Probability Of Pulmonary Hypertension Research Articles

Recurrent Infected Bronchiectasis in Poorly Controlled Patient Leading to Cardio Hepatorenal Syndrome

Background: Cardio hepatorenal syndrome is a severe condition due to chronic congestive heart failure complications characterized by liver and kidney function impairment, however, this condition has a potentially reversible complication.Bronchiectasis as a chronic lung disease was a burden for the healthcare system, especially involving other organs like heart, liver, and renal function. Those conditions were complicated and created a quandary regarding the effective treatments to improve the clinical condition and reduce morbidity and mortality. Case illustration: A 42-year-old man developed cardio hepatorenal syndrome (CHRS), which may have occurred from recurrent infected bronchiectasis that he had. His HRCT scan of the thorax with contrast showed multiple dilated bronchiwith tram track and signet ring appearance with decreased liver and renal function in laboratory findings, and probability of pulmonary hypertension (PH) and right heart failure (RHF) in echocardiography examination. The diuretic, beta-blocker, and antibiotics were given. During hospitalization, there was improvement day by day not only in his clinical condition but also in his liver and renal function. He has used oxygen as needed, and there was no longer any indication for him to be hospitalized. Conclusion: Patients with chronic lung diseases like bronchiectasis could have decreased lung function, which developed into other connected organ functions, like heart, liver, and renal. In this case, we found reduced heart, liver, and renal function, requiring a multidisciplinary approach to improve the condition.

Performance of handheld ultrasound devices in diagnosis of pulmonary hypertension and right heart dysfunction in ICU patients.

The use of handheld ultrasonography devices (HHUD) has increased recently but there are limited data about their performance in the evaluation of right heart dysfunction (RHD) and pulmonary hypertension (PHT). The aim of the study is to compare the performance of a HHUD with a conventional ultrasound device (CUD) in assessing PHT and RHD. This single-center prospective study was performed in a seven-bed teaching hospital intensive care unit (ICU). PHT and RHD criteria were compared by HHUD and CUD. Additional PHT criteria and right ventricle (RV) systolic and diastolic dysfunction criteria were also measured. Forty-six patients were included in the study. There was no significant difference between the imaging rates and mean values of the parameters measured by both devices. When the positivity rates for additional PHT parameters and RHD criteria were compared, there were no significant differences between the devices. In Bland-Altman's analysis, there was good agreement and there was no bias between the measurements of the two devices but left ventricular end-systolic eccentricity index (LVSEI), right atrium area (RAA), and pulmonary artery diameter (PAD). Ninety percent of the patients had PHT probability, of whom 43% had a low, 37% had intermediate and 10% had a high probability of PHT. Ninety-two percent of the patients had RHD and there was no significant difference between the devices in the diagnosis of RHD (p=.212). When RV systolic and diastolic dysfunction evaluations of the devices were compared according to the British Society of Echocardiography (BSE) criteria there was no significant difference between the devices' measurements in the evaluation of systolic and diastolic function. The imaging and measurement capabilities of the HHUDs for PHT and RHD parameters were similar to CUDs, and considering the inconsistent parameters, the HHUD can be useful in diagnosing these problems.

Cardiopulmonary exercise testing and echocardiography in the follow-up after acute pulmonary embolism

Abstract Background Echocardiography and cardiopulmonary exercise testing (CPET) can both provide prognostically relevant information during the follow-up after pulmonary embolism (PE). Objective To investigate the association of cardiopulmonary exercise limitation, as assessed by CPET, with the tricuspid regurgitation velocity (TRV) and probability of pulmonary hypertension (PH) as estimated by echocardiography after PE. Methods In a prospective cohort study, consecutive unselected survivors of acute PE underwent 3-month and 12-month follow-up, including echocardiography and CPET. We defined cardiopulmonary exercise limitation from CPET as at least one of VE/VCO2-slope ≥ 30 (≥ 36 for severe), or VE/VCO2-nadir ≥ 30 (≥ 36 for severe), peak O2 pulse < 80% of the predicted value (< 70% for severe). Echocardiographic probability of PH was defined according to the 2022 ESC/ERS PH Guidelines. Results Overall, 395 patients were included in the analysis. On CPET performed at 3 months, cardiopulmonary exercise limitation was found in 180/360 patients (50.0%; 34.7% mild/moderate; 15.3% severe), and at 12 months in 119/267 patients (44.5%; 28.8% mild/moderate; 15.7% severe). On echocardiography at 3 months, high probability was found in 13/360 patients (3.6%) and intermediate in 60/360 patients (16.7%); at 12 months, it was 10/267 (3.8%) and 36/267 (13.5%), respectively. TRV >2.8 m/s (Figure 1A) and high echocardiographic probability of PH (Figure 1B) were both significantly more prevalent among patients with severe cardiopulmonary limitation (both p <0.001 ). For patients who had measurable and quantified TRV values (n = 246 patients), TRV was significantly weakly/moderately associated with VE/VCO2 slope and VE/VCO2 nadir, but not associated with O2 pulse (Figure 2). Conclusion Abnormal exercise capacity of cardiopulmonary origin is frequent after PE and was associated with high echocardiographic probability of PH. Still, 67% of patients with severe cardiopulmonary limitation after PE exhibit low echocardiographic probability PH, thus supporting the argument to upgrade the role of CPET in the follow-up of patients after acute PE.Figure 1Figure 2

Papel del Doppler de la vena femoral en pacientes con insuficiencia cardiaca aguda: resultados de un estudio multicéntrico prospectivo

Background and objectiveThe aim of our study is to define the role of Pulsed-Doppler (PW-Doppler) Ultrasound of the common femoral vein in the assessment of dilatation Inferior Vena Cava (IVC), probability of Pulmonary Hypertension (PH), Tricuspid Regurgitation (TR), and Tricuspid annular plane systolic excursion (TAPSE). MethodsThis is a prospective two-hospital study in 74 patients admitted with acute heart failure (AHF). We performed PW-Doppler ultrasound of the common femoral vein, Point of Care cardiac ultrasonography and assessment of the IVC at the time of admission, as well as PW-Doppler and ultrasound of the IVC at hospital discharge. ResultsThe detection of a pulsatile flow (138 scans) had an excellent ROC curve for the detection of IVC greater than 2cm (AUC 0.931, Sn 95%, Sp 90%, PPV 93%, NPV 94%) with an Odds Ratio (OR) of 211.2 (95% confidence interval 48.13-926.72). The pulsatility of the flow also had the highest performance in the detection of PH (AUC 0.8, Sn 95%, Sp 64%, PPV 84%, NPV 84%) and in the detection of moderate-severe TR (AUC 0.79, Sn 95%, Sp 67%, PPV 88%, NPV 78%). If the flow is continuous, we can reasonably rule out diminished TAPSE (NPV 89%). ConclussionDetection of PW-Doppler flow of the common femoral vein may be an alternative window for the detection of an IVC dilation of 2cm, significant TR, and the likelihood of high PH in acute heart failure. It also allows us to reasonably rule out dysfunction of the right ventricle in cases of normality in these patients.

Role of the femoral vein doppler in acute heart failure patients: results from a prospective multicentric study

Background and objectiveThe aim of our study is to define the role of Pulsed-Doppler (PW-Doppler) Ultrasound of the Common Femoral Vein (CFV) in the assessment of dilatation Inferior Vena Cava (IVC), probability of Pulmonary Hypertension (PH), Tricuspid Regurgitation (TR), and Tricuspid annular plane systolic excursion (TAPSE). MethodsThis is a prospective two-hospital study in 74 patients admitted with acute heart failure (AHF). We performed PW-Doppler ultrasound of the common femoral vein, Point of Care (POC) cardiac ultrasonography and assessment of the IVC at the time of admission, as well as PW-Doppler and ultrasound of the IVC at hospital discharge. ResultsThe detection of a pulsatile flow (138 scans) had an excellent ROC curve for the detection of IVC greater than 2cm (AUC 0.931, Sn 95%, Sp 90%, PPV 93%, NPV 94%) with an Odds Ratio (OR) of 211.2 (95% confidence interval 48.13–926.72). The pulsatility of the flow also had the highest performance in the detection of PH (AUC 0.8, Sn 95%, Sp 64%, PPV 84%, NPV 84%) and in the detection of moderate-severe TR (AUC 0.79, Sn 95%, Sp 67%, PPV 88%, NPV 78%). If the flow is continuous, we can reasonably rule out diminished TAPSE (NPV 89%). ConclussionDetection of PW-Doppler flow of the CFV may be an alternative window for the detection of an IVC dilation of 2cm, significant TR, and the likelihood of high PH in acute heart failure. It also allows us to reasonably rule out dysfunction of the right ventricle in cases of normality in these patients.

Hallazgos ecocardiográficos en pacientes con lupus eritematoso sistémico: análisis retrospectivo en un centro de referencia terciaria

IntroductionIntroduction:Transthoracic echocardiography is a useful noninvasive tool in the assessment of cardiac involvement in patients with systemic lupus erythematosus. ObjectiveWe aimed to investigate the main echocardiographic alterations in patients with a diagnosis of systemic lupus erythematosus and to describe the relationship between various disease factors and echocardiographic findings. Materials and methodsWe performed a retrospective review of patients with a diagnosis of SLE between 2016 and 2020 at a referral centre. All 98 patients were included, 87% were female, the mean age for the whole population was 35 years (IQR 27.0- 49.7), 40% had a recent diagnosis, 55% with previous or new diagnosis of arterial hypertension, 37% were using steroids at admission. ResultsAmong the echocardiographic findings, 64.3% had valvular disease, 63% had pericardial involvement, 25.5% systolic function compromise, 27.5% some degree of diastolic dysfunction, 13% ventricular hypertrophy, 46% left atrial enlargement, 87% right ventricular systolic dysfunction, 24.5% some probability of pulmonary hypertension, 3% non-infectious vegetations. The presence of lupus activity was associated with a higher percentage of abnormal echocardiographic findings. There was no significant relationship between disease duration and cardiac abnormalities, anti-DNA and positive antiphospholipid antibodies were more frequently observed in the cardiac involvement group. ConclusionWe consider that echocardiography should be part of the routine evaluation in patients with lupus. Right ventricular systolic dysfunction, pericardial involvement and non-significant valvular disease were the most frequently reported abnormalities.

Unbowed, unbent, unbroken: predicting pulmonary hypertension using echocardiography

During the first meeting of the World Health Organization (WHO) in 1973, pulmonary hypertension (PH) was defined as mean pulmonary artery pressure (mPAP) ≥25 mmHg measured by right heart catheterisation [1]. This criterion was chosen arbitrarily and was founded on the premise that mPAP at rest in a supine position does not exceed 15 mmHg 2]. In 2009, the landmark paper of Kovacs et al . [3] provided scientific evidence for this statement and showed that normal mPAP at rest was 14 mmHg, with an upper limit of normal of 20 mmHg. In addition, accumulating data has indicated that patients with mPAP ≥19 mmHg but below the haemodynamic threshold of 25 mmHg are at increased mortality risk [4–6]. The probability of pulmonary hypertension can accurately be estimated by current echocardiographic criteria <https://bit.ly/3KMCWQ2> We thank Linda Grutterink, senior sonographer at the Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands, for the contribution of the echocardiographic images.

A Novel Doppler TRPG/AcT Index Improves Echocardiographic Diagnosis of Pulmonary Hypertension after Pulmonary Embolism.

Background: We hypothesized that a Doppler index, the ratio of tricuspid regurgitation peak gradient (TRPG) to pulmonary ejection acceleration time (AcT), improves the assessment of the echocardiographic probability of pulmonary hypertension in the identification of CTEPH and chronic thromboembolic pulmonary disease (CTED) in symptomatic patients after PE. Doppler echocardiography is recommended as the initial imaging tool for the diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) after acute pulmonary embolism (PE). Methods: We analyzed the data from 845 consecutive PE (468 women; 61 ± 18 years) survivors who completed at least 6 months of anticoagulation therapy. Here, 555 patients (325 women; 66 ± 16 years) reporting functional impairment (FI) underwent transthoracic echocardiography. We included 506 patients (297 women; age 63.4 ± 16.6 years) in whom both AcT and TRPG were available into the current study. The presence of a minimum of intermediate echocardiographic probability of PH necessitated the diagnosis of CTEPH. Results: Echocardiography revealed a high echocardiographic probability of PH in 69 (13.6%) and intermediate echocardiographic probability in 109 (21.5%) patients. CTEPH was diagnosed in 35 (6.9%) patients and CTED in 22 (4.3%) patients. TRPG/AcT was significantly higher in the combined CTEPH + CTED group than in those with other causes of FI (0.412 (0.100–2.197) vs. 0.208 (0.026–0.115), p < 0.001), and the area under the receiver operating characteristic curve of the TRPG/AcT for CTEPH + CTED was 0.804 (95% confidence interval (CI): 0.731–0.876). Importantly, multiple logistic regression showed that TRPG/AcT is a significant predictor of CTEPH + CTED after considering echocardiographic probability (odds ratio = 1.51, 95% CI: 1.25–1.91, p < 0.001). Conditional inference trees analysis revealed that TRPG/AcT > 0.595 identified patients with CTEPH or CTED with a positive predictive value of 78.6% and negative predictive value of 92.7%. Conclusions: A Doppler index TRPG/AcT improves the assessment of symptomatic PE survivors. TRPG/AcT > 0.6 indicates a high probability of CTEPH or CTED, whereas TRPG/AcT < 0.6 allows for the safe exclusion of CTEPH + CTED in patients with a low echocardiographic probability of PH.

CURATIVE BENEFIT OF SUBMUCOPERICHONDRIAL RESECTION OPERATION ON PULMONARY AR

Objective: We aimed at establishing a correlation between deviated nasal septum and pulmonary artery hypertension in patients reporting in Otorhinolaryngology (ENT) clinic at Combined Military Hospital Quetta, and evaluating the beneficial impact of sub mucoperichondrial resection (SMR) operation on right heart myocardial function, primarily related to Pulmonary Arterial Pressures of these patients of longstanding nasal septal deviation.&#x0D; Study Design: Descriptive; hospital-based cross-sectional survey.&#x0D; Place and Duration of Study: Departments of Otorhinolaryngology &amp; Cardiology, Combined Military Hospital, Quetta, from Sep 2019 to Apr 2021.&#x0D; Methodology: Electrocardiographic and 2-Dimensional Echocardiographic parameters of 87 randomized patients suffering from symptomatic longstanding deviated nasal septum (DNS) who had consented to undergo sub mucoperichondrial resection (SMR) operation were compared and studied for any change in status of probability of pulmonary arterial hypertension before and two months after their surgery. Probability of pulmonary hypertension was estimated using probability criteria from updated European Society of Cardiology Pulmonary Hypertension Guidelines 2019. Patients were classified into low, intermediate and high probability depending upon the number of criteria fulfilled by echocardiographic parameters.&#x0D; Results: Two (2.3%) patients suffering from deviated nasal septum presented with p-pulmonale. Twelve (13.8%) reported with right bundle branch block, and 7 (8%) patients demonstrated right axis deviation on electrocardiography. Overall high probability to develop pulmonary hypertension was discovered in 2 (2.3%) patients. We observed a significant improvement in pulmonary artery pressures in patients suffering from long term upper airway obstruction, two months following sub mucoperichondrial resection operation, in terms of maximum velocity and peak tricuspid regurgitation, right ventricle/left..........

OR70. The Impact of Mitral Valve Replacement on Right Ventricle Longitudinal Strain Case Study in Dr Kariadi General Hospital Semarang

Abstract Background Right ventricular (RV) function often overlooked in routine echocardiography examination even some research found its association with outcome in various cardiovascular and cardiac surgery setting. Deterioration of RV function occurred immediately after cardiac surgery. Compared with conventional echocardiography examination, free wall RV longitudinal strain (RVLS) is less load dependent and have a better association with cardiac magnetic resonance imaging, the gold standard for the examination of RV function Objective To investigate the changes in free wall RVLS pre- and post-surgical mitral valve replacement (MVR) and the factors that contribute to postoperative free wall RVLS change. Methods Patients undergoing MVR were enrolled consecutively. Free wall RVLS was assessed before the operation and 1-2 weeks after the operation. Results There were 29 samples in this study, consisted of 16 samples with mitral stenosis and 13 samples with mitral regurgitation. Paired T-test showed significant change between free wall RVLS pre- and post-operative (-18.8±3.41 and -13.5±3.21, respectively) with a difference of 5.07 (1.40-15.34), p&amp;lt;0.001. Analysis on preoperative and operative factors, such as preoperative left ventricular ejection fraction (LVEF), probability of pulmonary hypertension (PH), cardiopulmonary bypass (CPB) time, aortic cross clamp (Aox) time, and basal, mid, and longitudinal RV diameters, showed no significant association with postoperative free wall RVLS change. Conclusion There is significant decrease of free wall RVLS early after MVR. The decrease in postoperative free wall RVLS isn’t associated with factors such as preoperative LVEF, probability of PH, RV diameters CPB time and Aox time

Pulmonary Vascular Resistance Estimated by Echocardiography in Dogs With Myxomatous Mitral Valve Disease and Pulmonary Hypertension Probability.

Post-capillary pulmonary hypertension (PH) is a life-threatening complication in dogs with myxomatous mitral valve disease (MMVD). An increase in pulmonary vascular resistance (PVR) is associated with post-capillary PH progression. In humans, PVR estimated by echocardiography (PVRecho) enables the non-invasive assessment of PVR in patients with PH. This study aimed to evaluate the clinical utility of PVRecho in dogs with MMVD, PH probability, and right-sided congestive heart failure (R-CHF). Dogs with MMVD and detectable tricuspid valve regurgitation were included in the study. Dogs were classified into three PH probability groups (low/intermediate/high) and according to the presence or absence of R-CHF. All dogs underwent echocardiographic measurements for right ventricular (RV) morphology and function. PVRecho was calculated by two methods using tricuspid valve regurgitation velocity and velocity–time integral of the pulmonary artery flow (PVRecho and PVRecho2). RV size indicators were significantly higher with a higher probability of PH. RV strain and velocity–time integral of the pulmonary artery flow in the high probability group were significantly lower than those in the other groups. Tricuspid valve regurgitation velocity, PVRecho, and PVRecho2 were significantly higher with an increase in PH probability. Logistic regression analysis revealed a significant association between the presence of R-CHF and increased PVRecho2 and end-diastolic RV internal dimension normalized by body weight. PVRecho and PVRecho2 showed significant differences among the PH probability groups. These non-invasive variables may be useful for the diagnosis and stratification of PH and the determination of the presence of R-CHF in dogs with MMVD.

Echocardiographic probability of pulmonary hypertension according to the direct and indirect signs: a validation study

Abstract Background Transthoracic echocardiogram is the most important non-invasive screening tool for pulmonary hypertension (PH), but right heart catheterization (RHC) remains mandatory to establish the diagnosis. According to the current guidelines, the echocardiographic probability of PH is based on the combination of direct and indirect signs. In the 6th World Symposium on Pulmonary Hypertension, PH has been defined as mean pulmonary artery pressure (mPAP) &amp;gt;20 mmHg, and pulmonary vascular resistance (PVR) ≥3 WU. Aim To validate the echocardiographic direct and indirect signs of PH suggested by the guidelines in view of the new definition of PH in patients who underwent echocardiography and RHC. Methods All consecutive patients referred between January 2018 and December 2019 to undergo RHC for suspected PH were prospectively enrolled in the study. Echocardiography was performed within one hour from indicated RHC. Results Overall, 263 patients were enrolled: 33 (13%) had normal pulmonary pressures, and 230 (87%) had PH. Among the 230 patients with PH, 136 (59%) had pre-capillary and 94 (41%) had post-capillary PH. All underwent echocardiography within one hour from RHC. At univariable logistic regression test, tricuspid regurgitant jet (TRJ) &amp;gt;2.9 m/sec [OR 8.32 (3.15–26.37, p&amp;lt;0.001)], left ventricle eccentricity index &amp;gt;1.1 [OR 5.57 (2.44–14.41, p&amp;lt;0.001)], right ventricle outflow tract acceleration time &amp;lt;105 msec [OR 4.90 (2.29–10.59, p&amp;lt;0.001)], pulmonary artery diameter &amp;gt;25 mm [OR 4.74 (2.01–13.09, p=0.001)], right-to-left ventricle basal diameter &amp;gt;1 [OR 4.54 (1.83–13.74, p=0.003)], and early diastolic pulmonary regurgitation velocity &amp;gt;2.2 m/sec [OR 3.14 (1.07–13.46, p=0.067)], predicted PH, whereas dilated inferior vena cava and right atrial area did not. At multivariable analysis, only TRJ &amp;gt;2.9 m/sec [OR 7.95 (2.78–27.07, p&amp;lt;0.001)] and left ventricle eccentricity index &amp;gt;1.1 [OR 4.89 (1.75–15.35, p=0.004)] showed a positive correlation to PH. The best area under the curve (AUC, 0.86) for predicting PH was obtained with TVR &amp;gt;2.9 m/sec + 2 indirect signs (sensitivity 0.77, specificity 0.94). Non-invasive estimate of mPAP showed a good correlation to invasive measurement (regression coefficient β 16.8±0.7, p&amp;lt;0.001 and R2 for the linear regression 0.68). The Bland–Altman analysis demonstrated low bias (−2.0 mmHg) and acceptable limits of agreement (upper limit +11.0 mmHg; lower −15.1 mmHg) between echocardiographic estimates and invasive measurement of mPAP (Figure 1). Conclusions Echocardiographic direct and indirect signs of PH as suggested by the current guidelines should be used to assess the probability of PH being present. Echocardiographic measurements have high accuracy (low bias) and moderate precision (acceptable limits of agreement) The best area under the curve for predicting PH according to the new definition (mPAP &amp;gt;20 mmHg and PVR ≥3 WU) can be obtained with TVR &amp;gt;2.9 m/sec + 2 indirect signs. Funding Acknowledgement Type of funding sources: None. Figure 1

Prevalence and risk factors of high echocardiographic probability of pulmonary hypertension in myeloproliferative neoplasms patients.

Pulmonary hypertension (PH) is emerging as a complication of myeloproliferative neoplasms (MPNs). This was a prospective study conducted at Chiang Mai University Hospital. The primary objective was to determine the prevalence of high echocardiographic probability of PH in MPNs patients. The secondary objectives were to determine risk factors of PH and the correlation between risk factors and peak tricuspid regurgitation velocity (TRVmax). All MPNs patients aged over 18years, including polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF), were enrolled. All eligible patients underwent echocardiography for evaluation of the probability of PH in line with the 2015 European Society of Cardiology (ESC) and the European Respiratory Society (ERS) Guidelines. Sixty-six patients with a median age of 59years were enrolled. There were 35 PV, 25 ET, and 6 PMF patients included. The prevalence of high echocardiographic probability of PH was 4.55% (2 ET and 1 PMF). Risk factors associated with high echocardiographic probability of PHT were not analyzed. There were three risk factors associated with increased TRVmax, specifically lower hemoglobin, older age, and the presence of JAK2V617F mutation. The prevalence of high echocardiographic probability of PH in MPNs patients was 4.55%.

Prognostic Value of the Echocardiographic Probability of Pulmonary Hypertension in Patients with Acute Decompensated Heart Failure.

The prognostic value of pulmonary hypertension (PH) estimated by echocardiography in unselected patients with acute decompensated heart failure (ADHF) is poorly studied. Between November 2014 and September 2018, 657 patients were recruited in a prospective registry of ADHF (ClinicalTrials.gov NCT02444416). The probability of pulmonary hypertension was based on European Society of Cardiology (ESC) guidelines for echocardiographic evaluation. The median survival without all-cause mortality or readmission was 7 months. During the median follow-up period of 15 months, there were 450 events including 185 deaths. In multivariate analysis, the hazard ratio (HR) of all-cause mortality or readmission for patients with a high probability of PH was 1.67 (95% CI 1.29–2.17, p < 0.001) as compared to patients with a low or intermediate probability. The left ventricular ejection fraction (LVEF) and right ventricular function (RVF) were not associated with the primary outcome—HR 1.02 (95% CI 0.81–1.29; p = 0.84) and 0.96 (95% CI 0.76–1.23; p = 0.77) respectively. In patients admitted for ADHF, a high probability of PH as evaluated by echocardiography provided the highest independent prognostic value for mortality and readmission, whereas LVEF and RVF were not associated with prognosis. The identification of patients at high risk of PH by non-invasive measurement conveys important prognostic information and may guide management.

P2772The rule-out criteria for chronic thromboembolic pulmonary hypertension can identify patients without haemodynamic abnormalities and functional limitation 3 and 12 months after acute PE

Abstract Background Up to one-third of patients report persisting hemodynamic abnormalities and functional limitation over long-term follow-up after acute pulmonary embolism (PE). Purpose We tested whether a validated algorithm designed to rule-out chronic thromboembolic pulmonary hypertension (CTEPH) after acute PE can be used for identifying patients at lower risk of presenting with persisting symptoms and echocardiographic abnormalities. Methods The multicentre Follow-up of Acute Pulmonary Embolism (FOCUS) cohort study prospectively enrolled 1,100 consecutive patients diagnosed with acute symptomatic PE; two-year follow-up is ongoing. We focused on the scheduled visits for 3- and 12-month follow-up. The rule-out criteria are based on: the absence of ECG signs of right ventricular dysfunction and normal NT-proBNP/BNP values. Echocardiographic abnormalities were defined according to the presence of abnormal parameters indicating an intermediate/high probability of pulmonary hypertension as recommended by the 2015 ESC/ERS Society Guidelines on Pulmonary Hypertension. The presence of functional limitation was defined based on a World Health Organization classification grade ≥3, a Borg dyspnoea index ≥4, or a 6-minute walking distance &lt;300 m. Results We included 323 patients (mean age 61 years, 58% men), of whom 255 have meanwhile completed a one-year follow-up. At 3- and 12-month follow-up, 194 (60%) and 155 (61%) of patients exhibited no abnormal echocardiographic findings or natriuretic peptide levels. The percentage of patients with echocardiographic abnormalities was 20.4% and 18.0%, respectively. The negative predictive value of the score for ruling out the combination of functional limitation and intermediate/high probability of pulmonary hypertension as recommended by the 2015 ESC/ERS Guidelines on Pulmonary Hypertension was 0.96 (95% CI 0.92–0.98) at 3 and 0.97 (0.92–0.99) at 12 months. The corresponding positive predictive values were 0.10 (0.06–0.17) and 0.09 (0.05–0.17), respectively. Conclusions The CTEPH rule-out criteria are capable of excluding functional limitation and evidence of (chronic) pulmonary hypertension 3 and 12 months after the diagnosis of acute PE. Acknowledgement/Funding The sponsor (University Medical Center of the Johannes Gutenberg University, Mainz) has obtained grants from Bayer Vital GmbH and Bayer Pharma AG

Echocardiographic evaluation of prevalence of pulmonary hypertension in β-thalassemia major: A cross sectional study

Introduction: Pulmonary hypertension is a common complication associated with thalassemia syndromes and it may play an important role in the pathogenesis of right ventricle failure. The true prevalence of pulmonary hypertension in patients with thalassemia major remains unclear and has been reported to be between 2 and 79%.Materials and methods: In total, 70 patients with thalassemia major were initially examined. Patients with valvular left heart disease, congenital heart diseases such as atrial septal defect (ASD) and ventricular septal defect (VSD), left heart failure, and chronic embolism were excluded. All patients with thalassemia major underwent echocardiography. Based on tricuspid regurgitation velocity (TRV), the patients were divided into the following three groups: low, medium, and high risk of pulmonary hypertension.Results: The mean age of the subjects was 24 y; 60.6% of the subjects were males and 39.4% of the subjects were females. Overall, three (4.5%) subjects were considered at a high risk of pulmonary hypertension. The mean hemoglobin level in the patients with a high probability of pulmonary hypertension was 8.2 g/dL and that in the patients with a low or medium probability of pulmonary hypertension was 9.1 g/dL. No significant difference was observed between the groups (p = .059).Conclusion: This study showed that, based on new echocardiography criteria, the prevalence of pulmonary hypertension secondary to β-thalassemia was 4.5% and there was no correlation between TRV and the number of received blood units or disease duration.

Prognostic value of tricuspid regurgitation velocity and probability of pulmonary hypertension in patients undergoing transcatheter aortic valve implantation

Pulmonary hypertension (PH) is associated with adverse clinical outcomes after transcatheter aortic valve implantation (TAVI). We sought to investigate the effects of tricuspid regurgitant velocity (TRV) and echocardiographic probability of PH on clinical outcomes of patients undergoing TAVI. A total of 148 consecutive patients undergoing TAVI were included and stratified as having “low” (TRV ≤2.8 m/s), “intermediate” (TRV 2.9–3.4 m/s), and “high” (TRV >3.4 m/s) probability of PH. Only the patients from the “high” probability group were considered as patients with PH. All-cause mortality, complications rate and quality of life (QoL) were assessed according to VARC-2 recommendations. Of 148 patients, 65 (43.9%) were considered as patients with PH. These presented with higher NYHA class at baseline (p = 0.027) and had more frequently a history of previous stroke/transient ischemic attack (p = 0.019). A difference in all-cause mortality was noted at 12 months [PH (−) vs. PH (+): 9.6 vs. 21.5%; p = 0.043]; however, it was no longer significant after adjustment for age and gender (OR 2.39, 95% CI 0.91–6.24; p = 0.08). Unadjusted and adjusted rates of all-cause death at maximal follow-up of 13.3 (6.0–31.1) months were higher in patients with PH. However, the presence of PH was not identified as an independent predictor of all-cause mortality at follow-up. No difference in other complications rates and QoL were noted. The presence of TRV >3.4 m/s indicating “high” probability of PH may predict impaired clinical outcomes after TAVI. No impact of PH on QoL outcomes was confirmed.

Pulmonary hypertension associated with left-sided heart disease.

Pulmonary hypertension associated with left-sided heart disease (PH-LHD) is the most common type of pulmonary hypertension. In patients with left-sided heart disease, the presence of pulmonary hypertension is typically a marker of more advanced disease, more severe symptoms, and worse prognosis. In contrast to pulmonary arterial hypertension, PH-LHD is characterised by an elevated pulmonary artery wedge pressure (postcapillary pulmonary hypertension) without or with an additional precapillary component (isolated postcapillary versus combined postcapillary and precapillary pulmonary hypertension). Transthoracic echocardiography is the primary nonin-vasive imaging tool to estimate the probability of pulmonary hypertension and to establish a working diagnosis on the mechanism of pulmonary hyperten-sion. However, right heart catheterisation is always required if significant pulmonary hypertension is sus-pected and exact knowledge of the haemodynamic constellation is necessary. The haemodynamic con-stellation (mean pulmonary artery pressure, mean pulmonary artery wedge pressure, left ventricular end-diastolic pressure) in combination with clinical infor-mation and imaging findings (mainly echocardiog-raphy, coronary angiography and cardiac magnetic resonance imaging) will usually allow the exact mech-anism underlying PH-LHD to be defined, which is a prerequisite for appropriate treatment. The general principle for the management of PH-LHD is to treat the underlying left-sided heart disease in an optimal man-ner using drugs and/or interventional or surgical ther-apy. There is currently no established indication for pulmonary arterial hypertension-specific therapies in PH-LHD, and specific therapies may even cause harm in patients with PH-LHD.

Percutaneous atrial septal defect closure in patients with left ventricle failure or pulmonary hypertension

Transcatheter approach for closure of an ostium secundum atrial septal defect (ASD) is a safe and effective treatment that is now the first-line therapy in many centers based on various series demonstrating lower complication rates, shorter hospitalizations, and lower costs compared to surgery. Following transcatheter ASD closure, exercise capacity improves within days to weeks, and right heart hemodynamics can improve dramatically. Regression of right heart enlargement typically occurs over weeks to months, and immediate improvements in pulmonary artery pressure (PAP) can be seen with further improvement in late follow-up. Over recent years, the number of elderly patients treated percutaneously for ASD closure has increased. Since this population often presents with diastolic dysfunction, these patients are more prone to acute pulmonary edema following the procedure. Strategies have been developed to identify patients at high risk for post procedural heart failure. Patients with ASD and left to right shunts are also at risk of developing pulmonary hypertension (PHT) and the probability of PHT also increases with age. In this review, we will discuss ASD closure in patients with left ventricle (LV) failure and/or PHT corresponding to specific clinical settings more and more common in clinical practice.