bluuebunny/crossref_metadata_2025_split huggingface dataset:
Right ventricular diastolic adaptation to pressure overload in different rat strains
Authors: Axelsen J , Andersen S , Ringgaard S , Nielsen-Kudsk J E , De Man F S , Andersen A 
Published: November 2023

Abstract

Background
Different rat strains are used in various animal models of pulmonary hypertension and right ventricular (RV) failure. No systematic assessment has been performed to test differences in RV response to pressure overload between rat strains.

Purpose
We compared RV adaptation to pulmonary trunk banding (PTB) in Wistar, Sprague Dawley, and Fischer344 rats by hemodynamic profiling focusing on diastolic function.

Methods
Age-matched male rat weanlings were randomized to sham operation (Wistar sham, n=5; Sprague Dawley sham, n=4; Fischer344 sham, n=4) or PTB (Wistar PTB, n=8; Sprague Dawley PTB, n=8; Fischer344 PTB, n=8). RV function was evaluated after five weeks by echocardiography, cardiac MRI, and invasive pressure-volume measurements and RV remodelling assessed by histological analyses.

Results
At end of study, Fischer344 rats weighed 25 % less than Wistar and Sprague Dawley rats. PTB increased RV systolic pressures four-fold, and RV failure was evident by a decrease in cardiac index (Wistar PTB: 1.8±0.2 mL/s/m2 vs. Wistar sham: 3.9±0.2 mL/s/m2, p&lt;0.0001; Sprague Dawley PTB: 1.7±0.1 mL/s/m2 vs. Sprague Dawley sham: 3.0±0.3 mL/s/m2, p=0.0029; Fischer344 PTB: 2.1±0.2 mL/s/m2 vs. Fischer344 sham: 3.8±0.3 mL/s/m2, p&lt;0.0001). There was a 2.4-fold increase in RV end-systolic volume index in Wistar PTB and Sprague Dawley PTB compared with sham, while Fischer344 PTB rats were less affected with only a 2.0-fold increase in RV end-systolic volume index compared with Fischer344 sham. Diastolic and right atrial impairment were evident by increased end-diastolic elastance, filling pressure, and E/e’ in PTB rats compared with sham, again Fischer344 PTB the least affected. PTB increased RV fibrosis in all groups compared with sham, though Fischer344 PTB showed a trend towards a smaller increase in RV fibrosis (Fischer344 PTB: 9.2±0.4 % vs Wistar PTB: 10.7±0.2 %, p=0.0919).

Conclusions
PTB caused RV failure in all rats subjected to the procedure including signs of diastolic dysfunction. Despite similar increase in RV systolic pressure, Fischer344 PTB rats showed less RV dilatation and where more able to sustain diastolic function compared with Wistar and Sprague Dawley PTB rats. All three rat strains are suitable for PTB and studies of RV failure.
Lung ultrasound, echocardiography and fluid loading for the differential diagnosis of pulmonary hypertension
Authors: D'alto M , Liccardo B , Di Maio M , Del Giudice C , Romeo E , Argiento P , Renon F , Vergara A , Di Vilio A , Bossone E , Rea G , D'andrea A , Gargani L , Golino P , Naeije R 
Published: November 2023

Abstract

Background
There may be interest in combining echocardiography and lung ultrasound for the differential diagnosis between pulmonary arterial hypertension (PAH) and post-capillary pulmonary hypertension on heart failure with preserved ejection fraction (PH-HFpEF).

Methods
Patients referred for PH underwent a right heart catheterization, echocardiography and lung ultrasound before and after rapid infusion of 7 ml/kg of saline. A 7-points echocardiographic score based on cardiac chamber dimensions and estimates of filling pressures was implemented for the prediction of pre-capillary PH. Pulmonary congestion was identified by lung ultrasound B-lines.

Results
The study enrolled 70 patients with PAH and 77 patients with HFpEF. The PAH patients had a higher echocardiographic score (3.5±1.8 v 1.6±1.5, p &lt;0.001).
Figure 1 represents the typical baseline echocardiographic components of pre-capillary pulmonary hypertension prediction score and pre- and post-fluid loading lung ultrasound imaging from patients with PAH and HFpEF respectively. The HFpEF patients had more B-lines both before (8.1±4.2 vs 5.1±3.0; p &lt;0.001) and after fluid loading (14.6±5.4 vs 7.6±3.5; p &lt;0.001), and a more important increase (Δ) of B-lines after fluid loading (6.5±2.9 vs 2.5±1.6; p &lt;0.001). The sensitivity and specificity of the echocardiographic score alone for PAH were 0.91 and 0.49 respectively [area under the curve (AUC) 0.78]. The AUC for PAH was improved by addition of smaller ΔB-lines to the echocardiography prediction score after fluid loading, with significant increase in sensitivity [0.94 (95% CI 0.89;1.00)] and specificity [0.91 (95% CI 0.84;0.97)] and a positive predictive value of 0.90 (CI 0.84;0.97) and a negative predictive value of 0.95 (CI 0.89;1.00).
Figure 2 represents the bar plot of AUC for echocardiographic score, pre- fluid loading B-lines, delta E/e', delta B-lines, post- fluid loading E/e', post- fluid loading B-lines, in ascending order.

Conclusion
Lung ultrasound combined with echocardiography at baseline and after fluid loading has an incremental value for the differential diagnosis between PAH and PH-HFpEF.Figure 1Figure 2
CMR imaging to study biventricular pacing effects on the right ventricle in left bundle branch block patients
Authors: Hopman L H G , Zweerink A , Van De Veerdonk M C , Van Der Lingen A C J , Huntelaar M J , Mulder M J , Robbers L F H , Van Rossum A C , Van Halm V P , Gotte M J W , Allaart C P 
Published: November 2023

Abstract

Background
Cardiac resynchronization therapy (CRT) is an established treatment strategy for selected patients with symptomatic heart failure, left ventricular (LV) systolic dysfunction, and a left bundle branch block conduction abnormality. The effect of CRT on right ventricular (RV) function and possible reverse remodeling however, is less well understood and conflicting data are present. Moreover, the difficulty to accurately measure RV hemodynamics non-invasively may also hamper research on RV function in CRT patients.
Recent development of cardiac magnetic resonance (CMR) conditional CRT-devices allows for proper patient follow-up as BIV-pacing can be performed during the CMR exam. Therefore, this study assesses the effects of BIV-pacing on change in RV volumes and function using CMR.

Methods
Ten patients eligible for CRT-D implantation according to the ESC guidelines were prospectively enrolled in this study. All patients underwent CMR imaging at baseline including cine imaging for volume and function assessment. Six weeks after CRT-D implantation, patients received a follow-up CMR scan which consisted of a two-staged imaging protocol. First, patients were scanned during BIV-pacing and thereafter the CRT was turned off and patients were scanned during intrinsic rhythm. RV end systolic volume (ESV), end diastolic volume (EDV), and ejection fraction (RVEF) were assessed on cine images. RV volumes and function before and after device implantation are compared using paired samples T-tests and results are displayed in the figure.

Results
RV ESV, EDV, and RVEF were not different at CRT-on as compared to baseline (ESV; 94.0±20.3ml vs. 88.9±21.1ml, p=0.44, EDV; 182.4±29.5ml vs. 175.1±22.8ml, p=0.37, and RVEF; 48.6±6.6% vs. 49.6±8.1%, p=0.75). Also, an acute deterioration in RVEF was observed when switching CRT-off (48.6±6.6% vs. 41.1±5.7%, p=0.02). Moreover, RV function was significantly worse during CRT-off compared to baseline in terms of RVEF (41.1±5.7% vs. 49.6±8.1%, p&lt;0.01) and higher volumes (ESV; 119.0±26.4ml vs. 88.9±21.1ml, p&lt;0.001, EDV; 200.8±34.2ml vs. 175.1±22.8ml, p&lt;0.01).

Conclusions
This study showed that RV hemodynamics did not benefit from CRT. Moreover, turning off CRT at follow-up had an instantaneous negative effect on RV function as compared to BIV-pacing, leading to even worse RV hemodynamics as compared to baseline measurements.
Value of exercise right heart catheterization for differential diagnosis of dyspnoea in chronic thromboembolic pulmonary disease
Authors: Huertas Nieto S , Velazquez Martin M V , Sarnago Cebada F , Manerio Melon N , Albarran Gonzalez-Trevilla A , Rivadulla Varela C , Jimenez Lopez-Guarch C , Aguilar Colindres R , Segura De La Cal T , Flox Camacho A , Cruz Utrilla A , Martin De Miguel I , Revilla Ostozala Y , Arribas Ynsaurriaga F , Escribano Subias P 
Published: November 2023

Abstract

Background and Purpose
Chronic thromboembolic disease (CTED) refers to chronic thrombotic pulmonary vascular occlusion in the absence of pulmonary hypertension (PH) at rest but functional limitation attributable to incipient vasculopathy. Our aim is to evaluate the hemodynamic response to exercise in patients with suspected CTED without relevant resting PH.

Methods
We prospectively included symptomatic patients with persistent pulmonary thrombosis despite optimal anticoagulant therapy for a minimum of 3 months. Patients with left heart disease and abnormal lung function tests were excluded. Patients included had mean pulmonary arterial pressure (mPAP ) ≤25 mmHg, pulmonary vascular resistance (PVR) &lt; 3 WU and pulmonary arterial wedge pressure (PAWP) ≤15 mmHg. Exercise right heart catheterization (RHC) was performed via supine cycle ergometry. Exercise precapillary PH was defined as mPAP/CO slope &gt;3 mmHg/l/min and PAWP/CO slope &lt;2 mmHg/l/min. We made a subanalysis of those patients who fulfilled the new definition of resting PH (mPAP&gt;20mmHg & PVR &gt; 2 WU)

Results
We studied 39 patients (mean age 52.7 ± 15.7 years, 36 % women): 12 of them met new resting PH criteria (mPAP &gt; 20 mmHg & RVP &gt; 2 WU) , and 27 had normal resting hemodynamic. Baseline characteristics are summarized in Table 1 and did not reveal differences between groups except for haemodynamic parameters. From the entire cohort, 20 patients developed exercise PH: 14 (36%) with a precapillary pattern, and in 6 (15.4%) patients, the abnormal response was described as an abnormal PAWP/CO relationship during exercise. Exercise precapillary PH was documented in 67% of patients with resting PH according to the new PH criteria versus 37% of those without resting PH (Figure 1).

Conclusion
The functional limitation appears to be attributable to exercise precapillary PH in 36 % of patients with CTED suspicion and absence of significant resting PH. Exercise RHC is a valuable tool for diagnosing CTED and detecting other causes of dyspnoea, such as diastolic dysfunction. New resting PH haemodynamic criteria predict a higher percentage of abnormal exercise response, but one-third of patients develop exPH despite normal haemodynamic at rest.
Comparative investigation of pulmonary vasodilating effects of inhaled Nitric Oxide (NO) gas therapy and inhalation of SIN-1, a new drug formulation containing an NO-donor metabolite
Authors: Olah A , Barta B A , Ruppert M , Sayour A A , Nagy D , Balint T , Nagy G V , Puskas I , Szente L , Szocs L , Zima E , Merkely B , Radovits T 
Published: November 2023

Abstract

Background
The management of acute pulmonary hypertension has recently been in the center of attention as Coronavirus Disease 2019 (COVID-19) might lead to acute respiratory distress syndrome associated with hypoxia-induced pulmonary vasoconstriction. Therefore inhalation therapy has been the object of several clinical trials.

Purpose
In this experimental study we aimed at investigating the hemodynamic effect of inhalative SIN-1a (3-morpholino-syndnonimine, the unstable active metabolite of molsidomine, stabilized by cyclodextrine) administration during physiological and pathological conditions in a large animal model.

Methods
Landrace pigs were randomized into the following experimental groups: iNO (inhaled nitric-oxide, n=3), SIN-1-5 (5 mg, n=3), SIN-1-10 (10 mg, n=3). Hemodynamic parameters were recorded after parallel insertion of PiCCO system and Swan-Ganz catheter. The effect of iNO and SIN-1 inhalation (30 min) was investigated under physiologic conditions and U46619, a thromboxane-receptor agonist induced pulmonary hypertension.

Results
The observed alterations after inhalation therapy were quite similar under physiological and pathological condition. Pulmonary arterial pressure (PAP) was decreased by all of these drugs, SIN-1-10 had similar effect as iNO (physiological contidiont: -36.1% iNO, -23.8% SIN-1-5, -35.5% SIN-1-10; U46619-induced pulmonary hypertension: -30.1% iNO, -22.1% SIN-1-5, -31.2% SIN-1-10). While iNO therapy did not influence the mean arterial pressure (MAP) and systemic vascular resistance (SVR) values, SIN-1 administration resulted in decreased MAP and SVR values. Pulmonary vascular resistance (PVR) was decreased by iNO greater than with using SIN-1. As a result of these alterations, the PVR/SVR ratio decreased markedly in the iNO group, while it was stepwisely increased in the SIN-1-5 and SIN-1-10 group.

Conclusion
The pulmonary vasodilator effect of SIN-1 was dose dependent, and in case of larger dose it was comparable to that of iNO. However, the vasodilatory effects of SIN-1 inhalation was not limited to the pulmonary circulation, a significant and dose-dependent systemic vasodilation could also be documented.
PAH-specific treatment for patients with combined pre- and post-capillary pulmonary hypertension
Authors: Hofbauer T , Gerges C , Skoro-Sajer N , Sadushi-Kolici R , Prihoda M , Ondracek A S , Lang I M 
Published: November 2023

Abstract

Introduction
Pulmonary hypertension (PH) due to left heart disease (PH-LHD) is the most frequent form of PH, constituting approximately 70% of PH patients. Depending on the extent of pressure increase in the pre-capillary bed, PH-LHD is divided into isolated post-capillary PH, where pulmonary vascular resistance (PVR) is ≤2 WU, and combined pre- and post-capillary PH (Cpc-PH), where PVR exceeds 2 WU. Compared to Ipc-PH, Cpc-PH portents substantial morbidity and poor prognosis. Current PH guidelines recommend optimal treatment of underlying pathology, with drugs approved for pulmonary arterial hypertension (PAH) being not recommended; however, therapeutic regimens specifically targeting increases in pre-capillary pressure are urgently required.

Methods
For this analysis, we included all patients diagnosed with Cpc-PH invluding using right heart catheterization, who presented at the PH outpatient clinic of the Medical University of Vienna, Austria, between 02/2022 and 02/2023. Cpc-PH was defined hemodynamically as an elevated mean pulmonary arterial pressure (mPAP) of &gt;20 mmHg and a PVR &gt;2 WU.

Results
A total of 30 (6.5%) patients were diagnosed with Cpc-PH. Of these, 21 (70%) were female; median age was 75 [70, 76] years. Cardiovascular risk factors were arterial hypertension in 27 (90%), diabetes mellitus in 7 (23%), hyperlipidemia in 22 (73%), atrial fibrillation in 24 (80%), chronic kidney disease in 21 (70%), and coronary artery disease in 13 (43%) patients.
At diagnosis, median mPAP was 42 [36, 53] mmHg, with a PVR of 5.5 [3.4, 5.3] WU. Laboratory evidence of heart failure was illustrated by elevated NT-proBNP levels (2076 [1461, 3959] pg/mL). Transthoracic echocardiography showed mildly, moderately and severely reduced right ventricular (RV) function in 7 (23%), 9 (30%) and 3 (10%) patients. At diagnosis, 6 (20%), 20 (67%) and 4 (13%) patients were in WHO functional class II, III and IV, respectively.
PAH-specific therapy was initiated in 11 (37%) patients: 7 (23%) were put on treprostinil, 4 (13%) on macitentan, 3 (10%) on riociguat, and 3 (10%) on sildenafil. In 3 (10%) patients, combination therapy was started; one (3%) patient received triple therapy. In patients in whom PAH-specific therapy was initiated, PVR at baseline was higher (6.9 [5.4, 9.9] vs. 4.9 [3.1, 5.9] WU, p=0.019). Patients on PAH-specific therapy had a higher rate of improvement in WHO-FC at follow-up (82% vs. 31%, p=0.019).

Conclusions
In patients suffering from Cpc-PH, PAH-specific therapy leads to improvement of symptoms. Further studies are required to extend this finding to a larger patient group to assess whether PAH-specific drugs may also improve hemodynamics, right ventricular function and mortality.
Impact of triple vasodilator therapy on prognosis stratification of pulmonary arterial hypertension associated with congenital heart disease
Authors: Luna R , Segura De La Cal T , Sarnago Cebada F , Salguero R , Arribas F , Escribano Subias P 
Published: November 2023

Abstract

Background
Pulmonary arterial hypertension (PAH) affects 5-10% of congenital heart disease (CHD) patients but there is limited information on the effect of combination therapy in these patients. The aim of this study was to assess the effect of triple therapy (TT) with prostacyclins on the risk status of patients with PAH-CHD.

Methods
A retrospective, longitudinal, cohort study of patients with PAH-CHD under active follow-up in our center. All patients were receiving baseline dual therapy at maximum doses. A simplified global risk assessment according to the 2022 PAH guidelines was performed prior to initiation of treatment, and at subsequent annual follow-up for 2 years, including functional class, 6-minute walk test and NT proBNP.

Results
60 patients were included (median age 41, 31 women 61%). 32 had Eisenmenger syndrome, 9 had coincidental shunts, 18 had postoperative PAH, and 1 had a significant L-R shunt. TT was initiated based on the clinical situation, existence of shunt and ease of administration (epoprostenol 20%, treprostinil 41%, selexipag 32%, iloprost 7%). The use of triple therapy in patients with PAH-CHD demonstrated a significant overall improvement in risk status one year after initiation of treatment (p&lt;0.05), which was maintained two years after initiation (Figure 1). Only four deaths and one lung transplantation occurred within this intermediate-high baseline risk PAH group. The estimated 2-year survival among those who completed treatment was 90%.

Conclusions
The use of triple therapy vasodilator treatment in patients with PAH-CHD demonstrates an overall improvement in risk status maintained over 2 years in line with that observed in other types of PAH.Evolution of the risk situation
Incidence and predictors of in-stent restenosis following intervention for pulmonary vein stenosis due to fibrosing mediastinitis
Authors: Cao C , Jia J , Su S , Jiang J , Wang W , Guo G , Zhu Z , Zhang Z 
Published: November 2023

Abstract

Background
Percutaneous transluminal pulmonary venoplasty (PTPV) is an emerging treatment for pulmonary vein stenosis caused by fibrosing mediastinitis (PVS-FM). However, the incidence and predictors of in-stent restenosis (ISR) are elusive.

Purpose
We aim to identify the incidence and predictors of ISR in patients with pulmonary vein stenosis (PVS) caused by extra-luminal compression due to fibrosing mediastinitis (FM).

Methods
We enrolled patients with PVS-FM who underwent PTPV between 2018 and 2022. Patients were divided into ISR and non-ISR groups based on the presence of ISR. Baseline characteristics (demographics and lesions) and procedure-related information were abstracted from patient records and analyzed. Univariate and multivariate analyses were performed to determine the predictors of ISR.

Results
A total of 109 stents were implanted in 102 PVs of 50 patients with PVS-FM. Over a median follow-up of 4.0 months (interquartile range: 3.0 to 11.0 months), there were 47 of 102 PVs suffered from ISR. The cumulative ISR was 3%, 12%, 42%, and 50% at 1-, 3-, 6-, and 12-month follow-up, respectively. Multivariate analysis demonstrated a significantly lower risk of ISR in PVs with a larger reference vessel diameter (RVD) (OR 0.64, 95%CI 0.48-0.86, p = 0.002) and the narrowing severity of the corresponding pulmonary artery (Cor-PA) (severe) independently increased the risk of ISR (OR 6.63, 95%CI 1.82-24.18, p = 0.004), respectively.

Conclusions
ISR is very high in PVS-FM, which is independently associated with Cor-PA stenosis and RVD.
Acute effect of balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension
Authors: Yanaka K , Taniguchi Y , Miwa K , Fujii H , Yoneda S , Nakayama K , Emoto N , Hirata K 
Published: November 2023

Abstract

Background
Pulmonary endarterectomy is known to improve hemodynamics in the early postoperative period on chronic thromboembolic pulmonary hypertension (CTEPH). However, there are no reports of early hemodynamic changes after balloon pulmonary angioplasty (BPA) for CTEPH.

Purpose
The aim of this study was to clarify early hemodynamic changes of BPA. Furthermore, we investigated whether the early hemodynamic changes were related to the chronic phase hemodynamics after final BPA.

Methods
We retrospectively enrolled 43 consecutive CTEPH patients placed Swan-Ganz catheter for hemodynamic monitoring at first BPA. Hemodynamics were evaluated immediately before (Pre), immediately after (Post), 3 hours, 6 hours, 9 hours, 12 hours, and 1 week after BPA. The hemodynamics in the chronic phase after final BPA were confirmed in each group in which the mean pulmonary artery pressure (mPAP) did not decrease immediately after BPA and 12 hours later.

Results
Although mPAP improved immediately after BPA, no change were observed thereafter and significant improvement were observed after 6 hours (Figure). While, cardiac output rose immediately and reached a peak 6 hours later. Then, it decreased and returned to value of Post after 1 week (Figure). MPAP/CO continued to decrease after BPA until 12 hours later (Figure). There were 16 and 8 cases in which mPAP did not decrease immediately after BPA and 12 hours later. However, mPAP in 16 and 8 cases became less than 20mmHg in the chronic phase (mPAP: Post; 28.5±7.3 to 19.6±5.6 mmHg, P&lt;0.001, 12 hours; 26.0±7.8 to 17.8±3.5, P=0.02)

Conclusion
While mPAP after BPA decreased after 6 hours, there were a temporary rise in CO. Improvement can be obtained in the chronic phase after final BPA even if mean PAP did not decrease during the acute phase.