bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reappraisal of echocardiographic algorithm in predicting the pulmonary hypertension redefined by updated pulmonary artery mean pressure treshold
Authors: Tanyeri S , Tokgoz H C , Karagoz A , Akbal O Y , Keskin B , Kultursay B , Hakgor A , Kulahcioglu Ş , Ceneli D , Tosun A , Efe S C , Bayram Z , Tanboga I H , Ozdemir N , Kaymaz C 
Published: October 2022

Abstract

Background
Although an adopted echocardiography algorithm based on tricuspid regurgitation jet peak velocity (TRVmax) and suggestive findings (SF) for pulmonary hypertension (PH) has been utilized in the non-invasive prediction of PH probability, reliability of this approach for updated hemodynamic definition of PH remains to be determined.

Aims
In this study, first time, we aimed to evaluate the TRVmax and SF in predicting the probability of PH as defined by mean pulmonary arterial pressure (mPAP) &gt;20 mm Hg and mPAP &gt;25 mm Hg, respectively.

Methods
Our study group comprised of the retrospectively evaluated 1300 patients (age 53.1±18.8 years, female 62.1%) who underwent right heart catheterisation (RHC) with different indications between 2006 and 2018. All echocardigraphic and RHC assessments were performed in accordance with European Society of Cardiology (ESC)/European Respiratory Society (ERS) 2015 PH Guidelines.

Results
Although TRVmax showed a significant relation with mPAP in both definitions, SF offered significant contribution for only in predicting mPAP &gt;25 mm Hg, but not for mPAP &gt;20 mm Hg. In predicting the mPAP &gt;20 mm Hg TR Vmax and SF showed odds ratio (OR) of 2.57 (1.59–4.14, p&lt;0.001) and OR of 1.25 (0.86–1.82, p=0.16), respectively (Table 1). In predicting the mPAP &gt;25 mm Hg, TR Vmax and SF showed OR of 2.33 (1.80–3.04, p&lt;0.001) and OR of 1.54 (1.15–2.08, p&lt;0.001), respectively (Table 1). The TRVmax &gt;2.8 m/sec and TRVmax &gt;3.4 m/sec were associated with 70% and 84% probability of mPAP &gt;20 mm Hg, and 60% and 76% probability of mPAP &gt;25 mm Hg, respectively (Figure 1).

Conclusions
In contrast to those in predicting the mPAP &gt;25 mm Hg, SF did not provide a significant contribution to probability of mPAP &gt;20 mm Hg predicted by TRVmax solely. The impact of the novel mPAP treshold on echocardiographic prediction of PH remains to be clarifed by future studies.

Funding Acknowledgement
Type of funding sources: None.
Differences in the respiratory swings in COPD and ILD candidates for lung transplantation: a critical concern interpreting central pulmonary pressures
Authors: Grignola Rial J , Calabuig A , Trujillo P , Bravo C , Casas G , Azpiroz F , Lopez Messeguer M , Domingo E 
Published: October 2022

Abstract

Background
In different clinical scenarios (i.e., obesity, COPD, exercise, mechanical ventilation), the swings in intrathoracic pressure are much larger, and end-expiratory (Pee) pressure can be significantly greater than atmospheric pressure. In these scenarios, the intravascular (Piv) pulmonary pressure can overestimate the true transmural (tm) value and it is recommended to read the average of Piv over a few respiratory cycles (Pmrc) [1–3].

Purpose
To analyze the respiratory swings and the effect of esophageal pressure (PES) (as a surrogate of intrathoracic pressure) on the reading of Piv tracings during the RHC at rest in COPD and interstitial lung disease (ILD) candidates for lung transplantation (LTx).

Methods
Thirty-one COPD (15) and ILD (16) candidates for LTx underwent RHC. End-expiratory and mean respiratory cycle measurements were obtained. The respiratory swing was estimated as the difference between maximum-minimum values of Piv. Ten patients (5 COPD/5 ILD) underwent simultaneous RHC and PES (Micro-balloon Esophageal Catheter, LATITUDE) to assess the Ptm (Piv − PES) [4].

Results
Both demographic (11F/20M, 60±7 yrs, 25±4 kg/m2) and hemodynamic data (mPAP 24±9 mmHg, pulmonary arterial occlusion pressure [PAOP] 8.6±4 mmHg, right atrial pressure [RAP] 5.2±3.9 mmHg, pulmonary vascular resistance 3.5±2.6 Wu) did not show significant differences between ILD and COPD except the cardiac index (ILD: 2.8±0.8 vs. COPD: 2.4±0.3 L/min/m2). Intravascular RAPee and PAOPee were higher than mrc values in both groups (Fig 1). However, transmural RAPee and PAOPee were similar to and correlated with (r=0.62 and 0.69, respectively; p&lt;0.05) transmural Pmrc values. PESee values were positive in COPD and ILD (3.0±2.2 vs. 3.3±2.0 mmHg, NS). All ILD had negative PESmrc values and were lower than COPD patients (−1.76±1.7 vs. 0.78±1.6 mmHg, p&lt;0.05). ILD PES swings were higher than COPD (10.9±3.7 vs. 8.3±1.4 mmHg), although it did not reach statistical significance (p=0.08). The lower forced vital capacity (%), the more negative the PESmrc (Fig 2A). ILD pts showed higher transmural to intravascular Pmrc (p&lt;0.05) (Fig 2B).

Conclusion
End-expiratory intravascular RAP and PAOP overestimates the mean respiratory cycle pressures in COPD and ILD candidates for LTx. Averaging pulmonary vascular pressure tracings over the respiratory cycle would be accurate in COPD but could underestimate transmural values in ILD candidates for LTx. The reading of mean respiratory cycle pressure could not be enough to correct the pulmonary pressures measurement error associated with the presence of large swings of intrathoracic pressure.

Funding Acknowledgement
Type of funding sources: None.
Role of combined exercise stress echocardiography and cardiopulmonary exercise test in chronic thromboembolic disease
Authors: Kim M S , Jeon K N , Lee S C , Yang J H , Kim E K , Park S J , Park S W , Chang S A 
Published: October 2022

Abstract

Background
Chronic thromboembolic pulmonary disease (CTEPD) without pulmonary hypertension could cause significant exercise limitations. However, interventional or surgical treatments for CTEPD with mild pulmonary hypertension or normal pressure are on controversy.

Purpose
We aimed to evaluate cardiopulmonary function through cardiopulmonary exercise test (CPET) with stress echocardiography and to determine whether exercise pulmonary hypertension can explain exercise limitations in CTEPD patients with mPAP &lt;30mmHg.

Methods
Patients diagnosed as CTEPD with mPAP less than 30mmHg was derived from our pulmonary hypertension center registry from April 2014 to October 2021.Transthoracic echocardiography (TTE) was performed at baseline (resting state) and immediately after CPET. TTE derived parameters and CPET parameters were compared with hemodynamic parameters measured by right catheterization.

Results
Total 37 patients were enrolled. Of these, Thirty-five patients had previously been diagnosed with CTEPH and had undergone PEA, BPA, or both. Most of the patients complained dyspnea of WHO functional class II or III. Pulmonary vascular resistance (PVR) was slightly higher than normal (185.0±102.2 dyne sec cm–5). Also VO2max was decreased in CPET (23.1±6.5 mL/kg/min). In correlation analysis, the higher the mPAP and PVR at rest, the lower VO2max during exercise. Meanwhile basal right ventricular (RV) function was normal, an increase in RVSP was notably observed during exercise (RVSP: pre-exercise 36.2±11.9, post-exercise 60.7±19.3, p value &lt;0.001). Furthermore RV function deteriorated during exercise (TAPSE: pre-exercise 16.1±4.8, post-exercise 12.9±5.0, p value &lt;0.001).

Conclusions
CTEPD patients with mild or normal PAP showed limited exercise capacity with exercise induced hypertension. Even in the mPAP less than 30mmHg, PVR and mPAP was significantly associated with exercise capacity. CPET with stress echocardiography could help to identify the main cause of exercise limitation in CTEPD patients and possibly provide the guideline for treatment plan.

Funding Acknowledgement
Type of funding sources: None.
Added prognostic value of cardiopulmonary test variables in low-risk pulmonary artery hypertension patients
Authors: Luna R , Martinez Menaca A , Otero Escudero M , Segura De La Cal T , Flox A , Arribas Ynsaurriaga F , Escribano Subias P 
Published: October 2022

Abstract

Background
Pulmonary artery hypertension (PAH) results in progressive right heart failure, functional decline and finally death or the need for a lung transplant. Prognostic assessment based on a 6-minutes walking test (6MWT) may be insufficient due to the possibility of a ceiling effect, especially in young patients.

Purpose
To demonstrate the added prognostic value of functional assessment by cardiopulmonary exercise testing (CPET) in patients with a low-risk 6MWT.

Methods
We conducted a retrospective cohort study in patients with PAH referred to two centres between June 2006 and December 2021, who met the following criteria: PAPm ≥25 mmHg, PCP≤15 mmHg, PVR &gt;3 UW, age&gt;18 years and had a CPET performed in the same week as the 6MWT. For CPET variables showing statistical significance, optimal cut-off points were determined. The kappa statistic was used to test interrater reliability between low-risk classification with CPET and the 6-minute test using the Kappa index. Finally, the added prognostic power of CPET variables was assessed in low-risk patients according to TM6D (defined as &gt;440 metres) by survival analysis.

Results
We included a total of 313 patients (27% male). 116 patients (64.8%) walked more than 440 metres at TM6D, this subgroup being significantly younger than those who walked less than 440 metres (42±11 vs 48±16 years) and with a higher proportion of men (34.8% vs 23.4%). In patients who walked more than 440 metres, we applied the CPET model associated with prognosis according to the optimal cut-off points obtained (Eq CO2 VT1 ≥41 and/or peak VO2 &lt;15 ml/kg/min). Of the 116 patients classified as good prognosis by the 6MWT, 84 patients (72%) had altered CPET prognostic values. No substantial reliability was demonstrated between the low-risk classification by CPET and 6MWT (K&lt;0.6 in all cases). Kaplan-Meier survival analysis showed that patients with had Eq CO2 VT1 ≥41 and peak VO2 &lt;15 ml/kg/min had a worse prognosis at 5-year follow-up, despite walking more than 440m 6MWT (Figure 1).

Conclusion
Young patients may have a good-prognosis 6MWT and, however, be at high-risk of adverse events. A combination of CPET variables has a good predictive value for survival in low-risk 6MWT patients. Performing a CPET is mandatory in these patients to adequately stratify risk.

Funding Acknowledgement
Type of funding sources: None.
Human umbilical cord mesenchymal stem cells attenuate experimental pulmonary arterial hypertension
Authors: Dai H L , Lu X T , Guang X F 
Published: October 2022

Abstract

Background
Pulmonary arterial hypertension (PAH) is characterized by the remodeling of pulmonary arteries, with an increased pulmonary arterial pressure and right ventricle (RV) overload. Until now, there is still a lack of effective treatment applied. Experimental research has reported beneficial effects of mesenchymal stem cells (MSCs) therapy in PAH. However, there are few studies on human umbilical cord mesenchymal stem cells (hUC-MSCs) transplantation in the treatment of PAH.

Purpose
The purpose of the present study was to observe the protective effect of hUC-MSCs against experimental PAH and the colonization of hUC-MSCs in lung tissue.

Methods
Sprague Dawley rats were randomly divided into three groups: control group, monocrotaline (MCT)-induced PAH group, and stem cell therapy group (PAH+ hUC-MSCs). Rats with PAH were induced by a one-time intraperitoneal injection of 60mg/kg monocrotaline (PAH and PAH+hUC-MSCs groups) at the beginning of the experiment, while a control group received saline (SAL) instead. Huc-Mscs were treated by tail vein injection twice 1 and 2 weeks later (PAH+huc-MSC group dose: 3x106/each time), Ctr and PAH groups were given the same volume of SAL in tail vein. On day 28, Right ventricular systolic pressures (RVSP) were measured by right cardiac catheterization. WT% and WA% of pulmonary arterioles were evaluated by ipp6.0 Image Analysis Software. Right ventricular hypertrophy index (RVHI) were measured by weighing method. The colonization of hUC-MSCs in lung tissue was detected by immunohistochemistry.

Results
The RVHI and RVSP in MCT-induced PAH group were significantly higher than those in the control group (P&lt;0.05). Compared with the control group, the WT% and the WA% were significantly increased in MCT-induced PAH group (P&lt;0.05). The RVHI, RVSP, WT%, and the WA% in stem cell therapy group were significantly lower than those in the MCT-induced PAH group (P&lt;0.05). Immunohistochemical examination of lung tissue showed that the nuclear staining of the stem cell therapy group was brown, while no staining was observed in the control group and PAH group.

Conclusions
In MCT-induced PAH, hUC-MSCs can transplanted into the lung tissues by tail vein injection. hUC-MSCs therapy can reduced lung vascular remodeling, improved hemodynamics.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): National Natural Science Fundation of China (82060018) and Natural Science Fundation of Yunnan (202101AS070043, 202102AA31003-7).
High incidence of pulmonary artery thrombosis after balloon pulmonary angioplasty in CTEPH patients receiving direct oral anticoagulants
Authors: Suetomi T , Shimokawahara H , Fukuda Y , Kanezawa M , Suruga K , Hayashi K , Miyagi A , Kobashi S , Sugiyama Y , Shigetoshi M , Tabuchi I , Ogawa A , Watanabe A , Matsubara H 
Published: October 2022

Abstract

Background
Chronic thromboembolic pulmonary hypertension (CTEPH) requires life-long anticoagulant therapy, whereas limited data exist on the safety and efficacy of direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) along with balloon pulmonary angioplasty (BPA).

Objectives
To evaluate outcomes and complications in CTEPH following BPA for individuals receiving DOACs or VKAs.

Methods
Consecutive CTEPH patients underwent BPA from September 2014 to August 2021 were included in a retrospective analysis. Complications during BPA, post-BPA hemodynamics and bleeding events were obtained from patient's medical records. Our routine follow-up “selective” pulmonary angiography, to evaluate all segmental pulmonary arteries one by one at six months and every year after final BPA session, was performed to elucidate the incidence of in-situ fresh floating thrombus.

Results
Of total 250 individuals, 104 were treated with DOACs and 146 with VKAs following BPA. Mean observation period was 905 (SD ± 660) days. Total 1278 BPA sessions were performed among the period in which 409 sessions were treated with DOACs and 869 sessions with VKAs. Significant improvements in hemodynamics and functional status were observed in both groups following BPA. There was no significant difference of hemoptysis during BPA between DOACs and VKAs (7.1% vs 10.1%, P=0.131). Major bleeding events during observation period were equivalent in those treated with DOACs and VKAs. No significant re-elevation of pulmonary artery pressure was observed in both groups after BPA. Follow-up selective pulmonary angiography identified in-situ fresh floating thrombus in pulmonary artery in 22 cases of total 769 follow-up sessions. The occurrence of fresh thrombus was significantly higher in those receiving DOACs than VKAs in therapeutic range of PT-INR &gt;1.8 (3.9% vs 1.2%, P=0.023) whereas no significant difference between DOACs and overall VKAs (3.9% vs 2.4%, P=0.177)

Conclusions
Post-BPA hemodynamic outcomes and bleeding events appear unaffected by choice of anticoagulant. However, the incidence of in-situ pulmonary thrombosis detected by selective pulmonary angiography was significantly higher in those receiving DOACs than VKAs in therapeutic range, suggesting inadequate anticoagulation under current dose of DOACs. Our study provides a rationale for further examination to evaluate the efficacy of DOACs in CTEPH.

Funding Acknowledgement
Type of funding sources: None.
COVID-19 infection and its impact on case-fatality in patients with pulmonary embolism
Authors: Hobohm L , Sagoschen I , Barco S , Farmakis I , Fedeli U , Koelmel S , Gori T , Espinola-Klein C , Munzel T , Konstantinides S , Keller K 
Published: October 2022

Abstract

Background
Although a high prevalence of pulmonary embolism (PE) has been reported as a complication during severe COVID-19 infections in critical ill patients, nationwide data of hospitalized patients with COVID-19 with PE is still limited. Thus, we sought to analyze seasonal trends and predictors of in-hospital case-fatality in patients with COVID-19 and PE in Germany.

Methods
We used the German nationwide inpatient sample to analyze all data on hospitalizations for COVID-19 patients with and without PE in Germany during the year 2020 and to compare changes of PE prevalence to 2019.

Results
We analyzed data of 176,137 hospitalizations because of COVID-19 in 2020. Among those, PE was recorded in 1.9% (n=3,362) of discharge or death certificates. Almost one third of patients with COVID-19 and PE died during the in-hospital course (28.7%). The case-fatality rate increased with patients' age peaking in the 9th life-decade. Regardless of COVID-19, 196,203 inpatients were diagnosed with PE in Germany between 2019 and 2020. The number of PE hospitalizations were widely equally distributed between both years (98,485 vs. 97,718), while the case-fatality rate of all patients with PE was slightly lower in 2019 compared to 2020 (12.7% vs. 13.1%, P&lt;0.001). In contrast, considerable differences in prevalence and case-fatality were demonstrated in 2020 regarding PE patients with and without COVID-19 infection (28.7% vs. 13.1%, P&lt;0.001) (Figure 1). A COVID-19-infection was associated with a 2.8-fold increased risk of case-fatality in patients with PE (OR 2.81, 95% CI 1.66–2.12, P&lt;0.001).

Conclusions
In Germany, the prevalence of PE events complicating hospitalizations was similar in 2019 and 2020. However, the fatality rate among patients with COVID-19-associated PE was substantially higher than that in those without either COVID-19 or PE, indicating an additive prognostic effect of these two conditions.

Funding Acknowledgement
Type of funding sources: None.
Right ventricular and left ventricular diameters are independent predictors of death or cardiopulmonary resuscitation in intermediate and high-risk pulmonary embolisms
Authors: Kanwal A , Bali A , Isath A , Hassanin A , Malekan R , Goldberg J , Spevack D 
Published: October 2022

Abstract

Background
Increased right ventricular (RV) dilation measured by the ratio of RV diameter (RVD) to left ventricular (LV) diameter (LVD) (RV:LV) is associated with pulmonary embolism (PE) severity and mortality. Data regarding the individual contributions of RVD and LVD are limited.

Purpose
To examine RVD and LVD as independent contributors to death or need for cardiopulmonary resuscitation (CPR) in intermediate- or high-risk PEs treated with surgical or catheter-based strategies

Methods
We measured basal RVD and LVD on presenting transthoracic echocardiograms (TTE) using the diastolic 4-chamber view on 127 PEs managed with surgical embolectomy (n=95, 75%), extracorporeal membrane oxygenation (n=23, 18%), or catheter-directed embolectomy (n=9, 7%) for intermediate- (64%) or high-risk (36%) PE (based on European Society of Cardiology criteria) between 2005 and 2022. The primary outcome was the composite of death (n=2) or survivors requiring CPR (n=10).

Results
A total of 127 patients were analyzed. Subjects were 57±14 years, 38% women, BMI 34±8. Mean RVD and LVD were 4.4±0.9 cm and 3.9±0.8 cm respectively. All presented with severe RV dysfunction on TTE and elevated cardiac biomarkers (Troponin-I or B-type natriuretic peptide). Mean RV:LV was 1.2±0.3 (range 0.7 to 2.8). Using logistic regression, higher RV:LV was associated with increased odds of death or CPR (odds ratio (OR) 15 [95% confidence interval (CI): 2.5, 82] per 1-unit increase, p=0.002. RV:LV &gt;1.2 was the cutoff most associated with death or CPR, OR 7.2 [95% CI: 1.5, 34.5], p=0.01. Increasing RVD [OR 3.8 (95% CI: 1.1, 12.8), p=0.03] and decreasing LVD [OR 4.9 (95% CI: 1.3, 16.9), p=0.02] were independent predictors of death or CPR. RVD &gt;5.0 cm (OR 5.9 [95% CI: 1,5, 23.2], p 0.01) and LVD &lt;3.6 cm (OR 7.0 [95% CI: 1.7, 27.9], p=0.006) were the cutoff values most associated with the primary outcome. These cutoff values remained significant predictors even after adjustment for body surface area. Other parameters or RV size and function (diastolic area, systolic area and fractional area change) did not predict death or CPR. All of the subjects meeting the primary outcome had high-risk PE.

Discussion
In addition to RV:LV greater than 1.2, RVD and LVD were independently associated with death or CPR among high- or intermediate risk PEs. The independent contribution of declining LVD on PE mortality is a novel finding and highlights PE associatient LV pathophysiology (hyperdynamic and underfilled) antecedent to hemodynamic collapse. PE literature focuses on RV dilation as a predictor of PE mortality. LVD may represent a useful measure to risk stratify PE patients and predict hemodynamic decompensation.

Funding Acknowledgement
Type of funding sources: None.
Exercise hemodynamics by echocardiography and right heart catheterization in patients with chronic thromboembolic pulmonary disease
Authors: Dhayyat A , Mykland Hilde J , Jervan O , Stavem K , Ghanima W , Melsom M N , Steine K 
Published: October 2022

Abstract

Background
Chronic thromboembolic pulmonary hypertension (CTEPH) is an important cause of pulmonary hypertension (PH). A subclinical form of PH is referred to as exercise-induced pulmonary hypertension (EIPH), and its prevalence in patients with chronic thromboembolic pulmonary disease (CTEPD) without pulmonary hypertension at rest is unknown.

Purpose
To explore the occurrence of exercise-induced pulmonary hypertension (PH) in patients with CTEPD and compare exercise echocardiography with right heart catheterization (RHC).

Methods
In total, 16 patients with CTEPD, all diagnosed after pulmonary embolism, underwent exercise echocardiography and exercise RHC with dynamic supine leg exercise using a cycle ergometer. CTEPH at rest was defined as mean pulmonary artery pressure (mPAP) &gt;20 mmHg and pulmonary vascular resistance (PVR) ≥3WU. EIPH by RHC was defined as mPAP &gt;30 mmHg with total pulmonary resistance (TPR) ≥3 WU. Based on these criteria, our patients with CTEPD are presented by a flow chart (Figure 1). Systolic pulmonary artery pressure by echocardiography was calculated by tricuspid regurgitation peak velocity (TR V max) and the Bernoulli formula: 4 × (TR V)2. The RHC examination followed the exercise echocardiography within 2 hours. Groups were compared with independent sample t-test.

Results
Four patients (25%) were diagnosed with EIPH by exercise RHC. Patients with EIPH had a mean mPAP at peak exercise of 40.5 mmHg (range 38 to 43mmHg) and TPR of 3.7 WU (range 3.0 to 4.3 WU). The same patients also had a higher TR V max at peak exercise during exercise echocardiography compared to the patients without EIPH (Table 2). None of the patients had signs of elevated left-sided filling pressure during exercise by RHC, and none had left ventricular diastolic dysfunction during exercise by echocardiography.

Conclusion
In total, 4 of 16 patients with CTEPD were diagnosed with EIPH. The same four patients also had abnormal pulmonary artery pressure rise during exercise echocardiography and invasive RHC. These findings suggest that exercise echocardiography may be useful for screening patients with CTEPD and suspected EIPH.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Ostfold Hospital Trust