Pulmonary Artery Pressure In Patients Research Articles

The Predictive Value of Qanadli and Miller Index Scores in Patients with Intermediate-High–Risk and High-Risk Pulmonary Emboli Undergoing Aspiration Thrombectomy

PurposeTo evaluate the correlation between clot burden and pulmonary artery pressures in patients undergoing suction thromboembolectomy for high-risk and intermediate-high–risk pulmonary embolism with secondary outcomes of 30-day morality and intensive care unit (ICU) length of stay. Materials and MethodsInstitutional review board (IRB) exemption was granted for this retrospective study. The charts of 120 consecutive patients who underwent mechanical thromboembolectomy using the Flowtriever system (Inari Medical, Irvine, California) between February 2020 and August 2022 were retrospectively reviewed, and the following data were collected: (a) preprocedural B-type natriuretic peptide and creatinine levels, (b) echocardiographic findings, (c) preprocedural and postprocedural pulmonary artery pressures, (d) ICU length of stay, and (e) 30-day mortality. Clot burden was scored using Qanadli and Miller indices and correlated with the clinical outcomes. ResultsOf the 120 patients who underwent thromboembolectomy, pulmonary artery pressures and diagnostic-quality angiograms were available in 109 patients. In the 109 patients with adequate data, Qanadli, preprocedural Miller, and postprocedural Miller scores correlated with pulmonary artery pressures. Neither was independently associated with ICU length of stay. Freedom from 30-day mortality was 91%, and embolism-specific mortality was 92%. All-risk and high-risk patients who survived demonstrated a meaningfully lower preprocedural and postprocedural Miller score, respectively. ConclusionsThrombus burden as measured by the Qanadli and Miller scores appeared to be correlated with pulmonary artery pressures. Furthermore, catheter-directed thromboembolectomy led to a reduction in Miller scores, which appeared to be correlated with a reduction in pulmonary pressures. In high-risk patients, a reduced postprocedural Miller score and pulmonary pressure demonstrated improved 30-day survival. Further investigation between Miller scores and patient mortality is warranted to stratify patients who would benefit from emergency intervention.

Echocardiographic Assessment of Right Ventricular Function and Pulmonary Arterial Pressure in Patients with Multiple Myeloma Post Autologous Hematopoietic Stem Cell Transplantation

Echocardiographic Assessment of Right Ventricular Function and Pulmonary Arterial Pressure in Patients with Multiple Myeloma Post Autologous Hematopoietic Stem Cell Transplantation

Novel echocardiographic parameters in pulmonary hypertension assessment and the relationship between echocardiography and 6-minute walking test.

Pulmonary artery stiffness (PAS) has been shown to be related to pulmonary artery pressure in patients with pulmonary artery hypertension (PAH). The aim of this study was to determine the correlation between functional capacity and echocardiographic indices of PAS in patients with PAH. This cross-sectional study was performed on patients with PAH who were confirmed by right heart catheterization and referred to Imam Reza PAH clinic for routine follow-up between November 2019 and January 2020. All patients underwent echocardiography and the maximum Doppler frequency shift, pulmonary acceleration time, peak velocity of the pulmonary flow, and velocity time integral, as well as PAS, were measured. All patients performed a 6-minute walk test. Fifty patients with a mean age of 41.90 ± 14.73 years old participated in this study. The majority of the patients were female (74%). The most common cause of PAH was idiopathic (74%). There was a significant correlation between PAS and pulmonary artery systolic pressure (r = 0.302, P = .041), second pulmonary valve pulse Doppler velocity (V2) (r = -0.461, P = .003), time from onset of pulmonary flow ejection to V2/first pulmonary valve pulse Doppler velocity (r = -0.311, P = .037) and Z3 ratio (r = -0.346, P = .023). There was no significant correlation between PAS and 6-minute walk test, pulmonary vascular resistance, and tricuspid annular plane systolic excursion (P > .05). There was a significant correlation between V2 and pulmonary vascular resistance (r = 0.359, P = .049). PAS and first pulmonary valve pulse Doppler velocity are simple, noninvasive, available tools for the evaluation of pulmonary vascular beds and diagnosis of presymptomatic clinical status in patients with PAH.

Effects of cannabis on pulmonary arterial pressure in patients hospitalized for acute cardiac events: From the ADDICT-ICCU study

Effects of cannabis on pulmonary arterial pressure in patients hospitalized for acute cardiac events: From the ADDICT-ICCU study

Assess the pulmonary arterial pressure in patients with group 1 pulmonary arterial hypertension by echocardiography

Objective: We assess the right ventricular in patients with group 1 pulmonary arterial hypertension by echocardiography.
 Method and Results: 45 patients with group 1 pulmonary arterial hypertension was measured the right ventricular by echocardiography between September 2021 and October 2022. Right ventricular diameter and Right ventricular area in patients with idiopathic pulmonary arterial hypertension were not significantly different in patients with secondary pulmonary arterial hypertension (35.7 ± 10.1 mm versus 30.8 ± 9 mm; p=0,12) và (24.1 ± 11.6 cm2 versus 19.7 ± 7 cm2; p=0,12). However, right ventricular function in patients with idiopathic pulmonary arterial hypertension were significantly lower than in patients with secondary pulmonary arterial hypertension via %FAC (28.3 ± 8.5 versus 38.8 ± 8.3; p<0,001), TAPSE (14.2 ± 3.1 mm versus 19.4 ± 3.5 mm; p<0,001), S’tricuspid (9.6 ± 2.2 cm/s versus 11.7 ± 1.9;p=0,002).[1]
 Conclusion: Right ventricular function in patients with idiopathic pulmonary arterial hypertension was significantly lower than in patients with secondary arterial pulmonary hypertension.

Association of peak atrial longitudinal strain with right ventricular performance and short-term prognosis in patients with first acute coronary syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Background Myocardial infarction remains a leading cause of mortality worldwide. The abrupt elevation of left ventricular filling pressures can be backwards transmitted to the left atrium and pulmonary vascular bed leading to pulmonary oedema. Peak atrial longitudinal strain (PALS) is a sensitive surrogate marker of left atrial performance. Its association with right ventricular (RV) impairment and its prognostic role in patients with Acute Coronary Syndrome (ACS) has not been comprehensively explored. Purpose This study sought to identify the impact of PALS in RV contractile function and pulmonary artery pressures in patients presenting with first ACS and investigate its association with in-hospital mortality. Methods Three-hundred consecutive patients (N=300, STEMI=194, Non-STEMI=106) with first ACS were prospectively enrolled (mean age 61.2±11.8 years, 26% females). All patients underwent a transthoracic echocardiographic assessment within 24 hours after revascularization. The association between PALS and conventional indices of left ventricular diastolic dysfunction with RV indices was assessed using Pearson correlation coefficient. Study outcome was in-hospital mortality. Univariable and multivariable Cox Regression analysis was performed to identify outcome predictors. To construct a multivariable model, univariately significant variables (P<0.005) were selected from 3 different categories (clinical variables, laboratory indices, echocardiographic indices). Due to the limited number of events, a maximum of 4 variables were introduced in the multivariable model. To further assess the incremental advantage of PALS and Tricuspid Annular Plane Systolic Excursion/Pulmonary Artery Systolic Pressure (TAPSE/PASP) over Global Registry of Acute Coronary Event (GRACE) risk score the change in χ2 was assessed using the likelihood ratio test. Results PALS demonstrated a stronger correlation with RV contractile function and pulmonary artery pressure indices compared to mean E/e’ and E/A ratio (Table). A total of 23 (7.7%) patients died in-hospital after revascularization. In univariable Cox Regression analysis PALS was significantly associated with the outcome (HR=0.880, 95% CI=0.839–0.925, P<0.001). In the multivariable model after adjustment for GRACE risk score, LVEF, and white blood cells PALS retained independent association with the outcome (HR=0.828, 95% CI=0.698–0.983, P=0.031). A stepwise addition of PALS and RV/Pulmonary Artery coupling index (TAPSE/PASP) to GRACE risk score significantly improved the predictive value of the model (Figure). Conclusion PALS measured by transthoracic echocardiography within 24 hours of admission in patients with first ACS was a powerful predictor of in-hospital mortality. Progression of left ventricular damage to the left atrial and RV mechanics significantly worsens the risk of in-hospital mortality.

TAPSE/systolic pulmonary artery pressure in patients with repaired TOF: Does it correlate with cardiac magnetic resonance indices?

Abstract Funding Acknowledgements Type of funding sources: None. Background and Purpose Potential benefits and optimal timing of pulmonary valve replacement (PVR) in patients with repaired tetralogy of Fallot (rTOF) are still questionable because of high morbidity due to the need for reinterventions. Cardiac magnetic resonance (CMR) is a valuable tool for the detection of irreversible right ventricular (RV) remodelling. We sought to evaluate the relation between CMR derived volumes and peak tricuspid annular systolic excursion (TAPSE)/invasively measured systolic pulmonary artery pressure (sPAP) ratio in patients who underwent right heart catheterization. Methods One hundred and forty-eight patients with rTOF were evaluated; 26 of the patients either had right ventricular outflow tract obstruction or had corrective surgery with a pulmonary conduit. Patients with severe pulmonary regurgitation underwent CMR to quantify RV volumes and EF either before PVR or as part of the follow-up protocol including those who had previous PVR and recurrent pulmonary regurgitation. Echocardiographic indices of RV function were measured according to the EACVI 2015 recommendations for chamber quantification. In a subset of patients who underwent right heart catheterization, systolic RV pressure, sPAP were recorded and TAPSE/invasively measured sPAP ratio was calculated. CMR derived volumes and EF were compared with TAPSE/sPAP. Results Forty-six patients with matching studies for echo, CMR and right heart catheterization were analyzed. Mean age of the patients were 28.0 ± 7.3 years. Mean tricuspid systolic annular velocity (S’), TAPSE, and fractional area change were 11.4 ± 2.9 cm/sec, 16.8 ± 2.9 cm, and 31.7 ± 4.2 %, respectively. CMR derived end-diastolic volume index, end-systolic volume index and EF were 154.6 ± 38.5 ml/m2, 97.4 ± 26.5 ml/m2and 40.0 ± 7.6 %, respectively. There was a negative correlation between TAPSE/sPAP and CMR derived end-diastolic volume index (r= −0.44, p = 0.049) and end-systolic volume index (r= −0.50, p = 0.024) but not with RV EF. Conclusion In patient with rTOF and significant pulmonary regurgitation, TAPSE/invasively measured sPAP is more strongly correlated to CMR derived end-systolic volume index as opposed to end-diastolic volume index. Our findings support the use of CMR derived end-systolic volume index preferentially in the decision making for PVR.

The Effect of L-Arginine Oral Supplementation on the Improvement of Cardiovascular Function and Pulmonary Artery Pressure in Patients with Major and Intermedia β-Thalassemia.

Thalassemia is the most common inherited anemia in worldwide. Heart failure is the most common cause of mortality and morbidity in patients with major and intermedia β-thalassemia. This study aimed to evaluate the effect of oral administration of L-arginine on the improvement of systolic Pulmonary Artery Pressure (PAP) and cardiac function in patients with major and intermedia β-thalassemia. This randomized clinical trial was done on 88 patients with β-thalassemia admitted to Ali Asghar Hospital, Tehran, Iran between 2020 and 2021. Echocardiography was performed for all the patients before the intervention. Afterwards, the patients were randomly divided into two groups of placebo and L-arginine. The patients underwent echocardiography after eight weeks and were compared with respect to the results. The mean blood transfusion interval was 20.21 d in the placebo group and 17.14 d in the L-arginine group (P=0.082). The results revealed no significant difference between the two groups regarding the mean levels of Hemoglobin (Hb) and ferritin, frequency of splenectomy. However, the mean PAP significantly decreased from 32.88 to 26.02 in the L-arginine group (P=0.009), but did not change in the placebo group. Nonetheless, no significant change was observed in the mean Ejection Fraction (EF) before and after L-arginine administration. L-arginine administration prevented the increase of PAP and was effective in preventing cardiovascular disorders including increased systolic PAP in patients with major and intermedia B-thalassemia. However, the results have to be confirmed in further studies with larger sample sizes.

Remote haemodynamic monitoring of pulmonary artery pressures in patients with chronic heart failure (MONITOR-HF): a randomised clinical trial

The effect of haemodynamic monitoring of pulmonary artery pressure has predominantly been studied in the USA. There is a clear need for randomised trial data from patients treated with contemporary guideline-directed-medical-therapy with long-term follow-up in a different health-care system. MONITOR-HF was an open-label, randomised trial, done in 25 centres in the Netherlands. Eligible patients had chronic heart failure of New York Heart Association class III and a previous heart failure hospitalisation, irrespective of ejection fraction. Patients were randomly assigned (1:1) to haemodynamic monitoring (CardioMEMS-HF system, Abbott Laboratories, Abbott Park, IL, USA) or standard care. All patients were scheduled to be seen by their clinician at 3 months and 6 months, and every 6 months thereafter, up to 48 months. The primary endpoint was the mean difference in the Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary score at 12 months. All analyses were by intention-to-treat. This trial was prospectively registered under the clinical trial registration number NTR7673 (NL7430) on the International Clinical Trials Registry Platform. Between April 1, 2019, and Jan 14, 2022, we randomly assigned 348 patients to either the CardioMEMS-HF group (n=176 [51%]) or the control group (n=172 [49%]). The median age was 69 years (IQR 61-75) and median ejection fraction was 30% (23-40). The difference in mean change in KCCQ overall summary score at 12 months was 7·13 (95% CI 1·51-12·75; p=0·013) between groups (+7·05 in the CardioMEMS group, p=0·0014, and -0·08 in the standard care group, p=0·97). In the responder analysis, the odds ratio (OR) of an improvement of at least 5 points in KCCQ overall summary score was OR 1·69 (95% CI 1·01-2·83; p=0·046) and the OR of a deterioration of at least 5 points was 0·45 (0·26-0·77; p=0·0035) in the CardioMEMS-HF group compared with in the standard care group. The freedom of device-related or system-related complications and sensor failure were 97·7% and 98·8%, respectively. Haemodynamic monitoring substantially improved quality of life and reduced heart failure hospitalisations in patients with moderate-to-severe heart failure treated according to contemporary guidelines. These findings contribute to the aggregate evidence for this technology and might have implications for guideline recommendations and implementation of remote pulmonary artery pressure monitoring. The Dutch Ministry of Health, Health Care Institute (Zorginstituut), and Abbott Laboratories.

Effect of preoperative pulmonary artery pressure on the prognosis of end-stage heart failure patients after heart transplantation

ObjectiveTo evaluate the effect of preoperative pulmonary artery pressure on perioperative outcome of end-stage heart failure patients undergoing heart transplantation.MethodsRetrospective analysis was undertaken on the clinical data of patients receiving heart transplantation in the Department of Cardiovascular Surgery of our hospital from March 2017 to March 2022. A ROC curve analysis was developed between mean pulmonary artery pressure (mPAP) and postoperative mortality using mPAP as diagnostic criteria. Patients were divided into groups based on this threshold to determine the best mPAP threshold value for predicting postoperative nosocomial mortality, and the differences in preoperative and intraoperative data, postoperative complications, and clinical prognosis of patients in the two groups were compared. Patients were followed up to draw the survival curve of patients in the two groups.ResultsThe study enlisted the participation of 105 patients. ROC curve research revealed that preoperative pulmonary artery pressure was substantially linked with death following heart transplantation, with mPAP = 30.5mmHg being the best threshold. The group with mPAP ≥ 30.5mmHg had a greater incidence of postoperative ECMO support (28.2% vs. 10.6%, P = 0.021) and a higher incidence of in-hospital mortality (15.4% vs. 1.5%, P = 0.019) than the group with mPAP < 30.5mmHg. The postoperative survival rates of 105 patients were 91.3%, 88.7%, 81.6%, and 77.5% at 1, 2, 3, and 4 years, respectively, however, there was no significant difference between the two groups of patients in the postoperative intermediate-far survival rate (P = 0.431).ConclusionsPreoperative pulmonary artery pressure in patients with end-stage heart failure is intimately correlated with perioperative prognosis of heart transplant recipients. The optimal cut-off mPAP value in predicting perioperative prognosis of heart transplant recipients is 30.5mmHg. In the high mPAP group, perioperative ECMO support rate and perioperative mortality rate are high, which do not affect the medium and long-term prognosis of the recipients undergoing heart transplantation.

(951) The Role of Impella 5.5 to Reduce Pulmonary Artery Pressures in Patients with Cardiac Amyloidosis with Small Ventricular Cavity as a Bridge to Heart Transplant

(951) The Role of Impella 5.5 to Reduce Pulmonary Artery Pressures in Patients with Cardiac Amyloidosis with Small Ventricular Cavity as a Bridge to Heart Transplant

Impact of exercise on pulmonary artery pressure in patients with heart failure using an ambulatory pulmonary artery pressure monitor

In this multicenter prospective study, we explored the relationship between pulmonary artery pressure (PAP) at rest and in response to a 6-min walk test (6MWT) in ambulatory patients with heart failure (HF) with an implantable PAP sensor (CardioMEMS, Abbott). Between 5/2019 and 2/2021, HF patients with a CardioMEMS sensor were recruited from seven sites. PAP was recorded in the supine and seated position at rest and in the seated position immediately post-exercise. In our cohort of 66 patients, mean age was 70 ± 12 years, 67% male, left ventricular ejection fraction (LVEF) < 50% in 53%, mean 6MWT distance was 277 ± 95 meters. Resting seated PAPs were 31 ± 15 mmHg (systolic), 13 ± 8 mmHg (diastolic), and 20 ± 11 mmHg (mean). The pressures were lower in the seated rather than the supine position. After 6MWT, the pressures increased to PAP systolic 37 ± 19 mmHg (p < 0.0001), diastolic 15 ± 10 mmHg (p = 0.006), and mean 24 ± 13 mmHg (p < 0.0001). Patients with elevated PAP diastolic at rest (>15 mmHg) demonstrated a greater increase in post-exercise PAP. The measurement of PAP with CardioMEMS is feasible immediately post-exercise. Despite being well-managed, patients had severely limited functional capacity. We observed a significant increase in PAP with ambulation which was greater in patients with higher baseline pressures.

Function of sildenafil on diseases other than urogenital system: An umbrella review.

Background: To investigate the function of sildenafil on diseases other than urogenital system, an umbrella review was conducted. Methods: Meta-analysis and systematic reviews on this topic were comprehensively evaluated in this umbrella review. Quality of evidence was evaluated through AMSTAR and the Grading of Recommendations, Assessment, Development and Evaluation system to generate a reliable and valid conclusion. Results: 77 out of 1164 meta-analysis were enrolled. 33 significant outcomes and 41 non-significant outcomes were extracted from all eligible articles. We found sildenafil did significant help in reducing arterial systolic pressure, mean pulmonary arterial pressure, pulmonary arterial pressure, systolic pulmonary arterial pressure in patients with pulmonary and cardiovascular diseases. Besides, sildenafil also improved exercise capacity or performance in patients with pulmonary and cardiovascular diseases. Other than these patients, this drug contributed great help in pregnant women with fetal growth restriction and preeclampsia by increasing the weight of newborns and lowering uterine and umbilical pulsatility indices. Additionally, it was reported that utilization of sildenafil has brought increased risk of melanoma. Conclusion: We can conclude from our study that sildenafil played an important role in many fields, especially in vascular protection. This finding provides a strong evidence for further expansion of sildenafil utilization in other diseases.

Machine Learning Based on Computed Tomography Pulmonary Angiography in Evaluating Pulmonary Artery Pressure in Patients with Pulmonary Hypertension

Right heart catheterization is the gold standard for evaluating hemodynamic parameters of pulmonary circulation, especially pulmonary artery pressure (PAP) for diagnosis of pulmonary hypertension (PH). However, the invasive and costly nature of RHC limits its widespread application in daily practice. To develop a fully automatic framework for PAP assessment via machine learning based on computed tomography pulmonary angiography (CTPA). A machine learning model was developed to automatically extract morphological features of pulmonary artery and the heart on CTPA cases collected between June 2017 and July 2021 based on a single center experience. Patients with PH received CTPA and RHC examinations within 1 week. The eight substructures of pulmonary artery and heart were automatically segmented through our proposed segmentation framework. Eighty percent of patients were used for the training data set and twenty percent for the independent testing data set. PAP parameters, including mPAP, sPAP, dPAP, and TPR, were defined as ground-truth. A regression model was built to predict PAP parameters and a classification model to separate patients through mPAP and sPAP with cut-off values of 40 mm Hg and 55 mm Hg in PH patients, respectively. The performances of the regression model and the classification model were evaluated by analyzing the intraclass correlation coefficient (ICC) and the area under the receiver operating characteristic curve (AUC). Study participants included 55 patients with PH (men 13; age 47.75 ± 14.87 years). The average dice score for segmentation increased from 87.3% ± 2.9 to 88.2% ± 2.9 through proposed segmentation framework. After features extraction, some of the AI automatic extractions (AAd, RVd, LAd, and RPAd) achieved good consistency with the manual measurements. The differences between them were not statistically significant (t = 1.222, p = 0.227; t = -0.347, p = 0.730; t = 0.484, p = 0.630; t = -0.320, p = 0.750, respectively). The Spearman test was used to find key features which are highly correlated with PAP parameters. Correlations between pulmonary artery pressure and CTPA features show a high correlation between mPAP and LAd, LVd, LAa (r = 0.333, p = 0.012; r = -0.400, p = 0.002; r = -0.208, p = 0.123; r = -0.470, p = 0.000; respectively). The ICC between the output of the regression model and the ground-truth from RHC of mPAP, sPAP, and dPAP were 0.934, 0.903, and 0.981, respectively. The AUC of the receiver operating characteristic curve of the classification model of mPAP and sPAP were 0.911 and 0.833. The proposed machine learning framework on CTPA enables accurate segmentation of pulmonary artery and heart and automatic assessment of the PAP parameters and has the ability to accurately distinguish different PH patients with mPAP and sPAP. Results of this study may provide additional risk stratification indicators in the future with non-invasive CTPA data.

PS-C24-4: QUANTIFICATION OF EXERCISE-INDUCED HEMODYNAMIC CHANGE BY HEART SOUND ANALYSIS IN PATIENT WITH HEART FAILURE

Objective: Since an elevation of pulmonary artery pressure (PAP) often precedes clinical worsening of heart failure, early and non-invasive detection of that sign is useful in heart failure care. The purpose of this study was to assess whether a non-invasive technology called cardiac acoustic biomarkers (CABs) to quantify heart sounds can detect the exercise-induced elevation of PAP in patients with heart failure. Design and Methods: Patients with heart failure scheduled to undergo right heart catheterization (RHC) were prospectively enrolled between February 2020 to September 2021. CABs were concurrently recorded with PAP and pulmonary capillary wedge pressure (PCWP) at rest (baseline) and while applying a handgrip (exercise). Results: Forty-nine patients were included in the analysis dataset and their mean PAP significantly increased at exercise compared to baseline (32.45 ± 11.28 mmHg vs 23.52 ± 8.41 mmHg; p &lt; 0.001). Several CABs correlated significantly with mean PAP by absolute values, among which S2 Width (r = 0.354; p &lt; 0.05 and r = 0.363; p &lt; 0.05) and S3 Strength (r = 0.375; p &lt; 0.05 and r = 0.386; p &lt; 0.05) were consistent throughout baseline and exercise. The response of CABs to PAP elevation caused by exercise was divided into two patterns: increasing and decreasing. The frequency of cardiac index less than 2.2 mL/m2 was significantly higher in the decreasing pattern. Conclusions: CABs related to S2 and S3 can quantify heart sounds which reflect the exercise-induced hemodynamic change in patients with heart failure. It should be noted, however, that their reactions to hemodynamic change can be different depending on the background hemodynamics of individuals.

Ratio of Tricuspid Annular Plane Systolic Excursion to Systolic Pulmonary Artery Pressure in Patients with Heart Failure with Preserved Ejection Fraction

Ratio of Tricuspid Annular Plane Systolic Excursion to Systolic Pulmonary Artery Pressure in Patients with Heart Failure with Preserved Ejection Fraction

Copeptin as a diagnostic PH marker in acute pulmonary embolism

Objective: The present study aimed to investigate the effectiveness of copeptin levels in detecting increased pulmonary artery pressure and right ventricular dysfunction in patients with acute pulmonary embolism.&#x0D; Methods: A total of 116 patients who presented to the emergency department with chest pain or dyspnea and were diagnosed with acute pulmonary embolism and 30 healthy controls were included in the study. Plasma copeptin levels of patients and healthy control group were measured. Right ventricular functions and pulmonary artery pressures were evaluated in echocardiography of patients diagnosed with acute &#x0D; pulmonary embolism.&#x0D; Results: Copeptin levels were significantly higher in patients with right ventricular dysfunction than in those without right ventricular dysfunction [median 1.06(0.03–7.14) vs. 0.59(0.31–2.50), p= 0.01].&#x0D; Conclusion: Copeptin can be used as a new biomarker in the diagnosis of acute pulmonary embolism and in predicting right ventricular dysfunction and increased pulmonary artery pressure in patients with acute pulmonary embolism

Relationship between Cardiac Acoustic Biomarkers and Pulmonary Artery Pressure in Patients with Heart Failure.

Since an elevation of pulmonary artery pressure (PAP) often precedes clinical worsening of heart failure (HF), early and non-invasive detection of this sign is useful in HF care. This study aimed to assess whether cardiac acoustic biomarkers (CABs) are associated with the elevation of PAP in patients with HF. Patients with HF scheduled to undergo right heart catheterization were prospectively enrolled. CABs were concurrently recorded during catheterization at rest (baseline) and while applying a handgrip (exercise). Forty-nine patients were included in the analysis, and their mean PAP significantly increased after exercise compared to baseline. Several CABs correlated significantly with mean PAP by absolute values, among which S2 Width (r = 0.354; p = 0.014 and r = 0.363; p = 0.010) and S3 Strength (r = 0.375; p = 0.009 and r = 0.386; p = 0.007) were consistent throughout baseline and exercise. The response of CABs to exercise-induced PAP elevation was divided into two patterns: increasing and decreasing. The frequency of cardiac index below 2.2 mL/m2 was significantly higher in the decreasing pattern. CABs related to S2 and S3 showed significant correlations with absolute PAP values both at baseline and after exercise in patients with HF, but no significant correlations between their changes from baseline to post-exercise were observed in this study population. Further research is therefore needed to assess whether CABs can sensitively reflect changes in PAP according to HF status and underlying phenotypes.

Efficacy of High Dose Vitamin D on Pulmonary Artery Pressure in Thalassemia Patients Undergoing Blood Transfusion: A Randomized Trial

Background: Pulmonary arterial hypertension (PAH) may result in cardiomyopathy which is a major cause of death in thalassemia patients. Vitamin D is associated with benefits in cardiovascular disorders. Our purpose was to study effects of vitamin D on pulmonary artery pressure in thalassemia major and intermedia patients.&#x0D; Materials and Methods: This randomized trial was performed on 26 patients with thalassemia major (TM) and intermedia (TI) in Amir-Kabir Hospital, Arak, Iran in 2019-2020. Patients were randomized 1:1 to intervention group (vitamin D 50,000 IU/week) and control group (received no supplement) for 20 weeks. Echocardiography was used to measure pulmonary artery pressure and assess cardiovascular function. The levels of 1,25-dihydroxyvitamin D3, ferritin, and cardiac iron content were measured in study groups.&#x0D; Results: After 20 weeks, pulmonary arterial pressure (PAP), tricuspid regurgitant velocity (TRV), and pulmonary regurgitant velocity (PRV) significantly improved in the intervention group compared to the control group (P= 0.010, P= 0.003, and P= 0.001, respectively). Moreover, ejection fraction (EF) had significant increase in the intervention group compared to the control group (P= 0.008), although vitamin D supplementation had no significant impact on cardiac T2* values (P= 0.827), systolic and diastolic blood pressure (P= 0.388 and P= 0.509, respectively) and serum hemoglobin and ferritin levels (P= 0.557 and P= 0.620) as compared to the control group. However, the levels of 25-OHD3 significantly increased in the intervention group compared to the control group (P= 0.036).&#x0D; Conclusion: This study showed that vitamin D 50000 IU/week can improve PAP in patients with thalassemia. Sufficient intake of vitamin D may prevent cardiomyopathies related to PAH.

Reliability of echocardiographic estimation of pulmonary artery pressure in patients with severe tricuspid regurgitation

Abstract Background Transthoracic Echocardiography (TTE) seems to be mistaken for the estimation of systolic Pulmonary Artery Pressure (sPAP) especially in patients with severe Tricuspid Regurgitation (TR). This study aimed to determine the reliability of the assessment of sPAP by TTE in this population. Methods This is a monocentric analysis of 236 consecutive patients with concomitant Right Heart Catheterization (RHC) and TTE performed in the assessment of an heart failure syndrome. Lin's Concordance Coefficient (LCC) and Bland-Altman Analysis (BAA) were used to compare the values of RHC and TTE. Results The correlation between the two procedures was good in the total population (LCC = 0.80; 95% limits of agreement (LOA): 0.74; 0.84), but weaker in the 78 patients (33%) with severe TR (LCC = 0.67; 95% LOA: 0.49; 0.80), with a propensity to an underestimation by TTE. Altered Right Ventricular (RV) – Pulmonary Artery (AP) coupling did not lead to a misestimation, contrary to an elevated Right Atrial Pressure (RAP), which was associated with an underestimation by TTE of about 8 mmHg. The presence of “C-V waves” sign on the RAP curves (Odds-Ratio (OR) = 3.32; 95% Confidence Interval (CI): 1.02; 10.9; p=0.04) and invasive sPAP ≥50 mmHg (OR = 2.63; 95% CI: 1.35; 5.16; p&amp;lt;0.01) were two independent predictors of a misestimation of sPAP by TTE. Conclusion Severe TR led to an underestimation by TTE, especially if the RAP curve shows a “C-V waves” sign, and in the case of high invasive sPAP. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): CHU Rennes Pontchaillou