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Farley J, Brown LA, Garg P, Wahab A, Klassen JR, Jex N, Thirunavukarasu S, Chowdhary A, Sharrack N, Gorecka M, Xue H, Artis N, Levelt E, Dall'Armellina E, Kellman P, Greenwood JP, Plein S, Swoboda PP. Pulmonary transit time is a predictor of outcomes in heart failure: a cardiovascular magnetic resonance first-pass perfusion study. BMC Cardiovasc Disord 2024; 24:329. [PMID: 38943084 PMCID: PMC11212156 DOI: 10.1186/s12872-024-04003-w] [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: 11/15/2023] [Accepted: 06/21/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND Pulmonary transit time (PTT) can be measured automatically from arterial input function (AIF) images of dual sequence first-pass perfusion imaging. PTT has been validated against invasive cardiac catheterisation correlating with both cardiac output and left ventricular filling pressure (both important prognostic markers in heart failure). We hypothesized that prolonged PTT is associated with clinical outcomes in patients with heart failure. METHODS We recruited outpatients with a recent diagnosis of non-ischaemic heart failure with left ventricular ejection fraction (LVEF) < 50% on referral echocardiogram. Patients were followed up by a review of medical records for major adverse cardiovascular events (MACE) defined as all-cause mortality, heart failure hospitalization, ventricular arrhythmia, stroke or myocardial infarction. PTT was measured automatically from low-resolution AIF dynamic series of both the LV and RV during rest perfusion imaging, and the PTT was measured as the time (in seconds) between the centroid of the left (LV) and right ventricle (RV) indicator dilution curves. RESULTS Patients (N = 294) were followed-up for median 2.0 years during which 37 patients (12.6%) had at least one MACE event. On univariate Cox regression analysis there was a significant association between PTT and MACE (Hazard ratio (HR) 1.16, 95% confidence interval (CI) 1.08-1.25, P = 0.0001). There was also significant association between PTT and heart failure hospitalisation (HR 1.15, 95% CI 1.02-1.29, P = 0.02) and moderate correlation between PTT and N-terminal pro B-type natriuretic peptide (NT-proBNP, r = 0.51, P < 0.001). PTT remained predictive of MACE after adjustment for clinical and imaging factors but was no longer significant once adjusted for NT-proBNP. CONCLUSIONS PTT measured automatically during CMR perfusion imaging in patients with recent onset non-ischaemic heart failure is predictive of MACE and in particular heart failure hospitalisation. PTT derived in this way may be a non-invasive marker of haemodynamic congestion in heart failure and future studies are required to establish if prolonged PTT identifies those who may warrant closer follow-up or medicine optimisation to reduce the risk of future adverse events.
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Affiliation(s)
- Jonathan Farley
- Multidisciplinary Cardiovascular Research Centre, Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Louise Ae Brown
- Multidisciplinary Cardiovascular Research Centre, Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Pankaj Garg
- Norwich Medical School, University of East Anglia, Norfolk, UK
| | - Ali Wahab
- Multidisciplinary Cardiovascular Research Centre, Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Joel Rl Klassen
- Multidisciplinary Cardiovascular Research Centre, Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Nicholas Jex
- Multidisciplinary Cardiovascular Research Centre, Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Sharmaine Thirunavukarasu
- Multidisciplinary Cardiovascular Research Centre, Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Amrit Chowdhary
- Multidisciplinary Cardiovascular Research Centre, Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Noor Sharrack
- Multidisciplinary Cardiovascular Research Centre, Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Miroslawa Gorecka
- Multidisciplinary Cardiovascular Research Centre, Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Hui Xue
- National Institutes for Health, National Heart, Lung, and Blood Institute, Bethesda, USA
| | - Nigel Artis
- Department of Cardiology, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Eylem Levelt
- Multidisciplinary Cardiovascular Research Centre, Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Erica Dall'Armellina
- Multidisciplinary Cardiovascular Research Centre, Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Peter Kellman
- National Institutes for Health, National Heart, Lung, and Blood Institute, Bethesda, USA
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre, Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre, Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Peter P Swoboda
- Multidisciplinary Cardiovascular Research Centre, Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK.
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2
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Strotzer QD, Heidemanns S, Mayr V, Stuerzl R, Meiler S, Schmidt D, Blaas S, Grosse J, Hellwig D, Stroszczynski C, Hamer OW. Head-to-Head Comparison of Dual-Source and Split-Beam Filter Multi-Energy CT versus SPECT/CT for Assessing Lobar Lung Perfusion in Emphysema. Radiol Cardiothorac Imaging 2023; 5:e220273. [PMID: 37693196 PMCID: PMC10483249 DOI: 10.1148/ryct.220273] [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: 11/07/2022] [Revised: 05/07/2023] [Accepted: 05/22/2023] [Indexed: 09/12/2023]
Abstract
Purpose To evaluate dual-source and split-beam filter multi-energy chest CT in assessing pulmonary perfusion on a lobar level in patients with lung emphysema, using perfusion SPECT as the reference standard. Materials and Methods Patients with emphysema evaluated for lung volume reduction therapy between May 2016 and February 2021 were retrospectively included. All patients underwent SPECT and either dual-source or split-beam filter (SBF) multi-energy CT. To calculate the fractional lobar lung perfusion (FLLP), SPECT acquisitions were co-registered with chest CT scans (hereafter, SPECT/CT) and semi-manually segmented. For multi-energy CT scans, lung lobes were automatically segmented using a U-Net model. Segmentations were manually verified. The FLLP was derived from iodine maps computed from the multi-energy data. Statistical analysis included Pearson and intraclass correlation coefficients and Bland-Altman analysis. Results Fifty-nine patients (30 male, 29 female; 31 underwent dual-source CT, 28 underwent SBF CT; mean age for all patients, 67 years ± 8 [SD]) were included. Both multi-energy methods significantly correlated with the SPECT/CT acquisitions for all individual lobes (P < .001). Pearson correlation concerning all lobes combined was significantly better for dual-source (r = 0.88) than for SBF multi-energy CT (r = 0.78; P = .006). On the level of single lobes, Pearson correlation coefficient differed for the right upper lobe only (dual-source CT, r = 0.88; SBF CT, r = 0.58; P = .008). Conclusion Dual-source and SBF multi-energy CT accurately assessed lung perfusion on a lobar level in patients with emphysema compared with SPECT/CT. The overall correlation was higher for dual-source multi-energy CT.Keywords: Chronic Obstructive Pulmonary Disease, Comparative Studies, Computer Applications, CT Spectral Imaging, Image Postprocessing, Lung, Pulmonary Perfusion© RSNA, 2023.
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Affiliation(s)
- Quirin D. Strotzer
- From the Institute of Radiology (Q.D.S., V.M., R.S., S.M., C.S.,
O.W.H.) and Department of Nuclear Medicine (S.H., D.S., J.G., D.H.), University
of Regensburg Medical Center, Franz-Josef-Strauss-Allee 11, 93053 Regensburg,
Germany; and Departments of Pulmonology (S.B.) and Radiology (O.W.H.),
Donaustauf Hospital, Donaustauf, Germany
| | - Stefanie Heidemanns
- From the Institute of Radiology (Q.D.S., V.M., R.S., S.M., C.S.,
O.W.H.) and Department of Nuclear Medicine (S.H., D.S., J.G., D.H.), University
of Regensburg Medical Center, Franz-Josef-Strauss-Allee 11, 93053 Regensburg,
Germany; and Departments of Pulmonology (S.B.) and Radiology (O.W.H.),
Donaustauf Hospital, Donaustauf, Germany
| | - Vinzenz Mayr
- From the Institute of Radiology (Q.D.S., V.M., R.S., S.M., C.S.,
O.W.H.) and Department of Nuclear Medicine (S.H., D.S., J.G., D.H.), University
of Regensburg Medical Center, Franz-Josef-Strauss-Allee 11, 93053 Regensburg,
Germany; and Departments of Pulmonology (S.B.) and Radiology (O.W.H.),
Donaustauf Hospital, Donaustauf, Germany
| | - Roman Stuerzl
- From the Institute of Radiology (Q.D.S., V.M., R.S., S.M., C.S.,
O.W.H.) and Department of Nuclear Medicine (S.H., D.S., J.G., D.H.), University
of Regensburg Medical Center, Franz-Josef-Strauss-Allee 11, 93053 Regensburg,
Germany; and Departments of Pulmonology (S.B.) and Radiology (O.W.H.),
Donaustauf Hospital, Donaustauf, Germany
| | - Stefanie Meiler
- From the Institute of Radiology (Q.D.S., V.M., R.S., S.M., C.S.,
O.W.H.) and Department of Nuclear Medicine (S.H., D.S., J.G., D.H.), University
of Regensburg Medical Center, Franz-Josef-Strauss-Allee 11, 93053 Regensburg,
Germany; and Departments of Pulmonology (S.B.) and Radiology (O.W.H.),
Donaustauf Hospital, Donaustauf, Germany
| | - Daniel Schmidt
- From the Institute of Radiology (Q.D.S., V.M., R.S., S.M., C.S.,
O.W.H.) and Department of Nuclear Medicine (S.H., D.S., J.G., D.H.), University
of Regensburg Medical Center, Franz-Josef-Strauss-Allee 11, 93053 Regensburg,
Germany; and Departments of Pulmonology (S.B.) and Radiology (O.W.H.),
Donaustauf Hospital, Donaustauf, Germany
| | - Stefan Blaas
- From the Institute of Radiology (Q.D.S., V.M., R.S., S.M., C.S.,
O.W.H.) and Department of Nuclear Medicine (S.H., D.S., J.G., D.H.), University
of Regensburg Medical Center, Franz-Josef-Strauss-Allee 11, 93053 Regensburg,
Germany; and Departments of Pulmonology (S.B.) and Radiology (O.W.H.),
Donaustauf Hospital, Donaustauf, Germany
| | - Jirka Grosse
- From the Institute of Radiology (Q.D.S., V.M., R.S., S.M., C.S.,
O.W.H.) and Department of Nuclear Medicine (S.H., D.S., J.G., D.H.), University
of Regensburg Medical Center, Franz-Josef-Strauss-Allee 11, 93053 Regensburg,
Germany; and Departments of Pulmonology (S.B.) and Radiology (O.W.H.),
Donaustauf Hospital, Donaustauf, Germany
| | - Dirk Hellwig
- From the Institute of Radiology (Q.D.S., V.M., R.S., S.M., C.S.,
O.W.H.) and Department of Nuclear Medicine (S.H., D.S., J.G., D.H.), University
of Regensburg Medical Center, Franz-Josef-Strauss-Allee 11, 93053 Regensburg,
Germany; and Departments of Pulmonology (S.B.) and Radiology (O.W.H.),
Donaustauf Hospital, Donaustauf, Germany
| | - Christian Stroszczynski
- From the Institute of Radiology (Q.D.S., V.M., R.S., S.M., C.S.,
O.W.H.) and Department of Nuclear Medicine (S.H., D.S., J.G., D.H.), University
of Regensburg Medical Center, Franz-Josef-Strauss-Allee 11, 93053 Regensburg,
Germany; and Departments of Pulmonology (S.B.) and Radiology (O.W.H.),
Donaustauf Hospital, Donaustauf, Germany
| | - Okka W. Hamer
- From the Institute of Radiology (Q.D.S., V.M., R.S., S.M., C.S.,
O.W.H.) and Department of Nuclear Medicine (S.H., D.S., J.G., D.H.), University
of Regensburg Medical Center, Franz-Josef-Strauss-Allee 11, 93053 Regensburg,
Germany; and Departments of Pulmonology (S.B.) and Radiology (O.W.H.),
Donaustauf Hospital, Donaustauf, Germany
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Teramachi R, Taniguchi H, Kondoh Y, Kimura T, Kataoka K, Yokoyama T, Furukawa T, Yagi M, Sakamoto K, Hashimoto N, Hasegawa Y. Impact of post-capillary pulmonary hypertension on mortality in interstitial lung disease. Respir Investig 2021; 59:342-349. [PMID: 33579646 DOI: 10.1016/j.resinv.2020.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 12/02/2020] [Accepted: 12/22/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Pulmonary hypertension (PH) influences mortality in patients with interstitial lung disease (ILD). Almost all studies on patients with ILD, have focused on the clinical impact of pre-capillary PH on survival. Therefore, little is known about the influence of post-capillary PH. We aimed to assess the prevalence of post-capillary PH and its clinical impact on survival in patients with ILD, followed by comparison with pre-capillary PH. METHODS This retrospective study enrolled 1152 patients with ILD who were diagnosed with PH using right heart catheterization between May 2007 and December 2015. We analyzed the demographics and composite outcomes (defined as death from any cause or lung transplantation) of patients with post-capillary PH and compared them with patients with pre-capillary PH. RESULTS Thirty-two (20%) of the 157 patients with ILD-PH were diagnosed with post-capillary PH. Patients with post-capillary PH had significantly lower modified Medical Research Council scores, higher diffusion capacity for carbon monoxide, higher resting PaO2, lower pulmonary vascular resistance (PVR), and higher lowest oxygen saturation during the 6-min walk test compared to those with pre-capillary PH. Cardiovascular diseases were associated with a higher risk of mortality in patients with post-capillary PH. Multivariate Cox proportional hazards analysis demonstrated no significant difference between the composite outcomes in pre-capillary and post-capillary PH, while PVR and the ILD Gender-Age-Physiology Index were significantly associated with the composite outcome. CONCLUSIONS We found that approximately one-fifth of patients with ILD-PH were diagnosed with post-capillary PH, and that PVR and not post-capillary PH was associated with mortality.
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Affiliation(s)
- Ryo Teramachi
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hiroyuki Taniguchi
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
| | - Yasuhiro Kondoh
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan.
| | - Tomoki Kimura
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
| | - Kensuke Kataoka
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
| | - Toshiki Yokoyama
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
| | - Taiki Furukawa
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Department of Medical IT Center, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Mitsuaki Yagi
- Department of Respiratory Medicine, National Hospital Organization, Higashinagoya National Hospital, Nagoya, Aichi, Japan
| | - Koji Sakamoto
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Naozumi Hashimoto
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoshinori Hasegawa
- National Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan
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Colin GC, Pouleur AC, Gerber BL, Poncelet PA, de Meester C, D’Hondt AM, Vlassenbroek A, Houard L, Gevenois PA, Ghaye B. Pulmonary hypertension detection by computed tomography pulmonary transit time in heart failure with reduced ejection fraction. Eur Heart J Cardiovasc Imaging 2019; 21:1291-1298. [DOI: 10.1093/ehjci/jez290] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 07/25/2019] [Accepted: 11/11/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
To evaluate the relationships between pulmonary transit time (PTT), cardiac function, and pulmonary haemodynamics in patients with heart failure with reduced ejection fraction (HFrEF) and to explore how PTT performs in detecting pulmonary hypertension (PH).
Methods and results
In this prospective study, 57 patients with advanced HFrEF [49 men, 51 years ± 8, mean left ventricular (LV) ejection fraction 26% ± 8] underwent echocardiography, right heart catheterization, and cardiac computed tomography (CT). PTT was measured as the time interval between peaks of attenuation in right ventricle (RV) and LV and was compared between patients with or without PH and 15 controls. PTT was significantly longer in HFrEF patients with PH (21 s) than in those without PH (11 s) and controls (8 s) (P < 0.001) but not between patients without PH and controls (P = 0.109). PTT was positively correlated with pulmonary artery wedge pressure (PAWP) (r = 0.74), mean pulmonary artery pressure (r = 0.68), N-terminal pro-B-type natriuretic peptide (r = 0.60), mitral (r = 0.54), and tricuspid (r = 0.37) regurgitation grades, as well as with LV, RV, and left atrial volumes (r from 0.39 to 0.64) (P < 0.01). PTT was negatively correlated with cardiac index (r = −0.63) as well as with LV (r = −0.66) and RV (r = −0.74) ejection fractions. PAWP, cardiac index, mitral regurgitation grade, and RV end-diastolic volume were all independent predictors of PTT. PTT value ≥14 s best-detected PH with 91% sensitivity and 88% specificity (area under the receiver operating characteristic curve: 0.95).
Conclusion
In patients with HFrEF, PTT correlates with cardiac function and pulmonary haemodynamics, is determined by four independent parameters, and performs well in detecting PH.
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Affiliation(s)
- Geoffrey C Colin
- Division of Radiology, Cliniques Universitaires Saint-Luc UCL, Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Anne-Catherine Pouleur
- Division of Cardiology, Cliniques Universitaires Saint-Luc UCL, Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Bernhard L Gerber
- Division of Cardiology, Cliniques Universitaires Saint-Luc UCL, Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Pierre-Antoine Poncelet
- Division of Radiology, Cliniques Universitaires Saint-Luc UCL, Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Christophe de Meester
- Division of Cardiology, Cliniques Universitaires Saint-Luc UCL, Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Anne-Marie D’Hondt
- Division of Cardiology, Cliniques Universitaires Saint-Luc UCL, Avenue Hippocrate 10, 1200 Brussels, Belgium
| | | | - Laura Houard
- Division of Cardiology, Cliniques Universitaires Saint-Luc UCL, Avenue Hippocrate 10, 1200 Brussels, Belgium
| | | | - Benoit Ghaye
- Division of Radiology, Cliniques Universitaires Saint-Luc UCL, Avenue Hippocrate 10, 1200 Brussels, Belgium
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Agostoni P, Guazzi M. Exercise ventilatory inefficiency in heart failure: some fresh news into the roadmap of heart failure with preserved ejection fraction phenotyping. Eur J Heart Fail 2017; 19:1686-1689. [PMID: 28990273 DOI: 10.1002/ejhf.940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 06/13/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- Piergiuseppe Agostoni
- Cardiology Monzino Center, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Marco Guazzi
- University Cardiology Department, University of Milan, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
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Altit G, Dancea A, Renaud C, Perreault T, Lands LC, Sant'Anna G. Pathophysiology, screening and diagnosis of pulmonary hypertension in infants with bronchopulmonary dysplasia - A review of the literature. Paediatr Respir Rev 2017; 23:16-26. [PMID: 27986502 DOI: 10.1016/j.prrv.2016.11.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 11/02/2016] [Indexed: 10/20/2022]
Abstract
Bronchopulmonary dysplasia (BPD) is a common complication of extreme prematurity, which has increased over the last 20 years. BPD is associated with increased morbidities and mortality. It has been increasingly recognized that BPD affects overall lung development including the pulmonary vasculature. More recent studies have demonstrated an increased awareness of pulmonary arterial hypertension (PH) in BPD patients and recent international guidelines have advocated for better screening. This review will describe the current understanding of the pathophysiology of PH in infants with BPD, the in-depth assessment of the available literature linking PH and BPD, and propose an approach of screening and diagnosis of PH in infants with BPD.
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Cao JJ, Li L, McLaughlin J, Passick M. Prolonged central circulation transit time in patients with HFpEF and HFrEF by magnetic resonance imaging. Eur Heart J Cardiovasc Imaging 2017; 19:339-346. [DOI: 10.1093/ehjci/jex051] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 03/02/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jie J Cao
- Department of Cardiac Imaging, St Francis Hospital, The Heart Center, 100 Port Washington Blvd, Roslyn, NY 11576, USA
- Department of Cardiology, State University of New York at Stony Brook, 101 Nicolls Road, Stony Brook, NY 11794, USA
| | - Laura Li
- Department of Cardiac Imaging, St Francis Hospital, The Heart Center, 100 Port Washington Blvd, Roslyn, NY 11576, USA
| | - Jeannette McLaughlin
- Department of Cardiac Imaging, St Francis Hospital, The Heart Center, 100 Port Washington Blvd, Roslyn, NY 11576, USA
| | - Michael Passick
- Department of Cardiac Imaging, St Francis Hospital, The Heart Center, 100 Port Washington Blvd, Roslyn, NY 11576, USA
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Waheed S, Chaves PHM, Gardin JM, Cao JJ. Cardiovascular and Mortality Outcomes in the Elderly With Impaired Cardiac and Pulmonary Function: The Cardiovascular Health Study (CHS). J Am Heart Assoc 2015; 4:e002308. [PMID: 26645833 PMCID: PMC4845280 DOI: 10.1161/jaha.115.002308] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 11/04/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Impaired pulmonary function (IPF) and left ventricular systolic dysfunction (LVSD) are prevalent in the elderly and are associated with significant morbidity and mortality. The main objectives of this study were to examine the relative impact and joint association of IPF and LVSD with heart failure, cardiovascular mortality and all-cause mortality, and their impact on risk classification using a continuous net reclassification index. METHODS AND RESULTS We followed 2342 adults without prevalent cardiovascular disease (mean age, 76 years) from the Cardiovascular Health Study for a median of 12.6 years. LVSD was defined as LV ejection fraction <55%. IPF was defined as: forced expiratory volume in 1 second:forced vital capacity <70%, and predicted forced expiratory volume in 1 second <80%. Outcomes included heart failure hospitalization, cardiovascular mortality, all-cause mortality, and composite outcome. LVSD was detected in 128 subjects (6%), IPF in 441 (19%) and both in 38 (2%). Compared to those without LVSD or IPF, there was a significantly increased cardiovascular risk for groups of LVSD only, IPF only, and LVSD plus IPF, adjusted hazard ratio (95% CI) 2.1 (1.5-3.0), 1.7 (1.4-2.1), and 3.2 (2.0-5.1) for HF; 1.8 (1.2-2.6), 1.4 (1.1-1.8), and 2.8 (1.7-4.7) for cardiovascular mortality; 1.3 (1.0-1.8), 1.7 (1.4-1.9), and 2.1 (1.5-3.0) for all-cause mortality, and 1.6 (1.3-2.1), 1.7 (1.5-1.9), and 2.4 (1.7-3.3) for composite outcome, respectively. Risk classification improved significantly for all outcomes when IPF was added to the adjusted model with LVSD or LVSD to IPF. CONCLUSIONS While risk of cardiovascular outcomes was the highest among elderly with both LVSD and IPF, risk was comparable between subjects with IPF alone and those with LVSD alone. This observation, combined with improved risk classification by adding IPF to LVSD or LVSD to IPF, underscore the importance of comprehensive heart and lung evaluation in cardiovascular outcome assessment.
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Affiliation(s)
- Salman Waheed
- Saint Francis HospitalRoslynNY
- University of Kansas Medical CenterKansas CityKS
| | - Paulo H. M. Chaves
- Benjamin Leon Center for Geriatric Research and EducationFlorida International UniversityMiamiFL
| | | | - Jie Jane Cao
- Saint Francis HospitalRoslynNY
- State University of New York at Stony BrookNY
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Dupuis J, Harel F, Nguyen QT. Molecular imaging of the pulmonary circulation in health and disease. Clin Transl Imaging 2014; 2:415-426. [PMID: 25360422 PMCID: PMC4209091 DOI: 10.1007/s40336-014-0076-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 08/15/2014] [Indexed: 11/29/2022]
Abstract
The pulmonary circulation, at the unique crossroads between the left and the right heart, is submitted to large physiologic hemodynamic variations and possesses numerous important metabolic functions mediated through its vast endothelial surface. There are many pathologic conditions that can directly or indirectly affect the pulmonary vasculature and modify its physiology and functions. Pulmonary hypertension, the end result of many of these affections, is unfortunately diagnosed too late in the disease process, meaning that there is a crying need for earlier diagnosis and surrogate markers of disease progression and regression. By targeting endothelial, medial and adventitial targets of the pulmonary vasculature, novel molecular imaging agents could provide early detection of physiologic and biologic perturbation in the pulmonary circulation. This review provides the rationale for the development of molecular imaging agents for the diagnosis and follow-up of disorders of the pulmonary circulation and discusses promising targets for SPECT and positron emission tomographic imaging.
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Affiliation(s)
- Jocelyn Dupuis
- Research Center, Montreal Heart Institute, 5000 Belanger Street, Montreal, QC H1T 1C8 Canada ; Department of Medicine, Université de Montréal, Montreal, QC Canada
| | - François Harel
- Research Center, Montreal Heart Institute, 5000 Belanger Street, Montreal, QC H1T 1C8 Canada ; Department of Radiology, Radio-Oncology and Nuclear Medicine Université de Montréal, Montreal, QC Canada
| | - Quang T Nguyen
- Research Center, Montreal Heart Institute, 5000 Belanger Street, Montreal, QC H1T 1C8 Canada
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Thieme SF, Meinel FG, Graef A, Helck AD, Reiser MF, Johnson TRC. Dual-energy CT pulmonary angiography in patients with suspected pulmonary embolism: value for the detection and quantification of pulmonary venous congestion. Br J Radiol 2014; 87:20140079. [PMID: 24827378 DOI: 10.1259/bjr.20140079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate if vascular and pulmonary parenchymal enhancement values in dual-energy (DE) CT pulmonary angiography (CTPA) can suggest the diagnosis of pulmonary congestion. METHODS DE-CTPA images of 90 out of 1321 patients negative for pulmonary embolism showed signs of congestive heart failure. We measured DE-derived pulmonary parenchymal [perfused blood volume (PBV)], pulmonary artery (PA) and left atrium (LA) enhancement values in these patients and in 142 control patients. Enhancement values were compared between the populations and correlated with serum values of B-type natriuretic peptide (BNP) and proBNP, where available. RESULTS No significant difference of PBV but significant differences of mean PA and LA enhancement and individual enhancement differences (PA - LA) were found between the populations. PA - LA was higher in patients with elevated BNP and proBNP and was positively correlated with these values. Receiver operating characteristic analysis revealed a moderate discriminatory power of the PA - LA difference for the presence of cardiac biomarker elevations. CONCLUSION PBV in DE-CTPA is not altered in patients with signs of congestive heart failure. However, differences in enhancement values in the pre- and post-pulmonary vessels were found in comparison with the control population. ADVANCES IN KNOWLEDGE Altered pulmonary vascular haemodynamics in pulmonary venous congestion are not reflected in dual-energy-derived PBV maps. In the diagnosis of left heart failure in patients with chest pain and dyspnoea, density measurements in the pulmonary artery and in the left atrium in CTPA images may be a helpful diagnostic tool.
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Affiliation(s)
- S F Thieme
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
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Circulation: Cardiovascular Imaging
Editors’ Picks. Circ Cardiovasc Imaging 2013. [DOI: 10.1161/circimaging.113.001335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Little WC, Vasu S. Heart Failure. Circ Cardiovasc Imaging 2012; 5:689-90. [DOI: 10.1161/circimaging.112.981449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- William C. Little
- From the Cardiology Section, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Sujethra Vasu
- From the Cardiology Section, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC
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