Measurement Of Pulmonary Artery Pressure Research Articles

Cold ischemia with selective anterogradein situpulmonary perfusion preserves gas exchange and mitochondrial homeostasis and curbs inflammation in an experimental model of donation after cardiac death

The aim of this study was to assess the functional preservation of the lung graft with anterograde lung perfusion in a model of donation after cardiac death. Thirty minutes after cardiac arrest, in situ anterograde selective pulmonary cold perfusion was started in six swine. The alveolo-capillary membrane was challenged at 3, 6, and 8h with measurements of the mean pulmonary arterial pressure (mPAP), the pulmonary vascular resistance (PVR), the PaO2 /FiO2 ratio, the transpulmonary oxygen output (tpVO2 ), and the transpulmonary CO2 clearance (tpCO2 ). Mitochondrial homeostasis was investigated by measuring maximal oxidative capacity (Vmax ) and the coupling of phosphorylation to oxidation (ACR, acceptor control ratio) in lung biopsies. Inflammation and induction of primary immune response were assessed by measurement of tumor necrosis factor alpha (TNFα), interleukine-6 (IL-6) and receptor for advanced glycation endproducts (RAGE) in bronchoalveolar lavage fluid. Data were compared using repeated measures Anova. Pulmonary hemodynamics (mPAP: P=0.69; PVR: P=0.46), oxygenation (PaO2 /FiO2 : P=0.56; tpVO2 : P=0.46), CO2 diffusion (tpCO2 : P=0.24), mitochondrial homeostasis (Vmax : P=0.42; ACR: P=0.8), and RAGE concentrations (P=0.24) did not significantly change up to 8h after cardiac arrest. TNFα and IL-6 were undetectable. Unaffected pulmonary hemodynamics, sustained oxygen and carbon dioxide diffusion, preserved mitochondrial homeostasis, and lack of inflammation suggest a long-lasting functional preservation of the graft with selective anterograde in situ pulmonary perfusion.

Acute anesthetized measurements of right ventricular and pulmonary artery pressure in a rat model of pulmonary artery hypertension

Acute anesthetized measurements of right ventricular and pulmonary artery pressure in a rat model of pulmonary artery hypertension

AB0709 Pulmonary arterial hypertension in systemic lupus erythematosus: a study of 80 tunisian patients

BackgroundPulmonary hypertension (PH) is a serious form of pulmonary complication that occurs in Systemic lupus erythematosus (SLE). It is less frequent in SLE compared to systemic sclerosis. The symptoms of...

Disease management: remote monitoring in heart failure patients with implantable defibrillators, resynchronization devices, and haemodynamic monitors

Heart failure represents a major public health concern, associated with high rates of morbidity and mortality. A particular focus of contemporary heart failure management is reduction of hospital admission and readmission rates. While optimal medical therapy favourably impacts the natural history of the disease, devices such as cardiac resynchronization therapy devices and implantable cardioverter defibrillators have added incremental value in improving heart failure outcomes. These devices also enable remote patient monitoring via device-based diagnostics. Device-based measurement of physiological parameters, such as intrathoracic impedance and heart rate variability, provide a means to assess risk of worsening heart failure and the possibility of future hospitalization. Beyond this capability, implantable haemodynamic monitors have the potential to direct day-to-day management of heart failure patients to significantly reduce hospitalization rates. The use of a pulmonary artery pressure measurement system has been shown to significantly reduce the risk of heart failure hospitalization in a large randomized controlled study, the CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III Heart Failure Patients (CHAMPION) trial. Observations from a pilot study also support the potential use of a left atrial pressure monitoring system and physician-directed patient self-management paradigm; these observations are under further investigation in the ongoing LAPTOP-HF trial. All these devices depend upon high-intensity remote monitoring for successful detection of parameter deviations and for directing and following therapy.

Superoxide Dismutase Mimetic, MnTE-2-PyP, Attenuates Chronic Hypoxia-Induced Pulmonary Hypertension, Pulmonary Vascular Remodeling, and Activation of the NALP3 Inflammasome

Pulmonary hypertension (PH) is characterized by an oxidant/antioxidant imbalance that promotes abnormal vascular responses. Reactive oxygen species, such as superoxide (O(2)(•-)), contribute to the pathogenesis of PH and vascular responses, including vascular remodeling and inflammation. This study sought to investigate the protective role of a pharmacological catalytic antioxidant, a superoxide dismutase (SOD) mimetic (MnTE-2-PyP), in hypoxia-induced PH, vascular remodeling, and NALP3 (NACHT, LRR, and PYD domain-containing protein 3)-mediated inflammation. Mice (C57/BL6) were exposed to hypobaric hypoxic conditions, while subcutaneous injections of MnTE-2-PyP (5 mg/kg) or phosphate-buffered saline (PBS) were given 3× weekly for up to 35 days. SOD mimetic-treated groups demonstrated protection against increased right ventricular systolic pressure, indirect measurements of pulmonary artery pressure, and RV hypertrophy. Vascular remodeling was assessed by Ki67 staining to detect vascular cell proliferation, α-smooth muscle actin staining to analyze small vessel muscularization, and hyaluronan (HA) measurements to assess extracellular matrix modulation. Activation of the NALP3 inflammasome pathway was measured by NALP3 expression, caspase-1 activation, and interleukin 1-beta (IL-1β) and IL-18 production. Hypoxic exposure increased PH, vascular remodeling, and NALP3 inflammasome activation in PBS-treated mice, while mice treated with MnTE-2-PyP showed an attenuation in each of these endpoints. This study is the first to demonstrate activation of the NALP3 inflammasome with cleavage of caspase-1 and release of active IL-1 β and IL-18 in chronic hypoxic PH, as well as its attenuation by the SOD mimetic, MnTE-2-PyP. The ability of the SOD mimetic to scavenge extracellular O(2)(•-) supports our previous observations in EC-SOD-overexpressing mice that implicate extracellular oxidant/antioxidant imbalance in hypoxic PH and implicates its role in hypoxia-induced inflammation.

Right ventricular function in dilated cardiomyopathy: relation to location of focal myocardial fibrosis

Background Severe right ventricular dysfunction (RVD) is an important prognostic parameter in dilated cardiomyopathy (DCM). The relationship between myocardial fibrosis of the left ventricle (LV) and particularly the septum and right ventricular (RV) function remains poorly understood. We sought to investigate this relationship in a large cohort of DCM patients using cardiovascular magnetic resonance (CMR). Methods We studied 257 patients (52±15ys,193men) with known DCM using a clinical 1.5 T CMR scanner (Philips Achieva). Short axis slices covering entirely both ventricles were acquired using standard SSFP-sequences for measurement of LV and RV volumes and ejection fraction (EF). Focal myocardial fibrosis was assessed in late gadolinium enhancement (LGE) CMR images acquired 10 minutes after i.v. injection of 0.2mmol/kg Gd-DTPA (Magnevist). SSFP and LGE CMR images were assessed by different observers who were blinded to measurement results and clinical data. Severe RVD was defined as RVEF<35%. In a subgroup of patients (n=96) invasive measurement of pulmonary artery pressure was performed. Results Mean LVEF was 35±14% while mean RVEF was 42 ±13%. Focal myocardial fibrosis was present in 92 (36%) patients and was located a) intra-murally within the inter-ventricular septum in 29 patients (LGE -septum) or b) sub-epicardially/diffuse in 63 patients (any-LGE). None of the patients had sub-endocardial LGE. LGEseptum patients exhibited a significantly higher RVEF (49±12%; vs. 40±14%;p=0.006), a higher RV EDV index (115±43 ml/m2; vs. 99±23 ml/m2 ;p=0.05) and a higher RV ESV index (73±45 ml/m2; vs. 52±22 ml/m2 ;p=0.01)

Adequate time of initiation of continuous infusion of nitroglycerin for controlling pulmonary arterial pressure during ethanol embolotherapy of congenital arteriovenous malformation of the extremities

Adequate time of initiation of continuous infusion of nitroglycerin for controlling pulmonary arterial pressure during ethanol embolotherapy of congenital arteriovenous malformation of the extremities

Physiologic Changes in a Nonhuman Primate Model of HIV-Associated Pulmonary Arterial Hypertension

Pulmonary arterial hypertension (PAH) is increased in HIV, but its pathogenesis is not fully understood. Nonhuman primates infected with simian immunodeficiency virus (SIV) or SIV-HIV chimeric virus (SHIV) exhibit histologic changes characteristic of human PAH, but whether hemodynamic changes accompany this pathology is unknown. Repeated measurements of pulmonary artery pressures would permit longitudinal assessments of disease development and provide insights into pathogenesis. We tested the hypothesis that SIV-infected and SHIV-infected macaques develop physiologic manifestations of PAH. We performed right heart catheterizations, echocardiography, and computed tomography (CT) scans in macaques infected with either SIV (ΔB670) or SHIV (89.6P), and compared right heart and pulmonary artery pressures, as well as pulmonary vascular changes on CT scans, with those in uninfected control animals. Right atrial, right ventricular systolic, and pulmonary artery pressures (PAPs) were significantly elevated in 100% of macaques infected with either SIV or SHIV compared with control animals, with no difference in pulmonary capillary wedge pressure. PAPs increased as early as 3 months after SIV infection. Radiographic evidence of pulmonary vascular pruning was also found. Both SIV-infected and SHIV-infected macaques exhibited histologic changes in pulmonary arteries, predominantly consisting of intimal and medial hyperplasia. This report is the first to demonstrate SHIV-infected and SIV-infected macaques develop pulmonary hypertension at a high frequency, with physiologic changes occurring as early as 3 months after infection. These studies establish an important nonhuman primate model of HIV-associated PAH that will be useful in studies of disease pathogenesis and the efficacy of interventions.

Levosimendan is superior to dobutamine as an inodilator in the treatment of pulmonary hypertension for children undergoing cardiac surgery

To compare the effectiveness of levosimendan and dobutamine in reducing pulmonary artery pressure (PAP) and increasing cardiac output for children undergoing cardiac surgery. The study included 50 patients with high systolic pulmonary artery pressure (PAP) undergoing surgical repair of cardiac septal defects. Patients were randomly allocated to two equal groups: group L received levosimendan and group D received dobutamine. PAP was measured preoperatively, by use of transthoracic echocardiography (baseline), intraoperatively, directly, by use of a 22-gauge catheter inserted in the pulmonary artery, and postoperatively, by use of transesophageal echocardiography (TEE). Cardiac index (CI) was recorded by use of a transesophageal 4-MHz Doppler probe. Both drugs significantly reduced PAP compared with the level at the time of induction of anesthesia. Mean PAP measurement before chest closure, 1 and 20h after ICU admission were significantly lower for patients who received levosimendan (32.7±4.1, 25.8±2.8, 19.8±2mmHg, respectively) than for those who received dobutamine (37.6±2.75, 32.8±2.36, 26.5±2.2mmHg, respectively). Both drugs significantly improved CI compared with its level at the time of induction of anesthesia. Mean CI measurements 5min after weaning from cardiopulmonary bypass (CPB) until 20h after ICU admission were significantly higher for patients who received levosimendan than for those who received dobutamine (3.55±0.35, 3.8±0.36, 3.81±0.34, respectively, in group L vs. 3.4±0.36, 3.6±0.33, 3.66±0.29, respectively, in group D). Levosimendan is better than dobutamine for treatment of pulmonary hypertension of children undergoing cardiac surgery.

Pulmonary artery pressure in cystic fibrosis adults: Characteristics, clinical correlates and long-term follow-up

BackgroundWe examined pulmonary artery pressure (PAP) characteristics of CF adults, studied clinical correlates and long-term survival. MethodsComprehensive clinical data were collected and Doppler echocardiography was used to estimate PAP in 109 stable CF adults and 50 healthy controls. ResultsCF patients had lower day and night-time oxygen status, elevated CRP and BNP, and elevated PAP (27.7(13.2, 62.8) mmHg patients v 17.9(11.3, 30.9) mmHg controls, p<0.001). Even patients with mild pulmonary disease had raised PAP. PAP measurements strongly correlated with arterial partial pressure of oxygen (PaO2, r=−0.673, p<0.001), and FEV1 percentage predicted (FEV1%, r=−0.642, p<0.001) which were both independent predictors of PAP. At 10year follow up PAP measurements were related to survival but FEV1% and PaO2 were both stronger predictors of death. ConclusionsPAP is raised in CF adults and correlates with pulmonary disease severity. Unlike PaO2 and FEV1%, it does not appear to be an independent prognostic marker.

Telemonitoring of Outpatients With Heart Failure

Heart failure (HF) remains a large medical problem, and prevention of decompensation and HF-related hospitalizations is important not only for the patient, but also from an economic point of view. Close monitoring is crucial and can be done through a whole spectrum of modalities. This monitoring ranges from a (nurse-based) disease management program, to structured telephone support, to remote or telemonitoring with or without the use of an implantable device.1–3 Article see p 2985 Disease management programs, usually with a specialized nurse and in the hospital, are implemented on a large scale, but the optimal level and intensity of care is still unclear.4 Structured telephone support may be useful, and a recent meta-analysis showed a reduction in HF hospitalization, but no effect on mortality.2 Remote, home, or telemonitoring using a number of (relatively simple) noninvasive variables such as heart rate, blood pressure, and body weight was also examined in a number of studies, and the same meta-analysis showed that this method reduced both hospitalizations and mortality.2 However, 2 recent large studies not included in that analysis did not show such a positive effect.5,6 In the American Telemonitoring to improve outcomes in HF (TELE-HF) study5 and in the German Telemedical Intervention Monitoring in HF (TIM-HF) study,6 which together randomly assigned 2362 HF patients, no effect on HF hospitalizations or mortality was observed. In recent years, a number of studies in the field of telemonitoring have been published that measured invasive variables. In the Chronicle Offers Management to Patients with Advanced Signs and Symptoms of HF (COMPASS-HF) study,7 a strategy based on measurement of right-sided intracardiac pressures (with a special transvenous lead: Chronicle, Medtronic) was examined. The primary (composite) end point showed a nonsignificant 21% reduction, but there was a …

Recruitment of arteriovenous pulmonary shunts may attenuate the development of pulmonary hypertension in dogs experimentally infected with Angiostrongylus vasorum

ObjectivesThe purposes of this study were to evaluate if (1) Angiostrongylus vasorum-infected dogs recruit pulmonary arteriovenous (AV) shunts attenuating the development of pulmonary hypertension (PH), detectable using saline contrast echocardiography, (2) anthelmintic therapy causes an acute increase in pulmonary arterial pressure (PAP), (3) Tissue Doppler Imaging (TDI) allows detection of mild changes in right ventricular function secondary to pulmonary (vascular) disease. Animals6 healthy Beagle dogs, each infected with 200 A. vasorum larvae. MethodsConventional, TDI and contrast echocardiography, invasive PAP measurements before (T0), 7–12 weeks post infection (wpi, T1), and 1–5 days post therapy (dpt, T2). ResultsAll dogs had patent infections 7–8 wpi and respiratory signs 6–9 wpi. PAP was mildly but significantly increased at T2. Saline contrast echo was positive in 3/6 dogs at T1 and 4/6 dogs at T2. Pulmonary transit time did not change. Of all numeric echocardiographic parameters, only a non-significant decrease in the E′ wave and inversion of E′/A′ ratio in 3 dogs at T2 could be observed. Two of these had mild PH and negative saline contrast echocardiography. ConclusionA. vasorum infection causes only a mild increase in PAP following inoculation and anthelmintic therapy. The absence of important PH may in part be explained by the recruitment of AV shunts in the presence of vascular obstructive disease. TDI echocardiographic parameters may be more sensitive to detect mild changes in RV function than conventional parameters.

Right Atrial Pressure Affects the Interaction between Lung Mechanics and Right Ventricular Function in Spontaneously Breathing COPD Patients

IntroductionIt is generally known that positive pressure ventilation is associated with impaired venous return and decreased right ventricular output, in particular in patients with a low right atrial pressure and relative hypovolaemia. Altered lung mechanics have been suggested to impair right ventricular output in COPD, but this relation has never been firmly established in spontaneously breathing patients at rest or during exercise, nor has it been determined whether these cardiopulmonary interactions are influenced by right atrial pressure.MethodsTwenty-one patients with COPD underwent simultaneous measurements of intrathoracic, right atrial and pulmonary artery pressures during spontaneous breathing at rest and during exercise. Intrathoracic pressure and right atrial pressure were used to calculate right atrial filling pressure. Dynamic changes in pulmonary artery pulse pressure during expiration were examined to evaluate changes in right ventricular output.ResultsPulmonary artery pulse pressure decreased up to 40% during expiration reflecting a decrease in stroke volume. The decline in pulse pressure was most prominent in patients with a low right atrial filling pressure. During exercise, a similar decline in pulmonary artery pressure was observed. This could be explained by similar increases in intrathoracic pressure and right atrial pressure during exercise, resulting in an unchanged right atrial filling pressure.ConclusionsWe show that in spontaneously breathing COPD patients the pulmonary artery pulse pressure decreases during expiration and that the magnitude of the decline in pulmonary artery pulse pressure is not just a function of intrathoracic pressure, but also depends on right atrial pressure.

Pulmonary artery banding in the current era: Is it still useful?

Background:The objective of this study was to assess the results of the pulmonary artery (PA) banding in patients with congenital heart defects (CHD) and pulmonary hypertension (PH) in the current era.Methods:We analyzed data from 305 patients who underwent PA banding between April 2005 and April 2010 at our centre. All patients were approached through a left thoracotomy. Twenty percent of patients underwent PA banding based on Trusler's rule (Group 1), 55% of them underwent PA banding based on PA pressure measurement (Group 2), and the rest of them (25%) based on surgeon experience (Group 3). The follow-up period was 39 ± 20 month and 75% of patients (230 cases) had definitive repair at mean interval 23 ± 10 months.Results:The rate of anatomically and functionally effectiveness of PA banding in all groups was high (97% and 92%, respectively). There were no significant differences in anatomically and functionally efficacy rate between all groups (P=0.77, P=0.728, respectively). There was PA bifurcation stenosis in six cases (2%), and pulmonary valve injury in one case (0.3%). The mortality rate in PA banding was 2% and in definitive repair was 3%.Conclusions:We believe that PA banding still plays a role in management of patients with CHD, particularly for infants with medical problems such as sepsis, low body weight, intracranial hemorrhage and associated non cardiac anomalies. PA banding can be done safely with low morbidity and mortality.

Abstract P270: Systolic Pulmonary Artery Pressure Predicts Hospital Readmission in Patients with Congestive Heart Failure

Background: Left atrial hypertension results in pulmonary hypertension which is a frequent finding in the setting of left ventricular failure. We hypothesized that noninvasive measurement of systolic pulmonary artery pressure (SPAP) by echocardiography could be used to estimate the risk of hospital readmission in patients with congestive heart failure (CHF). Methods: We conducted a retrospective cohort study on patients discharged from a major urban hospital between June 2009 and October 2009 with a primary diagnosis of CHF. Noninvasive assessment of SPAP by 2D echocardiography performed within 6 months preceding hospital discharge was among the inclusion criteria. A SPAP of 40 mmHg or greater in addition to other factors potentially predictive of re-hospitalization were included in a univariable cox-regression analysis for predicting all-cause readmission. Variables with p-values less than 0.25 were allowed to participate in a stepwise cox-regression model which identified all statistically significant predictors within a mutlivariable setting. Results: 145 patients participated in the stepwise cox-regression analysis. The mean SPAP (mmHg) was 47 with a median of 46. The following statistically significant predictors were identified: hemoglobin nadir &lt; 10 g/dl (HR 1.63; 95% CI 1.07-2.48; P = 0.02), requirement of skilled nursing care after discharge (HR 1.73; 95% CI 1.14-2.63; P = 0.011), diagnosis of COPD (HR 1.62; 95% CI 1.04-2.51; P = 0.03), diagnosis of ESRD (HR 2.05; 95% CI 1.18-3.55; P = 0.01), use of cardiac resynchronization therapy (HR 4.71; 95% CI 1.95-11.35; P &lt; 0.001) and SPAP of 40 or above (HR 2.03; 95% CI 1.30-3.18; P = 0.002). Conclusions: Previous limited studies have suggested that pulmonary hypertension is a prognostic marker in patients with cardiomyopathy. Our data suggests that noninvasive measurement of SPAP by echocardiography can help to predict the risk of hospital readmission in patients hospitalized for CHF. A systolic PAP of 40 mmHg or above appears to be a stronger predictor of re-hospitalization when compared to traditional risk factors including COPD, ESRD and anemia.

Evaluation of two-dimensional strain echocardiography in quantifying right ventricular function in patients with pulmonary hypertension

ObjectiveTo evaluate RV longitudinal function in pulmonary hypertension (PH) patients by two-dimensional strain (2DS).MethodsForty one patients with PH were prospectively studied along with 40 control patients. RV 2DS and right...

The incidence of recurrent venous thromboembolism and chronic thromboembolic pulmonary hypertension following a first episode of pulmonary embolism

Pulmonary embolism is the most serious complication of venous thromboembolism, with an elevated case/fatality rate. Patients who survived a first episode of pulmonary embolism should be evaluated for the risk of recurrence and of chronic thromboembolic pulmonary hypertension (CTEPH). The risk of recurrence is higher in patients with unprovoked pulmonary embolism than in those with transient risk factors. Persistent risk factors, such as active cancer and antiphospholipid antibodies, are associated with high risk of recurrence. Recently, elevated D-dimer levels after discontinuation of therapy have been identified as a risk factor for recurrence. CTEPH is characterized by intravascular organization of emboli and occurs in 0.5-1% of cases. Some patients with CTEPH have impaired fibrinolysis, likely due to a structural abnormality of fibrin or fibrin clot. Echocardiography often reveals signs of pulmonary hypertension. This should be confirmed by direct measurement of pulmonary artery pressures at right heart catheterization. CTEPH patients should receive life-long anticoagulation for preventing recurrent pulmonary embolism. Pulmonary endarterectomy is the treatment of choice for patients with proximal pulmonary vascular occlusion. Patients with predominantly distal pulmonary vascular occlusion are candidates for pharmacological treatment. All patients with unprovoked pulmonary embolism should be evaluated for long-term anticoagulation.

OP-058: NEUTROPHIL/LYMPHOCYTE RATIO IN PATIENTS WITH NON-DIPPER HYPERTENSION

Objective: Heart Transplantation remains excellent long term outcomes with end stage cardiac failure. Pulmonary Hypertension is generally observed in patients with heart failure who are being considered for heart transplantation. Fixed pulmonary hypertension has been associated with a higher risk of early post heart transplant mortality. Fixed pulmonary hypertension is therefore considered as contraindication for heart transplantation. However pulmonary hypertension is reversible in many patients by medications and these patients may be treated by transplantation. We want to discriminate the effects and outcomes of pulmonary hypertension in heart transplantaion. Methods: Data were collected on 28 patients who underwent cardiac transplantation between September 2009 and January 2011. Data collected on recipients include demographics (age, gender), past medical history, echocardiographic pulmonary artery pressure measurement and postoperative hospital mortality and morbidity. Patients whom systolic pulmonary arterial pressure are greater than 45mmHg are accepted as pulmonary hypertension. Results: The follow up period was 30 days postoperatively. Mean age of the patients was 37. Systolic pulmonary arterial pressure was greater than 45mmHg in 7 patients. Hospital Mortality (30 days) for Pulmonary Hypertensive group was 28.5%. Mortality for the non-pulmonary hypertensive group was 9.5%. Mean ICU stay is also implied to be higher in pulmonary hypertensive group. Conclusions: Pulmonary Hypertension is a major risk factor that increase the morbidity and mortality. Decision of surgery should be made in the light of reversibility of the pulmonary pressure and patient’s clinic.

Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial

Results of previous studies support the hypothesis that implantable haemodynamic monitoring systems might reduce rates of hospitalisation in patients with heart failure. We undertook a single-blind trial to assess this approach. Patients with New York Heart Association (NYHA) class III heart failure, irrespective of the left ventricular ejection fraction, and a previous hospital admission for heart failure were enrolled in 64 centres in the USA. They were randomly assigned by use of a centralised electronic system to management with a wireless implantable haemodynamic monitoring (W-IHM) system (treatment group) or to a control group for at least 6 months. Only patients were masked to their assignment group. In the treatment group, clinicians used daily measurement of pulmonary artery pressures in addition to standard of care versus standard of care alone in the control group. The primary efficacy endpoint was the rate of heart-failure-related hospitalisations at 6 months. The safety endpoints assessed at 6 months were freedom from device-related or system-related complications (DSRC) and freedom from pressure-sensor failures. All analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00531661. In 6 months, 83 heart-failure-related hospitalisations were reported in the treatment group (n=270) compared with 120 in the control group (n=280; rate 0·31 vs 0·44, hazard ratio [HR] 0·70, 95% CI 0·60-0·84, p<0·0001). During the entire follow-up (mean 15 months [SD 7]), the treatment group had a 39% reduction in heart-failure-related hospitalisation compared with the control group (153 vs 253, HR 0·64, 95% CI 0·55-0·75; p<0·0001). Eight patients had DSRC and overall freedom from DSRC was 98·6% (97·3-99·4) compared with a prespecified performance criterion of 80% (p<0·0001); and overall freedom from pressure-sensor failures was 100% (99·3-100·0). Our results are consistent with, and extend, previous findings by definitively showing a significant and large reduction in hospitalisation for patients with NYHA class III heart failure who were managed with a wireless implantable haemodynamic monitoring system. The addition of information about pulmonary artery pressure to clinical signs and symptoms allows for improved heart failure management. CardioMEMS.

El estudio hemodinámico: indicaciones del cateterismo derecho e izquierdo en el diagnóstico y seguimiento de la hipertensión pulmonar

Pulmonary artery hypertension (PAH) is a category of pulmonary hypertension consisting of mean pulmonary artery pressure greater than 25mmHg at rest, with normal pulmonary capillary occlusion pressure (less than 15mmHg) and pulmonary vascular resistance greater than 3 Wood units. The diagnosis of PAH is made through the exclusion of other disorders, including pulmonary, thromboembolic, left ventricular and valvular heart disease.All patients with PAH suspected on the basis of non-invasive tests should undergo right-sided catheterization before treatment is started, with measurement of pulmonary artery pressure, pulmonary capillary wedge pressure, and pulmonary vascular resistance. Pulmonary vasoreactivity and cardiac output should also be measured.To test pulmonary vasoreactivity, inhaled nitric oxide and intravenous adenosine or epoprosterenol are used. A reduction of 10mmHg in mean pulmonary arterial pressure or achieving a mean pulmonary artery pressure of less than 40mmHg, with no change or an increase in cardiac output, is considered a positive response. These criteria are met by only 10% of patients with PAH undergoing this test. Patients with a positive response will probably also show a sustained response to calcium channel blockers. This test should not be used in patients with PAH secondary to left cardiac disease, pulmonary disease or pulmonary embolism.