Left Atrial Intrinsic Strain Rate Correcting for Pulmonary Wedge Pressure Is Accurate in Estimating Pulmonary Vascular Resistance in Breathless Patients

2016 ◽  
Vol 33 (8) ◽  
pp. 1156-1165 ◽  
Author(s):  
Erik Tossavainen ◽  
Michael Y. Henein ◽  
Christer Grönlund ◽  
Per Lindqvist
Keyword(s):  
Strain Rate ◽  
Pulmonary Vascular Resistance ◽  
Vascular Resistance ◽  
Left Atrial ◽  
Pulmonary Wedge Pressure ◽  
Wedge Pressure ◽  
Intrinsic Strain

scholarly journals Echocardiographic Pulmonary to Left Atrial Ratio (ePLAR): A Comparison Study between Ironman Athletes, Age Matched Controls and A General Community Cohort

2019 ◽  
Vol 8 (10) ◽  
pp. 1756 ◽  
Author(s):  
Tran ◽  
Kwon ◽  
Holt ◽  
Kierle ◽  
Fitzgerald ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Pulmonary Vascular Resistance ◽  
Vascular Resistance ◽  
Left Atrial ◽  
Systolic Pressure ◽  
Exercise Stress ◽  
Control Group ◽  
Right Ventricular Systolic Pressure ◽  
Ventricular Systolic Pressure ◽  
General Community

Background: During exercise there is a proportionally lower rise in systemic and pulmonary pressures compared to cardiac output due to reduced vascular resistance. Invasive exercise data suggest that systemic vascular resistance reduces more than pulmonary vascular resistance. The aim of this study was the non-invasive assessment of exercise hemodynamics in ironman athletes, compared with an age matched control group and a larger general community cohort. Methods: 20 ironman athletes (40 ± 11 years, 17 male) were compared with 20 age matched non-athlete controls (43 ± 7 years, 10 male) and a general community cohort of 230 non-athletes individuals (66 ± 11 years, 155 male), at rest and after maximal-symptom limited treadmill exercise stress echocardiography. Left heart parameters (mitral E-wave, e’-wave and E/e’) and right heart parameters (tricuspid regurgitation maximum velocity and right ventricular systolic pressure), were used to calculate the echocardiographic Pulmonary to Left Atrial Ratio (ePLAR) value of the three groups. Results: Athletes exercised for 12.2 ± 0.53 minutes, age matched controls for 10.1 ± 2.8 minutes and general community cohort for 8.3 ± 2.6 minutes. Mitral E/e’ rose slightly for athletes (0.9 ± 1.8), age matched controls (0.6 ± 3.0) and non-athletes (0.4 ± 3.2). Right ventricular systolic pressure increased significantly more in athletes than in both non-athlete cohorts (35.6 ± 17 mmHg vs. 20.4±10.8mmHg and 18 ± 9.6 mmHg). The marker of trans-pulmonary gradient, ePLAR, rose significantly more in athletes than in both non-athlete groups (0.15 ± 0.1 m/s vs. 0.07 ± 0.1 m/s). Conclusions: Pulmonary pressures increased proportionally four-fold compared with systemic pressures in ironman athletes. This increase in pulmonary vascular resistance corresponded with a two-fold increase in ePLAR. These changes were exaggerated compared with both non-ironman cohorts. Such changes have been previously suggested to lead to right ventricle dysfunction, arrhythmias and sudden cardiac death.

scholarly journals Pulmonary Hypertension Due to Left Heart Disease

Hypertension ◽  
2020 ◽  
Vol 75 (6) ◽  
pp. 1397-1408 ◽  
Author(s):  
Mohammed S. Al-Omary ◽  
Stuart Sugito ◽  
Andrew J. Boyle ◽  
Aaron L. Sverdlov ◽  
Nicholas J. Collins
Keyword(s):  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Pulmonary Vascular Resistance ◽  
Vascular Resistance ◽  
Left Atrial ◽  
Left Atrial Pressure ◽  
Left Heart ◽  
Pulmonary Arterial

Pulmonary hypertension (PH) due to left heart disease (LHD) is the most common type of PH and is defined as mean pulmonary artery systolic pressure of >20 mm Hg and pulmonary capillary wedge pressure >15 mm Hg during right heart catheterization. LHD may lead to elevated left atrial pressure alone, which in the absence of intrinsic pulmonary vascular disease will result in PH without changes in pulmonary vascular resistance. Persistent elevation in left atrial pressure may, however, also be associated with subsequent pulmonary vascular remodeling, vasoconstriction, and an increase in pulmonary vascular resistance. Hence, there are 2 subgroups of PH due to LHD, isolated postcapillary PH and combined post- and precapillary PH, with these groups have differing clinical implications. Differentiation of pulmonary arterial hypertension and PH due to LHD is critical to guide management planning; however, this may be challenging. Older patients, patients with metabolic syndrome, and patients with imaging and clinical features consistent with left ventricular dysfunction are suggestive of LHD etiology rather than pulmonary arterial hypertension. Hemodynamic measures such as diastolic pressure gradient, transpulmonary gradient, and pulmonary vascular resistance may assist to differentiate pre- from postcapillary PH and offer prognostic insights. However, these are influenced by fluid status and heart failure treatment. Pulmonary arterial hypertension therapies have been trialed in the treatment with concerning results reflecting disease heterogeneity, variation in inclusion criteria, and mixed end point criteria. The aim of this review is to provide an updated definition, discuss possible pathophysiology, clinical aspects, and the available treatment options for PH due to LHD.

Bedside evaluation of the resistance of large and medium pulmonary veins in various lung diseases

1992 ◽  
Vol 72 (3) ◽  
pp. 998-1003 ◽  
Author(s):  
J. L. Teboul ◽  
P. Andrivet ◽  
M. Ansquer ◽  
M. Besbes ◽  
N. Rekik ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Vascular Resistance ◽  
Vascular Resistance ◽  
Lung Diseases ◽  
Distress Syndrome ◽  
Pulmonary Veins ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Wedge Pressure ◽  
Normal Lungs

To evaluate the contribution of large and medium pulmonary veins to the total pulmonary vascular resistance in various human lung diseases, we compared in 64 patients the pulmonary arterial proximal wedge pressure (Ppw), obtained when the balloon of a 7F pulmonary artery catheter was inflated with 1.5 ml air, with the distal wedge pressure (Pdw), obtained after the tip of the catheter was advanced until wedged in a small artery without balloon inflation. Ppw, reflecting the pressure in a large pulmonary vein, approximates the left atrial pressure, whereas Pdw reflects the pressure in a smaller pulmonary vein. Pdw was greater than Ppw in all 64 patients. The Pdw-Ppw gradient was 1.1 +/- 0.5 mmHg in nine patients with normal lungs and was significantly higher in 13 patients with chronic congestive heart failure (3.8 +/- 0.8 mmHg, P less than 0.01) and in 22 patients with adult respiratory distress syndrome (3.8 +/- 0.8 mmHg; P less than 0.01), but not in 20 patients with chronic obstructive pulmonary disease (1.8 +/- 0.7 mmHg). The distribution of the pulmonary vascular resistance was clearly different among the four groups. The fraction of the total pulmonary vascular resistance attributable to large and medium pulmonary veins was significantly increased (P less than 0.01) in adult respiratory distress syndrome (27.5 +/- 12%) and cardiac patients (27.5 +/- 9%) compared with patients with chronic obstructive pulmonary disease (13 +/- 5%) and normal lungs (13.5 +/- 6%).(ABSTRACT TRUNCATED AT 250 WORDS)

scholarly journals Persistent Pulmonary Hypertension in Corrected Valvular Heart Disease: Hemodynamic Insights and Long‐Term Survival

2021 ◽  
Author(s):  
Javier Bermejo ◽  
Ana González‐Mansilla ◽  
Teresa Mombiela ◽  
Ana I. Fernández ◽  
Pablo Martínez‐Legazpi ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Pulmonary Vascular Resistance ◽  
Vascular Resistance ◽  
Valvular Heart Disease ◽  
Pulmonary Artery Wedge Pressure ◽  
Wedge Pressure

Background The determinants and consequences of pulmonary hypertension after successfully corrected valvular heart disease remain poorly understood. We aim to clarify the hemodynamic bases and risk factors for mortality in patients with this condition. Methods and Results We analyzed long‐term follow‐up data of 222 patients with pulmonary hypertension and valvular heart disease successfully corrected at least 1 year before enrollment who had undergone comprehensive hemodynamic and imaging characterization as per the SIOVAC (Sildenafil for Improving Outcomes After Valvular Correction) clinical trial. Median (interquartile range) mean pulmonary pressure was 37 mm Hg (32–44 mm Hg) and pulmonary artery wedge pressure was 23 mm Hg (18–26 mm Hg). Most patients were classified either as having combined precapillary and postcapillary or isolated postcapillary pulmonary hypertension. After a median follow‐up of 4.5 years, 91 deaths accounted for 4.21 higher‐than‐expected mortality in the age‐matched population. Risk factors for mortality were male sex, older age, diabetes mellitus, World Health Organization functional class III and higher pulmonary vascular resistance—either measured by catheterization or approximated from ultrasound data. Higher pulmonary vascular resistance was related to diabetes mellitus and smaller residual aortic and mitral valve areas. In turn, the latter correlated with prosthetic nominal size. Six‐month changes in the composite clinical score and in the 6‐minute walk test distance were related to survival. Conclusions Persistent valvular heart disease–pulmonary hypertension is an ominous disease that is almost universally associated with elevated pulmonary artery wedge pressure. Pulmonary vascular resistance is a major determinant of mortality in this condition and is related to diabetes mellitus and the residual effective area of the corrected valve. These findings have important implications for individualizing valve correction procedures. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00862043.

scholarly journals THE EFFECT OF ACETYLCHOLINE ON PULMONARY VASCULAR RESISTANCE AND LEFT ATRIAL PRESSURE IN MITRAL STENOSIS

Heart ◽  
1957 ◽  
Vol 19 (2) ◽  
pp. 279-286 ◽  
Author(s):  
P. Wood ◽  
E. M. Besterman ◽  
M. K. Towers ◽  
M. B. McIlroy
Keyword(s):  
Pulmonary Vascular Resistance ◽  
Vascular Resistance ◽  
Mitral Stenosis ◽  
Left Atrial ◽  
Atrial Pressure ◽  
Left Atrial Pressure

scholarly journals A novel echocardiographic method for estimation of pulmonary artery wedge pressure and pulmonary vascular resistance

2021 ◽  
Vol 8 (2) ◽  
pp. 1216-1229
Author(s):  
Vladislav Chubuchny ◽  
Nicola Riccardo Pugliese ◽  
Claudia Taddei ◽  
Elisa Poggianti ◽  
Valentina Spini ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Pulmonary Vascular Resistance ◽  
Vascular Resistance ◽  
Pulmonary Artery Wedge Pressure ◽  
Wedge Pressure

scholarly journals Influence of Pulmonary Arterial and Left Atrial Pressures on Pulmonary Vascular Resistance

1956 ◽  
Vol 4 (4) ◽  
pp. 393-399 ◽  
Author(s):  
HANS G. BORST ◽  
MAURICE MCGREGOR ◽  
JAMES L. WHITTENBERGER ◽  
ERIK BERGLUND
Keyword(s):  
Pulmonary Vascular Resistance ◽  
Vascular Resistance ◽  
Left Atrial ◽  
Pulmonary Arterial
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