1
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Xiao M, Lai D, Yu Y, Wu Q, Zhang C. Pathogenesis of pulmonary hypertension caused by left heart disease. Front Cardiovasc Med 2023; 10:1079142. [PMID: 36937903 PMCID: PMC10020203 DOI: 10.3389/fcvm.2023.1079142] [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: 10/25/2022] [Accepted: 02/14/2023] [Indexed: 03/06/2023] Open
Abstract
Pulmonary hypertension has high disability and mortality rates. Among them, pulmonary hypertension caused by left heart disease (PH-LHD) is the most common type. According to the 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension, PH-LHD is classified as group 2 pulmonary hypertension. PH-LHD belongs to postcapillary pulmonary hypertension, which is distinguished from other types of pulmonary hypertension because of its elevated pulmonary artery wedge pressure. PH-LHD includes PH due to systolic or diastolic left ventricular dysfunction, mitral or aortic valve disease and congenital left heart disease. The primary strategy in managing PH-LHD is optimizing treatment of the underlying cardiac disease. Recent clinical studies have found that mechanical unloading of left ventricle by an implantable non-pulsatile left ventricular assist device with continuous flow properties can reverse pulmonary hypertension in patients with heart failure. However, the specific therapies for PH in LHD have not yet been identified. Treatments that specifically target PH in LHD could slow its progression and potentially improve disease severity, leading to far better clinical outcomes. Therefore, exploring the current research on the pathogenesis of PH-LHD is important. This paper summarizes and classifies the research articles on the pathogenesis of PH-LHD to provide references for the mechanism research and clinical treatment of PH-LHD, particularly molecular targeted therapy.
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Affiliation(s)
- Mingzhu Xiao
- Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, School of Traditional Chinese Medicine, Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Disheng Lai
- Department of Cardiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Yumin Yu
- Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, School of Traditional Chinese Medicine, Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Qingqing Wu
- Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, School of Traditional Chinese Medicine, Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Caojin Zhang
- Department of Cardiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
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2
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Gerges C, Pistritto AM, Gerges M, Friewald R, Hartig V, Hofbauer TM, Reil B, Engel L, Dannenberg V, Kastl SP, Skoro-Sajer N, Moser B, Taghavi S, Klepetko W, Lang IM. Left Ventricular Filling Pressure in Chronic Thromboembolic Pulmonary Hypertension. J Am Coll Cardiol 2023; 81:653-664. [PMID: 36792280 DOI: 10.1016/j.jacc.2022.11.049] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 02/15/2023]
Abstract
BACKGROUND Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by obstruction of major pulmonary arteries with organized thrombi. Clinical risk factors for pulmonary hypertension due to left heart disease including metabolic syndrome, left-sided valvular heart disease, and ischemic heart disease are common in CTEPH patients. OBJECTIVES The authors sought to investigate prevalence and prognostic implications of elevated left ventricular filling pressures (LVFP) in CTEPH. METHODS A total of 593 consecutive CTEPH patients undergoing a first diagnostic right and left heart catheterization were included in this study. Mean pulmonary arterial wedge pressure (mPAWP) and left ventricular end-diastolic pressure (LVEDP) were utilized for assessment of LVFP. Two cutoffs were applied to identify patients with elevated LVFP: 1) for the primary analysis mPAWP and/or LVEDP >15 mm Hg, as recommended by the current pulmonary hypertension guidelines; and 2) for the secondary analysis mPAWP and/or LVEDP >11 mm Hg, representing the upper limit of normal. Clinical and echocardiographic features, and long-term mortality were assessed. RESULTS LVFP was >15 mm Hg in 63 (10.6%) and >11 mm Hg in 222 patients (37.4%). Univariable logistic regression analysis identified age, systemic hypertension, diabetes, atrial fibrillation, calcific aortic valve stenosis, mitral regurgitation, and left atrial volume as significant predictors of elevated LVFP. Atrial fibrillation, calcific aortic valve stenosis, mitral regurgitation, and left atrial volume remained independent determinants of LVFP in adjusted analysis. At follow-up, higher LVFPs were measured in patients who had meanwhile undergone pulmonary endarterectomy (P = 0.002). LVFP >15 mm Hg (P = 0.021) and >11 mm Hg (P = 0.006) were both associated with worse long-term survival. CONCLUSIONS Elevated LVFP is common, appears to be due to comorbid left heart disease, and predicts prognosis in CTEPH.
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Affiliation(s)
- Christian Gerges
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | | | - Mario Gerges
- Department of Internal Medicine V, Division of Cardiology, Clinic Favoriten, Vienna, Austria
| | - Richard Friewald
- Department of Internal Medicine I, Division of Cardiology, University Hospital of Krems, Krems an der Donau, Austria; Karl Landsteiner Private University for Health Sciences, Krems an der Donau, Austria
| | - Valerie Hartig
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Thomas M Hofbauer
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Benedikt Reil
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Leon Engel
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Varius Dannenberg
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Stefan P Kastl
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Nika Skoro-Sajer
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Bernhard Moser
- Department of Surgery, Division of Thoracic Surgery, Medical University Vienna, Vienna, Austria
| | - Shahrokh Taghavi
- Department of Surgery, Division of Thoracic Surgery, Medical University Vienna, Vienna, Austria
| | - Walter Klepetko
- Department of Surgery, Division of Thoracic Surgery, Medical University Vienna, Vienna, Austria
| | - Irene M Lang
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria.
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3
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Martínez-Solano J, Gutiérrez-Ibañes E, Ortiz-Bautista C, García-Cosío MD, Sarnago-Cebada F, Díaz-Molina B, Pascual I, Oteo-Domínguez JF, Gómez-Bueno M, Calviño-Santos R, Crespo-Leiro MG, Gómez-Hospital JA, Díez-López C, García-Lara J, Garrido-Bravo IP, de la Fuente-Galán L, López-Díaz J, Mirabet-Pérez S, Martínez-Sellés M. Pulmonary Vascular Remodeling and Prognosis in Patients Evaluated for Heart Transplantation: Insights from the OCTOPUS-CHF Study. J Cardiovasc Dev Dis 2022; 9:jcdd9120439. [PMID: 36547436 PMCID: PMC9785366 DOI: 10.3390/jcdd9120439] [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: 10/29/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE In patients with advanced heart failure, the intravascular optical coherence tomography (OCT) of subsegmental pulmonary artery measurements is correlated with right heart catheterization parameters. Our aim was to study the prognostic value of pulmonary OCT, right heart catheterization data, and the echocardiographic estimation of pulmonary pressure in patients studied for elective heart transplants. METHODS This research is an observational, prospective, multicenter study involving 90 adults with a one-year follow-up. RESULTS A total of 10 patients (11.1%) died due to worsening heart failure before heart transplantation, 50 underwent a heart transplant (55.6%), and 9 died in the first year after the transplant. The patients with and without events (mortality or heart failure-induced hospitalization) had similar data regarding echocardiography, right heart catheterization, and pulmonary OCT (with a median estimated pulmonary artery systolic pressure of 42.0 mmHg, interquartile range (IQR) of 30.3-50.0 vs. 47.0 mmHg, IQR 34.6-59.5 and p = 0.79, median pulmonary vascular resistance of 2.2 Wood units, IQR 1.3-3.7 vs. 2.0 Wood units, IQR 1.4-3.2 and p = 0.99, and a median pulmonary artery wall thickness of 0.2 ± 0.5 mm vs. 0.2 ± 0.6 mm and p = 0.87). CONCLUSION Pulmonary vascular remodeling (evaluated with echocardiography, right heart catheterization, and pulmonary OCT) was not associated with prognosis in a selected sample of adults evaluated for elective heart transplants. Pulmonary OCT is safe and feasible for the evaluation of these patients.
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Affiliation(s)
- Jorge Martínez-Solano
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), 28007 Madrid, Spain
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28026 Madrid, Spain
| | - Enrique Gutiérrez-Ibañes
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), 28007 Madrid, Spain
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28026 Madrid, Spain
| | - Carlos Ortiz-Bautista
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), 28007 Madrid, Spain
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28026 Madrid, Spain
| | - María Dolores García-Cosío
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28026 Madrid, Spain
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), 28041 Madrid, Spain
| | - Fernando Sarnago-Cebada
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28026 Madrid, Spain
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), 28041 Madrid, Spain
| | - Beatriz Díaz-Molina
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28026 Madrid, Spain
- Servicio de Cardiología, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Isaac Pascual
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28026 Madrid, Spain
- Servicio de Cardiología, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Juan Francisco Oteo-Domínguez
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28026 Madrid, Spain
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain
| | - Manuel Gómez-Bueno
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28026 Madrid, Spain
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain
| | - Ramón Calviño-Santos
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28026 Madrid, Spain
- Servizo de Cardioloxía, Complexo Hospitalario Universitario A Coruña, 15006 A Coruña, Spain
| | - María G Crespo-Leiro
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28026 Madrid, Spain
- Servizo de Cardioloxía, Complexo Hospitalario Universitario A Coruña, 15006 A Coruña, Spain
| | - Joan Antoni Gómez-Hospital
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28026 Madrid, Spain
- Servei de Cardiologia, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain
| | - Carles Díez-López
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28026 Madrid, Spain
- Servei de Cardiologia, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain
| | - Juan García-Lara
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28026 Madrid, Spain
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain
| | - Iris P Garrido-Bravo
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28026 Madrid, Spain
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain
| | - Luis de la Fuente-Galán
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28026 Madrid, Spain
- Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Javier López-Díaz
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28026 Madrid, Spain
- Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Sonia Mirabet-Pérez
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28026 Madrid, Spain
- Servei de Cardiologia, Hospital Universitario de la Santa Creu i Sant Pau, 08025 Barcelona, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), 28007 Madrid, Spain
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28026 Madrid, Spain
- Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea, 28670 Madrid, Spain
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4
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Baratto C, Caravita S, Soranna D, Dewachter C, Bondue A, Zambon A, Badano LP, Parati G, Vachiéry J. An updated meta-analysis of hemodynamics markers of prognosis in patients with pulmonary hypertension due to left heart disease. Pulm Circ 2022; 12:e12145. [PMID: 36568693 PMCID: PMC9768568 DOI: 10.1002/pul2.12145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/20/2022] [Accepted: 07/14/2022] [Indexed: 12/27/2022] Open
Abstract
Pulmonary hypertension (PH) is associated with a poor prognosis in left heart disease (LHD). We sought to provide an updated analysis on the association of hemodynamic variables, such as pulmonary vascular resistance (PVR), pulmonary artery compliance (PAC), and diastolic pressure gradient (DPG), with prognosis in PH-LHD, through a systematic literature review. Sixteen articles were identified, including 9600 patients with LHD, heterogeneous in terms of age, sex, and etiology of cardiac disease. In this large population, PVR (hazard ratio [HR], 1.07; 95% confidence interval [CI]: 1.05-1.0), DPG (HR, 1.02; 95% CI: 1.01-1.02) and PAC (HR, 0.76; 95% CI: 0.69-0.84) were associated with an increased risk of adverse outcome, albeit with a less solid performance of DPG. Similar results were found when hemodynamic variables were analyzed according to the thresholds commonly applied in clinical practice, or subdividing cohorts according to the underlying LHD. Furthermore, cumulative metanalysis indicated that these results are consistently stable since 2018. Thus, PVR, DPG and PAC have an established prognostic value in PH-LHD. These results are consistent through the years and unlikely to change with further studies.
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Affiliation(s)
- Claudia Baratto
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano IRCCSOspedale San LucaMilanoItaly
| | - Sergio Caravita
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano IRCCSOspedale San LucaMilanoItaly
- Department of Management, Information and Production EngineeringUniversity of BergamoDalmine (BG)Italy
| | - Davide Soranna
- IRCCS Istituto Auxologico ItalianoBiostatistics UnitMilanItaly
| | - Céline Dewachter
- Department of Cardiology, Cliniques Universitaires de BruxellesHôpital Académique ErasmeBruxellesBelgium
| | - Antoine Bondue
- Department of Cardiology, Cliniques Universitaires de BruxellesHôpital Académique ErasmeBruxellesBelgium
| | - Antonella Zambon
- IRCCS Istituto Auxologico ItalianoBiostatistics UnitMilanItaly
- Department of Statistic and Quantitative MethodsUniversity of Milano‐BicoccaMilanItaly
| | - Luigi P. Badano
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano IRCCSOspedale San LucaMilanoItaly
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanoItaly
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano IRCCSOspedale San LucaMilanoItaly
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanoItaly
| | - Jean‐Luc Vachiéry
- Department of Cardiology, Cliniques Universitaires de BruxellesHôpital Académique ErasmeBruxellesBelgium
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5
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Liu S, Yan Y. Animal models of pulmonary hypertension due to left heart disease. Animal Model Exp Med 2022; 5:197-206. [PMID: 35234367 PMCID: PMC9240728 DOI: 10.1002/ame2.12214] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/13/2022] [Accepted: 01/23/2022] [Indexed: 01/02/2023] Open
Abstract
Pulmonary hypertension due to left heart disease (PH‐LHD) is regarded as the most prevalent form of pulmonary hypertension (PH). Indeed, PH is an independent risk factor and predicts adverse prognosis for patients with left heart disease (LHD). Clinically, there are no drugs or treatments that directly address PH‐LHD, and treatment of LHD alone will not also ameliorate PH. To target the underlying physiopathological alterations of PH‐LHD and to develop novel therapeutic approaches for this population, animal models that simulate the pathophysiology of PH‐LHD are required. There are several available models for PH‐LHD that have been successfully employed in rodents or large animals by artificially provoking an elevated pressure load on the left heart, which by transduction elicits an escalated pressure in pulmonary artery. In addition, metabolic derangement combined with aortic banding or vascular endothelial growth factor receptor antagonist is also currently applied to reproduce the phenotype of PH‐LHD. As of today, none of the animal models exactly recapitulates the condition of patients with PH‐LHD. Nevertheless, the selection of an appropriate animal model is essential in basic and translational studies of PH‐LHD. Therefore, this review will summarize the characteristics of each PH‐LHD animal model and discuss the advantages and limitations of the different models.
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Affiliation(s)
- Shao‐Fei Liu
- Charité—Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin Berlin Germany
| | - Yi Yan
- Institute for Cardiovascular Prevention (IPEK) Ludwig‐Maximilians‐University Munich Munich Germany
- DZHK (German Centre for Cardiovascular Research) Partner Site Munich Heart Alliance Munich Germany
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6
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Ewert R, Stubbe B, Heine A, Desole S, Habedank D, Knaack C, Hortien F, Opitz CF. [Invasive Cardiopulmonary Exercise Testing: A Review]. Pneumologie 2021; 76:98-111. [PMID: 34844269 DOI: 10.1055/a-1651-7450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Right heart catheterization (RHC) is the internationally standardized reference method for measuring pulmonary hemodynamics under resting conditions. In recent years, increasing efforts have been made to establish the reliable assessment of exercise hemodynamics as well, in order to obtain additional diagnostic and prognostic data. Furthermore, cardiopulmonary exercise testing (CPET), as the most comprehensive non-invasive exercise test, is increasingly performed in combination with RHC providing detailed pathophysiological insights into the exercise response, so-called invasive cardiopulmonary exercise testing (iCPET).In this review, the accumulated experience with iCPET is presented and methodological details are discussed. This complex examination is especially helpful in differentiating the underlying causes of unexplained dyspnea. In particular, early forms of cardiac or pulmonary vascular dysfunction can be detected by integrated analysis of hemodynamic as well as ventilatory and gas exchange data. It is expected that with increasing validation of iCPET parameters, a more reliable differentiation of normal from pathological stress reactions will be possible.
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Affiliation(s)
- Ralf Ewert
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B, Bereich Pneumologie und Weaningzentrum, Greifswald
| | - Beate Stubbe
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B, Bereich Pneumologie und Weaningzentrum, Greifswald
| | - Alexander Heine
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B, Bereich Pneumologie und Weaningzentrum, Greifswald
| | - Susanna Desole
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B, Bereich Pneumologie und Weaningzentrum, Greifswald
| | - Dirk Habedank
- DRK Kliniken Berlin Köpenick, Medizinische Klinik Kardiologie, Berlin
| | - Christine Knaack
- Universitätsmedizin Greifswald, Klinik für Innere Medizin C, Greifswald
| | - Franziska Hortien
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B, Bereich Pneumologie und Weaningzentrum, Greifswald
| | - Christian F Opitz
- DRK Kliniken Berlin Westend, Klinik für Innere Medizin, Schwerpunkt Kardiologie, Berlin
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7
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Abstract
Pulmonary hypertension is common in left heart disease and is related most commonly to passive back transmission of elevated left atrial pressures. Some patients, however, may develop pulmonary vascular remodeling superimposed on their left-sided heart disease. This review provides a contemporary appraisal of existing criteria to diagnose a precapillary component to pulmonary hypertension in left heart disease as well as discusses etiologies, management issues, and future directions.
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Affiliation(s)
- Yogesh N V Reddy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55906, USA
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55906, USA.
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8
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Methods to improve the yield of right heart catheterization in pulmonary hypertension. RESPIRATORY MEDICINE: X 2020. [DOI: 10.1016/j.yrmex.2020.100015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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9
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Bashline MJ, Bachman TN, Helbling NL, Nouraie M, Gladwin MT, Simon MA. The Effects of Inhaled Sodium Nitrite on Pulmonary Vascular Impedance in Patients With Pulmonary Hypertension Associated with Heart Failure With Preserved Ejection Fraction. J Card Fail 2020; 26:654-661. [PMID: 32446946 DOI: 10.1016/j.cardfail.2020.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 04/03/2020] [Accepted: 04/10/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND The severity of pulmonary hypertension (PH) is monitored by measuring pulmonary vascular resistance, which is a steady-state measurement and ignores the pulsatile load encountered by the right ventricle (RV). Pulmonary vascular impedance (PVZ) can depict both steady-state and pulsatile forces, and thus may better predict clinical outcomes. We sought to calculate PVZ in patients with PH associated with heart failure with preserved ejection fraction who were administered inhaled sodium nitrite to better understand the acute effects on afterload. METHODS AND RESULTS Fourteen patients with PH associated with heart failure with preserved ejection fraction underwent right heart catherization and were administered inhaled sodium nitrite. A Fourier transform was used to calculate PVZ for both before and after nitrite for comparison. Inhaled sodium nitrite decreased characteristic impedance (inversely related to proximal pulmonary artery compliance) and total work performed by the RV. RV efficiency improved, defined by a reduction in the total work divided by cardiac output. There was a mild decrease in pulmonary steady-state resistance after the administration of inhaled sodium nitrite, but this effect was not significant. CONCLUSIONS PVZ analysis showed administration of inhaled sodium nitrite was associated with an improvement in pulmonary vascular compliance via a decrease in characteristic impedance, more so than pulmonary steady-state resistance. This effect was associated with improved RV efficiency and total work.
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Affiliation(s)
| | | | | | - Mehdi Nouraie
- Vascular Medicine Institute; Division of Pulmonary, Allergy and Critical Care Medicine
| | - Mark T Gladwin
- Vascular Medicine Institute; Division of Pulmonary, Allergy and Critical Care Medicine; Division of Cardiology and Heart and Vascular Institute
| | - Marc A Simon
- Department of Bioengineering; Vascular Medicine Institute; Division of Pulmonary, Allergy and Critical Care Medicine; Division of Cardiology and Heart and Vascular Institute.
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10
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Gerges C, Gerges M, Friewald R, Fesler P, Dorfmüller P, Sharma S, Karlocai K, Skoro-Sajer N, Jakowitsch J, Moser B, Taghavi S, Klepetko W, Lang IM. Microvascular Disease in Chronic Thromboembolic Pulmonary Hypertension. Circulation 2020; 141:376-386. [DOI: 10.1161/circulationaha.119.041515] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Pulmonary endarterectomy (PEA) is the gold standard treatment for patients with operable chronic thromboembolic pulmonary hypertension. However, persistent pulmonary hypertension (PH) after PEA remains a major determinant of poor prognosis. A concomitant small-vessel arteriopathy in addition to major pulmonary artery obstruction has been suggested to play an important role in the development of persistent PH and survival after PEA. One of the greatest unmet needs in the current preoperative evaluation is to assess the presence and severity of small-vessel arteriopathy. Using the pulmonary artery occlusion technique, we sought to assess the presence and degree of small-vessel disease in patients with chronic thromboembolic pulmonary hypertension undergoing PEA to predict postoperative outcome before surgery.
Methods:
Based on pulmonary artery occlusion waveforms yielding an estimate of the effective capillary pressure, we partitioned pulmonary vascular resistance in larger arterial (upstream resistance [R
up
]) and small arterial plus venous components (downstream resistance) in 90 patients before PEA. For validation, lung wedge biopsies were taken from nonobstructed and obstructed lung territories during PEA in 49 cases. Biopsy sites were chosen according to the pulmonary angiogram still frames that were mounted in the operating room. All vessels per specimen were measured in each patient. Percent media (%MT; arteries) and intima thickness (%IT; arteries, veins, and indeterminate vessels) were calculated relative to external vessel diameter.
Results:
Decreased R
up
was an independent predictor of persistent PH (odds ratio per 10%, 0.40 [95% CI, 0.23–0.69];
P
=0.001) and survival (hazard ratio per 10%, 0.03 [95% CI, 0.00–0.33];
p
=0.004). Arterial %MT and %IT of nonobstructed lung territories and venous %IT of obstructed lung territories were significantly increased in patients with persistent PH and nonsurvivors. R
up
correlated inversely with %MT (
r
=–0.72,
P
<0.001) and %IT (
r
=–0.62,
P
<0.001) of arteries from nonobstructed lung territories and with %IT (
r
=–0.44,
P
=0.024) of veins from obstructed lung territories. Receiver operating characteristic analysis disclosed that R
up
<66% predicted persistent PH after PEA, whereas R
up
<60% identified patients with poor prognosis after PEA.
Conclusions:
Pulmonary artery occlusion waveform analysis with estimation of R
up
seems to be a valuable technique for assessing the degree of small-vessel disease and postoperative outcome after PEA in chronic thromboembolic pulmonary hypertension.
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Affiliation(s)
- Christian Gerges
- Department of Internal Medicine II, Division of Cardiology, Vienna General Hospital (C.G., M.G., R.F., S.S. N.S.-S., I.M.L.), Medical University of Vienna, Austria
| | - Mario Gerges
- Department of Internal Medicine II, Division of Cardiology, Vienna General Hospital (C.G., M.G., R.F., S.S. N.S.-S., I.M.L.), Medical University of Vienna, Austria
| | - Richard Friewald
- Department of Internal Medicine II, Division of Cardiology, Vienna General Hospital (C.G., M.G., R.F., S.S. N.S.-S., I.M.L.), Medical University of Vienna, Austria
| | - Pierre Fesler
- PhyMedExp, University of Montpellier, CNRS, INSERM, and Department of Internal Medicine Lapeyronie, University Hospital of Montpellier, France (P.F.)
| | - Peter Dorfmüller
- Department of Pathology, University Hospital of Giessen and Marburg (UKGM), Germany (P.D.)
| | - Smriti Sharma
- Department of Internal Medicine II, Division of Cardiology, Vienna General Hospital (C.G., M.G., R.F., S.S. N.S.-S., I.M.L.), Medical University of Vienna, Austria
| | - Kristof Karlocai
- Department of Pulmonology, Semmelweis University, Budapest, Hungary (K.K.)
| | - Nika Skoro-Sajer
- Department of Internal Medicine II, Division of Cardiology, Vienna General Hospital (C.G., M.G., R.F., S.S. N.S.-S., I.M.L.), Medical University of Vienna, Austria
| | | | - Bernhard Moser
- Department of Thoracic Surgery, Division of Surgery (B.M., S.T., W.K.), Medical University of Vienna, Austria
| | - Shahrokh Taghavi
- Department of Thoracic Surgery, Division of Surgery (B.M., S.T., W.K.), Medical University of Vienna, Austria
| | - Walter Klepetko
- Department of Thoracic Surgery, Division of Surgery (B.M., S.T., W.K.), Medical University of Vienna, Austria
| | - Irene M. Lang
- Department of Internal Medicine II, Division of Cardiology, Vienna General Hospital (C.G., M.G., R.F., S.S. N.S.-S., I.M.L.), Medical University of Vienna, Austria
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11
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Huis in’t Veld AE, Oosterveer FP, De man FS, Marcus JTIM, Nossent EJ, Boonstra A, Van rossum A(B, Vonk Noordegraaf A, Bogaard HJ, Handoko ML. Hemodynamic Effects of Pulmonary Arterial Hypertension-Specific Therapy in Patients With Heart Failure With Preserved Ejection Fraction and With Combined Post- and Precapillay Pulmonary Hypertension. J Card Fail 2020; 26:26-34. [DOI: 10.1016/j.cardfail.2019.07.547] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 07/21/2019] [Accepted: 07/26/2019] [Indexed: 12/22/2022]
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12
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Lang IM. Pulmonary artery denervation - the time has come for a multicentre blinded randomised controlled trial. EUROINTERVENTION 2019; 15:659-661. [PMID: 31625915 DOI: 10.4244/eijv15i8a122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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13
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Gerges C, Gerges M, Lang IM. Pulmonary hypertension associated with left heart disease: efforts to improve the meaning of haemodynamic phenotypes. Eur Respir J 2019; 53:53/3/1802393. [DOI: 10.1183/13993003.02393-2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 11/05/2022]
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14
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Grignola JC, Trujillo P, Domingo E. Pulmonary hypertension associated with left heart disease: efforts to improve the meaning of haemodynamic phenotypes. Eur Respir J 2019; 53:53/3/1801894. [DOI: 10.1183/13993003.01894-2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 12/04/2018] [Indexed: 11/05/2022]
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15
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Domingo E, Grignola JC, Trujillo P, Aguilar R, Roman A. Proximal pulmonary arterial wall disease in patients with persistent pulmonary hypertension after successful left-sided valve replacement according to the hemodynamic phenotype. Pulm Circ 2018; 9:2045894018816972. [PMID: 30430894 PMCID: PMC6295709 DOI: 10.1177/2045894018816972] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Regression of pulmonary hypertension (PH) is often incomplete after successful left-sided valve replacement (LSVR). Proximal pulmonary arterial (PPA) wall disease can be involved in patients with persistent-PH after LSVR, affecting the right ventricular to pulmonary arterial (RV-PA) coupling. Fifteen patients underwent successful LSVR at least one year ago presenting PH by echo (> 50 mmHg). Prosthesis-patient mismatch and left ventricular dysfunction were discarded. All patients underwent hemodynamic and intravascular ultrasound (IVUS) study. We estimated PPA stiffness (elastic modulus [EM]) and the relative area wall thickness (AWT). Acute vasoreactivity was assessed by inhaled nitric oxide (iNO) testing. RV-PA coupling was estimated by the tricuspid annular plane systolic excursion to systolic pulmonary arterial pressure ratio. Patients were classified as isolated post-capillary PH (Ipc-PH; pulmonary vascular resistance [PVR] ≤ 3 WU and/or diastolic pulmonary gradient [DPG] < 7 mmHg) and combined post- and pre-capillary PH (Cpc-PH; PVR > 3 WU and DPG ≥ 7 mmHg). Both Ipc-PH and Cpc-PH showed a significant increase of EM and AWT. Despite normal PVR and DPG, Ipc-PH had a significant decrease in pulmonary arterial capacitance and RV-PA coupling impairment. Cpc-PH had worse PA stiffness and RV-PA coupling to Ipc-PH ( P < 0.05). iNO decreased RV afterload, improving the cardiac index and stroke volume only in Cpc-PH ( P < 0.05). Patients with persistent PH after successful LSVR have PPA wall disease and RV-PA coupling impairment beyond the hemodynamic phenotype. Cpc-PH is responsive to iNO, having the worse PA stiffness and RV-PA coupling. The PPA remodeling could be an early event in the natural history of PH associated with left heart disease.
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Affiliation(s)
- Enric Domingo
- 1 Area del Cor, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,2 Physiology Department, School of Medicine, Universitat Autonoma, Barcelona, Spain
| | - Juan C Grignola
- 3 Pathophysiology Department, Facultad de Medicina, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Pedro Trujillo
- 4 Cardiology Department, Centro Cardiovascular Universitario, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Rio Aguilar
- 5 Cardiology Department, Hospital de la Princesa, Madrid, Spain
| | - Antonio Roman
- 6 Department of Neumology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,7 Ciberes, IS Carlos III, Madrid, Spain
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16
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Guazzi M. Partitioning of pulmonary vascular resistances in group 2 pulmonary hypertension: insightful suggestions for bridging haemodynamics to underlying mechanisms. Eur Respir J 2018; 51:51/5/1800816. [PMID: 29794124 DOI: 10.1183/13993003.00816-2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 04/30/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Marco Guazzi
- Dept of Biomedical Sciences for Health, University of Milan, IRCCS Policlinico San Donato, Milan, Italy .,Dept of Cardiology University, IRCCS Policlinico San Donato, Milan, Italy
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