Portopulmonary hypertension: prognosis and management in the current treatment era - results from the REHAP registry.

BACKGROUND: Portopulmonary hypertension (PoPH) is a rare condition with poorer survival compared to idiopathic/familial pulmonary arterial hypertension (IPAH/FPAH). AIMS: To compare the characteristics, survival, prognostic factors and management of PoPH and IPAH/FPAH patients and to assess the impact of treatment on survival of PoPH patients. METHODS: Analysis of data of prevalent and incident PoPH patients enrolled in the Spanish registry of PAH (REHAP) from January 1998 to December 2017 and comparison with IPAH/FPAH patients. Variables analysed: patient and disease (PAH and liver) characteristics, first-line PAH-targeted therapy, causes of death, prognostic factors and survival (according to aetiology and treatment in PoPH patients). RESULTS: Compared to IPAH/FPAH patients (n = 678), patients with PoPH (n = 237) were predominantly men, older and had better functional class and higher prevalence of ascites. Haemodynamics were better. Biomarkers for heart failure were worse. Age- and sex-adjusted 5-year survival rate from diagnosis was 49.3% for PoPH patients and 68.7% for IPAH patients (P < 0.001). Treated PoPH had better survival than non-treated. PAH- and liver-related causes accounted for 30.2% and 24.7% of deaths in PoPH patients. PoPH patients were less likely to receive first-line PAH-targeted therapy and this was associated with greater mortality. Increasing age, worse exercise capacity and ascites were independent prognostic factors of poorer survival; first-line oral monotherapy was associated with improved survival. Eight (3.4%) PoPH patients underwent liver transplantation. CONCLUSIONS: PoPH patients are undertreated and show poorer survival than IPAH/FPAH patients. First-line treatment with PAH-targeted therapy was associated with better survival. Presence of ascites was a predictor of mortality.

Percutaneous pulmonary thrombectomy with aspiration catheters in patients with high-risk pulmonary embolism and absolute contraindication to systemic thrombolysis.

BACKGROUND: High-risk Pulmonary Embolism (PE) mortality remains very high. Systemic thrombolysis is effective but carries significant complications and contraindications related to the hemorrhagic risk. Percutaneous thrombectomy using aspiration catheters may be an alternative in patients with a high bleeding risk. OBJECTIVE: This study aimed to evaluate the results of catheter-directed thrombectomy using aspiration dedicated catheters in patients with high-risk PE and absolute contraindication to systemic thrombolysis, with specific focus on procedural success, safety, and in-hospital outcomes. METHODS: A prospective study enrolled all consecutive patients diagnosed with high-risk pulmonary embolism and absolute contraindication to systemic thrombolysis, who underwent percutaneous pulmonary thrombectomy using dedicated aspiration catheters. The study documented the effectiveness and complications of the procedure, as well as patient outcomes at discharge and during the follow-up period. RESULTS: Thirteen patients underwent percutaneous pulmonary thrombectomy using aspiration dedicated catheters. The procedure was successful for all patients, resulting in hemodynamic and respiratory improvement within the first 24 h. No deaths attributable to cardiovascular or respiratory causes occurred during admission or follow-up. Furthermore, no serious adverse events or complications were reported during the procedure or hospitalization. CONCLUSIONS: Percutaneous pulmonary thrombectomy with dedicated aspiration catheters in patients with high-risk pulmonary embolism and contraindications to systemic thrombolysis was associated with excellent clinical results and low rate of complications.

[Recording the daily physical activity of COPD patients with an accelerometer: An analysis of agreement and repeatability]. / Registro de la actividad física cotidiana mediante un acelerómetro en pacientes con EPOC. Análisis de concordancia y reproducibilidad.

OBJECTIVE: The purpose of this study was to assess the agreement between different measurements of mean daily physical activity taken over a week in chronic obstructive pulmonary disease (COPD) patients with an accelerometer and to analyze the medium-term repeatability of these measurements. PATIENTS AND METHODS: The study enrolled 12 healthy control subjects and 23 patients with stable COPD (mean [SD] forced expiratory volume in 1 second [FEV1] of 45% [13%] of predicted and a ratio of FEV1 to forced vital capacity of 53% [13%]). Accelerometer output, measured in vector magnitude units, was recorded in a physical activity log for a 1-week period. The results were then analyzed to compare output for a conventional recording period (Friday to Sunday) to that for 2 other periods (Monday to Wednesday and Tuesday to Thursday). The measurements were repeated 3 to 5 weeks later. RESULTS: Activity counts were lower in the COPD patients than in the control subjects (184 [99] vs 314 [75]; P < .001). In the COPD patients, the results for the Friday to Sunday period correlated well with the results for both the Monday to Wednesday period (95% confidence interval, -29.21 to 28.81) and the Tuesday to Thursday period (95% confidence interval, -32.13 to 28.43). There were no significant differences in terms of medium-term repeatability of accelerometer readings between the COPD group and the control group (repeatability coefficient of 11.2% [4.6%] and 8.5% [4.7%], respectively). CONCLUSIONS: Both agreement between the different measurements of physical activity taken during a 1-week period and medium-term repeatability for COPD patients and control subjects were very good.

[Massive cardiac lipomatosis, an autopsy finding in a patient with sudden death]. / Lipomatosis cardiaca masiva, hallazgo en la autopsia de un paciente con muerte súbita.

The fat replacement of myocardial cells is a degenerative process that usually affects the right ventricle and is found in 50% of the elderly. The problem arises when this degeneration occurs to a massive degree, a differential diagnosis with other pathologies being necessary. We present the case of a patient who died suddenly and a massive cardiac lipomatosis was found on autopsy, as the only explanation of the outcome.