Measurement Of Pulmonary Artery Pressure Research Articles

COMPARISON OF INFERIOR VENA CAVA ASSESSMENT BY 2-DIMENSIONAL AND M-MODE ECHOCARDIOGRAPHY FOR THE EVALUATION OF RIGHT ATRIAL PRESSURE

Echocardiographic estimation of right atrial pressure (RAP) is used to assess intravascular volume, is a marker of prognosis in patients with cardiovascular disease, and is an essential component of the Doppler echo measurement of pulmonary artery pressure. Current guidelines recommend measuring the diameter and collapsibility of the inferior vena cava (IVC) to assign a value for RAP but do not explicitly state whether 2-dimensional (2D) or M-mode (MM) echocardiography should be used. This has resulted in variations in clinical practice among centres. We sought to determine if MM and 2D techniques differ in their evaluation of RAP using current recommendations. 2D and MM images of the IVC were prospectively acquired by sonographers in 100 clinical echocardiograms performed on non-ventilated patients over a four-week period. Two reviewers independently assessed the 2D and MM images of the IVC and made guideline-based measurements of the diameter and collapsibility. Quality of MM cursor positioning was documented. RAP was classified as normal (3 mmHg), intermediate (8 mmHg), or high (15 mmHg) based on IVC diameter and collapsibility for the MM and 2D techniques. IVC measurements were larger by MM than 2D (IVC diameter 1.82±0.51 vs. 1.70±0.49 cm, p<0.001), and agreement between MM and 2D on the presence of IVC dilation was significantly influenced by the quality of M-mode cursor positioning (χ2=9.6582, p=0.002). IVC collapsibility was also greater by MM than 2D (61±20% vs. 55±22%, p=0.001). The agreement of MM- and 2D-derived RAP values was only moderate-good (74% agreement, weighted kappa 0.61) with no indication that one technique consistently overestimated or underestimated RAP relative to the other. In the subset of patients with MM RAP derived from an improperly positioned MM cursor (n=24), agreement between 2D and MM RAP was worse (58% agreement, weighted kappa 0.39, p=0.055 for interaction between MM cursor positioning and RAP agreement). Interobserver agreement for RAP was similar for 2D (weighted kappa=0.67) and MM (weighted kappa=0.69). IVC size and collapsibility differed when evaluated by MM and 2D techniques and resulted in discrepant assessments of RAP in 26% of patients. Quality of the MM cursor positioning was a predictor of the agreement between MM and 2D IVC size and tended to affect the RAP ultimately assigned. This study suggests that discrepant measurements of RAP using MM and 2D techniques are common in clinical practice, but can be minimized by ensuring proper MM techniques are employed.

Allele distribution and testing for association between an oxygen dependent degradation domain SNP in EPAS1 and pulmonary arterial pressures in yearling Angus cattle

At altitudes >1500 m, measurements of mean pulmonary arterial pressures (mPAP; mmHg) are a measure of pulmonary hypertension (PH) in cattle. Genotypes of a G/A single nucleotide polymorphism (SNP; rs208684340) in the endothelial PAS domain protein 1 (EPAS1) gene were determined for mPAP categories (low, moderate, high) on Angus cattle. The A allele of this SNP was postulated to be associated with altitude-induced PH. The first objective was to estimate allele and genotypic frequencies in Angus cattle at high- (elevation 1850 to 2800 m) and low-altitude (elevation 91 to 1192 m) ranches (n = 118; random sample of 1275). Percent of cattle at these low elevation ranches with genotypes G/G, G/A, and A/A were 64.4, 33.9, and 1.7%, respectively, and a minor allele frequency (MAF; A allele) of 18.6%. Bulls, steers, and heifers (n = 691) from 4 high-altitude Angus herds in Colorado and Wyoming were genotyped. Percent of cattle with genotypes G/G, G/A, and A/A were 48.6, 34.3, and 17.1%, respectively, with a MAF of 34.2%. Average mPAP was 40.5 ± 8.8 mmHg. Low, moderate, and high-mPAP category MAF were similar (χ2 = 3.03; P = 0.22), with values of 35.4, 31.0, and 37.8%, respectively. Additionally we sought to evaluate the genotype-to-phenotype association of this SNP with mPAP phenotypes (n = 532) from the Colorado State University Beef Improvement Center (elevation 2150 m) Angus herd. Linear mixed model analysis suggested genotype was not a predictor (P = 0.61) of mPAP. Results do not suggest the A allele of SNP in EPAS1 is associated with high altitude-induced PH in yearling Angus cattle.

Noninvasive pulmonary arterial pressure estimation using a logistic-based systolic model

RationaleA hemodynamic relationship of pulmonary artery pressure (PAP) to pulmonary acceleration time (PAcT) has not yet been explicitly presented. ObjectiveWe employed a logistic-based systolic model with a subtle modification for pulmonary circulation and provided a logical ground for the relationship between systolic PAP and PAcT using transthoracic echocardiography. Additionally, the logistic-based PAP estimation equation was deduced from the model to relate systolic PAP and PAcT. Methods and resultsThis equation was statistically tested in comparison to existing PAP estimation equations. Results showed that the logistic-based PAP estimation equation was at least as accurate as previous equations with respect to previously published mean PAP versus PAcT values. After the subtle pulmonary modification of the model, the pulmonary blood flow velocity and pressure not only well reflected the underlying pulmonary circulation physiology, but could also be presented in harmony with systemic circulation physiology. ConclusionsA future clinical study with actual systolic PAP versus PAcT measurements is needed to test the application of the logistic-based PAP estimation equation.

Выбор оптимального блокатора ренин- ангиотензин-альдостероновой системы у больных с сочетанием артериальной гипертонии и хронической обструктивной болезни легких

to compare hypotensive and pleiotropic effects of angiotensin II receptor blocker (ARB) azilsartan medoxomil (AM) and angiotensin converting enzyme inhibitor (ACEI) fosinopril in patients with concomitant arterial hypertension (AH) and chronic obstructive pulmonary disease (COPD). We included in this open study 49 patients with concomitant stage I-II AH and COPD. Initially all patients received hydrochlorothiazide (12.5 mg/day) and various ACEI but target blood pressure levels were not achieved, and these ACEI were withdrawn. By method of closed envelopes, the patients were divided into 2 groups. Patients of group 1 were given ARB АМ, of group 2 - ACEI fosinopril. Methods of investigation were repetitive 24‑hour ambulatory blood pressure monitoring (ABPM), spirometry, measurement of mean pulmonary artery pressure (mPAP), study of endothelial function by instrumental and laboratory methods. After 4 weeks of treatment with AM target BP level (.

Limitations and challenges of EIT-based monitoring of stroke volume and pulmonary artery pressure

Objective: Electrical impedance tomography (EIT) shows potential for radiation-free and noninvasive hemodynamic monitoring. However, many factors degrade the accuracy and repeatability of these measurements. Our goal is to estimate the impact of this variability on the EIT-based monitoring of two important central hemodynamic parameters: stroke volume (SV) and pulmonary artery pressure (PAP). Approach: We performed simulations on a 4D () bioimpedance model of a human volunteer to study the influence of four potential confounding factors (electrode belt displacement, electrode detachment, changes in hematocrit and lung air volume) on the performance of EIT-based SV and PAP estimation. Results were used to estimate how these factors affect the EIT measures of either absolute values or relative changes (i.e. trending). Main results: Our findings reveal that the absolute measurement of SV via EIT is very sensitive to electrode belt displacements and lung conductivity changes. Nonetheless, the trending ability of SV EIT might be a promising alternative. The timing-based measurement of PAP is more robust to lung conductivity changes but sensitive to longitudinal belt displacements at severe hypertensive levels and to rotational displacements (independent of the PAP level). Significance: We identify and quantify the challenges of EIT-based SV and PAP monitoring. Absolute SV via EIT is challenging, but trending is feasible, while both the absolute and trending of PAP via EIT are mostly impaired by belt displacements.

Correlation between mean pulmonary arterial pressure measurement by echocardiography and right ventricular function

Background: Echocardiography is usually the first imaging modality for the evaluation of the structural and functional disorders of the heart and the great vessels. Color flow and Doppler images can provide hemodynamic and bloodstream assessment. The goal of this study was to investigate the function of the right ventricular (RV) using echocardiography in patients with an increased mean pulmonary artery pressure (PAP) (>25 mmHg). Methods: This cross-sectional study recruited patients with an elevated mean PAP (>25 mmHg) according to echocardiography. The RV function was evaluated in terms of the fractional area change (FAC), pulmonary vascular resistance (PVR), the myocardial performance index (Tei index), and the S-wave velocity. The data were analyzed using SPSS software, version 16, as well as the Chi-square test, the Pearson correlation coefficient, and the t-test. P

Evaluation of Pulmonary Artery Pressure Measurements in Severe Pulmonic Valve Insufficiency in the Absence of Tricuspid Regurgitation.

Evaluation of Pulmonary Artery Pressure Measurements in Severe Pulmonic Valve Insufficiency in the Absence of Tricuspid Regurgitation.

Relationship of asymmetric dimethylarginine levels with disease severity and pulmonary hypertension in chronic obstructive pulmonary disease

Background:Asymmetric dimethylarginine (ADMA) has emerged as a risk marker for many conditions related to pulmonary hypertension (PH); however, little is known about ADMA and symmetric dimethylarginine (SDMA) plasma concentrations in chronic obstructive pulmonary disease (COPD). Our interest centers on the role of ADMA in regulation of endothelial function in COPD and secondary PH. The aim of the present study was to evaluate the serum ADMA, SDMA, and L-arginine concentrations in COPD and its association with PH.Methods:Patients with diagnosis of COPD underwent pulmonary function tests, echocardiography, and laboratory investigations including ADMA, SDMA, and L-arginine.Results:Serum concentrations of ADMA, SDMA, and L-arginine tend to increase as COPD progresses. Patients with PH had higher concentrations of ADMA, SDMA, and L-arginine compared to cases with normal pulmonary arterial pressure (PAP); the difference was not statistically significant.Conclusions:Our results show that increased ADMA, SDMA, and L-arginine concentrations are associated with increased PAP measurements in patients with COPD, however, the relationship is not statistically significant.

Hemodynamic Phenotyping of Pulmonary Hypertension in Left Heart Failure.

Increased pulmonary venous pressure secondary to left heart disease is the most common cause of pulmonary hypertension (PH). The diagnosis of PH due to left heart disease relies on a clinical probability assessment followed by the invasive measurements of a mean pulmonary artery pressure (PAP) ≥25 mm Hg and mean wedged PAP (PAWP) >15 mm Hg. A combination of mean PAP and mean PAWP defines postcapillary PH. Postcapillary PH is generally associated with a diastolic pulmonary pressure gradient (diastolic PAP minus mean PAWP) <7 mm Hg, a transpulmonary pressure gradient (mean PAP minus mean PAWP) <12 mm Hg, and pulmonary vascular resistance ≤3 Wood units (WU). This combination of criteria defines isolated postcapillary PH. Postcapillary PH with elevated vascular gradients and pulmonary vascular resistance defines combined post- and precapillary PH (Cpc-PH). Postcapillary PH is associated with a decreased survival in proportion to increased pulmonary vascular gradients, decreased pulmonary arterial compliance, and reduced right ventricular function. The Cpc-PH subcategory occurs in 12% to 13% of patients with PH due to left heart disease. Patients with Cpc-PH have severe PH, with higher diastolic pulmonary pressure gradient, transpulmonary pressure gradient, and pulmonary vascular resistance and more pronounced ventilatory responses to exercise, lower pulmonary arterial compliance, depressed right ventricular ejection fraction, and shorter life expectancy than isolated postcapillary PH. Cpc-PH bears similarities to pulmonary arterial hypertension. Whether Cpc-PH is amenable to therapies targeting the pulmonary circulation remains to be tested by properly designed randomized controlled trials.

Echocardiographic Evaluation of Pulmonary Pressures and Right Ventricular Function after Pediatric Cardiac Surgery: A Simple Approach for the Intensivist.

Pulmonary hypertension (PH) is diagnosed using cardiac catheterization and is defined as an elevation of mean pulmonary artery pressure (PAP) greater than 25 mmHg. Although invasive hemodynamics remains the gold standard and is mandatory for disease confirmation, transthoracic echocardiography (TTE) is an extremely useful non-invasive and widely available tool that allows for screening and follow-up, in particular, in the acute setting. TTE may be a valuable alternative, allowing for direct measurement and/or indirect assessment of PAP. Because of the complex geometric shape and pattern of contraction of the right ventricle (RV), as well as the inherent complexity of cardiac repair, no single view or measurement can provide definite information on RV function and PAP and/or pulmonary vascular resistance. In addition, specific training and expertise may be necessary to obtain the views and measurements required. Some simple measurements may be of help when rapid evaluation is mandatory and potentially life saving: the assessment of tricuspid and/or pulmonary valve regurgitant jet and the use of the Bernoulli equation allow for measurement of PAP. Measurements such as the analysis of the pulmonary Doppler wave flow, the septal curvature, or the eccentricity index, assessing ventricular interdependence, are useful for indirect assessment. A four-chamber view of the RV gives information on its size, hypertrophy, function (fractional area change), and tricuspid annular plane systolic excursion as an evaluation of the longitudinal function. Based on these simple measurements, TTE can provide detection of PH, measurement or estimation of PAP, and assessment of cardiac function. TTE is also of importance in follow up of PH as well as providing an assessment of therapeutic strategies in the postoperative setting of cardiac surgery. However, PAP may be misleading as it is dependent on cardiac output and requires accurate measurements. In the presence of residual lesions, analyses of some Doppler measurements may be misleading and not reflect real PAP. Should the TTE evaluation reveal non-conclusive, invasive hemodynamics remains the gold standard.

Abstract 65: Anemia-related Heart Failure in Sub-saharan African Sickle Cell Disease Patients

Introduction: Anemia has been implicated in heart failure. Existing literatures, involving predominantly African-Americans, suggests that Sickle Cell Disease (SCD) maybe linked to various cardiovascular complications including pulmonary hypertension and left venticular dysfunction. Peculiarly, our study involves exclusively Sub-Saharan population. Method: We conducted a cross sectional observational study of 208 hydroxyurea-naive consecutive SCD patients aged 10-52 years at steady state and 94 healthy non-matched controls who were studied in an out patient clinic in Sub-Saharan Africa. SCD patients were required to have electrophoretic or liquid chromatography documentation of major sickling phenotypes. Control group was required to have non-sickling phenotypes. Cardiac measurements were performed with TransThoracic Echo according to American Society of Echocardiography guidelines. Hemoglobin level was also obtained. Results: Hemoglobin level in SCD group (8.5+/- 1.5) was significant (P&lt;0.001) compared to control (13.8+/- 1.7). Although SCD group had significantly higher values of left ventricular (LV) size, there was no qualitative evidence of LV dysfunction. SCD group had higher values of Ejection Fraction but not statistically significant. There was no evidence of LV wall stiffening to impair proper filling in SCD group, with the ratio of early to late ventricular filling velocities, E/A ratio elevated (1.7+/-0.4 compared to 1.6+/- 0.4; P=0.010). Right ventricular systolic pressure was determined using the formula of 4x Tricuspid Reugurgitant jet (TRV) square as an indirect measurement of Pulmonary arterial systolic pressure. SCD patients had significantly higher mean±SD values for tricuspid regurgitant jet velocity than did the controls (2.1±0.6 vs. 1.8±0.5; p= 0.001). Within the SCD group, there was no clear pattern of worsening diastolic function with increased TRV. Furthermore, E/A had a significant positive relationship with jet velocity in bivariate analysis (R=0.20; P=0.013). Conclusions: We were unable to demonstrate existence of anemia-associated left ventricular dysfunction in Sub-Saharan African with SCD. Further studies is required to highlight the reason behind this finding.

Correlation between pulmonary artery pressure and thoracic impedance: Insights from daily monitoring through an implanted device in chronic heart failure

BackgroundThoracic impedance (TI) decrease and pulmonary artery pressure (PAP) elevation precede acute decompensation in congestive heart failure (HF). However, the relationship between TI and PAP has been studied only in the context of acute decompensation. MethodsThis prospective, observational study enrolled subjects with reduced ejection fraction HF, previously implanted with an ICD capable of measuring TI. Patients underwent implantation of a sensor for direct measurement of PAP (CardioMEMs™). Both TI and PAP were remotely monitored daily during follow up. Investigators were blinded to PAP values during the first three months, then PAP was used as a guide to therapy. ResultsTen patients were followed up for 405±141days (3720 patient-days). During hemodynamic guided therapy, diastolic PAP (dPAP) decreased from 27.8±10.2mmHg to 24.0±8.0mmHg (p<0.001); non-significant variations of TI were observed. A significant negative correlation was found between the variations of TI and PAP vs. baseline (p<0.001). Episodes of sustained increase of PAP preceded subsequent periods of TI decrease by 5.6±3.9days, but the former were poor predictors of the latter (sensitivity 0.37). ConclusionsOur study confirms the strict correlation that exists between left ventricular filling pressures and lung water content, estimated by dPAP and TI, respectively. However, dPAP acute variation analysis showed a limited value in predicting subsequent episodes of TI decrease.

6 CardioMEMS for Effective Management of Heart Failure: Reducing Healthcare Utilization and 30 Day Readmissions

Heart failure (HF) affects over 5 million Americans and is associated with frequent, costly acute care hospitalizations and penalties for high 30-day readmission rates. Although current guidelines emphasize the importance of implementing systems to coordinate and deliver effective care, HF admission rates have increased, while readmission rates have remained essentially unchanged in the past decade. Early recognition of a HF episode is paramount in preventing a readmission. Research from the Champion Trial (J Card Fail. 2011 Jan;17(1):3-10. http://dx.doi.org/10.1016/j.cardfail.2010.08.002) demonstrates that pulmonary artery pressures more accurately reflect volume status changes in the heart failure patient than traditional methods of weight monitoring and physical assessment. These changes in volume status are also shown to precede a change in weight or symptom development by 1-3 weeks. The CardioMEMS Heart Failure Monitoring System is a permanently implantable pulmonary artery sensor device designed to transmit daily pulmonary artery (PA) pressure measurements from the patient’s home to a website available to the healthcare team. Monitoring PA pressure provides tangible data to help guide HF management in an outpatient setting.

Three-dimensional fractal analysis of 99mTc-MAA SPECT images in chronic thromboembolic pulmonary hypertension for evaluation of response to balloon pulmonary angioplasty: association with pulmonary arterial pressure.

ObjectiveBalloon pulmonary angioplasty (BPA) is used for inoperable chronic thromboembolic pulmonary hypertension (CTEPH), but its effect cannot be evaluated noninvasively. We devised a noninvasive quantitative index of response to BPA using three-dimensional fractal analysis (3D-FA) of technetium-99m-macroaggregated albumin (99mTc-MAA) single-photon emission computed tomography (SPECT).Patients and methodsForty CTEPH patients who underwent pulmonary perfusion scintigraphy and mean pulmonary arterial pressure (mPAP) measurement by right heart catheterization before and after BPA were studied. The total uptake volume (TUV) in bilateral lungs was determined from maximum intensity projection 99mTc-MAA SPECT images. Fractal dimension was assessed by 3D-FA. Parameters were compared before and after BPA, and between patients with post-BPA mPAP more than 30 mmHg and less than or equal to 30 mmHg. Receiver operating characteristic analysis was carried out.ResultsBPA significantly improved TUV (595±204–885±214 ml, P<0.001) and reduced the laterality of uptake (238±147–135±131 ml, P<0.001). Patients with poor therapeutic response (post-BPA mPAP≥30 mmHg, n=16) showed a significantly smaller TUV increase (P=0.044) and a significantly greater post-BPA fractal dimension (P<0.001) than the low-mPAP group. Fractal dimension correlated with mPAP values before and after BPA (P=0.013 and 0.001, respectively). A post-BPA fractal dimension threshold of 2.4 distinguished between BPA success and failure with 75% sensitivity, 79% specificity, 78% accuracy, and area under the curve of 0.85.Conclusion3D-FA using 99mTc-MAA SPECT pulmonary perfusion scintigraphy enables a noninvasive evaluation of the response of CTEPH patients to BPA.

Left Atrium Maximal Axial Cross-Sectional Area is a Specific Computed Tomographic Imaging Biomarker of World Health Organization Group 2 Pulmonary Hypertension.

Left heart disease is associated with left atrial enlargement and is a common cause of pulmonary hypertension (PH). We investigated the relationship between left atrium maximal axial cross-sectional area (LA-MACSA), as measured on chest computed tomography (CT), and PH due to left heart disease (World Health Organization group 2) in patients with right heart catheterization-proven PH. A total of 165 patients with PH who had undergone right heart catheterization with pulmonary artery pressure and pulmonary capillary wedge pressure (PCWP) measurements and nongated chest CTs were included. LA-MACSA, LA anterior-posterior, and LA transverse measurements were independently obtained using the hand-drawn region-of-interest and distance measurement tools on standard PACS by 2 blinded cardiothoracic radiologists. Nonparametric statistical analyses and receiver operating characteristic curve were performed. Forty-three patients had group 2 PH (PCWP>15 mm Hg), and 122 had nongroup 2 PH (PCWP≤15 mm Hg). Median LA-MACSA was significantly different between the group 2 PH and nongroup 2 PH patients (2312 vs. 1762 mm, P<0.001). Interobserver concordance correlation for LA-MACSA was high at 0.91 (P<0.001). At a threshold of 2400 mm, LA-MACSA demonstrated 93% specificity for classifying group 2 PH (area under the curve, 0.73; P<0.001). LA-MACSA is a readily obtainable and reproducible measurement of left atrial enlargement on CT and can distinguish between group 2 and nongroup 2 PH with high specificity.

Evaluation of Pulmonary Artery Pressure Measurements in Severe Pulmonic Valve Insufficiency in the Absence of Tricuspid Regurgitation

Evaluation of Pulmonary Artery Pressure Measurements in Severe Pulmonic Valve Insufficiency in the Absence of Tricuspid Regurgitation

Abstract No. 254 - Evaluation of serial pulmonary artery pressure measurements and angiographic findings during catheter directed thrombolysis for acute pulmonary embolism

Abstract No. 254 - Evaluation of serial pulmonary artery pressure measurements and angiographic findings during catheter directed thrombolysis for acute pulmonary embolism

Tips and Tricks for MitraClip Procedure

There have been more than 10,000 MitraClip procedures performed to treat either functional or degenerative mitral regurgitation (MR). Echocardiography is the essential imaging modality for MitraClip treatment. Echocardiography in peri-interventional assessment is used for: (i) patient selection, (ii) guidance of the procedure, (iii) the identification as well as the assessment of the severity of any complications during the procedure, (iv) the evaluation of the final result after clip implantation, and (v) the assessment at follow-up. In order to select a patient for the MitraClip procedure, the first step is to assess the severity of MR. In addition to grading MR severity; the MV morphology and the cause of MR should be assessed in detail by transoesophageal echocardiography. Two-dimensional TEE can be used as the sole method for guidance during the MitraClip. However, 3D TEE provides valuable additional information and is therefore recommended for the guidance of MitraClip procedures. It has been demonstrated that MitraClip implantation is a remarkably safe procedure; however, complications may occur at any time of the intervention and the team performing the procedure must be aware of them and should be prepared for adequate detection and treatment. For post-procedural follow-up, TTE is usually sufficient. It has been suggested several parameters for quantitative MV assessment adapted from current guidelines, including color flow Doppler of the MR, MV inflow gradient, assessment of pulmonary vein flow, residual ASD evaluation, systolic pulmonary artery pressure, LV size and volume measurements in systole and diastole, and LVEF. In case there is an abnormality that needs clarification, an additional TEE should be performed.

Severe pulmonary hypertension due to combined pulmonary fibrosis and emphysema: another cause of death among smokers.

In 2005, the combined pulmonary fibrosis and emphysema (CPFE) was first defined as a distinct entity, which comprised centrilobular or paraseptal emphysema in the upper pulmonary lobes, and fibrosis in the lower lobes accompanied by reduced diffused capacity of the lungs for carbon monoxide (DLCO). Recently, the fibrosis associated with the connective tissue disease was also included in the diagnosis of CPFE, although the exposure to tobacco, coal, welding, agrochemical compounds, and tire manufacturing are the most frequent causative agents. This entity characteristically presents reduced DLCO with preserved lung volumes and severe pulmonary hypertension, which is not observed in emphysema and fibrosis alone. We present the case of a 63-year-old woman with a history of heavy tobacco smoking abuse, who developed progressive dyspnea, severe pulmonary hypertension, and cor pulmonale over a 2-year period. She attended the emergency facility several times complaining of worsening dyspnea that was treated as decompensate chronic obstructive pulmonary disease (COPD). The imaging examination showed paraseptal emphysema in the upper pulmonary lobes and fibrosis in the middle and lower lobes. The echo Doppler cardiogram revealed the dilation of the right cardiac chambers and pulmonary hypertension, which was confirmed by pulmonary trunk artery pressure measurement by catheterization. During this period, she was progressively restricted to the minimal activities of daily life and dependent on caregivers. She was brought to the hospital neurologically obtunded, presenting anasarca, and respiratory failure, which led her to death. The autopsy showed signs of pulmonary hypertension and findings of fibrosis and emphysema in the histological examination of the lungs. The authors highlight the importance of the recognition of this entity in case of COPD associated with severe pulmonary hypertension of unknown cause.

Anti-angiotensin II type 1 receptor autoantibodies (AT1R-AAs) in patients with systemic sclerosis: lack of association with disease manifestations.

Angiotensin II type 1 receptor autoantibodies (AT1R-AAs) are known to be associated with malignant hypertension, preeclampsia, and vascular rejection in kidney transplantation. They were also suspected to have pathogenetic role in vasculopathic changes in systemic sclerosis (SSc). Clinical data regarding AT1R-AAs in SSc are scarce. In this work, we will examine the relationship between serum levels of AT1R-AAs and disease manifestations. Serum samples from SSc patients and healthy controls were analyzed for AT1R-AAs by using a commercial ELISA kit. We examined the association of serum levels of AT1R-AA with disease duration, systolic pulmonary artery pressure (sPAP) measurements, and disease manifestations like cutaneous, lung and esophageal involvements, and the presence of digital ulcers in a cross-sectional manner. There was no statistically significant difference in levels of AT1R-AAs between SSc (n=93) patients and healthy controls (n=66) (p=0.23). Serum levels of AT1R-AAs were not correlated with disease duration, sPAP measurements, and showed no association with disease manifestations like lung involvement, esophageal involvement, digital ulcers, and cutaneous fibrosis. In our SSc cohort, AT1R-AA serum levels were not different from healthy subjects and higher levels were not associated with any disease manifestation neither.