scholarly journals ECHOCARDIOGRAPHIC EVALUATION OF THE RIGHT HEART IN THE PULMONARY HYPERTENSION

2020 ◽  
Vol 73 (9) ◽  
pp. 1874-1877
Author(s):  
Agnieszka Wojtkowska ◽  
Michał Tomaszewski ◽  
Weronika Topyła ◽  
Sylwia Łukasik ◽  
Andrzej Wysokiński ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Gold Standard ◽  
Diagnostic Process ◽  
Heart Catheterization ◽  
Right Heart ◽  
Diagnostic Modality ◽  
Echocardiographic Evaluation ◽  
The Right ◽  
And Function

Introduction: A comprehensive assessment of right ventricular size and function, as well as evaluation of pulmonary artery pressures is an integral part of every echocardiographic examination. It is important to know the relevant guidelines but also the pitfalls of echocardiography. The aim: To determine the significance of echocardiography in the diagnostic process, prognosis and evaluation of treatment effectiveness in pulmonary hypertension. Review and Discussion: The gold standard for evaluation of size, ejection fraction, and stroke volume of the right ventricle is cardiac magnetic resonance. Whereas, the gold standard for the assessments of pulmonary artery pressures is right heart catheterization. However, echocardiography is the first diagnostic modality in the assessment of size and function of the right heart. Conclusions: Echocardiographic evaluation of the right heart plays a fundamental role in the diagnostic process of pulmonary hypertension. Echocardiography is essential to predict the course of the disease and assess the treatment efficiency.

scholarly journals Effect of abnormal right heart structures on the diagnosis of pulmonary hypertension

2018 ◽  
Vol 8 (2) ◽  
pp. 204589401877305 ◽  
Author(s):  
Batool AbuHalimeh ◽  
Milind Y. Desai ◽  
Adriano R. Tonelli
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Right Heart Catheterization ◽  
The Other ◽  
Heart Catheterization ◽  
Right Heart ◽  
Cardiac Lesions ◽  
The Right ◽  
The Impact ◽  
Heart Lesions

The diagnosis of pulmonary hypertension (PH) requires a right heart catheterization (RHC) that reveals a mean pulmonary artery pressure ≥ 25 mmHg. The pulmonary artery catheter traverse the right atrium and ventricle on its way to the pulmonary artery. The presence of abnormal right heart structures, i.e. thrombus, vegetation, benign or malignant cardiac lesions, can lead to complications during this procedure. On the other hand, avoidance of RHC delays the diagnosis and treatment of PH, an approach that might be associated with worse outcomes. This paper discusses the impact of right heart lesions on the diagnosis of PH and suggests an approach on how to manage this association.

scholarly journals Hepatic Venous Duplex as an Alternative Non- invasive Diagnostic Tool for Diagnosis of Pulmonary Hypertension

2020 ◽  
Vol 16 (2) ◽  
pp. 86-91
Author(s):  
Md Harisul Hoque ◽  
SM Mustafa Zaman ◽  
Khurshid Ahmed ◽  
Sajal Krisna Banerjee ◽  
Md Faisal Ibne Kabir ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Diagnostic Tool ◽  
Right Heart Catheterization ◽  
Diagnostic Methods ◽  
Heart Catheterization ◽  
Right Heart ◽  
Non Invasive ◽  
Close Proximity ◽  
The Right ◽  
Practical Demonstration

Pulmonary hypertension is a hemodynamic disorder defined by abnormally high pulmonary artery pressure that affects the arteries in your lungs and the right side of your heart. In this study, hepatic venous duplex will be done to diagnose and quantify the PH. So that Patients can avoid unnecessary invasive right heart catheterization. This practical demonstration is the key to enrich our experience and knowledge in the field of PH. Objectives of this study was to assess PH status by Hepatic venous Duplex (HVD) as well by right heart catheterization and to compare them. This study was conducted in the Department of Cardiology, BSMMU, Shahbagh, Dhaka extending from July 2018 to December 2019. Total 100 (One hundred) subjects were enrolled in this study. It was an Observational study and includes the subjects between 18 years to 45 years of age. Results of this study shows very close proximity to that of Right heart catheterization. Hemodynamic changes in Hepatic venous duplex study could be used as an alternative diagnostic tool for evaluating moderate to severe pulmonary hypertension. This method could counteract the weakness of the currently used diagnostic methods and improve the accuracy of assessing pulmonary hypertension when combined with other methods. University Heart Journal Vol. 16, No. 2, Jul 2020; 86-91

Diagnosis of pulmonary hypertension associated whith systemic sclerosis

2020 ◽  
Vol 5-6 (215-216) ◽  
pp. 15-23
Author(s):  
Nazym Junusbayeva ◽  
◽  
Bakytsholpan Issayeva ◽  
Keyword(s):  
Pulmonary Hypertension ◽  
Systemic Sclerosis ◽  
Clinical Symptoms ◽  
Survival Rates ◽  
Early Death ◽  
Daily Practice ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Right Heart ◽  
The Right

Systemic sclerosis is the most common autoimmune disease associated with pulmonary hypertension. Pulmonary hypertension is a potential predictor of early death, and therefore, recently, interest in a comprehensive study of the diagnosis of pulmonary hypertension associated with systemic sclerosis has been increasing among researchers. Aim. Consideration of current diagnostic issues, as well as the principles of using diagnostic algorithms to verify pulmonary hypertension associated with systemic sclerosis, applied in daily clinical practice. Material and methods. In order to study the literature data, a search was carried out for information on this problem up to 10 years in depth in the Web of Science, PubMed/MEDLINE. During the search, the following terms were used individually and in combination: "systemic sclerosis", "pulmonary hypertension", "DETECT algorithm", "catheterization of the right heart chambers". The main search criteria were studies based on the study of patients with pulmonary hypertension associated with systemic sclerosis: meta-analyzes, original studies, retrospective and cohort studies. Results and discussion. The clinical symptoms of pulmonary hypertension can be nonspecific, which greatly complicates the diagnosis of the disease in the early stages. The absence of a specific clinical picture before the development of an advanced stage of pulmonary hypertension leads to late verification of the diagnosis. Key algorithms used in the daily practice of a doctor make it possible to minimize the number of undiagnosed cases of pulmonary hypertension. Conclusions. Diagnosis of PH associated with systemic sclerosis is often challenging for clinicians to practice. Early diagnosis and therefore treatment of PH are of paramount importance as they improve survival rates in patients with systemic sclerosis. Keywords: systemic sclerosis, pulmonary hypertension, screening, DETECT algorithm, right heart catheterization.

scholarly journals Right heart catheterization for pulmonary hypertension during the coronavirus disease 2019 pandemic

2020 ◽  
Vol 10 (3) ◽  
pp. 204589402094878 ◽  
Author(s):  
Kanza N. Qaiser ◽  
James E Lane ◽  
Adriano R. Tonelli
Keyword(s):  
Pulmonary Hypertension ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Clinical Practices ◽  
Right Heart ◽  
Diagnostic Modality ◽  
Hypertension Therapy ◽  
Pulmonary Arterial ◽  
Pulmonary Arterial Hypertension Therapy

Right heart catheterization is an essential diagnostic modality in the evaluation of pulmonary hypertension. The coronavirus disease 2019 pandemic has resulted in deferral of elective procedures including right heart catheterization. The benefits of proceeding with right heart catheterization, such as further characterization of hemodynamic subtype and severity of pulmonary hypertension, initiation of targeted pulmonary arterial hypertension therapy, as well as further hemodynamic testing, need to be carefully balanced with the risk of potentially exposing both patients and health care personnel to coronavirus disease 2019 infection. This review article aims to provide best clinical practices for safely performing right heart catheterization in pulmonary hypertension patients during the coronavirus disease 2019 pandemic.

scholarly journals Genetic Analysis of Right Heart Structure and Function in 40,000 People

2021 ◽  
Author(s):  
James P. Pirruccello ◽  
Paolo Di Achille ◽  
Victor Nauffal ◽  
Mahan Nekoui ◽  
Samuel N. Friedman ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Deep Learning ◽  
Right Ventricular ◽  
Congenital Heart ◽  
Left Ventricular ◽  
Structure And Function ◽  
Right Heart ◽  
Heart Chamber ◽  
The Right ◽  
And Function

The heart evolved hundreds of millions of years ago. During mammalian evolution, the cardiovascular system developed with complete separation between pulmonary and systemic circulations incorporated into a single pump with chambers dedicated to each circulation. A lower pressure right heart chamber supplies deoxygenated blood to the lungs, while a high pressure left heart chamber supplies oxygenated blood to the rest of the body. Due to the complexity of morphogenic cardiac looping and septation required to form these two chambers, congenital heart diseases often involve maldevelopment of the evolutionarily recent right heart chamber. Additionally, some diseases predominantly affect structures of the right heart, including arrhythmogenic right ventricular cardiomyopathy (ARVC) and pulmonary hypertension. To gain insight into right heart structure and function, we fine-tuned deep learning models to recognize the right atrium, the right ventricle, and the pulmonary artery, and then used those models to measure right heart structures in over 40,000 individuals from the UK Biobank with magnetic resonance imaging. We found associations between these measurements and clinical disease including pulmonary hypertension and dilated cardiomyopathy. We then conducted genome-wide association studies, identifying 104 distinct loci associated with at least one right heart measurement. Several of these loci were found near genes previously linked with congenital heart disease, such as NKX2-5, TBX3, WNT9B, and GATA4. We also observed interesting commonalities and differences in association patterns at genetic loci linked with both right and left ventricular measurements. Finally, we found that a polygenic predictor of right ventricular end systolic volume was associated with incident dilated cardiomyopathy (HR 1.28 per standard deviation; P = 2.4E-10), and remained a significant predictor of disease even after accounting for a left ventricular polygenic score. Harnessing deep learning to perform large-scale cardiac phenotyping, our results yield insights into the genetic and clinical determinants of right heart structure and function.

scholarly journals Diagnostic value of right heart and pulmonary artery catheterization in patients with suspected pulmonary hypertension. Part 1. Methodology of the procedure, nosology of the diseases and vasoreactivity testing

2020 ◽  
Vol 26 (6) ◽  
pp. 64-76
Author(s):  
Yu. M. Sirenko ◽  
I. O. Zhyvylo ◽  
G. D. Radchenko
Keyword(s):  
Pulmonary Hypertension ◽  
Cardiac Index ◽  
Pulmonary Artery ◽  
Pulmonary Vascular Resistance ◽  
Vascular Resistance ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Pulmonary Artery Catheterization ◽  
Right Heart ◽  
The Mean

The aim – critical review of our own experience, its compliance with current recommendations and data from international registries, as also assessment of pulmonary and systemic hemodynamics obtained in patients with pulmonary arterial hypertension (PAH) in Ukraine. Materials and methods. 220 procedures of the right heart and pulmonary artery catheterization were performed in 195 patients with medium or high probability of PAH according to echocardiography in compliance with current recommendations. All patients were hospitalized at National Scientific Center “M.D. Strazhesko Institute of Cardiology” of NAMS of Ukraine with suspected PAH (primary) or with worsening of the disease course (repeatedly) or in order to confirm the status of vasoreactivity (repeated).Results and discussion. 220 successful catheterization procedures were performed. Primary (diagnostic) right heart catheterization was performed in 195 patients, and repeated – in 25. A diagnosis of pulmonary hypertension was confirmed in 178 patients. In 17 patients, according to the results of catheterization, the diagnosis of PAH was excluded: the mean pressure in the pulmonary artery was less than 20 mm Hg. The structure of nosology in patients who underwent right heart catheterization was as follows: idiopathic PAH was fixed in 68 (38 %) patients, of which 11 (6 %) were vasoreactive; PAH associated with connective tissue diseases – in 21 (12 %) patients; PAH associated with HIV infection in – 4 (2 %) patients; PAH associated with portal hypertension – in 4 (2 %) patients; PAH associated with congenital heart disease – in 26 (15 %) patients; chronic thromboembolic pulmonary hypertension – in 50 (28 %) patients. Vasoreactivity testing was performed in 33 patients with idiopathic PAH. In 11 of them it was positive (33 %). In patients with a positive vasoreactivity testing, the mean pulmonary artery pressure decreased by an average of 21.8 mm Hg to the level of 26.5 mm Hg (p 0.0001), while the cardiac index increased by 31 % and reached 3.8 l · min · m–2 (p<0.1). Pulmonary vascular resistance decreased by 6.4 Wood units to the level of 2.7 Wood units (p<0.0001). In patients with a negative vasoreactivity testing, the decrease in mean pulmonary artery pressure and pulmonary vascular resistance was not statistically significant (p>0.05), and no changes in the cardiac index were detected. Conclusions. Based on the experience of our center, hemodynamic assessment using catheterization is safe and remains the diagnostic standard for PAH. Catheterization is necessary to clarify 4 parameters that are critical for the clinical profile of patients with pulmonary hypertension: right atrium pressure, pulmonary vascular resistance, cardiac output, pulmonary wedge pressure. Patients with idiopathic PAH also need to have vasoreactivity evaluated in order to predict sensitivity to calcium channel blockers therapy, the presence of which is associated with better treatment and survival outcomes.

scholarly journals Preoperative Evaluation of Pulmonary Hypertension in Lung Transplant Candidates: Echocardiography Versus Right Heart Catheterization

2021 ◽  
Author(s):  
Tal Abu ◽  
Amos Levi ◽  
David Hasdai ◽  
Mordechai R. Kramer ◽  
Tamir Bental ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Preoperative Evaluation ◽  
Systolic Pressure ◽  
Area Under The Curve ◽  
Right Heart Catheterization ◽  
Mean Value ◽  
Pulmonary Artery Systolic Pressure ◽  
Heart Catheterization ◽  
Right Heart

Abstract Background - Right heart catheterization (RHC) and echocardiography are both routinely used for pulmonary artery systolic pressure (PASP) assessment in lung transplantation (LT) candidates, although this is not mandated by current guidelines. We aimed to explore the correlation between PASP estimated by echocardiography to that measured by RHC, in this population in order to assess the necessity of RHC. Methods - From a retrospective registry of 393 LT candidates undergoing RHC and echocardiography during 2015-2019, patients were assessed for the presence of pulmonary hypertension (PH), defined as mean pulmonary artery pressure (mPAP) above 20 mmHg, according to two methods – echocardiography and RHC. The primary outcome was the correlation between the PASP estimated by echocardiography to that measured by RHC. Secondary outcomes were the prediction value of the echocardiographic evaluation and its accuracy. Results - The mean value of PASP estimated by echocardiography was 49.5±20.0 mmHg, compared to 42.5±18.0 mmHg measured by RHC. The correlation between the two measurements was moderate (Pearson’s correlation: r=0.609, p<0.01). Echocardiography PASP measurements were moderately discriminative to diagnose PH, with an area under the curve (AUC) of 0.72 (95% CI 0.66-0.76). Echocardiographic overestimation of PASP of more than 10 mmHg was found in 35.0% of the patients, and underestimation was found in 11.6% of the patients.Conclusion - In the pre-surgical evaluation of LT candidates, echocardiographic estimation of PASP had moderate correlation and limited accuracy compared to the PASP measured by RHC. We thus recommend performing routine RHC to all LT candidates, regardless of the echocardiographic estimation of PASP.

scholarly journals Accuracy of Echocardiographic Estimates of Pulmonary Artery Pressures in Pulmonary Hypertension: Insights From the KARUM Hemodynamic Database

2021 ◽  
Author(s):  
Ashwin Venkateshvaran ◽  
Natavan Seidova ◽  
Hande Oktay Tureli ◽  
Barbro Kjellström ◽  
Lars H Lund ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Population Studies ◽  
Right Heart Catheterization ◽  
Right Atrial ◽  
Heart Catheterization ◽  
Limits Of Agreement ◽  
Right Heart ◽  
Minimal Bias

Abstract BACKGROUND. Accurate assessment of pulmonary artery (PA) pressures is integral to diagnosis, follow-up and therapy selection in pulmonary hypertension (PH). Despite wide utilization, the accuracy of echocardiography to estimate PA pressures has been debated. We aimed to evaluate echocardiographic accuracy to estimate right heart catheterization (RHC) based PA pressures in a large, dual-centre hemodynamic database. METHODS. Consecutive PH referrals that underwent comprehensive echocardiography within 3 hours of clinically indicated right heart catheterization were enrolled. Subjects with absent or severe, free-flowing tricuspid regurgitation (TR) were excluded. Accuracy was defined as mean bias between echocardiographic and invasive measurements on Bland-Altman analysis for the cohort and estimate difference within ±10mmHg of invasive measurements for individual diagnosis. RESULTS. In 419 subjects, echocardiographic PA systolic and mean pressures demonstrated minimal bias with invasive measurements (+2.4 and +1.9mmHg respectively) but displayed wide limits of agreement (-20 to +25 and -14 to +18mmHg respectively) and frequently misclassified subjects. Recommendation-based right atrial pressure (RAP) demonstrated poor precision and was falsely elevated in 32% of individual cases. Applying a fixed, median RAP to echocardiographic estimates resulted in relatively lower bias between modalities when assessing PA systolic (+1.4mmHg; 95% limits of agreement +25 to –22mmHg) and PA mean pressures (+1.4mmHg; 95% limits of agreement +19 to -16mmHg).CONCLUSIONS. Echocardiography accurately represents invasive PA pressures for population studies but may be misleading for individual diagnosis owing to modest precision and frequent misclassification. Recommendation-based estimates of RAPmean may not necessarily contribute to greater accuracy of PA pressure estimates.

Acute hemodynamic changes and long term prognostic impact of pulmonary hypertension in patients undergoing percutaneous mitral valve edge to edge repair

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B Koell ◽  
S Ludwig ◽  
O Bhadra ◽  
A Gossling ◽  
N Schofer ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Mitral Valve ◽  
Pulmonary Artery ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Prognostic Impact ◽  
Right Heart ◽  
The Impact

Abstract Background Pulmonary hypertension (PH) due to left heart disease is the most common form of PH. Published literature suggests increased perisurgical mortality in patients undergoing surgical repair in the setting of preexisting PH. The data on the impact of preexisting PH on clinical outcomes after percutaneous Mitral Valve Edge-to-Edge Repair (pMVR) is limited to observational studies and rely mostly on echocardiographic data. Purpose The aim of the current study is to evaluate the influence of preexisting PH in patients undergoing pMVR analyzing periprocedural invasive right heart catheterization data. Methods Between September 2008 and July 2018, a total of 911 patients with moderate-to-severe or severe mitral regurgitation (MR) underwent pMVR at our center. This analysis includes 331 patients with a complete data set for pre- and postprocedural right heart catheterization and echocardiographic assessment as well as available follow-up information after the implantation. Patients are divided according to the etiology of PH. The combined primary endpoint consists of all-cause mortality and rehospitalization for heart failure. Furthermore, a sub-analysis is performed for all patients with preexisting post-capillary PH. Patients with post-capillary PH are divided into two groups based on a postprocedural decrease of pulmonary artery wedge pressure (mPAWP) below the threshold of 15mmHg. Univariate and multivariate Cox regression analyses are performed to assess the influence on long-term outcome. Results Of all 331 patients (57.7% [n= 191] male) undergoing pMVR, 195 (62.1%) had functional MR. Median ejection fraction was 40.5% (29.3, 54.0). Patients were followed-up for a maximum of 4.41 years and the median follow-up time was 1.98 years. Preexisting PH (mean pulmonary artery pressure ≥25 mmHg) was found in 236 (71.1%) patients: 49 patients had pre-capillary PH (≤15 mmHg), 187 had post-capillary PH (pcPH; n=183; mPAWP &gt;15 mmHg). In Kaplan-Meier analysis, no statistically significant difference could be found in overall mortality in patients without or with PH, irrespective of etiology (p=0.43). However, in patients suffering from post-capillary PH, patients with a postprocedural reduction of mPAWP below the threshold of 15mmHg showed a significantly lower risk for overall long-term mortality compared to patients without a relevant mPAWP reduction (p=0.018). Multivariate analysis revealed acute postprocedural decrease of mPAWP below 15mmHg in patients with post-capillary PH to have a significant influence on mortality (HR 2.81 [1.35, 5.86]; p=0.006; Figure 1). Conclusion In contrast to previously published findings, the present results were not able to show a significant impact of PH, disregarding its etiology, on outcome. Nevertheless, a postprocedural decrease of mPAWP below 15mmHg in patients with post-capillary PH is associated with a favorable outcome. Figure 1 Funding Acknowledgement Type of funding source: None

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