokardiografie (TTE) können in der kardiologischen Praxis oder Klinik angeborene kardiale Anomalien leicht fehlgedeutet werden, da der Fokus in der Erwachsenenkardiologie überwiegend bei erworbenen Herzfehlern, einer Kardiomyopathie, Klappenerkrankungen oder einer systolischen oder diastolischen Dysfunktion liegt. Demgegenüber spielt eine thematische Auseinandersetzung mit AHF häufig eine nur untergeordnete Rolle, die Erwartungshaltung hinsichtlich angeborener kardialer Anomalien ist eher gering und die Sinne für mögliche AHF oft nicht geschärft. Dieser Artikel soll dazu beitragen, die Wahrscheinlichkeit des Erkennens eines AHF im Rahmen der TTE-Untersuchung zu erhöhen.
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Affiliation(s)
- Michael Huntgeburth
- Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Technische Universität München, Deutschland
| | - Christopher Hohmann
- Klinik III für Innere Medizin, Klinik für Kardiologie, Angiologie, Pneumologie und internistische Intensivmedizin, Zentrum für Erwachsene mit angeborenen Herzfehlern (EMAH), Universitätsklinikum Köln, Köln, Deutschland
| | - Fabian von Scheidt
- Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Technische Universität München, Deutschland
| | - Christian Meierhofer
- Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Technische Universität München, Deutschland
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32
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Fernandes CJ, Calderaro D, Assad APL, Salibe-Filho W, Kato-Morinaga LT, Hoette S, Piloto B, Castro MA, Lisboa RP, da Silva TAF, Martins MDA, Alves-Jr JL, Jardim C, Terra-Filho M, de Souza R. Update on the Treatment of Pulmonary Arterial Hypertension. Arq Bras Cardiol 2021; 117:750-764. [PMID: 34709302 PMCID: PMC8528352 DOI: 10.36660/abc.20200702] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/13/2020] [Accepted: 11/04/2020] [Indexed: 11/28/2022] Open
Abstract
In the last decades, important advances have been made in the treatment of pulmonary arterial hypertension (PAH), a severe, progressive, incurable, and potentially fatal disease. For an adequate therapy, correct hemodynamic diagnosis and etiology classification are fundamental. Many etiologies - rheumatic disease, portal hypertension, congenital heart diseases, schistosomiasis - require specific measures, in addition to drug therapy for PAH. The specific therapy for PAH is based on medications that act on three pathophysiological pathways - prostacyclin, endothelin, and nitric oxide pathways. These drugs have multiple presentations (oral, intravenous, subcutaneous, and inhaled) and have changed the history of PAH. This review presents an overview of drug therapy strategies and different forms and peculiarities of PAH.
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Affiliation(s)
- Caio J. Fernandes
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Instituto do CâncerFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Câncer da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasilHospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Daniela Calderaro
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Medicina Interdisciplinar - Divisão de Cardiologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Ana Paula Luppino Assad
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasilHospital Sírio-Libanês, São Paulo, SP - Brasil
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilDisciplina de Reumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - William Salibe-Filho
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Luciana Tamie Kato-Morinaga
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasilHospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Susana Hoette
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Bruna Piloto
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasilHospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Marcela Araújo Castro
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasilHospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Roberta Pontes Lisboa
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasilHospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Taysa Antonia Felix da Silva
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasilHospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Murillo de Araújo Martins
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Jose L. Alves-Jr
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Instituto do CâncerFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Câncer da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasilHospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Carlos Jardim
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasilHospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Mario Terra-Filho
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasilHospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Rogerio de Souza
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasilHospital Sírio-Libanês, São Paulo, SP - Brasil
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Brida M, Chessa M, Celermajer D, Li W, Geva T, Khairy P, Griselli M, Baumgartner H, Gatzoulis MA. Atrial septal defect in adulthood: a new paradigm for congenital heart disease. Eur Heart J 2021; 43:2660-2671. [PMID: 34535989 DOI: 10.1093/eurheartj/ehab646] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/09/2021] [Accepted: 09/03/2021] [Indexed: 11/13/2022] Open
Abstract
Atrial septal defects (ASDs) represent the most common congenital heart defect diagnosed in adulthood. Although considered a simple defect, challenges in optimal diagnostic and treatment options still exist due to great heterogeneity in terms of anatomy and time-related complications primarily arrhythmias, thromboembolism, right heart failure and, in a subset of patients, pulmonary arterial hypertension (PAH). Atrial septal defects call for tertiary expertise where all options may be considered, namely catheter vs. surgical closure, consideration of pre-closure ablation for patients with atrial tachycardia and suitability for closure or/and targeted therapy for patients with PAH. This review serves to update the clinician on the latest evidence, the nuances of optimal diagnostics, treatment options, and long-term follow-up care for patients with an ASD.
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Affiliation(s)
- Margarita Brida
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK.,Division of Adult Congenital Heart Disease, Department of Cardiovascular Medicine, University Hospital Centre Zagreb, Kispaticeva ul. 12, Zagreb 10000, Croatia.,Department of Medical Rehabilitation, Medical Faculty, University of Rijeka, Ul. Braće Branchetta 20/1, Rijeka 51000, Croatia
| | - Massimo Chessa
- ACHD Unit - Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, Piazza Edmondo Malan, 2, Milan 20097, Italy.,UniSR - Vita Salute San Raffaele University, Via Olgettina, 58, Milan 20132, Italy
| | - David Celermajer
- Heart Research Institute, University of Sydney, Camperdown, NSW 2050, Australia
| | - Wei Li
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK
| | - Tal Geva
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA.,Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA
| | - Paul Khairy
- Department of Medicine, Montreal Heart Institute, Université de Montréal, 5000 Rue Bélanger, Montréal, QC H1T 1C8, Canada
| | - Massimo Griselli
- Division of Pediatric Cardiovascular Surgery, Masonic Children's Hospital, University of Minnesota, 2450 Riverside Ave, Minneapolis, MN 55454, USA
| | - Helmut Baumgartner
- Department of Cardiology III: Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, Muenster 48149, Germany
| | - Michael A Gatzoulis
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK
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Clark DE, Byrne RD, Mazurek JA, Opotowsky AR, Schlendorf KH, Xu M, Zalawadiya S, Menachem JN. Sizing heart transplant donors in adults with congenital heart disease. J Thorac Cardiovasc Surg 2021; 162:422-428.e1. [DOI: 10.1016/j.jtcvs.2020.01.099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/15/2020] [Accepted: 01/20/2020] [Indexed: 02/08/2023]
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Arshad HB, Duarte VE. Evaluation and Management of Pulmonary Arterial Hypertension in Congenital Heart Disease. Methodist Debakey Cardiovasc J 2021; 17:145-151. [PMID: 34326934 PMCID: PMC8298124 DOI: 10.14797/ufej2329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2021] [Indexed: 01/21/2023] Open
Abstract
Pulmonary arterial hypertension is a common complication in patients with congenital heart disease (CHD), aggravating the natural course of the underlying defect. Pulmonary arterial hypertension (PAH) has a multifactorial etiology depending on the size and nature of the cardiac defect as well as environmental factors. Although progress has been made in disease-targeting therapy using pulmonary vasodilators to treat Eisenmenger syndrome, important gaps still exist in the evaluation and management of adult patients with CHD-associated PAH (PAH-CHD) who have systemic-to-pulmonary shunts. The choice of interventional, medical, or both types of therapy is an ongoing dilemma that requires further data. This review focuses on the evaluation and management of PAH-CHD in the contemporary era.
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Affiliation(s)
- Hassaan B Arshad
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
| | - Valeria E Duarte
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
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Arvanitaki A, Ntiloudi D, Giannakoulas G, Dimopoulos K. Prediction Models and Scores in Adult Congenital Heart Disease. Curr Pharm Des 2021; 27:1232-1244. [PMID: 33430742 DOI: 10.2174/1381612827999210111181554] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 10/23/2020] [Indexed: 11/22/2022]
Abstract
Nowadays, most patients with congenital heart disease survive to adulthood due to advances in pediatric cardiac surgery but often present with various comorbidities and long-term complications, posing challenges in their management. The development and clinical use of risk scores for the prediction of morbidity and/or mortality in adults with congenital heart disease (ACHD) is fundamental in achieving optimal management for these patients, including appropriate follow-up frequency, treatment escalation, and timely referral for invasive procedures or heart transplantation. In comparison with other fields of cardiovascular medicine, there are relatively few studies that report prediction models developed in the ACHD population, given the small sample size, heterogeneity of the population, and relatively low event rate. Some studies report risk scores originally developed in pediatric congenital or non-congenital population, externally validated in ACHD with variable success. Available risk scores are designed to predict heart failure or arrhythmic events, all-cause mortality, post-intervention outcomes, infective endocarditis, or atherosclerosis-related cardiovascular disease in ACHD. A substantial number of these scores are derived from retrospective studies and are not internally or externally validated. Adequately validated risk scores can be invaluable in clinical practice and an important step towards personalized medicine. Multicenter collaboration, adequate study design, and the potential use of artificial intelligence are important elements in the effort to develop reliable risk scores for the ACHD population.
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Affiliation(s)
- Alexandra Arvanitaki
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer- Campus 1, 48149, Muenster, Germany
| | - Despoina Ntiloudi
- 1st Department of Cardiology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki St. Kiriakidi 1, 54636, Greece
| | - George Giannakoulas
- 1st Department of Cardiology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki St. Kiriakidi 1, 54636, Greece
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, United Kingdom
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Kücükoglu SM, Kaymaz C, Alehan D, Kula S, Akcevin A, Celiker A, Cicek SM, Tokgözoglu LS, Kentli S. Pulmonary arterial hypertension associated with congenital heart disease: lessons learnt from the large Turkish Nationwide Registry (THALES). Pulm Circ 2021; 11:20458940211024206. [PMID: 34211699 PMCID: PMC8216355 DOI: 10.1177/20458940211024206] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 05/23/2021] [Indexed: 11/24/2022] Open
Abstract
Pulmonary hypertension is a group of diseases, including pulmonary arterial hypertension associated with congenital heart disease (APAH-CHD), characterized by progressive deterioration in pulmonary hemodynamics associated with substantial morbidity and mortality risk. THALES is a national multicenter, prospective observational registry, providing data on patients with APAH-CHD. The study comprised APAH-CHD patients (>3 months of age) with confirmed diagnosis of right heart catheterization or echocardiographic findings. Initial and follow-up data were collected via regular hospital visits. Descriptive statistics are used for definitive purposes. Overall, 1034 patients aged 3 months–79 years (median 11.2 [Q1–Q3: 2.2–24.3] years) with APAH-CHD were enrolled at 61 centers, 50.3% being retrospectively enrolled. Most had either Eisenmenger's syndrome (49.2%) or systemic-to-pulmonary shunts (42.7%). Patients were mostly in functional class I–II at the time of diagnosis (46.6%). Mean 6-min walk distance (6MWD) was 369 ± 120 m. Mean pulmonary arterial pressure was 54.7 ± 22.2 mmHg for the whole group, and was highest in patients with Eisenmenger's syndrome. Targeted therapies were noted in 398 (38.5%) patients (monotherapy in 80.4%). Follow-up data were available in 506 patients. Survival at 140 months was 79% and was associated with baseline 6MWD >440 m (p = 0.009), brain natriuretic peptide level < 300 ng/L (p < 0.001). Follow-up 6MWD >165 m (p < 0.0001), brain natriuretic peptide level <300 ng/L (p = 0.031), and targeted therapies (p = 0.004) were also predictive of survival. THALES is the largest registry dedicated to APAH-CHD to date and provides important contributions on demographics, clinical characteristics, and gaps in disease management.
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Affiliation(s)
- Serdar M. Kücükoglu
- Department of Cardiology, Istanbul University Cardiology Institute, Istanbul, Turkey
- Serdar M. Kücükoglu, Department of Cardiology, Istanbul University Cardiology Institute, Haseki Caddesi, Istanbul 34096, Turkey.
| | - Cihangir Kaymaz
- Department of Cardiology, University of Health Sciences, Hamidiye Faculty of Medicine, Kartal Koşuyolu Yüksek Ihtisas Training and Research Hospital, Istanbul, Turkey
| | - Dursun Alehan
- Department of Pediatric Cardiology, Hacettepe University Hospitals, Hacettepe University Hospitals, Ankara, Turkey
| | - Serdar Kula
- Department of Pediatric Cardiology, Gazi University Hospital, Ankara, Turkey
| | - Atıf Akcevin
- Department of Pediatric Cardiovascular Surgery, Koc University Hospital, Istanbul, Turkey
| | - Alpay Celiker
- Department of Pediatric Cardiology, Koc University Hospital, Istanbul, Turkey
| | - Sertac M. Cicek
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Lale S. Tokgözoglu
- Department of Cardiology, Hacettepe University Hospitals, Ankara, Turkey
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Takaya Y, Akagi T, Sakamoto I, Kanazawa H, Nakazawa G, Murakami T, Yao A, Nanasato M, Saji M, Hirokami M, Fuku Y, Hosokawa S, Tada N, Matsumoto K, Imai M, Nakagawa K, Ito H. Efficacy of treat-and-repair strategy for atrial septal defect with pulmonary arterial hypertension. Heart 2021; 108:382-387. [PMID: 34415851 PMCID: PMC8862039 DOI: 10.1136/heartjnl-2021-319096] [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: 01/29/2021] [Accepted: 05/21/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Therapeutic strategies for atrial septal defect (ASD) with severe pulmonary arterial hypertension (PAH) are controversial. This study aimed to evaluate the efficacy of PAH-specific medications and subsequent transcatheter closure (ie, treat-and-repair strategy) on clinical outcomes. METHODS We enrolled 42 patients who were referred to 13 institutions for consideration of ASD closure with concomitant PAH and underwent the treat-and-repair strategy. The endpoint was cardiovascular death or hospitalisation due to heart failure or exacerbated PAH. RESULTS At baseline prior to PAH-specific medications, pulmonary to systemic blood flow ratio (Qp:Qs), pulmonary vascular resistance (PVR), and mean pulmonary artery pressure (PAP) were 1.9±0.8, 6.9±3.2 Wood units and 45±15 mm Hg. Qp:Qs was increased to 2.4±1.2, and PVR and mean PAP were decreased to 4.0±1.5 Wood units and 35±9 mm Hg at the time of transcatheter ASD closure after PAH-specific medications. Transcatheter ASD closure was performed without any complications. During a median follow-up period of 33 months (1-126 months) after transcatheter ASD closure, one older patient died and one patient was hospitalised due to heart failure, but the other patients survived with an improvement in WHO functional class. PAP was further decreased after transcatheter ASD closure. CONCLUSIONS The treat-and-repair strategy results in low complication and mortality rates with a reduction in PAP in selected patients with ASD complicated with PAH who have a favourable response of medical therapy.
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Affiliation(s)
- Yoichi Takaya
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Teiji Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ichiro Sakamoto
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Hideaki Kanazawa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Gaku Nakazawa
- Department of Cardiology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Tsutomu Murakami
- Department of Cardiology, Tokai University Hospital, Isehara, Japan
| | - Atsushi Yao
- Division for Health Service Promotion, University of Tokyo, Tokyo, Japan
| | - Mamoru Nanasato
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Mitsugu Hirokami
- Department of Cardiology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Yasushi Fuku
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Shinobu Hosokawa
- Department of Cardiology, Tokushima Red Cross Hospital, Komatsushima, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan
| | - Kensuke Matsumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masao Imai
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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A Woman with a Repaired Atrial Septal Defect and Pulmonary Hypertension with Worsening Dyspnea. Ann Am Thorac Soc 2021; 18:1052-1058. [PMID: 34076557 DOI: 10.1513/annalsats.202007-825cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Constantine A, Condliffe R, Clift P, Tulloh R, Dimopoulos K. Palliative care in pulmonary hypertension associated with congenital heart disease: systematic review and expert opinion. ESC Heart Fail 2021; 8:1901-1914. [PMID: 33660435 PMCID: PMC8120400 DOI: 10.1002/ehf2.13263] [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] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/13/2021] [Accepted: 01/29/2021] [Indexed: 01/10/2023] Open
Abstract
AIMS Pulmonary arterial hypertension (PAH) is common amongst patients with congenital heart disease (CHD). It is a severe and complex condition that adversely affects quality of life and prognosis. While quality of life questionnaires are routinely used in clinical pulmonary hypertension practice, little is known on how to interpret their results and manage PAH-CHD patients with evidence of impaired health-related quality of life, especially those with advanced disease and palliative care needs. METHODS AND RESULTS We performed a systematic review of studies concerning palliative care for people with PAH-CHD, also reviewing the health-related quality of life literature pertaining to these patients. Of 330 papers identified through initial screening, 17 were selected for inclusion. Underutilization of advance care planning and palliative care resources was common. Where palliative care input was sought, this was frequently late in the course of the disease. No studies provided evidence-based clinical criteria for triggering referral to palliative care, a framework for providing tailored care in this patient group, or how to manage the risk of sudden cardiac death and implantable cardioverter defibrillators in advanced PAH-CHD. We synthesize this information into eight important areas, including the impact of PAH-CHD on quality of life, barriers to and benefits of palliative care involvement, advance care planning discussions, and end-of-life care issues in this complex patient group, and provide expert consensus on best practice in this field. CONCLUSIONS This paper presents the results of a systematic review and expert statements on the preferred palliative care strategy for patients with PAH-CHD.
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Affiliation(s)
- Andrew Constantine
- Adult Congenital Heart Centre and Centre for Pulmonary HypertensionRoyal Brompton HospitalSydney StreetLondonSW3 6NPUK
- National Heart and Lung InstituteImperial College LondonLondonUK
| | - Robin Condliffe
- Pulmonary Vascular Disease UnitRoyal Hallamshire HospitalSheffieldUK
| | - Paul Clift
- Department of CardiologyQueen Elizabeth Hospital BirminghamBirminghamUK
| | - Robert Tulloh
- Bristol Heart InstituteUniversity Hospitals Bristol, Weston NHS Foundation TrustBristolUK
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Centre and Centre for Pulmonary HypertensionRoyal Brompton HospitalSydney StreetLondonSW3 6NPUK
- National Heart and Lung InstituteImperial College LondonLondonUK
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Barradas-Pires A, Constantine A, Dimopoulos K. Preventing disease progression in Eisenmenger syndrome. Expert Rev Cardiovasc Ther 2021; 19:501-518. [PMID: 33853494 DOI: 10.1080/14779072.2021.1917995] [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: 10/21/2022]
Abstract
Introduction: Eisenmenger syndrome describes a condition in which a congenital heart defect has caused severe pulmonary vascular disease, resulting in reversed (right-left) or bidirectional shunting and chronic cyanosis.Areas covered: In this paper, the progression of congenital heart defects to Eisenmenger syndrome, including early screening, diagnosis and operability are covered. The mechanisms of disease progression in Eisenmenger syndrome and management strategies to combat this, including the role of pulmonary arterial hypertension therapies, are also discussed.Expert opinion/commentary: Patients with congenital heart disease (CHD) are at increased risk of developing pulmonary arterial hypertension with Eisenmenger syndrome being its extreme manifestation. All CHD patients should be regularly assessed for pulmonary hypertension. Once Eisenmenger syndrome develops, shunt closure should be avoided. The clinical manifestations of Eisenmenger syndrome are driven by the systemic effects of the pulmonary hypertension, congenital defect and long-standing cyanosis. Expert care is essential for avoiding pitfalls and preventing disease progression in this severe chronic condition, which is associated with significant morbidity and mortality. Pulmonary arterial hypertension therapies have been used alongside supportive care to improve the quality of life, exercise tolerance and the outcome of these patients, although the optimal timing for their introduction and escalation remains uncertain.
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Affiliation(s)
- Ana Barradas-Pires
- Department of Cardiology, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
| | - Andrew Constantine
- Department of Cardiology, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK.,Biomedical Research Unit, National Heart & Lung Institute, Imperial College London, UK
| | - Konstantinos Dimopoulos
- Department of Cardiology, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK.,Biomedical Research Unit, National Heart & Lung Institute, Imperial College London, UK
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Baumgartner H, De Backer J, Babu-Narayan SV, Budts W, Chessa M, Diller GP, Iung B, Kluin J, Lang IM, Meijboom F, Moons P, Mulder BJ, Oechslin E, Roos-Hesselink JW, Schwerzmann M, Sondergaard L, Zeppenfeld K, Ernst S, Ladouceur M, Aboyans V, Alexander D, Christodorescu R, Corrado D, D’Alto M, de Groot N, Delgado V, Di Salvo G, Dos Subira L, Eicken A, Fitzsimons D, Frogoudaki AA, Gatzoulis M, Heymans S, Hörer J, Houyel L, Jondeau G, Katus HA, Landmesser U, Lewis BS, Lyon A, Mueller CE, Mylotte D, Petersen SE, Petronio AS, Roffi M, Rosenhek R, Shlyakhto E, Simpson IA, Sousa-Uva M, Torp-Pedersen CT, Touyz RM, Van De Bruaene A. Guía ESC 2020 para el tratamiento de las cardiopatías congénitas del adulto. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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43
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Li M, Wang Y, Li H, Huang Y, Huang T, Zhang C, Fei H. A prediction model of simple echocardiographic variables to screen for potentially correctable shunts in adult patients with pulmonary arterial hypertension associated with atrial septal defects: a cross-sectional study. Int J Cardiovasc Imaging 2021; 37:1551-1562. [PMID: 33528711 DOI: 10.1007/s10554-020-02128-5] [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: 08/15/2020] [Accepted: 12/01/2020] [Indexed: 02/05/2023]
Abstract
During the routine follow-up of adult patients with pulmonary arterial hypertension associated with atrial septal defects (ASD-PAH), the suitability of shunt closure depends on the invasive right heart catheterization (RHC). It is difficult to grasp the timing of RHC shunt closure for moderate-severe PAH. This retrospective cross-sectional study was designed to investigate which echocardiographic variables are related to pulmonary vascular resistance (PVR) in adult ASD-PAH patients and propose a method using echocardiographic variables to screen for patients where shunt closure is suitable. A total of 139 adult ASD-PAH patients with a PASP ≥ 60 mmHg measured by transthoracic echocardiogram (TTE) were included in this study. All RHCs were performed within a week after TTE. The Correctable shunt was defined as PVR ≤ 4.6 wood units (WU). Multivariate regressions were performed with echocardiographic variables. The nomogram of prediction model was constructed by the predictors of PVR ≤ 4.6 WU by multivariate logistic regression analysis. Multivariate linear regression revealed that TAPSE (tricuspid annular plane systolic excursion)/pulmonary artery systolic pressure (PASP) measured by TTE was negatively associated with PVR (β per SD: - 1.84, 95%CI - 2.62, - 1.06). Multivariate logistic regression showed that TAPSE/PASP and pulmonary valve (PV) peak velocity were positively associated with a potentially correctable shunt (PVR ≤ 4.6 WU) (OR per SD: 2.38, 95%CI 1.34, 4.25, and OR per SD: 2.67, 95%CI 1.26, 5.64, respectively). In receiver operating characteristic analysis, the TAPSE/PASP + PV peak velocity combined model achieved the best performance (AUC: 0.8584, sensitivity: 83.33%, specificity: 72.16%). Internal verification showed stable performance (AUC: 0.8591, sensitivity: 88.10%, specificity: 68.04%). The net benefit of this model was greater than other models when it came to a wide range probability threshold in decision curve analysis. TAPSE/PASP + PV the peak velocity model may have great value in predicting adult ASD-PAH patients with operability potential, which could help clinicians make the treatment decision for follow-up patients.
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Affiliation(s)
- Mingqi Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510100, China
- Shantou University Medical College, Shantou, 515000, Guangdong, China
| | - Yu Wang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510100, China
- Shantou University Medical College, Shantou, 515000, Guangdong, China
| | - Hezhi Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510100, China
| | - Yigao Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510100, China
| | - Tao Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510100, China
| | - Caojin Zhang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510100, China.
| | - Hongwen Fei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510100, China.
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Kearney K, Lau EM, Darley D, Romfh A, Bart N, Kotlyar E, Hayes D, Khush K, Keogh A. Waitlist and post-transplant outcomes for eisenmenger syndrome: A comparison of transplant strategies. J Heart Lung Transplant 2021; 40:841-849. [PMID: 34112578 DOI: 10.1016/j.healun.2021.04.005] [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: 10/16/2020] [Revised: 03/30/2021] [Accepted: 04/13/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND End-stage Eisenmenger syndrome (ES) due to unrepaired atrial septal defect (ASD) or ventricular septal defect (VSD) is an indication for lung transplantation (LTx) or heart-lung transplantation (HLTx). Limited evidence exists as to the optimal transplant strategy for this unique population. AIM To describe waitlist characteristics and post-transplant outcomes in patients with ES-ASD or ES-VSD. METHODS Using the ISHLT Registry, data were extracted for all ES-ASD or ES-VSD patients who underwent transplantation between 1987 and 2018. Additional data were sought for patients listed for LTx or HLTx in the OPTN Registry during the same period. Early era was defined as 1987-2004, and current era was defined as 2005-2018. RESULTS In the current era, patients with ES-ASD or ES-VSD represented a lessening proportion of all LTx and HLTx. Compared to LTx for other indications, the odds of transplantation were significantly less for both ES-ASD 0.18 [0.07-0.50] and ES-VSD 0.03 [0.004-0.22]. In the early era, an equivalent survival was observed for ES-ASD who underwent HLTx versus LTx (p = 0.47), and superior survival for ES-VSD (p = 0.015). In contrast, ES-ASD patients who underwent LTx from the current era displayed better survival compared with HLTx, 10-year survival 52% vs 30% p = 0.036. Similar survival were observed for ES-VSD for both transplant strategies (p = 0.68). CONCLUSION LTx shows superior survival outcomes in the current era for ES ASD patients, and equivalent outcomes for ES-VSD. In the current era, ES-ASD or ES-VSD patients were less likely to be transplanted than other candidates for LTx.
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Affiliation(s)
- Katherine Kearney
- Heart Transplant and Pulmonary Hypertension Unit, St Vincent's Hospital, Sydney, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, Australia.
| | - Edmund M Lau
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, Australia
| | - David Darley
- Lung Transplant Unit, St Vincent's Hospital, Sydney, Australia
| | - Anitra Romfh
- Department of Cardiology, Stanford University, California
| | - Nicole Bart
- Heart Transplant and Pulmonary Hypertension Unit, St Vincent's Hospital, Sydney, Australia
| | - Eugene Kotlyar
- Heart Transplant and Pulmonary Hypertension Unit, St Vincent's Hospital, Sydney, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Don Hayes
- Lung Transplant Unit, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kiran Khush
- Department of Cardiology, Stanford University, California
| | - Anne Keogh
- Heart Transplant and Pulmonary Hypertension Unit, St Vincent's Hospital, Sydney, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, Australia
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Windsor J, Mukundan C, Stopak J, Ramakrishna H. Analysis of the 2020 European Society of Cardiology (ESC) Guidelines for the Management of Adults With Congenital Heart Disease (ACHD). J Cardiothorac Vasc Anesth 2021; 36:2738-2757. [PMID: 33985885 DOI: 10.1053/j.jvca.2021.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 04/04/2021] [Indexed: 01/02/2023]
Abstract
Adult congenital heart disease (ACHD) continues to rapidly increase worldwide. With an estimated 1.5 million adults with ACHD in the USA alone, there is a growing need for better education in the management of these complex patients and multiple knowledge gaps exist. This manuscript comprehensively reviewed the recent (2020) updated European Society of Cardiology Guidelines for the management of ACHD created by the Task Force for the management of adult congenital heart disease of the European Society of Cardiology, with perioperative implications for the adult cardiac anesthesiologist and intensivist who may be called upon to manage these complex patients.
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Affiliation(s)
- Jimmy Windsor
- Clinical Associate Professor of Anesthesia, University of Iowa Carver College of Medicine Department of Anesthesia, Division of Pediatric Anesthesia, 200 Hawkins Drive, Iowa City, Iowa, 52242
| | - Chaitra Mukundan
- Clinical Assistant Professor of Anesthesia, University of Iowa Carver College of Medicine Department of Anesthesia, Division of Pediatric Anesthesia, 200 Hawkins Drive, Iowa City, Iowa, 52242
| | - Joshua Stopak
- Clinical Assistant Professor of Anesthesia, University of Iowa Carver College of Medicine Department of Anesthesia, Division of Pediatric Anesthesia, 200 Hawkins Drive, Iowa City, Iowa, 52242
| | - Harish Ramakrishna
- Professor of Anesthesiology, Mayo Clinic School of Medicine, Department of Anesthesiology and Perioperative Medicine, Division of Cardiovascular and Thoracic Anesthesiology, 200 First Street SW, Rochester, MN 55905.
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Xu Z, Gatzoulis MA, Dimopoulos K, Li Q, Zhang C, Keller BB, Gu H. Better Outcomes in Pulmonary Arterial Hypertension After Repair of Congenital Heart Disease, Compared With Idiopathic Pulmonary Arterial Hypertension. CJC Open 2021; 3:872-879. [PMID: 34401694 PMCID: PMC8347865 DOI: 10.1016/j.cjco.2021.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/11/2021] [Indexed: 11/18/2022] Open
Abstract
Background Pulmonary vascular changes in postoperative pulmonary artery hypertension (PAH) are similar to those seen in idiopathic PAH. Data are sparse on direct comparative midterm outcomes for these 2 high-risk populations. Methods Patients with idiopathic or postoperative PAH referred to a large tertiary hospital between June 2005 and July 2019 were retrospectively evaluated. Results A total of 364 consecutive patients were studied, including 201 postoperative PAH patients and 163 patients with idiopathic PAH, with a median age of 18.7 (interquartile range 10.0, 31.5) and 7.3 (IQR: 2.9, 18.3) years, respectively. PAH-specific drugs were used in 77.7% of patients; 31.4% received combination therapy. Patients with idiopathic PAH had a shorter 6-mintue walk distance, lower percutaneous oxygen saturation, and higher B-type natriuretic peptide levels than those with postoperative PAH at diagnosis (all P < 0.001), During a median follow-up time of 3.4 (interquartile range: 2.1, 5.8) years, 56 patients (15.4%) died, and one underwent bilateral lung transplantation. Patients with postoperative PAH had better survival than those with idiopathic PAH, according to age (hazard ratio [HR] 0.128, 95% confidence interval [CI]: 0.07-0.22, P < 0.0001); Kaplan–Meier survival estimates at 5 years for idiopathic and postoperative PAH patients were 74.3% and 92.6%, respectively. Patients in New York Heart Association functional class III–IV had an over 4-fold increased risk of death (HR 4.85, 95% CI: 2.61-9.00, P < 0.0001). Patients < 18 years of age at idiopathic PAH diagnosis had a worse survival compared to adult patients (HR 6.90, 95% CI: 4.19-15.56, P = 0.040). Conclusions Postoperative-PAH patients had better midterm survival compared to patients with idiopathic PAH. Mortality was significant in both PAH groups, reinforcing the need for early diagnosis and optimal individualized management to improve outcomes.
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Affiliation(s)
- Zhuoyuan Xu
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Michael A. Gatzoulis
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital and Imperial College, London, United Kingdom
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital and Imperial College, London, United Kingdom
| | - Qiangqiang Li
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Chen Zhang
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Bradley B. Keller
- Cincinnati Children’s Heart Institute Greater Louisville and Western Kentucky Practice, Louisville, Kentucky, USA
| | - Hong Gu
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
- Corresponding author: Dr Hong Gu, Department of Pediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Rd, Chaoyang District, Beijing 100029, China. Tel.: +1-86-10-64456498.
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Baumgartner H, De Backer J, Babu-Narayan SV, Budts W, Chessa M, Diller GP, Lung B, Kluin J, Lang IM, Meijboom F, Moons P, Mulder BJM, Oechslin E, Roos-Hesselink JW, Schwerzmann M, Sondergaard L, Zeppenfeld K. 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J 2021; 42:563-645. [PMID: 32860028 DOI: 10.1093/eurheartj/ehaa554] [Citation(s) in RCA: 878] [Impact Index Per Article: 292.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Successful outcomes for atrial septal defect associated with pulmonary arterial hypertension using a “treat-repair-treat” strategy. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2020.100075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Abstract
Presently, with increasing survival of patients with congenital heart disease (CHD), pulmonary arterial hypertension (PAH) associated with CHD is commonly encountered in children and adults. This increased prevalence is seen despite significant advances in early diagnosis and surgical correction of patients with structural CHD. PAH is the cause of significant morbidity and mortality in these patients and comes in many forms. With the increased availability of targeted therapies for PAH, there is hope for improved hemodynamics, exercise capacity, quality of life, and possibly survival for these patients. There may also be opportunities for combined medical and interventional/surgical approaches for some.
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Affiliation(s)
- Erika B Rosenzweig
- Division of Pediatric Cardiology, Columbia University Irving Medical Center - New York Presbyterian Hospital, 3959 Broadway-CH-2N, New York, NY 10032, USA.
| | - Usha Krishnan
- Division of Pediatric Cardiology, Columbia University Irving Medical Center - New York Presbyterian Hospital, 3959 Broadway-CH-2N, New York, NY 10032, USA
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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: 9] [Impact Index Per Article: 2.3] [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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