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Yoo GY, Lee J, Hong SB, Kim DY. Percutaneous OxyRVAD in a Patient with Severe Respiratory Failure and Right Heart Failure: A Case Report. J Chest Surg 2024; 57:319-322. [PMID: 38225830 DOI: 10.5090/jcs.23.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/06/2023] [Accepted: 11/21/2023] [Indexed: 01/17/2024] Open
Abstract
Venovenous extracorporeal membrane oxygenation (VV ECMO) is often used in cases of severe respiratory failure, especially in patients considered for lung transplantation. However, because many lung diseases can ultimately result in right heart failure, the treatment of secondary right heart failure can present a challenge when the patient is already under VV ECMO support. In such cases, an oxygenated-right ventricular assist device (OxyRVAD) can be used. OxyRVAD is designed to maintain anterograde blood flow and prevent right ventricular distension. Moreover, the pulmonary arterial cannula can be inserted percutaneously. We report a case in which percutaneous OxyRVAD was successfully implemented to manage right heart failure in a patient with respiratory failure who was on VV ECMO.
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Affiliation(s)
- Ga Young Yoo
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - June Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seok Beom Hong
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Do Yeon Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Rommel KP, Bonnet G, Fortmeier V, Stolz L, Schöber AR, von Stein J, Kassar M, Gerçek M, Rosch S, Stocker TJ, Körber MI, Kresoja KP, Rudolph TK, Pfister R, Baldus S, Windecker S, Thiele H, Praz F, Hausleiter J, Rudolph V, Burkhoff D, Lurz P. Congestion patterns in severe tricuspid regurgitation and transcatheter treatment: Insights from a multicentre registry. Eur J Heart Fail 2024. [PMID: 38571456 DOI: 10.1002/ejhf.3235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/22/2024] [Accepted: 03/28/2024] [Indexed: 04/05/2024] Open
Abstract
AIMS While invasively determined congestion holds mechanistic and prognostic significance in acute heart failure (HF), its role in patients with tricuspid regurgitation (TR)-related right- heart failure (HF) undergoing transcatheter tricuspid valve intervention (TTVI) is less well established. A comprehensive understanding of congestion patterns might aid in procedural planning, risk stratification, and the identification of patients who may benefit from adjunctive therapies before undergoing TTVI. The aim of this study was to investigate the role of congestion patterns in patients with severe TR and its implications for TTVI. METHODS AND RESULTS Within a multicentre, international TTVI registry, 813 patients underwent right heart catheterization (RHC) prior to TTVI and were followed up to 24 months. The median age was 80 (interquartile range 76-83) years and 54% were women. Both mean right atrial pressure (RAP) and pulmonary capillary wedge pressure (PCWP) were associated with 2-year mortality on Cox regression analyses with Youden index-derived cut-offs of 17 mmHg and 19 mmHg, respectively (p < 0.01 for all). However, RAP emerged as an independent predictor of outcomes following multivariable adjustments. Pre-interventionally, 42% of patients were classified as euvolaemic (RAP <17 mmHg, PCWP <19 mmHg), 23% as having left-sided congestion (RAP <17 mmHg, PCWP ≥19 mmHg), 8% as right-sided congestion (RAP ≥17 mmHg, PCWP <19 mmHg), and 27% as bilateral congestion (RAP ≥17 mmHg, PCWP ≥19 mmHg). Patients with right-sided or bilateral congestion had the lowest procedural success rates and shortest survival times. Congestion patterns allowed for discerning specific patient's physiology and specifying prognostic implications of right ventricular to pulmonary artery coupling surrogates. CONCLUSION In this large cohort of invasively characterized patients undergoing TTVI, congestion patterns involving right-sided congestion were associated with low procedural success and higher mortality rates after TTVI. Whether pre-interventional reduction of right-sided congestion can improve outcomes after TTVI should be established in dedicated studies.
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Affiliation(s)
- Karl-Philipp Rommel
- Department of Cardiology, Heart Center at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
- Cardiovacular Research Foundation, New York, NY, USA
| | - Guillaume Bonnet
- Cardiovacular Research Foundation, New York, NY, USA
- University of Bordeaux, Hopital Cardiologique Haut-Lévêque, University Hospital, Bordeaux, France
| | - Vera Fortmeier
- Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig Maximilians University of Munich, Munich, Germany
| | - Anne R Schöber
- Department of Cardiology, Heart Center at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Jennifer von Stein
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Mohammad Kassar
- Department of Cardiology, Inselspital Bern, Bern University Hospital, Bern, Switzerland
| | - Muhammed Gerçek
- Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Sebastian Rosch
- Department of Cardiology, Heart Center at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Thomas J Stocker
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig Maximilians University of Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Maria I Körber
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Karl-Patrik Kresoja
- Department of Cardiology, Heart Center at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Tanja K Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Roman Pfister
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Stephan Windecker
- Department of Cardiology, Inselspital Bern, Bern University Hospital, Bern, Switzerland
| | - Holger Thiele
- Department of Cardiology, Heart Center at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Fabien Praz
- Department of Cardiology, Inselspital Bern, Bern University Hospital, Bern, Switzerland
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig Maximilians University of Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | | | - Philipp Lurz
- Department of Cardiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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Onohara D, Silverman M, Suresh KS, Xu D, He Q, King CL, Tom SK, Kalra K, Padala M. An Animal Model of Functional Tricuspid Regurgitation by Leaflet Tethering Using Image-Guided Chordal Encircling Snares. J Cardiovasc Transl Res 2024; 17:417-425. [PMID: 37615887 DOI: 10.1007/s12265-023-10424-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/31/2023] [Indexed: 08/25/2023]
Abstract
Several interventional therapies are in development to treat functional tricuspid regurgitation. Most have failed to achieve adequate efficacy, as animal models of this lesion are lacking. We developed a new image-guided technique in swine, by tethering the tricuspid valve chordae using echo-guided chordal encircling snares. Five swine underwent baseline echocardiographic assessment of tricuspid valve function, followed by echo-guided placement of snares that encircle the chordae inserting into the anterior and posterior tricuspid valve leaflets. Tethering these snares and stabilizing them on the right ventricle caused the regurgitant fraction to increase from 8.48±5.38% to 48.76±12.5%, and the valve tenting area to increase from 60.26±52.19 to 160.9±86.92 mm2. Image-guided chordal encircling snares could reproducibly induce clinically significant levels of functional tricuspid regurgitation and create a valve geometry like that seen in patients, providing a new animal model for use to study novel interventional devices.
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Affiliation(s)
- Daisuke Onohara
- Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center at the Emory University Hospital Midtown, Atlanta, GA, USA
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael Silverman
- Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center at the Emory University Hospital Midtown, Atlanta, GA, USA
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Kirthana Sreerangathama Suresh
- Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center at the Emory University Hospital Midtown, Atlanta, GA, USA
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Dongyang Xu
- Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center at the Emory University Hospital Midtown, Atlanta, GA, USA
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Qi He
- Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center at the Emory University Hospital Midtown, Atlanta, GA, USA
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Chase L King
- Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center at the Emory University Hospital Midtown, Atlanta, GA, USA
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Stephanie K Tom
- Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center at the Emory University Hospital Midtown, Atlanta, GA, USA
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Kanika Kalra
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
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Opotowsky AR. The Pathophysiology(ies) of Heart Failure in Adults with Congenital Heart Disease. Heart Fail Clin 2024; 20:129-136. [PMID: 38462317 DOI: 10.1016/j.hfc.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
There is a growing, aging population of adults with congenital heart disease (CHD) with an increasing incidence of heart failure. Unquestioning extrapolation of widely applicable definitions of heart failure and guidelines for managing heart failure in adults with acquired heart failure to adults with CHD can be problematic. A nuanced and flexible application of clinical judgment founded on a deep understanding of underlying pathophysiology is needed to most effectively apply the many recent advances in managing acquired heart failure to the care of adults with CHD.
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Affiliation(s)
- Alexander R Opotowsky
- Cincinnati Adult Congenital Heart Disease Program, Department of Pediatrics, Heart Institute, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 2003, Cincinnati, OH 45229, USA.
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Krishnarao K, Yip DS, Goswami RM, Leoni JC, Patel PC. Stiff right atrial syndrome? A complex clinical case report utilizing multimodality imaging and invasive hemodynamics. Eur Heart J Case Rep 2024; 8:ytae163. [PMID: 38690555 PMCID: PMC11057788 DOI: 10.1093/ehjcr/ytae163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/12/2024] [Accepted: 03/27/2024] [Indexed: 05/02/2024]
Abstract
Background Stiff left atrial syndrome is a well-established cause of heart failure symptoms. A parallel entity involving the right atrium (RA) has not previously been described. We present a case of refractory right heart failure (RHF) 12 years following orthotopic heart transplantation. Case summary Patient underwent annuloplasty ring placement for severe tricuspid regurgitation in 2018 and kidney transplantation in 2020. The use of multimodality imaging and a multidisciplinary approach suggested a stiff RA as a potential etiology to refractory symptoms. Redo-heart and kidney transplantation in March 2021 led to the resolution of symptoms without recurrence. Discussion We propose stiff right atrial syndrome that may need to be considered in the setting of refractory RHF primarily suggested by significant right atrial enlargement and restrictive physiology.
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Affiliation(s)
- Krithika Krishnarao
- Department of Cardiovascular Disease, Orlando Health Heart & Vascular Institute, 1222 S Orange Ave 1st floor, Orlando, FL 32806, USA
- Department of Transplant, Mayo Clinic Florida, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA
| | - Daniel S Yip
- Department of Transplant, Mayo Clinic Florida, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA
| | - Rohan M Goswami
- Department of Transplant, Mayo Clinic Florida, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA
| | - Juan C Leoni
- Department of Transplant, Mayo Clinic Florida, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA
| | - Parag C Patel
- Department of Transplant, Mayo Clinic Florida, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA
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Xueyuan L, Yanping X, Jiaoqiong G, Yuehui Y. Autonomic nervous modulation: early treatment for pulmonary artery hypertension. ESC Heart Fail 2024; 11:619-627. [PMID: 38108098 DOI: 10.1002/ehf2.14616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 11/09/2023] [Accepted: 11/17/2023] [Indexed: 12/19/2023] Open
Abstract
Pulmonary artery hypertension (PAH) is a chronic vascular disease defined by the elevation of pulmonary vascular resistance and mean pulmonary artery pressure, which arises due to pulmonary vascular remodelling. Prior research has already established a link between the autonomic nervous system (ANS) and PAH. Therefore, the rebalancing of the ANS offers a promising approach for the treatment of PAH. The process of rebalancing involves two key aspects: inhibiting an overactive sympathetic nervous system and fortifying the impaired parasympathetic nervous system through pharmacological or interventional procedures. However, the understanding of the precise mechanisms involved in neuromodulation, whether achieved through medication or intervention, remains insufficient. This limited understanding hinders our ability to determine the appropriate timing and scope of such treatment. This review aims to integrate the findings from clinical and mechanistic studies on ANS rebalancing as a treatment approach for PAH, with the ultimate goal of identifying a path to enhance the safety and efficacy of neuromodulation therapy and improve the prognosis of PAH.
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Affiliation(s)
- Liu Xueyuan
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xu Yanping
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guan Jiaoqiong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yin Yuehui
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Arrigo M, Price S, Harjola VP, Huber LC, Schaubroeck HAI, Vieillard-Baron A, Mebazaa A, Masip J. Diagnosis and treatment of right ventricular failure secondary to acutely increased right ventricular afterload (acute cor pulmonale): a clinical consensus statement of the Association for Acute CardioVascular Care of the European Society of Cardiology. Eur Heart J Acute Cardiovasc Care 2024; 13:304-312. [PMID: 38135288 PMCID: PMC10927027 DOI: 10.1093/ehjacc/zuad157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 12/24/2023]
Abstract
Acute right ventricular failure secondary to acutely increased right ventricular afterload (acute cor pulmonale) is a life-threatening condition that may arise in different clinical settings. Patients at risk of developing or with manifest acute cor pulmonale usually present with an acute pulmonary disease (e.g. pulmonary embolism, pneumonia, and acute respiratory distress syndrome) and are managed initially in emergency departments and later in intensive care units. According to the clinical setting, other specialties are involved (cardiology, pneumology, internal medicine). As such, coordinated delivery of care is particularly challenging but, as shown during the COVID-19 pandemic, has a major impact on prognosis. A common framework for the management of acute cor pulmonale with inclusion of the perspectives of all involved disciplines is urgently needed.
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Affiliation(s)
- Mattia Arrigo
- Department of Internal Medicine, Stadtspital Zurich, Birmensdorferstrasse 497, 8063 Zürich, Switzerland
| | - Susanna Price
- Royal Brompton Hospital, National Heart & Lung Institute, Imperial College London, London, UK
| | - Veli-Pekka Harjola
- Department of Emergency Medicine, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Lars C Huber
- Department of Internal Medicine, Stadtspital Zurich, Birmensdorferstrasse 497, 8063 Zürich, Switzerland
| | | | | | - Alexandre Mebazaa
- Department of Anesthesia, Burn and Critical Care Medicine, AP-HP, Hôpitaux Universitaires Saint-Louis-Lariboisière, FHU PROMICE, INI-CRCT, and Université de Paris, MASCOT, Inserm, Paris, France
| | - Josep Masip
- Research Direction, Consorci Sanitari Integral, University of Barcelona, Barcelona, Spain
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Ueno K, Nakano J, Hirao S, Komiya T. Delayed surgical repair via right ventricular approach with Impella and extracorporeal life support in post-myocardial infarction ventricular septal defect: A case report. Int J Surg Case Rep 2024; 116:109417. [PMID: 38377896 PMCID: PMC10943985 DOI: 10.1016/j.ijscr.2024.109417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 02/22/2024] Open
Abstract
INTRODUCTION Post-myocardial infarction ventricular septal defect (PIVSD) is a life-threatening mechanical complication of acute myocardial infarction (AMI). Delayed elective surgical repair can be considered in patients who respond well to aggressive heart failure therapy. Impella has been reported as a bridge to allow the deferment of surgery for PIVSD. PRESENTATION OF CASE This report describes our case of a 62-year-old male with PIVSD and cardiogenic shock. Impella was placed to ensure hemodynamic stability. Subsequently, right heart failure was suspected to be caused by insufficient circulatory support from Impella alone. Emergency surgery was considered, but it was high risk and only a few days had passed since the onset. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) was implanted to treat right heart failure and delay surgical repair as long as possible. Six days after Impella implantation, the patient underwent a successful surgical repair via the right ventricle without associated adverse events. DISCUSSION Impella support can be insufficient for critically ill patients such as those with a larger ventricular septal defect and involvement of right ventricular function. VA-ECMO was implanted to support circulation, reduce the preload in the right ventricle, and avoid shunt inversion induced by increasing Impella flow. The patient was able to undergo a successful delayed repair with VA-ECMO at least one week after the onset of the AMI with hemodynamic stability and no associated adverse events. CONCLUSION Additional VA-ECMO could help patients who fail to bridge to surgery with Impella to avoid emergency surgery, leading to successful delayed surgical repair.
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Affiliation(s)
- Kazuhiro Ueno
- Department of Cardiovascular Surgery, Oita University, 1-1 Hasamamachi Idaigaok, Yufu, Oita 879-5503, Japan.
| | - Jota Nakano
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-0052, Japan
| | - Shingo Hirao
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-0052, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-0052, Japan
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Thum KY, Liao S, Šeman M, Khamooshi M, Carberry J, McGiffin D, Gregory SD. Effect of RVAD Cannulation Length on Right Ventricular Thrombosis Risk: An In Silico Investigation. Ann Biomed Eng 2024:10.1007/s10439-024-03474-4. [PMID: 38418690 DOI: 10.1007/s10439-024-03474-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/13/2024] [Indexed: 03/02/2024]
Abstract
Left ventricular assist devices (LVADs) have been used off-label as long-term support of the right heart due to the lack of a clinically approved durable right VAD (RVAD). Whilst various techniques to reduce RVAD inflow cannula protrusion have been described, the implication of the protrusion length on right heart blood flow and subsequent risk of thrombosis remains poorly understood. This study investigates the influence of RVAD diaphragmatic cannulation length on right ventricular thrombosis risk using a patient-specific right ventricle in silico model validated with particle image velocimetry. Four cannulation lengths (5, 10, 15 and 25 mm) were evaluated in a one-way fluid-structure interaction simulation with boundary conditions generated from a lumped parameter model, simulating a biventricular supported condition. Simulation results demonstrated that the 25-mm cannulation length exhibited a lower thrombosis risk compared to 5-, 10- and 15-mm cannulation lengths due to improved flow energy distribution (25.2%, 24.4% and 17.8% increased), reduced stagnation volume (72%, 68% and 49% reduction), better washout rate (13.0%, 11.6% and 9.1% faster) and lower blood residence time (6% reduction). In the simulated scenario, our findings suggest that a longer RVAD diaphragmatic cannulation length may be beneficial in lowering thrombosis risk; however, further clinical studies are warranted.
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Affiliation(s)
- Kar Ying Thum
- Cardiorespiratory Engineering and Technology Laboratory, Department of Mechanical and Aerospace Engineering, Monash University, Melbourne, VIC, Australia.
| | - Sam Liao
- Cardiorespiratory Engineering and Technology Laboratory, Department of Mechanical and Aerospace Engineering, Monash University, Melbourne, VIC, Australia
| | - Michael Šeman
- Cardiorespiratory Engineering and Technology Laboratory, Department of Mechanical and Aerospace Engineering, Monash University, Melbourne, VIC, Australia
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
- Department of Cardiology, Alfred Hospital, Melbourne, VIC, Australia
| | - Mehrdad Khamooshi
- Cardiorespiratory Engineering and Technology Laboratory, Department of Mechanical and Aerospace Engineering, Monash University, Melbourne, VIC, Australia
| | - Josie Carberry
- Cardiorespiratory Engineering and Technology Laboratory, Department of Mechanical and Aerospace Engineering, Monash University, Melbourne, VIC, Australia
| | - David McGiffin
- Department of Cardiothoracic Surgery and Transplantation, Alfred Hospital and Monash University, Melbourne, VIC, Australia
| | - Shaun D Gregory
- Cardiorespiratory Engineering and Technology Laboratory, Department of Mechanical and Aerospace Engineering, Monash University, Melbourne, VIC, Australia
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10
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D'Alto M, Di Maio M, Argiento P, Romeo E, Rea G, Liccardo B, Del Giudice C, Vergara A, Caiazza E, Del Vecchio GE, Di Vilio A, Gargani L, D'Andrea A, Bossone E, Golino P, Picano E, Naeije R. Right heart failure as a cause of pulmonary congestion in pulmonary arterial hypertension. Eur J Heart Fail 2024. [PMID: 38404257 DOI: 10.1002/ejhf.3172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/04/2024] [Accepted: 02/09/2024] [Indexed: 02/27/2024] Open
Abstract
AIMS Recent studies have shown that lung ultrasound-assessed pulmonary congestion is worse in heart failure when pulmonary vascular resistance (PVR) is increased, suggesting a paradoxical relationship between right heart failure and increased lung water content. Accordingly, we wondered if lung ultrasound would reveal otherwise clinically silent pulmonary congestion in patients with pulmonary arterial hypertension (PAH). METHODS AND RESULTS All patients referred for suspicion of PAH in a tertiary centre from January 2020 to December 2022 underwent a complete diagnostic work-up including echocardiography, lung ultrasound and right heart catheterization. Pulmonary congestion was identified by lung ultrasound B-lines using an 8-site scan. The study enrolled 102 patients with idiopathic PAH (mean age 53 ± 13 years; 71% female). World Health Organization functional classes I, II, and III were found in 2%, 52%, and 46% of them, respectively. N-terminal pro-brain natriuretic peptide (NT-proBNP) was 377 pg/ml (interquartile range [IQR] 218-906). B-lines were identified in 77 out of 102 patients (75%), with a median of 3 [IQR 1-5]. At univariable analysis, B-lines were positively correlated with male sex, age, NT-proBNP, systolic pulmonary artery pressure (sPAP), right atrial pressure (RAP), PVR, left ventricular end-diastolic volume and tricuspid annular plane systolic excursion (TAPSE), and negatively with cardiac output and stroke volume. At multivariable analysis, RAP (p < 0.001), TAPSE/sPAP (p = 0.001), and NT-proBNP (p = 0.04) were independent predictors of B-lines. CONCLUSION Lung ultrasound commonly discloses pulmonary congestion in PAH. This finding is related to right ventricular to pulmonary artery uncoupling, and may tentatively be explained by increased central venous pressure impeding lymphatic outflow.
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Affiliation(s)
- Michele D'Alto
- Department of Cardiology, University of Campania 'L. Vanvitelli', A.O.R.N. dei Colli, Monaldi Hospital, Naples, Italy
| | - Marco Di Maio
- Unit of Cardiology and Intensive Coronary Care, Umberto I Hospital, Nocera Inferiore, Salerno, Italy
| | - Paola Argiento
- Department of Cardiology, University of Campania 'L. Vanvitelli', A.O.R.N. dei Colli, Monaldi Hospital, Naples, Italy
| | - Emanuele Romeo
- Department of Cardiology, University of Campania 'L. Vanvitelli', A.O.R.N. dei Colli, Monaldi Hospital, Naples, Italy
| | - Gaetano Rea
- Unit of Radiology, A.O.R.N. dei Colli, Monaldi Hospital, Naples, Italy
| | - Biagio Liccardo
- Department of Cardiology, University of Campania 'L. Vanvitelli', A.O.R.N. dei Colli, Monaldi Hospital, Naples, Italy
| | - Carmen Del Giudice
- Department of Cardiology, University of Campania 'L. Vanvitelli', A.O.R.N. dei Colli, Monaldi Hospital, Naples, Italy
| | - Andrea Vergara
- Department of Cardiology, University of Campania 'L. Vanvitelli', A.O.R.N. dei Colli, Monaldi Hospital, Naples, Italy
| | - Eleonora Caiazza
- Department of Cardiology, University of Campania 'L. Vanvitelli', A.O.R.N. dei Colli, Monaldi Hospital, Naples, Italy
| | - Gerardo Elia Del Vecchio
- Department of Cardiology, University of Campania 'L. Vanvitelli', A.O.R.N. dei Colli, Monaldi Hospital, Naples, Italy
| | - Alessandro Di Vilio
- Department of Cardiology, University of Campania 'L. Vanvitelli', A.O.R.N. dei Colli, Monaldi Hospital, Naples, Italy
| | - Luna Gargani
- Department of Surgical Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Antonello D'Andrea
- Unit of Cardiology and Intensive Coronary Care, Umberto I Hospital, Nocera Inferiore, Salerno, Italy
| | - Eduardo Bossone
- Department of Public Health, University of Naples 'Federico II', Naples, Italy
| | - Paolo Golino
- Department of Cardiology, University of Campania 'L. Vanvitelli', A.O.R.N. dei Colli, Monaldi Hospital, Naples, Italy
| | - Eugenio Picano
- Biomedicine Department of the National Research Council, Pisa, Italy
| | - Robert Naeije
- Department of Pathophysiology, Free University of Brussels, Brussels, Belgium
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11
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Nakamura M, Imamura T, Hida Y, Izumida T, Nakagaito M, Nagura S, Doi T, Fukahara K, Kinugawa K. Successful management of HeartMate 3 in a patient with arrhythmogenic right ventricular cardiomyopathy. J Artif Organs 2024:10.1007/s10047-024-01434-2. [PMID: 38396198 DOI: 10.1007/s10047-024-01434-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/16/2024] [Indexed: 02/25/2024]
Abstract
The management of right heart failure during durable left ventricular assist device (LVAD) support remains an unsolved issue so far. We had a 44-year-old male patient who was diagnosed with arrhythmogenic right ventricular cardiomyopathy and received HeartMate 3 LVAD (Abbott, USA) implantation as a bridge-to-transplant indication. The pump speed was adjusted as low as 4500 rpm to avoid the left ventricular narrowing and interventricular septal leftward shift. Riociguat was administered to decrease the afterload of the right ventricle and increase the preload of the left ventricle, in addition to the combination of neurohormonal blockers. Frequent low-flow alarm events eventually disappeared after amlodipine administration, and he was successfully returned to work. We here present a unique management in a patient with right heart failure due to arrhythmogenic right ventricular cardiomyopathy during HeartMate 3 LVAD support.
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Affiliation(s)
- Makiko Nakamura
- The Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Teruhiko Imamura
- The Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
| | - Yuki Hida
- The Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Toshihide Izumida
- The Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Masaki Nakagaito
- The Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Saori Nagura
- Department of Cardiovascular Surgery, University of Toyama, Toyama, Japan
| | - Toshio Doi
- Department of Cardiovascular Surgery, University of Toyama, Toyama, Japan
| | - Kazuaki Fukahara
- Department of Cardiovascular Surgery, University of Toyama, Toyama, Japan
| | - Koichiro Kinugawa
- The Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
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12
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Wester M, Hamer OW, Meiler S. Massive dilation of the right atrium causes dyspnea and gastrointestinal symptoms. J Cardiovasc Comput Tomogr 2024:S1934-5925(24)00026-1. [PMID: 38316577 DOI: 10.1016/j.jcct.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/17/2024] [Accepted: 01/26/2024] [Indexed: 02/07/2024]
Affiliation(s)
- Michael Wester
- University Heart Centre, University Hospital Regensburg, Regensburg, Germany.
| | - Okka W Hamer
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Stefanie Meiler
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
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13
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Adamo M, Chioncel O, Pagnesi M, Bayes-Genis A, Abdelhamid M, Anker SD, Antohi EL, Badano L, Ben Gal T, Böhm M, Delgado V, Dreyfus J, Faletra FF, Farmakis D, Filippatos G, Grapsa J, Gustafsson F, Hausleiter J, Jaarsma T, Karam N, Lund L, Lurz P, Maisano F, Moura B, Mullens W, Praz F, Sannino A, Savarese G, Tocchetti CG, van Empel VPM, von Bardeleben RS, Yilmaz MB, Zamorano JL, Ponikowski P, Barbato E, Rosano GMC, Metra M. Epidemiology, pathophysiology, diagnosis and management of chronic right-sided heart failure and tricuspid regurgitation. A clinical consensus statement of the Heart Failure Association (HFA) and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC. Eur J Heart Fail 2024; 26:18-33. [PMID: 38131233 DOI: 10.1002/ejhf.3106] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 11/07/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023] Open
Abstract
Right-sided heart failure and tricuspid regurgitation are common and strongly associated with poor quality of life and an increased risk of heart failure hospitalizations and death. While medical therapy for right-sided heart failure is limited, treatment options for tricuspid regurgitation include surgery and, based on recent developments, several transcatheter interventions. However, the patients who might benefit from tricuspid valve interventions are yet unknown, as is the ideal time for these treatments given the paucity of clinical evidence. In this context, it is crucial to elucidate aetiology and pathophysiological mechanisms leading to right-sided heart failure and tricuspid regurgitation in order to recognize when tricuspid regurgitation is a mere bystander and when it can cause or contribute to heart failure progression. Notably, early identification of right heart failure and tricuspid regurgitation may be crucial and optimal management requires knowledge about the different mechanisms and causes, clinical course and presentation, as well as possible treatment options. The aim of this clinical consensus statement is to summarize current knowledge about epidemiology, pathophysiology and treatment of tricuspid regurgitation in right-sided heart failure providing practical suggestions for patient identification and management.
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Affiliation(s)
- Marianna Adamo
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine Carol Davila, Bucharest, Romania
| | - Matteo Pagnesi
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Antoni Bayes-Genis
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Stefan D Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site, Berlin, Germany
- Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Elena-Laura Antohi
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine Carol Davila, Bucharest, Romania
| | - Luigi Badano
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Tuvia Ben Gal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Victoria Delgado
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Julien Dreyfus
- Department of Cardiology, Centre Cardiologique du Nord, Saint-Denis, France
| | - Francesco F Faletra
- Division of Cardiology, ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Dimitrios Farmakis
- Department of Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Gerasimos Filippatos
- Department of Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Julia Grapsa
- Department of Cardiology, Guys and St Thomas NHS Trust, Kings College London, London, UK
| | - Finn Gustafsson
- Department of Cardiology, Heart Centre, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark
| | - Jörg Hausleiter
- Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany
| | | | - Nicole Karam
- Heart Valves Unit, Georges Pompidou European Hospital, Université Paris Cité, INSERM, Paris, France
| | - Lars Lund
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Philipp Lurz
- Division of Cardiology, University Medical Center, Mainz, Germany
| | - Francesco Maisano
- Cardiac Surgery and Heart Valve Center, Ospedale San Raffaele, University Vita Salute, Milan, Italy
| | - Brenda Moura
- Faculty of Medicine, University of Porto, Porto, Portugal
- Cardiology Department, Porto Armed Forces Hospital, Porto, Portugal
| | | | - Fabien Praz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Anna Sannino
- Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, Naples, Italy
| | - Gianluigi Savarese
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Carlo Gabriele Tocchetti
- Cardio-Oncology Unit, Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research (CISI), Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Interdepartmental Hypertension Research Center (CIRIAPA), 'Federico II' University, Naples, Italy
| | - Vanessa P M van Empel
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
| | | | - Mehmet Birhan Yilmaz
- Division of Cardiology, Department of Internal Medical Sciences, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - José Luis Zamorano
- Department of Cardiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Piotr Ponikowski
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Marco Metra
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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14
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Agarwal V, Hahn R. Tricuspid Regurgitation and Right Heart Failure: The Role of Imaging in Defining Pathophysiology, Presentation, and Novel Management Strategies. Interv Cardiol Clin 2024; 13:81-99. [PMID: 37980069 DOI: 10.1016/j.iccl.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
During the last few years, there has been a substantial shift in efforts to understand and manage secondary or functional tricuspid regurgitation (TR) given its prevalence, adverse prognostic impact, and symptom burden associated with progressive right heart failure. Understanding the pathophysiology of TR and right heart failure is crucial for determining the best treatment strategy and improving outcomes. In this article, we review the complex relationship between right heart structural and hemodynamic changes that drive the pathophysiology of secondary TR and discuss the role of multimodality imaging in the diagnosis, management, and determination of outcomes.
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Affiliation(s)
- Vratika Agarwal
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/ New York Presbyterian Hospital, 177 Fort Washington Avenue, Room 5C-501, New York, NY 10032, USA.
| | - Rebecca Hahn
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/ New York Presbyterian Hospital, 177 Fort Washington Avenue, Room 5C-501, New York, NY 10032, USA
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15
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Egbe AC, Abozied O, Miranda WR, Younis A, Burchill L, Kandlakunta S, Ahmed MH, Karnakoti S, Connolly HM. Prognostic role of inferior vena collapsibility index in congenital heart disease: A validation study. Int J Cardiol 2024; 394:131399. [PMID: 37774925 DOI: 10.1016/j.ijcard.2023.131399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/28/2023] [Accepted: 09/24/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND A recent study showed that inferior vena cava collapsibility index (IVCCI) <60% had better prognostic performance as compared to the American Society of Echocardiogram (ASE) criteria for estimating right atrial pressure (RAP). However, this study was based on a selected cohort of adults with congenital heart disease (CHD) that underwent right heart catheterization and limiting the generalizability of the results. The purpose of this study was, therefore, to validate the prognostic performance of IVCCI in a more representative sample of adults with CHD, which would in turn, improve generalizability of the results. METHODS Retrospective cohort study of adults with CHD that underwent echocardiogram at Mayo Clinic (2003-2021). Elevated RAP was defined as RAP >10 mmHg, and was estimated using IVCCI <60% or the ASE criteria (maximum IVC diameter < 2.1 cm and IVCCI <50%). Cardiovascular event was defined as heart failure hospitalization, heart transplant or cardiovascular death. RESULTS Of the 4029 patients, 754 (19%) and 601 (15%) had elevated RAP (RAP >10 mmHg) based on IVCCI <60%, and the ASE criteria, respectively. Of the 4029 patients, 374 (9%) had cardiovascular events during 7.6 (4.4-10.5) years of follow-up. IVCCI <60% was independently associated with cardiovascular events (adjusted HR 2.08, 95% CI 1.75-2.42; C-statistic 0.708, 95%CI 0.688-0.728), and provided improved prognostic performance as compared to the ASE criteria (C-statistic difference 0.036, 95%CI 0.017-0.055, P = 0.008). CONCLUSIONS IVCCI had superior prognostic performance as compared to the ASE criteria.
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Affiliation(s)
- Alexander C Egbe
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, United States of America.
| | - Omar Abozied
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, United States of America
| | - William R Miranda
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Ahmed Younis
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Luke Burchill
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Sriharsha Kandlakunta
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Marwan H Ahmed
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Snigdha Karnakoti
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Heidi M Connolly
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, United States of America
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16
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Abstract
Heart transplantation (HT) remains the best treatment of patients with severe heart failure who are deemed to be transplant candidates. The authors discuss postoperative management of the HT recipient by system, emphasizing areas where care might differ from other cardiac surgery patients. Working together, critical care physicians, heart transplant surgeons and cardiologists, advanced practice providers, pharmacists, transplant coordinators, nursing staff, physical therapists, occupational therapists, rehabilitation specialists, nutritionists, health psychologists, social workers, and the patient and their loved ones partner to increase the likelihood of a successful outcome.
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Affiliation(s)
- Gozde Demiralp
- Division of Critical Care Medicine, Department of Anesthesiology, University of Wisconsin School of Medicine & Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI 53792, USA
| | - Robert T Arrigo
- Division of Critical Care Medicine, Department of Anesthesiology, University of Wisconsin School of Medicine & Public Health, 600 Highland Avenue, Mail Code 3272, Madison, WI 53792, USA; Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, University of Wisconsin School of Medicine & Public Health, 600 Highland Avenue, Mail Code 3272, Madison, WI 53792, USA
| | - Christopher Cassara
- Division of Critical Care Medicine, Department of Anesthesiology, University of Wisconsin School of Medicine & Public Health, 600 Highland Avenue, Mail Code 3272, Madison, WI 53792, USA; Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, University of Wisconsin School of Medicine & Public Health, 600 Highland Avenue, Mail Code 3272, Madison, WI 53792, USA
| | - Maryl R Johnson
- Heart Failure and Transplant Cardiology, University of Wisconsin School of Medicine & Public Health, 600 Highland Avenue, E5/582 CSC, Mail Code 5710, Madison, WI 53792, USA.
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17
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Tong CX, Meng T. Twin pregnancy with sudden heart failure and pulmonary hypertension after atrial septal defect repair: A case report. World J Clin Cases 2023; 11:8350-8356. [PMID: 38130608 PMCID: PMC10731212 DOI: 10.12998/wjcc.v11.i35.8350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/14/2023] [Accepted: 12/05/2023] [Indexed: 12/14/2023] Open
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) in pregnancy is one of the major obstetric complications and is considered a contraindication to pregnancy as it is classified as a class IV risk in the revised risk classification of pregnancy by the World Health Organisation. Pregnancy, with its adaptive and expectant mechanical and hormonal changes, negatively affects the cardiopulmonary circulation in pregnant women. Do patients with repaired simple congenital heart disease (CHD) develop other pulmonary and cardiac complications during pregnancy? Can pregnant women with sudden pulmonary hypertension be treated and managed in time? In this paper, we present a case of a 39-year-old woman who underwent cesarean section at 33 wk' gestation and developed PAH secondary to repaired simple CHD. Our research began by a PubMed search for "pulmonary hypertension" and "pregnancy" and "CHD" case reports. Three cases were selected to review PAH in pregnancy after correction of CHD defects. These studies were reviewed, coupled with our own clinical experience. CASE SUMMARY Herein, a case involving a woman who underwent atrial septal defect repair at the age of 34, became pregnant five years later, and had a sudden onset of PAH and right heart failure secondary to symptoms of acute peripheral edema in the third trimester of her pregnancy. As a result, the patient underwent a cesarean section and gave birth to healthy twins. Within three days after cesarean delivery, her cardiac function deteriorated as the pulmonary artery pressure increased. Effective postpartum management, including diuresis, significant oxygen uptake, vasodilators, capacity and anticoagulants management, led to improvements in cardiac function and oxygenation. The patient was discharged from hospital with a stable recovery and transferred to local hospitals for further PAH treatment. CONCLUSION This case served as a reminder to obstetricians of the importance of pregnancy after repair of CHD. It is crucial for patients with CHD to receive early correction. It suggests doctors should not ignore edema of twin pregnancy. Also, it provides a reference for the further standardization of antenatal, intrapartum and postpartum management for patients with CHD worldwide.
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Affiliation(s)
- Chun-Xiao Tong
- Department of Obstetrical, First Affiliated Hospital of China Medical University, Shenyang 110000, Liaoning Province, China
| | - Tao Meng
- Department of Obstetrical, First Affiliated Hospital of China Medical University, Shenyang 110000, Liaoning Province, China
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18
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Alomari M, Reddy P, El Sabbagh A, Pollak P, Lyle M. Transcatheter edge-to-edge repair for tricuspid valve regurgitation in apolipoprotein A-I-associated cardiac amyloidosis: case report. Eur Heart J Case Rep 2023; 7:ytad582. [PMID: 38130865 PMCID: PMC10733207 DOI: 10.1093/ehjcr/ytad582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 11/08/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023]
Abstract
Background Amyloidosis is defined by abnormal protein folding and subsequent deposition in tissues. Cardiac involvement is usually related to misfolded monoclonal immunoglobulin light chains or misfolded transthyretin; however, apolipoprotein A-1-associated amyloidosis is a hereditary form of amyloidosis resulting from mutations in the AAPOA1 gene that can also result in cardiac amyloidosis. Although there have been advancements in noninvasive algorithms for the diagnosis of cardiac amyloidosis, endomyocardial biopsy (EMB) may still be warranted. All individuals undergoing EMB are susceptible to complications, including tricuspid valve injury resulting in severe tricuspid valve regurgitation. Case summary Our patient is a 70-year-old white man presented with symptoms of dyspnoea on exertion and decreased functional capacity, diagnosed previously with apolipoprotein A-I cardiac amyloidosis, confirmed by EMB. He developed progressive right-sided heart failure secondary to iatrogenic flail tricuspid leaflet related to the diagnostic EMB. He underwent a successful transcatheter tricuspid valve edge-to-edge repair with 4D intracardiac echocardiographic guidance. At the recent follow-up, the patient showed improved symptoms, with increased stamina, and transoesophageal echocardiography revealed a 65% ejection fraction and mild tricuspid regurgitation (TR). Discussion Tricuspid valve injury is one of the complications associated with EMB, which can result in severe TR. Transcatheter tricuspid valve edge-to-edge repair can be a useful option for patients considered too high risk for surgical intervention, such as those with advanced cardiac amyloidosis.
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Affiliation(s)
- Mohammad Alomari
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Prajwal Reddy
- Department of Cardiovascular Disease, Mayo Clinic, Jacksonville, FL, USA
| | | | - Peter Pollak
- Department of Cardiovascular Disease, Mayo Clinic, Jacksonville, FL, USA
| | - Melissa Lyle
- Division of Advanced Heart Failure and Transplant Cardiology, Department of Transplantation, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
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González-Gómez A, Fernández-Golfín C, Hinojar R, Monteagudo JM, García A, García-Sebastián C, García-Lunar I, Sánchez-Recalde Á, Salido L, Pardo A, Zamorano JL. The 4A classification for patients with tricuspid regurgitation. Rev Esp Cardiol (Engl Ed) 2023; 76:845-851. [PMID: 36898521 DOI: 10.1016/j.rec.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION AND OBJECTIVES Significant tricuspid regurgitation (TR) is associated with increased morbidity and mortality. Clinical evaluation of TR patients is challenging. Our aim was to establish a new clinical classification specific for patients with TR, the 4A classification, and evaluate its prognostic performance. METHODS We included patients with isolated TR that was at least severe and without previous episodes of heart failure (HF) who were assessed in the heart valve clinic. We registered signs and symptoms of asthenia, ankle swelling, abdominal pain or distention and/or anorexia and followed up the patients every 6 months. The 4A classification ranged from A0 (no A) to A3 (3 or 4 As present). We defined a combined endpoint consisting of hospital admission due to right HF or cardiovascular mortality. RESULTS We included 135 patients with significant TR between 2016 and 2021 (69% females, mean age 78±7 years). During a median follow-up of 26 [IQR, 10-41] months, 39% (n=53) patients had the combined endpoint: 34% (n=46) were admitted for HF and 5% (n=7) died. At baseline, 94% of the patients were in NYHA I or II, while 24% were in classes A2 or A3. The presence of A2 or A3 conferred a high incidence of events. The change in 4A class remained an independent marker of HF and cardiovascular mortality (adjusted HR per unit of change of 4A class, 1.95 [1.37-2.77]; P<.001). CONCLUSIONS This study reports a novel clinical classification specifically for patients with TR that is based on signs and symptoms of right HF and has prognostic value for events.
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Affiliation(s)
- Ariana González-Gómez
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Covadonga Fernández-Golfín
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Rocío Hinojar
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Juan Manuel Monteagudo
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Ana García
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | | | - Inés García-Lunar
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Laboratorio de Investigación en Imagen Cardiovascular Humana, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Ángel Sánchez-Recalde
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Luisa Salido
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Ana Pardo
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - José Luis Zamorano
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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20
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Agarwal V, Hahn R. Tricuspid Regurgitation and Right Heart Failure: The Role of Imaging in Defining Pathophysiology, Presentation, and Novel Management Strategies. Heart Fail Clin 2023; 19:505-523. [PMID: 37714590 DOI: 10.1016/j.hfc.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
During the last few years, there has been a substantial shift in efforts to understand and manage secondary or functional tricuspid regurgitation (TR) given its prevalence, adverse prognostic impact, and symptom burden associated with progressive right heart failure. Understanding the pathophysiology of TR and right heart failure is crucial for determining the best treatment strategy and improving outcomes. In this article, we review the complex relationship between right heart structural and hemodynamic changes that drive the pathophysiology of secondary TR and discuss the role of multimodality imaging in the diagnosis, management, and determination of outcomes.
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Affiliation(s)
- Vratika Agarwal
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/ New York Presbyterian Hospital, 177 Fort Washington Avenue, Room 5C-501, New York, NY 10032, USA.
| | - Rebecca Hahn
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/ New York Presbyterian Hospital, 177 Fort Washington Avenue, Room 5C-501, New York, NY 10032, USA
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21
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Tunthong R, Salama AA, Lane CM, Fine NM, Anand V, Padang R, Thaden JJ, Pislaru SV, Kane GC. Right ventricular systolic strain in patients with pulmonary hypertension: clinical feasibility, reproducibility, and correlation with ejection fraction. J Echocardiogr 2023; 21:105-112. [PMID: 36451073 DOI: 10.1007/s12574-022-00593-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 10/22/2022] [Accepted: 11/11/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Right ventricular (RV) systolic function is the major determinant of prognosis in patients with pulmonary hypertension (PH) with quantitative assessment by speckle-tracking strain echocardiography emerging as a viable candidate measure. METHOD We evaluated a prospective cohort of 231 patients with known or suspected PH referred for clinical echocardiography. All underwent measurement of RV free-wall systolic strain by sonographer staff. Digital images were recorded for blinded offline assessment by an expert echocardiographer. Reproducibility was assessed using the analysis methods of Bland-Altman and the Cohen's-Kappa coefficient. RESULTS RV strain was feasible in 213 (92%). The average RV systolic pressure was 59 ± 22 mmHg. RV systolic strain correlated with functional class, NT-proBNP, and the degree of RV enlargement. The average free-wall systolic strain was - 20 ± 7% (range - 2 to - 37%). The RV strain measures (clinical practice versus blinded expert) had an excellent correlation with a normal distribution (R2 0.87, p < 0.0001). By Bland-Altman analysis, the mean difference in measurement was - 1.7% (95% CI - 1.4 to - 2.1) with a correlation of 0.93, p value of < 0.0001. The reproducibility of RV strain for clinically relevant thresholds was also excellent (Kappa coefficients 0.68-0.83). There was no effect on the variability of strain measures across body mass, pulmonary pressures, or rhythm. RV strain correlated with RV diastolic volumes and ejection fraction with RV free wall strain being the best echo predictor for a reduction in ejection fraction. CONCLUSION Here RV systolic strain was found to be highly feasible and reproducible in clinical practice with excellent levels of agreement for clinically relevant thresholds.
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Affiliation(s)
- Ramaimon Tunthong
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Diseases, Mayo Clinic, Gonda 6, 200 First Street SW, Rochester, MN, 55905, USA
- Non-Invasive Cardiology Department, Bangkok Hospital Headquarters, BDMS, Bangkok, Thailand
| | - Abdalla A Salama
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Diseases, Mayo Clinic, Gonda 6, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Cardiovascular Diseases, Suez Canal University, Ismailia, Egypt
| | - Conor M Lane
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Diseases, Mayo Clinic, Gonda 6, 200 First Street SW, Rochester, MN, 55905, USA
| | - Nowell M Fine
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Diseases, Mayo Clinic, Gonda 6, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
| | - Vidhu Anand
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Diseases, Mayo Clinic, Gonda 6, 200 First Street SW, Rochester, MN, 55905, USA
| | - Ratnasari Padang
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Diseases, Mayo Clinic, Gonda 6, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jeremy J Thaden
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Diseases, Mayo Clinic, Gonda 6, 200 First Street SW, Rochester, MN, 55905, USA
| | - Sorin V Pislaru
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Diseases, Mayo Clinic, Gonda 6, 200 First Street SW, Rochester, MN, 55905, USA
| | - Garvan C Kane
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Diseases, Mayo Clinic, Gonda 6, 200 First Street SW, Rochester, MN, 55905, USA.
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22
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Park BW, Park YW, Nam BD, Kwon SS. Right heart failure due to arteriovenous fistula after spine surgery treated with endovascular repair. Acta Cardiol 2023; 78:846-847. [PMID: 37171404 DOI: 10.1080/00015385.2023.2209768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 04/20/2023] [Indexed: 05/13/2023]
Affiliation(s)
- Byoung-Won Park
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Young Woo Park
- Department of Chest Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Bo Da Nam
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Seong Soon Kwon
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
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23
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Kuang M, Chen Y, Xing Y, Du M, Feng H, Yang Q, Wen D, Li X, Yang K, Lin Z, Lai N, Jiang Q, Liu S, Zhou D, Hong W, Fu X, Lu W, Zhao T, Wang J, Chen Y. Echocardiographic evaluation of right heart failure which might be associated with DNA damage response in SU5416-hypoxia induced pulmonary hypertension rat model. Respir Res 2023; 24:202. [PMID: 37592245 PMCID: PMC10433698 DOI: 10.1186/s12931-023-02501-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/28/2023] [Indexed: 08/19/2023] Open
Abstract
Right heart failure is the leading cause of death in pulmonary hypertension (PH), and echocardiography is a commonly used tool for evaluating the risk hierarchy of PH. However, few studies have explored the dynamic changes in the structural and functional changes of the right heart during the process of PH. Previous studies have found that pulmonary circulation coupling right ventricular adaptation depends on the degree of pressure overload and other factors. In this study, we performed a time-dependent evaluation of right heart functional changes using transthoracic echocardiography in a SU5416 plus hypoxia (SuHx)-induced PH rat model. Rats were examined in 1-, 2-, 4-, and 6-week using right-heart catheterization, cardiac echocardiography, and harvested heart tissue. Our study found that echocardiographic measures of the right ventricle (RV) gradually worsened with the increase of right ventricular systolic pressure, and right heart hypofunction occurred at an earlier stage than pulmonary artery thickening during the development of PH. Furthermore, sarco-endoplasmic reticulum calcium ATPase 2 (SERCA2), a marker of myocardial damage, was highly expressed in week 2 of SuHx-induced PH and had higher levels of expression of γ-H2AX at all timepoints, as well as higher levels of DDR-related proteins p-ATM and p53/p-p53 and p21 in week 4 and week 6. Our study demonstrates that the structure and function of the RV begin to deteriorate with DNA damage and cellular senescence during the early stages of PH development.
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Affiliation(s)
- Meidan Kuang
- State Key Laboratory of Respiratory Diseases, National Center for Respiratory Medicine, Guangdong Key Laboratory of Vascular Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, GMU-GIBH Joint School of Life Sciences, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Yilin Chen
- State Key Laboratory of Respiratory Diseases, National Center for Respiratory Medicine, Guangdong Key Laboratory of Vascular Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, GMU-GIBH Joint School of Life Sciences, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Yue Xing
- State Key Laboratory of Respiratory Diseases, National Center for Respiratory Medicine, Guangdong Key Laboratory of Vascular Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, GMU-GIBH Joint School of Life Sciences, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Min Du
- State Key Laboratory of Respiratory Diseases, National Center for Respiratory Medicine, Guangdong Key Laboratory of Vascular Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, GMU-GIBH Joint School of Life Sciences, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Huazhuo Feng
- State Key Laboratory of Respiratory Diseases, National Center for Respiratory Medicine, Guangdong Key Laboratory of Vascular Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, GMU-GIBH Joint School of Life Sciences, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Qifeng Yang
- State Key Laboratory of Respiratory Diseases, National Center for Respiratory Medicine, Guangdong Key Laboratory of Vascular Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, GMU-GIBH Joint School of Life Sciences, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Dongmei Wen
- State Key Laboratory of Respiratory Diseases, National Center for Respiratory Medicine, Guangdong Key Laboratory of Vascular Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, GMU-GIBH Joint School of Life Sciences, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Xuanyi Li
- State Key Laboratory of Respiratory Diseases, National Center for Respiratory Medicine, Guangdong Key Laboratory of Vascular Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, GMU-GIBH Joint School of Life Sciences, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Kai Yang
- State Key Laboratory of Respiratory Diseases, National Center for Respiratory Medicine, Guangdong Key Laboratory of Vascular Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, GMU-GIBH Joint School of Life Sciences, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Ziying Lin
- State Key Laboratory of Respiratory Diseases, National Center for Respiratory Medicine, Guangdong Key Laboratory of Vascular Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, GMU-GIBH Joint School of Life Sciences, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Ning Lai
- State Key Laboratory of Respiratory Diseases, National Center for Respiratory Medicine, Guangdong Key Laboratory of Vascular Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, GMU-GIBH Joint School of Life Sciences, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Qian Jiang
- State Key Laboratory of Respiratory Diseases, National Center for Respiratory Medicine, Guangdong Key Laboratory of Vascular Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, GMU-GIBH Joint School of Life Sciences, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Shiyun Liu
- State Key Laboratory of Respiratory Diseases, National Center for Respiratory Medicine, Guangdong Key Laboratory of Vascular Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, GMU-GIBH Joint School of Life Sciences, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Dansha Zhou
- State Key Laboratory of Respiratory Diseases, National Center for Respiratory Medicine, Guangdong Key Laboratory of Vascular Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, GMU-GIBH Joint School of Life Sciences, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Wei Hong
- State Key Laboratory of Respiratory Diseases, National Center for Respiratory Medicine, Guangdong Key Laboratory of Vascular Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, GMU-GIBH Joint School of Life Sciences, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Xin Fu
- State Key Laboratory of Respiratory Diseases, National Center for Respiratory Medicine, Guangdong Key Laboratory of Vascular Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, GMU-GIBH Joint School of Life Sciences, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Wenju Lu
- State Key Laboratory of Respiratory Diseases, National Center for Respiratory Medicine, Guangdong Key Laboratory of Vascular Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, GMU-GIBH Joint School of Life Sciences, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Tengteng Zhao
- The Jackson Laboratory, Bar Harbor, Maine, 04609, USA
| | - Jian Wang
- State Key Laboratory of Respiratory Diseases, National Center for Respiratory Medicine, Guangdong Key Laboratory of Vascular Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, GMU-GIBH Joint School of Life Sciences, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510120, Guangdong, China.
- Guangzhou Laboratory, Guangzhou International Bio Island, Guangzhou, 510320, Guangdong, China.
| | - Yuqin Chen
- State Key Laboratory of Respiratory Diseases, National Center for Respiratory Medicine, Guangdong Key Laboratory of Vascular Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, GMU-GIBH Joint School of Life Sciences, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510120, Guangdong, China.
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24
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Kurnick A, Zaveri S, Tadayoni A, Chandrakumar HP, John S. Reversible severe pulmonary hypertension and right heart failure with cardiogenic shock due to scurvy: a case report. Eur Heart J Case Rep 2023; 7:ytad404. [PMID: 37650076 PMCID: PMC10464571 DOI: 10.1093/ehjcr/ytad404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/31/2023] [Accepted: 08/15/2023] [Indexed: 09/01/2023]
Abstract
Background The systemic complications of vitamin C deficiency, otherwise known as scurvy, have been well-documented in history. Few case reports have documented severe cardiopulmonary complications such as right heart failure (RHF) and pulmonary hypertension (PH). Case summary A 25-year-old female presented to the hospital with two weeks of progressive fatigue, dyspnoea, myalgias, and arthralgias. She was admitted for symptomatic anaemia requiring transfusion. Her symptoms persisted and she developed severe PH and RHF, complicated by cardiogenic shock and multiple episodes of cardiac arrest. She was found to have severe vitamin C deficiency secondary to a severely self-restricted diet. After repletion of vitamin C, the patient had complete resolution of RHF and PH. Discussion This case adds to the sparse literature documenting severe cardiopulmonary complications of vitamin C deficiency. We believe that this is the first adult case of scurvy causing RHF and PH leading to cardiogenic shock and episodes of cardiac arrest. There are multiple hypotheses on the pathogenesis of scurvy-associated PH and RHF, including overactivation of hypoxia-inducible transcription factors and deficiency of vitamin C's vasodilatory effect that acts through increased nitric oxide production in endothelial cells. When recognized, early vitamin C repletion may prevent severe cardiopulmonary complications of scurvy.
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Affiliation(s)
- Adam Kurnick
- Department of Internal Medicine, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
| | - Sahil Zaveri
- Department of Internal Medicine, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
| | - Ashkan Tadayoni
- Department of Internal Medicine, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
| | - Harshith P Chandrakumar
- Department of Internal Medicine, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
| | - Sabu John
- Department of Internal Medicine, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
- Division of Cardiology, Kings County Hospital, 451 Clarkson Avenue, Brooklyn, NY 11203, USA
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25
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Andersen S, Reese-Petersen AL, Braams N, Andersen MJ, Mellemkjær S, Andersen A, Bogaard HJ, Genovese F, Nielsen-Kudsk JE. Biomarkers of collagen turnover and wound healing in chronic thromboembolic pulmonary hypertension patients before and after pulmonary endarterectomy. Int J Cardiol 2023; 384:82-88. [PMID: 37178803 DOI: 10.1016/j.ijcard.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/19/2023] [Accepted: 05/10/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND In chronic thromboembolic pulmonary hypertension (CTEPH), fibrotic remodeling of tissue and thrombi contributes to disease progression. Removal of the thromboembolic mass by pulmonary endarterectomy (PEA) improves hemodynamics and right ventricular function, but the roles of different collagens before as well as after PEA are not well understood. METHODS In this study, hemodynamics and 15 different biomarkers of collagen turnover and wound healing were evaluated in 40 CTEPH patients at diagnosis (baseline) and 6 and 18 months after PEA. Baseline biomarker levels were compared with a historical cohort of 40 healthy subjects. RESULTS Biomarkers of collagen turnover and wound healing were increased in CTEPH patients compared with healthy controls, including a 35-fold increase in the PRO-C4 marker of type IV collagen formation and a 55-fold increase in the C3M marker of type III collagen degradation. PEA reduced pulmonary pressures to almost normal levels 6 months after the procedure, with no further improvement at 18 months. There were no changes in any of the measured biomarkers after PEA. CONCLUSIONS Biomarkers of collagen formation and degradation are increased in CTEPH suggesting a high collagen turnover. While PEA effectively reduces pulmonary pressures, collagen turnover is not significantly modified by surgical PEA.
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Affiliation(s)
- Stine Andersen
- Department of Cardiology, Aarhus University Hospital, Denmark.
| | | | - Natalia Braams
- Department of Pulmonology, Amsterdam University Medical Center, the Netherlands
| | | | | | - Asger Andersen
- Department of Cardiology, Aarhus University Hospital, Denmark
| | - Harm Jan Bogaard
- Department of Pulmonology, Amsterdam University Medical Center, the Netherlands
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Portillo-Romero A, Cuevas-Medina E, Santa Ana-Bayona MJ, Saenz-Ancira S. Acute pulmonary tumour embolism and right systolic dysfunction in a hidden intrahepatic cholangiocarcinoma: case report. Eur Heart J Case Rep 2023; 7:ytad291. [PMID: 37457051 PMCID: PMC10347672 DOI: 10.1093/ehjcr/ytad291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/04/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
Background Pulmonary tumour embolism is a rare entity that can arise from a wide variety of neoplasms. It can initially manifest as a pulmonary embolism with right heart failure and be refractory to thrombolytic therapy. Cholangiocarcinoma is a rare malignancy that arises from the epithelium of the biliary tree, representing 3% of all the gastrointestinal malignancies, being the intrahepatic cholangiocarcinoma the second most common liver tumour after hepatocellular carcinoma. Case summary This case regards a patient that presented to our centre with acute pulmonary embolism, deep vein thrombosis, and unrevealing previous medical history. Imaging studies revealed pulmonary embolism, an ovarian mass, and multiple hepatic hypodensities. Throughout the hospitalization, the patient's haemodynamic state and right heart failure worsened, eventually leading to multi-organ failure and death. Post-mortem evaluation revealed cholangiocarcinoma cells on the pulmonary arteries. Discussion Pulmonary tumour embolism is a rare pathology that can present with acute right heart failure. The diagnosis of occult cancer can be challenging, and the appropriate treatment for this entity remains an unexplored subject.
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Affiliation(s)
- Alejandra Portillo-Romero
- Department of Interventional Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano No. 1, Colonia Seccion XVI, Tlalpan, Mexico City 14030, Mexico
| | - Eric Cuevas-Medina
- Department of Interventional Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano No. 1, Colonia Seccion XVI, Tlalpan, Mexico City 14030, Mexico
| | - Maria Jose Santa Ana-Bayona
- Mexican Faculty of Medicine, La Salle University, Las Fuentes 17, Tlalpan Centro I, Tlalpan, 14000 Ciudad de México, CDMX, Mexico
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27
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Siems C, Aggarwal R, Shaffer A, John R. Right heart failure after left ventricular assist device implantation: a persistent problem. Indian J Thorac Cardiovasc Surg 2023; 39:161-169. [PMID: 37525713 PMCID: PMC10387018 DOI: 10.1007/s12055-023-01481-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 12/09/2022] [Accepted: 01/17/2023] [Indexed: 02/24/2023] Open
Abstract
Left ventricular assist device (LVAD) is an option for bridge-to-transplant or destination therapy for patients with end-stage heart failure. Right heart failure (RHF) remains a complication after LVAD implantation that portends high morbidity and mortality, despite advances in LVAD technology. Definitions of RHF vary, but generally include the need for inotropic or pulmonary vasodilator support, or potential right ventricular (RV) mechanical circulatory support. This review covers the complex pathophysiology of RHF related to underlying myocardial dysfunction, interventricular dependence, and RV afterload, as well as treatment strategies to curtail this challenging problem.
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Affiliation(s)
- Chesney Siems
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, 420 Delaware Street SE, MMC 207, Minneapolis, MN 55455 USA
| | - Rishav Aggarwal
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, 420 Delaware Street SE, MMC 207, Minneapolis, MN 55455 USA
| | - Andrew Shaffer
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, 420 Delaware Street SE, MMC 207, Minneapolis, MN 55455 USA
| | - Ranjit John
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, 420 Delaware Street SE, MMC 207, Minneapolis, MN 55455 USA
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Condello I, Nasso G, Contegiacomo G, Solimando C, Balducci G, Scaringi D, D'Alessandro P, Speziale G. ECMOLIFE intra-hospital transport in life-saving for pulmonary vein obstruction. Surg Case Rep 2023; 9:113. [PMID: 37341809 DOI: 10.1186/s40792-023-01702-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/16/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Transport with extracorporeal membrane oxygenation (ECMO) in the hospital setting can become a challenge as well as in the out-of-hospital setting. In particular, the management of intra-hospital transport with ECMO support of the critically ill patient foresees his shift from the intensive care to the diagnostic areas, from the diagnostic areas to the interventional and surgical areas. CASE PRESENTATION In this context, we present a life-saving transport case with the veno-venous (VV) configuration of the ECMOLIFE Eurosets system, for right heart and respiratory failure in a 54-year-old woman, due to thrombosed obstruction of the right superior pulmonary vein, following mitral valve repair surgery in minimally invasive approach in a patient already operated on for complex congenital heart disease. After stabilizing the vital parameters with Veno-venous ECMO for 19 h, the patient was transported to hemodynamics for angiography of the pulmonary vessels, where the diagnosis of obstruction of the pulmonary venous return was made. Subsequently, the patient was brought back to the operating room for a procedure of unblocking the right superior pulmonary vein using a minimally invasive approach, passing from the ECMO to the support in extracorporeal circulation. CONCLUSIONS The transportable ECMOLIFE Eurosets System was safe and effective during transport in maintaining the vital parameters of oxygenation and CO2 reuptake and systemic flow, allowing the patient to be mobilized for diagnostic tests instrumental to diagnosis. The patient was extubated 36 h after the surgical procedures and was discharged 10 days later from the hospital.
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Affiliation(s)
- Ignazio Condello
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Perfusion Service, Via Camillo Rosalba 35/37, 70124, Bari, Italy.
| | - Giuseppe Nasso
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Perfusion Service, Via Camillo Rosalba 35/37, 70124, Bari, Italy
| | - Gaetano Contegiacomo
- Department of Interventional Cardiology, Anthea Hospital, GVM Care & Research, Bari, Italy
| | - Carlo Solimando
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Perfusion Service, Via Camillo Rosalba 35/37, 70124, Bari, Italy
| | - Giuseppe Balducci
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Perfusion Service, Via Camillo Rosalba 35/37, 70124, Bari, Italy
| | - Domenico Scaringi
- Department of Interventional Cardiology, Anthea Hospital, GVM Care & Research, Bari, Italy
| | - Pasquale D'Alessandro
- Department of Interventional Cardiology, Anthea Hospital, GVM Care & Research, Bari, Italy
| | - Giuseppe Speziale
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Perfusion Service, Via Camillo Rosalba 35/37, 70124, Bari, Italy
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Ranjbar M, Amin A, Amin A, Pouraliakbar H, Mohamadifar A. High cardiac output state due to pelvic arterio-venous shunt: a case report and review of the literature. ESC Heart Fail 2023. [PMID: 37216928 PMCID: PMC10375175 DOI: 10.1002/ehf2.14396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 03/08/2023] [Accepted: 05/02/2023] [Indexed: 05/24/2023] Open
Abstract
We are presenting a 35-year-old woman with past medical history of disseminated leiomyomatosis who presented with heart failure symptoms and was found to have post-capillary pulmonary hypertension and high cardiac output state in right heart catheterization secondary to a huge pelvic arterio-venous fistula.
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Affiliation(s)
- Maryam Ranjbar
- Department of Cardiology, Cardiovascular Research Center, Mazandaran University of Medical Science, Sari, Iran
| | - Ahmad Amin
- Department of Heart Failure and Transplantation, Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
| | - Ali Amin
- Department of Pathology, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Hamidreza Pouraliakbar
- Department of Radiology, Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
| | - Arezoo Mohamadifar
- Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Massih Daneshvari Educational and Medical Center, Shahid Beheshti University of Medical Science, Tehran, Iran
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Yim IHW, Khan-Kheil AM, Drury NE, Lim HS. A Systematic Review and Physiology of Pulmonary Artery Pulsatility Index in Left Ventricular Assist Device Therapy. Interdiscip Cardiovasc Thorac Surg 2023:7160916. [PMID: 37171900 DOI: 10.1093/icvts/ivad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/24/2023] [Accepted: 05/11/2023] [Indexed: 05/14/2023]
Abstract
BACKGROUND Right heart failure is a major complication following left ventricular assist device (LVAD) implantation. Pulmonary artery pulsatility index (PAPi) has been evaluated as a haemodynamic marker for right heart failure, but PAPi is dependent on pulmonary vascular resistance. We conducted a systematic review to assess the relationship between PAPi and right heart failure and death in patients undergoing LVAD implantation; and examined the relationship between PAPi cut-off and pulmonary vascular resistance. METHODS We searched PubMed, EMBASE, CENTRAL and manually screened retrieved references to identify all clinical studies reporting PAPi in adult patients with a durable LVAD. Eligibility criteria were prespecified and two reviewers independently screened and extracted data; the Newcastle-Ottawa Scale was used to assess quality of non-randomized studies. This study was prospectively registered on PROSPERO (CRD42021259009). RESULTS From 283 unique records, we identified 16 studies reporting haemodynamic assessment in 20,634 adult patients with an implanted durable LVAD. Only 2 studies reported on mortality and in both, a lower PAPi was significantly associated with death. Fifteen studies reported right heart failure data and in ten studies a lower PAPi was significantly associated with right heart failure. Six studies reported on PAPi cut-offs ranging from 0.88 to 3.3; and the cut-offs were directly related to pulmonary vascular resistance (r = 0.6613, p = 0.019). CONCLUSIONS Lower PAPi was associated with right heart failure and death following LVAD implantation, but a single PAPi cut-off cannot be defined, as it is dependent on pulmonary vascular resistance.
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Affiliation(s)
- Ivan H W Yim
- Department of Cardiac Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Ayisha M Khan-Kheil
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Nigel E Drury
- Department of Cardiac Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Hoong Sern Lim
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
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Kocabeyoglu SS, Kervan U, Sert DE, Karahan M, Kavurt AV, Koca S. Adaptation of adult right ventricular scoring systems to pediatric patients undergoing continuous LVAD implantation: Feasible or not? Int J Artif Organs 2023; 46:280-288. [PMID: 37036016 DOI: 10.1177/03913988231166731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
PURPOSE The aim of this study is to investigate the efficacy of adaptation of right ventricular (RV) risk scores used in adult patients to pediatric age group undergoing LVAD implantation. METHODS Twenty-two pediatric patients who underwent LVAD implantation were retrospectively reviewed from January 2014 to September 2018. Preoperative patient characteristics, hemodynamic parameters, and echocardiographic data were collected. Adult RV risk scores were calculated for all patients. Effects of all the parameters on RV function were also investigated. Study endpoints were RVF and in-hospital mortality. RESULTS Eleven (50%) of 22 patients were male. The mean age of the patients was 13.4 ± 3.8 years. The mean body surface area of the patients was 1.4 ± 0.4 m2. In five patients BiVAD implantation was performed. Of these five BiVAD patients two underwent successful heart transplant; two weaned from temporary RVAD and last patient died due to multi-organ failure. Four patients showed signs of early RVF; one patient was transplanted successfully while on medical support. Three patients developing RVF did not respond medical therapy necessitating ECMO and died in the early postoperative period. All risk scores and potential predictive factors were evaluated individually and in combination of several parameters. No significant predictor for RVF in pediatric patients that underwent LVAD implantation was found (p > 0.05). CONCLUSION Neither an adult risk score nor a predictive factor was successful in predicting RVF, alone or in combination due to limited number of patients and events. Large further investigations are needed to identify the predictors or scoring system in pediatric population.
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Affiliation(s)
| | - Umit Kervan
- Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey
| | - Dogan Emre Sert
- Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey
| | - Mehmet Karahan
- Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey
| | - Ahmet Vedat Kavurt
- Department of Pediatric Cardiology, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey
| | - Serhat Koca
- Department of Pediatric Cardiology, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey
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Kol A, Kepez A, Akaslan D, Kanar B, Atas H, Mutlu B. Effects of balloon pulmonary angioplasty procedure on electrocardiographic parameters in patients with chronic thromboembolic pulmonary hypertension. J Electrocardiol 2023; 77:72-77. [PMID: 36736206 DOI: 10.1016/j.jelectrocard.2023.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/25/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023]
Abstract
AIM The aim of the present study was to evaluate the value of electrocardiography (ECG) in predicting postoperative hemodynamic improvement in patients with chronic thromboembolic pulmonary hypertension (CTEPH) undergoing balloon pulmonary angioplasty (BPA). MATERIAL AND METHODS A total of 32 patients were included in the study. During ECG analysis, parameters that have been suggested to be related to right ventricular hypertrophy and/or dilatation were evaluated. The significance of the change in each parameter obtained at the pre-BPA visit and at the scheduled control visit 6 months after BPA was tested. In addition to ECG analysis, data related to right heart catheterization (RHC) and echocardiography, B-type natriuretic peptide (BNP) levels and World Health Organization (WHO) functional classifications of all patients were also recorded. The relationship between the amount of possible change in ECG parameters and the amount of possible change in hemodynamic parameters was investigated. RESULTS The Daniel score, which has been suggested to have prognostic value in acute pulmonary embolism, decreased from 8.22 ± 5.68 to 6.56 ± 5.55 after the BPA procedure (p: 0.035). Among all parameters studied, only T wave height (V2 t) in V2 derivation changed significantly from -0.77 ± 2.39 to 1.27 ± 2.58 mm (p: 0.036). The amount of change in V2 T was found to significantly correlate with the amount of change in systolic right ventricular pressure, mean pulmonary artery pressure, pulmonary vascular resistance, and systemic vascular resistance. CONCLUSION Postprocedural T wave changes in lead V2 might serve as a marker of hemodynamic improvement in patients with CTEPH who undergo BPA.
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Affiliation(s)
- Ayhan Kol
- Marmara University School of Medicine, Department of Cardiology, Istanbul, Turkey.
| | - Alper Kepez
- Marmara University School of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Dursun Akaslan
- Marmara University School of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Batur Kanar
- Marmara University School of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Halil Atas
- Marmara University School of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Bulent Mutlu
- Marmara University School of Medicine, Department of Cardiology, Istanbul, Turkey
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Valente F, Stefanidis C, Vachiéry JL, Dewachter C, Engelman E, Vanden Eynden F, Roussoulières A. A novel metrics to predict right heart failure after left ventricular assist device implantation. J Artif Organs 2023; 26:24-35. [PMID: 35482120 DOI: 10.1007/s10047-022-01334-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 04/04/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Right Heart Failure (RHF) is a severe complication that can occur after left ventricular assist device (LVAD) implantation, increasing early and late mortality. Although numerous RHF predictive scores have been developed, limited data exist on the external validation of these models. We therefore aimed at comparing existent risk score models and identifying predictors of severe RHF at our center. METHODS In this retrospective, single-center analysis, clinical, biological and functional data were collected in patients implanted with a LVAD between 2011 and 2020. Early severe RHF was defined as the use of inotropes for ≥ 14 days, nitric oxide use for ≥ 48 h or unplanned right-sided circulatory support. Risk models were evaluated for the primary outcome of RHF or RVAD implantation by means of logistic regression and receiver operating characteristic curves. RESULTS Among 92 patients implanted, 24 (26%) developed early severe RHF. The EUROMACS-RHF risk score performed the best in predicting RHF (C = 0.82-95% CI: 0.68-0.90), compared with the other scores (Michigan, CRITT). In addition, we developed a new model, based on four variables selected for the best reduced logistic model: the INTERMACS level, the number of inotropes used, the ratio of right atrial/pulmonary capillary wedge pressure and the ratio of right ventricle/left ventricle diameters by echocardiography. This model demonstrated significant discrimination of RHF (C = 0.9-95% CI: 0.76-0.96). CONCLUSION Amongst available risk scores, EUROMACS-RHF performs best to predict the occurrence of RHF after LVAD implantation. Our model's performance compares well to the EUROMACS-RHF score, adding a more objective parameter to RV function evaluation.
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Affiliation(s)
- Federica Valente
- Department of Cardiology, Erasme University Hospital, Université Libre de Bruxelles, 808 Route de Lennik, 1070, Brussels, Belgium.
| | - Constantin Stefanidis
- Department of Cardiac Surgery, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Luc Vachiéry
- Department of Cardiology, Erasme University Hospital, Université Libre de Bruxelles, 808 Route de Lennik, 1070, Brussels, Belgium
| | - Céline Dewachter
- Department of Cardiology, Erasme University Hospital, Université Libre de Bruxelles, 808 Route de Lennik, 1070, Brussels, Belgium
| | | | - Frédéric Vanden Eynden
- Department of Cardiac Surgery, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Ana Roussoulières
- Department of Cardiology, Erasme University Hospital, Université Libre de Bruxelles, 808 Route de Lennik, 1070, Brussels, Belgium
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Xing C, Wang X, Pan X, Yu J, Wang C, Li Y, Shen L, He B. Outcomes of atrial septostomy and effect on long-term survival in patients with idiopathic pulmonary arterial hypertension: A single-center cohort. Int J Cardiol 2023; 373:118-23. [PMID: 36476671 DOI: 10.1016/j.ijcard.2022.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/19/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Pulmonary arterial hypertension (PAH) is a chronic progressive disease that may lead to right heart failure (RHF) and early death. Balloon atrial septostomy (BAS) may be used for the palliative treatment of RHF from PAH. We present our contemporary institutional experience of utilizing BAS in idiopathic PAH (IPAH) patients with refractory RHF to investigate the effect on the safety, efficacy and long-term survival. METHODS This retrospective analysis included 12 IPAH patients with severe RHF from March 2017 to May 2019 who were assessed as high risk. All patients received standard treatment including combination of PAH-specific drugs. Graded BAS was performed on these patients due to unsatisfactory clinical response. Clinical, functional and hemodynamic variables before and immediately after the procedure were collected. 1-year follow-up outcomes and 3-year survival rate were further analyzed. RESULTS Successful septostomy was achieved in cases with no procedure-related complications. All patients obtained hemodynamic improvement immediately after the procedure. The WHO functional class and exercise endurance improved at 1-year follow-up, 7 of 12 patients achieved intermediate-low risk status, while the rest remained at intermediate-high risk. 2 patients died at 18 and 20 months due to malignant arrhythmia and advanced heart failure, respectively. Survival at 1 year and 3 years was 100% and 83.3%. CONCLUSIONS In selected IPAH patients with refractory RHF, BAS is an additional therapeutic strategy, especially when PAH-specific drugs could not achieve the treatment target. BAS can improve hemodynamic variables, bring clinical and cardiac functional benefits and increase the 3-year survival.
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Rosenkranz S. [2022 ESC/ERS guidelines on the diagnostics and treatment of pulmonary hypertension : A focussed review]. Herz 2023; 48:23-30. [PMID: 36648489 DOI: 10.1007/s00059-022-05155-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2022] [Indexed: 01/18/2023]
Abstract
Pulmonary hypertension (PH) is a hemodynamic state that can be caused by a variety of underlying conditions. The pathophysiology is complex and can involve several organ systems, requiring a multidisciplinary approach to differential diagnostics and management. This review article provides a comprehensive overview of the most important changes in the updated 2022 European Society of Cardiology (ESC)/European Respiratory Society (ERS) guidelines on the diagnostics and treatment of pulmonary hypertension, as compared to the previous 2015 version. A special focus is on (i) updated hemodynamic definitions of PH, including general definition, precapillary vs. postcapillary PH, isolated postcapillary PH (IpcPH), combined postcapillary and precapillary PH (CpcPH), (ii) the clinical presentation and classification of PH, (iii) the diagnostic approach as well as (iv) specific aspects of pulmonary arterial hypertension (PAH, group 1), including risk assessment, treatment and PAH with comorbidities, PH associated with left heart (group 2) or lung disease (group 3), and chronic thromboembolic pulmonary hypertension (CTEPH, group 4). Regarding the latter, the specific diagnostic algorithm and the multimodal approach to treatment are presented. Finally, for each of the PH groups, clinically relevant aspects and innovations are briefly and concisely presented.
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Affiliation(s)
- Stephan Rosenkranz
- Klinik III für Innere Medizin (Kardiologie), Zentrum für Molekulare Medizin Köln (ZMMK), Cologne Cardiovascular Research Center (CCRC), Herzzentrum, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
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36
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Dandel M. Letter to the editor "Cardiac function in critically ill patients with severe COVID: A prospective cross-sectional study in mechanically ventilated patients". J Crit Care 2023; 73:154217. [PMID: 36379138 PMCID: PMC9653088 DOI: 10.1016/j.jcrc.2022.154217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 11/06/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Michael Dandel
- German Centre for Heart and Circulatory Research (DZHK) Partner Site Berlin, Berlin, Germany.
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Vahdatpour C, Epstein S, Jones K, Smoot M, Parker A, Ryan J, Bryant A. A review of cardio-pulmonary microvascular dysfunction in pulmonary hypertension. Am Heart J Plus 2023; 26:100255. [PMID: 38510189 PMCID: PMC10946046 DOI: 10.1016/j.ahjo.2023.100255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/16/2023] [Accepted: 01/19/2023] [Indexed: 03/22/2024]
Abstract
Microvascular dysfunction progressing to pulmonary hypertension can be a primary cause of right ventricular failure or a secondary cause because of an underlying systemic illness. Little is known regarding the etiology and epidemiology of coronary microvascular dysfunction in pulmonary hypertension. Despite this limitation, its presence has been described in patients with pulmonary hypertension. This review focuses on the pathogenesis of cardiac and pulmonary microvascular dysfunction in pulmonary hypertension. Additionally, this review provides a contemporary assessment on the diagnosis and treatment of microvascular dysfunction in patients in pulmonary hypertension. This topic is important to raise awareness of microvascular dysfunction in the coronary and pulmonary circulation, so that future studies will investigate its impact on the pulmonary hypertension patient cohort.
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Affiliation(s)
- Cyrus Vahdatpour
- Department of Pulmonary Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Samuel Epstein
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Kirk Jones
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Madeline Smoot
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Alex Parker
- Department of Cardiology, University of Florida, Gainesville, FL, USA
| | - John Ryan
- Department of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, USA
| | - Andrew Bryant
- Department of Pulmonary Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
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George TJ, Sheasby J, Kabra N, DiMaio JM, Rawitscher DA, Afzal A. Temporary Right Ventricular Assist Device Support for Acute Right Heart Failure: A Single-Center Experience. J Surg Res 2023; 282:15-21. [PMID: 36244223 DOI: 10.1016/j.jss.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/15/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Severe right ventricular (RV) failure is associated with significant morbidity and mortality. Although right ventricular assist devices (RVADs) are increasingly used for refractory RV failure, there is limited data on their short- and long-term outcomes. Therefore, we undertook this study to better understand our experience with temporary RVADs. METHODS We conducted a retrospective review of all RVADS performed from 2017 to 2021. Patients supported with surgical RVADs, the Protek Duo device, and the Impella RP device were included. Patients were stratified by the type of RVAD and by etiology of RV failure. Survival was assessed by the Kaplan-Meier method and multivariable Cox proportional hazards regression models. RESULTS From 2017 to 2021, 42 patients underwent RVAD implantation: 32 with a Protek Duo, 6 with an Impella RP, and 4 with a surgical RVAD. Majority of patients were already supported with an alternate form of mechanical support. Most patients had impaired renal function, decreased hepatic function, and lactic acidosis at the time of cannulation. The median duration of RVAD support was 8.5 [5-19] d. Survival to decannulation was 68.4%, to discharge was 47.4%, and to 1-y was 40.2%. Multivariable analysis identified elevated total bilirubin levels to be associated with 30-d mortality while increased hemoglobin levels were protective. After RVAD cannulation, the median number of pressors and inotropes was lower (P < 0.01) and the lactic acidosis was less (P < 0.01). CONCLUSIONS In conclusion, RVAD support is associated with lower lactate levels, and decreased number of vasoactive medications, but is associated with significant morbidity and mortality.
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Affiliation(s)
- Timothy J George
- Department of Advanced Heart Failure, Baylor Scott and White, The Heart Hospital, Plano, Texas.
| | - Jenelle Sheasby
- Department of Advanced Heart Failure, Baylor Scott and White, The Heart Hospital, Plano, Texas
| | - Nitin Kabra
- Department of Advanced Heart Failure, Baylor Scott and White, The Heart Hospital, Plano, Texas
| | - J Michael DiMaio
- Department of Advanced Heart Failure, Baylor Scott and White, The Heart Hospital, Plano, Texas
| | - David A Rawitscher
- Department of Advanced Heart Failure, Baylor Scott and White, The Heart Hospital, Plano, Texas
| | - Aasim Afzal
- Department of Advanced Heart Failure, Baylor Scott and White, The Heart Hospital, Plano, Texas
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Sajja A, Ibrahim R, Pernetz M, Lloyd M. Right ventricular cardiac resynchronization therapy in patients with right ventricular conduction delay and heart failure. Heart Rhythm 2023:S1547-5271(23)00033-4. [PMID: 36646236 DOI: 10.1016/j.hrthm.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 01/07/2023] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
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Sugimura Y, Kalampokas N, Arikan M, Rellecke P, Dalyanoglu H, Tudorache I, Westenfeld R, Boeken U, Lichtenberg A, Akhyari P, Aubin H. Preoperative Levosimendan therapy reduces postoperative right ventricular failure in patients undergoing left ventricular assist device implantation. Interdiscip Cardiovasc Thorac Surg 2023; 36:6978238. [PMID: 36802258 PMCID: PMC9931070 DOI: 10.1093/icvts/ivac289] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/12/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Perioperative mortality and complications still remain high after left ventricular assist device (LVAD) implantation, especially in highly compromised patient cohorts. Here, we evaluate the effects of preoperative Levosimendan therapy on peri- and postoperative outcomes after LVAD implantation. METHODS We retrospectively analysed 224 consecutive patients with LVAD implantation for end-stage heart failure between November 2010 and December 2019 in our centre with regard to short- and longer-term mortality as well as incidence of postoperative right ventricular failure (RV-F). Out of these, 117 (52.2%) received preoperative i.v. Levosimendan therapy within 7 days before LVAD implantation (Levo group). RESULTS In-hospital, 30-day and 5-year mortality was comparable (in-hospital mortality: 18.8% vs 23.4%, P = 0.40; 30-day mortality: 12.0% vs 14.0%, P = 0.65; Levo vs control group). However, in the multivariate analysis, preoperative Levosimendan therapy significantly reduced postoperative RV-F but increased postoperative vasoactive inotropic score ([RV-F: odds ratio 2.153, confidence interval 1.146-4.047, P = 0.017; vasoactive inotropic score 24 h post-surgery: odds ratio 1.023, confidence interval 1.008-1.038, P = 0.002). These results were further confirmed by 1:1 propensity score matching of 74 patients in each group. Especially in the subgroup of patients with normal preoperative RV function, the prevalence of postoperative RV-F was significantly lower in the Levo- group as compared to the control group (17.6% vs 31.1%, P = 0.03; respectively). CONCLUSIONS Preoperative Levosimendan therapy reduces the risk of postoperative RV-F, especially in patients with normal preoperative RV function without effects on mortality up to 5 years after LVAD implantation.
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Affiliation(s)
| | | | - Metin Arikan
- Department of Cardiac Surgery, Medical Faculty and University Hospital, Heinrich-Heine-University Medical School, Duesseldorf, Germany
| | - Phillip Rellecke
- Department of Cardiac Surgery, Medical Faculty and University Hospital, Heinrich-Heine-University Medical School, Duesseldorf, Germany
| | - Hannan Dalyanoglu
- Department of Cardiac Surgery, Medical Faculty and University Hospital, Heinrich-Heine-University Medical School, Duesseldorf, Germany
| | - Igor Tudorache
- Department of Cardiac Surgery, Medical Faculty and University Hospital, Heinrich-Heine-University Medical School, Duesseldorf, Germany
| | - Ralf Westenfeld
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Duesseldorf, Germany
| | - Udo Boeken
- Department of Cardiac Surgery, Medical Faculty and University Hospital, Heinrich-Heine-University Medical School, Duesseldorf, Germany
| | - Artur Lichtenberg
- Department of Cardiac Surgery, Medical Faculty and University Hospital, Heinrich-Heine-University Medical School, Duesseldorf, Germany
| | - Payam Akhyari
- Corresponding author. Department of Cardiac Surgery, Medical Faculty and RWTH University Hospital Aachen, RWTH Aachen University, Aachen, Germany. Tel: +49-241-8012345; fax: +49-241-80-33-12345; e-mail: (P. Akhyari)
| | - Hug Aubin
- Department of Cardiac Surgery, Medical Faculty and University Hospital, Heinrich-Heine-University Medical School, Duesseldorf, Germany
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Singh S, Takeda K, Kurlansky P. Tricuspid valve surgery at the time of left ventricular assist device insertion-digging deeper. Eur J Cardiothorac Surg 2022; 63:6982559. [PMID: 36625509 DOI: 10.1093/ejcts/ezad009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/09/2023] [Indexed: 01/11/2023]
Affiliation(s)
- Sameer Singh
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University, New York, NY, USA
| | - Koji Takeda
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University, New York, NY, USA
| | - Paul Kurlansky
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University, New York, NY, USA.,Center for Innovation and Outcomes Research, Department of Surgery, Columbia University, New York, NY, USA
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Mihalj M, Jezovnik MK, Benk J, Heg D, Podstatzky-Lichtenstein T, Beyersdorf F, Radovancevic R, Gregoric ID, Hunziker L, Siepe M, Reineke D. Concomitant tricuspid valve repair in left ventricular assist device implantation may increase the risk for temporary right ventricular support but does not impact overall outcomes. Eur J Cardiothorac Surg 2022; 63:6873742. [PMID: 36469336 DOI: 10.1093/ejcts/ezac555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/08/2022] [Accepted: 12/02/2022] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Tricuspid valve repair in left ventricular assist device implantation continues to pose a challenge and may impact the occurrence of early and late right heart failure. We investigated the effects of concomitant tricuspid repair on clinical outcomes. METHODS A retrospective, multicentre study enrolled adult patients who received continuous-flow left ventricular assist devices between 2005 and 2017 and compared those who received concomitant tricuspid valve repair to those who did not. Primary outcomes were early right heart failure necessitating temporary ventricular assist devices and right heart failure-related rehospitalizations requiring inotropic or diuretic treatment. RESULTS Out of 526 patients who underwent left ventricular assist device implantation, 110 (21%) received a concomitant tricuspid valve repair. Those patients were sicker, and most had moderate or severe tricuspid regurgitation. A significantly higher incidence of temporary right ventricular assist devices was observed in the group with concomitant tricupid valve repair (18% vs. 11%, P = 0.049), with a significantly elevated risk for temporary right heart assist device (sHR 1.68, 95% CI 1.04-2.72; P = 0.037). After adjusting for confounders, no significant differences were found in the incidence of and risk for most clinical outcomes, including right heart failure-related rehospitalizations (P = 0.891) and death (P = 0.563). CONCLUSIONS Concomitant tricuspid valve repair, when deemed necessary in left ventricular assist device implantation, may increase the risk of early right heart failure requiring a temporary right ventricular assist device but does not impact the incidence or risk of death or rehospitalizations due to late right heart failure.
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Affiliation(s)
- Maks Mihalj
- Department of Cardiac Surgery, University Hospital Bern, University of Bern, Bern, Switzerland.,Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Mateja K Jezovnik
- Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Julia Benk
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany.,Faculty of Medicine of the Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Dik Heg
- CTU Bern, University of Bern, Bern, Switzerland
| | | | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany.,Faculty of Medicine of the Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Rajko Radovancevic
- Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Igor D Gregoric
- Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Lukas Hunziker
- Department of Cardiology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Matthias Siepe
- Department of Cardiac Surgery, University Hospital Bern, University of Bern, Bern, Switzerland
| | - David Reineke
- Department of Cardiac Surgery, University Hospital Bern, University of Bern, Bern, Switzerland
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Lykins AJ, Garg P, Fleissner ZJ, Sareyyupoglu B. Successful management of complex haemorrhagic pericardial cyst with cirrhosis of liver: a case report. Interact Cardiovasc Thorac Surg 2022; 35:6835423. [PMID: 36409034 PMCID: PMC9707403 DOI: 10.1093/icvts/ivac278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022] Open
Abstract
Haemorrhagic pericardial cysts are rare and may be complicated by encasement of the heart, right heart failure and, rarely, cardiac cirrhosis. Surgical management of complicated cysts is challenging and has poor outcomes. We report a case of successful surgical management of a complicated pericardial cyst presenting with cardiac cirrhosis and the challenges associated with this condition.
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Affiliation(s)
- Amy J Lykins
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Pankaj Garg
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | - Basar Sareyyupoglu
- Corresponding author. Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA. Tel: +1-904-956-3212; fax: +1-904-953-7368; e-mail: (B. Sareyyupoglu)
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Abstract
PURPOSE OF REVIEW Heart failure (HF) after right ventricular myocardial infarction (RVMI) is common and complicates its clinical course. This review aims to provide a current overview on the characteristic features of RV failure with focus on acute management. RECENT FINDINGS While HF after RVMI is classically seen after acute proximal right coronary artery occlusion, RV dysfunction may also occur after larger infarctions in the left coronary artery. Because of its different anatomy and physiology, the RV appears to be more resistant to permanent infarction compared to the LV with greater potential for recovery of ischemic myocardium. Hypotension and elevated jugular pressure in the presence of clear lung fields are hallmark signs of RV failure and should prompt confirmation by echocardiography. Management decisions are still mainly based on small studies and extrapolation of findings from LV failure. Early revascularization improves short- and long-term outcomes. Acute management should further focus on optimization of preload and afterload, maintenance of sufficient perfusion pressures, and prompt management of arrhythmias and concomitant LV failure, if present. In case of cardiogenic shock, use of vasopressors and/or inotropes should be considered along with timely use of mechanical circulatory support (MCS) in eligible patients. HF after RVMI is still a marker of worse outcome in acute coronary syndrome. Prompt revascularization, careful medical therapy with attention to the special physiology of the RV, and selected use of MCS provide the RV the time it needs to recover from the ischemic insult.
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Affiliation(s)
- Matthias P Nägele
- University Heart Center Zurich, University Hospital Zurich, Raemistrasse 100, CH-8091, CardiologyZurich, Switzerland
| | - Andreas J Flammer
- University Heart Center Zurich, University Hospital Zurich, Raemistrasse 100, CH-8091, CardiologyZurich, Switzerland.
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Wu J, Liu T, Shi S, Fan Z, Hiram R, Xiong F, Cui B, Su X, Chang R, Zhang W, Yan M, Tang Y, Huang H, Wu G, Huang C. Dapagliflozin reduces the vulnerability of rats with pulmonary arterial hypertension-induced right heart failure to ventricular arrhythmia by restoring calcium handling. Cardiovasc Diabetol 2022; 21:197. [PMID: 36171554 PMCID: PMC9516842 DOI: 10.1186/s12933-022-01614-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 09/01/2022] [Indexed: 12/20/2022] Open
Abstract
Background Malignant ventricular arrhythmia (VA) is a major contributor to sudden cardiac death (SCD) in patients with pulmonary arterial hypertension (PAH)-induced right heart failure (RHF). Recently, dapagliflozin (DAPA), a sodium/glucose cotransporter-2 inhibitor (SGLT2i), has been found to exhibit cardioprotective effects in patients with left ventricular systolic dysfunction. In this study, we examined the effects of DAPA on VA vulnerability in a rat model of PAH-induced RHF. Methods Rats randomly received monocrotaline (MCT, 60 mg/kg) or vehicle via a single intraperitoneal injection. A day later, MCT-injected rats were randomly treated with placebo, low-dose DAPA (1 mg/kg/day), or high-dose (3 mg/kg/day) DAPA orally for 35 days. Echocardiographic analysis, haemodynamic experiments, and histological assessments were subsequently performed to confirm the presence of PAH-induced RHF. Right ventricle (RV) expression of calcium (Ca2+) handling proteins were detected via Western blotting. RV expression of connexin 43 (Cx43) was determined via immunohistochemical staining. An optical mapping study was performed to assess the electrophysiological characteristics in isolated hearts. Cellular Ca2+ imaging from RV cardiomyocytes (RVCMs) was recorded using Fura-2 AM or Fluo-4 AM. Results High-dose DAPA treatment attenuated RV structural remodelling, improved RV function, alleviated Cx43 remodelling, increased the conduction velocity, restored the expression of key Ca2+ handling proteins, increased the threshold for Ca2+ and action potential duration (APD) alternans, decreased susceptibility to spatially discordant APD alternans and spontaneous Ca2+ events, promoted cellular Ca2+ handling, and reduced VA vulnerability in PAH-induced RHF rats. Low-dose DAPA treatment also showed antiarrhythmic effects in hearts with PAH-induced RHF, although with a lower level of efficacy. Conclusion DAPA administration reduced VA vulnerability in rats with PAH-induced RHF by improving RVCM Ca2+ handling. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01614-5.
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Affiliation(s)
- Jinchun Wu
- Department of Cardiology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuhan, 430060, People's Republic of China.,Cardiovascular Research Institute, Wuhan University, 238 Jiefang Road, Wuhan, 430060, People's Republic of China.,Hubei Key Laboratory of Cardiology, 238 Jiefang Road, Wuhan, 430060, People's Republic of China.,Department of Cardiology, Qinghai Provincial People's Hospital, No.2 Gong He Road, Xining, 810007, People's Republic of China
| | - Tao Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuhan, 430060, People's Republic of China. .,Cardiovascular Research Institute, Wuhan University, 238 Jiefang Road, Wuhan, 430060, People's Republic of China. .,Hubei Key Laboratory of Cardiology, 238 Jiefang Road, Wuhan, 430060, People's Republic of China.
| | - Shaobo Shi
- Department of Cardiology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuhan, 430060, People's Republic of China.,Cardiovascular Research Institute, Wuhan University, 238 Jiefang Road, Wuhan, 430060, People's Republic of China.,Hubei Key Laboratory of Cardiology, 238 Jiefang Road, Wuhan, 430060, People's Republic of China
| | - Zhixing Fan
- Department of Cardiology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuhan, 430060, People's Republic of China.,Cardiovascular Research Institute, Wuhan University, 238 Jiefang Road, Wuhan, 430060, People's Republic of China.,Hubei Key Laboratory of Cardiology, 238 Jiefang Road, Wuhan, 430060, People's Republic of China
| | - Roddy Hiram
- Department of Medicine, Faculty of Medicine, Montreal Heart Institute (MHI), Université de Montréal, Montreal, QC, Canada
| | - Feng Xiong
- Department of Medicine, Faculty of Medicine, Montreal Heart Institute (MHI), Université de Montréal, Montreal, QC, Canada
| | - Bo Cui
- Department of Cardiology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuhan, 430060, People's Republic of China.,Cardiovascular Research Institute, Wuhan University, 238 Jiefang Road, Wuhan, 430060, People's Republic of China.,Hubei Key Laboratory of Cardiology, 238 Jiefang Road, Wuhan, 430060, People's Republic of China
| | - Xiaoling Su
- Department of Cardiology, Qinghai Provincial People's Hospital, No.2 Gong He Road, Xining, 810007, People's Republic of China
| | - Rong Chang
- Department of Cardiology, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, No. 187 Guanlan Road, Longhua District, Shenzhen, 518109, China
| | - Wei Zhang
- Department of Cardiology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuhan, 430060, People's Republic of China.,Cardiovascular Research Institute, Wuhan University, 238 Jiefang Road, Wuhan, 430060, People's Republic of China.,Hubei Key Laboratory of Cardiology, 238 Jiefang Road, Wuhan, 430060, People's Republic of China
| | - Min Yan
- Department of Cardiology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuhan, 430060, People's Republic of China.,Cardiovascular Research Institute, Wuhan University, 238 Jiefang Road, Wuhan, 430060, People's Republic of China.,Hubei Key Laboratory of Cardiology, 238 Jiefang Road, Wuhan, 430060, People's Republic of China
| | - Yanhong Tang
- Department of Cardiology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuhan, 430060, People's Republic of China.,Cardiovascular Research Institute, Wuhan University, 238 Jiefang Road, Wuhan, 430060, People's Republic of China.,Hubei Key Laboratory of Cardiology, 238 Jiefang Road, Wuhan, 430060, People's Republic of China
| | - He Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuhan, 430060, People's Republic of China.,Cardiovascular Research Institute, Wuhan University, 238 Jiefang Road, Wuhan, 430060, People's Republic of China.,Hubei Key Laboratory of Cardiology, 238 Jiefang Road, Wuhan, 430060, People's Republic of China
| | - Gang Wu
- Department of Cardiology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuhan, 430060, People's Republic of China. .,Cardiovascular Research Institute, Wuhan University, 238 Jiefang Road, Wuhan, 430060, People's Republic of China. .,Hubei Key Laboratory of Cardiology, 238 Jiefang Road, Wuhan, 430060, People's Republic of China.
| | - Congxin Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuhan, 430060, People's Republic of China. .,Cardiovascular Research Institute, Wuhan University, 238 Jiefang Road, Wuhan, 430060, People's Republic of China. .,Hubei Key Laboratory of Cardiology, 238 Jiefang Road, Wuhan, 430060, People's Republic of China.
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46
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Kramer T, Brinkkoetter P, Rosenkranz S. Right Heart Function in Cardiorenal Syndrome. Curr Heart Fail Rep 2022; 19:386-399. [PMID: 36166185 PMCID: PMC9653308 DOI: 10.1007/s11897-022-00574-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2022] [Indexed: 11/29/2022]
Abstract
Purpose of Review Since CRS is critically dependent on right heart function and involved in interorgan crosstalk, assessment and monitoring of both right heart and kidney function are of utmost importance for clinical outcomes. This systematic review aims to comprehensively report on novel diagnostic and therapeutic paradigms that are gaining importance for the clinical management of the growing heart failure population suffering from CRS. Recent Findings Cardiorenal syndrome (CRS) in patients with heart failure is associated with poor outcome. Although systemic venous congestion and elevated central venous pressure have been recognized as main contributors to CRS, they are often neglected in clinical practice. The delicate hemodynamic balance in CRS is particularly determined by the respective status of the right heart. Summary The consideration of hemodynamic and CRS profiles is advantageous in tailoring treatment for better preservation of renal function. Assessment and monitoring of right heart and renal function by known and emerging tools like renal Doppler ultrasonography or new biomarkers may have direct clinical implications.
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Affiliation(s)
- Tilmann Kramer
- Klinik III Für Innere Medizin, Herzzentrum Der Universität Zu Köln, Köln, Germany. .,Cologne Cardiovascular Research Center (CCRC), Klinikum Der Universität Zu Köln, Köln, Germany.
| | - Paul Brinkkoetter
- Cologne Cardiovascular Research Center (CCRC), Klinikum Der Universität Zu Köln, Köln, Germany.,Klinik II Für Innere Medizin, Nephrologie, Universität Zu Köln, Köln, Germany.,Center for Molecular Medicine Cologne (CMMC), Universität Zu Köln, Köln, Germany
| | - Stephan Rosenkranz
- Klinik III Für Innere Medizin, Herzzentrum Der Universität Zu Köln, Köln, Germany.,Cologne Cardiovascular Research Center (CCRC), Klinikum Der Universität Zu Köln, Köln, Germany.,Center for Molecular Medicine Cologne (CMMC), Universität Zu Köln, Köln, Germany
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47
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Nakamura J, Tsujino I, Ohira H, Nakaya T, Sugimoto A, Sato T, Watanabe T, Suzuki M, Kato M, Yokota I, Konno S. Various factors contribute to death in patients with different types of pulmonary hypertension: A retrospective pilot study from a single tertiary center. Respir Investig 2022; 60:647-657. [PMID: 35644802 DOI: 10.1016/j.resinv.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/03/2022] [Accepted: 05/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND A few studies have focused on the cause of death from different types of pulmonary hypertension (PH). This study aimed to systematically analyze the primary and secondary causes of death and compare the profiles between different PH groups. METHODS The contribution of PH to death was assessed in precapillary PH (i.e., group 1 [pulmonary arterial hypertension], group 3 [PH associated with lung disease], and group 4 [chronic thromboembolic PH]) using specific criteria; death was classified into three categories: PH death (death due to PH only), PH-related death, and PH-unrelated death. Disorders other than PH that contributed to death were analyzed, and mortality profiles were compared between groups. RESULTS Eighty deceased patients with PH were examined (group 1, n = 28; group 3, n = 39; and group 4, n = 13). The contribution of PH to death was significantly different between the three groups. "PH death" was most common in group 1 (61%), "PH-related death" in group 3 (56%), and "PH-related death" and "PH-unrelated death" in group 4 (38% for both). The highest contributing factor to death other than PH was respiratory failure in group 3 and malignant disease in group 4. CONCLUSIONS Significant variations in the causes of death were observed in groups 1, 3, and 4 PH patients. In addition to PH, respiratory failure and malignant disease significantly contributed to death in group 3 and group 4 PH, respectively. Understanding the precise death cause may be important in achieving better outcomes in PH patients.
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Affiliation(s)
- Junichi Nakamura
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, 060-8638, Japan
| | - Ichizo Tsujino
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, 060-8638, Japan; Division of Respiratory and Cardiovascular Innovative Research, Faculty of Medicine, Hokkaido University, Sapporo, 060-8638, Japan.
| | - Hiroshi Ohira
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, 060-8638, Japan
| | - Toshitaka Nakaya
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, 060-8638, Japan
| | - Ayako Sugimoto
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, 060-8638, Japan
| | - Takahiro Sato
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, 060-8638, Japan; Division of Respiratory and Cardiovascular Innovative Research, Faculty of Medicine, Hokkaido University, Sapporo, 060-8638, Japan
| | - Taku Watanabe
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, 060-8638, Japan
| | - Masaru Suzuki
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, 060-8638, Japan
| | - Masaru Kato
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, 060-8638, Japan
| | - Isao Yokota
- Department of Biostatistics, Graduate School of Medicine, Hokkaido University, Sapporo, 060-8638, Japan
| | - Satoshi Konno
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, 060-8638, Japan; Division of Respiratory and Cardiovascular Innovative Research, Faculty of Medicine, Hokkaido University, Sapporo, 060-8638, Japan
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48
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Kostura M, Smalley C, Koyfman A, Long B. Right heart failure: A narrative review for emergency clinicians. Am J Emerg Med 2022; 58:106-113. [PMID: 35660367 DOI: 10.1016/j.ajem.2022.05.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/18/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Right heart failure (RHF) is a clinical syndrome with impaired right ventricular cardiac output due to a variety of etiologies including ischemia, elevated pulmonary arterial pressure, or volume overload. Emergency department (ED) patients with an acute RHF exacerbation can be diagnostically and therapeutically challenging to manage. OBJECTIVE This narrative review describes the pathophysiology of right ventricular dysfunction and pulmonary hypertension, the methods to diagnose RHF in the ED, and management strategies. DISCUSSION Right ventricular contraction normally occurs against a low pressure, highly compliant pulmonary vascular system. This physiology makes the right ventricle susceptible to acute changes in afterload, which can lead to RHF. Patients with acute RHF may present with an acute illness and have underlying chronic pulmonary hypertension due to left ventricular failure, pulmonary arterial hypertension, chronic lung conditions, thromboemboli, or idiopathic conditions. Patients can present with a variety of symptoms resulting from systemic edema and hemodynamic compromise. Evaluation with electrocardiogram, laboratory analysis, and imaging is necessary to evaluate cardiac function and end organ injury. Management focuses on treating the underlying condition, optimizing oxygenation and ventilation, treating arrhythmias, and understanding the patient's hemodynamics with bedside ultrasound. As RHF patients are preload dependent they may require fluid resuscitation or diuresis. Hypotension should be rapidly addressed with vasopressors. Cardiac contractility can be augmented with inotropes. Efforts should be made to support oxygenation while trying to avoid intubation if possible. CONCLUSIONS Emergency clinician understanding of this condition is important to diagnose and treat this life-threatening cardiopulmonary disorder.
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Affiliation(s)
- Matthew Kostura
- Department of Emergency Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Courtney Smalley
- Department of Emergency Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Brit Long
- SAUSHEC, Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
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49
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Galloo X, Stassen J, Butcher SC, Meucci MC, Dietz MF, Mertens BJA, Prihadi EA, van der Bijl P, Ajmone Marsan N, Braun J, Bax JJ, Delgado V. Staging right heart failure in patients with tricuspid regurgitation undergoing tricuspid surgery. Eur J Cardiothorac Surg 2022; 62:6576630. [PMID: 35511132 PMCID: PMC9789688 DOI: 10.1093/ejcts/ezac290] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/26/2022] [Accepted: 04/28/2022] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES This study evaluated the prognostic value of staging right heart failure in patients with significant tricuspid regurgitation (TR) undergoing tricuspid valve (TV) surgery. METHODS Patients with significant TR who underwent TV surgery were divided into 4 right heart failure stages according to the presence of right ventricular (RV) dysfunction and clinical signs of right heart failure: stage 1 was defined as no RV dysfunction and no signs of right heart failure; stage 2 indicated RV dysfunction without signs of right heart failure; stage 3 included RV dysfunction and signs of right heart failure; and stage 4 was defined as RV dysfunction and refractory signs of right heart failure at rest. RESULTS A total of 278 patients [mean age 64 (12), 49% males] were included, of whom 34 (12%) patients were classified as stages 1 and 2, 141 (51%) as stage 3 and 103 (37%) as stage 4 right heart failure. The majority of patients (91%) had TV surgery concomitant to left-sided valve surgery or coronary artery bypass grafting and 95% underwent TV annuloplasty. Cumulative survival rates were 89%, 78% and 61% at 1 month, 1 year and 5 years, respectively. Stages 1 and 2 and stage 3 were independently associated with better survival compared to stage 4 (hazard ratio: 0.391 [95% confidence interval: 0.186-0.823] and 0.548 [95% confidence interval: 0.369-0.813], respectively). CONCLUSIONS Patients with significant TR undergoing TV surgery and diagnosed without advanced right heart failure have better survival as compared to patients with right heart failure.
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Affiliation(s)
- Xavier Galloo
- Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands,Department of Cardiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Jan Stassen
- Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Steele C Butcher
- Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands,Department of Cardiology, Royal Perth Hospital, Perth, Australia
| | - Maria Chiara Meucci
- Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands,Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Marlieke F Dietz
- Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Bart J A Mertens
- Department of Bioinformatics, Bioinformatics Centre of Expertise, Leiden University Medical Centre, Leiden, Netherlands
| | - Edgard A Prihadi
- Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands,Hartcentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Pieter van der Bijl
- Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Jerry Braun
- Department of Cardio-Thoracic Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands,Heart Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands,Corresponding author. Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2330 RC Leiden, Netherlands. Tel: +31-715262020; fax: +31-715266809; e-mail: (V. Delgado)
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50
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Naser A, Güvenç TS, Isgandarov K, Ekmekçi A, Gündüz S, Çetin Güvenç R, Şahin M. Lack of right ventricular hypertrophy is associated with right heart failure in patients with left ventricular failure. Heart Vessels 2022; 37:1728-1739. [PMID: 35471461 DOI: 10.1007/s00380-022-02075-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 04/08/2022] [Indexed: 11/04/2022]
Abstract
Presence of right heart failure (RHF) is associated with a worse prognosis in patients with left ventricular failure (LVF). While the cause of RHF secondary to LVF is multifactorial, an increased right ventricular (RV) afterload is believed as the major cause of RHF. However, data are scarce on the adaptive responses of the RV in patients with LVF. Our aim was to understand the relationship of right ventricular hypertrophy (RVH) with RHF and RV systolic and diastolic properties in patients with LVF. 55 patients with a left ventricular ejection fraction of 40% or less were included in the present study. A comprehensive two-dimensional transthoracic echocardiographic examination was done to all participants. 12 patients (21.8%) had RHF, and patients with RHF had a significantly lower right ventricular free wall thickness (RVFWT) as compared to patients without RHF (5.3 ± 1.7 mm vs. 6.6 ± 0.9 mm, p = 0.02) and the difference remained statistically significant after adjusting for confounders (Δx̅:1.34 mm, p = 0.002). RVFWT had a statistically significant correlation with tricuspid annular plane systolic excursion (r = 0.479, p < 0.001) and tricuspid annular lateral systolic velocity (r = 0.360, p = 0.007), but not with the indices of the RV diastolic function. None of the patients with concentric RVH had RHF, while 22.2% of patients with eccentric RVH and 66.7% of patients without RVH had RHF (p < 0.01 as compared to patients with concentric RVH). In patients with left ventricular systolic dysfunction, absence of RVH was associated with worse RV systolic performance and a significantly higher incidence of RHF.
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Affiliation(s)
- Abdulrahman Naser
- Department of Cardiology, Medical Park Pendik Hospital, Istanbul, Turkey
| | - Tolga Sinan Güvenç
- Department of Cardiology, Medical Park Pendik Hospital, Istanbul, Turkey. .,Division of Cardiology, Department of Internal Medical Sciences, Istinye University School of Medicine, Istinye University Topkapi Campus, Teyyareci Sami Street No. 3, Zeytinburnu, 34010, Istanbul, Turkey.
| | - Khagani Isgandarov
- Department of Cardiology, Medical Park Pendik Hospital, Istanbul, Turkey
| | - Ahmet Ekmekçi
- Department of Cardiology, Medical Park Pendik Hospital, Istanbul, Turkey
| | - Sabahattin Gündüz
- Department of Cardiology, Medical Park Pendik Hospital, Istanbul, Turkey.,Division of Cardiology, Department of Internal Medical Sciences, Bahcesehir University School of Medicine, Istanbul, Turkey
| | - Rengin Çetin Güvenç
- Division of Cardiology, Department of Internal Medical Sciences, Okan University School of Medicine, Istanbul, Turkey
| | - Müslüm Şahin
- Department of Cardiology, Medical Park Pendik Hospital, Istanbul, Turkey.,Division of Cardiology, Department of Internal Medical Sciences, Istinye University School of Medicine, Istinye University Topkapi Campus, Teyyareci Sami Street No. 3, Zeytinburnu, 34010, Istanbul, Turkey
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