Early return of reflected waves increases right ventricular wall stress in chronic thromboembolic pulmonary hypertension.

Early return of reflected waves increases right ventricular wall stress in chronic thromboembolic pulmonary hypertension. Am J Physiol Heart Circ Physiol. 2020 Oct 09;: Authors: Fukumitsu M, Westerhof BE, Ruigrok D, Braams NJ, Groeneveldt JA, Bayoumy AA, Marcus JT, Meijboom LJ, de Man FS, Westerhof N, Bogaard HJ, Noordegraaf AV Abstract BACKGROUND: Pulmonary vascular resistance (PVR) and compliance are comparable in proximal and distal chronic thromboembolic pulmonary hypertension (CTEPH). However, proximal CTEPH is associated with inferior right ventricular (RV) adaptation. Early wave reflection in proximal CTEPH may be responsible for altered RV function. The aims of the study are 1) investigate whether reflected pressure returns sooner in proximal than in distal CTEPH, and 2) elucidate whether timing of reflected pressure is related to RV dimensions, ejection fraction (RVEF), hypertrophy and wall stress. METHODS: Right heart catheterization and cardiac MRI were performed in 17 patients with proximal and 17 patients with distal CTEPH. In addition to determination of PVR, compliance and characteristic impedance, wave separation analysis was performed to determine the magnitude and timing of the peak reflected pressure (as % of systole). Findings were related to RV dimensions and time-resolved RV wall stress. RESULTS: Proximal CTEPH was characterized by higher RV volumes, mass and wall stress, and lower RVEF. While PVR, compliance and character...
Source: American Journal of Physiology. Heart and Circulatory Physiology - Category: Physiology Authors: Tags: Am J Physiol Heart Circ Physiol Source Type: research

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A well-validated diagnostic algorithm for heart failure with preserved ejection fraction (HFpEF) was recently developed, utilizing hemodynamic assessment by cardiac catheterization.[1] The combination of body mass index (BMI; “heavy”), hypertension, atrial fibrillation (AF), pulmonary hypertension (PH), age (“elder”), and left ventricular (LV) filling pressure, abbreviated as H2FPEF, can differentiate patients with HFpEF from those without HFpEF, with excellent accuracy.[1] Several studies have assessed the diagn ostic performance of the H2FPEF score in various populations and demonstrated the gener...
Source: Journal of Cardiac Failure - Category: Cardiology Authors: Source Type: research
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Source: Herz - Category: Cardiology Tags: Herz Source Type: research
Inadequate balloon occlusion while measuring pulmonary artery wedge pressure (PAWP) during right heart catheterization (RHC) may lead to inaccurate measures and clinically relevant misdiagnosis of disease. Following the 6th World Symposium on Pulmonary Hypertension (PH) recommendations, we instituted a standard of care clinical protocol at the Medical University of South Carolina that required obtaining a PAWP saturation (sat) to confirm complete occlusion whenever initially measured PAWP is>15 mmHg.
Source: Journal of Cardiac Failure - Category: Cardiology Authors: Tags: 110 Source Type: research
AbstractInvasive hemodynamic assessment remains the gold standard for the diagnosis of pediatric pulmonary hypertension and for longitudinal assessment of response to therapy. This analysis sought to describe the changes in hemodynamic variables after initiation of prostacyclin therapy and determine which changes bear predictive power of adverse clinical outcomes. A retrospective chart review of established patients at Cincinnati Children ’s Hospital with pulmonary arterial hypertension (PAH) who required prostacyclin therapy between 2004 and 2018 was performed. The baseline hemodynamic parameters at diagnosis as wel...
Source: Pediatric Cardiology - Category: Cardiology Source Type: research
We reported the clinical, functional, radiologic and hemodynamic characteristics at diagnosis and outcomes of patients with PVOD from the French PH Registry after exposure to MMC. The results are expressed as the median (minimum-maximum). RESULTS: From June 2011 to December 2018, 17 incident cases of MMC-induced PVOD were identified. At diagnosis, these patients had severe clinical and functional impairment, with12 patients having a New York Heart Association Functional Class (NYHA FC) of III or IV and a 6-minute walk distance (6MWD) of 220 (0-465) meters. Right heart catheterization confirmed severe precapillary PH w...
Source: Chest - Category: Respiratory Medicine Authors: Tags: Chest Source Type: research
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Source: Journal of Cardiology - Category: Cardiology Authors: Tags: J Cardiol Source Type: research
Abstract The 2015 European Society of Cardiology/European Respiratory Society guidelines for the diagnosis and treatment of pulmonary hypertension include a multidimensional risk assessment for patients with pulmonary arterial hypertension (PAH). However, prognostic validations of this risk assessment are limited, especially outside Europe. Here, we validated the risk assessment strategy in PAH patients in our institution in Japan. Eighty consecutive PAH patients who underwent right heart catheterization between November 2006 and December 2018 were analyzed. Patients were classified as low, intermediate, or high r...
Source: Canadian Journal of Physiology and Pharmacology - Category: Drugs & Pharmacology Authors: Tags: Can J Physiol Pharmacol Source Type: research
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Source: Arthritis and Rheumatology - Category: Rheumatology Authors: Tags: FULL LENGTH Source Type: research
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Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Original Articles: Research letters Source Type: research
Conclusions Volumetric analysis of the proximal pulmonary arteries using CTPA is a promising diagnostic tool for PH in a real-world cohort.
Source: Journal of Computer Assisted Tomography - Category: Radiology Tags: THORACIC IMAGING Source Type: research
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