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Genske F, Rawish E, Macherey-Meyer S, Büchel C, Dejanovikj M, Jurczyk D, Schulten-Baumer J, Marquetand C, Stiermaier T, Eitel I, Rosenkranz S, Frerker C, Schmidt T. Comparison of different venous access ways for right heart catheterization-a meta-analysis. Hellenic J Cardiol 2024:S1109-9666(24)00167-2. [PMID: 39094787 DOI: 10.1016/j.hjc.2024.07.008] [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: 04/16/2024] [Revised: 06/30/2024] [Accepted: 07/25/2024] [Indexed: 08/04/2024] Open
Abstract
OBJECTIVES Right heart catheterization (RHC) is a common diagnostic tool and of special importance in the diagnosis of pulmonary hypertension (PH). Until today, there have been no clear instructions or guidelines on which venous access to prefer. This meta-analysis assessed whether the choice of the venous access site for elective RHC has an impact on procedural or clinical outcomes. METHODS A structured literature search was performed. Single-arm reports and controlled trials reporting event data were eligible. The primary endpoint was a composite of access-related and overall complications. RESULTS Nineteen studies, including 6509 RHC procedures, were eligible. The results were analyzed in two groups. The first group compared central venous access (CVA; n = 2072) with peripheral venous access (PVA; n = 2680) and included only multi-arm studies (n = 12, C/P comparison). In the second group, all studies (n = 19, threeway comparison) were assessed to compare the three individual access ways. The overall complication rate was low at 1.0% (n = 68). The primary endpoint in the C/P comparison occurred significantly less for PVA than for CVA (0.1% vs. 1.2%; p = 0.004). In the threeway comparison, PVA had a significantly lower complication rate than femoral access (0.3% vs. 1.1%; p = 0.04). Jugular access had the numerically highest complication rate (2.0%), but the difference was not significant compared to peripheral (0.3%; p = 0.29) or femoral access (1.1%; p = 0.32). CONCLUSION This meta-analysis showed that PVA for RHC has a significantly lower complication rate than CVA. There was a low level of certainty and high heterogeneity. This pooled data analysis indicated PVA as the primary venous access for RHC.
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Affiliation(s)
- Florian Genske
- University Hospital Schleswig-Holstein, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Elias Rawish
- University Hospital Schleswig-Holstein, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Sascha Macherey-Meyer
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany
| | - Carina Büchel
- University Hospital Schleswig-Holstein, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Momir Dejanovikj
- University Hospital Schleswig-Holstein, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Dominik Jurczyk
- University Hospital Schleswig-Holstein, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Julia Schulten-Baumer
- University Hospital Schleswig-Holstein, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Christoph Marquetand
- University Hospital Schleswig-Holstein, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Thomas Stiermaier
- University Hospital Schleswig-Holstein, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Ingo Eitel
- University Hospital Schleswig-Holstein, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Stephan Rosenkranz
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany
| | - Christian Frerker
- University Hospital Schleswig-Holstein, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Tobias Schmidt
- University Hospital Schleswig-Holstein, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany.
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Turquier S, Huot L, Lamkhioued M, Subtil F, Traclet J, Ahmad K, Lestelle F, Chauvelot L, Cottin V, Mornex JF. Bioreactance assessment of cardiac output lacks reliability for the follow-up of patients with pulmonary hypertension. PLoS One 2024; 19:e0298727. [PMID: 38768104 PMCID: PMC11104646 DOI: 10.1371/journal.pone.0298727] [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: 12/01/2023] [Accepted: 01/27/2024] [Indexed: 05/22/2024] Open
Abstract
Cardiac output (CO) is one of the primary prognostic factors evaluated during the follow-up of patients treated for pulmonary hypertension (PH). It is recommended that it be measured using the thermodilution technique during right heart catheterization. The difficulty to perform iterative invasive measurements on the same individual led us to consider a non-invasive option. The aims of the present study were to assess the agreement between CO values obtained using bioreactance (Starling™ SV) and thermodilution, and to evaluate the ability of the bioreactance monitor to detect patients whose CO decreased by more than 15% during follow-up and, accordingly, its usefulness for patient monitoring. A prospective cohort study evaluating the performance of the Starling™ SV monitor was conducted in patients with clinically stable PH. Sixty patients referred for hemodynamic assessment were included. CO was measured using both the thermodilution technique and bioreactance during two follow-up visits. A total of 60 PH patients were included. All datasets were available at the baseline visit (V0) and 50 of them were usable during the follow-up visit (V1). Median [IQR] CO was 4.20 l/min [3.60-4.70] when assessed by bioreactance, and 5.30 l/min [4.57-6.20] by thermodilution (p<0.001). The Spearman correlation coefficient was 0.51 [0.36-0.64], and the average deviation on Bland-Altman plot was -1.25 l/min (95% CI [-1.48-1.01], p<0.001). The ability of the monitor to detect a variation in CO of more than 15% between two follow-up measurements, when such variation existed using thermodilution, was insufficient for clinical practice (AUC = 0.54, 95% CI [0.33-0.75]).
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Affiliation(s)
- Ségolène Turquier
- National Reference Centre for Rare Pulmonary Diseases and Centre for Pulmonary Hypertension, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
- Lung Physiology Unit, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - Laure Huot
- Innovation Department, Health Economic Evaluation Service, Public Health Centre, Hospices Civils de Lyon, Lyon, France
- Research on Healthcare Performance RESHAPE, INSERM U1290, Claude Bernard University, Lyon, France
| | - Medhi Lamkhioued
- National Reference Centre for Rare Pulmonary Diseases and Centre for Pulmonary Hypertension, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
- Lung Physiology Unit, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - Fabien Subtil
- Biostatistics and Bioinformatics Department, Public Health Centre, Hospices Civils de Lyon, Lyon, France
| | - Julie Traclet
- National Reference Centre for Rare Pulmonary Diseases and Centre for Pulmonary Hypertension, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - Kais Ahmad
- National Reference Centre for Rare Pulmonary Diseases and Centre for Pulmonary Hypertension, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - François Lestelle
- National Reference Centre for Rare Pulmonary Diseases and Centre for Pulmonary Hypertension, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - Louis Chauvelot
- National Reference Centre for Rare Pulmonary Diseases and Centre for Pulmonary Hypertension, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - Vincent Cottin
- National Reference Centre for Rare Pulmonary Diseases and Centre for Pulmonary Hypertension, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
- UMR754, INRAE, Claude Bernard University, Lyon, France
| | - Jean-François Mornex
- National Reference Centre for Rare Pulmonary Diseases and Centre for Pulmonary Hypertension, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
- UMR754, INRAE, Claude Bernard University, Lyon, France
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Cueto-Robledo G, González-Hermosillo LM, Porres-Aguilar M, Navarro-Vergara DI, Garcia-Cesar M, Torres-Rojas MB, Martinez-Carrillo AD, Cajigas HR. Complications of Right Heart Catheterization in Patients ≥70 Years of Age With Suspected Pulmonary Hypertension: Experience From a Tertiary Care Center. Curr Probl Cardiol 2024; 49:102136. [PMID: 37858849 DOI: 10.1016/j.cpcardiol.2023.102136] [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: 10/09/2023] [Accepted: 10/14/2023] [Indexed: 10/21/2023]
Abstract
Right heart catheterization (RHC) represents the gold standard diagnostic approach for pulmonary hypertension (PH). Historically, the complication rates of RHC are known to be low. The study aimed to evaluate the indications for performing RHC and the occurrence of adverse events related to the procedure in patients > over 70 years of age in a Mexican Tertiary Care Center. We conducted a retrospective single-center registry from July 2017 to July 2022. A total of 517 patients with suspected PH underwent RHC. The cohort included patients <70 (n = 427) and ≥70 years of age (n = 90). Adverse events were classified as major (eg, death, pneumothorax, and carotid artery puncture) and minor (eg, atrial arrhythmia, superior vena cava dissection, incidental arterial puncture, and local hematoma). Appropriate hemodynamic parameters were recorded. No report of major adverse events in the entire cohort. In the <70 years age group, 9 minor events, and 3 minor events were in the ≥70-year-old patients (P < 0.0001). There was a significant difference in the measurement of mean pulmonary artery pressure (mPAP) between the <70 years old vs ≥70 years old (P < 0.001); there was a significant difference in right atrial pressures: 4.71 ± 3.14 mmHg in the <70-year-old vs 4.07 ± 1.94 mmHg for the ≥ 70-year-old group (P = 0.014). Our findings suggest that RHC can be safely performed in patients aged ≥70 years using different vascular access routes without significant major complications.
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Affiliation(s)
- Guillermo Cueto-Robledo
- Cardiorespiratory Emergencies, Hospital General de México 'Dr Eduardo Liceaga', Mexico City, Mexico; Pulmonary Circulation Clinic, Hospital General de México 'Dr. Eduardo Liceaga', Mexico City, Mexico; Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.
| | - Leslie-Marisol González-Hermosillo
- Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico; Doctorate Program in Biomedical Sciences, Postgraduate Unit. National Autonomous University of Mexico, Mexico City, Mexico
| | - Mateo Porres-Aguilar
- Divisions of Hospital and Adult Thrombosis Medicine, Department of Internal Medicine, Texas Tech University Health Sciences Center and Paul L. Foster School of Medicine, El Paso, TX
| | - Dulce-Iliana Navarro-Vergara
- Cardiorespiratory Emergencies, Hospital General de México 'Dr Eduardo Liceaga', Mexico City, Mexico; Pulmonary Circulation Clinic, Hospital General de México 'Dr. Eduardo Liceaga', Mexico City, Mexico
| | - Marisol Garcia-Cesar
- Cardiorespiratory Emergencies, Hospital General de México 'Dr Eduardo Liceaga', Mexico City, Mexico; Pulmonary Circulation Clinic, Hospital General de México 'Dr. Eduardo Liceaga', Mexico City, Mexico
| | - Maria-Berenice Torres-Rojas
- Cardiorespiratory Emergencies, Hospital General de México 'Dr Eduardo Liceaga', Mexico City, Mexico; Pulmonary Circulation Clinic, Hospital General de México 'Dr. Eduardo Liceaga', Mexico City, Mexico
| | | | - Hector R Cajigas
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Mayo Clinic, Rochester, MN
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McGlothlin D, Granton J, Klepetko W, Beghetti M, Rosenzweig EB, Corris P, Horn E, Kanwar M, McRae K, Roman A, Tedford R, Badagliacca R, Bartolome S, Benza R, Caccamo M, Cogswell R, Dewachter C, Donahoe L, Fadel E, Farber HW, Feinstein J, Franco V, Frantz R, Gatzoulis M, Hwa (Anne) Goh C, Guazzi M, Hansmann G, Hastings S, Heerdt P, Hemnes A, Herpain A, Hsu CH, Kerr K, Kolaitis N, Kukreja J, Madani M, McCluskey S, McCulloch M, Moser B, Navaratnam M, Radegran G, Reimer C, Savale L, Shlobin O, Svetlichnaya J, Swetz K, Tashjian J, Thenappan T, Vizza CD, West S, Zuckerman W, Zuckermann A, De Marco T. ISHLT CONSENSUS STATEMENT: Peri-operative Management of Patients with Pulmonary Hypertension and Right Heart Failure Undergoing Surgery. J Heart Lung Transplant 2022; 41:1135-1194. [DOI: 10.1016/j.healun.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/13/2022] [Indexed: 10/17/2022] Open
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Aryal SR, Sharifov OF, Lloyd SG. Emerging role of cardiovascular magnetic resonance imaging in the management of pulmonary hypertension. Eur Respir Rev 2020; 29:29/156/190138. [PMID: 32620585 DOI: 10.1183/16000617.0138-2019] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/31/2019] [Indexed: 12/21/2022] Open
Abstract
Pulmonary hypertension (PH) is a clinical condition characterised by elevation of pulmonary arterial pressure (PAP) above normal range due to various aetiologies. While cardiac right-heart catheterisation (RHC) remains the gold standard and mandatory for establishing the diagnosis of PH, noninvasive imaging of the heart plays a central role in the diagnosis and management of all forms of PH. Although Doppler echocardiography (ECHO) can measure a range of haemodynamic and anatomical variables, it has limited utility for visualisation of the pulmonary artery and, oftentimes, the right ventricle. Cardiovascular magnetic resonance (CMR) provides comprehensive information about the anatomical and functional aspects of the pulmonary artery and right ventricle that are of prognostic significance for assessment of long-term outcomes in disease progression. CMR is suited for serial follow-up of patients with PH due to its noninvasive nature, high sensitivity to changes in anatomical and functional parameters, and high reproducibility. In recent years, there has been growing interest in the use of CMR derived parameters as surrogate endpoints for early-phase PH clinical trials. This review will discuss the role of CMR in the diagnosis and management of PH, including current applications and future developments, in comparison to other existing major imaging modalities.
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Affiliation(s)
- Sudeep R Aryal
- Dept of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Oleg F Sharifov
- Dept of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Steven G Lloyd
- Dept of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA .,Birmingham VA Medical Center, Birmingham, AL, USA
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Klinger JR, Elliott G, Levine DJ, Bossone E, Duvall L, Fagan K, Frantsve-Hawley J, Kawut SM, Ryan JJ, Rosenzweig EB, Sederstrom N, Steen VD, Badesch DB. Response. Chest 2020; 156:187-188. [PMID: 31279370 DOI: 10.1016/j.chest.2019.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 03/30/2019] [Indexed: 11/18/2022] Open
Affiliation(s)
- James R Klinger
- Department of Medicine, Rhode Island Hospital, Providence, RI
| | - Gregory Elliott
- Department of Medicine, Intermountain Medical Center, Murray, UT; Department of Medicine, University of Utah, Murray, UT
| | - Deborah J Levine
- Department of Cardiothoracic Surgery, University of Texas Health Science Center, San Antonio, TX
| | | | - Laura Duvall
- Department of Pharmacy, OhioHealth, Columbus, OH
| | - Karen Fagan
- Division of Pulmonary and Critical Care, University of South Alabama, Mobile, AL
| | | | - Steven M Kawut
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - John J Ryan
- Department of Medicine, University of Utah, Salt Lake City, UT
| | - Erika B Rosenzweig
- Department of Pediatric Cardiology, Columbia University Medical Center, New York, NY
| | - Nneka Sederstrom
- Clinical Ethics Department, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN
| | - Virginia D Steen
- Department of Medicine, Georgetown University School of Medicine, Washington, DC
| | - David B Badesch
- Department of Medicine, University of Colorado Health Sciences Center, Aurora, CO.
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Abstract
Historically, pulmonary arterial hypertension (PAH) has been considered a disease of young adults, but over the last three decades, the average age at diagnosis has increased, presenting clinicians with some unique challenges. Clinical symptoms of PAH, including shortness of breath and reduced functional capacity, are not specific for the disease and may be present in older patients because of their age or as a result of comorbid conditions. Eliminating other causes for these symptoms can delay PAH diagnosis and initiation of PAH-specific treatment compared with younger patients. Currently, there are no specific guidelines relating to PAH in older patients and existing guidelines for identifying patients at potential risk of PAH may not be appropriate for patients aged over 65 years. Even though older patients tend to be diagnosed with more advanced symptoms, and evidence suggests that they are less responsive to PAH-specific therapies, treatment is often less aggressive than in younger patients. Even after adjusting for age, survival rates remain disproportionately lower in the older vs. younger PAH populations. Specific guidelines for diagnosis and treatment of older patients with PAH are needed to improve care and outcomes in this growing population. This review aims to assess the challenges associated with diagnosing and managing PAH in older patients, based on literature searches, authors' experiences, and expert opinions.
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Affiliation(s)
- Olivier Sitbon
- Hôpital Universitaire de Bicêtre, Université Paris-Sud, Paris, France
| | - Luke Howard
- National Pulmonary Hypertension Service, Hammersmith Hospital, London, W12 0HS, UK
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