World Symposium Research Articles

Abstract 13977: Identification of Intermediate Right Ventricular Phenotypes Using Consensus Clustering in Patients With Pulmonary Hypertension

Introduction: Current right ventricular (RV) function phenotypes in pulmonary hypertension (PH) rely on few hemodynamic parameters to quantify RV dysfunction disease severity. The aim of the study was to identify novel RV phenotypes using RV hemodynamics and unsupervised machine learning in patients with PH. Methods: Participants were identified from the UArizona PH Registry (n=190). Correlation analyses identified 9 RV variables to include in clustering analysis. Consensus clustering was used to identify an unsupervised clustering method with a large inter-cluster, and small intra-cluster distance (Fig 1A). Significance was tested with Dunn and chi-square tests. Results: K-Medoids with a Pearson distance matrix over >1000 resampling iterations identified 5 clusters (consensus range: 0.8-0.9). World Symposium PH groups were distributed across clusters (Fig 1B). Clusters 1, 2 and 5 exhibit mild RV dysfunction with low diastolic stiffness (Eed) and afterload (Ea, Fig 1C). However, RV-PA coupling (Ees/Ea) was decreased in clusters 1 and 5. Clusters 3 and 4 have moderate to severe RV dysfunction with increased Eed and Ea but cluster 4 had decreased Ees/Ea. For pulmonary hemodynamics, clusters 3 and 4 have increased mean PA pressure (mPAP), increased pulmonary vascular resistance (PVR) and decreased PA compliance (Ca) compared to clusters 1 and 2. Cluster 5 has increased mPAP and high cardiac output resulting in moderately elevated PVR and decreased Ca. Conclusions: Unsupervised clustering identified 5 unique RV phenotypes ranging from mild to severe dysfunction. Further investigations are needed to identify factors modulating intermediate phenotypes to provide insight into RV dysfunction and disease progression.

Supra-systemic pulmonary hypertension after complicated percutaneous mitral balloon valvuloplasty: a case report and review of literature

BackgroundThe World Symposium of Pulmonary Hypertension in 2018, updated the definition of pulmonary hypertension (PH) as mean pulmonary artery pressures (PAP) > 20 mmHg. Pulmonary venous hypertension secondary to left-heart disease, constitutes the most common cause of PH, and the determination of a co-existent pre-capillary (primary) PH becomes paramount, particularly at the moment of evaluating and managing patients with heart failure. Pulmonary artery pressures above the systemic pressures define supra-systemic PH and generally leads to frank right ventricular failure and high mortality.Case presentationWe present the perioperative management of a patient with rheumatic mitral valve disease, initially found to have severe PH due to pulmonary venous hypertension, who underwent percutaneous mitral balloon valvuloplasty complicated with mitral chordae rupture, severe mitral regurgitation and supra-systemic PH. Multiple medical therapies and an intra-aortic balloon pump were used as means of non-surgical management of this complication.ConclusionsThis case report illustrates the perioperative implications of combined pre- and post-capillary PH and supra-systemic PH, as this has not been widely discussed in previous literature. A thorough literature review of the clinical characteristics of PH, methods to determine co-existent pre- and post-capillary PH components, as well as concomitant right ventricular failure is presented. Severe PH has known detrimental effects on the hemodynamic status of patients, which can ultimately lead to a decrease in effective cardiac output and poor tissue perfusion.

Biomarkers of Pulmonary Hypertension Are Altered in Children with Down Syndrome and Pulmonary Hypertension

To evaluate the performance of pulmonary hypertension (PH) biomarkers in children with Down syndrome, an independent risk factor for PH, in whom biomarker performance may differ compared with other populations. Serum endostatin, interleukin (IL)-1 receptor 1 (ST2), galectin-3, N-terminal pro hormone B-natriuretic peptide (NT-proBNP), IL-6, and hepatoma-derived growth factor (HDGF) were measured in subjects with Down syndrome and PH (n=29), subjects with Down syndrome and resolved PH (n=13), subjects with Down syndrome without PH (n=49), and subjects without Down syndrome with World Symposium on Pulmonary Hypertension group I pulmonary arterial hypertension (no Down syndrome PH group; n=173). Each biomarker was assessed to discriminate PH in Down syndrome. A classification tree was created to distinguish PH from resolved PH and no PH in children with Down syndrome. Endostatin, galectin-3, HDGF, and ST2 were elevated in subjects with Down syndrome regardless of PH status. Not all markers differed between subjects with Down syndrome and PH and subjects with Down syndrome and resolved PH. NT-proBNP and IL-6 levels were similar in the Down syndrome with PH group and the no Down syndrome PH group. A classification tree identified NT-proBNP and galectin-3 as the best markers for sequentially distinguishing PH, resolved PH, and no PH in subjects with Down syndrome. Proteomic markers are used to improve the diagnosis and prognosis of PH but, as demonstrated here, can be altered in genetically unique populations such as individuals with Down syndrome. This further suggests that clinical biomarkers should be evaluated in unique groups with the development of population-specific nomograms.

Complications of balloon pulmonary angioplasty for chronic thromboembolic pulmonary disease according to the classification proposed by the 6th world symposium on pulmonary hypertension

Abstract Introduction Balloon pulmonary angioplasty (BPA) is a complex procedure and not risk free. In an attempt to standardize reports of BPA complications in the several centers, a classification of complications was proposed by the task force on chronic thromboembolic hypertension (CTEPH) in the 6th World Symposium on Pulmonary Hypertension (WSPH). Purpose To determine the prevalence of BPA complications according to the classification of 6th WSPH and to identify its predictors. Methods Detailed procedural and technical aspects were collected for consecutive patients (pts) with inoperable, residual/recurrent chronic thromboembolic disease, undergoing BPA at a single institution from December/2017 to December/2020. Per procedure logistic regression analysis was used to evaluate the predictive variables for complications. Results A total of 76 BPA sessions in 15 pts were performed (mean age 63.2±14.0 years; 60.0% women; 86.7% CTEPH). Mean pulmonary artery pressure and pulmonary vascular resistance before the first BPA session were 33.1±13.3 mmHg and 4.8±3.2 woods unit, respectively (73.3% of pts under vasodilator therapy). Femoral access was used for all pts. Mean vessels treated per procedure were 4.3±1.9 (324 vessels in total). Webs, subtotal occlusions, ring-like stenosis and total occlusions were noted in 215 (66.4%), 58 (17.9%), 31 (9.6%) and 20 (6.2%) treated vessels, respectively. We performed 21 pressure-wire-guided sessions (27.6%). Intravascular imaging was used in 6 procedures (7.9%). Average time of fluoroscopy was 60.3±14.0 minutes and volume of contrast 273.0±73.0 mL per session. Procedure-related adverse events occurred in 25.0% of the interventions (27.6% in the first two years vs 16.7% in the last two). Pulmonary artery vascular injuries were noted in 6 BPA vessels (7.9% per procedure and 1.9% per treated vessel): haemoptysis in all, but perforation was only detected angiographically in 3 of them (balloon inflation was performed for 2 distal perforations, and 1 perforation sealed without any intervention). Vascular dissection in distal lesions occurred in 4 cases (5.3%) with no need of transcatheter or surgical procedures. We had 3 lung injuries, all grade 2. None of the pts required oral intubation or mechanical ventilation. Extra-pulmonary complications were illustrated in table. Importantly, there was no peri-procedural death. The occurrence of vascular or lung injuries was 0% in pressure-wire-guided BPA versus 14.5% in non-guided (p=0.098). Multivariate analysis revealed that age (OR 1.05; CI 1.01–1.10; p=0.030) was the only independent predictor of complications. Conclusions In our experience, BPA can be safely performed in inoperable, residual or recurrent CTEPH or CTED pts, with 25% minor procedural-related complications but no major adverse event. Age was the strongest factor related to the occurrence of complications. Funding Acknowledgement Type of funding sources: None.

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

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

World Symposium on Mechanical-Materials Engineering & Science - WMMES 2021

PrefaceThis volume of “IOP Conference Series: Material Science and Engineering” contains the papers presented in the “World Symposium on Mechanical-Materials Engineering & Science” in Prague (Czech Republic) during 9-11 September 2021. The aim of the WMMES 2021 to provide a forum for discussion of the latest findings and technologies in different fields of Mechanical Engineering, Materials Engineering and other related disciplines, to give opportunities for future collaborations, to be a platform for sharing knowledge and experiences in the fields of Mechanical Engineering, Materials Engineering and other related disciplines, and to lead in providing a forum for early career researchers for presentation of their work and discussion of their ideas with experts in different fields of Mechanical Engineering and Materials Engineering.However, the planned period of the 1st WMMES was 2020, it was postponed to 9-11 September 2021 because of the Covid-19 pandemic, and held in Prague (Czech Republic) by appearing in person of the participants, not on-line format.All the missions of World Symposium on Mechanical-Materials Engineering & Science – WMMES 2021 were completed, and 35 peer reviewed articles were published. We would like to thank all reviewers for their great effort to achieve the high quality of published articles.We would like to show our deep gratitude to the honored Scientific Committee given to be list below and Institutional Scientific Partners of WMMES. The Scientific Committee and Institutional Scientific Partners of WMMES was completed by paying strict attention, and all members were selected from well-known, very much appreciated, productive and representatives of the different countries.List of Committee Members are available in this pdf.

Impact of the revised hemodynamic definition on the diagnosis of precapillary pulmonary hypertension: a retrospective single-center study in China.

In the 6th World Symposium on Pulmonary Hypertension (PH), the hemodynamic definition of PH was reduced from a mean pulmonary artery pressure (mPAP) ≥25 to >20 mmHg. This study aimed to evaluate the impact of the revised hemodynamic definition on the diagnosis of precapillary PH. We retrospectively enrolled patients who underwent right heart catheterization from January 2012 to December 2018. All included patients were reassessed according to the revised hemodynamic definition. A total of 1,251 patients were included for analysis, of whom 1,044 patients had precapillary PH and 182 patients had mPAP <25 mmHg. After applying the revised definition, 33 (18.1%) of 182 patients with mPAP <25 mmHg were reclassified as having PH. However, only 7 of these 33 patients had a pulmonary vascular resistance ≥3 wood units and could be considered to have precapillary PH, accounting for 0.7% of the existing precapillary PH population. More importantly, 12 patients with mPAP ≥25 mmHg were delisted from precapillary PH for pulmonary vascular resistance <3 wood units (5 patients from Group III, 4 patients from Group IV, 3 patients from Group V). Overall, there was a net 0.5% decrease [(12-7)/1044×100%] in the population with precapillary PH. The revised hemodynamic definition had a minor impact on the diagnosis of precapillary PH. It should be noted that the revised definition would influence not only patients with mPAP =21-24 mmHg, but also patients with mPAP ≥25 mmHg.

OUTCOMES OF PATIENTS ACROSS THE SPECTRUM OF PULMONARY HYPERTENSION GROUPS PRESCRIBED INHALED TREPROSTINIL

TOPIC: Pulmonary Vascular Disease TYPE: Original Investigations PURPOSE: Pulmonary hypertension (PH) frequently complicates cardiopulmonary conditions and associates with worse outcomes. Treatment of PH disproportionate to concomitant heart and lung disease remains controversial, although inhaled treprostinil (iTRE) was recently approved for use in group 3 PH due to interstitial lung disease. We evaluated the impact of iTRE treatment on rates of disease progression in patients who fell into a spectrum of World Symposium PH groups. METHODS: We performed a retrospective cohort study in patients with PH who were treated with iTRE at Duke University between 2009 and 2017. All patients had PH (mean pulmonary artery pressure (mPAP) ≥ 25mmHg) due to groups 1, 4 or 5, and a subset had mixed disease with group 1 PH and components of groups 2 or 3 (a pulmonary vascular resistance [PVR] > 3 WU and pulmonary capillary wedge pressure > 15mmHg or with significant lung disease, respectively). We compared time to disease worsening, a composite measure of death, lung transplant or transition to IV prostacyclin, among patients who discontinued iTRE within 3 months versus patients remaining on iTRE > 3 months. We used multivariable cox proportional hazards models to adjust for age, sex and REVEAL Lite 2 Score. We also compared time to disease worsening among different PH groups, and evaluated if PH group mediated the relationship between iTRE duration and disease worsening. RESULTS: Our cohort included 270 patients with PH classified as follows: 30.6% group 1, 10% mixed group 1 and 2, 32.2% mixed group 1 and 3, 11.1% mixed group 1,2 and 3, and 15.9% with either group 4 or 5. The cohort had a median mPAP of 50.0 mmHg (44.0, 57.0) and median PVR of 9.1 mm Hg/l∙min (7.1, 11.6). Clinical and demographic characteristics were similar among the 203 (75.2%) subjects who continued iTRE for at least 3 months compared to the 67 (24.8%) who discontinued iTRE prior to 3 months. In a multivariable model, patients who discontinued iTRE prior to 3 months had a higher risk of disease worsening compared to patients who tolerated iTRE for > 3 months (HR 1.82 [95% CI 1.47, 2.16], p < 0.009). Patients with mixed groups 1,2, and 3 PH had the highest risk of disease worsening (p=0.02) in a univariable model, but in a multivariable model time to disease worsening did not significantly differ by PH group (p = 0.26). PH group also did not mediate the relationship between iTRE duration and disease worsening (p = 0.156). CONCLUSIONS: Irrespective of disease severity, discontinuation of iTRE before 3 months was associated with a higher risk of disease worsening. PH group was not associated with risk of disease worsening among PH patients started on iTRE. CLINICAL IMPLICATIONS: Treatment with iTRE in patients with PH groups 1&2 or 1&3 resulted in similar outcomes as in patients with group 1 disease. Prospective, randomized studies are necessary to confirm this finding. DISCLOSURES: No relevant relationships by Susana Almeida-Peters, source=Web Response No relevant relationships by Talal Dahhan, source=Web Response, value=PI site related funding Removed 04/29/2021 by Talal Dahhan, source=Web Response Research Support relationship with United Therapeutics Please note: 2019-current Added 05/06/2021 by Terry Fortin, source=Web Response, value=Grant/Research Support Research Support relationship with Johnson and Johnson Please note: 2019-current Added 05/06/2021 by Terry Fortin, source=Web Response, value=Grant/Research Support Research Support relationship with Acceleron Please note: 8/2020-current Added 05/06/2021 by Terry Fortin, source=Web Response, value=research support No relevant relationships by Cindy Green, source=Web Response No relevant relationships by Karla Kennedy, source=Web Response No relevant relationships by Amber Meservey, source=Web Response No relevant relationships by Kishan Parikh, source=Web Response No relevant relationships by Alice Parish, source=Web Response Consultant relationship with United Therapeutics Please note: 2014-present Added 04/28/2021 by Sudarshan Rajagopal, source=Web Response, value=Consulting fee Investigator-initiated study relationship with United Therapeutics Please note: 2019-present Added 04/28/2021 by Sudarshan Rajagopal, source=Web Response, value=Grant/Research Support Consultant relationship with Janssen / Actelion Please note: 2014-present Added 04/28/2021 by Sudarshan Rajagopal, source=Web Response, value=Consulting fee Investigator-initiated study relationship with Janssen/Actelion Please note: 2019-present Added 04/28/2021 by Sudarshan Rajagopal, source=Web Response, value=Grant/Research Support Consultant relationship with Altavant Please note: 2019-present Added 04/28/2021 by Sudarshan Rajagopal, source=Web Response, value=Consulting fee Consultant relationship with Liquidia Please note: 2020-present Added 04/28/2021 by Sudarshan Rajagopal, source=Web Response, value=Consulting fee Consultant relationship with Insmed Please note: 2020-present Added 04/28/2021 by Sudarshan Rajagopal, source=Web Response, value=Consulting fee Consultant relationship with Bayer Please note: 2018-2019 Added 04/28/2021 by Sudarshan Rajagopal, source=Web Response, value=Consulting fee Scientific Medical Advisor relationship with Apie Therapeutics Please note: 2020-present Added 04/28/2021 by Sudarshan Rajagopal, source=Web Response, value=Consulting fee No relevant relationships by Aparna Swaminathan, source=Web Response No relevant relationships by Jordan Whitson, source=Web Response No relevant relationships by Yen-Rei Yu, source=Web Response

MILD PULMONARY HYPERTENSION IN ADVANCED HEART FAILURE PATIENTS IS ASSOCIATED WITH BOTH ABNORMAL RESISTIVE AND PULSATILE LOAD AND LOWER 3-YEAR SURVIVAL

<h3>BACKGROUND</h3> Current guidelines require patients with heart failure (HF) being evaluated for advanced therapies such as heart transplantation or left ventricular assist device (LVAD) implantation to undergo right heart catheterization to identify the presence of pulmonary hypertension (PH). PH that is irreversible is a relative contraindication to heart transplantation and associated with poor prognosis. Based on the International Society for Heart and Lung Transplantation guidelines, reversibility is assessed with a vasodilator challenge if pulmonary artery systolic pressure (PASP) is > 50 mmHg, and either transpulmonary gradient (TPG) is > 15 mmHg or pulmonary vascular resistance (PVR) is > 3 WU. However, the most updated 6th World Symposium on Pulmonary Hypertension defined PH more broadly as to mean pulmonary artery pressure (mPAP) > 20 mmHg. As such, there is an intermediate group of patients with mild PH not meeting the threshold to receive a vasodilator challenge to determine whether mild PH is reversible. Our aim was to assess the hemodynamic characteristics of this group and determine whether they are at risk of worse clinical outcomes. <h3>METHODS AND RESULTS</h3> A retrospective analysis was performed of 175 patients with heart failure who were referred to our centre for right heart catheterization as part of evaluation for candidacy for advanced heart failure therapies. Patients were divided into three groups based on initial hemodynamics: patients with mPAP < 20 mmHg (No-PH, n=57), patients with significant PH meeting current guideline criteria for a vasodilator challenge (PH+V, n=41) and patients with mPAP > 20 mmHg that did not meet the threshold for vasodilator challenge (PH-V, n=77). Compared to the No-PH group, the PH-V group did not have a significantly different stroke volume index or cardiac index, however, they had a significantly higher PVR, indicating greater resistive load, and lower pulmonary artery compliance (PAC), indicating higher pulsatile load (Table). The PH-V group also had significantly higher mean right atrial pressure (mRAP) compared to the No-PH group, suggesting right ventricular decompensation. Composite pre-and post-intervention three-year survival after catheterization appeared lower in both PH+V and PH-V patients compared to the No-PH group (Figure). <h3>CONCLUSION</h3> HF patients assessed for advanced therapies identified as having mild PH have increased pulmonary pulsatile and resistive load, along with elevated right-sided filling pressures, and have increased mortality. Currently, this group does not undergo vasodilator testing to determine PH reversibility. Whether mild PH is modifiable, and its relationship to outcomes after heart transplantation or LVAD implant requires further study.

Preface

The World Symposium on Smart Materials and Applications (WSSMA 2021) was taken place in Bangkok, Thailand during July 16-18, 2021.This conference brought together leaders from industry and academia to exchange and share their experiences, present research results, explore collaborations and to spark new ideas, with the aim of developing new projects and exploiting new technology in the field of applied materials and advanced materials processing technologies.The committee of WSSMA 2021 expresses their sincere thanks to all authors for their high-quality research papers and careful presentations. All reviewers are also thanked for their careful comments and advices. Thanks, are finally given to Trans Tech Publication as well for producing this volume.List of Conference Photograph, Sponsors and Lists of Committees are available in this pdf.

The definition of pulmonary hypertension: history, practical implications and current controversies.

The definition of pulmonary hypertension (PH) is based on a growing body of evidence and represents the result of ongoing discussions within the PH community over the past 50 years. In 2018, the most recent World Symposium on Pulmonary Hypertension introduced significant changes in the definition of PH by lowering the mean pulmonary arterial pressure threshold to >20 mmHg and (re)introducing the pulmonary vascular resistance ≥3 WU cut-off for all forms of pre-capillary PH. These changes and their potential clinical impact have been the subject of lively discussions in the community and some important questions and controversies have been identified.In this review we aim to present the development of the definition of PH over the past decades and discuss the main arguments that led to relevant modifications. In addition, we address the practical implications of the most recent changes and controversies that still exist.Educational aimsTo review the historical development of the definition of pulmonary hypertension.To discuss practical implications and current controversies of the currently recommended definitions of pulmonary hypertension and pulmonary arterial hypertension.

Pulmonary hypertension phenotypes in patients with systemic sclerosis.

Pulmonary hypertension (PH) commonly affects patients with systemic sclerosis (SSc) and is associated with significant morbidity and increased mortality. PH is a heterogenous condition and several different forms can be associated with SSc, including pulmonary arterial hypertension (PAH) resulting from a pulmonary arterial vasculopathy, PH due to left heart disease and PH due to interstitial lung disease. The incidence of pulmonary veno-occlusive disease is also increased. Accurate and early diagnosis to allow optimal treatment is, therefore, essential. Recent changes to diagnostic haemodynamic criteria at the 6th World Symposium on Pulmonary Hypertension have resulted in therapeutic uncertainty regarding patients with borderline pulmonary haemodynamics. Furthermore, the optimal pulmonary vascular resistance threshold for diagnosing PAH and the role of exercise in identifying early disease require further elucidation. In this article we review the epidemiology, diagnosis, outcomes and treatment of the spectrum of pulmonary vascular phenotypes associated with SSc.

Characteristics of patients meeting the new definition of pre-capillary pulmonary hypertension (Nice 2018) in a single Japanese pulmonary hypertension center

BackgroundThe 6th World Symposium on Pulmonary Hypertension (Nice 2018) proposed a new definition of pre-capillary pulmonary hypertension (PH) as a condition with mean pulmonary artery pressure (mPAP) > 20 mmHg, pulmonary artery wedge pressure ≤ 15 mmHg, and pulmonary vascular resistance (PVR) ≥ 3 Wood units (WU). The characteristics and prognosis of patients with pre-capillary PH, according to this new definition, is unclear. Therefore, we determined the characteristics and survival of patients with borderline pre-capillary PH.MethodsWe retrospectively enrolled 683 patients who underwent their first right heart catheterization at Chiba University, Japan. Among them, 489 patients met the pre-capillary PH requirement with mPAP ≥ 25 mmHg (conventional pre-capillary PH group), while 22 patients met the borderline pre-capillary PH criteria (borderline pre-capillary PH group). Additionally, 16 patients with a mean PAP of 20–25 and PVR of 2–3 WU were also examined.ResultsThe borderline pre-capillary PH group comprised 4.3% of the total patients with pre-capillary PH, and the majority was in Group 3 (40.9%) or 4 (45.5%). The survival of the borderline pre-capillary PH group tended to be better than that of the conventional pre-capillary PH group. The prognosis of Group3 PH was the worst among the patients with borderline precapillary PH. There was no significant difference in survival between the borderline pre-capillary PH group with PVR ≥ 3 WU and that with PVR of 2–3 2WU, although none of the patients in the latter group died due to right heart failure.ConclusionsThis is the first study conducted in a PH center in an Asian country to reveal the characteristics of patients with pre-capillary PH, according to the Nice 2018 definition. They comprised 4.3% of the total population with pre-capillary PH, and the majority of the pre-capillary PH cases were in either Group3 or 4. The prognosis may be affected by the patients’ underlying diseases. Further prospective studies are needed to determine whether the new definition, including the PVR cut-off, is beneficial in clinical practice.

Update from the World Symposium on Pulmonary Hypertension 2018: does the new hemodynamic definition of pediatric pulmonary hypertension have an impact on treatment strategies?

Pediatric pulmonary arterial hypertension (PAH) is a progressive life-threatening disease of the pulmonary vasculature and is defined as an elevation of the mean pulmonary arterial pressure. Before the 6th World Symposium on Pulmonary Hypertension (WSPH) in 2018, pulmonary hypertension (PH) used to be defined as a mean pulmonary artery pressure (mPAP) of ≥25 mmHg. On the WSPH a revised hemodynamic definition of PH was introduced lowering the threshold for a normal mPAP from <25 to <21 mmHg. The Pediatric Task Force chose to follow this newly proposed definition of PH in order to speak a uniform language and facilitate transition to adult services. In this opinion paper we discuss the rationale behind the new PH definition and the impact on pediatric PH. We conclude, that to date, there is no evidence in children, suggesting that this decrease of threshold for PH warrants any further measures than clinical outpatient-follow-up. Hitherto, the new definition does not impact on currently applicable treatment strategies in children with PH.

Pulmonary Hypertension in 2021: Part I—Definition, Classification, Pathophysiology, and Presentation

The World Symposium on Pulmonary Hypertension (WSPH) was organized by the World Health Organization in 1973 in response to an increase in pulmonary arterial hypertension in Europe caused by aminorex, an appetite suppressant. The mandate of this meeting was to review the latest clinical and scientific research and to formulate recommendations to improve the diagnosis and management of pulmonary hypertension (PH).1 Since 1998, the WSPH has met every five years and in 2018, the sixth annual WSPH revised the hemodynamic definition of PH. This two-part series will review the updated definition, classification, pathophysiology, presentation, diagnosis, management, and perioperative management of patients with PH. In the first part of this series, the definition, classification, pathophysiology, and presentation will be reviewed.

6G - a generation too far? [News - analysis

Now that 5G has arrived with an advertising onslaught from operators like EE, what else could there be for the telecom industry to work on but 6G? Due out around the end of this decade, 6G would keep wireless communications on much the same timescale set since 3G first appeared. But questions are now being asked as to whether these generational shifts are working out the way the industry intended. One of the early aims for 5G was to bring cellular wireless to industrial applications that could not use its predecessors. Although 4G made some attempts to cut the round-trip latency for delivering packets over the air, 5G was designed to cut that to a millisecond or so. In principle, this makes it possible to coordinate robots without having to cable them up, assuming you do not try to have the control systems for those robots running in a data centre overseas. In practice, the wireless operators are, as with 3G and 4G, pushing new phones to consumers and, by all accounts, are not doing that badly at it. Both 3G and 4G suffered from false starts and so took a while to get out of the gate. 5G was somewhat luckier and may have had a boost from the pandemic and the shift to remote working, and living. At the recent 6G World Symposium, Andreas Müller, general chair of the 5G Alliance for Connected Industries and Automation and head of corporate-sector communication and network technology at Bosch&apos;s corporate research centre, said there is still some work to do on the standard to get it ready for factories. “The problem for industrials is that a lot for them only comes with Releases 16 and 17,” he said. The 3GPP group&apos;s Release 16 or 5G Phase 2 was finalised last summer, two years after the initial Release 15; Release 17 is due to become a finalised standard next year.

Evaluation, Diagnosis, and Classification of Pulmonary Hypertension.

Pulmonary hypertension (PH) is a rare heterogenous disease characterized by elevated blood pressure in the lungs. Patients with PH require careful evaluation and management at an expert center. Understanding of the mechanisms underlying the development of PH has increased over the past two decades, and several treatment options for pulmonary arterial hypertension have emerged. Despite this progress, PH continues to carry high morbidity and mortality. The 6th World Symposium on Pulmonary Hypertension that occurred in late 2018 modified the clinical classification of PH into five groups. In this review, we focus on the evaluation and diagnosis of PH and discuss the updated clinical classification.

How does severe functional mitral regurgitation redefined by European guidelines affect pulmonary vascular resistance and hemodynamics in heart transplant candidates?

Increased pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) are important prognostic factors in patients with heart transplantation (HT). It is well known that severe mitral regurgitation increases pulmonary pressures. However, the European Society of Cardiology and the 6th World Symposium of pulmonary hypertension (PH) task force redefined severe functional mitral regurgitation (FMR) and PH, respectively. We aimed to investigate the effect of severe FMR on PAP and PVR based on these major redefinitions in patients with HT. A total of 212 patients with HT were divided into 2 groups: those with severe FMR (n=70) and without severe FMR (n=142). Severe FMR was defined as effective orifice regurgitation area ≥20 mm2 and regurgitation volume ≥30 mL where the mitral valve was morphologically normal. A mean PAP of >20 mm Hg was accepted as PH. Patients with left ventricular ejection fraction ≤25% were included in the study. The systolic PAP, mean PAP, and PVR were higher in patients with severe FMR than in those without severe FMR [58.5 (48.0-70.2) versus 45.0 (36.0-64.0), p<0.001; 38.0 (30.2-46.6) versus 31.0 (23.0-39.5), p=0.004; 4.0 (2.3-6.8) versus 2.6 (1.2-4.3), p=0.001, respectively]. Univariate analysis revealed that the severe FMR is a risk factor for PVR ≥3 and 5 WU [odds ratio (OR): 2.0, 95% confidence interval (CI): 1.1-3.6, p=0.009; and OR: 3.2, 95% CI: 1.5-6.7, p=0.002]. The multivariate regression analysis results revealed that presence of severe FMR is an independent risk factor for PVR ≥3 WU and presence of combined pre-post-capillary PH (OR: 2.23, 95% CI: 1.30-3.82, p=0.003 and OR: 2.30, 95% CI: 1.25-4.26, p=0.008). Even in the updated definition of FMR with a lower threshold, severe FMR is associated with higher PVR, systolic PAP, and mean PAP and appears to have an unfavorable effect on pulmonary hemodynamics in patients with HT.

Executive Summary Thai Pulmonary Hypertension Guidelines 2020

In 2011, the Heart Association of Thailand (HAT) approved the first Thai guideline for the diagnosis and management of patients with pulmonary hypertension (PH). Since then, significant changes have occurred in the diagnosis and management of patients with PH, such as risk assessment and new strategies for combination therapies based on the 2015 European Society of Cardiology (ESC)/European Respiratory Society (ERS) pulmonary hypertension guidelines. The most recently updated definition of PH was from the Sixth World Symposium on Pulmonary Hypertension in 2018. Hence, HAT has revised the Thai guidelines for the diagnosis and management of patients with PH, which was approved by the Royal College of Physicians of Thailand in 2019. These guidelines are intended for use by 1) general practitioners for preliminary diagnoses and referral to a PH referral center and 2) specialist physicians such as cardiologists and pulmonologists, to collaborate in the caring process and diagnosis and management, including the use of Pulmonary artery hypertension (PAH)-specific drugs. The guidelines were written in Thai language to be easily understood and approved by HAT and the Royal College of Physicians of Thailand in 2019. The current executive summary is aimed to highlight important details of the 2020 Thai Pulmonary Hypertension Guidelines for a broader distribution. This updated version of the executive summary of the guidelines is aimed to achieve three objectives, 1) early diagnosis by using the algorithm, including pathophysiology into one of five PH groups, 2) risk assessment for PAH patients into low, intermediate, or high risk, and 3) sequential combination therapy as indicated by the risk assessment for PAH-specific drugs to maintain PAH patients within the low-risk group as much as possible to improve their long-term survival. Keywords: Guideline, Pulmonary hypertension, Diagnosis, Management

Impact of the new definition of pulmonary hypertension according to world symposium of pulmonary hypertension 2018 on diagnosis of post-capillary pulmonary hypertension

Background:The World Symposium on Pulmonary Hypertension (WSPH) in 2018 recommended new definitions of pulmonary hypertension (PH). We investigated the impact of the updated definition on prevalence of PH due to left heart disease (PH-LHD).Methods:The data of right heart catheterizations in patients with suspected PH-LHD between January 2008 and July 2015 was retrospectively analyzed applying different definitions. The number of patients diagnosed by the updated WSPH hemodynamic criteria of a mean pulmonary artery pressure (mPAP) > 20 mmHg was compared to the number of patients using mPAP ≥ 25 mmHg. The differentiation between patients with isolated post-capillary (Ipc) and combined post-capillary and pre-capillary (Cpc) PH was analyzed comparing the ESC/ERS guidelines, the recommendation of Cologne Consensus Conference (CCC) and WSPH.Results:Of the 726 patients with a suspected PH, 58 patients met the diagnostic criteria of the ESC/ERS guidelines for PH-LHD with 32.8% Ipc-cases, 34.4% Cpc-PH-cases and 32.8% unclassifiable cases. Overall, 58 patients were diagnosed by the CCC criteria, with 34.5% classified as Cpc-PH and 65.5% as Icp-PH. Using the criteria of WSPH, the number of PH-LHD rose by one patient. According to the new definition, 64.4% of the patients were classified as Cpc-PH and had a significantly higher right to left atrial area (RA/LA) ratio than Ipc-PH patients.Conclusion:Applying the new recommendation, the number of diagnosed patients with PH-LHD increases marginally. There is, however, a relevant shift in the number of Cpc-PH cases. An elevated RA/LA ratio might help to identify patients for invasive diagnostic work-up.