MO746CARDIAC REMODELING AND PULMONARY HYPERTENSION IN HEMODIALYSIS PATIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Ekaterina Borodulina ◽  
Alexander M Shutov
Keyword(s):  
Pulmonary Hypertension ◽  
Left Ventricular Hypertrophy ◽  
Arterial Pressure ◽  
Ventricular Hypertrophy ◽  
Pulmonary Arterial Pressure ◽  
Hemodialysis Patients ◽  
Left Ventricular ◽  
Hemodialysis Treatment ◽  
Systolic Pulmonary Arterial Pressure ◽  
Pulmonary Arterial

Abstract Background and Aims An important predictor of cardiovascular mortality and morbidity in hemodialysis patients is left ventricular hypertrophy. Also, pulmonary hypertension is a risk factor for mortality and cardiovascular events in hemodialysis patients. The aim of this study was to investigate cardiac remodeling and the dynamics of pulmonary arterial pressure during a year-long hemodialysis treatment and to evaluate relationship between pulmonary arterial pressure and blood flow in arteriovenous fistula. Method Hemodialysis patients (n=88; 42 males, 46 females, mean age was 51.7±13.0 years) were studied. Echocardiography and Doppler echocardiography were performed in the beginning of hemodialysis treatment and after a year. Echocardiographic evaluation was carried out on the day after dialysis. Left ventricular mass index (LVMI) was calculated. Left ventricular ejection fraction (LVEF) was measured by the echocardiographic Simpson method. Arteriovenous fistula flow was determined by Doppler echocardiography. Pulmonary hypertension was diagnosed according to criteria of Guidelines for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology. Results Pulmonary hypertension was diagnosed in 47 (53.4%) patients. Left ventricular hypertrophy was revealed in 71 (80.7%) patients. Only 2 (2.3%) patients had LVEF<50%. At the beginning of hemodialysis correlation was detected between systolic pulmonary arterial pressure and LVMI (r=0.52; P<0.001). Systolic pulmonary arterial pressure negatively correlated with left ventricular ejection fraction (r=-0.20; P=0.04). After a year of hemodialysis treatment LVMI decreased from 140.49±42.95 to 123.25±39.27 g/m2 (р=0.006) mainly due to a decrease in left ventricular end-diastolic dimension (from 50.23±6.48 to 45.13±5.24 mm, p=0.04) and systolic pulmonary arterial pressure decreased from 44.83±14.53 to 39.14±10.29 mmHg (р=0.002). Correlation wasn’t found between systolic pulmonary arterial pressure and arteriovenous fistula flow (r=0.17; p=0.4). Conclusion Pulmonary hypertension was diagnosed in half of patients at the beginning of hemodialysis treatment. Pulmonary hypertension in hemodialysis patients was associated with left ventricular hypertrophy, systolic left ventricular dysfunction. After a year-long hemodialysis treatment, a regress in left ventricular hypertrophy and a partial decrease in pulmonary arterial pressure were observed. There wasn’t correlation between arteriovenous fistula flow and systolic pulmonary arterial pressure.

scholarly journals P1300CARDIOVASCULAR COMPLICATIONS IN HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Helaoui Fadwa
Keyword(s):  
Pulmonary Hypertension ◽  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Clinical Status ◽  
Vena Cava ◽  
Cardiovascular Complications ◽  
Hemodialysis Patients ◽  
Left Ventricular ◽  
Chronic Hemodialysis ◽  
Cardiac Ultrasound

Abstract Background and Aims Cardiovascular complications are the leading cause of morbidity and mortality among dialysis patients. We aim to determine the cardiac damage showed by trans-thoracic ultrasound and to identify the various factors associated with it. Method Fourty chronic hemodialysis patients have benefited of transthoracic ultrasound during this year (2019). Clinical findings were collected from patients’ medical files. Data collected included demographics, Clinical Status and echocardiographic parameters. All the patients included in this study gave their consent. Data were collected and analysed using SPSS software. Chi-squared test with a level of significance of 0.05 was used for the qualitative variables. Results The mean age of our population is 53.1 (range: 26-78) with a sex ratio equal to 0.9. 72.5% of patients are hypertensive; 27.5% of patients are diabetic. Only 2 patients to be coronary. In this study, 11 patients remained asymptomatic while 29 patients (75.5%) presented with cardiac symptomatology: 39.7% complained of chest pain, 27.5% presented with acute dyspnea and 24,1% a pericardial rub. Rhythm disorders were objectified in electrocardiography in 3 patients (1 ventricular extrasystole and 2 cardiac arrhythmia by atrial fibrillation). Twenty percent of the cardiac ultrasounds performed are without abnormalities. Cardiac ultrasound revealed the presence of valvulopathies in 40% with 20% valve calcifications. Left ventricular hypertrophy is evident in 55% of patients, 45% of whom are hypertensive. Segmental hypokinesia was observed in 27.5% and pulmonary hypertension was observed in 37.5%. Cardiac ultrasound also showed dilated right cavities in 22.5% of cases and dilated left cavities in 32.5%. Dilatation of the inferior vena cava is observed only in 3 patients. Pericarditis is highlighted in 37.5% of which 36.3% are of medium abundance and 18.1% are of great abundance without signs of compression. Clinical data were correlated with echocardiographic findings. A correlation was found between left venticular hypertrophy and hypervolemia (p=0.001) and between perdialytic hemodynamic instability and ischemic cardiopathy (p=0.04) as well as pulmonary hypertension and vascular access dysfunction (p=0.02). Conclusion Cardiovascular complications are very common in chronic hemodialysis population. The left ventricular hypertrophy is the main cause of heart disease with predominance of high blood pressure as an associated comorbidity.

Pulmonary Hypertension May Be a Relevant Comorbidity in Patients with Myelodysplastic Syndromes

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 5039-5039 ◽  
Author(s):  
Xhylsime Kqiku ◽  
Gabor Kovacs ◽  
Sonja Reitter ◽  
Heinz Sill ◽  
Horst Olschewski
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Arterial Pressure ◽  
Myelodysplastic Syndromes ◽  
Doppler Echocardiography ◽  
Pulmonary Arterial Pressure ◽  
Left Ventricular ◽  
Functional Class ◽  
Increased Risk ◽  
Pulmonary Arterial

Abstract Abstract 5039 Background: Pulmonary hypertension (PH) is characterized by elevated pulmonary arterial pressure and increased pulmonary vascular resistance, leading to right-sided heart failure and death. PH is defined as an increase in mean pulmonary arterial pressure (mPAP) ≥25 mmHg at rest. PAP values can be non-invasively estimated by Doppler echocardiography while right heart catheterization is needed for definite diagnosis. Hematologic disorders are associated with PH but it is unknown if myelodysplastic syndromes (MDS) bear an increased risk for PH. The objective of this study was to investigate the prevalence of PH in patients with MDS. Patients and Methods: From March 2009 to July 2011 consecutive MDS patients were recruited from the Hematology Division of the Medical University of Graz and enrolled in this PH screening program. All patients underwent Doppler echocardiography. PH was suspected if resting systolic pulmonary arterial pressure (SPAP) exceeded 40 mmHg. Additionally six minute walk distance (6MWD), pulmonary function test (PFT), laboratory tests including N-terminal pro brain natriuretic peptide (NT-proBNP), IPSS Score and WHO functional class were determined. Results: Fourty four MDS patients (female:male=18:26, age 70±12 years, disease onset 5±8 years, NYHA functional class I:II:III:IV=21:16:7:0, IPSS low/intermediate-I/intermediate- II/high/unknown=16:14:8:3:3; hemoglobin: 11±2 g/dl, white blood cell count 4±3 g/l; platelet count 159±125 g/l; regular transfusions n=19; WHO Classification: RCUD/RARS/RCMD/MDS del(5q)/RAEBI/RAEB II/MDSU=2:3:21:2:6:6:4 ) were included. Six patients had elevated SPAP (PH group, SPAP: 56±9mmHg) vs. 38 patients with normal values (SPAP 29±5mmHg). PH group were slightly older (79±9 vs. 69±11 years, p=0.53), had a decreased right ventricular function (TAPSE: 18±5mm vs. 22±4mm, p=0.05), a larger left atrium (46±5mm vs. 36±9mm measured in the parasternal long axis, p=0.005), a slightly decreased left ventricular systolic function (fractional shortening: 30±11% vs. 38±9 %, p=0.1) a significantly lower 6MWD (275±117m vs. 438±105m, p=0.01) and higher NT proBNP (4515±4732 pg/ml vs. 313±252 pg/ml, p=0.001) than patients with normal SPAP. In 4/6 PH group patients a relevant diastolic dysfunction of the left ventricle was suggested by echocardiography. Conclusion: According to our data, PH is present in about 15% of MDS patients and is associated with decreased physical capacity and heart failure. This suggests that PH may be considered as a relevant comorbidity in this cohort of patients. The reason of PAP increase may be multifactorial, postcapillary factors probably playing a relevant role. Disclosures: No relevant conflicts of interest to declare.

Three-week neonatal hypoxia reduces blood CGRP and causes persistent pulmonary hypertension in rats

2000 ◽  
Vol 279 (4) ◽  
pp. H1571-H1578 ◽  
Author(s):  
I. M. Keith ◽  
S. Tjen-A-Looi ◽  
H. Kraiczi ◽  
R. Ekman
Keyword(s):  
Pulmonary Hypertension ◽  
Ventricular Hypertrophy ◽  
Pulmonary Arterial Pressure ◽  
Pulmonary Arteries ◽  
Left Ventricular ◽  
Persistent Pulmonary Hypertension ◽  
Perinatal Exposure ◽  
Calcitonin Gene ◽  
Potent Vasodilator ◽  
Pulmonary Arterial

To increase understanding of persistent pulmonary hypertension, we examined chronic pulmonary effects of hypoxia at birth and their relationships with immunoreactive levels of the potent vasodilator, calcitonin gene-related peptide (CGRP). Rats were born in 10% hypobaric hypoxia, where they remained for 1–2 days, or in 15% hypoxia, where they remained for 21 days. All were then reared in normoxia for 3 mo followed by reexposure to 10% hypoxia for 7 days (H→H) or continued normoxia (H→N); age-matched normoxic rats were hypoxic for the last 7 days (N→H) or normoxic throughout (N→N). Results are as follows. Pulmonary arterial pressure (PPA) in 10% H→N rats was normal at the end of the experiment (13 wk), but in rats reexposed to hypoxia (H→H), pressure rose to 19% above N→H controls. In 15% H→N rats, PPA remained high, similar to that of N→H rats, and increased further by 40% on reexposure (H→H). Medial thickness of small pulmonary arteries in 10% H→H rats also increased by 40% over N→H controls and was equally high in 15% H→N and H→H rats. In N→H rats from both experiments, right ventricular hypertrophy index (RVH) was increased after hypoxia at 15–16 wk. Also, in the 15% study, RVH remained elevated in H→N rats and increased in H→H rats by 19% above N→H controls. Blood CGRP was reduced by neonate and adult hypoxia, and hypoxic reexposure (H→H) further lowered blood CGRP in the 15% but not 10% study. Declining left ventricular blood CGRP correlated highly with logarithmically increasing PPA in the 15% study ( r = −0.81, P = 0.000). In conclusion, 1) short perinatal exposure to 10% O2 exacerbated pulmonary hypertension with hypoxia later in life, 2) 15% O2 at birth and for 21 days caused persistent pulmonary hypertension and exacerbation with reexposure, and 3) PPA correlated highly with declining blood CGRP levels in the 15% study.

scholarly journals Prevalence and factors associated with Pulmonary Arterial Hypertension on maintenance Hemodialysis Patients in Kinshasa, the Democratic Republic of the Congo

2020 ◽  
Author(s):  
Yannick Mompango Engole ◽  
François Bompeka Lepira ◽  
Yannick Mayamba Nlandu ◽  
Yves Simbi Lubenga ◽  
Augustin Luzayadio Longo ◽  
...  
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Arterial Pressure ◽  
Associated Factors ◽  
Pulmonary Arterial Pressure ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Maintenance Hemodialysis ◽  
Systolic Pulmonary Arterial Pressure ◽  
Pulmonary Arterial ◽  
Maintenance Hemodialysis Patients

Abstract Background: Cardiovascular diseases in particular Pulmonary arterial hypertension (PAH) is associed a high morbi-mortality in chronic hemodialysis, but it’s magnitude remains paradoxically unknown in sub-Saharan Africa. The aim of this study was to evaluate the prevalence of PAH and associated factors in chronic hemodialysis patients. Patients and method: In a cross-sectional study, patients treated with HD for at least 6 months in 4 hemodialysis centers were examined. PAH was defined as estimated systolic pulmonary arterial pressure (sPAP) ≥ 35 mmHg using transthoracic Doppler echocardiography performed 24 hours after the session. Results: A total of 85 HD patients were included. Their average age was 54.6 ± 14.3 years. 57 patients (67.1%) were male. Mean duration of HD was 13.3 ± 11 months. With reference to vascular access, 12 (14.1%), 29 (34.1%) and 44 (51.8%) patients had AVF, tunneled cuff and temporary catheter, respectively. The underlying cause of ESRD was diabetes in 30 patients (35.3%). The prevalence of PAH was 29.4%. In multivariate analysis, no secure healthcare funding (adjusted OR 5, 95% CI [1.24-8.27]), hyponatremia (adjusted OR 2, 95% CI [1.61-10.01]), arrhythmia (aOR 3, 95% CI [1.06 -5.85]), vascular access change (aOR 4, 95% CI [1.12-6.23]) and diastolic dysfunction (aOR 5, 95% CI [1.35-9.57] were independently associated with PAH. Conclusion: One third of hemodialysis patients exhibit PAH, which is associated with diastolic dysfunction and arrhythmia. Therefore, early detection and control of PAH and associated factors may help to tackle PAH associated morbidity and mortality in maintenance hemodialysis patients. Keywords: Pulmonary hypertension, Hemodialysis, Systolic pulmonary arterial pressure, Cardiovascular disease.

Abstract 14102: Prognostic Impact of Peak Systolic Pulmonary Arterial Pressure in Nonagenarians: An Echocardiographic Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Shunsuke Shimada ◽  
Taku Omori ◽  
Goki Uno ◽  
Florian Rader ◽  
Robert J Siegel ◽  
...  
Keyword(s):  
Arterial Pressure ◽  
Pulmonary Arterial Pressure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Prognostic Impact ◽  
Old Patients ◽  
Ventricular Ejection Fraction ◽  
Coronary Arterial Disease ◽  
Systolic Pulmonary Arterial Pressure ◽  
Pulmonary Arterial

Introduction: Recently, a low threshold of estimated peak systolic pulmonary arterial pressure (eSPAP) of 30 mm Hg was reported to be associated with mortality in the general population. However, less is known about the prognostic impact of eSPAP in nonagenarians. Methods: We retrospectively reviewed 596 patients ≥90 years of age referred for echocardiography with a recorded eSPAP and left ventricular ejection fraction ≥50%. eSPAPs were characterized according to their quartile distribution: first quartile (reference group) (<30 mm Hg), second quartile (30-38 mm Hg), third quartile (39-48 mm Hg), fourth quartile (>49 mm Hg). The associations between quartiles of eSPAP and all-cause mortality were tested in Cox models (adjusting for age, sex, body mass index, hypertension, coronary arterial disease, atrial fibrillation, diabetes mellitus, chronic kidney disease, chronic obstructive pulmonary disease, left-sided valve disease, left atrial area, NYHA class ≥II, left ventricular mass and right ventricular fractional area change). Results: Of the 596 patients, 61% were female, and the median age was 92 years (IQR 91-95). The median eSPAP was 39.0 mm Hg (IQR 30.3-49.0) (Figure). During the median follow-up of 522 days (IQR 59-1337), a total of 268 deaths (45%) occurred. The adjusted risk of mortality in eSPAP 39-48 mm Hg and eSPAP >49 mm Hg were 1.6 and 1.7 times higher than in eSPAP <30 mm Hg, respectively (Table). Conclusions: In conclusion, eSPAP ≥39 mm Hg was independently associated with mortality in nonagenarians. Estimated peak systolic pulmonary arterial pressure could help in prognostic stratification even in oldest-old patients.

Neonatal pulmonary hypertension during extracorporeal membrane oxygenation

2000 ◽  
Vol 10 (2) ◽  
pp. 130-139 ◽  
Author(s):  
Ronald B. Tanke ◽  
Otto Daniëls ◽  
Henk J. van Lier ◽  
Arno F. van Heyst ◽  
Cees Festen
Keyword(s):  
Pulmonary Hypertension ◽  
Arterial Pressure ◽  
Extracorporeal Membrane Oxygenation ◽  
Pulmonary Arterial Pressure ◽  
Ultra Sound ◽  
Severe Pulmonary Hypertension ◽  
Extra Corporeal Membrane Oxygenation ◽  
Membrane Oxygenation ◽  
Systolic Pulmonary Arterial Pressure ◽  
Pulmonary Arterial

AbstractObjectivesThis prospective study was designed to monitor severe pulmonary hypertension during extra corporeal membrane oxygenation using echo Doppler variables.BackgroundAll neonates treated with extracorporeal membrane oxygenation also have severe pulmonary hypertension. A study which monitors the reaction of the pre-existing pulmonary hypertension during extracorporeal oxygenation by frequent sampling of those variables related to pulmonary pressure is still lacking. Such a study is necessary to analyze the complex haemodynamic changes in patients undergoing extracorporeal membrane oxygenation.MethodIn 29 neonates, we estimated pulmonary arterial pressure using peakflow velocity of regurgitation across the tricuspid- and pulmonary valve, peakflow velocity of shunting across persistent arterial ductus, and systolic time intervals of the right ventricle. Correlation between the several estimations of pulmonary arterial pressure were analysed with the Spearman correlation coefficient.ResultsSystolic pulmonary arterial pressure measured by the velocity of tricuspid regurgitation illustrated severe pulmonary hypertension prior to extra corporeal membrane oxygenation (mean 63 mmHg, sd 20). Similar levels for the systolic pulmonary arterial pressure could be derived (mean 73 mmHg, sd 17) from ductal shunting. A fair correlation of 0.76 (p< 0.002) could be demonstrated. Pulmonary hypertension responded well and quickly to treatment by extra corporeal membrane oxygenation, with reductions within 24 hours to mean systolic levels of 35 mmHg, sd 23. This very early reaction has not previously been demonstrated and could be of importance in defining parameters for weaning from cardiopulmonary bypass. Diastolic pulmonary arterial pressure was investigated because of its relation to vascular resistance. It proved more difficult to measure because of the low incidence of pulmonary regurgitation. Derived diastolic pressures did not show any good correlations.ConclusionPulmonary hypertension is well documentated prior to extra corporeal membrane oxygenation and respons very quickly to the institution of treatment. Ultra sound techniques are indicated at the bedsite, and prove useful in monitoring pulmonary blood pressure during the procedure.

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