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Backhaus SJ, Nasopoulou A, Lange T, Schulz A, Evertz R, Kowallick JT, Hasenfuß G, Lamata P, Schuster A. Left Atrial Roof Enlargement Is a Distinct Feature of Heart Failure With Preserved Ejection Fraction. Circ Cardiovasc Imaging 2024; 17:e016424. [PMID: 39012942 PMCID: PMC11251503 DOI: 10.1161/circimaging.123.016424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 05/29/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND It remains unknown to what extent intrinsic atrial cardiomyopathy or left ventricular diastolic dysfunction drive atrial remodeling and functional failure in heart failure with preserved ejection fraction (HFpEF). Computational 3-dimensional (3D) models fitted to cardiovascular magnetic resonance allow state-of-the-art anatomic and functional assessment, and we hypothesized to identify a phenotype linked to HFpEF. METHODS Patients with exertional dyspnea and diastolic dysfunction on echocardiography (E/e', >8) were prospectively recruited and classified as HFpEF or noncardiac dyspnea based on right heart catheterization. All patients underwent rest and exercise-stress right heart catheterization and cardiovascular magnetic resonance. Computational 3D anatomic left atrial (LA) models were generated based on short-axis cine sequences. A fully automated pipeline was developed to segment cardiovascular magnetic resonance images and build 3D statistical models of LA shape and find the 3D patterns discriminant between HFpEF and noncardiac dyspnea. In addition, atrial morphology and function were quantified by conventional volumetric analyses and deformation imaging. A clinical follow-up was conducted after 24 months for the evaluation of cardiovascular hospitalization. RESULTS Beyond atrial size, the 3D LA models revealed roof dilation as the main feature found in masked HFpEF (diagnosed during exercise-stress only) preceding a pattern shift to overall atrial size in overt HFpEF (diagnosed at rest). Characteristics of the 3D model were integrated into the LA HFpEF shape score, a biomarker to characterize the gradual remodeling between noncardiac dyspnea and HFpEF. The LA HFpEF shape score was able to discriminate HFpEF (n=34) to noncardiac dyspnea (n=34; area under the curve, 0.81) and was associated with a risk for atrial fibrillation occurrence (hazard ratio, 1.02 [95% CI, 1.01-1.04]; P=0.003), as well as cardiovascular hospitalization (hazard ratio, 1.02 [95% CI, 1.00-1.04]; P=0.043). CONCLUSIONS LA roof dilation is an early remodeling pattern in masked HFpEF advancing to overall LA enlargement in overt HFpEF. These distinct features predict the occurrence of atrial fibrillation and cardiovascular hospitalization. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03260621.
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Affiliation(s)
- Sören J. Backhaus
- Department of Cardiology, Campus Kerckhoff of the Justus-Liebig-University Giessen, Kerckhoff-Clinic, Bad Nauheim, Germany (S.J.B.)
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Bad Nauheim, Germany (S.J.B.)
| | - Anastasia Nasopoulou
- Department of Biomedical Engineering, Division of Imaging Sciences and Biomedical Engineering, King’s College London, United Kingdom (A.N., P.L.)
| | - Torben Lange
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Germany (T.L., A. Schulz, R.E., G.H., A. Schuster)
- DZHK, Partner Site Lower Saxony, Germany (T.L., A. Schulz, R.E., J.T.K., G.H., A. Schuster)
| | - Alexander Schulz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Germany (T.L., A. Schulz, R.E., G.H., A. Schuster)
- DZHK, Partner Site Lower Saxony, Germany (T.L., A. Schulz, R.E., J.T.K., G.H., A. Schuster)
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Germany (T.L., A. Schulz, R.E., G.H., A. Schuster)
- DZHK, Partner Site Lower Saxony, Germany (T.L., A. Schulz, R.E., J.T.K., G.H., A. Schuster)
| | - Johannes T. Kowallick
- DZHK, Partner Site Lower Saxony, Germany (T.L., A. Schulz, R.E., J.T.K., G.H., A. Schuster)
- FORUM Radiology, Rosdorf, Germany (J.T.K.)
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Germany (T.L., A. Schulz, R.E., G.H., A. Schuster)
- DZHK, Partner Site Lower Saxony, Germany (T.L., A. Schulz, R.E., J.T.K., G.H., A. Schuster)
| | - Pablo Lamata
- Department of Biomedical Engineering, Division of Imaging Sciences and Biomedical Engineering, King’s College London, United Kingdom (A.N., P.L.)
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Germany (T.L., A. Schulz, R.E., G.H., A. Schuster)
- DZHK, Partner Site Lower Saxony, Germany (T.L., A. Schulz, R.E., J.T.K., G.H., A. Schuster)
- FORUM Cardiology, Rosdorf, Germany (A. Schuster)
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (A. Schuster)
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2
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Güder G, Reiter T, Drayss M, Bauer W, Lengenfelder B, Nordbeck P, Fette G, Frantz S, Morbach C, Störk S. Improved Interpretation of Pulmonary Artery Wedge Pressures through Left Atrial Volumetry-A Cardiac Magnetic Resonance Imaging Study. J Cardiovasc Dev Dis 2024; 11:178. [PMID: 38921678 PMCID: PMC11204227 DOI: 10.3390/jcdd11060178] [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: 04/23/2024] [Revised: 05/29/2024] [Accepted: 06/06/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND The pulmonary artery wedge pressure (PAWP) is regarded as a reliable indicator of left ventricular end-diastolic pressure (LVEDP), but this association is weaker in patients with left-sided heart disease (LHD). We compared morphological differences in cardiac magnetic resonance imaging (CMR) in patients with heart failure (HF) and a reduced left ventricular ejection fraction (LVEF), with or without elevation of PAWP or LVEDP. METHODS We retrospectively identified 121 patients with LVEF < 50% who had undergone right heart catheterization (RHC) and CMR. LVEDP data were available for 75 patients. RESULTS The mean age of the study sample was 63 ± 14 years, the mean LVEF was 32 ± 10%, and 72% were men. About 53% of the patients had an elevated PAWP (>15 mmHg). In multivariable logistic regression analysis, NT-proBNP, left atrial ejection fraction (LAEF), and LV end-systolic volume index independently predicted an elevated PAWP. Of the 75 patients with available LVEDP data, 79% had an elevated LVEDP, and 70% had concomitant PAWP elevation. By contrast, all but one patient with elevated PAWP and half of the patients with normal PAWP had concomitant LVEDP elevation. The Bland-Altman plot revealed a systematic bias of +5.0 mmHg between LVEDP and PAWP. Notably, LAEF was the only CMR variable that differed significantly between patients with elevated LVEDP and a PAWP ≤ or >15 mmHg. CONCLUSIONS In patients with LVEF < 50%, a normal PAWP did not reliably exclude LHD, and an elevated LVEDP was more frequent than an elevated PAWP. LAEF was the most relevant determinant of an increased PAWP, suggesting that a preserved LAEF in LHD may protect against backward failure into the lungs and the subsequent increase in pulmonary pressure.
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Affiliation(s)
- Gülmisal Güder
- Division of Cardiology, Department of Internal Medicine I, University Hospital Würzburg, 97080 Würzburg, Germany; (T.R.); (M.D.); (W.B.); (B.L.); (P.N.); (S.F.); (C.M.); (S.S.)
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, 97078 Würzburg, Germany;
| | - Theresa Reiter
- Division of Cardiology, Department of Internal Medicine I, University Hospital Würzburg, 97080 Würzburg, Germany; (T.R.); (M.D.); (W.B.); (B.L.); (P.N.); (S.F.); (C.M.); (S.S.)
- Department of Cardiac Rhythm Disorders, German Heart Center Munich, 80636 Munich, Germany
| | - Maria Drayss
- Division of Cardiology, Department of Internal Medicine I, University Hospital Würzburg, 97080 Würzburg, Germany; (T.R.); (M.D.); (W.B.); (B.L.); (P.N.); (S.F.); (C.M.); (S.S.)
| | - Wolfgang Bauer
- Division of Cardiology, Department of Internal Medicine I, University Hospital Würzburg, 97080 Würzburg, Germany; (T.R.); (M.D.); (W.B.); (B.L.); (P.N.); (S.F.); (C.M.); (S.S.)
| | - Björn Lengenfelder
- Division of Cardiology, Department of Internal Medicine I, University Hospital Würzburg, 97080 Würzburg, Germany; (T.R.); (M.D.); (W.B.); (B.L.); (P.N.); (S.F.); (C.M.); (S.S.)
| | - Peter Nordbeck
- Division of Cardiology, Department of Internal Medicine I, University Hospital Würzburg, 97080 Würzburg, Germany; (T.R.); (M.D.); (W.B.); (B.L.); (P.N.); (S.F.); (C.M.); (S.S.)
| | - Georg Fette
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, 97078 Würzburg, Germany;
- Service Center Medical Informatics (SMI), University of Würzburg, 97080 Würzburg, Germany
| | - Stefan Frantz
- Division of Cardiology, Department of Internal Medicine I, University Hospital Würzburg, 97080 Würzburg, Germany; (T.R.); (M.D.); (W.B.); (B.L.); (P.N.); (S.F.); (C.M.); (S.S.)
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, 97078 Würzburg, Germany;
| | - Caroline Morbach
- Division of Cardiology, Department of Internal Medicine I, University Hospital Würzburg, 97080 Würzburg, Germany; (T.R.); (M.D.); (W.B.); (B.L.); (P.N.); (S.F.); (C.M.); (S.S.)
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, 97078 Würzburg, Germany;
| | - Stefan Störk
- Division of Cardiology, Department of Internal Medicine I, University Hospital Würzburg, 97080 Würzburg, Germany; (T.R.); (M.D.); (W.B.); (B.L.); (P.N.); (S.F.); (C.M.); (S.S.)
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, 97078 Würzburg, Germany;
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Lui JK, Sangani RA, Gillmeyer KR, Vakhshoorzadeh J, Trojanowski MA, Bujor AM, Gopal DM, Wiener RS, LaValley MP, Klings ES. Hemodynamic Response to Oral Vasodilator Therapy in Systemic Sclerosis-Related Pulmonary Hypertension. Cardiovasc Drugs Ther 2024; 38:651-656. [PMID: 36607535 PMCID: PMC10666735 DOI: 10.1007/s10557-022-07420-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/26/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Although classified as group 1 pulmonary arterial hypertension (PAH), patients with systemic sclerosis-related pulmonary hypertension (SSc-PH) experience poorer clinical response to PAH therapy and increased mortality compared to those with idiopathic PAH. Due to heterogeneity in phenotypes, identifying patients likely to respond to therapy is challenging. The goal of this study was to determine clinical factors associated with hemodynamic response, defined by a > 20% reduction in pulmonary vascular resistance on repeat right heart catheterization. METHODS We applied a time-to-event model using a retrospective cohort of 39 patients with precapillary SSc-PH, defined by a mean pulmonary artery pressure of ≥ 25 mmHg and pulmonary arterial wedge pressure (PAWP) ≤ 15 mmHg on right heart catheterization. RESULTS Patients with PAWP ≤ 8 mmHg were nearly fourfold more likely to achieve a hemodynamic response compared to those with PAWP > 8 mmHg (HR 3.88; 95% CI: 1.20, 12.57); each 1 mmHg increase in PAWP was associated with a decreased hazard for hemodynamic response (HR 0.84; 95% CI: 0.70, 1.00). CONCLUSION In patients with precapillary SSc-PH, PAWP was associated with time to hemodynamic response, suggesting the importance of subclinical cardiac disease in determining hemodynamic response to oral vasodilator therapy.
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Affiliation(s)
- Justin K Lui
- The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
| | - Ruchika A Sangani
- The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Kari R Gillmeyer
- The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jasmine Vakhshoorzadeh
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Marcin A Trojanowski
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Section of Rheumatology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Andreea M Bujor
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Section of Rheumatology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Deepa M Gopal
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Section of Cardiovascular Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Renda Soylemez Wiener
- The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA, USA
| | - Michael P LaValley
- Section of Rheumatology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Elizabeth S Klings
- The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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4
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Zhang S, Gao L, Li S, Luo M, Chen L, Xi Q, Zhao Z, Zhao Q, Yang T, Zeng Q, Li X, Huang Z, Duan A, Wang Y, Luo Q, Guo Y, Liu Z. Association of non-insulin-based insulin resistance indices with disease severity and adverse outcome in idiopathic pulmonary arterial hypertension: a multi-center cohort study. Cardiovasc Diabetol 2024; 23:154. [PMID: 38702735 PMCID: PMC11069206 DOI: 10.1186/s12933-024-02236-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 04/12/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Insulin resistance (IR) plays an important role in the pathophysiology of cardiovascular disease. Recent studies have shown that diabetes mellitus and impaired lipid metabolism are associated with the severity and prognosis of idiopathic pulmonary arterial hypertension (IPAH). However, the relationship between IR and pulmonary hypertension is poorly understood. This study explored the association between four IR indices and IPAH using data from a multicenter cohort. METHODS A total of 602 consecutive participants with IPAH were included in this study between January 2015 and December 2022. The metabolic score for IR (METS-IR), triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio, triglyceride and glucose (TyG) index, and triglyceride-glucose-body mass index (TyG-BMI) were used to quantify IR levels in patients with IPAH. The correlation between non-insulin-based IR indices and long-term adverse outcomes was determined using multivariate Cox regression models and restricted cubic splines. RESULTS During a mean of 3.6 years' follow-up, 214 participants experienced all-cause death or worsening condition. Compared with in low to intermediate-low risk patients, the TG/HDL-C ratio (2.9 ± 1.7 vs. 3.3 ± 2.1, P = 0.003) and METS-IR (34.5 ± 6.7 vs. 36.4 ± 7.5, P < 0.001) were significantly increased in high to intermediate-high risk patients. IR indices correlated with well-validated variables that reflected the severity of IPAH, such as the cardiac index and stroke volume index. Multivariate Cox regression analyses indicated that the TyG-BMI index (hazard ratio [HR] 1.179, 95% confidence interval [CI] 1.020, 1.363 per 1.0-standard deviation [SD] increment, P = 0.026) and METS-IR (HR 1.169, 95% CI 1.016, 1.345 per 1.0-SD increment, P = 0.030) independently predicted adverse outcomes. Addition of the TG/HDL-C ratio and METS-IR significantly improved the reclassification and discrimination ability beyond the European Society of Cardiology (ESC) risk score. CONCLUSIONS IR is associated with the severity and long-term prognosis of IPAH. TyG-BMI and METS-IR can independently predict clinical worsening events, while METS-IR also provide incremental predictive performance beyond the ESC risk stratification.
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Affiliation(s)
- Sicheng Zhang
- Center for Respiratory and Pulmonary Vascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Beijing, 100037, Xicheng, China
| | - Luyang Gao
- Center for Respiratory and Pulmonary Vascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Beijing, 100037, Xicheng, China
| | - Sicong Li
- Center for Respiratory and Pulmonary Vascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Beijing, 100037, Xicheng, China
| | - Manqing Luo
- Department of Cardiology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, No. 134, East Street, Gulou District, Fuzhou, 350001, Fujian, China
| | - Lichuan Chen
- Department of Cardiology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, No. 134, East Street, Gulou District, Fuzhou, 350001, Fujian, China
| | - Qunying Xi
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, No. 12, Langshan Road, Shenzhen, 518057, Nanshan, China
| | - Zhihui Zhao
- Center for Respiratory and Pulmonary Vascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Beijing, 100037, Xicheng, China
| | - Qing Zhao
- Center for Respiratory and Pulmonary Vascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Beijing, 100037, Xicheng, China
| | - Tao Yang
- Center for Respiratory and Pulmonary Vascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Beijing, 100037, Xicheng, China
| | - Qixian Zeng
- Center for Respiratory and Pulmonary Vascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Beijing, 100037, Xicheng, China
| | - Xin Li
- Center for Respiratory and Pulmonary Vascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Beijing, 100037, Xicheng, China
| | - Zhihua Huang
- Center for Respiratory and Pulmonary Vascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Beijing, 100037, Xicheng, China
| | - Anqi Duan
- Center for Respiratory and Pulmonary Vascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Beijing, 100037, Xicheng, China
| | - Yijia Wang
- Center for Respiratory and Pulmonary Vascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Beijing, 100037, Xicheng, China
| | - Qin Luo
- Center for Respiratory and Pulmonary Vascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Beijing, 100037, Xicheng, China.
| | - Yansong Guo
- Department of Cardiology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, No. 134, East Street, Gulou District, Fuzhou, 350001, Fujian, China.
| | - Zhihong Liu
- Center for Respiratory and Pulmonary Vascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Beijing, 100037, Xicheng, China.
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5
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Shima H, Tsujino I, Nakamura J, Nakaya T, Sugimoto A, Sato T, Watanabe T, Ohira H, Suzuki M, Tsuneta S, Chiba Y, Murayama M, Yokota I, Konno S. Exploratory analysis of the accuracy of echocardiographic parameters for the assessment of right ventricular function and right ventricular-pulmonary artery coupling. Pulm Circ 2024; 14:e12368. [PMID: 38774813 PMCID: PMC11108640 DOI: 10.1002/pul2.12368] [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: 12/04/2023] [Revised: 03/12/2024] [Accepted: 04/07/2024] [Indexed: 05/24/2024] Open
Abstract
Echocardiography is a widely used modality for the assessment of right ventricular (RV) function; however, few studies have comprehensively compared the accuracy of echocardiographic parameters using invasively obtained reference values. Therefore, this exploratory study aimed to compare the accuracy of echocardiographic parameters of RV function and RV-pulmonary artery (PA) coupling. We calculated four indices of RV function (end-systolic elastance [Ees] for systolic function [contractility], τ for relaxation, and β and end-diastolic elastance [Eed] for stiffness), and an index of RV-PA coupling (Ees/arterial elastance [Ea]), using pressure catheterization, cardiac magnetic resonance imaging, and a single-beat method. We then compared the correlations of RV indices with echocardiographic parameters. In 63 participants (54 with pulmonary hypertension (PH) and nine without PH), Ees and τ correlated with several echocardiographic parameters, such as RV diameter and area, but the correlations were moderate (|correlation coefficients (ρ)| < 0.5 for all parameters). The correlations of β and Eed with echocardiographic parameters were weak, with |ρ| < 0.4. In contrast, Ees/Ea closely correlated with RV free wall longitudinal strain (RVFW-LS)/estimated systolic PA pressure (eSPAP) (ρ = -0.72). Ees/Ea also correlated with tricuspid annular plane systolic excursion/eSPAP, RV diameter, and RV end-systolic area, with |ρ | >0.65. In addition, RVFW-LS/eSPAP yielded high sensitivity (0.84) and specificity (0.75) for detecting reduced Ees/Ea. The present study indicated a limited accuracy of echocardiographic parameters in assessing RV systolic and diastolic function. In contrast to RV function, they showed high accuracy for assessing RV-PA coupling, with RVFW-LS/eSPAP exhibiting the highest accuracy.
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Affiliation(s)
- Hideki Shima
- Department of Respiratory Medicine, Faculty of MedicineHokkaido UniversitySapporoJapan
| | - Ichizo Tsujino
- Department of Respiratory Medicine, Faculty of MedicineHokkaido UniversitySapporoJapan
- Division of Respiratory and Cardiovascular Innovative Research, Faculty of MedicineHokkaido UniversitySapporoJapan
| | - Junichi Nakamura
- Department of Respiratory Medicine, Faculty of MedicineHokkaido UniversitySapporoJapan
| | - Toshitaka Nakaya
- Department of Respiratory Medicine, Faculty of MedicineHokkaido UniversitySapporoJapan
| | - Ayako Sugimoto
- Department of Respiratory Medicine, Faculty of MedicineHokkaido UniversitySapporoJapan
| | - Takahiro Sato
- Department of Respiratory Medicine, Faculty of MedicineHokkaido UniversitySapporoJapan
- Division of Respiratory and Cardiovascular Innovative Research, Faculty of MedicineHokkaido UniversitySapporoJapan
| | - Taku Watanabe
- Department of Respiratory Medicine, Faculty of MedicineHokkaido UniversitySapporoJapan
| | - Hiroshi Ohira
- Department of Respiratory Medicine, Faculty of MedicineHokkaido UniversitySapporoJapan
| | - Masaru Suzuki
- Department of Respiratory Medicine, Faculty of MedicineHokkaido UniversitySapporoJapan
| | - Satonori Tsuneta
- Department of Diagnostic and Interventional RadiologyHokkaido University HospitalSapporoJapan
| | - Yasuyuki Chiba
- Department of Cardiovascular MedicineHokkaido University Graduate School of MedicineSapporoJapan
| | - Michito Murayama
- Department of Medical Laboratory Science, Faculty of Health SciencesHokkaido UniversitySapporoJapan
- Diagnostic Center for SonographyHokkaido University HospitalSapporoJapan
| | - Isao Yokota
- Department of BiostatisticsHokkaido University Graduate School of MedicineSapporoJapan
| | - Satoshi Konno
- Department of Respiratory Medicine, Faculty of MedicineHokkaido UniversitySapporoJapan
- Division of Respiratory and Cardiovascular Innovative Research, Faculty of MedicineHokkaido UniversitySapporoJapan
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6
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Schulz A, Mittelmeier H, Wagenhofer L, Backhaus SJ, Lange T, Evertz R, Kutty S, Kowallick JT, Hasenfuß G, Schuster A. Assessment of the cardiac output at rest and during exercise stress using real-time cardiovascular magnetic resonance imaging in HFpEF-patients. Int J Cardiovasc Imaging 2024; 40:853-862. [PMID: 38236362 PMCID: PMC11052864 DOI: 10.1007/s10554-024-03054-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/08/2024] [Indexed: 01/19/2024]
Abstract
This methodological study aimed to validate the cardiac output (CO) measured by exercise-stress real-time phase-contrast cardiovascular magnetic resonance imaging (CMR) in patients with heart failure and preserved ejection fraction (HFpEF). 68 patients with dyspnea on exertion (NYHA ≥ II) and echocardiographic signs of diastolic dysfunction underwent rest and exercise stress right heart catheterization (RHC) and CMR within 24 h. Patients were diagnosed as overt HFpEF (pulmonary capillary wedge pressure (PCWP) ≥ 15mmHg at rest), masked HFpEF (PCWP ≥ 25mmHg during exercise stress but < 15mmHg at rest) and non-cardiac dyspnea. CO was calculated using RHC as the reference standard, and in CMR by the volumetric stroke volume, conventional phase-contrast and rest and stress real-time phase-contrast imaging. At rest, the CMR based CO showed good agreement with RHC with an ICC of 0.772 for conventional phase-contrast, and 0.872 for real-time phase-contrast measurements. During exercise stress, the agreement of real-time CMR and RHC was good with an ICC of 0.805. Real-time measurements underestimated the CO at rest (Bias:0.71 L/min) and during exercise stress (Bias:1.4 L/min). Patients with overt HFpEF had a significantly lower cardiac index compared to patients with masked HFpEF and with non-cardiac dyspnea during exercise stress, but not at rest. Real-time phase-contrast CO can be assessed with good agreement with the invasive reference standard at rest and during exercise stress. While moderate underestimation of the CO needs to be considered with non-invasive testing, the CO using real-time CMR provides useful clinical information and could help to avoid unnecessary invasive procedures in HFpEF patients.
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Affiliation(s)
- Alexander Schulz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Hannah Mittelmeier
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
| | - Lukas Wagenhofer
- Institute of Biomedical Imaging, University of Technology Graz, Graz, Austria
| | - Sören J Backhaus
- Department of Cardiology, Campus Kerckhoff of the Justus-Liebig-University Giessen, Kerckhoff-Clinic, Bad Nauheim, Germany
| | - Torben Lange
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Shelby Kutty
- Taussig Heart Center, Johns Hopkins Hospital and School of Medicine, Baltimore, MD, 21287, USA
| | - Johannes T Kowallick
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
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7
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Loosen G, Taboada D, Ortmann E, Martinez G. How Would I Treat My Own Chronic Thromboembolic Pulmonary Hypertension in the Perioperative Period? J Cardiothorac Vasc Anesth 2024; 38:884-894. [PMID: 37716891 DOI: 10.1053/j.jvca.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/04/2023] [Accepted: 07/14/2023] [Indexed: 09/18/2023]
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) results from an incomplete resolution of acute pulmonary embolism, leading to occlusive organized thrombi, vascular remodeling, and associated microvasculopathy with pulmonary hypertension (PH). A definitive CTEPH diagnosis requires PH confirmation by right-heart catheterization and evidence of chronic thromboembolic pulmonary disease on imaging studies. Surgical removal of the organized fibrotic material by pulmonary endarterectomy (PEA) under deep hypothermic circulatory arrest represents the treatment of choice. One-third of patients with CTEPH are not deemed suitable for surgical treatment, and medical therapy or interventional balloon pulmonary angioplasty presents alternative treatment options. Pulmonary endarterectomy in patients with technically operable disease significantly improves symptoms, functional capacity, hemodynamics, and quality of life. Perioperative mortality is <2.5% in expert centers where a CTEPH multidisciplinary team optimizes patient selection and ensures the best preoperative optimization according to individualized risk assessment. Despite adequate pulmonary artery clearance, patients might be prone to perioperative complications, such as right ventricular maladaptation, airway bleeding, or pulmonary reperfusion injury. These complications can be treated conventionally, but extracorporeal membrane oxygenation has been included in their management recently. Patients with residual PH post-PEA should be considered for medical or percutaneous interventional therapy.
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Affiliation(s)
- Gregor Loosen
- Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Basel, Switzerland
| | - Dolores Taboada
- Pulmonary Vascular Diseases Unit, Cambridge National Pulmonary Hypertension Service, Royal Papworth Hospital NHS, Department of Cardiothoracic Anesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Erik Ortmann
- Department of Anesthesiology, Schuechtermann-Heart-Centre, Bad Rothenfelde, Germany
| | - Guillermo Martinez
- Pulmonary Vascular Diseases Unit, Cambridge National Pulmonary Hypertension Service, Royal Papworth Hospital NHS, Department of Cardiothoracic Anesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom.
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8
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Mancusi C, Basile C, Spaccarotella C, Gargiulo G, Fucile I, Paolillo S, Gargiulo P, Santoro C, Manzi L, Marzano F, Ambrosino P, De Luca N, Esposito G. Novel Strategies in Diagnosing Heart Failure with Preserved Ejection Fraction: A Comprehensive Literature Review. High Blood Press Cardiovasc Prev 2024; 31:127-140. [PMID: 38489152 PMCID: PMC11043114 DOI: 10.1007/s40292-024-00629-1] [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: 12/26/2023] [Accepted: 01/26/2024] [Indexed: 03/17/2024] Open
Abstract
Heart failure (HF) with preserved ejection fraction (HFpEF) is a prevalent global condition affecting approximately 50% of the HF population. With the aging of the worldwide population, its incidence and prevalence are expected to rise even further. Unfortunately, until recently, no effective medications were available to reduce the high mortality and hospitalization rates associated with HFpEF, making it a significant unmet need in cardiovascular medicine. Although HFpEF is commonly defined as HF with normal ejection fraction and elevated left ventricular filling pressure, performing invasive hemodynamic assessments on every individual suspected of having HFpEF is neither feasible nor practical. Consequently, several clinical criteria and diagnostic tools have been proposed to aid in diagnosing HFpEF. Overall, these criteria and tools are designed to assist healthcare professionals in identifying and evaluating patients who may have HFpEF based on a combination of signs, symptoms, biomarkers, and non-invasive imaging findings. By employing these non-invasive diagnostic approaches, clinicians can make informed decisions regarding the best pharmacological and rehabilitation strategies for individuals with suspected HFpEF. This literature review aims to provide an overview of all currently available methods for diagnosing and monitoring this disabling condition.
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Affiliation(s)
- Costantino Mancusi
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.
| | - Christian Basile
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Carmen Spaccarotella
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Gargiulo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Ilaria Fucile
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Paola Gargiulo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Lina Manzi
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Federica Marzano
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Pasquale Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Directorate of Telese Terme Institute, Telese, Italy
| | - Nicola De Luca
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.
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9
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Backhaus SJ, Schulz A, Lange T, Evertz R, Kowallick JT, Hasenfuß G, Schuster A. Rest and exercise-stress estimated pulmonary capillary wedge pressure using real-time free-breathing cardiovascular magnetic resonance imaging. J Cardiovasc Magn Reson 2024; 26:101032. [PMID: 38431079 PMCID: PMC10950869 DOI: 10.1016/j.jocmr.2024.101032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/08/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Identification of increased pulmonary capillary wedge pressure (PCWP) by right heart catheterization (RHC) is the reference standard for the diagnosis of heart failure with preserved ejection fraction (HFpEF). Recently, cardiovascular magnetic resonance (CMR) imaging estimation of PCWP at rest was introduced as a non-invasive alternative. Since many patients are only identified during physiological exercise-stress, we hypothesized that novel exercise-stress CMR-derived PCWP emerges superior compared to its assessment at rest. METHODS The HFpEF-Stress Trial prospectively recruited 75 patients with exertional dyspnea and diastolic dysfunction who then underwent rest and exercise-stress RHC and CMR. HFpEF was defined according to PCWP (overt HFpEF ≥15 mmHg at rest, masked HFpEF ≥25 mmHg during exercise-stress). CMR-derived PCWP was calculated based on previously published formula using left ventricular mass and either biplane left atrial volume (LAV) or monoplane left atrial area (LAA). RESULTS LAV (rest/stress: r = 0.50/r = 0.55, p < 0.001) and LAA PCWP (rest/stress: r = 0.50/r = 0.48, p < 0.001) correlated significantly with RHC-derived PCWP while numerically overestimating PCWP at rest and underestimating PCWP during exercise-stress. LAV and LAA PCWP showed good diagnostic accuracy to detect HFpEF (area under the receiver operating characteristic curve (AUC) LAV rest 0.73, stress 0.81; LAA rest 0.72, stress 0.77) with incremental diagnostic value for the detection of masked HFpEF using exercise-stress (AUC LAV rest 0.54 vs stress 0.67, p = 0.019, LAA rest 0.52 vs stress 0.66, p = 0.012). LAV but not LAA PCWP during exercise-stress was a predictor for 24 months hospitalization independent of a medical history for atrial fibrillation (hazard ratio (HR) 1.26, 95% confidence interval 1.02-1.55, p = 0.032). CONCLUSION Non-invasive PCWP correlates well with the invasive reference at rest and during exercise stress. There is overall good diagnostic accuracy for HFpEF assessment using CMR-derived estimated PCWP despite deviations in absolute agreement. Non-invasive exercise derived PCWP may particularly facilitate detection of masked HFpEF in the future.
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Affiliation(s)
- Sören J Backhaus
- Department of Cardiology, Campus Kerckhoff of the Justus-Liebig-University Giessen, Kerckhoff-Clinic, Bad Nauheim, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Bad Nauheim, Germany.
| | - Alexander Schulz
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
| | - Torben Lange
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
| | - Ruben Evertz
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
| | - Johannes T Kowallick
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany; University Medical Center Göttingen (UMG), Institute for Diagnostic and Interventional Radiology, Göttingen, Germany.
| | - Gerd Hasenfuß
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
| | - Andreas Schuster
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
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10
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Ragnarsdottir H, Ozkan E, Michel H, Chin-Cheong K, Manduchi L, Wellmann S, Vogt JE. Deep Learning Based Prediction of Pulmonary Hypertension in Newborns Using Echocardiograms. Int J Comput Vis 2024; 132:2567-2584. [PMID: 38911323 PMCID: PMC11186939 DOI: 10.1007/s11263-024-01996-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 01/04/2024] [Indexed: 06/25/2024]
Abstract
Pulmonary hypertension (PH) in newborns and infants is a complex condition associated with several pulmonary, cardiac, and systemic diseases contributing to morbidity and mortality. Thus, accurate and early detection of PH and the classification of its severity is crucial for appropriate and successful management. Using echocardiography, the primary diagnostic tool in pediatrics, human assessment is both time-consuming and expertise-demanding, raising the need for an automated approach. Little effort has been directed towards automatic assessment of PH using echocardiography, and the few proposed methods only focus on binary PH classification on the adult population. In this work, we present an explainable multi-view video-based deep learning approach to predict and classify the severity of PH for a cohort of 270 newborns using echocardiograms. We use spatio-temporal convolutional architectures for the prediction of PH from each view, and aggregate the predictions of the different views using majority voting. Our results show a mean F1-score of 0.84 for severity prediction and 0.92 for binary detection using 10-fold cross-validation and 0.63 for severity prediction and 0.78 for binary detection on the held-out test set. We complement our predictions with saliency maps and show that the learned model focuses on clinically relevant cardiac structures, motivating its usage in clinical practice. To the best of our knowledge, this is the first work for an automated assessment of PH in newborns using echocardiograms.
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Affiliation(s)
- Hanna Ragnarsdottir
- Department of Computer Science, ETH Zurich, Universitätstrasse 6, 8092 Zürich, Switzerland
| | - Ece Ozkan
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, 43 Vassar Street, Cambridge, MA 02139 USA
| | - Holger Michel
- Department of Neonatology, University Children’s Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | - Kieran Chin-Cheong
- Department of Computer Science, ETH Zurich, Universitätstrasse 6, 8092 Zürich, Switzerland
| | - Laura Manduchi
- Department of Computer Science, ETH Zurich, Universitätstrasse 6, 8092 Zürich, Switzerland
| | - Sven Wellmann
- Department of Neonatology, University Children’s Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | - Julia E. Vogt
- Department of Computer Science, ETH Zurich, Universitätstrasse 6, 8092 Zürich, Switzerland
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11
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Reiter T, Kerzner J, Fette G, Frantz S, Voelker W, Ertl G, Bauer W, Morbach C, Störk S, Güder G. Accuracy of VO 2 estimation according to the widely used Krakau formula for the prediction of cardiac output. Herz 2024; 49:50-59. [PMID: 37439804 PMCID: PMC10830659 DOI: 10.1007/s00059-023-05196-0] [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: 03/14/2023] [Revised: 05/21/2023] [Accepted: 06/01/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Invasive cardiac output (CO) is measured with the thermodilution (TD) or the indirect Fick method (iFM) in right heart catheterization (RHC). The iFM estimates CO using approximation formulas for oxygen consumption ([Formula: see text]O2), but there are significant discrepancies (> 20%) between both methods. Although regularly applied, the formula proposed by Krakau has not been validated. We compared the CO discrepancies between the Krakau formula with the reference (TD) and three established formulas and investigated whether alterations assessed in cardiac magnetic resonance imaging (CMR) determined the extent of the deviations. METHODS This retrospective study included 188 patients aged 63 ± 14 years (30% women) receiving both CMR and RHC. The CO was measured with TD or with the iFM using the formulas by Krakau, LaFarge, Dehmer, and Bergstra for [Formula: see text]O2 estimation (iFM-K/-L/-D/-B). Percentage errors were calculated as twice the standard deviation of the difference between two CO methods divided by their means; a cut-off of < 30% was regarded as acceptable. The iFM and TD-derived CO ratio was built, and deviations > 20% were counted. Logistic regression analyses were performed to identify determinants of a deviation of > 20%. RESULTS The TD-derived CO (5.5 ± 1.7 L/min) was significantly different from all iFM (K: 4.8 ± 1.6, L: 4.3 ± 1.6; D: 4.8 ± 1.5 L/min; B: 5.4 ± 1.8 L/min all p < 0.05). The iFM-K-CO differed from all methods (p < 0.001) except iFM‑D (p = 0.19). Percentage errors between TD-CO and iFM-K/-L/-D/-B were all beyond the acceptance limit (44/45/44/43%), while percentage errors between iFM‑K and other iFM were all < 16%. None of the parameters measured in CMR was predictive of a discrepancy of > 20% between both methods. CONCLUSION The Krakau formula was comparable to other iFM in estimating CO levels, but none showed satisfactory agreement with the TD method. Improved derivation cohorts for [Formula: see text]O2 estimation are needed that better reflect today's patients undergoing RHC.
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Affiliation(s)
- Theresa Reiter
- Department of Internal Medicine I, Cardiology Division, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
| | - Julia Kerzner
- Department of Internal Medicine I, Cardiology Division, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
| | - Georg Fette
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzen Berg 26, 97078, Würzburg, Germany
- Chair of Computer Science VI, University of Würzburg, 97074, Würzburg, Germany
| | - Stefan Frantz
- Department of Internal Medicine I, Cardiology Division, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzen Berg 26, 97078, Würzburg, Germany
| | - Wolfram Voelker
- Department of Internal Medicine I, Cardiology Division, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
| | - Georg Ertl
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzen Berg 26, 97078, Würzburg, Germany
| | - Wolfgang Bauer
- Department of Internal Medicine I, Cardiology Division, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
| | - Caroline Morbach
- Department of Internal Medicine I, Cardiology Division, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzen Berg 26, 97078, Würzburg, Germany
| | - Stefan Störk
- Department of Internal Medicine I, Cardiology Division, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzen Berg 26, 97078, Würzburg, Germany
| | - Gülmisal Güder
- Department of Internal Medicine I, Cardiology Division, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany.
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12
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Deng W, Guo W, Yang A, Lin D, Cai Y, Zhang Y, Sun T, Yang S, Hong C, Huang X, Du J, Ding S. A better method to evaluate the reliability of echocardiography for assessment of pulmonary hypertension: comparison of tricuspid regurgitant spectrum quality grading and tricuspid valve regurgitation degree. J Thorac Dis 2024; 16:51-64. [PMID: 38410615 PMCID: PMC10894378 DOI: 10.21037/jtd-23-1084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/17/2023] [Indexed: 02/28/2024]
Abstract
Background Transthoracic echocardiography (TTE) is recommended as the most important noninvasive screening tool for the diagnosis of pulmonary hypertension (PH), sonographers usually measure the volume of regurgitant flow rather than evaluating the spectral quality, so physicians will determine whether the ultrasound measurements of pulmonary arterial systolic pressure (US-PASP) are reliable based on the volume of tricuspid regurgitation (TR). Therefore, for the first time, we grade the quality of TR spectrum (TRS) based on its integrity and clarity, aiming to assess clinical application value of different tricuspid regurgitant spectrum quality grades (TR-SQG), and investigate whether the accuracy of US-PASP is more trustworthy than TR. Methods We retrospectively analyzed 108 patients with chronic thromboembolic PH (CTEPH) to compare the correlation and agreement between US-PASP and right heart catheterization measurements of PASP (RHC-PASP). TR area (TRA) and TRS were measured in each patient, and TR-SQG was performed. Results The correlation coefficients between US-PASP and RHC-PASP were r=0.622 (P<0.001), r=0.754 (P<0.001), r=0.595 (P<0.001) in mild, moderate, severe TR, and r=0.301 (P=0.135), r=0.747 (P<0.001), r=0.739 (P<0.001), r=0.828 (P<0.001) in TR-SQG I-IV, respectively. Bland-Altman analysis revealed the mean biases of 5.05, 3.06, 7.62 mmHg in mild, moderate, severe TR, and -16.47, -8.07, 1.82, 6.09 mmHg in TR-SQG I-IV, respectively. In mild TR with the TR-SQG III and IV, the correlation coefficients between US-PASP and RHC-PASP were r=0.779 (P<0.001), intraclass correlation coefficient (ICC) =0.774, paired t-test P=0.160, respectively; and the consistency was significantly higher than that of mild TR without considering TR-SQG. In moderate TR with the TR-SQG III and IV, the r=0.749, ICC =0.746, paired t-test P=0.298 between US-PASP and RHC-PASP. Conclusions The US-PASP with TR-SQG III or IV is trustworthy, and its accuracy and consistency are better than those predicted by the traditional severity of TR. The establishment of the ultrasound evaluation system of TR-SQG helps clinicians to judge whether the US-PASP is accurate, credible, and reliable.
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Affiliation(s)
- Weimin Deng
- Department of Ultrasound, The First Affiliated Hospital of Guangzhou Medical University, National Clinical Research Center for Respiratory Disease, Guangzhou, China
- Department of Ultrasound, Dong Chong Hospital, Guangzhou, China
| | - Wenliang Guo
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Diseases/National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Aiping Yang
- The Second Clinical Medicine School of Guangzhou Medical University, Guangzhou, China
| | - Dongyuan Lin
- Department of Ultrasound, The First Affiliated Hospital of Guangzhou Medical University, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Yantong Cai
- Department of Ultrasound, The First Affiliated Hospital of Guangzhou Medical University, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Yuanmei Zhang
- Department of Ultrasound, The First Affiliated Hospital of Guangzhou Medical University, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Ting Sun
- Department of Ultrasound, The First Affiliated Hospital of Guangzhou Medical University, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Shuting Yang
- Department of Ultrasound, The First Affiliated Hospital of Guangzhou Medical University, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Cheng Hong
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Diseases/National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Xiaoping Huang
- Department of Ultrasound, Dongguan Songshan Lake Tungwah Hospital, Dongguan, China
| | - Jiye Du
- Department of Ultrasound, The First Affiliated Hospital of Guangzhou Medical University, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Shangwei Ding
- Department of Ultrasound, The First Affiliated Hospital of Guangzhou Medical University, National Clinical Research Center for Respiratory Disease, Guangzhou, China
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13
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Riley JM, Fradin JJ, Russ DH, Warner ED, Brailovsky Y, Rajapreyar I. Post-Capillary Pulmonary Hypertension: Clinical Review. J Clin Med 2024; 13:625. [PMID: 38276131 PMCID: PMC10816629 DOI: 10.3390/jcm13020625] [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: 12/04/2023] [Revised: 01/13/2024] [Accepted: 01/20/2024] [Indexed: 01/27/2024] Open
Abstract
Pulmonary hypertension (PH) caused by left heart disease, also known as post-capillary PH, is the most common etiology of PH. Left heart disease due to systolic dysfunction or heart failure with preserved ejection fraction, valvular heart disease, and left atrial myopathy due to atrial fibrillation are causes of post-capillary PH. Elevated left-sided filling pressures cause pulmonary venous congestion due to backward transmission of pressures and post-capillary PH. In advanced left-sided heart disease or valvular heart disease, chronic uncontrolled venous congestion may lead to remodeling of the pulmonary arterial system, causing combined pre-capillary and post-capillary PH. The hemodynamic definition of post-capillary PH includes a mean pulmonary arterial pressure > 20 mmHg, pulmonary vascular resistance < 3 Wood units, and pulmonary capillary wedge pressure > 15 mmHg. Echocardiography is important in the identification and management of the underlying cause of post-capillary PH. Management of post-capillary PH is focused on the treatment of the underlying condition. Strategies are geared towards pharmacotherapy and guideline-directed medical therapy for heart failure, surgical or percutaneous management of valvular disorders, and control of modifiable risk factors and comorbid conditions. Referral to centers with advanced heart and pulmonary teams has shown to improve morbidity and mortality. There is emerging interest in the use of targeted agents classically used in pulmonary arterial hypertension, but current data remain limited and conflicting. This review aims to serve as a comprehensive summary of postcapillary PH and its etiologies, pathophysiology, diagnosis, and management, particularly as it pertains to advanced heart failure.
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Affiliation(s)
- Joshua M. Riley
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA 19147, USA; (J.M.R.)
| | - James J. Fradin
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19147, USA
| | - Douglas H. Russ
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA 19147, USA; (J.M.R.)
| | - Eric D. Warner
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA 19147, USA; (J.M.R.)
| | - Yevgeniy Brailovsky
- Jefferson Heart Institute, Thomas Jefferson University Hospital, Philadelphia, PA 19147, USA;
| | - Indranee Rajapreyar
- Jefferson Heart Institute, Thomas Jefferson University Hospital, Philadelphia, PA 19147, USA;
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14
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Appadurai V, Kinno M, Minga I, Slostad B, Cascino GJ, Nayak T, Kane B, Maganti K. The value of ultrasound enhancing agents in the echocardiographic acquisition of pulmonary artery systolic pressure: An invasive to non-invasive correlation study. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-024-03051-9. [PMID: 38236363 DOI: 10.1007/s10554-024-03051-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/07/2024] [Indexed: 01/19/2024]
Abstract
PURPOSE Right heart catheterization (RHC) is the gold standard for the assessment of pulmonary artery systolic pressures (PASP). Despite high utilization of echocardiography for the non-invasive assessment of PASP, the data comparing real-time non-invasive echocardiographic PASP with invasive PASP is limited. Furthermore, evidence regarding the utility and diagnostic accuracy of ultrasound enhancing agents (UEA) for non-invasive PASP assessment is lacking. To evaluate the accuracy of non-invasive PASP assessment with real-time invasive measures and the incremental benefit of UEA in this setting. METHODS This was a prospective cohort study of 90 patients, undergoing clinically indicated RHC for hemodynamic assessment. All patients underwent a limited echocardiogram during RHC. Tricuspid regurgitant velocity (TRV) was measured on unenhanced echo, in the setting of centrally administrated agitated saline, then as either centrally administered or peripherally administered UEA. RESULTS Of the 90 patients enrolled in our study, 41% had pulmonary hypertension. The overall mean PASP measured by RHC was 32.8 mmHg (+/- 11.3 mmHg). Unenhanced echocardiograms had a moderate correlation with invasive PASP (r = 0.57; p = < 0.001) which improved to a strong correlation with administration of agitated saline (r = 0.75; p = < 0.001) or centrally administered UEA (r = 0.77; p = < 0.001), with the best correlation noted with peripherally administered UEA (r = 0.83; p = < 0.001). Against invasive PASP, agitated saline enhanced PASP had the lowest bias (0.12mmHg; -15.6 to 15.8mmHg) when compared with all other non-invasive measures of PASP. CONCLUSIONS Unenhanced echocardiographic estimation of TRV was found to have a poorer correlation with invasively measured PASP when compared to agitated saline and centrally administered UEA. Agitated saline enhanced PASP demonstrated the lowest bias with invasive PASP when compared to other non-invasive measures of PASP.
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Affiliation(s)
- Vinesh Appadurai
- Division of Cardiology, Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, IL, USA
- School of medicine, The University of Queensland, St Lucia, QLD, Australia
| | - Menhel Kinno
- Division of Cardiology, Loyola University Stritch School of Medicine, Chicago, IL, USA
| | - Iva Minga
- Northshore University Health System, Evanston, IL, USA
- University of Chicago Medical Center, Chicago, IL, USA
| | - Brody Slostad
- Division of Cardiology, Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Gregory J Cascino
- Division of Cardiology, Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Tanvi Nayak
- Division of Cardiology, Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Bonnie Kane
- Division of Cardiology, Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Kameswari Maganti
- Division of Cardiovascular Disease, Rutgers Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, New Brunswick, NJ, 08901, USA.
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15
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Zeng Y, Zhakeer G, Li B, Yu Q, Niu M, Maimaitiaili N, Mi M, Deji Z, Zhuang J, Peng W. A novel clinical prediction scoring system of high-altitude pulmonary hypertension. Front Cardiovasc Med 2024; 10:1290895. [PMID: 38259305 PMCID: PMC10801263 DOI: 10.3389/fcvm.2023.1290895] [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: 10/23/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024] Open
Abstract
Background High-altitude pulmonary hypertension (HAPH) is a common disease in regions of high altitude where performing right heart catheterization (RHC) is challenging. The development of a diagnostic scoring system is crucial for effective disease screening. Methods A total of 148 individuals were included in a retrospective analysis, and an additional 42 residents were prospectively enrolled. We conducted a multivariable analysis to identify independent predictors of HAPH. Subsequently, we devised a prediction score based on the retrospective training set to anticipate the occurrence and severity of HAPH. This scoring system was further subjected to validation in the prospective cohort, in which all participants underwent RHC. Results This scoring system, referred to as the GENTH score model (Glycated hemoglobin [OR = 4.5], Echocardiography sign [OR = 9.1], New York Heart Association-functional class [OR = 12.5], Total bilirubin [OR = 3.3], and Hematocrit [OR = 3.6]), incorporated five independent risk factors and demonstrated strong predictive accuracy. In the training set, the area under the curve (AUC) values for predicting the occurrence and severity of HAPH were 0.851 and 0.832, respectively, while in the validation set, they were 0.841 and 0.893. In the validation set, GENTH score model cutoff values of ≤18 or >18 points were established for excluding or confirming HAPH, and a threshold of >30 points indicated severe HAPH. Conclusions The GENTH score model, combining laboratory and echocardiography indicators, represents an effective tool for distinguishing potential HAPH patients and identifying those with severe HAPH. This scoring system improves the clinical screening of HAPH diseases and offers valuable insights into disease diagnosis and management.
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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
| | - Gulinigeer Zhakeer
- Department of Cardiology, Shigatse People’s Hospital, Tibet, China
- 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
| | - Qing Yu
- Department of Cardiology, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Mingyuan Niu
- Department of Cardiology, Shigatse People’s Hospital, Tibet, China
| | - Nuerbiyemu Maimaitiaili
- Department of Cardiology, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ma Mi
- Department of Cardiology, Shigatse People’s Hospital, Tibet, China
| | - Zhuoga Deji
- Department of Cardiology, Shigatse People’s Hospital, Tibet, China
| | - Jianhui Zhuang
- Department of Cardiology, Shigatse People’s Hospital, Tibet, China
- Department of Cardiology, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, 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
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16
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Manzi L, Sperandeo L, Forzano I, Castiello DS, Florimonte D, Paolillo R, Santoro C, Mancusi C, Di Serafino L, Esposito G, Gargiulo G. Contemporary Evidence and Practice on Right Heart Catheterization in Patients with Acute or Chronic Heart Failure. Diagnostics (Basel) 2024; 14:136. [PMID: 38248013 PMCID: PMC10814482 DOI: 10.3390/diagnostics14020136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/21/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
Heart failure (HF) has a global prevalence of 1-2%, and the incidence around the world is growing. The prevalence increases with age, from around 1% for those aged <55 years to >10% for those aged 70 years or over. Based on studies in hospitalized patients, about 50% of patients have heart failure with reduced ejection fraction (HFrEF), and 50% have heart failure with preserved ejection fraction (HFpEF). HF is associated with high morbidity and mortality, and HF-related hospitalizations are common, costly, and impact both quality of life and prognosis. More than 5-10% of patients deteriorate into advanced HF (AdHF) with worse outcomes, up to cardiogenic shock (CS) condition. Right heart catheterization (RHC) is essential to assess hemodynamics in the diagnosis and care of patients with HF. The aim of this article is to review the evidence on RHC in various clinical scenarios of patients with HF.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Giuseppe Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80131 Naples, Italy; (L.M.); (L.S.); (I.F.); (D.S.C.); (D.F.); (R.P.); (C.S.); (C.M.); (L.D.S.); (G.E.)
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17
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Nabeh OA, Saud AI, Amin B, Khedr AS, Amr A, Faoosa AM, Esmat E, Mahmoud YM, Hatem A, Mohamed M, Osama A, Soliman YMA, Elkorashy RI, Elmorsy SA. A Systematic Review of Novel Therapies of Pulmonary Arterial Hypertension. Am J Cardiovasc Drugs 2024; 24:39-54. [PMID: 37945977 PMCID: PMC10805839 DOI: 10.1007/s40256-023-00613-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is a progressive, cureless disease, characterized by increased pulmonary vascular resistance and remodeling, with subsequent ventricular dilatation and failure. New therapeutic targets are being investigated for their potential roles in improving PAH patients' symptoms and reversing pulmonary vascular pathology. METHOD We aimed to address the available knowledge from the published randomized controlled trials (RCTs) regarding the role of Rho-kinase (ROCK) inhibitors, bone morphogenetic protein 2 (BMP2) inhibitors, estrogen inhibitors, and AMP-activated protein kinase (AMPK) activators on the PAH evaluation parameters. This systematic review (SR) was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CDR42022340658) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Overall, 5092 records were screened from different database and registries; 8 RCTs that met our inclusion criteria were included. The marked difference in the study designs and the variability of the selected outcome measurement tools among the studies made performing a meta-analysis impossible. However, the main findings of this SR relate to the powerful potential of the AMPK activator and the imminent antidiabetic drug metformin, and the BMP2 inhibitor sotatercept as promising PAH-modifying therapies. There is a need for long-term studies to evaluate the effect of the ROCK inhibitor fasudil and the estrogen aromatase inhibitor anastrozole in PAH patients. The role of tacrolimus in PAH is questionable. The discrepancy in the hemodynamic and clinical parameters necessitates defining cut values to predict improvement. The differences in the PAH etiologies render the judgment of the therapeutic potential of the tested drugs challenging. CONCLUSION Metformin and sotatercept appear as promising therapeutic drugs for PAH. CLINICAL TRIALS REGISTRATION This work was registered in PROSPERO (CDR42022340658).
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Affiliation(s)
- Omnia Azmy Nabeh
- Medical Pharmacology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Alaa I Saud
- Kasralainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Basma Amin
- Kasralainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Alaa Amr
- Kasralainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Eshraka Esmat
- Kasralainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Aya Hatem
- Kasralainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mariam Mohamed
- Kasralainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Alaa Osama
- Kasralainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Reem Ibrahim Elkorashy
- Pulmonology, Pulmonary Medicine Department, Kasr Alainy Hospital, Cairo University, Cairo, Egypt
| | - Soha Aly Elmorsy
- Medical Pharmacology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
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18
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Sanges S, Sobanski V, Lamblin N, Hachulla E, Savale L, Montani D, Launay D. Pulmonary hypertension in connective tissue diseases: What every CTD specialist should know - but is afraid to ask! Rev Med Interne 2024; 45:26-40. [PMID: 37925256 DOI: 10.1016/j.revmed.2023.10.450] [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: 06/12/2023] [Revised: 10/15/2023] [Accepted: 10/16/2023] [Indexed: 11/06/2023]
Abstract
Pulmonary hypertension (PH) is a possible complication of connective tissue diseases (CTDs), especially systemic sclerosis (SSc), systemic lupus erythematosus (SLE) and mixed connective tissue disease (MCTD). It is defined by an elevation of the mean pulmonary arterial pressure above 20mmHg documented during a right heart catheterization (RHC). Due to their multiorgan involvement, CTDs can induce PH by several mechanisms, that are sometimes intricated: pulmonary vasculopathy (group 1) affecting arterioles (pulmonary arterial hypertension, PAH) and possibly venules (pulmonary veno-occlusive-like disease), left-heart disease (group 2), chronic lung disease (group 3) and/or chronic thromboembolic PH (group 4). PH suspicion is often raised by clinical manifestations (dyspnea, fatigue), echocardiographic data (increased peak tricuspid regurgitation velocity), isolated decrease in DLCO in pulmonary function tests, and/or unexplained elevation of BNP/NT-proBNP. Its formal diagnosis always requires a hemodynamic confirmation by RHC. Strategies for PH screening and RHC referral have been extensively investigated for SSc-PAH but data are lacking in other CTDs. Therapeutic management of PH depends of the underlying mechanism(s): PAH-approved therapies in group 1 PH (with possible use of immunosuppressants, especially in case of SLE or MCTD); management of an underlying left-heart disease in group 2 PH; management of an underlying chronic lung disease in group 3 PH; anticoagulation, pulmonary endartectomy, PAH-approved therapies and/or balloon pulmonary angioplasty in group 4 PH. Regular follow-up is mandatory in all CTD-PH patients.
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Affiliation(s)
- S Sanges
- Université de Lille, U1286, INFINITE, Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, 59000 Lille, France; CHU de Lille, Département de Médecine Interne et Immunologie Clinique, 59000 Lille, France; Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), 59000 Lille, France; Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), 59000 Lille, France.
| | - V Sobanski
- Université de Lille, U1286, INFINITE, Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, 59000 Lille, France; CHU de Lille, Département de Médecine Interne et Immunologie Clinique, 59000 Lille, France; Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), 59000 Lille, France; Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), 59000 Lille, France
| | - N Lamblin
- CHU de Lille, Service de Cardiologie, 59000 Lille, France; Institut Pasteur de Lille, Inserm U1167, 59000 Lille, France
| | - E Hachulla
- Université de Lille, U1286, INFINITE, Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, 59000 Lille, France; CHU de Lille, Département de Médecine Interne et Immunologie Clinique, 59000 Lille, France; Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), 59000 Lille, France; Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), 59000 Lille, France
| | - L Savale
- Université Paris Saclay, School of Medicine, Le Kremlin-Bicêtre, France; AP-HP, Department of Respiratory and Intensive Care Medicine, Hôpital Bicêtre, Le Kremlin-Bicêtre, France; Inserm UMR_S 999, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France
| | - D Montani
- Université Paris Saclay, School of Medicine, Le Kremlin-Bicêtre, France; AP-HP, Department of Respiratory and Intensive Care Medicine, Hôpital Bicêtre, Le Kremlin-Bicêtre, France; Inserm UMR_S 999, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France
| | - D Launay
- Université de Lille, U1286, INFINITE, Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, 59000 Lille, France; CHU de Lille, Département de Médecine Interne et Immunologie Clinique, 59000 Lille, France; Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), 59000 Lille, France; Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), 59000 Lille, France
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19
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Wessels JN, Celant LR, de Man FS, Vonk Noordegraaf A. The Right Ventricle in Pulmonary Hypertension. Semin Respir Crit Care Med 2023; 44:738-745. [PMID: 37487527 DOI: 10.1055/s-0043-1770117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
The right ventricle plays a pivotal role in patients with pulmonary hypertension (PH). Its adaptation to pressure overload determines a patient's functional status as well as survival. In a healthy situation, the right ventricle is part of a low pressure, high compliance system. It is built to accommodate changes in preload, but not very well suited for dealing with pressure overload. In PH, right ventricular (RV) contractility must increase to maintain cardiac output. In other words, the balance between the degree of RV contractility and afterload determines stroke volume. Hypertrophy is one of the major hallmarks of RV adaptation, but it may cause stiffening of the ventricle in addition to intrinsic changes to the RV myocardium. Ventricular filling becomes more difficult for which the right atrium tries to compensate through increased stroke work. Interaction of RV diastolic stiffness and right atrial (RA) function determines RV filling, but also causes vena cava backflow. Assessment of RV and RA function is critical in the evaluation of patient status. In recent guidelines, this is acknowledged by incorporating additional RV parameters in the risk stratification in PH. Several conventional parameters of RV and RA function have been part of risk stratification for many years. Understanding the pathophysiology of RV failure and the interactions with the pulmonary circulation and right atrium requires consideration of the unique RV anatomy. This review will therefore describe normal RV structure and function and changes that occur during adaptation to increased afterload. Consequences of a failing right ventricle and its implications for RA function will be discussed. Subsequently, we will describe RV and RA assessment in clinical practice.
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Affiliation(s)
- Jeroen N Wessels
- PHEniX Laboratory, Department of Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, The Netherlands
- European Reference Network on Rare Pulmonary Diseases (ERN-LUNG), Germany
| | - Lucas R Celant
- PHEniX Laboratory, Department of Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, The Netherlands
- European Reference Network on Rare Pulmonary Diseases (ERN-LUNG), Germany
| | - Frances S de Man
- PHEniX Laboratory, Department of Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, The Netherlands
- European Reference Network on Rare Pulmonary Diseases (ERN-LUNG), Germany
| | - Anton Vonk Noordegraaf
- PHEniX Laboratory, Department of Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, The Netherlands
- European Reference Network on Rare Pulmonary Diseases (ERN-LUNG), Germany
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20
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Grinstein J, Houston BA, Nguyen AB, Smith BA, Chinco A, Pinney SP, Tedford RJ, Belkin MN. Standardization of the Right Heart Catheterization and the Emerging Role of Advanced Hemodynamics in Heart Failure. J Card Fail 2023; 29:1543-1555. [PMID: 37633442 DOI: 10.1016/j.cardfail.2023.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/28/2023]
Abstract
The accurate assessment of hemodynamics is paramount to providing timely and efficacious care for patients presenting in cardiogenic shock. Recently, the regular use of the pulmonary artery catheter in cardiogenic shock has had a resurgence with emerging data indicating improved survival in the modern era. Optimal multidisciplinary management of advanced heart failure and cardiogenic shock relies on our ability to effectively communicate and understand the complete hemodynamic assessment. Standardization of data acquisition and a renewed focus on the physiological processes, and thresholds driving disease progression, including the coupling ratio and myocardial reserve, are needed to fully understand and interpret the hemodynamic assessment. This State-of-the-Art review discusses best practices in the cardiac catheterization laboratory as well as emerging data on the prognostic role of emerging advanced hemodynamic parameters.
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Affiliation(s)
- Jonathan Grinstein
- University of Chicago, Department of Medicine, Section of Cardiology, Chicago, Illinois.
| | - Brian A Houston
- Medical University of South Carolina, Department of Medicine, Section of Heart Failure, Charleston, South Carolina
| | - Ann B Nguyen
- University of Chicago, Department of Medicine, Section of Cardiology, Chicago, Illinois
| | - Bryan A Smith
- University of Chicago, Department of Medicine, Section of Cardiology, Chicago, Illinois
| | - Annalyse Chinco
- University of Chicago, Department of Surgery, Chicago, Illinois
| | - Sean P Pinney
- Mount Sinai Hospital, Department of Medicine, Section of Cardiology, New York, New York
| | - Ryan J Tedford
- Medical University of South Carolina, Department of Medicine, Section of Heart Failure, Charleston, South Carolina
| | - Mark N Belkin
- University of Chicago, Department of Medicine, Section of Cardiology, Chicago, Illinois
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21
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Güder G, Reiter T, Fette G, Hundertmark M, Frantz S, Morbach C, Störk S, Held M. Diagnosing post-capillary hypertension in patients with left heart disease: impact of new guidelines. Clin Res Cardiol 2023:10.1007/s00392-023-02290-5. [PMID: 37668664 DOI: 10.1007/s00392-023-02290-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 08/17/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND In 2022, the definition of pulmonary hypertension (PH) in the presence of left heart disease was updated according to the new joint guidelines of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS). The impact of the new ESC/ERS definition on the prevalence of post-capillary PH (pc-PH) and its subgroups of isolated post-capillary (Ipc-PH) and combined pre- and post-capillary PH (Cpc-PH) in patients with left heart disease is unclear. METHODS We retrospectively identified N = 242 patients with left heart disease with available data on right heart catheterisation (RHC) and cardiac magnetic resonance imaging (CMR). The proportion of pc-PH and its subgroups was calculated according to the old and new ESC/ERS PH definition. As the old definition did not allow the exact allocation of all patients with pc-PH into a respective subgroup, unclassifiable patients (Upc-PH) were regarded separately. RESULTS Seventy-six out of 242 patients had pc-PH according to the new ESC/ERS definitions, with 72 of these patients also meeting the criteria of the old definition. Using the old definition, 50 patients were diagnosed with Ipc-PH, 4 with Cpc-PH, and 18 with Upc-PH. Applying the new definition, Ipc-PH was diagnosed in 35 patients (4 newly), and Cpc-PH in 41 patients. No CMR parameter allowed differentiating between Ipc-PH and Cpc-PH, regardless of which guideline version was used. CONCLUSION Applying the new ESC/ERS 2022 guideline definitions mildly increased the proportion of patients diagnosed with pc-PH (+ 5.5%) but markedly increased Cpc-PH diagnoses. This effect was driven by the allocation of patients with formerly unclassifiable forms of post-capillary PH to the Cpc-PH subgroup and a significant shift of patients from the Ipc-PH to the Cpc-PH subgroup. Distribution of post-capillary pulmonary hypertension (pc-PH) subgroups according to the European Society of Cardiology/European Respiratory Society (ESC/ERS) PH guidelines from 2015 and 2022 in N = 242 patients with left heart disease.
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Affiliation(s)
- Gülmisal Güder
- Department of Internal Medicine I, Cardiology Division, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany.
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany.
| | - Theresa Reiter
- Department of Internal Medicine I, Cardiology Division, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
| | - Georg Fette
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
- Chair of Computer Science VI, University of Würzburg, Würzburg, Germany
| | - Moritz Hundertmark
- Department of Internal Medicine I, Cardiology Division, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
| | - Stefan Frantz
- Department of Internal Medicine I, Cardiology Division, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - Caroline Morbach
- Department of Internal Medicine I, Cardiology Division, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Störk
- Department of Internal Medicine I, Cardiology Division, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - Matthias Held
- Department of Internal Medicine, Respiratory Medicine and Ventilatory Support, Medical Mission Hospital, Central Clinic Würzburg, Würzburg, Germany
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22
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Mandoli GE, Landra F, Chiantini B, Sciaccaluga C, Pastore MC, Focardi M, Cavigli L, D’Ascenzi F, Bernazzali S, Maccherini M, Valente S, Cameli M, Henein M. Tricuspid Regurgitation Velocity and Mean Pressure Gradient for the Prediction of Pulmonary Hypertension According to the New Hemodynamic Definition. Diagnostics (Basel) 2023; 13:2619. [PMID: 37627879 PMCID: PMC10453142 DOI: 10.3390/diagnostics13162619] [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: 07/04/2023] [Revised: 08/02/2023] [Accepted: 08/06/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND The hemodynamic definition of PH has recently been revised with unchanged threshold of peak tricuspid regurgitation velocity (TRV). The aim of this study was to evaluate the predictive accuracy of peak TRV for PH based on the new (>20 mmHg) and the old (>25 mmHg) cut-off value for mean pulmonary artery pressure (mPAP) and to compare it with the mean right ventricular-right atrial (RV-RA) pressure gradient. METHODS Patients with advanced heart failure were screened from 2016 to 2021. The exclusion criteria were absent right heart catheterization (RHC) results, chronic obstructive pulmonary disease, any septal defect, inadequate acoustic window or undetectable TR. The mean RV-RA gradient was calculated from the velocity-time integral of TR. RESULTS The study included 41 patients; 34 (82.9%) had mPAP > 20 mmHg and 24 (58.5%) had mPAP > 25 mmHg. The AUC for the prediction of PH with mPAP > 20 mmHg was 0.855 for peak TRV and mean RV-RA gradient was 0.811. AUC for the prediction of PH defined as mPAP > 25 mmHg for peak TRV was 0.860 and for mean RV-RA gradient was 0.830. A cutoff value of 2.4 m/s for peak TRV had 65% sensitivity and 100% positive predictive value for predicting PH according to the new definition. CONCLUSIONS Peak TRV performed better than mean RV-RA pressure gradient in predicting PH irrespective of hemodynamic definitions. Peak TRV performed similarly with the two definitions of PH, but a lower cutoff value had higher sensitivity and equal positive predictive value for PH.
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Affiliation(s)
- Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy; (G.E.M.); (B.C.); (C.S.); (M.C.P.); (M.F.); (L.C.); (F.D.); (S.V.); (M.C.)
- Institute of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden;
| | - Federico Landra
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy; (G.E.M.); (B.C.); (C.S.); (M.C.P.); (M.F.); (L.C.); (F.D.); (S.V.); (M.C.)
| | - Benedetta Chiantini
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy; (G.E.M.); (B.C.); (C.S.); (M.C.P.); (M.F.); (L.C.); (F.D.); (S.V.); (M.C.)
| | - Carlotta Sciaccaluga
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy; (G.E.M.); (B.C.); (C.S.); (M.C.P.); (M.F.); (L.C.); (F.D.); (S.V.); (M.C.)
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy; (G.E.M.); (B.C.); (C.S.); (M.C.P.); (M.F.); (L.C.); (F.D.); (S.V.); (M.C.)
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy; (G.E.M.); (B.C.); (C.S.); (M.C.P.); (M.F.); (L.C.); (F.D.); (S.V.); (M.C.)
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy; (G.E.M.); (B.C.); (C.S.); (M.C.P.); (M.F.); (L.C.); (F.D.); (S.V.); (M.C.)
| | - Flavio D’Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy; (G.E.M.); (B.C.); (C.S.); (M.C.P.); (M.F.); (L.C.); (F.D.); (S.V.); (M.C.)
| | - Sonia Bernazzali
- Department of Cardiac Surgery, University of Siena, 53100 Siena, Italy; (S.B.); (M.M.)
| | - Massimo Maccherini
- Department of Cardiac Surgery, University of Siena, 53100 Siena, Italy; (S.B.); (M.M.)
| | - Serafina Valente
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy; (G.E.M.); (B.C.); (C.S.); (M.C.P.); (M.F.); (L.C.); (F.D.); (S.V.); (M.C.)
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy; (G.E.M.); (B.C.); (C.S.); (M.C.P.); (M.F.); (L.C.); (F.D.); (S.V.); (M.C.)
| | - Michael Henein
- Institute of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden;
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23
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Rezende CF, Mancuzo EV, Nunes MDCP, Corrêa RA. Accuracy of Transthoracic Echocardiogram as a Screening Method in the Clinical Practice of Pulmonary Hypertension Investigation. Arq Bras Cardiol 2023; 120:e20220461. [PMID: 37556652 PMCID: PMC10382154 DOI: 10.36660/abc.20220461] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 03/06/2023] [Accepted: 04/05/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND The transthoracic echocardiogram (TTE) plays a screening role in the diagnostic algorithm of pulmonary hypertension (PH). Studies have shown a significant disagreement between TTE measurements of the systolic pulmonary artery pressure (sPAP) and right atrial pressure (RAP) and those obtained by right heart catheterization (RHC). OBJECTIVE To compare TTE measurements of sPAP and RAP with those obtained by RHC in patients being investigated for PH. METHODS Patients referred to a PH reference center with a high or intermediate TTE probability of PH upon admission were submitted to RHC. The agreement between sPAP and RAP from both procedures was assessed through the Bland-Altman test. Differences of up to 10 mmHg for sPAP and 5 mmHg for RAP were considered within the variability of the test. Receiver Operating Characteristic (ROC) curve was constructed to determine the most accurate sPAP and Tricuspid regurgitation maximal velocity (TRV)values associated with the diagnosis of PH by RHC. The adopted level of statistical significance was 5%. RESULTS Ninety-five patients were included. The Bland-Altman analysis showed a bias of 8.03 mmHg (95% CI:-34.9-50.9) for sPAP and -3.30 mmHg (95% CI:-15.9-9.3) for RAP. AUC for sPAP and TRV measured by TTE for discrimination of probable PH were 0.936 (95% CI: 0.836-1.0) and 0.919 (95% CI: 0.837-1.0), respectively. However, only 33.4% of the echocardiographic estimate of sPAP and 55.1% of RAP were accurate, as compared to the measurements obtained by RHC. CONCLUSION TTE has a high discriminatory power as a screening diagnostic method for PH despite presenting disagreements between sPAP and RAP absolute values when compared to RHC measurements.
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Affiliation(s)
- Camila Farnese Rezende
- Universidade Federal de Minas GeraisPós-Graduação Ciências Aplicadas à Saúde do AdultoBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais – Pós-Graduação Ciências Aplicadas à Saúde do Adulto, Belo Horizonte, MG – Brasil
| | - Eliane Viana Mancuzo
- Universidade Federal de Minas GeraisPós-Graduação Ciências Aplicadas à Saúde do AdultoBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais – Pós-Graduação Ciências Aplicadas à Saúde do Adulto, Belo Horizonte, MG – Brasil
| | - Maria do Carmo Pereira Nunes
- Universidade Federal de Minas GeraisFaculdade de MedicinaBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais – Faculdade de Medicina, Belo Horizonte, MG – Brasil
| | - Ricardo Amorim Corrêa
- Universidade Federal de Minas GeraisPós-Graduação Ciências Aplicadas à Saúde do AdultoBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais – Pós-Graduação Ciências Aplicadas à Saúde do Adulto, Belo Horizonte, MG – Brasil
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24
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Balistrieri A, Makino A, Yuan JXJ. Pathophysiology and pathogenic mechanisms of pulmonary hypertension: role of membrane receptors, ion channels, and Ca 2+ signaling. Physiol Rev 2023; 103:1827-1897. [PMID: 36422993 PMCID: PMC10110735 DOI: 10.1152/physrev.00030.2021] [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: 08/02/2021] [Revised: 11/11/2022] [Accepted: 11/19/2022] [Indexed: 11/25/2022] Open
Abstract
The pulmonary circulation is a low-resistance, low-pressure, and high-compliance system that allows the lungs to receive the entire cardiac output. Pulmonary arterial pressure is a function of cardiac output and pulmonary vascular resistance, and pulmonary vascular resistance is inversely proportional to the fourth power of the intraluminal radius of the pulmonary artery. Therefore, a very small decrease of the pulmonary vascular lumen diameter results in a significant increase in pulmonary vascular resistance and pulmonary arterial pressure. Pulmonary arterial hypertension is a fatal and progressive disease with poor prognosis. Regardless of the initial pathogenic triggers, sustained pulmonary vasoconstriction, concentric vascular remodeling, occlusive intimal lesions, in situ thrombosis, and vascular wall stiffening are the major and direct causes for elevated pulmonary vascular resistance in patients with pulmonary arterial hypertension and other forms of precapillary pulmonary hypertension. In this review, we aim to discuss the basic principles and physiological mechanisms involved in the regulation of lung vascular hemodynamics and pulmonary vascular function, the changes in the pulmonary vasculature that contribute to the increased vascular resistance and arterial pressure, and the pathogenic mechanisms involved in the development and progression of pulmonary hypertension. We focus on reviewing the pathogenic roles of membrane receptors, ion channels, and intracellular Ca2+ signaling in pulmonary vascular smooth muscle cells in the development and progression of pulmonary hypertension.
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Affiliation(s)
- Angela Balistrieri
- Section of Physiology, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California, San Diego, La Jolla, California
- Harvard University, Cambridge, Massachusetts
| | - Ayako Makino
- Division of Endocrinology and Metabolism, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Jason X-J Yuan
- Section of Physiology, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California, San Diego, La Jolla, California
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25
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Hameed A, Condliffe R, Swift AJ, Alabed S, Kiely DG, Charalampopoulos A. Assessment of Right Ventricular Function-a State of the Art. Curr Heart Fail Rep 2023; 20:194-207. [PMID: 37271771 PMCID: PMC10256637 DOI: 10.1007/s11897-023-00600-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE OF REVIEW The right ventricle (RV) has a complex geometry and physiology which is distinct from the left. RV dysfunction and failure can be the aftermath of volume- and/or pressure-loading conditions, as well as myocardial and pericardial diseases. RECENT FINDINGS Echocardiography, magnetic resonance imaging and right heart catheterisation can assess RV function by using several qualitative and quantitative parameters. In pulmonary hypertension (PH) in particular, RV function can be impaired and is related to survival. An accurate assessment of RV function is crucial for the early diagnosis and management of these patients. This review focuses on the different modalities and indices used for the evaluation of RV function with an emphasis on PH.
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Affiliation(s)
- Abdul Hameed
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Andrew J Swift
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- INSIGNEO, Institute for in silico Medicine, University of Sheffield, Sheffield, UK
| | - Samer Alabed
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- INSIGNEO, Institute for in silico Medicine, University of Sheffield, Sheffield, UK
| | - David G Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- NIHR Sheffield Biomedical Research Centre, Sheffield, UK
| | - Athanasios Charalampopoulos
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK.
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.
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26
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Doyle M, Rayarao G, Biederman RWW. The sine transform is the sine qua non of the pulmonary and systemic pressure relationship. Front Cardiovasc Med 2023; 10:1120330. [PMID: 37304951 PMCID: PMC10250723 DOI: 10.3389/fcvm.2023.1120330] [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: 12/09/2022] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Assessment of therapeutic interventions in patients with pulmonary arterial hypertension (PAH) suffers from several commonly encountered limitations: (1) patient studies are often too small and short-term to provide definitive conclusions, (2) there is a lack of a universal set of metrics to adequately assess therapy and (3) while clinical treatments focus on management of symptoms, there remain many cases of early loss of life in a seemingly arbitrary distribution. Here we provide a unified approach to assess right and left pressure relationships in PAH and pulmonary hypertension (PH) patients by developing linear models informed by the observation of Suga and Sugawa that pressure generation in the ventricle (right or left) approximately follows a single lobe of a sinusoid. We sought to identify a set of cardiovascular variables that either linearly or via a sine transformation related to systolic pulmonary arterial pressure (PAPs) and systemic systolic blood pressure (SBP). Importantly, both right and left cardiovascular variables are included in each linear model. Using non-invasively obtained cardiovascular magnetic resonance (CMR) image metrics the approach was successfully applied to model PAPs in PAH patients with an r2 of 0.89 (p < 0.05) and SBP with an r2 of 0.74 (p < 0.05). Further, the approach clarified the relationships that exist between PAPs and SBP separately for PAH and PH patients, and these relationships were used to distinguish PAH vs. PH patients with good accuracy (68%, p < 0.05). An important feature of the linear models is that they demonstrate that right and left ventricular conditions interact to generate PAPs and SBP in PAH patients, even in the absence of left-sided disease. The models predicted a theoretical right ventricular pulsatile reserve that in PAH patients was shown to be predictive of the 6 min walk distance (r2 = 0.45, p < 0.05). The linear models indicate a physically plausible mode of interaction between right and left ventricles and provides a means of assessing right and left cardiac status as they relate to PAPs and SBP. The linear models have potential to allow assessment of the detailed physiologic effects of therapy in PAH and PH patients and may thus permit cross-over of knowledge between PH and PAH clinical trials.
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Affiliation(s)
- Mark Doyle
- Department Cardiology, Cardiovascular MRI, Cardiovascular Institute, Allegheny Health Network, Pittsburgh, PA, United States
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27
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Li Y, Zhang R, Shan H, Shi W, Feng X, Chen H, Yang X, Li Y, Zhang J, Zhang M. FVC/D LCO identifies pulmonary hypertension and predicts 5-year all-cause mortality in patients with COPD. Eur J Med Res 2023; 28:174. [PMID: 37183240 PMCID: PMC10184375 DOI: 10.1186/s40001-023-01130-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 04/26/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) is a common complication of chronic obstructive pulmonary disease (COPD). However, it is unknown whether the ratio of forced vital capacity (FVC) to diffusing lung capacity for carbon monoxide (DLCO) can identify PH in the patients with COPD and predict its prognosis. METHODS The study population I included 937 COPD patients who were admitted to inpatient treatments from 2010 to 2017, and finally 750 patients were available to follow-up the 5-year all-cause mortality (study population II). Clinical characteristics of the study population were recorded. RESULTS COPD patients with PH had a higher FVC/DLCO value compared with the patients without PH. The threshold for FVC/DLCO to identify PH in COPD patients was 0.44 l/mmol/min/kPa. Multivariate logistic regression analysis showed that FVC/DLCO was a significant predictor for PH in the patients with COPD. The study population II showed that the 5-year all-cause mortality of COPD patients was significantly higher in combined with PH group than without PH group. Compared with the survivor group, FVC/DLCO value was significantly increased in non-survivor group. The threshold for FVC/DLCO to predict 5-year all-cause mortality was 0.41 l/mmol/min/kPa. Kaplan-Meier survival curves showed that 5-year cumulative survival rate for COPD patients were significantly decreased when the value of FVC/DLCO was ≥ 0.41 l/mmol/min/kPa. Multivariate cox regression analysis showed that FVC/DLCO was an independent prognostic factor for 5-year all-cause mortality in COPD patients. CONCLUSION FVC/DLCO could identify PH in the patients with COPD and was an independent predictor for 5-year all-cause mortality of COPD.
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Affiliation(s)
- Yuer Li
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 West Fifth Road, Xi'an, 710004, Shaanxi, China
| | - Rui Zhang
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 West Fifth Road, Xi'an, 710004, Shaanxi, China
| | - Hu Shan
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 West Fifth Road, Xi'an, 710004, Shaanxi, China
| | - Wenhua Shi
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 West Fifth Road, Xi'an, 710004, Shaanxi, China
| | - Xiaoli Feng
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 West Fifth Road, Xi'an, 710004, Shaanxi, China
| | - Haijuan Chen
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 West Fifth Road, Xi'an, 710004, Shaanxi, China
| | - Xia Yang
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 West Fifth Road, Xi'an, 710004, Shaanxi, China
| | - Yali Li
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 West Fifth Road, Xi'an, 710004, Shaanxi, China
| | - Jie Zhang
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 West Fifth Road, Xi'an, 710004, Shaanxi, China.
| | - Ming Zhang
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 West Fifth Road, Xi'an, 710004, Shaanxi, China.
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28
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Richter MJ, Tello K. [Pulmonary hypertension associated with lung disease]. Herz 2023:10.1007/s00059-023-05173-7. [PMID: 37106074 DOI: 10.1007/s00059-023-05173-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2023] [Indexed: 04/29/2023]
Abstract
Pulmonary hypertension (PH) is a multifactorial pulmonary vascular disease. PH associated with pre-existing lung disease is common and classified as group 3 in the clinical classification. Patients with chronic obstructive or interstitial lung disease are most likely to develop PH, with up to 20% of patients showing signs of PH. Distinguishing between the symptoms of the underlying lung disease and concomitant PH can be difficult. Clinical assessment, lung function tests, laboratory tests, and echocardiography can be helpful. The hemodynamic definition of PH has recently been changed. PH associated with lung disease is a pre-capillary form by definition. A special sub-stratification in group 3 is the differentiation of hemodynamic severity. Severe PH in group 3 is defined as a pulmonary vascular resistance (PVR) greater than 5 Wood units (WU). This pulmonary vascular phenotype is characterized by rather mild to moderate impairment of lung function or lung parenchymal destruction but with severe pulmonary vascular disease or right heart strain. Currently, there are no specific PH medications approved for group 3. However, the use of specific PH medications for the pulmonary vascular phenotype is being discussed in studies or on a case-by-case basis, while in patients with a PVR below 5 WU treatment focuses on the underlying disease.
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Affiliation(s)
- Manuel J Richter
- Medizinische Klinik II, Universitätsklinikum Gießen und Marburg, Klinikstraße 32, 35392, Gießen, Deutschland.
- Lung Center (UGMLC), Cardio-Pulmonary Institute (CPI), Institute for Lung Health (ILH), Justus-Liebig University, Ludwigstraße 23, 35390, Gießen, Deutschland.
| | - Khodr Tello
- Medizinische Klinik II, Universitätsklinikum Gießen und Marburg, Klinikstraße 32, 35392, Gießen, Deutschland
- Lung Center (UGMLC), Cardio-Pulmonary Institute (CPI), Institute for Lung Health (ILH), Justus-Liebig University, Ludwigstraße 23, 35390, Gießen, Deutschland
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29
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Macera F, Dewachter C, Stefanidis C, Vanden Eynden F, Bondue A, Vachiéry J, Roussoulières A. Lung diffusion capacity correlates with pre-implant pulmonary hypertension and predicts outcome after LVAD implantation. ESC Heart Fail 2023; 10:1043-1053. [PMID: 36546904 PMCID: PMC10053279 DOI: 10.1002/ehf2.14256] [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: 07/14/2022] [Revised: 10/26/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022] Open
Abstract
AIMS Diffusing capacity of the lung for carbon monoxide (DLCO ) reduction is common in heart failure (HF) and is associated with a worse prognosis. Correlations between DLCO and pulmonary hypertension (PH) are unclear, and published data are conflicting; it has been shown that DLCO impairment may persist or even worsen after normalization of pulmonary pressures following left ventricle assist device (LVAD) implantation, maybe reflecting persistent pulmonary damage. We aimed to investigate the impact of pre-implant DLCO and central haemodynamics on outcome in patients with advanced HF implanted with a LVAD. METHODS AND RESULTS We retrospectively analysed pre-implant and post-implant data from 42 patients implanted with a LVAD at our institution. Out of 42 patients, 35 had post-capillary PH before implantation, including 17 with combined post- and pre-capillary PH (Cpc-PH). Median DLCO was 59% (IQR 47-68%), and it inversely correlated with pulmonary vascular resistance (PVR) (P 0.037) and diastolic pulmonary gradient (DPG) (P 0.042). Compared with baseline, LVAD resulted in improvement in LV diameter (LVDd, P < 0.001), mitral regurgitation (P 0.022), and PH (mPAP 24 vs. 36 mmHg, P < 0.001; PAWP 12 vs. 23 mmHg, P 0.001; pulmonary artery compliance, CPA 3.1 vs. 1.9 mL/mmHg, P 0.021). Lower DLCO and Cpc-PH at baseline were associated with a better LV reverse remodelling post-implantation (P 0.027 for LVDd) but also with a smaller gain in CPA (P 0.049). CONCLUSIONS Before LVAD implantation, DLCO impairment is associated with higher PVR and DPG, suggesting that it might be an expression of persistent pulmonary damage occurring in Cpc-PH. After LVAD implantation, both LV dimension and haemodynamics improve. Lower pre-implant DLCO is associated with better LV reverse remodelling.
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Affiliation(s)
- Francesca Macera
- Department of CardiologyHôpital Universitaire de Bruxelles – Hôpital ErasmeBrusselsBelgium
- Department of CardiologyNiguarda Ca' Granda HospitalMilanItaly
| | - Céline Dewachter
- Department of CardiologyHôpital Universitaire de Bruxelles – Hôpital ErasmeBrusselsBelgium
| | - Constantin Stefanidis
- Department of Cardiac SurgeryHôpital Universitaire de Bruxelles – Hôpital ErasmeBrusselsBelgium
| | - Frédéric Vanden Eynden
- Department of Cardiac SurgeryHôpital Universitaire de Bruxelles – Hôpital ErasmeBrusselsBelgium
| | - Antoine Bondue
- Department of CardiologyHôpital Universitaire de Bruxelles – Hôpital ErasmeBrusselsBelgium
| | - Jean‐Luc Vachiéry
- Department of CardiologyHôpital Universitaire de Bruxelles – Hôpital ErasmeBrusselsBelgium
| | - Ana Roussoulières
- Department of CardiologyHôpital Universitaire de Bruxelles – Hôpital ErasmeBrusselsBelgium
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30
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Rahmianti ND, Dinarti LK, Mumpuni H, Triastuti F. Global Longitudinal Strain Right Ventricle (GLS RV) as a Predictor for Mean Pulmonary Artery Pressure (MPAP) on Secundum Atrial Septal Defect (ASD) with Pulmonary Hypertension. J Cardiovasc Echogr 2023; 33:83-87. [PMID: 37772046 PMCID: PMC10529289 DOI: 10.4103/jcecho.jcecho_14_23] [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: 02/11/2023] [Revised: 04/24/2023] [Accepted: 05/21/2023] [Indexed: 09/30/2023] Open
Abstract
Objectives The objectives of the study were to determine the association between global longitudinal strain right ventricle (GLS-RV) and mean pulmonary artery pressure (mPAP) on secundum atrial septal defect (ASD) with pulmonary hypertension (PH). Methods This study was an analytic observational with the cross-sectional approach. This study was conducted with secundum ASD patients who underwent right heart catheterization (RHC) from February 2019 to July 2019 at Sardjito General Teaching Hospital Yogyakarta. Demographic data were collected and echocardiographic parameters were evaluated based on the standard examination. The results were statistically analyzed using the correlation hypothesis test. If the data were normally distributed, the Pearson's correlation test was used, if the data were not normally distributed, Spearman's correlation test was used to analyze the correlation. Results Thirty-four patients were enrolled in this study. There was strongly significant positive correlation between GLS-RV and mPAP found in patients with Secundum ASD (P = 0.0001, r = 90.5%). Conclusions This is the first study in Indonesia that analyzed the association between GLS-RV and mPAP in Secundum ASD patients. There was a strongly significant positive correlation between GLS-RV and mPAP in patients with Secundum ASD after RHC. We assume that the association is influenced by progressivity and degree of disease severity.
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Affiliation(s)
- Nia Dyah Rahmianti
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University, Airlangga Teaching Hospital, Surabaya, Indonesia
| | - Lucia Kris Dinarti
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Gadjah Mada University, Dr. Sardjito Teaching Hospital, Yogyakarta, Indonesia
| | - Hasanah Mumpuni
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Gadjah Mada University, Dr. Sardjito Teaching Hospital, Yogyakarta, Indonesia
| | - Fita Triastuti
- Master Program in Basic Medical Science, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
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31
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Atta ME, Khalil YM, Abd-Elhameed A, Morsi TS, Elbehairy AF. Physiological predictors of resting pulmonary hypertension associated with COPD: a retrospective analysis. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2023. [DOI: 10.1186/s43168-023-00179-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Abstract
Background
Resting pulmonary hypertension (PH) is not uncommon in patients with chronic obstructive pulmonary disease (COPD). In the current study, we aimed to identify physiological predictors of resting PH in patients with COPD.
Methods
We retrospectively analyzed data derived from right heart catheterization in sixty-nine stable patients with COPD. Patients were categorized into COPD-PH (n = 33) and COPD-non-PH (n = 36), based on the “6th World Symposium on PH.”
Results
Demographics, forced expiratory volume in 1 s (FEV1), lung volumes, cardiac output, and cardiac index were similar between groups, yet COPD-PH had greater pulmonary vascular resistance (PVR) and lower resting PaO2 (P < 0.05). The proportion of COPD-PH patients did not differ across the range of FEV1 (χ2 = 3.01, P = 0.22). No correlations were found between PVR and the degree of airflow obstruction or resting hyperinflation. Resting PaO2 was the only predictor of both pulmonary artery pressure and PVR.
Conclusions
Increased PVR, in response to arterial hypoxemia or directly induced by tobacco smoking, is likely the key factor that led to resting PH in the current sample of patients with moderate-severe COPD, regardless of the degree of airflow limitation or resting hyperinflation.
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32
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Swisher JW, Weaver E. The Evolving Management and Treatment Options for Patients with Pulmonary Hypertension: Current Evidence and Challenges. Vasc Health Risk Manag 2023; 19:103-126. [PMID: 36895278 PMCID: PMC9990521 DOI: 10.2147/vhrm.s321025] [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: 10/29/2022] [Accepted: 02/01/2023] [Indexed: 03/06/2023] Open
Abstract
Pulmonary hypertension may develop as a disease process specific to pulmonary arteries with no identifiable cause or may occur in relation to other cardiopulmonary and systemic illnesses. The World Health Organization (WHO) classifies pulmonary hypertensive diseases on the basis of primary mechanisms causing increased pulmonary vascular resistance. Effective management of pulmonary hypertension begins with accurately diagnosing and classifying the disease in order to determine appropriate treatment. Pulmonary arterial hypertension (PAH) is a particularly challenging form of pulmonary hypertension as it involves a progressive, hyperproliferative arterial process that leads to right heart failure and death if untreated. Over the last two decades, our understanding of the pathobiology and genetics behind PAH has evolved and led to the development of several targeted disease modifiers that ameliorate hemodynamics and quality of life. Effective risk management strategies and more aggressive treatment protocols have also allowed better outcomes for patients with PAH. For those patients who experience progressive PAH with medical therapy, lung transplantation remains a life-saving option. More recent work has been directed at developing effective treatment strategies for other forms of pulmonary hypertension, such as chronic thromboembolic pulmonary hypertension (CTEPH) and pulmonary hypertension due to other lung or heart diseases. The discovery of new disease pathways and modifiers affecting the pulmonary circulation is an ongoing area of intense investigation.
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Affiliation(s)
- John W Swisher
- East Tennessee Pulmonary Hypertension Center, StatCare Pulmonary Consultants, Knoxville, TN, USA
| | - Eric Weaver
- East Tennessee Pulmonary Hypertension Center, StatCare Pulmonary Consultants, Knoxville, TN, USA
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Dusik M, Fingrova Z, Marek J, Dytrych V, Jansa P, Havranek S. The impact of atrial fibrillation and atrial tachycardias on the hemodynamic status of patients with pulmonary hypertension. Physiol Res 2022. [DOI: 10.33549/physiolres.934941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The impact of atrial fibrillation and atrial tachycardias (AF/AT), and their optimal treatment strategy in PH patients is still being discussed. The goal of this study was to evaluate the effect of AF/AT termination on the hemodynamic parameters in PH patients. We compared patients with pre-capillary pulmonary hypertension (PH group), left ventricular heart failure (LV-HF group), and a Control group. A repeated right heart catheterization was performed during the catheter ablation (CA) procedure. The first measurement was done in arrhythmia, the second after the sinus rhythm (SR) was restored. High frequency atrial stimulation was used to simulate AT in patients without arrhythmia presence at the time of the CA. The variation of pressure parameters in PH patients did not differ significantly from the Controls. There was a significant increase in the right ventricle pressure after the SR restoration in the LV-HF group compared to the Controls and PH group (+4 vs. -2 vs. -3 mmHg, p < 0.05). The cardiac index (CI) variation was not significant when compared between the study groups. An increase of the CI after the SR restoration was found in those patients with AF (+0.31 l/min/m² [IQR 0.18; 0.58]) in contrast to those patients with organized AT/high frequency atrial stimulation (-0.09 l/min/m², [IQR - 0.45; 0.19]). This difference was statistically significant (p < 0.05). The acute hemodynamic response to arrhythmia termination was not significantly different in the PH patients when compared to the Controls. In contrast to AT/high frequency stimulation, the restoration of SR in AF patients leads to an increased CI, irrespective of the presence or absence of PH.
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Affiliation(s)
| | | | | | | | | | - S Havranek
- 2nd Department of Medicine - Department of Cardiovascular Medicine, General University Hospital in Prague, 1st Faculty of Medicine, Charles University in Prague, Czech Republic.
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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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35
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Cullivan S, Higgins M, Gaine S. Diagnosis and management of pulmonary arterial hypertension. Breathe (Sheff) 2022; 18:220168. [PMID: 36865939 PMCID: PMC9973456 DOI: 10.1183/20734735.0168-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/03/2022] [Indexed: 12/15/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a progressive disease of the pulmonary vasculature that is characterised by elevated pressures within the pulmonary vascular tree. Recent decades have witnessed a dramatic expansion in our understanding of the pathobiology and the epidemiology of PAH, and improvements in treatment options and outcomes. The prevalence of PAH is estimated to be between 48 and 55 cases per million adults. The definition was recently amended and a diagnosis of PAH now requires evidence of a mean pulmonary artery pressure >20 mmHg, a pulmonary vascular resistance >2 Wood units and a pulmonary artery wedge pressure ≤15 mmHg at right heart catheterisation. Detailed clinical assessment and a number of additional diagnostic tests are required to assign a clinical group. Biochemistry, echocardiography, lung imaging and pulmonary function tests provide valuable information to assist in the assignment of a clinical group. Risk assessment tools have been refined, and these greatly facilitate risk stratification and enhance treatment decisions and prognostication. Current therapies target three therapeutic pathways: the nitric oxide, prostacyclin and endothelin pathways. While lung transplantation remains the only curative intervention for PAH, there are a number of promising therapies under investigation which may further reduce morbidity and improve outcomes. This review describes the epidemiology, pathology and pathobiology of PAH and introduces important concepts regarding the diagnosis and risk stratification of PAH. The management of PAH is also discussed, with a special focus on PAH specific therapy and key supportive measures.
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Affiliation(s)
- Sarah Cullivan
- National Pulmonary Hypertension Unit, Mater Misericordiae University Hospital, Dublin, Ireland,Corresponding author: Sarah Cullivan ()
| | - Margaret Higgins
- National Pulmonary Hypertension Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Sean Gaine
- National Pulmonary Hypertension Unit, Mater Misericordiae University Hospital, Dublin, Ireland
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36
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Otto M, McGiffin D, Whitford H, Kure C, Snell G, Diehl A, Orosz J, Burrell AJC. Survival and left ventricular dysfunction post lung transplantation for pulmonary arterial hypertension. J Crit Care 2022; 72:154120. [PMID: 35914371 DOI: 10.1016/j.jcrc.2022.154120] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/17/2022] [Accepted: 07/17/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Bilateral lung transplantation for end-stage pulmonary arterial hypertension (PAH) is traditionally associated with higher early post-transplant mortality when compared with other indications. Changes in perioperative management, including the growing use of perioperative extracorporeal membrane oxygenation (ECMO) and an increased awareness of postoperative left ventricular dysfunction (LVD), have resulted in outcomes that are uncertain. MATERIALS AND METHODS We conducted a single-center, retrospective observational study at a lung transplantation center in Melbourne, Australia, from 2006 to 2019. ECMO use was categorized as preoperative, prophylactic, or rescue. Postoperative LVD was defined as a reduction in left ventricular function on echocardiography or using strict clinical criteria. RESULTS 50 patients underwent lung transplantation for PAH. 12-month survival was 48/50 (96%). ECMO was used in 26 (52%) patients, and the use of prophylactic VA-ECMO increased over the study period. Postoperative LVD was diagnosed in 21 (42%) patients. 12-month survival and left ventricular function was no different between LVD and non-LVD groups. CONCLUSIONS This study showed that high survival rates can be achieved following lung transplantation for PAH. We found that ECMO utilization was common, and indications have changed over time. LVD was common but did not impact 12-month survival.
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Affiliation(s)
- Madeleine Otto
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, 55 Commercial Road, Melbourne, Australia.
| | - David McGiffin
- Department of Cardiothoracic Surgery and Transplantation, The Alfred Hospital, 55 Commercial Road, Melbourne, Australia.
| | - Helen Whitford
- Lung Transplant Service, Department of Respiratory Medicine, The Alfred Hospital, 55 Commercial Road, Melbourne, Australia.
| | - Christina Kure
- Department of Cardiothoracic Surgery and Transplantation, The Alfred Hospital, 55 Commercial Road, Melbourne, Australia.
| | - Gregory Snell
- Lung Transplant Service, Department of Respiratory Medicine, The Alfred Hospital, 55 Commercial Road, Melbourne, Australia.
| | - Arne Diehl
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, 55 Commercial Road, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Australia.
| | - Judit Orosz
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, 55 Commercial Road, Melbourne, Australia.
| | - Aidan J C Burrell
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, 55 Commercial Road, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Australia.
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37
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DUSIK M, FINGROVA Z, MAREK J, DYTRYCH V, JANSA P, HAVRANEK S. The impact of atrial fibrillation and atrial tachycardias on the hemodynamic status of patients with pulmonary hypertension. Physiol Res 2022; 71:791-799. [PMID: 36281725 PMCID: PMC9814991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The impact of atrial fibrillation and atrial tachycardias (AF/AT), and their optimal treatment strategy in PH patients is still being discussed. The goal of this study was to evaluate the effect of AF/AT termination on the hemodynamic parameters in PH patients. We compared patients with pre-capillary pulmonary hypertension (PH group), left ventricular heart failure (LV-HF group), and a Control group. A repeated right heart catheterization was performed during the catheter ablation (CA) procedure. The first measurement was done in arrhythmia, the second after the sinus rhythm (SR) was restored. High frequency atrial stimulation was used to simulate AT in patients without arrhythmia presence at the time of the CA. The variation of pressure parameters in PH patients did not differ significantly from the Controls. There was a significant increase in the right ventricle pressure after the SR restoration in the LV-HF group compared to the Controls and PH group (+4 vs. -2 vs. -3 mmHg, p<0.05). The cardiac index (CI) variation was not significant when compared between the study groups. An increase of the CI after the SR restoration was found in those patients with AF (+0.31 l/min/m2 [IQR 0.18; 0.58]) in contrast to those patients with organized AT/high frequency atrial stimulation ( 0.09 l/min/m2, [IQR - 0.45; 0.19]). This difference was statistically significant (p<0.05). The acute hemodynamic response to arrhythmia termination was not significantly different in the PH patients when compared to the Controls. In contrast to AT/high frequency stimulation, the restoration of SR in AF patients leads to an increased CI, irrespective of the presence or absence of PH.
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Affiliation(s)
- Milan DUSIK
- 2nd Department of Medicine - Department of Cardiovascular Medicine, General University Hospital in Prague, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Zdenka FINGROVA
- 2nd Department of Medicine - Department of Cardiovascular Medicine, General University Hospital in Prague, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Josef MAREK
- 2nd Department of Medicine - Department of Cardiovascular Medicine, General University Hospital in Prague, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Vladimir DYTRYCH
- 2nd Department of Medicine - Department of Cardiovascular Medicine, General University Hospital in Prague, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Pavel JANSA
- 2nd Department of Medicine - Department of Cardiovascular Medicine, General University Hospital in Prague, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Stepan HAVRANEK
- 2nd Department of Medicine - Department of Cardiovascular Medicine, General University Hospital in Prague, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
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Zanatta E, Marra MP, Famoso G, Balestro E, Giraudo C, Calabrese F, Rea F, Doria A. The Challenge of Diagnosing and Managing Pulmonary Arterial Hypertension in Systemic Sclerosis with Interstitial Lung Disease. Pharmaceuticals (Basel) 2022; 15:ph15091042. [PMID: 36145263 PMCID: PMC9504220 DOI: 10.3390/ph15091042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/12/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022] Open
Abstract
Pulmonary hypertension (PH) in patients with Systemic Sclerosis (SSc) may stem from a variety of underlying causes, thus making a correct diagnosis and management difficult. The main challenges lie in the distinction between pulmonary arterial hypertension (PAH, group 1) and PH due to interstitial lung disease (PH-ILD, group 3) in patients with concomitant lung fibrosis — a very common occurrence in SSc. A consensus among experts remains elusive. Some studies have suggested that among SSc patients with PH, those with an ILD extension > 20% at high-resolution computed tomography (HRCT) should be considered as affected by PH-ILD, whereas other Authors have found that a wide proportion of these patients exhibit features of both PAH and group 3 PH-ILD. We report the case of a 46-year-old male SSc patient with a stable and extensive ILD (>20%) who developed a histologically documented pulmonary vasculopathy typical of PAH and received PAH-specific treatment as bridge to transplant. Moreover, we documented PH disease course by right heart catheterization (RHC), with and without specific vasodilator therapies, which are essential in PAH but not indicated and/or harmful in PH-ILD.
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Affiliation(s)
- Elisabetta Zanatta
- Department of Medicine-DIMED, Padova University Hospital, Via Giustiniani 2, 35126 Padova, Italy
- Correspondence: ; Tel.: +39-049-821-2193
| | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, Via Giustiniani 2, 35126 Padova, Italy
| | - Giulia Famoso
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, Via Giustiniani 2, 35126 Padova, Italy
| | - Elisabetta Balestro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, Via Giustiniani 2, 35126 Padova, Italy
| | - Chiara Giraudo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, Via Giustiniani 2, 35126 Padova, Italy
| | - Fiorella Calabrese
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, Via Giustiniani 2, 35126 Padova, Italy
| | - Federico Rea
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, Via Giustiniani 2, 35126 Padova, Italy
| | - Andrea Doria
- Department of Medicine-DIMED, Padova University Hospital, Via Giustiniani 2, 35126 Padova, Italy
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39
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Chacko SR, Ram P, Fox T, Sooknanan N, Lo KB, Menezes RG, Lasrado S, Eiger G, Vaidya A. Impact of achieving euthyroidism on pulmonary artery systolic pressures in hyperthyroidism-associated pulmonary hypertension - a systematic review. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2022; 12:212-223. [PMID: 36147789 PMCID: PMC9490158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/29/2022] [Indexed: 06/16/2023]
Abstract
In this systematic review, we seek to clarify the impact of treatment of hyperthyroidism on pulmonary hypertension in patients with both these conditions. We included 39 of 709 articles retrieved, that studied patients with hyperthyroidism and pulmonary hypertension (PH). From these, those with a documented pre-treatment Pulmonary Artery Systolic Pressure (PASP) > 35 mmHg and complete follow up were analyzed, yielding 3 case series and 22 case reports with a total of 81 cases. A significant improvement in PASP was noted with achieving euthyroidism in the 3 case series. The case reports showed a significant reduction in mean PASP from 60.5 ± 13.2 mmHg to 37.5 ± 10.1 mmHg (p < 0.001) in patients with Grave's disease with achieving euthyroidism. No deaths were reported during the follow up period. Achievement of a euthyroid state in patients with hyperthyroidism is associated with statistically significant reductions in PASP.
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Affiliation(s)
- Shireen R Chacko
- Department of Medicine, Albert Einstein Medical Center PhiladelphiaPA, United States of America
| | - Pradhum Ram
- Division of Cardiology, Emory University HospitalAtlanta, GA, United States of America
| | - Tamaryn Fox
- Department of Medicine, Albert Einstein Medical Center PhiladelphiaPA, United States of America
| | - Naveen Sooknanan
- Department of Medicine, Albert Einstein Medical Center PhiladelphiaPA, United States of America
| | - Kevin Bryan Lo
- Department of Medicine, Albert Einstein Medical Center PhiladelphiaPA, United States of America
| | - Ritesh G Menezes
- Department of Pathology, College of Medicine, King Fahd Hospital of The University, Imam Abdulrahman Bin Faisal UniversityDammam, Saudi Arabia
| | - Savita Lasrado
- Department of Otorhinolaryngology and Head & Neck Surgery, Father Muller Medical CollegeMangalore, India
| | - Glenn Eiger
- Department of Medicine, Albert Einstein Medical Center PhiladelphiaPA, United States of America
- Division of Pulmonary and Critical Care and Sleep Medicine, Einstein Medical Center PhiladelphiaPA, United States of America
| | - Anjali Vaidya
- Division of Cardiology, Temple University HospitalPhiladelphia, PA, United States of America
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Ruaro B, Confalonieri P, Caforio G, Baratella E, Pozzan R, Tavano S, Bozzi C, Lerda S, Geri P, Biolo M, Cortale M, Confalonieri M, Salton F. Chronic Thromboembolic Pulmonary Hypertension: An Observational Study. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58081094. [PMID: 36013561 PMCID: PMC9415110 DOI: 10.3390/medicina58081094] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 08/01/2022] [Accepted: 08/12/2022] [Indexed: 01/29/2023]
Abstract
Background and Objectives: Chronic thromboembolic pulmonary hypertension (CTEPH) has a high mortality. The treatment of CTEPH could be balloon pulmonary angioplasty (BPA), medical (MT) or pulmonary endarterectomy (PEA). This study aims to assess the clinical characteristics of CTEPH patients, surgically or medically treated, in a pulmonology referral center. Materials and Methods: A total of 124 patients with PH with suspected CTEPH (53 male subjects and 71 female subjects; mean age at diagnosis 67 ± 6) were asked to give informed consent and then were evaluated. The presence of CTEPH was ascertained by medical evaluations, radiology and laboratory tests. Results: After the evaluation of all clinical data, 65 patients met the inclusion criteria for CTEPH and they were therefore enrolled (22 males and 43 females; mean age at diagnosis was 69 ± 8). 26 CTEPH patients were treated with PEA, 32 with MT and 7 with BPA. There was a statistically significant age difference between the PEA and MT groups, at the time of diagnosis, the PEA patients were younger than the MT patients, whereas there was no statistically significant difference in other clinical characteristics (e.g., smoking habit, thrombophilia predisposition), as well as functional and hemodynamic parameters (e.g., 6-min walk test, right heart catheterization). During three years of follow-up, no patients in the PEA groups died; conversely, eleven patients in the MT group died during the same period (p < 0.05). Furthermore, a significant decrease in plasma BNP values and an increase in a meter at the six-minute walk test, 1 and 3 years after surgery, were observed in the PEA group (p < 0.05). Conclusions: This study seems to confirm that pulmonary endarterectomy (PEA) can provide an improvement in functional tests in CTEPH.
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Affiliation(s)
- Barbara Ruaro
- Department of Pulmonology, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
- Correspondence: ; Tel.: +39-040-399-4871
| | - Paola Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Gaetano Caforio
- Department of Pulmonology, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Elisa Baratella
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy
| | - Riccardo Pozzan
- Department of Pulmonology, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Stefano Tavano
- Department of Pulmonology, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Chiara Bozzi
- Department of Pulmonology, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Selene Lerda
- 24ore Business School, Via Monte Rosa, 91, 20149 Milan, Italy
| | - Pietro Geri
- Department of Pulmonology, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Marco Biolo
- Department of Pulmonology, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Maurizio Cortale
- Department of Medical, Surgical, & Health Sciences, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy
| | - Marco Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Francesco Salton
- Department of Pulmonology, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
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Right Heart Catheterization (RHC): A comprehensive review of provocation tests and hepatic hemodynamics in patients with pulmonary hypertension (PH). Curr Probl Cardiol 2022; 47:101351. [DOI: 10.1016/j.cpcardiol.2022.101351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/04/2022] [Indexed: 12/26/2022]
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42
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Xanthouli P, Miazgowski J, Benjamin N, Gordjani O, Egenlauf B, Harutyunova S, Seeger R, Marra AM, Blank N, Lorenz HM, Grünig E, Eichstaedt CA. Prognostic meaning of right ventricular function and output reserve in patients with systemic sclerosis. Arthritis Res Ther 2022; 24:173. [PMID: 35864554 PMCID: PMC9306074 DOI: 10.1186/s13075-022-02863-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/05/2022] [Indexed: 11/23/2022] Open
Abstract
Background The objective of this study was to investigate the prognostic impact of right ventricular (RV) function at rest and during exercise in patients with systemic sclerosis (SSc) presenting for a screening for pulmonary hypertension (PH). Methods In this study, data from SSc patients who underwent routinely performed examinations for PH screening including echocardiography and right heart catheterization at rest and during exercise were analysed. Uni- and multivariable analyses were performed to identify prognostic parameters. Results Out of 280 SSc patients screened for PH, 225 were included in the analysis (81.3% female, mean age 58.1±13.0 years, 68% limited cutaneous SSc, WHO-FC II–III 74%, 24 manifest PH). During the observation period of 3.2±2.7 (median 2.6) years 35 patients died. Tricuspid annular plane systolic excursion (TAPSE) at rest <18 mm (p=0.001), RV output reserve as increase of cardiac index (CI) during exercise <2 l/min (p<0.0001), RV pulmonary vascular reserve (Δ mean pulmonary artery pressure/Δ cardiac output) ≥3 mmHg/l/min (p<0.0001), peak CI <5.5 l/min/m2 (p=0.001), pulmonary arterial compliance <2 ml/mmHg (p=0.002), TAPSE/systolic pulmonary arterial pressure (sPAP) ratio ≤0.6 ml/mmHg (p<0.0001) and echocardiographic qualitative RV function at rest (p<0.0001) significantly predicted worse survival. In the multivariable analysis TAPSE/sPAP ratio and diffusion capacity for carbon monoxide ≤65% were identified as independent prognostic predictors and had 75% sensitivity and 69% specificity to predict future development of pulmonary vascular disease (PVD) during follow-up. Conclusions This study demonstrates that assessment of RV function at rest and during exercise may provide crucial information to identify SSc patients who are at a high risk of poor outcome and for the development of PH and/or PVD.
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Affiliation(s)
- Panagiota Xanthouli
- Centre for Pulmonary Hypertension, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany.,Department of Pneumology and Critical Care Medicine, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Heidelberg, Germany.,Department of Internal Medicine V: Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Julia Miazgowski
- Centre for Pulmonary Hypertension, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Heidelberg, Germany
| | - Nicola Benjamin
- Centre for Pulmonary Hypertension, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany
| | - Ojan Gordjani
- Centre for Pulmonary Hypertension, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Heidelberg, Germany
| | - Benjamin Egenlauf
- Centre for Pulmonary Hypertension, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany.,Department of Pneumology and Critical Care Medicine, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Heidelberg, Germany
| | - Satenik Harutyunova
- Centre for Pulmonary Hypertension, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany.,Department of Pneumology and Critical Care Medicine, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Heidelberg, Germany
| | - Rebekka Seeger
- Centre for Pulmonary Hypertension, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany.,Department of Pneumology and Critical Care Medicine, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Heidelberg, Germany
| | - Alberto M Marra
- Centre for Pulmonary Hypertension, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany.,Department of Translational Medical Sciences, "Federico II" University and School of Medicine, Naples, Italy
| | - Norbert Blank
- Department of Internal Medicine V: Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Hanns-Martin Lorenz
- Department of Internal Medicine V: Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ekkehard Grünig
- Centre for Pulmonary Hypertension, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany.,Department of Pneumology and Critical Care Medicine, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Heidelberg, Germany
| | - Christina A Eichstaedt
- Centre for Pulmonary Hypertension, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Heidelberg, Germany. .,Translational Lung Research Centre Heidelberg (TLRC), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany. .,Laboratory for Molecular Genetic Diagnostics, Institute of Human Genetics, Heidelberg University, Heidelberg, Germany.
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Garg P, Gosling R, Swoboda P, Jones R, Rothman A, Wild JM, Kiely DG, Condliffe R, Alabed S, Swift AJ. Cardiac magnetic resonance identifies raised left ventricular filling pressure: prognostic implications. Eur Heart J 2022; 43:2511-2522. [PMID: 35512290 PMCID: PMC9259376 DOI: 10.1093/eurheartj/ehac207] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 03/13/2022] [Accepted: 04/07/2022] [Indexed: 11/28/2022] Open
Abstract
AIMS Non-invasive imaging is routinely used to estimate left ventricular (LV) filling pressure (LVFP) in heart failure (HF). Cardiovascular magnetic resonance (CMR) is emerging as an important imaging tool for sub-phenotyping HF. However, currently, LVFP cannot be estimated from CMR. This study sought to investigate (i) if CMR can estimate LVFP in patients with suspected HF and (ii) if CMR-modelled LVFP has prognostic power. METHODS AND RESULTS Suspected HF patients underwent right heart catheterization (RHC), CMR and transthoracic echocardiography (TTE) (validation cohort only) within 24 h of each other. Right heart catheterization measured pulmonary capillary wedge pressure (PCWP) was used as a reference for LVFP. At follow-up, death was considered as the primary endpoint. We enrolled 835 patients (mean age: 65 ± 13 years, 40% male). In the derivation cohort (n = 708, 85%), two CMR metrics were associated with RHC PCWP:LV mass and left atrial volume. When applied to the validation cohort (n = 127, 15%), the correlation coefficient between RHC PCWP and CMR-modelled PCWP was 0.55 (95% confidence interval: 0.41-0.66, P < 0.0001). Cardiovascular magnetic resonance-modelled PCWP was superior to TTE in classifying patients as normal or raised filling pressures (76 vs. 25%). Cardiovascular magnetic resonance-modelled PCWP was associated with an increased risk of death (hazard ratio: 1.77, P < 0.001). At Kaplan-Meier analysis, CMR-modelled PCWP was comparable to RHC PCWP (≥15 mmHg) to predict survival at 7-year follow-up (35 vs. 37%, χ2 = 0.41, P = 0.52). CONCLUSION A physiological CMR model can estimate LVFP in patients with suspected HF. In addition, CMR-modelled LVFP has a prognostic role.
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Affiliation(s)
- Pankaj Garg
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Rebecca Gosling
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Peter Swoboda
- The Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK
| | - Rachel Jones
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Alexander Rothman
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Jim M Wild
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - David G Kiely
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
- Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Samer Alabed
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Andrew J Swift
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
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44
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Sharma D, Shah RJ, Sreenivasan J, Kafle P, Gupta R, Levine A, Lanier GM, Aronow WS. The role of serial right heart catheterization in risk stratification and management of pulmonary arterial hypertension. Expert Rev Cardiovasc Ther 2022; 20:543-547. [PMID: 35726644 DOI: 10.1080/14779072.2022.2092095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Pulmonary arterial hypertension (PAH) is characterized by elevated pulmonary arterial blood pressure secondary to increased pulmonary vascular resistance. AREAS COVERED Invasive hemodynamic assessment by heart catheterization (RHC) remains the gold standard to confirm the diagnosis, to determine the severity of right ventricular dysfunction and to test for pulmonary vasoreactivity. After diagnosis and initiation of therapy, many PAH centers continue to perform RHC at regular intervals to monitor for disease progression and alter management. We discuss the importance of risk stratification in PAH, the role of RHC in the evaluation and treatment of these patients and compare non-invasive risk assessment tools to that of RHC. EXPERT OPINION RHC is useful for diagnosis of PAH, assessing the risk of mortality and morbidity, directing the escalation and de-escalation of therapy, and monitoring for disease progression. In the current era of improved non-invasive cardiac hemodynamic assessment, the role for routine follow-up serial RHC in patients with PAH needs to be reassessed in future studies. With the availability of non-invasive risk assessment tools such as REVEAL Lite 2, it may be reasonable to reconsider the role of annual or protocoled RHC, and instead, move on to an "as needed" and individual approach.
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Affiliation(s)
- Dikshya Sharma
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Ravi J Shah
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Jayakumar Sreenivasan
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Paritosh Kafle
- Dvision of Cardiology, Department of Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Rahul Gupta
- Division of Cardiology, Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, PA, USA
| | - Avi Levine
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Gregg M Lanier
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
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45
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Butcher SC, Feloukidis C, Kamperidis V, Yedidya I, Stassen J, Fortuni F, Vrana E, Mouratoglou SA, Boutou A, Giannakoulas G, Playford D, Ajmone Marsan N, Bax JJ, Delgado V. Right Ventricular Myocardial Work Characterization in Patients With Pulmonary Hypertension and Relation to Invasive Hemodynamic Parameters and Outcomes. Am J Cardiol 2022; 177:151-161. [PMID: 35691706 DOI: 10.1016/j.amjcard.2022.04.058] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/17/2022] [Accepted: 04/23/2022] [Indexed: 11/01/2022]
Abstract
Noninvasive evaluation of indexes of right ventricular (RV) myocardial work (RVMW) derived from RV pressure-strain loops may provide novel insights into RV function in precapillary pulmonary hypertension. This study was designed to evaluate the association between the indexes of RVMW and invasive parameters of right heart catheterization and all-cause mortality. Noninvasive analysis of RVMW was completed in 51 patients (mean age 58.1 ± 12.7 years, 31% men) with group I or group IV pulmonary hypertension. RV global work index (RVGWI), RV global constructive work (RVGCW), RV global wasted work (RVGWW), and RV global work efficiency (RVGWE) were compared with parameters derived invasively during right heart catheterization. Patients were followed-up for the occurrence of all-cause death. The median RVGWI, RVGCW, RVGWW, and RVGWE were 620 mm Hg%, 830 mm Hg%, 105 mm Hg% and 87%, respectively. Compared with conventional echocardiographic parameters of RV systolic function, RVGCW and RVGWI correlated more closely with invasively derived RV stroke work index (R = 0.63, p <0.001 and R = 0.60, p <0.001, respectively). Invasively derived pulmonary vascular resistance correlated with RVGWW (R = 0.63, p <0.001), RVGWE (R = 0.48, p <0.001), and RV global longitudinal strain (R = 0.58, p <0.001). RVGCW (hazard ratio 1.42 per 100 mm Hg% <900 mm Hg%, 95% confidence interval 1.12 to 1.81, p = 0.004) and RVGWI (hazard ratio 1.46 per 100 mm Hg% <650 mm Hg%, 95% confidence interval 1.09 to 1.94, p = 0.010) were significantly associated with all-cause mortality, whereas RV global longitudinal strain, RVGWE, and RVGWW were not. In conclusion, indexes of RVMW were more closely correlated with invasively derived RV stroke work index and peripheral vascular resistance than conventional echocardiographic parameters of RV systolic function. Decreased values of RVGCW and RVGWI were associated with all-cause mortality, whereas conventional echocardiographic parameters of RV function were not.
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Affiliation(s)
- Steele C Butcher
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Christos Feloukidis
- Department of Cardiology, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece
| | - Vasileios Kamperidis
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece
| | - Idit Yedidya
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, Rabin Medical Center, Petah-Tikva, Israel
| | - Jan Stassen
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Federico Fortuni
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Division of Cardiology, "Città della Salute della Scienza" University Hospital, Turin, Italy
| | - Elena Vrana
- Department of Cardiology, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece
| | - Sophia A Mouratoglou
- Department of Cardiology, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece
| | - Afroditi Boutou
- Department of Cardiology, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece
| | - George Giannakoulas
- Department of Cardiology, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece
| | - David Playford
- School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
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46
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Wang M, Hu Y, Guo B, Tang H. Simulation of Acute Pulmonary Hypertension in Beagle Dogs. Int Heart J 2022; 63:612-622. [PMID: 35650161 DOI: 10.1536/ihj.21-676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Acoustic cardiography (AC) combined with heart sound (HS) recording and electrocardiogram (ECG) provides a noninvasive and inexpensive way to understand the electrical mechanical activity of the heart. Pulmonary artery stenosis can cause hemodynamic abnormalities that might lead to pulmonary hypertension (PH). In this paper, we examined the relationships between the acoustic characteristics of the AC and hemodynamic changes in a beagle dog model of PH.Four healthy beagle dogs were injected with the prostaglandin endoperoxide receptor agonist U-44069 to induce acute PH states. AC was employed to analyze the process of pre-PH, intra-PH, and post-PH. Right ventricular blood pressure (RVBP) was measured via right cardiac catheterization, an invasive method performed in parallel for comparative hemodynamic evaluation. As RVBP increased or decreased, the HS features changed accordingly during acute PH occurrence and development. Right ventricular systolic blood pressure (RVSBP) significantly correlated with the minimum of the first HS (S1) amplitude (correlation coefficient (CC) = -0.82), energy of the S1 (CC = 0.86), energy of the second HS (S2) (CC = 0.67), entropy of the S1 (CC = -0.94), and ratio of electromechanical systolic time (EMST) to the cardiac cycle time (CC = 0.81). The two techniques (AC [HSs and ECG] versus right cardiac catheterization [RVBP]) were significantly correlated. Especially, the diastolic filling time (DFT) had a significant relationship with the right ventricular diastolic time (RVDT) (CC = 0.97), perfusion time (PT) (CC = 0.96), and cardiac cycle time (RR) (CC = 0.96). The CCs between the RVDT and the max dp/dt to min dp/dt, the EMST and the Q to min dp/dt, and the electromechanical activation time and the Q to max dp/dt were 0.95, 0.99, and 0.86, respectively. Furthermore, the logistic regression model with different combinations was used to identify the effective features for monitoring hemodynamic and pathophysiologic conditions.AC provided significant insight into mechanical dysfunction in a rapid and noninvasive way that could be used for early screening of PH.
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Affiliation(s)
- Miao Wang
- School of Biomedical Engineering, Dalian University of Technology
| | - YaTing Hu
- School of Biomedical Engineering, Dalian University of Technology
| | - BinBin Guo
- School of Biomedical Engineering, Dalian University of Technology
| | - Hong Tang
- School of Biomedical Engineering, Dalian University of Technology
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47
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Göransson C, Vejlstrup N, Carlsen J. Clinically important changes of right ventricular volume and function in pulmonary arterial hypertension assessed with cardiac magnetic resonance imaging. Pulm Circ 2022; 12:e12097. [PMID: 35833097 PMCID: PMC9262318 DOI: 10.1002/pul2.12097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/22/2022] [Accepted: 05/26/2022] [Indexed: 11/25/2022] Open
Abstract
Right ventricular (RV) dilatation predicts clinical worsening in pulmonary arterial hypertension (PAH) and RV volumes can be measured with high precision using cardiovascular magnetic resonance imaging. In regular follow‐up of patients and in studies of improvement in RV function, knowledge of clinically significant changes of RV volumes and function are of relevance. Patients with PAH were followed with cardiovascular magnetic resonance imaging and clinical assessment at 6‐month intervals. Changes in RV volumes associated with changes in clinical status were assessed. Twenty‐five patients with PAH (Group 1) were included and examined every 6 months for 2.5 years, with a total of 107 MRI scans. For a step change in WHO functional class, the associated change in RV volume was 11% (confidence interval 7%−14%, p < 0.0001) and in stroke volume 9% (confidence interval 3%−15%, p = 0.003). This study found an 11% change in RV volume to be clinically significant. The combination of clinically significant changes and the known precision in the measurements enables individualized follow‐up of RV‐function in PAH. To our knowledge, this study is the first to use repeated assessments to suggest clinically significant changes of RV volume based on changes in clinical presentation.
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Affiliation(s)
- Christoffer Göransson
- Department of Cardiology, Rigshospitalet Copenhagen University Hospital 9‐ Blegdamsvej Copenhagen Denmark
| | - Niels Vejlstrup
- Department of Cardiology, Rigshospitalet Copenhagen University Hospital 9‐ Blegdamsvej Copenhagen Denmark
| | - Jørn Carlsen
- Department of Cardiology, Rigshospitalet Copenhagen University Hospital 9‐ Blegdamsvej Copenhagen Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences University of Copenhagen Blegdamsvej 3B Copenhagen 2200 Denmark
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48
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Kretzschmar D, Schulze PC. Right Heart Catheterization and Pulmonary Hemodynamics. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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49
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Wang M, Wang J, Hu Y, Guo B, Tang H. Detection of pulmonary hypertension with six training strategies based on deep learning technology. Comput Intell 2022. [DOI: 10.1111/coin.12527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Miao Wang
- School of Biomedical Engineering Dalian University of Technology Dalian China
| | - JiWen Wang
- Cardiovascular Department The Second Hospital of DaLian Medical University Dalian China
| | - YaTing Hu
- School of Biomedical Engineering Dalian University of Technology Dalian China
| | - BinBin Guo
- School of Biomedical Engineering Dalian University of Technology Dalian China
| | - Hong Tang
- School of Biomedical Engineering Dalian University of Technology Dalian China
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50
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Shima H, Nakaya T, Tsujino I, Nakamura J, Sugimoto A, Sato T, Watanabe T, Ohira H, Suzuki M, Kato M, Yokota I, Konno S. Accuracy of Swan‒Ganz catheterization‐based assessment of right ventricular function: Validation study using high‐fidelity micromanometry‐derived values as reference. Pulm Circ 2022; 12:e12078. [PMID: 35514782 PMCID: PMC9063972 DOI: 10.1002/pul2.12078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/15/2022] [Accepted: 04/06/2022] [Indexed: 11/14/2022] Open
Abstract
Right ventricular (RV) function critically affects the outcomes of patients with pulmonary hypertension (PH). Pressure wave analysis using Swan‒Ganz catheterization (SG‐cath) allows for the calculation of indices of RV function. However, the accuracy of these indices has not been validated. In the present study, we calculated indices of systolic and diastolic RV functions using SG‐cath‐derived pressure recordings in patients with suspected or confirmed PH. We analyzed and validated the accuracies of three RV indices having proven prognostic values, that is, end‐systolic elastance (Ees)/arterial elastance (Ea), β (stiffness constant), and end‐diastolic elastance (Eed), using high‐fidelity micromanometry‐derived data as reference. We analyzed 73 participants who underwent SG‐cath for the diagnosis or evaluation of PH. In this study, Ees/Ea was calculated via the single‐beat pressure method using [1.65 × (mean pulmonary arterial pressure) − 7.79] as end‐systolic pressure. SG‐cath‐derived Ees/Ea, β, and Eed were 0.89 ± 0.69 (mean ± standard deviation), 0.027 ± 0.002, and 0.16 ± 0.02 mmHg/ml, respectively. The mean differences (limits of agreement) between SG‐cath and micromanometry‐derived data were 0.13 (0.99, −0.72), 0.002 (0.020, −0.013), and 0.04 (0.20, −0.12) for Ees/Ea, β, and Eed, respectively. The intraclass correlation coefficients of the indices derived from the two catheterizations were 0.76, 0.71, and 0.57 for Ees/Ea, β, and Eed, respectively. In patients with confirmed or suspected PH, SG‐cath‐derived RV indices, especially Ees/Ea and β, exhibited a good correlation with micromanometry‐derived reference values.
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Affiliation(s)
- Hideki Shima
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University Sapporo Japan
| | - Toshitaka Nakaya
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University Sapporo Japan
| | - Ichizo Tsujino
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University Sapporo Japan
- Division of Respiratory and Cardiovascular Innovative Research Faculty of Medicine, Hokkaido University Sapporo Japan
| | - Junichi Nakamura
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University Sapporo Japan
| | - Ayako Sugimoto
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University Sapporo Japan
| | - Takahiro Sato
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University Sapporo Japan
- Division of Respiratory and Cardiovascular Innovative Research Faculty of Medicine, Hokkaido University Sapporo Japan
| | - Taku Watanabe
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University Sapporo Japan
| | - Hiroshi Ohira
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University Sapporo Japan
| | - Masaru Suzuki
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University Sapporo Japan
| | - Masaru Kato
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine Hokkaido University Sapporo Japan
| | - Isao Yokota
- Department of Biostatistics, Graduate School of Medicine Hokkaido University Japan
| | - Satoshi Konno
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University Sapporo Japan
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