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Trittmann JK, Almazroue H, Nelin LD, Shaffer TA, Celestine CR, Green HW, Malbrue RA. PATET ratio by Doppler echocardiography: noninvasive detection of pediatric pulmonary arterial hypertension. Pediatr Res 2022; 92:631-636. [PMID: 34795389 PMCID: PMC9114166 DOI: 10.1038/s41390-021-01840-9] [Citation(s) in RCA: 1] [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: 05/26/2021] [Revised: 10/09/2021] [Accepted: 10/28/2021] [Indexed: 11/12/2022]
Abstract
Pulmonary artery acceleration time (PAT) and PAT: ejection time (PATET) ratio are echocardiographic measurements of pulmonary arterial hypertension (PAH). These noninvasive quantitative measurements are ideal to follow longitudinally through the clinical course of PAH, especially as it relates to the need for and/or response to treatment. This review article focuses on the current literature of PATET measurement for infants and children as it relates to the shortening of the PATET ratio in PAH. At the same time, further development of PATET as an outcome measure for PAH in preclinical models, particularly mice, such that the field can move forward to human clinical studies that are both safe and effective. Here, we present what is known about PATET in infants and children and discuss what is known in preclinical models with particular emphasis on neonatal mouse models. In both animal models and human disease, PATET allows for longitudinal measurements in the same individual, leading to more precise determinations of disease/model progression and/or response to therapy. IMPACT: PATET ratio is a quantitative measurement by a noninvasive technique, Doppler echocardiography, providing clinicians a more precise/accurate, safe, and longitudinal assessment of pediatric PAH. We present a brief history/state of the art of PATET ratio to predict PAH in adults, children, infants, and fetuses, as well as in small animal models of PAH. In a preliminary study, PATET shortened by 18% during acute hypoxic exposure compared to pre-hypoxia. Studies are needed to establish PATET, especially in mouse models of disease, such as bronchopulmonary, as a routine measure of PAH.
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Affiliation(s)
- Jennifer K. Trittmann
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH,Department of Pediatrics, The Ohio State University, College of Medicine, Columbus, OH,Jennifer K. Trittmann, MD, MPH, Center for Perinatal Research, Abigail Wexner Research Institute at, Nationwide Children’s Hospital and, The Ohio State University, College of Medicine, Columbus, OH, USA,
| | - Hanadi Almazroue
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
| | - Leif D. Nelin
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH,Department of Pediatrics, The Ohio State University, College of Medicine, Columbus, OH
| | - Terri A. Shaffer
- Animal Resources Core, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
| | - Charanda R. Celestine
- Louisiana State University, School of Veterinary Medicine, Department of Veterinary Clinical Sciences, Baton Rouge, LA, USA
| | - Henry W. Green
- Louisiana State University, School of Veterinary Medicine, Department of Veterinary Clinical Sciences, Baton Rouge, LA, USA
| | - Raphael A. Malbrue
- Animal Resources Core, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH,The Ohio State University, College of Veterinary Medicine, Columbus, OH
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Deng J. Clinical application of pulmonary vascular resistance in patients with pulmonary arterial hypertension. J Cardiothorac Surg 2021; 16:311. [PMID: 34670595 PMCID: PMC8527803 DOI: 10.1186/s13019-021-01696-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/11/2021] [Indexed: 12/03/2022] Open
Abstract
Pulmonary arterial hypertension is a type of malignant pulmonary vascular disease, which is mainly caused by the increase of pulmonary vascular resistance due to the pathological changes of the pulmonary arteriole itself, which eventually leads to right heart failure and death. As one of the diagnostic indicators of hemodynamics, pulmonary vascular resistance plays an irreplaceable role in the pathophysiology, diagnosis and treatment of pulmonary arterial hypertension. It provides more references for the evaluation of pulmonary arterial hypertension patients. This article summarizes the clinical application of pulmonary vascular resistance in patients with pulmonary arterial hypertension.
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Affiliation(s)
- Jianying Deng
- Department of Cardiovascular Surgery, Chongqing Kanghua Zhonglian Cardiovascular Hospital, 168# Haier Road, District of Jiangbei, Chongqing, 400015, China.
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Engole YM, Lepira FB, Nlandu YM, Lubenga YS, Longo AL, Nkodila A, Makulo JRR, Mokoli VM, Bukabau JB, Mboliasa MFI, Kadima EM, Ilunga CK, Mvunzi TS, Nseka NM, Sumaili EK. Prevalence and factors associated with pulmonary arterial hypertension on maintenance hemodialysis patients in Kinshasa, Democratic Republic of Congo: a cross-sectional study. BMC Nephrol 2020; 21:460. [PMID: 33148221 PMCID: PMC7640388 DOI: 10.1186/s12882-020-02131-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 10/27/2020] [Indexed: 11/11/2022] Open
Abstract
Background Although cardiovascular diseases in particular Pulmonary Arterial Hypertension (PAH) is associated with, high morbid-mortality in chronic hemodialysis, but its magnitude remains paradoxically unknown in sub-Saharan Africa. The aim of this study was to evaluate the prevalence of PAH and associated factors in chronic hemodialysis in Sub-Saharan African population. Method In a cross-sectional study, patients treated with HD for at least 6 months in 4 hemodialysis centers were examined. PAH was defined as estimated systolic pulmonary arterial pressure (sPAP) ≥ 35 mmHg using transthoracic Doppler echocardiography performed 24 h after the HD session. Results Eighty-five HD patients were included; their average age was 52.6 ± 15.9 years. Fifty-seven patients (67.1%) were male. Mean duration of HD was 13.3 ± 11 months. With reference to vascular access, 12 (14.1%), 29 (34.1%) and 44 (51.8%) patients had AVF, tunneled cuff and temporary catheter, respectively. The underlying cause of ESRD was diabetes in 30 patients (35.3%). The prevalence of PAH was 29.4%. Patients with PAH had more hyponatremia (11 (44%) vs 10 (16.7%), p = 0.010). In multivariate analysis, unsecured healthcare funding (aOR 4, 95% CI [1.18–6.018]), arrhythmia (aOR 3, 95% CI [1.29–7.34]), vascular access change (aOR 4, 95% CI [1.18–7.51]) and diastolic dysfunction (aOR 5, 95% CI [1.35–9.57] were independently associated with PAH. Conclusion One third of hemodialysis patients exhibit PAH, which is independently associated with low socioeconomic status (unsecured funding, vascular access change) and cardiovascular complications (arrhythmia, diastolic dysfunction).
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Affiliation(s)
- Yannick Mompango Engole
- Nephrology Unit, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo.
| | - François Bompeka Lepira
- Nephrology Unit, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Yannick Mayamba Nlandu
- Nephrology Unit, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Yves Simbi Lubenga
- Cardiology Unit, University Hospital of Kinshasa, BP: 123, Kinshasa, XI, Democratic Republic of the Congo
| | | | - Aliocha Nkodila
- Nephrology Unit, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Vieux Momeme Mokoli
- Nephrology Unit, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Justine Busanga Bukabau
- Nephrology Unit, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Evariste Mukendi Kadima
- Nephrology Unit, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Cedric Kabemba Ilunga
- Nephrology Unit, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Tresor Swambulu Mvunzi
- Cardiology Unit, University Hospital of Kinshasa, BP: 123, Kinshasa, XI, Democratic Republic of the Congo
| | - Nazaire Mangani Nseka
- Nephrology Unit, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Ernest Kiswaya Sumaili
- Nephrology Unit, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
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Payzin KB, Savasoglu K, Alacacioglu I, Dalgic EE, Kucukzeybek BB, Calli AO, Bener S, Payzin S. BCR-ABL1-Negative Chronic Myeloproliferative Neoplasms and Pulmonary Hypertension: A Prospective Long-Term Follow-up Study of the Impact of Pulmonary Hypertension on Survival. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 21:125-131. [PMID: 32919926 DOI: 10.1016/j.clml.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 11/15/2022]
Abstract
PURPOSE To assess the prevalence of PHT in patients with BCR-ABL1-negative CMPN and to evaluate impact of PHT on survival during long-term follow-up. PATIENTS AND METHODS A total of 122 patients with BCR-ABL1-negative CMPN underwent transthoracic echocardiographic (TTE) evaluation at the beginning of study. Patients undergoing PHT on TTE examination were also evaluated by a pulmonologist. Patients were divided into 3 groups. Group A comprised patients with CMPN-related PHT; group B, patients with no PHT; and group C, patients with PHT due to secondary causes. Patients were evaluated again every 3 to 6 months. RESULTS PHT was detected in 33 (27%) of 122 patients. Eight (6.5%) had CMPN-related PHT and the remaining 25 (20.5%) had non-CMPN-related PHT. Positivity for JAK2 V617F mutation in the study population was 72.9%. Groups were similar with respect to hematologic parameters and gender. Follow-up times were as follows: median (range) time from diagnosis to TTE and study end were 34 (1-158) months and 107 (16-251) months, respectively, and from TTE to study end was 88 (7-110) months. No significant differences found among the groups in terms of median time from diagnosis to TTE, follow-up, and overall survival. CONCLUSION BCR-ABL1-negative CMPN patients had a lower prevalence of PHT compared to earlier studies. There was no statistically significant difference in median overall survival between patients with or without PHT. This may be because patients with PHT were asymptomatic and PHT was mild. The impact of PHT on survival was negligible.
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Affiliation(s)
- Kadriye Bahriye Payzin
- Division of Hematology, Department of Internal Medicine, Katip Celebi University School of Medicine, Ataturk Education and Research Hospital, Izmir, Turkey.
| | - Kaan Savasoglu
- Department of Genetics, Katip Celebi University School of Medicine, Ataturk Education and Research Hospital, Izmir, Turkey
| | - Inci Alacacioglu
- Department of Hematology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Elif Ebru Dalgic
- Department of Pulmonary Disease, Cigli Education and Research Hospital, Izmir, Turkey
| | - Betul Bolat Kucukzeybek
- Department of Pathology, Katip Celebi University School of Medicine, Ataturk Education and Research Hospital, Izmir, Turkey
| | - Aylin Orgen Calli
- Department of Pathology, Katip Celebi University School of Medicine, Ataturk Education and Research Hospital, Izmir, Turkey
| | - Sadi Bener
- Department of Pathology, Katip Celebi University School of Medicine, Ataturk Education and Research Hospital, Izmir, Turkey
| | - Serdar Payzin
- Department of Cardiology, Ege University Hospital, Bornova, Izmir, Turkey
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Ruocco G, Gavazzi A, Gonnelli S, Palazzuoli A. Pulmonary arterial hypertension and heart failure with preserved ejection fraction: are they so discordant? Cardiovasc Diagn Ther 2020; 10:534-545. [PMID: 32695633 DOI: 10.21037/cdt-19-405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Heart failure with preserved ejection fraction (HFpEF) and pulmonary arterial hypertension (PAH) are two emerging diseases focusing the attention of numerous researchers. In the last PAH guideline, there is a crossroad between the two diseases and pulmonary hypertension (PH) due to heart failure (HF) is categorized as subtype 2. In order to assess the correct diagnosis and management, it should be better understood the points of convergence and divergence of two diseases. Although, risk factors, demographic characteristics and haemodynamics are different, we report several similarities regarding vascular alterations, some aspects of cardiac remodelling, and clinical presentation. This model suggests HFpEF and PAH as two comparable conditions, with different cardiac adaptation and trajectories, linked to the intrinsic properties of either right and left ventricles. In both diseases the early pathophysiological mechanisms appear to begin from peripheral vasculature and to be backward transmitted to the larger arterial vascular district, and eventually to the myocardial structure. In this paper we would propose a simple approach to recognize the concordances and, all at once, distinguish the peculiarities of the two diseases.
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Affiliation(s)
- Gaetano Ruocco
- Cardiology Unit, Regina Montis Regalis Hospital, ASLCN1, Mondovì (Cuneo), Italy
| | - Antonello Gavazzi
- FROM Research Foundation of the Bergamo Hospital, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Stefano Gonnelli
- Cardiovascular Diseases Unit, Department of Internal Medicine, Le Scotte Hospital, University of Siena, Siena, Italy
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Department of Internal Medicine, Le Scotte Hospital, University of Siena, Siena, Italy
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Kim YW, Moon JY, Li WJ, Kim JH, Park YH, Lee JS, Jang Y. Effect of membrane insertion for tricuspid regurgitation using immersed-boundary lattice Boltzmann method. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 191:105421. [PMID: 32146209 DOI: 10.1016/j.cmpb.2020.105421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Tricuspid regurgitation is treated by valve repair or replacement. However, these methods have limitations, and alternative treatment methods are therefore required. OBJECTIVES In this study, a new method of tricuspid valve treatment using artificial membrane insertion is analyzed. We performed tricuspid valve simulations using an artificial membrane inserted into the right ventricle (RV) or right atrium (RA). METHODS We use the lattice Boltzmann method with the immersed boundary condition to model the structural motion of the valve leaflet. The effect of membrane insertion is analyzed in terms of the stress, force, and impulse on the valve leaflet, along with the velocity, pressure, jet volume, and Reynolds stress in the flow field. RESULTS While the use of either membrane (RA or RV) leads to improved valve closure relative to the use of no membrane, the RV membrane is more effective than the RA membrane in achieving improved valve closure. In addition, a larger membrane area with a shorter distance between the leaflet and membrane increases membrane efficacy. CONCLUSION Our results suggest that membrane insertion can form an effective new method for the treatment of tricuspid regurgitation.
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Affiliation(s)
- Young Woo Kim
- Department of Mechanical Engineering, Yonsei University, Korea
| | | | - Wen Jie Li
- Department of Mechanical Engineering, Yonsei University, Korea
| | - June-Hong Kim
- Cardiovascular Center, Pusan National University Yangsan Hospital, Korea
| | - Yong-Hyun Park
- Cardiovascular Center, Pusan National University Yangsan Hospital, Korea
| | - Joon Sang Lee
- Department of Mechanical Engineering, Yonsei University, Korea.
| | - Yeongho Jang
- Department of Pain Medicine and Anesthesiology, Saedongsan Hospital, Korea
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7
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Binder ZW, O'Brien SE, Boyle TP, Cabral HJ, Sekhavat S, Pare JR. Novice Physician Ultrasound Evaluation of Pediatric Tricuspid Regurgitant Jet Velocity. West J Emerg Med 2020; 21:1029-1035. [PMID: 32726279 PMCID: PMC7390548 DOI: 10.5811/westjem.2020.3.45882] [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: 11/13/2019] [Accepted: 03/28/2020] [Indexed: 11/20/2022] Open
Abstract
Introduction Pulmonary hypertension, associated with high mortality in pediatric patients, is traditionally screened for by trained professionals by measuring a tricuspid regurgitant jet velocity (TRJV). Our objective was to test the feasibility of novice physician sonographers (NPS) to perform echocardiograms of adequate quality to exclude pathology (defined as TRJV > 2.5 meters per second). Methods We conducted a cross-sectional study of NPS to assess TRJV by echocardiogram in an urban pediatric emergency department. NPS completed an educational course consisting of a didactic curriculum and hands-on workshop. NPS enrolled a convenience sample of patients aged 7–21 years. Our primary outcome was the proportion of echocardiograms with images of adequate quality to exclude pathology. Our secondary outcome was NPS performance on four image elements. We present descriptive statistics, binomial proportions, kappa coefficients, and logistic regression analysis. Results Eight NPS completed 80 echocardiograms. We found 82.5% (95% confidence interval [CI], 74.2–90.8) of echocardiograms had images of adequate quality to exclude pathology. Among image elements, NPS obtained a satisfactory, apical 4-chamber view in 85% (95% CI, 77.1–92.9); positioned the color box accurately 65% (95% CI, 54.5–75.5); optimized TRJV color signal 78.7% (95% CI, 69.8–87.7); and optimized continuous-wave Doppler in 55% (95% CI, 44.1–66.0) of echocardiograms. Conclusion NPS obtained images of adequate quality to exclude pathology in a majority of studies; however, optimized acquisition of specific image elements varied. This work establishes the basis for future study of NPS assessment of TRJV pathology when elevated pulmonary pressures are of clinical concern.
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Affiliation(s)
- Zachary W Binder
- Boston Medical Center, Boston University School of Medicine, Department of Pediatrics, Boston, Massachusetts
| | - Sharon E O'Brien
- Boston Medical Center, Boston University School of Medicine, Department of Pediatrics, Boston, Massachusetts
| | - Tehnaz P Boyle
- Boston Medical Center, Boston University School of Medicine, Department of Pediatrics, Boston, Massachusetts
| | - Howard J Cabral
- Boston University School of Public Health, Department of Biostatistics, Boston, Massachusetts
| | - Sepehr Sekhavat
- Boston Medical Center, Boston University School of Medicine, Department of Pediatrics, Boston, Massachusetts
| | - Joseph R Pare
- Boston Medical Center, Boston University School of Medicine, Department of Emergency Medicine, Boston, Massachusetts
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8
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Krishnan M, Barnett CF. Advances in the diagnosis and treatment of HIV-associated pulmonary arterial hypertension. Expert Opin Orphan Drugs 2020. [DOI: 10.1080/21678707.2020.1770080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Mrinalini Krishnan
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Department of Cardiology, Division of Advanced Heart Failure, Washington, D.C, USA
| | - Christopher F. Barnett
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Department of Cardiology, Division of Advanced Heart Failure, Washington, D.C, USA
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9
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Basyal B, Jarrett H, Barnett CF. Pulmonary Hypertension in HIV. Can J Cardiol 2019; 35:288-298. [PMID: 30825951 DOI: 10.1016/j.cjca.2019.01.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/17/2019] [Accepted: 01/17/2019] [Indexed: 12/16/2022] Open
Abstract
Human immunodeficiency virus-associated pulmonary arterial hypertension (HIV-PAH) is important to recognize given its association with significant morbidity and mortality. With the introduction of antiretroviral therapy, the focus of disease management has largely shifted from treating immunodeficiency-related opportunistic infections to managing chronic cardiopulmonary complications. Symptoms are nonspecific, and a high index of clinical suspicion is needed to avoid significant delay in the diagnosis of HIV-PAH. Although several viral proteins have been implicated in the pathogenesis of HIV-PAH, the exact mechanism remains uncertain. Further studies are needed to elucidate precise pathogenic mechanisms, early diagnostic tools, and novel therapeutic targets to improve prognosis of this severe complication.
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Affiliation(s)
- Binaya Basyal
- MedStar Heart and Vascular Institute, Washington Hospital Center, Washington, DC, USA
| | - Harish Jarrett
- MedStar Heart and Vascular Institute, Washington Hospital Center, Washington, DC, USA; MedStar Georgetown University Hospital, Washington, DC, USA
| | - Christopher F Barnett
- MedStar Heart and Vascular Institute, Washington Hospital Center, Washington, DC, USA; MedStar Georgetown University Hospital, Washington, DC, USA.
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10
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Meng XY, Chen MY, Pan ZY, Lu YF, Wei W, Lu YG. Living Donor Liver Transplantation in Biliary Atresia Children with Pulmonary Hypertension. Int J Med Sci 2019; 16:1215-1220. [PMID: 31588186 PMCID: PMC6775259 DOI: 10.7150/ijms.34073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/17/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Though living donor liver transplantation (LDLT) is commonly performed for pediatric patients with biliary atresia (BA), pulmonary hypertension (PH) is seldom encountered or reported previously. The aim of this study is mainly to identify the prevalence of PH in pediatric patients undergoing liver transplantation and assess whether PH significantly augment the operative risk and evaluate the outcomes in this series of patients. DESIGN Retrospectively cohort study. SETTING Renji hospital, Shanghai, China. PARTICIPANTS This study comprised 161 pediatric patients undergoing LDLT. INTERVENTIONS Patient diagnosed of PH in preoperative examination was compared to those without PH in intra- or post- operative complications or outcomes. MEASUREMENTS AND MAIN RESULTS We collected clinical records of LDLT surgery for pediatric patients during the year of 2016 in our hospital. Results suggested that pediatric patients undergoing LDLT had a substantial number of PH with a prevalence of 16.1% in this study. No significant difference was identified between two groups of patients regarding intraoperative outcomes and postoperative complications and mortality. CONCLUSION LDLT is a safe procedure in a selected group of BA patients with PH, however, further long-term clinical investigations and mechanical researches are needed.
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Affiliation(s)
- Xiao-Yan Meng
- Department of Anesthesiology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200433, China
- Department of Anesthesiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Mi-Yuan Chen
- Department of Anesthesiology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Zhi-Ying Pan
- Department of Anesthesiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Ye-Feng Lu
- Department of Hepatic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Wei Wei
- Department of Medical Imaging-Ultrasound, JiaHui International Hospital, Shanghai, 200233, China
| | - Yu-Gang Lu
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China
- Department of Anesthesiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
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11
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Allanore Y, Gharibdoost F, Jamshidi AR, Javinani A, Avouac J, Rastkar E, Hooshmandi S, Kavosi H. Comparison of the clinical phenotype of systemic sclerosis patients in Iran and France in two university centers. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2019; 4:149-159. [PMID: 35382390 PMCID: PMC8922647 DOI: 10.1177/2397198318809224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/30/2018] [Indexed: 06/29/2024]
Abstract
OBJECTIVES Systemic sclerosis is a severe and rare chronic auto-immune multisystem disorder characterized by vasculopathy and skin stiffness. Ethnic and geographical origin can influence the outcomes. In this study, we compared the phenotypic characteristics of Iranian and French patients. METHODS This cross-sectional study was performed on 200 Iranian and 268 French systemic sclerosis patients. Iranian patients collected from the Iranian systemic sclerosis cohort of the Rheumatology Research Center, Shariati hospital, Tehran University of Medical Sciences. The French population was monocentric, and it was constituted by the patients included locally in the EUSTAR database in December 2016. RESULTS The mean age at onset was significantly lower in Iranian patients (35.58 ± 11.68 vs 47.06 ± 13.54, p-value < 0.001). The female-to-male ratio was approximately 5.2:1 and was not different in the two populations. The prevalence of diffuse cutaneous systemic sclerosis was significantly higher in Iranian patients (60.2% vs 42.85%, p-value < 0.001). Calcinosis cutis and joint synovitis were more prevalent in French patients (p-value = 0.013, <0.001). The positivity of anti-topoisomerase antibody was higher in Iranian patients, whereas the anti-centromere antibody predominated in French cases (p-value < 0.001). Restrictive pattern of pulmonary function test was more common in Iranian patients (p-value < 0.001), while estimated pulmonary arterial pressure by echocardiography was higher in French patients (p-value < 0.001). CONCLUSION It seems that systemic sclerosis occurred in younger ages among Iranian female with the predominance of diffuse cutaneous subtype. In addition, lung interstitial disease appeared to be more prevalent and severe in Iranians than French patients.
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Affiliation(s)
- Yannick Allanore
- Department of Rheumatology, Cochin Hospital, Paris Descartes University, Paris, France
| | - Farhad Gharibdoost
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Jamshidi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Javinani
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Jérôme Avouac
- Department of Rheumatology, Cochin Hospital, Paris Descartes University, Paris, France
| | - Elnaz Rastkar
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sadid Hooshmandi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hoda Kavosi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Prognostic Value of Right Ventricular Strain Using Speckle-Tracking Echocardiography in Pulmonary Hypertension: A Systematic Review and Meta-analysis. Can J Cardiol 2018; 34:1069-1078. [DOI: 10.1016/j.cjca.2018.04.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 04/05/2018] [Accepted: 04/17/2018] [Indexed: 12/17/2022] Open
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13
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Urantide improves the structure and function of right ventricle as determined by echocardiography in monocrotaline-induced pulmonary hypertension rat model. Clin Rheumatol 2018; 38:29-35. [DOI: 10.1007/s10067-018-3978-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 12/24/2017] [Accepted: 01/03/2018] [Indexed: 12/27/2022]
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14
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Zhang J, Cao Y, Gao X, Zhu M, Zhang Z, Yang Y, Guo Q, Peng Y, Wang E. Lipopolysaccharide acutely suppresses right-ventricular strain in rats with pulmonary artery hypertension. Pulm Circ 2017; 8:2045893217744504. [PMID: 29251561 PMCID: PMC5798687 DOI: 10.1177/2045893217744504] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Worsening right ventricular (RV) dysfunction in the presence of pulmonary artery hypertension (PAH) increases morbidity and mortality in this patient population. Transthoracic echocardiography (TTE) is a non-invasive modality to evaluate RV function over time. Using a monocrotaline-induced PAH rat model, we evaluated the effect of acute inflammation on RV function. In this study, both PAH and control rats were injected with Escherichia coli lipopolysaccharide (LPS) to induce an acute inflammatory state. We evaluated survival curves, TTE parameters, and inflammatory markers to better understand the mechanism and impact of acute inflammation on RV function in the presence of PAH. The survival curve of the PAH rats dropped sharply within 9 h after LPS treatment. Several echocardiographic parameters including left ventricular (LV) stroke volume, RV tricuspid annular plane systolic excursion, RV longitudinal peak systolic strain, and strain rate decreased significantly in PAH rats before LPS injection and 2 h after LPS injection. The expression of phospholamban (PLB) and tumor necrosis factor-α (TNF-α) significantly increased and the expression of SERCA2a significantly decreased in PAH rats after LPS administration. LPS suppressed the RV longitudinal peak systolic strain and strain rate and cardiac function deteriorated in PAH rats. These effects may be associated with the signal pathway activity of SERCA2a/PLB.
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Affiliation(s)
- Junjie Zhang
- 1 159374 Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yanan Cao
- 1 159374 Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiaowei Gao
- 1 159374 Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Maoen Zhu
- 1 159374 Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhong Zhang
- 1 159374 Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yue Yang
- 1 159374 Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qulian Guo
- 1 159374 Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yonggang Peng
- 2 Department of Anesthesiology, Shands Hospital, University of Florida, Gainesville, FL, USA
| | - E Wang
- 1 159374 Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
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15
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Raza F, Dillane C, Mirza A, Brailovsky Y, Weaver S, Keane MG, Forfia P. Differences in right ventricular morphology, not function, indicate the nature of increased afterload in pulmonary hypertensive subjects with normal left ventricular function. Echocardiography 2017; 34:1584-1592. [PMID: 28942616 DOI: 10.1111/echo.13699] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The aim of study was to assess whether a specific morphology of the right ventricle (RV) by 2D echo predicts the hemodynamic nature of pulmonary hypertension (PH). METHODS We reviewed clinical, 2D echo, and hemodynamic data of 100 patients with PH: divided into three groups: PH from pulmonary vascular disease (PHPVD ; n = 34) with pulmonary vascular resistance (PVR) > 3 mm Hg/L/min (Wood unit [WU]) and pulmonary artery wedge pressure (PAWP) ≤ 15 mm Hg, pulmonary venous hypertension (PVH; n = 33) with PVR < 3 WU and PAWP > 15 mm Hg and PHMIXED (n = 33) with PVR > 3 WU and PAWP > 15 mm Hg. We analyzed several two-dimensional parameters of right heart morphology and function, including the degree of tapering of the RV diameter from base (just above tricuspid annulus) to apex (level of moderator band) in the apical four-chamber view. P = <.05. RESULTS Baseline characteristics were similar in all three groups: age 62 ± 14.4 years, 69% females, 57% Caucasians. Hemodynamics and 2D echo data of PHPVD vs PVH vs PHMIXED were as follows: PVR 13 ± 6 vs 2 ± 1 vs 7 ± 2 WU, mean pulmonary artery pressure 53 ± 14 vs 34 ± 8 vs 49 ± 8 mm Hg and cardiac index 2.0 ± 0.5 vs 2.8 ± 0.7 vs 2.2 ± 0.7 L/m2 , RV base/apex ratio during systole (sRVb/a ) 1.3 ± 0.2 vs 2.6 ± 0.5 vs 1.5 ± 0.3. Thus, sRVb/a was twofold higher in the PVH vs PHPVD cohort. On ROC analysis, the AUC for sRVb/a for predicting PVR > 3 WU was 0.873, with optimal cutoff of 1.5. CONCLUSION Systolic RV base/apex ratio is a simple 2D index of RV shape that powerfully predicts a PVR > 3 WU and provides powerful discriminating ability between PVH and PHPVD .
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Affiliation(s)
- Farhan Raza
- Heart and Vascular Institute, Temple University Hospital, Philadelphia, PA, USA
| | - Catherine Dillane
- Heart and Vascular Institute, Temple University Hospital, Philadelphia, PA, USA
| | - Arslan Mirza
- Heart and Vascular Institute, Temple University Hospital, Philadelphia, PA, USA
| | - Yevgeniy Brailovsky
- Center for Heart and Vascular Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Sheila Weaver
- Temple Lung Center, Temple University Hospital, Philadelphia, PA, USA
| | - Martin G Keane
- Heart and Vascular Institute, Temple University Hospital, Philadelphia, PA, USA
| | - Paul Forfia
- Heart and Vascular Institute, Temple University Hospital, Philadelphia, PA, USA
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16
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Relation between Vascular Endothelial Markers and Right Ventricular Function in the Children with Asthma. IRANIAN JOURNAL OF PEDIATRICS 2017. [DOI: 10.5812/ijpbs.9363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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17
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Ali ER, Mohamad AM. Diagnostic accuracy of cardiovascular magnetic resonance imaging for assessment of right ventricular morphology and function in pulmonary artery hypertension. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2017. [DOI: 10.1016/j.ejcdt.2016.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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18
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¿Es útil evaluar la reactividad vascular pulmonar por ecocardiografía en la hipertensión pulmonar? Un reto aún por resolver. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2017; 87:260-262. [DOI: 10.1016/j.acmx.2016.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 03/18/2016] [Accepted: 03/21/2016] [Indexed: 11/19/2022] Open
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19
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Li Y, Wang Y, Meng X, Zhu W, Lu X. Assessment of right ventricular longitudinal strain by 2D speckle tracking imaging compared with RV function and hemodynamics in pulmonary hypertension. Int J Cardiovasc Imaging 2017; 33:1737-1748. [PMID: 28553693 DOI: 10.1007/s10554-017-1182-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 05/26/2017] [Indexed: 11/30/2022]
Abstract
The right ventricular longitudinal strain (RVLS) of pulmonary hypertension (PH) patients and its relationship with RV function parameters measured by echocardiography and hemodynamic parameters measured by right heart catheterization was investigated. According to the WHO functional class (FC), 66 PH patients were divided into FC I/II (group 1) and III/IV (group 2). RV function parameters were measured by echocardiographic examinations. Hemodynamic parameters were obtained by right heart catheterization. Patients in group 2 had higher systolic pulmonary artery pressure (sPAP; P < 0.05) than patients in group (1) significant between-group differences were observed in global RVLS (RVLSglobal), free wall RVLS (RVLSFW; P < 0.01), and RV conventional function parameters (all P < 0.05). Moreover, mPAP and PVR increased remarkably and CI decreased significantly in group (2) RVLSglobal had a positive correlation with 6-min walking distance (6MWD; r = 0.492, P < 0.001) and N-terminal pro-brain natriuretic peptide (NT-proBNP; r = 0.632, P < 0.001), while RVLSFW had a positive correlation with 6MWD (r = 0.483, P < 0.001) and NT-proBNP (r = 0.627, P < 0.001). Hemodynamics analysis revealed that RVLSglobal had a positive correlation with mPAP (r = 0.594, P < 0.001), PVR (r = 0.573, P < 0.001) and CI (r = 0.366, P = 0.003), while RVLSFW had a positive correlation with mPAP (r = 0.597, P < 0.001), PVR (r = 0.577, P < 0.001) and CI (r = 0.369, P = 0.002). According to receiver operating characteristic curves, the optimal cut-off values of RVLSglobal (-15.0%) and RVLSFW (-15.3%) for prognosis detection with good sensitivity and specificity. Evidence has shown that RVLS measurement can provide the much-needed and reliable information on RV function and hemodynamics. Therefore, this qualifies as a patient-friendly approach for the clinical management of PH patients.
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Affiliation(s)
- Yidan Li
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
| | - Yidan Wang
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Xiangli Meng
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Weiwei Zhu
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Xiuzhang Lu
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
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20
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Nowak J, Hudzik B, Jastrzȩbski D, Niedziela JT, Rozentryt P, Wojarski J, Ochman M, Karolak W, Żegleń S, Gierlotka M, Gąsior M. Pulmonary hypertension in advanced lung diseases: Echocardiography as an important part of patient evaluation for lung transplantation. CLINICAL RESPIRATORY JOURNAL 2017; 12:930-938. [DOI: 10.1111/crj.12608] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 12/04/2016] [Accepted: 12/20/2016] [Indexed: 01/05/2023]
Affiliation(s)
- Jolanta Nowak
- 3rd Department of Cardiology; SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases; Zabrze Poland
| | - Bartosz Hudzik
- 3rd Department of Cardiology; SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases; Zabrze Poland
| | - Dariusz Jastrzȩbski
- Department of Lung Diseases and Tuberculosis; SMDZ in Zabrze, Medical University of Silesia in Katowice; Zabrze Poland
| | - Jacek T. Niedziela
- 3rd Department of Cardiology; SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases; Zabrze Poland
| | - Piotr Rozentryt
- 3rd Department of Cardiology; SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases; Zabrze Poland
| | - Jacek Wojarski
- Department of Cardiac Surgery and Transplantology; SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases; Zabrze Poland
| | - Marek Ochman
- Department of Cardiac Surgery and Transplantology; SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases; Zabrze Poland
| | - Wojciech Karolak
- Department of Cardiac Surgery and Transplantology; SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases; Zabrze Poland
| | - Sławomir Żegleń
- Department of Cardiac Surgery and Transplantology; SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases; Zabrze Poland
| | - Marek Gierlotka
- 3rd Department of Cardiology; SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases; Zabrze Poland
| | - Mariusz Gąsior
- 3rd Department of Cardiology; SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases; Zabrze Poland
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21
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Elgazzar AG, Elmahdy MAE, Elshazly IM, Ramzy AM, Abo Youssef SM. Evaluation of role of computed tomography (CT) in the diagnosis of pulmonary hypertension. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2016. [DOI: 10.4103/1687-8426.193632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Cardiomyopathy in children: Can we rely on echocardiographic tricuspid regurgitation gradient estimates of right ventricular and pulmonary arterial pressure? Cardiol Young 2016; 26:1406-13. [PMID: 26940013 DOI: 10.1017/s1047951116000020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED Introduction Agreement between echocardiography and right heart catheterisation-derived right ventricular systolic pressure is modest in the adult heart failure population, but is unknown in the paediatric cardiomyopathy population. METHODS All patients at a single centre from 2001 to 2012 with a diagnosis of cardiomyopathy who underwent echocardiography and catheterisation within 30 days were included in this study. The correlation between tricuspid regurgitation gradient and catheterisation-derived right ventricular systolic pressure and mean pulmonary artery pressure was determined. Agreement between echocardiography and catheterisation-derived right ventricular systolic pressure was assessed using Bland-Altman plots. Analysis was repeated for patients who underwent both procedures within 7 days. Haemodynamic data from those with poor agreement and good agreement between echocardiography and catheterisation were compared. RESULTS A total of 37 patients who underwent 48 catheterisation procedures were included in our study. The median age was 11.8 (0.1-20.6 years) with 22 males (58% total). There was a modest correlation (r=0.65) between echocardiography and catheterisation-derived right ventricular systolic pressure, but agreement was poor. Agreement between tricuspid regurgitation gradient and right ventricular systolic pressure showed wide 95% limits of agreement. There was a modest correlation between the tricuspid regurgitation gradient and mean pulmonary artery pressure (r=0.6). Shorter time interval between the two studies did not improve agreement. Those with poor agreement between echocardiography and catheterisation had higher right heart pressures, but this difference became insignificant after accounting for right atrial pressure. CONCLUSION Transthoracic echocardiography estimation of right ventricular systolic pressure shows modest correlation with right heart pressures, but has limited agreement and may underestimate the degree of pulmonary hypertension in paediatric cardiomyopathy patients.
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23
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Lomivorotov VV, Efremov SM, Kirov MY, Fominskiy EV, Karaskov AM. Low-Cardiac-Output Syndrome After Cardiac Surgery. J Cardiothorac Vasc Anesth 2016; 31:291-308. [PMID: 27671216 DOI: 10.1053/j.jvca.2016.05.029] [Citation(s) in RCA: 168] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Vladimir V Lomivorotov
- Department of Anesthesiology and Intensive Care, Research Institute of Circulation Pathology, Novosibirsk, Russia.
| | - Sergey M Efremov
- Department of Anesthesiology and Intensive Care, Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - Mikhail Y Kirov
- Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russia
| | - Evgeny V Fominskiy
- Department of Anesthesiology and Intensive Care, Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - Alexander M Karaskov
- Department of Cardiac Surgery, Research Institute of Circulation Pathology, Novosibirsk, Russia
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24
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The Prognostic Utility of a Simplified Biventricular Echocardiographic Index of Cardiac Remodeling in Patients with Pulmonary Hypertension. J Am Soc Echocardiogr 2016; 29:554-60. [DOI: 10.1016/j.echo.2016.02.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Indexed: 11/23/2022]
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25
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Novel Therapeutic Strategies for Reducing Right Heart Failure Associated Mortality in Fibrotic Lung Diseases. BIOMED RESEARCH INTERNATIONAL 2015; 2015:929170. [PMID: 26583148 PMCID: PMC4637079 DOI: 10.1155/2015/929170] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 08/26/2015] [Indexed: 11/21/2022]
Abstract
Fibrotic lung diseases carry a significant mortality burden worldwide. A large proportion of these deaths are due to right heart failure and pulmonary hypertension. Underlying contributory factors which appear to play a role in the mechanism of progression of right heart dysfunction include chronic hypoxia, defective calcium handling, hyperaldosteronism, pulmonary vascular alterations, cyclic strain of pressure and volume changes, elevation of circulating TGF-β, and elevated systemic NO levels. Specific therapies targeting pulmonary hypertension include calcium channel blockers, endothelin (ET-1) receptor antagonists, prostacyclin analogs, phosphodiesterase type 5 (PDE5) inhibitors, and rho-kinase (ROCK) inhibitors. Newer antifibrotic and anti-inflammatory agents may exert beneficial effects on heart failure in idiopathic pulmonary fibrosis. Furthermore, right ventricle-targeted therapies, aimed at mitigating the effects of functional right ventricular failure, include β-adrenoceptor (β-AR) blockers, angiotensin-converting enzyme (ACE) inhibitors, antioxidants, modulators of metabolism, and 5-hydroxytryptamine-2B (5-HT2B) receptor antagonists. Newer nonpharmacologic modalities for right ventricular support are increasingly being implemented. Early, effective, and individualized therapy may prevent overt right heart failure in fibrotic lung disease leading to improved outcomes and quality of life.
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26
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Ruocco G, Cekorja B, Rottoli P, Refini RM, Pellegrini M, Di Tommaso C, Del Castillo G, Franci B, Nuti R, Palazzuoli A. Role of BNP and echo measurement for pulmonary hypertension recognition in patients with interstitial lung disease: An algorithm application model. Respir Med 2015; 109:406-15. [DOI: 10.1016/j.rmed.2014.12.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 12/19/2014] [Accepted: 12/28/2014] [Indexed: 02/06/2023]
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27
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Soydan LC, Kellihan HB, Bates ML, Stepien RL, Consigny DW, Bellofiore A, Francois CJ, Chesler NC. Accuracy of Doppler echocardiographic estimates of pulmonary artery pressures in a canine model of pulmonary hypertension. J Vet Cardiol 2015; 17:13-24. [PMID: 25601540 DOI: 10.1016/j.jvc.2014.10.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 10/10/2014] [Accepted: 10/21/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To compare noninvasive estimates of pulmonary artery pressure (PAP) obtained via echocardiography (ECHO) to invasive measurements of PAP obtained during right heart catheterization (RHC) across a range of PAP. To examine the accuracy of estimating right atrial pressure via ECHO (RAPECHO) compared to RAP measured by RHC (RAPRHC), and determine if adding RAPECHO improves the accuracy of noninvasive PAP estimations. ANIMALS 14 healthy female beagle dogs. METHODS Comparison of ECHO and RHC measures of PAP, both at normal PAP and increased PAP generated by microbead embolization. RESULTS Noninvasive estimates of PAP were moderately but significantly correlated (r of 0.68-0.78; p < 0.0006) with invasive measurements of PAP. Wide variance was noted for all estimations, with increased variance at higher PAP. The addition of RAPECHO improved correlation and bias in all cases. RAPRHC was significantly correlated with RAPECHO (r = 0.38; p = 0.04) as estimated by the ellipse area method. Median RAPRHC was significantly different between 3 subjective assessments of right atrial size (p = 0.037). CONCLUSIONS Spectral Doppler assessments of tricuspid and pulmonic regurgitation are imperfect methods for predicting PAP as measured by catheterization despite an overall moderate correlation between invasive and noninvasive values. Noninvasive measurements may be better utilized as part of a comprehensive assessment of PAP in canine patients. RAPRHC appears best estimated based on subjective assessment of RA size. Including estimated RAPECHO in estimates of PAP improves the correlation and relatedness between noninvasive and invasive measures of PAP, but notable variability in accuracy of estimations persists.
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Affiliation(s)
- Lydia C Soydan
- University of Wisconsin, School of Veterinary Medicine, Department of Medical Sciences (Cardiology), 2015 Linden Drive, Madison, WI 53706, USA
| | - Heidi B Kellihan
- University of Wisconsin, School of Veterinary Medicine, Department of Medical Sciences (Cardiology), 2015 Linden Drive, Madison, WI 53706, USA.
| | - Melissa L Bates
- University of Wisconsin, School of Medicine and Public Health, Department of Pediatrics and the John Rankin Laboratory of Pulmonary Medicine, 600 Highland Avenue, Madison, WI 53792, USA; University of Iowa, Department of Health and Human Physiology, 225 S. Grand Avenue, Iowa City, IA 52242, USA
| | - Rebecca L Stepien
- University of Wisconsin, School of Veterinary Medicine, Department of Medical Sciences (Cardiology), 2015 Linden Drive, Madison, WI 53706, USA
| | - Daniel W Consigny
- University of Wisconsin, School of Medicine and Public Health, Department of Radiology, 600 Highland Avenue, Madison, WI 53792, USA
| | - Alessandro Bellofiore
- University of Wisconsin, College of Engineering, Department of Biomedical Engineering, 1550 Engineering Dr., Madison, WI 53706, USA
| | - Christopher J Francois
- University of Wisconsin, School of Medicine and Public Health, Department of Radiology, 600 Highland Avenue, Madison, WI 53792, USA
| | - Naomi C Chesler
- University of Wisconsin, College of Engineering, Department of Biomedical Engineering, 1550 Engineering Dr., Madison, WI 53706, USA
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28
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Ruocco G, Palazzuoli A. Early detection of pulmonary arterial hypertension: do not forget the right ventricle. Nat Rev Cardiol 2015; 12:134. [DOI: 10.1038/nrcardio.2014.191-c1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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29
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Ploegstra MJ, Roofthooft MT, Douwes JM, Bartelds B, Elzenga NJ, van de Weerd D, Hillege HL, Berger RM. Echocardiography in Pediatric Pulmonary Arterial Hypertension. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.113.000878. [DOI: 10.1161/circimaging.113.000878] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background—
The value of echocardiography in assessing disease severity and predicting outcome in pediatric pulmonary arterial hypertension (PAH) is insufficiently defined. The aim of this study was to describe correlations between echocardiography and disease severity and outcome in pediatric PAH.
Methods and Results—
Forty-three consecutive children (median age, 8.0 years; range, 0.4–21.5) with idiopathic/hereditary PAH (n=25) or PAH associated with congenital heart disease (n=18) were enrolled in a prospective single-center observational study. Anatomic and right ventricular-functional variables were obtained by two-dimensional echocardiography and Doppler-echocardiography at presentation and at standardized follow-up and were correlated with measures of disease severity (World Health Organization functional class [WHO-FC], N-terminal-pro-B-type natriuretic peptide, hemodynamics) and lung-transplantation–free survival. Right atrial and right ventricular dimensions correlated with WHO-FC and hemodynamics (
P
<0.05), whereas left ventricular dimensions correlated with hemodynamics and survival (
P
<0.05). Right-to-left ventricular dimension ratiocorrelated with WHO-FC, hemodynamics and survival (
P
<0.05). Right ventricular ejection time correlated with hemodynamics and survival (
P
<0.05) and tended to correlate with WHO-FC (
P
=0.071). Tricuspid annular plane systolic excursion correlated with WHO-FC, mean right atrial pressure and survival (
P
<0.05).
Conclusions—
This early descriptive study shows that echocardiographic chararacteristics of both the right and the left heart correlate with disease severity and outcome in pediatric PAH, both at presentation and during the course of the disease. The preliminary data from this study support the potential value of echocardiography as a tool in guiding management in children with PAH.
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Affiliation(s)
- Mark-Jan Ploegstra
- From the Center for Congenital Heart Diseases, Dutch National Referral Center for Children with Pulmonary Hypertension, Beatrix Children’s Hospital (M.-J.P., M.T.R.R., J.M.D., B.B., N.J.E., D.v.d.W., R.M.F.B) and Department of Epidemiology (H.L.H), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marcus T.R. Roofthooft
- From the Center for Congenital Heart Diseases, Dutch National Referral Center for Children with Pulmonary Hypertension, Beatrix Children’s Hospital (M.-J.P., M.T.R.R., J.M.D., B.B., N.J.E., D.v.d.W., R.M.F.B) and Department of Epidemiology (H.L.H), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Johannes M. Douwes
- From the Center for Congenital Heart Diseases, Dutch National Referral Center for Children with Pulmonary Hypertension, Beatrix Children’s Hospital (M.-J.P., M.T.R.R., J.M.D., B.B., N.J.E., D.v.d.W., R.M.F.B) and Department of Epidemiology (H.L.H), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Beatrijs Bartelds
- From the Center for Congenital Heart Diseases, Dutch National Referral Center for Children with Pulmonary Hypertension, Beatrix Children’s Hospital (M.-J.P., M.T.R.R., J.M.D., B.B., N.J.E., D.v.d.W., R.M.F.B) and Department of Epidemiology (H.L.H), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nynke J. Elzenga
- From the Center for Congenital Heart Diseases, Dutch National Referral Center for Children with Pulmonary Hypertension, Beatrix Children’s Hospital (M.-J.P., M.T.R.R., J.M.D., B.B., N.J.E., D.v.d.W., R.M.F.B) and Department of Epidemiology (H.L.H), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Dick van de Weerd
- From the Center for Congenital Heart Diseases, Dutch National Referral Center for Children with Pulmonary Hypertension, Beatrix Children’s Hospital (M.-J.P., M.T.R.R., J.M.D., B.B., N.J.E., D.v.d.W., R.M.F.B) and Department of Epidemiology (H.L.H), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hans L. Hillege
- From the Center for Congenital Heart Diseases, Dutch National Referral Center for Children with Pulmonary Hypertension, Beatrix Children’s Hospital (M.-J.P., M.T.R.R., J.M.D., B.B., N.J.E., D.v.d.W., R.M.F.B) and Department of Epidemiology (H.L.H), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rolf M.F. Berger
- From the Center for Congenital Heart Diseases, Dutch National Referral Center for Children with Pulmonary Hypertension, Beatrix Children’s Hospital (M.-J.P., M.T.R.R., J.M.D., B.B., N.J.E., D.v.d.W., R.M.F.B) and Department of Epidemiology (H.L.H), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Palazzuoli A, Ruocco G, Cekorja B, Pellegrini M, Del Castillo G, Nuti R. Combined BNP and Echocardiographic assessment in interstitial lung disease for pulmonary hypertension detection. Int J Cardiol 2015; 178:34-6. [DOI: 10.1016/j.ijcard.2014.10.120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 10/21/2014] [Indexed: 11/15/2022]
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Çetin M, Yılmaz M, Özen S, Bozan N, Coşkun Ş. Assessment of pulmonary artery pressure and right ventricular function in children with adenotonsillar hypertrophy using different parameters. Int J Pediatr Otorhinolaryngol 2014; 78:1837-42. [PMID: 25183378 DOI: 10.1016/j.ijporl.2014.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 08/01/2014] [Accepted: 08/02/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Our aim was comparison of preoperative and postoperative right ventricular functions of children with adenotonsillar hypertrophy (ATH) who have findings of upper airway obstruction, using new echocardiographic parameters. METHODS Forty-one children who have admitted to our hospital with symptoms suggestive of upper airway obstruction, whose history and physical examination findings suggest upper airway obstruction and who have undergone adenoidectomy/adenotonsillectomy and 40 healthy children, all of whom between 2 and 12 years of age, were included in the study. Patient group was evaluated by pulsed wave tissue Doppler echocardiography as well as with conventional echocardiography before the operation and 6 months after the operation. RESULTS Of 41 children in study group, 26 (63.4%) had adenotonsillectomy and 15 (36.6%) had adenoidectomy. Tricuspid annular plane systolic excursion (TAPSE) was significantly lower in preoperative group compared to control group (18.46±1.67, 19.77±1.62; p=0.000, respectively). Myocardial performance index (MPI) was significantly higher in preoperative group than postoperative and control group (0.40±0.07, 0.36±0.06, 0.35±0.07; p=0.032, respectively). Tricuspid isovolumic acceleration (TIVA) was significantly lower in preoperative group than preoperative and control group (2.97±0.8, 3.43±0.7, 3.43±0.9; p=0.020, respectively). Disappearance of this difference was found between postoperative and control groups (p=0.984). Pulmonary acceleration time (PAcT) was found to be significantly lower in preoperative group compared to postoperative and control group (109.68±18.03, 118.93±17.46, 120.0±14.07; p=0.010, respectively). Mean pulmonary artery pressure (mPAP) was significantly higher in preoperative group than control group (29.64±8.11, 24.95±6.33; p=0.010, respectively). In postoperative group mPAP was found to be similar to control group (25.48±7.85, 24.95±6.33; p=0.740, respectively). CONCLUSIONS TAPSE, PAcT, MPI and TIVA are useful markers for evaluation of preoperative and postoperative ventricular function in children with ATH who have findings of upper airway obstruction. We think that using these practical and easy-to perform parameters may be relevant for evaluation and postoperative follow-up of patients with ATH who have findings of upper airway obstruction. Besides adenotonsillectomy is a beneficial treatment option for these patients.
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Affiliation(s)
- Mecnun Çetin
- Division of Pediatric Cardiology, Department of Pediatrics, Van İpekyolu State Hospital, Van, Turkey.
| | - Münevver Yılmaz
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Serkan Özen
- Department of Pediatrics, Ağrı State Hospital, Ağrı, Turkey
| | - Nazım Bozan
- Department of Otolaryngology, Faculty of Medicine, Yüzüncü Yıl University, Van, Turkey
| | - Şenol Coşkun
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
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Venco L, Mihaylova L, Boon JA. Right Pulmonary Artery Distensibility Index (RPAD Index). A field study of an echocardiographic method to detect early development of pulmonary hypertension and its severity even in the absence of regurgitant jets for Doppler evaluation in heartworm-infected dogs. Vet Parasitol 2014; 206:60-6. [PMID: 25218885 DOI: 10.1016/j.vetpar.2014.08.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 06/18/2014] [Accepted: 08/20/2014] [Indexed: 11/17/2022]
Abstract
Despite the term "heartworm disease" Dirofilaria immitis infection in dogs should be considered a pulmonary arterial disease that might only involve the right heart structures in its late stage. Chronic infection by adult heartworms in dogs results in proliferative endoarteritis leading to progressively increasing pulmonary artery pressure due to reduced elasticity. Elasticity allows the pulmonary arteries to stretch in response to each pulse and helps maintain a relatively constant pressure in the arteries despite the pulsating nature of the blood flow. Pulmonary artery distensibility for both acute and chronic pulmonary hypertension has been investigated in humans using MRI and has been correlated with the severity of hypertension and its outcome and treatment response. The aim of the present study was to investigate whether echocardiographic measurement of the percentage change in diameter of the right pulmonary artery in systole and diastole (distensibility) may be of value in assessing the presence and severity of pulmonary hypertension in heartworm-infected dogs. The Right Pulmonary Artery Distensibility Index (RPAD Index) (which is calculated as the difference in diameter of the right pulmonary artery in systole and diastole) was calculated in healthy and naturally infected heartworm-positive dogs. The right pulmonary artery was chosen because it is usually affected earlier and to a greater degree. Data were obtained from healthy heartworm-free dogs without any clinical, radiographic, or echocardiographic signs of pulmonary hypertension; naturally infected heartworm-positive dogs in different stages of the disease in which pulmonary pressure could be measured by Doppler echocardiography (using tricuspid and or pulmonary regurgitation velocity and pressure gradient); and naturally infected heartworm-positive dogs in different stages of the disease (with or without tricuspid and or pulmonary regurgitation) in which the pulmonary pressure was measured invasively and noninvasively if possible. Results of these evaluations indicated that RPAD Index is a valuable method for early detection of the presence and severity of pulmonary hypertension in heartworm-infected dogs even in the absence of regurgitant jets for Doppler evaluation and that there is a strong correlation between the RPAD Index and the level of pulmonary hypertension.
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Affiliation(s)
- Luigi Venco
- Veterinary Hospital Città di Pavia, viale Cremona 179, 27100 Pavia, Italy.
| | | | - June A Boon
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 300 West Drake Road, Fort Collins, CO 80523, USA
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Ikeda S, Tsuneto A, Kojima S, Koga S, Nakata T, Yoshida T, Eto M, Minami T, Yanagihara K, Maemura K. Longitudinal strain of right ventricular free wall by 2-dimensional speckle-tracking echocardiography is useful for detecting pulmonary hypertension. Life Sci 2014; 111:12-7. [DOI: 10.1016/j.lfs.2014.06.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 06/05/2014] [Accepted: 06/30/2014] [Indexed: 10/25/2022]
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Al-Azem MA, Al-Hazmi MS. Saudi Guidelines on the Diagnosis and Treatment of Pulmonary Hypertension: Intensive care management of pulmonary hypertension. Ann Thorac Med 2014; 9:S121-6. [PMID: 25076990 PMCID: PMC4114270 DOI: 10.4103/1817-1737.134056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 04/05/2014] [Indexed: 12/20/2022] Open
Abstract
Pulmonary hypertension (PH) in the Intensive Care Unit (ICU) may be due to preexisting pulmonary vascular lung disease, liver disease, or cardiac diseases. PH also may be caused by critical illnesses, such as acute respiratory distress syndrome (ARDS), acute left ventricular dysfunction and pulmonary embolism, or may occur after cardiac or thoracic surgery. Regardless of the underlying cause of PH, the final common pathway for hemodynamic deterioration and death is RV failure, which is the most challenging aspect of patient management. Therapy is thus aimed at acutely relieving RV overload by decreasing PVR and reversing RV failure with pulmonary vasodilators and inotropes.
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Affiliation(s)
- M Ali Al-Azem
- Department of Critical Care Medicine, King Fahd Specialist Hospital, Dammam, Saudi Arabia
| | - Manal S Al-Hazmi
- Department of Pulmonary and Critical Care Medicine, King Fahd Medical City, Riyadh, Saudi Arabia
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Corson N, Armato SG, Labby ZE, Straus C, Starkey A, Gomberg-Maitland M. CT-based pulmonary artery measurements for the assessment of pulmonary hypertension. Acad Radiol 2014; 21:523-30. [PMID: 24594422 DOI: 10.1016/j.acra.2013.12.015] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 12/27/2013] [Accepted: 12/30/2013] [Indexed: 10/25/2022]
Abstract
RATIONALE AND OBJECTIVES Pulmonary hypertension (PH) is a complex and fatal disease that is difficult to diagnose noninvasively. This study evaluated previously published computed tomography-based vessel measurement criteria and investigated the predictive power and diagnostic ability of the main pulmonary artery diameter (MPAD) and the ratio of MPAD to aorta diameter (rPA). MATERIALS AND METHODS The database for this study consisted of 175 PH patients (for whom mean pulmonary artery pressure [mPAP] was known), 16 patients without PH but with known mPAP (non-PH patients), and 114 "normal" patients without known mPAP. The performance of previously published criteria, MPAD > 29 mm and rPA > 1, was determined. The relationship between vessel measurements and mPAP was evaluated through correlation and linear regression analysis. The ability of these measurements to discriminate between patients with and without PH was determined by receiver operating characteristic analysis. RESULTS For discriminating between PH and "normal" patients, the sensitivity and specificity of the criterion MPAD > 29 mm were 0.89 (0.84-0.93) and 0.83 (0.76-0.90), respectively, and the sensitivity and specificity of the criterion rPA > 1 were 0.89 (0.85-0.94) and 0.82 (0.74-0.89), respectively. At a specificity of 0.95 in the task of separating PH and "normal" patients, the sensitivity of MPAD was 0.81 (0.72-0.90) and the sensitivity of rPA was 0.76 (0.66-0.85), but the specificity for both decreased when non-PH patients were included. For the combined PH and non-PH patient groups, the correlation between the vessel measurements and mPAP was significant but low, and the ability of the vessel measurements to predict mPAP was limited. CONCLUSION This study found that the sensitivity of previously published vessel criteria for identifying PH patients is high, but the specificity may not be high enough for routine use in a clinical patient population.
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Kim EY, Seo JB, Oh SY, Lee CW, Hwang HJ, Lee SM, Lee YK. Assessment of perfusion pattern and extent of perfusion defect on dual-energy CT angiography: correlations between the causes of pulmonary hypertension and vascular parameters. Korean J Radiol 2014; 15:286-94. [PMID: 24642727 PMCID: PMC3955797 DOI: 10.3348/kjr.2014.15.2.286] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 01/10/2014] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To assess perfusion patterns on a dual-energy pulmonary CT angiography (DECTA) of pulmonary hypertension (PHT) with variable causes and to assess whether the extent of perfusion defect can be used in the severity assessment of PHT. MATERIALS AND METHODS Between March 2007 and February 2011, DECTA scans of 62 consecutive patients (24 men, 38 women; mean age, 58.5 ± 17.3 [standard deviation] years; range, 19-87 years) with PHT were retrospectively included with following inclusion criteria; 1) absence of acute pulmonary thromboembolism, 2) maximal velocity of tricuspid regurgitation jet (TR Vmax) above 3 m/s on echocardiography performed within one week of the DECTA study. Perfusion patterns of iodine map were divided into normal (NL), diffuse heterogeneously decreased (DH), multifocal geographic and multiple peripheral wedging patterns. The extent of perfusion defects (PD), the diameter of main pulmonary artery (MPA) and the ratio of ascending aorta diameter/MPA (aortopulmonary ratio, APR) were measured. Pearson correlation analysis was performed between TR Vmax on echocardiography and CT imaging parameters. RESULTS Common perfusion patterns of primary PHT were DH (n = 15) and NL (n = 12). The perfusion patterns of secondary PHT were variable. On the correlation analysis, in primary PHT, TR Vmax significantly correlated with PD, MPA and APR (r = 0.52, r = 0.40, r = -0.50, respectively, all p < 0.05). In secondary PHT, TR Vmax significantly correlated with PD and MPA (r = 0.38, r = 0.53, respectively, all p < 0.05). CONCLUSION Different perfusion patterns are observed on DECTA of PHT according to the causes. PD and MPA are significantly correlated with the TR Vmax.
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Affiliation(s)
- Eun Young Kim
- Department of Radiology, Chonbuk National University Medical School and Hospital, Research Institute of Clinical Medicine, Jeonju 561-712, Korea. ; Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, Korea
| | - Joon Beom Seo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, Korea
| | - Sang Young Oh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, Korea
| | - Choong Wook Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, Korea
| | - Hye Jeon Hwang
- Department of Radiology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang 431-796, Korea
| | - Sang Min Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, Korea
| | - Young Kyung Lee
- Department of Radiology, Seoul Medical Center, Seoul 131-865, Korea
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McGoon MD, Benza RL, Escribano-Subias P, Jiang X, Miller DP, Peacock AJ, Pepke-Zaba J, Pulido T, Rich S, Rosenkranz S, Suissa S, Humbert M. Pulmonary Arterial Hypertension. J Am Coll Cardiol 2013; 62:D51-9. [DOI: 10.1016/j.jacc.2013.10.023] [Citation(s) in RCA: 355] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 10/22/2013] [Indexed: 11/26/2022]
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Zeng GQ, Liu R, Liao HX, Zhang XF, Qian YX, Liu BH, Wu QH, Zhao J, Gu WW, Li HT. Single intraperitoneal injection of monocrotaline as a novel large animal model of chronic pulmonary hypertension in Tibet minipigs. PLoS One 2013; 8:e78965. [PMID: 24244396 PMCID: PMC3823945 DOI: 10.1371/journal.pone.0078965] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 09/17/2013] [Indexed: 11/19/2022] Open
Abstract
Objective The purpose of this study was to establish an animal model of chronic pulmonary hypertension with a single-dose intraperitoneal injection of monocrotaline (MCT) in young Tibet minipigs, so as to enable both invasive and noninvasive measurements and hence facilitate future studies. Methods Twenty-four minipigs (8-week-old) were randomized to receive single-dose injection of 12.0 mg/kg MCT (MCT group, n = 12) or placebo (control group, n = 12 each). On day 42, all animals were evaluated for pulmonary hypertension with conventional transthoracic echocardiography, right heart catheterization (RHC), and pathological changes. Findings of these studies were compared between the two groups. Results At echocardiography, the MCT group showed significantly higher pulmonary arterial mean pressure (PAMP) compared with the controls (P<0.001). The pulmonary valve curve showed v-shaped signals with reduction of a-waves in minipigs treated with MCT. In addition, the MCT group had longer pulmonary artery pre-ejection phases, and shorter acceleration time and ejection time. RHC revealed higher mean pulmonary arterial pressure (mPAP) in the MCT group than in the control group (P<0.01). A significant and positive correlation between the mPAP values and the PAMP values (R = 0.974, P<0.0001), and a negative correlation between the mPAP and ejection time (R = 0.680, P<0.0001) was noted. Pathology demonstrated evidence of pulmonary vascular remodeling and higer index of right ventricular hypertrophy in MCT-treated minipigs. Conclusion A chronic pulmonary hypertension model can be successfully established in young minipigs at six weeks after MCT injection. These minipig models exhibited features of pulmonary arterial hypertension that can be evaluated by both invasive (RHC) and noninvasive (echocardiography) measurements, and may be used as an easy and stable tool for future studies on pulmonary hypertension.
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Affiliation(s)
- Guang-qiao Zeng
- First Affiliated Hospital, Guangzhou Medical University; Guangzhou, Guangdong, China
- State Key Laboratory of Respiratory Diseases, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Rong Liu
- First Affiliated Hospital, Guangzhou Medical University; Guangzhou, Guangdong, China
- State Key Laboratory of Respiratory Diseases, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Hai-xing Liao
- First Affiliated Hospital, Guangzhou Medical University; Guangzhou, Guangdong, China
| | - Xin-feng Zhang
- First Affiliated Hospital, Guangzhou Medical University; Guangzhou, Guangdong, China
| | - Yuan-xin Qian
- First Affiliated Hospital, Guangzhou Medical University; Guangzhou, Guangdong, China
| | - Bao-hua Liu
- First Affiliated Hospital, Guangzhou Medical University; Guangzhou, Guangdong, China
| | - Qing-hong Wu
- Laboratory Animal Centre, Southern Medical University, Guangzhou, Guangdong, China
| | - Jin Zhao
- First Affiliated Hospital, Guangzhou Medical University; Guangzhou, Guangdong, China
- State Key Laboratory of Respiratory Diseases, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Wei-wang Gu
- Laboratory Animal Centre, Southern Medical University, Guangzhou, Guangdong, China
| | - Hong-tao Li
- First Affiliated Hospital, Guangzhou Medical University; Guangzhou, Guangdong, China
- State Key Laboratory of Respiratory Diseases, Guangzhou Medical University, Guangzhou, Guangdong, China
- * E-mail:
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Groh GK, Levy PT, Holland MR, Murphy JJ, Sekarski TJ, Myers CL, Hartman DP, Roiger RD, Singh GK. Doppler echocardiography inaccurately estimates right ventricular pressure in children with elevated right heart pressure. J Am Soc Echocardiogr 2013; 27:163-71. [PMID: 24183542 DOI: 10.1016/j.echo.2013.09.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Doppler echocardiography (DE) is widely used as a surrogate for right heart catheterization (RHC), the gold standard, to assess and monitor elevated right heart pressure in children. However, its accuracy has not been prospectively validated in children. The objectives of this study were to evaluate the accuracy of DE in predicting simultaneously measured right ventricular (RV) pressure by RHC in pediatric patients and to determine if the degree of RV hypertension affects the accuracy of DE in assessing right heart pressure. METHODS Eighty children (age range, 0-17.9 years; median age, 5.5 years) with two-ventricle physiology and a wide range of right heart pressures underwent simultaneous DE and RHC. The pressure gradient between the right ventricle and the right atrium was directly measured by RHC and simultaneously estimated by DE using tricuspid regurgitation. Patients were then grouped on the basis of RHC-measured RV systolic pressure (RVSP): group 1 (n = 43), with RVSP < 1/2 systemic systolic blood pressure (SBP); group 2 (n = 37), with RVSP ≥ 1/2 SBP; group 3 (n = 56), with RVSP < 2/3 SBP; and group 4 (n = 24), with RVSP ≥ 2/3 SBP. Correlation and Bland-Altman analyses were performed on all groups. Accuracy was predefined as 95% limits of agreement within ±10 mm Hg. RESULTS Despite a reasonable correlation between DE and RHC in all groups, there was poor agreement between techniques as RVSP/SBP increased. DE was inaccurate in one of 43 patients in group 1 (2%) versus nine of 37 in group 2 (24%) and was inaccurate in one of 56 patients in group 3 (2%) versus eight of 24 in group 4 (33%). Overestimation and underestimation occurred equally in all groups. CONCLUSION DE inaccurately estimates RV pressure in children with elevated right heart pressure. It should not be relied on as the sole method of assessing right heart hemodynamics in children with RV hypertension.
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Affiliation(s)
- Georgeann K Groh
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Philip T Levy
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Mark R Holland
- Department of Physics, Washington University, St. Louis, Missouri
| | - Joshua J Murphy
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Timothy J Sekarski
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Craig L Myers
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Diana P Hartman
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | | | - Gautam K Singh
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri.
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Elshazly M, Hosny H, Abdel-Hafiz H, Zakaria A, Elkaffas K, Okasha N. Assessment of endothelial dysfunction in idiopathic pulmonary fibrosis. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2013. [DOI: 10.1016/j.ejcdt.2013.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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D’Andrea A, Riegler L, Nunziata L, Scarafile R, Gravino R, Salerno G, Amarelli C, Maiello C, Limongelli G, Di Salvo G, Caso P, Bossone E, Calabrò R, Pacileo G, Russo MG. Right heart morphology and function in heart transplantation recipients. J Cardiovasc Med (Hagerstown) 2013; 14:648-58. [DOI: 10.2459/jcm.0b013e32835ec634] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Fine NM, Chen L, Bastiansen PM, Frantz RP, Pellikka PA, Oh JK, Kane GC. Outcome Prediction by Quantitative Right Ventricular Function Assessment in 575 Subjects Evaluated for Pulmonary Hypertension. Circ Cardiovasc Imaging 2013; 6:711-21. [PMID: 23811750 DOI: 10.1161/circimaging.113.000640] [Citation(s) in RCA: 309] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
MESH Headings
- Adult
- Aged
- Arterial Pressure
- Biomechanical Phenomena
- Chi-Square Distribution
- Echocardiography, Doppler
- Feasibility Studies
- Female
- Humans
- Hypertension, Pulmonary/complications
- Hypertension, Pulmonary/diagnostic imaging
- Hypertension, Pulmonary/mortality
- Hypertension, Pulmonary/physiopathology
- Kaplan-Meier Estimate
- Male
- Middle Aged
- Multivariate Analysis
- Predictive Value of Tests
- Prognosis
- Proportional Hazards Models
- Prospective Studies
- Pulmonary Artery/diagnostic imaging
- Pulmonary Artery/physiopathology
- Stress, Mechanical
- Time Factors
- Ventricular Dysfunction, Right/diagnostic imaging
- Ventricular Dysfunction, Right/etiology
- Ventricular Dysfunction, Right/mortality
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Function, Right
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Affiliation(s)
- Nowell M Fine
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN
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Suzuki K, Akashi YJ, Manabe M, Mizukoshi K, Kamijima R, Kou S, Takai M, Izumo M, Kida K, Yoneyama K, Omiya K, Yamasaki Y, Yamada H, Nobuoka S, Miyake F. Simple exercise echocardiography using a Master's two-step test for early detection of pulmonary arterial hypertension. J Cardiol 2013; 62:176-82. [DOI: 10.1016/j.jjcc.2013.04.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 03/11/2013] [Accepted: 04/10/2013] [Indexed: 11/29/2022]
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Reichenberger F, Kaps M, Seeger W, Tanislav C. Shunt volume dynamics in stroke patients with patent foramen ovale. J Appl Physiol (1985) 2013; 115:704-7. [PMID: 23743402 DOI: 10.1152/japplphysiol.00507.2012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A variation in right atrial and pulmonary arterial pressure might result in a shunt dynamic across a patent foramen ovale (PFO). In the present study we tested if peak exercise facilitates a restoration of right to left shunt (RLS) in stroke patients who demonstrated a functional PFO closure (no evidence of RLS across an initially demonstrated PFO). In stroke patients with PFO demonstrating a functional closure, the RLS was reassessed on peak exercise using contrast-enhanced transcranial Doppler sonography. The exercise procedure consisted of a cardiopulmonary exercise test with supplementary stress echocardiography for assessment of pulmonary circulation. Four stroke patients with initially PFO curtain pattern and a subsequent functional PFO closure (no evidence for RLS) underwent the procedure. In all four patients a RLS could be resurrected during peak physical exercise after a Valsalva strain. While in two patients peak exercise led to an RLS in a countable range of microembolic signals, in two patients a curtain pattern was obtained. One patient showed evidence for reoccurrence of RLS on peak exercise without a Valsalva strain. The patients with curtain pattern had a better peak exercise performance. Although the systolic pulmonary arterial pressure increased during exercise in all patients, there was no direct correlation with the detected RLS. After a functional PFO closure peak exercise combined with a Valsalva strain facilitates the reoccurrence of RLS in stroke patients.
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Affiliation(s)
- F Reichenberger
- University Giessen Lung Center, University Hospital Giessen, Giessen, Germany
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Pulmonary hypertension after hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2013; 19:1546-56. [PMID: 23891748 DOI: 10.1016/j.bbmt.2013.07.017] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 07/16/2013] [Indexed: 12/17/2022]
Abstract
Pulmonary hypertension (PH) is a potentially fatal complication of hematopoietic stem cell transplantation (HSCT). Given its nonspecific clinical presentation, it is likely that this clinical entity is underdiagnosed after HSCT. Data describing the incidence, risk factors, and etiology of PH in HSCT recipients are minimal. Physicians caring for HSCT recipients should be aware of this severe post-transplant complication because timely diagnosis and treatment may allow improved clinical outcomes. We summarize the pathophysiology, clinical presentation, diagnosis, and management of PH in HSCT recipients.
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Cotrim C, João I, Fazendas P, Almeida AR, Lopes L, Stuart B, Cruz I, Caldeira D, Loureiro MJ, Morgado G, Pereira H. Clinical applications of exercise stress echocardiography in the treadmill with upright evaluation during and after exercise. Cardiovasc Ultrasound 2013; 11:26. [PMID: 23875614 PMCID: PMC3723430 DOI: 10.1186/1476-7120-11-26] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 06/17/2013] [Indexed: 12/11/2022] Open
Abstract
Exercise stress echocardiography is the most frequently used stress test in our laboratory. Exercise echocardiography is used mainly in the study of patients with coronary artery disease. However, the technique is increasingly being used to study other diseases. In our centre, we use an original methodology, published by us in 2000, in which we evaluate heart function during exercise in the treadmill. After the exercise, patients are maintained in orthostatic position when appropriate or lying down in left lateral decubitus for further evaluation. Since this method seems to increase the quality and the quantity of information obtained in so many clinical arenas, we now present a detailed review of this methodology and its applications.
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Affiliation(s)
- Carlos Cotrim
- Cardiology Department, Garcia de Orta Hospital, Avenida Torrado da Silva, 2805-267 Almada, Portugal
| | - Isabel João
- Cardiology Department, Garcia de Orta Hospital, Avenida Torrado da Silva, 2805-267 Almada, Portugal
| | - Paula Fazendas
- Cardiology Department, Garcia de Orta Hospital, Avenida Torrado da Silva, 2805-267 Almada, Portugal
| | - Ana R Almeida
- Cardiology Department, Garcia de Orta Hospital, Avenida Torrado da Silva, 2805-267 Almada, Portugal
| | - Luís Lopes
- Cardiology Department, Garcia de Orta Hospital, Avenida Torrado da Silva, 2805-267 Almada, Portugal
| | - Bruno Stuart
- Cardiology Department, Garcia de Orta Hospital, Avenida Torrado da Silva, 2805-267 Almada, Portugal
| | - Inês Cruz
- Cardiology Department, Garcia de Orta Hospital, Avenida Torrado da Silva, 2805-267 Almada, Portugal
| | - Daniel Caldeira
- Cardiology Department, Garcia de Orta Hospital, Avenida Torrado da Silva, 2805-267 Almada, Portugal
| | - Maria José Loureiro
- Cardiology Department, Garcia de Orta Hospital, Avenida Torrado da Silva, 2805-267 Almada, Portugal
| | - Gonçalo Morgado
- Cardiology Department, Garcia de Orta Hospital, Avenida Torrado da Silva, 2805-267 Almada, Portugal
| | - Hélder Pereira
- Cardiology Department, Garcia de Orta Hospital, Avenida Torrado da Silva, 2805-267 Almada, Portugal
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Incidence and Significance of Pericardial Effusion in Patients With Pulmonary Arterial Hypertension. Can J Cardiol 2013; 29:678-82. [DOI: 10.1016/j.cjca.2012.04.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 04/06/2012] [Accepted: 04/11/2012] [Indexed: 11/17/2022] Open
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D'Andrea A, Riegler L, Rucco MA, Cocchia R, Scarafile R, Salerno G, Martone F, Vriz O, Caso P, Calabrò R, Bossone E, Russo MG. Left Atrial Volume Index in Healthy Subjects: Clinical and Echocardiographic Correlates. Echocardiography 2013; 30:1001-7. [DOI: 10.1111/echo.12217] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
| | - Lucia Riegler
- Chair of Cardiology; Second University of Naples; Naples; Italy
| | | | | | | | - Gemma Salerno
- Chair of Cardiology; Second University of Naples; Naples; Italy
| | | | - Olga Vriz
- Cardiology; San Daniele del Friuli Hospital; Udine; Italy
| | - Pio Caso
- Chair of Cardiology; Second University of Naples; Naples; Italy
| | | | - Eduardo Bossone
- Department of Cardiac Surgery; IRCCS Policlinico San Donato; San Donato Milanese; Milan; Italy
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A pilot study of the effect of spironolactone therapy on exercise capacity and endothelial dysfunction in pulmonary arterial hypertension: study protocol for a randomized controlled trial. Trials 2013; 14:91. [PMID: 23547564 PMCID: PMC3653687 DOI: 10.1186/1745-6215-14-91] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 03/14/2013] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Pulmonary arterial hypertension is a rare disorder associated with poor survival. Endothelial dysfunction plays a central role in the pathogenesis and progression of pulmonary arterial hypertension. Inflammation appears to drive this dysfunctional endothelial phenotype, propagating cycles of injury and repair in genetically susceptible patients with idiopathic and disease-associated pulmonary arterial hypertension. Therapy targeting pulmonary vascular inflammation to interrupt cycles of injury and repair and thereby delay or prevent right ventricular failure and death has not been tested. Spironolactone, a mineralocorticoid and androgen receptor antagonist, has been shown to improve endothelial function and reduce inflammation. Current management of patients with pulmonary arterial hypertension and symptoms of right heart failure includes use of mineralocorticoid receptor antagonists for their diuretic and natriuretic effects. We hypothesize that initiating spironolactone therapy at an earlier stage of disease in patients with pulmonary arterial hypertension could provide additional benefits through anti-inflammatory effects and improvements in pulmonary vascular function. METHODS/DESIGN Seventy patients with pulmonary arterial hypertension without clinical evidence of right ventricular failure will be enrolled in a randomized, double-blinded, placebo-controlled trial to investigate the effect of early treatment with spironolactone on exercise capacity, clinical worsening and vascular inflammation in vivo. Our primary endpoint is change in placebo-corrected 6-minute walk distance at 24 weeks and the incidence of clinical worsening in the spironolactone group compared to placebo. At a two-sided alpha level of 0.05, we will have at least 84% power to detect an effect size (group mean difference divided by standard deviation) of 0.9 for the difference in the change of 6-minute walk distance from baseline between the two groups. Secondary endpoints include the effect of spironolactone on the change in placebo-corrected maximal oxygen consumption; plasma markers of vascular inflammation and peripheral blood mononuclear cell gene expression profiles; sympathetic nervous system activation, renin-angiotensin-aldosterone system activation and sex hormone metabolism; and right ventricular structure and function using echocardiography and novel high-resolution magnetic resonance imaging-based techniques. Safety and tolerability of spironolactone will be assessed with periodic monitoring for hyperkalemia and renal insufficiency as well as the incidence of drug discontinuation for untoward effects. TRIAL REGISTRATION ClinicalTrials.gov: NCT01712620.
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Affiliation(s)
- Ghanshyam Biyani
- Departments of Anaesthesiology and Critical Care, Dr. SN Medical College, Jodhpur, India
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