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Adhyapak SM, Konda A, K T T, Shivakumar, Varghese K. Right heart catheterization in idiopathic pulmonary hypertension: An all-inclusive necessity. Curr Probl Cardiol 2024; 49:102642. [PMID: 38750992 DOI: 10.1016/j.cpcardiol.2024.102642] [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: 05/10/2024] [Accepted: 05/12/2024] [Indexed: 05/19/2024]
Abstract
The gold standard for diagnosis of pulmonary hypertension is right heart catheterization. This procedure requires considerable expertise and has its own procedure related complications. If not done properly, it can lead to misinterpretations of its findings. We have highlighted the procedural technique and major pitfalls in the diagnosis of pulmonary hypertension.
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Affiliation(s)
- Srilakshmi M Adhyapak
- Department of Cardiology, St. John's medical College Hospital, Bangalore 560034, India.
| | - Abhilash Konda
- Department of Cardiology, St. John's medical College Hospital, Bangalore 560034, India
| | - Thirumal K T
- Department of Cardiology, St. John's medical College Hospital, Bangalore 560034, India
| | - Shivakumar
- Department of Cardiology, St. John's medical College Hospital, Bangalore 560034, India
| | - Kiron Varghese
- Department of Cardiology, St. John's medical College Hospital, Bangalore 560034, India
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2
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Sahay S, Lane J, Sharpe MG, Toth D, Paul D, Siuba MT, Tonelli AR. Impact on Pulmonary Hypertension Hemodynamic Classification Based on the Methodology Used to Measure Pulmonary Artery Wedge Pressure and Cardiac Output. Ann Am Thorac Soc 2023; 20:1752-1759. [PMID: 37561068 DOI: 10.1513/annalsats.202303-216oc] [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: 03/12/2023] [Accepted: 08/09/2023] [Indexed: 08/11/2023] Open
Abstract
Rationale: Guidelines recommend using end-expiration pulmonary pressure measurements to determine the hemodynamic subgroups in pulmonary hypertension. Pulmonary artery wedge pressure (PAWP) determinations averaged across the respiratory cycle (PAWPav) instead of PAWP at end-expiration (PAWPee) and cardiac output (CO) measured by Fick (COFick) instead of thermodilution (COTD) may affect the hemodynamic classification of pulmonary hypertension. Objectives: To assess the impact on the pulmonary hypertension hemodynamic classification of the use of PAWPee versus PAWPav as well as COFick versus COTD. Methods: This was a single-center retrospective study of consecutive patients (n = 151) who underwent right heart catheterization with COTD, COFick, PAWPee, and PAWPav. A secondary cohort consisted of consecutive patients (n = 71) who had mean pulmonary artery pressure at end-expiration (mPAPee) and mPAP averaged across the respiratory cycle (mPAPav) measured, as well as PAWPee and PAWPav. Results: The PAWPee and PAWPav were 16.8 ± 6.4 and 15.1 ± 6.8 mm Hg, respectively, with a mean difference of 1.7 ± 2.1 mm Hg. The COTD and COFick determinations were 5.0 ± 2.4 and 5.3 ± 2.5 L/min, respectively, with a mean difference of -0.4 ± 1.3 L/min. The hemodynamic group distribution was significantly different when using PAWPee versus PAWPav, when using either COTD or COFick (P < 0.001 for both comparisons), and these results were consistent in our secondary cohort. The pulmonary hypertension hemodynamic group distribution was not significantly different between COTD and COFick when using either PAWPee or PAWPav. Conclusions: The methodology used to measure PAWP, either at end-expiration or averaged across the respiratory cycle, significantly impacts the hemodynamic classification of pulmonary hypertension.
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Affiliation(s)
- Sandeep Sahay
- Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Hospital, Houston, Texas; and
| | - James Lane
- Department of Pulmonary, Allergy, and Critical Care Medicine, Respiratory Institute, and
| | - Megan G Sharpe
- Case Western Reserve University School of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - David Toth
- Department of Pulmonary, Allergy, and Critical Care Medicine, Respiratory Institute, and
| | - Deborah Paul
- Department of Pulmonary, Allergy, and Critical Care Medicine, Respiratory Institute, and
| | - Matthew T Siuba
- Department of Pulmonary, Allergy, and Critical Care Medicine, Respiratory Institute, and
| | - Adriano R Tonelli
- Department of Pulmonary, Allergy, and Critical Care Medicine, Respiratory Institute, and
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Velidakis N, Khattab E, Gkougkoudi E, Kadoglou NPE. Pulmonary Hypertension in Left Ventricular Valvular Diseases: A Comprehensive Review on Pathophysiology and Prognostic Value. Life (Basel) 2023; 13:1793. [PMID: 37763197 PMCID: PMC10532440 DOI: 10.3390/life13091793] [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: 07/05/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023] Open
Abstract
Left ventricular (LV) valvular diseases, make up one of the most common etiologies for pulmonary hypertension (PH), and it is not well understood how and at which degree it affects prognosis. The aim of the present study was a comprehensive review of the pathophysiologic mechanism of PH in patients with LV valvular diseases and the prognostic value of baseline and post-intervention PH in patients undergoing interventional treatment. The pathophysiology of PH in patients with LV valvular diseases involves gradual elevation of left ventricular filling pressure and left atrial pressure, which are passively transmitted to the pulmonary circulation and raise pulmonary artery systolic pressure (PASP). A long-lasting exposure to elevated PASP progressively leads to initially functional and thereafter irreversible structural changes in the pulmonary vasculature, leading up to high pulmonary vascular resistance. Surgical treatment of severe LV valvular diseases is highly effective in patients without resting PH or those with exercise-induced PH (EIPH) before intervention. In the case of pre-operative PH, successful interventional therapy decreases PASP, but the post-operative cardiac and all-cause mortality remain higher compared to patients without pre-operative PH. Hence, it is of paramount importance to detect patients with severe LV valvulopathies before the development of PH, since they will get greater benefits from early intervention.
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Affiliation(s)
| | | | | | - Nikolaos P. E. Kadoglou
- Medical School, University of Cyprus, Palaios Dromos Lefkosias Lemesou No. 215/62029 Aglantzia, P.O. Box 20537 1678, Nicosia 2024, Cyprus
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Molnár AÁ, Sánta A, Merkely B. Echocardiography Imaging of the Right Ventricle: Focus on Three-Dimensional Echocardiography. Diagnostics (Basel) 2023; 13:2470. [PMID: 37568832 PMCID: PMC10416971 DOI: 10.3390/diagnostics13152470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/28/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
Right ventricular function strongly predicts cardiac death and adverse cardiac events in patients with cardiac diseases. However, the accurate right ventricular assessment by two-dimensional echocardiography is limited due to its complex anatomy, shape, and load dependence. Advances in cardiac imaging and three-dimensional echocardiography provided more reliable information on right ventricular volumes and function without geometrical assumptions. Furthermore, the pathophysiology of right ventricular dysfunction and tricuspid regurgitation is frequently connected. Three-dimensional echocardiography allows a more in-depth structural and functional evaluation of the tricuspid valve. Understanding the anatomy and pathophysiology of the right side of the heart may help in diagnosing and managing the disease by using reliable imaging tools. The present review describes the challenging echocardiographic assessment of the right ventricle and tricuspid valve apparatus in clinical practice with a focus on three-dimensional echocardiography.
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Affiliation(s)
- Andrea Ágnes Molnár
- Heart and Vascular Center, Semmelweis University, 1085 Budapest, Hungary; (A.S.); (B.M.)
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5
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Zeng Y, Yu Q, Maimaitiaili N, Li B, Liu P, Hou Y, Mima, Cirenguojie, Sumit G, Dejizhuoga, Liu Y, Peng W. Clinical and Predictive Value of Computed Tomography Angiography in High-Altitude Pulmonary Hypertension. JACC. ASIA 2022; 2:803-815. [PMID: 36713752 PMCID: PMC9877215 DOI: 10.1016/j.jacasi.2022.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 12/15/2022]
Abstract
Background High-altitude pulmonary hypertension (HAPH), as the group 3 pulmonary hypertension, has been less studied so far. The limited medical conditions in the high-altitude plateau are responsible for the delay of the clinical management of HAPH. Objectives This study aims to identify the imaging characteristics of HAPH and explore noninvasive assessment of mean pulmonary arterial pressure (mPAP) based on computed tomography angiography (CTA). Methods Twenty-five patients with suspected HAPH were enrolled. Right heart catheterization (RHC) and pulmonary angiography were performed. Echocardiography and CTA image data were collected for analysis. A multivariable linear regression model was fit to estimate mPAP (mPAPpredicted). A Bland-Altman plot and pathological analysis were performed to assess the diagnostic accuracy of this model. Results Patients with HAPH showed slow blood flow and coral signs in lower lobe pulmonary artery in pulmonary arteriography, and presented trend for dilated pulmonary vessels, enlarged right atrium, and compressed left atrium in CTA (P for trend <0.05). The left lower pulmonary artery-bronchus ratio (odds ratio: 1.13) and the ratio of right to left atrial diameter (odds ratio: 1.09) were significantly associated with HAPH, and showed strong correlation with mPAPRHC, respectively (r = 0.821 and r = 0.649, respectively; all P < 0.0001). The mPAPpredicted model using left lower artery-bronchus ratio and ratio of right to left atrial diameter as covariates showed high correlation with mPAPRHC (r = 0.907; P < 0.0001). Patients with predicted HAPH also had the typical pathological changes of pulmonary hypertension. Conclusions Noninvasive mPAP estimation model based on CTA image data can accurately fit mPAPRHC and is beneficial for the early diagnosis of HAPH.
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Key Words
- ABR, pulmonary artery-bronchus ratio
- HAPH, high-altitude pulmonary hypertension
- LVEF, left ventricle ejection fraction
- PASP, pulmonary arterial systolic pressure
- PH, pulmonary hypertension
- RHC, right heart catheterization
- TRPG, tricuspid regurgitation pressure gradient
- computed tomography
- mPAP, mean pulmonary arterial pressure
- plateau
- pulmonary arterial pressure
- pulmonary artery-bronchus ratio
- rPA, the ratio of main pulmonary artery to aorta diameter
- rRLA, the ratio of right to left atrial diameter
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Affiliation(s)
- Yanxi Zeng
- Department of Cardiology, Shigatse People’s Hospital, Tibet, China,Department of Cardiology, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Qing Yu
- Department of Cardiology, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Nuerbiyemu Maimaitiaili
- Department of Cardiology, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Bingyu Li
- Department of Cardiology, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Panjin Liu
- Department of Cardiology, Shigatse People’s Hospital, Tibet, China
| | - Yongzhi Hou
- Department of Ultrasound, Shigatse People’s Hospital, Tibet, China
| | - Mima
- Department of Cardiology, Shigatse People’s Hospital, Tibet, China
| | - Cirenguojie
- Department of Radiology, Shigatse People’s Hospital, Tibet, China
| | - Gupta Sumit
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Dejizhuoga
- Department of Cardiology, Shigatse People’s Hospital, Tibet, China,Department of Cardiology, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yong Liu
- Department of Radiology, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China,Dr. Yong Liu, Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Shanghai 200072, China.
| | - Wenhui Peng
- Department of Cardiology, Shigatse People’s Hospital, Tibet, China,Department of Cardiology, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China,Address for correspondence: Dr Wenhui Peng, Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Shanghai 200072, China.
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Qin X, Gao A, Hou X, Xu X, Chen L, Sun L, Hao Y, Shi Y. Connexins may play a critical role in cigarette smoke-induced pulmonary hypertension. Arch Toxicol 2022; 96:1609-1621. [PMID: 35344070 DOI: 10.1007/s00204-022-03274-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/02/2022] [Indexed: 11/02/2022]
Abstract
Pulmonary hypertension (PH) is a chronic progressive disease characterized by pulmonary vasoconstriction and remodeling. It causes a gradual increase in pulmonary vascular resistance leading to right-sided heart failure, and may be fatal. Chronic exposure to cigarette smoke (CS) is an essential risk factor for PH group 3; however, smoking continues to be prevalent and smoking cessation is reported to be difficult. A majority of smokers exhibit PH, which leads to a concomitant increase in the risk of mortality. The current treatments for PH group 3 focus on vasodilation and long-term oxygen supplementation, and fail to stop or reverse PH-associated continuous vascular remodeling. Recent studies have suggested that pulmonary vascular endothelial dysfunction induced by CS exposure may be an initial event in the natural history of PH, which in turn may be associated with abnormal alterations in connexin (Cx) expression. The relationship between Cx and CS-induced PH development has not yet been directly investigated. Therefore, this review will describe the roles of CS and Cx in the development of PH and discuss the related downstream pathways. We also discuss the possible role of Cx in CS-induced PH. It is hoped that this review may provide new perspectives for early intervention.
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Affiliation(s)
- Xiaojiang Qin
- School of Public Health, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, Shanxi, China.
- China Key Laboratory of Cellular Physiology (Shanxi Medical University), Ministry of Education, 56 Xinjian South Road, Taiyuan, 030001, Shanxi, China.
| | - Anqi Gao
- School of Public Health, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, Shanxi, China
| | - Xiaomin Hou
- Department of Pharmacology, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, Shanxi, China
- China Key Laboratory of Cellular Physiology (Shanxi Medical University), Ministry of Education, 56 Xinjian South Road, Taiyuan, 030001, Shanxi, China
| | - Xinrong Xu
- School of Public Health, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, Shanxi, China
| | - Liangjin Chen
- School of Public Health, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, Shanxi, China
| | - Lin Sun
- School of Public Health, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, Shanxi, China
| | - Yuxuan Hao
- School of Public Health, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, Shanxi, China
| | - Yiwei Shi
- Department of Respiratory and Critical Care Medicine, Shanxi Medical University Affiliated First Hospital, 85 Jiefang South Road, Taiyuan, 030001, Shanxi, China.
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Leong K, Howard L, Lo Giudice F, Pavey H, Davies R, Haji G, Gibbs S, Gopalan D. MRI Feature Tracking Strain in Pulmonary Hypertension: Utility of Combined Left Atrial Volumetric and Deformation Assessment in Distinguishing Post- From Pre-capillary Physiology. Front Cardiovasc Med 2022; 9:787656. [PMID: 35369294 PMCID: PMC8968034 DOI: 10.3389/fcvm.2022.787656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/09/2022] [Indexed: 11/13/2022] Open
Abstract
AimsPulmonary hypertension (PH) is dichotomized into pre- and post-capillary physiology by invasive catheterization. Imaging, particularly strain assessment, may aid in classification and be helpful with ambiguous hemodynamics. We sought to define cardiac MRI (CMR) feature tracking biatrial peak reservoir and biventricular peak systolic strain in pre- and post-capillary PH and examine the performance of peak left atrial strain in distinguishing the 2 groups compared to TTE.Methods and ResultsRetrospective cross-sectional study from 1 Jan 2015 to 31 Dec 2020; 48 patients (22 pre- and 26 post-capillary) were included with contemporaneous TTE, CMR and catheterization. Mean pulmonary artery pressures were higher in the pre-capillary cohort (55 ± 14 vs. 42 ± 9 mmHg; p < 0.001) as was pulmonary vascular resistance (median 11.7 vs. 3.7 WU; p < 0.001). Post-capillary patients had significantly larger left atria (60 ± 22 vs. 25 ± 9 ml/m2; p < 0.001). There was no difference in right atrial volumes between groups (60 ± 21 vs. 61 ± 29 ml/m2; p = 0.694), however peak RA strain was lower in post-capillary PH patients (8.9 ± 5.5 vs. 18.8 ± 7.0%; p < 0.001). In the post-capillary group, there was commensurately severe peak strain impairment in both atria (LA strain 9.0 ± 5.8%, RA strain 8.9 ± 5.5%). CMR LAVi and peak LA strain had a multivariate AUC of 0.98 (95% CI 0.89–1.00; p < 0.001) for post-capillary PH diagnosis which was superior to TTE.ConclusionCMR volumetric and deformation assessment of the left atrium can highly accurately distinguish post- from pre-capillary PH.
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Affiliation(s)
- Kai'En Leong
- Department of Radiology, Imperial College National Health Service Trust/Hammersmith Hospital, London, United Kingdom
- Department of Cardiology, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Luke Howard
- National Pulmonary Hypertension Service, Imperial College National Health Service Trust, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Francesco Lo Giudice
- National Pulmonary Hypertension Service, Imperial College National Health Service Trust, London, United Kingdom
- Department of Cardiology, Imperial College National Health Service Trust/Hammersmith Hospital, London, United Kingdom
| | - Holly Pavey
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom
| | - Rachel Davies
- National Pulmonary Hypertension Service, Imperial College National Health Service Trust, London, United Kingdom
| | - Gulammehdi Haji
- National Pulmonary Hypertension Service, Imperial College National Health Service Trust, London, United Kingdom
| | - Simon Gibbs
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Deepa Gopalan
- Department of Radiology, Imperial College National Health Service Trust/Hammersmith Hospital, London, United Kingdom
- Department of Radiology, Cambridge University Hospitals National Health Service Trust, Cambridge, United Kingdom
- *Correspondence: Deepa Gopalan
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Zhao Y, Tian L, Zhang L, Ma T, Di L, Wang Y, Gu X, Wang D, Gao S, Wang H. the comparative effects of sacubitril/valsartan vs. enalapril on pulmonary hypertension due to heart failure with reduced ejection fraction. Pulm Circ 2022; 12:e12034. [PMID: 35874853 PMCID: PMC9297686 DOI: 10.1002/pul2.12034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 08/11/2021] [Accepted: 08/17/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- Ying Zhao
- Department of Cardiology the Hai‐gang Hospital of Qinhuangdao Hebei 066000 China
| | - Li‐guo Tian
- Department of Cardiology the Hai‐gang Hospital of Qinhuangdao Hebei 066000 China
| | - Li‐xin Zhang
- Department of Cardiology the Hai‐gang Hospital of Qinhuangdao Hebei 066000 China
| | - Tao Ma
- Department of Cardiology the Hai‐gang Hospital of Qinhuangdao Hebei 066000 China
| | - Liang Di
- Department of Cardiology the Hai‐gang Hospital of Qinhuangdao Hebei 066000 China
| | - Yan‐bo Wang
- Department of Cardiology the Second Hospital of Hebei Medical University Shijiazhuang, Hebei 050000 China
| | - Xin‐shun Gu
- Department of Cardiology the Second Hospital of Hebei Medical University Shijiazhuang, Hebei 050000 China
| | - Dandan Wang
- Department of Cardiology the Hai‐gang Hospital of Qinhuangdao Hebei 066000 China
| | - Shang Gao
- Department of Cardiology the Hai‐gang Hospital of Qinhuangdao Hebei 066000 China
| | - Haiyan Wang
- Department of Cardiology Handan Central Hospital Hebei 056002 China
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Tea I, Hussain I. Under Pressure: Right Heart Catheterization and Provocative Testing for Diagnosing Pulmonary Hypertension. Methodist Debakey Cardiovasc J 2021; 17:92-100. [PMID: 34326928 PMCID: PMC8298122 DOI: 10.14797/afui4711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2021] [Indexed: 11/09/2022] Open
Abstract
Pulmonary hypertension (PH) is a heterogenous disorder involving multiple
pathophysiological processes that ultimately affect the vasculature within the
lungs. Right heart catheterization (RHC) continues to be the benchmark for
diagnosing PH. The use of provocation techniques during RHC can help
sub-characterize the type of PH and thus assist in developing appropriate
treatment strategies for the management of each PH subtype. This review examines
proven and novel approaches for evaluating the pulmonary vasculature during RHC
and aspires to provide an accurate, clinically relevant framework for using RHC
to diagnose and manage PH. Further improvement in standardized protocols will
help optimize the application of RHC in patients with PH.
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Affiliation(s)
- Isaac Tea
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Imad Hussain
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
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Wang L, Zhao LP, Chen Y, Chang X, Jin F, Liu X. Obesity paradox in pulmonary hypertension due to left ventricular systolic dysfunction. Herz 2021; 46:575-580. [PMID: 33544153 DOI: 10.1007/s00059-021-05023-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/18/2020] [Accepted: 01/11/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Pulmonary hypertension (PH) due to left ventricular systolic dysfunction (PH-HFrEF) is a common heart disease with poor prognosis. In this study, we explored the risk factors for PH-HFrEF and investigated the related factors affecting the prognosis of PH-HFrEF patients. METHODS The study recruited consecutive patients with PH-HFrEF and systolic pulmonary artery pressure (sPAP) of more than 40 mm Hg with left ventricular ejection fraction (LVEF) of less than 45% on echocardiography. Patients with left ventricular systolic dysfunction (HFrEF) but without PH (sPAP < 30 mmHg and LVEF < 45%) were chosen as the control group. Patients were followed up for 18 months, and major adverse cardiac events (MACE) were recorded. RESULTS In total, 93 patients with PH-HFrEF formed the study group and 93 LVEF-matched patients with HFrEF were enrolled as controls. Body mass index (BMI) in PH-HFrEF patients was significantly lower compared with the control group (p < 0.05). Multivariate logistic regression analysis revealed that low BMI was an independent predictor of the presence of PH in patients with HFrEF (p < 0.05). There were 23 (24.7%) MACE in the PH-HFrEF group and 18 (19.4%) MACE in the control group. Cox regression analysis showed that low BMI was an independent predictor of MACE occurrence in the PH-HFrEF group (p < 0.05). CONCLUSION Low BMI appear to be significantly associated with PH occurrence in patients with HFrEF, and is an independent predictor of MACE in patients with PH-HFrEF.
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Affiliation(s)
- Li Wang
- Department of Cardiology, The Second Affiliated Hospital of Soochow University, No 1055, Sanxiang Road, 215004, Suzhou City, China
- Emergency Department, The Seventh People's Hospital of Suzhou, Suzhou City, China
| | - Liang-Ping Zhao
- Department of Cardiology, The Second Affiliated Hospital of Soochow University, No 1055, Sanxiang Road, 215004, Suzhou City, China.
| | - Yuqi Chen
- Department of Cardiology, The Second Affiliated Hospital of Soochow University, No 1055, Sanxiang Road, 215004, Suzhou City, China
| | - Xiansong Chang
- Department of Cardiology, The Second Affiliated Hospital of Soochow University, No 1055, Sanxiang Road, 215004, Suzhou City, China
- Emergency Department, The Seventh People's Hospital of Suzhou, Suzhou City, China
| | - Fulu Jin
- Department of Cardiology, The Second Affiliated Hospital of Soochow University, No 1055, Sanxiang Road, 215004, Suzhou City, China
| | - Xiang Liu
- Department of Cardiology, The Second Affiliated Hospital of Soochow University, No 1055, Sanxiang Road, 215004, Suzhou City, China
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11
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Xu D, Zhang H, Cheng H, Xu T, Sun W, Sheng Y, Yang R, Xu D, Zhou F, Zhou Y, Xu F, Zhu H, Cheang I, Ding Q, Chen Y, Zhao P, Kong X, Li X, Zhang H. Pulmonary hypertension due to left heart disease with pulmonary arterial wedge pressure ≤15 mm Hg. Herz 2020; 46:209-214. [PMID: 32990814 DOI: 10.1007/s00059-020-04983-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/14/2020] [Accepted: 08/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pulmonary hypertension due to left heart disease (PH-LHD) is the most prevalent type of pulmonary hypertension (PH). The hemodynamic diagnostic standard of pulmonary arterial wedge pressure (PAWP) >15 mm Hg that is traditionally recommended by guidelines is being challenged. METHODS To address this problem, we analyzed the data of 154 patients with PH-LHD admitted to our center from April 2013 to March 2018. Pharmacological or nonpharmacological treatment of underlying left heart disease was offered to all 154 patients. RESULTS In total, there were 24 patients (15.6%) with PAWP ≤15 mm Hg. Comparison of echocardiography and right heart catheterization parameters between the two groups (PAWP >15 mm Hg and PAWP ≤15 mm Hg) showed that the group with PAWP ≤15 mm Hg had smaller left ventricular diameter, higher cardiac output, lower pressure and higher oxygen saturation in the pulmonary artery, right atrium, right ventricle, and superior vena cava. No significant difference was found regarding dilated cardiomyopathy, diabetes mellitus, hypertension, atrial fibrillation, and left heart valvular disease, but a significant difference was found for coronary heart disease (higher morbidity in group with PAWP ≤15 mm Hg) between the two groups. CONCLUSION We found that 15.6% of the patients with PH-LHD under pharmacological or nonpharmacological treatment had PAWP ≤15 mm Hg. These results suggest that the diagnostic criterion of PAWP and the characteristics for this group of patients should be further investigated.
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Affiliation(s)
- Dongxu Xu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, 210029, Nanjing, China.,Department of Cardiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China
| | - Hao Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, 210029, Nanjing, China
| | - Huiling Cheng
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, 210029, Nanjing, China
| | - Tianbao Xu
- Department of Cardiology, The People's Hospital of Kizilsu Kirghiz Autonomous Prefecture, Xinjiang, China
| | - Wei Sun
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, 210029, Nanjing, China
| | - Yanhui Sheng
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, 210029, Nanjing, China
| | - Rong Yang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, 210029, Nanjing, China
| | - Dongjie Xu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, 210029, Nanjing, China
| | - Fang Zhou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, 210029, Nanjing, China
| | - Yanli Zhou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, 210029, Nanjing, China
| | - Fang Xu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, 210029, Nanjing, China
| | - Hongyan Zhu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, 210029, Nanjing, China
| | - IokFai Cheang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, 210029, Nanjing, China
| | - Qiang Ding
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, 210029, Nanjing, China.,Department of Cardiology, The People's Hospital of Kizilsu Kirghiz Autonomous Prefecture, Xinjiang, China
| | - Yan Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, 210029, Nanjing, China.,Department of Cardiology, The People's Hospital of Kizilsu Kirghiz Autonomous Prefecture, Xinjiang, China
| | - Pei Zhao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, 210029, Nanjing, China.,Department of Cardiology, The People's Hospital of Kizilsu Kirghiz Autonomous Prefecture, Xinjiang, China
| | - Xiangqing Kong
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, 210029, Nanjing, China
| | - Xinli Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, 210029, Nanjing, China
| | - Haifeng Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, 210029, Nanjing, China. .,Department of Cardiology, The People's Hospital of Kizilsu Kirghiz Autonomous Prefecture, Xinjiang, China.
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12
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Mandras SA, Mehta HS, Vaidya A. Pulmonary Hypertension: A Brief Guide for Clinicians. Mayo Clin Proc 2020; 95:1978-1988. [PMID: 32861339 DOI: 10.1016/j.mayocp.2020.04.039] [Citation(s) in RCA: 123] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/03/2020] [Accepted: 04/30/2020] [Indexed: 12/19/2022]
Abstract
Pulmonary hypertension (PH) is classified into 5 clinical subgroups: pulmonary arterial hypertension (PAH), PH due to left-sided heart disease, PH due to chronic lung disease, chronic thromboembolic PH (CTEPH), and PH with an unclear and/or multifactorial mechanisms. A range of underlying conditions can lead to these disorders. Overall, PH affects approximately 1% of the global population, and over half of patients with heart failure may be affected. Cardiologists are therefore likely to encounter PH in their practice. Routine tests in patients with symptoms and physical findings suggestive of PH include electrocardiography, chest radiography, and pulmonary function tests. Transthoracic echocardiography is used to estimate the probability of PH. All patients with suspected or confirmed PH, without confirmed left-sided heart or lung diseases, should have a ventilation-perfusion scan to exclude CTEPH. Right-sided heart catheterization is essential for accurate diagnosis and classification. All patients with PAH or CTEPH must be referred to a specialist center. Surgical pulmonary endarterectomy is the treatment of choice for eligible patients with CTEPH. Targeted treatments (phosphodiesterase type 5 inhibitors, soluble guanylate cyclase stimulators, endothelin receptor antagonists, prostacyclin analogues, and prostacyclin receptor agonists) are licensed for patients with PAH. The soluble guanylate cyclase stimulator riociguat is the only licensed targeted therapy for patients with inoperable or persistent/recurrent CTEPH. Management of PH resulting from left-sided heart disease primarily involves treatment of the underlying condition.
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Affiliation(s)
| | | | - Anjali Vaidya
- Pulmonary Hypertension, Right Heart Failure and CTEPH Program, Temple University Lewis Katz School of Medicine, Philadelphia, PA
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13
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Pott A, Jäck S, Schweizer C, Baumhardt M, Stephan T, Rattka M, Weinmann K, Bothner C, Scharnbeck D, Keßler M, Rottbauer W, Dahme T. Atrial fibrillation ablation in heart failure patients: improved systolic function after cryoballoon pulmonary vein isolation. ESC Heart Fail 2020; 7:2258-2267. [PMID: 32578969 PMCID: PMC7524096 DOI: 10.1002/ehf2.12735] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 04/03/2020] [Accepted: 04/15/2020] [Indexed: 12/14/2022] Open
Abstract
Aims Atrial fibrillation (AF) and heart failure (HF) are the most common cardiac diseases and often coexist leading to increased mortality and morbidity compared with AF patients without HF. As shown previously, AF ablation using radio frequency (RF) in HF patients leads to a reduction of AF burden, an increase of left ventricular ejection fraction (LVEF) and consequently to reduced hospitalization and mortality. Previous AF ablation studies on HF patients have been liberal about additional targets beyond pulmonary vein isolation (PVI). Thus, the aim of this study was to assess systematically the impact of a straightforward PVI‐only strategy on LVEF, NYHA functional class, and cardiovascular hospitalization rate in HF patients. Methods and results Out of 414 consecutive patients undergoing PVI, only with the cryoballoon 113 patients with reduced LVEF [mean: 38.4 ± 10.8%, reduced ejection fraction (rEF) group] and 301 patients with normal LVEF (>55%) at baseline were identified [normal ejection fraction (nEF) group]. Remarkably, even though freedom from arrhythmia recurrence after 1 year was significantly lower in the rEF group (64.9%) compared with the nEF group (71.2%, P = 0.036), mean LVEF improved from 38.4 ± 10.8% to 52.5 ± 17.2% (P < 0.001) after cryoballoon ablation in the rEF group. Accordingly, HF‐related symptoms as well as hospitalization rate declined significantly in the rEF group during follow‐up compared with baseline. Conclusions The results of the present study suggest that catheter ablation restricted to a straightforward PVI‐only strategy using the cryoballoon leads to improved left ventricular ejection fraction as well as improvement of NYHA functional class and increased freedom from cardiovascular rehospitalization.
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Affiliation(s)
- Alexander Pott
- Medicine II, Ulm University Medical Center, Ulm, Germany
| | - Saskia Jäck
- Medicine II, Ulm University Medical Center, Ulm, Germany
| | | | | | - Tilman Stephan
- Medicine II, Ulm University Medical Center, Ulm, Germany
| | - Manuel Rattka
- Medicine II, Ulm University Medical Center, Ulm, Germany
| | | | - Carlo Bothner
- Medicine II, Ulm University Medical Center, Ulm, Germany
| | | | - Mirjam Keßler
- Medicine II, Ulm University Medical Center, Ulm, Germany
| | | | - Tillman Dahme
- Medicine II, Ulm University Medical Center, Ulm, Germany
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14
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Bohbot Y, Guignant P, Rusinaru D, Kubala M, Maréchaux S, Tribouilloy C. Impact of Right Ventricular Systolic Dysfunction on Outcome in Aortic Stenosis. Circ Cardiovasc Imaging 2020; 13:e009802. [DOI: 10.1161/circimaging.119.009802] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Pulmonary hypertension is an established outcome predictor in patients with aortic stenosis (AS), but the prognostic impact of right ventricular dysfunction has not been well studied.
Methods:
We included 2181 patients (50.4% men; mean age, 77 years) with aortic valve area <1.3 cm
2
and analyzed the occurrence of all-cause death during follow-up according to tricuspid annular plane systolic excursion (TAPSE) quartiles.
Results:
Patients in the lowest quartile (TAPSE <17 mm) were at a high risk of death, whereas survival was comparable for the 3 other quartiles. Five-year survival was 55±2% for TAPSE <17 mm, 72±2% for TAPSE of 17 to 20 mm, 71±2% for TAPSE of 20 to 24 mm, and 73±2% for TAPSE >24 mm (overall
P
<0.001). TAPSE <17 mm was associated with increased mortality after adjustment for established prognostic factors (adjusted hazard ratio [HR], 1.55 [95% CI, 1.21–1.97]) and after further adjustment for aortic valve replacement (AVR; adjusted HR, 1.47 [95% CI, 1.15–1.87]). The excess mortality risk associated with TAPSE <17 mm was noticed in both patients managed initially conservatively (adjusted HR, 1.46 [95% CI, 1.20–1.76]) and patients who underwent early (within 3 months after diagnosis) AVR (adjusted HR, 1.61 [95% CI, 1.03–2.52]). In asymptomatic patients with severe AS and preserved ejection fraction, TAPSE <17 mm was independently predictive of mortality (adjusted HR, 2.14 [95% CI, 1.31–3.51]). Early AVR was associated with similar survival benefit in TAPSE <17 and ≥17 mm (adjusted HR, 0.23 [95% CI, 0.16–0.34] for TAPSE <17 mm, adjusted HR, 0.26 [95% CI, 0.19–0.35] for TAPSE ≥17 mm;
P
for interaction, 0.97).
Conclusions:
Right ventricular dysfunction is an important and independent predictor of mortality in AS. TAPSE <17 mm at the time of AS diagnosis is a marker of poor survival under conservative management and after AVR even in asymptomatic patients with severe AS. AVR was associated with a pronounced reduction in mortality independent of TAPSE suggesting that AVR should be discussed before right ventricular dysfunction occurs in severe AS.
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Affiliation(s)
- Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, France (Y.B., P.G., D.R., M.K., C.T.)
- EA 7517 MP3CV, Jules Verne University of Picardie, Amiens, France (Y.B., D.R., M.K., S.M., C.T.)
| | - Pierre Guignant
- Department of Cardiology, Amiens University Hospital, France (Y.B., P.G., D.R., M.K., C.T.)
| | - Dan Rusinaru
- Department of Cardiology, Amiens University Hospital, France (Y.B., P.G., D.R., M.K., C.T.)
- EA 7517 MP3CV, Jules Verne University of Picardie, Amiens, France (Y.B., D.R., M.K., S.M., C.T.)
| | - Maciej Kubala
- Department of Cardiology, Amiens University Hospital, France (Y.B., P.G., D.R., M.K., C.T.)
- EA 7517 MP3CV, Jules Verne University of Picardie, Amiens, France (Y.B., D.R., M.K., S.M., C.T.)
| | - Sylvestre Maréchaux
- EA 7517 MP3CV, Jules Verne University of Picardie, Amiens, France (Y.B., D.R., M.K., S.M., C.T.)
- Groupement des Hôpitaux de l’Institut Catholique de Lille, Faculté libre de médecine, Université Lille Nord de France (S.M.)
| | - Christophe Tribouilloy
- Department of Cardiology, Amiens University Hospital, France (Y.B., P.G., D.R., M.K., C.T.)
- EA 7517 MP3CV, Jules Verne University of Picardie, Amiens, France (Y.B., D.R., M.K., S.M., C.T.)
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15
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Wang L, Zhu X, Zhao LP, Wang M, Liu X, Chen Y, Chen J, Xu W. Effect of beraprost on pulmonary hypertension due to left ventricular systolic dysfunction. Medicine (Baltimore) 2019; 98:e14965. [PMID: 31008926 PMCID: PMC6494404 DOI: 10.1097/md.0000000000014965] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Beraprost is used to treat peripheral chronic arterial occlusive disease. However, the efficacy and safety of beraprost in patients with pulmonary hypertension (PH) due to left ventricular systolic dysfunction (PH-HFrEF) remains unknown. The primary objective of this study was to determine the effects of beraprost on PH-HFrEF.We prospectively recruited patients with PH-HFrEF as determined by echocardiography and right cardiac catheterization. Beraprost sodium was given orally (1 μg/kg/d) added to the usual treatment, and patients were evaluated at 1-year follow-up.Twenty-five patients were recruited with baseline systolic pulmonary artery pressure (PAP) of 49.5 ± 10.8 mm Hg. Systolic PAP results at 3, 6, 9, and 12 months were 39.1 ± 8.1, 30.4 ± 5.2, 27.7 ± 3.0, and 27.0 ± 4.7 mm Hg, respectively, which were all significantly lower than systolic PAP at baseline (P < .05). Left ventricular ejection fraction results at 6 months (43.5 ± 7.0%), 9 months (47.0 ± 5.5%), and 12 months (48.2 ± 4.8%) were significantly higher than at baseline (34.7 ± 9.2%) (P < .05). Six-minute walking distance at 3 months (282.8 ± 80.6 m), 6 months (367.1 ± 81.2 m), 9 months (389.8 ± 87.1 m), and 12 months (395.7 ± 83.4 m) increased with time, and all were significantly higher than baseline (190.1 ± 75.5 m) (P < .05). One patient developed atrial fibrillation and recovered to sinus rhythm after intravenous administration of amiodarone. There were no instances of cardiac-related death, severe bleeding, or severe impairment of liver function.Routine oral administration of beraprost sodium added to the usual treatment may improve cardiopulmonary hemodynamics and exercise capacityin patients with PH-HFrEF.
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Affiliation(s)
- Li Wang
- Department of Cardiology, The Second Affiliated Hospital of Soochow University
- Emergency Department, The Seventh People's Hospital of Suzhou, China
| | - Xinyi Zhu
- Department of Cardiology, The Second Affiliated Hospital of Soochow University
| | - Liang-Ping Zhao
- Department of Cardiology, The Second Affiliated Hospital of Soochow University
| | - Maosong Wang
- Department of Cardiology, The Second Affiliated Hospital of Soochow University
| | - Xiang Liu
- Department of Cardiology, The Second Affiliated Hospital of Soochow University
| | - Yuqi Chen
- Department of Cardiology, The Second Affiliated Hospital of Soochow University
| | - JianChang Chen
- Department of Cardiology, The Second Affiliated Hospital of Soochow University
| | - WeiTing Xu
- Department of Cardiology, The Second Affiliated Hospital of Soochow University
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16
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Gall H, Felix JF, Schneck FK, Milger K, Sommer N, Voswinckel R, Franco OH, Hofman A, Schermuly RT, Weissmann N, Grimminger F, Seeger W, Ghofrani HA. The Giessen Pulmonary Hypertension Registry: Survival in pulmonary hypertension subgroups. J Heart Lung Transplant 2017; 36:957-967. [DOI: 10.1016/j.healun.2017.02.016] [Citation(s) in RCA: 164] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 02/09/2017] [Accepted: 02/15/2017] [Indexed: 11/29/2022] Open
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17
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Levy F, Bohbot Y, Sanhadji K, Rusinaru D, Ringle A, Delpierre Q, Smaali S, Gun M, Marechaux S, Tribouilloy C. Impact of pulmonary hypertension on long-term outcome in patients with severe aortic stenosis. Eur Heart J Cardiovasc Imaging 2017; 19:553-561. [DOI: 10.1093/ehjci/jex166] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 06/06/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Franck Levy
- Department of Cardiology, Centre Cardiothoracique de Monaco, 11 bis Avenue d'Ostende, Monaco 98000, Monaco
- Department of Cardiology, University Hospital Amiens, Avenue Rene Laennec, Salouel, Amiens 80054, France
| | - Yohann Bohbot
- Department of Cardiology, University Hospital Amiens, Avenue Rene Laennec, Salouel, Amiens 80054, France
| | - Khalil Sanhadji
- Department of Cardiology, University Hospital Amiens, Avenue Rene Laennec, Salouel, Amiens 80054, France
| | - Dan Rusinaru
- Department of Cardiology, University Hospital Amiens, Avenue Rene Laennec, Salouel, Amiens 80054, France
- INSERM U-1088, Jules Verne University of Picardie, 1 Chemin du Thil, Amiens 80000, France
| | - Anne Ringle
- Groupement des Hôpitaux de l'Institut Catholique de Lille / Faculté libre de médecine, Université Lille Nord de France, 115 Rue du Grand But, Lille 59160, France
| | - Quentin Delpierre
- Department of Cardiology, University Hospital Amiens, Avenue Rene Laennec, Salouel, Amiens 80054, France
| | - Sondes Smaali
- Department of Cardiology, University Hospital Amiens, Avenue Rene Laennec, Salouel, Amiens 80054, France
| | - Mesut Gun
- Department of Cardiology, University Hospital Amiens, Avenue Rene Laennec, Salouel, Amiens 80054, France
| | - Sylvestre Marechaux
- INSERM U-1088, Jules Verne University of Picardie, 1 Chemin du Thil, Amiens 80000, France
- Groupement des Hôpitaux de l'Institut Catholique de Lille / Faculté libre de médecine, Université Lille Nord de France, 115 Rue du Grand But, Lille 59160, France
| | - Christophe Tribouilloy
- Department of Cardiology, University Hospital Amiens, Avenue Rene Laennec, Salouel, Amiens 80054, France
- INSERM U-1088, Jules Verne University of Picardie, 1 Chemin du Thil, Amiens 80000, France
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18
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Cuthbert JJ, Pellicori P, Shah P, Clark AL. New pharmacological approaches in heart failure therapy: developments and possibilities. Future Cardiol 2017; 13:173-188. [PMID: 28181443 DOI: 10.2217/fca-2016-0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
There have been few major breakthroughs in heart failure (HF) drug therapies in recent years yet HF morbidity and mortality remain high, and there is a clear need for further research. Several newer agents that appear promising in Phase I and II trials do not progress to show clinical benefit in later trials. Part of the failure to find new therapies may lie in flawed trial design compounded by the need for ever-increasing patient numbers in order to prove outcome benefit. We summarize some of the most recent and promising medical therapies for HF.
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Affiliation(s)
- Joseph J Cuthbert
- Department of Cardiology, Hull York Medical School, Hull & East Yorkshire Medical Research & Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull HU16 5JQ, UK
| | - Pierpaolo Pellicori
- Department of Cardiology, Hull York Medical School, Hull & East Yorkshire Medical Research & Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull HU16 5JQ, UK
| | - Parin Shah
- Department of Cardiology, Hull York Medical School, Hull & East Yorkshire Medical Research & Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull HU16 5JQ, UK
| | - Andrew L Clark
- Department of Cardiology, Hull York Medical School, Hull & East Yorkshire Medical Research & Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull HU16 5JQ, UK
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19
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Mehta S, Vachiéry JL. Pulmonary hypertension: the importance of correctly diagnosing the cause. Eur Respir Rev 2016; 25:372-380. [DOI: 10.1183/16000617.0104-2016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 10/18/2016] [Indexed: 01/22/2023] Open
Abstract
Pulmonary hypertension (PH) is a complex condition that can occur as a result of a wide range of disorders, including left heart disease, lung disease and chronic pulmonary thromboembolism. Contemporary PH patients are older and frequently have a multitude of comorbidities that may contribute to or simply coincide with their PH. Identifying the cause of PH in these complicated patients can be challenging but is essential, given that the aetiology of the disease has a significant impact on the management options available. In this article, we present two cases that highlight the difficulties involved in obtaining a precise diagnosis of the cause of PH within the setting of multiple comorbidities. The importance of performing a comprehensive, multidimensional diagnostic work-up is demonstrated, in addition to the need to specifically consider cardiopulmonary haemodynamic data in the context of the wider clinical picture. The article also illustrates why achieving an accurate diagnosis is necessary for optimal patient management. This may involve treatment of comorbidities as a priority, which can ameliorate the severity of PH, obviating the need to consider PH-targeted medical treatment.
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20
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Rosenkranz S, Preston IR. Right heart catheterisation: best practice and pitfalls in pulmonary hypertension. Eur Respir Rev 2016; 24:642-52. [PMID: 26621978 DOI: 10.1183/16000617.0062-2015] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Right heart catheterisation (RHC) plays a central role in identifying pulmonary hypertension (PH) disorders, and is required to definitively diagnose pulmonary arterial hypertension (PAH). Despite widespread acceptance, there is a lack of guidance regarding the best practice for performing RHC in clinical practice. In order to ensure the correct evaluation of haemodynamic parameters directly measured or calculated from RHC, attention should be drawn to standardising procedures such as the position of the pressure transducer and catheter balloon inflation volume. Measurement of pulmonary arterial wedge pressure, in particular, is vulnerable to over- or under-wedging, which can give rise to false readings. In turn, errors in RHC measurement and data interpretation can complicate the differentiation of PAH from other PH disorders and lead to misdiagnosis. In addition to diagnosis, the role of RHC in conjunction with noninvasive tests is widening rapidly to encompass monitoring of treatment response and establishing prognosis of patients diagnosed with PAH. However, further standardisation of RHC is warranted to ensure optimal use in routine clinical practice.
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Affiliation(s)
- Stephan Rosenkranz
- Dept III of Internal Medicine and Cologne Cardiovascular Research Center (CCRC), Cologne University Heart Center, Cologne, Germany
| | - Ioana R Preston
- Pulmonary, Critical Care, and Sleep Division, Tufts Medical Center, Boston, MA, USA
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21
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Galiè N, McLaughlin VV, Rubin LJ, Simonneau G. Improving patient outcomes in pulmonary hypertension. Eur Respir Rev 2016; 24:550-1. [PMID: 26621969 DOI: 10.1183/16000617.0064-2015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Nazzareno Galiè
- Dept of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Vallerie V McLaughlin
- Dept of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Lewis J Rubin
- Division of Pulmonary and Critical Care Medicine, University of California, San Diego, CA, USA
| | - Gérald Simonneau
- Hôpital Universitaire de Bicêtre, Université Paris-Sud, Le Kremlin Bicêtre, France
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22
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Agarwal M, Waxman AB. Physiological Techniques and Pulmonary Hypertension - Left Heart Disease. Prog Cardiovasc Dis 2016; 59:30-41. [PMID: 27211586 DOI: 10.1016/j.pcad.2016.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 05/11/2016] [Indexed: 01/06/2023]
Abstract
Group 2 Pulmonary hypertension (PH) is associated with left heart disease (LHD;Group 2 PH) and is the most common form of PH. Group 2 PH represents an important subgroup of patients with LHD where the development of PH leads to a significant increase in morbidity and mortality. Early diagnosis may provide an opportunity to intervene and significantly delay progression. In addition to clinical suspicion, several approaches including hemodynamic assessment, exercise testing, and imaging techniques play an important role in better disease characterization and management. Here, we review the role of physiologic based hemodynamic and exercise assessments of Group 2 PH patients.
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Affiliation(s)
- Manyoo Agarwal
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA; Pulmonary and Critical Care Medicine, Center for Pulmonary Heart Disease, Brigham and Women's Hospital Heart and Vascular Center
| | - Aaron B Waxman
- Pulmonary and Critical Care Medicine, Center for Pulmonary Heart Disease, Brigham and Women's Hospital Heart and Vascular Center; Pulmonary and Critical Care Medicine, Cardiovascular Medicine, Pulmonary Vascular Disease Program, Center for Pulmonary-Heart Diseases, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School.
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