1,721,139 research outputs found
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
Oxygen supplementation for pulmonary arterial hypertension? Clues from the REVEAL registry
No full textPulmonary 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
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
The 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
Right ventricular/pulmonary artery coupling in patients with heart failure with preserved ejection fraction. a clue for pulmonary hypertension
Full text linkpulmonary hypertension (PH) in left heart disease is a common condition, primarily caused by backward transmission of an elevated left atrial pressure (this hemodynamic picture is defined as isolated postcapillary PH). Through poorly understood mechanisms, the increase in pulmonary venous pressure
may cause a remodeling of the small pulmonary arteries with the development of a precapillary component that identifies a combined pre-post capillary PH. As pulmonary vascular resistance increases, right ventricular (RV) adaptation to the increased afterload may fail, and abnormal RV systolic function develops during exercise and at rest. The development of PH in patients affected by heart failure has a relevant prognostic impact, increasing morbidity and mortality; and, in particular, when associated with RV dysfunction, it represents an adverse clinical turning point in the history of the diseas
[Echocardiography in aortic stenosis: new insights into challenging scenarios].
No full textThe natural history of aortic stenosis is well defined. There is overwhelming evidence that patients with this disease who develop symptoms require prompt aortic valve replacement, as average survival rapidly falls. Once surgery has been performed age-corrected rates of survival approach the rate in the normal population. Conversely, asymptomatic patients with severe aortic stenosis have an excellent clinical prognosis. Nevertheless, there is a low risk of sudden death or rapid rate of progression to the symptomatic state. This low risk while patients remain asymptomatic does not outweigh the risk associated with valve replacement surgery or the complications of artificial prostheses, so surgery is not recommended for the entire group of asymptomatic patients. Therefore, therapeutic decisions in patients with aortic stenosis are based on the definition of symptomatic status and of hemodynamic severity, so accurate evaluation of these two issues is mandatory. However, establishing symptomatic status and severity of valve disease can be challenging because assessment of subjective symptoms and functional capacity is sometimes ambiguous, particularly in the elderly. Furthermore, it is well recognized that assessment of hemodynamic obstruction defined by echocardiographic indexes such as transvalvular pressure gradient and aortic valve area, is suboptimal because of technical difficulties and poor correlation with symptoms. Hence, aortic stenosis evaluation should be also performed introducing in clinical practice new simple indexes, such as function- and pressure-corrected indexes and energy loss index, that could provide a different estimate of disease severity, based on prognostic indication of adverse clinical outcome. Indeed, clinical outcome represents the real endpoint for defining severity and should be incorporated in clinical assessment and used to aid patient management in unclear situations. The development of heart failure in patients with aortic stenosis is associated with a high mortality rate and requires a careful management that includes an initial evaluation of the severity of the stenosis and the functional state of the left ventricle. Left ventricular dysfunction is usually due to afterload mismatch, but as end stage develops, decline in the intrinsic myocardial contractility becomes the most relevant mechanism. However, separating the effect of myocardial contractile dysfunction from that of afterload mismatch on pump performance is difficult. Dobutamine echocardiography can be useful both by testing myocardial contractile reserve and by separating true from relative aortic stenosis. Unfortunately the optimal management of patients with severe aortic stenosis and left ventricular dysfunction remains controversial, and we still have missing data to determine which patients are more likely to benefit from aortic valve replacement, by improving survival and functional status, with an acceptable perioperative mortality rate
Porto-pulmonary arterial hypertension. translation of pathophysiological concepts to the bedside
No full textPorto-pulmonary arterial hypertension (PoPAH) is a form of pulmonary arterial hypertension (PAH) that affects patients with cirrhosis, and - to a lesser extent - patients with non-cirrhotic liver diseases. Compared with other forms of PAH, PoPAH is more prevalent in male, in older subjects, and is characterized by lower mean pulmonary arterial pressure (mPAP) and lower pulmonary vascular resistance (PVR) with higher cardiac output. Despite more favorable hemodynamics and functional class, patients with PoPAH have a significantly worse survival than patients with other forms of PAH, likely because of liver-related events and therapeutic barriers to PAH-specific therapy. Furthermore, here cardiopulmonary and hepatic complications may affect treatment efficacy. These patients have been excluded from most randomized clinical trials testing PAH-specific treatments. To date, there is only one study investigating efficacy, safety, tolerability and pharmacokinetics of PAH-specific therapy in patients with PoPAH in a randomized placebo-controlled setting. In this trial the use of the endothelin1 receptor antagonist macitentan showed clear hemodynamic benefit without safety concerns. However, the drug effects on functional capacity and mortality remain unclear. Here we review the current knowledge on the pathophysiology and management of PoPAH and report a case vignette of a patient with PoPAH due to hepatorenal polycystic disease
Comment on Topyła-Putowska et al. Echocardiography in Pulmonary Arterial Hypertension: Comprehensive Evaluation and Technical Considerations. J. Clin. Med. 2021, 10, 3229
Full text linkA 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
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