1,721,042 research outputs found
The burden of comorbidities in pulmonary arterial hypertension
Full text linkPatients with comorbidities are often excluded from clinical trials, limiting the evidence base for pulmonary arterial hypertension (PAH)-specific therapies. This review aims to discuss the effect of comorbidities on the diagnosis and management of PAH. The comorbidities discussed in this review (systemic hypertension, obesity, sleep apnoea, clinical depression, obstructive airway disease, thyroid disease, diabetes, and ischaemic cardiovascular event) were chosen based on their prevalence in patients with idiopathic PAH in the REVEAL registry (Registry to EValuate Early and Long-term PAH disease management). Comorbidities can mask the symptoms of PAH, leading to delays in diagnosis and also difficulty evaluating disease progression and treatment effects. Due to the multifactorial pathophysiology of pulmonary hypertension (PH), the presence of comorbidities can lead to difficulties in distinguishing between Group 1 PH (PAH) and the other group classifications of PH. Many comorbidities contribute to the progression of PAH through increased pulmonary artery pressures and cardiac output, therefore treatment of the comorbidity may also reduce the severity of PAH. Similarly, the development of one comorbidity can be a risk factor for the development of other comorbidities. The management of comorbidities requires consideration of drug interactions, polypharmacy, adherence and evidence-based strategies. A multidisciplinary team should be involved in the management of patients with PAH and comorbidities, with appropriate referral to supportive services when necessary. The treatment goals and expectations of patients must be managed in the context of comorbidities
The difficult diagnosis of pulmonary vascular disease in heart failure
No full textPulmonary hypertension (PH), defined as a mean pulmonary arterial pressure (PAP) ≥25 mmHg, is a well-recognised complication of left heart disease (LHD). PH prevalence is variable ranging from 25% to 80% of LHD patients according to the methods of assessment, cut-off values and characteristics of the patient population [1–3]. All aetiological types of LHD are affected, including heart failure with reduced (HFrEF) or preserved (HFpEF) left ventricular ejection fraction, and valvular LHD. The presence of PH-LHD is associated with advanced symptoms, reduced exercise capacity and impaired outcome after medical, interventional or surgical therapy [1, 3, 4].
The relevance of PH-LHD is highlighted by the recognised epidemiological predominance of this condition, which represents the most common form among the five groups included in the PH clinical classification, accounting for 65–80% of the PH cases [1, 3, 5, 6]. PH-LHD is distinctively characterised by an increase of the pulmonary artery wedge pressure (PAWP) >15 mmHg [5, 6], an accepted surrogate for left atrial pressure
GPs meet rare lung disorders task force factsheet: Pulmonary arterial hypertension
Full text linkDiscussion on pulmonary hypertension with GP
Exercise training in pulmonary hypertension: improving performance but waiting for outcome
No full textPulmonary hypertension is a pathophysiological condition characterized by an increase of mean pulmonary arterial pressure ≥25 mmHg at rest.1 Pulmonary hypertension may complicate multiple clinical disorders and invariably it reduces exercise and functional capacity and represents a risk factor for morbidity and mortality.2 Although important progress in the pharmacotherapy of pulmonary arterial hypertension has been achieved in the past 15 years,3,4 limited functional capacity and reduced survival still characterize patient outcome. Further advances are needed in this area to improve the clinical results of a comprehensive treatment strategy.
Effects of exercise training
Ehlken and colleagues now present the data of a randomized controlled trial on the impact of exercise training on peak oxygen consumption and haemodynamics in 87 patients with pulmonary arterial hypertension or inoperable chronic thrombo-embolic pulmonary hypertension.5 The majority of subjects (91%) were on background approved pulmonary arterial hypertension therapies. The exercise training started with an in-hospital 3-week programme and was continued at home with at least 15 min/day for 5 days a week for the following 12 weeks.
After 15 weeks, the peak oxygen uptake (primary endpoint) significantly improved in the training group by +24.3% and the 6-min walk distance improved by 41 m. Haemodynamics at rest and during exercise significantly improved in the training group compared with the control group. However, the haemodynamic data were collected only in 74 patients (85%)
Thrombolysis in high-risk patients with acute pulmonary embolism: underuse of a life-saving treatment in the real-world setting
No full textThis editorial refers to ‘Trends in thrombolytic treatment and outcomes of acute pulmonary embolism in Germany’, by K. Keller et al., doi:10.1093/eurheartj/ehz236
Challenges in pulmonary hypertension: managing the unexpected
Full text linkThe diverse challenges associated with diagnosis and management of patients with pulmonary hypertension are illustrated in this case-based review. Case 1 describes a patient diagnosed with pulmonary arterial hypertension (PAH) with right heart failure and active systemic lupus erythematosus who was effectively treated with an up-front triple combination of PAH therapies and immunosuppressive therapy. In case 2, a diagnosis of pulmonary veno-occlusive disease was reached after a combined approach of clinical suspicion, physical examination, and invasive and noninvasive tests. Cautious PAH therapy and high-dose diuretics provided clinical benefit in this patient and served as a bridge to lung transplantation. These cases highlight the need for ongoing follow-up of patients with PAH, comprising frequent assessment of treatment success and continued diagnostic evaluation
Pulmonary vascular disease due to left heart disease: How to achieve a more accurate approach beyond the haemodynamic phenotype: Reply
No full textPulmonary vascular disease due to left heart disease: how to achieve a more accurate approach beyond the hemodynamic phenotype - Repl
Aiming at the appropriate target for the treatment of pulmonary hypertension due to left heart disease
No full textThis editorial refers to ‘Sildenafil for improving outcomes
in patients with corrected valvular heart disease and persistent
pulmonary hypertension’, by J. Bermejo et al.
doi:10.1093/eurheartj/ehx700
Progress in the treatment of acute pulmonary embolism and chronic thrombo-embolic pulmonary hypertension/disease
No full textThe combination of an initial clinical approach aimed at evaluating the early risk of mortality with subsequent diagnostic and therapeutic approaches articulated on the overall patient's profile is recommended in acute pulmonary embolism (PE). The presence of pulmonary hypertension associated with the persistence of chronic vascular obstructions in the pulmonary arteries after one or more acute thrombo-embolic events identifies a condition defined as chronic thrombo-embolic pulmonary hypertension (CTEPH). The evolution of technology and knowledge in the field of imaging has allowed us to qualify the computed tomography angiography of the pulmonary arteries as the gold standard for the diagnostic confirmation of both acute PE and CTEPH. In both these conditions, the first therapeutic step is the immediate initiation of anticoagulant therapy. In acute high-risk PE, in addition to anticoagulant therapy, thrombolytic therapy is recommended; in the event of contraindications to thrombolysis, surgical embolectomy or percutaneous catheter-directed treatment represents viable treatment options. In CTEPH, the combination of data collected from cardiac catheterization, computed tomography angiography, and conventional angiography of pulmonary arteries allows a team of experts to identify candidates for pulmonary endarterectomy surgery. Inoperable patients should be considered for percutaneous balloon angioplasty of the pulmonary arteries which can improve patients' symptoms, quality of life, and prognosis
Cardiologia pediatrica. Problematiche cliniche
No full textL'ipertensione polmonare (Pulmonary hypertension - PH) è una malattia rara nei neonati, nei lattanti ed in tutta l’età pediatrica, associata ad una significativa morbidità e mortalità. Nella maggior parte dei pazienti pediatrici, la PH è idiopatica o associata a cardiopatie congenite; raramente è associata ad altre condizioni come malattie del tessuto connettivo o cuore polmonare cronico tromboembolico. Dati di incidenza dei Paesi Bassi hanno rivelato un'incidenza annuale ed una prevalenza puntuale (espresse in casi per milione di bambini) di 0.7 e 4.4 per l’ipertensione arteriosa polmonare idiopatica (Idiopathic pulmonary arterial hypertension - IPAH) e 2.2 e 15.6 per l’ipertensione arteriosa polmonare (Pulmonary arterial hypertension - PAH) associata a cardiopatie congenite (congenital heart disease - CHD). La classificazione di Nizza aggiornata della PH include e classifica con maggiore precisione alcune cardiopatie congenite e, in particolare, enfatizza l'ipertensione polmonare persistente del neonato (persistent pulmonary hypertension of the newborn - PPHN) e le pneumopatie della età evolutiva come la displasia broncopolmonare (bronchopulmonary dysplasia - BPD) e l’ernia diaframmatica congenita (congenital diaphragmatic hernia - CDH). La gestione della PH in età pediatrica rimane impegnativa poiché le decisioni terapeutiche continuano a dipendere in gran parte dai risultati degli studi clinici effettuati sugli adulti e dall'esperienza clinica degli specialisti pediatrici
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