Influence Of Pulmonary Hypertension Research Articles

Prevalence and influence of pulmonary hypertension in patients with obstructive hypertrophic cardiomyopathy undergoing septal myectomy

ObjectivesPulmonary hypertension (PH) is an independent predictor of all-cause mortality among patients with obstructive and nonobstructive hypertrophic cardiomyopathy (HCM). However, there is little information on the influence of coexisting PH on long-term survival following septal myectomy. This study investigates the prevalence of PH among patients with obstructive HCM undergoing septal myectomy and analyzes patient survival and the course of PH after operation. MethodsWe included 1342 patients with obstructive HCM who had Doppler echocardiographic estimates of the right ventricular systolic pressure (RVSP) before and after transaortic septal myectomy. PH was defined as RVSP ≥35 mm Hg, with ≥50 mm Hg categorized as moderate-to-severe PH. A multivariable Cox proportional hazards model was used to identify characteristics associated with survival, and longitudinal trends in RVSP were modeled with generalized least squares analysis. ResultsPatients underwent operations from 1989 to 2019. The median age was 57.9 years (interquartile range, 47.4-66.7 years); 49.5% were women. Preoperatively, PH was present in 47.8% of patients, and 14.4% had moderate-to-severe PH. Higher preoperative RVSP was independently associated with overall mortality in the multivariable Cox model. Among patients with moderate to severe preoperative RVSP elevation, postoperative RVSP decreased from baseline by a median of 12 mm Hg. ConclusionsPreoperative PH is independently associated with late mortality following septal myectomy, and the magnitude of preoperative RVSP was associated with a postoperative decrease in pulmonary pressure. The influence of PH on late postoperative survival may influence the timing of operation in patients who are candidates for septal myectomy.

Influence of Pulmonary Hypertension on Surgical PDA Ligation Outcomes in Preterm Neonates

Background: Pulmonary hypertension (PH) increases mortality in infants with bronchopulmonary dysplasia (BPD). As practice has shifted towards expectant management of patent ductus arteriosus (PDA), there is limited data guiding treatment with PH. Methods: Retrospective single center cohort study of neonates <32 weeks gestation who underwent surgical PDA ligation before discharge. Ductal gradients by echocardiogram defined PH severity: severe PH as bidirectional/ right to left shunting, mild-to-moderate PH as greater than half-systemic pressure, no PH as less than half-systemic pressure. Primary outcome was mortality. Secondary outcomes were length of stay (LOS), duration of ventilation, post-operative inotropes, steroids, systemic pulmonary vasodilators, and incidence of BPD. Results: Eighty patients, median gestational age 25 (23-31) weeks, underwent surgical PDA ligation between 2010-2016. Ten had severe PH, 54 mild-to-moderate PH, and 16 no PH. Severe PH group had significantly longer LOS, 173 vs. 143 days (p=.05). PH cohort had higher surgical weight, 1.71 kg vs. 1.06 kg (p=0.04). All deaths occurred in the PH group (6% vs. 0%), p=NS. No significant difference in ventilation, inotropes, steroids, pulmonary vasodilators, and BPD. Although, statistically insignificant, the PH group had higher rates of tracheostomies (18.8% vs. 6.25%). Conclusion: Premature infants requiring PDA ligation with severe PH had longer overall LOS. All mortality occurred in the PH group. More data is needed to determine effect of PDA on lung disease and the development of PH.

Acute Respiratory Failure in Interstitial Lung Disease Complicated by Pulmonary Hypertension.

Interstitial lung disease represents a group of diffuse parenchymal lung diseases with overwhelming morbidity and mortality when complicated by acute respiratory failure. Recently, trials investigating outcomes and their determinants have provided insight into these high mortality rates. Pulmonary hypertension is a known complication of interstitial lung disease and there is high prevalence in idiopathic pulmonary fibrosis, connective tissue disease, and sarcoidosis subtypes. Interstitial lung disease associated pulmonary hypertension has further increased mortality with acute respiratory failure, and there is limited evidence to guide management. This review describes investigations and management of interstitial lung disease associated acute respiratory failure complicated by pulmonary hypertension. Despite the emerging attention on interstitial lung disease associated acute respiratory failure and the influence of pulmonary hypertension, critical care management remains a clinical and ethical challenge.

Influence of Pulmonary Hypertension on Intrahospital Mortality in Lung Transplantation for Interstitial Lung Disease

BackgroundPulmonary hypertension (PH) is a comorbidity associated with interstitial lung disease (ILD). The purpose of this study was to evaluate the influence of PH on intrahospital mortality in lung transplantation (LT) for ILD. MethodsWe conducted a retrospective cohort study of 66 patients who underwent LT for ILD at the 12 de Octubre University Hospital (Madrid, Spain) from October 2008 to June 2014. PH was defined as mean pulmonary arterial pressure (mPAP) ≥25 mmHg on right-sided heart catheterization and intrahospital mortality as any death taken place after the transplantation of patients not being discharged. ResultsWe retrospectively analyzed data of 66 patients; they were stratified by the presence or absence of PH before LT. Twenty-seven patients (41%) had PH. The PH group had a lower diffusing capacity of carbon monoxide (DLCO), carbon monoxide transfer coefficient (KCO), and 6-minute walk distance test (6MWT) and a higher total lung capacity (TLC), modified medical research council dyspnea scale (mMRC), and lung allocation score (LAS) than the non-PH group. Patients with PH more often underwent double lung transplantation (DLT; 59%) than single lung transplantation (SLT).Intrahospital mortality was 13% (9/66). No significant differences were observed in Kaplan-Meier survival curves for the PH and non-PH groups with a median survival time of 46 days versus 33 days (IQR 26–74; log-rank P = .056); however, the postoperative length of stay in the hospital was greater in the PH group. ConclusionsIn our cohort, pulmonary hypertension was not related to early mortality in lung transplantation recipients for interstitial lung diseases.

Influence of Pulmonary Hypertension on Patients with Advanced Idiopathic Pulmonary Fibrosis Prior to Lung Transplantation

Influence of Pulmonary Hypertension on Patients with Advanced Idiopathic Pulmonary Fibrosis Prior to Lung Transplantation

(302) - Influence of Pulmonary Hypertension on Adverse Outcomes Following Non-Cardiac Surgery

(302) - Influence of Pulmonary Hypertension on Adverse Outcomes Following Non-Cardiac Surgery

Influence of Pulmonary Hypertension on Outcome of Egyptian Patients with Congenital Diaphragmatic Hernia : An Experience in Low-Resource Settings

Congenital Diaphragmatic Hernia (CDH) is a rare congenital anomaly that includes pulmonary hypoplasia and pulmonary hypertension and associated with high mortality and morbidity. Pulmonary hypertension is considered the main cause of mortality in patients with CDH. Recently, many new management modalities mainly directed to control pulmonary hypertension have been introduced which led to improved survival. These modalities are not available in countries with low resource settings as in Africa and Asia. This work detected the effect of pulmonary hypertension on the outcome of patients with CDH in absence of such new management modalities. The study included retrospective analysis of 50 patients with CDH referred to the echocardiography unit, Cairo University Children's Hos-pital from the Neonatal Surgical Unit (September 2010 to September 2011). 60% of patients were male with a median age 6.5 days. (41) 82% had CDH repair at a median of 4 days from admission, 26 (63.4%) needed postoperative inotropic support. The median hospital stay was 8 days. There was 50% mortality rate, 18% of them without surgical intervention. The mean pre-operative PAP was significantly higher than postoperatively (p value .000). Non survival patients had significantly higher mean PAP both pre and post operatively, more inotropic support, more delayed surgery, and lower age at admission compared to survival. Patients were classificed regarding severity of PH, those with severe PH had significantly younger age, more delayed surgery, needed more inotropic support postoperatively and with highest mortality compared to the mild/moderate PH ones. There was a significant negative correlation between preoperative PAP and age at admission and positive correlation with both, day of surgery and postoperative PAP. Post-operative PAP had positive correlation with day of surgery and hospital stay. There was an association between both pre and postoperative PAP and use of inotropes. Logistic re-gression analysis showed that postoperative PAP is a significant predictor for morta-lity (P value .001, OR 1.164, 95.0% C.I. for OR 1.068:1.270).

Ablation of Typical Right Atrial Flutter in Patients with Pulmonary Hypertension

RF ablation for cavotricuspid isthmus (CTI) dependent flutter is an established therapy. Right atrial hypertrophy and enlargement are associated with the occurrence of cavotricuspid isthmus dependent flutter. Therefore, patients with pulmonary hypertension (PAH) are prone to atrial arrhythmias like cavotricuspid isthmus dependent flutter. However, the influence of PAH on typical atrial flutter ablation procedure has not been systematically examined. In a retrospective single-centre analysis data of patients undergoing an ablation procedure for cavotricuspid isthmus dependent flutter between January 2007 and October 2009 at Hannover Medical School, Germany were analysed. Only procedures performed by experienced electrophysiologists with an 8mm RF-ablation catheter were included. Data for 196 patients were analysed. Thirty-eight patients were identified with PAH and were compared to 158 patients without PAH for procedural ablation parameters, procedure time, ablation time, ablation points and fluoroscopy time. A bidirectional block of the CTI was achieved in all patients. Patients with severe PAH had a significantly longer procedure time (78±40 min vs. 62±29 min; p=0.033), total ablation time (20±11 min vs. 15±9 min; p=0.02) and more ablation lesions (26±16 vs. 19±12; p=0.018) as compared to patients without PAH. Cavotricuspid isthmus dependent flutter ablation in patients with PAH is associated with longer procedure duration and a greater amount of cumulative tissue ablation needed to achieve bidirectional block of the CTI compared to patients without pulmonary hypertension.

154 Exercise Testing: Influence of Pulmonary Hypertension in Patients with Interstitial Lung Disease Awaiting Lung Transplantation

Pulmonary hypertension (PH), a complication in patients with interstitial lung disease (ILD), has a prevalence of 30-40% and is a predictor of mortality. Early diagnosis of PH in ILD before clinical signs of right heart failure develop is needed. Since physical stress often allows for the detection of abnormalities not seen at rest, cardiopulmonary exercise testing (CPET) may offer a way to non-invasively test for PH. We investigated the impact of PH on exercise capacity and the correlation between mean pulmonary artery pressure (mPAP), CPET and pulmonary function test (PFT) parameters in patients with ILD awaiting lung transplantation (LTx).

Ventricular arrhythmic disturbances and autonomic modulation after beating-heart revascularization in patients with pulmonary normotension

De-novo ventricular arrhythmias are potentially life-threatening complications after beating-heart revascularization (off-pump CABG). Whether pulmonary hypertension can influence initiation of ventricular arrhythmias through increased sympathetic activity is controversial. In order to determine the influence of pulmonary hypertension on its relative contribution to ventricular arrhythmia, we first had to define the role of cardiac autonomic modulation in patients with pulmonary normotension. We aimed to observe how parameters of linear and nonlinear heart rate variability are changed pre- and postoperatively in patients with pulmonary normotension undergoing off-pump CABG. Fifteen-minute ECG recordings were collected before and after off-pump CABG in 54 patients with multivessel coronary artery disease and pulmonary normotension to determine linear (TP, HF, LF, LF:HF ratio) and nonlinear detrended fluctuation analysis (alpha1, alpha2) and fractal dimension (average, high and low) parameters of heart rate variability. Arrhythmia was monitored preoperatively in 24-hour Holter recordings and postoperatively by continuous monitoring and clinical assessment. Deterioration from simple (Lown I-II) to complex (Lown III-V) ventricular arrhythmia was observed in 19 patients, and improvement from complex to simple arrhythmia in five patients (P = 0.022). Patients with postoperative deterioration of ventricular arrhythmia had preoperatively significantly lower values of TP, HF and LF (P = 0.024-0.043) and postoperatively significantly higher values on the low fractal dimension index (P = 0.031) than patients with postoperative improvement of arrhythmia. Patients experiencing postoperative deterioration of ventricular arrhythmia already have impaired autonomic regulation before surgery. Higher postoperative values on the low fractal dimension index indicate that sympathetic predominance with or without concomitant vagal withdrawal is the underlying neurogenic mechanism contributing to ventricular arrhythmia.

763 Influence of pulmonary hypertension (PH) and its potential reversibility assessed with sodium nitroprusside (NPS) test on early result of orthotopic heart transplantation (OHT)

763 Influence of pulmonary hypertension (PH) and its potential reversibility assessed with sodium nitroprusside (NPS) test on early result of orthotopic heart transplantation (OHT)

Heart rate variability in systemic sclerosis. The influence of pulmonary hypertension

Heart rate variability in systemic sclerosis. The influence of pulmonary hypertension

Endothelium-dependent pulmonary artery responses in chronic heart failure: Influence of pulmonary hypertension

Objectives. The purpose of this study was to determine whether pulmonary artery responses to acetylcholine are abnormal in patients with chronic heart failure.Background. Defective pulmonary artery endothelium-dependent responses have been observed in chronic heart failure models in animals. However, pulmonary artery endothelial response in humans with chronic heart failure are unknown.Methods. Twenty-two patients with chronic treated heart failure (12 with secondary pulmonary hypertension, Group I; 10 with normal pulmonary artery pressure, Group II) and 8 control patients constituted the study groups. Intravascular ultrasound measurements of pulmonary artery area just beyond the tip of an 8F infusion sheath were obtained in response to acetylcholine (10−6, 10−5and 10−4mol/liter). The 10−6mol/liter infusion was repeated after methylene blue infusion. Indomethacin (5 μg/ml) was sequentially added to this combination in 17 patients.Results. There were no significant differences among the three groups in vascular area responses to the lowest concentration (10−6and 10−5mol/liter) of acetylcholine, but the 10−4mol/liter infusion resulted in significant constriction in Group II patients (p < 0.05, analysis of variance [ANOVA]). Pretreatment with methylene blue in Group II also resulted in significant pulmonary artery vasoconstriction to even the 10−6mol/liter acetylcholine infusion (10.4 ± 7.8% in Group II vs. 1.7 ± 3.9% in the control group and 0.1 ± 4.3% in Group I, p < 0.05, ANOVA). The addition of indomethacin resulted in reversal of the constriction in Group II patients.Conclusions. These responses indicate that the pulmonary artery endothelium may play a significant role in inhibiting vasoconstriction in patients with chronic heart failure who maintain normal pulmonary artery pressure.

Cytoskeletal features of immature pulmonary vascular smooth muscle cells: the influence of pulmonary hypertension on normal development.

Using an immunohistochemical technique, the development of the cytoskeletal proteins desmin, vimentin, and actin (using alpha isotype and non-isotype specific antibodies) was assessed using a semi-quantitative grading system in the pulmonary vascular smooth muscle of nine normal pigs and 19 normal humans at different ages, and in 13 children with pulmonary hypertensive congenital heart disease. In the normal of both species, immunostaining for vimentin decreased after birth and then increased gradually while immunostaining for desmin and alpha actin increased steadily with age. In pulmonary hypertension, immunostaining for alpha actin and vimentin showed an accelerated increase at between 2 and 8 months. Also, the media showed regional differences in immunostaining which preceded the development of intimal proliferation. The inner media showed less immunoreactivity for all cytoskeletal proteins studied than did the outer media. Within areas of intimal proliferation many cells were immunonegative. These results suggest that the cytoskeletal features of medial smooth muscle cells are remodelled in the normal infant; that this process is altered from at least 2 months in the pulmonary hypertensive infant; and that the smooth muscle cells immediately beneath the internal elastic lamina are remodelled before migrating to form intimal proliferation. Changes in cytoskeletal composition can be related to the previously described postnatal maturation of pulmonary vascular smooth muscle cells.

Influence of pulmonary hypertension on pulmonary diffusing capacity in patients with mitral stenosis.

The pulmonary diffusing capacity (DLCO--steady state method according to Bates and coworkers) was measured at the time of heart catheterization in 12 patients with mitral stenosis without mitral incompetence. DLCO correlates with the tidal volume at rest and during exercise and with pulmonary vascular resistance during exercise only. DLCO and left atrial pressure exhibit a positive correlation up to 22.5 mm Hg only. In patients with mitral stenosis DLCO depends on the alveolar surface area and DLCO is influenced by regional changes in the pulmonary vascular resistance.

Auscultatory and phonocardiographic manifestations of pulmonary hypertension

Summary Interpretation of the auscultatory and phonocardiographic manifestations of pulmonary hypertension has benefited from the meticulous correlation of clinical information, on the one hand, and physiologic—anatomic information, on the other. The purpose of this report has been to review the acoustic features associated with elevated pressure in the pulmonary artery. In discussing these features, the following topics were covered: (1) the acoustic events due to pulmonary hypertension per se; (2) the disorders such as primary pulmonary hypertension, recurrent peripheral pulmonary emboli, etc., that permit the purest expression of these acoustic events; (3) the influence of pulmonary hypertension on the acoustic signs of coexisting congenital or acquired heart disease; (4) the alterations that occur in the auditory signs of pulmonary hypertension in the presence of disorders such as emphysema, kyphoscoliosis, obesity or large pulmonary arterial thrombi; and (5) disorders that can cause mistaken ausculatory impressions of pulmonary hypertension.