scholarly journals The Prevalence of Pulmonary Hypertension Among Maintenance Dialysis Patients With ESRD and Its Associated Factors: A Retrospective Study

2020 ◽  
Vol 7 ◽  
Author(s):  
Ying Zhang ◽  
Xiao-Han Ding ◽  
Rongsheng Rao ◽  
Yiqin Wang ◽  
Fang Pang ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Left Ventricle ◽  
Pulmonary Artery ◽  
Left Atrium ◽  
Right Atrium ◽  
Associated Factors ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Maintenance Dialysis ◽  
Esrd Patients

Aim: To determine the prevalence of pulmonary hypertension (PH) and its associated factors among end-stage renal disease (ESRD) patients who underwent maintenance dialysis.Methods: A total of 491 patients received echocardiography examinations and underwent pulmonary artery systolic pressure (PASP) assessments. A subgroup of 283 patients were subjected to plasma creatinine (Cr) and blood urea nitrogen concentration (BUN) tests, routine blood examinations and electrolyte analysis. First, we compared the differences in echocardiographic, Cr and BUN, blood routine and electrolyte parameters between PH and non-PH groups. The correlations between PASP and the parameters mentioned above were also analyzed. Furthermore, univariate and adjusted logistic regression analyses were performed to identify the independent associated factors.Results: The incidence of PH among ESRD patients who were treated with maintenance dialysis was 34.6%. Most of the echocardiographic parameters, including end-diastolic internal diameters of the left atrium, left ventricle, right atrium, and pulmonary artery, as well as interventricular septum mobility, left ventricular posterior wall mobility, fractional shortening, stroke volume and left ventricle ejection fraction (LVEF), were associated with PH. Furthermore, Mg2+ (p = 0.037) and Cl− (p = 0.043) were significantly associated with PASP. However, after adjustments were made in the regression analysis, only internal diameters of the left atrium, right atrium, and LVEF were independently associated with PH.Conclusion: PH is prevalent, with a relatively high incidence among ESRD patients who undergo maintenance dialysis. The sizes of the left and right atria as well as LVEF were independently associated with PH, but further cohort and basic mechanistic studies are needed to confirm this finding.

Cat heart acetylcholine: structural proof and distribution

1976 ◽  
Vol 231 (3) ◽  
pp. 781-785 ◽  
Author(s):  
OM Brown
Keyword(s):  
Left Ventricle ◽  
Right Ventricle ◽  
Left Atrium ◽  
Right Atrium ◽  
Interventricular Septum ◽  
Pyrolysis Product ◽  
Heart Tissue ◽  
Choline Esters ◽  
The Right ◽  
Cat Heart

The distribution of acetylcholine (ACh) in the cat heart was investigated by a pyrolysis-gas chromatography (PGC) method. The hearts were dissected into various regions and homogenized in acetonitrile in the presence of propionylcholine, internal standard. Following extraction with toluene and hexane, the choline esters were precipitated as the enneaiodide complex. The isolated choline esters were analyzed by PGC, and the peak corresponding to ACh was quantified. The compound extracted from heart tissue that eluted with the retention time of authentic ACh was identified by mass spectrometry as dimethylaminoethylacetate, the pyrolysis product of ACh. ACh concentrations were found to be higher in the atria than the ventricles. In both the atria and the ventricles, a higher content of ACh was found in the right than the left portions: right ventricle, 5.0 compared to left ventricle, 2.0 nmol/g; and right atrium, 16.8 compared to left atrium, 11.3 nmol/g. Some cats were subjected to a bilateral cervical vagotomy 3 wk before removal and analysis of heart tissue. Hearts from vagotomized cats contained less ACh than controls in the right ventricle (-31%), right atrium (-54%), SA node (-42%), and papillary muscle (-53%), but no decreases were found in the left ventricle, left atrium, or interventricular septum.

412 Prevalence of pulmonary hypertension in patients referred for sleep apnea diagnostics

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A163-A164
Author(s):  
Eugeniya Elfimova ◽  
Oxana Mikhailova ◽  
Nikolai Danilov ◽  
Alexander Litvin ◽  
Alexander Pevzner ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Sleep Apnea ◽  
Left Atrium ◽  
Interventricular Septum ◽  
Posterior Wall ◽  
Severe Form ◽  
Left Ventricular ◽  
Chronic Obstructive ◽  
Systolic Pulmonary Artery Pressure ◽  
Sleep Laboratory

Abstract Introduction The aim to evaluate the prevalence of pulmonary hypertension according to echocardiography in patients referred for sleep apnea diagnostics. Methods We included 145 patients referred to Sleep laboratory for sleep apnea diagnostics. Mean age 63,8 ± 10,4 years, BMI 34,0 ± 5,7 kg/m2, AHI 31,3 ± 20,3/h, ODI 3% 28,2 ± 19,5/h, min SpO2 77,4 ± 9,8%, systolic pulmonary artery pressure (systolic PAP) 25,9 ± 16,4 mmHg. All patients underwent cardiorespiratory and respiratory diagnostics for sleep apnea and echocardiography. Results From the random sample of patients referred to Sleep laboratory 14,5% (21) had systolic PAP > 40 mmHg (by echocardiography). Patients with higher levels of systolic PAP (Systolic PAP, mmHg 49,9 [43,6; 56,2] vs 20,7 [19,9; 23,5],p=0.000) had more severe OSA (AHI 35,7 [27,1; 44,3] vs 26,6 [22,6; 30,6], p = 0.029, ODI 3%, /h 35,8 [25,1; 46,4] vs 23,8 [19,8; 27,8], p= 0.017) and were more obese (BMI 37,1 [33,8; 40,4] vs 33,4 [32,4; 34,5], p=0.024). Prevalence of AHI > 30 /h was 62% in group with systolic PAP > 40 mmHg vs 23% in the group with systolic PAP < 40 mmHg. We observed differences in echocardiography, in group with systolic PAP > 40 mmHg: left atrium (4.6 ± 0,5 vs 4,2 ± 0,4 cm, p=0.012), left atrium volume (94.0 ± 23.6 vs 71.7 ± 16.5 ml, p=0.001) and right atrium area (24.5 ± 4.9 vs 18.4 ± 3.8cm2, p=0.000) were higher. Though ejection fraction (58.2 ± 3.8 vs 59.0 ± 3.8%, p=0.268), interventricular septum thickness (1,13 ± 0,2 vs 1,06 ± 0,3 cm, p=0,654) and left ventricular posterior wall thickness (1,05 ± 0,08 vs 1,00 ± 0,13 cm, p=0,117) didn’t differ. In terms of excessive daytime sleepiness, snoring and nocturia groups didn’t differ, as well as for the prevalence of arterial hypertension, coronary artery disease, chronic heart failure, diabetes mellitus and chronic obstructive pulmonary disease. Conclusion Pulmonary hypertension is frequently observed in patients with OSA and appears to be related to the severity of sleep apnea and obesity. PH should be considered in the regular clinical assessment of all patients with sleep apnea, especially with severe form. Support (if any):

scholarly journals FEATURES OF HEART LESIONS IN PATIENTS WITH VIRAL LIVER CIRRHOSIS

2018 ◽  
Vol 14 (3) ◽  
pp. 387-392
Author(s):  
M. V. Chistyakova ◽  
A. V. Govorin
Keyword(s):  
Liver Cirrhosis ◽  
Left Ventricle ◽  
Pulmonary Artery ◽  
Antiviral Therapy ◽  
Left Atrium ◽  
Systolic Function ◽  
Systolic Pressure ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Control Group

Aim. To study the structural and functional parameters of the heart, as well as the effect of antiviral therapy on certain cardiohemodynamic parameters in patients with viral liver cirrhosis (VLC).Material and methods. 96 patients with VLC (median age 42.1 [36;44] years, median duration of the disease – 3.5 [2.8;6.7] years) were examined. Patients without ascites (n=59) were included into the 1st group, and patients with ascites (n=37) – into the 2nd group. The control group included 21 healthy volunteers. Standard and tissue echocardiography, Holter monitoring of electrocardiogram were performed in all participants.Results. Ventricular extrasystoles (class I to IVB) were found in 8 (13%) patients of the 1st group and in 12 (33%) patients in the 2nd group. The corrected interval of QT in the patients of the 1st group was 457.9 [442;468] msec, in the second group – 478 [433;502] msec, in control – 427.9 [406;438] msec (p<0.001). Supraventricular arrhythmias were represented by supraventricular extrasystoles in 15 (25%) patients of the 1st group and 18 (50%) – of the 2nd group; paroxysmal atrial fibrillation in 2 (3%) and 7 (19%) patients, respectively. The systolic velocity Sm of the lateral wall (3, 9 segments) in patients with ascites was lower by 23% and 25%, respectively, compared with the patients of the 1st group; Tei index increased in patients with ascites compared with the control group and the 1st group, p<0.001. In patients with VLC without ascites, the parameters characterizing the mass of the myocardium of the left ventricle increased, the left atrium and pulmonary artery widened. These disorders increased in patients with ascites; besides the systolic pressure in the pulmonary artery increased, and segmental and global systolic function of the left ventricle decreased. Antiviral therapy was accompanied by a decrease in the mass of the left ventricular myocardium, the index of left atrial volume and systolic pressure in the pulmonary artery.Сonclusion. The increase in the myocardium mass of left ventricle, left atrium, pulmonary artery diameter, as well as cardiac arrhythmia and prolongation of the corrected QT interval were found in patients with VLC without ascites. These changes were more pronounced in patients with ascites, and additionally they increased pressure in the pulmonary artery and decreased systolic function of the ventricles of the heart. The antiviral therapy had a positive effect on some cardiohemodynamic parameters. 

scholarly journals Hemodynamic Support Using Percutaneous Transfemoral Impella 5.0 and Impella RP for Refractory Cardiogenic Shock

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Pratik K. Dalal ◽  
Amy Mertens ◽  
Dinesh Shah ◽  
Ivan Hanson
Keyword(s):  
Left Ventricle ◽  
Pulmonary Artery ◽  
Cardiogenic Shock ◽  
Ventricular Function ◽  
Standard Of Care ◽  
Left Ventricular ◽  
Biventricular Failure ◽  
Ventricular Support ◽  
The Right ◽  
Flow Pump

Acute myocardial infarction (AMI) resulting in cardiogenic shock continues to be a substantial source of morbidity and mortality despite advances in recognition and treatment. Prior to the advent of percutaneous and more durable left ventricular support devices, prompt revascularization with the addition of vasopressors and inotropes were the standard of care in the management of this critical population. Recent published studies have shown that in addition to prompt revascularization, unloading of the left ventricle with the placement of the Impella percutaneous axillary flow pump can lead to improvement in mortality. Parameters such as the cardiac power output (CPO) and pulmonary artery pulsatility index (PAPi), obtained through pulmonary artery catheterization, can help ascertain the productivity of right and left ventricular function. Utilization of these parameters can provide the information necessary to escalate support to the right ventricle with the insertion of an Impella RP or the left ventricle with the insertion of larger devices, which provide more forward flow. Herein, we present a case of AMI complicated by cardiogenic shock resulting in biventricular failure treated with the percutaneous insertion of an Impella RP and Impella 5.0 utilizing invasive markers of left and right ventricular function to guide the management and escalation of care.

scholarly journals Delineating the molecular and histological events that govern right ventricular recovery using a novel mouse model of pulmonary artery de-banding

2019 ◽  
Vol 116 (10) ◽  
pp. 1700-1709 ◽  
Author(s):  
Mario Boehm ◽  
Xuefei Tian ◽  
Yuqiang Mao ◽  
Kenzo Ichimura ◽  
Melanie J Dufva ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Mouse Model ◽  
Pulmonary Artery ◽  
Right Ventricular ◽  
Exercise Capacity ◽  
Pressure Overload ◽  
Left Ventricular ◽  
Sequence Of Events ◽  
Reverse Remodelling ◽  
Rv Function

Abstract Aims The temporal sequence of events underlying functional right ventricular (RV) recovery after improvement of pulmonary hypertension-associated pressure overload is unknown. We sought to establish a novel mouse model of gradual RV recovery from pressure overload and use it to delineate RV reverse-remodelling events. Methods and results Surgical pulmonary artery banding (PAB) around a 26-G needle induced RV dysfunction with increased RV pressures, reduced exercise capacity and caused liver congestion, hypertrophic, fibrotic, and vascular myocardial remodelling within 5 weeks of chronic RV pressure overload in mice. Gradual reduction of the afterload burden through PA band absorption (de-PAB)—after RV dysfunction and structural remodelling were established—initiated recovery of RV function (cardiac output and exercise capacity) along with rapid normalization in RV hypertrophy (RV/left ventricular + S and cardiomyocyte area) and RV pressures (right ventricular systolic pressure). RV fibrotic (collagen, elastic fibres, and vimentin+ fibroblasts) and vascular (capillary density) remodelling were equally reversible; however, reversal occurred at a later timepoint after de-PAB, when RV function was already completely restored. Microarray gene expression (ClariomS, Thermo Fisher Scientific, Waltham, MA, USA) along with gene ontology analyses in RV tissues revealed growth factors, immune modulators, and apoptosis mediators as major cellular components underlying functional RV recovery. Conclusion We established a novel gradual de-PAB mouse model and used it to demonstrate that established pulmonary hypertension-associated RV dysfunction is fully reversible. Mechanistically, we link functional RV improvement to hypertrophic normalization that precedes fibrotic and vascular reverse-remodelling events.

scholarly journals Interventricular septal curvature as an additional echocardiographic parameter for evaluating chronic thromboembolic pulmonary hypertension: A single-center retrospective study

2021 ◽  
Author(s):  
Akane Matsumura ◽  
Ayako Shigeta ◽  
Hajime Kasai ◽  
Hajime Yokota ◽  
Jiro Terada ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pressure Gradient ◽  
Interventricular Septum ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Left Ventricular ◽  
Accurate Estimation ◽  
Heart Catheterization ◽  
Systolic Pulmonary Artery Pressure ◽  
Additional Tool ◽  
Thromboembolic Pulmonary Hypertension

Abstract Background: Noninvasive estimation of the actual systolic pulmonary artery pressure measured via right-sided heart catheterization (sPAPRHC) is important for the management of pulmonary hypertension, including chronic thromboembolic pulmonary hypertension (CTEPH). Evaluation related to the interventricular septum (IVS) is generally performed with only visual assessment and has been rarely assessed quantitatively in the field of echocardiography. Thus, this study aimed to investigate the utility of echocardiographic IVS curvature to estimate sPAPRHC in patients with CTEPH. Methods: Data of 72 patients with CTEPH were studied retrospectively. We estimated sPAPRHC using echocardiographic IVS curvature (esPAPcurv) and left ventricular eccentricity index (esPAPLVEI), and compared their ability to predict sPAPRHC with estimated sPAPRHC using tricuspid regurgitant pressure gradient (esPAPTRPG). Results: IVS curvature and LVEI were significantly correlated with sPAPRHC (r = - 0.52 and r = 0.49, respectively). Moreover, the IVS curvature was effective in estimating the sPAPRHC of patients with trivial tricuspid regurgitation (r = - 0.56) and in determining patients with sPAPRHC ≥70 mmHg with higher sensitivity (77.0%) compared to those with esPAPTRPG and esPAPLVEI. Conclusion: Our results indicate that the echocardiographic IVS curvature could be a useful additional tool for estimating sPAPRHC in CTEPH patients in whom accurate estimation of sPAPRHC using tricuspid regurgitant pressure gradient is difficult.

scholarly journals Prediction of Extubation Readiness Using Transthoracic Ultrasound in Preterm Infants

2020 ◽  
Author(s):  
Reem M. Soliman ◽  
Yasser Elsayed ◽  
Reem N. Said ◽  
Abdulaziz M. Abdulbaqi ◽  
Rania H. Hashem ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Preterm Infants ◽  
Pulmonary Artery Pressure ◽  
Neonatal Intensive Care ◽  
Ductus Arteriosus ◽  
Interventricular Septum ◽  
Area Under The Curve ◽  
Left Ventricular ◽  
Predictive Values ◽  
Artery Pressure

ABSTRACTObjectiveTo test the hypothesis that a lung ultrasound severity score (LUSsc) and assessment of left ventricular eccentricity index of the interventricular septum (LVEI) by focused heart ultrasound can predict extubation success in mechanically ventilated preterm infants with respiratory distress syndrome (RDS).DesignProspective observational study of premature infants <34 weeks’ of gestation age supported with mechanical ventilation due to RDS. LUSsc and LVEI were performed on postnatal days 3 and 7 by an investigator who was masked to infants’ ventilator parameters and clinical conditions. RDS was classified based on LUSsc into mild (score 0–9) and moderate-severe (score 10–18). A receiver operator curve was constructed to assess the ability to predict extubation success. Pearson’s correlation was performed between LVEI and pulmonary artery pressure (PAP).SettingLevel III neonatal intensive care unit, Cairo, Egypt.ResultsA total of 104 studies were performed to 66 infants; of them 39 had mild RDS (LUSsc 0–9) and 65 had moderate-severe RDS (score ≥10). LUSsc predicted extubation success with a sensitivity and a specificity of 91% and 69%; the positive and negative predictive values were 61% and 94%, respectively. Area under the curve (AUC) was 0.83 (CI: 0.75-0.91). LVEI did not differ between infants that succeeded and failed extubation. However, it correlated with pulmonary artery pressure during both systole (r=0.62) and diastole (r=0.53) and with hemodynamically significant patent ductus arteriosus (r=0.27 and r=0.46, respectively).ConclusionLUSsc predicts extubation success in preterm infants with RDS whereas LVEI correlates with high PAP.

Norepinephrine and dobutamine improve cardiac index equally by supporting opposite sides of the heart in an experimental model of chronic pulmonary hypertension

2021 ◽  
Author(s):  
Janus Adler Hyldebrandt ◽  
Nikolaj Bøgh ◽  
Camilla Omann Christensen ◽  
Peter Agger
Keyword(s):  
Pulmonary Hypertension ◽  
Cardiac Index ◽  
Pulmonary Artery ◽  
Right Ventricular ◽  
Left Ventricular ◽  
Ventricular Contractility ◽  
End Diastolic Volume ◽  
Chronic Pulmonary Hypertension ◽  
Blood Pressures ◽  
The Right

Abstract Background: Pulmonary hypertension is a significant risk factor in patients undergoing surgery. The combined effects of general anaesthesia and positive pressure ventilation can aggravate this condition and cause increased pulmonary blood pressures, reduced systemic blood pressures and ventricular contractility. Although perioperative use of inotropic support or vasopressors is almost mandatory for these patients, preference is disputed. In this study, we investigated the effects of norepinephrine and dobutamine and their ability to improve the arterio-ventricular relationship and haemodynamics in pigs suffering from chronic pulmonary hypertension.Method: Pulmonary hypertension was induced in five pigs by banding the pulmonary artery at 2–3 weeks of age. Six pigs served as controls. After 16 weeks of pulmonary artery banding, the animals were re-examined under general anaesthesia using biventricular conductance catheters and a pulmonary artery catheter. After baseline measurements, the animals were exposed to both norepinephrine and dobutamine infusions in incremental doses, with a stabilizing period in between the infusions. The hypothesis of differences between norepinephrine and dobutamine with incremental doses was tested using repeated two-way ANOVA and Bonferroni multiple comparisons post-test. Results: At baseline, pulmonary artery banded animals had increased right ventricular pressure (+39%, p=0.04), lower cardiac index (-23% p=0.04), lower systolic blood pressure (-13%, p=0.02) and reduced left ventricular end-diastolic volume (-33%, p=0.02). When incremental doses of norepinephrine and dobutamine were administered, the right ventricular arterio-ventricular coupling was improved only by dobutamine (p<0.05). Norepinephrine increased both left ventricular end-diastolic volume and left ventricular contractility to a greater extent (p<0.05) in pulmonary artery banded animals. While the cardiac index was improved equally by norepinephrine and dobutamine treatments in pulmonary artery banded animals, norepinephrine had a significantly greater effect on mean arterial pressure (p<0.05) and diastolic arterial pressure (p<0.05).Conclusion: While norepinephrine and dobutamine improved cardiac index equally, it was obtained in different manners. Dobutamine significantly improved the right ventricular function and the arterio-ventricular coupling. Norepinephrine increased systemic resistance, thereby improving arterial pressures and left ventricular systolic function by maintaining left ventricular end-diastolic volume.

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