Pulmonary Artery Research Articles

The Winding Road to Dyspnea: A Case Report of an Unusual Presentation of Anomalous Left Coronary Artery from the Pulmonary Artery

The Winding Road to Dyspnea: A Case Report of an Unusual Presentation of Anomalous Left Coronary Artery from the Pulmonary Artery

A rare case of idiopathic portal hypertension with portopulmonary hypertension occurred following splenectomy with a change in portal hemodynamics.

A 22-year-old female was referred to our hospital due to thrombocytopenia and esophagogastric varices (EGV) [LmF2CbRC1, Lg-c,F1RC0], therefore we performed endoscopic variceal ligation. Dynamic abdominal computed tomography showed giant portosystemic shunts (PSSs) from the left gastric vein to the superior vena cava and splenomegaly despite normal hepatic contour. Blood tests showed thrombocytopenia and hypoalbuminemia, but there were no abnormalities in hepatic function. Retrograde hepatic venography and transjugular liver biopsy were subsequently performed in order to further examine liver pathology. These examinations revealed anastomosis between the right and middle hepatic veins, with no features to suggest cirrhosis, therefore diagnosed as idiopathic portal hypertension. Splenectomy was performed for the treatment of hypersplenism with thrombocytopenia. Nine months after undergoing a splenectomy, the patient consulted a cardiologist due to exertional dyspnea with WHO functional class II. Echocardiography revealed a mild dilatated right ventricle (RV) with an estimated systolic pressure of 55mmHg, consistent with pulmonary hypertension. Right heart catheterization determined an increased mean pulmonary arterial pressure of 40mmHg and pulmonary vascular resistance of 7.5 wood units, but a normal pulmonary capillary wedge pressure value of 7mmHg, resulting in the diagnosis of portopulmonary hypertension (PoPH). Administration of oral macitentan 5mg/day was initiated. Exertional dyspnea and the findings from right heart catheterization were improved with macitentan 10mg/day. No report exists of PoPH occurring within one year after splenectomy, however we report here a very rare case in which a splenectomy brought about the onset of PoPH.

Unfolded protein response modulates the effects of GHRH antagonists in experimental models of in vivo and in vitro lung injury

ABSTRACT The development of efficient targeted therapies to ameliorate endothelial disorders is of the utmost need, as evident by the devastating outcomes of the recent pandemic. Recent findings suggest that unfolded protein response (UPR) modulates barrier function. In the current study, we reveal that the aforementioned highly conservative mechanism is involved in the protective effects of growth hormone-releasing hormone antagonists (GHRHAnt) in lung injury, both in vivo and in vitro. In bovine pulmonary artery endothelial cells, UPR suppression counteracted the protective effects of GHRHAnt in lipopolysaccharide (LPS)–induced endothelial hyperpermeability. In mouse lungs, UPR activation enhanced the beneficial effects of GHRHAnt against LPS-induced acute lung injury. Our observations – which are focused on lung endothelial cells and tissues – enhance our knowledge on the mechanisms mediating the barrier function and contribute to the development of novel therapies toward sepsis, direct and indirect lung injury. The effects of UPR modulation on the effects of GHRHAnt in other tissues are unknown, and they are the subject of future investigations.

Catheter-directed therapy with the FlowTriever system for intermediate-high and high-risk pulmonary embolism: asingle-centre experience.

Pulmonary embolism is an important cause of preventable mortality. Treatment strategies depend on risk stratification. High-risk patients, and some intermediate-high-risk patients, require urgent reperfusion therapy. Systemic thrombolysis (ST) is the effective first-choice treatment in these patients; however, the high risk of bleeding complications is amajor drawback. In this single-centre retrospective cohort study, we report our experience with the FlowTriever thrombosuction system as an alternative or adjunct to ST in intermediate-high and high-risk pulmonary embolism. Demographic and clinical data of all patients treated with the FlowTriever system from December 2021 until March 2024 were retrieved from the electronic medical records. Primary outcomes were technical success rate, 30-day all-cause mortality and major bleeding. Twenty-one patients were treated with the FlowTriever system, 14 of whom were considered high risk. The technical success rate was 100%. Thirty-day all-cause mortality was 29% and major bleeding was recorded in 5patients (24%), of which one bleeding event was related to the FlowTriever procedure. Asignificant reduction was seen in mean pulmonary arterial pressure and right ventricular end-diastolic dimension. In intermediate-high and high-risk pulmonary embolism patients with ST treatment failure or acontraindication for ST, the FlowTriever thrombosuction system seems to be aminimally invasive alternative treatment modality with low complication rates.

Perioperative Anesthetic Management of Brain Abscess Evacuation in a Child with Double Outlet Right Ventricle: A Case Report

Introduction: Double outlet right ventricle (DORV) is a rare congenital heart defect where both the aorta and pulmonary artery arise from the right ventricle. This anomaly poses unique challenges for anesthetic management, especially during intracranial surgeries. Case presentation: We present the case of a 7-year-old female child diagnosed with a brain abscess and DORV, who underwent open evacuation and cranioplasty. Anesthetic management focuses on maintaining hemodynamic stability and ensuring adequate oxygenation. The patient was successfully extubated postoperatively and transferred to the intensive care unit (ICU) for close monitoring. Conclusion: Surgical interventions in patients with DORV require careful preoperative evaluation and close perioperative monitoring to minimize morbidity and mortality. This case highlights the importance of a multidisciplinary approach and meticulous anesthetic management in ensuring a successful outcome.

Impact of Laparoscopic Sleeve Gastrectomy on Pulmonary Arterial Stiffness and Right Ventricular Function in Obese Patients.

Pulmonary hypertension (PH) is a serious condition associated with high morbidity and mortality, with obesity identified as a significant risk factor. Pulmonary arterial stiffness (PAS) is an early marker of PH, often preceding clinical symptoms. While laparoscopic sleeve gastrectomy (LSG) has been shown to improve various cardiac parameters in obese patients, its impact on PAS and right ventricular (RV) function in the absence of PH remains unclear. This study investigates the effects of LSG on PAS and RV function in obese patients without pre-existing PH. A cohort of 54 patients with obesity who underwent LSG between January and June 2023 at the University hospital was prospectively studied. Patients were evaluated preoperatively and six months postoperatively using comprehensive echocardiographic assessments. Key parameters measured included tricuspid annular systolic velocity (TAS), tricuspid regurgitation velocity (TRV), pulmonary flow acceleration time (PFAT), pulmonary artery velocity, and PAS. Statistical analyses were conducted using paired t-tests and the Wilcoxon signed-rank test. Significant improvements were observed in several echocardiographic and hemodynamic parameters post-LSG. PAS showed a notable reduction from 2.44 ± 0.68 preoperatively to 1.74 ± 0.32 postoperatively (p < 0.001). Additionally, significant decreases were observed in TRV (2.00 ± 0.30m/sec to 1.79 ± 0.40m/sec, p = 0.025) and systolic pulmonary artery pressure (SPAP) (21.28 ± 4.69mmHg to 18.36 ± 5.28mmHg, p = 0.025). Improvements in RV function were indicated by an increase in tricuspid annular plane systolic excursion (TAPSE) from 17.68 ± 4.17mm preoperatively to 21.18 ± 3.53mm postoperatively (p < 0.001). LSG significantly reduces PAS and improves RV function in obese patients, even in the absence of PH. These findings suggest that LSG may offer protective effects on pulmonary vascular health, highlighting its potential as a therapeutic intervention for reducing PH risk in obese patients. Further research is warranted to explore the long-term cardiovascular benefits of LSG in diverse populations.

SPARCL1 and NT-proBNP as biomarkers of right ventricular-to-pulmonary artery uncoupling in pulmonary hypertension.

SPARCL1 was recently identified as a biomarker of right ventricular (RV) maladaptation in patients with pulmonary hypertension (PH), and N-terminal pro-brain natriuretic protein (NT-proBNP) is an established biomarker of RV failure in PH. The present study investigated whether NT-proBNP and SPARCL1 concentrations are associated with load-independent parameters of RV function and RV-to-pulmonary artery (RV-PA) coupling as measured using invasive pressure-volume (PV) loops in the RV. SPARCL1 and NT-proBNP were measured in the plasma of patients with idiopathic pulmonary artery hypertension (IPAH, n=73). Participants without LV or RV abnormalities served as controls (n=28). All patients underwent echocardiography and right heart catheterization with invasive PV loop measurements. Our cohort had more females with IPAH than the control group (64% vs. 35%; P=0.01) and was older [69 (interquartile range, IQR 57-76) vs. 51 (IQR 35-62) years; P<0.001]. SPARCL1 and NT-proBNP levels were significantly higher in patients with IPAH as compared with controls (P<0.0001). Patients with IPAH and maladaptive RV remodelling had higher SPARCL1 and NT-proBNP concentrations than those with adaptive RV remodelling (P<0.01). Both SPARCL1 and NT-proBNP were good predictors of maladaptive RV remodelling in receiver operating characteristic analysis [area under the curve (AUC) (AUCSPARCL1=0.75, AUCNT-proBNP=0.72, P=0.36 for AUCSPARCL1 vs. AUCNT-proBNP]. The combined predictive value of SPARCL1 and NT-proBNP (AUC 0.78, P<0.001) for maladaptive RV was numerically higher than that of either SPARCL1 or NT-proBNP alone (P=0.16 for AUCSPARCL1+NT-proBNP vs. AUCNT-proBNP and P=0.18 for AUCSPARCL1+NT-proBNP vs. AUCSPARC1). SPARCL1 showed numerically a tendency for a better predictive power than NT-proBNP for parameters of early maladaptive RV remodelling such as RV ejection fraction<50% (AUCSPARCL1=0.77, AUCNT-proBNP=0.67, P=0.06 for AUCSPARCL1 vs. AUCNT-proBNP), RV end-diastolic diameter>42mm (AUCSPARCL1=0.72, AUCNT-proBNP=0.65, P=0.19 for AUCSPARCL1 vs. AUCNT-proBNP) and RV end-systolic volume index RVESVI>31mL/m2 (AUCSPARCL1=0.78, AUCNT-proBNP=0.71, PP=0.10 for AUCSPARCL1 vs. AUCNT-proBNP). SPARCL1 and NT-proBNP are good predictors of maladaptive RV remodelling and RV-PA uncoupling in IPAH patients. SPARCL1 may be a better predictor of early maladaptive RV remodelling than NT-proBNP.

Comparison of ventilation/perfusion scintigraphy and pulmonary CT angiography: Findings in the diagnosis of CTEPH and CTED.

Despite the high sensitivity and specificity of ventilation/perfusion (VQ) scintigraphy in the diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) and chronic thromboembolic disease (CTED), V/Q scintigraphy cannot distinguish whether the thrombus is acute or chronic. In our study, we aimed to compare pulmonary computed tomography angiography (CTA) findings with V/Q scintigraphy findings in CTEPH and CTED patients and to identify findings that would indicate chronic thrombus. Eighteen patients diagnosed with CTEPH and CTED at our institution were included in the study between January 2020 and January 2024. Computed tomography angiographyfindings were recorded as V/Q findings [location (segmental, subsegmental, lobar), number, appearance (wedge or patchy) of mismatch perfusion defects], and the correlation of these findings was investigated. The average age of 18 patients was 63.3±11.7, 66.7% were female and the majority of the patients were non-smokers, and no significant difference was detected between the CTED and CTEPH groups. Apart from the areas where chronic thrombus was localized on CTA, more widespread mismatch defects were observed by VQ scintigraphy. Most of the mismatch defects were wedge-shaped and there was similarity between groups. The presence of mosaic perfusion was detected in 62.5% of those with mismatch patchy defects (P=0.043). A negative correlation was detected between pulse oxygen saturation and the number of mismatch subsegmentary defects (r: -0.651, P=0.005). Systolic pulmonary artery pressure (sPAP) was found to be positively correlated with the number of mismatch defects (r: 0.523, P=0.026). Ventilation/perfusionscintigraphy is superior in the diagnosis of CTEPH/CTED. The presence of mismatch patch defects on V/Q scintigraphy in patients with clinical, echocardiographic, and CTA findings suggests that the presence of mismatch patch defects on V/Q scintigraphy may be a sign of chronic thrombus and the number of mismatch defects may be correlated with the severity of the disease.

Human induced pluripotent stem cell-derived cardiomyocyte patches ameliorate right ventricular function in a rat pressure-overloaded right ventricle model.

Right ventricular (RV) failure following surgical repair of congenital heart disease affects survival. Human induced pluripotent stem cell-derived cardiomyocyte (hiPS-CM) sheet transplantation ameliorated left ventricular dysfunction in preclinical studies, indicating its efficacy in RV failure in congenital heart disease. This study aimed to evaluate whether hiPS-CMs could improve RV function in rats with pressure-overloaded RV failure. F344/NJcl-rnu/rnu rats underwent pulmonary artery banding (PAB) via left thoracotomy. Four weeks after PAB, hiPS-CM patch transplantation to the RV was performed in the hiPS-CM group (n = 33), and a sham operation was performed in the sham group (n = 18). We evaluated cardiac catheterization, positron emission tomography data, and pathological results 8weeks following PAB. RV end-diastolic pressure, the time constant of isovolumic relaxation, and end-diastolic pressure-volume relation were significantly ameliorated in the hiPS-CM group compared with in the sham group. Picrosirius red staining revealed that anti-fibrotic effects were significantly higher in the hiPS-CM group than in the sham group. Von Willebrand factor staining revealed significantly higher myocardial capillary vascular density in the hiPS-CM group than in the sham group. hiPS-CMs were detected in the epicardium 4weeks after hiPS-CM sheet transplantation. The angiogenic gene expression in the myocardium was significantly higher in the hiPS-CM group than in the sham group. Overall, in rats with pressure-overloaded RV failure, hiPS-CM patch transplantation could improve diastolic function, suppress ventricular fibrosis, and increase capillary density, suggesting that it is a promising treatment for RV failure.

Pulmonary artery peak Doppler velocity as an estimator of systemic blood flow and predictor of intraventricular haemorrhage in preterm infants: a multicentre prognostic accuracy study

Objectives(1) To assess how main pulmonary artery peak Doppler velocity (MPAVpeak) correlates with right ventricular output (RVO) and superior vena cava flow (SVCf), (2) to assess the reproducibility of MPAVpeak...

Discovery and Optimization of Dihydroquinolin-2(1H)-ones as Novel Highly Selective and Orally Bioavailable Phosphodiesterase 5 Inhibitors for the Treatment of Pulmonary Arterial Hypertension.

Phosphodiesterase 5 (PDE5) is a cGMP-specific hydrolytic enzyme and widely distributed in versatile tissues. PDE5 has been identified as a valid therapeutic target for treating erectile dysfunction and pulmonary arterial hypertension (PAH). Herein, a hit-to-lead structural optimizations were performed on the PDE1 inhibitor 10c, leading to compound 14b possessing great potency against PDE5A (IC50 = 3 nM) with high selectivity over PDE1, PDE2, PDE3, PDE4, PDE7, PDE8, PDE9, PDE10, and PDE11 by more than 1125-fold, and remarkable safety properties. Furthermore, oral administration of 14b (5.0 mg/kg) exerted much better pharmacodynamics effects on both mPAP (mean pulmonary artery pressure) and RVHI (index of right ventricle hypertrophy) than sildenafil citrate (10.0 mg/kg) in a monocrotaline-induced PAH rat model. Overall, these results proposed a novel highly selective PDE5 inhibitor 14b which could serve as a potential candidate for treatment of PAH.

Mean pulmonary artery pressure prediction with explainable multi-view cardiac MR cine series deep learning model

BackgroundPulmonary hypertension (PH) is a heterogeneous condition and regardless of aetiology impacts negatively on survival. Diagnosis of PH is based on hemodynamic parameters measured invasively at right heart catheterization (RHC), however, a non-invasive alternative would be clinically valuable. Our aim was to estimate RHC parameters non-invasively from cardiac MR data using deep learning models and to identify key contributing imaging features. MethodsWe constructed an explainable convolutional neural network (CNN) taking cardiac MR cine series from 4 different views as input to predict mean pulmonary artery pressure (mPAP). The model was trained and evaluated on 1646 examinations. The model’s attention weight and predictive performance associated with each frame, view, or phase was used to judge its importance. Additionally, the importance of each cardiac chamber was inferred by perturbing part of the input pixels. ResultsThe model achieved a Pearson Correlation Coefficient (PCC) of 0.80 and R2 of 0.64 in predicting mPAP, and identified the right ventricle (RV) region on short-axis (SAX) view to be especially informative. ConclusionsHemodynamic parameters can be estimated non-invasively with a CNN, using MR cine series from 4 views, revealing key contributing features at the same time.

Fractal Analysis of Chest Radiographs Using Image-J-FIJI Software- A Pilot Study

Background: Lung vasculature has nutritive and functional roles. Unlike the bronchial tree which branches dichotomously into twenty-one generations, the pulmonary arteries give supernumerary branches to perfuse the neighboring parenchyma. The pulmonary arteries additionally branch for five more generations than airways before forming capillaries. Further pulmonary veins are interlobular in position. Hence the characterization quantifying the pulmonary vascular networks is challenging. Objective: In this study, we assessed the pulmonary vasculature in chest radiographs using the fractal analysis method on Image-J-Fiji software. Design: Cross-sectional study Settings: Patients referred to the Department of Radiodiagnosis, Akash Institute of Medical Sciences and Research Centre and Dr. B. R. Ambedkar Medical College, Bangalore, Karnataka, India Participants: One hundred and thirty-two chest radiographs of normal healthy individuals (aged 2 months to 80 years) were photographed. Each of these images was processed in the Image-J-Fiji software. A box-counting algorithm quantified the images. Data results of the fractal dimensions were validated at the probability of significance [0.05]. Results: The mean fractal dimension of the pulmonary vasculature was 1.39. For males and females, the Pearson's correlation coefficient between the fractal dimension and age in years was 0.102 and 0.16, respectively. In males, a chi-square value of 0.58, in females, a chi-square value of 1.03, degree of freedom 2 and critical value of p-value 0.05, showed the relation was statistically not significant. Comparison between fractal dimension and Gender using Cramer’s V test in males, 0.066, and in females, 0.088, indicates a weak association between fractal dimension and gender. Conclusion: The applicability of the fractal dimensions is to screen the high risks of severe chronic obstructive pulmonary diseases. The determination of fractal values helps evaluate the complexity of lung tumors. The baseline data concerning fractal properties of pulmonary vasculature obtained from this study helps to evaluate lung diseases like emphysema and vascular abnormalities during the progression of chronic obstructive pulmonary disease. KEYWORDS: Chest Radiograph, Image Analysis, Fractal dimension, Pulmonary vasculature.

Pulmonary artery pseudoaneurysm in a young man with pulmonary hypertension on computed tomography angiography

Pulmonary artery aneurysms and pseudoaneurysms are uncommon anomalies; however, their associated morbidity underscores the importance of recognizing them. Herein, we present a clinical case involving a 15-year-old male patient who presented at our clinic with complaints of hemoptysis. Upon diagnosis, a left lung aneurysm was found. Subsequent computed tomography angiography and intervention on the pulmonary arteries confirmed the presence of pulmonary artery aneurysms, elucidating that the hemoptysis was caused by the rupture of the aneurysm. The intervention on the pulmonary artery further confirmed the diagnosis. Early detection and management of pulmonary artery aneurysms are crucial, particularly in young patients, as timely intervention can prevent severe complications and improve patient outcomes. Raising awareness of these vascular abnormalities and promptly addressing them through appropriate diagnostic measures and interventions can help healthcare providers effectively mitigate the potential risks associated with pulmonary artery aneurysms, thereby enhancing patient care and prognosis.

SMAD5 as a novel gene for familial pulmonary arterial hypertension.

Genetic diagnostic testing of 325 pulmonary arterial hypertension (PAH) patients using a PAH specific gene panel including 18 known PAH genes revealed mutations in 23 %. Further PAH candidate genes were sequenced in the remaining patients exposing two SMAD5 variants, which were clinically and functionally characterized. We first recorded familial cosegregation and clinical parameters. Functional tests were performed following transient over-expression of the two SMAD5 variants in pulmonary artery smooth muscle cells (PAMSCs). Expression of these variants was confirmed by qPCR, Sanger sequencing and Western blotting. Cell viability was evaluated using cell counting kit 8, cell proliferation by BrdU and apoptosis by annexin V assay. Both SMAD5 missense variants were absent in healthy controls and predicted to be pathogenic. The variant c.1175T>C p.(Leu392Pro) was identified in a heritable PAH patient and her healthy son. The mother had died of suspected PAH aged 42. Expression of this variant in PAMSCs led to significantly higher cell viability due to higher proliferation in comparison to SMAD5 wild type cells. The second variant c.277T>A p.(Trp93Arg) was identified in a patient with congenital heart disease associated PAH with a surgically repaired ventricle septal defect. Its expression led to significant lower cell viability due to increased apoptosis in comparison to wild type SMAD5 cells. Taking into account familial aggregation, clinical findings and functional evidence both variants could be classified as likely pathogenic. This is the first description of SMAD5 as a potential novel PAH gene for genetic diagnostic testing.

LncRNA H19 Promotes Angiogenesis in Mouse Pulmonary Artery Endothelial Cells by Regulating the HIF-1α/VEGF Signaling Pathway.

Persistent pulmonary hypertension of the newborn (PPHN) is a syndrome of acute respiratory failure characterized by systemic hypoxemia and elevated pulmonary arterial pressure, which leads to pathological changes in pulmonary vascular remodeling and endothelial cell function. Long non-coding RNA (lncRNA) H19 has been shown to be involved in the regulation of arterial endothelial cell function, but its regulatory role in PPHN is not fully understood. In the present study, mouse pulmonary artery endothelial cells (MPAECs) were cultured in a hypoxic conditions. Subsequently, the regulatory function of lncRNA H19 on MPAECs was explored by constructing adenoviruses knocking down and overexpressing lncRNA H19. The results revealed that the hypoxic conditions could induce the proliferation and migration of MPAECs, as well as the high expression of lncRNA H19 in MPAECs. Knockdown of lncRNA H19 expression in MPAECs reversed hypoxic environment-induced functional changes in endothelial cells, whereas overexpression of lncRNA H19 further enhanced the proliferation and migration of MPAECs. In addition, lncRNA H19 upregulated the hypoxia-inducible factor-1α (HIF-1α)/vascular endothelial growth factor (VEGF) pathway through sponge of miNA-20a-5p, which in turn promoted changes in endothelial cell function. LncRNA H19 may interfere with vascular remodeling in hypoxia-induced pulmonary hypertension by upregulating the expression of HIF-1α and VEGF in vascular endothelial cells.

Transcatheter closure of a right pulmonary artery to left atrium fistula using multi-modality image fusion guidance.

We present the case of 53-year-old woman with a late diagnosis of an right pulmonary artery-left atrium fistula who underwent transcatheter device closure using multi-modality imaging for pre-procedural planning and procedural guidance.

The effect of trimetazidine on cardiac haemodynamics and mitochondrial function in wild-type transthyretin amyloidosis.

Wild-type transthyretin cardiac amyloidosis (ATTRwt) is a cardiomyopathy causing myocardial hypoperfusion and impaired cardiac mitochondrial function. Trimetazidine is an antianginal agent used in patients with stable angina pectoris, which improves cardiac contractility and mitochondrial function. The aim of the study was to investigate the effect of trimetazidine on invasive haemodynamics and cardiac mitochondrial function in ATTRwt. In a randomized, double-blind, placebo-controlled, crossover trial, 22 patients with ATTRwt received 4weeks of trimetazidine and placebo in randomized order. After each treatment period followed examinations with endomyocardial biopsies taken for high-resolution respirometry and right heart catheterization at rest and during a cardiopulmonary exercise test. The primary endpoint was mean pulmonary artery wedge pressure (mPAWP) during peak exercise. The secondary endpoint was cardiac mitochondrial oxidative phosphorylation capacity. Exploratory endpoints were echocardiographic parameters, cardiac biomarker levels and quality of life. Trimetazidine did not significantly reduce mPAWP during peak exercise (31±12 vs. 31±13mmHg, P=0.61) or improve the cardiac mitochondrial oxidative phosphorylation capacity (73.4±7.7 vs. 75.3±7.7pmol O2/(mg*s), P=0.81) compared with placebo, nor did treatment with trimetazidine improve ejection fraction (P=0.93), global longitudinal strain (P=0.23), N-terminal pro-brain natriuretic peptide (NT-proBNP) levels (P=0.92) or the patients' quality of life (P=0.98). In ATTRwt, treatment with trimetazidine did not improve mPAWP or cardiac mitochondrial oxidative phosphorylation capacity compared with placebo.

Esophageal Manometry in Pediatric Acute Respiratory Distress Syndrome: Necessity or Simply a Neighbor of the Pulmonary Artery Catheter?

Esophageal Manometry in Pediatric Acute Respiratory Distress Syndrome: Necessity or Simply a Neighbor of the Pulmonary Artery Catheter?

Electrocardiography in pulmonary hypertension: search for new diagnostic possibilities (literature review)

The review covers current clinical guidelines for the use of electrocardiography (ECG) in examining patients with pulmonary hypertension (PH), provides data on the correlation of ECG parameters with hemodynamic parameters in PH, discusses the possibilities of using ECG in PH screening, including the inclusion of ECG parameters in clinical scales. Particular attention is paid to data on the relationship between ECG changes and the prognosis of patients with PH and the use of ECG to assess the effectiveness of PH treatment, in particular, pulmonary artery balloon angioplasty in chronic thromboembolic pulmonary hypertension. Special sections are devoted to such ways of improving electrocardiographic diagnostics of PH as the use of three-dimensional vectorcardiographic parameters and ECG processing using deep machine learning methods. The paper describes «soft» functional tests that can potentially provide useful information in the diagnosis of PH (fluid challenge, passive leg raise, deep inhalation).