scholarly journals Imaging of pulmonary hypertension in adults: a position paper from the Fleischner Society

2021 ◽  
Vol 57 (1) ◽  
pp. 2004455
Author(s):  
Martine Remy-Jardin ◽  
Christopher J. Ryerson ◽  
Mark L. Schiebler ◽  
Ann N.C. Leung ◽  
James M. Wild ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Working Group ◽  
Position Paper ◽  
Or Management ◽  
Multidisciplinary Assessment ◽  
Work Up ◽  
Key Questions ◽  
Pathophysiologic Mechanisms

Pulmonary hypertension (PH) is defined by a mean pulmonary artery pressure greater than 20 mmHg and classified into five different groups sharing similar pathophysiologic mechanisms, haemodynamic characteristics, and therapeutic management. Radiologists play a key role in the multidisciplinary assessment and management of PH. A working group was formed from within the Fleischner Society based on expertise in the imaging and/or management of patients with PH, as well as experience with methodologies of systematic reviews. The working group identified key questions focusing on the utility of CT, MRI, and nuclear medicine in the evaluation of PH: a) Is noninvasive imaging capable of identifying PH? b) What is the role of imaging in establishing the cause of PH? c) How does imaging determine the severity and complications of PH? d) How should imaging be used to assess chronic thromboembolic PH before treatment? e) Should imaging be performed after treatment of PH? This systematic review and position paper highlights the key role of imaging in the recognition, work-up, treatment planning, and follow-up of PH.

Thrombosis associated with ventriculoatrial shunts

2008 ◽  
Vol 2 (4) ◽  
pp. 286-291 ◽  
Author(s):  
Norka Wilkinson ◽  
Sandeep Sood ◽  
Steven D. Ham ◽  
Holly Gilmer-Hill ◽  
Patricia Fleming ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Anticoagulation Therapy ◽  
Treatment Strategies ◽  
Outcome Data ◽  
Single Center Study ◽  
Prophylactic Anticoagulation ◽  
Risk For Thrombosis ◽  
Work Up

Object In this single-center study, the authors examined the clinical characteristics, risk factors, treatment strategies, and outcomes in patients with thrombosis associated with ventriculoatrial (VA) shunts. Methods Inpatient and outpatient charts of patients who underwent treatment and follow-up in the Hematology-Oncology Division at the authors' institution and in whom thrombosis developed secondary to a VA shunt placement were reviewed. A complete thrombophilia work-up was performed in each patient, and these records were also reviewed. Treatment including medical and surgical management was noted and outcome data were recorded. Results Resolution of thrombosis was seen after anticoagulation therapy in all patients; this may be an alternative to surgical therapy. Conclusions Patients with VA shunts represent a unique group at risk for thrombosis. The duration of anticoagulation therapy must be individualized. However, larger studies are needed to evaluate the efficacy of screening for asymptomatic thrombosis and to investigate the role of prophylactic anticoagulation.

Imaging to Differentiate the Various Forms of Seronegative Arthritis

2018 ◽  
Vol 22 (02) ◽  
pp. 189-196
Author(s):  
Kay-Geert Hermann ◽  
Anna Zejden ◽  
Iwona Sudoł-Szopińska ◽  
Iris Eshed
Keyword(s):  
Human Leukocyte ◽  
Leukocyte Antigen ◽  
Important Diagnostic Tool ◽  
Inflammatory Bowel ◽  
Diagnostic Work ◽  
Factor Α ◽  
Work Up ◽  
Necrosis Factor

AbstractSpondyloarthritis (SpA) is a group of diseases characterized by back pain, spinal inflammation, human leukocyte antigen-B27 positivity, and peripheral findings such as dactylitis, enthesitis, and uveitis. It includes ankylosing spondylitis, psoriatic arthritis, reactive arthritis, arthritis associated with inflammatory bowel disease, and undifferentiated SpA. The role of imaging in the diagnosis, management, and follow-up of patients with SpA has become dramatically more important with the introduction of new therapies such as tumor necrosis factor-α inhibitors. Although in many instances differentiating between the SpA entities is straightforward based on the clinical presentation, often such differentiation remains challenging, and categorization of an individual patient into a subset of SpA can be difficult. Imaging, mainly radiography and magnetic resonance imaging, serves as an important diagnostic tool. Diseases in the spondyloarthritis complex share common presentation but at the same time may have distinct radiographic phenotypes. We present these common and distinct imaging manifestations that may potentially help distinguish between the entities in the diagnostic work-up.

scholarly journals The role of echocardiography in the diagnostic work-up of pulmonary hypertension

2018 ◽  
Vol 4 (1) ◽  
pp. 13-22
Author(s):  
V. Sachpekidis ◽  
H. Karvounis ◽  
G. Giannakoulas
Keyword(s):  
Pulmonary Hypertension ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

scholarly journals PERAN BADAN KEPENDUDUKAN DAN KELUARGA BERENCANA NASIONAL (BKKBN) PROVINSI BENGKULU DALAM PELATIHAN PETUGAS LAPANGAN KELUARGA BERENCANA (PLKB)

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Eli Ermawati ◽  
Antonio Imanda ◽  
Asnawati Asnawati
Keyword(s):  
Family Planning ◽  
Working Group ◽  
Qualitative Method ◽  
Training Time ◽  
Field Officer ◽  
Post Test ◽  
Branch Office ◽  
Split Time

This research was conducted at BKKBN Branch office bengkulu Province, training and developing (Latbang). This research purpose is to find out the role of BKKBN Bengkulu province in Training of Family Planning field officer. This research uses descriptive qualitative method. Data is collected thru observation, interview and documentation. Faried Ali (2011) theory is used in this research. The result of this research shows that the roles of BKKBN in PLKB training are: (1) Stabilizator, PLKB can increase the knowledge and ability in PLKB Training, it can be seen from pre-test and post-test. But not in all PLKB trainers can increase their skills because some of them weren’t listening or taking a note, some of them playing with their smartphone and talking; (2) Dinamisator, the process of PLKB training started by holding a preparation meeting. In that meeting, materials are discussed, training time, administration preparation like correspondence and financial, also facility in training; (3) Inovator, BKKBN found new things in PLKB Training because there was an evaluation after training, observation, suggestions, all trainees can give suggestion about the training. BKKBN also give material according to PLKB need and has provide the material professionally because they split time into discussion, working group, field practive, refreshing (outbound) and follow-up.

scholarly journals Relationships between Pulmonary Hypertension Risk, Clinical Profiles, and Outcomes in Dilated Cardiomyopathy

2020 ◽  
Vol 9 (6) ◽  
pp. 1660
Author(s):  
Ewa Dziewięcka ◽  
Sylwia Wiśniowska-Śmiałek ◽  
Aleksandra Karabinowska ◽  
Katarzyna Holcman ◽  
Matylda Gliniak ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Dilated Cardiomyopathy ◽  
Ventricular Tachyarrhythmia ◽  
Risk Groups ◽  
Right Atrial ◽  
Symptom Duration ◽  
Patient Status ◽  
Patients With Heart Failure

Pulmonary hypertension (PH) in patients with heart failure (HF) contributes to a poorer prognosis. However, in those with dilated cardiomyopathy (DCM), the true prevalence and role of PH is unclear. Therefore, this study aimed to analyze the profile of DCM patients at various levels of PH risk, determined via echocardiography, and its impact on outcomes. The 502 DCM in- and out-patient records were retrospectively analyzed. Information on patient status was gathered after 45.9 ± 31.3 months. Patients were divided into 3 PH-risk groups based on results from echocardiography measurements: low (L, n = 239, 47.6%), intermediate (I, n = 153, 30.5%), and high (H, n = 110, 21.9%). Symptom duration, atrial fibrillation, ventricular tachyarrhythmia, ejection fraction, right atrial area, and moderate or severe mitral regurgitation were found to be independently associated with PH risk. During the follow-up period, 83 (16.5%) DCM patients died: 29 (12.1%) in L, 31 (20.3%) in I, and 23 (20.9%) in H. L-patients had a significantly lower risk of all-cause death (L to H: HR 0.55 (95%CI 0.32–0.98), p = 0.01), while no differences in prognosis were found between I and H. In conclusion, over one in five DCM patients had a high PH risk, and low PH risk was associated with better prognoses.

scholarly journals Fractional Exhaled Nitric Oxide Measurement in Pulmonary Hypertension: A Follow-Up Study

2017 ◽  
Vol 24 (3) ◽  
pp. 483-488 ◽  
Author(s):  
Nilay Orak Akbay ◽  
Zuleyha Bingol ◽  
Esen Kiyan ◽  
Ekrem Bilal Karaayvaz ◽  
Ahmet Kaya Bilge ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Pulmonary Hypertension ◽  
Pulmonary Function Tests ◽  
Exhaled Nitric Oxide ◽  
World Health ◽  
Control Group ◽  
Healthy Controls ◽  
Fractional Exhaled Nitric Oxide

Pulmonary hypertension (PH) is a fatal disease although significant improvements in treatment are achieved. Easily implemented and noninvasive prognostic techniques are needed while following-up these patients. The aim was to investigate the role of fractional exhaled nitric oxide (FeNO) in follow-up for patients with PH. In this longitudinal study, patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic PH (CTEPH) who were seen in PH Outpatient Clinic, Istanbul Faculty of Medicine, Istanbul University, were enrolled in the study. Echocardiography, 6-minute walking test, brain natriuretic peptide, and FeNO measurements were performed, and World Health Organization functional class was evaluated to all patients at baseline, and third, and sixth months. Right-heart catheterization and pulmonary function tests at the time of diagnosis were recorded. The study comprised 31 patients (23 women, 8 men; mean age: 53.4 ± 17.1 years) with PAH (n = 19) and CTEPH (n = 12) and 80 healthy controls. Patients with PH had lower FeNO values than the control group (16.5 ppb vs 19.8 ppb; P < .05). Fractional exhaled nitric oxide values did not change during follow-up and did not correlate with other follow-up measures except tricuspid annular plane systolic excursion values. Fractional exhaled nitric oxide was higher in the idiopathic PAH subgroup at baseline and at third month than patients with PAH associated with other diseases. Fractional exhaled nitric oxide did not change in patients who had clinical deterioration. As a conclusion; Patients with PH had lower FeNO values than healthy controls, but FeNO did not change significantly during follow-up. Large-scale studies with prolonged follow-up periods are needed to understand the role of FeNO in the follow-up of the patients with PH.

Current use and potential role of procalcitonin in the diagnostic work up and follow up of febrile neutropenia in hematological patients

2017 ◽  
Vol 10 (6) ◽  
pp. 543-550 ◽  
Author(s):  
Benedetto Bruno ◽  
Alessandro Busca ◽  
Stefano Vallero ◽  
Stefania Raviolo ◽  
Nicola Mordini ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Potential Role ◽  
Hematological Patients ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

scholarly journals The role of asymmetric dimethylarginine (ADMA) in the follow-up of patients with precapillary pulmonary hypertension (PH)

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
I Shafran ◽  
V Probst ◽  
J Campean ◽  
R Sadushi-Kolici ◽  
C Gerges ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
High Risk ◽  
Plasma Level ◽  
Plasma Levels ◽  
Asymmetric Dimethylarginine ◽  
Low Risk ◽  
Hemodynamic Assessment ◽  
Significant Difference

Abstract Introduction Asymmetric dimethylarginine (ADMA) interferes with L-arginine in the production of nitric oxide, a key mediator of endothelial cell function. ADMA is elevated in pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) and is associated with unfavorable outcomes. Aim To assess the role of ADMA to monitor disease progression of PH patients treated with PAH-specific therapy. Methods ADMA was measured by competitive ELISA at baseline (BL) and follow-up (FU). Risk assessment including a clinical assessment, echocardiography, 6-minute walking test, NT-pro-BNP and hemodynamic assessment by right heart catheterization was performed accordingly. Risk was calculated according to the ESC/ERS 2015 guidelines by the SPHAR method. Results ADMA samples were collected from 113 patients treated at our institution between 2012 and 2019. 89 (79%) patients had PAH, 15 (13%) were diagnosed with CTEPH and 9 (8%) with group 3 – PH associated with lung disease. 69% were females. 15 (13.3%) patients had a low risk at baseline, 96 (85%) intermediate risk and 2 (1.8%) were high risk patients. 75% received oral medications, 31% received subcutaneous treprostinil. Median baseline ADMA was 0.738umol/l. At BL no significant difference of ADMA plasma levels was found among the different PH types (p=0.063), or between different risk categories (p=0.531). Change in ADMA plasma levels correlated with change in risk (p=0.002, rs 0.291) and with change in mixed venous saturation (p=0.034, rs −0.205). Change in ADMA plasma levels also correlated with risk at FU (p=0.011, rs 0.240). Patients categorized as low risk at FU had a median ADMA plasma level decrease of 22%, compared with −3 to 0% ADMA plasma level change in patients with moderate to high risk at FU (p=0.04). Patients who improved their risk category had a median decrease of ADMA plasma level of 23% vs. 2.3% in patients who did not improve (p=0.011). Decrease of ADMA plasma levels was a weak but significant discriminator for improvement of risk in ROC analysis (p=0.032, AUC 0.374). Conclusion ADMA plasma levels paralleled the hemodynamic and clinical benefit of PAH-specific treatments in patients with precapillary PH. ADMA could be used as a biomarker for monitoring treatment effects in precapillary PH. Funding Acknowledgement Type of funding source: None

scholarly journals Clinical observations of COVID-19 infection in patients with chronic thromboembolic pulmonary hypertension

Kardiologiia ◽  
2021 ◽  
Vol 61 (6) ◽  
pp. 28-34
Author(s):  
O. V. Kamenskaya ◽  
I. Yu. Loginova ◽  
A. S. Klinkova ◽  
V. V. Lomivorotov ◽  
A. M. Chernyavsky
Keyword(s):  
Pulmonary Hypertension ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Care Group ◽  
Specific Therapy ◽  
Clinical Observations ◽  
Follow Up Care ◽  
Thromboembolic Pulmonary Hypertension ◽  
Functional Features

Aim    To present clinical observations of the novel coronavirus infection (COVID-19) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) after a surgical intervention in the form of thromobendarterectomy from pulmonary artery branches.Material and methods    The Acad. E.N. Meshalkin National Medical Research Center performed 127 open surgical interventions for CTEPH in the form of thromobendarterectomy from 2016 through 2020. The present study enrolled 113 patients included into the follow-up care group and into the Center Registry who were followed up for more than 6 months after the surgery. Clinical and functional features of COVID-19 were evaluated in the studied group.Results    In the follow-up care group, 5 (4.4%) postoperative CTEPH patients had COVID-19. One patient had asymptomatic disease, and others had typical clinical symptoms and bilateral polysegmental pneumonia. There were no cases requiring artificial ventilation and no lethal outcomes. All patients with COVID-19 received anticoagulants as a basis therapy for CTEPH, and two patients who had residual pulmonary arterial hypertension (PAH) additionally received a PAH-specific therapy. During the treatment of COVID-19, no adjustment of the anticoagulant or PAH-specific therapy was required.Conclusion    The group of patients with CTEPH is a unique pathophysiological model for studying the effect of COVID-19 under the conditions of compromised pulmonary circulation. In the studied follow-up care group, the COVID-19 morbidity was 4.4 % without fatal outcomes. Evaluation of the role of chronic anticoagulant and PAH-specific therapy in COVID-19 postoperative patients as well as evaluation of the role of COVID-19 in CTEPH progression merit further investigation. 

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