Chronic thromboembolic pulmonary hypertension

Chronic thromboembolic pulmonary hypertension (CTEPH) is a complication of pulmonary embolism and a major cause of chronic PH leading to right heart failure and death. Lung ventilation/perfusion scintigraphy is the screening test of choice; a normal scan rules out CTEPH. In the case of an abnormal perfusion scan, a high-quality pulmonary angiogram is necessary to confirm and define the pulmonary vascular involvement and prior to making a treatment decision. PH is confirmed with right heart catheterisation, which is also necessary for treatment determination. In addition to chronic anticoagulation therapy, each patient with CTEPH should receive treatment assessment starting with evaluation for pulmonary endarterectomy, which is the guideline recommended treatment. For technically inoperable cases, PH-targeted medical therapy is recommended (currently riociguat based on the CHEST studies), and balloon pulmonary angioplasty should be considered at a centre experienced with this challenging but potentially effective and complementary intervention.
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Original Articles: World Symposium on Pulmonary Hypertension Source Type: research

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CONCLUSIONS: Our data suggest a potential use of treprostinil as an early treatment for mild metabolic syndrome-associated PH-HFpEF and that combined treatment with treprostinil and metformin may improve hyperglycemia and cardiac function in a more severe disease. PMID: 32268788 [PubMed - as supplied by publisher]
Source: Arteriosclerosis, Thrombosis and Vascular Biology - Category: Cardiology Authors: Tags: Arterioscler Thromb Vasc Biol Source Type: research
RARITAN, N.J., March 20, 2020 – The Janssen Pharmaceutical Companies of Johnson &Johnson announced today that it will unveil late-breaking data from its leading cardiovascular and metabolism portfolio during the virtual American College of Cardiology’s 69th Annual Scientific Session together with the World Congress of Cardiology (ACC.20/WCC) on March 28-30, 2020. Notably, four late-breaking abstracts for XARELTO® (rivaroxaban) will be presented, including data from the Phase 3 VOYAGER PAD study in patients with symptomatic peripheral artery disease (PAD) after lower-extremity revascularization.Click to ...
Source: Johnson and Johnson - Category: Pharmaceuticals Source Type: news
Pulmonary artery systolic pressure – MCQ – Answer Normal pulmonary artery systolic pressure – Correct Answer: b) 15 – 30 mm Hg Pulmonary circulation is a low pressure circulation and the pressures are much lower than that of systemic circulation. An acute rise in systolic pressure to 50 mmHg can cause right heart failure in conditions like pulmonary embolism. But gradually rising pressures are better tolerated as the right ventricle has time to compensate by hypertrophy. In severe primary pulmonary hypertension and atrial septal defect with severe pulmonary hypertension, pulmonary pressures can eve...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Medicine MCQ - CVS Source Type: blogs
Authors: Aubry A, Paternot A, Vieillard-Baron A Abstract Cor pulmonale is a disease of the heart characterised by dilatation of the right ventricle and paradoxical movement of the interventricular septum. The diagnosis depends on echocardiography even if pulmonary artery catheterisation suggests it. It is secondary to pulmonary disease or a disorder of the pulmonary circulation. These two mechanisms, which are often connected, involve pulmonary hypertension as the origin of a systolic and diastolic overload of the right ventricle, which then leads to the alterations of its structure and performance. Acute cor pulmo...
Source: Revue des Maladies Respiratoires - Category: Respiratory Medicine Tags: Rev Mal Respir Source Type: research
Backgrounds: Chronic thromboembolic disease (CTED) is characterized by similar symptoms and perfusion defect as chronic thromboembolic pulmonary hypertension (CTEPH), but without pulmonary hypertension at rest. Recently, successful pulmonary endarterectomy (PEA) and balloon pulmonary angioplasty (BPA) for symptomatic patients with CTED has been reported. However, it remains unclear whether CTED evolves to CTEPH. The aim of this study is to clarify the natural history of CTED.Methods: Consecutive patients diagnosed as CTED between 1986 and 2017 were retrospective enrolled. CTED was defined as follows: a mean pulmonary arterial pressure at rest
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Pulmonary hypertension Source Type: research
Conclusion: High concentrations of air pollutants are associated with a higher probability of post-operative residual PH and of being eligible for surgical treatment in CTEPH patients.
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Pulmonary hypertension Source Type: research
Chronic thromboembolic pulmonary hypertension (CTEPH), a late complication of pulmonary embolism (PE), is associated with high mortality. However, whether the right ventricular (RV) echocardiographic parameters can predict – in the short- and long-term – the development of CTEPH and mortality after PE remains unknown. Herein, we aim to investigate the incidence of CTEPH after acute PE and to evaluate the risk factors of CTEPH. In this retrospective cohort, patients with PE were followed for 10 years for the onset of CTEPH. The screening was initially conducted through echocardiography and confirmed by right hea...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research
Abstract BACKGROUND: Although cardiac troponin and natriuretic peptide have been shown to decrease after balloon pulmonary angioplasty (BPA) with improved right ventricular afterload in chronic thromboembolic pulmonary hypertension (CTEPH), biomarkers to evaluate the effects of BPA independently of heart failure status remain to be developed. METHODS: In 39 consecutive CTEPH patients including 31 who underwent BPA, we measured plasma levels of cyclophilin A (CyPA), which we demonstrated is secreted from pulmonary vascular smooth muscle cells in response to mechanical stretch and hypoxia. RESULTS: CyPA le...
Source: Journal of Cardiology - Category: Cardiology Authors: Tags: J Cardiol Source Type: research
We read with great interest the article by Ma and colleagues1 about elevated gradient after mitral valve repair and the effect of surgical technique and relevance of postoperative atrial fibrillation. Elevated transmitral gradient may cause not only delayed atrial fibrillation but also all other complications associated with pure mitral stenosis, such as left atrial enlargement, thromboembolism, secondary pulmonary hypertension, and delayed right heart failure. In the article of Ma and colleagues,1 the elevated pressure gradient after mitral annuloplasty was due to 2 main surgical problems: the use of small, complete, semi...
Source: The Journal of Thoracic and Cardiovascular Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Letter to the Editor Source Type: research
Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by chronic thrombi in the pulmonary arteries, causing pulmonary hypertension and right heart failure. Early and accurate diagnosis are essential for successful treatment but are often difficult because clinical signs and symptoms can be nonspecific and risk factors, such as history of venous thromboembolism, may not always be present. Here, we report a case involving a 76-year-old woman who demonstrated paradoxical cerebral embolism as the initial manifestation of CTEPH.
Source: Journal of Stroke and Cerebrovascular Diseases - Category: Neurology Authors: Tags: Case Report Source Type: research
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