1,721,013 research outputs found
Exercise-induced pulmonary hypertension: rationale for correcting pressures for flow and guide to non-invasive diagnosis
No full textExercise-induced pulmonary hypertension (exPHT) is a haemodynamic condition linked to increased morbidity and mortality across various cardiopulmonary diseases. Traditional definitions of exPHT rely on absolute cut-offs, such as mean pulmonary artery pressure (mPAP) above 30 mmHg during exercise. However, recent research suggests that these cut-offs may not accurately reflect pathophysiological changes, leading to false positives and false negatives. Instead, the mPAP over cardiac output (CO) slope, which incorporates both pressure and flow measurements, has emerged as a more reliable indicator. A slope exceeding 3 mmHg/L/min is now considered diagnostic for exPHT and strongly correlates with adverse outcomes. Stress echocardiography serves as a viable alternative to invasive assessment, enabling broader implementation. This review discusses the physiological basis of pulmonary haemodynamics during exercise, the advantages of the mPAP/CO slope over absolute pressure measurements, the evidence supporting its inclusion in clinical guidelines, and provides a practical guide for non-invasive determining the mPAP/CO slope in clinical practice. Graphical Abstract The rationale for correcting pressures for flow. CO, cardiac output; iCPET, invasive cardiopulmonary exercise testing; mPAP, mean pulmonary arterial pressure; PHT, pulmonary hypertension.Fund for Research Foundation- Flanders (FWO) [11PGA24N
The MPAP/CO slope and oxygen uptake add prognostic value in aortic stenosis
No full textBackground: Guidelines redefined exercise pulmonary hypertension as a mean pulmonary artery pressure/cardiac output (mPAP/ CO) slope >3 mmHg/L/min. A systolic pulmonary artery pressure (peak sPAP) >60 mmHg during exercise has been associated with an increased risk of cardiovascular events in aortic valve stenosis (AS). The prognostic value of the mPAP/CO slope in AS remains unknown
The MPAP/CO slope and oxygen uptake add prognostic value in aortic stenosis
No full textBackground: Guidelines redefined exercise pulmonary hypertension as a mean pulmonary artery pressure/cardiac output (mPAP/ CO) slope >3 mmHg/L/min. A systolic pulmonary artery pressure (peak sPAP) >60 mmHg during exercise has been associated with an increased risk of cardiovascular events in aortic valve stenosis (AS). The prognostic value of the mPAP/CO slope in AS remains unknown
Exercise Echocardiography for mPAP/CO Slope Estimation
No full textWe read with interest the paper by Gargani et al 1 on the prognostic implications of exercise echocardiog-raphy of the right ventricle and pulmonary circulation. The value of exercise echocardiography for assessing the mean pulmonary artery pressure over cardiac output (mPAP/CO) slope has been a source of conjecture for many years. Particularly, its accuracy and feasibility have been debated, and so far, invasive determination of pulmonary pressures is typically deemed necessary for diagnosing exercise-induced pulmonary hypertension. However, the current study challenges this concept by elegantly demonstrating that noninvasive determination of the mPAP/CO slope, irrespective of its relation to invasive pressures, does provide major diagnostic and prog-nostic information. Acceptable feasibility is another essential requirement for the mPAP/CO slope to become widely adopted in daily practice. Although information regarding feasibility is not provided in the paper, based on the data provided, we could infer that the mPAP/CO slope was obtained in only 720 of 1,356 patients with survival data available. Limited feasibility of mPAP/CO slope estimation was also reported by a previous study, in which tricuspid regurgitation gradients could only be obtained during exercise in 34% of patients. 2 In our experience, the accuracy and feasibility of noninvasive mPAP/CO slope determination can be improved substantially by the use of FI GURE 1 Pulmonary Artery Pressure Measurement Using Colloid Enhancement of the TR Signal Agitated colloid administration (white arrow) improves exercise pressure estimation in a patient without a detectable TR signal. The dotted yellow line represents the echocardiographic estimation of right ventricular systolic pressure. TR ¼ tricuspid regurgitation
Non-invasive imaging in acute decompensated heart failure with preserved ejection fraction
No full textNon-invasive imaging plays an increasingly important role in emergency medicine, given the trend towards smaller, portable ultrasound devices, the integration of ultrasound imaging across diverse medical disciplines, and the growing evidence supporting its clinical benefits for the patient. Heart failure with preserved ejection fraction (HFpEF) provides a compelling illustration of the impactful role that imaging plays in distinguishing diverse clinical presentations of heart failure with numerous associated comorbidities, including pulmonary, renal, or hepatic diseases. While a preserved left ventricular ejection fraction might misguide the clinician away from diagnosing cardiac disease, there are several clues provided by cardiac, vascular, and lung ultrasonography, as well as other imaging modalities, to rapidly identify (decompensated) HFpEF. Congestion remains the primary reason why patients with heart failure (irrespective of ejection fraction) seek emergency care. Furthermore, comprehensive phenotyping is becoming increasingly important, considering the development of targeted treatments for conditions exhibiting HFpEF physiology, such as cardiac amyloidosis. Timely recognition in such cases has lasting implications for long-term outcomes.Funding
Sebastiaan Dhont is supported as predoctoral fundamental research fellow by the Fund for Scientific Research Flanders (FWO 11PGA24N)
Cardiopulmonary Exercise Testing With Simultaneous Echocardiography Blueprints of a Dyspnea Clinic for Suspected HFpEF
No full textDr Claessen is supported by the KOOR postdoctoral research mandate of University Hospitals Leuven. All other authors have reported ventricles are hyperdynamic and small, iCPET is needed for confirmation. In addition, patients with poor image quality in whom reliable stroke volume measurements and/or tricuspid valve regurgitation signals cannot be obtained should get an iCPET
Answer: Acute limb ischaemia and apical abnormality
No full textA 58-year-old man with peripheral artery disease and ischaemic pain at rest had signs of congestion. The electrocardiogram (ECG) showed normal sinus rhythm and reduced R-wave progression in the anterior lead. Echocardiography revealed a reduced left ventricular function, elevated left and right ventricular filling pressures, and an apical abnormality (see supplementary materials online)
Generalized Pairwise Comparisons to Assess Treatment Effects
No full textA time-to-first-event composite endpoint analysis has well-known shortcomings in evaluating a treatment effect in cardiovascular clinical trials. It does not fully describe the clinical benefit of therapy because the severity of the events, events repeated over time, and clinically relevant nonsurvival outcomes cannot be considered. The generalized pairwise comparisons (GPC) method adds flexibility in defining the primary endpoint by including any number and type of outcomes that best capture the clinical benefit of a therapy as compared with standard of care. Clinically important outcomes, including bleeding severity, number of interventions, and quality of life, can easily be integrated in a single analysis. The treatment effect in GPC can be expressed by the net treatment benefit, the success odds, or the win ratio. This review provides guidance on the use of GPC and the choice of treatment effect measures for the analysis and reporting of cardiovascular trials.The data supporting this study's findings on the simulation of the TAVR-UNLOAD trial are available upon request from the corresponding author at [email protected]. The data that support the findings of this study on the MATRIX study are available upon request from Dr Marco Valgimigli at [email protected]
Left Atrial Function as Predictor of Recurrent Stroke or Paroxysmal Atrial Fibrillation in Patients with Cryptogenic Stroke
No full textAssessment of Venous Congestion Using Vascular Ultrasound
No full text2023 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION PUBLISHED BY ELSEVIE
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