scholarly journals Use of Noninvasive Gas Exchange to Track pulmonary Vascular Responses to exercise in Heart Failure

2013 ◽  
Vol 7 ◽  
pp. CCRPM.S12178 ◽  
Author(s):  
Bryan J. Taylor ◽  
Thomas P. Olson ◽  
Chul-Ho-Kim ◽  
Dean Maccarter ◽  
Bruce D. Johnson
Keyword(s):  
Heart Failure ◽  
Gas Exchange ◽  
Pulmonary Arterial Pressure ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Pulmonary Wedge Pressure ◽  
Non Invasive ◽  
Pulmonary Arterial ◽  
Response To Exercise ◽  
Wedge Pressure

We determined whether a non-invasive gas exchange based estimate of pulmonary vascular (PV) capacitance [PVCAP = stroke volume (SV) x pulmonary arterial pressure (Ppa)] (GXCAP) tracked the PV response to exercise in heart-failure (HF) patients. Pulmonary wedge pressure (Ppw), Ppa, PV resistance (PVR), and gas exchange were measured simultaneously during cycle exercise in 42 HF patients undergoing right-heart catheterization. During exercise, PETCO2 and VE/VCO2 were related to each other ( r= -0.93, P < 0.01) and similarly related to mean Ppa (mPpa) ( r = -0.39 and 0.36; P < 0.05); PETCO2 was subsequently used as a metric of mPpa. Oxygen pulse (O2 pulse) tracked the SV response to exercise (r = 0.91, P < 0.01). Thus, GXCAP was calculated as O2 pulse x PETCO2. During exercise, invasively determined PVCAP and non-invasive GXCAP were related (r = 0.86, P < 0.01), and GXCAP correlated with mPpa and PVR (r = -0.46 and -0.54; P < 0.01). In conclusion, noninvasive gas exchange measures may represent a simple way to track the PV response to exercise in HF.

THE NATURAL HISTORY OF PULMONARY HYPERTENSION IN CHILDREN WITH VENTRICULAR SEPTAL DEFECTS ASSESSED BY SERIAL RIGHT-HEART CATHETERIZATION

PEDIATRICS ◽  
1961 ◽  
Vol 27 (4) ◽  
pp. 621-626
Author(s):  
Robert E. Stanton ◽  
Donald C. Fyler
Keyword(s):  
Natural History ◽  
Arterial Pressure ◽  
Pulmonary Arterial Pressure ◽  
Clinical Status ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Ventricular Septal Defects ◽  
Septal Defects ◽  
History Of ◽  
Pulmonary Arterial

The natural history of the pulmonary arterial pressure in 23 children with isolated ventricular septal defects has been evaluated by serial night heart catheterization. In none of the 23 patients was there a significant increase in pulmonary arterial pressure. Eight patients showed a significant decrease. The direction of shunts did not change between procedures, and the clinical status was stable. Our experience correlated well with the majority of institutions. It would appear that the natural course of pulmonary arterial pressure in ventricular septal defect is not commonly one of progressive rise.

scholarly journals Investigating Cardiac MRI Based Right Ventricular Contractility as a Novel Non-Invasive Metric of Pulmonary Arterial Pressure

2014 ◽  
Vol 8s1 ◽  
pp. CMC.S15711 ◽  
Author(s):  
Prahlad G. Menon ◽  
Srilakshmi M. Adhypak ◽  
Ronald B. Williams ◽  
Mark Doyle ◽  
Robert W. W. Biederman
Keyword(s):  
Systolic Pressure ◽  
Right Heart Catheterization ◽  
Three Dimensions ◽  
Heart Catheterization ◽  
Ventricular Contractility ◽  
Shape Variation ◽  
Predictive Values ◽  
Non Invasive ◽  
Pulmonary Arterial ◽  
Rv Function

Background We test the hypothesis that cardiac magnetic resonance (CMR) imaging-based indices of four-dimensional (4D) (three dimensions (3D) + time) right ventricle (RV) function have predictive values in ascertaining invasive pulmonary arterial systolic pressure (PASP) measurements from right heart catheterization (RHC) in patients with pulmonary arterial hypertension (PAH). Methods We studied five patients with idiopathic PAH and two age and sex-matched controls for RV function using a novel contractility index (CI) for amplitude and phase to peak contraction established from analysis of regional shape variation in the RV endocardium over 20 cardiac phases, segmented from CMR images in multiple orientations. Results The amplitude of RV contractility correlated inversely with RV ejection fraction (RVEF; R2 = 0.64, P = 0.03) and PASP ( R2 = 0.71, P = 0.02). Phase of peak RV contractility also correlated inversely to RVEF ( R2 = 0.499, P = 0.12) and PASP ( R2 = 0.66, P = 0.04). Conclusions RV contractility analyzed from CMR offers promising non-invasive metrics for classification of PAH, which are congruent with invasive pressure measurements.

Rapid transition from oral selexipag to parenteral treprostinil in a patient with mixed-etiology pulmonary hypertension

2020 ◽  
Vol 77 (15) ◽  
pp. 1208-1212
Author(s):  
John J Radosevich ◽  
Audra DeChristopher ◽  
Maykel Irandost ◽  
Jade Fann ◽  
Jeremy Feldman
Keyword(s):  
Receptor Agonist ◽  
Pulmonary Arterial Pressure ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Target Dose ◽  
Right Heart ◽  
Prostacyclin Receptor ◽  
Rapid Transition ◽  
Pulmonary Arterial ◽  
Mild Headache

Abstract Purpose Selexipag is an oral nonprostanoid IP prostacyclin receptor agonist that is indicated for treatment of pulmonary arterial hypertension (PAH). In patients with continued symptoms of PAH despite maximized oral therapy with selexipag and other oral therapies, a transition to parenteral prostacyclin may be warranted. There is a paucity of data regarding how to safely transition from oral selexipag to parenteral treprostinil. We describe rapid transition from oral selexipag to parenteral treprostinil in this case report. Summary A 65-year-old female with mixed-etiology PAH as result of pulmonary fibrosis related to polymyositis was admitted to the intensive care unit to be transitioned from selexipag to treprostinil due to dyspnea at rest despite therapy with selexipag 1,600 mg twice daily and macitentan 10 mg daily for 3 years. At baseline the patient required oxygen support (4 L/min) at rest to maintain oxygen saturation at or above 90%. Right heart catheterization performed 8 weeks prior to admission revealed severe PAH, with a pulmonary arterial pressure of 73/27 mm Hg and pulmonary vascular resistance of 10 Wood units. On the day of admission the patient was given selexipag 800 µg at 9 am and simultaneously started on intravenous (i.v.) treprostinil at a dose of 2 ng/kg/min. The treprostinil dose was increased by 2 ng/kg/min every 3 hours until a target dose of 22 ng/kg/min was achieved, at which point the patient had experienced dyspnea improvement. She experienced a mild headache and flushing during rapid treprostinil dose escalation. After 30 hours of i.v. treprostinil infusion, the patient was transitioned to subcutaneous treprostinil therapy and discharged. Conclusion In this case the patient was rapidly transitioned from oral selexipag to i.v. and then subcutaneous treprostinil therapy over a 30-hour period, with minimal adverse effects.

Effect of cold pressor test on single-breath DLCO in normal subjects

1994 ◽  
Vol 76 (2) ◽  
pp. 750-755 ◽  
Author(s):  
A. Frans ◽  
E. Lampert ◽  
O. Kallay ◽  
B. Nejadnik ◽  
C. Veriter ◽  
...  
Keyword(s):  
Pulmonary Arterial Pressure ◽  
Raynaud’S Phenomenon ◽  
Cold Pressor Test ◽  
Cold Pressor ◽  
Normal Subjects ◽  
Raynaud's Phenomenon ◽  
Pulmonary Wedge Pressure ◽  
Single Breath ◽  
Pulmonary Arterial ◽  
Wedge Pressure

We hypothesized that the decrease in single-breath diffusing capacity of CO (DLCO) as observed in patients with Raynaud's phenomenon (P.J. Fahey et al. Am. J. Med. 76:263–269, 1984) may be present in normal subjects. Therefore, we examined 31 healthy subjects in two different laboratories. Two series of experiments were performed. In the first series DLCO was measured in 22 volunteers before (twice) and 5, 10, and 30 min after a cold pressor test (CPT), which consisted of immersing both hands in a 12 degrees C water bath for 2 min. In the second series right heart catheterization was performed in nine healthy seated subjects. Cardiac output, mean pulmonary arterial pressure, heart rate, and pulmonary wedge pressure were measured before, during, and 10, 20, and 30 min after the CPT. In every volunteer the CPT induced a decrease in DLCO that was still present 30 min after the test. In the nine catheterized subjects DLCO increased above control values during the CPT and then decreased below control values for 30 min. The CPT had no effect on cardiac output, heart rate, or pulmonary wedge pressure. In contrast, pulmonary arterial pressure and pulmonary vascular resistance increased during the CPT and then became lower than the control values for at least 30 min. In summary, the CPT induced a biphasic evolution of DLCO in normal subjects, being increased during the CPT and decreased after it. Our data are best explained by the West model of the lung. Our data suggest that the pulmonary Raynaud's phenomenon is not specific to patients with primary Raynaud's phenomenon.(ABSTRACT TRUNCATED AT 250 WORDS)

scholarly journals Right ventricle performances with echocardiography and 99mTc myocardial perfusion imaging in pulmonary arterial hypertension patients

2018 ◽  
Vol 243 (9) ◽  
pp. 754-761
Author(s):  
Jie Liu ◽  
Lei Fei ◽  
Guang-Qing Huang ◽  
Xiao-Ke Shang ◽  
Mei Liu ◽  
...  
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Myocardial Perfusion ◽  
Arterial Pressure ◽  
Right Ventricle ◽  
Arterial Hypertension ◽  
Pulmonary Arterial Pressure ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Mean Pulmonary Arterial Pressure ◽  
Pulmonary Arterial

Right heart catheterization is commonly used to measure right ventricle hemodynamic parameters and is the gold standard for pulmonary arterial hypertension diagnosis; however, it is not suitable for patients’ long-term follow-up. Non-invasive echocardiography and nuclear medicine have been applied to measure right ventricle anatomy and function, but the guidelines for the usefulness of clinical parameters remain to be established. The goal of this study is to identify reliable clinical parameters of right ventricle function in pulmonary arterial hypertension patients and analyze the relationship of these clinical parameters with the disease severity of pulmonary arterial hypertension. In this study, 23 normal subjects and 23 pulmonary arterial hypertension patients were recruited from January 2015 to March 2016. Pulmonary arterial hypertension patients were classified into moderate and severe pulmonary arterial hypertension groups according to their mean pulmonary arterial pressure levels. All the subjects were subjected to physical examination, chest X-ray, 12-lead electrocardiogram, right heart catheterization, two-dimensional echocardiography, and technetium 99m (99mTc) myocardial perfusion imaging. Compared to normal subjects, the right heart catheterization indexes including right ventricle systolic pressure, right ventricle end diastolic pressure, pulmonary artery systolic pressure, pulmonary artery diastolic pressure, pulmonary vascular resistance, and right ventricle end systolic pressure increased in pulmonary arterial hypertension patients and were correlated with mean pulmonary arterial pressure levels. Echocardiography parameters, including tricuspid regurgitation peak velocity, tricuspid regurgitation pressure gradient, tricuspid annular plane systolic excursion and fractional area, right ventricle-myocardial performance index, were significantly associated with the mean pulmonary arterial pressure levels in pulmonary arterial hypertension patients. Furthermore, myocardial perfusion imaging was not observed in the normal subjects but in pulmonary arterial hypertension patients, especially severe pulmonary arterial hypertension subgroup, and showed potential diagnostic properties for pulmonary arterial hypertension. In conclusion, mean pulmonary arterial pressure levels are correlated with several right heart catheterization and echocardiography markers in pulmonary arterial hypertension patients; echocardiography and 99mTc myocardial perfusion can be used to evaluate right ventricle performance in pulmonary arterial hypertension patients. Impact statement In this study, we analyzed the clinical parameters for evaluating RV function, including right ventricle catheterization (RHC), echocardiography, and technetium 99m (99mTc) myocardial perfusion imaging (MPI) in normal Asian subjects and PAH patients ( n = 23 for each group). Our results demonstrated that six RHC indexes, four echocardiography indexes and MPI index were significantly altered in PAH patients and correlated with the levels of mean pulmonary arterial pressure. Importantly, we evaluated the diagnostic performance of MPI and found that MPI has a strong diagnostic accuracy in PAH patients. The findings from this study will be of interest to clinical investigators who make diagnosis and therapeutic strategies for PAH patients.

Abstract 17184: An Increase in the Respiratory Effort Immediately Intensifies the Hemodynamic Congestion; a Mechanism for Progressive Cardiac Decompensation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Noa Markovitch ◽  
Shmuel Rispler ◽  
Yair Feld ◽  
Amir Solomonica ◽  
Sergey Yalonetsky ◽  
...  
Keyword(s):  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Respiratory Effort ◽  
Vicious Cycle ◽  
Right Heart ◽  
Pulmonary Wedge Pressure ◽  
Cardiac Decompensation ◽  
Respiratory Waves ◽  
Respiratory Wave ◽  
Wedge Pressure

Introduction: An increase in the pulmonary wedge pressure (PCWP) is associated with an increase in the respiratory effort and the sensation of dyspnea. Hypothesis: We investigated the inverse cause and effect relationship, whether an increase in the respiratory effort can by itself aggravate the hemodynamic congestion. Methods: We scrutinized the cardiopulmonary interactions by simultaneously measuring hemodynamic and respiratory indices in heart failure (HF) patients undergoing right heart catheterization. The immediate effects of the respiratory effort on the hemodynamic indices were analyzed by asking the patients to perform short events of apnea and intentional vigorous breathing. The cardiac waves are superimposed on the respiratory waves in the PCWP. To quantify the respiratory effort, the PCWP was decomposed into cardiac and respiratory waves. The respiratory effort (PRESP) was defined as the peak to peak swing in the respiratory wave that modulated the PCWP. Results: HF patients (n=38) exhibited a high PRESP of 9.0±3.2 mmHg, ~3.5-fold higher than the reported normal respiratory effort. The end-expiratory PCWP rose with PRESP, by 0.83±0.06 mmHg for every 1 mmHg of PRESP (p<0.01). The pulmonary artery pressure (PAP) rose with PRESP by 1.40±0.09 mmHg for every 1 mmHg of PRESP. The changes in the respiratory effort had immediate effect on PCWP, within a single breathing-cycle (t =1.67±0.40 s) in all patients. Interestingly, similar changes in the PCWP with PRESP were obtained in all the patients, independently of the HF etiology. Conclusions: An increase in the respiratory effort is not just a result of cardiac decompensation. The respiratory effort has immediate detrimental effects on the PCWP, PAP and the workloads of the heart. The results highlight the existence of a cardiopulmonary vicious cycle the can lead to progressive decompensation, where the respiratory effort plays a pivotal role.

scholarly journals 70 Estimation of pulmonary arterial pressures by tricuspid regurgitation: a comparison with invasive data

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Federico Landra ◽  
Giulia Elena Mandoli ◽  
Benedetta Chiantini ◽  
Maria Barilli ◽  
Giacomo Merello ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Heart Transplantation ◽  
Tricuspid Regurgitation ◽  
High Specificity ◽  
Right Heart Catheterization ◽  
Advanced Heart Failure ◽  
Heart Catheterization ◽  
Right Heart ◽  
Pulmonary Arterial

Abstract Aims The evaluation of the haemodynamic of pulmonary circulation is essential in various pathological conditions. Right heart catheterization (RHC) is the gold standard for the measurement of pressures and resistances in this context. However, since indications for RHC are limited, a more accessible estimation method would be helpful. This study aimed to explore the reliability of an echocardiographic method based on tricuspid regurgitation (TR) to estimate mean, systolic and diastolic pulmonary arterial (PA) pressures in a cohort of patients with advanced heart failure considered for heart transplantation. Methods and results All consecutive patients with advanced heart failure considered for heart transplantation from 2016 to 2021 that had already performed right heart catheterization (RHC) as part of the workup and with an available echocardiographic exam were included (n = 91). Mean PA pressure was obtained adding mean right ventricular-right atrial (RV-RA) gradient to mean RA pressure. Systolic PA pressure was obtained adding maximum RV-RA gradient to mean RA pressure. Diastolic PA pressure was derived from mean and systolic PA pressures. Results were compared with PA pressures by RHC. Median time between RHC and echocardiography was 0 months [interquartile range (IQR): 0–3.5]. Median age was 58 years (IQR: 52–61.5), most of the patients were men (83.5%). The absolute mean difference between mean, systolic and diastolic PA pressures by RHC and echocardiography was 0.46 ±9.78 mmHg, 2.18 ±12.92 mmHg and −2.30 ±8.61 mmHg, respectively. PA pressures by echocardiography significantly correlated with PA pressures by RHC (mean PA pressure: r = 0.460, P &lt; 0.001; systolic PA pressure: r = 0.520, P &lt; 0.001; diastolic PA pressure: r = 0.372, P &lt; 0.001). AUC for prediction of pulmonary hypertension, defined as mean PA &gt; 25 mmHg, by mean PA pressure by echocardiography was 0.828 and a cut-off of 25.5 mmHg demonstrated a high specificity (sensibility 66.7%, specificity 93.2%). Conclusions Estimation of pulmonary arterial pressures through an echocardiographic method mainly based on tricuspid regurgitation gradients is reliable and an estimated mean pulmonary arterial pressure &gt;25.5 mmHg has a high specificity for predicting pulmonary hypertension.

Abstract 15161: Increased Right Atrial Stiffness in Patients With Heart Failure With Preserved Ejection Fraction and Pulmonary Hypertension

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jessie van Wezenbeek ◽  
Arno van der Bovenkamp ◽  
Jeroen N Wessels ◽  
Sophia-Anastasia Mouratoglou ◽  
Marie Jose Goumans ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Ejection Fraction ◽  
Right Heart Catheterization ◽  
Right Atrial ◽  
Heart Catheterization ◽  
Preserved Ejection Fraction ◽  
Chamber View ◽  
Patients With Heart Failure ◽  
Pulmonary Arterial

Background: Patients with Heart Failure with preserved Ejection Fraction (HFpEF) and Pulmonary Hypertension (PH) have increased right atrial (RA) pressures. Whether the higher RA pressures are related to increased afterload or overall stiffening of the heart is unknown. The aim of this study is to gain further insight into the right atrium in HFpEF-PH. Methods: This is a retrospective analysis of patients with HFpEF (no PH), HFpEF-PH and Pulmonary Arterial Hypertension (PAH) that underwent right heart catheterization and cardiac magnetic resonance (CMR) imaging. CMR was used to determine RA function by quantifying volume and strain on the 4-chamber view. Total, passive and active RA emptying fraction (RAEF) were calculated. RA stiffness was calculated by determining the slope of maximum and minimum pressure during v-wave and minimal and maximal RA volumes. Groups were compared with ANOVA and post-hoc comparison with Bonferroni correction. Results: 176 patients were included: 13 HFpEF, 33 HFpEF-PH and 130 PAH patients. Although afterload was lower in PAH and higher in HFpEF patients, as shown by mean pulmonary arterial pressure (mPAP) (41 ± 2 mmHg in HFpEF-PH vs 53 ± 21 mmHg in PAH vs 19 ± 1 mmHg in HFpEF, p<0.001) and pulmonary vascular resistance (PVR) (2.3 ± 0.3 wu/m 2 in HFpEF-PH vs 5.7 ± 0.2 wu/m 2 in PAH vs 0.4 ± 0.06 wu/m 2 in HFpEF, p<0.001), mean RA pressure was significantly higher in HFpEF-PH patients compared to both groups (Figure 1A). HFpEF-PH patients had significantly increased RA stiffness compared to HFpEF and PAH patients (Figure 1B). Total RAEF was reduced in HFpEF-PH compared to PAH and HFpEF patients: passive RAEF was similar, but active RAEF was slightly reduced in HFpEF-PH (Figure 1C). This was in line with measurements of RA longitudinal strain (Figure 1D). Conclusions: Despite lower afterload, HFpEF-PH patients have worse RA function and increased RA stiffness compared to PAH. Higher RA pressures in HFpEF-PH may reflect additional stiffening of the heart.

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