scholarly journals P960 Response of alveolo-capillar membrane diffusion to mitral regurgitation in heart failure with reduced ejection fraction

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
F Bandera ◽  
G Ghizzardi ◽  
M Agnifili ◽  
S Pizzocri ◽  
S Boveri ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Pulmonary Artery ◽  
Right Ventricle ◽  
Systolic Function ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Membrane Diffusion ◽  
Alveolar Volume ◽  
Reduced Ejection Fraction ◽  
Capillary Membrane

Abstract Background In HFrEF patients, high pulmonary vascular resistances (PVR) imply a combined increase of both pre- and post-capillary pressures, associated with worse outcome. Mitral regurgitation (MR) may play a role in this complex physiopathology. We sought to investigate MR impact on lung DLCO and pulmonary vascular hemodynamic in HFrEF patient. Methods 27 HFrEF patients (age 69 ± 9; LV EF 34 ± 6) underwent right heart catheterization, rest and exercise echocardiography, right ventricle 3D assessment and lung alveolo-capillary membrane DLCO. We identified 2 subgroups divided by normal (<3 WU, n= 20) or abnormal (>3 WU, n = 7) PVR. Results Abnormal PVR patients showed increased pulmonary artery pressures and TPG, reduced CO and pulmonary artery compliance. Total DLCO was not significantly different between groups. The membrane component (Dm) and the alveolar volume (Va) were significantly reduced in abnormal PVR group, while the capillary volume (VC) showed a strong trend toward higher values. Abnormal PVR group had a very high percentage of moderate-to-severe MR. The TASPE/SPAP ratio and the circumferential component of RV systolic function were significantly reduced in abnormal PVR group. Conclusion The presence of severe MR is associated with alveolar-capillary membrane remodeling (lower Dm), worse hemodynamic profile (higher PA pressures, lower PA compliance and higher PA resistance) and worse right ventricle to pulmonary circulation coupling (lower TAPSE/SPAP and lower 3D RV circumferential EF) in this cohort of HFrEF patients. These results confirm the adequacy of using therapeutic strategies aimed to solve valvular disease.

P3549Impact of mitral regurgitation on alveolo-capillar membrane diffusion: an hemodynamic and functional study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
F Bandera ◽  
G Ghizzardi ◽  
M Agnifili ◽  
S Pizzocri ◽  
A Giammarresi ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Pulmonary Artery ◽  
Right Ventricle ◽  
Systolic Function ◽  
Right Heart Catheterization ◽  
Functional Study ◽  
Heart Catheterization ◽  
Membrane Diffusion ◽  
Alveolar Volume ◽  
Capillary Membrane

Abstract Background In HFrEF patients, high pulmonary vascular resistances (PVR) reflect a combined increase of pre- and post-capillary pressures, associated with worse outcome. Mitral regurgitation (MR) may play a role in this complex physiopathology. We sought to investigate MR impact on lung DLCO and pulmonary vascular hemodynamic in HFrEF patient. Methods 22 HFrEF patients (age 67±11; LV EF) underwent right heart catheterization, rest and exercise echocardiography, right ventricle 3D assessment and lung alveolo-capillary membrane DLCO. We identified 2 subgroups according to normal (<3 WU, n=17) or abnormal (>3 WU, n=5) PVR. Results Abnormal PVR patients showed increased pulmonary artery pressures and TPG, reduced CO and pulmonary artery compliance. Total DLCO was not significantly different between groups. The membrane component (Dm) and the alveolar volume (Va) were significantly reduced in abnormal PVR group, while the capillary volume (VC) showed a strong trend toward higher values. Abnormal PVR group had a very high percentage of moderate-to-severe MR. The TASPE/SPAP ratio and the circumferential component of RV systolic function were significantly reduced in abnormal PVR group. Normal PVR (n=17) Abnormal PVR (n=5) p NTproBNP, ng/L 3021±2527 7023±8785 0.55 MR moderate-to-severe, n (%) 3 (19%) 4 (80%) 0.025 TAPSE/SPAP, mm/mmHg 0.4761±0.1695 0.2956±0.0739 0.019 3D RV global EF, % 40.616±9.350 29.486±14.062 0.119 3D RV longitudinal EF, % 15.611±7.773 12.086±9.694 0.497 3D RV circumferential EF, % 31.0567±6.5744 21.1746±11.5823 0.019 Lung diffusion of CO (DLCO), ml/min/mmHg 19.021±4.643 15.233±1.761 0.197 Dm ml/min/mmHg 26.8±8.2 17.8±4.1 0.047 VC, ml 110±77 247±152 0.121 Graphics Conclusion The presence of severe MR, in this cohort of HFrEF patients, is associated with alveolar-capillary membrane remodeling (lower Dm), worse hemodynamic profile (higher PA pressures, lower PA compliance and higher PA resistance) and worse right ventricle to pulmonary circulation coupling (lower TAPSE/SPAP and lower 3D RV circumferential EF), confirming the use of therapeutic strategies aimed at correction of valvular disease.

scholarly journals P1425 Association between severity of mitral regurgitation and right ventricular function in patients with moderate to severe mitral regurgitation assessed by invasive hemodynamics measurements

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Omar
Keyword(s):  
Mitral Regurgitation ◽  
Pulmonary Artery ◽  
Stroke Volume ◽  
Right Ventricular ◽  
Right Heart Catheterization ◽  
Right Atrial ◽  
Heart Catheterization ◽  
Right Heart ◽  
Ambulatory Patients ◽  
Primary Mitral Regurgitation

Abstract Funding Acknowledgements - Background Primary mitral regurgitation (MR) will cause volume overload to the left ventricle (LV) but due to systolic reguritant flow the pulmonary circulation will be affected often leading to post-capillary pulmonary hypertension and thus increased afterload to the right heart. As a consequence right ventricular (RV) dysfunction may be a consequence of MR. Purpose To assess the association between RV function assessed with cardiac magnetic resonance imaging (CMRI) and hemodynamics at rest and during exercise in ambulatory patients with primary mitral regurgitation (MR). Methods In an observational study, patients with significant primary MR with effective regurgitant orifice ≥0.30 cm2 and LV ejection fraction &gt;60% were examined with right heart catheterization during rest and exercise and CMRI at rest. Patients were examined in semi-supine position (30 degree). From right heart catheterization pulmonary artery systolic pressure (PAPs) was measured, where RV stroke work index (RVSWI = 0.0136*(mean pulmonary artery pressure – right atrial pressure *stroke volume index) and pulmonary artery compliance (PAC= stroke volume / (PAPsystolic – PAPdiastolic)) was calculated. Patients were dichotomized according to effective regurgitant orifice (ERO) (≤0.4 cm2). Results The two groups (total n = 46) have same baseline characters with no significant differences. In both groups resting RVEF was normal and no difference in RV stroke volume was seen between the groups at rest or with exercise. However RVSWi was significantly higher in patients with ERO &gt; 0.4, (rest p = 0.0039, exercise p = 0.01), Figure. The increase in RVSWi was driven by increased sPAP and where significantly in ERO &gt; 0.4 at rest at during exercise (rest p = 0.00027, exercise p = 0.0352). At rest PAC was significantly higher in ERO above 0.4, but during exercise no differences was found in the two groups. RVEF at rest measured by CMRI showed no correlation with RVSWi in the two groups (r = 0.11, p = 0.45) Conclusion In ambulatory patients with mitral regurgitation above 0.4 cm2, RVSW is associated with an increased right ventricle workload and contractility at rest and during exercise which especially is driven by increased post capillary pressure whereas pulmonary arterial compliance only is mildly affected. Abstract P1425 Figure. Ventricle function at rest/exercise

scholarly journals Circulating sLR11 levels predict severity of pulmonary hypertension due to left heart disease

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261753
Author(s):  
Yusuke Joki ◽  
Hakuoh Konishi ◽  
Hiroyuki Ebinuma ◽  
Kiyoshi Takasu ◽  
Tohru Minamino
Keyword(s):  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Mitral Regurgitation ◽  
Pulmonary Artery ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Severe Mitral Regurgitation ◽  
Left Heart ◽  
Right Heart ◽  
Left Heart Disease

Background Heart failure is a severe condition often involving pulmonary hypertension (PH). Soluble low-density lipoprotein receptor with 11 ligand-binding repeats (sLR11) has been associated with pulmonary artery hypertension. We examined whether sLR11 correlates with PH in left heart disease and can be used as a predictive marker. Method We retrospectively analyzed patients with severe mitral regurgitation who underwent right heart catheterization before surgery for valve replacement or valvuloplasty from November 2005 to October 2012 at Juntendo University. We measured sLR11 levels before right heart catheterization and analyzed correlations with pulmonary hemodynamics. We compared prognoses between a group with normal sLR11 (≤9.4 ng/ml) and a group with high sLR11 (>9.4 ng/ml). Follow-up was continued for 5 years, with end points of hospitalization due to HF and death due to cardiovascular disease. Results Among 34 patients who met the inclusion criteria, sLR11 correlated with mean pulmonary artery pressure (r = 0.54, p<0.001), transpulmonary pressure gradient (r = 0.42, p = 0.012), pulmonary vascular resistance (r = 0.36, p<0.05), and log brain natriuretic peptide (BNP). However, logBNP did not correlate with pulmonary vascular resistance (p = 0.6). Levels of sLR11 were significantly higher in the 10 patients with PH (14.4±4.3 ng/ml) than in patients without PH (9.9±3.9 ng/ml; p = 0.002). At 5 years, the event rate was higher in the high-sLR11 group than in the normal-sLR11 group. The high-sLR11 group showed 5 hospitalizations due to HF (25.0%) and 2 deaths (10.0%), whereas the normal-sLR11 group showed no hospitalizations or deaths. Analyses using receiver operating characteristic curves showed a higher area under the concentration-time curve (AUC) for sLR11 level (AUC = 0.85; 95% confidence interval (CI) = 0.72–0.98) than for BNP (AUC = 0.80, 95%CI = 0.62–0.99) in the diagnosis of PH in left heart disease. Conclusions Concentration of sLR11 is associated with severity of PH and offers a strong predictor of severe mitral regurgitation in patients after surgery.

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

scholarly journals Serial echocardiographical assessment for urgent control of rapid atrial fibrillation in acute heart failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Iwahashi ◽  
J Kirigaya ◽  
M Horii ◽  
Y Hanajima ◽  
T Abe ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Reduced Ejection Fraction ◽  
Initial Hospitalization

Abstract Objectives Doppler echocardiography is a well-recognized technique for noninvasive evaluation; however, little is known about its efficacy in patients with rapid atrial fibrillation (AF) accompanied by acute decompensated heart failure (ADHF). The aim of this study was to explore the usefulness of serial echocardiographical assessment for rapid AF patients with ADHF. Patients A total of 110 ADHF patients with reduced ejection fraction (HFrEF) and rapid AF who were admitted to the CCU unit and received landiolol treatmentto decrease the heart rate (HR) to &lt;110 bpm and change HR (ΔHR) of &gt;20% within 24 hours were enrolled. Interventions Immediately after admission, the patients (n=110) received landiolol, and its dose was increased to the maximum; then, we repeatedly performed echocardiography. Among them, 39 patients were monitored using invasive right heart catheterization (RHC) simultaneously with echocardiography. Measurements and main results There were significant relationships between Doppler and RHC parameters through the landiolol treatment (Figure, baseline–max HR treatment). We observed for the major adverse events (MAE) during initial hospitalization, which included cardiac death, HF prolongation (required intravenous treatment at 30 days), and worsening renal function (WRF). MAE occurred in 44 patients, and logistic regression analyses showed that the mean left atrial pressure (mLAP)-Doppler (odds ratio = 1.132, 95% confidence interval [CI]: 1.05–1.23, p=0.0004) and stroke volume (SV)-Doppler (odds ratio = 0.93, 95% confidence interval [CI]: 0.89–0.97, p=0.001) at 24 hours were the significant predictors for MAE, and multivariate analysis showed that mLAP-Doppler was the strongest predictor (odds ratio = 1.16, 95% CI: 0.107–1.27, p=0.0005) (Table). Conclusions During the control of the rapid AF in HFrEF patients withADHF, echocardiography was useful to assess their hemodynamic condition, even at bedside. Doppler for rapid AF of ADHF Funding Acknowledgement Type of funding source: None

scholarly journals Effect of abnormal right heart structures on the diagnosis of pulmonary hypertension

2018 ◽  
Vol 8 (2) ◽  
pp. 204589401877305 ◽  
Author(s):  
Batool AbuHalimeh ◽  
Milind Y. Desai ◽  
Adriano R. Tonelli
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Right Heart Catheterization ◽  
The Other ◽  
Heart Catheterization ◽  
Right Heart ◽  
Cardiac Lesions ◽  
The Right ◽  
The Impact ◽  
Heart Lesions

The diagnosis of pulmonary hypertension (PH) requires a right heart catheterization (RHC) that reveals a mean pulmonary artery pressure ≥ 25 mmHg. The pulmonary artery catheter traverse the right atrium and ventricle on its way to the pulmonary artery. The presence of abnormal right heart structures, i.e. thrombus, vegetation, benign or malignant cardiac lesions, can lead to complications during this procedure. On the other hand, avoidance of RHC delays the diagnosis and treatment of PH, an approach that might be associated with worse outcomes. This paper discusses the impact of right heart lesions on the diagnosis of PH and suggests an approach on how to manage this association.

Abstract 17141: Pulmonary Artery Pulsatility Index is Associated With Greater Mortality Across a Broad Hospital-Based Cohort

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Emily K Zern ◽  
Paula Rambarat ◽  
Samantha Paniagua ◽  
Elizabeth Liu ◽  
Jenna McNeill ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Pulmonary Artery ◽  
Pulsatility Index ◽  
Right Heart Catheterization ◽  
Left Ventricular ◽  
Right Atrial ◽  
Heart Catheterization ◽  
Right Heart ◽  
Risk Of Death ◽  
Valvular Surgery

Introduction: The pulmonary artery pulsatility index (PAPi), calculated from the ratio of pulmonary artery pulse pressure to right atrial pressure, was initially described as a novel predictor of right ventricular failure after inferior myocardial infarction or left ventricular assist device implantation. Whether PAPi is associated with adverse outcomes in broader samples is unknown. Hypothesis: A lower PAPi is associated with mortality in a broad population referred for right heart catheterization. Methods: We examined consecutive patients undergoing right heart catheterization between 2005-2016 in a hospital-based cohort. The following exclusion criteria were applied: shock or cardiac arrest within 24 hours of catheterization, presence of mechanical circulatory support, prior cardiac transplant, prior valvular surgery, or those with missing key clinical covariates. Multivariable Cox models were utilized to examine the association between PAPi and mortality. Analyses were adjusted for age, sex, BMI, hypertension, diabetes, prior myocardial infarction, and prior heart failure. Results: We studied 8559 patients with mean age 63 years and 40% women. We found that patients in the lowest quartile of PAPi were younger, with greater proportion of men, and higher BMI, yet similar NT-proBNP compared with other quartiles ( Table 1 ). Over 12.5 years of follow-up, there were 2441 death events. Patients in the lowest PAPi quartile had a 31% greater risk of death compared with the highest quartile (multivariable adjusted HR 1.31, 95% CI 1.15-1.48, p<0.001), whereas no differences in survival were seen among individuals in quartile 2 or 3 (p>0.05 vs quartile 4 for both). Conclusions: Patients in the lowest PAPi quartile had a 31% increased risk of all-cause mortality in a broad population referred for right heart catheterization. These findings highlight a potential role for PAPi in identifying high-risk individuals across a spectrum of disease.

Chronic heart failure diagnosis: HFpEF

ESC CardioMed ◽  
2018 ◽  
pp. 1762-1768
Author(s):  
Daniel N. Silverman ◽  
Sanjiv J. Shah
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiopulmonary Exercise Testing ◽  
Clinical History ◽  
Right Heart Catheterization ◽  
Clinical Syndrome ◽  
Exercise Intolerance ◽  
Heart Catheterization ◽  
Reduced Ejection Fraction ◽  
Treatment Measures

Heart failure (HF) with preserved ejection fraction (HFpEF) is a very common clinical syndrome that is often misdiagnosed or overlooked due to diagnostic challenges with the lack of a specific imaging test or biomarker to make a conclusive diagnosis. Unlike HF with reduced ejection fraction, neither a reduced ejection fraction nor a dilated left ventricle is available to easily make the diagnosis of HFpEF. Furthermore, while echocardiographic evidence of diastolic dysfunction is common in patients with HFpEF, it is not a universal phenomenon. Even natriuretic peptides, which are generally thought to have good negative predictive value for the diagnosis of HF, are frequently not elevated in HFpEF patients. Finally, the cardinal symptoms of HFpEF such as dyspnoea and exercise intolerance are non-specific and may be due to many of the co-morbidities present in patients in whom the HFpEF diagnosis is entertained. This chapter presents a step-wise approach utilizing a careful clinical history, physical examination, natriuretic peptide testing, and echocardiography, which can reliably provide appropriate information to rule in or rule out the HFpEF diagnosis in the majority of patients. If there is still a question about the diagnosis, or if initial general treatment measures for the HF syndrome do not result in clinical improvement, additional testing such as right heart catheterization or cardiopulmonary exercise testing can be performed to further confirm the diagnosis. With a systematic approach to the patient with dyspnoea, the accurate diagnosis of HFpEF can be made reliably so that these high-risk patients can be appropriately treated.

Sign in / Sign up

Export Citation Format

Share Document