Validation of New Pulsed Doppler Echocardiographic Techniques for Assessment of Pulmonary Hemodynamics

Sajkov, Dimitar; Cowie, R. J.; Bradley, Julie A.; Mahar, L. J.; Rd, McEvoy

doi:10.1378/chest.103.5.1348

Cited by 24 publications

(8 citation statements)

References 15 publications

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“…Furthermore, it is reasonable to assume that a substantial number of patients would refuse to undergo right heart catheterization because of the invasiveness of the procedure. There are previous reports that Doppler echocardiography offers a reliable noninvasive alternative in estimating P PA [11, 12, 13]. The results of our study have shown that P PA measurements with either Swan-Ganz catheterization or Doppler echocardiography are in close agreement and, hence, Doppler echocardiography is a reliable method of P PA estimation.…”

Section: Discussionsupporting

confidence: 75%

Daytime Pulmonary Hypertension in Patients with Obstructive Sleep Apnea

et al. 2001

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Background: Limited information exists regarding the development of pulmonary hypertension in patients with obstructive sleep apnea (OSA) in the absence of lung and heart comorbidity. Objectives: The aims of this study were to investigate whether OSA patients without any other cardiac or lung disease develop pulmonary hypertension, and to assess the effect of continuous positive airway pressure (CPAP) treatment on pulmonary artery pressure (P_PA). Methods: Twenty-nine patients aged 51 ± 10 years with OSA and 12 control subjects were studied with pulsed-wave Doppler echocardiography for estimation of P_PA before and after 6-month effective treatment with CPAP. Results: A significantly higher mean P_PA was found in OSA patients as compared to control subjects (17.2 ± 5.2 vs. 12.1 ± 1.9 mm Hg, p < 0.001). Six out of the 29 OSA patients had mild pulmonary hypertension (P_PA ≧ 20 mm Hg). Significant differences were observed between pulmonary hypertensive and normotensive OSA patients with respect to age (62 ± 4 vs. 48 ± 15 years, respectively, p < 0.05), body mass index (41 ± 7 vs. 32 ± 4 kg/m², p < 0.02) and daytime P_aO₂ (81 ± 9 vs. 92 ± 9 mm Hg, p < 0.05). CPAP treatment was effective in reducing mean P_PA in both groups of pulmonary hypertensive and normotensive OSA patients (decreases in P_PA from 25.6 ± 4.0 to 19.5 ± 1.5 mm Hg, p < 0.001; from 14.9 ± 2.2 to 11.5 ± 2.0 mm Hg, respectively, p < 0.001). Conclusions: A proportion (20.7%) of OSA patients without any other lung or heart disease and characterized by older age, greater obesity and lower daytime oxygenation develop mild pulmonary hypertension which has been partially or completely reversed after 6-month CPAP treatment. In conclusion, OSA alone constitutes an independent risk factor for the development of pulmonary hypertension.

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Section: Discussionsupporting

confidence: 75%

Daytime Pulmonary Hypertension in Patients with Obstructive Sleep Apnea

et al. 2001

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“…Pulmonary hypertension as well as right and left ventricular chamber functions in OSA has become increasingly amenable to study by echocardiographic techniques (M-mode, 2D, Doppler, and TDI) [22][23][24][25][26][27][28]. These techniques have provided new insights into the effects of OSA on the pulmonary circulation and heart performance.…”

Section: Discussionmentioning

confidence: 99%

“…Echocardiographic techniques, both conventional and Tissue Doppler Imaging (TDI), are well-established methods for the evaluation of myocardial performance in OSA patients [22][23][24][25][26][27][28]. The aims of this investigation were as follows: (i) to evaluate structure and function of both ventricles by echocardiography (conventional and tissue Doppler study) in patients suffering from OSA, (ii) to determine the relation between OSA severity and the extent of left and right ventricular dysfunction, and (iii) to assess the magnitude of beneficial effect of CPAP treatment on the above disorders after 12 months of CPAP use.…”

Section: Introductionmentioning

confidence: 99%

Impact of continuous positive airway pressure treatment on myocardial performance in patients with obstructive sleep apnea. A conventional and tissue Doppler echocardiographic study

Karamanzanis¹,

Panou

Lazaros³

et al. 2014

Sleep Breath

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“…Echocardiography has been put forward as a useful tool in patients with suspected PH if right heart catheterisation is not feasible or warranted [29]. However, it might be imprecise in determining actual pressures compared with invasive evaluation in a portion of patients and its inherent limitations in COPD have been extensively described previously [30].…”

Section: Discussionmentioning

confidence: 99%

A randomised, controlled trial of bosentan in severe COPD

Stolz¹,

Rasch²,

Linka³

et al. 2008

Eur Respir J

289

193

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Pulmonary hypertension during exercise is common in severe chronic obstructive pulmonary disease (COPD). It was hypothesised that the use of the endothelin-receptor antagonist bosentan can improve cardiopulmonary haemodynamics during exercise, thus increasing exercise tolerance in patients with severe COPD.In the present double-blind, placebo-controlled study, 30 patients with severe or very severe COPD were randomly assigned in a 2:1 ratio to receive either bosentan or placebo for 12 weeks. The primary end-point was change in the 6-min walking distance. Secondary end-points included changes in health-related quality of life, lung function, cardiac haemodynamics, maximal oxygen uptake and pulmonary perfusion patterns.Compared with placebo, patients treated with bosentan during 12 weeks showed no significant improvement in exercise capacity as measured by the 6-min walking distance (mean¡SD 331¡123 versus 329¡94 m). There was no change in lung function, pulmonary arterial pressure, maximal oxygen uptake or regional pulmonary perfusion pattern. In contrast, arterial oxygen pressure dropped, the alveolar-arterial gradient increased and quality of life deteriorated significantly in patients assigned bosentan.The oral administration of the endothelin receptor antagonist bosentan not only failed to improve exercise capacity but also deteriorated hypoxaemia and functional status in severe chronic obstructive pulmonary disease patients without severe pulmonary hypertension at rest. KEYWORDS: Endothelin-receptor antagonist, exercise capacity, pulmonary hypertension, treatment P ulmonary hypertension (PH) at rest and during exercise is a very frequent complication in the natural history of chronic obstructive pulmonary disease (COPD) [1,2]. Correspondingly, this condition has been reported in 20-91% of patients with severe COPD and/or emphysema [3,4]. The presence of PH is commonly associated with more frequent use of healthcare resources and worse clinical outcome [5]. Remarkably, pulmonary artery pressure has been suggested to be the single best predictor of mortality in COPD [6].In COPD, PH is generally of moderate severity, but the range of mean pulmonary artery pressures varies substantially [7]. Moderate and severe PH are present in 9.8 and 3.7%, respectively, of the patients undergoing right heart catheterisation before lung volume reduction surgery [7]. Despite many uncertainties, studies indicate that 35% of all patients with severe COPD have pulmonary artery pressures of .20 mmHg at rest [8]. In addition, pulmonary pressures during exercise are greater than predicted by the pulmonary vascular resistance (PVR) equation in COPD, suggesting active pulmonary vasoconstriction on exertion [9]. Hence, of those patients without PH at rest, a further 52% are estimated to develop PH during exercise [5].There are many pathological similarities between idiopathic pulmonary arterial hypertension (PAH) and PH related to COPD. Like idiopathic PAH, pulmonary arteries in patients with COPD show evidence of fibromuscula...

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Validation of New Pulsed Doppler Echocardiographic Techniques for Assessment of Pulmonary Hemodynamics

Cited by 24 publications

References 15 publications

Daytime Pulmonary Hypertension in Patients with Obstructive Sleep Apnea

Daytime Pulmonary Hypertension in Patients with Obstructive Sleep Apnea

Impact of continuous positive airway pressure treatment on myocardial performance in patients with obstructive sleep apnea. A conventional and tissue Doppler echocardiographic study

A randomised, controlled trial of bosentan in severe COPD

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