SIGNIFICANCE OF THE PASSIVE LEG RAISING TEST IN THE DIAGNOSIS OF PULMONARY HYPERTENSION DUE TO LEFT HEART DISEASES IN SYSTEMIC SCLEROSIS

CHEST Journal ◽  
2021 ◽  
Vol 160 (4) ◽  
pp. A2256
Author(s):  
Alexander Volkov ◽  
Ekaterina Nikolaeva ◽  
Ildar Kurmukov ◽  
Eugene Nasonov
Keyword(s):  
Pulmonary Hypertension ◽  
Systemic Sclerosis ◽  
Heart Diseases ◽  
Passive Leg Raising ◽  
Left Heart

scholarly journals Different effects on right ventricular function in different etiology of secondary tricuspid regurgitation

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
WC Tsai ◽  
WY Lee ◽  
MS Huang ◽  
WH Lee
Keyword(s):  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Right Ventricular ◽  
Tricuspid Regurgitation ◽  
Congenital Heart ◽  
Heart Diseases ◽  
Right Atrial ◽  
Left Heart ◽  
Left Heart Disease ◽  
Rv Function

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Science and Technology, Excutive Yuan, Taiwan Background Tricuspid regurgitation (TR) is traditionally classified as primary or secondary TR. The effects of TR on right ventricular (RV) function were not consistent. We hypothesized that secondary TR is not a unique group, sophisticated sub-grouping can be useful for studying effects of TR on RV function. Methods 207 consecutive patients identified as significant TR (moderate and severe) by echocardiography were recruited. Standard measurements for right heart were done according to guideline. Lateral tricuspid annulus systolic tissue velocity (S’) and RV fractional area change (FAC) were used for RV function. We classified these patients into primary TR and 6 subgroups of secondary TR according to a new systemic approach. Results Mean age of subjects was 71.2 ± 14.7 years, and there were 84 (40.6%) male. There were 29 (14%) primary TR. Secondary TR was further classified into 6 groups included 18 (8.7%) pacemaker related, 81 (39.1 %) left heart diseases, 6 (2.9%) congenital heart diseases, 3 (1.4%) RV myopathy, 27 (13.0%) pulmonary hypertension, and 43 (20.8%) idiopathic TR. Among 4 major groups (congenital heart disease and RV myopathy were not included in analysis due to low numbers) of secondary TR, S’ was significant higher in idiopathic TR and RV FAC were higher in pacemaker related and idiopathic TR. RV dysfunction was defined as FAC < 35%. RV dysfunction presented mostly in pulmonary hypertension related TR and leastly in idiopathic TR (59.3% vs. 14%, p <0.001). Multivariate analysis using idiopathic TR as reference and controlled TR maximal velocity, RV end-diastolic area, right atrial area, and severity of TR, left heart disease related TR had higher risk of RV dysfunction (OR 4.178, 95% CI 1.490-11.703, p = 0.007). Conclusions Effects of TR on RV function were different among different subgroups of secondary TR. Left heart disease related TR had highest risk for RV dysfunction. Secondary TR should not be regarded as a single disease.

scholarly journals Pulmonary hypertension associated with left heart diseases (clinical case)

2020 ◽  
Vol 27 (3) ◽  
pp. 89-106
Author(s):  
G. D. Radchenko ◽  
S. M. Kushnir ◽  
Yu. M. Sirenko
Keyword(s):  
Pulmonary Hypertension ◽  
Arterial Hypertension ◽  
Clinical Case ◽  
Heart Diseases ◽  
Chronic Obstructive Lung Disease ◽  
Chronic Obstructive ◽  
Heart Catheterization ◽  
Left Heart ◽  
Right Heart ◽  
High Level

This paper presents clinical case of pulmonary hypertension associated with left heart diseases (PH-LHD) in 63 year old woman with heart failure and preserved ejection fraction (HFpEF). The history of disease (arterial hypertension, atrial fibrillation, diabetes mellitus, acute pulmonary embolism, obesity, chronic obstructive lung disease) and results of standard investigations (no signs of thrombi in pulmonary arteries, significant enlargement of right heart and normal size of left heart, high level of calculated systolic blood pressure in pulmonary artery, high level of B-type natriuretic peptide) did not help to classify the type of pulmonary hypertension (PH). Only after right heart catheterization it was possible to state right diagnosis – post capillary combined PH-LHD. There are also discussed the latest guidelines in diagnosis and treatment of HFpEF and PH-LHD. Some considerations in favor of new step algorithm for diagnosis of HFpEF that was proposed by European Cardiology Congress in Paris (2019) were done and there was demonstrated its possible use in Ukraine. Some questions of morphological and pathogenic differences between precapillary pulmonary arterial hypertension (PAH) and post-capillary PH-LHD were discussed. Conclusion about not using of specific PAH therapy in PH-LHD patients was based on some arguments. There are elucidated some drug interventions in patients with HFpEF. Especial emphasized the necessity of risk factor and concomitant state corrections, including life style modification and non-drug treatment.

scholarly journals Characteristics of idiopathic tricuspid regurgitation

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
LWY Li ◽  
MS Huang ◽  
WH Lee ◽  
WC Tsai
Keyword(s):  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Tricuspid Regurgitation ◽  
Congenital Heart ◽  
Heart Diseases ◽  
Systemic Approach ◽  
Left Heart ◽  
Tricuspid Annulus ◽  
Left Heart Disease ◽  
Rv Function

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Science and Technology, Executive Yuan, Taiwan Background Tricuspid regurgitation (TR) were traditionally classified as primary and secondary TR. Recently a new category of TR was developed and named as idiopathic TR. However, diagnosis and characteristics of idiopathic TR were not consisted. We tried to identify idiopathic TR by a new systemic approach and studied its characteristics. Methods 207 consecutive patients (mean age 71.2 ± 14.7 years, 40.6% male) identified as significant TR (moderate and severe) by echocardiography were recruited. We classified TR by a new systemic approach. The classification process started from identified primary TR, then pacemaker related TR, left heart disease related TR, congenital heart related TR, right ventricular (RV) myopathy, pulmonary hypertension and, finally idiopathic TR step by step. Results There were 29 (14%) primary TR, 18 (8.7%) pacemaker related, 81 (39.1 %) left heart diseases, 6 (2.9%) congenital heart diseases, 3 (1.4%) RV myopathy, 27 (13%) pulmonary hypertension, and 43 (20.8%) idiopathic TR. Mean age of idiopathic TR was 72.9 ± 11.4 years and 39.5% was male which were not different from other groups. Atrial fibrillation was presented highest in patients with pacemaker related TR (77.8%) and left heart disease (55.6%), lowest in primary TR (24.1%) and pulmonary HT (25.9%), and modest in idiopathic TR (44.2%). Among the echocardiographic characteristics of right heart measurements, idiopathic TR had lowest TR maximal velocity (3.0 ± 0.3 m/s), pulmonary (41.2 ± 8.7 mmHg) and right atrium pressure (5.3 ± 0.3 mmHg; all p <0.001). Idiopathic TR had smallest RV wall thickness (4.5 ± 1.4 mm; p = 0.008), tricuspid annulus diameter (3.2 ± 0.7 cm; p = 0.001), and right atrial area (18.9 ± 8.4 cm2; p <0.001). RV function represented as tricuspid annulus velocity S’ (12.8 ± 3.3 cm/s; p = 0.011) and RV fractional area change FAC (42.6 ± 16.0 %; p <0.001) were best in idiopathic TR. RV dysfunction (FAC < 35%) was lowest (14%) in idiopathic TR. Conclusions Idiopathic TR had better RV function then other types of TR. Idiopathic TR can be regarded as a unique disease category in studying TR.

scholarly journals Pulmonary hypertension phenotypes in patients with systemic sclerosis

2021 ◽  
Vol 30 (161) ◽  
pp. 210053
Author(s):  
Ashraful Haque ◽  
David G. Kiely ◽  
Gabor Kovacs ◽  
A.A. Roger Thompson ◽  
Robin Condliffe
Keyword(s):  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Systemic Sclerosis ◽  
Interstitial Lung Disease ◽  
Left Heart ◽  
Significant Morbidity ◽  
Early Disease ◽  
Pulmonary Haemodynamics ◽  
Pulmonary Arterial

Pulmonary hypertension (PH) commonly affects patients with systemic sclerosis (SSc) and is associated with significant morbidity and increased mortality. PH is a heterogenous condition and several different forms can be associated with SSc, including pulmonary arterial hypertension (PAH) resulting from a pulmonary arterial vasculopathy, PH due to left heart disease and PH due to interstitial lung disease. The incidence of pulmonary veno-occlusive disease is also increased. Accurate and early diagnosis to allow optimal treatment is, therefore, essential. Recent changes to diagnostic haemodynamic criteria at the 6th World Symposium on Pulmonary Hypertension have resulted in therapeutic uncertainty regarding patients with borderline pulmonary haemodynamics. Furthermore, the optimal pulmonary vascular resistance threshold for diagnosing PAH and the role of exercise in identifying early disease require further elucidation. In this article we review the epidemiology, diagnosis, outcomes and treatment of the spectrum of pulmonary vascular phenotypes associated with SSc.

scholarly journals Intracardiac hemodynamics and effects of nebulized bronchidilating therapy in elderly patients with asthma

2007 ◽  
pp. 60-63
Author(s):  
K. M. Alieva ◽  
M. I. Ibragimova ◽  
K. I. Masuev
Keyword(s):  
Pulmonary Hypertension ◽  
Elderly Patients ◽  
Bronchial Asthma ◽  
Heart Diseases ◽  
Asthma Severity ◽  
Control Group ◽  
Left Heart ◽  
Effective Medication ◽  
Reduced Time

The objective of the study was to evaluate right and left heart hemodynamics, right (RV) and left (LV) ventricular dyastolic function and effectiveness of nebulized bronchodilators. The study involved 86 elderly patients with bronchial asthma (BA). The control group included 22 elderly patients without lung or heart diseases. The results found remodeling RV and LV, RV and LV dyastolic dysfunction that worsened as asthma severity increased. These parameters correlated to a level of pulmonary hypertension which was mostly moderate (35.0 ± 7.9 mmHg). Nebulized bronchodilators improved the heart hemodynamics: pulmonary hypertension reduced, time and velocity parameters of RV and LV improved. The most effective medication in elderly patients with BA was Berodual.

scholarly journals Management of Pulmonary Hypertension in Left Heart Disease

2021 ◽  
Vol 17 (2) ◽  
pp. 115-123
Author(s):  
Francesca Macera ◽  
Jean-Luc Vachiéry
Keyword(s):  
Pulmonary Hypertension ◽  
Ejection Fraction ◽  
Current Knowledge ◽  
Heart Diseases ◽  
Endothelin Receptor ◽  
Left Heart ◽  
Reduced Ejection Fraction ◽  
Pulmonary Arterial ◽  
Approved Drugs ◽  
Prevalent Form

Pulmonary hypertension due to left heart diseases (PH-LHD) is the most prevalent form of pulmonary hypertension. It frequently complicates heart failure with reduced ejection fraction (HFrEF) or preserved ejection fraction (HFpEF) and negatively impacts prognosis, particularly when a precapillary component is present. PH-LHD is distinctive from pulmonary arterial hypertension (PAH) even though both conditions may share some common characteristics. In addition, the mechanisms involved in the development of a precapillary component are yet to be fully clarified, in particular in PH due to HFpEF. Several studies have been exploring PAH pathways as potential therapies for PH-LHD, but no PAH-approved drug has demonstrated efficacy in PH-LHD. Rather, some classes of drugs, such as endothelin-receptor antagonists or prostacycline-analogues, have been found to be harmful in patients with HF. Therefore, at present, the only established treatments for PH-LHD are those that target the heart as recommended in the international guidelines for HF. Based on current knowledge, off-label prescription of PAH-approved drugs in PH-LHD patients must be strongly discouraged.

scholarly journals Pulmonary hypertension due to left heart diseases

ESC CardioMed ◽  
2018 ◽  
pp. 2543-2547
Author(s):  
Jean-Luc Vachiery
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Negative Impact ◽  
Heart Diseases ◽  
Exercise Intolerance ◽  
Left Heart ◽  
Common Complication ◽  
Reduced Ejection Fraction ◽  
Left Heart Disease

Pulmonary hypertension is a common complication of left heart diseases. Although it may be encountered in all disorders, pulmonary hypertension in left heart disease is most common in heart failure with preserved or reduced ejection fraction. When present, pulmonary hypertension in left heart disease has been associated with more symptoms, exercise intolerance, and a negative impact on outcome.

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