Association of Mild Echocardiographic Pulmonary Hypertension With Mortality and Right Ventricular Function

Huston, Jessica; Maron, Bradley A.; French, John K.; Huang, Shi; Thayer, Timothy E.; Farber‐Eger, Eric; Wells, Quinn S.; Choudhary, Gaurav; Hemnes, Anna R.; Brittain, Evan L.

doi:10.1001/jamacardio.2019.3345

Cited by 90 publications

(86 citation statements)

References 52 publications

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“…In ESRD patients, PH may be caused by the side effects of renal dysfunction (2). Furthermore, in many disease contexts, PH is considered one of the leading causes of death due to the associated complication of right heart failure (16,24,25). Thus, data on the prevalence of PH or PASP among dialysis patients are valuable toward informing guidelines for the management of complications in ESRD patients who undergo hemodialysis.…”

Section: Ph Is Prevalent Among Esrd Patients Who Undergo Dialysis Trementioning

confidence: 99%

The Prevalence of Pulmonary Hypertension Among Maintenance Dialysis Patients With ESRD and Its Associated Factors: A Retrospective Study

et al. 2020

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Aim: To determine the prevalence of pulmonary hypertension (PH) and its associated factors among end-stage renal disease (ESRD) patients who underwent maintenance dialysis.Methods: A total of 491 patients received echocardiography examinations and underwent pulmonary artery systolic pressure (PASP) assessments. A subgroup of 283 patients were subjected to plasma creatinine (Cr) and blood urea nitrogen concentration (BUN) tests, routine blood examinations and electrolyte analysis. First, we compared the differences in echocardiographic, Cr and BUN, blood routine and electrolyte parameters between PH and non-PH groups. The correlations between PASP and the parameters mentioned above were also analyzed. Furthermore, univariate and adjusted logistic regression analyses were performed to identify the independent associated factors.Results: The incidence of PH among ESRD patients who were treated with maintenance dialysis was 34.6%. Most of the echocardiographic parameters, including end-diastolic internal diameters of the left atrium, left ventricle, right atrium, and pulmonary artery, as well as interventricular septum mobility, left ventricular posterior wall mobility, fractional shortening, stroke volume and left ventricle ejection fraction (LVEF), were associated with PH. Furthermore, Mg2+ (p = 0.037) and Cl− (p = 0.043) were significantly associated with PASP. However, after adjustments were made in the regression analysis, only internal diameters of the left atrium, right atrium, and LVEF were independently associated with PH.Conclusion: PH is prevalent, with a relatively high incidence among ESRD patients who undergo maintenance dialysis. The sizes of the left and right atria as well as LVEF were independently associated with PH, but further cohort and basic mechanistic studies are needed to confirm this finding.

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Section: Ph Is Prevalent Among Esrd Patients Who Undergo Dialysis Trementioning

confidence: 99%

The Prevalence of Pulmonary Hypertension Among Maintenance Dialysis Patients With ESRD and Its Associated Factors: A Retrospective Study

et al. 2020

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“…Mohammed et al 22 . reported comparable results by echocardiography in which survival varied across PASP tertiles among patients in the highest, middle, or lowest TAPSE tertiles, later confirmed by Huston et al 23 . in HF‐PEF.…”

Section: Discussionmentioning

confidence: 72%

The dangerous and contradictory prognostic significance of PVR<3WU when TAPSE<16mm in postcapillary pulmonary hypertension

et al. 2020

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Aims In 2019, pulmonary vascular resistance (PVR) < 3WU was adopted to stratify patients at low risk in pulmonary hypertension due to left heart disease (PH-LHD) as well those with isolated PH-LHD. We sought to evaluate whether supervised machine learning with decision tree analysis, which provides more information than Cox Proportional analysis by forming a hierarchy of multiple covariates, confirms this risk stratification. Methods and results Two hundred two consecutive patients (mean age: 69 ± 11 years, female: 42%) with mean pulmonary artery pressure ≥ 20 mmHg and wedge pressure > 15 mmHg were recruited. Transpulmonary pressure gradient ⩾̸ 12 mmHg, PVR ⩾̸ 3WU, diastolic pressure gradient ⩾̸ 7 mmHg, pulmonary arterial capacitance < 1.1 mL/mmHg, tricuspid annular plane systolic excursion (TAPSE) < 16 mm, peak systolic tissue Doppler velocity < 10 cm/s, right ventricular end-diastolic area ⩾̸ 25 cm 2 were the seven categorical values entered into the model due to their prognostic significance in PH. We used the chi-squared automatic interaction detection method to predict mortality. Each node and branch were compared using survival analysis at 6-year follow-up. Mean pulmonary artery pressure, wedge pressure, cardiac index, and PVR were 40.3 ± 10.0 mmHg, 22.3 ± 7.1 mmHg, 2.9 ± 0.8 L/min/m 2 , and 3.6 ± 2.1WU, respectively. Among the seven dichotomous, TAPSE was first selected following by PVR. Compared with patients with PVR < 3WU and TAPSE ⩾̸ 16 mm, patients with PVR ⩾̸ 3WU and TAPSE ⩾̸ 16 mm, or patients with PVR ⩾̸ 3WU and TAPSE<16 mm had significantly increased mortality, HR = 3.0, 95% CI = [1.4-6.4], P = 0.006 and HR = 3.3, 95% CI = [1.6-6.9], P = 0.002, respectively, while patients with PVR < 3WU and TAPSE < 16 mm exhibited the worst prognosis, HR = 7.2, 95% CI = [3.3-15.9], P = 0.0001. Conclusions Used for solving regression and classification problems, decision tree analysis confirms that PVR and TAPSE have to be analysed together in PH-LHD and revealed the dangerous and contradictory prognostic significance of PVR < 3WU when TAPSE<16 mm.

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“…When the RV systolic pressure is greater than half of the systemic pressure, there will be progressive leftward displacement and flattening of the interventricular septum. The eccentricity index (the ratio of the LV minor and major axes in the short-axis view at the level of the mitral tendinous chords) can be used to quantify this IVS flattening [ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Pulmonary hypertension associated with congenital heart disease; clinical decision scenario

Alakhfash

Alqwaiee

Alakhfash³

et al. 2020

Respiratory Medicine Case Reports

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Pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD) is one type under group 1 PH. Undiagnosed or delayed diagnosis of significant CHD might lead to significant PAH and at the end might lead to Eisenmenger syndrome. We could expect the degree of PAH in patients with CHD by proper clinical assessment as well as by the basic assessment tools including the chest x-ray (CXR), ECG, and transthoracic echocardiography (TTE). We are presenting a three and half years old child with a delayed/missed diagnosis of large patent ductus arteries (PDA) who present with significant PAH. Clinical evaluation, CXR, ECG, TTE, as well as cardiac catheterization data are presented, with a review of the current guidelines regarding the management of pediatric patients with PAH-CHD.

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Association of Mild Echocardiographic Pulmonary Hypertension With Mortality and Right Ventricular Function

Cited by 90 publications

References 52 publications

The Prevalence of Pulmonary Hypertension Among Maintenance Dialysis Patients With ESRD and Its Associated Factors: A Retrospective Study

The Prevalence of Pulmonary Hypertension Among Maintenance Dialysis Patients With ESRD and Its Associated Factors: A Retrospective Study

The dangerous and contradictory prognostic significance of PVR<3WU when TAPSE<16mm in postcapillary pulmonary hypertension

Pulmonary hypertension associated with congenital heart disease; clinical decision scenario

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