Frequency Of Pulmonary Hypertension Research Articles

Frequency of Pulmonary Hypertension and Its Associated Risk Factors in End-Stage Renal Disease (ESRD) Patients on Maintenance Hemodialysis.

Introduction Pulmonary hypertension (PH) is a recognized complication in patients with end-stage renal disease (ESRD undergoing maintenance hemodialysis (MHD).PHiscommonly foundin patients with chronic kidney disease (CKD) and ESRD.PH is associated with increased morbidity and mortality in patients with CKD. Methodology This cross-sectional study aimed to assess the prevalence of PH and its associated risk factors in MHD patients. A total of 220 ESRD patients on MHD patients at The Kidney Center, Karachi, Pakistan, aged 18-70 were included. Patients with chronic obstructive lung disease, valvular heart disease, and obstructive sleep apnea were excluded, as these conditions can be responsible for PH. PH was evaluated by echocardiography (ECHO), which was performed by a cardiologist. Results The mean age was 50.65 ± 14.4 years, with 131 (59.5%) males and 89 (40.5%) females. The average duration on hemodialysis was 5.3 ± 2.8 years. Hypertension (89.5%) and ischemic heart disease (24.1%) were prominent comorbidities. Hypertensive nephropathy (42.7%) was the leading cause of ESRD. Left ventricular hypertrophy was mild in most cases (85.5%), whereas regional wall motion abnormality (RWMA) was common (67.3%). The average pulmonary artery pressure was 35.2 ± 15.3 mmHg. Out of 220 patients, 109 patients (49.8%) of them had mild PH, nine patients (4.1%) had severe PH, and 72 patients (32.7%) had moderate PH. Associations between PH and various factors were examined. RWMA, left ventricular hypertrophy, and left ventricular ejection fraction were significantly associated with PH (p < 0.001). Serum calcium and albumin levels were also associated with PH severity (p < 0.05). Other demographic and laboratory parameters did not show a significant association. Conclusion This study highlights the prevalence of PH in MHD patients and identifies associated risk factors. Understanding these associations can aid in better managing PH in ESRD patients.

Frequency of Pulmonary Hypertension in Patients with Chronic Kidney Disease Undergoing Hemodialysis

Objective: To determine the frequency of pulmonary arterial hypertension (PAH) in patients with chronic kidney disease (SKD) undergoing hemodialysis. Materials and Methods: A total number of 80 patients of age 16-75 years, either gender presenting with CKD undergoing hemodialysis were included. This study was conducted in the department of nephrology of Nishtar Hospital Multan from June-2021 to February 2022. The patients underwent echocardiography. If there was pulmonary artery systolic pressure &gt;35 mm Hg, then pulmonary hypertension was labeled. Results: Mean age of patients was 48.67±11.71 years. Mean BMI patients was 24.79±3.25 kg/m2. There were 57 (76.00%) males and 18 (24.00%) female patients. 31 (38.8%) out of 80 patients were smokers, diabetes was found in 35 (43.8%) patients. Hypertension was found in 53 (66.3%) patients. Mean pulmonary artery systolic pressure were 29.47±9.16 mmHg. PAH was found in 15 (18.75%) patients. Conclusion: PAH is a common disorder in patients of CKD undergoing maintenance hemodialysis and more than 18% of CKD patients undergoing maintenance HD had PAH. Keywords: Pulmonary hypertension, chronic kidney disease, hemodialysis.

Frequency of Pulmonary Hypertension in Patients with Chronic Kidney Disease Stage 5 (CKD Stage 5) and Correlation of PASP with Biochemical Parameters of CKD

Background: Pulmonary hypertension is an independent predictor of mortality. It is a recognized condition in patients with chronic kidney disease. Objective: To find out the frequency of pulmonary hypertension in CKD stage 5 patients and relation of PASP with biochemical parameters of CKD. Methods: This cross-sectional study was conducted in the Department of Nephrology at Bangabandhu Sheikh Mujib Medical University, Dhaka from July 2014 to June 2016 over a period of 2(two) years. One hundred twenty patients with CKD stage 5 on dialysis (HD and CAPD) and pre dialysis for more than 3 months were selected for this study. Result: Pulmonary hypertension was found in 56.6% maintenance HD patients, in 13.3% CAPD patients and in 20.6% pre dialysis patients. A significant correlation of pulmonary arterial systolic pressure with age, duration of dialysis, serum phosphate, and serum iPTH levels was found. Conclusion: Frequency of pulmonary hypertension was highest in hemodialysis group (56.6%). Routine screening and early detection is important in order to avoid the serious consequences of the disease.

PULMONARY HYPERTENSION STILL AN ‘ORPHAN LUNG DISEASE’ IN PAKISTAN

In our country when it comes to diagnosis and treatment of Pulmonary Hypertension (PH) especially Pulmonary Arterial Hypertension (PAH), it seems that it is still an Orphan Lung disease. Whether it is data about its prevalence in our country, available diagnostic services or treatment options, one may easily feel the scarcity in all mentioned areas.&#x0D; Most current classification of PH, categorizes it into 5 groups.1 However this categorization requires availability of diagnostic tools especially right heart catheterization data to classify and know the severity of PH and to offer targeted treatment to patients who belong to group 1 PH i.e. Pulmonary Arterial Hypertension (PAH).&#x0D; Studies done about PH prevalence in Pakistan have mainly focused on data in selected patients group e.g. in patients with Chronic Obstructive Pulmonary Diseases (COPD) or Systemic Lupus Erythematosus (SLE).2,3 All of these studies relied on diagnosis without using the diagnostic bench mark i.e. Right heart catheterization. Moreover, effects of targeted treatment for PAH have also been studied only in selected group of patients e.g. COPD.4,5&#x0D; While above work by the learned colleagues has to be appreciated, it emphasizes the need to,&#x0D; &#x0D; Spread the awareness about PH more so to reduce inadvertent use of targeted treatment which may prove detrimental outside group 1 PH and should only be considered at specialized centers.&#x0D; Develop specialized centers with required diagnostic services especially Lung functional and anatomical evaluation and Right heart catheterization.&#x0D; Establish PH registries (at least one in each province) which can play a vital role to collect data and ensure effective evidence based patient management.&#x0D; &#x0D; This may be an uphill task however the right direction to move forward.&#x0D; &#x0D; REFERENCES&#x0D; &#x0D; Simonneau G, Montani D, David SC, Christopher PD, Michael AG, Michael K, at el. Paul G. Haemodynamic definitions and updated clinical classification of pulmonary hypertension. Eur Respir J. 2019;53(1):1801913.&#x0D; Amir S, Azmat A, Raza U, Hamid N, Zafar I, Shahida N, at el. Frequency of Pulmonary Hypertension in COPD patients. Pak J Chest Med. 2017;23(4):144-50.&#x0D; Sadia A, Aflak R, Tafazzul H, Ahmed A. Frequency and predictors of Pulmonary Hypertension in patients with SLE. Pak J Med Sci. 2019;35(1):86-9.&#x0D; Nasir H, Faisal F, Kausar R, Saadia A, Anjum N, Shafi K, at el. Efficacy of bosentan in the treatment of pulmonary hypertension; a prospective study focusing on safety and efficacy in patients with COPD. J Lung Pulm Respir Res. 2018;5(2):67-72.&#x0D; Sharieff S. Effect of sildenafil in primary pulmonary hypertension. Pak J Med Sci. 2007;23(2):264.&#x0D;

Evaluation of the Relationship Between Pulmonary Artery Hypertension and Esophageal Varices Bleeding in Transplantation Candidates.

Introduction: Esophageal varices bleeding (EVB) in liver cirrhosis is an important cause of mortality and morbidity. We aimed to study the relationship between systolic pulmonary artery pressure (sPAP) and EV grade and EVB.Methods: A total of 229 patients, 183 male and 46 female, who were determined to have EV in the upper gastrointestinal tract endoscopy and who had a transthoracic echocardiogram (TTE) were included in this study.Results: The frequency of pulmonary hypertension (PHT) and EVB was determined to be 16% and 45%, respectively, in our study, and 20% of those who had bleeding had PHT; 70.3% of the cases with PHT were determined to have grade III varices while this rate was lower at 52.9% in cirrhosis without PHT. A significant correlation was determined between Model for End-Stage Liver Disease (MELD) score, Child-Turcotte-Pugh score, platelet, albumin, and sPAP in those without a history of bleeding (p<0.05).Conclusion: An increase in the rate of grade III varices has been noted along with the prevalence of PHT in patients with portal hypertension. It has been determined that the increase in PAP is associated with an increase in the MELD score, which is closely associated with mortality and morbidity. Therefore, this positive relationship between the MELD score and PHT may lead to an increase in the frequency of advanced-stage EV.

The frequency of pulmonary hypertension in newborn with intrauterine growth restriction

Intrauterine growth restriction (IUGR) is a clinical definition applied to neonates born with clinical features of malnutrition and in-utero growth retardation irrespective of their birth weight percentile. This study was aimed to determine the frequency of pulmonary hypertension (PH) in neonates with IUGR. In this descriptive cross-sectional study, we followed 96 neonates with IUGR (≤28 days) and 38 neonates without IUGR born in the department of the neonatal intensive care unit children hospital complex Multan, Pakistan. We analyzed certain factors such as gender, gestational age (GA) (weeks), birth weight (BW in kg), weight percentile (WP) for GA, meconium aspiration syndrome (MAS), birth asphyxia (BA) and respiratory distress syndrome (RDS) for pulmonary hypertension (PH) in IUGR and non-IUGR group. GA was measured by the Ballard scoring system. Echocardiography was performed for all patients by the pediatric cardiologist to measure pulmonary arterial (PA) pressure using Bernoulli’s equation. Out of total 96 IUGR neonates, 33.3% (n = 32) suffered from PH, of which 65.3% (n = 18) were male and 43.7% (n = 14) were female. The percentages of IUGR neonates with BA, MAS and RDS were 34.4%, 18.8% and 22.9% respectively. The data were analyzed using the SPSS-16 software to test the statistical significance of the results. A p-value less than 0.05 was considered significant. When the chi-square test was applied, it depicted that MAS was significantly associated with PH in IUGR neonates (p = 0.0001) compared to non-IUGR neonates. Our findings suggested an increased chance of PH in IUGR neonates and MAS may be a strong factor.

Using Autoantibodies and Cutaneous Subset to Develop Outcome-Based Disease Classification in Systemic Sclerosis.

To describe the associations between autoantibodies, clinical presentation, and outcomes among patients with systemic sclerosis (SSc) in order to develop a novel SSc classification scheme that would incorporate both antibodies and the cutaneous disease subset as criteria. Demographic and clinical characteristics, including cutaneous subset, time of disease and organ complication onset, and autoantibody specificities, were determined in a cohort of SSc subjects. Survival analysis was used to assess the effect of the autoantibodies on organ disease and death. The study included 1,325 subjects. Among the antibody/skin disease subsets, anticentromere antibody-positive patients with limited cutaneous SSc (lcSSc) (n = 374) had the highest 20-year survival (65.3%), lowest incidence of clinically significant pulmonary fibrosis (PF) (8.5%) and scleroderma renal crisis (SRC) (0.3%), and lowest incidence of cardiac SSc (4.9%), whereas the frequency of pulmonary hypertension (PH) was similar to the mean value in the SSc cohort overall. The anti-Scl-70+ groups of patients with lcSSc (n = 138) and patients with diffuse cutaneous SSc (dcSSc) (n = 149) had the highest incidence of clinically significant PF (86.1% and 84%, respectively, at 15 years). Anti-Scl-70+ patients with dcSSc had the lowest survival (32.4%) and the second highest incidence of cardiac SSc (12.9%) at 20 years. In contrast, in anti-Scl-70+ patients with lcSSc, other complications were rare, and these patients demonstrated the lowest incidence of PH (6.9%) and second highest survival (61.8%) at 20 years. Anti-RNA polymerase antibody-positive SSc patients (n = 147) had the highest incidence of SRC (28.1%) at 20 years. The anti-U3 RNP+ SSc group (n = 56) had the highest incidence of PH (33.8%) and cardiac SSc (13.2%) at 20 years. Among lcSSc patients with other autoantibodies (n = 295), the risk of SRC and cardiac SSc was low at 20 years (2.7% and 2.4%, respectively), while the frequencies of other outcomes were similar to the mean values in the full SSc cohort. Patients with dcSSc who were positive for other autoantibodies (n = 166) had a poor prognosis, demonstrating the second lowest survival (33.6%) and frequent organ complications. These findings highlight the importance of autoantibodies, cutaneous subset, and disease duration when assessing morbidity and mortality in patients with SSc. Our novel classification scheme may improve disease monitoring and benefit future clinical trial designs in SSc.

ECHOCARDIOGRAPHIC STUDY OF RIGHT VENTRICLE CHANGES IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) PATIENTS OF DIFFERENT SEVERITY

Chronic obstructive pulmonary disease (COPD) characterized by interminable air flow limitation that is not fully reversible COPD includes chronic bronchitis, emphysema, and chronic asthmatic bronchitis. Chronic obstructive pulmonary disease as a complex disease with various systemic manifestations and one of the co-morbidity linked with COPD is cardiovascular disease. Hypoxic vasoconstriction and alterations in pulmonary microvasculature, which are both observed in COPD patients, leads to an increase in pulmonary vascular resistance. As a result, this increase in right ventricular (RV) after load causes right ventricular remodeling, including chamber dilatation and wall hypertrophy and ultimately to functional deterioration. The aim of this study to evaluate the right ventricular changes that develop secondary to COPD using GOLD guidelines and echocardiographic findings .This cross-sectional study involved 134 patients who presented to the pulmonary disease outpatient clinic with COPD. We assessed the right ventricular changes in COPD patients of different severity using echocardiography .COPD patients shown change in the right ventricular dimensions as the severity of COPD increases and right ventricular function as well. It is also observed that frequency of pulmonary hypertension also increased as the severity of COPD increases. The study shows high prevalence of cardiac co-morbidities such as RV dysfunction and pulmonary hypertension in COPD patients. The severity of complications increases with severity of COPD and makes a linear relation.&#x0D; Keywords: Echocardiography, ECG, COPD

Frequency of pulmonary hypertension in transthoracic echocardiography screening is not increased in Takayasu arteritis: Experience from a single center in Turkey.

ObjectivePulmonary hypertension (PH) may occur in Takayasu arteritis (TA), mostly due to pulmonary arteritis, but also due to left heart disease and/or chronic thromboembolism (CTE). Using transthoracic echocardiography (TTE), we investigated the frequency of PH caused by pulmonary arteritis.MethodsThis cross-sectional study included 70 patients with TA fulfilling the 1990 ACR criteria, 68 healthy controls, and 67 patients with systemic sclerosis (SSc) fulfilling the 1980 ACR criteria representing the disease control group. Patients with severe left heart disease or CTE were excluded. The ESC-ERS guideline definition was considered for diagnosis of PH.ResultsThe mean systolic pulmonary artery pressure (SPAP) values in TA, SSc, and healthy control groups were 20.93±6.06, 31.57±12.75, and 18.88±5.39 mmHg, respectively. While the SPAP values were similar between TA and healthy groups, the SPAP values in the SSc group were significantly higher than in other groups. Based on conventional and/or magnetic resonance angiography findings, pulmonary arteritis was present in 4 out of 70 TA patients; however, PH was not detected in any patients with TA, including those with pulmonary arteritis.ConclusionThe TTE findings suggested that the frequency of PH was not increased in TA. However, a low frequency of pulmonary arteritis in our series might have affected our results.

Pulmonary Hypertension: An Emerging Problem in Patients Undergoing Regular Hemodialysis.

To find out the frequency of pulmonary hypertension (PH) and its association with various contributing factors in patients undergoing regular hemodialysis (HD) due to end-stage renal disease (ESRD). Cross-sectional analytical study. Nephrology Department, Lahore General Hospital, Pakistan, from July to December 2016. Fifty patients with end-stage renal disease. Various parameters, including the pulmonary arterial systolic pressure (PASP), were recorded. Pulmonary arterial pressure greater than 25 mmHg at rest was defined as pulmonary hypertension. It was further divided into three sub categories as mild (25-40 mmHg), moderate (40-55 mmHg), and severe (greater than 55 mmHg). Data were correlated with age, gender, body mass index, systemic hypertension, diabetes, duration of dialysis, and Hb (hemoglobin) concentration. Data was analysed using SPSS version 23.0. The median (IQR) duration of dialysis was 12 (11.25) months. Eighteen (36%) patients were found to have PH. It is greater in patients who had been on dialysis for more than 5 months. A positive association was seen between the duration of dialysis and the prevalence of PH (p=0.024). A considerable number of patients on hemodialysis have pulmonary hypertension which is associated with the longer duration of maintenance hemodialysis.

Prognostic markers in congenital diaphragmatic hernia: Left ventricular diameter and pulmonary hypertension.

The aim of this study was to investigate whether the outcome of congenital diaphragmatic hernia (CDH) in newborns can be predicted using left ventricular (LV) diameter and estimated pulmonary artery pressure. Patients in the newborn unit in 2012-2016 were screened retrospectively. Echocardiographic measurements of 35 patients with isolated left lateral CDH and 27 healthy newborns were compared in the first 24 h of life. Mean LV end-diastolic diameter (LVEDD) and end-systolic diameter (LVESD), and LV ejection fraction were significantly lower in the CDH group. Moreover, tricuspid regurgitation (TR) and pulmonary regurgitation (PR) were significantly higher than in the controls (P < 0.001). Six CDH patients died within the next 40 days after birth. Mean LVEDD and LVESD were significantly lower in the CHD patients who died compared with those who were discharged (P < 0.001, P = 0.016). Also, mean TR and PR (P < 0.001) and the frequency of pulmonary hypertension (PH; P = 0.001) were significantly higher in these patients. On receiver operating characteristic analysis of the CDH non-survivors, LVEDD < 11 mm (sensitivity, 100%; 95%CI: 87.9-100; specificity, 100%; 95%CI: 54.1-100) and TR > 3.5 m/s (sensitivity, 89.66%; 95%CI: 72.6-97.7; specificity, 100%; 95%CI: 54.1-100) were associated with poor prognosis. Decrease in LVEDD and presence of PH are associated with poor prognosis. Also, PH was associated with mortality in CDH patients. Thus, outcome may be predicted on careful echocardiographic evaluation of the LV diameters and pulmonary pressure.

Long-term outcomes in patients who underwent surgical correction for atrioventricular septal defect.

Objective:The follow-up results of patients operated for atrioventricular septal defect (AVSD) during 1996–2016 at Başkent University are presented.Methods:Data obtained from hospital records consists of preoperative echocardiographic and angiographic details, age and weight at surgery, operative details, Down syndrome presence, postoperative care details, early postoperative and latest echocardiographic findings and hospitalization for reintervention.Results:A total of 496 patient-files were reviewed including 314 patients (63.4%) with complete and 181 (36.6%) with partial AVSD (48.4% of all patients had Down syndrome). Atrioventricular (AV) valve morphology was Rastelli type A in 92.2%, B in 6.5%, and C in 1.3% of patients. The operative technique used was single-patch in 21.6% (108), double-patch in 25.8% (128), and modified single-patch (Wilcox) in 52.5% (260) of patients. The follow-up time was 37.79±46.70 (range, 0–198) months. A total of 64 patients (12.9%) had arrhythmias while in the intensive care unit; pacemaker was implanted in 12 patients. A total of 78 patients (15.7%) were treated for pulmonary hypertensive crisis. The early morbidity and mortality in the postoperative first month were calculated as 38% and 10%, and the late morbidity and mortality (>1 month) were calculated as 13.1% and 1.9%, respectively. The rate of reoperation in our cohort was 8.9%.Conclusion:Although the early morbidity and mortality are low in AVSD operations, the rate of reoperations for left AV valve insufficiency are still high. Although Down syndrome is not a risk factor for early mortality, the co-morbid factors, such as longer postoperative mechanical ventilator or inotropic support, lead to higher risk for morbidity. The frequency of pulmonary hypertension and consequent complications are also high.

Pulmonary hypertension in patients with systemic scleroderma

Aim. To evaluate the frequency of pulmonary hypertension (PH) in patients with systemic scleroderma (SSD) and elucidate clinical features of SSD with and without concomitant PH. Materials and methods. The study included 206 patients (189 women and 17 men) with SSD treated in Rheumatological Department, Saratov Regional Hospital. Clinical features, results of echocardiography and external respiration function (ERF) studies were analyzed in SSD patients with and without concomitant PH. Results. PH was documented in 33% of the patients. Their clinical condition, changes in left and right hear as well as ERF were elucidated. Conclusion. The study confirmed the high informative value of echocardiography used to evaluate ERF in patients with SSD and the possibility to apply this method for screening PH in SSD patients. The risk factors of PH in SSD patients include advanced age, apnoea, disturbed ERF, and sclerodactylia.

Pulmonary Hypertension in Children with Cancer

Background: The advances in medicine have led to improved survival rates for children diagnosed with cancer. Despite these improvements, late mortality rates for cancer survivors exceed those of the general population. Leading causes of death in this population include subsequent cancer, followed by pulmonary and cardiovascular events. Objective: To study the frequency of pulmonary hypertension in children with cancer after finishing their treatments, and to study the effects of different determined factors like age of diagnosis or type of treatment on the development of pulmonary hypertension. Patient and methods: A cross-sectional study was carried out to focus on the frequency of pulmonary hypertension in patients with cancer after finishing their treatment in Basra Children’s Specialty Hospital, pediatric oncology center over 6 months; from the 1st of October, 2014 till 31th of March 2015. A total of 67 patients were included in the study, their age ranged from 6 months to 16 years, with 41 males and 26 females. The collected patients have been evaluated for development of pulmonary hypertension by Echocardiograph device in same hospital. Results: Acute lymphoblastic leukemia accounts for the greatest percentage (34.3%), followed by Acute myeloid leukemia (15%) then Hodgkin`s lymphoma, (13.4%) and the rest are solid tumors (37.3%). pulmonary hypertension is no statistically significant in relation to type of cancer, (P=0.729). The age of patient at time of diagnoses is statistically significant affects the development of pulmonary hypertension; the frequency tends to occur more in patients who have been diagnosed before the age of five years compared to those diagnosed at age older than 5 years, (P=0.035) but the sex of patient is statistically no significant effect (P=0.773) while no relation to type of treatment with chemotherapy (Methotrexate) radiotherapy is statistically significant (P=0.04). The occurrence of pulmonary hypertension also affected by period after the treatment ,cardiovascular complication is more seen in patient who completed two years after finishing treatment with statistically significant association (P=0.036). Pulmonary hypertension occurred more in patients who exposed to radiation for chest, cervical and brain areas (above diaphragm) than those exposed to abdomen (below diaphragm), but statistically no significant (P=0.264). Route of administration of chemotherapy (Methotrexate) either oral or intravenous on the occurrence of pulmonary hypertension is statistically no significant (P=0.432). Conclusion: The pulmonary hypertension is one of adverse cardiovascular effects that develop in patients who exposed to radiation or certain types of chemotherapy (Methotrexate) so the patient radiotherapy or should have regular screening programs for cardiac functions after complete the course of therapy.

The frequency of pulmonary hypertension in patients with juvenile scleroderma.

Juvenile scleroderma (JS) represents a rarely seen group of connective tissue diseases with multiple organ involvement. Cardiac involvement in JSS is well known and, although rare in children, it may be an important cause of mortality and morbidity. Therefore, an early determination of cardio-vascular and pulmonary involvement is of the most relevance to reduce the mortality in patients with juvenile scleroderma. The aim of the study was to explore the non-invasive methods (Doppler echocardiography, pulmonary function tests), Forced vital capacity (FVC) and Carbon monoxide diffusion capacity (DLCO) in the assessment of the cardiopulmonary involvement in patients with JS. The assessment of pulmonary arterial pressure (PAP) and risk factors for pulmonary arterial hypertension (PAH) were made by the measurement of maximum tricuspid insufficiency (TI), end-diastolic pulmonary insufficiency (PI), ratio of acceleration time (AT) to ejection time (ET) (AT/ET), right atrial pressure (RAP) and contraction of vena cava inferior during inspiration. Thirty-five patients with confirmed JS were included in the study. The mean age of onset of the disease was 9.57 years (median 10 years, range 2-18 years). The mean disease duration and follow-up time was 2 years (median 1 year, range 0.5-8 years) and 3.57 years (median 2 years, range 0.5-14.5 years), respectively.The values of all the analyzed parameters including TI, PI, AT/ET, PAP, FVC and DLCO were found to be within normal ranges in all the patients tested, confirming an uncommonness of cardiopulmonary involvement in patients with juvenile scleroderma.

Non-invasive estimation of pulmonary artery pressures in patients with sickle cell anaemia in Ibadan, Nigeria: an echocardiographic study

Introduction Pulmonary hypertension is emerging as one of the causes of morbidity and mortality in adults with sickle cell disease. The prevalence of pulmonary hypertension in Nigerian adults with sickle cell anaemia is unknown. We decided to estimate the pulmonary artery systolic and diastolic pressures in subjects with sickle cell anaemia seen at the University College Hospital, Ibadan, Nigeria, and to determine the frequency of pulmonary hypertension among them.Methods Ninety patients (38 males and 52 females) with sickle cell anaemia in steady state and comparable age- and sex-matched normal controls had a clinical evaluation and echocardiographic examination.Results The mean age of the subjects with sickle cell anaemia was 24.0 (9.00) years while the mean age for the control group was 24.0 (7.00) years. The frequency of pulmonary hypertension as assessed by a tricuspid regurgitant jet velocity of > 2.5 m/s in this study was 12.2%. Larger left ventricular dimensions and volumes, higher stroke volume and increased left ventricular mass indexed by body surface area were found to be associated with pulmonary hypertension. A multivariate analysis of the potential predictors of pulmonary hypertension in this study showed that male sex and lower packed cell volume (PCV) were independent predictors of pulmonary hypertension in patients with sickle cell anaemia.Conclusion We conclude that pulmonary artery systolic and diastolic pressures are higher in subjects with sickle cell disease than normal controls. Male sex and low PCV are independent determinants of pulmonary arterial pressure in subjects with sickle cell anaemia in Nigeria.

The frequency of pulmonary hypertension in juvenile scleroderma

Juvenile scleroderma (JS), represents a rarely seen group of connective tissue disease with multiple organ involvement. Although quite rare in childhood, cardio-vascular and pulmonary involvements are the most important mortality and morbidity factors. Pulmonary arterial hypertension (PAH), the most important sequelae of pulmonary involvement, could be determined by echocardiographic examinations. Early cardio-vascular and pulmonary involvement determination is extremely important in reducing mortality of patients.

Frequency of Pulmonary Hypertension in hemodialysis patients

Objective: Pulmonary hypertension (PH) has been described in hemodialysis (HD) patients and has been associated with increased morbidity and mortality. Our objective was to determine the prevalence of pulmonary hypertension in patients on regular hemodialysis. Methods: This cross sectional study was conducted in Department of Nephrology, Liaquat National Hospital Karachi from April 2013 to March 2014. Eighty patients of end stage renal disease (ESRD), on maintenance hemodialysis (HD); underwent Trans thoracic Echocardiography were selected. Systolic pulmonary arterial pressure (SPAP) was recorded. Pulmonary hypertension was defined as, pulmonary artery pressure (PAP) greater than 30 mm Hg at rest. Pulmonary hypertension was further divided into mild (PAP b/w 30-45mmHg), moderate (PAP b/w 45-65mmHg) and severe pulmonary hypertension (PAP > 65mmHg). The effect of different vascular accesses, age, gender, dialysis vintage on the development of pulmonary hypertension was observed. Results: Out of 80 patients, 45 patients (56%) had pulmonary hypertension (PH); 25(55.5%) had moderate, 13(29%) had mild, and 7 (15.5%) patients had severe pulmonary hypertension (PH). Pulmonary hypertension was present in 41(60%) patients with AVF, 3(27%) patients with tunnel cuffed catheter and 1 patient had AV bridge graft. Pulmonary hypertension was more common in females; present in 28 females (67%) and 17 males (45%), that was statistically significant (p<0.05). Mean duration of hemodialysis in (months) of patients with PH was 20.93 ± 12 vs. 10.29 ±10 in patients without PH (p<0.05). Age had no relation to development of PH. Conclusion: ESRD patients on HD have strong tendency to develop PH. Our study demonstrated that PH is more common among females. Duration of hemodialysis and AV access has strong relation to the development of PH.

Pulmonary Hypertension in Dialysis Patients

Cardiovascular complications are encountered frequently in end-stage renal disease (ESRD) patients. The study was designed as a prospective cohort study and a total of 105 dialysis patients, 77 hemodialysis and 28 peritoneal dialysis patients, were investigated. All patients had undergone M-Mode Doppler echocardiography every 6 months by which their systolic pulmonary arterial pressures (sPAPs) and left ventricular mass indices (LVMIs) were recorded. Thirty-nine (37.1%) patients had pulmonary hypertension (PHT), that is, a mean sPAP of more than 35 mmHg. The frequency of PHT was higher in peritoneal dialysis patients but the difference was insignificant (p = 0.08). However, the frequency of left ventricular hypertrophy (LVH) was found to be significantly higher in peritoneal dialysis patients than in hemodialysis patients (p = 0.001). When patients with and without PHT were compared, the duration of dialysis (p = 0.02), hemoglobin (p = 0.01), HbA1c (p = 0.03), and serum albumin levels (p = 0.003) were found to be significantly higher in patients with PHT than those without PHT. In conclusion, although nonsignificant, we found a higher prevalence of PHT in peritoneal dialysis patients when compared with hemodialysis patients. This might be due to the significantly higher prevalence of LVH, hence hypervolemia, in peritoneal dialysis patients. The prevention and treatment of PHT in dialysis patients is very important for the improvement of survival in these patients. Hence, the increased prevalence of PHT in ESRD patients necessitates understanding the multiple and interacting factors, such as LVH, serum albumin and hemoglobin levels, and control of diabetes, that might contribute to this pathology in these patients.

Frequency of Pulmonary Hypertension in Patients with COPD due to Biomass Smoke and Tobacco Smoke

Objectives; Pulmonary hypertension (PH) is a common and well established complication of chronic obstructive pulmonary disease (COPD). Its presence is associated with decreased survival. This study was designed to investigate the PH frequency and its relations in hospitalized tobacco and biomass related COPD patients. Methods and Results; The study was a retrospective review of inpatients with COPD defined as a history of tobacco or biomass smoking, Pulmonary function tests (PFT) within stable status, an echocardiogram within stable status. PH was defined as systolic pulmonary artery pressure (sPAP) >35 mmHg. Of the 694 individuals, 600 had suitable aspects for inclusion of study. All Females were biomass exposer and males were tobacco smoker. The Prevalence of PH was found more frequent in females than males. It was more prominent in moderate level COPD cases (56,2% and 37,5%, P<0,002). Both groups had airflow limitation, hypercapnia and hypoxemia, but no differences were found in terms of PaCO2 and PaO2. However, FEV1 % was lower in males than females (p<0,005). On the other hand, FVC % was lower in the females compared with the males (p < 0.02). When analyzing the influence of PFT and demographic parameters on PH in separate COPD level groups, the results a bit varied among the groups. Conclusion; Our study demonstrated that PH frequency is higher in female COPD cases due to biomass smoke than in male COPD cases due to tobacco smoke. The influence of FVC % on the risk of a person having PH increased with increasing COPD level.