Incidence and prognostic significance of pleural effusions in pulmonary arterial hypertension

Chandel, Abhimanyu; Verster, A. S. W.; Rahim, H.; Khangoora, Vikramjit; Nathan, Steven D.; Ahmad, Kareem; Aryal, Shambhu; Bagnola, Aaron; Singhal, Anju; Brown, Anne; Shlobin, Oksana A.; King, Christopher S.

doi:10.1177/20458940211012366

Cited by 8 publications

(5 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This lends further support to the hypothesis that right ventricular–pulmonary artery uncoupling and resulting elevation of central venous pressure may impede lymphatic flow and lead to pulmonary oedema and increased B‐lines. This is very similar to the pathophysiology hypothesized in the development of pleural and pericardial effusions in isolated PAH 14 …”

Section: Figuresupporting

confidence: 83%

Pulmonary congestion in patients with pulmonary arterial hypertension? New insights from lung ultrasound

Platz,

Systrom,

Leopold

2024

European J of Heart Fail

View full text Add to dashboard Cite

This article refers to 'Right heart failure as a cause of pulmonary congestion in pulmonary arterial hypertension' by M. D'Alto et al., published in this issue on pages 817-824.Pulmonary congestion (or oedema) is a key feature of the heart failure (HF) syndrome and associated with dyspnoea, a decrease in exercise tolerance, and morbidity. Over the past two decades, lung ultrasound (LUS) has gained increasing popularity as a non-invasive and sensitive tool for the detection of pulmonary congestion in patients with or at risk for HF in a variety of research and clinical settings. So-called 'B-lines' on LUS are reverberation artefacts that appear as vertical lines and extend from the pleural line towards the far-field of the ultrasound screen. B-lines are markers of increased lung density and can be quantified in one intercostal space across several areas of the chest (also called 'zones'). In patients presenting with undifferentiated dyspnoea to the emergency department, the detection of ≥3 B-lines in at least 2 zones on each hemithorax (i.e. at least 12 B-lines in total across 8 zones) identifies patients with acute HF with higher accuracy than the combination of natriuretic peptides and chest x-ray. 1 As a result, LUS has been incorporated in the diagnostic strategy for patients with suspected acute HF in the 2021 European Society of Cardiology HF guidelines. 2 B-lines change with the degree of pulmonary congestion: they decrease with diuresis and increase with infusion of intravenous fluids in patients with HF. 3,4 The presence of multiple B-lines is also associated with an increased risk of subsequent HF hospitalizations or death both in hospitalized patients with acute HF and in ambulatory HF cohorts. 5 Despite this significant body of literature on the utility of LUS in patients with HF, it has been unclear whether pulmonary congestion on LUS could also be detected in patients with pulmonary arterial hypertension (PAH) who have a normal pulmonary capillary wedge pressure and develop HF as a result of right ventricular dysfunction and not left heart disease (isolated post-capillaryThe opinions expressed in this article are not necessarily those of the Editors of the European Journal of Heart Failure or of the European Society of Cardiology.

show abstract

Section: Figuresupporting

confidence: 83%

Pulmonary congestion in patients with pulmonary arterial hypertension? New insights from lung ultrasound

Platz,

Systrom,

Leopold

2024

European J of Heart Fail

View full text Add to dashboard Cite

show abstract

“…During the occurrence and development of TR, TR is often accompanied by an increase in pulmonary artery pressure and atrial pressure, which is the cause of pericardial effusion. There is no significant difference in the volume of pericardial effusion between patients with isolated pulmonary venous hypertension or systemic hypertension, but in the presence of both, the volume of pericardial effusion increased due to obstruction of pericardial venous return due to elevated right atrial pressure [25,26]. In this study, we found an association between pericardial effusion and moderate-to-severe tricuspid regurgitation, but further associations between them require further validation in relevant studies.…”

Section: Tricuspid Regurgitation Is Very Common In Patients Undergoin...mentioning

confidence: 50%

Prevalence and contributing factors associated with tricuspid regurgitation among patients underwent echocardiography assessment

Zheng,

Yu,

Zhou

et al. 2023

Preprint

View full text Add to dashboard Cite

Background Tricuspid regurgitation (TR) is common in patients evaluated by echocardiography. However, the prevalence and contributing factors of the disease remain limited. This hospital-based study was designed to analyze adult patients first diagnosed with tricuspid regurgitation by Doppler echocardiography to determine the prevalence and characteristics of clinically meaningful TR.Methods A total of 22,317 patients over the age of 18 who underwent echocardiography at the Cardiac Ultrasound Center of the First Affiliated Hospital of Guangdong Pharmaceutical University from July 1, 2015 to December 31, 2019 were collected. We collected basic information about the patients, including age, gender, history of heart disease, etc. Patients with valvular heart disease were assessed by transthoracic echocardiography. According to the degree of regurgitation and regurgitation, TR was divided into 6 grades (0–5). Pericardial effusion was recorded and bilateral atrial and ventricular diameters were measured. Logistic regression analysis was used to assess risk factors for significant TR (≥ grade 2 reflux).Results A total of 2299 significant TR cases were found in people over 18 years old, accounting for 10.3% of the total population. The occurrence of TR was found to be closely related to age. The prevalence rates of significant TR in different groups were: 3.3% in the younger than 45-year-old group, 4.1% in the 46-55-year-old group, 5.8% in the 56-65-year-old group, 10.1% in the 66-75-year-old group, and the prevalence of significant TR rose directly to 22.3% in patients over 75-year-old group. Further logistic regression analysis showed that male, age, pacemaker, congenital heart disease, pericardial effusion, pulmonary hypertension, mitral regurgitation, left ventricular diastolic dysfunction and aortic regurgitation were associated with the occurrence of significant TR. Both RVD and RA-1 were effective predictors of significant TR, with RVD ≥ 33.5 mm having a sensitivity of 0.638, specificity of 0.675, and ROC curve area of 0.722. The sensitivity of RA1 ≥ 45.5mm was 0.652, the specificity was 0.699, and the area under the ROC curve was 0.736.Conclusions TR is common in people undergoing echocardiography. Gender, age, pacemaker implantation, congenital heart disease, pericardial effusion, pulmonary hypertension, mitral insufficiency, and aortic insufficiency are the influencing factors of TR.

show abstract

“…In our study, the mPAP in IPAH group was significantly lower than that in PAH-CHD group, but a higher baseline PVR implied more severe pulmonary vascular disorders in the IPAH cohort. Pericardial effusion, a relatively common complication of PAH, is associated with increased mortality ( Fenstad et al, 2013 ; Shimony et al, 2013 ; Chandel et al, 2021 ). In this study, the incidence of pericardial effusion (40.5%) in patients with IPAH was similar to that in Shimony’s study (47.1%), which may be related to RV dysfunction and subsequent increased right atrial filling pressure ( Shimony et al, 2013 ).…”

Section: Discussionmentioning

confidence: 99%

Differences in right ventricular function and response to targeted therapy between patients with IPAH and PAH-CHD

Zhu

Wu²,

Tan³

et al. 2023

Front. Pharmacol.

View full text Add to dashboard Cite

Background and aims: Pulmonary arterial hypertension (PAH) is a chronic pulmonary vascular disorder characterized by elevated pulmonary vascular resistance (PVR) and pulmonary arterial pressure (PAP). Right heart failure is a life-threatening complication of PAH and predicts a poor prognosis. PAH associated with congenital heart disease (PAH-CHD) and idiopathic PAH (IPAH) are two prevalent PAH subtypes in China. In this section, we set out to explore baseline right ventricular (RV) function and its response to targeted agents between IPAH and PAH-CHD.Methods and results: Consecutive patients diagnosed with IPAH or PAH-CHD by right heart catheterization (RHC) in the Second Xiangya Hospital from November 2011 to June 2020 were included. All patients received PAH-targeted therapy and the RV function was assessed by echocardiography at baseline and during follow-up. A total of 303 patients (age, 36.23 ± 13.10 years; women, 213 (70.3%); mean PAP [mPAP], 63.54 ± 16.12 mmHg; PVR, 14.74 ± 7.61 WU) with IPAH (n = 121) or PAH-CHD (n = 182) were included in this study. Compared with PAH-CHD, patients with IPAH had worse baseline RV function. As of the latest follow-up, forty-nine patients with IPAH and six patients with PAH-CHD died. Kaplan-Meier analyses showed better survival in PAH-CHD versus IPAH. After PAH-targeted therapy, patients with IPAH had less improvement in 6 MWD, World Health Organization functional class, and RV functional parameters compared with patients with PAH-CHD.Conclusion: Compared with patients with PAH-CHD, patients with IPAH had worse baseline RV function, unfavourable prognosis, and inadequate response to targeted treatment.

show abstract

Incidence and prognostic significance of pleural effusions in pulmonary arterial hypertension

Cited by 8 publications

References 30 publications

Pulmonary congestion in patients with pulmonary arterial hypertension? New insights from lung ultrasound

Pulmonary congestion in patients with pulmonary arterial hypertension? New insights from lung ultrasound

Prevalence and contributing factors associated with tricuspid regurgitation among patients underwent echocardiography assessment

Differences in right ventricular function and response to targeted therapy between patients with IPAH and PAH-CHD

Contact Info

Product

Resources

About