scholarly journals P834 Pulmonary arterial hypertension in patients with direct-acting antiviral medications for hepatitis C virus infection - a prospective observational cohort study

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
D Schild ◽  
G J Hellige ◽  
R J Piso ◽  
N Arenja
Keyword(s):  
Hepatitis C ◽  
Pulmonary Artery ◽  
Right Ventricular ◽  
Pulmonary Artery Pressure ◽  
Left Ventricular ◽  
Hcv Infection ◽  
P Value ◽  
Systolic Pulmonary Artery Pressure ◽  
Artery Pressure ◽  
Direct Acting Antiviral

Abstract Funding Acknowledgements Kantonsspital Olten, Switzerland Background In patients with chronic hepatitis C virus (HCV) infection, a higher risk for pulmonary artery hypertension (PAH) has been described after interferon (IFN) therapy. With the development of direct-acting antiviral (DAA) agents, vast improvements have been made in tolerance and less complications of HCV treatment. However, except of a few case reports, to date no clinical study about the evidence of PAH in patients with DAA medication for HCV infection has been published. We hypothesized that in patients, who receive DAA medication for HCV-infection, the systolic pulmonary artery pressure (sPAP) will not change significantly during and after competition of the therapy and there may be a lower post treatment risk for PAH within the population. Methods We prospectively enrolled patients who underwent treatment with DAA for chronic HCV infection. The patients received a transthoracic echocardiography (TTE) for the measurement of the pulmonary artery pressure before, during (8 weeks after starting the medication) and 8 weeks after completion of the HCV medication for evaluation of sPAP (figure 1). The whole treatment period took 8-12 weeks. Results Between June 2016 and October 2018, 33 patients completed the study protocol. In mean, the patient’s age was 50.1 ± 1.4 years and 30% of the population were female. Three patients (9 %) were HCV and human immunodeficiency virus (HIV) coinfected. The patients received different treatment regimens, according to hepatitis C genotype and co-medication. The left ventricular systolic and diastolic function were normal in all patients before treatment was started (left ventricular ejection fraction 60.7% [59.7 – 61.7%], E/A 1.18 [1.0 – 1.37]). The following table depicts the right ventricular parameter before the DAA therapy was started, 8 weeks after therapy start, and 8 weeks after therapy was completed. The analysis showed no significant difference between the sPAP in all three groups (25.9 ± 1.2 mmHg vs. 26.0 ± 1.3 mmHg vs.26.9 ± 1.1 mmHg, p-value 0.37, see figure). Conclusion DAA-therapy in chronic HCV infected patients is not associated with PAH in a follow-up of 2 months after the treatment was completed. Echocardiography Data Echocardiography data Before DAA medication was started 8 weeks after DAA-therapy 8 weeks after completion of DAA-therapy p-Value Right ventricular fractional area change (FAC), % 49.1 ± 1.4 51.7 ± 1.0 51.8 ± 1.1 0.09 Tricuspid Annular Plane Systolic Excursion (TAPSE), mm 25.2 ± 1.1 25.8 ± 0.7 24.3 ± 0.5 0.4 Right ventricular/right atrial gradient, mmHg 19.9 ± 1.0 20.5 ± 0.9 21.0 ± 0.8 0.24 Systolic pulmonary artery pressure (sPAP), mmHg 25.9 ± 1.2 26.0 ± 1.3 26.9 ± 1.1 0.37 Abstract P834 Figure. Multiple variable graph of sPAP

scholarly journals A Simplified Ultrasound Comet Tail Grading Scoring to Assess Pulmonary Congestion in Patients with Heart Failure

2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
Hong Li ◽  
Yi-Dan Li ◽  
Wei-Wei Zhu ◽  
Ling-Yun Kong ◽  
Xiao-Guang Ye ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Systolic Pulmonary Artery Pressure ◽  
Pulmonary Congestion ◽  
Functional Classification ◽  
Artery Pressure ◽  
Patients With Heart Failure

Ultrasound lung comets (ULCs) are a nonionizing bedside approach to assess extravascular lung water. We evaluated a protocol for grading ULC score to estimate pulmonary congestion in heart failure patients and investigated clinical and echocardiographic correlates of the ULC score. Ninety-three patients with congestive heart failure, admitted to the emergency department, underwent pulmonary ultrasound and echocardiography. A ULC score was obtained by summing the ULC scores of 7 zones of anterolateral chest scans. The results of ULC score were compared with echocardiographic results, the New York Heart Association (NYHA) functional classification, radiologic score, and N-terminal pro-b-type natriuretic peptide (NT-proBNP). Positive linear correlations were found between the 7-zone ULC score and the following: E/e′, systolic pulmonary artery pressure, severity of mitral regurgitation, left ventricular global longitudinal strain, NYHA functional classification, radiologic score, and NT-proBNP. However, there was no significant correlation between ULC score and left ventricular ejection fraction, left ventricle diameter, left ventricular volume, or left atrial volume. A multivariate analysis identified the E/e′, systolic pulmonary artery pressure, and radiologic score as the only independent variables associated with ULC score increase. The simplified 7-zone ULC score is a rapid and noninvasive method to assess lung congestion. Diastolic rather than systolic performance may be the most important determinant of the degree of lung congestion in patients with heart failure.

scholarly journals P211 Short term impact of hemodialysis on right ventricular systolic function and pulmonary artery pressure in patients with end stage renal disease

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A M F Ali ◽  
A Salama ◽  
I Abd El Aziz ◽  
H Kamal
Keyword(s):  
Pulmonary Artery ◽  
Renal Disease ◽  
Right Ventricular ◽  
Pulmonary Artery Pressure ◽  
End Stage Renal Disease ◽  
Systolic Function ◽  
P Value ◽  
Artery Pressure ◽  
Stage Renal Disease ◽  
End Stage

Abstract Introduction Chronic kidney disease (CKD) is associated with increased morbidity and mortality. Cardiovascular disease (CVD) is the most common complication and a chief cause of death in patients with end stage renal disease (ESRD) accounting for 45% to 50% of causes of death in ESRD patient. Pulmonary hypertension (PH) occurs frequently in patients with CKD. The role of hemodialysis in reducing pulmonary artery pressure (PAP) and improving RV systolic function in not properly studied. Purpose To evaluate the effect of hemodialysis on Right ventricular (RV) systolic function and Pulmonary artery pressures using echocardiography in newly diagnosed end stage renal disease patients and after three months of regular hemodialysis. Patients and Methods 30 patients recently diagnosed to have ESRD were enrolled and were followed up after three months. Trans-thoracic echocardiography was done prior to the first dialysis session and after three months of regular hemodialysis to asses RV systolic function and PAP. Results There was a significant improvement of RV systolic function assessed by trans-annular plane systolic excursion (TAPSE)(mm)(pre dialysis 18.9 ± 3.76, post 21.56 ±3.51, p <0.01), fractional area change (FAC)(%)(pre dialysis 41.27 ± 8.9, post 47.5 ± 6.1, p < 0.01),tricuspid lateral annular systolic velocity (S’)(cm/s) (pre dialysis 12.3 ± 2.79, post 14.16 ± 2.3, p < 0.01),myocardial performance index (MPI)(pre dialysis 0.2 ± 0.1, post 0.1 ± 0.1, p < 0.01)and right ventricular outflow tract fractional shortening (RVOT-FS)(%)(pre dialysis 36.5 ± 9.5, post 39.3 ± 8.6, p < 0.01)post dialysis (P value <0.01). All parameters of assessing pulmonary artery pressures; systolic pulmonary artery pressure (PASP)(mmHg)(pre dialysis 48.03 ± 17.16, post 35.12 ± 14.73, p < 0.01), pulmonary diastolic artery pressure (PADP)(mmHg)(pre dialysis 24.05 ± 9.7, post 18.12 ± 9.64, p < 0.01), mean pulmonary artery pressure (MPAP)(mmHg) (pre dialysis 35.61 ± 15.07, post 25.8 ± 12.06, p < 0.01), pulmonary capillary wedge pressure (PCWP)((pre dialysis 23.28 ± 8.74, post 17.39 ± 5.87, p < 0.01) and pulmonary vascular resistance (PVR)(Wood unit)(pre dialysis 1.89 ± 0.57, post 1.43 ± 0.46, p < 0.01) improved significantly post dialysis (P value <0.01).There was a significant inverse correlation between the duration of renal impairment and the improvement in SPAP and PCWP after the initiation of dialysis (P values are 0.021 and 0.015, Correlation co-efficient -0.421, -0.441 respectively). The best cut-off value for weight reductionduring dialysis for prediction of improvement of SPAP is 2.75 Kg (AUC = 0.950, CI = 0.881-1.000, P value < 0.01). Conclusions The present study shows that significant improvement occurred in all RV systolic function parameters and all parameters of assessing pulmonary artery pressures post dialysis in patients recently diagnosed to have ESRD. RVOT FS is a reliable method for assessing RV function and it is significantly correlated only with TAPSE and FAC at the baseline before dialysis.

Abstract 19195: Pulmonary Artery Pulsatility Index Predicts Right Ventricular Failure Following LVAD Surgery

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Kevin J Morine ◽  
Michael S Kiernan ◽  
Duc T Pham ◽  
David Denofrio ◽  
Navin K Kapur
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricular ◽  
Pulmonary Artery Pressure ◽  
Pulsatility Index ◽  
Right Ventricular Failure ◽  
Right Atrial ◽  
Systolic Pulmonary Artery Pressure ◽  
Stroke Work ◽  
Ventricular Failure ◽  
Artery Pressure

Introduction: Identification of pre-operative right ventricular dysfunction may improve patient selection for isolated LVAD surgery. The pulmonary artery pulsatility index (PaPi) is a recently described hemodynamic metric. We evaluated baseline PaPi as a predictor of post-operative right ventricular failure (RVF) following LVAD surgery. Methods: We conducted a retrospective review of 132 consecutive LVAD implantations at our hospital. Demographic, clinical, hemodynamic and echocardiographic data were evaluated for their association with the development of RVF. RVF was defined as need for RVAD or inotrope dependence for greater than 14 days. PaPi was calculated as [(systolic pulmonary artery pressure-diastolic pulmonary artery pressure)/right atrial (RA) pressure]. Univariate analysis was performed to identify baseline predictors of RVF. Multivariate logistic regression was used to adjust for baseline RA pressure. Results: RVF occurred in 31 of 132 patients (23%); all cases were due to prolonged inotropes. PaPi was lower among patients with RVF compared to those without (no RVF: mean 2.75± SD1.17 vs RVF: 1.38±0.46, P<0.0001). RA pressure, RA to pulmonary capillary wedge pressure ratio (RA/PCWP) and RV stroke work index (RVSWI) were also associated with RVF. Previously identified markers of RV function including mean pulmonary artery pressure and qualitative RV dysfunction by 2D echo were not associated with RVF. Comparison of the area under the curve from receiver operator characteristic curve analysis demonstrated that a PaPi<1.85 was most predictive of RVF (Figure). PaPi remained an independent predictor of RVF after adjusting for RA pressure in a multivariate model. Conclusions: PaPi is a routinely available and easily calculated hemodynamic variable associated with RVF following LVAD surgery superior to established markers. Further evaluation of PaPi as part of a risk prediction model to guide clinical decision making may be warranted.

Abstract 16599: Impaired Right Ventricular Contractile Reserve During Exercise in Endurance Athletes With Right Ventricular Arrhythmias

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Guido Claessen ◽  
Andre La Gerche ◽  
Jens-Uwe Voigt ◽  
Steven Dymarkowski ◽  
Luc Van Hees ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricular ◽  
Pulmonary Artery Pressure ◽  
Ventricular Arrhythmias ◽  
Systolic Pressure ◽  
Endurance Athletes ◽  
Contractile Reserve ◽  
Systolic Pulmonary Artery Pressure ◽  
Exercise Echocardiography ◽  
Artery Pressure

Introduction: Ventricular arrhythmias in endurance athletes (EAs) frequently originate from a mildly dysfunctional right ventricle (RV). We evaluated whether RV dysfunction in EAs with ventricular arrhythmias of RV origin (EA-VAs) becomes more apparent during exercise than at rest. Methods: Ten healthy EAs, 7 healthy non-athletes (NAs) and 17 EA-VAs (8 with ICD) first underwent cardiopulmonary exercise testing to determine maximal power (Pmax). Then, exercise echocardiography was performed at 25%, 50% and 66% of Pmax to measure the RV end-systolic pressure-area ratio (ESPAR), a surrogate of RV contractility, which was calculated as systolic pulmonary artery pressure/RV end-systolic area. Finally, all subjects without ICD underwent cardiac MRI during supine bicycle exercise at similar workloads with simultaneous invasive pulmonary artery pressure measurement to determine the RV end-systolic pressure-volume ratio (SP/ESV). Results: At rest, RV ESPAR was similar in EA-VAs relative to NAs (P=0.1), although slightly lower than in NAs (P=0.02). During exercise, EA-VAs had an impaired increase in RV ESPAR compared to both EAs and NAs (interaction P<0.0001; Figure 1A). Also the slopes of RV ESPAR to absolute workload (in Watts) were lower in EA-VAs than in EAs and NAs (P<0.0001) and correlated highly with the slopes of RV SP/ESV to workload obtained by MRI and invasive pressure measures (R=0.75; P<0.0001). Figure 1B shows that resting and peak exercise RV ESPAR cutoffs of 1.4 and 3.9 mmHg/cm 2 had a sensitivity of 77% and 79% and specificity of 80% and 100%, respectively, to identify EA-VAs. Conclusion: EA-VAs have impaired RV contractility which is evident during exercise but hardly at rest. This strengthens the association between RV arrhythmias and functional impairment. Our data suggest that exercise echocardiography is sufficiently accurate to determine RV contractile reserve in a non-invasive manner and may assist in risk stratification of RV remodeling in EAs.

scholarly journals Evaluation of the Results of Balloon Pulmonary Angioplasty in Patients with Chronic Distal Pulmonary Thromboembolic Disease and Pulmonary Hypertension

2021 ◽  
Vol 06 (03) ◽  
pp. 157-164
Author(s):  
M. Hanumantha Reddy ◽  
George Cherian ◽  
Bagirath Raghuraman
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Right Ventricular ◽  
Pulmonary Artery Pressure ◽  
Thromboembolic Disease ◽  
Right Atrial ◽  
P Value ◽  
Artery Pressure ◽  
Balloon Pulmonary Angioplasty ◽  
Minute Walk

Introduction The gold standard curative treatment for chronic pulmonary thromboembolic disease and pulmonary hypertension (CTEPH) is pulmonary thromboendarterectomy (PTE). Balloon pulmonary angioplasty (BPA) is emerging for distal CTEPH patients, where lesion is inaccessible for surgery. This is the first study conducted in Indian patients for evaluating the impact of BPA in patients with distal CTEPH. Aims and Objectives To evaluate the effect of BPA in patients with distal CTEPH with the help of New York Heart Association (NYHA) functional class and 6-minute walk distance (6MWD). To study decrease in pulmonary artery pressure and improvement in right atrial and right ventricular function with the help of echocardiography. Material and Methods Study population—CTEPH patients presenting to the hospital during the study interval of 16 months from January 2017 to April 2018. A. Method: This was an observational retrospective and prospective follow-up study. All distal CTEPH patients after meeting inclusion and exclusion criteria were taken for study. B. Detailed case records containing information on demographics, clinical features and necessary blood and imaging investigations, ventilation/perfusion (V/Q) scan, computed tomography pulmonary angiography (CTPA), right heart catheterization (RHC) study, pulmonary angiogram, and BPA procedure details were obtained for all participants. C. After 8 weeks of last BPA session, patients were assessed clinically and then 6-minute walk test, blood investigations and echocardiography were done. Data Analysis Statistical analysis was performed by using the software SPSS 22.0 version. We used paired t-test to test the significant difference in the mean pre- and post-BPA. p-value < 0.05 will be considered as statistically significant. Results In our study, mean age of presentation was 39.81 ± 12 years. Out of 11 patients, 5 were females and 6 were males. Mean duration of symptoms was 40.5 months. The total number of BPA sessions performed were 30. The minimum number of BPA sessions undergone was 1 and maximum number of BPA sessions undergone by one patient was 5, with 45% of patients undergoing 2 BPA sessions. The total number of segmental arteries dilated was 104. Segmental vessels dilated per each session was 3.46. There was statistically significant improvement in NYHA class and 6MWD after BPA. 6MWD increased from 299 m to 421 m (p-value < 0.001). This improvement in functional capacity is strongly associated with the improvement in right ventricular (RV) function (tricuspid annular plane systolic excursion [TAPSE] from 15.3 mm to 18.9 mm) and with the reduction in pulmonary artery systemic pressure (PASP) (from 92 mm Hg to 60 mm Hg). Conclusion In patients with distal CTEPH who undergo BPA, there was statistically significant improvement in 6MWD. These changes correspond to a treatment-induced reduction in pulmonary artery pressure and lend support to use of BPA in patients with distal CTEPH. ECHO and 6MWD can be used for evaluating BPA efficacy and monitoring disease progression.

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