scholarly journals Right ventricular S wave tissue Doppler velocity and TAPSE can identify low risk pulmonary arterial hypertension patients to avoid almost 50% of right heart catheterization

2020 ◽  
Vol 12 (1) ◽  
pp. 191-192
Author(s):  
C. Fauvel ◽  
O. Raitiere ◽  
J. Burdeau ◽  
N. Si-Belkacem ◽  
E. Artaud-Macari ◽  
...  
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Right Ventricular ◽  
Tissue Doppler ◽  
Right Heart Catheterization ◽  
Doppler Velocity ◽  
Heart Catheterization ◽  
S Wave ◽  
Right Heart ◽  
Pulmonary Arterial

scholarly journals P1360 Tricuspid peak systolic S wave tissue doppler velocity >12 cm/s avoid 50% of right heart catheterization in Pulmonary Arterial Hypertension

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
C Fauvel ◽  
O Raitiere ◽  
J Burdeau ◽  
N Si Belkacem ◽  
F Bauer
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Validation Cohort ◽  
Tissue Doppler ◽  
Right Heart Catheterization ◽  
Doppler Velocity ◽  
Heart Catheterization ◽  
S Wave ◽  
Right Heart ◽  
Initial Cohort ◽  
Pulmonary Arterial

Abstract Background Clinical risk stratification in pulmonary arterial hypertension (PAH) relies on BNP level, NYHA functional class, 6min-walk distance and cardiac output by right heart catheterization (RHC) with no place for non-invasive mean like echocardiography. Purpose To avoid systematic RHC in PAH patients, we aimed to determine both tricuspid peak systolic S wave tissue Doppler velocity (S-DTI, cm/s) and tricuspid annular plane systolic excursion (TAPSE, mm) cut-off values that best correlated to invasive cardiac index ≥2.5l/min/m² (CI, meaning low risk clinical worsening or death) in an initial cohort and to test them in a validation cohort. Methods From a single referral pulmonary hypertension centre, 125 PAH patients (initial cohort) underwent 406 hemodynamic investigations with RHC and echocardiography on the same day. S-DTI and TAPSE were performed from a standard manner following the 2015 EACVI/ASE recommendations. This initial cohort served for the receiver operating characteristic analysis from which the cut-off values were investigated in a validation cohort, to test the cardiac index stratification. Results The initial cohort had a mean age of 66.9 ± 14.4 y. Mean pulmonary artery pressure averaged 44 ± 12 mmHg, CI was 2.8 ± 1.0 l/min/m2, S-DTI was 11.2 ± 2.9 cm/s and TAPSE was 18.4 ± 4.7 mm. Both pulsed S-DTI and TAPSE were correlated to invasive CI (p < 0.001 and p < 0.0001, respectively). S-DTI ≥12 cm/s or between <12 cm/s and ≥10 cm/s with TAPSE > 17 mm had a specificity of 0.89 and 0.90, respectively to detect CI ≥ 2.5l/min/m² from the ROC curve analysis. Applying this cutoff-based stratification provided similar results in the validation cohort of 97 PAH patients (mean age = 65 ± 16 y, mean pulmonary artery pressure = 45 ± 16 mmHg, CI = 3.0 ± 1.0 l/min/m2, while S-DTI = 11.1 ± 3.1 cm/s, TAPSE = 17.8 ± 5.4 mm). Overall, almost 50% of patients were appropriately classified avoiding RHC Conclusion Considering tricuspid peak systolic S wave tissue Doppler velocity ≥12 cm/s or <12 cm/s but ≥10 cm/s with tricuspid annular plane systolic excursion by M-mode >17 mm, then RHC may be avoided in almost 50% of patient to predict CI≥2.5l/min/m² in PAH patients.

scholarly journals Right ventricular dimension index by cardiac magnetic resonance for prognostication in connective tissue diseases and pulmonary hypertension

Rheumatology ◽  
2019 ◽  
Author(s):  
Nobuya Abe ◽  
Masaru Kato ◽  
Michihito Kono ◽  
Yuichiro Fujieda ◽  
Hiroshi Ohira ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Right Ventricular ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Right Heart ◽  
Pulmonary Arterial ◽  
Dimension Index

Abstract Objectives Pulmonary hypertension (PH) in patients with CTD is a heterogeneous condition affected by left heart disease, chronic lung disease and thromboembolism as well as pulmonary vascular disease. Recent studies using cardiac magnetic resonance (CMR) have shown that right ventricular dysfunction is predictive for mortality in patients with PH, but limited to pulmonary arterial hypertension. This study aimed to analyse prognostic factors in PH-CTD. Methods This retrospective analysis comprised 84 CTD patients, including SSc, who underwent both CMR and right heart catheterization from 2008 to 2018. Demographics, laboratory findings, and haemodynamic and morphological parameters were extracted. The prognostic value of each parameter was evaluated by multivariate analysis using covariables derived from propensity score to control confounding factors. Results Of 84 patients, 65 had right heart catheterization-confirmed PH (54 pulmonary arterial hypertension, 11 non-pulmonary arterial hypertension). Nine out of these PH patients died during a median follow-up period of 25 months. In 65 patients with PH, right ventricular end-diastolic dimension index (RVEDDI) evaluated by CMR was independently associated with mortality (hazard ratio 1.24; 95% CI: 1.08–1.46; P = 0.003). In a receiver operating characteristic analysis, RVEDDI highly predicted mortality, with area under the curve of 0.87. The 0.5–2-year follow-up data revealed that RVEDDI in both survivors and non-survivors did not significantly change over the clinical course, leading to the possibility that an early determination of RVEDDI could predict the prognosis. Conclusion RVEDDI simply evaluated by CMR could serve as a significant predictor of mortality in PH-CTD. A further validation cohort study is needed to confirm its usability.

scholarly journals The Right Ventricular Diameter can Predict the Presence of Pulmonary Hypertension

2016 ◽  
Vol 30 (2) ◽  
pp. 48-52 ◽  
Author(s):  
Abrar Kaiser ◽  
Fazilatunnessa Malik ◽  
Tuhin Haque ◽  
Iftekhar Alam ◽  
Abdullah Al Masud ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Arterial Hypertension ◽  
Pulmonary Artery ◽  
Arterial Hypertension ◽  
Right Ventricular ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Right Heart ◽  
Non Invasive ◽  
Pulmonary Arterial

Background: Pulmonary arterial hypertension (PAH) is a severe disease characterized by a progressive increase of pulmonary pressure and resistance leading to right heart failure. Pulmonary arterial hypertension is commonly diagnosed at a late stage of the disease and is associated with progressive clinical deterioration and premature death. The assessment of pulmonary artery pressure is important in clinical management and prognostic evaluation of patients with cardiovascular and pulmonary disease. Although PH can be detected invasively by right ventricular (RV) catheterization, accurate non-invasive assessment by echocardiography has many advantages. Reliable non-invasive evaluation of pulmonary pressure at present is still a problem as echocardiographic measurement of pulmonary hypertension relies on the presence of tricuspid regurgitation (TR). Objective: The purpose of this study was to determine whether right ventricular end diastolic diameter can predict the presence of pulmonary hypertension. Methods: Eighty consecutive patients with echo detectable tricuspid regurgitation who underwent right heart catheterization for either diagnostic or therapeutic procedure were recruited. They were divided into two groups on the basis of pulmonary artery systolic pressure (PASP). Group I consists of 40 patients with PASP >35 mm Hg and Group II 40 patients having PASP d• 35 mm Hg. Right ventricular end-diastolic diameter (RVD) was measured in the apical 4 chamber view. PASP was measured from right heart catheterization. Results: The RVD has strong correlation with catheter-derived PASP, at a cutoff value of >3 cm, predicted the presence of PAH with 78% sensitivity and 71% specificity. Conclusion: RVD is a good non-invasive predictor for PAH. RVD can predict the presence of PAH even in absence of TR and correlates well with PASP measured by RV catheterization.Bangladesh Heart Journal 2015; 30(2) : 48-52

scholarly journals Schistosomiasis Pulmonary Arterial Hypertension

2020 ◽  
Vol 11 ◽  
Author(s):  
Jean Pierre Sibomana ◽  
Aloma Campeche ◽  
Roberto J. Carvalho-Filho ◽  
Ricardo Amorim Correa ◽  
Helena Duani ◽  
...  
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Right Heart Failure ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Right Heart ◽  
Systematic Screening ◽  
Pulmonary Vasodilators ◽  
Pulmonary Arterial

Pulmonary arterial hypertension (PAH) is a disease of the lung blood vessels that results in right heart failure. PAH is thought to occur in about 5% to 10% of patients with hepatosplenic schistosomiasis, particularly due to S. mansoni. The lung blood vessel injury may result from a combination of embolization of eggs through portocaval shunts into the lungs causing localized Type 2 inflammatory response and vessel remodeling, triggering of autonomous pathology that becomes independent of the antigen, and high cardiac output as seen in portopulmonary hypertension. The condition is likely underdiagnosed as there is little systematic screening, and risk factors for developing PAH are not known. Screening is done by echocardiography, and formal diagnosis requires invasive right heart catheterization. Patients with Schistosoma-associated PAH show reduced functional capacity and can be treated with pulmonary vasodilators, which improves symptoms and may improve survival. There are animal models of this disease that might help in understanding disease pathogenesis and identify novel targets to screen and treatment. Pathogenic mechanisms include Type 2 immunity and activation and signaling in the TGF-β pathway. There are still major uncertainties regarding Schistosoma-associated PAH development, course and treatment.

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