scholarly journals A stepwise composite echocardiographic score predicts severe pulmonary hypertension in patients with interstitial lung disease

2018 ◽  
Vol 4 (2) ◽  
pp. 00124-2017 ◽  
Author(s):  
Simon Bax ◽  
Charlene Bredy ◽  
Aleksander Kempny ◽  
Konstantinos Dimopoulos ◽  
Anand Devaraj ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Predictive Value ◽  
Validation Cohort ◽  
Systolic Pressure ◽  
Right Atrial ◽  
Receiver Operating Curve ◽  
Severe Pulmonary Hypertension ◽  
Right Heart Catheterisation

European Respiratory Society (ERS) guidelines recommend the assessment of patients with interstitial lung disease (ILD) and severe pulmonary hypertension (PH), as defined by a mean pulmonary artery pressure (mPAP) ≥35 mmHg at right heart catheterisation (RHC). We developed and validated a stepwise echocardiographic score to detect severe PH using the tricuspid regurgitant velocity and right atrial pressure (right ventricular systolic pressure (RVSP)) and additional echocardiographic signs.Consecutive ILD patients with suspected PH underwent RHC between 2005 and 2015. Receiver operating curve analysis tested the ability of components of the score to predict mPAP ≥35 mmHg, and a score devised using a stepwise approach. The score was tested in a contemporaneous validation cohort. The score used “additional PH signs” where RVSP was unavailable, using a bootstrapping technique.Within the derivation cohort (n=210), a score ≥7 predicted severe PH with 89% sensitivity, 71% specificity, positive predictive value 68% and negative predictive value 90%, with similar performance in the validation cohort (n=61) (area under the curve (AUC) 84.8% versus 83.1%, p=0.8). Although RVSP could be estimated in 92% of studies, reducing this to 60% maintained a fair accuracy (AUC 74.4%).This simple stepwise echocardiographic PH score can predict severe PH in patients with ILD.

Risk assessment in severe pulmonary hypertension due to interstitial lung disease

2020 ◽  
Author(s):  
Athiththan Yogeswaran ◽  
Marlene Faber ◽  
Khodr Tello ◽  
Natascha Sommer ◽  
Hossein Ardeschir Ghofrani ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Pulmonary Hypertension ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Severe Pulmonary Hypertension

scholarly journals A Retrospective Study on the Efficacy of PAH-targeted Therapy in Patients with Severe Pulmonary Hypertension in Chronic Lung Disease

2020 ◽  
Author(s):  
li jieying ◽  
sun zhang ◽  
haiming Chen ◽  
wenliang Guo ◽  
chunli Liu ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Targeted Therapy ◽  
Lung Disease ◽  
Chronic Lung Disease ◽  
Survival Rates ◽  
Oxygenation Index ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Right Atrial ◽  
Severe Pulmonary Hypertension

Abstract Background Using PAH-targeted therapy in severe pulmonary hypertension (PH) patients with chronic lung disease (CLD) is controversial as the pulmonary vasodilation could worsen hypoxemia. Objective To investigate the efficacy of patients with severe PH-CLD to PAH targeted therapy. Methods We retrospectively enrolled patients with severe PH-CLD in our study. Each patient underwent laboratory indicators and transthoracic echocardiography at baseline and after the therapy, and survival after therapy were also evaluated. Results After PAH targeted therapy, NT - proBNP significantly decreased (1043.10(236.75-2697.50) pg/ml vs 287.10(21.00-555.90) pg/ml, p=0.035), whereas PaO2 and the oxygenation index in blood gas analysis significantly increased(59.18± 30.12 mmHg vs 74.35(61.63-163.95)mmHg, p=0.010 and 177.21± 84.38 mmHg vs 286.22± 165.13 mmHg, p=0.035, respectively). But the difference at 1-,3- years survival rates between the two groups was not statistically significant (82.82% and 66.26% vs 75.87% and 20.23%, respectively, p=0.094). Multivariate regression analysis identified baseline mean right atrial pressure values and cardiac index as significant predictors of survival of patients with severe PH-CLD. Conclusions PAH targeted therapy may have benefit in patients with severe PH-CLD and didn’t worsen their hypoxemia. Right ventricular function might have an important impact on the survival of patients.

P6469Predictive value of currently available echocardiographic work-up algorithm for previous and updated pulmonary hypertension definitions

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Tanyeri ◽  
O Y Akbal ◽  
B Keskin ◽  
A Hakgor ◽  
A Karagoz ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Predictive Value ◽  
Roc Analysis ◽  
Receiver Operating Curve ◽  
Logistic Regression Models ◽  
Right Heart Catheterisation ◽  
Pulmonary Arterial ◽  
Diagnostic Work ◽  
European Society Of Cardiology ◽  
Work Up

Abstract Background and aim In this study we evaluated the predictive value of currently available European Society of Cardiology 2015 Pulmonary Hypertension (PH) Guidelines two-step echocardiographic (Echo) work-up algorithm for two PH definitions as invasively evaluated pulmonary arterial mean pressures (PAMP) ≥25 mmHg and >20 mmHg. Methods Study group comprised the retrospectively evaluated 1299 patients (pts) (53.1±18.8 years, female 807, 62.1%) who underwent right heart catheterisation (RHC) with different indications between 2006 and 2018. Echo data obtained from same day and pre-RHC evaluation were available in all pts. Chemla method was used for Doppler estimation of PAMP from tricuspid regurgitant jet. For two PH definitions as PAMP ≥25 mmHg (definition-A) and PAMP >20 mmHg (definition-B) predictive value of the ESC Echo algorithm was tested with two logistic regression models based on only PAMP-Echo (Model-1) and PAMP-Echo and Echo findings supportive for PH (Model-2). Results RHC revealed that criteria for PH definitions A and B were met in 891 (68.6%) and 1051 (80.9%) of overall pts. Pre-RHC Echo findings supportive for PH were noted in 529 (40.7%) of pts. Because pulmonary regurgitant velocity data were imprecise, other 6 supportive Echo findings were utilised. The % of the supportive Echo measures were as follows; 1 (11%), 2 (10%),3 (8.1%), 4 (7.2%), 5 (2.5%) and 6 (1.8%). In Model-1, for definitions A and B, odds ratio (OR) of PAMP-Echo were (1.07; 0.99–1.19, p=0.058, LRX2:139, c: 0.72) and (1.05; 0.98–1.12, p=0.102, LRX2:129, c: 0.71), respectively. In Model-2, for definition-A, OR of PAMP-Echo and number of supportive findings were (1.05; 0.98–1.12, p=0.162) and (1.58; 1.42–1.75, p<0.001) (LRX2:217, c: 0.77), respectively. Using the same model for definition-B, OR of PAMP-Echo and number of supportive findings were (1.04; 0.97–1.11, p=0.264) and (1.56; 1.40–1.73, p<0.001),(LRX2:203, c: 0.76), respectively. Receiver operating curve (ROC) analysis yielded that PAMP-Echo >39.8 mmHg had a sensitivity of 80% and a specificity of 54% for definition-A, and a sensitivity of 81% and a specificity of 52% for definition-B, respectively. Regardless of the definition tresholds for PH on RHC, number of supportive Echo findings were responsible for nearly 70% of the overall variance in the PH diagnosis. Conclusions Irrespective of the RHC definition criteria as PAMP ≥25 mmHg or >20 mmHg, number of supportive Echo findings but not PAMP-Echo only approach seems to be reliable in the diagnostic work-up for PH.

scholarly journals Anaesthesia management in a patient of interstitial lung disease with pulmonary hypertension for emergency laparotomy

2021 ◽  
Vol 9 (10) ◽  
pp. 3216
Author(s):  
Hardik A. Parekh ◽  
Prajakta D. Latkar ◽  
Ameya G. Nalavade ◽  
Hemant H. Mehta
Keyword(s):  
Mechanical Ventilation ◽  
Pulmonary Hypertension ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Exploratory Laparotomy ◽  
Pulmonary Complications ◽  
Emergency Laparotomy ◽  
Cecal Volvulus ◽  
Severe Pulmonary Hypertension ◽  
Spinal Epidural

We report the anesthaetic management of a patient with known case of interstitial lung disease (ILD) with profound fibrotic changes and bullae with severe pulmonary hypertension (PH) posted for exploratory laparotomy for cecal volvulus. Emergency exploratory laparotomy was done under combined spinal-epidural anaesthesia to avoid intra-operative and post-operative pulmonary complications associated with general anaesthesia and mechanical ventilation.

scholarly journals Usefulness of the second heart sound for predicting pulmonary hypertension in patients with interstitial lung disease

2016 ◽  
Vol 134 (1) ◽  
pp. 34-39
Author(s):  
Sandra de Barros Cobra ◽  
Rayane Marques Cardoso ◽  
Marcelo Palmeira Rodrigues
Keyword(s):  
Pulmonary Hypertension ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Heart Sound ◽  
Clinical Signs ◽  
Systolic Pressure ◽  
Heart Sounds ◽  
Aortic Area ◽  
Second Heart Sound ◽  
Mitral Area

CONTEXT AND OBJECTIVE: P2 hyperphonesis is considered to be a valuable finding in semiological diagnoses of pulmonary hypertension (PH). The aim here was to evaluate the accuracy of the pulmonary component of second heart sounds for predicting PH in patients with interstitial lung disease. DESIGN AND SETTING: Cross-sectional study at the University of Brasilia and Hospital de Base do Distrito Federal. METHODS: Heart sounds were acquired using an electronic stethoscope and were analyzed using phonocardiography. Clinical signs suggestive of PH, such as second heart sound (S2) in pulmonary area louder than in aortic area; P2 > A2 in pulmonary area and P2 present in mitral area, were compared with Doppler echocardiographic parameters suggestive of PH. Sensitivity (S), specificity (Sp) and positive (LR+) and negative (LR-) likelihood ratios were evaluated. RESULTS: There was no significant correlation between S2 or P2 amplitude and PASP (pulmonary artery systolic pressure) (P = 0.185 and 0.115; P= 0.13 and 0.34, respectively). Higher S2 in pulmonary area than in aortic area, compared with all the criteria suggestive of PH, showed S = 60%, Sp= 22%; LR+ = 0.7; LR- = 1.7; while P2> A2 showed S= 57%, Sp = 39%; LR+ = 0.9; LR- = 1.1; and P2 in mitral area showed: S= 68%, Sp = 41%; LR+ = 1.1; LR- = 0.7. All these signals together showed: S= 50%, Sp = 56%. CONCLUSIONS: The semiological signs indicative of PH presented low sensitivity and specificity levels for clinically diagnosing this comorbidity.

Risk assessment in severe pulmonary hypertension due to interstitial lung disease

2020 ◽  
Vol 39 (10) ◽  
pp. 1118-1125
Author(s):  
Athiththan Yogeswaran ◽  
Khodr Tello ◽  
Marlene Faber ◽  
Natascha Sommer ◽  
Stefan Kuhnert ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Pulmonary Hypertension ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Severe Pulmonary Hypertension

scholarly journals Serum Human Epididymis Protein 4 as a Novel Biomarker in Identifying Patients With Interstitial Lung Disease in Rheumatoid Arthritis

2021 ◽  
Vol 8 ◽  
Author(s):  
Liu Liang ◽  
Jiali Chen ◽  
Chun Di ◽  
Minghua Zhan ◽  
Huizhang Bao ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Validation Cohort ◽  
Multivariate Logistic Regression Analysis ◽  
Receiver Operating Curve ◽  
Discovery Cohort ◽  
High Resolution Computed Tomography ◽  
Human Epididymis Protein 4 ◽  
Human Epididymis

Objective: Human epididymis protein 4 (HE4) have been implicated in the pulmonary involvements. We aimed to investigate the clinical utility of HE4 in clinical stratification in patients with rheumatoid arthritis (RA).Methods: This study included a discovery cohort comprising 70 RA patients and 64 healthy controls (HCs), and a validation cohort comprising 98 RA patients and 75 HCs. Human epididymis protein 4 were determined by electrochemical luminescence analyzer.Results: The levels of HE4 were significantly elevated in patients with RA compared to HCs. The positive rates of HE4 in patients with RA and HCs were 50.0% and 0, respectively, in the discovery cohort and 53.1 and 1.3%, respectively, in the validation cohort. When RA patients were subgrouped according to HE4 status, HE4-positive group displayed higher prevalence of interstitial lung disease (ILD) compared to HE4-negative group (28.6 vs. 11.4% in discovery cohort and 57.7 vs. 8.7% in the validation cohort). A positive correlation between the levels of HE4 with the degree of lung impairment was identified. Receiver operating curve (ROC) analysis revealed an optimal cut-off value of 104.3 pmol/L in HE4 for distinguishing RA-ILD from RA-non ILD with the areas under the curve (AUC) of 0.790. Multivariate logistic regression analysis illustrated that high levels of HE4 independently identified patients with RA-ILD (OR, 9.080, p &lt; 0.001).Conclusion: Our findings showed a novel role of HE4 in RA risk stratification, suggest that introducing HE4 to the current RA test panel may serve as an indicator in identifying RA patients for further RA-ILD workups, such as high-resolution computed tomography (HRCT).

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