Mixed venous oxygen tension is a crucial prognostic factor in pulmonary hypertension: a retrospective cohort study

Nagata, Jun; Sekine, Ayumi; Tanabe, Nobuhiro; Taniguchi, Yu; Ishida, Keiichi; Shiko, Yuki; Sakao, Seiichiro; Suzuki, Takuji

doi:10.1186/s12890-022-02073-0

Cited by 5 publications

(6 citation statements)

References 35 publications

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“…A low partial pressure of arterial blood carbon dioxide (PaCO2) may be a useful noninvasive prognostic factor since a reduced PaCO2 reflects hyperventilation to maintain the partial pressure of arterial blood oxygen (PaO2). Similar results were shown for hypoxemia upon diagnosis as well as during follow-up under PAH medication [ 28 , 29 , 30 ]. In a recent study, pro-atrial natriuretic peptide (pro-ANP) and high-sensitivity troponin T (hsTnT) were found to have a significant prognostic value in patients with PAH [ 31 ].…”

Section: Pah Prognostic Factorssupporting

confidence: 81%

“…This formula demonstrates that the SvO2 is directly associated with the CO and the oxygen delivery according to each patient’s need. However, it raises concerns about potential errors in measurement [ 29 ]. In a group of 98 patients with a CTEPH or PH associated with a systemic disease, Higgenbotam et al demonstrated that SvO2 is a robust prognostic factor of survival [ 58 ].…”

Section: Pah Prognostic Factorsmentioning

confidence: 99%

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Risk Stratification in Pulmonary Arterial Hypertension, Update and Perspectives

Vraka

Diamanti

Kularatne

et al. 2023

JCM

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Risk stratification in pulmonary arterial hypertension (PAH) is crucial in assessing patient prognosis. It serves a prominent role in everyday patient care and can be determined using several validated risk assessment scores worldwide. The recently published 2022 European Society of Cardiology (ESC)/European Respiratory Society (ERS) guidelines underline the importance of risk stratification not only at baseline but also during follow-up. Achieving a low-risk status has now become the therapeutic goal, emphasising the importance of personalised therapy. The application of these guidelines is also important in determining the timing for lung transplantation referral. In this review, we summarise the most relevant prognostic factors of PAH as well as the parameters used in PAH risk scores and their evolution in the guidelines over the last decade. Finally, we describe the central role that risk stratification plays in the current guidelines not only in European countries but also in Asian countries.

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Section: Pah Prognostic Factorssupporting

confidence: 81%

Section: Pah Prognostic Factorsmentioning

confidence: 99%

Risk Stratification in Pulmonary Arterial Hypertension, Update and Perspectives

Vraka

Diamanti

Kularatne

et al. 2023

JCM

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“…30 Global tissue hypoxia can be identified by using PvO 2 and it may be used as a prognostic marker. 30 PvO 2 and SvO 2 are closely related via the oxygen dissociation curve, but when the curve is shifted to the left by hypothermia the SvO 2 will be higher for any given, PvO 2 15 indicating an increased reluctance to release oxygen from hemoglobin. While SvO 2 is a marker of the oxygen supply demand matching under normothermic conditions, it is the partial pressure of oxygen that provides the driving gradient for oxygen movement into the tissues.…”

Section: Discussionmentioning

confidence: 99%

“…If the partial pressure of oxygen at the end of tissue capillaries falls below a critical level, it will hinder the oxygen supply to the tissues in the vulnerable “lethal corner.” 30 Global tissue hypoxia can be identified by using falsenormalPtruev¯O2 and it may be used as a prognostic marker. 30 falsenormalPtruev¯O2 and falsenormalStruev¯O2 are closely related via the oxygen dissociation curve, but when the curve is shifted to the left by hypothermia the falsenormalStruev¯O2 will be higher for any given, falsenormalPtruev¯O2 15 indicating an increased reluctance to release oxygen from hemoglobin. While falsenormalStruev¯O2 is a marker of the oxygen supply demand matching under normothermic conditions, it is the partial pressure of oxygen that provides the driving gradient for oxygen movement into the tissues.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Hypothermia for Refractory Hypoxemia on Venovenous Extracorporeal Membrane Oxygenation: An In Silico Study

et al. 2023

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Patients with respiratory failure may remain hypoxemic despite treatment with venovenous extracorporeal membrane oxygenation (VV-ECMO). Therapeutic hypothermia is a potential treatment for such hypoxia as it reduces cardiac output ( ) and oxygen consumption. We modified a previously published mathematical model of gas exchange to investigate the effects of hypothermia during VV-ECMO. Partial pressures were expressed as measured at 37°C (α-stat). The effect of hypothermia on gas exchange was examined in four clinical scenarios of hypoxemia on VV-ECMO, each with different physiological derangements. All scenarios had arterial partial pressure of oxygen (PaO2) ≤ 46 mm Hg and arterial oxygen saturation of hemoglobin (SaO2) ≤ 81%. Three had high with low extracorporeal blood flow to ratio ( ). The problem in the fourth scenario was recirculation, with normal . Cooling to 33°C increased SaO2 to > 89% and PaO2 to > 50 mm Hg in all scenarios. Mixed venous oxygen saturation of hemoglobin as % ( ) increased to > 70% and mixed venous partial pressure of oxygen in mm Hg ( ) increased to > 34 mm Hg in scenarios with low . In the scenario with high recirculation, and increased, but to < 50% and < 27 mm Hg, respectively. This in silico study predicted cooling to 33°C will improve oxygenation in refractory hypoxemia on VV-ECMO, but the improvement will be less when the problem is recirculation.

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“…Despite the establishment of treatment algorithms and reduced mortality due to PAH, the number of patients in the intermediate- and high-risk groups remain high (risk stratification according to the European Society of Cardiology and European Respiratory Society guidelines) [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Artificial intelligence-based model for predicting pulmonary arterial hypertension on chest x-ray images

Imai,

Sakao,

Nagata

et al. 2024

BMC Pulm Med

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Background Pulmonary arterial hypertension is a serious medical condition. However, the condition is often misdiagnosed or a rather long delay occurs from symptom onset to diagnosis, associated with decreased 5-year survival. In this study, we developed and tested a deep-learning algorithm to detect pulmonary arterial hypertension using chest X-ray (CXR) images. Methods From the image archive of Chiba University Hospital, 259 CXR images from 145 patients with pulmonary arterial hypertension and 260 CXR images from 260 control patients were identified; of which 418 were used for training and 101 were used for testing. Using the testing dataset for each image, the algorithm outputted a numerical value from 0 to 1 (the probability of the pulmonary arterial hypertension score). The training process employed a binary cross-entropy loss function with stochastic gradient descent optimization (learning rate parameter, α = 0.01). In addition, using the same testing dataset, the algorithm’s ability to identify pulmonary arterial hypertension was compared with that of experienced doctors. Results The area under the curve (AUC) of the receiver operating characteristic curve for the detection ability of the algorithm was 0.988. Using an AUC threshold of 0.69, the sensitivity and specificity of the algorithm were 0.933 and 0.982, respectively. The AUC of the algorithm’s detection ability was superior to that of the doctors. Conclusion The CXR image-derived deep-learning algorithm had superior pulmonary arterial hypertension detection capability compared with that of experienced doctors.

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Mixed venous oxygen tension is a crucial prognostic factor in pulmonary hypertension: a retrospective cohort study

Cited by 5 publications

References 35 publications

Risk Stratification in Pulmonary Arterial Hypertension, Update and Perspectives

Risk Stratification in Pulmonary Arterial Hypertension, Update and Perspectives

Therapeutic Hypothermia for Refractory Hypoxemia on Venovenous Extracorporeal Membrane Oxygenation: An In Silico Study

Artificial intelligence-based model for predicting pulmonary arterial hypertension on chest x-ray images

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