Inflammation and Congenital Heart Disease Associated Pulmonary Hypertension

2015 ◽  
Vol 18 (1) ◽  
pp. 038 ◽  
Author(s):  
Mete Gursoy ◽  
Ece Salihoglu ◽  
Ali Can Hatemi ◽  
A. Faruk Hokenek ◽  
Suleyman Ozkan ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Neutrophil To Lymphocyte Ratio ◽  
Cell Distribution ◽  
Inflammation Markers ◽  
Distribution Width ◽  
Artery Pressure ◽  
Lymphocyte Ratio ◽  
Mean Pulmonary Artery Pressure ◽  
Pulmonary Arterial

<strong>Background:</strong> Increased blood flow may trigger pulmonary arterial wall inflammation, which may influence progression of pulmonary artery hypertension in patients with congenital heart disease. In this study, we aimed to investigate the correlation between preoperative inflammation markers and pulmonary arterial hypertension. <br /><strong>Methods:</strong> A total of 201 patients with pulmonary hypertension were enrolled in this study retrospectively; they had undergone open heart surgery between January 2012 and December 2013. Patients’ preoperative C-reactive protein (CRP), neutrophil to lymphocyte ratio, red blood cell distribution width, pulmonary pressures, and postoperative outcomes were evaluated.<br /><strong>Results:</strong> Patient age, neutrophil to lymphocyte ratio, red blood cell distribution width, and CRP were found to be significantly correlated with both preoperative peak and mean pulmonary artery pressures. These data were entered into a linear logistic regression analysis. Patient age, neutrophil to lymphocyte ratio, and CRP were found to be independently correlated with peak pulmonary pressure (P &lt; .001, P &lt; .001, and P = .004) and mean pulmonary artery pressure (P &lt; .001, P &lt; .001, and P = .001), whereas preoperative mean pulmonary artery pressure was found to be independently correlated with intensive care unit stay (P &lt; .001). No parameter was found to be significantly correlated with extubation time and mortality. Eighteen patients had experienced pulmonary hypertensive crisis; in this subgroup, patients’ mean pulmonary artery pressure and neutrophil to lymphocyte ratio were found to be significant (P = .047, P = .003). <br /><strong>Conclusion:</strong> Preoperative inflammation markers may be correlated with the progression of pulmonary hypertensive disease, but further studies with larger sample size are needed to determine the predictive role of these markers for postoperative outcomes.<br /><br />

Abstract 17062: A Novel Non-Invasive Index to Characterize Right Ventricle-Pulmonary Arterial Vascular Coupling in Children

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Philip Levy ◽  
Kel Vin Woo ◽  
Amanda T Hauck ◽  
Aaron Hamvas ◽  
Gautam K Singh
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricle ◽  
Pulmonary Artery Pressure ◽  
Reliable Estimate ◽  
Artery Pressure ◽  
Non Invasive ◽  
Mean Pulmonary Artery Pressure ◽  
Wide Range ◽  
Pulmonary Arterial ◽  
Force Relationship

Introduction: The right ventricle (RV) is a pulsatile pump, the efficiency or work of which depends on proper hemodynamic coupling with the compliant pulmonary arterial vasculature (PV). RV-PV coupling derived by right heart catheritization (RHC) measures the ratio of ventricular elastance (Ees, contractility) to arterial elastance (Ea, afterload) and is based on the work-energy principle that states a change in energy is equal to the work expended by a force through displacement. Non-invasive echocardiography derived surrogates to the Ees/Ea ratio that account for the length-force relationship have been proposed, but their clinical correlation as estimates of RV-PV coupling remain to be established. Hypothesis: We hypothesize that the non-invasive index of RV length-force relationship is a reliable measure of invasive RV-PV coupling (Ees/Ea) in children. Methods: Prospectively acquired simultaneous echocardiography-derived ratio of tricuspid annular plane systolic excursion to pulmonary artery acceleration time (TAPSE/PAAT) and RHC-derived Ees/Ea were compared using regression analysis in a cohort of 125 children (median age, 5 years; IQR, 1-13 years) with a wide range of pulmonary hemodynamics. Ees/Ea was calculated using the single beat method from RHC measures with the following equation: (RV systolic pressure - mean pulmonary artery pressure) / mean pulmonary artery pressure. TAPSE (mm), as a measure of RV contractile reserve, was substituted for length, and PAAT (msec), a reliable estimate of RV afterload, was exchanged for force. PAAT was adjusted for RV ejection time (PAATi=PAAT/RVET) to account for heart rate variability. Results: TAPSE/PAAT and TAPSE/PAATi both correlated with invasive Ees/Ea (r = 0.81, p<0.01 and r=0.76, p<0.01, respectively, Figure). TAPSE/PAAT and TAPSE/PAATi were both decreased (p<0.001) in children with pulmonary hypertension by RHC (mPAP>25 mmHg and PVRi>3 WU.m2). With ROC analysis, TAPSE/PAAT < 0.13 m/sec and TAPSE/PAATi < 38 mm detected Ees/Ea < 1.0 with sensitivity of 95% and specificity of 91% with an AUC of 0.90 (95% CI, 0.85-0.96). Conclusions: TAPSE/PAAT and TAPSE/PAATi , non-invasive indices of the length-force relationship, provide reliable estimates of invasive RV-PV coupling in children.

Prognostic importance of mitral e′ velocity in constrictive pericarditis

2020 ◽  
Author(s):  
Jeong Hoon Yang ◽  
William R Miranda ◽  
Rick A Nishimura ◽  
Kevin L Greason ◽  
Hartzell V Schaff ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Constrictive Pericarditis ◽  
Multivariable Analysis ◽  
Artery Pressure ◽  
Myocardial Disease ◽  
Mean Pulmonary Artery Pressure ◽  
Diastolic Velocity ◽  
Long Term Mortality

Abstract Aims  Increased medial mitral annulus early diastolic velocity (e′) plays an important role in the echocardiographic diagnosis of constrictive pericarditis (CP) and mitral e′ velocity is also a marker of underlying myocardial disease. We assessed the prognostic implication of mitral e′ for long-term mortality after pericardiectomy in patients with CP. Methods and results  We studied 104 surgically confirmed CP patients who underwent echocardiography and cardiac catheterization within 7 days between 2005 and 2013. Patients were classified as primary CP (n = 45) or mixed CP (n = 59) based on the clinical history of concomitant myocardial disease. On multivariable analysis, medial e′ velocity and mean pulmonary artery pressure were independently associated with long-term mortality post-pericardiectomy. There were significant differences in survival rates among the groups divided by cut-off values of 9.0 cm/s and 29 mmHg for medial e′ and mean pulmonary artery pressure, respectively (both P &lt; 0.001). Ninety-two patients (88.5%) had elevated pulmonary artery wedge pressure (PAWP) (≥15 mmHg); there was no significant correlation between medial E/e′ and PAWP (r = 0.002, P = 0.998). However, despite the similar PAWP between primary CP and mixed CP groups (21.6 ± 5.4 vs. 21.2 ± 5.8, P = 0.774), all primary CP individuals with elevated PAWP had medial E/e′ &lt;15 as opposed to 34 patients (57.6%) in the mixed CP group (P &lt; 0.001). Conclusion  Increased mitral e′ velocity is associated with better outcomes in patients with CP. A paradoxical distribution of the relationship between E/e′ and PAWP is present in these patients but there is no direct inverse correlation between them.

Effect of hypoxia on pulmonary artery pressure of dogs

1964 ◽  
Vol 207 (6) ◽  
pp. 1314-1318 ◽  
Author(s):  
Benson R. Wilcox ◽  
W. Gerald Austen ◽  
Harvey W. Bender
Keyword(s):  
Pulmonary Artery ◽  
Arterial Pressure ◽  
Pulmonary Artery Pressure ◽  
Pulmonary Arterial Pressure ◽  
Venous Pressure ◽  
Artery Pressure ◽  
Pulmonary Vasoconstriction ◽  
Systemic Hypoxia ◽  
Pump Output ◽  
Pulmonary Arterial

The mechanism by which the pulmonary artery pressure rises in response to hypoxia has never been clearly demonstrated. This problem was reinvestigated in experiments utilizing separate pulmonary and systemic perfusion systems. These vascular beds were perfused in such a fashion that a change in pulmonary artery pressure could only result from changes in vasomotor tone. Alveolar-pulmonary vein hypoxia was usually associated with a slight fall in pulmonary artery pressure. Systemic hypoxia resulted in elevation of pulmonary arterial pressure in 10 of the 12 animals tested with a constant-flow and constant-pulmonary venous pressure. In addition, all animals with systemic desaturation showed an increased venous return. When the "cardiac output" (pump output) was increased to match this return, the elevation in pulmonary artery pressure increased. It was concluded that the pulmonary arterial pressure elevation seen with hypoxia is the result of active pulmonary vasoconstriction coupled with an increased pulmonary blood flow.

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