Pulmonary Arterial Hemodynamic Assessment by a Novel Index in Systemic Sclerosis Patients: Pulmonary Pulse Transit Time

Doğan, Mehmet; Efe, Tolga Han; Çi̇men, Tolga; Felekoğlu, Mehmet Ali; Ertem, Ahmet Göktuğ; Erat, Mehmet; Yi̇ği̇ner, Ömer; Tulmaç, Murat

doi:10.1007/s00408-018-0098-6

Cited by 11 publications

(11 citation statements)

References 28 publications

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“…PAS and other abnormal ow hemodynamics in PAH are strongly associated with impaired elevated right ventricular functions and also with disease severity and poor clinical outcomes in patients with PAH [23]. [32]. Consistent with this, we revealed that PAS increased in SSc patients compared to healthy volunteers, and we also determined a positive correlation between Scl duration and PAS.…”

Section: Discussionsupporting

confidence: 88%

Assessment of pulmonary arterial stiffness in patients with systemic sclerosis without overt pulmonary hypertension

Çoksevim

Çerik²,

Yenerçağ³

et al. 2022

Int J Cardiovasc Imaging

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Pulmonary hypertension (PH) is a pathophysiological disorder that may involve multiple clinical conditions and complicate most systemic diseases. Systemic Sclerosis (SSc), represents the leading cause of connective tissue disease (CTD) associated with PAH. Although SSc is a rare disease, it is associated with higher morbidity and early mortality than other rheumatological diseases due to developing SSc-associated interstitial pulmonary disease (ILD) and/or pulmonary arterial hypertension (PAH). The impact of the early diagnosis on the prognosis is evident. In this context, in our study, we aimed to investigate the early changes in pulmonary vascular bed by measuring pulmonary arterial stiffness (PAS) in SSc patients without overt PAH. Sixty-two SSc patients and fty-eight gender and agematched, healthy subjects enrolled in this cross-sectional observational study. SSc patients were evaluated in terms of disease duration and severity. Modi ed Rodnan skin score (mRSS) was calculated as disease severity index. Echocardiographic parameters were assessed and compared to the control group. Right Ventricular (RV) diameters, systolic pulmonary artery pressure (sPAP), and right ventricle myocardial performance index (RV-MPI) were signi cantly higher in the SSc group compared to the control group (p < 0.05). Tricuspid annular plane systolic excursion (TAPSE) and right ventricular fractional area change (RV-FAC) were signi cantly lower in the SSc group compared to the control group (p < 0.05). PAS value (25.5 ± 9.2 kHz/ms vs. 18.1 ± 7.4 kHz/ms, p <0.001) was signi cantly higher in the SSc group than in the control group. A statistically signi cant positive correlation relationship was detected between the PAS value and CRP, ESR, disease duration, mRSS. According to these results, in SSc patients, PAS as an inexpensive and easily applicable echocardiographic method might serve as a marker of early detection of PAH.

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Section: Discussionsupporting

confidence: 88%

Assessment of pulmonary arterial stiffness in patients with systemic sclerosis without overt pulmonary hypertension

Çoksevim

Çerik²,

Yenerçağ³

et al. 2022

Int J Cardiovasc Imaging

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“…In another study, pPTT was significantly shorter in PHT than without pulmonary fibrosis . It has been shown that pPTT is shortened and inversely correlated with disease severity and duration in patients with scleroderma and systemic lupus erythematosus, which cause increased pulmonary arterial stiffness . In the aforementioned studies, pulmonary arterial hemodynamics was assessed with pPTT in patients with precapillary PHT.…”

Section: Discussionmentioning

confidence: 99%

Prolonged pulmonary pulse transit time is associated with symptoms in patients with significant mitral stenosis and sinus rhythm

Gürbüz

Öztürk

Alsancak

et al. 2019

J of Clinical Ultrasound

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Introduction: Pulmonary pulse transit time (pPTT) is a novel noninvasive echocardiographic measure to assess pulmonary arterial hemodynamics. It has been shown to be shorter in precapillary pulmonary hypertension (PHT). Mitral stenosis (MS) is one of the causes of postcapillary PHT. We aimed to investigate pPTT in patients with MS and its relationship with symptoms. Methods:We included 51 patients with MS (25 were asymptomatic, NYHA I, and 26 were symptomatic, NHYA II or III), and 50 controls, and evaluated their demographic characteristics and echocardiographic variables, including pPTT.Results: Baseline characteristics, including age, sex, body mass index, and cardiovascular risk factors, were similar between the MS and the control group. The pPTT was longer in the MS group than in the control group (0.21 ± 0.08 vs 0.15 ± 0.05, P < .001).Patients with symptomatic MS had longer pPTT than asymptomatic patients (P = .005).The pPTT was positively correlated with left atrial volume index and systolic pulmonary artery pressure, and negatively with tricuspid annular plane systolic excursion (r = .432; P < .001, r = .319; P = .001, r = −.293; and P = .003, respectively). Conclusion: The measurement of pPTT appears clinically relevant in patients withPHT. Further studies evaluating whether it is useful in distinguishing precapillary from postcapillary PHT are required. K E Y W O R D S arterial stiffness, echocardiography, mitral stenosis, pulmonary hypertension, pulmonary pulse transit time, pulmonary venous flow 1 | INTRODUCTION Although the incidence of rheumatic mitral stenosis (MS) has decreased considerably in industrialized countries, it remains a significant cause of morbidity in developing countries. 1 Valve area measured with planimetry constitutes the reference for grading severity, whereas mean transvalvular gradient and pulmonary artery pressure are rather indirect measures and have prognostic value. 2 In addition, the presence of high pulmonary arterial pressure is taken into account for deciding intervention in patients with clinically significant, albeit asymptomatic, mitral stenosis. 3 Left-sided heart disease is the most common cause of pulmonary hypertension (PHT), although severe PHT is relatively uncommon in this setting. Pulmonary hypertension can be diagnosed as either precapillary or postcapillary by using

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“…Research's on PPTT continued after the study by Wibmer et al Doan et al found that PPTT may be the first sign of early abnormalities of pulmonary hemodynamics in individuals with systemic sclerosis (SSc) 14 . In a study of HIV‐positive patients, PPTT has been shown to indicate the potential presence of pulmonary vascular disease, even though sPAP is within the normal range 15 .…”

Section: Discussionmentioning

confidence: 99%

The importance of pulmonary pulse transit time in indicating right ventricular dysfunction and pulmonary arterial stiffness in rheumatoid arthritis

Ulutas,

Tasolar,

Bayramoglu

et al. 2023

J of Clinical Ultrasound

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SubjectRheumatoid arthritis patients are at risk of developing cardiovascular disease such as right heart failure and pulmonary hypertension (PH). Arterial stiffness can be used to assess pulmonary hemodynamics. Noninvasive approaches can also be used to assess pulmonary hemodynamics. Recently, there have been reports that pulmonary pulse transit time (PPTT) may also be a useful measure. This study aims to examine the effects of pulmonary hemodynamic alterations on PPTT in RA patients.MethodsForty RA patients and 40 healthy controls were included in the study. Sociodemographic characteristics, laboratory data, and echocardiographic examinations were performed in both groups. Conventional echocardiographic examination included left and right ventricular systolic and diastolic diameters, right ventricular myocardial performance index (RVMPI), right ventricular diastolic function, estimated pulmonary artery systolic pressure (sPAP), tricuspid annular plane systolic excursion (TAPSE), pulmonary artery stiffness (PAS), and PPTT. Right ventricular diastolic and systolic volumes, right ventricular ejection fraction (RVEF), and right ventricular fractional area change (RVFAC) were determined by four‐dimensional echocardiography (4DE).ResultsThere was no difference between the sPAP values of the patients. RVMPI and PAS were increased in RA patients compared with controls. The PPTT was shortened in RA patients and correlated with RVEF, RVFAC, RVMPI, TAPSE/sPAP, disease duration, and C‐reactive protein (CRP). In univariate linear regression analysis, PPTT (p < .001) was thought to be an independent predictor of PAS. RVFAC, disease duration, and PAS were also independent predictors of PPTT.ConclusionIn RA patients, PPTT may be the first evidence of early abnormalities in pulmonary vascular hemodynamics. PPTT and PAS are the values that may predict each other in RA patients. Due to its more practical application, PPTT can be used instead of PAS to assess pulmonary hemodynamics.

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Pulmonary Arterial Hemodynamic Assessment by a Novel Index in Systemic Sclerosis Patients: Pulmonary Pulse Transit Time

Abstract: pPTT was found to be shorter in SSc patients. pPTT might serve as a surrogate marker of pulmonary hemodynamics in patients with SSc, even prior to the development of pulmonary hypertension.

Cited by 11 publications

References 28 publications

Assessment of pulmonary arterial stiffness in patients with systemic sclerosis without overt pulmonary hypertension

Assessment of pulmonary arterial stiffness in patients with systemic sclerosis without overt pulmonary hypertension

Prolonged pulmonary pulse transit time is associated with symptoms in patients with significant mitral stenosis and sinus rhythm

The importance of pulmonary pulse transit time in indicating right ventricular dysfunction and pulmonary arterial stiffness in rheumatoid arthritis

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