Moderate Pulmonary Hypertension Group Research Articles

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.

Prognostic effect of pulmonary hypertension in patients with chronic kidney disease: Univariate and multivariate analyses of factors associated with survival.

BackgroundPrognostic effect of pulmonary hypertension (PH) in patients with chronic kidney disease (CKD) is not fully clear yet, this study was designed to elucidate baseline characteristics of CKD patients with different severities of PH, the association between kidney indicators and PH severity, and survival factors in CKD patients with PH.MethodsWe extracted clinical data from electronic medical records of all patients diagnosed with PH in CKD from Jan 2016 to Dec 2020, and those with comorbid conditions causing PH were excluded. CKD stages were defined by estimated glomerular filtration rate thresholds. PH was defined as a systolic pulmonary artery pressure (sPAP) >35 mmHg estimated using echocardiograms. Demographics, clinical data, and test results were analyzed, and all-cause mortality data were obtained.ResultsA total of 137 patients were included in the study. The mean age of the participants was 60 (42.5, 67) years, the mean sPAP was 58 (51, 69.5) mmHg, and 40.9% of the patients were women. Moderate PH group had more patients undergoing dialysis and higher frequency of coronary heart disease. Moderate-severe PH group had higher parathyroid hormone levels and lower low-density lipoprotein levels. Severe PH group had better kidney function parameters and lower serum phosphorus levels. PH severity had no direct relationship with CKD stages. In the univariate analysis, age and PH severity influenced survival. Multivariate analysis also showed independent prognostic effects for age and sPAP. Kaplan-Meyer curve intuitively displayed the survival differences among CKD patients with different PH severity. Predictor values of nomogram identified from survival analyses enabled calculation of death probabilities for CKD with PH patients. Nomogram was validated by ROC analysis.ConclusionsPH begins with early-stage CKD, and PH severity is not related to CKD progression. A higher pulmonary artery pressure and an older age are associated with an increased risk of death.

Use of small pulmonary vascular alterations to identify different types of pulmonary hypertension: a quantitative computed tomography analysis.

The morphological alterations of small pulmonary vessels measured by computed tomography (CT) is increasingly used in evaluation of suspected pulmonary hypertension (PH). To investigate the significance alterations of quantitative assessment of small pulmonary vessels on chest CT in distinguishing different types of PH and their severity. We retrospectively analyzed a dataset of 120 healthy controls (HCs) and 91 PH patients, including 34 patients with connective tissue diseases-related PH (CTD-PH), 26 patients with idiopathic pulmonary arterial hypertension (iPAH), and 31 patients with chronic obstructive pulmonary disease-related PH (COPD-PH). The CTD-PH patients were divided into mild to moderate PH (CTD-LM-PH) group (n = 17) and severe PH (CTD-S-PH) group (n = 17). A total of 53 CTD patients without PH (CTD-nPH) were enrolled for comparison with the CTD-PH. We measured the cross-sectional area of small pulmonary vessels < 5 mm2 (%CSA<5) and between 5-10 mm2 (%CSA5-10) as a percentage of total lung area among the populations included above and compared %CSA in different types of PH groups and HCs group. The mean pulmonary arterial pressure (mPAP) was measured by right heart catheterization. The %CSA5-10 of COPD-PH, CTD-PH, and iPAH patients increased (0.21±0.09, 0.49±0.20 and 0.61±0.20, p < 0.02) sequentially, while the %CSA<5 of CTD-PH, iPAH, and COPD-PH patients decreased (0.79±0.65, 0.65±0.38 and 0.52±0.27, p < 0.05) sequentially. The %CSA5-10 was significantly higher in CTD-S-PH patients than CTD-LM-PH patients and CTD-nPH patients (0.51±0.21, 0.31±0.15 and 0.28±0.12, p < 0.01). The %CSA5-10 was positively correlated with mPAP in the CTD-PH group. The quantitative parameters %CSA<5 and %CSA5-10 assessed by chest CT are useful for distinguishing different types of PH. In addition, the %CSA5-10 can provide information for identification of CTD-PH severity.

Evaluation of Regional Left and Right Ventricular Function in Patients with Ostium-Secundum Atrial Septal Defect Using Speckle Tracking Echocardiography

The aim of this study was to provide evidence of abnormalities of right ventricular (RV) and left ventricular (LV) function using speckle tracking echocardiography (STE) in adults with ostium secundum-atrial septal defect (OS-ASD) and pulmonary hypertension (PH). Sixty-three adult patients with OS-ASD were enrolled. Control group (n=10) with mean pulmonary arterial pressure (MPAP) ≤25 mmHg. Three PH groups were divided based on pulmonary artery systolic pressure (PASP): mild (n=18), moderate (n=24) and severe (n=11). RV free wall strain (RVFWS) and LV global longitudinal strain (LVGLS) were measured. RVFWS and RV fractional area change were significantly lower in the severe PH group. No difference was found in LVGLS among groups. The moderate PH group had significantly higher right atrial (RA) volume and RV impaired relaxation. RVFWS had a positive correlation with PASP and MPAP. STE is a valuable non-invasive technique to assess RV and LV systolic function in patients with OS-ASD.

Pulmonary Arterial Histologic Lesions in Patients With COPD With Severe Pulmonary Hypertension

The development of pulmonary hypertension (PH) during the course of COPD is a well-known phenomenon, with the prevalence depending on the severity of airway obstruction. When mean pulmonary pressure (mPAP) level at rest is≥ 35mmHg or≥ 25mmHg with low cardiac index, the term severe PH is used. For these patients, little is known on the underlying histologic lesions. Our objective was to describe these lesions. From the explants of patients undergoing lung transplantation, we compared retrospectively three groups of patients with COPD: severe PH-COPD (n= 10), moderate PH-COPD (mPAP between 25 and 34mmHg without low cardiac index) (n= 10), and no PH (mPAP< 25mmHg) (n= 10). Histologic analysis of the explanted lungs examined the wall of medium-size arteries, the remodeling of microvessels, and the pulmonary capillary density using morphometric measurements performed on three sections per patient. Compared with the moderate PH group, the remodeling score of the microvessels was significantly higher (P= .0045) and the capillary density was lower (P= .0049) in the severe PH-COPD group. The alterations of the medium-size arteries, important in group 1 PH, seemed less discriminating. Patients with severe PH-COPD appear to have a specific histologic pattern, different from that observed in patients with COPD with moderate PH or without PH.

Additive and independent prognostic role of abnormal right ventricle and pulmonary hypertension in mitral-tricuspid surgery.

To evaluate the additive and independent prognostic value of abnormal right ventricle (aRV) and pulmonary hypertension (PH) in patients undergoing mitral-tricuspid surgery. From January 2009 to December 2012, 541 patients underwent mitro-tricuspid surgery. The entire cohort was divided into 6 subgroups: 63 cases had normal RV and no PH (Group A), 180 normal RV but moderate PH (Group B), 101 normal RV but severe PH (Group C), 15 abnormal RV and no-PH (Group D), 86 abnormal RV and moderate PH (Group E) and 96 abnormal RV and severe PH (Group F). Forty-two (7.8%) patients died in hospital due to any cause: 1.6% in group A, 3.9% in group B, 8.9% in group C, 13.3% in group D, 9.3% in group E, 15.6% in group E, p = 0.005. Among 78 patients with no-PH, mortality was significantly higher in patients with aRV (1.6%vs 13.3%. p = 0.03). Among 344 patients with normal RV, mortality was significantly higher in patients with severe PH (1.6% vs 3.9% vs 8.9%. p = 0.03). Comparing the presence of both abnormal RV and severe PH with the remaining patients, mortality was significantly higher in the first group (15.6% 6.1%, p = 0.004). Multivariable analysis confirmed either the independent or the additive role of RV and PH. In patients undergoing mitral-tricuspid valve surgery, the presence of either RV dysfunction/dilatation or severe pulmonary hypertension, might play an independent prognostic role for mortality. The worst scenario is surely the contemporary presence of both conditions.

Serum uric acid is associated with disease severity and an important predictor for clinical outcome in patients with pulmonary hypertension

Objective: The growing body of literature showed a link between uric acid and pulmonary hypertension (PH), but the impact of hyperuremia on outcome of patients with PH has not been well defined. Therefore, the present study was performed to analyze the impact of uric acid on outcome of PH patients. Methods: One hundred seventy-three PH patients (112 females, mean age 38 years old), who were hospitalized in our department between January 2010 and December 2015, were included in our study, the PH diagnosis was made based on right heart catheterization examination result (mean pulmonary artery pressure≥25 mmHg(1 mmHg=0.133 kPa)). PH patients were divided into mild to moderate PH group (Rp/Rs≤0.6, n=97) and severe PH group (Rp/Rs>0.6, n=76). Fifty-one patients (33 females, mean age 45 years old) without PH based on right heart catheterization were included as control subjects. All participants were followed up for a median of 24 months(6-71 months). Clinical endpoints were defined as cardiogenic death or heart-and-lung transplantation. Results: Uric acid was positively correlated with pulmonary vascular resistance(r=0.398, P<0.01), systemic vascular resistance(r=0.244, P<0.01) and mean right atrial pressure (r=0.26, P<0.01), and was negatively correlated with cardiac index(r=-0.278, P<0.01)and mixed venous oxygen saturation (r=-0.322, P<0.01)in PH patients. Serum uric acid level was significantly higher in patients with severe PH than in patients with mild-to-moderate PH and the control subjects (both P<0.05). According to the receiver operating characteristic curve (ROC), 425.5 μmol/L was found to be the best cut-off value of serum uric acid level to predict the outcome of PH patients (sensitivity 50%, specificity 72%). During follow-up, patients with higher level of uric acid (>425.5 μmol/L) were linked with poorer clinical outcome compared to patients with uric acid <425.5 μmol/L(P=0.027). Conclusion: Our findings suggests that uric acid is associated with the severity of PH and higher uric acid level serves as an important predictor for poor clinical outcome of PH patients.

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.

Do Patients With Complete Transposition of the Great Arteries and Severe Pulmonary Hypertension Benefit From an Arterial Switch Operation?

Whether an arterial switch operation benefits patients with transposition of the great arteries and severe pulmonary hypertension (PH) remains controversial. Therefore, we evaluated the relationship between preoperative PH and early and midterm clinical outcomes after an arterial switch procedure. In this retrospective study, 101 consecutive patients with transposition of the great arteries underwent an arterial switch operation between February 2004 and October 2007. Seventy had a ventricular septal defect as well; patients with intact ventricular septum and complicated concomitant abnormities were excluded. Preoperative medical records were reviewed and mean follow-up was 22.4±15.2 months. After sternotomy, we directly measured pulmonary artery pressure before and after instituting extracorporeal circulation. Patients were divided into three groups according to mean pulmonary artery pressure (mPAP): control group (mPAP<25 mm Hg, n=23), moderate PH group (mPAP 25 to 50 mm Hg, n=37), and severe PH group (mPAP≥50 mm Hg, n=10). Early and midterm results were compared among groups. Postoperatively, pulmonary artery pressure of both the moderate and severe PH groups decreased significantly. There were no significant differences in occurrence of postoperative complications or in-hospital mortality in the three groups (control group, 8.7%; moderate PH group, 8.1%; severe PH group, 10%; p=0.98). However, midterm mortality differed significantly (control group, 4.3%; moderate PH group, 2.7%; severe PH group, 40%; p<0.01). Patients with transposition of the great arteries and mPAP less than 50 mm Hg can achieve satisfying results after an arterial switch operation. However, even though the operation can decrease pulmonary artery pressure, patients with preoperative mPAP greater than 50 mm Hg still suffer from high midterm mortality.

The analysis of the change in patients with Chronic pulmonary heart disease pulmonary arterial pressure with B-type natriuretic peptide

Objective Investigate the clinical of chronic pulmonary heart disease (PHD) with pulmo-nary hypertension and the level of B-typo natriuretic peptide (BNP). Methods 80 cases of PHD measure pul-monary arterial pressure by cardiac ultrasound BNP, At the same time, Detected their blood BNP. According to the level of pulmonary arterial pressure is divided into normal, mild, moderate, severe pulmonary hypertension group,compared the level of BNP in each group. Results The level of BNP in Severe pulmonary hypertension group was the most highest in normal,mild and moderate pulmonary hypertension group (P<0.01). There has a positive correlation between Pulmonary artery pressure and the level of BNP (r=0.79, P<0.001). Conclu-sion In patients of Chronic pulmonary heart disease,pulmonary hypertension increased with the BNP,There has a positive correlation between Pulmonary artery pressure and the level of BNP. Key words: Chronic pulmonary heart disease; Pulmonary artery pressure; B-type natriuretic peptide