Pulmonary vascular resistance index: Getting the units right and why it matters

Kwan, Wilson; Shavelle, David M.; Laughrun, David

doi:10.1002/clc.23151

Cited by 20 publications

(12 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These echocardiography parameters have not been validated and compared with the catheterization criteria henceforth making a discrepancy data especially between mPAP and PVRi. Although, there is still a possibility of reduced baseline PVR due to the effects of general anesthesia and the use of the oxygen fraction prior to hemodynamic measurements during cardiac catheterization [ 25 38 ]. These might have resulted in reduced baseline PVRi in our study.…”

Section: Study Limitationmentioning

confidence: 99%

Survival of Left-to-Right Shunt Repair in Children with Pulmonary Arterial Hypertension at a Tertiary Hospital in a Low-to-Middle-Income Country

Arafuri

Murni

Idris

et al. 2021

View full text Add to dashboard Cite

Background: In low-to-middle-income countries, repair of the left-to-right shunts congenital heart disease (CHD) are often done with existing pulmonary arterial hypertension (PAH). Long-term outcomes data of this condition in either low-to-middle or high-income countries are limited. We conducted a study to evaluate the outcomes of children with PAH related to left-to-right shunt CHD who underwent surgical or transcatheter repair. Methods: All cases of PAH related to left-to-right shunt CHD repairs from 2015–2018 were retrospectively reviewed with additional new patients who underwent repair within our study period (2019–2020). Cases with complex congenital heart disease and incomplete hemodynamic echocardiography or catheterization measurements were excluded. Kaplan-Meier curves, log-rank test, Cox regression with Firth’s correction and restricted mean survival time were used for survival analysis. Results: Of the 118 patients, 103 patients were enrolled and 15 patients were excluded due to complex congenital heart disease and missing hemodynamic measurements prior to repair. Overall, median age at intervention was 44 months, mPAP mean was 43.17 ± 16.05 mmHg and Pulmonary Vascular Resistance index (PVRi) mean was 2.84 ± 2.09 (WU.m 2 ). Nine patients died after repair. The survival rate for patients with PAH-CHD at 1 day, 30 days and 1400 days (4 years) was 96.1%, 92.1%, and 91.0% respectively. Patients with persisting PAH after correction had –476.1 days (95% confidence interval [CI]: –714.4, –237,8) shorter survival over 4 years of follow up compared to patients with reversed PAH. PVRi was found to be the influencing covariate of the difference of restricted mean survival time between these groups. Conclusion: In low-to-middle income settings, with accurate PAH reversibility assessment prior to intervention, repair of left-to-right shunt CHD with existing PAH in children has a favourable outcome. Inferior survival is found in patients with persistence of PAH. PVRi at baseline predicts between-group survival difference.

show abstract

Section: Study Limitationmentioning

confidence: 99%

Survival of Left-to-Right Shunt Repair in Children with Pulmonary Arterial Hypertension at a Tertiary Hospital in a Low-to-Middle-Income Country

Arafuri

Murni

Idris

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Although this study focuses on PVR, as used by ISHLT guidelines, future studies could include PVRI. 26 Future studies may also address medication adjustments and speed titration studies.…”

Section: Discussionmentioning

confidence: 99%

The Role of Serial Right Heart Catheterization Survey in Patients Awaiting Heart Transplant on Ventricular Assist Device

et al. 2021

View full text Add to dashboard Cite

Current guidelines recommend serial right heart catheterization (RHC) to survey pulmonary hypertension in patients awaiting heart transplant. However, the role and impact of this surveillance is unclear in patients with a left ventricular assist device (LVAD). We reviewed our surveillance RHC protocol to determine whether useful data were obtained to justify the risks of serial invasive procedures (i.e., excessive bleeding). Between January 2015 and December 2018, 78 patients who received an LVAD as bridge-to-transplant (BTT) were included in this study. Routine RHC surveillance was performed every 6 months. Hemodynamic variables were retrospectively collected and reviewed. In 78 patients, 205 RHCs were analyzed. Median patient age was 54 years (IQR 46–61), and 64 (82%) were male. Thirty-six patients (46%) had pulmonary vascular resistance (PVR) ≤ 3 Wood units (WUs), and 42 patients (54%) had PVR > 3 WUs before LVAD. After LVAD implantation, mean PVR decreased by 36% from 3.8 ± 2.1 to 2.4 ± 1.1 WUs (p < 0.001) at 6 months and stabilized below 3 WUs at all post-LVAD time points. Four patients (11%) with pre-LVAD PVR ≤ 3 and 16 patients (38%) with a pre-LVAD PVR > 3 had PVR > 3 at least once during RHC survey. Of the 56 (76%) transplanted patients, six (40%) of 15 patients with a post-LVAD PVR >3 at least once developed moderate-to-severe right ventricular dysfunction. Although PVR significantly decreased after LVAD implant, PVR values fluctuated, particularly for those with pre-LVAD PVR > 3.0 WUs. Routine RHC appears valid for all BTT patients.

show abstract

“…Índice de resistencia vascular pulmonar: Relaciona el valor absoluto de la RVP con el área de superficie corporal de la persona que está siendo valorada, para tener en cuenta el efecto del tamaño corporal sobre el flujo sanguíneo 120 .…”

Section: Glosariounclassified

“…donde PAPm es Presión arterial pulmonar media, PAI es presión en aurícula izquierda y GC es el gasto cardíaco. Se define como hipertensión pulmonar precapilar aquella que cursa con PAPm ≥ 25 mmHg, PAI ≤ 15 mmHg y RVP > 3 UW 120 .…”

Section: Ptfe (Politetrafluoroetileno) Membrana Deunclassified

Tratamiento de la Comunicación Interventricular (CIV) congénita con dispositivos de inserción percutánea y perventricular

Vázquez¹,

Martín-Sánchez²,

Muñoz³

et al. 2022

View full text Add to dashboard Cite

Los desenlaces analizados muestran una incidencia de eventos baja sin que el análisis haya mostrado diferencias estadísticamente significativas entre técnicas y, además, presentan limitaciones importantes por la heterogeneidad en los diseños de los estudios considerados. No hay pruebas científicas que permitan dilucidar si la técnica quirúrgica estándar o el cierre de la CIV mediante el uso de dispositivos es más eficaz que la otra. En términos de necesidad de reintervención para el control de sangrado o de necesidad de transfusión sanguínea, la técnica percutánea parece más segura que la técnica quirúrgica estándar. Si las circunstancias clínicas lo permiten, la información disponible sobre eficacia y seguridad debe ser compartida con los familiares para el proceso de toma de decisiones compartidas. Con cautela, el cierre de la CIV mediante la técnica de inserción percutánea supone una estrategia socialmente eficiente, respecto a la cirugía estándar.

show abstract

Pulmonary vascular resistance index: Getting the units right and why it matters

Cited by 20 publications

References 23 publications

Survival of Left-to-Right Shunt Repair in Children with Pulmonary Arterial Hypertension at a Tertiary Hospital in a Low-to-Middle-Income Country

Survival of Left-to-Right Shunt Repair in Children with Pulmonary Arterial Hypertension at a Tertiary Hospital in a Low-to-Middle-Income Country

The Role of Serial Right Heart Catheterization Survey in Patients Awaiting Heart Transplant on Ventricular Assist Device

Tratamiento de la Comunicación Interventricular (CIV) congénita con dispositivos de inserción percutánea y perventricular

Contact Info

Product

Resources

About