Pulmonary hypertension and valvular heart disease

Tichelbäcker, Tobias; Dumitrescu, Daniel; Gerhardt, Felix; Stern, Daniel; Wissmüller, Max; Adam, Matti; Schmidt, Tobias; Frerker, Christian; Pfister, Roman; Halbach, Marcel; Baldus, Stephan; Rosenkranz, Stephan

doi:10.1007/s00059-019-4823-6

Cited by 29 publications

(29 citation statements)

References 63 publications

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“…Similarly, patients with either primary or functional mitral regurgitation are at high risk of developing postcapillary PH, which is an additional risk factor for surgery. 11 …”

Section: The Problemmentioning

confidence: 99%

Management of Pulmonary Hypertension in Left Heart Disease

Macera

Vachiéry

2021

Methodist DeBakey Cardiovascular Journal

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Pulmonary hypertension due to left heart diseases (PH-LHD) is the most prevalent form of pulmonary hypertension. It frequently complicates heart failure with reduced ejection fraction (HFrEF) or preserved ejection fraction (HFpEF) and negatively impacts prognosis, particularly when a precapillary component is present. PH-LHD is distinctive from pulmonary arterial hypertension (PAH) even though both conditions may share some common characteristics. In addition, the mechanisms involved in the development of a precapillary component are yet to be fully clarified, in particular in PH due to HFpEF. Several studies have been exploring PAH pathways as potential therapies for PH-LHD, but no PAH-approved drug has demonstrated efficacy in PH-LHD. Rather, some classes of drugs, such as endothelin-receptor antagonists or prostacycline-analogues, have been found to be harmful in patients with HF. Therefore, at present, the only established treatments for PH-LHD are those that target the heart as recommended in the international guidelines for HF. Based on current knowledge, off-label prescription of PAH-approved drugs in PH-LHD patients must be strongly discouraged.

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“…Similarly, patients with either primary or functional mitral regurgitation are at high risk of developing postcapillary PH, which is an additional risk factor for surgery. 11 …”

Section: The Problemmentioning

confidence: 99%

Management of Pulmonary Hypertension in Left Heart Disease

Macera

Vachiéry

2021

Methodist DeBakey Cardiovascular Journal

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“…Other demographic (age and sex) and disease-related risk factors (cardiopulmonary conditions) were consistent with previous epidemiologic studies [ 4 , 5 , 6 , 7 , 8 ] and/or recognised etiologic factors [ 2 ]. This latter group includes left heart disease [ 14 ] and cardiac valvular disease [ 33 ], even if the only independent association was with prevalent PH at an RVSP >30 mmHg. The use of aspirin (prevalent PH) and lipid-modifying agents (incident PH) likely represent confounding by indication since these medications are indicated for people with, or at high risk of, cardiovascular disease.…”

Section: Discussionmentioning

confidence: 99%

Prevalence, Incidence and Associates of Pulmonary Hypertension Complicating Type 2 Diabetes: Insights from the Fremantle Diabetes Study Phase 2 and National Echocardiographic Database of Australia

Nundlall

Playford

Strange

et al. 2021

JCM

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There is a paucity of epidemiologic data examining the relationship between pulmonary hypertension (PH) and diabetes. The aim of this study was to determine prevalence, incidence and associates of PH complicating type 2 diabetes. Data from 1430 participants (mean age 65.5 years, 51.5% males) in the Fremantle Diabetes Study Phase 2 (FDS2) were linked with the National Echocardiographic Database of Australia (NEDA) to ascertain the prevalence and incidence of PH (estimated right ventricular systolic pressure (eRVSP) >30 mmHg as a new suggested threshold or the conventional >40 mmHg) over a 12-year period. PH prevalence in FDS2 was compared with that in NEDA overall and a geographically close sub-population. Multivariable analyses identified associates of prevalent/incident PH in the FDS2 cohort. Of 275 FDS2 patients (19.2%) with pre-entry echocardiography, 90 had eRVSP >30 mmHg and 35 had eRVSP >40 mmHg (prevalences 32.7% (95% CI 27.3–38.7%) and 12.7% (9.1–17.4%), respectively), rates that are 35–50% greater than national/local NEDA general population estimates. Moreover, 70 (5.0%) and 123 (9.2%) FDS2 participants were identified with incident PH at the respective eRVSP thresholds (incidence (95% CI) 7.6 (6.0–9.7) and 14.2 (11.8–17.0)/1000 person-years), paralleling data from recognised high-risk conditions such as systemic sclerosis. The baseline plasma N-terminal pro-brain natriuretic peptide concentration was the strongest independent associate of prevalent/incident PH. Approximately 1 in 8 people with type 2 diabetes have PH using the eRVSP >40 mmHg threshold. Its presence should be considered as part of regular clinical assessment of individuals with type 2 diabetes.

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“…Functional parameters of the right ventricle such as fractional area change (FAC) and tricuspid annular plane systolic excursion (TAPSE) do not generally show impairment whereas the RVsphericity index (diameter/length) increases with progression of TR. Right atrial (RA) dilation is also frequently associated with PAH and severe TR (23). Tricuspid valve tenting height and area is also significantly increased.…”

Section: Precapillary Pulmonary Hypertension Related Tricuspid Regurgitationmentioning

confidence: 99%

Secondary Tricuspid Regurgitation: Pathophysiology, Incidence and Prognosis

Gerçek

Rudolph

2021

Front. Cardiovasc. Med.

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Tricuspid regurgitation (TR) can be divided into primary and secondary origins. Primary TR is mostly caused by infective endocarditis, leaflet perforation, entrapment after device placement and congenital abnormalities. The natural cause of secondary (functional) TR is not well-understood and underdiagnoses is likely. Because symptoms such as ascites, edema and hepatomegaly usually manifest at a late state, assessment of TR is challenging requiring a multiparametric approach. Secondary TR can be subdivided into four morphologic types according to the underlying mechanism: Left-heart related TR, precapillary pulmonary hypertension related TR, right ventricular disease related TR and isolated TR.

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Pulmonary hypertension and valvular heart disease

Cited by 29 publications

References 63 publications

Management of Pulmonary Hypertension in Left Heart Disease

Management of Pulmonary Hypertension in Left Heart Disease

Prevalence, Incidence and Associates of Pulmonary Hypertension Complicating Type 2 Diabetes: Insights from the Fremantle Diabetes Study Phase 2 and National Echocardiographic Database of Australia

Secondary Tricuspid Regurgitation: Pathophysiology, Incidence and Prognosis

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