scholarly journals The prognostic value of DLCO and pulmonary blood flow in patients with pulmonary hypertension

2019 ◽  
Vol 9 (4) ◽  
pp. 204589401989453 ◽  
Author(s):  
Stefan Stadler ◽  
Nicoletta Mergenthaler ◽  
Tobias J. Lange
Keyword(s):  
Blood Flow ◽  
Pulmonary Hypertension ◽  
Cardiac Output ◽  
Pulmonary Blood Flow ◽  
Cox Regression ◽  
Functional Class ◽  
Inert Gas ◽  
Heart Catheterization ◽  
Cox Regression Analysis ◽  
Inert Gas Rebreathing

Background Cardiac output is a prognostic marker in patients with pulmonary hypertension. Pulmonary blood flow as a surrogate for cardiac output can be measured non-invasively by inert gas rebreathing. We hypothesized that pulmonary blood flow can predict outcome in patients with pulmonary hypertension. Methods From January 2009 to January 2012, we measured pulmonary blood flow by inert gas rebreathing in outpatients with pulmonary hypertension. Patients with pulmonary hypertension confirmed by right heart catheterization and a valid inert gas rebreathing maneuver were followed until January 2016. The investigated outcome was all-cause mortality. Results We included 259 patients (mean age 65 ± 13 years, 53% female) with pulmonary hypertension and classified into groups 1 (n = 103), 2 (n = 26), 3 (n = 80), and 4 (n = 50) according to the current pulmonary hypertension classification system. The median time between pulmonary hypertension diagnosis and inert gas rebreathing was 9 (IQR 0; 36) months. During a median follow-up time of 51 (IQR 20; 68) months, 109 patients (42%) died. Parameters significantly associated with survival (in order of decreasing statistical strength) were diffusion capacity of the lung for carbon monoxide (DLCO), 6-minute walk distance (6-MWD), age, NTpro-BNP, WHO functional class, group 3 pulmonary hypertension, and tricuspid annular plane systolic excursion (TAPSE), while baseline hemodynamics and pulmonary blood flow were not. In multivariable Cox regression analysis, DLCO, age, 6-MWD, and TAPSE remained significant and independent predictors of the outcome. DLCO as the strongest parameter also significantly predicted survival in aetiological subgroups except for group 4. Conclusions DLCO is a strong and independent predictor for survival in patients with pulmonary hypertension of different aetiologies, while pulmonary blood flow measured by inert gas rebreathing is not.

Is cardiac output assessed by inert gas rebreathing technique predictive of mortality in pulmonary hypertension?

2020 ◽  
Author(s):  
Lucy Robertson ◽  
Katherine Bunclark ◽  
Robert Mackenzie ◽  
John Cannon ◽  
Karen Sheares ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Cardiac Output ◽  
Inert Gas ◽  
Inert Gas Rebreathing

Influence of Bag Volume on Reproducibility of Inert Gas Rebreathing Pulmonary Blood Flow Measurements in Patients with Pulmonary Diseases

Lung ◽  
2013 ◽  
Vol 191 (5) ◽  
pp. 467-473 ◽  
Author(s):  
Joachim Saur ◽  
Franziska Kraus ◽  
Joachim Brade ◽  
Dariusch Haghi ◽  
Michael Behnes ◽  
...  
Keyword(s):  
Blood Flow ◽  
Pulmonary Blood Flow ◽  
Inert Gas ◽  
Pulmonary Diseases ◽  
Flow Measurements ◽  
Inert Gas Rebreathing ◽  
Blood Flow Measurements

scholarly journals Non-invasive assessment of pulmonary blood flow using an inert gas rebreathing device in fibrotic lung disease

Thorax ◽  
2010 ◽  
Vol 65 (4) ◽  
pp. 341-345 ◽  
Author(s):  
T. J Corte ◽  
A. U Wells ◽  
M. A Gatzoulis ◽  
D. Cramer ◽  
S. Ward ◽  
...  
Keyword(s):  
Blood Flow ◽  
Lung Disease ◽  
Pulmonary Blood Flow ◽  
Inert Gas ◽  
Non Invasive ◽  
Inert Gas Rebreathing ◽  
Fibrotic Lung Disease

Thermodilution versus inert gas rebreathing for estimation of effective pulmonary blood flow

2000 ◽  
Vol 28 (1) ◽  
pp. 51-56 ◽  
Author(s):  
Poul Christensen ◽  
Peter Clemensen ◽  
Poul Klint Andersen ◽  
Steen W. Henneberg
Keyword(s):  
Blood Flow ◽  
Pulmonary Blood Flow ◽  
Inert Gas ◽  
Inert Gas Rebreathing

Noninvasive Cardiac Output Measurement by Inert Gas Rebreathing in Suspected Pulmonary Hypertension

2014 ◽  
Vol 113 (3) ◽  
pp. 546-551 ◽  
Author(s):  
Stefania Farina ◽  
Giovanni Teruzzi ◽  
Gaia Cattadori ◽  
Cristina Ferrari ◽  
Stefano De Martini ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Cardiac Output ◽  
Cardiac Output Measurement ◽  
Inert Gas ◽  
Output Measurement ◽  
Inert Gas Rebreathing ◽  
Noninvasive Cardiac Output

How does increased cardiac output increase shunt in pulmonary edema?

1982 ◽  
Vol 53 (5) ◽  
pp. 1273-1280 ◽  
Author(s):  
P. H. Breen ◽  
P. T. Schumacker ◽  
G. Hedenstierna ◽  
J. Ali ◽  
P. D. Wagner ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiac Output ◽  
Pulmonary Edema ◽  
Pulmonary Blood Flow ◽  
Inert Gases ◽  
Inert Gas ◽  
Gas Transfer ◽  
Output Increase ◽  
Air Ventilation ◽  
The Relationship

In pulmonary edema, the relationship between cardiac output (QT) and shunt (QS/QT) may be due to a diffusion barrier for O2 transfer (incomplete alveolar-capillary equilibration) or to redistribution of increased pulmonary blood flow toward edematous units. We compared transfer of O2 and multiple inert gases in the left (LLL) and right (RLL) lower lobes and in the whole lungs of eight dogs having oleic acid edema in LLL. When mean QT was increased from 3.0 to 5.5 l X min-1 during O2 ventilation, relative perfusion of LLL did not increase but QS/QT increased because LLL shunt increased from 56 to 78%. We conclude that increased pulmonary blood flow is not redistributed toward edematous regions, but we cannot exclude such redistribution within LLL and other slightly edematous lobes. In LLL, inert gas shunt and O2 shunt were not systematically different during O2 ventilation, and lobar venous PO2 measured during air ventilation was not different from that predicted by inert gas transfer. We conclude that diffusion limitation for O2 does not contribute to QS/QT or to the increase in QS/QT when QT increases. Conceivably, increased QT increased QS/QT by increasing edema or hematocrit in edematous regions.

Noninvasive Investigation of Pulmonary Blood Flow in Children with Pulmonary Hypertension Using the TRV/RVOT VTI Ratio

2017 ◽  
Vol 65 (S 02) ◽  
pp. S111-S142
Author(s):  
M. Koestenberger ◽  
D. Baumgartner ◽  
G. Hansmann ◽  
S. Schweintzger ◽  
G. Grangl ◽  
...  
Keyword(s):  
Blood Flow ◽  
Pulmonary Hypertension ◽  
Pulmonary Blood Flow

Long-Term Clinical Outcome in Elderly Patients Undergoing Mitral Valve Repair

2020 ◽  
Author(s):  
Julia Götte ◽  
Armin Zittermann ◽  
Kavous Hakim-Meibodi ◽  
Masatoshi Hata ◽  
Rene Schramm ◽  
...  
Keyword(s):  
Mitral Valve ◽  
General Population ◽  
Elderly Patients ◽  
Cox Regression ◽  
Functional Class ◽  
Tricuspid Valve Repair ◽  
Valve Repair ◽  
Cox Regression Analysis

Abstract Background Long-term data on patients over 75 years undergoing mitral valve (MV) repair are scarce. At our high-volume institution, we, therefore, aimed to evaluate mortality, stroke risk, and reoperation rates in these patients. Methods We investigated clinical outcomes in 372 patients undergoing MV repair with (n = 115) or without (n = 257) tricuspid valve repair. The primary endpoint was the probability of survival up to a maximum follow-up of 9 years. Secondary clinical endpoints were stroke and reoperation of the MV during follow-up. Univariate and multivariable Cox regression analysis was performed to assess independent predictors of mortality. Mortality was also compared with the age- and sex-adjusted general population. Results During a median follow-up period of 37 months (range: 0.1–108 months), 90 patients died. The following parameters were independently associated with mortality: double valve repair (hazard ratio, confidence interval [HR, 95% CI]: 2.15, 1.37–3.36), advanced age (HR: 1.07, CI: 1.01–1.14 per year), diabetes (HR: 1.97, CI: 1.13–3.43), preoperative New York Heart Association (NYHA) functional class (HR: 1.41, CI: 1.01–1.97 per class), and operative creatininemax levels (HR: 1.32, CI: 1.13–1.55 per mg/dL). The risk of stroke in the isolated MV and double valve repair groups at postoperative year 5 was 5.0 and 4.1%, respectively (p = 0.65). The corresponding values for the risk of reoperation were 4.0 and 7.0%, respectively (p = 0.36). Nine-year survival was comparable with the general population (53.2 vs. 53.1%). Conclusion Various independent risk factors for mortality in elderly MV repair patients could be identified, but overall survival rates were similar to those of the general population. Consequently, our data indicates that repairing the MV in elderly patients represents a suitable and safe surgical approach.

Effects of Vaporized Perfluorocarbon on Pulmonary Blood Flow and Ventilation/Perfusion Distribution in a Model of Acute Respiratory Distress Syndrome

2001 ◽  
Vol 95 (6) ◽  
pp. 1414-1421 ◽  
Author(s):  
Matthias Hübler ◽  
Jennifer E. Souders ◽  
Erin D. Shade ◽  
Nayak L. Polissar ◽  
Carmel Schimmel ◽  
...  
Keyword(s):  
Blood Flow ◽  
Oleic Acid ◽  
Gas Exchange ◽  
Lung Injury ◽  
Repeated Measures ◽  
Pulmonary Blood Flow ◽  
Analysis Of Covariance ◽  
Inert Gas ◽  
Low Flow ◽  
Repeated Measures Analysis

Background Perfluorocarbon (PFC) liquids are known to improve gas exchange and pulmonary function in various models of acute respiratory failure. Vaporization has been recently reported as a new method of delivering PFC to the lung. Our aim was to study the effect of PFC vapor on the ventilation/perfusion (VA/Q) matching and relative pulmonary blood flow (Qrel) distribution. Methods In nine sheep, lung injury was induced using oleic acid. Four sheep were treated with vaporized perfluorohexane (PFX) for 30 min, whereas the remaining sheep served as control animals. Vaporization was achieved using a modified isoflurane vaporizer. The animals were studied for 90 min after vaporization. VA/Q distributions were estimated using the multiple inert gas elimination technique. Change in Qrel distribution was assessed using fluorescent-labeled microspheres. Results Treatment with PFX vapor improved oxygenation significantly and led to significantly lower shunt values (P < 0.05, repeated-measures analysis of covariance). Analysis of the multiple inert gas elimination technique data showed that animals treated with PFX vapor demonstrated a higher VA/Q heterogeneity than the control animals (P < 0.05, repeated-measures analysis of covariance). Microsphere data showed a redistribution of Qrel attributable to oleic acid injury. Qrel shifted from areas that were initially high-flow to areas that were initially low-flow, with no difference in redistribution between the groups. After established injury, Qrel was redistributed to the nondependent lung areas in control animals, whereas Qrel distribution did not change in treatment animals. Conclusion In oleic acid lung injury, treatment with PFX vapor improves gas exchange by increasing VA/Q heterogeneity in the whole lung without a significant change in gravitational gradient.

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