Mild Pulmonary Hypertension Group Research Articles

Pregnancy feasibility in women with mild pulmonary arterial hypertension: a systematic review and meta-analysis

BackgroundThe aim of this study was to evaluate the pregnancy feasibility of women with mild pulmonary hypertension according to pregnancy outcomes.MethodsThis systematic review and meta-analysis compared the differences in maternal and fetal outcomes between mild and moderate-to-severe pulmonary hypertension. Relevant English and Chinese literature were searched in the PubMed, Embase, Cochrane Central Register of Controlled Trials (COCHRANE), CNKI, WanFang Data, and VIP databases between January 1st, 1990 and April 18th, 2023, and the references of the included articles and relevant systematic reviews were reviewed to determine whether studies were missed. The inclusion criteria were randomized controlled and observational studies (including case-control studies and cohort studies) examining maternal and fetal pregnancy outcomes with pulmonary hypertension. Conference abstracts, case reports, case series reports, non-comparative studies, and review articles were excluded.ResultsThis meta-analysis included 32 studies. In this study, maternal and fetal outcomes were better in the mild pulmonary hypertension group than in the moderate-to-severe group. Regarding maternal mortality, the mild group was much lower than the moderate to severe group. We found a significant decrease in maternal mortality in the mild group after 2010. However, no significant difference in maternal mortality before and after 2010 was observed in the moderate to severe group. Cardiac complications, ICU admission, neonatal preterm birth, small for gestational age infants, low birth weight infants, neonatal asphyxia, and neonatal mortality were significantly lower in the mild pulmonary hypertension group than in the moderate to severe pulmonary hypertension group. The cesarean section rates of the two groups were similar. However, the vaginal delivery rate in the mild pulmonary hypertension group was significantly higher than that in the moderate to severe pulmonary hypertension group.ConclusionsThis meta-analysis confirmed that pregnancies with mild pulmonary hypertension had significantly better maternal and fetal outcomes than those with moderate to severe pulmonary hypertension. For patients with mild pulmonary hypertension and good cardiac function, continued pregnancy or even delivery should be considered under multidisciplinary monitoring. However, maternal and fetal complications with moderate to severe pulmonary hypertension significantly increase. Hence, it is essential to evaluate pregnancy risk and terminate it in time.

Maternal and fetal/neonatal outcomes of pregnancies complicated by pulmonary hypertension: a retrospective study of 154 patients

ObjectivesTo determine the main clinical and demographic outcomes related to Pulmonary Hypertension (PH) and adverse obstetric and fetal/neonatal outcomes. MethodsThis study retrospectively analyzed the medical record data of 154 patients with PH who were admitted to the Third Affiliated Hospital of Guangzhou Medical University between January 2011 and December 2020. ResultsAccording to the severity of elevated Pulmonary Artery Systolic Pressure (PASP), 82 women (53.2%) were included in the mild PH group, 34 (22.1%) were included in the moderate PH group, and 38 (24.7%) were included in the severe PH group. There were significant differences in the incidence of heart failure, premature delivery, Very-Low-Birth-Weight (VLBW) infants, and Small-for-Gestational-Age (SGA) infants among the three PH groups (p < 0.05). Five (3.2%) women died within 7-days after delivery, 7 (4.5%) fetuses died in utero, and 3 (1.9%) neonates died. The authors found that PASP was an independent risk factor for maternal mortality. After adjustment for age, gestational weeks, systolic blood pressure, Body Mass Index (BMI), mode of delivery, and anesthesia, the risk of maternal mortality in the severe PH group was 20.21 times higher than that in the mild-moderate PH group (OR = 21.21 [95% CI 1.7∼264.17]), p < 0.05. All 131 (85.1%) patients were followed up for 12 months postpartum. ConclusionsThe authors found that the risk of maternal mortality in the severe PH group was significantly higher than that in the mild-moderate group, highlighting the importance of pulmonary artery pressure screening before pregnancy, early advice on contraception, and multidisciplinary care.

Hemodynamic pulmonary response to exercise according to different resting pulmonary hypertension thresholds in chronic thromboembolic pulmonary disease

Abstract Background Chronic thromboembolic pulmonary disease (CTEPD) defines all symptomatic patients who present mismatched perfusion defects on ventilation/perfusion (V/Q) scan and specific signs of organized fibrotic clots on computed tomography after at least three months of adequate anticoagulation in the absence of pulmonary hypertension (PH) at rest. Exercise limitation in CTED has been attributed either to an abnormal hemodynamic response to exercise or increased dead space ventilation. The proposal to decrease the PH threshold to mean pulmonary arterial pressure (mPAP) ≥20 mmHg and pulmonary vascular resistance (PVR) &amp;gt;3 uWood (uW) in all PH groups could identify a subgroup of patients with borderline PH criteria, and an abnormal response at exercise in CTEPD. Aim We sought to determine the hemodynamic behaviour at exercise according to different resting pulmonary pressures in a cohort of patients with CTEPD. Methods We selected symptomatic patients with confirmed perfusion defects in lung scintigraphy despite optimal anticoagulant therapy for a minimum of 6 months after a pulmonary embolism.Significant PH were ruled out with right heart catheterization (RHC): inclusion criteria implied mPAP &amp;lt;25 mmHg and PVR &amp;lt;3 uW and pulmonary arterial wedge pressure (PWAP) &amp;lt;15 mmHg. Exercise RHC was performed in supine following an incremental stepwise protocol using a cycle ergometer. Pulmonary pressures and cardiac output (CO) estimated by thermodilution were collected in each exercise level. Abnormal hemodynamic exercise response was defined when a value of multipoint mPAP/CO slope &amp;gt;3 mmHg L–1 min–1 was reached. Patients were stratified in three groups according to resting mPAP and PVR: 1) Normal-no PH (mPAP &amp;lt;20 mmH + RVP &amp;lt;2 uW), 2) Borderline (mPAP ≥20 + RVP &amp;lt;3 uW), 3) mild PH (mPAP ≥20 mmHg + RVP &amp;gt;3 uW). Results Twenty-two CTEPD patients were stratified into three groups 1) mild PH: 3 patients, 2) borderline PH: 11 patients and 3) no PH: 8 patients. Median age between groups did not reveal differences. At rest, the mild PH group showed higher mPAP, higher total pulmonary resistance (TPR) and lower compliance, relative to borderline and normal groups without significant differences in PWAP and stroke volume (Figure 1). At peak exercise, no differences in the estimated flow between the three groups were found, despite a substantial increase of mPAP with respect to resting pressures (57.3±11 mmHg Vs 47.7±10.0 mmHg vs 34.1±5.7 mmHg, p trend = 0.006). The prevalence of an abnormal hemodynamic response the mild, borderline and normal groups was 100%, 63.6% and 37.5% respectively. Figure 2 summarizes exercise RHC parameters. Conclusion In patients with CTEPD, the presence of borderline or mild PH at rest, predicts an abnormal hemodynamic response to exercise, when compared with patients with no PH at rest. Nevertheless, in this latter group, more than a third of patients showed an abnormal response, suggesting the presence of established pulmonary vasculopathy Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Sociedad Española de Cardiologia

MicroRNA-204 as an Indicator of Severity of Pulmonary Hypertension in Children with Congenital Heart Disease Complicated with Pulmonary Hypertension.

BackgroundThe objective of this study was to investigate the changes and significance of microRNA-204 (miR-204) in children with congenital heart disease (CHD) complicated with pulmonary hypertension (PH).Material/MethodsFifty-two CHD patients with left-to-right shunt were divided into 3 groups according to preoperative pulmonary artery systolic pressure (PASP) detected by color Doppler echocardiography: a control group (PASP <30 mmHg), a mild PH group (PASP 30–49 mmHg), and a severe PH group (PASP >50 mmHg). Peripheral venous blood and supernatant were collected on an empty stomach at 1 h before surgery and 7 days after surgery. The expression of miR-204 in plasma was detected by RT-qPCR.ResultsOne hour before surgery and 7 days after surgery, plasma miR-204 expression was at a higher level than that in the mild PH group and higher than in the severe PH group. miR-204 expression in children in each group showed a decreasing trend after surgery. The mild PH and severe PH groups had lower plasma miR-204 expression and PASP after surgery than before surgery. In the mild PH and severe PH groups, plasma miR-204 expression was negatively correlated with PASP. In all 52 cases, plasma miR-204 expression was negatively correlated with PASP.ConclusionsThe plasma miR-204 expression in CHD children with PH was negatively correlated with the degree of PH, suggesting miR-204 may be involved in PH development, and miR-204 expression may be an indicator of PH severity.

Clinical characteristics and pregnancy outcomes in parturients with pulmonary hypertension: experience with 39 consecutive cases from China

Purpose: The authors aimed to understand the clinical characteristics of pulmonary hypertension (PH) with pregnancy and pregnancy outcomes in Chinese population. Materials and Methods: The authors retrospectively analyzed 39 parturients with PH. The patients were divided into mild PH group (n = 20) and severe PH group (n = 19). They compared some clinical characteristics, as well as maternal and fetal outcomes between the mild and severe PH groups. Results: The diagnostic rate of PH before pregnancy was 7.7% and the overall maternal mortality was 15.4%. There was no significant difference in age, body mass index, average termination of gestation weeks, and New York Heart Association functional class pre-pregnancy between the mild and severe PH groups. The mortality in the severe PH group (31.6%) was significantly higher than that in the mild PH group (0%) (p p Conclusion: The overall mortality of parturients with PH is high and severe PH increase the risk of death, occurrence rate of PPH, and natality of LBWN.

The effects of pulmonary hypertension severity on the outcomes of mitral valve replacement for rheumatic mitral stenosis

BackgroundWe performed this study to evaluate the effects of pulmonary hypertension (PH) severity on the hemodynamic and echocardiographic outcomes of mitral valve replacement (MVR) for rheumatic mitral stenosis (MS). MethodsPatients with rheumatic MS were divided into two groups: Group-A with mean pulmonary arterial pressure (mPAP) equal to 26–40 mmHg and group-B with mPAP > 55 mmHg. We compared the hemodynamic and arterial blood gases (ABG) data between both groups. ResultsOur analysis showed no significant difference between mild and severe PH groups in terms of all analyzed baseline and pre-operative data (p < 0.05), except for NYHA class distribution and O2 saturation on room-air, which were better in the mild PH group. Moreover, post-induction ABG data and heart rate were similar between both groups; however, post-induction central venous pressure (p = 0.01) and systolic blood pressure (p < 0.001) were significantly higher in the severe PH group, compared to the mild PH. All analyzed hemodynamic and ABG data in the 24 post-operative hours were comparable between both groups. The hospital stay duration was significantly longer (p = 0.01) in the severe PH group than the mild PH group. Concerning the echocardiographic data at three-months of follow-up, the left atrial size was comparable (p = 0.4) between both groups; however, the left ventricular end-systolic (p = 0.009) and end-diastolic (p = 0.01) dimensions were significantly higher in the severe PH group, compared to the mild PH group. ConclusionsOur study showed that both mild and severe PH groups were comparable in most operative and post-operative hemodynamic and ABG outcomes of MVR surgery.

Obstetric outcome in pregnancy complained with pulmonary hypertension

Objective: To identify whether pregnancy outcomes vary by the severity of pulmonary hypertension. Methods: A retrospective study was conducted on 78 cases of pregnancies complained with pulmonary hypertension who delivered in the First Affiliated Hospital, Sun Yat-sen University from 2006 to 2016.The selected cases were divided into three groups according to severity of pulmonary hypertension: mild pulmonary hypertension group (mild PAH group) was defined as a mean pulmonary artery pressure 30-49 mmHg, moderate pulmonary hypertension (moderate PAH group) as mean pulmonary artery pressure 50-69 mmHg and severe pulmonary hypertension (severe PAH group) as mean pulmonary artery pressure 70 mmHg or greater.The clinical features, risk pregnant complication, maternal and neonatal outcomes were described between these three groups.Analysis of variance, Chi-square test was used for statistical analysis. Results: The average age of mild, moderate and severe PAH group were (31±5) years old, (31±5) years old and (27±3) years old, respectively (P=0.050). The rate of natural fertilization (P=0.414), parity (P=0.527) and gestational age (P=0.165) were similar in these three groups. In 78 pregnancies with pulmonary hypertension, 64.9% of pregnancies in mild PAH group was NYHA Ⅰ, 50.0% of moderate PAH group was NYHA Ⅱ and 54.5% of severe PAH group was NYHA Ⅲ(P<0.001). There was no significant difference in the incidence of gestational diabetes mellitus (GDM, P=0.589), preeclampsia (P=0.942), premature rupture of membrane (PROM, P=0.276), scarred uterus (P=0.493) and postpartum hemorrhage (P=0.424). The cesarean section rate was 84.2%, 90.0% and 63.6% in three groups (P=0.208). However, neuraxial anesthesia was performed in 82.5% of cases in mild PAH and 90.0% of cases in moderate PAH, while 27.3% of cases of severe PAH underwent neuraxial anesthesia (P<0.001). The fetal outcome was similar in there groups.But the rate of admission of NICU was significantly different in three groups (P=0.011). Conclusions: Maternal and neonatal outcomes was similar in different severity of pulmonary hypertension.But the severity of pulmonary hypertension affect the type of anesthesia.Close monitoring during pregnancy and timely termination of pregnancy can improve the outcome of pregnancy.

Prevalence of pulmonary hypertension in patients with hypertrophic obstructive cardiomyopathy: a case-control study

Objective: To explore the clinical characteristics and risk factors of pulmonary hypertension (PH) in patients with hypertrophic obstructive cardiomyopathy (HOCM). Methods: A total of 301 patients admitted in Fuwai Hospital and diagnosed with HOCM were included in our study. Incidence rate and severity of PH were depicted. The study population was divided into two groups (PH group and control group), and the differences in clinical profile were elucidated. Risk factors of PH in patients with HOCM were assessed by multivariate logistic regression analysis. Results: The incidence of PH was 12.3% (37 cases), in which 48.6% patients (18 cases) were mild PH, 40.5% patients (15 cases) were moderate PH, and patients with severe PH accounts for 10.8% (4 cases). Multivariate logistic regression analysis indicated that female(OR=3.95, 95%CI 1.74-8.98, P=0.001), age ≥65 years(OR=3.87, 95%CI 1.16-12.97, P=0.030), history of atrial fibrillation(OR=2.76, 95%CI 1.01-7.57, P=0.049)and moderate or severe mitral regurgitation(OR=6.63, 95%CI 3.02-14.57, P=0.000)were independent risk factors of PH. Stratification according to sex showed that age ≥65 years(OR=7.79, 95%CI 1.35-47.26, P<0.05)and moderate or severe mitral regurgitation(OR=9.83, 95%CI 2.26-42.67, P<0.01)were independent risk factors of PH for male patients; while history of atrial fibrillation(OR=6.32, 95%CI 1.57-25.40, P=0.01)and moderate or severe mitral regurgitation(OR=5.23, 95%CI 1.92-14.26, P<0.01)were independent risk factors of PH for female patients. Risk factors were similar between the mild PH group and moderate to severe PH groups. Conclusion: Compared with patients without PH, HOCM patients complicated with PH were older and with higher percentage of female, and resting obstruction, history of atrial fibrillation and moderate or severe mitral regurgitation. Independent risk factors for PH in obstructive hypertrophic cardiomyopathy patients are female, advanced age, history of atrial fibrillation and moderate or severe mitral regurgitation.

The impact of concomitant pulmonary hypertension on early and late outcomes following surgery for mitral stenosis

ObjectivesTo provide initial evidence on the management of mitral stenosis and pulmonary hypertension (PH) based on short-term and long-term outcomes following mitral valve surgery. MethodsConsecutive patients with mitral stenosis (n = 317) who had undergone mitral valve surgery between 1992 and 2014 with recorded pulmonary artery pressure (PAP) data were reviewed. PH severity, based on systolic PAP, was categorized as mild (35 to 44 mm Hg), moderate (45 to 59 mm Hg), or severe (>60 mm Hg). Primary outcomes were 30-day mortality and long-term survival. ResultsThere were no significant between-group differences in age or preoperative comorbidities. Mitral valve surgery included mitral valve replacement (78%) and repair (22%). The severe PH group had more mitral valve replacement (81%; P = .04), severe tricuspid valve regurgitation (31%; P = .003), right heart failure (17%; P = .02), and concomitant tricuspid valve procedures (46%; P < .001). For severe PH, 30-day mortality was 9%, with no significant group differences. Ten- and 12-year survival were significantly worse in the moderate–severe PH group (58% and 51%, respectively) compared with the normal PAP–mild PH group (83% and 79%, respectively) with a hazard ratio of 2.98 (95% confidence interval, 1.55-5.75; P = .001). Ten-year survival after mitral valve surgery for mitral stenosis was inversely associated with preoperative PAP. ConclusionsMitral valve surgery can be performed with acceptable 30-day mortality for patients with mitral stenosis and moderate to severe PH, but long-term survival is impaired by moderate to severe PH. Patients with mitral stenosis and mild PH (systolic PAP 35-44 mm Hg) should be considered for mitral valve surgery.

Relationship between severity of pulmonary hypertension and coronary sinus diameter

Introduction and ObjectiveWe investigated the relationship between coronary sinus (CS) diameter and pulmonary artery systolic pressure (PASP) in patients with pulmonary hypertension (PH) and normal left ventricular systolic function. MethodsA total of 155 participants referred for transthoracic echocardiography were included in the study. The study population consisted of 100 patients with chronic PH and 55 control subjects. Patients with PH were divided into two groups according to PASP: those with PASP 36–45 mmHg, the mild PH group (n=53); and those with PASP >45 mmHg, the moderate to severe PH group (n=47). CS diameter was measured from the posterior atrioventricular groove in apical 4-chamber view during ventricular systole according to the formula: mean CS=(proximal CS+mid CS+distal CS)/3. ResultsMean CS diameter was significantly higher in the moderate to severe PH group than in the controls and in the mild PH group (1.12±0.2 cm vs. 0.82±0.1 cm and 0.87±0.1 cm, respectively; p<0.001). It was significantly correlated with right atrial (RA) area (r=0.674, p<0.001), RA pressure (r=0.458, p<0.001), PASP (r=0.562, p<0.001), inferior vena cava diameter (r=0.416, p<0.001), right ventricular E/A ratio (r=−0.290, p<0.001), and E/Em ratio (r=0.235, p=0.004). RA area (β=0.475, p<0.001) and PASP (β=0.360, p=0.002) were found to be independent predictors of CS diameter. ConclusionsA dilated CS was associated with moderate to severe pulmonary hypertension, and RA area and PASP were independent predictors of CS diameter.

Relationship between severity of pulmonary hypertension and coronary sinus diameter

Introduction and ObjectiveWe investigated the relationship between coronary sinus (CS) diameter and pulmonary artery systolic pressure (PASP) in patients with pulmonary hypertension (PH) and normal left ventricular systolic function. MethodsA total of 155 participants referred for transthoracic echocardiography were included in the study. The study population consisted of 100 patients with chronic PH and 55 control subjects. Patients with PH were divided into two groups according to PASP: those with PASP 36–45 mmHg, the mild PH group (n=53); and those with PASP >45 mmHg, the moderate to severe PH group (n=47). CS diameter was measured from the posterior atrioventricular groove in apical 4-chamber view during ventricular systole according to the formula: mean CS=(proximal CS+mid CS+distal CS)/3. ResultsMean CS diameter was significantly higher in the moderate to severe PH group than in the controls and in the mild PH group (1.12±0.2 cm vs. 0.82±0.1 cm and 0.87±0.1 cm, respectively; p<0.001). It was significantly correlated with right atrial (RA) area (r=0.674, p<0.001), RA pressure (r=0.458, p<0.001), PASP (r=0.562, p<0.001), inferior vena cava diameter (r=0.416, p<0.001), right ventricular E/A ratio (r=−0.290, p<0.001), and E/Em ratio (r=0.235, p=0.004). RA area (β=0.475, p<0.001) and PASP (β=0.360, p=0.002) were found to be independent predictors of CS diameter. ConclusionsA dilated CS was associated with moderate to severe pulmonary hypertension, and RA area and PASP were independent predictors of CS diameter.

Pulmonary hypertension predicts adverse cardiac events after restrictive mitral annuloplasty for severe functional mitral regurgitation

Pulmonary hypertension (PH) is an indicator of a poor prognosis in patients with dilated cardiomyopathy. Few studies have investigated the prognostic role of PH in patients undergoing restrictive mitral annuloplasty (RMA) for severe functional mitral regurgitation secondary to advanced cardiomyopathy. A total of 46 patients undergoing RMA were classified into 3 groups on the basis of the Doppler-derived systolic pulmonary artery pressure (PAP) at baseline. Of the 46 patients, 19 had a systolic PAP less than 40 mm Hg (mild PH group), 17 had a systolic PAP of 40 to 60 mm Hg (moderate PH group), and 10 had a systolic PAP greater than 60 mm Hg (severe PH group). Postoperative cardiac catheterization showed that the RMA procedure resulted in a significant reduction of the left ventricular (LV) preload and improvements in LV systolic function in all 3 groups, along with the relief of symptoms. During the follow-up period (mean, 36 ± 19 months), cardiac death occurred in 6 patients, readmission because of heart failure in 3, and fatal arrhythmia in 1. The rate of freedom from these cardiac events at 3 years was 93% ± 7%, 88% ± 8%, and 56% ± 17% in the mild, moderate, and severe PH groups (P < .001). Serial echocardiography showed that significant LV reverse remodeling occurred in 89%, 71%, and 25% of the mild, moderate, and severe PH groups, respectively. Multivariate Cox regression analysis identified severe PH (systolic PAP > 60 mm Hg) as a significant predictor of adverse cardiac events, as well as LV remodeling after RMA. Noninvasive assessment of preoperative PH has a prognostic value in patients undergoing RMA for severe functional mitral regurgitation secondary to advanced cardiomyopathy.