Systolic Pulmonary Artery Pressure Values Research Articles

Tricuspid repair: short and long-term results of suture annuloplasty techniques and rigid and flexible ring annuloplasty techniques

BackgroundFunctional tricuspid regurgitation may arise from left heart valve diseases or other factors. If not addressed concurrently with primary surgical intervention, it may contribute to increased morbidity and mortality rates during the postoperative period. This study investigates the impact of various repair techniques on crucial factors such as systolic pulmonary artery pressure (SPAP), tricuspid valve regurgitation, and New York Heart Association (NYHA) functional capacity class in the postoperative period.Materials and methodsFrom April 2007 to June 2013, 379 adults underwent open-heart surgery for functional tricuspid regurgitation. Patients were categorized into four groups: Group 1 (156) with De Vega suture annuloplasty, Group 2 (60) with Kay suture annuloplasty, Group 3 (122) with Flexible Duran ring annuloplasty, and Group 4 (41) with Semi-Rigid Carpentier-Edwards ring annuloplasty. Demographic, clinical, operative, and postoperative data were recorded over a mean follow-up of 35.6 ± 19.1 months. Postoperative SPAP values, tricuspid regurgitation grades, and NYHA functional capacity classes were compared among the groups.ResultsNo statistically significant differences were observed among the groups regarding age, gender, preoperative disease diagnoses, history of previous cardiac operations, or echocardiographic characteristics such as preoperative ejection fraction, SPAP, and tricuspid regurgitation. Hospital and intensive care unit length of stay and postoperative complications also showed no significant differences. However, patients in Group 3 exhibited longer Cardio-Pulmonary Bypass duration, cross-clamp duration, and higher positive inotrope requirements. While the mortality rate within the first 30 days was higher in Group 1 compared to the other groups (p: 0.011), overall mortality rates did not significantly differ among the groups. Significant regression in functional tricuspid regurgitation and a notable decrease in SPAP values were observed in patients from Group 3 and Group 4 (p: 0.001). Additionally, patients in Group 3 and Group 4 showed a more significant reduction in NYHA functional capacity classification during the postoperative period (p: 0.001).ConclusionAmong the repair techniques, ring annuloplasty demonstrated superiority in reducing SPAP, regressing tricuspid regurgitation, and improving NYHA functional capacity in functional tricuspid regurgitation repairs.

The impact of sleeping in an elevated upper body position during acclimatization to high altitude on acute mountain sickness and pulmonary artery systolic pressure

Background: The effect of sleeping positions during acclimatization to high altitude on Acute Mountain Sickness (AMS) and High Altitude Pulmonary Edema (HAPE) is unknown. We tested whether sleeping with the upper body raised by 5° reduces prevalence and severity of symptoms of AMS as well as of elevated pulmonary artery systolic pressure (PASP) values as a risk factor of HAPE. Methods: Randomly assigning trekking tourist volunteers n = 44 (25 m, 19 f; mean age 42.9 yr) sleeping at 4280 m or 5170 m to the experimental group (upper body elevated by 5°), or to the control group. After exclusion of other reasons for AMS-like symptoms those assumed to be related to AMS were rated by Lake Louise Score questionnaire in the evening and the following morning of the study. Transthoracic echocardiography was performed on both occasions to estimate PASP. Results: In the study group, symptoms of AMS were significantly reduced in younger subjects (p = 0.021), prevalence of AMS was reduced in women (p = 0.156), and PASP values were significantly reduced in older subjects and men (p = 0.032; p = 0.031 respectively). Conclusion: Results suggest that sleeping with the upper body in elevated position during a high altitude ascent may benefit those suffering from AMS or at risk of HAPE due to elevated PASP values.

Systolic Pulmonary Artery Pressure Thresholds Predictive of Dyspnea on Stress Doppler Echocardiography in Mitral Stenosis.

On Stress Doppler Echocardiography (SDE) in mitral stenosis, the systolic pulmonary artery pressure (SPAP) threshold at peak exercise recommended by the guidelines as an indication for percutaneous mitral commissurotomy (PMC) used to be 60 mmHg. However, because of the paucity of studies, that threshold has been controversial. The Europeans stopped using the value in 2007, followed by the Americans in 2014. Determine SPAP thresholds on SDE at peak exercise and post-exercise predictive of dyspnea as an indication for PMC in mitral stenosis. Three hundred mitral stenosis patients with a mitral valve area (MVA) ≤ 2 cm2 and NYHA I-II-III were included. A treadmill stress test (Bruce protocol) was used in all cases to distinguish dyspneic patients (n = 182) from non dyspneic patients (n = 118). SDE was performed on a stress echocardiography bed, starting at 30 W and increasing by 30 W every 3 min. At peak exercise, the best SPAP threshold obtained was 75 mmHg: specificity (Sp) = 0.98 (0.94-1), positive likelihood ratio (LR+) = 47 (41-50), positive predictive value (PPV) = 0.99 (0.95-1), and positive predictive error (PPE) = 0.01 (0.002-0.05). This compared with, respectively, 0.34, 1, 0.69 and 0.31 at 60 mmHg. Post-exercise, the best SPAP threshold found was 60 mmHg: Sp = .94 (0.88-0.97), LR = 9 (4-10), PPV = 0.94 (0.87-0.97), and PPE = 0.06 (0.03-0.13). Regarding the prediction of dyspnea as an indication for PMC, our study shows that a SPAP value at peak exercise of 60 mmHg lacks predictive power (LR+=1). The optimal threshold observed was 75 mmHg at peak exercise (LR+ = 47 [41-50]) and 60 mmHg post-exercise (LR+ = 9 [4-10]).

Prevalence, sex differences, and implications of pulmonary hypertension in patients with apical hypertrophic cardiomyopathy.

Apical hypertrophic cardiomyopathy (ApHCM) is a subtype of hypertrophic cardiomyopathy (HCM) that affects up to 25% of Asian patients and is not as well understood in non-Asian patients. Although ApHCM has been considered a more "benign" variant, it is associated with increased risk of atrial and ventricular arrhythmias, apical thrombi, stroke, and progressive heart failure. The occurrence of pulmonary hypertension (PH) in ApHCM, due to elevated pressures on the left side of the heart, has been documented. However, the exact prevalence of PH in ApHCM and sex differences remain uncertain. We sought to evaluate the prevalence, risk associations, and sex differences in elevated pulmonary pressures in the largest cohort of patients with ApHCM at a single tertiary center. A total of 542 patients diagnosed with ApHCM were identified using ICD codes and clinical notes searches, confirmed by cross-referencing with cardiac MRI reports extracted through Natural Language Processing and through manual evaluation of patient charts and imaging records. In 414 patients, echocardiogram measurements of pulmonary artery systolic pressure (PASP) were obtained at the time of diagnosis. The mean age was 59.4 ± 16.6 years, with 181 (44%) being females. The mean PASP was 38 ± 12 mmHg in females vs. 33 ± 9 mmHg in males (p < 0.0001). PH as defined by a PASP value of > 36 mmHg was present in 140/414 (34%) patients, with a predominance in females [79/181 (44%)] vs. males [61/233 (26%), p < 0.0001]. Female sex, atrial fibrillation, diagnosis of congestive heart failure, and elevated filling pressures on echocardiogram remained significantly associated with PH (PASP > 36 mmHg) in multivariable modeling. PH, when present, was independently associated with mortality [hazard ratio 1.63, 95% CI (1.05-2.53), p = 0.028] and symptoms [odds ratio 2.28 (1.40, 3.71), p < 0.001]. PH was present in 34% of patients with ApHCM at diagnosis, with female sex predominance. PH in ApHCM was associated with symptoms and increased mortality.

Prognostic impact of postprocedural pulmonary artery systolic pressure on late mortality after transcatheter aortic valve implantation

Abstract Background Pulmonary hypertension is a common finding in patients with aortic stenosis. Although transcatheter aortic valve implantation (TAVI) is frequently associated with a reduction of pulmonary artery systolic pressure (PASP), data regarding the independent impact of postprocedural PASP (post PASP) on long-term clinical outcome are still contradictory. Methods Patients with severe and symptomatic aortic stenosis [effective orifice area (EOA)≤1cm2] referred for TAVI at our institution were consecutively enrolled. Prospectively collected demographic, laboratory and echocardiographic data were retrospectively analysed. Patients were stratified into three groups according to PASP at 30 days: group 1 (≤ 35mmHg), group 2 (36-49mmHg), group 3 (≥50mmHg). Primary clinical endpoint was all-cause mortality at 8 years, as defined by the criteria proposed by the Valve Academic Research Consortium3. Results A total of 166 consecutive patients were enrolled in the study: 76 (45.8%) patients in group 1, 71 (42.8%) in group 2 and 19 (11.4%) in group 3. The primary clinical end point occurred in 76.8% of all patients. The Kaplan–Meier curves for 8 year mortality showed that the high value of post PASP was associated with poor survival. Interestingly, patients in group 3 had the highest rate of all-cause mortality compared to patients in group 1 and 2 ( group 1 : 69%, group 2: 78.5%, group 3: 100%, p=0.016). Performing a multivariable analysis demonstrated that post PASP could independently predict cumulative 8 year mortality [OR 1.151, (95% CI 1.051 – 1.260, p=0.002)]. Using ROC analysis for 8 year survival, PASP had 75% sensitivity, and 64% specificity (p&amp;lt;0.0001, AUC=0.730). Conclusion Patients with increased PASP at 30 days after TAVI are at higher risk of all cause mortality at 8 years. Moreover, post PASP is independent predictor of late mortality and should be performed to determine the best follow up strategy in TAVI patients.

Abstract 12547: Incidence of Pulmonary Hypertension in the Echocardiographic Referral Population

Background: Incident rates (IRs) for pulmonary hypertension (PH) using diagnostic data rather than diagnostic codes (DC) have not been reported. We examined PH IRs, risk factors, and mortality among patients (pts) referred for echocardiography (TTE) in a national healthcare system and a separate tertiary care center. Methods: Pulmonary artery systolic pressure (PASP) estimates were extracted from the Veterans Affairs (1999-2020) and Vanderbilt (1994-2020) systems. PH was defined as PASP &gt;35 mmHg. Individuals free of PH at baseline were followed through incident PH, death, or censored at end of study. Secondary outcome was mortality rate (MR) after incident PH. We used Poisson regression to estimate IRs and cox models for hazard ratios. Results: We identified 245,067 veterans (60 years [IQR 55-64], 94% male, 20% Black) and 117,526 VUMC pts (60 years [IQR 46-70], 46% male, 11% Black) free of PH at baseline. Only 22% of pts with TTE-based PH had a DC for PH. PH IRs and adjusted hazard were substantially higher in pts with HF or COPD and highest in pts with both ( Table 1 ). MR after incident PH was highest in pts with both HF and COPD and lowest in pts without either (Figure 1A ). MRs increased markedly at PASP values &gt;45mmHg ( Figure 1B ). Independent risk factors for incident PH included older age (HR 1.07; 95%CI 1.06-1.09), male sex (HR 1.24; 95%CI 1.17-1.30), black race (HR 1.10; 95%CI 1.07-1.13), and cardiometabolic comorbidities. Conclusions: PH IRs estimated by raw diagnostic data are higher than DC-based IRs and strongly associated with HF and COPD. PASP &gt;45mmHg at the time of incident PH is associated with high mortality.

CT measured pulmonary artery to ascending aorta ratio stratified by echocardiographically obtained systolic pulmonary artery pressure values for noninvasive detection of pulmonary hypertension in patients with severe aortic valve stenosis.

Transthoracic echocardiography (TTE) offers a measurement method for the determination of pulmonary hypertension (PH) in patients with severe aortic valve stenosis (AS) with determination of maximal tricuspid regurgitation velocity (TRVmax) and systolic pulmonary artery pressure (sPAP). Radiological parameters for noninvasive detection of PH, most importantly computed tomography (CT) based PA/AA-ratio = ratio of pulmonary artery diameter (PA) and ascending aorta diameter (AA), are also included in the latest ESC guidelines. The aim of the present study was to define cut-off values for PA/AA-ratio taking also into account cardiovascular biomarkers to determine criteria for noninvasive diagnosis of PH. 194 patients with severe AS undergoing transcatheter aortic valve replacement (TAVR) underwent pre-procedural TTE and CT with measurement of PA/AA-ratio. Additionally, common cardiovascular biomarkers were determined. TAVR patients with an sPAP ≥ 40mmHg or a TRVmax ≥ 2.9m/s had a PA/AA-ratio ≥ 0.80 in an AUROC analysis. The cut-off value of ≥ 0.80 resulted in a significantly higher mortality rate (log-rank test: p = 0.034) in these patients in a Kaplan-Meier analysis regarding 1-year survival after TAVR. Significant differences in biomarker expression between patients with a PA/AA-ratio ≥ 0.80 or < 0.80 occurred for BNP (p = 0.001), cTnI (p = 0.032), GDF-15 (p = 0.002) and H-FABP (p = 0.015). PA/AA-ratio ≥ 0.80 is a promising radiological parameter that can provide information about mortality in patients with severe AS undergoing TAVR; combined with biomarkers it may contribute to noninvasive detection of PH in patients with severe AS.

Study of left ventricular systolic dysfunction, left ventricular diastolic dysfunction and pulmonary hypertension in CKD 3b-5ND patients—A single centre cross-sectional study

IntroductionCardiovascular diseases are associated with increased morbidity and mortality among CKD (chronic kidney disease) population. Recent studies have found increasing prevalence of PH (pulmonary hypertension) in CKD population. Present study was done to determine prevalence and predictors of LV (left ventricular) systolic dysfunction, LVDD (left ventricular diastolic dysfunction) and PH in CKD 3b-5ND (non-dialysis) patients. MethodsA cross sectional observational study was done from Jan/2020 to April/2021. CKD 3b-5ND patients aged ≥15 yrs were included. Transthoracic 2D (2 dimensional) echocardiography was done in all patients. PH was defined as if PASP (pulmonary artery systolic pressure) value above 35mm Hg, LV systolic dysfunction was defined as LVEF (left ventricular ejection fraction)≤50% and LVDD as E/e′ ratio >14 respectively. Multivariate logistic regression model was done to determine the predictors. ResultsA total of 378 patients were included in the study with 103 in stage 3b, 175 in stage 4 and 100 patients in stage 5ND. Prevalence of PH was 12.2%, LV systolic dysfunction was 15.6% and LVDD was 43.65%. Predictors of PH were duration of CKD, haemoglobin, serum 25-OH vitamin D, serum iPTH (intact parathyroid hormone) and serum albumin. Predictors of LVDD were duration of CKD and presence of arterial hypertension. Predictors of LV systolic dysfunction were eGFR (estimated glomerular filtration rate), duration of CKD, serum albumin and urine protein. ConclusionIn our study of 378 CKD 3b-5ND patients prevalence of PH was 12.2%, LV systolic dysfunction was 15.6% and LVDD was 43.65%.

Different right ventricular maladaptation in heart failure patients with reduced or preserved ejection fraction: diagnostic and prognostic implication

Abstract Background The prognostic impact of right ventricle (RV) dysfunction and pulmonary hypertension (PH) in patients affected by chronic heart failure (HF) has been well described by several studies in both patients affected by HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF). It has been been demonstrated that tricuspidal anular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) ratio, may provide additional prognostic information. However, the pathophysiological mechanisms leading to RV dysfunction may differ in HFpEF and HFrEF. Aims In this study we would like to evaluate: 1. Different RV adaptation in hospitalized HF patients with reduced or preserved EF 2. prognostic significance of an early echocardiographic assessment of RV structure comparing TAPSE/PASP vs s'/PASP in HFrEF and HFpEF. Methods We included 381 patients included in the study, 209 had HFrEF and 172 had HFpEF who were studied by echocardiography. S' wave and RV longitudinal function strain (RVLS) were obtained by apical four chamber view and optimal visualization of RV lateral free wall. RV diameter was measured at basal level below tricuspidal anular plane. Patients were followed for 6 months after discharge for the composite outcome of cardiovascular death and re-hospitalization. Results Patients with HFrEF demonstrated a larger RV end diastolic diameter (EDD) compared to HFpEF (43 [37–45] vs 39 [36–44] mm; p=0.009) and more reduced TAPSE (19 [16–21] vs 20 [17–22] mm; p=0.04). Whereas PASP values were similar in both groups. Conversely, s' wave and RVLS were much more reduced in HFpEF (9 [7–11] vs 12 [9–13] cm/sec; p=0.008; 16 [14–21] vs 20 [15–23]% p&amp;gt;0.05) than in HFrEF. TAPSE/PASP was significantly reduced in HFrEF (0.38 [0.29–0.42] vs 0.43 [0.35–0.48]; p=0.02). Conversely s'/PAPS was lower in HFpEF group (0.29 [0.24–0.33] vs 0.25 [0.21–0.31]; p=0.01). At univariate analysis several parameters were related to outcome: TAPSE≤14 mm, (HR 1.70 [1.14–2.52]; p=0.009), PASP≥40 mmHg (HR 1.51 [1.05–2.17]; p=0.02), RVEDD &amp;gt;38 mm (HR; 1.88 [1.36–2.61]; p&amp;lt;0.001), s wave&amp;lt;9 (HR1.88 [1.30–2.41] p&amp;lt;0.001),inferior cave vein diameter&amp;gt;21 mm (HR 1.90 [1.31–2.75]; p=0.001. Multivariable analysis confirmed prognostic role of TAPSE, RVEDD, IVC and s' wave. Therefore TAPSE /PAPS was associated with adverse event in HFrEF but not in HFpEF (HR 1,75 [1.41–2.92] in HFrEF, p=0.003; HR 1.02 [0.67–1.32] in HFpEF, p=0.55). Whereas, s/PAPS was associated with more increased risk in HFpEF (HR 1.88 [1.65–3.46] in HFpEF, p&amp;lt;0.001; HR 1.34 [1,08–4.32] in HFrEF, p=0.03). Conclusions Right ventricular dysfunction and maladaptation are associated with poor outcome in either HFrEF and HFpEF. Tissue excursion and longitudinal strain are much more impaired in HFpEF, whereas RV dilatation and reduced longitudinal function are closely related to HFrEF. Funding Acknowledgement Type of funding sources: None.

Pulmonary Vasodilator Response of Combined Inhaled Epoprostenol and Inhaled Milrinone in Cardiac Surgical Patients.

Pulmonary hypertension (PH) and right ventricular (RV) dysfunction are major complications in cardiac surgery. Intraoperative management of patients at high risk of RV failure should aim to reduce RV afterload and optimize RV filling pressures, while avoiding systemic hypotension, to facilitate weaning from cardiopulmonary bypass (CPB). Inhaled epoprostenol and inhaled milrinone (iE&iM) administered in combination before CPB may represent an effective strategy to facilitate separation from CPB and reduce requirements for intravenous inotropes during cardiac surgery. Our primary objective was to report the rate of positive pulmonary vasodilator response to iE&iM and, second, how it relates to perioperative outcomes in cardiac surgery. This is a retrospective cohort study of consecutive patients with PH or RV dysfunction undergoing on-pump cardiac surgery at the Montreal Heart Institute from July 2013 to December 2018 (n = 128). iE&iM treatment was administered using an ultrasonic mesh nebulizer before the initiation of CPB. Demographic and baseline clinical data, as well as hemodynamic, intraoperative, and echocardiographic data, were collected using electronic records. An increase of 20% in the mean arterial pressure (MAP) to mean pulmonary artery pressure (MPAP) ratio was used to indicate a positive response to iE&iM. In this cohort, 77.3% of patients were responders to iE&iM treatment. Baseline systolic pulmonary artery pressure (SPAP) (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.24-2.16 per 5 mm Hg; P = .0006) was found to be a predictor of pulmonary vasodilator response, while a European System for Cardiac Operative Risk Evaluation (EuroSCORE II) score >6.5% was a predictor of nonresponse to treatment (≤6.5% vs >6.5% [reference]: OR, 5.19; 95% CI, 1.84-14.66; P = .002). Severity of PH was associated with a positive response to treatment, where a higher proportion of responders had MPAP values >30 mm Hg (42.4% responders vs 24.1% nonresponders; P = .0237) and SPAP values >55 mm Hg (17.2% vs 3.4%; P = .0037). Easier separation from CPB was also associated with response to iE&iM treatment (69.7% vs 58.6%; P = .0181). A higher proportion of nonresponders had a very difficult separation from CPB and required intravenous inotropic drug support compared to responders, for whom easy separation from CPB was more frequent. Use of intravenous inotropes after CPB was lower in responders to treatment (8.1% vs 27.6%; P = .0052). A positive pulmonary vasodilator response to treatment with a combination of iE&iM before initiation of CPB was observed in 77% of patients. Higher baseline SPAP was an independent predictor of pulmonary vasodilator response, while EuroSCORE II >6.5% was a predictor of nonresponse to treatment.

Pulmonary artery systolic pressure at 1-month predicts 1-year survival after transcatheter aortic valve implantation.

Pulmonary hypertension related to left ventricle heart disease is a common finding in patients with severe aortic stenosis treated with transcatheter aortic valve implantation (TAVI) and is associated with a higher mortality rate. The study aimed to analyze the influence of pulmonary artery systolic pressure (PASP) changes after TAVI on long-term survival. TAVI was performed in 362 patients between January 2013 and December 2018. The study group comprised 210 patients who underwent a detailed 1-month follow-up. At 1-month, 142 had a stable or decreased PASP value (Group 1), while in 68 patients an increase was observed (Group 2). During 1-year follow-up, 20 patients died (9.5%), 9 in Group 1 and 11 in Group 2 (P = 0.02). The receiver operating characteristic (ROC) curve analysis (area under the curve [AUC], 0.750) revealed a significant value of 1-month measurement for 1-year mortality prediction. The cutoff for the PASP value predictive of mortality was ≤41 mm Hg. A Kaplan-Meier analysis showed significantly higher mortality in patients without a 1-month PASP decrease. In the multivariable analysis, PASP measured at 1-month after TAVI (hazard ratio, 1.040; 95% confidence interval, 1.019-1.062; P < 0.001) was an independent predictor of 1-year mortality. Each 1 mm Hg increase in PASP predicts a 4% increase in the risk of death. Decreased or stable value of PASP at 1-month follow-up may predict better 1-year survival after TAVI, while each 1 mm Hg increase in PASP confers a 4% greater risk of 1-year mortality.

Study of left ventricular systolic dysfunction, left ventricular diastolic dysfunction and pulmonary hypertension in CKD 3b-5ND patients—A single centre cross-sectional study

IntroductionCardiovascular diseases are associated with increased morbidity and mortality among CKD (chronic kidney disease) population. Recent studies have found increasing prevalence of PH (pulmonary hypertension) in CKD population. Present study was done to determine prevalence and predictors of LV (left ventricular) systolic dysfunction, LVDD (left ventricular diastolic dysfunction) and PH in CKD 3b-5ND (non-dialysis) patients. MethodsA cross sectional observational study was done from Jan/2020 to April/2021. CKD 3b-5ND patients aged ≥15 yrs were included. Transthoracic 2D (2 dimensional) echocardiography was done in all patients. PH was defined as if PASP (pulmonary artery systolic pressure) value above 35mm Hg, LV systolic dysfunction was defined as LVEF (left ventricular ejection fraction)≤50% and LVDD as E/e′ ratio >14 respectively. Multivariate logistic regression model was done to determine the predictors. ResultsA total of 378 patients were included in the study with 103 in stage 3b, 175 in stage 4 and 100 patients in stage 5ND. Prevalence of PH was 12.2%, LV systolic dysfunction was 15.6% and LVDD was 43.65%. Predictors of PH were duration of CKD, haemoglobin, serum 25-OH vitamin D, serum iPTH (intact parathyroid hormone) and serum albumin. Predictors of LVDD were duration of CKD and presence of arterial hypertension. Predictors of LV systolic dysfunction were eGFR (estimated glomerular filtration rate), duration of CKD, serum albumin and urine protein. ConclusionIn our study of 378 CKD 3b-5ND patients prevalence of PH was 12.2%, LV systolic dysfunction was 15.6% and LVDD was 43.65%.

Prediction of pulmonary hypertension using central-to-peripheral pulmonary vascular volume ratio on three-dimensional cardiothoracic CT in patients with congenital heart disease.

To evaluate whether the central-to-peripheral pulmonary vascular volume ratio measured using three-dimensional cardiothoracic CT can serve as a potential predictor of pulmonary hypertension (PH) in patients with congenital heart disease. Cardiothoracic CT was used to quantify right and left total, central, and peripheral pulmonary vascular volumes segmented based on a three-dimensional threshold-based approach in 60 patients with congenital heart disease (group with PH, n = 30; group without PH, n = 30). The CT-based central-to-peripheral pulmonary vascular volume ratios were correlated with the echocardiography-based maximum velocity of tricuspid regurgitation (TR Vmax) and systolic pulmonary arterial pressure (PAP) values. The diagnostic ability of the central-to-peripheral pulmonary vascular volume ratio to predict PH was analyzed. The central-to-peripheral pulmonary vascular volume ratios were significantly higher in the group with PH compared to the group without PH (1.6 ± 0.9 vs. 0.8 ± 0.3 for the right side, p < 0.001; 2.4 ± 2.2 vs. 1.0 ± 1.4 for the left side, p < 0.004). The right central-to-peripheral pulmonary volume ratios were significantly positively correlated with the TR Vmax and estimated systolic PAP values (R = 0.627 and 0.633, respectively; p < 0.001) in patients with and without PH, while the ratios were moderately correlated with the TR Vmax and estimated systolic PAP values (R = 0.431 and 0.435, respectively; p < 0.020) in the group with PH. The right and left central-to-peripheral pulmonary vascular volume ratios demonstrated a good diagnostic ability for predicting the presence of PH (area under the receiver-operating characteristic curve = 0.867, p < 0.001 and 0.859, p < 0.001 for the right and left, respectively). The CT-based central-to-peripheral pulmonary vascular volume ratio can be used to predict PH in patients with congenital heart disease.

Preoperative evaluation of pulmonary hypertension in lung transplant candidates: echocardiography versus right heart catheterization

BackgroundRight heart catheterization (RHC) and echocardiography are both routinely used for pulmonary artery systolic pressure (PASP) assessment in lung transplantation (LT) candidates, although this is not mandated by current guidelines. We aimed to explore the performance of echocardiographic PASP as an indicator of pulmonary hypertension in LT candidates, in order to assess the necessity of RHC.MethodsFrom a retrospective registry of 393 LT candidates undergoing RHC and echocardiography during 2015–2019, patients were assessed for the presence of pulmonary hypertension (PH), defined as mean pulmonary artery pressure (mPAP) above 20 mmHg, according to two methods—echocardiography and RHC. The primary outcome was the correlation between the PASP estimated by echocardiography to that measured by RHC. Secondary outcomes were the prediction value of the echocardiographic evaluation and its accuracy.ResultsThe mean value of PASP estimated by echocardiography was 49.5 ± 20.0 mmHg, compared to 42.5 ± 18.0 mmHg measured by RHC. The correlation between the two measurements was moderate (Pearson’s correlation: r = 0.609, p < 0.01). Echocardiography PASP measurements were moderately discriminative to diagnose PH, with an area under the curve (AUC) of 0.72 (95% CI 0.66–0.77). Echocardiographic overestimation of PASP of more than 10 mmHg was found in 35.0% of the patients, and underestimation was found in 11.6% of the patients.ConclusionIn the pre-surgical evaluation of LT candidates, echocardiographic estimation of PASP had moderate correlation and limited accuracy compared to the PASP measured by RHC. We thus recommend performing routine RHC to all LT candidates, regardless of the echocardiographic estimation of PASP.

Arterial partial pressure of oxygen and procalcitonin levels correlate with pulmonary artery systolic pressure in patients with active pulmonary tuberculosis

ObjectWe aimed to study whether arterial blood gas parameters, inflammatory markers, and coagulation indicators correlate with pulmonary artery systolic pressure (PASP) values in patients with active pulmonary tuberculosis (PTB). MethodsA total of 121 patients with PTB who had a measurement of PASP by Doppler echocardiography in the active phase of tuberculosis were included in this study. We carried out univariate and multivariate linear regression analyses to determine factors correlated with PASP values. We excluded patients with other diseases or conditions that might lead to increased PASP. ResultsUnivariate linear regression analysis revealed positive correlations of age, white blood cell count, neutrophils ratio, Log procalcitonin, erythrocyte sedimentation rate, Log C-reactive protein, fibrinogen, Log D-dimer with PASP and showed an inverse correlation of arterial partial pressure of oxygen (PaO2) and arterial oxygen saturation (SaO2) with PASP. Multiple linear regression analysis demonstrated that PaO2 and Log procalcitonin remained correlated with PASP values. ConclusionPaO2 and procalcitonin were strongly correlated with PASP values in patients with active PTB. The degree of hypoxia and severity of secondary respiratory bacterial infection may influence PASP value in active PTB.

Does pulmonary hypertension affect early-term outcomes of off-pump coronary artery bypass surgery?

This study aimed to investigate the effect of preoperative pulmonary hypertension (PHT) on postoperative early mortality and morbidity in patients undergoing off-pump coronary artery bypass grafting (CABG). A total of 1107 patients undergoing elective first-time off-pump CABG between January 2011 and April 2022 were included in this retrospective observational cohort study. The patients were categorized into two groups according to their preoperative systolic pulmonary artery pressure (SPAP) values. The PHT group (n=104) consisted of patients with a SPAP value >30 mmHg, while the non-PHT group (n=1003) consisted of patients with a SPAP value ≤30 mmHg. Patients' preoperative demographics and clinical features, operative data, and postoperative outcomes were recorded and then compared between the groups. In the PHT group, the median age was significantly higher (66 vs. 63 years, p=0.001) and the median left ventricular ejection fraction level was significantly lower (45 vs. 50%, p=0.045) as compared to the non-PHT group. Additionally, the PHT group included a significantly greater percentage of patients with chronic obstructive pulmonary disease (22.1 vs. 7.4%, p=0.019). As perioperative early-term outcomes, complications, and mortality were considered, the groups were statistically similar, and there were no significant differences between the groups, except for the development of atrial fibrillation. For the first time in the literature, this study revealed that mild PHT (mean SPAP=38.9±8.7 mmHg) did not significantly affect early-term outcomes of off-pump CABG.

The prognostic value of exercise-induced pulmonary hypertension in asymptomatic patients with primary mitral regurgitation

BackgroundWe examined whether the early development of exercise-induced pulmonary hypertension (EIPH) and right ventricular dysfunction during exercise stress echocardiography (ESE) may predict clinical deterioration in so-called “asymptomatic” patients with primary, at least moderate mitral regurgitation (MR). Methods79 consecutive patients underwent a symptom-limited, graded ESE protocol on semi-supine bicycle at the beginning of the study. During the test, we assessed symptom development, test duration, and the following echocardiographic parameters: MR severity, maximum velocity of the tricuspid regurgitation jet (TR Vmax), pulmonary artery systolic pressure (PASP), and tricuspid annulus systolic excursion (TAPSE). All patients were then followed-up for at least 12 months for clinical end-points (heart failure-related symptoms requiring pharmaceutical therapy, heart failure hospitalization, and/or mitral valve surgery in case of refractory symptoms). ResultsAfter 16 ± 4 months of follow-up, 75 patients completed the study; 26 of them achieved any clinical end-point and were classified as ‘high-risk’, while the rest (49 patients) were assigned to the ‘low-risk’ group. High-risk group showed significantly higher exercise-induced TR Vmax and PASP levels at maximum workload of ESE than low-risk counterparts (p<0.001). Based on receiver operating characteristic analysis, the early (within the first two stages of ESE or up to 50 W) steep rise of calculated PASP ≥51 mmHg (TR Vmax ≥3.4 m/s) had a 92.3% sensitivity and 100% specificity to predict clinical deterioration within the following year. That cut-off value seemed superior predictor than peak value of PASP at the end of ESE. TAPSE levels during ESE did not add prognostic value in our sample. ConclusionThis is the first study demonstrating that the early development of EIPH has prognostic value in asymptomatic patients with primary at least moderate MR and may become a new valid determinant of mitral valve surgery. Additional larger prospective studies are needed to validate our findings.

The Effect of The Thrombolytic Treatment on Inflammatory Markers in Male Patients with Pulmonary Thromboembolism

Objective: Neutrophil to lymphocyte (NLR) and platelet to lymphocyte (PLR) ratios play an important role in monitoring the progression of the disease and determining the course of the disease in patients with acute pulmonary thromboembolism (APTE). This study aims to determine whether there is any change in NLR, PLR, and C-reactive protein (CRP) in patients with APTE receiving thrombolytic therapy. Materials and Methods: Sixty-five male patients with shortness of breath, chest pain, and palpitations, who were diagnosed with APTE by examinations and thorax computed tomography angiography, and who were hospitalized and given thrombolytic therapy were included in the study. The files of these patients were scanned retrospectively, and NLR and PLR and CRP values were recorded 1-2 days before and 1-4 days after thrombolytic therapy. Then, it was checked whether there was a difference between pre-treatment and post-treatment values. Results: NLR, PLR, CRP and systolic pulmonary artery pressure values decreased statistically significantly in patients with APTE by thrombolytic therapy. Conclusion: NLR, PLR, CRP and sPAP values were found to be statistically significantly decreased with thrombolytic treatment.

The Effect of Oral Sildenafil on the Decrease in the Degree of Pulmonary Artery Systolic Pressure in PPHN Infants at Siti Khodijah Muhammadiyah Hospital Sepanjang

Background: Persistent Pulmonary Hypertension of the Newborn (PPHN) is a condition of the failure to decrease pulmonary artery pressure, so that blood pressure in the lungs remains high, as in a fetus. PPHN cases are 2-6 of 1000 live births and responsible for 10% of confirmed deaths in the neonatal intensive care unit (NICU). Sildenafil is vasodilator that can be used to reduce pulmonary artery systolic pressure (PASP), morbidity, and mortality in PPHN infants.Objective: To analyze the effect of sildenafil on decrease the severity of pulmonary artery systolic pressure in PPHN infants.Method: This is an analytic observational study with cross-sectional design. The samples were collected using consecutive sampling on 30 PPHN infant patients in 2018. The data were collected from medical records of PPHN infant patients, then assessing the severity value of PASP which obtained from echocardiography result. The severity of PASP is classified into normal (PASP≤35 mmHg), mild (PASP36-45 mmHg), moderate (PASP 45-60 mmHg), and severe (PASP&gt;60 mmHg)Results: This study showed that 27 PPHN infant patients have decreased PASP level to normal, previously from mild 7 infants (23.3%), moderate 16 infants (53.3%), and severe 4 infants (13%), after being given oral sildenafil. There were 1 (3.3%) infant patient remained severes, 1 (3.3%) patient was decreased from severe to moderate, and 1 patient (3.3%) was decreased from severe to mild. The p value &lt;0.05 was obtained, so oral sildenafil significantly decreased the PASP severity in PPHN infants patients.Conclusion: There is a beneficial effect of oral sildenafil on decreasing the severity of pulmonary artery systolic pressure in PPHN infants at the NICU of Siti Khodijah Muhammadiyah Hospital Sepanjang.

The systolic pulmonary artery pressure and the E/e’ ratio decrease after septoplasty in patients with grade 2 and 3 pure nasal septal deviation

IntroductionNasal septal deviation may contribute to a wide range of symptoms including nasal obstruction, headache, increased secretion, crusting, mucosal damage, and loss of taste and smell. Excessive increase in the respiratory resistance, as seen in nasal septal deviation, results in reduced lung ventilation, thereby potentially leading to hypoxia, hypercapnia, pulmonary vasoconstriction. The deformities in the nasal cavity can be associated with major respiratory and circulatory system diseases. ObjectiveTo investigate cardiovascular effects of septoplasty by comparing pre- and postoperative transthoracic echocardiography findings in nasal septal deviation patients undergoing septoplasty. MethodsThe prospective study included 35 patients with moderate and severe nasal septal deviation (mean age, 23.91±7.01) who underwent septoplasty. The Turkish version of the nasal obstruction symptom evaluation, NOSE questionnaire, was administered to each participant both pre- and postoperatively in order to assess their views on the severity of nasal septal deviation, the effect of nasal obstruction, and the effectiveness of surgical outcomes. A comprehensive transthoracic echocardiography examination was performed both preoperatively and at three months postoperatively for each patient and the findings were compared among patients. ResultsMean preoperative NOSE score was 17.34±1.62 and the mean postoperative score was 2.62±1.68 (p=0.00). Mean preoperative systolic pulmonary artery pressure value was 22.34±4.31mmHg and postoperative value was 18.90±3.77mmHg (p=0.00). Mean E/e’ ratio was 5.33±1.00 preoperatively and was 5.01±0.90 postoperatively (p=0.01). The NOSE scores, systolic pulmonary artery pressure values, and the E/e’ ratios decreased significantly after septoplasty (p<0.05 for all), whereas no significant difference was found in other transthoracic echocardiography parameters (p>0.05). ConclusionThe decrease in NOSE scores following septoplasty indicated that the satisfaction levels of the patients were increased. Upper airway obstruction secondary to nasal septal deviation may be a cardiovascular risk factor and may affect transthoracic echocardiography measurements. Moreover, the significant decrease in the systolic pulmonary artery pressure value and E/e’s ratio following septoplasty indicated that negative echocardiographic findings may be prevented by this surgery.