6,114 research outputs found
Oxygen supplementation for pulmonary arterial hypertension? Clues from the REVEAL registry
No full textThe overloaded right heart and ventricular interdependence
No full textThe right and the left ventricle are interdependent as both structures are nested within the pericardium, have the septum in common and are encircled with common myocardial fibres. Therefore, right ventricular volume or pressure overloading affects left ventricular function, and this in turn may affect the right ventricle. In normal subjects at rest, right ventricular function has negligible interaction with left ventricular function. However, the right ventricle contributes significantly to the normal cardiac output response to exercise. In patients with right ventricular volume overload without pulmonary hypertension, left ventricular diastolic compliance is decreased and ejection fraction depressed but without intrinsic alteration in contractility. In patients with right ventricular pressure overload, left ventricular compliance is decreased with initial preservation of left ventricular ejection fraction, but with eventual left ventricular atrophic remodelling and altered systolic function. Breathing affects ventricular interdependence, in healthy subjects during exercise and in patients with lung diseases and altered respiratory system mechanics. Inspiration increases right ventricular volumes and decreases left ventricular volumes. Expiration decreases both right and left ventricular volumes. The presence of an intact pericardium enhances ventricular diastolic interdependence but has negligible effect on ventricular systolic interdependence. On the other hand, systolic interdependence is enhanced by a stiff right ventricular free wall, and decreased by a stiff septum. Recent imaging studies have shown that both diastolic and systolic ventricular interactions are negatively affected by right ventricular regional inhomogeneity and prolongation of contraction, which occur along with an increase in pulmonary artery pressure. The clinical relevance of these observations is being explored
Audiomobiles, Sculptures and Conundrums
No full textRoberto Gerhard was a pioneer of electronic music in England creating a number of substantial concert, theatre and radio works from as early as 1954. Gerhard’s electronic music is one of the richest repositories for understanding the development of the composer’s late compositional technique. Apart from the Symphony no.3, ‘Collages’, none of Gerhard’s electronic music is published. This paper will discuss aspects of Gerhard’s electronic music, focusing on Audiomobiles (1958-59) and Sculptures (1963)
Comment on Topyła-Putowska et al. Echocardiography in Pulmonary Arterial Hypertension: Comprehensive Evaluation and Technical Considerations. J. Clin. Med. 2021, 10, 3229
Get PDFA comprehensive PAH echocardiographic examination of patients with pulmonary arterial hypertension (PAH) should include a set of parameters resembling the pathophysiological changes occurring in the course of the disease. This approach could help clinicians build a complete picture of the patient, test the effects of targeted therapies and identify patients who need a more aggressive therapeutic approach to achieve a low risk-status
Non-invasive assessment of pulmonary hypertension: Doppler-echocardiography
No full textPulmonary hypertension (PH) is a clinical condition characterised by elevated pulmonary artery pressure (PAP) and vascular resistances. At the onset of the disease, symptoms are frequently atypical so that PH diagnosis is usually made when the disease is advanced, which often is too late for efficacious treatment. As a consequence the prognosis is poor. Echo-Doppler evaluation allows: (a) an early identification of patients with PH, (b) to establish a patient's prognosis and (c) to evaluate a proper patient's follow-up. In patients with PH echocardiography provides information about right heart dimensions, pulmonary artery pressures, right ventricle systolic and diastolic function and left and right ventricle interdependence. Most importantly Echo-Doppler evaluation has became a major diagnostic tool for PH allowing evaluation of changes with time and with different treatments which are aimed at reducing pulmonary artery pressure and right heart dimensions and at improving right heart function
Pulmonary hypertension: ecocardiographic assessment.
No full textPulmonary arterial hypertension (PAH) is a clinical condition characterized by elevated vascular resistance, associated with a poor prognosis and usually diagnosed in late stage. Echocardiographic assessment of PAH includes early disease detection and functional heart evaluation, in order to introduce a more accurate surveillance at an early stage of the disease and to contribute to prognostic stratification of advanced disease. Detection involves pulmonary artery systolic pressure (PASP) estimation. There is no clear consensus on defining normal distribution, but a PASP of 36 mmHg has been widely assumed as a cut-off value for mild PAH, requiring a more aggressive surveillance to detect further progression. Functional heart evaluation requires an accurate characterization of morphologic and hemodynamic changes, secondary to PAH development, which involves description of dimensional parameters, ventricular interdependency, intracardiac flow patterns, and right ventricular systolic performance. A valid assessment of these issues results in a useful evaluation of cardiac function, supporting clinical context in defining heart failure condition
Roberto Gerhard’s Sound Compositions: A Historical-Philological Perspective. Archive, Process, Intent and reenactment
No full textThis research advances the current state of knowledge in the field of early tape music both empirically and methodologically. The purpose of this study is to evaluate the impact that the electronic medium exerted in the musical thinking of Roberto Gerhard, one of the most outspoken, prolific and influential composers in the Spanish diaspora whose musical legacy, for the most part unknown, is a major landmark in the early history of electroacoustic music. Gerhard’s personal tape collection, one of the largest historical archives of its kind reported in the literature, is exceptional for both its antiquity (50+-year-old tapes) and its abundance of production materials. Through the digitisation and analysis of the composer’s tape collection this research argues that the empirical study of audio documents sets out a basis for a broader understanding of textual processes. More specifically, the research demonstrates that the reconstruction of works based on magnetic tape sketches is a powerful method to advance the understanding of early tape music. This research also examines Gerhard’s sound compositions in relation to the post-war context in which they were composed. Finally, this research presents performance documentation that proposes an approach to the electroacoustic music repertoire in which creativity is not at odds with rigor and critical discernment demonstrating that archival study can be closely aligned to the concept of re-enactment
Multidimensional assessment and cluster analysis for idiopathic pulmonary arterial hypertension phenotyping
No full textWe read with great interest the cluster analysis from the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA) registry to identify different phenotypes among patients with idiopathic pulmonary arterial hypertension (PAH) (IPAH).
The population-based study reported by Hoeper is a further important contemporary explorative insight into the
characterization of IPAH that follows a few other studies using cluster analysis for partitioning patients in phenotyp
Modelling and simulation of the combined use of IABP and impella as a rescue procedure in cardiogenic shock. an alternative for non-transplant centres
Get PDFThe treatment of critically ill patients remains an evolving and controversial issue. Mechanical circulatory support through a percutaneous approach for the management of cardiogenic shock has taken place in recent years. The combined use of IABP and the Impella 2.5 device may have a role to play for this group of patients. A simulation approach may help with a quantitative assessment of the achievable degree of assistance. In this paper, we analyse the interaction between the Impella 2.5 pump applied as the LVAD and IABP using the numerical simulator of the cardiovascular system developed in our laboratory. Starting with pathological conditions reproduced using research data, the simulations were performed by setting different rotational speeds for the LVAD and driving the IABP in full mode (1:1) or partial mode (1:2, 1:3 and 1:4). The effects induced by drug administration during the assistance were also simulated. The haemodynamic parameters under investigation were aa follows: mean aortic pressure, systolic and diastolic aortic pressure, mean pulmonary arterial pressure, mean left and right atrial pressure, cardiac output, cardiac index, left and right ventricular end-systolic volume, left ventricular end-diastolic volume and mean coronary blood flow. The energetic variables considered in this study were as follows: left and right ventricular external work and left and right atrial pressure-volume area. The outcome of our simulations shows that the combined use of IABP and Impella 2.5 achieves adequate support in the acute phase of cardiogenic shock compared to each standalone device. This would allow further stabilisation and transfer to a transplant centre should the escalation of treatment be required
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