A noninvasive algorithm to exclude pre-capillary pulmonary hypertension

Bonderman, Diana; Wexberg, Paul; Am, Martischnig; Heinzl, Harald; Mb, Lang; Sadushi, Roela; Skoro-Sajer, Nika; Im, Lang

doi:10.1183/09031936.00089610

Cited by 101 publications

(82 citation statements)

References 51 publications

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“…Our model differs from the study by BONDERMAN et al [35], as we specifically aimed to identify LHF as alternative cause of PH, whereas the model of BONDERMAN et al [35] aimed to exclude PAH and included patients with normal pulmonary pressures. Considering this, and as logistic regression models have better predictive characteristics compared to regression trees, the model of BONDERMAN et al [35] and our own model may have additional value in reducing the need for RHC [36]. The LHF patient cohort in our study displays specific characteristics, with relatively elevated PVR and pulmonary artery pressures.…”

Section: Figurementioning

confidence: 64%

Section: Figurementioning

confidence: 99%

“…BONDERMAN et al [35] showed that in the absence of right ventricular strain and, subsequently, an NT-proBNP level ⩽80 pg·mL , PAH can be excluded. Our model differs from the study by BONDERMAN et al [35], as we specifically aimed to identify LHF as alternative cause of PH, whereas the model of BONDERMAN et al [35] aimed to exclude PAH and included patients with normal pulmonary pressures. Considering this, and as logistic regression models have better predictive characteristics compared to regression trees, the model of BONDERMAN et al [35] and our own model may have additional value in reducing the need for RHC [36].…”

Section: Figurementioning

confidence: 99%

“…Validation in community hospitals is warranted before use of the model is recommended outside PH centres. BONDERMAN et al [35] developed a decision tree to exclude PAH, relying on the Chi-squared automatic interaction detection procedure; two out of 28 clinical, echocardiographic or ECG parameters were automatically identified (right ventricular strain on ECG, defined as ST-segment deviation and T-wave inversion in leads V1-V3; and N-terminal pro-brain natriuretic protein (NT-proBNP) with a cut off of 80 pg·mL…”

Section: Figurementioning

confidence: 99%

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Noninvasive identification of left-sided heart failure in a population suspected of pulmonary arterial hypertension

et al. 2015

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Exclusion of pulmonary hypertension secondary to left-sided heart disease (left heart failure (LHF)) is pivotal in the diagnosis of pulmonary arterial hypertension (PAH). In case of doubt, invasive measurements are recommended. The aim of the present study was to investigate whether it is possible to diagnose LHF using noninvasive parameters in a population suspected of PAH. 300 PAH and 80 LHF patients attended our pulmonary hypertension clinic before August 2010, and were used to build the predictive model. 79 PAH and 55 LHF patients attended our clinic from August 2010, and were used for prospective validation.A medical history of left heart disease, S deflection in V1 plus R deflection in V6 in millimetres on ECG, and left atrial dilation or left valvular heart disease that is worse than mild on echocardiography were independent predictors of LHF. The derived risk score system showed good predictive characteristics: R 2 =0.66 and area under the curve 0.93. In patients with a risk score ⩾72, there is 100% certainty that the cause of pulmonary hypertension is LHF. Using this risk score system, the number of right heart catheterisations in LHF may be reduced by 20%.In a population referred under suspicion of PAH, a predictive model incorporating medical history, ECG and echocardiography data can diagnose LHF noninvasively in a substantial percentage of cases. @ERSpublications A risk score system can identify left-heart failure as alternative PH cause in patients suspected of PAH clinically http://ow.ly/JAIkR

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Section: Figurementioning

confidence: 64%

Section: Figurementioning

confidence: 99%

Section: Figurementioning

confidence: 99%

Section: Figurementioning

confidence: 99%

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Noninvasive identification of left-sided heart failure in a population suspected of pulmonary arterial hypertension

et al. 2015

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“…While the gold standard of CO determination is the direct Fick method, this method is rarely used in the clinical setting because of the technical and logistical demands involved in directly measuring V9O 2 , which makes this method impractical. As a result, the current reference standards most commonly employed in clinical practice in the evaluation of patients with PH, and the cardiac output methods employed in the largest PH registries, are the indirect Fick and TD methods, both of which are invasive and possess certain inherent limitations [2,14,15,17]. For example, TD suffers from imprecision because of the potential influences from catheter migration, differences in injector technique (with intra-and inter-investigator variability), the influence of the different phases of the respiratory cycle, and other factors [18][19][20][21].…”

Section: Discussionmentioning

confidence: 99%

Noninvasive cardiac output measurements in patients with pulmonary hypertension

2012

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Pulmonary hypertension (PH) is characterised by a progressive decline in cardiac output (CO) and right heart failure. NICOM1 (noninvasive cardiac output monitor) is a bioreactance-based technology that has been broadly validated, but its specific application in right heart failure and PH is unknown.Cardiac catheterisation was performed in 50 consecutive patients with PH. CO measurements were performed using three different methods (thermodilution, Fick and NICOM) at baseline and after vasodilator challenge. We compared the precision (coefficient of variation) and accuracy of NICOM compared to thermodilution and Fick.The mean CO (L?min -1 ) at baseline as measured by the three methods was 4.73¡1.15 (NICOM), 5.69¡1.74 (thermodilution) and 4.84¡1.39 (Fick). CO measured by NICOM was more precise than by thermodilution (3.5¡0.3% versus 9.6¡6.1%, p,0.001). Bland-Altman analyses comparing NICOM to thermodilution and Fick revealed bias and 95% limits of agreement that were comparable to those comparing Fick to thermodilution. All three CO methods detected an increase in CO in response to vasodilator challenge.CO measured via NICOM is precise and reliably measures CO at rest and changes in CO with vasodilator challenge in patients with PH. NICOM may allow for the noninvasive haemodynamic assessment of patients with PH and their response to therapy. @ERSpublications Cardiac output measurements allow for haemodynamic assessment of patients with PH and their response to therapy

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Diagnosis and Treatment of Pulmonary Arterial Hypertension

Ruopp

Cockrill

2022

JAMA

292

144

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ulmonary arterial hypertension (PAH) is a life-threatening disorder characterized by elevated pressure in the pulmonary arteries due to increased pulmonary vascular resistance. 1 Symptoms of PAH are nonspecific but commonly include dyspnea on exertion and fatigue. 2 The estimated prevalence of PAH is 10.6 per 1 million adults in the US. Untreated, PAH typically progresses to right ventricular failure and death. 3 Treatment has significantly improved outcomes in the last decade. 4 The diagnosis should be considered in any patient presenting with unexplained exertional dyspnea. This Review summarizes current evidence regarding diagnosis and treatment of PAH. MethodsPubMed was searched for English-language articles from 1985 through December 30, 2021, using search terms for pulmonary arterial hypertension. Articles were selected for inclusion based on relevance to current clinical practice. Randomized clinical trials, large longitudinal observational studies, and more recent articles were prioritized. Bibliographies of retrieved articles were searched for other relevant articles. Of the articles identified, 99 were included, consisting of 23 randomized clinical trials, 3 meta-analyses and systematic reviews, 36 observational studies, 16 registry-based studies, and 21 clinical practice guidelines or other reports. Definition and Classification of Pulmonary HypertensionThe clinical classification of pulmonary hypertension (PH), of which PAH is a subtype, is important for understanding the approach to both diagnosis and treatment of PAH. Pulmonary hypertension is currently defined by a mean pulmonary artery pressure greater than IMPORTANCE Pulmonary arterial hypertension (PAH) is a subtype of pulmonary hypertension (PH), characterized by pulmonary arterial remodeling. The prevalence of PAH is approximately 10.6 cases per 1 million adults in the US. Untreated, PAH progresses to right heart failure and death.OBSERVATIONS Pulmonary hypertension is defined by a mean pulmonary artery pressure greater than 20 mm Hg and is classified into 5 clinical groups based on etiology, pathophysiology, and treatment. Pulmonary arterial hypertension is 1 of the 5 groups of PH and is hemodynamically defined by right heart catheterization demonstrating a mean pulmonary artery pressure greater than 20 mm Hg, a pulmonary artery wedge pressure of 15 mm Hg or lower, and a pulmonary vascular resistance of 3 Wood units or greater. Pulmonary arterial hypertension is further divided into subgroups based on underlying etiology, consisting of idiopathic PAH, heritable PAH, drug-and toxin-associated PAH, pulmonary veno-occlusive disease, PAH in long-term responders to calcium channel blockers, and persistent PH of the newborn, as well as PAH associated with other medical conditions including connective tissue disease, HIV, and congenital heart disease. Early presenting symptoms are nonspecific and typically consist of dyspnea on exertion and fatigue. Currently approved therapy for PAH consists of drugs that enhance the nitric oxide-cyclic guanosine m...

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A noninvasive algorithm to exclude pre-capillary pulmonary hypertension

Cited by 101 publications

References 51 publications

Noninvasive identification of left-sided heart failure in a population suspected of pulmonary arterial hypertension

Noninvasive identification of left-sided heart failure in a population suspected of pulmonary arterial hypertension

Noninvasive cardiac output measurements in patients with pulmonary hypertension

Diagnosis and Treatment of Pulmonary Arterial Hypertension

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