Pulmonary Hypertension Research Articles

Guiding pulmonary vasodilatory therapy in systemic sclerosis associated pulmonary hypertension using morphology of the right ventricle outflow tract velocity time integral

AbstractSystemic sclerosis (SSc) is a chronic, autoimmune disease involving small vessels characterized by skin and internal organs fibrosis. Interstitial lung disease (ILD) is one of the main findings, along with pulmonary hypertension, as a marker of morbidity and mortality. Diagnosis is usually late, and therefore treatment is established in the advanced stages of the disease. Point of care ultrasound (POCUS) emerges as a tool at the bedside for shortening diagnostic times and guiding therapy. Here, we performed a multi‐organ POCUS, evidencing the presence of ILD and pulmonary hypertension in a patient with no cardiovascular symptoms suggestive of advanced disease. We did real‐time monitoring of pulmonary vasodilator therapy at the patient's bedside using right ventricle outflow tract velocity time integral morphology (RVOT VTI). Midsystolic notching of RVOT VTI is highly specific for pulmonary hypertension. POCUS is a valuable tool that could improve diagnostic times and optimize therapy monitoring in asymptomatic patients with early manifestations of organic involvement in patients with SSc. This case demonstrates the value of POCUS as a follow‐up tool in treating patients with SSc.

Nationwide Analysis of Variables Associated With Sarcoid Inpatient Mortality.

Sarcoidosis is a multisystem autoimmune disease that can result in significant morbidity and mortality. This study aims to identify factors associated with in-hospital death for sarcoid patients on a national level. We performed a medical records review study of all adult sarcoid hospitalizations from 2016 to 2020 National Inpatient Sample database. A univariable screen followed by multivariable analysis was completed to identify predictors of in-hospital death among sarcoid patients. There were 405,650 admissions with a diagnosis of sarcoidosis, 10,210 of whom died. Multivariable analysis showed the following factors were independently associated with a higher odds of in-hospital death: age (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.026-1.034), Charlson Comorbidity Index (OR, 1.09; 95% CI, 1.066-1.116), male sex (OR, 1.21; 95% CI, 1.101-1.331), other race (OR, 1.45; 95% CI, 1.073-1.954), arrhythmia/heart blocks (OR, 1.80; 95% CI, 1.617-1.995), cirrhosis/hepatic failure (OR, 8.26; 95% CI, 6.928-9.844), hemophagocytic lymphohistiocytosis (OR, 11.15; 95% CI, 4.172-29.802), infection (OR, 3.31; 95% CI, 3.007-3.633), interstitial lung disease (OR, 1.31; 95% CI, 1.193-1.438), heart failure/myocarditis (OR, 1.29; 95% CI, 1.157-1.436), neurologic diagnoses (OR, 1.37; 95% CI, 1.241-1.502), and pulmonary hypertension (OR, 1.47; 95% CI, 1.305-1.652). Our multiyear national analysis showed that 2.5% of hospital admissions with a sarcoid diagnosis ended in death. The following factors were associated with death: age, Charlson Comorbidity Index, male sex, other race, arrhythmia/heart blocks, cirrhosis/hepatic failure, hemophagocytic lymphohistiocytosis, infection, interstitial lung disease, heart failure/myocarditis, neurologic diseases, and pulmonary hypertension. This information can help clinicians by improving awareness of these life-threatening complications because early recognition and intervention may improve inpatient sarcoid outcomes.

Derivation and internal validation of prediction models for pulmonary hypertension risk assessment in a cohort inhabiting Tibet, China.

Individuals residing in plateau regions are susceptible to pulmonary hypertension (PH) and there is an urgent need for a prediction nomogram to assess the risk of PH in this population. A total of 6603 subjects were randomly divided into a derivation set and a validation set at a ratio of 7:3. Optimal predictive features were identified through the least absolute shrinkage and selection operator regression technique, and nomograms were constructed using multivariate logistic regression. The performance of these nomograms was evaluated and validated using the area under the curve (AUC), calibration curves, the Hosmer-Lemeshow test, and decision curve analysis. Comparisons between nomograms were conducted using the net reclassification improvement (NRI) and integrated discrimination improvement (IDI) indices. NomogramI was established based on independent risk factors, including gender, Tibetan ethnicity, age, incomplete right bundle branch block (IRBBB), atrial fibrillation (AF), sinus tachycardia (ST), and T wave changes (TC). The AUCs for NomogramI were 0.716 in the derivation set and 0.718 in the validation set. NomogramII was established based on independent risk factors, including Tibetan ethnicity, age, right axis deviation, high voltage in the right ventricle, IRBBB, AF, pulmonary P waves, ST, and TC. The AUCs for NomogramII were 0.844 in the derivation set and 0.801 in the validation set. Both nomograms demonstrated satisfactory clinical consistency. The IDI and NRI indices confirmed that NomogramII outperformed NomogramI. Therefore, the online dynamic NomogramII was established to predict the risks of PH in the plateau population.

Derivation and internal validation of prediction models for pulmonary hypertension risk assessment in a cohort inhabiting Tibet, China

Individuals residing in plateau regions are susceptible to pulmonary hypertension (PH) and there is an urgent need for a prediction nomogram to assess the risk of PH in this population. A total of 6603 subjects were randomly divided into a derivation set and a validation set at a ratio of 7:3. Optimal predictive features were identified through the least absolute shrinkage and selection operator regression technique, and nomograms were constructed using multivariate logistic regression. The performance of these nomograms was evaluated and validated using the area under the curve (AUC), calibration curves, the Hosmer–Lemeshow test, and decision curve analysis. Comparisons between nomograms were conducted using the net reclassification improvement (NRI) and integrated discrimination improvement (IDI) indices. NomogramI was established based on independent risk factors, including gender, Tibetan ethnicity, age, incomplete right bundle branch block (IRBBB), atrial fibrillation (AF), sinus tachycardia (ST), and T wave changes (TC). The AUCs for NomogramI were 0.716 in the derivation set and 0.718 in the validation set. NomogramII was established based on independent risk factors, including Tibetan ethnicity, age, right axis deviation, high voltage in the right ventricle, IRBBB, AF, pulmonary P waves, ST, and TC. The AUCs for NomogramII were 0.844 in the derivation set and 0.801 in the validation set. Both nomograms demonstrated satisfactory clinical consistency. The IDI and NRI indices confirmed that NomogramII outperformed NomogramI. Therefore, the online dynamic NomogramII was established to predict the risks of PH in the plateau population.

A prediction model of echocardiographic variables to screen for potentially correctable shunts in adult ASD-PAH patients.

Atrial septal defect (ASD) is a prevalent congenital heart condition in adults that leads to pulmonary hypertension (PAH) and right heart failure if left untreated. During a routine follow-up of adult ASD-PAH patients, the suitability of shunt closure depends on the invasive right heart catheterization (RHC).Nevertheless, performing RHC at every follow-up is impractical and may be harmful. The present retrospective cross-sectional study was designed to investigate which echocardiographic variables are related to pulmonary vascular resistance (PVR) in adult ASD-PAH patients and proposed a model using these variables to screen for patients with a correctable shunt. A total of 530 adult ASD-PAH patients with pulmonary arterial systolic pressure (PASP) of ≥60 mmHg measured using transthoracic echocardiogram (TTE) were included in the study. All RHCs were performed within 3 months after TTE. The correctable shunt was defined as PVR ≤3 wood units (WU). Multivariate regressions were performed utilizing echocardiographic variables. A scoring system was constructed based on the predictors of PVR ≤3 WU using multivariate logistic regression analysis. The scoring system was then examined using a receiver operating characteristic (ROC) analysis. In addition, clinical utility of the model was determined based on decision curve analysis and a calibration curve was used to evaluate model conformity. Estimated pulmonary arterial systolic pressure, velocity through the pulmonary valve, tricuspid annulus early diastolic velocity, and maximum defect dimension were identified as independent predictors. The area under the ROC curve of the predictive value in the model was 0.905 [95% confidence interval (CI): 0.878-0.931, sensitivity: 84.3%, specificity: 83.6%]. The net benefit of the model was notable in terms of a wide-range probability threshold in decision curve analysis, indicating that the prediction model had good clinical applicability. The model's calibration curve was close to an ideal diagonal line, showing good predictive accuracy between the actual and predictive probabilities. The study model was demonstrated to be valuable in predicting adult ASD-PAH patients with a correctable shunt, which may help clinicians to make appropriate treatment decision for follow-up patients.

NIMG-04. MASSIVE THORACIC MENINGOCELE IN A PATIENT WITH NF1

Abstract Thoracic meningoceles are uncommon but when seen are often associated with neurofibromatosis 1 (NF1). Here we present a unique case where a massive thoracic meningocele presented with chest pain in a patient with NF1. A 56-year-old female with a diagnosis of NF1 presented with pain in the entire chest wall. She described the pain as circumferential around the entire chest “like a barrel”. Cardiology evaluation (with echocardiography) revealed no pulmonary hypertension or other cardiac disorder. MR angiogram of the chest also revealed no intrathoracic vascular structural abnormality. Inflammatory myopathy was considered to explain the pain but electromyography was unremarkable as were creatine kinase and erythrocyte sedimentation rate. MRI of thoracic spine demonstrated a large thoracic meningocele involving the spinal canal from T5-T10 and extending into the left hemithorax with measurements of 11.5 x 6.1 x 12.5 cm. Imaging was also notable for leftward displacement of the spinal cord toward the meningocele starting at the T6 level and extending to the T9 level with kyphosis of the thoracic spine centered on the block vertebral bodies forming the T7-T8 levels. Significant posterior scalloping was evident from T6-T10 with attendant dural ectasia. Neurosurgical consultation recommended no intervention to correct the meningocele as plication carried a risk of producing a subarachnoid-pleural fistula from the meningocele into the pleural space of the thoracic cavity. This case adds to our understanding of how unique and diverse the presentations of NF1 can be, and of the surgical challenges posed by NF1-associated meningoceles.

Vitamin D receptor and its antiproliferative effect in human pulmonary arterial hypertension

Vitamin D (vitD) deficiency is frequently observed in patients with pulmonary arterial hypertension (PAH) and, in these patients, low levels of vitD correlate with worse prognosis. The aim of this study was to examine the expression and the antiproliferative role of vitD receptor (VDR) and its signalling pathway in the human pulmonary vasculature. VDR presence and expression was analyzed in lungs, pulmonary artery smooth muscle cells (PASMC) and endothelial cells (PAEC) from controls and PAH-patients. VDR expression and VDR-target genes were examined in PASMC treated with calcitriol. The antiproliferative effect of 48 h-calcitriol was studied in PASMC by MTT and BrdU assays. VDR is expressed in PASMC. It is downregulated in lungs and in PASMC, but not in PAEC, from PAH-patients compared to non-hypertensive controls. Calcitriol strongly upregulated VDR expression in PASMC and the VDR target genes KCNK3 (encoding TASK1), BIRC5 (encoding survivin) and BMP4. Calcitriol produced an antiproliferative effect which was diminished by silencing or by pharmacological inhibition of survivin or BMPR2, but not of TASK1. In conclusion, the expression of VDR is low in PAH-patients and can be rescued by calcitriol. VDR exerts an antiproliferative effect in PASMC by modulating survivin and the BMP signalling pathway.

Modification of Intestinal Flora Can Improve Host Metabolism and Alleviate the Damage Caused by Chronic Hypoxia

Prolonged exposure to hypoxic conditions can lead to reduced appetite, stunted growth, systemic inflammation, and pulmonary hypertension. Previous studies have indicated a correlation between gut dysbiosis and the development of hypoxia-related hazards. We designed an experiment to investigate the effect of microbiota on mitigating hypoxic damage. Gut microbiota from high-altitude-adapted species (Ochotona curzoniae) were transplanted into Sprague Dawley (SD) rats, which were then housed in a simulated 6000 m altitude environment for 30 days. After the experiment, we conducted analyses on average daily weight gain (ADG), feed conversion ratio (FCR), mean pulmonary artery pressure (mPAP), gut flora, and fecal metabolism. The results demonstrated that the ADG in the transplantation group (2.98 ± 0.17 g) was significantly higher than in the control groups (2.68 ± 0.19 g and 2.26 ± 0.13 g) (p < 0.05). The FCR was reduced in the transplantation group (6.30 ± 0.33 g) compared to the control groups (8.20 ± 1.15 g and 8.83 ± 0.45 g) (p < 0.05). The mPAP was decreased in the transplantation group (38.1 ± 1.13 mmHg) compared to the control groups (43.4 ± 1.30 mmHg and 43.5 ± 1.22 mmHg) (p < 0.05). Multi-omics analysis revealed that Lachnospiraceae, Desulfovibrionaceae, and specific amino acid metabolic pathways play crucial roles in hypoxia and are associated with both inflammation and nutritional metabolism. This study proposes a novel approach to the treatment of hypoxic pulmonary hypertension and holds potential significance for improving high-altitude developmental potential.

Effect of tadalafil on pulmonary hypoplasia in congenital diaphragmatic hernia of rat fetuses

Background. Pulmonary hypoplasia and persistent pulmonary hypertension in congenital diaphragmatic hernia are the cause of adverse perinatal outcomes. Dissatisfaction with the outcomes of intrauterine surgical correction of CDH determines the search for alternative non-surgical prenatal methods of treating pulmonary hypoplasia in CDH. Objective. To study the effect of a reversible selective inhibitor of specific phosphodiesterase type 5 (tadalafil) on the development of fetal lungs in rats in a model of congenital diaphragmatic hernia. Design and methods. An experimental study was conducted on the possibility of correcting fetal lung hypoplasia in rats when modeling a diaphragmatic hernia with nitrophen (100 mg orally, once on the 9th day of pregnancy). Results. Congenital diaphragmatic hernia was recorded in 12.5 % of offspring. Subcutaneous administration of tadalafil to pregnant rats (0,83 mg/kg, for 10 days, from the 9th day of pregnancy) in the lungs of fetuses increases the number of alveoli (by 22 % at p ≤ 0.05), the area of microvasculature vessels and the volume of lung parenchyma increases (by 1.25 % and 1.13 % more (at p ≤ 0.05)). Conclusion. The results obtained from the first experiment conducted in the Russian Federation to study the effect of tadalafil on the lungs in congenital diaphragmatic hernia of the fetus are comparable with the data of the authors who used sildenafil, however, the use of tadalafil seems more optimal due to the ease of its administration for potential practical use.

Long-Term Safety and Efficacy of Macitentan in Inoperable Chronic Thromboembolic Pulmonary Hypertension: Results from MERIT and its Open-Label Extension.

Evidence for use of pulmonary arterial hypertension targeted-therapies in patients with chronic thromboembolic pulmonary hypertension (CTEPH) is limited. In MERIT-1, the endothelin receptor antagonist macitentan improved hemodynamic and functional parameters versus placebo in patients with inoperable CTEPH over a 24-week double-blind (DB) period. Its open-label (OL) extension study (MERIT-2) provides long-term safety/efficacy data. MERIT-2 (NCT02060721) was a multicenter, single-arm, OL, phase 2 extension study of MERIT-1. Patients completing MERIT-1 were eligible to receive 10 mg macitentan once-daily in MERIT-2. Safety and efficacy (6-min walk distance [6MWD] and change in World Health Organization functional class [WHO FC]) were assessed in all patients in MERIT-2 regardless of treatment received in DB (All patients MERIT-2 OL macitentan 10mg group) and the subgroup of patients receiving DB macitentan in MERIT-1 (Long-term [DB/OL] macitentan 10mg subgroup). Of the 80 patients randomized in MERIT-1, 76 entered MERIT-2 (All patients MERIT-2 OL macitentan 10mg group): 40 who received DB macitentan (DB-macitentan patients) and 36 DB placebo (DB-placebo patients). Median (interquartile range) macitentan exposure in the All patients MERIT-2 OL macitentan 10mg group was 45.5 (26.0, 66.1) months. During the OL period, treatment-emergent adverse events (AE) were reported in 72 (94.7%) patients; most frequent were worsening of pulmonary hypertension (19.7%), decreased hemoglobin (18.4%) and upper respiratory tract infection (15.8%). Fourteen (18.4%) patients died; none were assessed as macitentan-related. At Month 6 post-OL baseline, mean (standard deviation) change in 6MWD was - 0.4m (43.62) for DB-macitentan patients and 10.7m (45.63) for DB-placebo patients; the majority had unchanged (83.3%) or improved (12.5%) WHO FC. Safety/efficacy analyses were consistent in the Long-term (DB/OL) macitentan 10 mg subgroup. These analyses provide long-term safety/efficacy data in patients with inoperable CTEPH treated with macitentan. No unexpected safety findings occurred; reported AEs were consistent with the known safety profile of macitentan. At 6 months post-OL baseline, DB-placebo patients modestly improved 6MWD; DB-macitentan patients maintained improvements observed in MERIT-1. WHO FC was largely unchanged. ClinicalTrials.gov Identifiers: NCT02021292; NCT02060721.

Automatic Segmentation and Evaluation of Mitral Regurgitation Using Doppler Echocardiographic Images

Background: Mitral Regurgitation (MR) is a common heart valve disease. Severe MR can lead to pulmonary hypertension, cardiac arrhythmia, and even death. Therefore, early diagnosis and assessment of MR severity are crucial. In this study, we propose a deep learning-based method for segmenting MR regions, aiming to improve the efficiency of MR severity classification and diagnosis. Methods: We enhanced the Efficient Multi-Scale Attention (EMA) module to capture multi-scale features more effectively, thereby improving its segmentation performance on MR regions, which vary widely in size. A total of 367 color Doppler echocardiography images were acquired, with 293 images used for model training and 74 images for testing. To fully validate the capability of the improved EMA module, we use ResUNet as the backbone, partially integrating the enhanced EMA module into the decoder’s upsampling process. The proposed model is then compared with classic models like Deeplabv3+ and PSPNet, as well as UNet, ResUNet, ResUNet with the original EMA module added, and UNet with the improved EMA module added. Results: The experimental results demonstrate that the model proposed in this study achieved the best performance for the segmentation of the MR region on the test dataset: Jaccard (84.37%), MPA (92.39%), Recall (90.91%), and Precision (91.9%). In addition, the classification of MR severity based on the segmentation mask generated by our proposed model also achieved acceptable performance: Accuracy (95.27%), Precision (88.52%), Recall (91.13%), and F1-score (90.30%). Conclusion: The model proposed in this study achieved accurate segmentation of MR regions, and based on its segmentation mask, automatic and accurate assessment of MR severity can be realized, potentially assisting radiologists and cardiologists in making decisions about MR.

Photon-Counting CT Iodine Maps for Diagnosing Chronic Pulmonary Thromboembolism: A Pilot Study.

The aim of this study was to evaluate the feasibility and efficacy of chronic pulmonary thromboembolism assessment using photon-counting detector computed tomography (PCD-CT) iodine maps of the lung parenchyma. This institutional review board-approved retrospective study included 83 subjects (49.4% male, aged 62.4 ± 13.4 years; 50.6% female, aged 59.9 ± 17.1 years) who underwent clinically indicated PCD-CT scan to rule out chronic thromboembolic pulmonary hypertension (CTEPH). Two blinded readers used iodine maps and corresponding sharp-kernel CT reconstructions in the lung window to evaluate perfusion defects and identify patients with chronic pulmonary thromboembolism (CTEPH, CTEPH overlap with other causes of pulmonary hypertension [PH], chronic thromboembolic disease [CTED]). No other clinical or imaging information was given. Discordance was resolved in a subsequent consensus read. The clinical diagnosis was reviewed in an interdisciplinary clinical setting. The accuracy, sensitivity, and specificity of radiologic evaluation and clinical diagnosis were calculated. Of the 83 subjects included, 32 were diagnosed with CTEPH, CTEPH overlap, or CTED, 35 were diagnosed with PH caused by other pathologic mechanisms, 10 had no PH, and 6 had suffered previous acute pulmonary embolism, which resolved. The interreader agreement was good (Cohen κ = 0.74). The consensus reached high accuracy (0.88), sensitivity (0.94), and specificity (0.84), as well as good agreement with interdisciplinary clinical diagnosis (Cohen κ = 0.75). No cases with confirmed CTEPH as the primary cause of PH or CTED were missed. Patients with pulmonary arterial hypertension were most frequently rated false-positive. The mean effective dose (±standard deviation) was 1.3 (±0.76) mSv. Accurate, sensitive, and specific diagnosis of pulmonary chronic thromboembolism at low radiation dose is possible using iodine maps reconstructed from PCD-CT scans.

Nutrition and Diet Quality in Pulmonary Arterial Hypertension.

Nutrition and Diet Quality in Pulmonary Arterial Hypertension.

Balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension: short- and long-term results

Balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension: short- and long-term results

Pulmonary hypertension in patients carrying FLNA loss-of-function variants.

Pulmonary hypertension (PH) is an unusual complication of X-linked disease caused by loss-of-function (LOF) variants in the filamin A (FLNA) gene. Patients with FLNA LOF may also present dysmorphic facial features, aortic dilation, thrombopenia, and periventricular nodular heterotopia (PVNH). We reported clinical, functional, radiologic, and hemodynamic characteristics of patients with FLNA LOF variants and PH from the French PH Network. Nine patients were identified with a female to male ratio of 8:1. PH was diagnosed at a median age of 36 [0-69] years. Associated conditions included epilepsy (n=5), PVNH (n=7), valvular heart disease (n=8), congenital heart diseases (n=4), thrombocytopenia (n=4), and hyperlaxity (n=4). Right heart catheterisation confirmed moderate-to-severe precapillary PH with a median mPAP of 33 [22-49] mmHg and PVR of 4.7 [2.4-8.0] WU. The DLCO was markedly decreased (48 [22-64] %pred) and five patients had obstructive ventilatory disorder. High-resolution CT showed heterogeneous parenchyma (n=8), emphysema (n=3), presence of a peripheral hyperclear band (n=3) and aortic ectasia (n=4). Pathologic assessment available in one patient revealed significant remodelling of small pulmonary arteries, interstitial edema, and irregular alveoli shapes. During follow-up, three patients died, including two from right heart failure. No patient died from aortic rupture. Precapillary PH, likely due to multiple mechanisms, may complicate the course of patients with LOF FLNA variants and may be the presenting symptom leading to diagnosis. The combination of PH with parenchymal involvement and extrapulmonary symptoms (epilepsy, congenital heart diseases, valvular and aortic involvement, thrombocytopenia) should prompt genetic screening for FLNA.

Deciphering the inhibitory effects of trimetazidine on pulmonary hypertension development via decreasing fatty acid oxidation and promoting glucose oxidation

Pulmonary hypertension (PH) is a devastating disease characterized by vascular remodeling, resulting in right ventricular failure and death. Dysregulation of energy metabolism is linked to PH pathogenesis. Trimetazidine (TMZ), a selective long-chain 3-ketoacyl coenzyme A thiolase inhibitor, is critical in maintaining energy metabolism. Despite the indicated TMZ’s inhibitory effect on pulmonary vascular remodeling in PH development, the integrated evaluation of the changes in biomolecules, such as metabolites and transcripts, that TMZ induces in the lung and heart tissues is largely unknown in vivo. For an improved understanding of the molecular mechanism involving the effects of TMZ on PH development, we performed a comprehensive analysis of the changes in cardiac metabolites and pulmonary transcripts of SU5416-Hypoxia (Su/Hx) rats treated with TMZ. Metabolomic analysis of the Su/Hx-induced PH hearts demonstrated that TMZ reduced the long-chain fatty acid concentration. Additionally, TMZ alleviated PH degree and excessive strain on the right heart functions in rats with Su/Hx-induced PH. We identified the candidate target genes for TMZ treatment during PH development. Interestingly, the mRNA levels of the fatty acid transporters were substantially downregulated by TMZ administration in the lungs with Su/Hx-induced PH. Notably, TMZ suppressed excessive proliferation of human pulmonary artery smooth muscle cells under hypoxic conditions. Our study suggests that TMZ ameliorates PH development by involving energy metabolism in the lungs and heart.

Association of daily physical activity with pulmonary artery pressure in HFpEF and HFmrEF NYHA class III patients: a pilot trial-feasibility and first results.

Supervised physical exercise has been shown to benefit patients with heart failure with preserved/mildly reduced ejection fraction (HFpEF/HfmrEF) by improving symptoms and diastolic function. This study aimed to investigate the correlation between unsupervised daily physical activity and changes in daily pulmonary artery pressure (PAP) in patients with stable NYHA class III heart failure (HF) and left ventricular ejection fraction (LVEF) of 45% or higher. Daily physical activity was monitored over a 3-month period using a Holter-ECG with an accelerometer that calculated an activity-associated, heart rate-derived metabolic equivalent of task (MET) score. PAP was measured using an implanted sensor in 17 patients. During 3months of PAP monitoring in parallel with Holter ECG in our HF patients (median age 77 [IQR 72-79.5] years, LVEF 55 [49-56] %, mean cardiac index 1.9 ± 0.3), mean, diastolic, and systolic PAP remained unchanged. Patients engaged in unsupervised daily activity with a mean MET score of 5.0 ± 1.2 and a median daily duration of 41 [13-123] minutes. Intensity of daily activity was associated with a higher diastolic PAP on the following day (R2 = 0.017, p = 0.003), particularly in female patients and those with pulmonary hypertension (PH) (female: R2 = 0.044, p = 0.002; PH: R2 = 0.024, p = 0.004). Patients with longer daily activity durations had lower systolic and mean PAP (p = 0.038 and p = 0.048) and a similar diastolic PAP (p = 0.053) after 3months. Tracking changes in daily PAP based on intensity and duration of unsupervised daily activity using implanted sensors and a PocketECG® is feasible. While daily activity duration was not directly linked to diastolic PAP on the first day after daily activity, intensity, especially in female and PH patients, was associated with increased diastolic PAP. In addition, longer daily activity, rather than higher intensity, might be more important for lowering PAP in the long term. Further research in larger trials is warranted to confirm these findings.

Features of acute coronary syndrome after a COVID-19 in the aspect of pulmonary hypertension

BACKGROUND: After recovery from COVID-19 patients may develop new risk factors that lead to changes in cardiopulmonary interactions, i.e. an increase in the afterload on the right ventricle due to increased pressure in the pulmonary artery and change in pulmonary vascular resistance. It can be assumed that the presence of such a spectrum of problems can influence the severity of dyspnea and the development of pathogenetic events (pulmonary hypertension, right ventricular failure, subendocardial ischemia), which in turn can determine the outcome. AIM: To identify the characteristics of acute coronary syndrome after a COVID-19, taking into account angiographic data on coronary artery lesions and hemodynamic manifestations. MATERIALS AND METHODS: A comparative analysis of the clinical and hemodynamic consequences of the COVID-19 and the development of acute coronary syndrome in 157 patients was carried out. The group 1 included 69 patients who had had COVID-19 (vaccinated — 24.6%) during the 6 months preceding acute coronary syndrome; group 2 — 88 patients without a history of COVID-19 (vaccinated — 42%). The 12-lead electrocardiogram has been used in the diagnosis of subendocardial ischemia in acute coronary syndrome. The ST segment displacement in lead aVR was analyzed. RESULTS: After COVID-19, dispnoe occurred in 52% of the patients and in 14.8% without previous infection. Echocardiographic signs of right ventricular overload were present in 42% of the patients in group 1 and 10.2% in group 2. The mean pressure in the pulmonary artery was increased after COVID-19 in 58% of the patients in group 1 and in 10.2% of group 2 in the range from 20 to 24 mm Hg and in the range from 25 to 36 mm Hg in 29% of the patients in group 1 and 2.3% of the patients in group 2. The average value of left ventricular ejection fraction in the patients who had had COVID-19 was 55.9 ± 14%, which was less than in the patients in the control group (63.2 ± 5.5%; p 0.001). ST segment elevation in lead aVr indicated high incidence of subendocardial ischemia. 40.6% in group 1, and 11.4% in group 2 (χ2 = 17.9; p 0.001); in group 1 vaccinated — 17.6%, and not vaccinated — 48.1% (χ2 = 4.9; p = 0.027), in group 2 vaccinated — 8.1%, and not vaccinated — 13.7% (χ2 = 0.7; p = 0.41). All the patients had drug-eluting stents implanted in the infarct-related artery. After stenting, no recurrence of pain or further increase in chest pain was observed. CONCLUSIONS: After coronavirus infection COVID-19, 58% of patients have increased mean pressure in the pulmonary artery in the range from 20 to 24 mm Hg and in the range from 25 to 36 mm Hg in 29%. Atherothrombosis is the main mechanism of acute coronary syndrome after COVID-19 coronavirus infection. The main feature of acute coronary syndrome after a coronavirus infection COVID-19 is increased pressure in the pulmonary artery after a lung injury, which must be taken into account when planning surgical treatment tactics and management tactics in the postoperative period.

Acute effect of acetazolamide on exercise hemodynamics in patients with pulmonary arterial and chronic thromboembolic pulmonary hypertension: a randomised controlled trial

Acute effect of acetazolamide on exercise hemodynamics in patients with pulmonary arterial and chronic thromboembolic pulmonary hypertension: a randomised controlled trial

Phenotyping vasodilator responsiveness in idiopathic pulmonary arterial hypertension: any role for the cardiopulmonary exercise test?

Phenotyping vasodilator responsiveness in idiopathic pulmonary arterial hypertension: any role for the cardiopulmonary exercise test?