Right Atrial Pacing to Improve Acute Hemodynamics in Pulmonary Arterial Hypertension

Optimal sized balloon atrial septostomy improves hemodynamics in advanced pulmonary arterial hypertension. Occlutech Atrial Flow Regulator is designed to provide an atrial septal fenestration diameter titrated according to the age and right atrial pressures. This observational study analyzed symptoms, exercise distance, oxygen saturations, hemodynamics and echocardiographic parameters after Atrial Flow Regulator implantation in patients with syncope or right-heart failure. Patients with high-risk predictors of mortality during septostomy were scrutinized. Thirty-nine patients (9 children) with syncope (34/39) or right-heart failure (27/39) underwent Atrial Flow Regulator implantation without procedural complications. Six-minute walk distance increased from 310 ± 158.2 to 376.4 ± 182.6 m, none developed syncope. Oxygen saturations reduced from 96.4 ± 6.4% to 92 ± 4.9% at rest and further to 80.3 ± 5.9% on exercise. Right atrial pressures reduced from 9.4 ± 5 (2–27) mmHg to 6.9 ± 2.6 (1–12) mmHg, while cardiac index increased from 2.4 ± 0.8 (0.98–4.3) to 3 ± 1 (1.1–5.3) L/min/m2 and systemic oxygen transport increased from 546.1 ± 157.9 (256.2–910.5) to 637.2 ± 191.1 (301.3–1020.2) ml/min. Echocardiographic improvement included significant reduction of pericardial effusion and inferior caval congestion at a median follow-up of 37 months. Overall survival improved except two early and one late deaths in high-risk patients. Five of seven patients with advanced disease and key hemodynamic predictors of mortality survived. Acute hemodynamic benefits in pulmonary arterial hypertension after Atrial Flow Regulator were improved cardiac output, systemic oxygen transport, and reduced right atrial pressures. Improvement of symptoms especially syncope, exercise duration, and right ventricular systolic function as well as device patency were sustained on mid-term follow-up. Implantation was safe in all including young children without procedural complications. Mortality was noted only in patients who had high-risk predictors and patients at advanced stage of the disease.

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A programmable pulse generator for atrial pacing in rats for studies on Pulmonary Arterial Hypertension

10.1109/icecs53924.2021.9665487 ◽

2021 ◽

Author(s):

Fanny Pan ◽

Emilie Avignon-Meseldzija ◽

Frederic Perros ◽

Delphine Mika ◽

David Boulate ◽

...

Keyword(s):

Pulmonary Arterial Hypertension ◽

Arterial Hypertension ◽

Pulse Generator ◽

Atrial Pacing ◽

Pulmonary Arterial

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Single-center prognostic validation of the risk assessment of the 2015 ESC/ERS guidelines in patients with pulmonary arterial hypertension in Japan

Canadian Journal of Physiology and Pharmacology ◽

10.1139/cjpp-2019-0640 ◽

2020 ◽

Vol 98 (9) ◽

pp. 653-658 ◽

Cited By ~ 1

Author(s):

Ryo Imai ◽

Shiro Adachi ◽

Masahiro Yoshida ◽

Shigetake Shimokata ◽

Yoshihisa Nakano ◽

...

Keyword(s):

Risk Assessment ◽

Pulmonary Arterial Hypertension ◽

High Risk ◽

Arterial Hypertension ◽

Risk Group ◽

Low Risk ◽

World Health ◽

Right Atrial ◽

Walking Distance ◽

Pulmonary Arterial

The 2015 European Society of Cardiology/European Respiratory Society guidelines for the diagnosis and treatment of pulmonary hypertension include a multidimensional risk assessment for patients with pulmonary arterial hypertension (PAH). However, prognostic validations of this risk assessment are limited, especially outside Europe. Here, we validated the risk assessment strategy in PAH patients in our institution in Japan. Eighty consecutive PAH patients who underwent right heart catheterization between November 2006 and December 2018 were analyzed. Patients were classified as low, intermediate, or high risk by using a simplified version of the risk assessment that included seven variables: World Health Organization functional class, 6-min walking distance, peak oxygen consumption, brain natriuretic peptide, right atrial pressure, mixed venous oxygen saturation, and cardiac index. The high-risk group showed significantly higher mortality than the low- or intermediate-risk group at baseline (P < 0.001 for both comparisons), and the mortalities in the intermediate- and low-risk groups were both low (P = 0.989). At follow-up, patients who improved to or maintained a low-risk status showed better survival than those who did not (P = 0.041). Our data suggest that this risk assessment can predict higher mortality risk and long-term survival in PAH patients in Japan.

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Is hyponatremia associated with mortality in pulmonary arterial hypertension?

Pulmonary Circulation ◽

10.1177/2045894018776888 ◽

2018 ◽

Vol 8 (2) ◽

pp. 204589401877688 ◽

Cited By ~ 1

Author(s):

Anastasiia A. Rudkovskaia ◽

Adriano R. Tonelli ◽

Youlan Rao ◽

Jeffrey P. Hammel ◽

Gregory K. Buller ◽

...

Keyword(s):

Pulmonary Arterial Hypertension ◽

Arterial Hypertension ◽

Sodium Level ◽

Continuous Variable ◽

Functional Class ◽

Right Atrial ◽

Left Heart Failure ◽

Tertiary Referral Center ◽

Pulmonary Arterial ◽

One Year

Hyponatremia is associated with poor prognosis in left heart failure and liver disease. Its prognostic role in pulmonary arterial hypertension (PAH) is not well defined. We investigated the association between hyponatremia and one-year mortality in two large cohorts of PAH. This study is a secondary analysis evaluating the association between hyponatremia and one-year mortality in patients treated with subcutaneous treprostinil (cohort 1). The results are validated using a PAH registry at a tertiary referral center (cohort 2). Eight-hundred and twenty patients were enrolled in cohort 1 (mean age = 47 ± 14 years) and 791 in cohort 2 (mean age = 55 ± 15 years). Sodium level is negatively correlated with mean right atrial pressure (r = −0.09, P = 0.018; r = −0.089, P = 0.015 in cohorts 1 and 2, respectively). In unadjusted analyses of cohort 1, the sodium level (as a continuous variable) is associated with one-year mortality (hazard ratio = 0.94; P = 0.035). Hyponatremia loses its significance (as a continuous variable and when dichotomized at ≤ 137 mmol/L; P = 0.12) when adjusted for functional class (FC), which is identified as the variable whose presence turns the effect of sodium level into non-significant. Secondary analyses using a cut-off value of < 135 mmol/L showed similar results. These results are validated in cohort 2. Although the sample size for patients with sodium < 130 mmol/L is small (n = 31), severe hyponatremia is associated with higher overall mortality (47% versus 23%; P = 0.01), even when adjusting for age, FC, and baseline 6-min walk distance ( P < 0.001). Although baseline hyponatremia is associated with one-year mortality, it loses its significance when adjusted for FC.

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Higher plasma fibroblast growth factor 23 levels are associated with a higher risk profile in pulmonary arterial hypertension

Pulmonary Circulation ◽

10.1177/2045894019895446 ◽

2019 ◽

Vol 9 (4) ◽

pp. 204589401989544 ◽

Cited By ~ 2

Author(s):

Habib Bouzina ◽

Roger Hesselstrand ◽

Göran Rådegran

Keyword(s):

Growth Factor ◽

Pulmonary Arterial Hypertension ◽

Arterial Hypertension ◽

Fibroblast Growth Factor ◽

Fibroblast Growth Factor 23 ◽

Right Atrial ◽

Walking Distance ◽

Fibroblast Growth ◽

Pulmonary Arterial ◽

Metabolic Biomarkers

Metabolic abnormalities are proposed to contribute to pulmonary arterial as well as right ventricular remodelling in pulmonary arterial hypertension. Among the proposed abnormalities are altered glucose and lipid processing, mitochondrial malfunction, oxidative stress as well as vitamin D and iron abnormalities. In the present study, we investigated 11 metabolic plasma biomarkers, with the hypothesis that metabolic proteins may mirror disease severity in pulmonary arterial hypertension. Using proximity extension assays, plasma metabolic biomarkers were measured in 48 pulmonary arterial hypertension patients at diagnosis and, in 33 of them, at an early treatment follow-up, as well as in 16 healthy controls. Among the studied metabolic biomarkers, plasma fibroblast growth factor-23 ( p < 0.001), fibroblast growth factor-21 ( p < 0.001), fatty acid binding protein 4 ( p < 0.001) and lectin-like oxidised low-density lipoprotein receptor 1 ( p < 0.001) were increased and paraoxonase-3 was decreased ( p < 0.001) in pulmonary arterial hypertension at diagnosis versus controls. Fibroblast growth factor-23 showed the strongest correlations to studied clinical parameters and was therefore selected for further analyses. Fibroblast growth factor-23 correlated specifically to mean right atrial pressure ( r = 0.67, p < 0.001), six-min walking distance ( r = −0.66, p < 0.001), NT-proBNP ( r = 0.64, p < 0.001), venous oxygen saturation ( r = −0.61, p < 0.001), cardiac index ( r = −0.39, p < 0.007) and pulmonary vascular resistance ( r = 0.37, p < 0.01). Fibroblast growth factor-23 correlated moreover to ESC/ERS ( r = 0.72, p < 0.001) and the REVEAL risk score ( r = 0.61, p < 0.001). Comparing early treatment follow-up with baseline, fibroblast growth factor-23 decreased ( p < 0.02), with changes in fibroblast growth factor-23 correlating to changes in six-min walking distance ( r = −0.56, p < 0.003), venous oxygen saturation ( r = −0.46, p < 0.01), pulmonary vascular resistance ( r = 0.43, p < 0.02), mean right atrial pressure ( r = 0.38, p < 0.04) and cardiac index ( r = −0.39, p < 0.04). Elevated plasma fibroblast growth factor-23 levels at pulmonary arterial hypertension diagnosis were associated with worse haemodynamics and a higher risk profile, and were decreased after the administration of pulmonary arterial hypertension-specific treatment.

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RIGHT ATRIAL STRAIN IS PREDICTIVE OF CLINICAL OUTCOMES AND INVASIVE HEMODYNAMIC DATA IN GROUP 1 PULMONARY ARTERIAL HYPERTENSION

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(16)32070-8 ◽

2016 ◽

Vol 67 (13) ◽

pp. 2069

Author(s):

Nicole Martin Bhave ◽

Scott Visovatti ◽

Brian Kulick ◽

Theodore Kolias ◽

Vallerie McLaughlin

Keyword(s):

Pulmonary Arterial Hypertension ◽

Arterial Hypertension ◽

Clinical Outcomes ◽

Right Atrial ◽

Pulmonary Arterial ◽

Right Atrial Strain ◽

Atrial Strain ◽

Group 1

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Growth differentiation factor-15 levels in the blood around the pulmonary artery is associated with hospitalization for heart failure in patients with pulmonary arterial hypertension

Pulmonary Circulation ◽

10.1177/2045894020962948 ◽

2020 ◽

Vol 10 (4) ◽

pp. 204589402096294

Author(s):

Wei-Ting Chang ◽

Jhih-Yuan Shih ◽

Yu-Wen Lin ◽

Zhih-Cherng Chen ◽

Jun-Neng Roan ◽

...

Keyword(s):

Heart Failure ◽

Pulmonary Arterial Hypertension ◽

Arterial Hypertension ◽

Right Atrial ◽

Heart Catheterization ◽

Growth Differentiation Factor 15 ◽

Arterial Blood ◽

Differentiation Factor ◽

Group I ◽

Pulmonary Arterial

Despite no significant differences of growth differentiation factor-15 expressions in peripheral, right atrial, and right ventricular blood, in the pulmonary arterial blood, there was a significantly high level of growth differentiation factor-15 in Group I pulmonary arterial hypertension patients subsequently developing heart failure. During right heart catheterization, collecting pulmonary blood samples is suggested to measure growth differentiation factor-15.

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