Diagnosis Of Pulmonary Hypertension Research Articles

Pulmonary vascular stenosis scoring in fibrosing mediastinitis

Abstract Aims This study aimed to develop a scoring system for evaluating the degree of pulmonary vascular stenosis in fibrosing mediastinitis (FM). Methods and Results A retrospective single-center study was conducted on 56 patients with FM in China between April 2014 and August 2021. The involvement of pulmonary vessels in patients with FM was assessed using dual phase-computed tomography pulmonary angiography, and we found that 85.7% of the patients had both pulmonary artery (PA) and vein (PV) involvement. PA involvement was mainly located proximal to both the upper PA and bilateral basal trunk levels in the lower lungs. The involvement of the superior PV was more common than that of the inferior PV, and the right inferior PV was the least involved. Most of these lesions exhibited moderate or severe stenosis. Additionally, a scoring system for the degree of pulmonary vascular stenosis was developed. Correlation analysis revealed a negative correlation between the final pulmonary vascular score and pulmonary arterial pressure, pulmonary vascular resistance, and maximum tricuspid regurgitation velocity. The calculated score of 17.1 was the best cut-off value for the diagnosis of mild and severe pulmonary hypertension. Conclusion We successfully developed a scoring system for pulmonary vascular stenosis that can be used to evaluate the severity of pulmonary vessel involvement and pulmonary hypertension. This scoring system may be relevant in the future development of target-based strategies for percutaneous interventions.

The Role of Echocardiography in the Diagnosis and Prognosis of Pulmonary Hypertension

The right heart catheterisation constitutes the gold standard for pulmonary hypertension (PH) diagnosis. However, echocardiography remains a reliable, non-invasive, inexpensive, convenient, and easily reproducible modality not only for the preliminary screening of PH but also for PH prognosis. The aim of this review is to describe a cluster of echocardiographic parameters for the detection and prognosis of PH and analyse the challenges of echocardiography implementation in patients with suspected or established PH. The most important echocardiographic index is the calculation of pulmonary arterial systolic pressure (PASP) through the tricuspid regurgitation (TR). It has shown high correlation with invasive measurement of pulmonary pressure, but several drawbacks have questioned its accuracy. Besides this, the right ventricular outflow track acceleration time (RVOT-AT) has been proposed for PH diagnosis. A plethora of echocardiographic indices: right atrial area, pericardial effusion, the tricuspid annular plane systolic excursion (TAPSE), the TAPSE/PASP ratio, tricuspid annular systolic velocity (s′), can reflect the severity and prognosis of PH. Recent advances in echocardiography with 3-dimensional right ventricular (RV) ejection fraction, RV free wall strain and right atrial strain may further assist the prognosis of PH.

Clinical Features and Multimodality Diagnostic Tools of Pulmonary Hypertension

Pulmonary hypertension (PH) is defined as an increase in mean pulmonary arterial pressure (mPAP) above normal (> 20 mmHg) and an increase in pulmonary vascular resistance (pulmonary vascular resistance / PVR) above normal in resting settings. The pathophysiology of PH involves remodeling of the pulmonary vessels, from the main pulmonary arteries, lobar arteries, segmental arteries, distal arteries, pulmonary arterioles, capillaries to the postcapillary pulmonary veins. In general, the epidemiological figures for PH are not known with certainty. The United Kingdom reported a PH prevalence of 97 cases per one million people, with a female-to-male ratio of 1.8. The diagnostic strategy for PH focuses primarily on two issues. The primary objective is to improve the early detection of PH and expedite the transfer of patients at high risk for PAH, CTEPH, or other forms of severe PH to a PH center. The second objective is to identify the underlying disease, including left heart disease (Group 2 PH) and lung disease (Group 3 PH), as well as comorbidities, in order to assure proper classification, risk assessment, and therapy. The gold standard for detecting and categorizing pulmonary hypertension is right heart catheterization (RHC). Clinical scoring in the form of shortness of breath without any obvious cause accompanied by physical examination, ECG and Thorax X-ray images which depict an enlarged right heart have good specificity and sensitivity for the diagnosis of pulmonary hypertension in patients with congenital heart disease. A high right ventricular pressure, mean PAP, and BNP values during observation, as well as heart size on chest X-ray can be predictors of a poorer prognosis in this population. Keyword: Clinical Risk Scoring, Pulmonary Hypertension, Right Heart Catheterization.

A single institution anesthetic experience with catheterization of pediatric pulmonary hypertension patients.

Cardiac catheterization remains the gold standard for the diagnosis and management of pediatric pulmonary hypertension (PH). There is lack of consensus regarding optimal anesthetic and airway regimen. This retrospective study describes the anesthetic/airway experience of our single center cohort of pediatric PH patients undergoing catheterization, in which obtaining hemodynamic data during spontaneous breathing is preferential. A total of 448 catheterizations were performed in 232 patients. Of the 379 cases that began with a natural airway, 274 (72%) completed the procedure without an invasive airway, 90 (24%) received a planned invasive airway, and 15 (4%) required an unplanned invasive airway. Median age was 3.4 years (interquartile range [IQR] 0.7-9.7); the majority were either Nice Classification Group 1 (48%) or Group 3 (42%). Vasoactive medications and cardiopulmonary resuscitation were required in 14 (3.7%) and eight (2.1%) cases, respectively; there was one death. Characteristics associated with use of an invasive airway included age <1 year, Group 3, congenital heart disease, trisomy 21, prematurity, bronchopulmonary dysplasia, WHO functional class III/IV, no PH therapy at time of case, preoperative respiratory support, and having had an intervention (p < 0.05). A composite predictor of age <1 year, Group 3, prematurity, and any preoperative respiratory support was significantly associated with unplanned airway escalation (26.7% vs. 6.9%, odds ratio: 4.9, confidence interval: 1.4-17.0). This approach appears safe, with serious adverse event rates similar to previous reports despite the predominant use of natural airways. However, research is needed to further investigate the optimal anesthetic regimen and respiratory support for pediatric PH patients undergoing cardiac catheterization.

Diagnosis of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: data from a practice-based longitudinal cohort

Background and AimsA large prospective multicentre cohort study with systematic follow-up recently reported a 2.3% two-year cumulative incidence of chronic thromboembolic pulmonary hypertension (CTEPH) after acute pulmonary embolism (PE). The present investigation aimed to determine the reported prevalence and incidence of CTEPH diagnosis after acute PE in real-world practice over a twelve-year period. MethodsThis study was based on nationwide ambulatory billing claims and drug prescription data of all residents with public health insurance in Germany from 2010 to 2021. ResultsA total of 573,972 patients with acute PE (median age 71 years; 57.4% women) were identified between 2010 and 2021. Prevalence of CTEPH among patients with history of PE increased during period from 0.4% in 2010 to 0.9% in 2021. CTEPH was diagnosed in 2556 patients after acute PE, with most (17.6%) diagnoses reported within the first three months after the index PE event. The cumulative incidence rate after 3 months (1st quarter) was calculated at 0.08%, and after the first two years (8th quarter) at 0.36%; it was 0.75% over the entire (90-month) follow-up period. Patients with CTEPH diagnosis during follow-up more often had right ventricular dysfunction at the index acute PE (14.9% vs. 8.3%; p<0.001). ConclusionsThe low CTEPH incidence rate after acute PE in the present analysis suggests low awareness of CTEPH. It further suggests a lack of systematic follow-up protocols for acute PE survivors in the real world. Improved implementation of existing recommendations on follow-up strategies post PE is warranted.

(647) - Journey from Symptoms to Diagnosis in Pulmonary Arterial Hypertension: Results from a Cross-Sectional Survey of Real-World Patients in Latin America

(647) - Journey from Symptoms to Diagnosis in Pulmonary Arterial Hypertension: Results from a Cross-Sectional Survey of Real-World Patients in Latin America

The place of tadalafil in the treatment of PAH in the light of new clinical guidelines of the Eurasian Association of Cardiologists

Pulmonaryarterialhypertension(PAH)isalife-threateningcardiovascular disease that is characterized by a marked increase in pulmonary vascular resistance and pulmonary artery pressure due to obstructive remodeling of the pulmonary vascular bed with the development of right ventricular heart failure as a cause of premature mortality. Impaired synthesis and reduced bioavailability of nitric oxide is one of the key pathophysiological mechanisms of the development and progression of the disease. The review paper presents key data from the evidence base on the clinical use of tadalafil, a phosphodiesterase type 5 inhibitor (PDE5), which in August 2023 approved by the Pharmaceutical Committee of the Russian Ministry of Health for the indication – treatment of patients with PAH. Tadacardil from Canonpharma Production is the first and only drug in Russian practice today with the active substance tadalafil with the registered indication “PAH”, approved in the Eurasian Guidelines for the diagnosis and treatment of pulmonary hypertension 2023 and available on the territory of the Russian Federation and the EAEU. Tadacardil is indicated for use in adult patients with PAH functional class II and III according to the WHO classification to increase exercise tolerance. The efficacy of tadalafil has been shown in idiopathic PAH and PAH associated with connective tissue diseases. The recommended dose is 40 mg (2 tablets of 20 mg) once a day. The paper describes the mechanism of action and pharmacological effects of PDE5 inhibitors, features of the pharmacokinetics of tadalafil in comparison with other drugs of the class. The advantages of Tadacardil from Canonpharma Production are the proven effecacy of use in patients with PAH, ease of use due to a single dose of 2 tablets of 20 mg once a day in a standard dose; good tolerability and favorable safety profile; proven bioequivalence to the reference drug. In light of the new Eurasian recommendations for the diagnosis and treatment of PH, tadalafil has a wide field for clinical use, which will improve the treatment options for patients with PAH both in mono- and combination therapy.

Eurasian guidelines for the diagnosis and treatment of pulmonary hypertension (2023)

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Evaluation of handgrip strength in children with pulmonary hypertension.

Handgrip strength is a crucial indicator of upper extremity muscular strength and is vital for monitoring disorders like cardiac diseases that restrict a patient's physical activity and result in muscle atrophy. The aim of our study was to evaluate whether muscle strength loss is present in patients with pulmonary hypertension and whether this test can be an alternative to 6-minute walk test. The study included 39 healthy children who were admitted to the outpatient clinic and 16 children with a diagnosis of pulmonary hypertension who were being followed in our centre. We assessed the differences in upper extremity handgrip strength using the Jamar Hydraulic Hand Dynamometer device among both healthy children and those diagnosed with pulmonary hypertension. Moreover, we compared the handgrip strength of pulmonary hypertension patients with significant prognostic indicators such as NYHA class, 6-minute walk test, and pro-brain natriuretic peptide. The mean dominant handgrip strength was 20.8 ± 12 kg in the patient group and 21.6 ± 12.4 kg in the control group (p = 0.970). Handgrip strength was shown to be negatively connected with pro-brain natriuretic peptide (r = -0.565, p = 0.023) and positively correlated with 6-minute walk test (r = 0.586, p = 0.022) during the patient group evaluation. Six-minute walk test needs a customised physical area (30 m of a straight hallway) and trained personnel for applying the test. The handgrip strength test, a different muscle strength indicator, can be used to more clearly and simply indicate the decline in patients' ability for effort. Additionally, it was found in our study that handgrip strength decreased as pro-brain natriuretic peptide levels rose, a crucial measure in the monitoring of pulmonary hypertension.

Clinical Correlates of a Nonplexiform Vasculopathy in Patients With a Diagnosis of Idiopathic Pulmonary Arterial Hypertension

The clinical phenotype of idiopathic pulmonary arterial hypertension (IPAH) patients has changed. . Whether or not subgroups of IPAH patients have different vascular phenotypes is a subject of debate. What are the histological patterns and their clinical correlates in patients diagnosed with IPAH or hereditary PAH? In this this cross-sectional registry study lung histology of 50 IPAH patients was qualitatively assessed by two experienced pathologists. In addition, quantitative analysis by means of histopathological morphometry using immunohistochemistry was performed. Histopathological characteristics were correlated with clinical and hemodynamic parameters. In this cohort of 50 IPAH patients, a plexiform vasculopathy was observed in 26/50 (52%) of patients, while 24/50 (48%) patients had a non-plexiform vasculopathy. The non-plexiform vasculopathy was characterized by prominent pulmonary microvascular (arterioles and venules) remodeling and vascular rarefaction. While hemodynamic parameters were comparable in plexiform versus non-plexiform vasculopathy, patients with non-plexiform vasculopathy were older, more often male, had a stronger history of cigarette smoking and lower diffusing capacity for carbon monoxide (DLCO) at diagnosis No mutations in established PAH genes were found in the non-plexiform group. This study reveals different vascular phenotypes within the current spectrum of patients diagnosed with IPAH, separated by clinical characteristics (age, sex, , history of cigarette smoking, and DLCO at diagnosis). Potential differences in underlying pathobiological mechanisms between patients with plexiform and non-plexiform / microvascular disease should be taken into account in future research strategies unravelling the pathophysiology of pulmonary hypertension and developing biology-targeted treatment approaches.

Evaluating the efficacy of balloon pulmonary angioplasty using quantitative analysis of SPECT pulmonary ventilation/perfusion scintigraphy in patients with chronic thromboembolic pulmonary hypertension.

Single-photon emission computed tomography (SPECT) ventilation perfusion imaging is the main imaging method for the diagnosis of pulmonary embolism, and its application in the diagnosis and efficacy evaluation of chronic thromboembolic pulmonary hypertension (CTEPH) has been paid more and more attention. In recent years, with the development of computer software technology, ventilation/perfusion (V/Q) imaging quantitative analysis technology has become more and more mature. The objective of this study was to investigate the utility of quantitative analysis of pulmonary V/Q scintigraphy in evaluating the efficacy of balloon pulmonary angioplasty (BPA) in patients with CTEPH. In this retrospective analysis, we collected data of patients diagnosed with CTEPH who underwent BPA at the China-Japan Friendship Hospital from April 2018 to September 2020. The sample consisted of 23 males and 28 females, with an average age of 55.1±12.7 years. All patients underwent V/Q scintigraphy within one week before surgery, and we reviewed the pulmonary angiography within 1-3 months following the last BPA procedure. We repeated V/Q scintigraphy within 1 week before or after the pulmonary angiography, at the time of collecting clinical and hemodynamic parameters of these patients. We divided the patients into two groups based on the presence of residual pulmonary hypertension post-surgery and compared the pre- and post-operative quantitative pulmonary perfusion defect percentage scores (PPDs%) using the t-test. In all, 102 V/Q scintigraphy scans were performed in 51 patients. The quantitative PPDs% were positively correlated with the hemodynamic indexes mean pulmonary arterial pressure (mPAP), pulmonary vascular resistance (PVR), and mean right ventricular pressure (RVP) (r=0.605, 0.391, and 0.464, respectively, all P<0.001) and negatively correlated with the 6-minute walking distance (6MWD) (r=-0.254, P=0.010). The average preoperative quantitative PPDs% were (49.0±15.6)% which significantly decreased to (33.5±13.9)% after surgery (t=11.249, P<0.001). The preoperative quantitative PPDs% were (54.7±15.7)% and (44.0±13.8)% in the residual pulmonary hypertension group and the non-residual pulmonary hypertension group, respectively (t=2.599, P=0.012). The postoperative quantitative PPDs% were (41.5±12.5)% and (26.3±11.0)%, in the residual pulmonary hypertension group and the non-residual pulmonary hypertension group, respectively (t=4.647, P<0.001). In this study, we found that quantitative analysis of SPECT pulmonary V/Q scintigraphy adequately reflected the pulmonary artery pressure and clinical status in patients with CTEPH. Our results demonstrate its definite utility in predicting residual pulmonary hypertension and in evaluating the postoperative efficacy of BPA in patients with CTEPH.

Updated Clinical Classification and Hemodynamic Definitions of Pulmonary Hypertension and Its Clinical Implications.

Pulmonary hypertension (PH) refers to a pathologic elevation of the mean pulmonary artery pressure (mPAP) and is associated with increased morbidity and mortality in a wide range of medical conditions. These conditions are classified according to similarities in pathophysiology and management in addition to their invasive hemodynamic profiles. The 2022 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension present the newest clinical classification system and includes significant updates to the hemodynamic definitions. Pulmonary hypertension is now hemodynamically defined as an mPAP > 20 mmHg, reduced from the previous threshold of ≥25 mmHg, due to important insights from both normative and prognostic data. Pulmonary vascular resistance has been extended into the definition of pre-capillary pulmonary hypertension, with an updated threshold of >2 Wood Units (WU), to help differentiate pulmonary vascular disease from other causes of increased mPAP. Exercise pulmonary hypertension has been reintroduced into the hemodynamic definitions and is defined by an mPAP/cardiac output slope of >3 mmHg/L/min between rest and exercise. While these new hemodynamic thresholds will have a significant impact on the diagnosis of pulmonary hypertension, no evidence-based treatments are available for patients with mPAP between 21-24 mmHg and/or PVR between 2-3 WU or with exercise PH. This review highlights the evidence underlying these major changes and their implications on the diagnosis and management of patients with pulmonary hypertension.

Clinical, electrical, and functional changes following CRT-P implantation: short-term results in patients with non-ischaemic cardiomyopathy

Aim. Assessment of the correlation between cardiac remodeling, functional status and electrical remodeling after cardiac resynchronisation therapy (CRT) in patients with non-ischaemic cardiomyopathy.Material and methods. A single center, prospective, observational study included 50 patients with non-ischaemic cardiomyopathy who were candidate for CRT implantation. All patients prior to CRT and then 3 months after implantation had standard 12-lead surface ECGs to assess QRSd for assessment electrical response, for assessment of left ventricular ejection fraction (LVEF) and volumes (left ventricular end diastolic and systolic volume, LVEDV and LVESV), mitral regurgitation (degree of mitral regurgitation), pulmonary artery systolic pressure (for diagnosis of pulmonary hypertension), NYHA class and 6 minute walk test (6MWT) to assess patient’s functional capacity.Results. 50 patients with CRT were included (35 males and 15 females, mean age 54.88±7.48 years). All patients were in sinus rhythm with QRS duration (QRSd) ≥120 ms, EF&lt;35% and left bundle branch block. After 3 months; there was significant improvement in QRSd in 82% of the cases (145.3±16.3 ms vs 133.3±17.2 ms, p&lt;0.001). NYHA class improved at least one class in 78% and 6 min walk test improved in 80% (168.5 [131.0; 181.0] m vs 280.0 [237.0; 297.0] m, p&lt;0.001). LVEF increased significantly in 74% of study cases (28.6±2.7 vs 34.5±3.1, p value 0.001) also there were statistically significant improvement in LVEDV (267.0±45.7 to 221.8±41.9 ml, p=0.002) and LVESV (137.43±47.19 to 105.03±42.7 ml, p=0.003). There was statistically significant correlation between QRSd and NYHA class (r=0.392, p=0.005), QRSd and 6MWT (r=0.323, p=0.022) and QRSd with LVEF (r=0.672 with p&lt;0.001). Only seven patients showed improvement in the 3 parameters: LVESV, QRS duration and 6 min walk test.Conclusion. The CRT-pacemaker implantation was associated with significant improvement in QRSd, NYHA class, 6MWT and LV volumes in the short-term period. QRSd improvement was significantly correlated with functional status and LV EF.

[Diagnosis of pulmonary hypertension associated with congenital heart disease based on statistical features of the second heart sound].

Aiming at the problems of obscure clinical auscultation features of pulmonary hypertension associated with congenital heart disease and the complexity of existing machine-aided diagnostic algorithms, an algorithm based on the statistical characteristics of the high-frequency components of the second heart sound signal is proposed. Firstly, an endpoint detection adaptive segmentation method is employed to extract the second heart sounds. Subsequently, the high-frequency component of the heart sound is decomposed using the discrete wavelet transform. Statistical features including the Hurst exponent, Lempel-Ziv information and sample entropy are extracted from this component. Finally, the extracted features are utilized to train an extreme gradient boosting algorithm (XGBoost) classifier, which achieves an accuracy of 80.45% in triple classification. Notably, this method eliminates the need for a noise reduction algorithm, allows for swift feature extraction, and achieves effective multi-classification using only three features. It is promising for early screening of pulmonary hypertension associated with congenital heart disease.

Circulating miR-let7a levels predict future diagnosis of chronic thromboembolic pulmonary hypertension

Distinct patterns of circulating microRNAs (miRNAs) were found to be involved in misguided thrombus resolution. Thus, we aimed to investigate dysregulated miRNA signatures during the acute phase of pulmonary embolism (PE) and test their diagnostic and predictive value for future diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH). Microarray screening and subsequent validation in a large patient cohort (n = 177) identified three dysregulated miRNAs as potential biomarkers: circulating miR-29a and miR-720 were significantly upregulated and miR-let7a was significantly downregulated in plasma of patients with PE. In a second validation study equal expression patterns for miR-29a and miR-let7a regarding an acute event of recurrent venous thromboembolism (VTE) or deaths were found. MiR-let7a concentrations significantly correlated with echocardiographic and laboratory parameters indicating right ventricular (RV) dysfunction. Additionally, circulating miR-let7a levels were associated with diagnosis of CTEPH during follow-up. Regarding CTEPH diagnosis, ROC analysis illustrated an AUC of 0.767 (95% CI 0.54–0.99) for miR-let7a. Using logistic regression analysis, a calculated patient-cohort optimized miR-let7a cut-off value derived from ROC analysis of ≥ 11.92 was associated with a 12.8-fold increased risk for CTEPH. Therefore, miR-let7a might serve as a novel biomarker to identify patients with haemodynamic impairment and as a novel predictor for patients at risk for CTEPH.

Diagnosis and Treatment Patterns of Chronic Thromboembolic Pulmonary Hypertension in Russia, Kazakhstan, Turkey, Lebanon, and Saudi Arabia: A Registry Study.

Patients with chronic thromboembolic pulmonary hypertension (CTEPH) in countries with limited resources have, to date, been poorly represented in registries. This work assesses the epidemiology, diagnosis, hemodynamic and functional parameters, and treatment of CTEPH in Russia, Kazakhstan, Turkey, Lebanon, and Saudi Arabia. A prospective, cohort, phase IV, observational registry with 3-year follow-up (n = 212) in patients aged ≥ 18 years diagnosed with CTEPH was created. Clinical, hemodynamic, and functional parameters were obtained at an initial visit, follow-up visits, and a final visit at the end of 3years' observation or end of follow-up. Data were recorded on electronic case report forms. Parameters evaluated included 6-minute walking distance (6MWD), use of pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA), pulmonary hypertension (PH)-targeted therapy, and survival. All statistical analyses were exploratory and descriptive, and were performed in the overall population. The most common symptoms were typical of those expected for CTEPH. Almost 90% of patients underwent right heart catheterization at diagnosis or initial study visit. In total, 66 patients (31%) underwent PEA before the initial visit; 95 patients (45%) were considered operable, 115 (54%) were inoperable, and two (1%) had no operability data. Only 26 patients (12%) had been assessed for BPA at their initial visit. PH-targeted therapy was documented at diagnosis for 77 patients (36%), most commonly a phosphodiesterase type 5 inhibitor (23%). Use of PH-targeted therapy increased to 142patients (67%) at the initial visit, remaining similar after 3 years. Use of riociguat increased from 6% of patients at diagnosis to 38% at 3 years. Between baseline and end of observation, results for patients with paired data showed an increase in 6MWD. Survival at the end of observation was 88%. These data highlight the current diagnosis and management of CTEPH in the participating countries. They show that early CTEPH diagnosis remains challenging, and use of off-label PH-targeted therapy is common. gov: NCT02637050; registered December 2015.

Practice guidance for stress echocardiography.

Stress echocardiography has been one of the most promising methods for the diagnosis of ischemic heart disease, hypertrophic cardiomyopathy, and pulmonary hypertension. The Japanese Society of Echocardiography produced practical guidance for the implementation of stress echocardiography in 2018. At that time, stress echocardiography was not yet widely disseminated in Japan; therefore, the 2018 practical guidance for the implementation of stress echocardiography included a report on stress echocardiography and a specific protocol to promote its use at many institutions in Japan in the future. And now, an era of renewed interest and enthusiasm surrounding the diagnosis and treatment of valvular heart disease and heart failure with preserved ejection fraction (HFpEF) has come, which are driven by emerging trans-catheter procedures and new recommended guideline-directed medical therapy. Based on the continued evidence of stress echocardiography, the new practical guideline that describes the safe and effective methodology of stress echocardiography is now created by the Guideline Development Committee of the Japanese Society of Echocardiography and is designed to expand the use of stress echocardiography for valvular heart disease and HFpEF, as well as ischemic heart disease, hypertrophic cardiomyopathy, and pulmonary hypertension. The readers are encouraged to perform stress echocardiography which will enhance the diagnosis and management of these patients.

(072) Comparing Risk of Post-Infection Erectile Dysfunction Following SARS Coronavirus 2 Stratified by Acute and Long COVID, Vasopressor Administration, and Hospitalization Status

Abstract Introduction While multiple studies have shown an association between acute COVID-19 infection and subsequent development of erectile dysfunction (ED), no study has yet assessed the risk of developing ED after a diagnosis of long COVID. It is unclear if there is an increased risk of ED in those with long COVID compared to only those diagnosed with acute COVID. In addition, the impact of vasopressor use and hospitalization for an acute COVID infection on ED development is uncertain. Objective This study sought to assess the risk of ED in individuals with acute COVID-19 when compared to individuals with long COVID-19, as well as risk of ED following more severe cases requiring vasopressors and hospitalization. Methods The TriNetX COVID-19 Research Network was queried from December 1st 2020 through June 2023. We included men aged ≥ 18-years old and analyzed cohorts comparing the following 1) men diagnosed with long COVID-19 (ICD-10: U09) were compared to those that were diagnosed with or had positive test for acute COVID-19 but no diagnosis of long COVID. Men were included if they had at least one outpatient follow-up visit 2 weeks after the initial positive test result and excluded if they received a prior ED diagnosis or treatment, prostatectomy, pelvis radiation, or pulmonary hypertension diagnosis at any time. Additional analyses were performed with the same above criteria including men that were and were not hospitalized within 1 month of acute COVID diagnosis and whether men needed vasopressors or not. Cohorts were propensity score matched and compared for differences in new ED diagnosis and/or prescription of phosphodiesterase-5 inhibitors (PDE5i). Variables on which propensity scores were matched are detailed in Table 1. Results A total of 2839 men were included in each cohort after propensity score matching with an average age of 54.5 +/- 16.7 years and 55.1 +/- 17.1 years in the long and acute COVID cohorts, respectively. Men diagnosed with long COVID-19 were more likely to develop ED or be prescribed PDE5i (3.63%) when compared to men with only acute COVID-19 infections (2.61%) [RR 1.39; 95% CI 1.04, 1.87]. There was no statistically significant increased or decreased risk of developing ED or being prescribed PDE5i for individuals who received vasopressors [RR 0.922; 95% CI 0.774,1.098] or were hospitalized [RR 0.933; 95% CI 0.824,1.056]. Conclusions We found that long COVID-19 infection was associated with greater risk for ED diagnosis or PDE5i prescriptions when compared with men diagnosed with only an acute COVID-19 infection, while there was no significantly increased risk for individuals requiring vasopressors or hospitalization. Disclosure No.

[Once in a blue moon: coronavirus disease complicates pregnancy in a patient with unknown pulmonary hypertension and subsequent left ventricular dysfunction].

During COVID-19 pandemic, several clinical manifestations have been described beyond respiratory compromise that characterizes the viral disease. Cardiovascular manifestations are one of the main complications. In this case, we report an unusual association between the novo diagnosis of pulmonary arterial hypertension in a pregnant patient with SARS Cov-2, with subsquent development of left ventricular dysfunction.

Electrocardiogram Parameters Associated With the Diagnosis of Pulmonary Hypertension in High-Altitude Tibetan Populations: A Retrospective Single-Centre Study

Electrocardiogram (ECG) is a commonly used diagnostic method for pulmonary hypertension (PH) in Tibetan areas, but its sensitivity and specificity are not good enough. This study aimed to investigate the ECG parameters associated with the diagnosis of PH in Tibetan areas. Ninety-four PH patients of Tibetan ethnicity who were treated at the hospital between March 2019 and October 2020, and 52 Tibetan individuals as controls, were included. The ECG parameters were compared between groups. Multivariate logistic analysis was performed to identify the ECG parameters that can be used for the diagnosis of PH. The univariate significances of ECG parameters were included in the multivariate analyses, whereas those exhibiting opposite trends between different PH subtypes were excluded. Two ECG parameters were significant in multivariate analysis. The final model included S wave amplitude in lead V3 (OR 5.81; 95% CI 2.79-12.11; p<0.001) and a negative T wave in leads V1-V3 (OR 0.05; 95% CI 0.01-0.41; p=0.005). The ROC curve analysis on the final model yielded an AUC of 0.830 (95% CI 0.766-0.894; p<0.001), indicating good diagnostic performance. A nomogram for diagnosis of PH was also established using S wave amplitude in lead V3 and a negative T wave in leads V1-V3. The ECG parameters S wave amplitude in lead V3 and a negative T wave in leads V1-V3 were independent factors associated with the diagnosis of PH in high-altitude Tibetan populations.