Pulmonary Hypertension with Left Heart Disease: Prevalence, Temporal Shifts in Etiologies and Outcome

Weitsman, Tatyana; Weisz, Giora; Farkash, Rivka; Klutstein, Marc; Butnaru, Adi; Rosenmann, David; Hasin, Tal

doi:10.1016/j.amjmed.2017.05.003

Cited by 45 publications

(33 citation statements)

References 27 publications

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“…A full assessment including history, ECG and echocardiography will help to identify PH due to left heart disease ( 38 ). This is important as left heart disease will be the major aetiology of PH encountered in echocardiography departments ( 9 ). If there is an intermediate or high probability of PH then further echocardiographic evaluation should be made to exclude a cardiac cause for PH.…”

Section: Appendicesmentioning

confidence: 99%

“…The classification of PH categorises different clinical conditions into five groups ( Table 1 ). This is an important categorisation for two reasons: first, the most common form of PH encountered in any echocardiography department will be secondary to left heart disease ( 9 ) and hence a full study with consideration of indirect measures of elevation in left ventricular end-diastolic pressure must be performed in all cases consistent with the minimum dataset ( 1 ); secondly, the interpretation of supportive measurements for classification of patients with intermediate probability of PH, such pulmonary artery acceleration/mid systolic notching, must be taken in the context of the possible underlying cause as these may be more likely in cases with pre-capillary PH.…”

Section: Introductionmentioning

confidence: 99%

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Echocardiographic assessment of pulmonary hypertension: a guideline protocol from the British Society of Echocardiography

Augustine¹,

Coates-Bradshaw²,

Willis³

et al. 2018

Echo Res Pract

228

175

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Pulmonary hypertension is defined as a mean arterial pressure of ≥25 mmHg as confirmed on right heart catheterisation. Traditionally, the pulmonary arterial systolic pressure has been estimated on echo by utilising the simplified Bernoulli equation from the peak tricuspid regurgitant velocity and adding this to an estimate of right atrial pressure. Previous studies have demonstrated a correlation between this estimate of pulmonary arterial systolic pressure and that obtained from invasive measurement across a cohort of patients. However, for an individual patient significant overestimation and underestimation can occur and the levels of agreement between the two is poor. Recent guidance has suggested that echocardiographic assessment of pulmonary hypertension should be limited to determining the probability of pulmonary hypertension being present rather than estimating the pulmonary artery pressure. In those patients in whom the presence of pulmonary hypertension requires confirmation, this should be done with right heart catheterisation when indicated. This guideline protocol from the British Society of Echocardiography aims to outline a practical approach to assessing the probability of pulmonary hypertension using echocardiography and should be used in conjunction with the previously published minimum dataset for a standard transthoracic echocardiogram.

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Section: Appendicesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Echocardiographic assessment of pulmonary hypertension: a guideline protocol from the British Society of Echocardiography

Augustine¹,

Coates-Bradshaw²,

Willis³

et al. 2018

Echo Res Pract

228

175

View full text Add to dashboard Cite

show abstract

“…The most common cause of pulmonary hypertension (PH) worldwide is left heart disease (LHD), 1 and valvular heart disease (VHD) is amongst the leading causes of this type of secondary PH. 2 Pulmonary hypertension affects virtually all patients with severe symptomatic mitral valve disease and up to 65% of those with symptomatic aortic stenosis. 3 Mitral and aortic valve diseases increase left atrial pressure which, in turn, leads to an initially passive and potentially reversible increase in pulmonary pressures.…”

Section: Introductionmentioning

confidence: 99%

Sildenafil for improving outcomes in patients with corrected valvular heart disease and persistent pulmonary hypertension: a multicenter, double-blind, randomized clinical trial

Bermejo

Yotti

García‐Orta

et al. 2017

European Heart Journal

191

132

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AimsWe aimed to determine whether treatment with sildenafil improves outcomes of patients with persistent pulmonary hypertension (PH) after correction of valvular heart disease (VHD).Methods and resultsThe sildenafil for improving outcomes after valvular correction (SIOVAC) study was a multricentric, randomized, parallel, and placebo-controlled trial that enrolled stable adults with mean pulmonary artery pressure ≥ 30 mmHg who had undergone a successful valve replacement or repair procedure at least 1 year before inclusion. We assigned 200 patients to receive sildenafil (40 mg three times daily, n = 104) or placebo (n = 96) for 6 months. The primary endpoint was the composite clinical score combining death, hospital admission for heart failure (HF), change in functional class, and patient global self-assessment. Only 27 patients receiving sildenafil improved their composite clinical score, as compared with 44 patients receiving placebo; in contrast 33 patients in the sildenafil group worsened their composite score, as compared with 14 in the placebo group [odds ratio 0.39; 95% confidence interval (CI) 0.22–0.67; P < 0.001]. The Kaplan–Meier estimates for survival without admission due to HF were 0.76 and 0.86 in the sildenafil and placebo groups, respectively (hazard ratio 2.0, 95% CI = 1.0–4.0; log-rank P = 0.044). Changes in 6-min walk test distance, natriuretic peptides, and Doppler-derived systolic pulmonary pressure were similar in both groups.ConclusionTreatment with sildenafil in patients with persistent PH after successfully corrected VHD is associated to worse clinical outcomes than placebo. Off-label usage of sildenafil for treating this source of left heart disease PH should be avoided.The trial is registered with ClinicalTrials.gov, number NCT00862043.

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“…In patients with left heart disease, the presence of pulmonary hypertension (PH) is an important feature as it represents a marker of more advanced disease and poor prognosis ( 1 ). Pulmonary hypertension due to left heart disease (group 2 PH) is the by far most common type of PH, and valve disease is the leading cause ( 2 ). Independent of symptoms the presence of PH in patients with valve disease indicates a decompensated state of the disease with left ventricular (LV) and left atrial (LA) dysfunction and exhausted compensatory mechanism, i.e., a state of chronic heart failure (HF) with a propensity for acute exacerbations, e.g., in the context of arrhythmia or volume challenges.…”

Section: Introductionmentioning

confidence: 99%

Pulmonary Hypertension in Aortic and Mitral Valve Disease

Maeder

Weber

Buser

et al. 2018

Front. Cardiovasc. Med.

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In patients with aortic and/or mitral valve disease the presence of pulmonary hypertension (PH) indicates a decompensated state of the disease with left ventricular and left atrial dysfunction and exhausted compensatory mechanism, i.e., a state of heart failure. Pulmonary hypertension in this context is the consequence of the backwards transmission of elevated left atrial pressure. In this form of PH, pulmonary vascular resistance is initially normal (isolated post-capillary PH). Depending on the extent and chronicity of left atrial pressure elevation additional pulmonary vascular remodeling may occur (combined pre- and post-capillary PH). Mechanical interventions for the correction of valve disease often but not always reduce pulmonary pressures. However, the reduction in pulmonary pressures is often modest, and persistent PH in these patients is common and a marker of poor prognosis. In the present review we discuss the pathophysiology and clinical impact of PH in patients with aortic and mitral valve disease, the comprehensive non-invasive and invasive diagnostic approach required to define treatment of PH, and recent insights from mechanistic studies, registries and randomized studies, and we provide an outlook regarding gaps in evidence, future clinical challenges, and research opportunities in this setting.

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Pulmonary Hypertension with Left Heart Disease: Prevalence, Temporal Shifts in Etiologies and Outcome

Cited by 45 publications

References 27 publications

Echocardiographic assessment of pulmonary hypertension: a guideline protocol from the British Society of Echocardiography

Echocardiographic assessment of pulmonary hypertension: a guideline protocol from the British Society of Echocardiography

Sildenafil for improving outcomes in patients with corrected valvular heart disease and persistent pulmonary hypertension: a multicenter, double-blind, randomized clinical trial

Pulmonary Hypertension in Aortic and Mitral Valve Disease

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