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.

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.

scholarly journals HUMAN IDENTIFICATION BASED ON HEART SOUND AUSCULTATION POINT

2017 ◽  
Vol 79 (7) ◽  
Author(s):  
I. Nur Fariza ◽  
Sh-Hussain Salleh ◽  
Fuad Noman ◽  
Hadri Hussain
Keyword(s):  
Heart Sound ◽  
Recognition Rate ◽  
Human Identification ◽  
Personal Identification ◽  
Heart Sounds ◽  
Electronic Stethoscope ◽  
The Past ◽  
Technology Advancement ◽  
Aortic Area ◽  
Mitral Area

The application of human identification and verification has widely been used for over the past few decades.  Drawbacks of such system however, are inevitable as forgery sophisticatedly developed alongside the technology advancement.  Thus, this study proposed a research on the possibility of using heart sound as biometric. The main aim is to find an optimal auscultation point of heart sounds from either aortic, pulmonic, tricuspid or mitral that will most suitable to be used as the sound pattern for personal identification.  In this study, the heart sound was recorded from 92 participants using a Welch Allyn Meditron electronic stethoscope whereas Meditron Analyzer software was used to capture the signal of heart sounds and ECG simultaneously for duration of 1 minute.  The system is developed by a combination Mel Frequency Cepstrum Coefficients (MFCC) and Hidden Markov Model (HMM).  The highest recognition rate is obtained at aortic area with 98.7% when HMM has 1 state and 32 mixtures, the lowest Equal Error Rate (EER) achieved was 0.9% which is also at aortic area.  In contrast, the best average performance of HMM for every location is obtained at mitral area with 99.1% accuracy and 17.7% accuracy of EER at tricuspid area.

Impact of post-capillary pulmonary hypertension on mortality in interstitial lung disease

2021 ◽  
Author(s):  
Ryo Teramachi ◽  
Hiroyuki Taniguchi ◽  
Yasuhiro Kondoh ◽  
Tomoki Kimura ◽  
Kensuke Kataoka ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Interstitial Lung Disease ◽  
Lung Disease

Sleep architecture in patients with interstitial lung disease with and without pulmonary hypertension

2022 ◽  
Author(s):  
Joseph L. Simonson ◽  
Dhwani Pandya ◽  
Sarah Khan ◽  
Sameer Verma ◽  
Harly E. Greenberg ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Sleep Architecture

scholarly journals Treatment of Pulmonary Hypertension in Patients with Connective Tissue Disease and Interstitial Lung Disease

2010 ◽  
Vol 17 (6) ◽  
pp. 282-286 ◽  
Author(s):  
Shikha Mittoo ◽  
Thomas Jacob ◽  
Andrea Craig ◽  
Zoheir Bshouty
Keyword(s):  
Pulmonary Hypertension ◽  
Interstitial Lung Disease ◽  
Connective Tissue ◽  
Lung Disease ◽  
Connective Tissue Disease ◽  
Term Treatment ◽  
Kaplan Meier ◽  
Long Term Treatment ◽  
Survival Differences

BACKGROUND: Pulmonary hypertension (PH) in patients with connective tissue disease (CTD) can occur in isolation or concomitantly with interstitial lung disease (ILD). Targeted therapies for PH can mitigate clinical deterioration in CTD patients with isolated PH; however, the effect of these therapies in CTD patients with PH and ILD (CTD-PH-ILD) are poorly characterized.OBJECTIVE: To investigate outcomes following long-term treatment of PH in patients with CTD-PH-ILD.METHODS: A retrospective evaluation of 13 CTD-PH-ILD patients who were treated with bosentan, sildenafil or bosentan plus sildenafil, was conducted. Immunosuppressants were prescribed as indicated. Patients underwent pulmonary function testing and assessment of 6 min walk distance at the time of treatment initiation and during follow-up. Patients were followed until time of death, lung transplantation or the end of the study. Kaplan-Meier estimates of survival were calculated and log-rank testing was used to analyze survival differences according to CTD subtype.RESULTS: Thirteen patients (seven with systemic sclerosis [SSc], four with overlap syndrome, and two with rheumatoid arthritis) were followed for a mean (± SD) duration of 33.8±21.7 months. The survival estimate at a median duration of 34 months was 85%; two patients with SSc died. Mortality rates were greater among patients with SSc versus other CTD subtypes (P=0.04). No changes from baseline to follow-up in mean forced vital capacity or exercise capacity, and no treatment-related toxicity, were observed.CONCLUSION: Treatment using PH-specific therapies in patients with CTD, PH and ILD was well tolerated. Further studies to investigate the efficacy of PH-specific therapies in CTD-PH-ILD patients are warranted.

PDE5A inhibition attenuates bleomycin-induced pulmonary fibrosis and pulmonary hypertension through inhibition of ROS generation and RhoA/Rho kinase activation

2008 ◽  
Vol 294 (1) ◽  
pp. L24-L33 ◽  
Author(s):  
Anna R. Hemnes ◽  
Ari Zaiman ◽  
Hunter C. Champion
Keyword(s):  
Pulmonary Hypertension ◽  
Interstitial Lung Disease ◽  
Pulmonary Fibrosis ◽  
Right Ventricular ◽  
Lung Disease ◽  
Rho Kinase ◽  
Saline Control ◽  
Ros Generation ◽  
Pde5 Inhibition ◽  
Phosphodiesterase Type

Pulmonary hypertension frequently complicates interstitial lung disease, where it is associated with a high mortality. Patients with this dual diagnosis often fare worse than those with pulmonary arterial hypertension (PAH) alone and respond poorly to standard PAH therapy, often dying of right ventricular (RV) failure. We hypothesize that nitric oxide synthase (NOS) uncoupling is important in the pathogenesis of interstitial lung disease-associated pulmonary hypertension, and this process can be abrogated by phosphodiesterase type 5 (PDE5) inhibition to improve pulmonary vascular remodeling and right ventricular function. Intratracheal bleomycin (4 U/kg) or saline control was administered to C57/BL6 mice after anesthesia. After recovery, animals were fed a diet of sildenafil (100 mg·kg−1·day−1) or vehicle for 2 wk when they underwent hemodynamic measurements, and tissues were harvested. Survival was reduced in animals treated with bleomycin compared with controls and was improved with sildenafil (100.0 vs. 73.7 vs. 84.2%, P < 0.05). RV/LV+S ratio was higher in bleomycin-alone mice with improvement in ratio when sildenafil was administered (33.00 ± 0.01% vs. 20.98 ± 0.01% P < 0.05). Histology showed less pulmonary vascular and RV fibrosis in the group cotreated with sildenafil. Bleomycin was associated with a marked increase in superoxide generation by DHE histological staining and luminol activity in both heart and lung. Treatment with sildenafil resulted in a concomitant reduction in superoxide levels in both heart and lung. These data demonstrate that PDE5 inhibition ameliorates RV hypertrophy and pulmonary fibrosis associated with intratracheal bleomycin in a manner that is associated with improved NOS coupling and a reduction in reactive oxygen species signaling.

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