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Pust F, Deis T, Larsson J, Hansen BL, Rossing K, Ersbøll M, Kristensen SL, Gustafsson F. Importance of heart failure duration for development of pulmonary hypertension in advanced heart failure. Int J Cardiol 2023; 391:131232. [PMID: 37604286 DOI: 10.1016/j.ijcard.2023.131232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/24/2023] [Accepted: 07/28/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND AND OBJECTIVES Pulmonary vascular resistance (PVR) is critical when evaluating candidacy for advanced heart failure (HF) therapies, but risk factors for elevated PVR are not well studied. We hypothesized that HF duration would be associated with elevated PVR. METHODS Danish single-center registry of consecutive in- and outpatients undergoing right heart catheterization as part of advanced HF work up. The relation between HF duration and PVR was estimated by regression analysis. Finally, the relation between PVR and long-term mortality was assessed by Cox proportional hazards regression and Kaplan-Meier analyses. RESULTS A total of 549 patients (77% men, median age 54 (43-61) years, median HF duration 1.6 years (0.1-7.1)) were included. Univariate linear regression displayed an association between longer HF duration and increasing PVR (p = 0.014). PVR > 3 WU was present in 92 patients (17%) who were older (median p < 0.001) and had longer HF duration (p = 0.03). HF duration (per 1 year increase) did not predict PVR > 3 WU after adjustment for covariables (OR 1.00; p = 0.99). During a mean follow-up time of 4.5 years, there were 240 (44%) deaths. Increasing PVR was associated with elevated all-cause mortality risk (adjusted HR 1.24; p < 0.001). PVR > 3 WU was associated with higher mortality (adjusted HR 1.49; p = 0.027). CONCLUSION Longer duration of HF was associated with higher PVR in patients with advanced HF, but this association disappeared in multivariate analyses. Longer HF duration per se likely does not cause elevated PVR and should not discourage evaluation for heart transplantation.
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Affiliation(s)
- Freja Pust
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Tania Deis
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Johan Larsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | | | - Kasper Rossing
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Mads Ersbøll
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | | | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark.
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2
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Radchenko GD, Botsiuk YA, Sirenko YM. Ventricular Function and Cardio-Ankle Vascular Index in Patients With Pulmonary Artery Hypertension. Vasc Health Risk Manag 2022; 18:889-904. [PMID: 36597509 PMCID: PMC9805732 DOI: 10.2147/vhrm.s385536] [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: 08/30/2022] [Accepted: 11/18/2022] [Indexed: 12/29/2022] Open
Abstract
Aim This study aims to evaluate the left ventricle (LV) systolic and diastolic function in patients with idiopathic pulmonary arterial hypertension (IPAH) and its correlation with systemic arterial stiffness assessed by cardio-ankle vascular index (CAVI). Patient and methods We included 37 patients with IPAH and 20 healthy people matched by age. All patients were assessed: vital signs, 6-minute walk test, NT-proBNP level, the CAVI, the right ventricular (RV) and LV function parameters, including ejection time (ET), tissue speckle-tracking values - global longitudinal strain (GLS) and strain rate (SR). Results The groups were matched by age, gender, BMI, office SBP and DBP. Patients with IPAH had higher heart rate, NT-proBNP level and lower ferritin level, GFR (CKD-EPI), SaO2 than healthy people. The mean CAVIleft was higher in IPAH patients than in the control group- 8.7±1.1 vs 7.5±0.9, P=0.007. Healthy people had significantly less E/e' and lower IVRT. LVET and RVET were shorter in IPAH patients. Patients with IPAH had mean LVGLS -(-17.6±4.8%) and 35.1% of them were with LVGLS ≤16% compared to healthy people -(-21.8±1.4%) and 0%, respectively. LVSR was significant less in IPAH patients, but in the normal range. We found significant correlations of CAVI with age, history of syncope, bilirubin, uric acid, total cholesterol, cardiac output, cardiac index, RVET, LVET and E/A. Multiple linear regression confirmed the independent significance for age (β=0.083±0.023, CI 0.033-0.133) and RVET (β=-0.018±0.005, CI -0.029 to -0.008) only. The risk to have CAVI ≥8 increased in 5.8 times in IPAH patients with RVET <248 ms (P=0.046). CAVI did not correlate with LVGLS and LVSR. Conclusion Significant worse systolic and diastolic LV functions were stated in pulmonary hypertensive patients compared to the control group. No LV GLS, no LV SR had significant associations with arterial stiffness evaluated by CAVI.
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Affiliation(s)
- Ganna Dmytrivna Radchenko
- State Institution “National Scientific Center “The M.D. Strazhesko Institute of Cardiology, Clinical and Regenerative Medicine of the National Academy of Medical Science of Ukraine”, Kyiv, Ukraine,Correspondence: Ganna Dmytrivna Radchenko, State Institution National Scientific Center “The M.D. Strazhesko Institute of Cardiology, Clinical and Regenerative Medicine of the National Academy of Medical Science of Ukraine”, 5, Svyatoslava Khorobroho str., Kyiv, 03151, Ukraine, Tel +38-0667128405, Email
| | - Yurii Anatoliiovych Botsiuk
- State Institution “National Scientific Center “The M.D. Strazhesko Institute of Cardiology, Clinical and Regenerative Medicine of the National Academy of Medical Science of Ukraine”, Kyiv, Ukraine
| | - Yuriy Mykolaiyovich Sirenko
- State Institution “National Scientific Center “The M.D. Strazhesko Institute of Cardiology, Clinical and Regenerative Medicine of the National Academy of Medical Science of Ukraine”, Kyiv, Ukraine
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3
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Kwon HJ, Park JH, Park JJ, Lee JH, Seong IW. Improvement of Left Ventricular Ejection Fraction and Pulmonary Hypertension Are Significant Prognostic Factors in Heart Failure with Reduced Ejection Fraction Patients. J Cardiovasc Imaging 2019; 27:257-265. [PMID: 31614396 PMCID: PMC6795568 DOI: 10.4250/jcvi.2019.27.e36] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/20/2019] [Accepted: 06/05/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND We evaluated long-term prognosis according to improvement of pulmonary hypertension (PH) and left ventricular ejection fraction (LVEF) in patients with heart failure with reduced ejection fraction (HFrEF) and PH. METHODS We included all consecutive patients with HFrEF and PH who had a baseline and follow-up echocardiographic examinations from September 2011 to March 2017. PH was defined as maximal velocity of tricuspid regurgitation (TR Vmax) over 3.0 m/s, and LVEF improvement was defined as LVEF change ≥ 15% from the baseline echocardiography. Primary outcome was 5-year major adverse cardio-cerebrovascular events (MACCE). RESULTS We analyzed 271 patients. Mean LVEF was 28±8% and TR Vmax was 3.4±0.4 m/s. On follow-up, 183 (68%) showed improvement of LVEF, and 165 (61%) demonstrated improvement of PH. We classified patients into 4 groups according to improvement of PH and LVEF; group 1 (both improvement, 134 patients), group 2 (PH improvement only, 31 patients), group 3 (LVEF improvement only, 49 patients) and group 4 (no improvement, 57 patients). Group 4 had older age, higher incidence of myocardial infarction and aggravation of pre-existing HF. During the follow-up (31±20 months), 27% died and 40.8% experienced MACCE. Group 4 had the worst survival (HR=4.332, 95% CI=2.396-7.833, p<0.001), and group 3 had increased MACCE rate (HR=2.030, 95% CI=1.060-3.888, p=0.033) compared with group 1. Group 2 had similar long-term clinical events (HR=1.085, 95% CI=0.458-2.571, p=0.853) to group 1. CONCLUSIONS In patients with HFrEF and PH, persistence of PH and no LVEF improvement was associated with the worst long-term outcome.
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Affiliation(s)
- Hee Jin Kwon
- Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jae Hyeong Park
- Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.
| | - Jin Joo Park
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Hwan Lee
- Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - In Whan Seong
- Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
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4
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Prognostic value and diagnostic properties of the diastolic pulmonary pressure gradient in patients with pulmonary hypertension and left heart disease. Int J Cardiol 2019; 290:138-143. [DOI: 10.1016/j.ijcard.2019.05.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 04/20/2019] [Accepted: 05/05/2019] [Indexed: 11/17/2022]
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5
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Kato TS, Daimon M, Satoh T. Use of Cardiac Imaging to Evaluate Cardiac Function and Pulmonary Hemodynamics in Patients with Heart Failure. Curr Cardiol Rep 2019; 21:53. [PMID: 31076948 DOI: 10.1007/s11886-019-1138-4] [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: 10/26/2022]
Abstract
PURPOSE OF REVIEW Noninvasive hemodynamic assessments in patients with heart failure (HF) are essential for appropriate diagnosis and establishment of the best treatment strategies. Recently, the impact of pulmonary circulation and right ventricular function on prognosis in HF patients has drawn increasing attention. In this article, we explore the usefulness of cardiac imaging for hemodynamic assessments, mainly focusing on echocardiographic evaluation. RECENT FINDINGS The reliability of Doppler echocardiography as a noninvasive alternative to Swan-Ganz catheterization has been well investigated with higher than 80% accuracy for estimating pulmonary artery pressure. Strain measurement and three-dimensional echocardiography are useful for evaluating right ventricular function together with pulmonary circulation. The accuracy of analyzing left and right ventricular functions by cardiac computed tomography and cardiac magnetic resonate imaging has also been established. These modalities can provide myocardial tissue information and allow calculation of the extracellular volume fraction as well. According to the rapid improvement of technologies, cardiac imaging has become an essential tool for hemodynamic evaluation in HF management.
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Affiliation(s)
- Tomoko S Kato
- Department of Medicine, Division of Cardiology, Showa University Koto Toyosu Hospital, 5-1-38 Toyosu, Koto-ku, Tokyo, 135-8577, Japan. .,Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan.
| | - Masao Daimon
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan.,Department of Clinical Laboratory, The University of Tokyo Hospital, Tokyo, Japan
| | - Toru Satoh
- Department of Cardiovascular Medicine, Kyorin University, Tokyo, Japan
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6
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Aronson D, Hardak E, Burger AJ. Hemodynamics of the diastolic pressure gradients in acute heart failure: implications for the diagnosis of pre-capillary pulmonary hypertension in left heart disease. Pulm Circ 2018; 9:2045894018815438. [PMID: 30419797 PMCID: PMC6299913 DOI: 10.1177/2045894018815438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The diastolic pressure gradient (DPG) has been proposed as the metric of choice for the diagnosis of pulmonary vascular changes in left heart disease. We tested the hypothesis that this metric is less sensitive to changes in left atrial pressure and stroke volume (SV) than the transpulmonary gradient (TPG). We studied the effect of dynamic changes in pulmonary capillary wedge pressure (PCWP), SV, and pulmonary artery capacitance (PAC) on DPG and TPG in 242 patients with acute heart failure undergoing decongestive therapy with continuous hemodynamic monitoring. There was a close impact of PCWP reduction on TPG and DPG, with a 0.13 mmHg (95% confidence interval [CI] 0.07–0.19, P < 0.0001) and 0.21 mmHg (95% CI 0.16–0.25, P < 0.0001) increase for every 1 mmHg decrease in PCWP, respectively. Changes in SV had a negligible effect on TPG and DPG (0.19 and 0.13 mmHg increase, respectively, for every 10-mL increase in SV). Heart rate was positively associated with DPG (0.41-mmHg increase per 10 BPM [95% CI 0.22–0.60, P < 0.0001]). The resistance-compliance product was positively associated with both TPG and DPG (2.65 mmHg [95% CI 2.47–2.83] and 1.94 mmHg [95% CI 1.80–2.08] for each 0.1-s increase, respectively). In conclusion, DPG is not less sensitive to changes in left atrial pressure and SV compared with TPG. Although DPG was not affected by changes in PAC, the concomitant increase in the resistance-compliance product increases DPG.
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Affiliation(s)
- Doron Aronson
- 1 Department of Cardiology, Rambam Medical Center, Haifa, Israel.,2 Ruth and Bruce Rappaport Faculty of Medicine and Research Institute, Technion, Israel Institute of Technology, Haifa, Israel
| | - Emilia Hardak
- 2 Ruth and Bruce Rappaport Faculty of Medicine and Research Institute, Technion, Israel Institute of Technology, Haifa, Israel.,3 Pulmonary Division, Rambam Health Care Campus, Haifa, Israel
| | - Andrew J Burger
- 4 Division of Cardiovascular Disease, University of Cincinnati, Cincinnati, OH, USA
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7
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Santiago-Vacas E, Farrero M, Ivey-Miranda JB, Castel MÁ, García-Álvarez A, Rios J, Perez-Villa F. Initial experience with bosentan for the management of pulmonary hypertension after heart transplantation. Clin Transplant 2018; 32:e13364. [PMID: 30058129 DOI: 10.1111/ctr.13364] [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: 03/18/2018] [Revised: 07/25/2018] [Accepted: 07/25/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pulmonary hypertension (PH) after heart transplantation (HT) is associated to right ventricular (RV) dysfunction and increased morbidity and mortality. We present our experience with bosentan for the treatment of PH after HT. METHODS A retrospective evaluation of patients with PH receiving bosentan post-transplant was performed. Pulmonary hemodynamics before and after bosentan (BG) and clinical outcomes were assessed and compared to a historical control group (CG) not receiving bosentan. RESULTS Between 2013 and 2016, 21 patients were treated post-transplant with bosentan. Twenty-four hours after bosentan initiation, there were significant decreases in systolic (42.5 ± 8 to 38.1 ± 8 mm Hg, P = 0.015), diastolic (21.4 ± 4 to 17.8 ± 6 mm Hg, P = 0.008) and mean (29.6 ± 5 to 25 ± 6 mm Hg, P = 0.001) pulmonary artery pressures (PAP), transpulmonary gradient (13.1 ± 3 to 9.7 ± 4 mm Hg, P < 0.001), diastolic gradient (5.2 ± 4 to 2.3 ± 3 mm Hg, P = 0.001) and pulmonary vascular resistance (PVR) (2.2 ± 1 to 1.6 ± 1WU, P = 0.015). This effect was maintained at day 3. Compared with CG, BG showed significantly more decrease in PVR (0.7 ± 0.9 vs 0.3 ± 1.7WU, P = 0.025) and mean PAP (4.6 ± 5.2 vs 1.5 ± 4.4 mm Hg, P = 0.040). RV function 7 days post-transplant was significantly better in BG compared to CG, P = 0.004. There were not clinically significant interactions between bosentan and immunosuppressive treatment. CONCLUSIONS Bosentan, initiated early post-transplant, was associated with a significant decrease in PVR. Bosentan was well tolerated and did not interact with immunosuppressive treatment.
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Affiliation(s)
- Evelyn Santiago-Vacas
- Heart Failure and Heart Transplantation Unit, Cardiovascular Institute, Hospital Clinic, Barcelona, Spain
| | - Marta Farrero
- Heart Failure and Heart Transplantation Unit, Cardiovascular Institute, Hospital Clinic, Barcelona, Spain
| | - Juan B Ivey-Miranda
- Heart Failure and Heart Transplantation Unit, Cardiovascular Institute, Hospital Clinic, Barcelona, Spain
| | - Maria Ángeles Castel
- Heart Failure and Heart Transplantation Unit, Cardiovascular Institute, Hospital Clinic, Barcelona, Spain
| | - Ana García-Álvarez
- Heart Failure and Heart Transplantation Unit, Cardiovascular Institute, Hospital Clinic, Barcelona, Spain
| | - José Rios
- Medical Statistics Core Facility, August Pi and Sunyer Biomedical Research Institute (IDIBAPS), Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Felix Perez-Villa
- Heart Failure and Heart Transplantation Unit, Cardiovascular Institute, Hospital Clinic, Barcelona, Spain
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8
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Sahay S, Khirfan G, Tonelli AR. Management of combined pre- and post-capillary pulmonary hypertension in advanced heart failure with reduced ejection fraction. Respir Med 2017; 131:94-100. [PMID: 28947049 DOI: 10.1016/j.rmed.2017.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 07/01/2017] [Accepted: 08/07/2017] [Indexed: 10/19/2022]
Abstract
Management of pulmonary hypertension (PH) has remained an unmet need in advanced left heart failure with reduced ejection fraction. In fact, patients are frequently denied heart transplant due to untreated pulmonary hypertension. The availability of mechanically circulatory devices and PH therapies has provided a ray of hope. PH specific therapies are currently not FDA approved for patients with left heart failure with reduced ejection fraction. However, clinicians have used these medications in anecdotal manner. With this review, we want to highlight the expanding use of PH specific therapy and mechanical circulatory devices in the management of PH in the setting of advanced heart failure with reduced ejection fraction.
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Affiliation(s)
- Sandeep Sahay
- Weill Cornell Medical College, Institute of Academic Medicine, Houston Methodist Lung Center, Houston Methodist Hospital, Houston, TX, USA.
| | - Ghaleb Khirfan
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Adriano R Tonelli
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Ohio, USA
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9
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Cardiomyopathy in children: Can we rely on echocardiographic tricuspid regurgitation gradient estimates of right ventricular and pulmonary arterial pressure? Cardiol Young 2016; 26:1406-13. [PMID: 26940013 DOI: 10.1017/s1047951116000020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED Introduction Agreement between echocardiography and right heart catheterisation-derived right ventricular systolic pressure is modest in the adult heart failure population, but is unknown in the paediatric cardiomyopathy population. METHODS All patients at a single centre from 2001 to 2012 with a diagnosis of cardiomyopathy who underwent echocardiography and catheterisation within 30 days were included in this study. The correlation between tricuspid regurgitation gradient and catheterisation-derived right ventricular systolic pressure and mean pulmonary artery pressure was determined. Agreement between echocardiography and catheterisation-derived right ventricular systolic pressure was assessed using Bland-Altman plots. Analysis was repeated for patients who underwent both procedures within 7 days. Haemodynamic data from those with poor agreement and good agreement between echocardiography and catheterisation were compared. RESULTS A total of 37 patients who underwent 48 catheterisation procedures were included in our study. The median age was 11.8 (0.1-20.6 years) with 22 males (58% total). There was a modest correlation (r=0.65) between echocardiography and catheterisation-derived right ventricular systolic pressure, but agreement was poor. Agreement between tricuspid regurgitation gradient and right ventricular systolic pressure showed wide 95% limits of agreement. There was a modest correlation between the tricuspid regurgitation gradient and mean pulmonary artery pressure (r=0.6). Shorter time interval between the two studies did not improve agreement. Those with poor agreement between echocardiography and catheterisation had higher right heart pressures, but this difference became insignificant after accounting for right atrial pressure. CONCLUSION Transthoracic echocardiography estimation of right ventricular systolic pressure shows modest correlation with right heart pressures, but has limited agreement and may underestimate the degree of pulmonary hypertension in paediatric cardiomyopathy patients.
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10
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Frantz RP. Pulmonary arterial hypertension or left heart disease with pulmonary hypertension? Toward noninvasive clarity, but time for a new paradigm. Eur Respir J 2016; 46:299-302. [PMID: 26232475 DOI: 10.1183/13993003.00456-2015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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11
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Nunes SS, Feric N, Pahnke A, Miklas JW, Li M, Coles J, Gagliardi M, Keller G, Radisic M. Human Stem Cell-Derived Cardiac Model of Chronic Drug Exposure. ACS Biomater Sci Eng 2016; 3:1911-1921. [DOI: 10.1021/acsbiomaterials.5b00496] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sara S. Nunes
- Toronto
General Research Institute, University Health Network, 101 College
Street Toronto, Ontario, Canada M5G 1L7
- Heart & Stroke/Richard Lewar Centre of Excellence, University of Toronto, 101 College Street, MaRS Third Floor, Room 902, Toronto, Ontario, Canada M5G 1L7
- Institute
of Biomaterials and Biomedical Engineering, University of Toronto, 164 College St, RS 407, Toronto, Ontario, Canada M5S 3G9
| | - Nicole Feric
- Institute
of Biomaterials and Biomedical Engineering, University of Toronto, 164 College St, RS 407, Toronto, Ontario, Canada M5S 3G9
| | - Aric Pahnke
- Heart & Stroke/Richard Lewar Centre of Excellence, University of Toronto, 101 College Street, MaRS Third Floor, Room 902, Toronto, Ontario, Canada M5G 1L7
- Department
of Chemical Engineering and Applied Chemistry, University of Toronto, 200 College Street, Toronto, Ontario, Canada M5S 1A1
| | - Jason W. Miklas
- Institute
of Biomaterials and Biomedical Engineering, University of Toronto, 164 College St, RS 407, Toronto, Ontario, Canada M5S 3G9
| | - Mark Li
- Heart & Stroke/Richard Lewar Centre of Excellence, University of Toronto, 101 College Street, MaRS Third Floor, Room 902, Toronto, Ontario, Canada M5G 1L7
- Institute
of Biomaterials and Biomedical Engineering, University of Toronto, 164 College St, RS 407, Toronto, Ontario, Canada M5S 3G9
| | - John Coles
- Hospital of Sick Children, 555
University Avenue, Toronto, Ontario, Canada M5G 1X8
| | - Mark Gagliardi
- McEwen
Centre for Regenerative Medicine, University Health Network, MaRS
Centre, Toronto Medical Discovery Tower, 101 College Street, eighth
floor, room 701 Toronto, Ontario, Canada M5G 1L7
| | - Gordon Keller
- McEwen
Centre for Regenerative Medicine, University Health Network, MaRS
Centre, Toronto Medical Discovery Tower, 101 College Street, eighth
floor, room 701 Toronto, Ontario, Canada M5G 1L7
| | - Milica Radisic
- Toronto
General Research Institute, University Health Network, 101 College
Street Toronto, Ontario, Canada M5G 1L7
- Heart & Stroke/Richard Lewar Centre of Excellence, University of Toronto, 101 College Street, MaRS Third Floor, Room 902, Toronto, Ontario, Canada M5G 1L7
- Institute
of Biomaterials and Biomedical Engineering, University of Toronto, 164 College St, RS 407, Toronto, Ontario, Canada M5S 3G9
- Department
of Chemical Engineering and Applied Chemistry, University of Toronto, 200 College Street, Toronto, Ontario, Canada M5S 1A1
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Ong KC, Geske JB, Hebl VB, Nishimura RA, Schaff HV, Ackerman MJ, Klarich KW, Siontis KC, Coutinho T, Dearani JA, Ommen SR, Gersh BJ. Pulmonary hypertension is associated with worse survival in hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2016; 17:604-10. [DOI: 10.1093/ehjci/jew024] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 01/18/2016] [Indexed: 01/09/2023] Open
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13
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Samson R, Jaiswal A, Ennezat PV, Cassidy M, Le Jemtel TH. Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction. J Am Heart Assoc 2016; 5:e002477. [PMID: 26811159 PMCID: PMC4859363 DOI: 10.1161/jaha.115.002477] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Rohan Samson
- Tulane University Heart and Vascular InstituteTulane University School of MedicineNew OrleansLA
| | - Abhishek Jaiswal
- Tulane University Heart and Vascular InstituteTulane University School of MedicineNew OrleansLA
| | - Pierre V. Ennezat
- Department of CardiologyCentre Hospitalier Universitaire de GrenobleGrenoble Cedex 09France
| | - Mark Cassidy
- Tulane University Heart and Vascular InstituteTulane University School of MedicineNew OrleansLA
| | - Thierry H. Le Jemtel
- Tulane University Heart and Vascular InstituteTulane University School of MedicineNew OrleansLA
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14
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Pulmonary Hypertension After Heart Transplantation in Patients Bridged with the Total Artificial Heart. ASAIO J 2016; 62:69-73. [DOI: 10.1097/mat.0000000000000298] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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15
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Vanhercke D, Pardaens S, Weytjens C, Vande Kerckhove B, De Laet N, Janssens E, Van Camp G, De Sutter J. Prevalence, Determinants, and Prognostic Significance of Pulmonary Hypertension in Elderly Patients Admitted with Acute Decompensated Heart Failure: A Report from the BIO-HF Registry. Echocardiography 2014; 32:1333-8. [DOI: 10.1111/echo.12857] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Daniel Vanhercke
- Department of Internal Medicine; Ghent University; Ghent Belgium
| | - Sofie Pardaens
- Department of Internal Medicine; Ghent University; Ghent Belgium
| | - Caroline Weytjens
- Department of Cardiology; University Hospital Brussels; Brussels Belgium
| | | | - Nancy De Laet
- Department of Cardiology; University Hospital Brussels; Brussels Belgium
| | - Emilie Janssens
- Department of Internal Medicine; Ghent University; Ghent Belgium
| | - Guy Van Camp
- Department of Cardiology; University Hospital Brussels; Brussels Belgium
| | - Johan De Sutter
- Department of Internal Medicine; Ghent University; Ghent Belgium
- Department of Cardiology; AZ Maria Middelares; Ghent Belgium
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16
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Dragu R, Rispler S, Habib M, Sholy H, Hammerman H, Galie N, Aronson D. Pulmonary arterial capacitance in patients with heart failure and reactive pulmonary hypertension. Eur J Heart Fail 2014; 17:74-80. [PMID: 25388783 DOI: 10.1002/ejhf.192] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 09/17/2014] [Accepted: 09/19/2014] [Indexed: 11/10/2022] Open
Abstract
AIMS Reactive pulmonary hypertension (PH) is a severe form of PH secondary to left-sided heart failure (HF). Given the structural and functional abnormalities in the pulmonary vasculature that occur in reactive PH, we hypothesized that pulmonary artery capacitance (PAC) may be profoundly affected, with implications for clinical outcome. METHODS AND RESULTS We studied 393 HF patients of whom 124 (32%) were classified as having passive PH and 140 (36%) as having reactive PH, and 91 patients with pulmonary arterial hypertension (PAH). Mean PAC was highest in patients without PH (4.5 ± 2.1 mL/mmHg), followed by the passive PH group (2.8 ± 1.4 mL/mmHg) and was lowest in those with reactive PH (1.8 ± 0.7 mL/mmHg) (P = 0.0001). PAC and pulmonary vascular resistance (PVR) fitted well to a hyperbolic inverse relationship (PAC = 0.25/PVR, R(2) = 0.70), with reactive PH patients dispersed almost predominantly on the flat part of the curve where a reduction in PVR is associated with a small improvement in PAC. Elevated PCWP was associated with a significant lowering of PAC for any PVR (P = 0.036). During a median follow-up of 31 months, both reactive PH [hazard ratio (HR) 2.59, 95% confidence interval (CI) 1.14-4.46, P = 0.02] and reduced PAC (HR 0.72 per 1 mL/mmHg increase, 95% CI 0.59-0.88, P = 0.001) were independent predictors of mortality. CONCLUSIONS The development of reactive PH is associated with a marked reduction in PAC. PAC is a strong independent haemodynamic marker of mortality in HF and may contribute to the increased mortality associated with reactive PH.
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Affiliation(s)
- Robert Dragu
- Department of Cardiology, Rambam Health Care Campus and the Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
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Pieske B, Butler J, Filippatos G, Lam C, Maggioni AP, Ponikowski P, Shah S, Solomon S, Kraigher-Krainer E, Samano ET, Scalise AV, Müller K, Roessig L, Gheorghiade M. Rationale and design of the SOluble guanylate Cyclase stimulatoR in heArT failurE Studies (SOCRATES). Eur J Heart Fail 2014; 16:1026-38. [DOI: 10.1002/ejhf.135] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 06/06/2014] [Accepted: 06/13/2014] [Indexed: 12/24/2022] Open
Affiliation(s)
- Burkert Pieske
- Department of Cardiology; Medical University Graz; Graz Austria
| | - Javed Butler
- Division of Cardiology; Emory University School of Medicine; Atlanta GA USA
| | | | - Carolyn Lam
- Cardiovascular Research Institute; Singapore
| | - Aldo Pietro Maggioni
- Associazione Nazionale Medici Cardiologi Ospedalieri Research Center; Florence Italy
| | - Piotr Ponikowski
- Department of Heart Diseases; Medical University; Military Hospital Wroclaw Poland
| | - Sanjiv Shah
- Division of Cardiology, Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Scott Solomon
- Cardiovascular Division; Brigham and Women's Hospital; Boston MA USA
| | | | | | | | | | | | - Mihai Gheorghiade
- Division of Cardiology, Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
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18
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Hosseinian L. Pulmonary hypertension and noncardiac surgery: implications for the anesthesiologist. J Cardiothorac Vasc Anesth 2014; 28:1064-74. [PMID: 24675000 DOI: 10.1053/j.jvca.2013.11.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Leila Hosseinian
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY.
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Kalogeropoulos AP, Siwamogsatham S, Hayek S, Li S, Deka A, Marti CN, Georgiopoulou VV, Butler J. Echocardiographic assessment of pulmonary artery systolic pressure and outcomes in ambulatory heart failure patients. J Am Heart Assoc 2014; 3:e000363. [PMID: 24492947 PMCID: PMC3959670 DOI: 10.1161/jaha.113.000363] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Pulmonary hypertension (PH) in patients with heart failure (HF) is associated with worse outcomes and is rapidly being recognized as a therapeutic target. To facilitate pragmatic research efforts, data regarding the prognostic importance of noninvasively assessed pulmonary artery systolic pressure (PASP) in stable ambulatory patients with HF are needed. Methods and Results We examined the association between echocardiographic PASP and outcomes in 417 outpatients with HF (age, 54±13 years; 60.7% men; 50.4% whites; 24.9% with preserved ejection fraction). Median PASP was 36 mm Hg (interquartile range [IQR]: 29, 46). After a median follow‐up of 2.6 years (IQR: 1.7, 3.9) there were 72 major events (57 deaths; 9 urgent heart transplants; and 6 ventricular assist device implantations) and 431 hospitalizations for HF. In models adjusting for clinical risk factors and therapy, a 10‐mm Hg higher PASP was associated with 37% higher risk (95% CI: 18, 59; P<0.001) for major events, and 11% higher risk (95% CI: 1, 23; P=0.039) for major events or HF hospitalization. The threshold that maximized the likelihood ratio for both endpoints was 48 mm Hg; those with PASP ≥48 mm Hg (N=84; 20.1%) had an adjusted hazard ratio of 3.33 (95% CI: 1.96, 5.65; P<0.001) for major events and 1.47 (95% CI: 1.02, 2.11; P=0.037) for major events or HF hospitalization. Reduced right ventricular systolic function had independent prognostic utility over PASP for adverse outcomes. Right atrial pressure and transtricuspid gradient both contributed to risk. Conclusions Elevated PASP, determined by echocardiography, identifies ambulatory patients with HF at increased risk for adverse events.
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Affiliation(s)
- Andreas P Kalogeropoulos
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University, Atlanta, GA
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Aronson D, Dragu R, Azzam ZS. Reply to Acute Decompensated Heart Failure and Pulmonary Hypertension. J Card Fail 2014; 20:63-4. [DOI: 10.1016/j.cardfail.2013.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Indexed: 11/26/2022]
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