Right-heart failure after right heart catheterization in a patient with scleroderma and suspected pulmonary hypertension

2008 ◽  
Vol 28 (12) ◽  
pp. 1269-1271 ◽  
Author(s):  
Gernot Keyßer ◽  
Carola Schwerdt ◽  
Christiane Taege
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Right Heart Failure ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Right Heart

scholarly journals Right Heart Size and Right Ventricular Reserve in Pulmonary Hypertension: Impact on Management and Prognosis

Diagnostics ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. 1110
Author(s):  
Ekkehard Grünig ◽  
Christina A. Eichstaedt ◽  
Rebekka Seeger ◽  
Nicola Benjamin
Keyword(s):  
Pulmonary Hypertension ◽  
Right Ventricular ◽  
Ventricular Function ◽  
Right Ventricular Function ◽  
Right Heart Failure ◽  
Right Heart Catheterization ◽  
Contractile Reserve ◽  
Heart Catheterization ◽  
Right Heart ◽  
Heart Size

Various parameters reflecting right heart size, right ventricular function and capacitance have been shown to be prognostically important in patients with pulmonary hypertension (PH). In the advanced disease, patients suffer from right heart failure, which is a main reason for an impaired prognosis. Right heart size has shown to be associated with right ventricular function and reserve and is correlated with prognosis in patients with PH. Right ventricular reserve, defined as the ability of the ventricle to adjust to exercise or pharmacologic stress, is expressed by various parameters, which may be determined invasively by right heart catheterization or by stress-Doppler-echocardiography as a noninvasive approach. As the term “right ventricular contractile reserve” may be misleading, “right ventricular output reserve” seems desirable as a preferred term of increase in cardiac output during exercise. Both right heart size and right ventricular reserve have been shown to be of prognostic importance and may therefore be useful for risk assessment in patients with pulmonary hypertension. In this article we aim to display different aspects of right heart size and right ventricular reserve and their prognostic role in PH.

scholarly journals Anti-synthetase syndrome-associated pulmonary veno-occlusive disease

2020 ◽  
Vol 10 (3) ◽  
pp. 204589402093528 ◽  
Author(s):  
Dana Kay ◽  
Ferdous Kadri ◽  
Garrett Fitzpatrick ◽  
Hassan Alnuaimat ◽  
Raju Reddy ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Right Heart Failure ◽  
Right Heart Catheterization ◽  
Occlusive Disease ◽  
Heart Catheterization ◽  
Right Heart ◽  
Pulmonary Arterial ◽  
Pulmonary Arterial Hypertension Therapy

Pulmonary arterial hypertension has been reported with a prevalence of 7.9% in patients with anti-synthetase syndrome; however, anti-synthetase syndrome associated with pulmonary veno-occlusive disease (PVOD) has never before been described in the literature. We present a novel case of anti-synthetase syndrome-associated PVOD in a patient who presented with hypoxic respiratory failure associated with right heart failure and was diagnosed with anti-synthetase syndrome based on his autoimmune serology and pre-capillary pulmonary hypertension on right heart catheterization. He was initiated on pulmonary arterial hypertension therapy, but with escalating dose of parenteral epoprostenol, experienced acute clinical worsening with chest imaging concerning for PVOD that was confirmed on autopsy. Anti-synthetase syndrome can be associated with PVOD, and it should be suspected in patients who have evidence of pre-capillary pulmonary hypertension and who deteriorate with the initiation of pulmonary hypertension-specific therapy.

Abstract 6165: Increased Circulating Cd62e+ Endothelial Microparticles Levels Predict Poor Outcome in Pulmonary Hypertension Patients

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Nicolas J Amabile ◽  
Yerem Yeghiazarians ◽  
Vivian Chang ◽  
Lauren Damon ◽  
Christian Heiss ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Pulmonary Hypertension ◽  
Body Mass ◽  
Venous Blood ◽  
Right Heart Failure ◽  
Right Heart Catheterization ◽  
Clinical Event ◽  
Heart Catheterization ◽  
Right Heart ◽  
And Gender

Pulmonary hypertension (PH) is characterized by vascular remodeling and endothelial dysfunction. Levels of endothelial (EMPs) and leukocytes-derived (LMPs) microparticles, which are submicron membrane fragments shed from damaged or activated cells, have been shown to be significantly increased in PH patients compared to healthy controls. We hypothesized that the levels of circulating endothelial and leukocytes-MPs could predict outcome in these patients. Patients undergoing right heart catheterization for untreated pre-capillary PH, and without any conditions associated with increased circulating MPs levels, were eligible for the study. The following were measured at the time of enrollment: body mass index, mean pulmonary artery pressure (mPAP), C reactive protein (CRP)and BNP. CD62e+, CD144+, and CD31+/CD41− EMPs and CD45+ LMPs were measured using flow cytometry in platelet-free plasma from venous blood. After inclusion, patients were treated at the discretion of the physician and prospectively followed for 12 months. The primary endpoint assessed was the combined occurrence of death and readmission for right heart failure (RHF) or worsening of RHF symptoms. Seven of 21 patients (mean age=54.1±3.5y/62% female) experienced an adverse clinical event during this period. These patients had significantly higher baseline levels of CD62e+ EMPs (581±123 vs. 202±52 ev/μL, p=0.003), CD45+ LMPs (500±141 vs. 247±44 ev/μL, p=0.03) and CRP (9.9±2.2 vs. 3.8±0.7 IU/L, p=0.004) than patients without events, whereas no difference was observed for CD31+/CD41− and CD144+ EMPs, mPAP or baseline plasma BNP values. Moreover, CD62e+ levels correlated significantly with CD45+ LMPs (r=0.70, p=0.001). Multivariate analysis revealed that 4th quartile levels of CD62e+ EMPs was an independent predictor of adverse event after adjustment for CRP, CD45+ LMPs levels, body mass index and gender. These preliminary results show that high levels of circulating CD62e+ EMPs prior to treatment, but not other MPs subpopulations, are associated with clinical adverse events in PH subjects. These data suggest that this new biological parameter may be useful to predict outcome in patients with PH.

scholarly journals 70 Estimation of pulmonary arterial pressures by tricuspid regurgitation: a comparison with invasive data

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Federico Landra ◽  
Giulia Elena Mandoli ◽  
Benedetta Chiantini ◽  
Maria Barilli ◽  
Giacomo Merello ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Heart Transplantation ◽  
Tricuspid Regurgitation ◽  
High Specificity ◽  
Right Heart Catheterization ◽  
Advanced Heart Failure ◽  
Heart Catheterization ◽  
Right Heart ◽  
Pulmonary Arterial

Abstract Aims The evaluation of the haemodynamic of pulmonary circulation is essential in various pathological conditions. Right heart catheterization (RHC) is the gold standard for the measurement of pressures and resistances in this context. However, since indications for RHC are limited, a more accessible estimation method would be helpful. This study aimed to explore the reliability of an echocardiographic method based on tricuspid regurgitation (TR) to estimate mean, systolic and diastolic pulmonary arterial (PA) pressures in a cohort of patients with advanced heart failure considered for heart transplantation. Methods and results All consecutive patients with advanced heart failure considered for heart transplantation from 2016 to 2021 that had already performed right heart catheterization (RHC) as part of the workup and with an available echocardiographic exam were included (n = 91). Mean PA pressure was obtained adding mean right ventricular-right atrial (RV-RA) gradient to mean RA pressure. Systolic PA pressure was obtained adding maximum RV-RA gradient to mean RA pressure. Diastolic PA pressure was derived from mean and systolic PA pressures. Results were compared with PA pressures by RHC. Median time between RHC and echocardiography was 0 months [interquartile range (IQR): 0–3.5]. Median age was 58 years (IQR: 52–61.5), most of the patients were men (83.5%). The absolute mean difference between mean, systolic and diastolic PA pressures by RHC and echocardiography was 0.46 ±9.78 mmHg, 2.18 ±12.92 mmHg and −2.30 ±8.61 mmHg, respectively. PA pressures by echocardiography significantly correlated with PA pressures by RHC (mean PA pressure: r = 0.460, P < 0.001; systolic PA pressure: r = 0.520, P < 0.001; diastolic PA pressure: r = 0.372, P < 0.001). AUC for prediction of pulmonary hypertension, defined as mean PA > 25 mmHg, by mean PA pressure by echocardiography was 0.828 and a cut-off of 25.5 mmHg demonstrated a high specificity (sensibility 66.7%, specificity 93.2%). Conclusions Estimation of pulmonary arterial pressures through an echocardiographic method mainly based on tricuspid regurgitation gradients is reliable and an estimated mean pulmonary arterial pressure >25.5 mmHg has a high specificity for predicting pulmonary hypertension.

scholarly journals Pulmonary veno-occlusive disease: a rare and enigmatic cause of pulmonary hypertension—a case report

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Angan Karmakar ◽  
Biva Bhakat
Keyword(s):  
Pulmonary Hypertension ◽  
Lung Transplant ◽  
Right Heart Failure ◽  
Symptomatic Improvement ◽  
Right Heart Catheterization ◽  
Occlusive Disease ◽  
Systematic Evaluation ◽  
Heart Catheterization ◽  
Right Heart ◽  
Life Threatening

Abstract Background Pulmonary veno-occlusive disease (PVOD) is a rare form of pulmonary hypertension characterized by remodelling of the pulmonary venules. PVOD and pulmonary arterial hypertension share similar clinical presentation. It is important to differentiate between these two conditions as PVOD carries a worse prognosis and life-threatening pulmonary oedema may occur following the initiation of conventional therapy. Case presentation We are reporting a case of pulmonary hypertension in a middle-aged lady who presented with hemoptysis and features of right heart failure. After extensive work up, no definite aetiology of pulmonary hypertension could be found out. Standard therapy did not cause any symptomatic improvement. After right heart catheterization, we got pre capillary pulmonary hypertension and along with typical findings in HRCT scan of thorax we established PVOD. We did not try lung biopsy as the procedure often lands up with complications. As we could not arrange for lung transplant we eventually lost the patient. Conclusions High suspicion and thorough systematic evaluation helped us to diagnose PVOD in this case. Thus, early diagnosis should be the primary aim in suspected cases of PVOD so that we can prepare for lung transplant at the earliest.

scholarly journals Non-Invasive Assessment of Pulmonary Vasculopathy

Hearts ◽  
2021 ◽  
Vol 2 (1) ◽  
pp. 5-14
Author(s):  
Ines Ponz ◽  
Jorge Nuche ◽  
Violeta Sanchez Sanchez ◽  
Javier Sanchez-Gonzalez ◽  
Zorba Blazquez-Bermejo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Resonance Imaging ◽  
Right Heart ◽  
Non Invasive ◽  
Patients With Heart Failure ◽  
Function Test ◽  
Invasive Evaluation

Right heart catheterization remains necessary for the diagnosis of pulmonary hypertension and, therefore, for the prognostic evaluation of patients with chronic heart failure. The non-invaSive Assessment of Pulmonary vasculoPathy in Heart failure (SAPPHIRE) study was designed to assess the feasibility and prognostic relevance of a non-invasive evaluation of the pulmonary artery vasculature in patients with heart failure and pulmonary hypertension. Patients will undergo a right heart catheterization, cardiac resonance imaging, and a pulmonary function test in order to identify structural and functional parameters allowing the identification of combined pre- and postcapillary pulmonary hypertension, and correlate these findings with the hemodynamic data.

scholarly journals Characteristics of patients meeting the new definition of pre-capillary pulmonary hypertension (Nice 2018) in a single Japanese pulmonary hypertension center

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Keiko Yamamoto ◽  
Nobuhiro Tanabe ◽  
Yukiko Takahashi ◽  
Akira Naito ◽  
Ayumi Sekine ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Right Heart Failure ◽  
Asian Country ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Right Heart ◽  
Significant Difference ◽  
Definition Of ◽  
Underlying Diseases

Abstract Background The 6th World Symposium on Pulmonary Hypertension (Nice 2018) proposed a new definition of pre-capillary pulmonary hypertension (PH) as a condition with mean pulmonary artery pressure (mPAP) > 20 mmHg, pulmonary artery wedge pressure  ≤ 15 mmHg, and pulmonary vascular resistance (PVR) ≥ 3 Wood units (WU). The characteristics and prognosis of patients with pre-capillary PH, according to this new definition, is unclear. Therefore, we determined the characteristics and survival of patients with borderline pre-capillary PH. Methods We retrospectively enrolled 683 patients who underwent their first right heart catheterization at Chiba University, Japan. Among them, 489 patients met the pre-capillary PH requirement with mPAP ≥ 25 mmHg (conventional pre-capillary PH group), while 22 patients met the borderline pre-capillary PH criteria (borderline pre-capillary PH group). Additionally, 16 patients with a mean PAP of 20–25 and PVR of 2–3 WU were also examined. Results The borderline pre-capillary PH group comprised 4.3% of the total patients with pre-capillary PH, and the majority was in Group 3 (40.9%) or 4 (45.5%). The survival of the borderline pre-capillary PH group tended to be better than that of the conventional pre-capillary PH group. The prognosis of Group3 PH was the worst among the patients with borderline precapillary PH. There was no significant difference in survival between the borderline pre-capillary PH group with PVR ≥ 3 WU and that with PVR of 2–3 2WU, although none of the patients in the latter group died due to right heart failure. Conclusions This is the first study conducted in a PH center in an Asian country to reveal the characteristics of patients with pre-capillary PH, according to the Nice 2018 definition. They comprised 4.3% of the total population with pre-capillary PH, and the majority of the pre-capillary PH cases were in either Group3 or 4. The prognosis may be affected by the patients’ underlying diseases. Further prospective studies are needed to determine whether the new definition, including the PVR cut-off, is beneficial in clinical practice.

Inhibition of mTOR by rapamycin does not improve hypoxic pulmonary hypertension-induced right heart failure in old mice

2021 ◽  
pp. 111395
Author(s):  
Benjamin D. McNair ◽  
Jacob A. Schlatter ◽  
Ross F. Cook ◽  
Musharraf Yusifova ◽  
Danielle R. Bruns
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Right Heart Failure ◽  
Right Heart ◽  
Hypoxic Pulmonary Hypertension ◽  
Old Mice

scholarly journals IMPACT OF RIGHT HEART CATHETERIZATION IN ACUTE HEART FAILURE WITH REDUCED EJECTION FRACTION

2021 ◽  
Vol 77 (18) ◽  
pp. 726
Author(s):  
Samarthkumar Thakkar ◽  
Harsh Patel ◽  
Kirtenkumar Patel ◽  
Ashish Kumar ◽  
Smit Patel ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Acute Heart Failure ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Right Heart ◽  
Reduced Ejection Fraction
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