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 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 (&lt;3 WU, n= 20) or abnormal (&gt;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.

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 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.

scholarly journals P1529 Impact of the new PH guidelines on echocardiographic definition leading to double demand of right heart catheterization

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
C Fauvel ◽  
O Raitiere ◽  
J Burdeau ◽  
N Si Belkacem ◽  
F Bauer
Keyword(s):  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Tricuspid Regurgitation ◽  
Peak Velocity ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Right Heart ◽  
Artery Pressure ◽  
Mean Pulmonary Artery Pressure ◽  
Definition Of

Abstract Background Doppler echocardiography is the most widespread and well-recognized technique for the screening of patients with pulmonary hypertension (PH). When tricuspid regurgitation peak velocity (TRPV) ≥3.4 m/s, right heart catheterization is requested to confirm mean pulmonary artery pressure &gt;25 mm Hg. In the proceedings from the 6th world symposium on pulmonary arterial hypertension recently released, the new definition of PH has been lowered to mean pulmonary artery pressure &gt; 20 mm Hg. Purpose The purpose of our work was twofold : i) to determine a new cut-off value for TRPV to accommodate the new hemodynamic definition of PH, ii) to investigate the impact on the demand of right heart catheterization (RHC) from our echo CORE lab. Methods We extracted and analyzed both the haemodynamic and echocardiographic records of 130 patients who underwent investigations the same day. Tricuspid regurgitation peak velocity was measured in apical-4 chamber view using continuous-wave doppler modality and compared to mean pulmonary artery pressure recorded from fluid-filled catheter. Results Tricuspid regurgitation peak velocity has a weak correlation with mean pulmonary pressure (y = 9.2x-2.2, r² = 0.22, p &lt; 0.01). Targeting a mean pulmonary pressure on right heart catheterization of 20 mm Hg for the definition of PH, receiver operating characteristic curve analysis demonstrated a good association between TRPV and PH diagnosis (area under the curve, 0.78 ; p &lt; 0.001). The cut-off value obtained for TRPV was 3.0 m/s (Se = 0.78, Sp = 0.37). From 01/01/18 to 31/12/18, 2539 out of 6215 had TRPV recorded from which 283 had TRPV ≥ 3.0 m/s (24,1%) and 615 had TRPV ≥ 3.4 m/s (11,1%). When applied to a community population the new TRPV cutoff &gt; 3m/s used as surrogate for mean pulmonary artery pressure &gt; 20 mm Hg may produce a 111% increase of right heart catheterization demand. Conclusions The new definition of pulmonary hypertension (invasive mean pulmonary artery pressure &gt; 20mm Hg) necessitates revisiting tricuspid regurgitation peak velocity &gt; 3 m/s as a screening test leading to more than twice RHC demand.

P4685Validation of noninvasive pulmonary artery pressure/flow relationship: echocardiography vs right heart catheterization

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Caravita ◽  
P Yerly ◽  
C Baratto ◽  
C Dewachter ◽  
A Rimouche ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Doppler Echocardiography ◽  
Pulmonary Circulation ◽  
Right Heart Catheterization ◽  
Peak Exercise ◽  
Heart Catheterization ◽  
Right Heart ◽  
Pressure Flow ◽  
Relationship Of

Abstract Background Invasive pressure-flow (P/Q) relationship of the pulmonary circulation can detect the presence of pulmonary hypertension (PH) during exercise and provide information on patients' symptoms and assess disease severity. Doppler-echocardiography was reported to provide accurate but imprecise noninvasive estimates of both resting and exercise pulmonary haemodynamics. However, data on the direct comparison of invasive vs noninvasive approaches to build pressure-flow relationship are scarce. Purpose To compare echocardiographic estimates with invasive measurements of P/Q relationship of the pulmonary circulation during exercise. Methods Patients undergoing a clinically indicated right heart catheterization and echocardiography were studied at rest and during exercise. The ratio between mean pulmonary artery pressure and cardiac output at peak exercise (TPR), as well as P/Q slope throughout exercise were calculated. Both TPR and P/Q slope are abnormal when ≥3 mmHg/L/min. Echocardiographic estimates were compared with invasive measurements. Results Sixty patients were included (mean age 65±14 years, 73% female). PH was present at rest in 38 cases (63%), of precapillary origin in 23 (61%). Heart failure with preserved ejection fraction was diagnosed in 23 patients, of which 17 had no PH at rest. TPR at peak exercise and P/Q slope were abnormal (≥3 mmHg/L/min) in the majority of patients (56 and 45 subjects, respectively). Echocardiographic estimates of P/Q slope and TPR correlated significantly although weakly with invasive measurements (R2=0.38 and 0.56, respectively, p<0.001). Bias of echocardiography for P/Q slope and TPR was 1.1±4.2 and 0.4±2.9 mmHg/L/min, respectively (figure). Sensitivity of echocardiography to detect an abnormal TPR or P/Q slope (i.e. ≥3 mmHg/L/min) was 100 and 98%, respectively, faced by low specificity (0 and 33%, respectively). Figure 1 Conclusions Doppler-echocardiography can provide rather accurate and sensitive but imprecise estimates of pressure-flow relationships of the pulmonary circulation during exercise. This intrinsic imprecision may limit its use in clinical practice.

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