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Pulmonary vascular and right ventricular burden during exercise in interstitial lung disease.
CONCLUSIONS: ILD with resting and exercise PH is associated with increased exercise RV work, reduced pulmonary vascular reserve and reduced peak VO2. The findings highlight the role of pulmonary vascular and RV burden to ILD exercise limit. PMID: 32173491 [PubMed - as supplied by publisher]
Source: Chest - March 11, 2020 Category: Respiratory Medicine Authors: Oliveira RKF, Waxman AB, Hoover PJ, Dellaripa PF, Systrom DM Tags: Chest Source Type: research

When it all comes down to pressure: right ventricular ejection fraction at cardiac catheterisation
In the present issue of the European Respiratory Journal, Heerdt et al. [1] report on the validation of right ventricularejection fraction (RVEF) calculated from a pressure curve at cardiac catheterisation. This is of great interest as right ventricular (RV) function is the main determinant of symptomatology and outcome in pulmonary hypertension [2], and RVEF accordingly adds significantly to risk stratification in these patients [3]. However, ejection fraction (EF) is a ratio of stroke volume (SV) to end-diastolic volume (EDV), with no pressure in the equation. So, how is it possible to calculate a volume ratio from pressure measurements?
Source: European Respiratory Journal - March 11, 2020 Category: Respiratory Medicine Authors: Naeije, R., Richter, M. J., Vanderpool, R., Tello, K. Tags: Editorials Source Type: research

Renal implications of pulmonary arterial capacitance in acute heart failure with preserved ejection fraction.
Authors: Toroghi HM, Lo KB, Ziccardi MR, Horn B, Kanjanahattakij N, Malik E, Penalver J, Rangaswami J, Gupta S, Amanullah A Abstract Worsening renal function in patients with heart failure with preserved ejection fraction is associated with poor outcomes. Pulmonary arterial capacitance is a novel right heart catheterization derived hemodynamic metric representing pulmonary arterial tree distensibility and right ventricle afterload. Given the strong association between heart failure, pulmonary hypertension, and kidney function, the goal of this study is to investigate the correlation between Pulmonary arterial capac...
Source: Reviews in Cardiovascular Medicine - January 10, 2020 Category: Cardiology Tags: Rev Cardiovasc Med Source Type: research

Safety and efficacy of balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension in the Netherlands.
CONCLUSIONS: BPA performed in a CTEPH expert centre is an effective and safe treatment in patients with inoperable CTEPH. PMID: 31782109 [PubMed - as supplied by publisher]
Source: Netherlands Heart Journal - November 27, 2019 Category: Cardiology Authors: van Thor MCJ, Lely RJ, Braams NJ, Ten Klooster L, Beijk MAM, Heijmen RH, van den Heuvel DAF, Rensing BJWM, Snijder RJ, Vonk Noordegraaf A, Nossent EJ, Meijboom LJ, Symersky P, Mager JJ, Bogaard HJ, Post MC Tags: Neth Heart J Source Type: research

MnTBAP reduces pulmonary vascular remodeling in experimental pulmonary arterial hypertension
Conclusion: MnTBAP treatment can partly reverse RV afterload and pulmonary vascular remodeling in established experimental PAH. Together with the improved cardiac function, MnTBAP may be a promising intervention for PAH.
Source: European Respiratory Journal - November 20, 2019 Category: Respiratory Medicine Authors: Sun, X.-Q., Gomez-Puerto, M. C., Schalij, I., Vonk-Noordegraaf, A., De Man, F. S., Ten Dijke, P., Bogaard, H.-J. Tags: Pulmonary hypertension Source Type: research

Predictors of physical activity in pulmonary arterial and chronic thromboembolic pulmonary hypertension
Conclusions: Daily physical activity as steps/day assessed in patients newly diagnosed with PAH/CTEPH did not well correlate with invasive hemodynamics at rest nor during exercise, but very well with the 6MWD. Whether daily activity assessments provide additional information to simple walk distance on risk factor profiles during follow-up in patients with PAH/CTEPH remains to be clarified.
Source: European Respiratory Journal - November 20, 2019 Category: Respiratory Medicine Authors: Saxer, S., Lichtblau, M., Berlier, C., Hasler, E., Schwarz, E., Ulrich, S. Tags: Pulmonary hypertension Source Type: research

Vena cava backflow and right ventricular stiffness in pulmonary arterial hypertension
Vena cava backflow is a well-recognised clinical hallmark of right ventricular failure in pulmonary arterial hypertension (PAH). Backflow may result from tricuspid regurgitation during right ventricular systole or from impaired right ventricular diastolic filling during atrial contraction. Our aim was to quantify the forward and backward flow in the vena cava and to establish the main cause in PAH. In 62 PAH patients, cardiac magnetic resonance measurements provided volumetric flows (mL·s–1) in the superior and inferior vena cava; time integration of flow gave volume. The "backward fraction" was defined as the...
Source: European Respiratory Journal - October 16, 2019 Category: Respiratory Medicine Authors: Marcus, J. T., Westerhof, B. E., Groeneveldt, J. A., Bogaard, H. J., de Man, F. S., Vonk Noordegraaf, A. Tags: Pulmonary vascular disease Original Articles: Pulmonary hypertension Source Type: research

Balloon Pulmonary Angioplasty for the Treatment of Nonoperable Chronic Thromboembolic Pulmonary Hypertension: Single-Center Experience with Low Initial Complication Rate
ConclusionsBPA significantly improves cardiopulmonary hemodynamics with an acceptable safety profile. Further studies assessing the long-term efficacy of BPA are required.
Source: Journal of Vascular and Interventional Radiology - July 25, 2019 Category: Radiology Source Type: research

Physical activity in incident patients with pulmonary arterial and chronic thromboembolic hypertension
ConclusionDaily physical activity as steps/day assessed in incident patients with PAH/CTEPH did not well correlate with invasive hemodynamics at rest or during exercise, but very well with the 6MWD. Whether daily activity assessments provide additional information to simple walk distance on risk factor profiles during follow-up in patients with PAH/CTEPH remains to be clarified.
Source: Lung - June 30, 2019 Category: Respiratory Medicine Source Type: research

Echocardiographic determination of pulmonary arterial capacitance
AbstractA growing body of evidence has demonstrated that pulmonary arterial capacitance (PAC) is the strongest hemodynamic predictor of clinical outcomes across a wide spectrum of cardiovascular disease, including pulmonary hypertension and heart failure. We hypothesized that a ratio of right ventricular stroke volume (RVOT VTI) to the associated peak arterial systolic pressure (PASP) could function as a reliable non-invasive surrogate for PAC. We performed a prospective study of patients undergoing simultaneous transthoracic echocardiography and right heart catheterization (RHC) for various clinical indications. Measureme...
Source: The International Journal of Cardiovascular Imaging - April 8, 2019 Category: Radiology Source Type: research

Not Just Acid Reflux: The Need to Think Worst First
Discussion Heart disease is the leading cause of death in the United States.1 This year, 720,000 Americans will have a new coronary event—defined as first hospitalized myocardial infarction (MI) or coronary heart disease death—and around 335,000 will have a recurrent event. Approximately 35% of people who experience a coronary event in a given year and around 14% of patients who have an acute coronary syndrome will die from it.1 Roughly 60% of patients with an acute coronary syndrome are transported to the emergency department via ambulance.2–4. Up to one-third of patients experiencing an MI may not complain of chest...
Source: JEMS Special Topics - January 13, 2019 Category: Emergency Medicine Authors: Stephen Sanko, MD, FACEP Tags: Exclusive Articles Cardiac & Resuscitation Source Type: news

Reduced right ventricular output reserve in patients with systemic sclerosis and mildly elevated pulmonary arterial pressures
ConclusionThe results of this study suggest that impaired 6MWD in SSc ‐patients with mildly elevated mPAP might be caused by reduced PAC during exercise and reduced RV output reserve, presumably due to impaired coupling between the right ventricle and the pulmonary vasculature. These findings give further evidence for the clinical relevance of mildly elevated mPAP i n patients with SSc.This article is protected by copyright. All rights reserved.
Source: Arthritis and Rheumatology - January 7, 2019 Category: Rheumatology Authors: Christian Nagel, Alberto M. Marra, Nicola Benjamin, Norbert Blank, Antonio Cittadini, Gerry Coghlan, Oliver Distler, Christopher P Denton, Benjamin Egenlauf, Christoph Fiehn, Christine Fischer, Satenik Harutyunova, Marius M Hoeper, Hanns ‐M Tags: Full Length Source Type: research

Reappraising the effects of pulmonary artery wedge pressure on right ventricular pulsatile loading
Conclusion: Unexpectedly, PAWP decreased RV pulsatile loading (as reflected in PA stiffness) when potential confounding factors, including the prevailing mPAP, were taken into account. Our results deserve further independent confirmation.
Source: European Respiratory Journal - November 19, 2018 Category: Respiratory Medicine Authors: Chemla, D., Berthelot, E., Weatherald, J., Savale, L., Attal, P., Montani, D., Sitbon, O., Humbert, M., Herve, P., Assayag, P. Tags: Pulmonary hypertension Source Type: research

Right ventricular size and contractile reserve significantly correlate in patients with pulmonary hypertension
Conclusion: RV and RA area represent valuable and easily accessible indicators of RV pump function during exercise and might therefore be used for non-invasive estimation of right ventricular contractile reserve. CIPeak should be considered as an important clinical parameter. Prospective studies are needed for further evaluation.
Source: European Respiratory Journal - November 19, 2018 Category: Respiratory Medicine Authors: Fischer, L., Benjamin, N., Egenlauf, B., Harutyunova, S., Lorenz, H.-M., Blank, N., Marra, A. M., Nagel, C., Fischer, C., Gruenig, E. Tags: Pulmonary hypertension Source Type: research

Lower than expected pulsatile pulmonary arterial load in a thromboembolic pulmonary hypertension model
Conclusions: To our knowledge, this is the first documentation of a PH state where the mPAP-corrected indices of pulsatile arterial load (sPAP, PAPp) were lower than expected. The young age of the animals, the short-term nature of our analysis, or some specific features of the thromboembolic PH model may be involved.
Source: European Respiratory Journal - November 19, 2018 Category: Respiratory Medicine Authors: Boulate, D., Chemla, D., Loisel, F., Coblence, M., Provost, B., Decante, B., Herve, P., Fadel, E., Mercier, O. Tags: Pulmonary hypertension Source Type: research

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