1
|
Gotchev D, Dorsey BD, Nguyen D, Kakarla R, Dugan B, Chen S, Gao M, Bailey L, Liu F, Harasym T, Chiu T, Tang S, Lee ACH, Cole AG, Sofia MJ. Structure-Activity Relationships and Discovery of ( S)-6-Isopropyl-2-methoxy-3-(3-methoxypropoxy)-10-oxo-5,10-dihydro-6 H-pyrido[1,2- h][1,7]naphthyridine-9-carboxylic Acid (AB-452), a Novel Orally Available HBV RNA Destabilizer. J Med Chem 2024; 67:1421-1446. [PMID: 38190324 DOI: 10.1021/acs.jmedchem.3c01981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Approved therapies for hepatitis B virus (HBV) treatment include nucleos(t)ides and interferon alpha (IFN-α) which effectively suppress viral replication, but they rarely lead to cure. Expression of viral proteins, especially surface antigen of the hepatitis B virus (HBsAg) from covalently closed circular DNA (cccDNA) and the integrated genome, is believed to contribute to the persistence of HBV. This work focuses on therapies that target the expression of HBV proteins, in particular HBsAg, which differs from current treatments. Here we describe the identification of AB-452, a dihydroquinolizinone (DHQ) analogue. AB-452 is a potent HBV RNA destabilizer by inhibiting PAPD5/7 proteins in vitro with good in vivo efficacy in a chronic HBV mouse model. AB-452 showed acceptable tolerability in 28-day rat and dog toxicity studies, and a high degree of oral exposure in multiple species. Based on its in vitro and in vivo profiles, AB-452 was identified as a clinical development candidate.
Collapse
Affiliation(s)
- Dimitar Gotchev
- Arbutus Biopharma, 701 Veterans Circle, Warminster, Pennsylvania 18974, United States
| | - Bruce D Dorsey
- Arbutus Biopharma, 701 Veterans Circle, Warminster, Pennsylvania 18974, United States
| | - Duyan Nguyen
- Arbutus Biopharma, 701 Veterans Circle, Warminster, Pennsylvania 18974, United States
| | - Ramesh Kakarla
- Arbutus Biopharma, 701 Veterans Circle, Warminster, Pennsylvania 18974, United States
| | - Benjamin Dugan
- Arbutus Biopharma, 701 Veterans Circle, Warminster, Pennsylvania 18974, United States
| | - Shuai Chen
- Arbutus Biopharma, 701 Veterans Circle, Warminster, Pennsylvania 18974, United States
| | - Min Gao
- Arbutus Biopharma, 701 Veterans Circle, Warminster, Pennsylvania 18974, United States
| | - Laurèn Bailey
- Arbutus Biopharma, 701 Veterans Circle, Warminster, Pennsylvania 18974, United States
| | - Fei Liu
- Arbutus Biopharma, 701 Veterans Circle, Warminster, Pennsylvania 18974, United States
| | - Troy Harasym
- Arbutus Biopharma, 701 Veterans Circle, Warminster, Pennsylvania 18974, United States
| | - Tim Chiu
- Arbutus Biopharma, 701 Veterans Circle, Warminster, Pennsylvania 18974, United States
| | - Sunny Tang
- Arbutus Biopharma, 701 Veterans Circle, Warminster, Pennsylvania 18974, United States
| | - Amy C-H Lee
- Arbutus Biopharma, 701 Veterans Circle, Warminster, Pennsylvania 18974, United States
| | - Andrew G Cole
- Arbutus Biopharma, 701 Veterans Circle, Warminster, Pennsylvania 18974, United States
| | - Michael J Sofia
- Arbutus Biopharma, 701 Veterans Circle, Warminster, Pennsylvania 18974, United States
| |
Collapse
|
2
|
Harada D, Noto T, Takagawa J. Right ventricular diastolic dysfunction worsens clinical outcomes in Japanese patients with heart failure. IJC HEART & VASCULATURE 2023; 49:101291. [PMID: 37953805 PMCID: PMC10632725 DOI: 10.1016/j.ijcha.2023.101291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023]
Abstract
Background Heart failure (HF) is a rapidly growing public health issue in super aging societies, such as Japan. Right HF is common in older patients. Therefore, the present study investigated the relationship between right ventricular diastolic function and poor clinical outcomes in patients with HF. Methods We retrospectively enrolled 387 Japanese HF patients. All data were obtained from our echocardiographic and jugular venous pulse (JVP) databases and medical records. A less-distensible right ventricle (RV) was identified by a deeper 'Y' descent than 'X' descent in the JVP waveform. We defined cardiac events of HF as follows: sudden death, death from HF, emergent infusion of loop diuretics, or hospitalization for deterioration of HF. Comparisons between patients with and without cardiac events and a multivariate analysis of cardiac events were performed. Results Eighty-five patients had cardiac events. Left ventricular ejection fraction (LVEF) was lower, average mitral E/e' and the prevalence of a less-distensible RV were higher, and tricuspid annular plane systolic excursion was shorter in patients with than in those without cardiac events (median55vs65, p < 0.001; median15vs11, p < 0.001; 64 %vs27%, p < 0.001; median17vs20, p < 0.001, respectively). In a multivariate Cox proportional hazard model, LVEF and a less-distensible RV were independent risk factors for cardiac events (hazard ratio [HR]:0.983 per 1 % increase, p = 0.048; HR:3.150, p < 0.001, respectively). The event-free rate was the lowest for patients with LVEF < 50 % and a less-distensible RV (p for trend < 0.001). Conclusions When right ventricular diastolic function is impaired and irreversible, Japanese patients with HF may become intractable regardless of LVEF.
Collapse
Affiliation(s)
- Daisuke Harada
- The Cardiology Division, Imizu Municipal Hospital, Toyama, Japan
| | - Takahisa Noto
- The Cardiology Division, Imizu Municipal Hospital, Toyama, Japan
| | - Junya Takagawa
- The Cardiology Division, Imizu Municipal Hospital, Toyama, Japan
| |
Collapse
|
3
|
Arnone MI, Sforza A, Carlino MV, Guarino M, Candido R, Bertolone D, Fucile I, De Luca N, Mancusi C. Assessment of E/A ratio helps emergency clinicians in the management of patients with acute dyspnea. Intern Emerg Med 2023; 18:1823-1830. [PMID: 37103762 PMCID: PMC10504390 DOI: 10.1007/s11739-023-03279-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 04/14/2023] [Indexed: 04/28/2023]
Abstract
Acute dyspnea (AD) is one of the main reasons for admission to the Emergency Department (ED). In the last years integrated ultrasound examination (IUE) of lung, heart and inferior vena cava (IVC) has become an extension of clinical examination for a fast differential diagnosis. The aim of present study is to assess the feasibility and diagnostic accuracy of E/A ratio for diagnosing acute heart failure (aHF) in patients with acute dyspnea. We included 92 patients presenting to the ED of CTO Hospital in Naples (Italy) for AD. All patients underwent IUE of lung-heart-IVC with a portable ultrasound device. Left ventricle diastolic function was assessed using pulse wave doppler at the tips of the mitral valve and E wave velocity and E/A ratio were recorded. The FINAL diagnosis was determined by two expert reviewers: acute HF or non-acute HF (non-aHF). We used 2 × 2 contingency tables to analyze sensitivity, specificity, positive predictive and negative predictive value of ultrasound parameters for the diagnosis of AD, comparing with the FINAL diagnosis. Lung ultrasound (LUS) showed high sensitivity, good specificity and accuracy in identification of patients with aHF. However, the highest accuracy was obtained by diastolic function parameters. The E/A ratio showed the highest diagnostic performance with an AUC for aHF of 0.93. In patients presenting with AD, E/A ratio is easy to obtain in a fast ultrasound protocol and showed an excellent accuracy for diagnosis of aHF.
Collapse
Affiliation(s)
| | - Alfonso Sforza
- Cardiology Department and Cardiology Intensive Care Unit, Santa Maria Delle Grazie, Pozzuoli, Italy
| | - Maria Viviana Carlino
- Cardiology Department and Cardiology Intensive Care Unit, San Giuliano Hospital, Giugliano, Italy
| | | | | | - Dario Bertolone
- Emergency Medicine School & Department of Advanced Biomedical Science, Federico II University Hospital, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Ilaria Fucile
- Emergency Medicine School & Department of Advanced Biomedical Science, Federico II University Hospital, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Nicola De Luca
- Emergency Medicine School & Department of Advanced Biomedical Science, Federico II University Hospital, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Costantino Mancusi
- Emergency Medicine School & Department of Advanced Biomedical Science, Federico II University Hospital, Via Sergio Pansini 5, 80131, Naples, Italy.
| |
Collapse
|
4
|
Omar M, Omote K, Sorimachi H, Popovic D, Kanwar A, Alogna A, Reddy YNV, Lim KG, Shah SJ, Borlaug BA. Hypoxaemia in patients with heart failure and preserved ejection fraction. Eur J Heart Fail 2023; 25:1593-1603. [PMID: 37317621 DOI: 10.1002/ejhf.2930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/16/2023] Open
Abstract
AIMS It is widely held that heart failure (HF) does not cause exertional hypoxaemia, based upon studies in HF with reduced ejection fraction, but this may not apply to patients with HF and preserved ejection fraction (HFpEF). Here, we characterize the prevalence, pathophysiology, and clinical implications of exertional arterial hypoxaemia in HFpEF. METHODS AND RESULTS Patients with HFpEF (n = 539) and no coexisting lung disease underwent invasive cardiopulmonary exercise testing with simultaneous blood and expired gas analysis. Exertional hypoxaemia (oxyhaemoglobin saturation <94%) was observed in 136 patients (25%). As compared to those without hypoxaemia (n = 403), patients with hypoxaemia were older and more obese. Patients with HFpEF and hypoxaemia had higher cardiac filling pressures, higher pulmonary vascular pressures, greater alveolar-arterial oxygen difference, increased dead space fraction, and greater physiologic shunt compared to those without hypoxaemia. These differences were replicated in a sensitivity analysis where patients with spirometric abnormalities were excluded. Regression analyses revealed that increases in pulmonary arterial and pulmonary capillary pressures were related to lower arterial oxygen tension (PaO2 ), especially during exercise. Body mass index (BMI) was not correlated with the arterial PaO2 , and hypoxaemia was associated with increased risk for death over 2.8 (interquartile range 0.7-5.5) years of follow-up, even after adjusting for age, sex, and BMI (hazard ratio 2.00, 95% confidence interval 1.01-3.96; p = 0.046). CONCLUSION Between 10% and 25% of patients with HFpEF display arterial desaturation during exercise that is not ascribable to lung disease. Exertional hypoxaemia is associated with more severe haemodynamic abnormalities and increased mortality. Further study is required to better understand the mechanisms and treatment of gas exchange abnormalities in HFpEF.
Collapse
Affiliation(s)
- Massar Omar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Kazunori Omote
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Hidemi Sorimachi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Dejana Popovic
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Alessio Alogna
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Yogesh N V Reddy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kaiser G Lim
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
5
|
Cazzola M, Rogliani P, Ora J, Calzetta L, Matera MG. Cardiovascular diseases or type 2 diabetes mellitus and chronic airway diseases: mutual pharmacological interferences. Ther Adv Chronic Dis 2023; 14:20406223231171556. [PMID: 37284143 PMCID: PMC10240559 DOI: 10.1177/20406223231171556] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/06/2023] [Indexed: 06/08/2023] Open
Abstract
Chronic airway diseases (CAD), mainly asthma and chronic obstructive pulmonary disease (COPD), are frequently associated with different comorbidities. Among them, cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) pose problems for the simultaneous treatment of CAD and comorbidity. Indeed, there is evidence that some drugs used to treat CAD negatively affect comorbidity, and, conversely, some drugs used to treat comorbidity may aggravate CAD. However, there is also growing evidence of some beneficial effects of CAD drugs on comorbidities and, conversely, of the ability of some of those used to treat comorbidity to reduce the severity of lung disease. In this narrative review, we first describe the potential cardiovascular risks and benefits for patients using drugs to treat CAD and the potential lung risks and benefits for patients using drugs to treat CVD. Then, we illustrate the possible negative and positive effects on T2DM of drugs used to treat CAD and the potential negative and positive impact on CAD of drugs used to treat T2DM. The frequency with which CAD and CVD or T2DM are associated requires not only considering the effect that drugs used for one disease condition may have on the other but also providing an opportunity to develop therapies that simultaneously favorably impact both diseases.
Collapse
Affiliation(s)
| | - Paola Rogliani
- Chair of Respiratory Medicine, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
- Division of Respiratory Medicine, University Hospital Tor Vergata, Rome, Italy
| | - Josuel Ora
- Division of Respiratory Medicine, University Hospital Tor Vergata, Rome, Italy
| | - Luigino Calzetta
- Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Maria Gabriella Matera
- Chair of Pharmacology, Department of Experimental Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| |
Collapse
|
6
|
Macera F, Dewachter C, Stefanidis C, Vanden Eynden F, Bondue A, Vachiéry J, Roussoulières A. Lung diffusion capacity correlates with pre-implant pulmonary hypertension and predicts outcome after LVAD implantation. ESC Heart Fail 2023; 10:1043-1053. [PMID: 36546904 PMCID: PMC10053279 DOI: 10.1002/ehf2.14256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/26/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022] Open
Abstract
AIMS Diffusing capacity of the lung for carbon monoxide (DLCO ) reduction is common in heart failure (HF) and is associated with a worse prognosis. Correlations between DLCO and pulmonary hypertension (PH) are unclear, and published data are conflicting; it has been shown that DLCO impairment may persist or even worsen after normalization of pulmonary pressures following left ventricle assist device (LVAD) implantation, maybe reflecting persistent pulmonary damage. We aimed to investigate the impact of pre-implant DLCO and central haemodynamics on outcome in patients with advanced HF implanted with a LVAD. METHODS AND RESULTS We retrospectively analysed pre-implant and post-implant data from 42 patients implanted with a LVAD at our institution. Out of 42 patients, 35 had post-capillary PH before implantation, including 17 with combined post- and pre-capillary PH (Cpc-PH). Median DLCO was 59% (IQR 47-68%), and it inversely correlated with pulmonary vascular resistance (PVR) (P 0.037) and diastolic pulmonary gradient (DPG) (P 0.042). Compared with baseline, LVAD resulted in improvement in LV diameter (LVDd, P < 0.001), mitral regurgitation (P 0.022), and PH (mPAP 24 vs. 36 mmHg, P < 0.001; PAWP 12 vs. 23 mmHg, P 0.001; pulmonary artery compliance, CPA 3.1 vs. 1.9 mL/mmHg, P 0.021). Lower DLCO and Cpc-PH at baseline were associated with a better LV reverse remodelling post-implantation (P 0.027 for LVDd) but also with a smaller gain in CPA (P 0.049). CONCLUSIONS Before LVAD implantation, DLCO impairment is associated with higher PVR and DPG, suggesting that it might be an expression of persistent pulmonary damage occurring in Cpc-PH. After LVAD implantation, both LV dimension and haemodynamics improve. Lower pre-implant DLCO is associated with better LV reverse remodelling.
Collapse
Affiliation(s)
- Francesca Macera
- Department of CardiologyHôpital Universitaire de Bruxelles – Hôpital ErasmeBrusselsBelgium
- Department of CardiologyNiguarda Ca' Granda HospitalMilanItaly
| | - Céline Dewachter
- Department of CardiologyHôpital Universitaire de Bruxelles – Hôpital ErasmeBrusselsBelgium
| | - Constantin Stefanidis
- Department of Cardiac SurgeryHôpital Universitaire de Bruxelles – Hôpital ErasmeBrusselsBelgium
| | - Frédéric Vanden Eynden
- Department of Cardiac SurgeryHôpital Universitaire de Bruxelles – Hôpital ErasmeBrusselsBelgium
| | - Antoine Bondue
- Department of CardiologyHôpital Universitaire de Bruxelles – Hôpital ErasmeBrusselsBelgium
| | - Jean‐Luc Vachiéry
- Department of CardiologyHôpital Universitaire de Bruxelles – Hôpital ErasmeBrusselsBelgium
| | - Ana Roussoulières
- Department of CardiologyHôpital Universitaire de Bruxelles – Hôpital ErasmeBrusselsBelgium
| |
Collapse
|
7
|
Zhou YH, Pang S, Miao GR, Zhao XY, Dong JZ. Combining the anion gap with the sequential organ failure assessment score to evaluate the short-term prognosis of patients in the cardiac intensive care unit. Int J Cardiol 2023; 370:381-387. [PMID: 36332753 DOI: 10.1016/j.ijcard.2022.10.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/28/2022] [Accepted: 10/30/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND We attempted to determine the predictive ability of the first-day Sequential Organ Failure Assessment (SOFA) score in the cardiac intensive care unit, as well as a new score combining the anion gap (AG) with the SOFA score (SOFA-AG). METHODS Information was obtained from the Medical Information Mart for Intensive Care III (MIMIC III 1.4) database. We plotted the relationship between the maximum first-day AG and 90-day mortality after admission to the care unit. Patients were divided into five groups based on the hazard ratio (HR) and assigned scores of 0, 1, 2, 3, or 4 points. We compared the area under the curve (AUC) for the receiver-operating characteristic curve of the SOFA and that of the SOFA-AG. RESULTS A total of 1316 patients were identified and divided into the following five groups: AG 8 to <16 mmol/L; AG 16 to <17 mmol/L; AG 17 to <19 mmol/L; AG 19 to <21 mmol/L; and AG ≥ 21 mmol/L. The SOFA-AG score had a greater AUC than the SOFA score at 7 days (0.770 vs. 0.711; P < 0.001), 14 days (0.751 vs. 0.692; P < 0.001), 28 days (0.741 vs. 0.684; P < 0.001), and 90 days (0.727 vs. 0.667; P < 0.001). CONCLUSIONS The SOFA score showed moderate predictive value only for 7-day mortality after admission to the cardiac intensive care unit, but the SOFA-AG score had improved predictive ability for up to 90 days after admission.
Collapse
Affiliation(s)
- Yuan-Hang Zhou
- Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Shuo Pang
- Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Guang-Rui Miao
- Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Xiao-Yan Zhao
- Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
| | - Jian-Zeng Dong
- Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing 100029, China
| |
Collapse
|
8
|
Omote K, Hsu S, Borlaug BA. Hemodynamic Assessment in Heart Failure with Preserved Ejection Fraction. Cardiol Clin 2022; 40:459-472. [PMID: 36210131 DOI: 10.1016/j.ccl.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Heart failure (HF) with preserved ejection fraction (HFpEF) is characterized by an inability of the heart to perfuse the body without pathologic increases in filling pressure at rest or during exertion. Right heart catheterization provides direct assessment for HF, providing the most robust and direct method to evaluate the central hemodynamic abnormalities, and serves as the gold standard to confirm or refute the presence of HFpEF. This article reviews current understanding of the best practices in the performance and interpretation of hemodynamic assessment, relates important pathophysiologic concepts to clinical care, and discusses current and evidence-based applications of hemodynamics in HFpEF.
Collapse
Affiliation(s)
- Kazunori Omote
- Department of Cardiovascular Medicine, Mayo Clinic and Foundation, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Steven Hsu
- Division of Cardiology, Department of Medicine, Johns Hopkins University, 700 Rutland Avenue, Baltimore, MD 21205, USA
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic and Foundation, 200 First Street Southwest, Rochester, MN 55905, USA.
| |
Collapse
|
9
|
Spiliotaki E, Saranteas T, Moschovaki N, Panagouli K, Pistioli E, Kitsinelis V, Briasoulis P, Papadimos T. Inferior vena cava ultrasonography in the assessment of intravascular volume status and fluid responsiveness in the emergency department and intensive care unit: A critical analysis review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:733-744. [PMID: 35302241 DOI: 10.1002/jcu.23194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/23/2022] [Accepted: 03/09/2022] [Indexed: 06/14/2023]
Abstract
Rapid evaluation of intravascular volume status is vital; either excessive or limited fluid administration may result in adverse patient outcomes. In this narrative review, critical analysis of pertinent diagnostic accuracy studies is developed to delineate the role of inferior vena cava ultrasound measurements in the assessment of both intravascular volume status and fluid responsiveness in the emergency department and intensive care unit. In addition, limitations, and technical considerations of inferior vena cava ultrasound measurements as well as directions for future research are thoroughly discussed.
Collapse
Affiliation(s)
- Eleni Spiliotaki
- Department of Anesthesiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodosios Saranteas
- Department of Anesthesiology, National and Kapodistrian University of Athens, Athens, Greece
- Department of Anesthesia, Division of critical care, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Nefeli Moschovaki
- Department of Anesthesiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantina Panagouli
- Department of Anesthesiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstathia Pistioli
- Department of Anesthesiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasilios Kitsinelis
- Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Briasoulis
- Department of Anesthesiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Thomas Papadimos
- Department of Anesthesia, Division of critical care, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| |
Collapse
|
10
|
Abstract
The development of pulmonary hypertension (PH) is common and has adverse prognostic implications in patients with heart failure due to left heart disease (LHD), and thus far, there are no known treatments specifically for PH-LHD, also known as group 2 PH. Diagnostic thresholds for PH-LHD, and clinical classification of PH-LHD phenotypes, continue to evolve and, therefore, present a challenge for basic and translational scientists actively investigating PH-LHD in the preclinical setting. Furthermore, the pathobiology of PH-LHD is not well understood, although pulmonary vascular remodeling is thought to result from (1) increased wall stress due to increased left atrial pressures; (2) hemodynamic congestion-induced decreased shear stress in the pulmonary vascular bed; (3) comorbidity-induced endothelial dysfunction with direct injury to the pulmonary microvasculature; and (4) superimposed pulmonary arterial hypertension risk factors. To ultimately be able to modify disease, either by prevention or treatment, a better understanding of the various drivers of PH-LHD, including endothelial dysfunction, abnormalities in vascular tone, platelet aggregation, inflammation, adipocytokines, and systemic complications (including splanchnic congestion and lymphatic dysfunction) must be further investigated. Here, we review the diagnostic criteria and various hemodynamic phenotypes of PH-LHD, the potential biological mechanisms underlying this disorder, and pressing questions yet to be answered about the pathobiology of PH-LHD.
Collapse
Affiliation(s)
- Jessica H Huston
- Division of Cardiology, Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA (J.H.H.)
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Feinberg Cardiovascular and Renal Research Institute, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| |
Collapse
|
11
|
Chang HC, Huang WM, Yu WC, Cheng HM, Guo CY, Chiang CE, Chen CH, Sung SH. Prognostic Role of Pulmonary Function in Patients With Heart Failure With Reduced Ejection Fraction. J Am Heart Assoc 2022; 11:e023422. [PMID: 35289186 PMCID: PMC9075473 DOI: 10.1161/jaha.121.023422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Both ventilatory abnormalities and pulmonary hypertension (PH) are frequently observed in patients with heart failure with reduced ejection fraction. We aim to investigate the association between ventilatory abnormalities and PH in heart failure with reduced ejection fraction, as well as their prognostic impacts. Methods and Results A total of 440 ambulatory patients (age, 66.2±15.8 years; 77% men) with left ventricular ejection fraction ≤40% who underwent comprehensive echocardiography and spirometry were enrolled. Total lung capacity, forced vital capacity, and forced expiratory volume in the first second were obtained. Pulmonary arterial systolic pressure was estimated. PH was defined as a pulmonary arterial systolic pressure of >50 mm Hg. The primary end point was all‐cause mortality at 5 years. Patients with PH had significantly reduced total lung capacity, forced vital capacity, and forced expiratory volume in the first second. During a median follow‐up of 25.9 months, there were 111 deaths. After accounting for age, sex, body mass index, renal function, smoking, left ventricular ejection fraction, and functional capacity, total lung capacity (hazard ratio [HR] per 1 SD, 0.66; 95% CI per 1 SD, 0.46–0.96), forced vital capacity (HR per 1 SD, 0.64; 95% CI per 1 SD, 0.48–0.84), and forced expiratory volume in the first second (HR per 1 SD, 0.72; 95% CI per 1 SD, 0.53–0.98) were all significantly correlated with mortality in patients without PH. Kaplan‐Meier curve demonstrated impaired pulmonary function, defined as forced expiratory volume in the first second ≤58% of predicted or forced vital capacity ≤65% of predicted, was associated with higher mortality in patients without PH (HR, 2.85; 95% CI, 1.66–4.89), but not in patients with PH (HR, 1.05; 95% CI, 0.61–1.82). Conclusions Ventilatory abnormality was more prevalent in patients with heart failure with reduced ejection fraction with PH than those without. However, such ventilatory defects were related to long‐term survival only in patients without PH, regardless of their functional status.
Collapse
Affiliation(s)
- Hao-Chih Chang
- Department of Medicine Taipei Veterans General Hospital Yuanshan and Suao Branch Yilan Taiwan.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan
| | - Wei-Ming Huang
- Department of Medicine National Yang Ming Chiao Tung University College of Medicine Taipei Taiwan.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan
| | - Wen-Chung Yu
- Department of Medicine National Yang Ming Chiao Tung University College of Medicine Taipei Taiwan.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Cardiovascular Research Center National Yang Ming Chiao Tung University College of Medicine Taipei Taiwan
| | - Hao-Min Cheng
- Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Cardiovascular Research Center National Yang Ming Chiao Tung University College of Medicine Taipei Taiwan.,Center for Evidence-Based Medicine Taipei Veterans General Hospital Taipei Taiwan.,Department of Medical Education Taipei Veterans General Hospital Taipei Taiwan.,Institute of Public Health National Yang Ming Chiao Tung University College of Medicine Taipei Taiwan
| | - Chao-Yu Guo
- Institute of Public Health National Yang Ming Chiao Tung University College of Medicine Taipei Taiwan
| | - Chern-En Chiang
- Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Cardiovascular Research Center National Yang Ming Chiao Tung University College of Medicine Taipei Taiwan.,General Clinical Research Center Taipei Veterans General Hospital Taipei Taiwan
| | - Chen-Huan Chen
- Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Cardiovascular Research Center National Yang Ming Chiao Tung University College of Medicine Taipei Taiwan.,Department of Medical Education Taipei Veterans General Hospital Taipei Taiwan
| | - Shih-Hsien Sung
- Department of Medicine National Yang Ming Chiao Tung University College of Medicine Taipei Taiwan.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Cardiovascular Research Center National Yang Ming Chiao Tung University College of Medicine Taipei Taiwan.,Institute of Emergency and Critical Care Medicine National Yang Ming Chiao Tung University College of Medicine Taipei Taiwan
| |
Collapse
|
12
|
Assessment of fluid unresponsiveness guided by lung ultrasound in abdominal surgery: a prospective cohort study. Sci Rep 2022; 12:1350. [PMID: 35079044 PMCID: PMC8789825 DOI: 10.1038/s41598-022-05251-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 01/10/2022] [Indexed: 12/02/2022] Open
Abstract
A fluid challenge can generate an infraclinical interstitial syndrome that may be detected by the appearance of B-lines by lung ultrasound. Our objective was to evaluate the appearance of B-lines as a diagnostic marker of preload unresponsiveness and postoperative complications in the operating theater. We conducted a prospective, bicentric, observational study. Adult patients undergoing abdominal surgery were included. Stroke volume (SV) was determined before and after a fluid challenge with 250 mL crystalloids (Delta-SV) using esophageal Doppler monitoring. Responders were defined by an increase of Delta-SV > 10% after fluid challenge. B-lines were collected at four bilateral predefined zones (right and left anterior and lateral). Delta-B-line was defined as the number of newly appearing B-lines after a fluid challenge. Postoperative pulmonary complications were prospectively recorded according to European guidelines. In total, 197 patients were analyzed. After a first fluid challenge, 67% of patients were responders and 33% were non-responders. Delta-B-line was significantly higher in non-responders than responders [4 (2–7) vs 1 (0–3), p < 0.0001]. Delta-B-line was able to diagnose fluid non-responders with an area under the curve of 0.74 (95% CI 0.67–0.80, p < 0.0001). The best threshold was two B-lines with a sensitivity of 80% and a specificity of 57%. The final Delta-B-line could predict postoperative pulmonary complications with an area under the curve of 0.74 (95% CI 0.67–0.80, p = 0.0004). Delta-B-line of two or more detected in four lung ultrasound zones can be considered to be a marker of preload unresponsiveness after a fluid challenge in abdominal surgery. The objectives and procedures of the study were registered at Clinicaltrials.gov (NCT03502460; Principal investigator: Stéphane BAR, date of registration: April 18, 2018).
Collapse
|
13
|
Kim SH, Kim GY, Oh JS, Lee SY. Heart transplantation in a patient with complex heart lung disease: a case report. KOREAN JOURNAL OF TRANSPLANTATION 2021; 35:257-261. [PMID: 35769857 PMCID: PMC9235457 DOI: 10.4285/kjt.21.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/08/2021] [Indexed: 12/02/2022] Open
Abstract
Heart disease is often accompanied by lung disease as they share the same risk factors. Heart or lung transplantation is regarded as a definitive treatment for the end-stage disease of each, while the expected median survival for lung transplantation is far shorter than heart transplantation. We present a case of refractory heart failure along with severe obstructive and restrictive lung disease that showed dramatic improvement in pulmonary function after single heart transplantation.
Collapse
Affiliation(s)
- Seok Hyun Kim
- Division of Cardiology, Department of Internal Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Ga Yun Kim
- Division of Cardiology, Department of Internal Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Ji Soo Oh
- Division of Cardiology, Department of Internal Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Soo Yong Lee
- Division of Cardiology, Department of Internal Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| |
Collapse
|
14
|
Choudhury TA, Ofori-Amanfo G, Choi J, Eisenberg RE, Rycus P, Medar SS, Aydin SI. Left Heart Decompression on Veno-Arterial Extracorporeal Membrane Oxygenation in Children With Dilated Cardiomyopathy and Myocarditis: An Extracorporeal Life Support Organization Registry Review. Pediatr Crit Care Med 2021; 22:1026-1032. [PMID: 34054118 DOI: 10.1097/pcc.0000000000002775] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe the association between left heart decompression on veno-arterial extracorporeal membrane oxygenation and survival in patients with myocarditis and dilated cardiomyopathy. The secondary outcome is to study association of left heart decompression with survival in children with myocarditis compared with those with dilated cardiomyopathy. DESIGN Retrospective study of a multicenter registry database. SETTING Data reported to Extracorporeal Life Support Organization from international extracorporeal membrane oxygenation centers. PATIENTS Patients less than or equal to 18 years old with a diagnosis of myocarditis or dilated cardiomyopathy receiving extracorporeal membrane oxygenation. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 1,438 pediatric extracorporeal membrane oxygenation runs were identified. Thirty-seven percent of the patients had myocarditis (n = 532), whereas the rest had dilated cardiomyopathy. Survival to hospital discharge was 63%. Median extracorporeal membrane oxygenation duration was 148 hours with interquartile range (84-248 hr). Nineteen percent of patients (n = 274) had left heart decompression. Multivariable analysis revealed using left heart decompression (adjusted odds ratio, 1.42; 95% CI, 1.06-1.89; p = 0.02), e-cardiopulmonary resuscitation (adjusted odds ratio, 0.63; 95% CI, 0.51-0.79; p < 0.001), higher pH (adjusted odds ratio, 3.69; 95% CI, 1.80-7.53; p < 0.001), and diagnosis of myocarditis (adjusted odds ratio, 1.69; 95% CI, 1.35-2.08; p < 0.001) were associated with greater odds of survival. In the multivariable analysis for patients with dilated cardiomyopathy, left heart decompression failed to reveal a significant association with survival (20% among survivors vs 17% among nonsurvivors, 95% CI, -2.2% to 8.0%). Meanwhile in patients with myocarditis, the multivariable analysis failed to exclude the possibility that left heart decompression was associated with up to a three-fold greater odds of survival (adjusted odds ratio, 1.77; 95% CI, 0.99-.15). CONCLUSIONS Retrospective review of the Extracorporeal Life Support Organization registry revealed an association between left heart decompression and greater odds of survival in children with myocarditis and dilated cardiomyopathy on extracorporeal membrane oxygenation. When comparing patients with dilated cardiomyopathy against those with myocarditis, we could not exclude a three-fold greater odds of survival associated with the use of left heart decompression. This finding warrants further prospective evaluation.
Collapse
Affiliation(s)
- Tarif A Choudhury
- Divisions of Pediatric Critical Care Medicine and Pediatric Cardiology, Morgan Stanley Children's Hospital of New York, Columbia University Medical Center, New York, NY
| | - George Ofori-Amanfo
- Division of Critical Care Medicine, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jaeun Choi
- Division of Critical Care Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
| | - Ruth E Eisenberg
- Division of Critical Care Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
| | - Peter Rycus
- Extracorporeal Life Support Organization, Ann Arbor, MI
| | - Shivanand S Medar
- Division of Critical Care Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
| | - Scott I Aydin
- Division of Critical Care Medicine, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY
| |
Collapse
|
15
|
Das AB. Lung disease network reveals impact of comorbidity on SARS-CoV-2 infection and opportunities of drug repurposing. BMC Med Genomics 2021; 14:226. [PMID: 34535131 PMCID: PMC8447809 DOI: 10.1186/s12920-021-01079-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 09/08/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Higher mortality of COVID-19 patients with lung disease is a formidable challenge for the health care system. Genetic association between COVID-19 and various lung disorders must be understood to comprehend the molecular basis of comorbidity and accelerate drug development. METHODS Lungs tissue-specific neighborhood network of human targets of SARS-CoV-2 was constructed. This network was integrated with lung diseases to build a disease-gene and disease-disease association network. Network-based toolset was used to identify the overlapping disease modules and drug targets. The functional protein modules were identified using community detection algorithms and biological processes, and pathway enrichment analysis. RESULTS In total, 141 lung diseases were linked to a neighborhood network of SARS-CoV-2 targets, and 59 lung diseases were found to be topologically overlapped with the COVID-19 module. Topological overlap with various lung disorders allows repurposing of drugs used for these disorders to hit the closely associated COVID-19 module. Further analysis showed that functional protein-protein interaction modules in the lungs, substantially hijacked by SARS-CoV-2, are connected to several lung disorders. FDA-approved targets in the hijacked protein modules were identified and that can be hit by exiting drugs to rescue these modules from virus possession. CONCLUSION Lung diseases are clustered with COVID-19 in the same network vicinity, indicating the potential threat for patients with respiratory diseases after SARS-CoV-2 infection. Pathobiological similarities between lung diseases and COVID-19 and clinical evidence suggest that shared molecular features are the probable reason for comorbidity. Network-based drug repurposing approaches can be applied to improve the clinical conditions of COVID-19 patients.
Collapse
Affiliation(s)
- Asim Bikas Das
- Department of Biotechnology, National Institute of Technology Warangal, Warangal, 506004, Telangana, India.
| |
Collapse
|
16
|
Kawakami R, Nakada Y, Hashimoto Y, Ueda T, Nakagawa H, Nishida T, Onoue K, Soeda T, Watanabe M, Saito Y. Prevalence and Prognostic Significance of Pulmonary Function Test Abnormalities in Hospitalized Patients With Acute Decompensated Heart Failure With Preserved and Reduced Ejection Fraction. Circ J 2021; 85:1426-1434. [PMID: 33867406 DOI: 10.1253/circj.cj-20-1069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study evaluated the prevalence and prognostic impact of lung function abnormalities in patients with acute decompensated heart failure (ADHF) with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF).Methods and Results:Of the 1,012 consecutive patients who were admitted to Nara Medical University with ADHF between 2011 and 2018, 657 routinely underwent spirometry (pulmonary function test [PFT]) before discharge. Lung function was classified as normal or abnormal (restrictive, obstructive, or mixed). Abnormal PFTs were seen in 63.0% of patients with ADHF (36.7%, 13.1%, and 13.2% for restrictive, obstructive, and mixed, respectively). The prevalence of abnormal PFT increased with age (P<0.001). Overall, abnormal PFT was an independent predictor of the composite endpoint of cardiovascular mortality or hospitalization for HF (adjusted hazard ratio [HR] 1.402; 95% confidence interval [CI] 1.039-1.914; P=0.027). Abnormal PFT (adjusted HR 2.294; 95% CI 1.368-4.064; P=0.001), as well as the restrictive (HR 2.299; 95% CI 1.322-4.175; P=0.003) and mixed (HR 2.784; 95% CI 1.399-5.581; P=0.004) patterns, were predictive of the composite endpoint in HFpEF, but not in HFrEF. CONCLUSIONS Abnormal PFT was prevalent and associated with poor outcomes in ADHF. Spirometry may be a useful tool in patients with ADHF, especially in those with HFpEF, to identify those at higher risk of a poorer outcome.
Collapse
Affiliation(s)
- Rika Kawakami
- Department of Cardiovascular Medicine, Nara Medical University
| | - Yasuki Nakada
- Department of Cardiovascular Medicine, Nara Medical University
| | | | - Tomoya Ueda
- Department of Cardiovascular Medicine, Nara Medical University
| | | | - Taku Nishida
- Department of Cardiovascular Medicine, Nara Medical University
| | - Kenji Onoue
- Department of Cardiovascular Medicine, Nara Medical University
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University
| | - Makoto Watanabe
- Department of Cardiovascular Medicine, Nara Medical University
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University
| |
Collapse
|
17
|
Gal R, Deres L, Horvath O, Eros K, Sandor B, Urban P, Soos S, Marton Z, Sumegi B, Toth K, Habon T, Halmosi R. Resveratrol Improves Heart Function by Moderating Inflammatory Processes in Patients with Systolic Heart Failure. Antioxidants (Basel) 2020; 9:antiox9111108. [PMID: 33187089 PMCID: PMC7696241 DOI: 10.3390/antiox9111108] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 12/11/2022] Open
Abstract
The effects of resveratrol (RES) in heart failure have already been evaluated in animal models; however, in human clinical trials, they have not been confirmed yet. The aim of this study was to assess the effects of resveratrol treatment in systolic heart failure patients (heart failure with reduced ejection fraction or HFrEF). In this human clinical trial, 60 outpatients with NYHA (New York Heart Association) class II-III HFrEF were enrolled and randomized into two groups: receiving either 100-mg resveratrol daily or placebo for three months. At the beginning and at the end of the study echocardiography, a six-minute walk test, spirometry, quality of life questionnaire, lab test and RNA profile analysis were performed. The systolic and diastolic left ventricular function, as well as the global longitudinal strain, were improved significantly in the resveratrol-treated group (RES). Exercise capacity, ventilation parameters and quality of life also improved significantly in the RES group. In parallel, the cardiac biomarker levels (N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and galectin-3) decreased in the treated group. The level of inflammatory cytokines decreased significantly after RES supplementation, as a consequence of the decreased expression level of leucocyte electron transport chain proteins. The main findings of our trial are that RES treatment added to the standard heart failure therapy improved heart function and the clinical condition by moderating the inflammatory processes in patients with HFrEF.
Collapse
Affiliation(s)
- Roland Gal
- Division of Cardiology, 1st Department of Medicine, Medical School, University of Pecs, 7602 Pecs, Hungary; (R.G.); (L.D.); (O.H.); (B.S.); (Z.M.); (K.T.); (T.H.)
- Szentágothai Research Centre, University of Pecs, 7602 Pecs, Hungary; (K.E.); (P.U.); (B.S.)
| | - Laszlo Deres
- Division of Cardiology, 1st Department of Medicine, Medical School, University of Pecs, 7602 Pecs, Hungary; (R.G.); (L.D.); (O.H.); (B.S.); (Z.M.); (K.T.); (T.H.)
- Szentágothai Research Centre, University of Pecs, 7602 Pecs, Hungary; (K.E.); (P.U.); (B.S.)
- HAS-UP Nuclear-Mitochondrial Interactions Research Group, 1007 Budapest, Hungary
| | - Orsolya Horvath
- Division of Cardiology, 1st Department of Medicine, Medical School, University of Pecs, 7602 Pecs, Hungary; (R.G.); (L.D.); (O.H.); (B.S.); (Z.M.); (K.T.); (T.H.)
- Szentágothai Research Centre, University of Pecs, 7602 Pecs, Hungary; (K.E.); (P.U.); (B.S.)
| | - Krisztian Eros
- Szentágothai Research Centre, University of Pecs, 7602 Pecs, Hungary; (K.E.); (P.U.); (B.S.)
- HAS-UP Nuclear-Mitochondrial Interactions Research Group, 1007 Budapest, Hungary
- Department of Biochemistry and Medical Chemistry, Medical School, University of Pecs, 7602 Pecs, Hungary
| | - Barbara Sandor
- Division of Cardiology, 1st Department of Medicine, Medical School, University of Pecs, 7602 Pecs, Hungary; (R.G.); (L.D.); (O.H.); (B.S.); (Z.M.); (K.T.); (T.H.)
- Szentágothai Research Centre, University of Pecs, 7602 Pecs, Hungary; (K.E.); (P.U.); (B.S.)
| | - Peter Urban
- Szentágothai Research Centre, University of Pecs, 7602 Pecs, Hungary; (K.E.); (P.U.); (B.S.)
| | - Szilvia Soos
- Division of Pulmonology, 1st Department of Medicine, Medical School, University of Pecs, 7602 Pecs, Hungary;
| | - Zsolt Marton
- Division of Cardiology, 1st Department of Medicine, Medical School, University of Pecs, 7602 Pecs, Hungary; (R.G.); (L.D.); (O.H.); (B.S.); (Z.M.); (K.T.); (T.H.)
- Szentágothai Research Centre, University of Pecs, 7602 Pecs, Hungary; (K.E.); (P.U.); (B.S.)
| | - Balazs Sumegi
- Szentágothai Research Centre, University of Pecs, 7602 Pecs, Hungary; (K.E.); (P.U.); (B.S.)
- HAS-UP Nuclear-Mitochondrial Interactions Research Group, 1007 Budapest, Hungary
- Department of Biochemistry and Medical Chemistry, Medical School, University of Pecs, 7602 Pecs, Hungary
| | - Kalman Toth
- Division of Cardiology, 1st Department of Medicine, Medical School, University of Pecs, 7602 Pecs, Hungary; (R.G.); (L.D.); (O.H.); (B.S.); (Z.M.); (K.T.); (T.H.)
- Szentágothai Research Centre, University of Pecs, 7602 Pecs, Hungary; (K.E.); (P.U.); (B.S.)
| | - Tamas Habon
- Division of Cardiology, 1st Department of Medicine, Medical School, University of Pecs, 7602 Pecs, Hungary; (R.G.); (L.D.); (O.H.); (B.S.); (Z.M.); (K.T.); (T.H.)
- Szentágothai Research Centre, University of Pecs, 7602 Pecs, Hungary; (K.E.); (P.U.); (B.S.)
| | - Robert Halmosi
- Division of Cardiology, 1st Department of Medicine, Medical School, University of Pecs, 7602 Pecs, Hungary; (R.G.); (L.D.); (O.H.); (B.S.); (Z.M.); (K.T.); (T.H.)
- Szentágothai Research Centre, University of Pecs, 7602 Pecs, Hungary; (K.E.); (P.U.); (B.S.)
- Correspondence:
| |
Collapse
|
18
|
Lalande S, Cross TJ, Keller-Ross ML, Morris NR, Johnson BD, Taylor BJ. Exercise Intolerance in Heart Failure: Central Role for the Pulmonary System. Exerc Sport Sci Rev 2020; 48:11-19. [PMID: 31453845 DOI: 10.1249/jes.0000000000000208] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We propose that abnormalities of the pulmonary system contribute significantly to the exertional dyspnea and exercise intolerance observed in patients with chronic heart failure. Interventions designed to address the deleterious pulmonary manifestations of heart failure may, therefore, yield promising improvements in exercise tolerance in this population.
Collapse
Affiliation(s)
- Sophie Lalande
- Department of Kinesiology and Heath Education, The University of Texas at Austin, Austin, TX
| | | | - Manda L Keller-Ross
- Divisions of Physical Therapy and Rehabilitation Sciences, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN
| | - Norman R Morris
- School of Physiotherapy and Exercise Science, Griffith University, Queensland, Australia
| | - Bruce D Johnson
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Bryan J Taylor
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| |
Collapse
|
19
|
Harada D, Asanoi H, Noto T, Takagawa J. The impact of right ventricular dysfunction on the effectiveness of beta-blockers in heart failure with preserved ejection fraction. J Cardiol 2020; 76:325-334. [DOI: 10.1016/j.jjcc.2020.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/02/2020] [Accepted: 04/16/2020] [Indexed: 01/01/2023]
|
20
|
Lazarevic A, Dobric M, Goronja B, Trninic D, Krivokuca S, Jovanic J, Picano E. Lung ultrasound-guided therapeutic thoracentesis in refractory congestive heart failure. Acta Cardiol 2020; 75:398-405. [PMID: 30955462 DOI: 10.1080/00015385.2019.1591677] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: Pleural effusion refractory to diuretic treatment is frequent in advanced heart failure. Therapeutic thoracentesis is a time-honored practice, recently made simpler and safer by guidance with lung ultrasound. To assess the feasibility and clinical impact of lung ultrasound-driven therapeutic thoracentesis in refractory heart failure.Methods and results: In a single-centre retrospective analysis we recruited 373 patients with heart failure with reduced ejection fraction (26 ± 12%), New York Heart Association class ≥3, and pleural effusion ≥ moderate at lung ultrasound. All patients underwent lung ultrasound-guided therapeutic thoracentesis. Total of 462 lung ultrasound-guided therapeutic thoracentesis procedures were successfully performed without complications. Evacuated pleural fluid by passive drainage was 1030 ± 534 mL. The maximal interpleural space was 73.6 ± 15.6 mm before, and 12.4 ± 3.1 mm after therapeutic thoracentesis (p < .001). Therapeutic thoracentesis induced an immediate symptomatic improvement in all patients, with New York Heart Association class decrease from 3.84 ± 0.37 pre- to 2.7 ± 0.55 post-therapeutic thoracentesis (p <.001). The improvement was long-lasting (for weeks/months) in 89% of patients. The 6-min walking test was 52 ± 29 m before, and 287 ± 56 m one month after therapeutic thoracentesis (p < .05).Conclusion: Lung ultrasound-driven therapeutic thoracentesis of pleural effusion in decompensated heart failure patients is feasible, safe, and efficient. Therapeutic thoracentesis induces immediate and substantial symptomatic relief followed by long-lasting improvement.
Collapse
Affiliation(s)
- Aleksandar Lazarevic
- Division of Cardiovascular Diseases, Faculty of Medicine, University Clinical Center of the Republic of Srpska, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
- Cardio Internal Medicine Outpatient Clinic, Banja Luka, Bosnia and Herzegovina
| | - Milan Dobric
- Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Boris Goronja
- Division of Cardiovascular Diseases, Faculty of Medicine, University Clinical Center of the Republic of Srpska, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Dijana Trninic
- Division of Cardiovascular Diseases, Faculty of Medicine, University Clinical Center of the Republic of Srpska, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Svetozar Krivokuca
- Division of Cardiovascular Diseases, Faculty of Medicine, University Clinical Center of the Republic of Srpska, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Jelena Jovanic
- Division of Cardiovascular Diseases, Faculty of Medicine, University Clinical Center of the Republic of Srpska, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Eugenio Picano
- CNR Institute of Clinical Physiology of Pisa, Pisa, Italy
| |
Collapse
|
21
|
Farkhooy A, Bellocchia M, Hedenström H, Libertucci D, Bucca C, Janson C, Solidoro P, Malinovschi A. Lung function in relation to six-minute walk test in pulmonary hypertension. Eur Clin Respir J 2020; 7:1745492. [PMID: 32363016 PMCID: PMC7178896 DOI: 10.1080/20018525.2020.1745492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/16/2020] [Indexed: 11/21/2022] Open
Abstract
Background: Pulmonary hypertension (PH) is a progressive disorder of the pulmonary circulation, associated with diverse medical conditions. Exercise limitation is the most prominent symptom in PH. Exercise capacity, commonly assessed through a six-minute walk test (6MWT), correlates with both functional status and survival in PH. Few studies have analysed the relation between respiratory function and exercise limitation. Therefore, we investigated the relationship between resting pulmonary function, exercise capacity, and exertional desaturation, assessed through the 6MWT, in unselected PH patients. Methods: Fifty consecutive patients with PH diagnosis, referred for pulmonary function testing (lung volume, spirometry, and diffusing capacity for carbon monoxide (DLCO)) and 6MWT, were recruited at Molinette University Hospital, Turin. Results: The majority of the patients (54%) had PH due to left heart disease. Airway obstruction (FEV1/VC-ratio < 0.7) was found in 46% of the patients and they performed significantly worse in the 6MWT than unobstructed patients (307 m vs. 377 m). Patients with PH due to left heart disease also performed significantly poorer 6MWT when airway obstruction was present (305 m vs. 389 m). Twenty-two patients (44%) presented exertional desaturation upon 6MWT. Lower DLCO divided by the alveolar volume (DLCO/VA), FEV1/VC-ratios and resting PaO2-values were significantly correlated with exertional desaturation after adjustments for age, sex, BMI, and smoking habits. DLCO/VA was the main determinant of exertional desaturation in a stepwise regression model. Conclusions: Spirometric parameters of airway obstruction were related to walk distance and exercise-induced desaturation in PH patients. This suggests a place for spirometry in clinical monitoring of PH patients.
Collapse
Affiliation(s)
- Amir Farkhooy
- Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden.,Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Michaela Bellocchia
- Cardiovascular and Thoracic Department, Pneumology Unit, AOU Molinette, Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Hans Hedenström
- Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Daniela Libertucci
- Cardiovascular and Thoracic Department, Pneumology Unit, AOU Molinette, Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Caterina Bucca
- Cardiovascular and Thoracic Department, Pneumology Unit, AOU Molinette, Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Paolo Solidoro
- Cardiovascular and Thoracic Department, Pneumology Unit, AOU Molinette, Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Andrei Malinovschi
- Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden
| |
Collapse
|
22
|
Ramírez Gutiérrez de Velasco A. Haga su diagnóstico (edema pulmonar agudo). REVISTA DE LA FACULTAD DE MEDICINA 2020. [DOI: 10.22201/fm.24484865e.2020.63.1.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
23
|
Lin X, Fang L. Pharmaceutical Treatment for Heart Failure. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1177:269-295. [PMID: 32246448 DOI: 10.1007/978-981-15-2517-9_7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Heart failure (HF) is defined as a clinical syndrome resulting from structural or functional impairment of ventricular fillings or ejections of blood. Currently, HF is divided into three groups which include HF with reduced ejection fraction (HFrEF), HF with preserved ejection fraction (HFpEF) and HF with midrange EF (HFmrEF). Even though major advances have been made in treating HFrEF during the past decades, heart failure is a fatal disease. In this review, we briefly summarize the current advances in pharmaceutical managements for heart failure, which includes drugs used in acute heart failure as well as those that prevent heart failure progression, in each category major clinical trials are also described. In addition, information about some of potential new drugs are also mentioned. Traditional Chinese medicine also shows its potential in treating HF, and we are still lack of medicine to treat HFpEF.
Collapse
Affiliation(s)
- Xue Lin
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ligang Fang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| |
Collapse
|
24
|
Cross TJ, Kim CH, Johnson BD, Lalande S. The interactions between respiratory and cardiovascular systems in systolic heart failure. J Appl Physiol (1985) 2019; 128:214-224. [PMID: 31774354 DOI: 10.1152/japplphysiol.00113.2019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Heart failure (HF) is a complex and multifaceted disease. The disease affects multiple organ systems, including the respiratory system. This review provides three unique examples illustrating how the cardiovascular and respiratory systems interrelate because of the pathology of HF. Specifically, these examples outline the impact of HF pathophysiology on 1) respiratory mechanics and the mechanical "cost" of breathing; 2) mechanical interactions of the heart and lungs; and on 3) abnormalities of pulmonary gas exchange during exercise, and how this may be applied to treatment. The goal of this review is to, therefore, raise the awareness that HF, though primarily a disease of the heart, is accompanied by marked pathology of the respiratory system.
Collapse
Affiliation(s)
- Troy James Cross
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester Minnesota
| | - Chul-Ho Kim
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester Minnesota
| | - Bruce D Johnson
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester Minnesota
| | - Sophie Lalande
- Department of Kinesiology and Heath Education, University of Texas at Austin, Austin, Texas
| |
Collapse
|
25
|
Tsutsui H, Isobe M, Ito H, Ito H, Okumura K, Ono M, Kitakaze M, Kinugawa K, Kihara Y, Goto Y, Komuro I, Saiki Y, Saito Y, Sakata Y, Sato N, Sawa Y, Shiose A, Shimizu W, Shimokawa H, Seino Y, Node K, Higo T, Hirayama A, Makaya M, Masuyama T, Murohara T, Momomura SI, Yano M, Yamazaki K, Yamamoto K, Yoshikawa T, Yoshimura M, Akiyama M, Anzai T, Ishihara S, Inomata T, Imamura T, Iwasaki YK, Ohtani T, Onishi K, Kasai T, Kato M, Kawai M, Kinugasa Y, Kinugawa S, Kuratani T, Kobayashi S, Sakata Y, Tanaka A, Toda K, Noda T, Nochioka K, Hatano M, Hidaka T, Fujino T, Makita S, Yamaguchi O, Ikeda U, Kimura T, Kohsaka S, Kosuge M, Yamagishi M, Yamashina A. JCS 2017/JHFS 2017 Guideline on Diagnosis and Treatment of Acute and Chronic Heart Failure ― Digest Version ―. Circ J 2019; 83:2084-2184. [DOI: 10.1253/circj.cj-19-0342] [Citation(s) in RCA: 276] [Impact Index Per Article: 55.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | | | - Hiroshi Ito
- Department of Cardiovascular and Respiratory Medicine, Akita University Graduate School of Medicine
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Division of Biophysiological Sciences, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Masafumi Kitakaze
- Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Center
| | | | - Yasuki Kihara
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | | | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Yoshikatsu Saiki
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Naoki Sato
- Department of Cardiovascular Medicine, Kawaguchi Cardiovascular and Respiratory Hospital
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Akira Shiose
- Department of Cardiovascular Surgery, Kyushu University Graduate School of Medical Sciences
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | | | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Taiki Higo
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Atsushi Hirayama
- The Division of Cardiology, Department of Medicine, Nihon University Graduate School of Medicine
| | | | - Tohru Masuyama
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | | | - Masafumi Yano
- Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Kenji Yamazaki
- Department of Cardiology Surgery, Tokyo Women’s Medical University
| | - Kazuhiro Yamamoto
- Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University
| | | | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | - Masatoshi Akiyama
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Shiro Ishihara
- Department of Cardiology, Nippon Medical School Musashi-Kosugi Hospital
| | - Takayuki Inomata
- Department of Cardiovascular Medicine, Kitasato University Kitasato Institute Hospital
| | | | - Yu-ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Tomohito Ohtani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | - Takatoshi Kasai
- Cardiovascular Respiratory Sleep Medicine, Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Mahoto Kato
- Department of Cardiovascular Medicine, Nihon University Graduate School of Medicine
| | - Makoto Kawai
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | | | - Shintaro Kinugawa
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Toru Kuratani
- Department of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Shigeki Kobayashi
- Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Yasuhiko Sakata
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | | | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kotaro Nochioka
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Masaru Hatano
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | | | - Takeo Fujino
- Department of Advanced Cardiopulmonary Failure, Kyushu University Graduate School of Medical Sciences
| | - Shigeru Makita
- Department of Cardiac Rehabilitation, Saitama Medical University International Medical Center
| | - Osamu Yamaguchi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
| | - Masakazu Yamagishi
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine
| | - Akira Yamashina
- Medical Education Promotion Center, Tokyo Medical University
| | | |
Collapse
|
26
|
Shafuddin E, Chang CL, Cooray M, McAnulty KA, Karalus NC, Lee MHS, Hancox RJ. Cardiac dysfunction in exacerbations of chronic obstructive pulmonary disease is often not detected by electrocardiogram and chest radiographs. Intern Med J 2019; 49:761-769. [DOI: 10.1111/imj.14144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/02/2018] [Accepted: 10/10/2018] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Manisha Cooray
- School of MedicineUniversity of Auckland Auckland New Zealand
| | - Kim A. McAnulty
- Department of RadiologyWaikato Hospital Hamilton New Zealand
| | - Noel C. Karalus
- Department of Respiratory MedicineWaikato Hospital Hamilton New Zealand
| | - Marcus H. S. Lee
- Department of CardiologyWaikato Hospital Hamilton New Zealand
- Department of General MedicineWhangarei Hospital Whangarei New Zealand
| | - Robert J. Hancox
- Department of Respiratory MedicineWaikato Hospital Hamilton New Zealand
- Department of Preventive and Social MedicineUniversity of Otago Dunedin New Zealand
| |
Collapse
|
27
|
Harada D, Asanoi H, Noto T, Takagawa J. Prominent 'Y' descent is an ominous sign of a poorer prognosis in heart failure with preserved ejection fraction. ESC Heart Fail 2019; 6:799-808. [PMID: 31111677 PMCID: PMC6676302 DOI: 10.1002/ehf2.12460] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 02/25/2019] [Accepted: 04/30/2019] [Indexed: 11/08/2022] Open
Abstract
AIMS The heterogeneity of heart failure with preserved ejection fraction (HFpEF) represents different pathophysiological paths by which individual patients develop heart failure. The deterioration mechanisms are considered to be mainly left ventricular diastolic dysfunction, right ventricular (RV) systolic function, and RV afterload. It is unclear whether RV distensibility affects the deterioration of HFpEF. Our study aimed to clarify whether impaired RV distensibility is associated with the deterioration of HFpEF. METHODS AND RESULTS We retrospectively enrolled 322 patients with HFpEF and examined their echocardiography results, electrocardiograms, phonocardiograms, and jugular venous pulse waves. Using signal-processing techniques, the prominent 'Y' descent of the jugular venous waveform was detected as an established haemodynamic sign of a less-distensible right ventricle. We defined cardiovascular events of HFpEF as follows: sudden death, death from heart failure, or hospitalization for HFpEF. During a mean follow-up period of 33 ± 20 months, 73 patients had cardiovascular events of HFpEF. The prevalence of a less-distensible right ventricle and the variables of RV systolic pressure were independent risk factors for cardiovascular events (hazard ratio, 2.046, P = 0.005, and hazard ratio, 1.032 per 1 mmHg, P = 0.002, respectively). The event-free rate of HFpEF was the lowest for HFpEF with a less-distensible right ventricle and elevated RV systolic pressure (≥35 mmHg) (P for trend <0.001). CONCLUSIONS A less-distensible right ventricle and elevated RV systolic pressure were found to be closely associated with the deterioration of HFpEF. Assessment of a less-distensible right ventricle may help to stratify patients and improve therapeutic strategies for HFpEF.
Collapse
Affiliation(s)
- Daisuke Harada
- The Cardiology Division, Imizu Municipal Hospital, Toyama, Japan
| | - Hidetsugu Asanoi
- Department of Chronic Heart Failure Management, Global Center for Medical Engineering and Informatics, Osaka University, Osaka, Japan
| | - Takahisa Noto
- The Cardiology Division, Imizu Municipal Hospital, Toyama, Japan
| | - Junya Takagawa
- The Cardiology Division, Imizu Municipal Hospital, Toyama, Japan
| |
Collapse
|
28
|
Yuan G, Han A, Wu J, Lu Y, Zhang D, Sun Y, Zhang J, Zhao M, Zhang B, Cui X. Bao Yuan decoction and Tao Hong Si Wu decoction improve lung structural remodeling in a rat model of myocardial infarction: Possible involvement of suppression of inflammation and fibrosis and regulation of the TGF-β1/Smad3 and NF-κB pathways. Biosci Trends 2019; 12:491-501. [PMID: 30473557 DOI: 10.5582/bst.2018.01242] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Chronic heart failure (CHF) leads to pulmonary structural remodeling, which may be a key factor for poor clinical outcomes in patients with end-stage heart failure, and few effective therapeutic options are presently available. The aim of the current study was to explore the mechanism of action and pulmonary-protective effects of treatment with Bao Yuan decoction combined with Tao Hong Si Wu decoction (BYTH) on lung structural remodeling in rats with ischemic heart failure. In a model of myocardial infarction (MI) induced by ligation of the left anterior descending (LAD) artery, rats were treated with BYTH. Heart function and morphometry were measured followed by echocardiography, histological staining, and immunohistochemical analysis of lung sections. The levels of transforming growth factor-β1 (TGF-β1), type I collagen, phosphorylated-Smad3 (p-Smad3), tumor necrosis factor-α (TNF-α), toll-like receptor 4 (TLR4), active nuclear factor κB (NF-κB) and alpha smooth muscle actin (α-SMA) were detected using Western blotting. Lung weight increased after an infarct with no evidence of pulmonary edema and returned to normal as a result of BYTH. In addition, BYTH treatment reduced levels of type I collagen, TGF-β1, and α-SMA expression and decreased the phosphorylation of Smad3 in the lungs of rats after MI. BYTH treatment also reduced the elevated levels of lung inflammatory mediators such as TNF-α, TLR4, and NF-κB. Results suggested that BYTH could effectively improve lung structural remodeling after MI because of its anti-inflammatory and anti-fibrotic action, which may be mediated by suppression of the TGF-β1/Smad3 and NF-κB signaling pathways.
Collapse
Affiliation(s)
- Guozhen Yuan
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences
| | - Anbang Han
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences
| | - Jing Wu
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences
| | - Yingdong Lu
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences
| | - Dandan Zhang
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences
| | - Yuxiu Sun
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences
| | | | - Mingjing Zhao
- The Key Laboratory of Chinese Internal Medicine of the Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine
| | - Bingbing Zhang
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences
| | - Xiangning Cui
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences
| |
Collapse
|
29
|
Lai JV, Muthiah K, Robson D, Prichard R, Walker R, Pin Lim C, Wang LW, Macdonald PS, Jansz P, Hayward CS. Impact of Pump Speed on Hemodynamics With Exercise in Continuous Flow Ventricular Assist Device Patients. ASAIO J 2019; 66:132-138. [PMID: 30913099 DOI: 10.1097/mat.0000000000000975] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
At fixed speed, the spontaneous increase in pump flow accompanying exercise in patients with continuous flow left ventricular assist devices (cfLVADs) is slight in comparison to normal physiologic response, limiting exercise capacity. We systematically exercised 14 patients implanted with an isolated HeartWare HVAD undergoing routine right heart catheterization at baseline and at maximal safe pump speed. In addition to hemodynamics, mixed venous oxygen saturation (SvO2), echocardiography and noninvasive mean arterial pressure, and heart rate were measured. Significantly greater pump flows were achieved with maximum pump speed compared with baseline speed at rest (mean ± standard deviation [SD]: 5.0 ± 0.7 vs. 4.6 ± 0.8 L/min) and peak exercise (6.7 ± 1.0 vs. 5.9 ± 0.9 L/min, p = 0.001). Pulmonary capillary wedge pressure was significantly reduced with maximum pump speed compared to baseline pump speed at rest (10 ± 4 vs. 15 ± 5 mmHg, p < 0.001) and peak exercise (27 ± 8 vs. 30 ± 8 mmHg, p = 0.002). Mixed venous oxygen saturation decreased with exercise (p < 0.001) but was unaffected by changes in pump speed. In summary, although higher pump speeds synergistically augment the increase in pump flow associated with exercise and blunt the exercise-induced rise in left heart filling pressures, elevated filling pressures and markedly diminished SvO2 persist at maximal safe pump speed, suggesting that physiologic flow increases are not met by isolated cfLVADs in the supported failing heart.
Collapse
Affiliation(s)
- Jacqueline V Lai
- From the Heart Failure and Transplant Unit, St Vincent's Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Kavitha Muthiah
- From the Heart Failure and Transplant Unit, St Vincent's Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia
| | - Desiree Robson
- From the Heart Failure and Transplant Unit, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Ros Prichard
- From the Heart Failure and Transplant Unit, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Robyn Walker
- From the Heart Failure and Transplant Unit, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Choon Pin Lim
- From the Heart Failure and Transplant Unit, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Louis W Wang
- From the Heart Failure and Transplant Unit, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Peter S Macdonald
- From the Heart Failure and Transplant Unit, St Vincent's Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia
| | - Paul Jansz
- From the Heart Failure and Transplant Unit, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Christopher S Hayward
- From the Heart Failure and Transplant Unit, St Vincent's Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia
| |
Collapse
|
30
|
Mehra P, Mehta V, Sukhija R, Sinha AK, Gupta M, Girish M, Aronow WS. Pulmonary hypertension in left heart disease. Arch Med Sci 2019; 15:262-273. [PMID: 30697278 PMCID: PMC6348356 DOI: 10.5114/aoms.2017.68938] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 09/14/2016] [Indexed: 12/20/2022] Open
Affiliation(s)
- Pratishtha Mehra
- Department of Cardiology, Maulana Azad Medical College and G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Vimal Mehta
- Department of Cardiology, Maulana Azad Medical College and G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Rishi Sukhija
- Division of Cardiology, Indiana University La Porte Hospital, La Porte, Indiana, USA
| | - Anjan K. Sinha
- Division of Cardiology, Indiana University Health, Indianapolis, Indiana, USA
| | - Mohit Gupta
- Department of Cardiology, Maulana Azad Medical College and G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - M.P. Girish
- Department of Cardiology, Maulana Azad Medical College and G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | | |
Collapse
|
31
|
Sajgalik P, Kim CH, Stulak JM, Kushwaha SS, Maltais S, Joyce DL, Joyce LD, Johnson BD, Schirger JA. Pulmonary function assessment post-left ventricular assist device implantation. ESC Heart Fail 2018; 6:53-61. [PMID: 30311748 PMCID: PMC6351887 DOI: 10.1002/ehf2.12348] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 07/26/2018] [Indexed: 12/22/2022] Open
Abstract
Aim The lungs—and particularly the alveolar‐capillary membrane—may be sensitive to continuous flow (CF) and pulmonary pressure alterations in heart failure (HF). We aimed to investigate long‐term effects of CF pumps on respiratory function. Methods and results We conducted a retrospective study of patients with end‐stage HF at our institution. We analysed pulmonary function tests [e.g. forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1)] and diffusing capacity of the lung for carbon monoxide (DLCO) from before and after left ventricular assist device (LVAD) implantation and compared them with invasive haemodynamic studies. Of the 274 patients screened, final study analysis involved 44 patients with end‐stage HF who had CF LVAD implantation between 1 February 2007 and 31 December 2015 at our institution. These patients [mean (standard deviation, SD) age, 50 (9) years; male sex, n = 33, 75%] received either the HeartMate II (Thoratec Corp.) pump (77%) or the HeartWare (HeartWare International Inc.) pump. The mean (SD) left ventricular ejection fraction was 21% (13%). At a median of 237 days post‐LVAD implantation, we observed significant DLCO decrease (−23%) since pre‐implantation (P < 0.001). ΔDLCO had an inverse relationship with changes in pulmonary capillary wedge pressure (PCWP) and right atrial pressure (RAP) from pre‐LVAD to post‐LVAD implantation: ΔDLCO to ΔPCWP (r = 0.50, P < 0.01) and ΔDLCO to ΔRAP (r = 0.39, P < 0.05). We observed other reductions in FEV1, FVC, and FEV1/FVC between pre‐LVAD and post‐LVAD implantation. In mean (SD) values, FEV1 changed from 2.3 (0.7) to 2.1 (0.7) (P = 0.005); FVC decreased from 3.2 (0.8) to 2.9 (0.9) (P = 0.01); and FEV1/FVC went from 0.72 (0.1) to 0.72 (0.1) (P = 0.50). Landmark survival analysis revealed that ΔDLCO from 6 months after LVAD implantation was predictive of death for HF patients [hazard ratio (95% confidence interval), 0.60 (0.28–0.98); P = 0.03]. Conclusions Pulmonary function did not improve after LVAD implantation. The degree of DLCO deterioration is related to haemodynamic status post‐LVAD implantation. The ΔDLCO within 6 months post‐operative was associated with survival.
Collapse
Affiliation(s)
- Pavol Sajgalik
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Chul-Ho Kim
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Sudhir S Kushwaha
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Simon Maltais
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - David L Joyce
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Lyle D Joyce
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Bruce D Johnson
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - John A Schirger
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
32
|
Carlino MV, Paladino F, Sforza A, Serra C, Liccardi F, de Simone G, Mancusi C. Assessment of left atrial size in addition to focused cardiopulmonary ultrasound improves diagnostic accuracy of acute heart failure in the Emergency Department. Echocardiography 2018. [PMID: 29522655 DOI: 10.1111/echo.13851] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Acute dyspnea is one of the main reasons for admission to Emergency Department (ED). Availability of ultraminiaturized pocket ultrasound devices (PUD) adds diagnostic power to the clinical examination. The aim of this study was to identify an integrated ultrasound approach for diagnosis of acute heart failure (acute HF), using PUD and combining evaluation from lung, heart and inferior vena cava (IVC). METHODS We included 102 patients presenting to the ED of "Antonio Cardarelli" Hospital in Naples (Italy) for acute dyspnea (AD). All patients underwent integrated ultrasound examination (IUE) of lung-heart-IVC, using PUD. The gold standard was the final diagnosis determined by two expert reviewers: acute heart failure (acute HF) or noncardiac dyspnea. We used 2 × 2 contingency tables to analyze sensitivity, specificity, positive and negative predictive value and accuracy of the three ultrasonic methods, and their combinations for the diagnosis of acute HF, comparing with the final, validated diagnosis. RESULTS Lung ultrasound (LUS) alone exhibited a good sensitivity (100%) and specificity (82%) and had the highest accuracy (89%) among single modalities (heart and IVC) for the diagnosis of acute HF. The highest accuracy among all methods (96%) was obtained by the combination of positive LUS and either dilated left atrium or EF ≤ 40% or both (all P < .01 vs single modalities). CONCLUSION In patients presenting to ED, IUE using PUD is a useful extension of clinical examination and has a reliable diagnostic discriminant ability in the immediate evaluation of acute dyspnea. The combination of positive LUS with focused cardiac ultrasonography (FoCUS), including also dilated left atrium, substantially extends the spectrum of recognizable acute HF.
Collapse
Affiliation(s)
- Maria Viviana Carlino
- Hypertension Research Center, UOC Emergency Medicine, Federico II University Hospital, Naples, Italy.,Emergency Department, Cardarelli Hospital, Naples, Italy
| | | | - Alfonso Sforza
- Hypertension Research Center, UOC Emergency Medicine, Federico II University Hospital, Naples, Italy.,Emergency Department, Cardarelli Hospital, Naples, Italy
| | - Claudia Serra
- Emergency Department, Cardarelli Hospital, Naples, Italy
| | | | - Giovanni de Simone
- Hypertension Research Center, UOC Emergency Medicine, Federico II University Hospital, Naples, Italy
| | - Costantino Mancusi
- Hypertension Research Center, UOC Emergency Medicine, Federico II University Hospital, Naples, Italy
| |
Collapse
|
33
|
Foster AJ, Platt MJ, Huber JS, Eadie AL, Arkell AM, Romanova N, Wright DC, Gillis TE, Murrant CL, Brunt KR, Simpson JA. Central-acting therapeutics alleviate respiratory weakness caused by heart failure-induced ventilatory overdrive. Sci Transl Med 2018; 9:9/390/eaag1303. [PMID: 28515334 DOI: 10.1126/scitranslmed.aag1303] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 03/13/2017] [Indexed: 12/22/2022]
Abstract
Diaphragmatic weakness is a feature of heart failure (HF) associated with dyspnea and exertional fatigue. Most studies have focused on advanced stages of HF, leaving the cause unresolved. The long-standing theory is that pulmonary edema imposes a mechanical stress, resulting in diaphragmatic remodeling, but stable HF patients rarely exhibit pulmonary edema. We investigated how diaphragmatic weakness develops in two mouse models of pressure overload-induced HF. As in HF patients, both models had increased eupneic respiratory pressures and ventilatory drive. Despite the absence of pulmonary edema, diaphragmatic strength progressively declined during pressure overload; this decline correlated with a reduction in diaphragm cross-sectional area and preceded evidence of muscle weakness. We uncovered a functional codependence between angiotensin II and β-adrenergic (β-ADR) signaling, which increased ventilatory drive. Chronic overdrive was associated with increased PERK (double-stranded RNA-activated protein kinase R-like ER kinase) expression and phosphorylation of EIF2α (eukaryotic translation initiation factor 2α), which inhibits protein synthesis. Inhibition of β-ADR signaling after application of pressure overload normalized diaphragm strength, Perk expression, EIF2α phosphorylation, and diaphragmatic cross-sectional area. Only drugs that were able to penetrate the blood-brain barrier were effective in treating ventilatory overdrive and preventing diaphragmatic atrophy. These data provide insight into why similar drugs have different benefits on mortality and symptomatology, despite comparable cardiovascular effects.
Collapse
Affiliation(s)
- Andrew J Foster
- Department of Human Health and Nutritional Science, University of Guelph, Guelph, Ontario N1G 2W1, Canada
| | - Mathew J Platt
- Department of Human Health and Nutritional Science, University of Guelph, Guelph, Ontario N1G 2W1, Canada
| | - Jason S Huber
- Department of Human Health and Nutritional Science, University of Guelph, Guelph, Ontario N1G 2W1, Canada
| | - Ashley L Eadie
- Department of Pharmacology, Dalhousie Medicine, Saint John, New Brunswick E2L 4L5, Canada
| | - Alicia M Arkell
- Department of Human Health and Nutritional Science, University of Guelph, Guelph, Ontario N1G 2W1, Canada
| | - Nadya Romanova
- Department of Human Health and Nutritional Science, University of Guelph, Guelph, Ontario N1G 2W1, Canada
| | - David C Wright
- Department of Human Health and Nutritional Science, University of Guelph, Guelph, Ontario N1G 2W1, Canada
| | - Todd E Gillis
- Department of Integrative Biology, University of Guelph, Guelph, Ontario N1G 2W1, Canada
| | - Coral L Murrant
- Department of Human Health and Nutritional Science, University of Guelph, Guelph, Ontario N1G 2W1, Canada
| | - Keith R Brunt
- Department of Pharmacology, Dalhousie Medicine, Saint John, New Brunswick E2L 4L5, Canada.
| | - Jeremy A Simpson
- Department of Human Health and Nutritional Science, University of Guelph, Guelph, Ontario N1G 2W1, Canada.
| |
Collapse
|
34
|
Echocardiography in the Intensive Care Unit. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9438-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
35
|
Apostolopoulou SC. The respiratory system in pediatric chronic heart disease. Pediatr Pulmonol 2017; 52:1628-1635. [PMID: 29076654 DOI: 10.1002/ppul.23900] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 09/25/2017] [Accepted: 09/28/2017] [Indexed: 11/08/2022]
Abstract
Cardiovascular disease in the pediatric population closely affects the respiratory system inducing water retention in the lungs and pulmonary edema, airway compression by cardiovascular structures, restrictive pulmonary physiology as a result of hemodynamic changes and surgical repair, susceptibility to respiratory infections, development of pulmonary hypertension, thrombosis, or hemorrhage. Chronic heart failure and congenital heart disease are characterized by various respiratory manifestations and symptoms mimicking lung disease, which are frequently difficult to diagnose and treat. Pulmonary function is multiply affected in pediatric heart disease with mostly restrictive but also obstructive and diffusion abnormalities. Patients with Fontan circulation represent a separate group with slow, passive pulmonary blood flow and distinct pathophysiology with low cardiac output heart failure, restrictive lung pattern, increased thromboembolic complications and rare conditions such as protein losing enteropathy and plastic bronchitis. Distinguishing between cardiovascular and pulmonary symptoms may be challenging in the growing population of pediatric and adult survivors of congenital heart disease and understanding of the relationship of the two systems in heart disease is crucial for the optimal management of these patients.
Collapse
|
36
|
Chase SC, Taylor BJ, Cross TJ, Coffman KE, Olson LJ, Johnson BD. Influence of Thoracic Fluid Compartments on Pulmonary Congestion in Chronic Heart Failure. J Card Fail 2017; 23:690-696. [PMID: 28716688 DOI: 10.1016/j.cardfail.2017.07.394] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 06/28/2017] [Accepted: 07/11/2017] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Pulmonary congestion is a common finding of heart failure (HF), but it remains unclear how pulmonary and heart blood volumes (Vp and Vh, respectively) and extravascular lung water (EVLW) change in stable HF and affect lung function. METHODS Fourteen patients with HF (age 68 ± 11 y, LVEF 33 ± 8%) and 12 control subjects (age 65 ± 9 y) were recruited. A pulmonary function test, thoracic computerized tomographic (CT) scan, and contrast perfusion scan were performed. From the thoracic scan, a histogram of CT attenuation of lung tissue was generated and skew, kurtosis, and full-width half-max (FWHM) calculated as surrogates of EVLW. Blood volumes were calculated from the transit time of the contrast through the great vessels of the heart. RESULTS Patients with HF had greater Vp and Vh (Vp 0.55 ± 0.21 L vs 0.41 ± 0.13 L; Vh 0.53 ± 0.33 L vs 0.40 ± 0.15 L) and EVLW (skew 3.2 ± 0.5 vs 3.7 ± 0.7; kurtosis 19.4 ± 6.6 vs 25.9 ± 9.4; FWHM 73 ± 13 HU vs 59 ± 9 HU). Spirometric measures were decreased in HF (percentage of predicted: forced vital capacity 86 ± 17% vs 104 ± 9%; forced expiratory volume in 1 second 83 ± 20% vs 105 ± 11%; maximal mid-expiratory flow 82 ± 42% vs 115 ± 43%). Vp was associated with decreased expiratory flows, and EVLW was associated with decreased lung volumes. CONCLUSIONS Congestion in stable patients with HF includes expanded Vp and Vh and increased EVLW associated with reductions in lung volumes and expiratory flows.
Collapse
Affiliation(s)
- Steven C Chase
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Bryan J Taylor
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Troy J Cross
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Kirsten E Coffman
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Lyle J Olson
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Bruce D Johnson
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
| |
Collapse
|
37
|
Impairment of pulmonary diffusion correlates with hypoxemic burden in central sleep apnea heart failure patients. Respir Physiol Neurobiol 2017; 243:7-12. [PMID: 28467884 DOI: 10.1016/j.resp.2017.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 04/26/2017] [Accepted: 04/27/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE Central sleep apnea (CSA) and Cheyne-Stokes respiration (CSR) are highly prevalent in heart failure (HF) and are linked to increased mortality. Impaired pulmonary diffusion capacity [DLCO] and [KCO]) have been suggested to play a key role in CSA-CSR pathophysiology. This study investigated the relationship between HF, CSR, DLCO and KCO in well-characterized HF patients. METHODS This prospective study included HF patients with CSR, all patients underwent full overnight polysomnography (PSG) and lung function testing. RESULTS A total of 100 patients were included (age 70.7±9.7years, 95% male, body mass index 28.9±5.3kg/m2, left ventricular ejection fraction 33.5±7.7%, New York Heart Association class III 65%. DLCO and oxygenation were significantly correlated with hypoxemic burden (p<0.05). Mean oxygen saturation, oxygen desaturation, C-reactive protein level and pH were significantly associated with CSA-CSR severity (p<0.05). CONCLUSION The finding that lung diffusion capacity is significantly associated with hypoxemic burden in HF patients with CSA-CSR highlights the important of lung function in HF patients.
Collapse
|
38
|
Seguchi O, Hisamatsu E, Nakano A, Nakajima S, Kuroda K, Watanabe T, Sato T, Sunami H, Yanase M, Hata H, Hamasaki T, Fujita T, Kobayashi J, Nakatani T, Kitakaze M, Fukushima N. Low partial pressure of end-tidal carbon dioxide predicts left ventricular assist device implantation in patients with advanced chronic heart failure. Int J Cardiol 2016; 230:40-46. [PMID: 28038817 DOI: 10.1016/j.ijcard.2016.12.102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 12/03/2016] [Accepted: 12/17/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND This study aimed to clarify the prognostic impact of partial pressure of end-tidal carbon dioxide (PETCO2) in patients with advanced chronic heart failure (HF). METHODS Forty-eight patients (mean age 43.1±11.9years, 32 males) with chronic HF (44 with non-ischemic and 4 with ischemic cardiomyopathy) were prospectively enrolled. Echocardiography, blood tests, pulmonary function testing, and PETCO2 measurements were performed as noninvasive tests, whereas right heart catheterization and arterial blood gas analysis were conducted as invasive tests. The primary end point of this study was left ventricular assist device (LVAD) implantation or cardiac death. RESULTS Eighteen patients underwent LVAD implantation at the Interagency Registry for Mechanically Circulatory Support (INTERMACS) profile 3 during the follow-up period, and no patient died. PETCO2 was significantly lower in a stepwise manner with New York Heart Association functional class (class I or II, 34.2±9.3mmHg vs. class III or IV, 27.7±2.5mmHg; p<0.001). Univariate and multivariate Cox proportional hazard models and time-dependent receiver operating characteristic curve analysis revealed that PETCO2≤31mmHg is an independent noninvasive predictor of LVAD implantation. Univariable and multivariable linear regression analyses showed that pulmonary arterial pressure was independently and highly correlated with PETCO2 (r2=-0.512, p<0.001). CONCLUSIONS Among various noninvasive clinical parameters investigated, PETCO2 was the independent predictor of LVAD implantation at the INTERMACS profile 3 in patients with chronic HF. Pulmonary congestion may significantly contribute to decreases in PETCO2 in patients with HF.
Collapse
Affiliation(s)
- Osamu Seguchi
- Department of Transplantation,National Cerebral and Cardiovascular Center, Osaka, Japan.
| | - Eriko Hisamatsu
- Department of Transplantation,National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Atsushi Nakano
- Department of Clinical Research, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Seiko Nakajima
- Department of Transplantation,National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kensuke Kuroda
- Department of Transplantation,National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Takuya Watanabe
- Department of Transplantation,National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Takuma Sato
- Department of Transplantation,National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Haruki Sunami
- Department of Transplantation,National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masanobu Yanase
- Department of Transplantation,National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hiroki Hata
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Toshimitsu Hamasaki
- Department of Data Science, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Takeshi Nakatani
- Department of Transplantation,National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masafumi Kitakaze
- Department of Clinical Research, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Norihide Fukushima
- Department of Transplantation,National Cerebral and Cardiovascular Center, Osaka, Japan
| |
Collapse
|
39
|
Jaenisch RB, Quagliotto E, Chechi C, Calegari L, Dos Santos F, Borghi-Silva A, Dal Lago P. Respiratory Muscle Training Improves Chemoreflex Response, Heart Rate Variability, and Respiratory Mechanics in Rats With Heart Failure. Can J Cardiol 2016; 33:508-514. [PMID: 28132741 DOI: 10.1016/j.cjca.2016.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 10/25/2016] [Accepted: 11/01/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The aim of the present report was to evaluate respiratory muscle training (RMT) effects on hemodynamic function, chemoreflex response, heart rate variability, and respiratory mechanics in rats with heart failure (HF rats). METHODS Wistar rats were divided into 4 groups: sedentary-sham (Sed-Sham, n = 8), respiratory muscle trained-sham (RMT-Sham, n = 8), sedentary-HF (Sed-HF, n = 8) and respiratory muscle trained-HF (RMT-HF, n = 8). Animals were submitted to an RMT protocol performed 30 minutes per day, 5 days per week for 6 weeks, whereas the sedentary animals did not exercise. RESULTS In HF rats, RMT promoted the reduction of left ventricular end-diastolic pressure, right ventricular hypertrophy, and pulmonary edema. Moreover, RMT produced a reduction in pressure response during chemoreflex activation, sympathetic modulation, and sympathetic vagal balance in addition to an increase in parasympathetic modulation. Also after RMT, HF rats demonstrated a reduction in respiratory system resistance, tissue resistance, Newtonian resistance, respiratory system compliance, and quasistatic compliance. CONCLUSIONS These findings suggested that 6 weeks of RMT in HF rats promoted beneficial adaptations in hemodynamics, autonomic function, and respiratory mechanics and attenuated pressure response evoked by chemoreflex activation in HF rats.
Collapse
Affiliation(s)
- Rodrigo B Jaenisch
- Post Graduation Program in Health Sciences, Laboratory of Experimental Physiology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Edson Quagliotto
- Post Graduation Program in Health Sciences, Laboratory of Experimental Physiology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Chalyne Chechi
- Post Graduation Program in Health Sciences, Laboratory of Experimental Physiology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Leonardo Calegari
- Post Graduation Program in Health Sciences, Laboratory of Experimental Physiology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Fernando Dos Santos
- Laboratory of Experimental Hypertension, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Pedro Dal Lago
- Post Graduation Program in Health Sciences, Laboratory of Experimental Physiology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Post Graduation Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
| |
Collapse
|
40
|
Jaiswal A, Chichra A, Nguyen VQ, Gadiraju TV, Le Jemtel TH. Challenges in the Management of Patients with Chronic Obstructive Pulmonary Disease and Heart Failure With Reduced Ejection Fraction. Curr Heart Fail Rep 2016; 13:30-6. [PMID: 26780914 DOI: 10.1007/s11897-016-0278-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) and heart failure with reduced ejection fraction (HFrEF) commonly coexist in clinical practice. The prevalence of COPD among HFrEF patients ranges from 20 to 32 %. On the other hand; HFrEF is prevalent in more than 20 % of COPD patients. With an aging population, the number of patients with coexisting COPD and HFrEF is on rise. Coexisting COPD and HFrEF presents a unique diagnostic and therapeutic clinical conundrum. Common symptoms shared by both conditions mask the early referral and detection of the other. Beta blockers (BB), angiotensin-converting enzyme inhibitors, and aldosterone antagonists have been shown to reduce hospitalizations, morbidity, and mortality in HFrEF while long-acting inhaled bronchodilators (beta-2-agonists and anticholinergics) and corticosteroids have been endorsed for COPD treatment. The opposing pharmacotherapy of BBs and beta-2-agonists highlight the conflict in prescribing BBs in COPD and beta-2-agonists in HFrEF. This has resulted in underutilization of evidence-based therapy for HFrEF in COPD patients owing to fear of adverse effects. This review aims to provide an update and current perspective on diagnostic and therapeutic management of patients with coexisting COPD and HFrEF.
Collapse
Affiliation(s)
- Abhishek Jaiswal
- Tulane School of Medicine, Tulane University Heart and Vascular Institute, 1430 Tulane Avenue, SL-48, New Orleans, LA, 70112, USA
| | - Astha Chichra
- Division of Pulmonary and critical care medicine, Tulane School of Medicine, 1430 Tulane Avenue, SL-48, New Orleans, LA, 70112, USA
| | - Vinh Q Nguyen
- Tulane School of Medicine, Tulane University Heart and Vascular Institute, 1430 Tulane Avenue, SL-48, New Orleans, LA, 70112, USA
| | - Taraka V Gadiraju
- Tulane School of Medicine, Tulane University Heart and Vascular Institute, 1430 Tulane Avenue, SL-48, New Orleans, LA, 70112, USA
| | - Thierry H Le Jemtel
- Tulane School of Medicine, Tulane University Heart and Vascular Institute, 1430 Tulane Avenue, SL-48, New Orleans, LA, 70112, USA.
| |
Collapse
|
41
|
Chase SC, Wheatley CM, Olson LJ, Beck KC, Wentz RJ, Snyder EM, Taylor BJ, Johnson BD. Impact of chronic systolic heart failure on lung structure-function relationships in large airways. Physiol Rep 2016; 4:4/13/e12867. [PMID: 27418546 PMCID: PMC4945845 DOI: 10.14814/phy2.12867] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 06/22/2016] [Indexed: 11/24/2022] Open
Abstract
Heart failure (HF) is often associated with pulmonary congestion, reduced lung function, abnormal gas exchange, and dyspnea. We tested whether pulmonary congestion is associated with expanded vascular beds or an actual increase in extravascular lung water (EVLW) and how airway caliber is affected in stable HF. Subsequently we assessed the influence of an inhaled short acting beta agonist (SABA). Thirty‐one HF (7F; age, 62 ± 11 years; ht. 175 ± 9 cm; wt. 91 ± 17 kg; LVEF, 28 ± 15%) and 29 controls (11F; age; 56 ± 11 years; ht. 174 ± 8 cm; wt. 77 ± 14 kg) completed the study. Subjects performed PFTs and a chest computed tomography (CT) scan before and after SABA. CT measures of attenuation, skew, and kurtosis were obtained from areas of lung tissue to assess EVLW. Airway luminal areas and wall thicknesses were also measured. CT tissue density suggested increased EVLW in HF without differences in the ratio of airway wall thickness to luminal area or luminal area to TLC (skew: 2.85 ± 1.08 vs. 2.11 ± 0.79, P < 0.01; Kurtosis: 15.5 ± 9.5 vs. 9.3 ± 5.5 P < 0.01; control vs. HF). PFTs were decreased in HF at baseline (% predicted FVC:101 ± 15% vs. 83 ± 18%, P < 0.01;FEV1:103 ± 15% vs. 82 ± 19%, P < 0.01;FEF25–75: 118 ± 36% vs. 86 ± 36%, P < 0.01; control vs. HF). Airway luminal areas, but not CT measures, were correlated with PFTs at baseline. The SABA cleared EVLW and decreased airway wall thickness but did not change luminal area. Patients with HF had evidence of increased EVLW, but not an expanded bronchial circulation. Airway caliber was maintained relative to controls, despite reductions in lung volume and flow rates. SABA improved lung function, primarily by reducing EVLW.
Collapse
Affiliation(s)
- Steven C Chase
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | | | - Lyle J Olson
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Kenneth C Beck
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Robert J Wentz
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Eric M Snyder
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Bryan J Taylor
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Bruce D Johnson
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
42
|
Sani MU, Cotter G, Davison BA, Mayosi BM, Damasceno A, Edwards C, Ogah OS, Mondo C, Dzudie A, Ojji DB, Kouam Kouam C, Suliman A, Yonga G, Abdou Ba S, Maru F, Alemayehu B, Sliwa K. Symptoms and Signs of Heart Failure at Admission and Discharge and Outcomes in the Sub-Saharan Acute Heart Failure (THESUS-HF) Registry. J Card Fail 2016; 23:739-742. [PMID: 27664511 DOI: 10.1016/j.cardfail.2016.09.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 09/02/2016] [Accepted: 09/13/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Symptoms and signs of heart failure (HF) are the most common reasons for admission to hospital for acute HF (AHF) and are used routinely throughout admission to assess the severity of disease and response to therapy. METHODS AND RESULTS The data were collected in The Sub-Saharan Africa Survey on Heart Failure (THESUS-HF) study, a prospective, multicenter, observational survey of AHF from 9 countries in sub-Saharan Africa. A total of 1006 patients, ≥12 years of age, hospitalized for AHF were recruited. Symptoms and signs of HF and changes in dyspnea and well-being, relative to admission, were assessed at entry and on days 1, 2, and 7 (or on discharge if earlier) and included oxygen saturation, degree of edema and rales, body weight, and level of orthopnea. The patient determined dyspnea and general well-being, whereas the physician determined symptoms and signs of HF, as well as improvements in vital sign measurement, throughout the admission. After multivariable adjustment, baseline rales and changes to day 7 or discharge in general well-being predicted death or HF hospitalization through day 60, and baseline orthopnea, edema, rales, oxygen saturation, and changes to day 7 or on discharge in respiratory rate and general well-being were predictive of death through day 180. CONCLUSIONS In AHF patients in sub-Saharan Africa, symptoms and signs of HF improve throughout admission, and simple assessments, including edema, rales, oxygen saturation, respiratory rate, and asking the patient about general well-being, are valuable tools in patients' clinical assessment.
Collapse
Affiliation(s)
- Mahmoud U Sani
- Department of Medicine, Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Nigeria.
| | - Gad Cotter
- Momentum Research, Durham, North Carolina, United States
| | - Beth A Davison
- Momentum Research, Durham, North Carolina, United States
| | - Bongani M Mayosi
- Department of Medicine, GF Jooste and Groote Schuur Hospitals, University of Cape Town, Cape Town, South Africa
| | | | | | - Okechukwu S Ogah
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | | | - Anastase Dzudie
- Department of Internal Medicine, Douala General Hospital and Buea Faculty of Health Sciences, Douala, Cameroon
| | - Dike B Ojji
- Department of Medicine, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Charles Kouam Kouam
- Department of Internal Medicine, Douala General Hospital and Buea Faculty of Health Sciences, Douala, Cameroon
| | - Ahmed Suliman
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Gerald Yonga
- Department of Medicine, Aga Khan University, Nairobi, Kenya
| | - Sergine Abdou Ba
- Service de Cardiologie, Faculté de Médecine de Dakar, Dakar, Senegal
| | - Fikru Maru
- Addis Cardiac Hospital, Addis Ababa, Ethiopia
| | | | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| |
Collapse
|
43
|
Pacheco DM, Silveira VD, Thomaz A, Nunes RB, Elsner VR, Dal Lago P. Chronic heart failure modifies respiratory mechanics in rats: a randomized controlled trial. Braz J Phys Ther 2016; 20:320-7. [PMID: 27556388 PMCID: PMC5015674 DOI: 10.1590/bjpt-rbf.2014.0163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 01/18/2016] [Indexed: 11/22/2022] Open
Abstract
Objective To analyze respiratory mechanics and hemodynamic alterations in an experimental model of chronic heart failure (CHF) following myocardial infarction. Method Twenty-seven male adult Wistar rats were randomized to CHF group (n=12) or Sham group (n=15). Ten weeks after coronary ligation or sham surgery, the animals were anesthetized and submitted to respiratory mechanics and hemodynamic measurements. Pulmonary edema as well as cardiac remodeling were measured. Results The CHF rats showed pulmonary edema 26% higher than the Sham group. The respiratory system compliance (Crs) and the total lung capacity (TLC) were lower (40% and 27%, respectively) in the CHF rats when compared to the Sham group (P<0.01). There was also an increase in tissue resistance (Gti) and elastance (Hti) (28% and 45%, respectively) in the CHF group. Moreover, left ventricular end-diastolic pressure was higher (32 mmHg vs 4 mmHg, P<0.01), while the left ventricular systolic pressure was lower (118 mmHg vs 130 mmHg, P=0.02) in the CHF group when compared to the control. Pearson’s correlation coefficient showed a negative association between pulmonary edema and Crs (r=–0.70, P=0.0001) and between pulmonary edema and TLC (r=–0.67, P=0.0034). Pulmonary edema correlated positively with Gti (r=0.68, P=0.001) and Hti (r=0.68, P=0.001). Finally, there was a strong positive relationship between pulmonary edema and heart weight (r=0.80, P=0.001). Conclusion Rats with CHF present important changes in hemodynamic and respiratory mechanics, which may be associated with alterations in cardiopulmonary interactions.
Collapse
Affiliation(s)
- Deise M Pacheco
- Laboratório de Fisiologia Cardiovascular, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.,Programa de Pós-graduação em Ciências da Saúde, UFCSPA, Porto Alegre, RS, Brazil
| | - Viviane D Silveira
- Laboratório de Fisiologia Cardiovascular, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Alex Thomaz
- Laboratório de Fisiologia Cardiovascular, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Ramiro B Nunes
- Laboratório de Fisiologia Cardiovascular, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.,Programa de Pós-graduação em Ciências da Reabilitação, UFCSPA, Porto Alegre, RS, Brazil
| | - Viviane R Elsner
- Laboratório de Fisiologia Cardiovascular, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.,Programa de Pós-graduação em Biociências e Reabilitação, Centro Universitário Metodista do IPA, Porto Alegre, RS, Brazil
| | - Pedro Dal Lago
- Laboratório de Fisiologia Cardiovascular, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.,Programa de Pós-graduação em Ciências da Saúde, UFCSPA, Porto Alegre, RS, Brazil.,Programa de Pós-graduação em Ciências da Reabilitação, UFCSPA, Porto Alegre, RS, Brazil
| |
Collapse
|
44
|
Malaspinas I, Petak F, Chok L, Perrin A, Martin AL, Beghetti M, Habre W. Surgical Repair of Mitral Valve Disease in Children: Perioperative Changes in Respiratory Function. J Cardiothorac Vasc Anesth 2016; 30:1286-95. [PMID: 27495965 DOI: 10.1053/j.jvca.2016.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess the profile of changes in airway and respiratory tissue mechanics within a follow-up study performed in children with mitral valve disease, before and after surgical valve repair. DESIGN Perioperative measurements in a prospective, consecutive cross-sectional study. SETTING University hospital, tertiary care teaching hospital PARTICIPANTS The study comprised 24 children with congenital or post-rheumatic mitral valve insufficiency. INTERVENTIONS Input impedance of the respiratory system during spontaneous breathing was measured before and 5 days and 3 weeks after mitral valve surgery. In addition, airway and respiratory tissue mechanics and pulmonary arterial pressure were assessed with the patient under general anesthesia preoperatively and immediately postoperatively. Respiratory tissue elastance and changes in airway measurements were estimated from forced oscillatory impedance data by fitting an appropriate model. MEASUREMENT AND MAIN RESULTS Relating airway and respiratory tissue mechanics to previously established reference values obtained in age-matched healthy control patients revealed abnormal respiratory function (135±6.2% and 148±13% in respiratory elastance and resistance, respectively; p<0.001). Improvement in the airway properties was observed immediately after surgery (-15.2±3.4%; p<0.005) and lasted for the study period (-19±4.1%; p<0.001). Respiratory tissue elastance, which correlated preoperatively to the diastolic pulmonary arterial pressure, decreased only 5 days postoperatively (-20.6±4.1%; p<0.005). However, there was no evidence of a clear, immediate effect of surgery on the tissue mechanical parameters measured intraoperatively despite a decrease in diastolic pulmonary pressure. CONCLUSIONS Mitral valve disease in children leads to abnormal airway and respiratory tissue mechanics. Even though surgical repair of mitral insufficiency alleviates abnormal airway function, residual lung tissue stiffening may persist even weeks after the surgery, contributing to a sustained impairment in lung function.
Collapse
Affiliation(s)
- Iliona Malaspinas
- Pediatric Anesthesia Unit, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland; †Unit for Anesthesiological Investigations, Department of Anesthesiology, Pharmacology and Intensive Care, University of Geneva, Geneva, Switzerland; ‡Pediatric Cardiology Unit, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Ferenc Petak
- §Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Lionel Chok
- Pediatric Anesthesia Unit, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Anne Perrin
- Pediatric Anesthesia Unit, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Anne-Laure Martin
- ‡Pediatric Cardiology Unit, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Maurice Beghetti
- ‡Pediatric Cardiology Unit, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Walid Habre
- Pediatric Anesthesia Unit, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland; †Unit for Anesthesiological Investigations, Department of Anesthesiology, Pharmacology and Intensive Care, University of Geneva, Geneva, Switzerland.
| |
Collapse
|
45
|
Dean KE, Lin F, Kampaktsis PN, George MP, Giambrone A, Coya AB, Juluru K. Semi-automated Quantification of Lung Density on Chest CT Used as a Predictive Biomarker of Pulmonary Venous Hypertension. Acad Radiol 2016; 23:935-9. [PMID: 27209264 DOI: 10.1016/j.acra.2016.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/11/2016] [Accepted: 03/14/2016] [Indexed: 01/25/2023]
Abstract
RATIONALE AND OBJECTIVES We sought to determine if lung densities derived from computed tomography scans could be used to identify patients with pulmonary venous hypertension (Group II pulmonary hypertension [PH]), and to compare the performance of this metric with previously described metrics. MATERIALS AND METHODS Patients were retrospectively included from a single-center cohort of patients with aortic stenosis being evaluated for transcatheter aortic valve replacement from April 2009 to July 2014. Fifty-four patients met inclusion criteria. Thirty-three had PH (pulmonary arterial pressure [PAP] ≥25 mmHg). Thirty-two had Group II PH (pulmonary capillary wedge pressure [PCWP] ≥15 mmHg). Mean lung density (mLD) was measured from chest computed tomography scans using semi-automated techniques. Aortic diameter (mAo) and main pulmonary artery diameter (mPA) were measured manually. These metrics were correlated with PAP and PCWP values. RESULTS mLD was significantly correlated with PCWP (R = 0.45, P = .0006) and significantly higher in patients with elevated PCWP (P = .006). mPA was weakly correlated with PCWP (R = 0.28, P = .04), but not significantly different in patients with elevated PCWP. mPA/mAo was not significantly correlated with PCWP, nor was it significantly different in patients with elevated PCWP. mLD, mPA, and mPA/mAo were all significantly correlated with PAP and were significantly higher in patients with PH. CONCLUSIONS Of all metrics, only mLD was significantly correlated with PCWP and served to differentiate patients with elevated and normal PCWP. As such, mLD may contribute to a noninvasive biomarker of pulmonary venous hypertension.
Collapse
Affiliation(s)
- Kathryn E Dean
- Department of Radiology, Weill Cornell Medical College, 525 E. 68th St., New York, NY 10065
| | - Fay Lin
- Department of Radiology, Weill Cornell Medical College, 525 E. 68th St., New York, NY 10065; Department of Cardiology, Weill Cornell Medical College, New York, New York
| | | | - M Patricia George
- Department of Pulmonology, Immunology, Allergy and Critical Care, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ashley Giambrone
- Department of Health Care Policy and Research, Weill Cornell Medical College, New York, New York
| | - Adrienne B Coya
- Imaging Data Evaluation and Analytics Laboratory (IDEAL), Department of Radiology, Weill Cornell Medical College, New York, New York
| | - Krishna Juluru
- Department of Radiology, Weill Cornell Medical College, 525 E. 68th St., New York, NY 10065.
| |
Collapse
|
46
|
Mateika JH, Komnenov D. Intermittent hypoxia initiated plasticity in humans: A multipronged therapeutic approach to treat sleep apnea and overlapping co-morbidities. Exp Neurol 2016; 287:113-129. [PMID: 27170208 DOI: 10.1016/j.expneurol.2016.05.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/18/2016] [Accepted: 05/03/2016] [Indexed: 10/21/2022]
Abstract
Over the past three decades exposure to intermittent hypoxia (IH) has generally been considered a stimulus associated with a number of detrimental outcomes. However, there is sufficient evidence to link IH to many beneficial outcomes but they have largely been ignored, particularly in the field of sleep medicine in the United States. Recent reviews have postulated that this apparent contradiction is related to the severity and duration of exposure to IH; mild forms of IH initiate beneficial outcomes while severe forms of IH are coupled to detrimental consequences. In the present review we explore the role that IH has in initiating respiratory plasticity and the potential this form of plasticity has to mitigate obstructive sleep apnea (OSA) in humans. In taking this approach, we address the possibility that IH could serve as an adjunct therapy coupled with continuous positive airway pressure (CPAP) to treat OSA. Our working hypothesis is that exposure to mild IH leads to respiratory plasticity that manifests in increased stability of the upper airway, which could ultimately reduce the CPAP required to treat OSA. In turn, this reduction could increase CPAP compliance and extend the length of treatment each night, which might improve the magnitude of outcome measures. Improved treatment compliance coupled with the direct effect that IH has on numerous overlapping conditions (i.e. asthma, chronic obstructive pulmonary disease, spinal cord injury) may well lead to substantial improvements that exceed outcomes following treatment with CPAP alone. Overall, this review will consider evidence from the published literature which suggests that IH could serve as an effective multipronged therapeutic approach to treat sleep apnea and its overlapping co-morbidities.
Collapse
Affiliation(s)
- Jason H Mateika
- John D. Dingell Veterans Affairs Medical Center, Detroit, MI 48201, United States; Department of Physiology, Wayne State University School of Medicine, Detroit, MI 48201, United States; Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI 48201, United States.
| | - Dragana Komnenov
- John D. Dingell Veterans Affairs Medical Center, Detroit, MI 48201, United States; Department of Physiology, Wayne State University School of Medicine, Detroit, MI 48201, United States
| |
Collapse
|
47
|
Park JJ, Choi DJ, Yoon CH, Oh IY, Lee JH, Ahn S, Yoo BS, Kang SM, Kim JJ, Baek SH, Cho MC, Jeon ES, Chae SC, Ryu KH, Oh BH. The prognostic value of arterial blood gas analysis in high-risk acute heart failure patients: an analysis of the Korean Heart Failure (KorHF) registry. Eur J Heart Fail 2016; 17:601-11. [PMID: 26096207 DOI: 10.1002/ejhf.276] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 02/24/2015] [Accepted: 03/04/2015] [Indexed: 02/01/2023] Open
Abstract
AIMS In acute heart failure (AHF) patients, pulmonary oedema and low tissue perfusion may lead to changes in the acid-base balance, which may be associated with worse outcomes. METHODS AND RESULTS In this prospective nationwide cohort study from 24 academic hospitals, arterial blood gas (ABG) was measured in 1982 AHF patients at hospital admission. Acidosis was defined as pH <7.36, and alkalosis as pH >7.44. Mortality was stratified according to ABG results. Overall, 19% had acidosis, 37% had normal pH, and 44% had alkalosis. The most common type of acidosis was the mixed type (42%) followed by metabolic acidosis (40%), and the most common type of alkalosis was respiratory alkalosis (58%). At 12 months' follow-up 304 patients (15%) died. Patients with acidosis had higher mortality (acidosis 19.5%, neutral pH 13.7%, alkalosis 14.9%; P = 0.007). In the Cox proportional-hazards regression model, acidosis was a significant predictor of mortality (hazard ratio 1.93; 95% confidence intervals 1.27-2.93) along with N-terminal pro-brain type natriuretic peptide (NT-proBNP), among others. In contrast, alkalosis was not associated with increased mortality. pH had an incremental prognostic value over NT-proBNP (net reclassification improvement 30%; P < 0.001), and ABG analysis identified extra patients at increased risk for mortality among patients with an NT-proBNP level less than the median (12-month mortality 17.5% vs. 9.9%; P = 0.009). CONCLUSION In high-risk AHF patients, the most common acid-base imbalance is respiratory alkalosis. Acidosis is observed in every fifth patient and is a significant predictor of mortality. pH provides an additional prognostic value and may be used to optimize risk stratification in high-risk AHF patients.
Collapse
Affiliation(s)
- Jin Joo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong-Ju Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chang-Hwan Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Il-Young Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ju Hyun Lee
- the Medical Research Collaborating Centre, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Soyeon Ahn
- the Medical Research Collaborating Centre, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Byung-Su Yoo
- Division of Cardiology, Yonsei University Wonju Severance Christian Hospital, Wonju, Korea
| | - Seok-Min Kang
- Division of Cardiology, Yonsei University Severance Hospital, Seoul, Korea
| | - Jae-Joong Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Korea
| | - Sang-Hong Baek
- Department of Internal Medicine, The Catholic University of Korea, Seoul St Mary's Hospital, Seoul, Korea
| | - Myeong-Chan Cho
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Eun-Seok Jeon
- Department of Internal Medicine, Sungkyunkwan University College of Medicine, Samsung Medical Centre, Seoul, Korea
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University College of Medicine, Daegu, Korea
| | - Kyu-Hyung Ryu
- Department of Internal Medicine, Konkuk University Medical Centre, Seoul, Korea
| | - Byung-Hee Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | | |
Collapse
|
48
|
Dixon DL, Bersten AD, Lawrence MD, Bihari S, Crouch G, De Pasquale CG. Lung surfactant in chronic heart failure patients. Int J Cardiol 2016; 207:213-4. [PMID: 26803248 DOI: 10.1016/j.ijcard.2016.01.134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 01/05/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Dani-Louise Dixon
- Intensive and Critical Care Unit, Flinders Medical Centre, Adelaide, Australia; Department of Critical Care Medicine, Flinders University, Adelaide, Australia.
| | - Andrew D Bersten
- Intensive and Critical Care Unit, Flinders Medical Centre, Adelaide, Australia; Department of Critical Care Medicine, Flinders University, Adelaide, Australia
| | - Mark D Lawrence
- Department of Critical Care Medicine, Flinders University, Adelaide, Australia
| | - Shailesh Bihari
- Intensive and Critical Care Unit, Flinders Medical Centre, Adelaide, Australia; Department of Critical Care Medicine, Flinders University, Adelaide, Australia
| | - Gareth Crouch
- Cardiac Services, Flinders Medical Centre, Adelaide, Australia; Department of Medicine, Flinders University, Adelaide, Australia
| | - Carmine G De Pasquale
- Cardiac Services, Flinders Medical Centre, Adelaide, Australia; Department of Medicine, Flinders University, Adelaide, Australia
| |
Collapse
|
49
|
Left atrio-vertebral ratio: A new computed-tomography measurement to identify left atrial dilation. Eur J Radiol 2016; 85:255-260. [PMID: 26724674 DOI: 10.1016/j.ejrad.2015.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 11/09/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND Left cardiac chambers dilation, interstitial lung changes and pleural effusions are the characteristics of cardiogenic pulmonary oedema on computed tomography (CT) of the chest but mensuration of the left atrial size is not routinely performed. Cardiac chambers normal dimensions are known to be proportional to the patient's build and anthropomorphic data but adjustment of chambers dimensions to available elements seen on the axial CT images has never been evaluated before. OBJECTIVES Our objective was to use data easily available on axial images to directly scale the left atrium. We chose to divide the left atrial diameter by the thoracic vertebral diameter, using the latter as a body-mass indicator. As a preliminary study, we aimed to evaluate the range of values of this left atrio-vertebral ratio (LAVR) by comparing patients suffering from cardiogenic pulmonary oedema with patients free of cardiac disease. We hypothesized that if the difference of values in these two populations of patients was significant enough, this ratio would be relevant and could be used as a quick criterion in different clinical situations. METHOD Two radiologists reviewed CT scans of 32 of patients free of cardiac disease and 40 patients in acute cardiac failure. The maximum diameter of the left atrium at the level of the right inferior pulmonary vein was divided by the vertebral transverse diameter to generate a left atrio-vertebral ratio. Receiver operating characteristic curves identified the threshold associated with pulmonary oedema. MEASUREMENTS AND MAIN RESULTS The mean LAVR was 1.85 ± 0.27 in asymptomatic patients and 2.48 ± 0.35 in patients with pulmonary oedema. A LAVR of 2.1 yielded 85% sensitivity and 88% specificity for the diagnosis of cardiogenic pulmonary oedema. CONCLUSIONS LAVR is a simple new measure directly scaling the left atrial diameter to the anthropomorphic characteristics of the patient. In our series, a ratio above 2.1 is strongly associated with cardiogenic pulmonary oedema indirectly suggesting left atrial dilation. The results were significantly different between the two populations of patients (no heart condition versus cardiogenic pulmonary oedema) suggesting a high potential for clinical application.
Collapse
|
50
|
Journal of Clinical Monitoring and Computing 2015 end of year summary: respiration. J Clin Monit Comput 2015; 30:7-12. [PMID: 26719297 DOI: 10.1007/s10877-015-9820-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 12/17/2015] [Indexed: 11/27/2022]
Abstract
This paper reviews 17 papers or commentaries published in Journal of Clinical Monitoring and Computing in 2015, within the field of respiration. Papers were published covering monitoring and training of breathing, monitoring of gas exchange, hypoxemia and acid-base, and CO2 monitoring.
Collapse
|