pulmonary capillary
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Author(s):  
Dustin Hillerson ◽  
Richard Charnigo ◽  
Sun Moon Kim ◽  
Amrita Iyengar ◽  
Matthew Lane ◽  
...  

Background: Hemodynamic values from right heart catheterization aid diagnosis and clinical decision-making but may not predict outcomes. Mixed venous oxygen saturation percentage and pulmonary capillary wedge pressure relate to cardiac output and congestion, respectively. We theorized that a novel, simple ratio of these measurements could estimate cardiovascular prognosis. Methods: We queried Veterans Affairs’ databases for clinical, hemodynamic, and outcome data. Using the index right heart catheterization between 2010 and 2016, we calculated the ratio of mixed venous oxygen saturation-to-pulmonary capillary wedge pressure, termed ratio of saturation-to-wedge (RSW). The primary outcome was time to all-cause mortality; secondary outcome was 1-year urgent heart failure presentation. Patients were stratified into quartiles of RSW, Fick cardiac index (CI), thermodilution CI, and pulmonary capillary wedge pressure alone. Kaplan-Meier curves and Cox proportional hazards models related comparators with outcomes. Results: Of 12 019 patients meeting inclusion criteria, 9826 had values to calculate RSW (median 4.00, interquartile range, 2.67–6.05). Kaplan-Meier curves showed early, sustained separation by RSW strata. Cox modeling estimated that increasing RSW by 50% decreases mortality hazard by 19% (estimated hazard ratio, 0.81 [95% CI, 0.79–0.83], P <0.001) and secondary outcome hazard by 28% (hazard ratio, 0.72 [95% CI, 0.70–0.74], P <0.001). Among the 3793 patients with data for all comparators, Cox models showed RSW best associated with outcomes (by both C statistics and Bayes factors). Furthermore, pulmonary capillary wedge pressure was superior to thermodilution CI and Fick CI. Multivariable adjustment attenuated without eliminating the association of RSW with outcomes. Conclusions: In a large national database, RSW was superior to conventional right heart catheterization indices at assessing risk of mortality and urgent heart failure presentation. This simple calculation with routine data may contribute to clinical decision-making in this population.


Author(s):  
Navin K. Kapur ◽  
Michael S. Kiernan ◽  
Irakli Gorgoshvili ◽  
Rayan Yousefzai ◽  
Esther E. Vorovich ◽  
...  

Background: Reducing congestion remains a primary target of therapy for acutely decompensated heart failure. The VENUS-HF EFS (VENUS-Heart Failure Early Feasibility Study) is the first clinical trial testing intermittent occlusion of the superior vena cava with the preCARDIA system, a catheter mounted balloon and pump console, to improve decongestion in acutely decompensated heart failure. Methods: In a multicenter, prospective, single-arm exploratory safety and feasibility trial, 30 patients with acutely decompensated heart failure were assigned to preCARDIA therapy for 12 or 24 hours. The primary safety outcome was a composite of major adverse cardiovascular and cerebrovascular events through 30 days. Secondary end points included technical success defined as successful preCARDIA placement, treatment, and removal and reduction in right atrial and pulmonary capillary wedge pressure. Other efficacy measures included urine output and patient-reported symptoms. Results: Thirty patients were enrolled and assigned to receive the preCARDIA system. Freedom from device- or procedure-related major adverse events was observed in 100% (n=30/30) of patients. The system was successfully placed, activated and removed after 12 (n=6) or 24 hours (n=23) in 97% (n=29/30) of patients. Compared with baseline values, right atrial pressure decreased by 34% (17±4 versus 11±5 mm Hg, P <0.001) and pulmonary capillary wedge pressure decreased by 27% (31±8 versus 22±9 mm Hg, P <0.001). Compared with pretreatment values, urine output and net fluid balance increased by 130% and 156%, respectively, with up to 24 hours of treatment ( P <0.01). Conclusions: We report the first-in-human experience of intermittent superior vena cava occlusion using the preCARDIA system to reduce congestion in acutely decompensated heart failure. PreCARDIA treatment for up to 24 hours was well tolerated without device- or procedure-related serious or major adverse events and associated with reduced filling pressures and increased urine output. These results support future studies characterizing the clinical utility of the preCARDIA system. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03836079.


2021 ◽  
Author(s):  
putri yubbu ◽  
Hunter Kauffman ◽  
Renzo Calderon-Anyosa ◽  
Andrea E. Monteroa ◽  
Tomoyuki Sato ◽  
...  

Abstract AimsTo simplify measurement of untwist by measuring the recoil rate of LV apex only, to validate and apply peak apical recoil rate (PARR) as an index of diastolic dysfunction (DD) in pediatric subjects during increased and decreased lusitropic states. Methods and ResultsWe recruited 153 healthy subjects (mean age 13.8+2.9 years), of whom 48 performed straight leg raising exercise and an additional 46 patients (mean 8.4+5.6 years) with documented pulmonary capillary wedge pressures (PCWP) (validation cohort). In addition, we studied 16 dilated cardiomyopathy patients (mean age 9.5+6.3years) (application cohort). PARR and isovolumic relaxation time (IVRT) were compared to PCWP. Both PARR and PARR normalized by heart rate (nPARR) were excellent in detecting patient with PCWP >12 mmHg and greatly superior to IVRT in this respect (AUC: 0.98, 95% CI [0.96, 1.0] vs. AUC: 0.7 95%CI [0.54,0.86]). In DCM patients, PARR and nPARR were greatly decreased compared to controls (-38.58+18.59º/s vs -63.07+16.35º /s, p< 0.001) and (-0.43+0.20 º/ s/min vs -0.83+0.28º/s/min, p<0.0001) but increased with straight leg raising exercise (-59.4+19.4º/s vs -97.82+39.0 º/s, p<0.01) and -0.85+0.36 vs -1.4+0.62 º/s/min (p< 0.0001). The intra-observer and inter-observer intraclass correlation (ICC) coefficients were 0.95 and 0.88, respectively.ConclusionPARR successfully detected increased and decreased lusitropic states and was not affected by age when normalized with heart rate. Both PARR and nPARR are superior to IVRT in their correlation with PCWP and offer incremental value over traditional indices of DD. This highly reproducible parameter may potentially serve as a useful index of elevated PCWP in children.


2021 ◽  
pp. 74-78
Author(s):  
E. A. Devetyarova ◽  
T. V. Martynyuk ◽  
A. A. Dyuzhikov ◽  
E. V. Paschenko ◽  
A. V. Dyuzhikova

The article describes a clinical case of a 37-year-old patient with pulmonary capillary hemangiomatosis of functional class IV according to the WHO classification with difficulties of diagnostic search and features of PAH-specific therapy.Pulmonary arterial hypertension - group 1 in the clinical classification is represented by several forms of pathology, including very rare diseases such as pulmonary veno-occlusive disease and pulmonary capillary hemangiomatosis.The difficulties of diagnostic search consist in the absence of specific symptoms, a variety of interstitial or focal changes according to spiral computed tomography, and the final diagnosis can be made only after performing a lung biopsy, which is associated with a high risk of possible complications. During the initial treatment and examination of the patient, clinical and hemodynamic parameters did not immediately allow to suspect the presence of pulmonary capillary hemangiomatosis. And only the difficulties of the patient’s management associated with the lack of the expected effect of the therapy with PAH-specific drugs served as the basis for further diagnostic search.Against the background of taking vasodilators, with the normalization of hemodynamic parameters, the progression of respiratory and right ventricular insufficiency was noted in the patient. According to the results of an additional examination, a diagnosis of pulmonary capillary hemangiomatosis was established, therapy was corrected and further tactics of management and treatment of the patient were determined. Currently, the patient is awaiting transplantation at V.I. Shumakov national medical research center and receives specific therapy with riociguate 2.5 mg TID and bosentan 125 mg BID.


2021 ◽  
Vol 102 (5) ◽  
pp. 703-715
Author(s):  
R R Gainetdinov ◽  
S V Kurochkin

This review aimed to summarize the literature data regarding the pathomorphology of lung lesions in COVID-19 and compare it with lung lesions in bacterial pneumonia and pneumonia caused by influenza virus. The analysis of scientific literature containing studies of domestic and foreign authors of different years related to morphology and anatomical pathology of lung injury was carried out. Special attention was paid to the data devoted to COVID-19 obtained between 2019 and 2021. Based on the study, the main aspects of lung lesions were identified and grouped into blocks depending on the etiology of the process. The review collects and summarizes information on etiology, pathogenesis and stages of disease development, outcomes and morphological picture during the autopsy of patients with bacterial pneumonia, influenza pneumonia and COVID-19 pneumonia. The common features and differences in the course, outcomes and typical morphological findings, most characteristics for each of the diseases were presented in the table. There is a great similarity of morphological findings in influenza pneumonia and COVID-19 pneumonia despite the background of the difference in their epidemiology. Most Russian and foreign authors agree that a key factor in the pathogenesis of the development of COVID-19 is the presence of a specific receptor-mediated pathway of penetration into the cells of the respiratory epithelium. According to most authors, the main morphological difference that determines the severity and unfavorable outcome of COVID-19 is angiopathy and microthrombosis of the pulmonary capillary bed, which aggravate the typical picture of viral pneumonia.


CHEST Journal ◽  
2021 ◽  
Vol 160 (4) ◽  
pp. A2275-A2278
Author(s):  
Franck Rahaghi ◽  
Richard Channick ◽  
Nick Kim ◽  
Vallerie McLaughlin ◽  
Eliana Martinez ◽  
...  

Author(s):  
David M. Kaye ◽  
Emil Wolsk ◽  
Shane Nanayakkara ◽  
Justin Mariani ◽  
Christian Hassager ◽  
...  

Background Although a rapid rise in left atrial pressure during exertion is considered pathognomonic of heart failure with preserved ejection fraction (HFpEF), the fundamental circulatory determinants of this response are not clear, impacting upon the development of more effective therapies. We aimed to comprehensively describe the circulatory mechanics of patients with HFpEF at rest and during exercise in comparison with controls. Methods and Results We performed simultaneous right‐heart catheterization and echocardiography at rest and during exercise in 22 healthy control volunteers and 60 patients with confirmed HFpEF. Using detailed individual patient‐level hemodynamic and left ventricular ejection fraction data we performed computer simulations to evaluate the circulatory parameters including the estimated stressed blood volumethat contribute to the resting and exercise pulmonary capillary pressure. At rest and during exercise, left ventricular stiffness (V 30 , the end‐diastolic pressure–volume relationship at a filling pressure of 30 mm Hg), left ventricular elastance, and arterial elastance were all significantly greater in HFpEF than in controls. Stressed blood volume was significantly greater in HFpEF (26.9±5.4 versus 20.2±4.7 mL/kg, P <0.001), becoming even more pronounced during exercise (40.9±3.7 versus 27.5±7.0 mL per 70 kg, P <0.001). During exercise, the magnitude of the change in stressed blood volume ( r =0.67, P <0.001) and left ventricular stiffness ( r =−0.44, P <0.001) were key determinants of the rise in pulmonary capillary wedge pressure. Further detailed modeling studies showed that the hemodynamic response to exercise results from a complex non‐linear interaction between circulatory parameters. Conclusions The circulatory determinants of HFpEF physiology are complex. We identified stressed blood volume at rest and during exercise is a novel, key factor, therebyrepresenting an important potential therapeutic target.


2021 ◽  
Vol 8 ◽  
Author(s):  
Poonavit Pichayapaiboon ◽  
Lalida Tantisuwat ◽  
Pakit Boonpala ◽  
Nakkawee Saengklub ◽  
Tussapon Boonyarattanasoonthorn ◽  
...  

Objectives: This study was designed to thoroughly evaluate the effects of bolus pimobendan at a dose of 0.15 mg/kg on cardiac functions, hemodynamics, and electrocardiographic parameters together with the pharmacokinetic profile of pimobendan and its active metabolite, o-desmethyl-pimobendan (ODMP), in anesthetized dogs.Methods: Nine beagle dogs were anesthetized and instrumented to obtain left ventricular pressures, aortic pressures, cardiac outputs, right atrial pressures, pulmonary arterial pressures, pulmonary capillary wedge pressures, electrocardiograms. After baseline data were collected, dogs were given a single bolus of pimobendan, and the pharmacodynamic parameters were obtained at 10, 20, 30, 60, and 120 min. Meanwhile, the venous blood was collected at baseline and 2, 5, 10, 20, 30, 60, 120, 180, 360, and 1,440 min after administration for the determination of pharmacokinetic parameters.Results: Compared with baseline measurements, the left ventricular inotropic indices significantly increased in response to intravenous pimobendan, as inferred from the maximum rate of rise in the left ventricular pressure and the contractility index. Conversely, the left ventricular lusitropic parameters significantly decreased, as inferred from the maximum rate of fall in the left ventricular pressure and the left ventricular relaxation time constant. Significant increases were also noted in cardiac output and systolic blood pressure. Decreases were observed in the systemic vascular resistance, pulmonary vascular resistance, left ventricular end-diastolic pressure, pulmonary capillary wedge pressure, right atrial pressure, and pulmonary arterial pressure. The heart rate increased, but the PQ interval decreased. There was no arrhythmia during the observed period (2 h). The mean maximum plasma concentration (in μg/L) for ODMP was 30.0 ± 8.8. Pimobendan exerted large volume of distribution ~9 L/kg.Conclusions: Intravenous pimobendan at the recommended dose for dogs increased cardiac contraction and cardiac output, accelerated cardiac relaxation but decreased both vascular resistances. These mechanisms support the use of injectable pimobendan in acute heart failure.


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