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[PMID]:29332912
[Au] Autor:Higo K; Kubota K; Miyanaga S; Miyata M; Nakajo M; Jinguji M; Ohishi M
[Ad] Endereço:Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University.
[Ti] Título:Impairment of Iodine-123-Metaiodobenzylguanidine ( I-MIBG) Uptake in Patients with Pulmonary Artery Hypertension.
[So] Source:Int Heart J;59(1):112-119, 2018 Jan 27.
[Is] ISSN:1349-3299
[Cp] País de publicação:Japan
[La] Idioma:eng
[Ab] Resumo:According to recent studies, lung uptake of iodine-123-metaiodobenzylguanidine ( I-MIBG) is impaired in many lung diseases and low lung uptake of I-MIBG suggests endothelial dysfunction of the pulmonary artery. I-MIBG scintigraphy in patients with pulmonary hypertension (PH) has not yet been clinically evaluated. We hypothesized that the lung uptake of I-MIBG is reduced in patients with PH and differs among PH subtypes. The purpose of the present study was to analyze the lung uptake of I-MIBG in patients with PH and compare it with the data obtained by echocardiography or right heart catheterization. I-MIBG scintigraphy was performed in 286 consecutive patients from 2003 to 2014. We enrolled 21 patients with PH and 8 control patients. The 21 patients with PH were categorized into those with pulmonary artery hypertension (PAH, n = 12) and those with chronic thromboembolic pulmonary hypertension (CTEPH, n = 9). The mean pulmonary artery pressure was not significantly different between patients with CTEPH and PAH (37.7 ± 6.8 versus 32.3 ± 5.3 mmHg respectively; P = 0.054). There were no significant differences in any other hemodynamic parameters between the two groups. The lung uptake of I-MIBG in PAH patients (early image: 1.54 ± 0.18, delayed image: 1.41 ± 0.16) was significantly lower than that of CTEPH patients (early image: 2.17 ± 0.25, P < 0.0001; delayed image: 1.99 ± 0.20, P = 0.0001, adjusted for age and World Health Organization classification) and controls (early image: 2.32 ± 0.27, P = 0.0007; delayed image: 1.92 ± 0.19, P = 0.0007). In conclusion, we found for the first time that the lung uptake of I-MIBG in patients with PAH is lower than that in patients with CTEPH and controls.
[Mh] Termos MeSH primário: 3-Iodobenzilguanidina/farmacocinética
Hipertensão Pulmonar/diagnóstico
Pulmão/metabolismo
Artéria Pulmonar/diagnóstico por imagem
Pressão Propulsora Pulmonar/fisiologia
Cintilografia/métodos
[Mh] Termos MeSH secundário: 3-Iodobenzilguanidina/administração & dosagem
Adulto
Idoso
Cateterismo Cardíaco
Ecocardiografia
Endotélio Vascular/fisiopatologia
Teste de Esforço
Feminino
Seres Humanos
Hipertensão Pulmonar/metabolismo
Hipertensão Pulmonar/fisiopatologia
Pulmão/diagnóstico por imagem
Masculino
Meia-Idade
Artéria Pulmonar/fisiopatologia
Compostos Radiofarmacêuticos/administração & dosagem
Compostos Radiofarmacêuticos/farmacocinética
Estudos Retrospectivos
Volume Sistólico/fisiologia
Tomografia Computadorizada por Raios X
Função Ventricular Esquerda/fisiologia
Função Ventricular Direita/fisiologia
Adulto Jovem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Radiopharmaceuticals); 35MRW7B4AD (3-Iodobenzylguanidine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180206
[Lr] Data última revisão:
180206
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180116
[St] Status:MEDLINE
[do] DOI:10.1536/ihj.16-629


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[PMID]:29279530
[Au] Autor:Miura M; Ikeda S; Yoshida T; Yamagata Y; Nakata T; Koga S; Koide Y; Kawano H; Maemura K
[Ad] Endereço:Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences.
[Ti] Título:Deeper S Wave in Lead V5 and Broader Extent of T Wave Inversions in the Precordial Leads are Clinically Useful Electrocardiographic Parameters for Predicting Pulmonary Hypertension.
[So] Source:Int Heart J;59(1):136-142, 2018 Jan 27.
[Is] ISSN:1349-3299
[Cp] País de publicação:Japan
[La] Idioma:eng
[Ab] Resumo:Electrocardiography (ECG) is used to screen for pulmonary hypertension (PH). However, it is unclear which parameters of ECG are the most useful for screening.ECG parameters related to right ventricular hypertrophy criteria were examined in 145 ECGs of subjects who were suspected to have PH and underwent right heart catheterization (RHC) (age 58.4 ± 17.5 years, 112 women, mean pulmonary arterial pressure [MPAP] 35.4 ± 13.3 mmHg). Based on the results of RHC, 108 subjects had PH (56 pulmonary arterial hypertension [PAH] and 52 chronic thromboembolic pulmonary hypertension [CTEPH]).Fourteen of 17 ECG parameters in the present study were significantly associated with PH on univariate analysis. On multivariable logistic regression analysis, S wave depth in lead V5 (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.10-1.47) and depth of T wave inversion in lead V4 (OR 1.21, 95% CI 1.03-1.46) were independent predictors of MPAP ≥ 25 mmHg, and the cut-off values determined by receiver operating characteristic curve analyses were 0.42 mV and -0.28 mV, respectively.In conclusion, a deeper S wave in lead V5 and the presence of a wider extent of negative T waves in the precordial leads may be clinically simple and useful ECG parameters for screening for PH.
[Mh] Termos MeSH primário: Eletrocardiografia/métodos
Hipertensão Pulmonar/diagnóstico
Pressão Propulsora Pulmonar/fisiologia
[Mh] Termos MeSH secundário: Doença Crônica
Feminino
Seguimentos
Seres Humanos
Hipertensão Pulmonar/etiologia
Hipertensão Pulmonar/fisiopatologia
Masculino
Meia-Idade
Valor Preditivo dos Testes
Embolia Pulmonar/complicações
Embolia Pulmonar/diagnóstico
Embolia Pulmonar/fisiopatologia
Curva ROC
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180206
[Lr] Data última revisão:
180206
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171228
[St] Status:MEDLINE
[do] DOI:10.1536/ihj.16-647


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[PMID]:28991555
[Au] Autor:Chaddha U; Puscas I; Prosper A; Ganesh S; Yaghmour B
[Ad] Endereço:Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA. Electronic address: udit.chaddha@med.usc.edu.
[Ti] Título:A 63-Year-Old Woman With Neurofibromatosis Type 1 and Pulmonary Hypertension With Worsening Hypoxemia.
[So] Source:Chest;152(4):e89-e93, 2017 Oct.
[Is] ISSN:1931-3543
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:CASE PRESENTATION: A 63-year-old woman with a history of neurofibromatosis type-1 (NF-1) and pulmonary arterial hypertension (PAH) thought to be secondary to the NF-1 presented with a few weeks of worsening dyspnea on exertion. She took no medications other than sildenafil for her pulmonary hypertension (PH). She denied tobacco, alcohol, and illicit or anorectic drug use. She had previously worked as a waitress. Her mother and her brother had NF-1 but no PH or lung disease.
[Mh] Termos MeSH primário: Hemangioma Capilar/diagnóstico
Hipertensão Pulmonar/complicações
Hipóxia/etiologia
Neoplasias Pulmonares/diagnóstico
Neurofibromatose 1/complicações
[Mh] Termos MeSH secundário: Biópsia
Diagnóstico Diferencial
Ecocardiografia
Feminino
Hemangioma Capilar/complicações
Hemangioma Capilar/terapia
Seres Humanos
Hipertensão Pulmonar/diagnóstico
Hipertensão Pulmonar/terapia
Hipóxia/diagnóstico
Hipóxia/terapia
Neoplasias Pulmonares/complicações
Neoplasias Pulmonares/terapia
Imagem Cinética por Ressonância Magnética
Meia-Idade
Oxigenoterapia
Pressão Propulsora Pulmonar/fisiologia
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171012
[Lr] Data última revisão:
171012
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171010
[St] Status:MEDLINE


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[PMID]:28966315
[Au] Autor:Cheng XL; Liu ZH; Gu Q; Ni XH; Luo Q; Zhao ZH; He JG; Xiong CM
[Ad] Endereço:State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College.
[Ti] Título:Prognostic Value of Pulmonary Artery Compliance in Patients with Pulmonary Arterial Hypertension Associated with Adult Congenital Heart Disease.
[So] Source:Int Heart J;58(5):731-738, 2017 Oct 21.
[Is] ISSN:1349-3299
[Cp] País de publicação:Japan
[La] Idioma:eng
[Ab] Resumo:In congenital heart disease (CHD), the presence of pulmonary arterial hypertension (PAH) is associated with a poor prognosis. In this study, we aim to investigate the role of pulmonary artery compliance (Cp) in predicting the mortality of PAH associated with adult congenital heart disease (APAH-CHD). One-hundred and seventy-five patients of APAH-CHD who underwent a comprehensive clinical evaluation were included in this study. All patients were followed up in a 6-month interval and the primary end point was all cause of death. The duration of mean follow-up was 67±26 months, of which there were twenty-three death. Cp had an inverse correlation with pulmonary artery resistance (PVR), regardless of the clinical phenotype (Eisenmenger syndrome, PAH with small defect and PAH after defect correction). Patients in the lowest Cp group (Cp ≤ 0.84 mL/mmHg) had advanced WHO function class, worse exercise tolerance, liver function, and status of oxygen saturation. In univariate cox regression analysis, Cp (HR = 1.359, P < 0.001), PVR (HR = 0.972, P = 0.001), pulmonary blood flow (HR = 1.092, P = 0.001), heart rate (HR = 1.038, P = 0.028) and 6-minute walking distance (HR = 1.003, P = 0.037) were predictors of survival. After adjustment by bivariate analysis, Cp was the independent predictor. Kaplan-Meier survival curves showed that patients with Cp < 1.04 mL/mmHg had worse prognosis. In conclusion, Cp possibly reflects disease severity and decreased Cp was associated with poor prognosis in patients with APAH-CHD.
[Mh] Termos MeSH primário: Cardiopatias Congênitas/complicações
Hipertensão Pulmonar/fisiopatologia
Artéria Pulmonar/fisiopatologia
Pressão Propulsora Pulmonar/fisiologia
[Mh] Termos MeSH secundário: Adulto
Cateterismo Cardíaco
China/epidemiologia
Angiografia por Tomografia Computadorizada
Ecocardiografia
Elasticidade
Tolerância ao Exercício/fisiologia
Feminino
Seguimentos
Cardiopatias Congênitas/diagnóstico
Cardiopatias Congênitas/mortalidade
Seres Humanos
Hipertensão Pulmonar/diagnóstico
Hipertensão Pulmonar/etiologia
Masculino
Prognóstico
Artéria Pulmonar/diagnóstico por imagem
Estudos Retrospectivos
Taxa de Sobrevida/tendências
Pressão Ventricular/fisiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171003
[St] Status:MEDLINE
[do] DOI:10.1536/ihj.16-449


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[PMID]:28912263
[Au] Autor:Naeije R; Gerges M; Vachiery JL; Caravita S; Gerges C; Lang IM
[Ad] Endereço:From the Department of Cardiology, Cliniques Universitaires de Bruxelles, Hôpital Académique Erasme, Brussels, Belgium (R.N., J.-L.V., S.C.); Department of Internal Medicine II, Division of Cardiology, General Hospital of Vienna (AKH-Wien), Medical University of Vienna, Austria (M.G., C.G., I.M.L.);
[Ti] Título:Hemodynamic Phenotyping of Pulmonary Hypertension in Left Heart Failure.
[So] Source:Circ Heart Fail;10(9), 2017 Sep.
[Is] ISSN:1941-3297
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Increased pulmonary venous pressure secondary to left heart disease is the most common cause of pulmonary hypertension (PH). The diagnosis of PH due to left heart disease relies on a clinical probability assessment followed by the invasive measurements of a mean pulmonary artery pressure (PAP) ≥25 mm Hg and mean wedged PAP (PAWP) >15 mm Hg. A combination of mean PAP and mean PAWP defines postcapillary PH. Postcapillary PH is generally associated with a diastolic pulmonary pressure gradient (diastolic PAP minus mean PAWP) <7 mm Hg, a transpulmonary pressure gradient (mean PAP minus mean PAWP) <12 mm Hg, and pulmonary vascular resistance ≤3 Wood units (WU). This combination of criteria defines isolated postcapillary PH. Postcapillary PH with elevated vascular gradients and pulmonary vascular resistance defines combined post- and precapillary PH (Cpc-PH). Postcapillary PH is associated with a decreased survival in proportion to increased pulmonary vascular gradients, decreased pulmonary arterial compliance, and reduced right ventricular function. The Cpc-PH subcategory occurs in 12% to 13% of patients with PH due to left heart disease. Patients with Cpc-PH have severe PH, with higher diastolic pulmonary pressure gradient, transpulmonary pressure gradient, and pulmonary vascular resistance and more pronounced ventilatory responses to exercise, lower pulmonary arterial compliance, depressed right ventricular ejection fraction, and shorter life expectancy than isolated postcapillary PH. Cpc-PH bears similarities to pulmonary arterial hypertension. Whether Cpc-PH is amenable to therapies targeting the pulmonary circulation remains to be tested by properly designed randomized controlled trials.
[Mh] Termos MeSH primário: Pressão Arterial
Insuficiência Cardíaca/complicações
Hipertensão Pulmonar/etiologia
Artéria Pulmonar/fisiopatologia
Pressão Propulsora Pulmonar
Função Ventricular Esquerda
[Mh] Termos MeSH secundário: Tolerância ao Exercício
Insuficiência Cardíaca/diagnóstico
Insuficiência Cardíaca/mortalidade
Insuficiência Cardíaca/fisiopatologia
Seres Humanos
Hipertensão Pulmonar/diagnóstico
Hipertensão Pulmonar/mortalidade
Hipertensão Pulmonar/fisiopatologia
Fenótipo
Valor Preditivo dos Testes
Prognóstico
Veias Pulmonares/fisiopatologia
Ventilação Pulmonar
Fatores de Risco
Índice de Gravidade de Doença
Resistência Vascular
Rigidez Vascular
Pressão Venosa
Função Ventricular Direita
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170916
[St] Status:MEDLINE


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[PMID]:28912262
[Au] Autor:Wright SP; Moayedi Y; Foroutan F; Agarwal S; Paradero G; Alba AC; Baumwol J; Mak S
[Ad] Endereço:From the Institute of Medical Science, Faculty of Medicine, University of Toronto, Ontario, Canada (S.P.W., S.M.); Division of Cardiology, Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada (S.P.W., Y.M., F.F., S.A., G.P., A.C.A., S.M.); and Advanced
[Ti] Título:Diastolic Pressure Difference to Classify Pulmonary Hypertension in the Assessment of Heart Transplant Candidates.
[So] Source:Circ Heart Fail;10(9), 2017 Sep.
[Is] ISSN:1941-3297
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The diastolic pressure difference (DPD) is recommended to differentiate between isolated postcapillary and combined pre-/postcapillary pulmonary hypertension (Cpc-PH) in left heart disease (PH-LHD). However, in usual practice, negative DPD values are commonly calculated, potentially related to the use of mean pulmonary artery wedge pressure (PAWP). We used the ECG to gate late-diastolic PAWP measurements. We examined the method's impact on calculated DPD, PH-LHD subclassification, hemodynamic profiles, and mortality. METHODS AND RESULTS: We studied patients with advanced heart failure undergoing right heart catheterization to assess cardiac transplantation candidacy (N=141). Pressure tracings were analyzed offline over 8 to 10 beat intervals. Diastolic pulmonary artery pressure and mean PAWP were measured to calculate the DPD as per usual practice (diastolic pulmonary artery pressure-mean PAWP). Within the same intervals, PAWP was measured gated to the ECG QRS complex to calculate the QRS-gated DPD (diastolic pulmonary artery pressure-QRS-gated PAWP). Outcomes occurring within 1 year were collected retrospectively from chart review. Overall, 72 of 141 cases demonstrated PH-LHD. Within PH-LHD, the QRS-gated DPD yielded higher calculated DPD values (3 [-1 to 6] versus 0 [-4 to 3] mm Hg; <0.01) and a greater proportion of Cpc-PH (24% versus 8%; <0.01) versus the usual practice DPD. Cases reclassified as Cpc-PH based on QRS-gated DPD demonstrated higher pulmonary arterial pressures versus isolated postcapillary pulmonary hypertension ( <0.05). One-year mortality was similar between PH-LHD groups. CONCLUSIONS: The DPD calculated in usual practice is underestimated in PH-LHD, which may classify Cpc-PH patients as isolated postcapillary pulmonary hypertension. The QRS-gated DPD reclassifies a subset of PH-LHD patients from isolated postcapillary pulmonary hypertension to Cpc-PH, which is characterized by an adverse hemodynamic profile.
[Mh] Termos MeSH primário: Pressão Arterial
Cateterismo Cardíaco
Insuficiência Cardíaca/diagnóstico
Transplante de Coração
Hipertensão Pulmonar/diagnóstico
Artéria Pulmonar/fisiopatologia
Pressão Propulsora Pulmonar
[Mh] Termos MeSH secundário: Idoso
Eletrocardiografia
Feminino
Insuficiência Cardíaca/complicações
Insuficiência Cardíaca/fisiopatologia
Insuficiência Cardíaca/cirurgia
Seres Humanos
Hipertensão Pulmonar/classificação
Hipertensão Pulmonar/complicações
Hipertensão Pulmonar/fisiopatologia
Masculino
Meia-Idade
Valor Preditivo dos Testes
Prognóstico
Reprodutibilidade dos Testes
Estudos Retrospectivos
Medição de Risco
Fatores de Risco
Índice de Gravidade de Doença
Processamento de Sinais Assistido por Computador
Função Ventricular Direita
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170916
[St] Status:MEDLINE


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[PMID]:28912260
[Au] Autor:Imamura T; Chung B; Nguyen A; Rodgers D; Sayer G; Adatya S; Sarswat N; Kim G; Raikhelkar J; Ota T; Song T; Juricek C; Kagan V; Jeevanandam V; Mehra M; Burkhoff D; Uriel N
[Ad] Endereço:From the Department of Medicine (T.I., B.C., A.N., D.R., G.S., S.A., N.S., G.K., J.R., N.U.) and Department of Surgery (T.O., T.S., C.J., V.K., V.J.), University of Chicago Medical Center, IL; Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.M.); and Columbia University Medical Ce
[Ti] Título:Decoupling Between Diastolic Pulmonary Artery Pressure and Pulmonary Capillary Wedge Pressure as a Prognostic Factor After Continuous Flow Ventricular Assist Device Implantation.
[So] Source:Circ Heart Fail;10(9), 2017 Sep.
[Is] ISSN:1941-3297
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: A cohort of heart failure (HF) patients receiving left ventricular assist devices (LVADs) has decoupling of their diastolic pulmonary artery pressure and pulmonary capillary wedge pressure. However, the clinical implications of this decoupling remain unclear. METHODS AND RESULTS: In this prospective study, patients with LVADs underwent routine invasive hemodynamic ramp testing with right heart catheterization, during which LVAD speeds were adjusted. Inappropriate decoupling was defined as a >5 mm Hg difference between diastolic pulmonary artery pressure and pulmonary capillary wedge pressure. The primary outcomes of survival and heart failure readmission rates after ramp testing were assessed. Among 63 LVAD patients (60±12 years old and 25 female [40%]), 27 patients (43%) had inappropriate decoupling at their baseline speed. After adjustment of their rotation speed during ramp testing, 30 patients (48%) had inappropriate decoupling. Uni/multivariable Cox analyses demonstrated that decoupling was the only significant predictor for the composite end point of death and heart failure readmission during the 1 year following the ramp study (total of 18 events; hazards ratio, 1.09; 95% confidence interval, 1.04-1.24; <0.05). Furthermore, normalization of decoupling (n=8) during ramp testing was significantly associated with higher 1-year heart failure readmission-free survival rate compared with the non-normalized group (n=19, 100% versus 53%; =0.035). CONCLUSIONS: The presence of inappropriate decoupling was associated with worse outcomes in patients with LVADs. Prospective, large-scale multicenter studies to validate the result are warranted.
[Mh] Termos MeSH primário: Pressão Arterial
Insuficiência Cardíaca/terapia
Coração Auxiliar
Implante de Prótese/instrumentação
Artéria Pulmonar/fisiopatologia
Pressão Propulsora Pulmonar
Função Ventricular Esquerda
[Mh] Termos MeSH secundário: Idoso
Cateterismo Cardíaco
Distribuição de Qui-Quadrado
Intervalo Livre de Doença
Feminino
Insuficiência Cardíaca/diagnóstico
Insuficiência Cardíaca/mortalidade
Insuficiência Cardíaca/fisiopatologia
Seres Humanos
Estimativa de Kaplan-Meier
Masculino
Meia-Idade
Análise Multivariada
Readmissão do Paciente
Modelos de Riscos Proporcionais
Estudos Prospectivos
Desenho de Prótese
Implante de Prótese/efeitos adversos
Implante de Prótese/mortalidade
Recuperação de Função Fisiológica
Fatores de Risco
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170916
[St] Status:MEDLINE


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[PMID]:28786237
[Au] Autor:Hsu CH; Roan JN; Wang JN; Huang CC; Shih CJ; Chen JH; Wu JM; Lam CF
[Ad] Endereço:Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
[Ti] Título:Hemodynamic, biological, and right ventricular functional changes following intraatrial shunt repair in patients with flow-induced pulmonary hypertension.
[So] Source:Congenit Heart Dis;12(4):533-539, 2017 Jul.
[Is] ISSN:1747-0803
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Atrial septal defects may result in pulmonary hypertension and right heart remodeling. We analyzed improvements in patients with flow-induced pulmonary hypertension and the activation of endothelial progenitor cells after flow reduction. DESIGN: This prospective cohort study included 37 patients who were admitted for an occluder implantation. Blood samples were collected before and after the procedure. We determined the number of endothelial progenitor cells in outgrowth colonies and serum Hsp27 concentrations. Daily performance and cardiothoracic ratio were reevaluated later. RESULTS: Closure of the defect significantly reduced the pulmonary pressure and B-type natriuretic peptide levels. The cardiothoracic ratio and daily performance status also improved. The number of endothelial progenitor cell outgrowth colony-forming units significantly increased and was positively correlated with daily performance. In patients with enhanced colony formation, Hsp27 levels were significantly increased. CONCLUSIONS: The implantation of an occluder successfully improved hemodynamic, right ventricular, and daily performance. Qualitative enhancement of colony formation for endothelial progenitor cells was also noted and positively correlated with daily performance. Closure of defects may serve as a valid, reliable model to obtain a deeper understanding of the modulation of endothelial progenitor cell activity and its relationship with pulmonary hypertension prognosis.
[Mh] Termos MeSH primário: Comunicação Interatrial/cirurgia
Ventrículos do Coração/fisiopatologia
Hipertensão Pulmonar/etiologia
Complicações Pós-Operatórias
Dispositivo para Oclusão Septal
Função Ventricular Direita/fisiologia
Remodelação Ventricular
[Mh] Termos MeSH secundário: Adolescente
Adulto
Estudos de Casos e Controles
Ecocardiografia
Feminino
Seguimentos
Comunicação Interatrial/fisiopatologia
Hemodinâmica/fisiologia
Seres Humanos
Hipertensão Pulmonar/diagnóstico
Hipertensão Pulmonar/fisiopatologia
Masculino
Meia-Idade
Prognóstico
Estudos Prospectivos
Pressão Propulsora Pulmonar
Radiografia Torácica
Fatores de Tempo
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170809
[St] Status:MEDLINE
[do] DOI:10.1111/chd.12479


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[PMID]:28754567
[Au] Autor:Gilotra NA; Tedford RJ; Wittstein IS; Yenokyan G; Sharma K; Russell SD; Silber HA
[Ad] Endereço:Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: naggarw2@jhmi.edu.
[Ti] Título:Usefulness of Pulse Amplitude Changes During the Valsalva Maneuver Measured Using Finger Photoplethysmography to Identify Elevated Pulmonary Capillary Wedge Pressure in Patients With Heart Failure.
[So] Source:Am J Cardiol;120(6):966-972, 2017 Sep 15.
[Is] ISSN:1879-1913
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The pulse amplitude ratio, the ratio of pulse pressure at the end of a Valsalva maneuver to before the onset of Valsalva, correlates with filling pressure. This study aimed to noninvasively estimate cardiac filling pressure in patients with heart failure. We developed a noninvasive handheld device to measure pulse amplitude ratio using finger photoplethysmography. In 69 patients who underwent right heart catheterization, photoplethysmography waveforms were recorded during a standardized Valsalva maneuver, and in 60 of these patients, pulse amplitude ratio was able to be calculated. Pulse amplitude ratio correlated with pulmonary capillary wedge pressure (PCWP) (r = 0.58, p <0.0001), particularly among those subjects with reduced ejection fraction (r = 0.60, p = 0.002, n = 25). A multivariable linear regression model for PCWP including pulse amplitude ratio, age, body mass index, systolic blood pressure, diastolic blood pressure, and heart rate yielded an R of 0.54. Difference in mean pulse amplitude ratio for subjects with a PCWP ≤15 mm Hg versus >15 mm Hg was statistically significant (p <0.0001, area under receiver operating characteristics curve 0.79 [0.66, 0.92]). Pulse amplitude ratio ≥0.55 predicted PCWP >15 mm Hg with 73% sensitivity and 77% specificity. Pulse amplitude ratio also increased by an average of 0.03 with a leg raise maneuver (p = 0.05, n = 36). In conclusion, we demonstrate that noninvasively measured response to the Valsalva maneuver in patients with HF can estimate PCWP and also detect changes within a single patient.
[Mh] Termos MeSH primário: Pressão Sanguínea/fisiologia
Insuficiência Cardíaca/fisiopatologia
Frequência Cardíaca/fisiologia
Fotopletismografia/métodos
Pressão Propulsora Pulmonar/fisiologia
Manobra de Valsalva/fisiologia
[Mh] Termos MeSH secundário: Cateterismo Cardíaco
Feminino
Seguimentos
Seres Humanos
Masculino
Meia-Idade
Reprodutibilidade dos Testes
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170901
[Lr] Data última revisão:
170901
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170730
[St] Status:MEDLINE


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[PMID]:28705377
[Au] Autor:Amsallem M; Boulate D; Aymami M; Guihaire J; Selej M; Huo J; Denault AY; McConnell MV; Schnittger I; Fadel E; Mercier O; Zamanian RT; Haddad F
[Ad] Endereço:Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California; Cardiovascular Institute, Stanford University School of Medicine, Stanford, California; Division of Cardiothoracic Surgery, Marie Lannelongue Hospital, Le Plessis Robinson, France. Electronic address:
[Ti] Título:Load Adaptability in Patients With Pulmonary Arterial Hypertension.
[So] Source:Am J Cardiol;120(5):874-882, 2017 Sep 01.
[Is] ISSN:1879-1913
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Right ventricular (RV) adaptation to pressure overload is a major prognostic factor in patients with pulmonary arterial hypertension (PAH). The objectives were first to define the relation between RV adaptation and load using allometric modeling, then to compare the prognostic value of different indices of load adaptability in PAH. Both a derivation (n = 85) and a validation cohort (n = 200) were included. Load adaptability was assessed using 3 approaches: (1) surrogates of ventriculo-arterial coupling (e.g., RV area change/end-systolic area), (2) simple ratio of function and load (e.g., tricuspid annular plane systolic excursion/right ventricular systolic pressure), and (3) indices assessing the proportionality of adaptation using allometric pressure-function or size modeling. Proportional hazard modeling was used to compare the hazard ratio for the outcome of death or lung transplantation. The mean age of the derivation cohort was 44 ± 11 years, with 80% female and 74% in New York Heart Association class III or IV. Mean pulmonary vascular resistance index (PVRI) was 24 ± 11 with a wide distribution (1.6 to 57.5 WU/m ). Allometric relations were observed between PVRI and RV fractional area change (R = 0.53, p < 0.001) and RV end-systolic area indexed to body surface area right ventricular end-systolic area index (RVESAI) (R = 0.29, p < 0.001), allowing the derivation of simple ratiometric load-specific indices of RV adaptation. In right heart parameters, RVESAI was the strongest predictor of outcomes (hazard ratio per SD = 1.93, 95% confidence interval 1.37 to 2.75, p < 0.001). Although RVESAI/PVRI provided small incremental discrimination on multivariate modeling, none of the load-adaptability indices provided stronger discrimination of outcome than simple RV adaptation metrics in either the derivation or the validation cohort. In conclusion, allometric modeling enables quantification of the proportionality of RV load adaptation but offers small incremental prognostic value to RV end-systolic dimension in PAH.
[Mh] Termos MeSH primário: Ventrículos do Coração/fisiopatologia
Hipertensão Pulmonar/fisiopatologia
Artéria Pulmonar/fisiopatologia
Pressão Propulsora Pulmonar/fisiologia
Resistência Vascular/fisiologia
Função Ventricular Direita/fisiologia
[Mh] Termos MeSH secundário: Adulto
Cateterismo Cardíaco
Ecocardiografia
Feminino
Seguimentos
Ventrículos do Coração/diagnóstico por imagem
Seres Humanos
Hipertensão Pulmonar/diagnóstico
Masculino
Prognóstico
Estudos Prospectivos
Artéria Pulmonar/diagnóstico por imagem
Volume Sistólico/fisiologia
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170901
[Lr] Data última revisão:
170901
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170715
[St] Status:MEDLINE



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