scholarly journals Measurement of Pulmonary Artery Wave Reflection Before and After Mitral Valvuloplasty in Canine Patients With Pulmonary Hypertension Caused by Myxomatous Mitral Valve Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Tomohiko Yoshida ◽  
Kazumi Shimada ◽  
Lina Hamabe ◽  
Tsuyoshi Uchide ◽  
Ryou Tanaka ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Wave Reflection ◽  
Systolic Pressure ◽  
Pulmonary Artery Systolic Pressure ◽  
Mitral Valvuloplasty ◽  
Before And After ◽  
Echocardiographic Parameters ◽  
Pulmonary Arterial ◽  
The Right ◽  
Arterial Wave Reflection

Background: Pulmonary arterial wave reflection provides novel information about pulmonary artery hemodynamics in pulmonary hypertension (PH). PH is common in dogs with myxomatous mitral valve disease (MMVD), though research examining the relationship between pulmonary arterial wave reflection and MMVD with PH is lacking.Hypothesis/Objective: This study investigated conventional echocardiographic parameters and pulmonary artery wave reflection parameters before and after mitral valvuloplasty in canine patients with PH due to MMVD. The parameters were backward pressure (Pb), forward pressure (Pf), and the reflection coefficient calculated as the ratio of peak Pb to peak Pf (RC).Animals: The study subjects were 10 client-owned dogs receiving mitral valvuloplasty for MMVD with PH.Methods: Conventional echocardiographic parameters and pulmonary artery wave reflection parameters were measured before and after mitral valvuloplasty. The relationships between pulmonary artery wave reflection parameters and echocardiographic parameters, estimation of pulmonary artery systolic pressure, and right atrium pressure (RAP) gained by catheter in mitral valvuloplasty were also investigated. Post-operative echocardiography and the measurement of pulmonary arterial wave reflection were performed 2 weeks after mitral valvuloplasty.Results: The parameters of normalized left ventricular internal diameter at end-diastole (LVIDDN), E velocity, and the estimation of pulmonary artery systolic pressure were significantly reduced post-operatively compared with baseline measurements (p < 0.05). Post-operative Pb decreased significantly compared with pre-operative measurements (8.8 ± 5.9 to 5.0 ± 3.2 mmHg, p = 0.037) as did RC (0.37 ± 0.15 to 0.22 ± 0.11, p < 0.01). A statistically significant positive correlation existed between wave reflection parameters and RAP, an estimation of pulmonary artery systolic pressure.Conclusions: Results demonstrate that mitral valvuloplasty can be used to treat secondary PH caused by MMVD, resulting in the improvement of post-operative echocardiographic and wave reflection parameters and a decrease in the right afterload. In some patients, some degree of vascular admittance mismatch persisted, despite the improvement of left atrial pressure. This may be indicative of residual pulmonary arterial disease, which may continue to adversely affect interactions between the right ventricle and the vasculature.

Abstract 15388: Persistent Pulmonary Hypertension After Transcatheter Aortic Valve Implantation: Impact on Mortality

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Maria Drakopoulou ◽  
Konstantinos Stathogiannis ◽  
Konstantinos Toutouzas ◽  
George Latsios ◽  
Andreas Synetos ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Aortic Stenosis ◽  
Pulmonary Artery ◽  
Severe Aortic Stenosis ◽  
Systolic Pressure ◽  
Right Atrial ◽  
Pulmonary Artery Systolic Pressure ◽  
End Point ◽  
The Right ◽  
The Impact

Objective: Severe aortic stenosis leads to increased pulmonary arterial systolic pressure. A controversy still remains regarding the impact of persistent pulmonary hypertension (PHT) on prognosis of patients undergoing transcatheter aortic valve implantation (TAVI). We sought to investigate the impact of persistent PHT on 2-year all-cause mortality of patients with severe aortic stenosis following TAVI. Methods: Patients with severe and symptomatic aortic stenosis (effective orifice area [EOA]≤1 cm 2 ) who were scheduled for TAVI with a self-expanding valve at our institution were prospectively enrolled. Prospectively collected echocardiographic data before and after TAVI were retrospectively analyzed in all patients. Pulmonary artery systolic pressure was estimated as the sum of the right ventricular to the right atrial gradient during systole and the right atrial pressure. PHT following TAVI was classified as absent if <35 mmHg and persistent if ≥35 mmHg. Primary clinical end-point was 2-year all-cause mortality defined according to the criteria proposed by the Valve Academic Research Consortium-2. Results: Hundred and forty patients (mean age: 82±9 years) were included in the study. The primary clinical end point occurred in 17 patients (12%) during a median follow-up period of 2 years. Mean pulmonary artery systolic pressure was reduced in all patients following TAVI (45±9 versus 41±6 mmHg, p<0.01). Mortality rate was higher in patients with persistent PHT compared to patients with normal pulmonary artery systolic pressure following TAVI (26% versus 14 %, p<0.01). Patients that reached the primary clinical end point had a higher post procedural mean systolic pulmonary pressure (43±9 versus 39±6 mmHg, p=0.02). In multivariate regression analysis, persistence of PHT (OR: 2.51, 95% CI: 1.109-7.224, p=0.01) was an independent predictor of long-term mortality. Conclusions: The persistence of pulmonary hypertension after TAVI is associated with long term mortality. Identifying the population that will clearly benefit from TAVI is still need to be validated by larger trials.

scholarly journals Noninvasive evaluation of pulmonary artery pressure during exercise: the importance of right atrial hypertension

2019 ◽  
Vol 55 (2) ◽  
pp. 1901617 ◽  
Author(s):  
Masaru Obokata ◽  
Garvan C. Kane ◽  
Hidemi Sorimachi ◽  
Yogesh N.V. Reddy ◽  
Thomas P. Olson ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Pressure Gradient ◽  
Systolic Pressure ◽  
Area Under The Curve ◽  
Right Atrial ◽  
Pulmonary Artery Systolic Pressure ◽  
Therapeutic Implications ◽  
Exercise Induced ◽  
The Right ◽  
Minimal Bias

IntroductionIdentification of elevated pulmonary artery pressures during exercise has important diagnostic, prognostic and therapeutic implications. Stress echocardiography is frequently used to estimate pulmonary artery pressures during exercise testing, but data supporting this practice are limited. This study examined the accuracy of Doppler echocardiography for the estimation of pulmonary artery pressures at rest and during exercise.MethodsSimultaneous cardiac catheterisation-echocardiographic studies were performed at rest and during exercise in 97 subjects with dyspnoea. Echocardiography-estimated pulmonary artery systolic pressure (ePASP) was calculated from the right ventricular (RV) to right atrial (RA) pressure gradient and estimated RA pressure (eRAP), and then compared with directly measured PASP and RAP.ResultsEstimated PASP was obtainable in 57% of subjects at rest, but feasibility decreased to 15–16% during exercise, due mainly to an inability to obtain eRAP during stress. Estimated PASP correlated well with direct PASP at rest (r=0.76, p<0.0001; bias −1 mmHg) and during exercise (r=0.76, p=0.001; bias +3 mmHg). When assuming eRAP of 10 mmHg, ePASP correlated with direct PASP (r=0.70, p<0.0001), but substantially underestimated true values (bias +9 mmHg), with the greatest underestimation among patients with severe exercise-induced pulmonary hypertension (EIPH). Estimation of eRAP during exercise from resting eRAP improved discrimination of patients with or without EIPH (area under the curve 0.81), with minimal bias (5 mmHg), but wide limits of agreement (−14–25 mmHg).ConclusionsThe RV–RA pressure gradient can be estimated with reasonable accuracy during exercise when measurable. However, RA hypertension frequently develops in patients with EIPH, and the inability to noninvasively account for this leads to substantial underestimation of exercise pulmonary artery pressures.

Elevated Estimated Pulmonary Arterial Pressures in Patients with Chuvash Polycythemia.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1634-1634
Author(s):  
Victor R. Gordeuk ◽  
Adelina I. Sergueeva ◽  
Galina Y. Miasnikova ◽  
Lydia A. Polyakova ◽  
Daniel J. Okhotin ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Tricuspid Regurgitation ◽  
Chronic Hypoxia ◽  
Primary Pulmonary Hypertension ◽  
Systolic Pressure ◽  
Pulmonary Artery Systolic Pressure ◽  
Normal Range ◽  
Pulmonary Arterial ◽  
The Mean

Abstract Chuvash polycythemia is characterized by a homozygous 598C>T mutation in VHL and up regulation of HIF-1α during normoxia. Disorders of chronic hypoxia may be complicated by the development of pulmonary hypertension. Because of the up regulation of the hypoxic response in Chuvash polycythemia, we postulated that there may be a tendency to increased pulmonary artery pressures in this condition as well. To test this hypothesis, we analyzed results for Doppler echocardiography in 15 patients with Chuvash polycythemia and 15 Chuvash individuals without polycythemia. The tricuspid regurgitation velocity (TRV) allows estimation of pulmonary artery systolic pressure. A TRV of 2.5 m/sec or higher corresponds to a pulmonary artery systolic pressure of at least 35 mm Hg (normal up to 32 mm Hg), while a TRV of 3.0 m/sec or higher to a pressure of at least 46 mm Hg. The results are summarized in the Table. Pulmonary artery pressures as estimated by tricuspid regurgitation velocity (TRV) in Chuvash subjects with and without polycythemia Chuvash polycythemia (n = 15) Controls (n = 15) P Age in years; mean (SD) 35 (17) 35 (17) 1.0 Female sex in no. (%) 8 (53%) 8 (53%) 1.0 Hemoglobin in g/dL; mean (SD) 16.7 (2.3) 13.3 (1.2) <0.001 TRV in m/sec; mean (SD) 2.2 (0.6) 1.4 (0.6) 0.001 TRV > 2.4 m/sec in no. (%) 4 (27%) 0 (0%) 0.1 Most of the patients with Chuvash polycythemia were receiving phlebotomy therapy and therefore many had hemoglobin concentrations in the upper normal range. Four of the patients with Chuvash polycythemia and none of the others had TRV ≥ 2.5 m/sec (range of 2.5 to 3.0), and mean TRVs were significantly higher in the patients with Chuvash polycythemia. Interestingly, the mean ± SD TRV in these 15 patients with Chuvash polycythemia was identical to the mean ± SD TRV that was recently reported in 195 American patients with sickle cell disease (Gladwin et al, NEJM2004;350:886), another hematological condition with a tendency to pulmonary hypertension. While the pulmonary arterial pressures detected so far in Chuvash polycythemia patients are lower than those in patients with primary pulmonary hypertension, our results suggest that pulmonary hypertension may be an unrecognized complication of Chuvash polycythemia.

scholarly journals Echocardiographic parameters related to pulmonary arterial hypertension in patients with chronic myeloid leukemia under dasatinib treatment

2021 ◽  
Vol 21 (4) ◽  
pp. 682-691
Author(s):  
Karla Poot Noh ◽  
Ernesto Hernández Jiménez ◽  
María del Rayo Juárez Santiesteban ◽  
Patricia Zaqoya Martínez ◽  
Alvaro J. Monliel Jarquin ◽  
...  
Keyword(s):  
Treatment Time ◽  
Pearson Correlation ◽  
Systolic Pressure ◽  
Pulmonary Artery Systolic Pressure ◽  
Cross Sectional ◽  
Mean Pulmonary Arterial Pressure ◽  
Ventricular Diastolic Dysfunction ◽  
Echocardiographic Parameters ◽  
Pulmonary Arterial

Introduction: The use of dasatinib in patients with CML has improved life expectancy and follow-up with transthoracic echocardiography (ECOTT) for early detection of PAH allows modifications to the treatment. Objective: To determine the echocardiographic parameters and echocardiographic probability for PAH in patients with CML treated with dasatinib. Methods: Correlation, cross-sectional, retrospective, single-center study; patients with CML treated with dasatinib were included. Spearman and Pearson correlation was used. Results: 16 patients were analyzed, mean age 53.5 years; 62.5% men, 37.5% women. The dasatinib dose was 50 mg / day in 18.7%, and 100 mg / day in 81.2%, mean pulmonary arterial pressure (mPAP) 26.3 mmHg, mean maximum tricuspid regurgitation velocity (VmxRT) 2.9 m / s, mean pulmonary artery systolic pressure (PSAP) 41 mmHg. 56.2% had right ventricular diastolic dysfunction (RVDD). 43% were categorized as low probability for PAH, 18.7% intermediate, and 37.5% as high. Relationship between PAPm and VmxRT with p = 0.012. Relationship between mPAP and RV diastolic function, with p = 0.002. Relationship between probability for PAH and mPAP, with p = 0.008. Conclusion: The echocardiographic parameters PAPm, VmxRT, PSAP, DDVD and echocardiographic probability for PAH are useful and necessary for the diagnosis of PAH. The determination of all these parameters should be carried out early and as a follow-up, since a considerable positive relationship was found for each one with the presence of PAH, which is not dependent on the treatment time or the dose of dasatinib.

scholarly journals The Effects of Dexmedetomidine Prescription in Paediatric Patients With Pulmonary Hypertension Under Congenital Heart Surgery

2020 ◽  
Author(s):  
Bahram Ghasemzadeh ◽  
Bahador Azizi ◽  
Simin Azemati ◽  
Mostafa Bagherinasab
Keyword(s):  
Blood Pressure ◽  
Pulmonary Hypertension ◽  
Pulmonary Arterial Hypertension ◽  
Pulmonary Artery ◽  
Arterial Hypertension ◽  
Systolic Blood Pressure ◽  
Systolic Pressure ◽  
Pulmonary Artery Systolic Pressure ◽  
Anesthetic Care ◽  
Pulmonary Arterial

Anesthetized patient management for pediatric patients with pulmonary arterial hypertension (PAH) is a major challenge. The aim of this study was to evaluate the ability of dexmedetomidine to reduce pulmonary arterial hypertension in patients with pulmonary arterial hypertension undergoing cardiac surgery. Sixty-six patients with pulmonary arterial hypertension underwent the study. Patients were randomly divided into two groups: group D received a dexmedetomidine injection in a dose of 1 μg/kg in the first hour and then decreased to 0.5 μg/kg/hr, injection continued after surgery until extubation in the post-anesthetic care unit (PACU). Group C received normal saline 0.9% in a similar volume. Pulmonary artery systolic pressure (PASP) and systemic systolic blood pressure (SSBP) were recorded during and after the surgery in the postanesthetic care unit. Needing vasodilators, sedatives, extubation time, and the length of ICU stay were recorded for all patients. Patients in the dexmedetomidine group showed a significant reduction in Pulmonary artery systolic pressure and Pulmonary artery systolic pressure/systemic systolic blood pressure rates during surgery and during the first 24 hours in the post-anesthetic care unit (P<0.001). The dexmedetomidine group, in comparison with the control group, needed a significantly lower dose of a vasodilator (P<0.001) and a lower dose of sedation (P<0.001). It is concluded that the use of dexmedetomidine during the surgery in children with pulmonary hypertension reduces pulmonary artery systolic pressure during and after the surgery.

scholarly journals Assessment of pulmonary artery hypertension by Doppler echocardiography and its correlation with right heart catheterization

2021 ◽  
Vol 8 (4) ◽  
pp. 523
Author(s):  
Vikrant B. Khese ◽  
Chandrakant B. Chavan ◽  
Ravi Kalra ◽  
Anirudh K. Allam ◽  
Abhinav Mohabey
Keyword(s):  
Pulmonary Artery ◽  
Systolic Pressure ◽  
Maximum Velocity ◽  
Right Heart Catheterization ◽  
Pulmonary Artery Hypertension ◽  
Pulmonary Artery Systolic Pressure ◽  
Heart Catheterization ◽  
Right Heart ◽  
Number Of Patients ◽  
Pulmonary Arterial

Background: Definitive diagnosis of pulmonary artery hypertension (PH) requires an elevated mean pulmonary arterial pressure (MPAP) of 25 mmHg at rest measured by right heart catheterization (RHC). As it is invasive mode of investigation, it is declined by many patients, echocardiography was thought to be an acceptable substitute to assess pulmonary arterial pressures. Whether there is a correlation between these measurements is controversial. The aim of this study was to assess PH by echocardiography and its correlation with RHC.Methods: Twenty-six patients aged ≥18 years with pulmonary artery hypertension with or without tricuspid regurgitation (TR) were included in this cross-sectional study. All the patients underwent a transthoracic echocardiography evaluation and were taken for RHC study within an hour.Results: The correlation between pulmonary artery acceleration time (PAAT) and pulmonary artery systolic pressure (PASP) and PAAT and MPAP was significant in all degrees of PH. In contrast, correlation between TR jet maximum velocity (TR Vmax) derived estimated pulmonary artery systolic pressure (EPASP) and PASP was significant in moderate and severe PH, while it did not correlate in mild PH.Conclusions: PAAT is easily measurable parameter and strongly correlates with the values of PASP and the MPAP obtained by right heart catheterization. Implementation of a novel method of determining EPASP from PAAT shall increase significantly the number of patients in whom TTE can be used for the assessment of pulmonary hemodynamic non-invasively.

scholarly journals P1837 The severity of acute ischemic stroke is associated with the right heart remodeling in patients with arterial hypertension

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
D Serova ◽  
V Serov ◽  
A Shutov ◽  
E Efremova ◽  
A Braun ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Pulmonary Artery ◽  
Arterial Hypertension ◽  
Right Atrium ◽  
Systolic Pressure ◽  
Pulmonary Artery Systolic Pressure ◽  
Stroke Severity ◽  
Right Heart ◽  
Nihss Score ◽  
The Right

Abstract It is known, that the right heart structural and functional abnormalities play an important role in the disregulation of venous return, however their role in the pathogenesis of ischemic stroke is still unclear. Purpose The aim of this study was to determine the relationship of echocardiographic signs of the right heart remodeling and the stroke severity in patients with arterial hypertension and ischemic stroke. Methods 98 patients with acute ischemic stroke (31 females and 67 males, mean age was 68.2 ± 12.1 years) were studied. All patients had arterial hypertension. Most of them (96.9%) had grade 3 hypertension according to ESH/ESC Guidelines for the management of arterial hypertension, 2018. Forty-two (43.1%) patients had coronary artery disease, 35 (35.4%) - atrial fibrillation (AF). The exclusion criteria was the presence of chronic obstructive pulmonary disease or other diseases associated with pulmonary hypertension. Patients were categorized according to National Institutes of Health Stroke Scale (NIHSS) severity in mild NIHSS (≤8) - 54 (55.1%) patients, moderate NIHSS (9–15) - 23 (23.5%) patients, and severe stroke NIHSS (≥16) - 21 (21.4%) patients. Median NIHSS score was 11.2 ± 1.7. All patients underwent a transthoracic echocardiography. A comparative assessment of echocardiographic parameters was performed in patients of lower (NIHSS score ≤ 4.5) and upper (NIHSS score≥14.5) quartile according to the NIHSS score. Results Linear regression analysis revealed that stroke severity was significantly correlated with right atrium end-diastolic volume (EDV) (r = 0.48, p &lt; 0.0001), right ventricular EDV (r = 0.62, p &lt; 0.0001), left atrium EDV (r = 0.41, p = 0.002), left ventricular ejection fraction (LVEF) (r = 0.4, p = 0.003) and pulmonary artery systolic pressure (PASP) (r = 0.89, p &lt; 0.0001). A multiple regression analysis showed that stroke severity was independently correlated with PASP (β=0.471, р=0.01), left atrium EDV (β=0.961, р=0.02) and LVEF (β=0.931, р=0.005) in patients with arterial hypertension and ischemic stroke. In the group of patients with the upper quartile of NIHSS score, the right atrium EDV (64.7 ± 21.1 mm versus 47.6 ± 25.2 mm, р=0.04) and PASP (25.8 ± 9.3 mm versus 20.8 ± 8.0 mm, р=0.045) were higher. The left atrium EDV was higher in patients with LVEF below 50% ( 73.3 ± 36.9 mm vs 49.9 ± 18.5 mm, р=0.02) and in patients with AF (55.3 ± 19.8 vs 36.4 ± 14.6 mm, p &lt; 0.0001). At the same time PASP did not depend on the LVEF (22.1 ± 10.7 mm vs 21.6 ± 8.1 mm, р=0.9) and the presence of AF (21.9 ± 9.0 mm vs 21.7 ± 8.1 mm, р=0.9). Conclusions In patients with arterial hypertension the severity of acute ischemic stroke is associated with increases in right atrium end-diastolic volume and in pulmonary artery systolic pressure. An increase in pulmonary artery systolic pressure in patients with arterial hypertension and ischemic stroke does not depend on the left ventricular ejection fraction and atrial fibrillation.

scholarly journals Effect of Successful Percutaneous Transvenous Mitral Commissurotomy on Pulmonary Function

2017 ◽  
Vol 32 (1) ◽  
pp. 45-49 ◽  
Author(s):  
Umme Salma Khan ◽  
AKM Monwarul Islam ◽  
Abdullah Al Shafi Majumder
Keyword(s):  
Pulmonary Artery ◽  
Systolic Pressure ◽  
Pulmonary Artery Systolic Pressure ◽  
Before And After ◽  
Procedural Complications ◽  
Percutaneous Transvenous Mitral Commissurotomy ◽  
Echocardiographic Assessment ◽  
The Mean ◽  
Hemodynamic Measurements

A total of 58 patients of severe mitral stenosis with Wilkins score < 10 were studied, all of them underwent PTMC. Spirometry and peak expiratory flow rate were done before and after PTMC. A follow up echocardiographic assessment of successful PTMC and pulmonary artery systolic pressure were taken. Two patients died of PTMC related procedural complications. There was no dropout. Hemodynamic measurements obtained by echocardiography showed improvement of mean mitral valve area from 0.764 ± 0.1257 cm2 to 1.404 ± 0.1194 cm2 after PTMC (p < 0.001). Transmitral peak pressure gradient decreased from 26.43 + 5.62 mmHg to 11.36 + 2.40 mmHg after PTMC (p < 0.001). Pulmonary artery systolic pressure was decreased from 57.73 ± 17.03 mmHg to 31.27± 8.30 mmHg after the procedure (p < 0.001). pulmonary functions - The mean FEV1 was increased from 60.18 ± 13.054 to 78.32 ± 11.874 after PTMC (p<0.001). The mean FVC was 53.80+ 12.313 before PTMC, which significantly improved to 68.57 + 11.662. PEF also showed an improvement from 223.75 + 62.3215 to 372.05 + 62.2. (p<0.001).Bangladesh Heart Journal 2017; 32(1) : 45-49

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