Diagnosis and Assessment of Pulmonary Arterial Hypertension

Badesch, David B.; Champion, Hunter C.; Sánchez, Miguel; Hoeper, Marius M.; Loyd, James E.; Manes, Alessandra; McGoon, Michael D.; Naeije, Robert; Olschewski, Horst; Oudiz, Ronald J.; Torbicki, Adam

doi:10.1016/j.jacc.2009.04.011

Cited by 1,022 publications

(787 citation statements)

References 160 publications

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“…PH is defined as a resting mean pulmonary artery pressure (mPAP) Ն25 mm Hg at right heart catheterization; PAH is defined as PH in addition to pulmonary capillary wedge pressure (PCWP) Յ15 mm Hg (27). A hemodynamic evaluation was performed during maximal exercise for patients without resting PH.…”

Section: Methodsmentioning

confidence: 99%

Exercise‐induced pulmonary hypertension associated with systemic sclerosis: Four distinct entities

Saggar

Khanna

Fürst

et al. 2010

Arthritis & Rheumatism

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Objective. Exercise-induced pulmonary hypertension (PH) may represent an early but clinically relevant phase in the spectrum of pulmonary vascular disease. There are limited data on the prevalence of exerciseinduced PH determined by right heart catheterization in scleroderma spectrum disorders. We undertook this study to describe the hemodynamic response to exercise in a homogeneous population of patients with scleroderma spectrum disorders at risk of developing pulmonary vascular disease. Methods.Patients with normal resting hemodynamics underwent supine lower extremity exercise testing. A classification and regression tree (CART) analysis was used to assess combinations of variables collected during resting right heart catheterization that best predicted abnormal exercise physiology, applicable to each individual subject.Results. Fifty-seven patients who had normal resting hemodynamics underwent subsequent exercise right heart catheterization. Four distinct hemodynamic groups were identified during exercise: a normal group, an exercise-induced pulmonary venous hypertension (ePVH) group, an exercise out of proportion PH (eoPH) group, and an exercise-induced PH (ePH) group. The eoPH and ePVH groups had higher pulmonary capillary wedge pressure (PCWP) than the ePH group (P < 0.05). The normal and ePH groups had exercise PCWP <18 mm Hg, which was lower than that in the ePVH and eoPH groups (P < 0.05). During submaximal exercise, the transpulmonary gradient and pulmonary vascular resistance (PVR) were elevated in the ePH and eoPH groups as compared with the normal and ePVH groups (P < 0.05). CART analysis suggested that resting mean pulmonary artery pressure (mPAP) >14 mm Hg and PVR >160 dynes/seconds/cm ؊5 were associated with eoPH and ePH (positive predictive value 89% for mPAP 14-20 mm Hg and 100% for mPAP >20 mm Hg).Conclusion. We characterized the exercise hemodynamic response in at-risk patients with scleroderma spectrum disorders who did not have resting PH. Four distinct hemodynamic groups were identified during exercise. These groups may have potentially different prognoses and treatment options.

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Section: Methodsmentioning

confidence: 99%

Exercise‐induced pulmonary hypertension associated with systemic sclerosis: Four distinct entities

Saggar

Khanna

Fürst

et al. 2010

Arthritis & Rheumatism

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“…The 6-minute walk test has been found to be a significant prognostic indicator in several cardiopulmonary diseases such as COPD, congestive heart failure, and pulmonary hypertension. 21–23 Physical inactivity has been associated with an increased risk of VTE in the past. The Nurses’ Health Study, following 69,950 female nurses for an average of 18 years, found that those that were the most sedentary were 2 to 3 times more likely to develop an unprovoked VTE compared to those that were the least sedentary.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Venous Thromboembolism in Chronic Obstructive Pulmonary Disease

Kim¹,

Goel²,

Gangar³

et al. 2014

J COPD F

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Background COPD patients are at increased risk for venous thromboembolism (VTE). VTE however remains under-diagnosed in this population and the clinical profile of VTE in COPD is unclear. Methods Global initiative for chronic Obstructive Lung Disease (GOLD) stages II-IV participants in the COPD Genetic Epidemiology (COPDGene) study were divided into 2 groups: VTE+, those who reported a history of VTE by questionnaire, and VTE−, those who did not. We compared variables in these 2 groups with either t-test or chi-squared test for continuous and categorical variables, respectively. We performed a univariate logistic regression for VTE, and then a multivariate logistic regression using the significant predictors of interest in the univariate analysis to ascertain the determinants of VTE. Results The VTE+ group was older, more likely to be Caucasian, had a higher body mass index (BMI), smoking history, used oxygen, had a lower 6-minute walk distance, worse quality of life scores, and more dyspnea and respiratory exacerbations than the VTE− group. Lung function was not different between groups. A greater percentage of the VTE+ group described multiple medical comorbidities. On multivariate analysis, BMI, 6-minute walk distance, pneumothorax, peripheral vascular disease, and congestive heart failure significantly increased the odds for VTE by history. Conclusions BMI, exercise capacity, and medical comorbidities were significantly associated with VTE in moderate to severe COPD. Clinicians should suspect VTE in patients who present with dyspnea and should consider possibilities other than infection as causes of COPD exacerbation.

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“…36 Generally only 10-15% of iPAH patients show a positive acute vasoreactive response and about half of them will continue to respond to calcium channel blockers over a long period of time. 1 In a recent study, Sitbon and colleagues showed that of 12.6% patients with iPAH who displayed acute pulmonary vasoreactivity, only 54% had a sustained, long-term benefit with oral calcium channel blockers as monotherapy. 37 Hence overall <7% of 557 patients with iPAH were long-term responders.…”

Section: Vasodilator Challengementioning

confidence: 99%

“…1 It is a progressive disease involving small pulmonary arteries and is characterised by vascular proliferation and remodelling. The pulmonary vascular resistance (PVR) gradually rises, often leading to right heart failure and death.…”

Section: Introductionmentioning

confidence: 99%

Pulmonary hypertension—“state of the art” management in 2012

Saxena

2012

Indian Heart Journal

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A B S T R A C TPulmonary artery hypertension (PAH) is a pathological condition of small pulmonary arteries, characterised by vascular proliferation and remodelling. The pulmonary artery pressure and pulmonary vascular resistance progressively rise, leading to right heart failure and death. Pulmonary artery hypertension may be secondary to various conditions, or it may be idiopathic where no underlying cause is identifiable. Earlier, only symptomatic treatment was available for such patients which did not change the natural history of the disease. However, over the years, improvement in understanding the pathogenesis has resulted in the development of targeted approaches to the treatment of PAH. Survival advantage has also been shown with some of the pharmacologic agents. This review article discusses the current management strategy for PAH with special emphasis on an idiopathic variety, in an Indian context.

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Diagnosis and Assessment of Pulmonary Arterial Hypertension

Cited by 1,022 publications

References 160 publications

Exercise‐induced pulmonary hypertension associated with systemic sclerosis: Four distinct entities

Exercise‐induced pulmonary hypertension associated with systemic sclerosis: Four distinct entities

Risk Factors for Venous Thromboembolism in Chronic Obstructive Pulmonary Disease

Pulmonary hypertension—“state of the art” management in 2012

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