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Koike H, Nishimura T, Morikawa M. Quantitative evaluation of pulmonary hypertension using 4D flow MRI: A retrospective study. Heliyon 2024; 10:e31177. [PMID: 38813238 PMCID: PMC11133668 DOI: 10.1016/j.heliyon.2024.e31177] [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: 04/21/2023] [Revised: 05/01/2024] [Accepted: 05/12/2024] [Indexed: 05/31/2024] Open
Abstract
Background Pulmonary hypertension (PH) is a severe vascular disorder that may affect 50 % of patients with heart failure. Currently, right-sided heart catheterization is required to definitively diagnose PH. However, this method is invasive and thus may not be appropriate for repeated, long-term monitoring of PH patients. This retrospective study's aim was to evaluate whether 4D flow magnetic resonance imaging (MRI) can be used to quantitively measure flow parameters to identify patients with PH. Methods The study cohort included 97 patients recruited from a single institution and divided into three groups based on echocardiographic estimate of pulmonary artery systolic pressure (PASP): normal group with PASP<36 mmHg, borderline PH group with PASP of 37-50 mmHg, and PH group with PASP>50 mmHg. 4D flow MRI was used to quantitively assess blood flow and velocity, regurgitation, wall shear stress (WSS) and kinetic energy in the pulmonary artery trunk, right main pulmonary artery, and left pulmonary artery. Two experienced radiologists independently analyzed the MR images, blinded to clinical details. Results We found a significant difference in WSS in the pulmonary artery trunk, right main pulmonary artery and left main pulmonary artery among the three patient groups. We also found significant differences in the kinetic energy and average through velocity in the pulmonary artery trunk and right main pulmonary artery, and significant differences in the flow rate in the right main pulmonary artery. Conclusion These data suggest that 4D flow MRI can quantitate pulmonary artery flow parameters and distinguish between patients with and without PH.
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Affiliation(s)
- Hirofumi Koike
- Department of Radiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Takamasa Nishimura
- Department of Radiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Minoru Morikawa
- Department of Radiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
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2
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Aguirre-Franco C, Torres-Duque CA, Salazar G, Casas A, Jaramillo C, Gonzalez-Garcia M. Prevalence of pulmonary hypertension in COPD patients living at high altitude. Pulmonology 2024; 30:247-253. [PMID: 35151623 DOI: 10.1016/j.pulmoe.2021.12.006] [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: 04/03/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) is associated with poor prognosis for patients with chronic obstructive pulmonary disease (COPD). Most of the knowledge about PH in COPD has been generated at sea level, with limited information associated with high altitude (HA). OBJECTIVES To assess the prevalence and severity of PH in COPD patients living in a HA city (2,640 m). METHODS Cross-sectional study in COPD patients with forced expiratory volume in the first second / forced vital capacity ratio (FEV1/FVC) post-bronchodilator <0,7. Transthoracic echocardiography (TTE), spirometry, carbon monoxide diffusing capacity, and arterial blood gasses tests were performed. Patients were classified according to the severity of airflow limitation. PH was defined by TTE as an estimated systolic pulmonary artery pressure (sPAP) > 36 mmHg or indirect PH signs; severe PH as sPAP > 60 mmHg; and disproportionate PH as an sPAP > 60 mmHg with non-severe airflow limitation (FEV1 > 50% predicted). RESULTS We included 176 COPD patients. The overall estimated prevalence of PH was 56.3% and the likelihood of having PH increased according to airflow-limitation severity: mild (31.6%), moderate (54.9%), severe (59.6%) and very severe (77.8%) (p = 0.038). The PH was severe in 7.3% and disproportionate in 3.4% of patients. CONCLUSIONS The estimated prevalence of PH in patients with COPD at HA is high, particularly in patients with mild to moderate airflow limitation, and greater than that described for COPD patients at low altitude. These results suggest a higher risk of developing PH for COPD patients living at HA compared to COPD patients with similar airflow limitation living at low altitude.
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Affiliation(s)
- C Aguirre-Franco
- Fundación Neumológica Colombiana. Bogotá, Colombia; Universidad de La Sabana. Chía, Colombia.
| | - C A Torres-Duque
- Fundación Neumológica Colombiana. Bogotá, Colombia; Universidad de La Sabana. Chía, Colombia
| | - G Salazar
- Fundación Cardioinfantil - Instituto de Cardiología. Bogotá, Colombia
| | - A Casas
- Fundación Neumológica Colombiana. Bogotá, Colombia; Universidad de La Sabana. Chía, Colombia
| | - C Jaramillo
- Universidad de La Sabana. Chía, Colombia; Fundación Clínica Shaio. Bogotá, Colombia
| | - M Gonzalez-Garcia
- Fundación Neumológica Colombiana. Bogotá, Colombia; Universidad de La Sabana. Chía, Colombia
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3
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Louw E, Baines N, Maarman G, Osman M, Sigwadhi L, Irusen E, Koegelenberg C, Doubell A, Nathan S, Channick R, Allwood B. The prevalence of pulmonary hypertension after successful tuberculosis treatment in a community sample of adult patients. Pulm Circ 2023; 13:e12184. [PMID: 36699148 PMCID: PMC9852678 DOI: 10.1002/pul2.12184] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 12/15/2022] [Accepted: 12/26/2022] [Indexed: 01/06/2023] Open
Abstract
There are an estimated 155 million survivors of tuberculosis (TB). Clinical experience suggests that post tuberculosis lung disease (PTLD) is an important cause of Group 3 pulmonary hypertension (PH). However, TB is not listed as a cause of PH in most guidelines. A cross-sectional, community-based study was conducted in nonhealthcare seeking adults who had successfully completed TB treatment. Subjects underwent questionnaires, spirometry, a 6-min walk distance test (6MWD) and transthoracic echocardiography (TTE). Screen probable PH was defined on TTE as an estimated pulmonary artery peak systolic pressure (PASP) of ≥40 mmHg. One hundred adults (71 males) were enrolled, with a mean age of 42 years (SD 13.8 years) and a median of one TB episode (interquartile range: 1-2). Co-morbidities included hypertension (21%), diabetes (16%), human immunodeficiency virus (10%) and asthma/COPD (5%). Only 25% had no residual symptoms after TB. Probable PH was found in 9%, while 7% had borderline raised PASP values (PASP 35-40 mmHg). An association was found between PH and the number of previous TB episodes, with each additional episode of TB increasing the odds of PH-postTB 2.13-fold (confidence interval [CI]: 1.17-3.88; p = 0.013). All of those found to have PH were smokers or ex-smokers yielding an unadjusted odds ratio for PH-postTB of 3.67 (95% CI: 0.77-17.46). There was no statistical difference in spirometry or 6MWD, between those with and without PH. Neither symptoms nor co-morbidities demonstrated significant association with PH. PH after TB was a common finding in this community-based population. Further research is needed to confirm and determine the significance of these findings.
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Affiliation(s)
- Elizabeth Louw
- Division of Pulmonology, Department of MedicineStellenbosch University & Tygerberg HospitalCape TownSouth Africa
| | - Nicola Baines
- Division of Pulmonology, Department of MedicineStellenbosch University & Tygerberg HospitalCape TownSouth Africa
| | - Gerald Maarman
- Division of Medical Physiology, Department of Biomedical Sciences, CARMA: Centre for Cardio‐Metabolic Research in Africa, Faculty of Medicine & Health SciencesStellenbosch UniversityStellenboschSouth Africa
| | - Muhammad Osman
- Department of Paediatrics and Child Health, Desmond Tutu TB CentreStellenbosch UniversityCape TownSouth Africa,Public Health, School of Human SciencesUniversity of GreenwichLondonUK
| | - Lovemore Sigwadhi
- Division of Epidemiology and BiostatisticsStellenbosch UniversityStellenboschSouth Africa,Division of StatisticsBiomedical Research and Training Institute, ZimbabweHarareZimbabwe
| | - Elvis Irusen
- Division of Pulmonology, Department of MedicineStellenbosch University & Tygerberg HospitalCape TownSouth Africa
| | - Coenraad Koegelenberg
- Division of Pulmonology, Department of MedicineStellenbosch University & Tygerberg HospitalCape TownSouth Africa
| | - Anton Doubell
- Division of Cardiology, Department of MedicineStellenbosch University & Tygerberg HospitalCape TownSouth Africa
| | - Steven Nathan
- The Advanced Lung Disease and Transplant ProgramInova Fairfax HospitalFalls ChurchVirginiaUSA
| | - Richard Channick
- Pulmonary and Critical Care DivisionDavid Geffen School of MedicineLos AngelesCaliforniaUSA
| | - Brian Allwood
- Division of Pulmonology, Department of MedicineStellenbosch University & Tygerberg HospitalCape TownSouth Africa
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Kerget B, Özkan HB, Afşin DE, Koçak AO, Laloglu E, Uçar EY, Sağlam L. Evaluation of serum YKL-40 level among clinical risk scores for early mortality in acute pulmonary thromboembolism. Clin Biochem 2022; 108:20-26. [PMID: 35853494 DOI: 10.1016/j.clinbiochem.2022.07.003] [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: 05/22/2022] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Pulmonary embolism (PE) often occurs secondary to deep vein thrombosis and is an important cause of mortality and morbidity. This study aimed to evaluate the relationship between YKL-40 level and clinical risk score in patients with PE. METHODS The study included a total of 100 patients, 80 patients diagnosed with PE in the emergency department and 20 healthy controls. Patients with PE were divided into four groups: high-risk patients (n = 20), high-intermediate-risk patients (n = 20), low-intermediate-risk patients (n = 20), and low-risk patients (n = 20). Serum YKL-40 levels were measured by enzyme-linked immunosorbent assay. Pulmonary artery obstruction index (PAOI) was calculated from computed tomography angiography images. RESULTS PAOI increased in correlation with PE risk and differed significantly between all patient groups (p < 0.001). Troponin-I levels were significantly higher in the high-risk and high-intermediate-risk groups compared to the other groups (p < 0.001), but did not differ significantly between high-risk and high-intermediate-risk patients (p = 0.09). YKL-40 level was significantly higher in the high-risk PE group than the high-intermediate-risk group (p < 0.001). In receiving operator characteristic curve analysis assessing the discriminatory value of YKL-40 for high-risk PE patients, a cut-off value of 227.2 ng/mL had sensitivity of 85 % and specificity of 70 %. DISCUSSION YKL-40 may be an important biomarker in decisions regarding early thrombolytic treatment in patients with high-intermediate-risk PE. In addition, medical treatments targeting YKL-40 may also reduce thrombotic tendency in high-risk patient groups.
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Affiliation(s)
- Buğra Kerget
- Department of Pulmonary Diseases, Ataturk University School of Medicine, 25240, Yakutiye, Erzurum, Turkey.
| | - Hatice Beyza Özkan
- Department of Pulmonary Diseases, Ataturk University School of Medicine, 25240, Yakutiye, Erzurum, Turkey
| | - Dursun Erol Afşin
- Depertmant of Pulmonary Diseases, Health Sciences University Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Abdullah Osman Koçak
- Department of Emergency Medicine, Ataturk University School of Medicine, 25240, Yakutiye, Erzurum, Turkey
| | - Esra Laloglu
- Department of Biochemistry, Ataturk University School of Medicine, 25240, Yakutiye, Erzurum, Turkey
| | - Elif Yılmazel Uçar
- Department of Pulmonary Diseases, Ataturk University School of Medicine, 25240, Yakutiye, Erzurum, Turkey
| | - Leyla Sağlam
- Department of Pulmonary Diseases, Ataturk University School of Medicine, 25240, Yakutiye, Erzurum, Turkey
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Maloney MA, Ward SLD, Su JA, Durazo-Arvizu RA, Breunig JM, Okpara DU, Gillett ES. Prevalence of pulmonary hypertension on echocardiogram in children with severe obstructive sleep apnea. J Clin Sleep Med 2022; 18:1629-1637. [PMID: 35212261 PMCID: PMC9163633 DOI: 10.5664/jcsm.9944] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
STUDY OBJECTIVES Pulmonary hypertension (PH) is a rare yet serious complication of obstructive sleep apnea (OSA). Echocardiographic screening for PH is recommended in children with severe OSA, but the health care burden of universal screening is high. We sought to determine the prevalence of PH on echocardiogram among children with severe OSA and identify variables associated with a positive PH screen. METHODS Retrospective study of 318 children with severe OSA (obstructive apnea-hypopnea index ≥ 10 events/h) and echocardiogram within 1 year of polysomnogram. PH-positive echocardiogram was defined by peak tricuspid regurgitation velocity ≥ 2.5 m/s and/or 2 or more right-heart abnormalities suggestive of elevated pulmonary artery pressure. Patient characteristics and polysomnogram data were compared to identify factors associated with PH. RESULTS Twenty-six children (8.2%; 95% confidence interval [CI] 5.4-11.8%) had echocardiographic evidence of PH. There was no difference in age, sex, body mass index, obstructive apnea-hypopnea index, or oxygenation indices between patients with and without PH. Sleep-related hypoventilation (end-tidal CO2 > 50 mmHg for > 25% of total sleep time) was present in 25% of children with PH compared with 6.3% of children without PH (adjusted prevalence ratio = 2.73; 95% CI 1.18-6.35). Forty-six percent of children (12/26) with PH had Down syndrome vs 14% (41/292) without PH (adjusted prevalence ratio = 3.11; 95% CI 1.46-6.65). CONCLUSIONS There was a relatively high prevalence of PH on echocardiogram in our cohort of children with severe OSA. The findings of increased PH prevalence among children with sleep-related hypoventilation or Down syndrome may help inform the development of targeted screening recommendations for specific pediatric OSA populations. CITATION Maloney MA, Davidson Ward SL, Su JA, et al. Prevalence of pulmonary hypertension on echocardiogram in children with severe obstructive sleep apnea. J Clin Sleep Med. 2022;18(6):1629-1637.
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Affiliation(s)
- Melissa A. Maloney
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California,Address correspondence to: Melissa A. Maloney, MD, 4650 Sunset Blvd, Mailstop #83, Los Angeles, CA, 90027; Tel: (323) 361-2101;
| | - Sally L. Davidson Ward
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California,Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Jennifer A. Su
- Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, California,Division of Cardiology, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California
| | - Ramon A. Durazo-Arvizu
- Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, California,Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, California
| | | | | | - Emily S. Gillett
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California,Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, California
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6
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Boulate D, Loisel F, Coblence M, Provost B, Todesco A, Decante B, Beurnier A, Herve P, Perros F, Humbert M, Fadel E, Mercier O, Chemla D. Pulsatile pulmonary artery pressure in a large animal model of chronic thromboembolic pulmonary hypertension: Similarities and differences with human data. Pulm Circ 2022; 12:e12017. [PMID: 35506099 PMCID: PMC9052967 DOI: 10.1002/pul2.12017] [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: 04/27/2021] [Revised: 10/27/2021] [Accepted: 11/20/2021] [Indexed: 11/20/2022] Open
Abstract
A striking feature of the human pulmonary circulation is that mean (mPAP) and systolic (sPAP) pulmonary artery pressures (PAPs) are strongly related and, thus, are essentially redundant. According to the empirical formula documented under normotensive and hypertensive conditions (mPAP = 0.61 sPAP + 2 mmHg), sPAP matches ~160%mPAP on average. This attests to the high pulsatility of PAP, as also witnessed by the near equality of PA pulse pressure and mPAP. Our prospective study tested if pressure redundancy and high pulsatility also apply in a piglet model of chronic thromboembolic pulmonary hypertension (CTEPH). At baseline (Week‐0, W0), Sham (n = 8) and CTEPH (n = 27) had similar mPAP and stroke volume. At W6, mPAP increased in CTEPH only, with a two‐ to three‐fold increase in PA stiffness and total pulmonary resistance. Seven CTEPH piglets were also studied at W16 at baseline, after volume loading, and after acute pulmonary embolism associated with dobutamine infusion. There was a strong linear relationship between sPAP and mPAP (1) at W0 and W6 (n = 70 data points, r² = 0.95); (2) in the subgroup studied at W16 (n = 21, r² = 0.97); and (3) when all data were pooled (n = 91, r² = 0.97, sPAP range 9–112 mmHg). The PA pulsatility was lower than that expected based on observations in humans: sPAP matched ~120%mPAP only and PA pulse pressure was markedly lower than mPAP. In conclusion, the redundancy between mPAP and sPAP seems a characteristic of the pulmonary circulation independent of the species. However, it is suggested that the sPAP thresholds used to define PH in animals are species‐ and/or model‐dependent and thus must be validated.
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Affiliation(s)
- David Boulate
- Hôpital Marie Lannelongue INSERM UMR_S 999 Le Plessis Robinson France
| | - Fanny Loisel
- Hôpital Marie Lannelongue INSERM UMR_S 999 Le Plessis Robinson France
| | - Mathieu Coblence
- Hôpital Marie Lannelongue INSERM UMR_S 999 Le Plessis Robinson France
| | - Bastien Provost
- Hôpital Marie Lannelongue INSERM UMR_S 999 Le Plessis Robinson France
| | - Alban Todesco
- Hôpital Marie Lannelongue INSERM UMR_S 999 Le Plessis Robinson France
| | - Benoit Decante
- Hôpital Marie Lannelongue INSERM UMR_S 999 Le Plessis Robinson France
| | - Antoine Beurnier
- Hôpital Marie Lannelongue INSERM UMR_S 999 Le Plessis Robinson France
| | - Philippe Herve
- Hôpital Marie Lannelongue INSERM UMR_S 999 Le Plessis Robinson France
| | - Frédéric Perros
- Hôpital Marie Lannelongue INSERM UMR_S 999 Le Plessis Robinson France
| | - Marc Humbert
- Hôpital Marie Lannelongue INSERM UMR_S 999 Le Plessis Robinson France
- Service de Pneumologie, Hôpital Bicêtre DMU‐THORINO, AP‐HP Le Kremlin‐Bicêtre France
| | - Elie Fadel
- Hôpital Marie Lannelongue INSERM UMR_S 999 Le Plessis Robinson France
- Pôle Thoracique, Vasculaire et Transplantations Hôpital Marie Lannelongue Le Plessis Robinson France
| | - Olaf Mercier
- Hôpital Marie Lannelongue INSERM UMR_S 999 Le Plessis Robinson France
- Pôle Thoracique, Vasculaire et Transplantations Hôpital Marie Lannelongue Le Plessis Robinson France
| | - Denis Chemla
- Hôpital Marie Lannelongue INSERM UMR_S 999 Le Plessis Robinson France
- Service d'Explorations Fonctionnelles Multidisciplinaires Bi‐site, Hôpitaux Antoine Béclère–Kremlin Bicêtre, Faculté de médecine‐Université Paris Saclay DMU‐CORREVE, AP‐HP Le Kremlin‐Bicêtre France
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7
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Björkman A, Lund LH, Faxén UL, Lindquist P, Venkateshvaran A. Accuracy and diagnostic performance of doppler echocardiography to estimate mean pulmonary artery pressure in heart failure. Echocardiography 2021; 38:1624-1631. [PMID: 34510533 DOI: 10.1111/echo.15188] [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: 06/08/2021] [Revised: 07/26/2021] [Accepted: 08/15/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Multiple echocardiographic algorithms have been proposed to estimate mean pulmonary artery pressure (PAPM ) and assess pulmonary hypertension (PH) likelihood. We assessed the accuracy of four echocardiographic approaches to estimate PAPM in heart failure (HF) patients undergoing near-simultaneous right heart catheterization (RHC), and compared diagnostic performance to identify PH with recommendation-advised tricuspid regurgitation peak velocity (TRVmax ). METHODS We employed four validated echocardiographic algorithms incorporating tricuspid regurgitation peak or mean gradient, pulmonary regurgitation peak gradient, and right ventricular outflow tract acceleration time to estimate PAPM . Echocardiographic estimates of right atrial pressure were incorporated in all algorithms but one. Association and agreement with invasive PAPM were assessed. Diagnostic performance of all algorithms to identify PH was evaluated and compared with the recommended TRVmax cut-off. RESULTS In 112 HF patients, all echocardiographic algorithms demonstrated reasonable association (r = .41-.65; p < 0.001) and good agreement with invasive PAPM , with relatively lower mean bias and higher precision observed in algorithms that incorporated tricuspid regurgitation peak or mean gradient. All methods demonstrated strong ability to identify PH (AUC = .70-.80; p < 0.001) but did not outperform TRVmax (AUC = .84; p < 0.001). Echocardiographic estimates of right atrial pressure were falsely elevated in 30% of patients. CONCLUSIONS Echocardiographic estimates demonstrate reasonable association with invasive PAPM and strong ability to identify PH in HF. However, none of the algorithms outperformed recommendation-advised TRVmax . The incremental value of echocardiographic estimates of right atrial pressure may need to be re-evaluated.
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Affiliation(s)
- Alva Björkman
- Department of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden
| | - Lars H Lund
- Department of Medicine, Cardiology Unit, Department of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden
| | - Ulrika Ljung Faxén
- Department of Medicine, Cardiology Unit, Department of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden.,Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Per Lindquist
- Department of Clinical Physiology, Surgical & Perioperative sciences, Umeå University, Umeå, Sweden
| | - Ashwin Venkateshvaran
- Department of Medicine, Cardiology Unit, Department of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden
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Topyła-Putowska W, Tomaszewski M, Wysokiński A, Tomaszewski A. Echocardiography in Pulmonary Arterial Hypertension: Comprehensive Evaluation and Technical Considerations. J Clin Med 2021; 10:jcm10153229. [PMID: 34362015 PMCID: PMC8348437 DOI: 10.3390/jcm10153229] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/18/2021] [Accepted: 07/20/2021] [Indexed: 12/21/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a rare, progressive disease in which there is a persistent, abnormal increase in pulmonary artery pressure. Symptoms of pulmonary hypertension are nonspecific and mainly associated with progressive right ventricular failure. The diagnosis of PAH is a multistep process and often requires the skillful use of several tests. The gold standard for the diagnosis of PAH is hemodynamic testing. Echocardiography currently plays an important role in the diagnostic algorithm of PAH as it is minimally invasive and readily available. Moreover, many echocardiographic parameters are closely related to pulmonary hemodynamics. It allows assessment of the right heart′s structure and function, estimation of the pressure in the right ventricle, right atrium, and pulmonary trunk, and exclusion of other causes of elevated pulmonary bed pressure. Echocardiographic techniques are constantly evolving, and recently, measurements made using new techniques, especially 3D visualization, have become increasingly important. In echocardiographic assessment, it is crucial to know current guidelines and new reports that organize the methodology and allow standardization of the examination. This review aims to discuss the different echocardiographic techniques used to evaluate patients with PAH.
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9
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Cobra SDB, Rodrigues MP, de Melo FX, Ferreira NMC, Melo-Silva CA. Right ventricular contractility decreases during exercise in patients with non-advanced idiopathic pulmonary fibrosis. Medicine (Baltimore) 2021; 100:e25915. [PMID: 34232164 PMCID: PMC8270621 DOI: 10.1097/md.0000000000025915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 04/21/2021] [Indexed: 01/04/2023] Open
Abstract
Early right ventricular dysfunction in patients with non-advanced idiopathic pulmonary fibrosis (IPF) has not been fully elucidated. Thus, we aimed to assess right ventricular functions in IPF patients and controls by speckle-tracking strain echocardiography at rest and peak exercise.We screened 116 IPF patients from February to August 2019 to include 20 patients with no history of oxygen therapy, peripheral saturation levels ≥92% at rest, Gender-Age-Physiology Index score ≤5, and modified Medical Research Council score ≤3. Additionally, we enrolled 10 matched controls. Transthoracic echocardiography images were acquired at rest and during a cardiopulmonary exercise test. We analyzed 2-dimensional echocardiographic parameters and right ventricular function using the global longitudinal strain assessed by the 2-dimensional speckle-tracking technique.In the control group, we found normal values of right ventricle longitudinal strain (RVLS) at rest and at peak exercise, the latter being much more negative (-23.6 ± 2.2% and -26.8 ± 3.1%, respectively; P < .001). By contrast, RVLS values in the IPF group increased from -21.1 ± 3.8% at rest to -17.0 ± 4.5% at peak exercise (P < .001). The exercise revealed a difference between the 2 groups as the mean RVLS values moved during peak exercise in opposite directions. Patients with IPF got worse, whereas control patients presented improved right ventricular contractility.Right ventricular dysfunction was unveiled by speckle-tracking echocardiography during exercise in non-advanced IPF patients. We suggest that this reflects an inadequate right ventricular-arterial coupling decreasing the right ventricular longitudinal contraction during exercise in these patients. This parameter may be useful as an early index of suspected pulmonary hypertension.
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Affiliation(s)
- Sandra de Barros Cobra
- Department of Cardiology, Federal District Base Hospital Institute and School of Medicine, University of Brasília, Brasília 70.330-150 – DF
| | | | | | | | - César Augusto Melo-Silva
- Laboratory of Respiratory Physiology, University of Brasília
- Division of Physical Therapy, University Hospital of Brasília, Brasília 70.910-900 – DF
- Núcleo de Integração Funcional, Rehabilitation Center, Brasília 70.830-350 – DF, Brazil
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10
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Chang JC. COVID-19 Sepsis: Pathogenesis and Endothelial Molecular Mechanisms Based on "Two-Path Unifying Theory" of Hemostasis and Endotheliopathy-Associated Vascular Microthrombotic Disease, and Proposed Therapeutic Approach with Antimicrothrombotic Therapy. Vasc Health Risk Manag 2021; 17:273-298. [PMID: 34103921 PMCID: PMC8179800 DOI: 10.2147/vhrm.s299357] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/24/2021] [Indexed: 12/15/2022] Open
Abstract
COVID-19 sepsis is characterized by acute respiratory distress syndrome (ARDS) as a consequence of pulmonary tropism of the virus and endothelial heterogeneity of the host. ARDS is a phenotype among patients with multiorgan dysfunction syndrome (MODS) due to disseminated vascular microthrombotic disease (VMTD). In response to the viral septicemia, the host activates the complement system which produces terminal complement complex C5b-9 to neutralize pathogen. C5b-9 causes pore formation on the membrane of host endothelial cells (ECs) if CD59 is underexpressed. Also, viral S protein attraction to endothelial ACE2 receptor damages ECs. Both affect ECs and provoke endotheliopathy. Disseminated endotheliopathy activates two molecular pathways: inflammatory and microthrombotic. The former releases inflammatory cytokines from ECs, which lead to inflammation. The latter initiates endothelial exocytosis of unusually large von Willebrand factor (ULVWF) multimers and FVIII from Weibel–Palade bodies. If ADAMTS13 is insufficient, ULVWF multimers activate intravascular hemostasis of ULVWF path. In activated ULVWF path, ULVWF multimers anchored to damaged endothelial cells recruit circulating platelets and trigger microthrombogenesis. This process produces “microthrombi strings” composed of platelet-ULVWF complexes, leading to endotheliopathy-associated VMTD (EA-VMTD). In COVID-19, microthrombosis initially affects the lungs per tropism causing ARDS, but EA-VMTD may orchestrate more complex clinical phenotypes, including thrombotic thrombocytopenic purpura (TTP)-like syndrome, hepatic coagulopathy, MODS and combined micro-macrothrombotic syndrome. In this pandemic, ARDS and pulmonary thromboembolism (PTE) have often coexisted. The analysis based on two hemostatic theories supports ARDS caused by activated ULVWF path is EA-VMTD and PTE caused by activated ULVWF and TF paths is macrothrombosis. The thrombotic disorder of COVID-19 sepsis is consistent with the notion that ARDS is virus-induced disseminated EA-VMTD and PTE is in-hospital vascular injury-related macrothrombosis which is not directly related to viral pathogenesis. The pathogenesis-based therapeutic approach is discussed for the treatment of EA-VMTD with antimicrothrombotic regimen and the potential need of anticoagulation therapy for coinciding macrothrombosis in comprehensive COVID-19 care.
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Affiliation(s)
- Jae C Chang
- Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA
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11
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Wang B, Huang LT, Hsieh ML, Wang CK, Wang JN, Kan CD, Wu JM, Tsai YS. Diastolic and systolic right ventricular diameters for predicting pulmonary hypertension in children with congenital heart disease. Clin Imaging 2020; 70:67-73. [PMID: 33125987 DOI: 10.1016/j.clinimag.2020.10.027] [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: 03/15/2020] [Revised: 09/24/2020] [Accepted: 10/14/2020] [Indexed: 11/25/2022]
Abstract
Prospective electrocardiography (ECG)-gated cardiac computed tomography angiography (CTA) is widely used for pediatric patients with congenital heart disease (CHD) due to the lower radiation dose compared with the ECG-gated technique. However, functional parameters acquired using ECG-gated cardiac CT to predict pulmonary hypertension (PH) in children with CHD have not yet been reported. This study aimed to investigate the potential of diastolic and systolic right ventricular diameters (RVD) on prospective ECG-gated cardiac CTA to predict PH in children with CHD. A total of 44 children with CHD were divided into two groups: CHD with PH (n = 22) and CHD without PH (n = 22). The association between ECG-gated CTA parameters and PH was evaluated by logistic regression. The receiver operating characteristic curve (ROC) was used to find the best cut-off point for the parameters measured by Youden's index. Patients with higher RVD-BSA [aOR (95% CI) diastolic: 2.76 (1.23-6.23); systolic: 6.15 (1.72-22.06)] had higher risk of PH after adjusting for age and patent ductus arteriosus. The area under the curve (AUC) of D-RVD-BSA was 0.907 and the AUC of S-RVD-BSA was 0.917. Logistic regression showed that patients with D-RVD-BSA over 6.86 or S-RVD-BSA over 5.87 had significantly higher risk of PH after adjustments (aOR = 23.52, 95% CI = 2.89-191.03; aOR = 31.14, 95% CI = 2.75-352.85). In conclusion, in children with CHD, measurements of diastolic or systolic BSA-modified RVDs on prospective ECG-gated CTA are non-invasive markers of PH. BSA-modified D-RVD of 6.86 or BSA-modified S-RVD of 5.87 may be used to identify PH in children with CHD.
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Affiliation(s)
- Bow Wang
- Departments of Diagnostic Radiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Li-Ting Huang
- Departments of Diagnostic Radiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Min-Ling Hsieh
- Departments of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Kuo Wang
- Departments of Diagnostic Radiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jieh-Neng Wang
- Departments of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Dann Kan
- Department of Surgery and Institute of Cardiovascular Research Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jing-Ming Wu
- Departments of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Shan Tsai
- Departments of Diagnostic Radiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Cobra SDB, Rodrigues MP, de Melo FX, Ferreira NMC, Passini VV, Amado VM, Melo-Silva CA. Right ventricular dysfunction in patients with non-severe idiopathic pulmonary fibrosis: a cross-sectional prospective single-center study. Expert Rev Respir Med 2020; 15:249-256. [PMID: 33070645 DOI: 10.1080/17476348.2021.1834856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Little is known about right ventricular dysfunction in non-advanced idiopathic pulmonary fibrosis (IPF) patients without hypoxemia at rest. We evaluated it at rest and during exercise. RESEARCH DESIGN AND METHODS 123 IPF patients were evaluated, and 27 met all the following criteria: Gender-Age-Physiology Index score ≤5, modified Medical Research Council dyspnea score ≤3, peripheral oxygen saturation ≥92% at rest, and no history of oxygen therapy. They were submitted to two-dimensional speckle-tracking echocardiography at rest and during cardiopulmonary exercise to analyze right ventricular global longitudinal strain. RESULTS Abnormal speckle-tracking echocardiography findings were identified in 10/27 patients (37%), indicating right ventricular (RV) dysfunction. No patients had abnormalities observed in conventional echocardiographic parameters. Significant differences in mPAP were observed between patients with RV dysfunction and those without dysfunction (at rest: 26.0 ± 4.8 vs. 19.1 ± 4.2 mmHg, p = 0.001; during exercise: 51.3 ± 6.4 vs. 36.9 ± 14.7 mmHg, p = 0.002). CONCLUSIONS RV dysfunction was detected in 37% of non-advanced IPF patients and early recognition was only possible using speckle-tracking echocardiography. Special attention should be given to these patients as RV dysfunction is suggestive of worse prognosis. These patients could benefit from new specific drugs or even oxygen therapy for transitory hypoxia.
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Affiliation(s)
- Sandra de Barros Cobra
- Federal District Base Hospital Institute and School of Medicine, University of Brasília , Brasília, Brazil
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13
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Truong U, Meinel K, Haddad F, Koestenberger M, Carlsen J, Ivy D, Jone PN. Update on noninvasive imaging of right ventricle dysfunction in pulmonary hypertension. Cardiovasc Diagn Ther 2020; 10:1604-1624. [PMID: 33224776 DOI: 10.21037/cdt-20-272] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Pulmonary hypertension (PH) is a progressive disease affecting patients across the life span. The pathophysiology primarily involves the pulmonary vasculature and right ventricle (RV), but eventually affects the left ventricular (LV) function as well. Safe, accurate imaging modalities are critical for diagnosis, serial monitoring, and tailored therapy. While cardiac catheterization remains the conventional modality for establishing diagnosis and serial monitoring, noninvasive imaging has gained considerable momentum in providing accurate assessment of the entire RV-pulmonary axis. In this state-of-the-art review, we will discuss the most recent developments in echocardiography, magnetic resonance imaging, and computed tomography in PH evaluation from pediatric to adult population.
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Affiliation(s)
- Uyen Truong
- Division of Pediatric Cardiology, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Katharina Meinel
- Division of Pediatric Cardiology, Medical University of Graz, Graz, Austria
| | - Francois Haddad
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | | | - Jørn Carlsen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dunbar Ivy
- Division of Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Pei-Ni Jone
- Division of Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
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14
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Peter ID, Asani MO, Abdullahi SU, Aliyu I, Obaro SK, Bode-Thomas F. Pulmonary hypertension and right ventricular function in Nigerian children with sickle cell anaemia. Trans R Soc Trop Med Hyg 2020; 113:489-496. [PMID: 31086994 PMCID: PMC6677931 DOI: 10.1093/trstmh/trz038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 04/02/2019] [Indexed: 01/28/2023] Open
Abstract
Background Pulmonary hypertension (PH), a complication of sickle cell anaemia (SCA), results in considerable morbidity. This study aims to determine the prevalence and associations of echocardiography-suggested PH in children with SCA. Methods We performed a cross-sectional comparative study involving 100 systematically sampled SCA subjects 3–14 y of age in their steady state with matched haemoglobin AA phenotype controls. Clinical, laboratory and echocardiography data (including tricuspid regurgitation velocity [TRV], mean pulmonary arterial pressure [mPAP] and tricuspid annular plane systolic excursion [TAPSE]) were obtained from all patients. Statistical analyses were performed using SPSS version 22 (IBM, Armonk, NY, USA). A p-value <0.05 was considered statistically significant. Results Of the 100 SCA subjects studied, 22 (22%) had echocardiographic findings suggestive of PH compared with none in the controls. The median TAPSE was significantly lower in the PH group (2.55 cm [interquartile range {IQR} 2.2–2.8]) compared with the no PH group (2.77 cm [IQR 2.4–3.2]) (p=0.03). No significant correlation existed between mPAP and age, nor any laboratory parameters studied. The odds ratio (OR) suggested PH significantly increased with an increase in the frequency of hospitalizations for vaso-occlusive crises within a 12-month period (OR 15.15 [95% CI 1.57 to 146.35], p=0.02) and a lifetime history of blood transfusion (OR 5.44 [95% CI 1.09 to 27.24], p=0.04). Conclusions Echocardiography-suggested PH is common in children with SCA and is associated with poorer right ventricular function, frequent vaso-occlusive crises and blood transfusions.
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Affiliation(s)
- Igoche D Peter
- Department of Paediatrics, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Mustafa O Asani
- Department of Paediatrics, Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Shehu U Abdullahi
- Department of Paediatrics, Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Ibrahim Aliyu
- Department of Paediatrics, Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Stephen K Obaro
- Department of Paediatrics, Aminu Kano Teaching Hospital, Kano, Nigeria.,Department of Paediatrics, University of Nebraska Medical Centre, Omaha, NE, USA.,International Foundation Against Infectious Diseases in Nigeria, Abuja, Nigeria
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15
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Transvascular endosonographic-guided needle biopsy of intrathoracic lesions. J Thorac Cardiovasc Surg 2020; 159:2057-2065. [DOI: 10.1016/j.jtcvs.2019.10.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 10/07/2019] [Accepted: 10/09/2019] [Indexed: 12/25/2022]
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16
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Ghio S. The haemodynamic assessment of patients with pulmonary arterial hypertension. Glob Cardiol Sci Pract 2020; 2020:e202004. [PMID: 33150149 PMCID: PMC7590935 DOI: 10.21542/gcsp.2020.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Stefano Ghio
- Division of Cardiology, Foundation "I.R.C.C.S. Policlinico San Matteo", Pavia, Italy
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Mahtab S, Lawrenson J, Jamieson-Luff N, Asafu-Agyei NA, Meiring A, Lemmer-Hunsinger C, Myer L, Zar HJ, Zühlke LJ. Echocardiographic Findings in a Cohort of Perinatally HIV-Infected Adolescents Compared with Uninfected Peers from the Cape Town Adolescent Antiretroviral Cohort. J Am Soc Echocardiogr 2020; 33:604-611. [PMID: 32147093 DOI: 10.1016/j.echo.2019.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 12/12/2019] [Accepted: 12/12/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known about the cardiac health of perinatally HIV-infected (PHIV+) adolescents on antiretroviral therapy (ART) in sub-Saharan Africa. The authors examined cardiac structure and function in PHIV+ adolescents on ART compared with HIV-uninfected (HIV-) adolescents. METHODS Echocardiography was performed on PHIV+ and age- and sex-frequency-matched HIV- adolescents enrolled in the Cape Town Adolescent Antiretroviral Cohort. Participants were eligible if they were 9 to 14 years of age and had been on ART for ≥6 months. RESULTS Overall, 474 PHIV+ adolescents (median age, 12 years; 51% boys; mean age at ART initiation, 5 years) and 109 HIV- adolescents (median age, 11.8 years; 45% boys) were included. The mean duration on ART was 7 years, with 37% starting treatment before 2 years of age. Compared with HIV- adolescents, PHIV+ adolescents had higher median Z scores for left ventricular (LV) internal end-diastolic dimension, LV end-systolic posterior wall thickness, and end-systolic interventricular septal thickness. PHIV+ adolescents had a lower median Z score for right ventricular internal end-diastolic dimension as compared with HIV- adolescents. There was no difference in ejection fraction or diastolic function between groups. Later initiation of ART (after 6 years) was associated with increased risk for LV hypertrophy (odds ratio, 2.9; 95% CI, 1.3-6.6; P = .01) compared with those who started ART earlier. PHIV+ adolescents with World Health Organization stage IV HIV infection were at increased risk (odds ratio, 2.2; 95% CI, 1.0-4.6; P = .05) of having LV diastolic dysfunction compared with those with less advanced clinical disease. CONCLUSIONS This study revealed subtle differences in echocardiographic parameters between PHIV+ and HIV- adolescents. Although these were not clinically significant, starting ART at an older age was a significant risk factor for LV hypertrophy, while more advanced clinical disease was associated with LV diastolic dysfunction.
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Affiliation(s)
- Sana Mahtab
- Department of Pediatrics & Child Health, Red Cross War Memorial Children's Hospital, and SA MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa.
| | - John Lawrenson
- Western Cape Paediatric Cardiac Services and Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Norme Jamieson-Luff
- Department of Pediatrics & Child Health, Red Cross War Memorial Children's Hospital, and SA MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Nana Akua Asafu-Agyei
- Department of Pediatrics & Child Health, Red Cross War Memorial Children's Hospital, and SA MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Alet Meiring
- Department of Pediatrics & Child Health, Red Cross War Memorial Children's Hospital, and SA MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Carolise Lemmer-Hunsinger
- Division of Cardiology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- Department of Pediatrics & Child Health, Red Cross War Memorial Children's Hospital, and SA MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Liesl J Zühlke
- Department of Pediatrics & Child Health, Red Cross War Memorial Children's Hospital, and SA MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa; Division of Cardiology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Effectiveness and short-term survival associated with adding sildenafil to conventional therapy in the management of children with pulmonary hypertension. PROGRESS IN PEDIATRIC CARDIOLOGY 2020. [DOI: 10.1016/j.ppedcard.2019.101168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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19
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Yaylali YT, Yilmaz S, Akgun-Cagliyan G, Kilic O, Kaya E, Senol H, Ozen F. Association of Disease Subtype and Duration with Echocardiographic Evidence of Pulmonary Hypertension in Myeloproliferative Neoplasm. Med Princ Pract 2020; 29:486-491. [PMID: 32069470 PMCID: PMC7511681 DOI: 10.1159/000506596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/16/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) can complicate the course of myeloproliferative neoplasms (MPNs). Echocardiography is a useful noninvasive screening test for PH in populations at risk. We aimed to investigate the echocardiographic evidence of PH and clinical characteristics of patients with MPNs. METHODS This study included 197 patients with MPNs (mean age, 59 ± 14 years; females, 53%; mean disease duration, 3.4 ± 2.8 years). Clinical and laboratory characteristics, including JAK2V617F mutation status, were obtained. All participants underwent a comprehensive transthoracic echocardiographic examination. The echocardiographic evidence of PH was defined as systolic pulmonary artery pressure (SPAP) ≥40 mm Hg. RESULTS Overall, 11 patients (5.5%) with SPAP ≥40 mm Hg had echocardiographic evidence of PH. Patients with myelofibrosis had echocardiographic evidence of PH more often than patients with other MPNs (p < 0.001). Disease duration since the diagnosis of MPNs was 6.7 ± 4.6 years in the PH group and 3.1 ± 2.5 years in the non-PH group (p < 0.001). There was a weak positive correlation between SPAP values and time since diagnosis (r = 0.236, p =0.001). JAK2V617F mutation was not associated with PH. In multivariate logistic regression analysis, the presence of myelofibrosis (odds ratio [OR]: 22.177, 95% CI: 4.480-109.790, p < 0.001), long disease duration (OR: 1.217, 95% CI: 1.024-1.447, p = 0.026), and high uric acid levels (OR: 1.868, 95% CI: 1.049-3.328, p = 0.034) were found to be related with the echocardiographic evidence of PH. Survival was worse in the PH group (p = 0.0001). CONCLUSION Our results suggest that patients with myelofibrosis are more likely to develop PH than other MPNs patients. Disease duration may predict the development of PH in MPN patients.
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Affiliation(s)
- Yalin Tolga Yaylali
- Department of Cardiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey,
| | - Samet Yilmaz
- Department of Cardiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Gulsum Akgun-Cagliyan
- Department of Hematology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Oguz Kilic
- Department of Cardiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Emrah Kaya
- Division of Cardiology, Ardahan State Hospital, Ardahan, Turkey
| | - Hande Senol
- Department of Biostatistics, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Furkan Ozen
- Department of Cardiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
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Frigati LJ, Brown K, Mahtab S, Githinji L, Gray D, Zühlke L, Nourse P, Stein DJ, Hoare J, Cotton MF, Myer L, Zar HJ. Multisystem impairment in South African adolescents with Perinatally acquired HIV on antiretroviral therapy (ART). J Int AIDS Soc 2019; 22:e25386. [PMID: 31441211 PMCID: PMC6706702 DOI: 10.1002/jia2.25386] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/31/2019] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Adolescents with perinatally acquired HIV (PHIV) are at risk of chronic disease due to long-standing immune suppression, HIV disease and antiretroviral therapy (ART) exposure. However, there are few data on multisystem disease in this population. We investigated the overlapping burden of neurocognitive, cardiovascular, respiratory and/or renal impairment among PHIV positive (PHIV+) adolescents. METHODS In this cross-sectional analysis, participants aged 9 to 14 years on ART for >6 months were recruited from seven sites across Cape Town from July 2013 through March 2015, together with age-matched HIV-negative (HIV-) adolescents. Impairment at enrolment was assessed across neurocognitive functioning (using the youth-International HIV Dementia Scale); cardiac function (echocardiogram abnormality); respiratory function (abnormal spirometry) and renal function (abnormal glomerular filtration rate). RESULTS AND DISCUSSION Overall, 384 PHIV+ and 95 HIV- adolescents were included (mean age, 11.9 years; 49% female). Median age of ART initiation was 4.2 years (IQR: 1.7 to 7.6) and median CD4 count was 709 (IQR: 556 to 944) with 302 (79%) of PHIV+ adolescents virologically suppressed. Abacavir and Zidovudine were the most commonly used nucleoside reverse transcriptase inhibitors (NRTIs) with 60% of adolescents on non-nucleoside reverse transcriptase inhibitors (NNRTI) and 38% on a protease inhibitor (PI). Among PHIV+ adolescents, 167 (43.5%) had single system impairment only, 110 (28.6%) had two systems involved, and 39 (10.2%) had three or four systems involved. PHIV+ participants had more 2-system and 3-system impairment than HIV-, 110 (28.6%) versus 17 (17.9%), p = 0.03 and 39 (10.2%) versus 3 (4.3%), p = 0.03. PHIV+ participants who had failed a year of school (73.8% vs. 46.4%, p = 0.00) and with a viral load >1000 copies/mL at enrolment (16.8% vs. 8.1%, p = 0.03) were more likely to have dual or multisystem impairment. Of those with cardiac impairment, 86.7% had an additional system impaired. Similarly, in those with neurocognitive impairment, almost 60% had additional systems impaired and of those with respiratory impairment, 74% had additional systems impaired. CONCLUSIONS Despite relatively early ART initiation, there is a substantial burden of multisystem chronic impairment among PHIV+ adolescents. This phenomenon needs to be further explored as this population ages and begins to engage in adult lifestyle factors that may compound these impairments.
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Affiliation(s)
- Lisa J Frigati
- Department of Paediatrics and Child HealthUniversity of Cape TownCape TownSouth Africa
- Department of Paediatrics and Child HealthStellenbosch UniversityCape TownSouth Africa
| | - Karryn Brown
- Division of Epidemiology and BiostatisticsSchool of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Sana Mahtab
- Department of Paediatrics and Child HealthUniversity of Cape TownCape TownSouth Africa
| | - Leah Githinji
- Department of Paediatrics and Child HealthUniversity of Cape TownCape TownSouth Africa
| | - Diane Gray
- Department of Paediatrics and Child HealthUniversity of Cape TownCape TownSouth Africa
| | - Liesl Zühlke
- Department of Paediatrics and Child HealthUniversity of Cape TownCape TownSouth Africa
| | - Peter Nourse
- Department of Paediatrics and Child HealthUniversity of Cape TownCape TownSouth Africa
| | - Dan J Stein
- Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
| | - Jaqueline Hoare
- Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
| | - Mark F Cotton
- Department of Paediatrics and Child HealthStellenbosch UniversityCape TownSouth Africa
| | - Landon Myer
- Division of Epidemiology and BiostatisticsSchool of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Heather J Zar
- Department of Paediatrics and Child HealthUniversity of Cape TownCape TownSouth Africa
- SAMRC Unit on Child and Adolescent HealthUniversity of Cape TownCape TownSouth Africa
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21
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Githinji LN, Mahtab S, Zühlke L, Lawrenson J, Myer L, Gray D, Zar H. Cardiopulmonary dysfunction in perinatally HIV-infected South African adolescents on antiretroviral therapy: baseline findings from the Cape Town Adolescent Antiretroviral Cohort. J Int AIDS Soc 2019; 22:e25340. [PMID: 31291058 PMCID: PMC6619484 DOI: 10.1002/jia2.25340] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 06/12/2019] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Antiretroviral therapy (ART) has reduced morbidity and mortality in sub-Saharan Africa, but the burden of coexistent cardiopulmonary disease in perinatally HIV-positive adolescents on antiretroviral therapy (ART) has not been well described. The aim of this study was to investigate the prevalence and associations of cardiopulmonary dysfunction in adolescents with perinatally acquired HIV on ART. METHODS For this cross-sectional analysis, 515 perinatally HIV-positive adolescents ages 9 to 14 years on ART for at least six months, and a comparator group of 110 age-matched HIV-uninfected adolescents were tested between August 2013 and April 2015 using echocardiography, six-minute walk test (6MWT) and spirometry. Those with either abnormal spirometry or abnormal 6MWT and any right or left systolic or diastolic dysfunction or abnormal mean pulmonary arterial pressure were considered as having impaired cardiopulmonary function. Logistic regression was used to investigate determinants of impaired cardiopulmonary function. RESULTS Overall, 474 adolescents with perinatally acquired HIV (mean [SD] age, 12 [1.6] years; median [IQR] ART duration, 7 [4.6 to 9.3] years; median [IQR] CD4 count, 712 [571 to 959] cell/mm3 ) and 109 HIV-uninfected adolescents mean (SD) age 11.8 (1.8) years, had successful cardiac and lung function testing. Impaired cardiopulmonary function was detected in 13% of adolescents with perinatally acquired HIV and 8% of HIV-uninfected adolescents, p = 0.136. Among adolescents with perinatally acquired HIV, those with low tricuspid annular plane systolic excursion (TAPSE) had significantly lower mean FEV1 , 1.5 L versus 1.6 L, p = 0.011. Height (OR 0.7, 95%CI 0.5 to 0.9), body mass index (OR 0.7, 95%CI 0.5 to 0.9) and past pulmonary tuberculosis (OR 2.3, 95%CI 1.2 to 4.4) were significantly associated with a low cardiopulmonary function. CONCLUSIONS Despite being on ART, cardiopulmonary dysfunction occurs in an appreciable proportion of perinatally HIV-infected adolescents but no significant difference to uninfected controls. This finding requires further exploration. Factors associated with dysfunction may be amenable to public health interventions to reduce cardiopulmonary disease in this population.
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Affiliation(s)
- Leah N Githinji
- South Africa MRC unit on Child and Adolescent HealthDepartment of Paediatrics and Child Health Red Cross War Memorial Children's HospitalUniversity of Cape TownCape TownSouth Africa
| | - Sana Mahtab
- South Africa MRC unit on Child and Adolescent HealthDepartment of Paediatrics and Child Health Red Cross War Memorial Children's HospitalUniversity of Cape TownCape TownSouth Africa
| | - Liesl Zühlke
- Division of Paediatric CardiologyDepartment of Paediatrics and Child Health Red Cross War Memorial Children's HospitalUniversity of Cape TownCape TownSouth Africa
- Division of CardiologyDepartment of Medicine Groote Schuur HospitalFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | - John Lawrenson
- Department of Paediatrics and Child HealthStellenbosch UniversityMatielandSouth Africa
| | - Landon Myer
- Division of Epidemiology & BiostatisticsSchool of Public Health & Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Diane Gray
- South Africa MRC unit on Child and Adolescent HealthDepartment of Paediatrics and Child Health Red Cross War Memorial Children's HospitalUniversity of Cape TownCape TownSouth Africa
| | - Heather Zar
- South Africa MRC unit on Child and Adolescent HealthDepartment of Paediatrics and Child Health Red Cross War Memorial Children's HospitalUniversity of Cape TownCape TownSouth Africa
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22
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Chemla D, Boulate D, Weatherald J, Lau EM, Attal P, Savale L, Montani D, Fadel E, Mercier O, Sitbon O, Humbert M, Hervé P. Golden Ratio and the Proportionality Between Pulmonary Pressure Components in Pulmonary Arterial Hypertension. Chest 2019; 155:991-998. [DOI: 10.1016/j.chest.2018.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/13/2018] [Accepted: 12/03/2018] [Indexed: 12/14/2022] Open
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23
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Meng XY, Chen MY, Pan ZY, Lu YF, Wei W, Lu YG. Living Donor Liver Transplantation in Biliary Atresia Children with Pulmonary Hypertension. Int J Med Sci 2019; 16:1215-1220. [PMID: 31588186 PMCID: PMC6775259 DOI: 10.7150/ijms.34073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/17/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Though living donor liver transplantation (LDLT) is commonly performed for pediatric patients with biliary atresia (BA), pulmonary hypertension (PH) is seldom encountered or reported previously. The aim of this study is mainly to identify the prevalence of PH in pediatric patients undergoing liver transplantation and assess whether PH significantly augment the operative risk and evaluate the outcomes in this series of patients. DESIGN Retrospectively cohort study. SETTING Renji hospital, Shanghai, China. PARTICIPANTS This study comprised 161 pediatric patients undergoing LDLT. INTERVENTIONS Patient diagnosed of PH in preoperative examination was compared to those without PH in intra- or post- operative complications or outcomes. MEASUREMENTS AND MAIN RESULTS We collected clinical records of LDLT surgery for pediatric patients during the year of 2016 in our hospital. Results suggested that pediatric patients undergoing LDLT had a substantial number of PH with a prevalence of 16.1% in this study. No significant difference was identified between two groups of patients regarding intraoperative outcomes and postoperative complications and mortality. CONCLUSION LDLT is a safe procedure in a selected group of BA patients with PH, however, further long-term clinical investigations and mechanical researches are needed.
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Affiliation(s)
- Xiao-Yan Meng
- Department of Anesthesiology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200433, China.,Department of Anesthesiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Mi-Yuan Chen
- Department of Anesthesiology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Zhi-Ying Pan
- Department of Anesthesiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Ye-Feng Lu
- Department of Hepatic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Wei Wei
- Department of Medical Imaging-Ultrasound, JiaHui International Hospital, Shanghai, 200233, China
| | - Yu-Gang Lu
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China.,Department of Anesthesiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
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24
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Kasprzak JD, Huttin O, Wierzbowska-Drabik K, Selton-Suty C. Imaging the Right Heart-Pulmonary Circulation Unit. Heart Fail Clin 2018; 14:361-376. [DOI: 10.1016/j.hfc.2018.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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25
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Peter ID, Asani MO, Aliyu I, Obiagwu PN. Elevated Mean Pulmonary Artery Pressure and Right Ventricular Dysfunction in Children with Chronic Kidney Disease. J Cardiovasc Echogr 2018; 28:109-113. [PMID: 29911007 PMCID: PMC5989541 DOI: 10.4103/jcecho.jcecho_56_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Elevated mean pulmonary artery pressure (mPAP) and right heart failure increase mortality in patients with chronic kidney disease (CKD). Objectives The objective of this study is to determine the prevalence of elevated mPAP in children with CKD compared with matched controls and to ascertain the relationship between elevated mPAP with right ventricular dysfunction and history of hemodialysis. Materials and Methods A cross-sectional comparative study of mPAP and tricuspid annular plane systolic excursion of 21 children with CKD and age- and sex-matched controls asymptomatic for cardiac disease was conducted. Results Median mPAP was 27.69 (18.3-36.1) mmHg in CKD patients compared with 14.55 (13.5-17.1) mmHg in controls (P = 0.002). Elevated mPAP was present in 42.9% of CKD group and 0% in controls (P < 0.001). The prevalence of right ventricle (RV) dysfunction in CKD was 9.5% and 0% in controls (P = 0.49). Right ventricular dysfunction was significantly more common in patients with elevated mPAP compared with those with normal mPAP (P < 0.001). Children with CKD who had a history of having been dialyzed were less likely to have elevated mPAP (P < 0.001). Conclusion Elevated mPAP is significantly more common in children with CKD compared with controls. CKD population with mPAP elevation is more likely to have impaired RV function. The occurrence of elevated mPAP was more common in those who were never dialyzed.
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Affiliation(s)
- Igoche D Peter
- Paediatric Cardiology Unit, Aminu Kano Teaching Hospital, Bayero University Kano, Nigeria
| | - Mustafa O Asani
- Paediatric Cardiology Unit, Aminu Kano Teaching Hospital, Bayero University Kano, Nigeria
| | - Ibrahim Aliyu
- Paediatric Cardiology Unit, Aminu Kano Teaching Hospital, Bayero University Kano, Nigeria
| | - Patience N Obiagwu
- Department of Paediatrics, Paediatric Nephrology Unit, Aminu Kano Teaching Hospital, Bayero University Kano, Nigeria
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26
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Vanden Eynden F, Bové T, Chirade ML, Van Nooten G, Segers P. Measuring pulmonary arterial compliance: mission impossible? Insights from a novel in vivo continuous-flow based experimental model. Pulm Circ 2018; 8:2045894018776882. [PMID: 29708019 PMCID: PMC5960867 DOI: 10.1177/2045894018776882] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Arterial compliance (C) is related to the elasticity, size, and geometrical distribution of arteries. Compliance is a determinant of the load that impedes ventricular ejection. Measuring compliance is difficult, particularly in the pulmonary circulation in which resistive and compliant vessels overlap. Comparing different methods for quantification of compliance to a method that involves a continuous flow might help to identify the optimal method. Pulmonary arterial compliance was computed in six pigs based on the stroke volume to pulse pressure ratio, diastolic decay exponential fitting, area method, and the pulse pressure method (PPM). Compliance measurements were compared to those obtained under continuous flow conditions through a right ventricular bypass (Heartware Inc., Miami Lakes, FL, USA). Compliance was computed for various flows using diastolic decay exponential fitting after an abrupt interruption of the pump. Under the continuous flow conditions, resistance (R) was a decreasing function of the flow, and the fitting to P = e-t/RC yielded a pulmonary time constant (RC) of 2.06 s ( ± 0.48). Compliance was an increasing function of flow. Steady flow inter-method comparisons of compliance under pulsatile flow conditions showed large discrepancies and values (7.23 ± 4.47 mL/mmHg) which were lower than those obtained under continuous flow conditions (10.19 ± 1 0.31 mL/mmHg). Best agreement with steady flow measurements is obtained with the diastolic decay method. Resistance and compliance are both flow-dependent and are inversely related in the pulmonary circulation. The dynamic nature of the pulsatile flow may induce a non-uniformly distributed compliance, with an influence on the methods of measurement.
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Affiliation(s)
- Frédéric Vanden Eynden
- 1 Cardiac Surgery, Université Libre de Bruxelles, Hôpital Académique Erasme, Brussels, Belgium.,2 Laboratory of Experimental Cardiac Surgery, Ghent University Hospital, Belgium
| | - Thierry Bové
- 2 Laboratory of Experimental Cardiac Surgery, Ghent University Hospital, Belgium
| | - Marie-Luce Chirade
- 1 Cardiac Surgery, Université Libre de Bruxelles, Hôpital Académique Erasme, Brussels, Belgium
| | - Guido Van Nooten
- 1 Cardiac Surgery, Université Libre de Bruxelles, Hôpital Académique Erasme, Brussels, Belgium.,2 Laboratory of Experimental Cardiac Surgery, Ghent University Hospital, Belgium
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27
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Kaymaz C, Akbal OY, Hakgor A, Tokgoz HC, Tanboga IH, Aktemur T, Turkday S, Tanyeri S, Poci N, Keskin B, Dogan C, Bayram Z, Acar RD, Ozdemir N. Reappraisal of the reliability of Doppler echocardiographic estimations for mean pulmonary artery pressure in patients with pulmonary hypertension: a study from a tertiary centre comparing four formulae. Pulm Circ 2018; 8:2045894018762270. [PMID: 29480067 PMCID: PMC5865458 DOI: 10.1177/2045894018762270] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Different Doppler echocardiography (DE) models have been proposed for estimation of mean pulmonary arterial pressures (PAMP) from tricuspid regurgitation (TR) jet velocity. We aimed to compare four TR-derived DE models in predicting the PAMP measured by right heart catheterization (RHC) in different groups of precapillary pulmonary hypertension (PH). A total of 287 patients with hemodynamically pre-capillary PH were enrolled (mean age = 51 ± 17.4 years, 59.9% female). All patients underwent DE before RHC (< 3 h) and four formulae (F) were used for TR-derived PAMP estimation (PAMP-DE). These were as follows: F1 = Chemla (0.61 × systolic pulmonary artery pressure [PASP] + 2); F2 = Friedberg (0.69 × PASP - 0.22), F3 = Aduen (0.70 × PASP); and F4 = Bech-Hanssen (0.65 × PASP - 1.2). The PASP and PAMP (mmHg) measured by RHC were 89.1 ± 30.4 and 55.8 ± 20.8, respectively. In the overall PH group, DE estimates for PASP (r = 0.59, P = 0.001) and PAMP (r = 0.56, P = 0.001 for all) showed significant correlations with corresponding RHC measures. Concordance was noted between Chemla and Bech-Hanssen, and Aduen and Bech-Hanssen. The Bland-Altman plot showed that Chemla and Bech-Hanssen overestimated and Friedberg and Aduen underestimated PAMP-RHC measures. Paired-t test showed significant systematic biases for Aduen and Bech-Hanssen while Passing-Bablok non-parametric analysis revealed significant systematic biases all four PAMP-DE estimates. There was poor agreement between PAMP-RHC measures and PAMP-DE deciles (Kappa values were 0.112, 0.097, 0.095, and 0.121, respectively). This study showed a poor agreement between PAMP-DE estimates by four TR-derived formulae and PAMP-RHC in patients with PH, regardless of the etiology. However, these results can not be fully extrapolated to a normal population and did not address the reliability of DE estimates for PH screening procedures.
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Affiliation(s)
- Cihangir Kaymaz
- 1 Department of Cardiology, University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Ozgur Yasar Akbal
- 1 Department of Cardiology, University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Aykun Hakgor
- 1 Department of Cardiology, University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Hacer Ceren Tokgoz
- 1 Department of Cardiology, University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Ibrahim Halil Tanboga
- 2 Department of Cardiology, Hisar Intercontinental Hospital, Istanbul, Turkey.,3 Department of Biostatistics, Ataturk University Medical School, Erzurum, Turkey
| | - Tugba Aktemur
- 1 Department of Cardiology, University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Sevim Turkday
- 1 Department of Cardiology, University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Seda Tanyeri
- 1 Department of Cardiology, University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Nertila Poci
- 1 Department of Cardiology, University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Berhan Keskin
- 1 Department of Cardiology, University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Cem Dogan
- 1 Department of Cardiology, University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Zubeyde Bayram
- 1 Department of Cardiology, University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Rezzan Deniz Acar
- 1 Department of Cardiology, University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Nihal Ozdemir
- 1 Department of Cardiology, University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
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28
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Chang Z, Zhang H, Wu X, Nabi F, Rehman MU, Yuan X, Mehmood K, Zhou D. Renal Dose Dopamine Mediates the Level of Aquaporin-2 Water Channel (Aqp2) in Broiler Chickens. BRAZILIAN JOURNAL OF POULTRY SCIENCE 2017. [DOI: 10.1590/1806-9061-2016-0406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Z Chang
- Huazhong Agricultural University, China
| | - H Zhang
- Huazhong Agricultural University, China
| | - X Wu
- Huazhong Agricultural University, China
| | - F Nabi
- Huazhong Agricultural University, China
| | - MU Rehman
- Huazhong Agricultural University, China
| | - X Yuan
- Huazhong Agricultural University, China
| | - K Mehmood
- Huazhong Agricultural University, China; Islamia University of Bahawalpur, Pakistan
| | - D Zhou
- Huazhong Agricultural University, China
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29
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Jiang R, Wu C, Pudasaini B, Wang L, Zhao QH, Zhang R, Wu WH, Yuan P, Jing ZC, Liu JM. A novel scoring index by Doppler echocardiography for predicting severe pulmonary hypertension due to chronic lung diseases: a cross-sectional diagnostic accuracy study. Int J Chron Obstruct Pulmon Dis 2017; 12:1741-1751. [PMID: 28652726 PMCID: PMC5476678 DOI: 10.2147/copd.s133854] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Severe pulmonary hypertension (PH) resulting from a chronic lung disease (CLD) (severe CLD-PH) requires more aggressive treatment due to its increased mortality compared with mild PH. Therefore, we developed a Doppler echocardiography scoring index (ESI) to predict severe CLD-PH. Methods A derivation cohort of 107 patients with CLD who underwent echocardiography was classified into two groups, the normal/mild PH group and the severe PH group, based on the right heart catheterization. Meanwhile, we designed the ESI by multivariate logistic regression to validate the predicted outcomes. The ESI was calculated using the following formula: ESI = ESIRVEDTD + ESIPASP + ESIPAd − ESITAPSE. Additionally, the ESI was weighted by +2 points for right ventricular end-diastolic transverse dimension ≥3.8 cm or pulmonary artery diameter ≥2.7 cm, +3 points for systolic pulmonary artery pressure (PASP) ≥61 mmHg, and −3 points for tricuspid annular plane systolic excursion ≥1.65 cm. Results In the derivation cohort, PASP ≥61 mmHg estimated by echocardiography exhibited 80.4% sensitivity and 84.3% specificity with area under receiver-operating characteristic curve of 0.823 (95% CI: 0.797–0.942, P<0.0001). Compared with PASP, ESI ≥1.0 exhibited 91.1% sensitivity and 80.4% specificity, resulting in a net improvement in model performance with a change in the c-statistic from 0.823 to 0.937 and an integrated discrimination improvement of 11.3% (95% CI: 4.5%–18.2%, P=0.001). The ESI was applied to the validation cohort, resulting in 84.2% sensitivity and 81.3% specificity with 82.9% accuracy. Conclusion The ESI showed high capacity for predicting severe CLD-PH, further implying the value of noninvasive examinations in clinic.
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Affiliation(s)
- Rong Jiang
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine
| | - Cheng Wu
- Department of Health Statistics, Second Military Medical University, Shanghai, People's Republic of China
| | - Bigyan Pudasaini
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine
| | - Lan Wang
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine
| | - Qin-Hua Zhao
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine
| | - Rui Zhang
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine
| | - Wen-Hui Wu
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine
| | - Ping Yuan
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine
| | - Zhi-Cheng Jing
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine
| | - Jin-Ming Liu
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine
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30
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Cottini S, Benden C, Huber LC, Arrigo M. Echocardiography accurately predicts pulmonary hypertension in patients with advanced lung disease. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:115. [PMID: 28545472 PMCID: PMC5445310 DOI: 10.1186/s13054-017-1697-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Silvia Cottini
- Intensive Care Unit, University Hospital Zurich, Zurich, Switzerland
| | - Christian Benden
- Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Lars C Huber
- Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland.,Clinic for Internal Medicine, City Hospital Triemli, Zurich, Switzerland
| | - Mattia Arrigo
- Department of Cardiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
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31
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Jalalian R, Moghadamnia AA, Tamaddoni A, Khafri S, Iranian M. Comparing the Efficacy of Tadalafil Versus Placebo on Pulmonary Artery Systolic Pressure and Right Ventricular Function in Patients with Beta-Thalassaemia Intermedia. Heart Lung Circ 2016; 26:677-683. [PMID: 27989690 DOI: 10.1016/j.hlc.2016.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 10/28/2016] [Accepted: 11/01/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Conventional oral therapies in the management of pulmonary hypertension in people without haemoglobinopathies are of limited value in thalassaemia patients because of toxicity and poor effectiveness. This study was conducted to assess the effect of tadalafil on pulmonary artery pressure and right ventricular systolic function in patients with beta-thalassaemia intermedia. METHODS Forty-four patients with beta-thalassaemia intermedia with pulmonary hypertension based on transthoracic echocardiography (TTE) were entered in the study. Patients with hepatic or renal insufficiency and also patients who were treated with organic nitrates or alpha-blockers were excluded. The patients were randomly divided into two groups (n=22) and they were treated for six weeks with tadalafil (40mg daily) or placebo. The pulmonary artery systolic pressure (PASP), tricuspid regurgitation velocity (TRV) and parameters related to systolic function of the right ventricle were measured by the TTE before and after treatment. RESULTS Significant improvement in TRV (3.02±0.02 m/s-2.52±0.06 m/s), PASP (45.31±0.66 mmHg-34.26±1.15mmHg) and parameters related to systolic function of the right ventricle were observed in the group who received tadalafil compared to placebo (p< 0.05). CONCLUSIONS Tadalafil significantly decreased PASP and TRV in patients with beta-thalassaemia intermedia. Likewise, tadalafil improved right ventricular systolic function in the patients.
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Affiliation(s)
- Rozita Jalalian
- Department of Cardiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Akbar Moghadamnia
- Neuroscience Research Center and Department of Pharmacology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Ahmad Tamaddoni
- Department of Pediatric Oncology & Hematology, Amirkola Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Soraya Khafri
- Department of Social Medicine and Health, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Mohammadreza Iranian
- Department of Pharmacology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran.
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32
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Zhang G, McCombie SA, Greenstein R, McCombie DB. Assessing the challenges of a pulse wave velocity based blood pressure measurement in surgical patients. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2014:574-7. [PMID: 25570024 DOI: 10.1109/embc.2014.6943656] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Development of a continuous noninvasive blood pressure (cNIBP) monitor that is unobtrusive to patients is an attractive alternative to the cuff based measurements performed on medical-surgical floors in the hospital. Pulse wave velocity (PWV) provides a means to continuously monitor blood pressure in these patients. However, a PWV based cNIBP monitor faces a number of challenges in order to accurately measure blood pressure. In our study, we investigated some of the challenges faced by a body-worn cNIBP monitor (i.e. ViSi Mobile) on data collected on patients undergoing surgery. Results indicated that 1) pulse arrival time (PAT) values from ViSi Mobile were well correlated with PAT values obtained from an invasive reference; 2) the reciprocal of the PAT measurements were linearly correlated with blood pressure but the calibration curve was altered by administration of certain vasoactive substances; and 3) there are deterministic correlations between systolic pressure, diastolic pressure and the corresponding mean arterial pressure over a wide range of blood pressure values.
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Vanden Eynden F, Racapé J, Vincent J, Vachiéry JL, Bové T, Van Nooten G. The linear relationship between systolic pulmonary artery pressure and mean pulmonary artery pressure is maintained regardless of autonomic or rhythm disturbances. Respir Res 2016; 17:33. [PMID: 27036612 PMCID: PMC4815171 DOI: 10.1186/s12931-016-0350-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 03/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the pulmonary circulation, there is a linear relationship between systolic pulmonary arterial pressure (SPAP) and mean pulmonary arterial pressure (MPAP). The aim of this study was to determine the passive or active nature of this mechanism by exploring the relationship in patients with and without autonomic rhythm control of the heart and pulmonary circulation. METHODS Pulmonary arterial pressure recordings from non-transplanted patients and patients with heart transplants or double lung transplants were retrospectively reviewed. The relationships between systolic, diastolic, and mean pulmonary arterial pressures were explored. RESULTS A linear relationship was observed between the SPAP and MPAP, whether patients were paced (MPAP = 0.56 SPAP + 3.86 mmHg, r (2) = 0.889), treated with inotropes (MPAP = 0.55 SPAP + 5.52 mmHg, r (2) = 0.947) or pulmonary vasodilators (MPAP = 0.58 SPAP + 2.41 mmHg, r (2) = 0.927), were exercising (MPAP = 0.61 SPAP + 1.18 mmHg, r (2) = 0.967), had a heart transplant (MPAP = 0.66 SPAP +0.87 mmHg, r (2) = 0.849), a double lung transplant (MPAP = 0.7 SPAP +0.48 mmHg, r (2) = 0.915), or no intervention (MPAP = 0.59 SPAP +1.75 mmHg, r (2) = 0.937). CONCLUSION We demonstrate that the linear relationship between SPAP and MPAP remains in several situations. Therefore, we conclude that the underlying mechanism is a passive consequence of the elastic properties of the cardiopulmonary unit.
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Affiliation(s)
- Frédéric Vanden Eynden
- Department of Cardiac Surgery, Université Libre de Bruxelles, Hôpital Académique Erasme, 808 Route de Lennick, B-1070, Brussels, Belgium.
| | - Judith Racapé
- Research Center of Biostatistics, Epidemiology and Clinical Research, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Jame Vincent
- Anesthesiology Departments, Université Libre de Bruxelles, Hôpital Académique Erasme, Brussels, Belgium
| | - Jean-Luc Vachiéry
- Cardiology, Université Libre de Bruxelles, Hôpital Académique Erasme, Brussels, Belgium
| | - Thierry Bové
- Laboratory of Experimental Cardiac Surgery, University Hospital of Gent, Gent, Belgium
| | - Guido Van Nooten
- Department of Cardiac Surgery, Université Libre de Bruxelles, Hôpital Académique Erasme, 808 Route de Lennick, B-1070, Brussels, Belgium
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34
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D'Alto M, Dimopoulos K, Budts W, Diller GP, Di Salvo G, Dellegrottaglie S, Festa P, Scognamiglio G, Rea G, Ait Ali L, Li W, Gatzoulis MA. Multimodality imaging in congenital heart disease-related pulmonary arterial hypertension. Heart 2016; 102:910-8. [DOI: 10.1136/heartjnl-2015-308903] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 02/04/2016] [Indexed: 12/20/2022] Open
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35
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Ong KC, Geske JB, Hebl VB, Nishimura RA, Schaff HV, Ackerman MJ, Klarich KW, Siontis KC, Coutinho T, Dearani JA, Ommen SR, Gersh BJ. Pulmonary hypertension is associated with worse survival in hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2016; 17:604-10. [DOI: 10.1093/ehjci/jew024] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 01/18/2016] [Indexed: 01/09/2023] Open
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Espinola-Zavaleta N, Soto ME, Romero-Gonzalez A, Gómez-Puente LDC, Muñoz-Castellanos L, Gopal AS, Keirns C, Lupi-Herrera E. Prevalence of Congenital Heart Disease and Pulmonary Hypertension in Down's Syndrome: An Echocardiographic Study. J Cardiovasc Ultrasound 2015; 23:72-7. [PMID: 26140148 PMCID: PMC4486181 DOI: 10.4250/jcu.2015.23.2.72] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 04/25/2015] [Accepted: 05/19/2015] [Indexed: 01/29/2023] Open
Abstract
Background Down's syndrome (DS) is a genetic anomaly, which undergoes increased morbidity and mortality when associated with congenital heart disease (CHD). The aims of the study were to determine the prevalence of CHD and pulmonary hypertension (PH) in DS. Methods One hundred twenty-seven patients with DS living in Mexico City were evaluated by physical exam, electrocardiogram and echocardiogram. Results CHD was found in 40%. In 80% (n = 102) PH was present [systolic pulmonary artery pressure (SPAP) of 47 ± 19 mm Hg and mean pulmonary artery pressure (MPAP) of 32 ± 11 mm Hg]. Patients with CHD and PH were classified as having 1) no shunt (n = 18) with SPAP of 37 ± 9 mm Hg and MPAP of 25 ± 6 mm Hg and 2) with shunt (n = 26) with PASP of 57 ± 29 mm Hg and MPAP of 38 ± 19 mm Hg (p ≤ 0.001). In those without CHD or with CHD without shunt (n = 76), SPAP was 37 ± 19 mm Hg and the MPAP 25 ± 6 mm Hg. The prevalence of PH in DS was 5.9% at one year and 15% at 10 years. The odds ratio of PH in DS with CHD was 7.3 vs. 3 without CHD. Conclusion DS has a high prevalence of CHD and PH. PH prevalence increases when it is associated with CHD. The pathophysiology of PH in DS without CHD should be studied in the near future. Echocardiography is an indispensible tool for evaluation of DS.
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Affiliation(s)
- Nilda Espinola-Zavaleta
- ABC Medical Center I.A.P, Cardiovascular Division, Mexico City, Mexico. ; National Institute of Cardiology "Ignacio Chavez", Echocardiography in Out-Patient Clinic, Immunology Department, Embryology Department, Mexico City, Mexico
| | - María Elena Soto
- ABC Medical Center I.A.P, Cardiovascular Division, Mexico City, Mexico. ; National Institute of Cardiology "Ignacio Chavez", Echocardiography in Out-Patient Clinic, Immunology Department, Embryology Department, Mexico City, Mexico
| | - Angel Romero-Gonzalez
- National Institute of Cardiology "Ignacio Chavez", Echocardiography in Out-Patient Clinic, Immunology Department, Embryology Department, Mexico City, Mexico
| | | | - Luis Muñoz-Castellanos
- National Institute of Cardiology "Ignacio Chavez", Echocardiography in Out-Patient Clinic, Immunology Department, Embryology Department, Mexico City, Mexico
| | - Aasha S Gopal
- St. Francis Hospital, Cardiac Imaging, New York, USA
| | - Candace Keirns
- Massachusetts General Hospital, Interpreters Service, Boston, USA
| | - Eulo Lupi-Herrera
- ABC Medical Center I.A.P, Cardiovascular Division, Mexico City, Mexico
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D'Andrea A, Stanziola A, Di Palma E, Martino M, D'Alto M, Dellegrottaglie S, Cocchia R, Riegler L, Betancourt Cordido MV, Lanza M, Maglione M, Diana V, Calabrò R, Russo MG, Vannan M, Bossone E. Right Ventricular Structure and Function in Idiopathic Pulmonary Fibrosis with or without Pulmonary Hypertension. Echocardiography 2015; 33:57-65. [DOI: 10.1111/echo.12992] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Antonello D'Andrea
- Department of Cardiology; Second University of Naples; Monaldi Hospital; “dei Colli - Monaldi” Hospitals; Naples Italy
| | - Anna Stanziola
- Division of Pneumology; Federico II University; Monaldi Hospital; “dei Colli - Monaldi” Hospitals; Naples Italy
| | - Enza Di Palma
- Department of Cardiology; Second University of Naples; Monaldi Hospital; “dei Colli - Monaldi” Hospitals; Naples Italy
| | - Maria Martino
- Division of Pneumology; Federico II University; Monaldi Hospital; “dei Colli - Monaldi” Hospitals; Naples Italy
| | - Michele D'Alto
- Department of Cardiology; Second University of Naples; Monaldi Hospital; “dei Colli - Monaldi” Hospitals; Naples Italy
| | | | - Rosangela Cocchia
- Department of Cardiology; Second University of Naples; Monaldi Hospital; “dei Colli - Monaldi” Hospitals; Naples Italy
| | - Lucia Riegler
- Department of Cardiology; Second University of Naples; Monaldi Hospital; “dei Colli - Monaldi” Hospitals; Naples Italy
| | | | - Maurizia Lanza
- Division of Pneumology; Federico II University; Monaldi Hospital; “dei Colli - Monaldi” Hospitals; Naples Italy
| | - Marco Maglione
- Global Marketing US Cardio - Esaote Ultrasound Technology; Florence Italy
| | - Veronica Diana
- Department of Cardiology; Second University of Naples; Monaldi Hospital; “dei Colli - Monaldi” Hospitals; Naples Italy
| | - Raffaele Calabrò
- Department of Cardiology; Second University of Naples; Monaldi Hospital; “dei Colli - Monaldi” Hospitals; Naples Italy
| | - Maria Giovanna Russo
- Department of Cardiology; Second University of Naples; Monaldi Hospital; “dei Colli - Monaldi” Hospitals; Naples Italy
| | - Mani Vannan
- Department of Cardiovascular Medicine; Piedmont Heart Institute; Atlanta Georgia
| | - Eduardo Bossone
- Department of Cardiology and Cardiac Surgery; “San Giovanni di Dio e Ruggi d'Aragona” University Hospital; Salern Italy
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38
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Hadinnapola C, Li Q, Su L, Pepke-Zaba J, Toshner M. The resistance-compliance product of the pulmonary circulation varies in health and pulmonary vascular disease. Physiol Rep 2015; 3:3/4/e12363. [PMID: 25902784 PMCID: PMC4425968 DOI: 10.14814/phy2.12363] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pulmonary vascular resistance (PVR) is traditionally used to describe pulmonary hemodynamic characteristics. However, it does not take into account pulmonary artery compliance (Ca) or pulsatile flow. The product of PVR and Ca is known as RC time. Previous studies assert that the PVR-Ca relationship is fixed and RC time is constant between health and disease states. We hypothesized that RC time was not constant in health and pulmonary vascular disease. Right heart catheterizations performed in Papworth Hospital over a 6 year period were analyzed. Subjects were divided into those with normal pulmonary hemodynamics (NPH group; n = 156) and pulmonary arterial hypertension (PAH group; n = 717). RC time and the right ventricle (RV) oscillatory power fraction were calculated. RC time for the NPH group (0.47 ± 0.13 sec) is significantly lower than the PAH group (0.56 ± 0.16 sec; P < 0.0001). The RV oscillatory power fraction is lower in the NPH group (P < 0.0001). RC time correlates inversely with the RV oscillatory power fraction in each group. We conclude, there is an inverse relationship between PVR and Ca, however, this relationship is not always fixed. Consequently, RC time is significantly lower in health compared to disease with elevated pulmonary artery pressures. PAH leads to a decrease in cardiac efficiency.
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Affiliation(s)
- Charaka Hadinnapola
- Pulmonary Vascular Diseases Unit, Papworth Hospital NHS Foundation Trust, Papworth Everard Cambridge, UK
| | - Qiuju Li
- MRC Biostatistics Unit, Cambridge Institute of Public Health, Cambridge Biomedical Campus, Robinson Way Cambridge, UK
| | - Li Su
- MRC Biostatistics Unit, Cambridge Institute of Public Health, Cambridge Biomedical Campus, Robinson Way Cambridge, UK
| | - Joanna Pepke-Zaba
- Pulmonary Vascular Diseases Unit, Papworth Hospital NHS Foundation Trust, Papworth Everard Cambridge, UK
| | - Mark Toshner
- Pulmonary Vascular Diseases Unit, Papworth Hospital NHS Foundation Trust, Papworth Everard Cambridge, UK
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39
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Chemla D, Humbert M, Sitbon O, Montani D, Hervé P. Systolic and Mean Pulmonary Artery Pressures. Chest 2015; 147:943-950. [DOI: 10.1378/chest.14-1755] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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40
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Houston BA, Tedford RJ. Putting "at-rest" evaluations of the right ventricle to rest: insights gained from evaluation of the right ventricle during exercise in CTEPH patients with and without pulmonary endarterectomy. J Am Heart Assoc 2015; 4:e001895. [PMID: 25801758 PMCID: PMC4392453 DOI: 10.1161/jaha.115.001895] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Brian A Houston
- Division of Cardiology, Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD (B.A.H., R.J.T.)
| | - Ryan J Tedford
- Division of Cardiology, Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD (B.A.H., R.J.T.)
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41
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Left ventricular adaptation to high altitude: speckle tracking echocardiography in lowlanders, healthy highlanders and highlanders with chronic mountain sickness. Int J Cardiovasc Imaging 2015; 31:743-52. [DOI: 10.1007/s10554-015-0614-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 02/04/2015] [Indexed: 10/24/2022]
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42
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Reiter G, Reiter U, Kovacs G, Olschewski H, Fuchsjäger M. Blood flow vortices along the main pulmonary artery measured with MR imaging for diagnosis of pulmonary hypertension. Radiology 2014; 275:71-9. [PMID: 25372980 DOI: 10.1148/radiol.14140849] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To approximate the functional relationship between invasively measured mean pulmonary arterial pressure (mPAP) and the phase-contrast magnetic resonance (MR) imaging-derived duration of vortical blood flow along the main pulmonary artery and to analyze its applicability for noninvasive diagnosis of pulmonary hypertension (PH) and borderline mPAP. MATERIALS AND METHODS The local ethics review board approved this prospective study of 145 patients suspected of having PH (69 patients with PH, 19 patients with borderline mPAP, and 57 patients with normal mPAP) who underwent right heart catheterization (RHC) and three-directional phase-contrast MR imaging of the main pulmonary artery. Velocity fields were viewed with dedicated software and evaluated for the duration of vortical blood flow in the main pulmonary artery (tvortex, the percentage of cardiac phases with vortex present). The relationship between mPAP at RHC and tvortex was assessed by means of a segmented linear regression model, and by Bland-Altman and receiver operating characteristic curve analyses. RESULTS The relationship between mPAP and tvortex was described adequately (R(2) = 0.95) as linearly increasing, from tvortex of 0% (mPAP ≤ 16.0 mm Hg) with a slope of 1.59% per millimeter of mercury. The standard deviation between mPAP values derived from RHC and those estimated by using tvortex was 3.9 mm Hg. The area under the curve for tvortex-based diagnosis of PH was 0.994 (95% confidence interval [CI]: 0.982, 0.998), and the calculated PH cut-off value (tvortex ≥ 14.3%) resulted in sensitivity of 0.97 (95% CI: 0.90, 0.99) and specificity of 0.96 (95% CI: 0.89, 0.99). Vortical blood flow with tvortex less than 14.3% was specific for borderline mPAP. CONCLUSION Duration of vortical blood flow in the main pulmonary artery that is determined by using phase-contrast MR imaging allows accurate estimation of elevated mPAP and diagnosis of PH. Clinical trial registration no. NCT00575692.
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Affiliation(s)
- Gert Reiter
- From Research and Development, Siemens AG, Healthcare Sector, Graz, Austria (G.R.); Division of General Radiology, Department of Radiology (U.R., M.F.), and Division of Pulmonology, Department of Internal Medicine (G.K., H.O.), Medical University of Graz, Auenbruggerplatz 9/P, A-8036 Graz, Austria; and LBI for Lung Vascular Research, Graz, Austria (G.K., H.O.)
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D'Alto M, Romeo E, Argiento P, Di Salvo G, Badagliacca R, Cirillo AP, Kaemmerer H, Bossone E, Naeije R. Pulmonary arterial hypertension: the key role of echocardiography. Echocardiography 2014; 32 Suppl 1:S23-37. [PMID: 25244441 DOI: 10.1111/echo.12283] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Echocardiography is a key screening tool in the diagnostic algorithm of pulmonary arterial hypertension (PAH). It provides an estimate of right ventricular function and pulmonary artery pressure, either at rest or during exercise, and is useful in ruling out secondary causes of pulmonary hypertension (PH) such as left heart disease or congenital heart disease. Several studies have showed that echocardiography is insufficiently precise as single tool for the ultimate diagnosis of PH respect to the right heart catheterization, considered the gold standard technique. Echocardiography is valuable in assessing prognosis and treatment options, monitoring the efficacy of specific therapeutic interventions, and detecting the preclinical stages of disease. The ideal imaging modality for accurate noninvasive assessment of the right heart should be accurate and precise, not influenced by loading conditions, routinely practicable and easily repeatable. For all such reasons and considering that PAH is a rare and severe condition, a complete noninvasive assessment of right heart function requires a deep knowledge of the disease and a multimodality approach.
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Affiliation(s)
- Michele D'Alto
- Department of Cardiology, Second University of Naples - Monaldi Hospital, Naples, Italy
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44
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Abstract
The pulmonary circulation is a high-flow and low-pressure circuit. The functional state of the pulmonary circulation is defined by pulmonary vascular pressure-flow relationships conforming to distensible vessel models with a correction for hematocrit. The product of pulmonary arterial compliance and resistance is constant, but with a slight decrease as a result of increased pulsatile hydraulic load in the presence of increased venous pressure or proximal pulmonary arterial obstruction. An increase in left atrial pressure is transmitted upstream with a ratio ≥1 for mean pulmonary artery pressure and ≤1 the diastolic pulmonary pressure. Therefore, the diastolic pressure gradient is more appropriate than the transpulmonary pressure gradient to identify pulmonary vascular disease in left heart conditions. Exercise is associated with a decrease in pulmonary vascular resistance and an increase in pulmonary arterial compliance. Right ventricular function is coupled to the pulmonary circulation with an optimal ratio of end-systolic to arterial elastances of 1.5-2.
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Affiliation(s)
- Robert Naeije
- Department of Physiology, Erasme Campus of the Free University of Brussels, CP 604, 808, Lennik Road, 1070, Brussels, Belgium,
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45
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Ikeda S, Tsuneto A, Kojima S, Koga S, Nakata T, Yoshida T, Eto M, Minami T, Yanagihara K, Maemura K. Longitudinal strain of right ventricular free wall by 2-dimensional speckle-tracking echocardiography is useful for detecting pulmonary hypertension. Life Sci 2014; 111:12-7. [DOI: 10.1016/j.lfs.2014.06.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 06/05/2014] [Accepted: 06/30/2014] [Indexed: 10/25/2022]
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46
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Tedford RJ. Determinants of right ventricular afterload (2013 Grover Conference series). Pulm Circ 2014; 4:211-9. [PMID: 25006440 DOI: 10.1086/676020] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 01/17/2014] [Indexed: 01/08/2023] Open
Abstract
Right ventricular (RV) afterload consists of both resistive and capacitive (pulsatile) components. Total afterload can be measured directly with pulmonary artery input impedance spectra or estimated, either with lumped-parameter modeling or by pressure-volume analysis. However, the inverse, hyperbolic relationship between resistance and compliance in the lung would suggest that the pulsatile components are a predictable and constant proportion of the resistive load in most situations, meaning that total RV load can be estimated from mean resistive load alone. Exceptions include elevations in left atrial pressures and, to a lesser extent, chronic thromboembolic disease. The pulsatile components may also play a more significant role at normal or near-normal pulmonary artery pressures. Measures of coupling between RV afterload and RV contractility may provide important information not apparent by other clinical and hemodynamic measures. Future research should be aimed at development of noninvasive measures of coupling.
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Affiliation(s)
- Ryan J Tedford
- Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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47
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The Role of Exercise Testing in the Modern Management of Pulmonary Arterial Hypertension. Diseases 2014. [DOI: 10.3390/diseases2020120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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48
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Patel V, Mehta HJ, Sadikot RT. Pulmonary artery dissection and rupture in a patient with idiopathic pulmonary artery hypertension. Am J Respir Crit Care Med 2014; 189:e10-1. [PMID: 24628324 DOI: 10.1164/rccm.201304-0693im] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Vipul Patel
- 1 Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Florida, Gainesville, Florida; and
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49
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D'Andrea A, Naeije R, Grünig E, Caso P, D'Alto M, Di Palma E, Nunziata L, Riegler L, Scarafile R, Cocchia R, Vriz O, Citro R, Calabrò R, Russo MG, Bossone E. Echocardiography of the Pulmonary Circulation and Right Ventricular Function. Chest 2014; 145:1071-1078. [DOI: 10.1378/chest.12-3079] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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50
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Twite MD, Friesen RH. The anesthetic management of children with pulmonary hypertension in the cardiac catheterization laboratory. Anesthesiol Clin 2014; 32:157-173. [PMID: 24491655 DOI: 10.1016/j.anclin.2013.10.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Children need cardiac catheterization to establish the diagnosis and monitor the response to treatment when undergoing drug therapy for the treatment of pulmonary arterial hypertension (PAH). Children with PAH receiving general anesthesia for cardiac catheterization procedures are at significantly increased risk of perioperative complications in comparison with other children. The most acute life-threatening complication is a pulmonary hypertensive crisis. It is essential that the anesthesiologist caring for these children understands the pathophysiology of the disease, how anesthetic medications may affect the patient's hemodynamics, and how to manage an acute pulmonary hypertensive crisis.
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Affiliation(s)
- Mark D Twite
- Department of Anesthesiology, University of Colorado School of Medicine, CO, USA.
| | - Robert H Friesen
- Department of Anesthesiology, University of Colorado School of Medicine, CO, USA
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