scholarly journals Right Ventricular Enlargement within Months of Arteriovenous Fistula Creation in 2 Hemodialysis Patients

2016 ◽  
Vol 43 (4) ◽  
pp. 350-353 ◽  
Author(s):  
Loheetha Ragupathi ◽  
Drew Johnson ◽  
Gregary D. Marhefka
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Right Ventricular ◽  
Diastolic Heart Failure ◽  
Ventricular Enlargement ◽  
Upper Arm ◽  
Echocardiographic Finding ◽  
Obstructive Sleep ◽  
Stage Renal Disease ◽  
End Stage

Surgically created arteriovenous fistulae (AVF) for hemodialysis can contribute to hemodynamic changes. We describe the cases of 2 male patients in whom new right ventricular enlargement developed after an AVF was created for hemodialysis. Patient 1 sustained high-output heart failure solely attributable to the AVF. After AVF banding and subsequent ligation, his heart failure and right ventricular enlargement resolved. In Patient 2, the AVF contributed to new-onset right ventricular enlargement, heart failure, and ascites. His severe pulmonary hypertension was caused by diastolic heart failure, diabetes mellitus, and obstructive sleep apnea. His right ventricular enlargement and heart failure symptoms did not improve after AVF ligation. We think that our report is the first to specifically correlate the echocardiographic finding of right ventricular enlargement with AVF sequelae. Clinicians who treat end-stage renal disease patients should be aware of this potential sequela of AVF creation, particularly in the upper arm. We recommend obtaining preoperative echocardiograms in all patients who will undergo upper-arm AVF creation, so that comparisons can be made postoperatively. Alternative consideration should be given to creating the AVF in the radial artery, because of less shunting and therefore less potential for right-sided heart failure and pulmonary hypertension. A multidisciplinary approach is optimal when selecting patients for AVF banding or ligation.

scholarly journals Pulmonary Hypertension and Chronic Obstructive Pulmonary Disease: When Is It Out of Proportion?

2013 ◽  
Vol 12 (3) ◽  
pp. 122-126
Author(s):  
Sonja Bartolome
Keyword(s):  
Heart Failure ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Hypertension ◽  
Pulmonary Disease ◽  
Diastolic Heart Failure ◽  
Hypoxic Pulmonary Vasoconstriction ◽  
Systolic Heart Failure ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Obstructive Sleep

Patients with chronic obstructive pulmonary disease (COPD) often present with mild pulmonary hypertension (PH). This finding has been attributed to hypoxic pulmonary vasoconstriction. However, a small proportion of COPD patients will present with moderate or severe elevations in their pulmonary artery pressure (PAP), and these patients appear to have worsened symptoms and survival when compared to patients with milder elevations in PAP. The diagnosis of PH in COPD may be difficult, due to inaccuracies in the echocardiographic estimates of PAP in these patients. Additionally, many patients with COPD will also have comorbid conditions such as diastolic heart failure, systolic heart failure, or obstructive sleep apnea, which may cause increased pulmonary pressures through other mechanisms. Clinical trials investigating the effect of PH-specific therapy for patients with PH and COPD have been small, with mixed results. A careful evaluation for other causes of PH and hemodynamic evaluation will help guide medical therapy for this group of patients.

scholarly journals Predictive Modeling of Secondary Pulmonary Hypertension in Left Ventricular Diastolic Dysfunction

2021 ◽  
Vol 12 ◽  
Author(s):  
Karlyn K. Harrod ◽  
Jeffrey L. Rogers ◽  
Jeffrey A. Feinstein ◽  
Alison L. Marsden ◽  
Daniele E. Schiavazzi
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Right Ventricular ◽  
Diastolic Dysfunction ◽  
Diastolic Heart Failure ◽  
Circulation Model ◽  
Left Ventricular ◽  
Data Availability ◽  
Model Parameters ◽  
Ventricular Afterload

Diastolic dysfunction is a common pathology occurring in about one third of patients affected by heart failure. This condition may not be associated with a marked decrease in cardiac output or systemic pressure and therefore is more difficult to diagnose than its systolic counterpart. Compromised relaxation or increased stiffness of the left ventricle induces an increase in the upstream pulmonary pressures, and is classified as secondary or group II pulmonary hypertension (2018 Nice classification). This may result in an increase in the right ventricular afterload leading to right ventricular failure. Elevated pulmonary pressures are therefore an important clinical indicator of diastolic heart failure (sometimes referred to as heart failure with preserved ejection fraction, HFpEF), showing significant correlation with associated mortality. However, accurate measurements of this quantity are typically obtained through invasive catheterization and after the onset of symptoms. In this study, we use the hemodynamic consistency of a differential-algebraic circulation model to predict pulmonary pressures in adult patients from other, possibly non-invasive, clinical data. We investigate several aspects of the problem, including the ability of model outputs to represent a sufficiently wide pathologic spectrum, the identifiability of the model's parameters, and the accuracy of the predicted pulmonary pressures. We also find that a classifier using the assimilated model parameters as features is free from the problem of missing data and is able to detect pulmonary hypertension with sufficiently high accuracy. For a cohort of 82 patients suffering from various degrees of heart failure severity, we show that systolic, diastolic, and wedge pulmonary pressures can be estimated on average within 8, 6, and 6 mmHg, respectively. We also show that, in general, increased data availability leads to improved predictions.

scholarly journals Predictive modeling of secondary pulmonary hypertension in left ventricular diastolic dysfunction

2020 ◽  
Author(s):  
K. K. Harrod ◽  
J. L. Rogers ◽  
J. A. Feinstein ◽  
A. L. Marsden ◽  
D. E. Schiavazzi
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Right Ventricular ◽  
Diastolic Dysfunction ◽  
Diastolic Heart Failure ◽  
Circulation Model ◽  
Left Ventricular ◽  
Data Availability ◽  
Model Parameters ◽  
Ventricular Afterload

AbstractDiastolic dysfunction is a common pathology occurring in about one third of patients affected by heart failure. This condition is not associated with a marked decrease in cardiac output or systemic pressure and therefore is more difficult to diagnose then its systolic counterpart. Compromised relaxation or increased stiffness of the left ventricle with or without mitral valve stenosis induces an increase in the upstream pulmonary pressures, and classified as secondary or group II (2018 Nice classification) pulmonary hypertension. This may result in an increase in the right ventricular afterload leading to right ventricular failure. Elevated pulmonary pressures are therefore an important clinical indicator of diastolic heart failure (sometimes referred to as heart failure with preserved ejection fraction), showing significant correlation with associated mortality. Accurate measurements of this quantity, however, are typically obtained through invasive catheterization, and after the onset of symptoms. In this study, we use the hemodynamic consistency of a differential-algebraic circulation model to predict pulmonary pressures in adult patients from other, possibly non-invasive, clinical data. We investigate several aspects of the problem, including the well posedness of a modeling approach for this type of disease, identifiability of its parameters, to the accuracy of the predicted pulmonary pressures. We also find that a classifier using the assimilated model parameters as features is free from the problem of missing data and is able to detect pulmonary hypertension with sufficiently high accuracy. For a cohort of 82 patients suffering from various degrees of heart failure severity we show that systolic, diastolic and wedge pulmonary pressures can be estimated on average within 8, 6 and 6 mmHg, respectively. We also show that, in general, increased data availability leads to improved predictions.

scholarly journals Prevalence of Right Ventricular Dysfunction & Pulmonary Hypertension and their Relationship to the Number of Hemodialysis Sessions in Patients of End-Stage Renal Disease (ESRD)

2021 ◽  
Vol 35 (3) ◽  
pp. 64-68
Author(s):  
Rakesh Bahadur Adhikari
Keyword(s):  
Pulmonary Hypertension ◽  
Renal Disease ◽  
Right Ventricular ◽  
End Stage Renal Disease ◽  
Chronic Hemodialysis ◽  
Dialysis Session ◽  
Systolic Pulmonary Artery Pressure ◽  
Cross Sectional ◽  
Stage Renal Disease ◽  
End Stage

Introduction: Chronic hemodialysis (HD) ends up with right ventricular (RV) dysfunction and increased pulmonary hypertension (PHTN). Left to right shunt in dialysis patients due to arterio-venous fistula (AVF) causes chronic volume overload, independent of rise in body water leading to worsening RV overload and RV dysfunction (RVD). Aims & Objectives: To determine the prevalence of RV dysfunction & pulmonary hypertension and its relationship to the number of dialysis sessions in patients of ESRD. Place and duration of study: Department of Cardiology & Nephrology, Sheikh Zayed Hospital, Lahore for one year from March 2016 - March 2017. Material & Methods: This cross-sectional analytical hospital based study enrolled 145 Patients of End-Stage Renal Disease (ESRD) on regular 4-hours HD sessions at two or more times per week for at least 3 months. Echocardiography (Echo) with 2-D, M (Motion) Mode & Doppler studies were done. RV dysfunction by TAPSE value less than 15mm & PHTN by Systolic pulmonary artery pressure >35 mm Hg or tricuspid regurgitation velocity (VTR) ?2m/s at rest were noted. Data was analyzed on SPSS version 20. Results: RV dysfunction was seen in 40.7% (59) of patients and the frequency rose across the 4 dialysis session groups (13.8%, 37.3%, 51.7% & 100%, p<0.001). PHTN was observed in 44.1% of the patients and the prevalence progressively increased across the groups (17.2%, 45.1%, 53.3% & 80.01%, p<0.003). There was significant association between RVD and PHTN (p=0.011). Conclusion: We observed positive correlation between RV dysfunction and PHTN with total number of hemodialysis sessions. Early detection of sub-clinical RV dysfunction may improve mortality and morbidity by optimizing treatment options.

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