scholarly journals Predictors of Chronic Thromboembolic Pulmonary Hypertension

Kardiologiia ◽  
2018 ◽  
Vol 58 (12) ◽  
pp. 60-65
Author(s):  
M. R. Kuznetsov ◽  
I. V. Reshetov ◽  
B. B. Orlov ◽  
A. A. Khotinsky ◽  
A. A. Atayan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Anticoagulant Therapy ◽  
Vena Cava ◽  
Significant Risk ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Thromboembolic Pulmonary Hypertension ◽  
Group 2 ◽  
Group 1

Purpose:to elucidate predictors of development of chronic thromboembolic pulmonary hypertension (CTEPH) after acute pulmonary artery thromboembolism (PTE).Material and methods. We included in this study 210 patients hospitalized with diagnosis of submassive and massive PTE from 2013 to 2017. In 1 to 3 years after initial hospitalization these patients were invited for control examination. According to results of this examination patients were divided into two groups: with (group 1, n=45) and without (group 2, n=165) signs of CTEPH. Severity of pulmonary artery vascular bed involvement was assessed by multislice computed tomography (MSCT) angiography and lung scintigraphy. For detection of thrombosis in the inferior vena cava system we used ultrasound angioscanning.   Examination also included echocardiography.Results.In the process of mathematical analysis, the following risk factors for the development of CTEPH embolism were determined: duration of thrombotic history (group 1 – 13.70±2.05 days, group 2– 16.16±1.13 days, p=0.015), localization of venous thrombosis in the lower extremities (the most favorable – shin veins, popliteal, and common femoral veins, unfavorable – superficial femoral vein). The choice of the drug for thrombolytic and anticoagulant therapy: streptokinase and urokinase were significantly more effective than alteplase, rivaroxaban was superior to the combination of unfractionated or low molecular weight heparins with warfarin. Also, risk factors for the development of CTEPH were the initial degree of pulmonary hypertension and tricuspid insufficiency, as well as the positive dynamics of these indicators at the background of thrombolytic or anticoagulant therapy. Of concomitant diseases, significant risk factors for development of CTEPH were grade 3 hypertensive disease, diabetes mellitus, post­infarction cardiosclerosis. On the other hand, age, gender, degree of severity at the time of admission, presence of infarction pneumonia, surgical prevention of recurrent pulmonary embolism, number of pregnancies and deliveries, history of trauma and malignancies, cardiac arrhythmias produced no significant impact on the development of CTEPH.

Experience with pulmonary endarterectomy: Lessons learned across 17 years

2021 ◽  
pp. 021849232110440
Author(s):  
Varun Shetty ◽  
Julius Punnen ◽  
Pooja Natarajan ◽  
Sanjay Orathi ◽  
Basha Khan ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Systolic Pressure ◽  
Significant Risk ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Pulmonary Artery Systolic Pressure ◽  
Pulmonary Endarterectomy ◽  
Female Ratio ◽  
Thromboembolic Pulmonary Hypertension

Background Pulmonary endarterectomy is potential curative therapy for chronic thromboembolic pulmonary hypertension patients. Here, we present our experience with pulmonary endarterectomy spanning 17 years and detail our management strategy. Methods This is a single-centre retrospective study conducted on chronic thromboembolic pulmonary hypertension patients who underwent pulmonary endarterectomy at our centre across 17 years. Results Between 2004 and 2020, 591 patients underwent pulmonary endarterectomy. Amongst them 429 (72.4%) were males with a male to female ratio of 2.6:1, the median age was 38 (range, 14–73) years. The median length of hospital stay was 11 days (IQR, 8–16). Extra corporeal membranous oxygenation was used in 82 (13.9%) patients during/after surgery, out of whom 28 (34.1%) survived. There were 70 (11.8%) in-hospital deaths. Female gender ( p < 0.01), pulmonary artery systolic pressure >100 mmHg ( p < 0.05) and use of extra corporeal membrane oxygenation ( p < 0.001) were significant risk factors for in-hospital mortality. The mortality in the first period (2004–2012) was 15.7% which reduced to 9.1% in the later period (2013–2020). The reduction in mortality rate was 42% ( p < 0.05). Following pulmonary endarterectomy, there was a significant reduction in pulmonary artery systolic pressure (86.68 ± 24.38 vs. 39.71 ± 13.13 mmHg; p < 0.001) and improvement in median walk distance as measured by 6-min walk test on follow-up (300 vs. 450 meters; p < 0.001). The median duration of follow-up was 8 months (inter-quartile range: 2–24). Conclusions pulmonary endarterectomy has a learning curve, high pulmonary vascular resistance alone is not a contraindication for surgery. Patients following surgery have improved survival and quality of life.

scholarly journals EXPRESS: Global Trends in Chronic Thromboembolic Pulmonary Hypertension Clinical Trials and Dissemination of Results

2021 ◽  
pp. 204589402110599
Author(s):  
Micheal McInnis ◽  
Clement T Chow ◽  
Alexandre Boutet ◽  
Sebastian Mafeld ◽  
John Granton ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Pulmonary Hypertension ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
World Health ◽  
Thromboembolic Pulmonary Hypertension ◽  
National Affiliation ◽  
Group 3 ◽  
Group 2 ◽  
Clinical Trials Registry ◽  
Group 1

Treatment options for chronic thromboembolic pulmonary hypertension (CTEPH) are rapidly expanding. The purpose of this study is to identify trends in CTEPH clinical trials and the publication of results. We performed a worldwide review of completed and ongoing clinical trials through searching the ClinicalTrials.gov database and the World Health Organization International Clinical Trials Registry Platform for “CTEPH” and related terms. Entries were classified as pharmaceutical/procedural interventions (Group 1), all other clinical trials (Group 2) and patient registries (Group 3). Trial characteristics and national affiliation were recorded. PubMed was searched for related publications. There were 117 clinical trials registry entries after removing duplicates and non-target records. Group 1 comprised 29 pharmaceutical, 15 procedural, and 4 combined interventions starting in 2005, 2010 and 2016, respectively. Riociguat and balloon pulmonary angioplasty (BPA) were the most frequent pharmaceutical and procedural interventions, respectively. The proportion of procedural trials increased over time from 0% of those in 2005-2009, to 29% in 2010-2014 and 54% in 2015-2020. There were 56 entries in Group 2 and 13 in Group 3. Japan was the most frequent national affiliation and the most frequent participating country, present in 28% of all trials. The proportion of entries with published results was highest with Group 3 (62%) and lowest with Group 1 (27%). 30% of all publications occurred in 2020. In conclusion, CTEPH clinical trials are increasingly procedural based with growth largely attributable to Japan and BPA. Most trials have not published but results from BPA clinical trials are anticipated soon.

Pulmonary Endarterectomy: Assessment of Operability, Surgical Description, and Post-op Care

2014 ◽  
Vol 12 (4) ◽  
pp. 186-192 ◽  
Author(s):  
David Poch ◽  
Victor Pretorius
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Pulmonary Arteries ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Pulmonary Artery Wedge Pressure ◽  
Pulmonary Endarterectomy ◽  
Pulmonary Thromboendarterectomy ◽  
Thromboembolic Pulmonary Hypertension ◽  
Wedge Pressure

Chronic thromboembolic pulmonary hypertension (CTEPH) is defined as a mean pulmonary artery pressure ≥25 mm Hg and pulmonary artery wedge pressure ≤15 mm Hg in the presence of occlusive thrombi within the pulmonary arteries. Surgical pulmonary thromboendarterectomy (PTE) is considered the best treatment option for CTEPH.

P2774Galectin-3, GDF-15, and ST2 in noninvasive assessment of myocardial remodelling in chronic thromboembolic pulmonary hypertension

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S D Kriechbaum ◽  
K Peters ◽  
R Ajnwojner ◽  
J S Wolter ◽  
M Haas ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Disease Severity ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Control Group ◽  
Right Heart ◽  
Non Invasive ◽  
Galectin 3 ◽  
Myocardial Remodelling ◽  
Thromboembolic Pulmonary Hypertension

Abstract Background In chronic thromboembolic pulmonary hypertension (CTEPH), pulmonary artery obstruction leads to impaired pulmonary hemodynamics and secondary right heart failure, which is highly predictive of outcome. Thus, the extent of myocardial -especially right heart- remodelling is an indicator of disease severity. Purpose The aim of the present study was to assess growth differentiation factor-15 (GDF-15), galectin-3, and suppression of tumorigenicity 2 (ST2) as non-invasive biomarkers of myocardial remodelling in patients suffering from CTEPH. Methods We analysed the serum levels of GDF-15, galectin-3 and ST2 in a cohort of 64 CTEPH patients and in a control group of 25 patients without cardiovascular disease. The biomarker levels were further correlated with clinical, laboratory, and hemodynamic data, including 6-minute walking distance (6-MWD), N-terminal pro-brain natriuretic peptide (NT-proBNP), mean pulmonary artery pressure (meanPAP), pulmonary vascular resistance (PVR), and right atrial pressure (RAP). Results The biomarker levels in the control group were: galectin-3: 3.5 ng/l (IQR 2.7–4.0), GDF-15: 92.6 pg/ml (IQR 78.5–129.1), and ST2: 48.65 ng/l (IQR 35.5–57.0). CTEPH patients had higher levels of GDF-15 (196.7 pg/ml; IQR 128.4–302.8; p<0.001) and ST2 (52.6 ng/l; IQR 44.5–71.9; p=0.05) but not galectin-3 (3.4 ng/l; IQR 2.7–4.3; p=0.84). In the CTEPH cohort, patients with a meanPAP >35 mmHg (GDF-15: p=0.01; ST2: p=0.04) and patients with a PVR >500 dyn sec cm–5 (GDF-15: p=0.004; ST2: p=0.002) had significantly increased biomarker levels. For the detection of a meanPAP >35mmHg, ROC analysis revealed an AUC of 0.71 for GDF-15 and 0.67 for ST2. The level of GDF-15 correlated with the level of NT-proBNP (rrs=0.69; p≤0.001) and the RAP (rrs=0.54; p≤0.001) and inversely with the 6-MWD (rrs=−0.47; p≤0.001). The level of ST2 correlated with the level of NT-proBNP (rrs=0.67; p≤0.001) and the RAP (rrs=0.54; p≤0.001) and inversely with the 6-MWD (rrs=-0.31; p=0.02). Conclusion Our results demonstrate that GDF-15 and ST2, non-invasive biomarkers of myocardial remodelling, are significantly elevated in patients suffering from CTEPH. The correlation of biomarker levels with established outcome predictors suggests a use as indicators of disease severity.

Sign in / Sign up

Export Citation Format

Share Document