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Resumo Fundamento A hipertensão pulmonar (HP) é uma doença rara e complexa com prognóstico ruim, que exige tratamento pela vida toda. Objetivo Descrever dados de 3 anos de acompanhamento da vida real sobre o tratamento com estimuladores de guanilato ciclase solúvel (Riociguate) de pacientes com HP, medindo parâmetros atuais de avaliação de risco. Métodos Coletamos dados clínicos e epidemiológicos retrospectivamente de pacientes com HP do grupo 1 (hipertensão arterial pulmonar) e do grupo 4 (HP tromboembólica crônica). Parâmetros não invasivos e invasivos correspondentes à avaliação de risco foram analisados na linha de base e no acompanhamento. Foram realizadas análises estatísticas usando o software SPSS 18.0, e os p-valores <0,050 foram considerados estatisticamente significativos. Resultados No total, 41 pacientes tratados com riociguate foram incluídos no estudo. Entre eles, 31 já concluíram 3 anos de tratamento e foram selecionados para a seguinte análise. Na linha de base, 70,7% dos pacientes estavam nas classes funcionais III ou IV da OMS. Depois de 3 anos de tratamento, a classe funcional da OMS melhorou significativamente em todos os pacientes. Além disso, a mediana do teste de caminhada de 6 minutos (TC6M) aumentou significativamente de 394 ± 91 m na linha de base para 458 ± 100 m após 3 anos de acompanhamento (p= 0,014). O índice de sobrevida após três anos foi de 96,7%. Conclusão Em nossa coorte de vida real, a maioria dos pacientes com HP tratados com riociguate demonstraram parâmetros de risco estáveis ou melhores, especialmente no TC6M, aos 3 anos de acompanhamento.
Abstract Background Pulmonary hypertension (PH) is a rare and complex disease with poor prognosis, which requires lifelong treatment. Objective To describe 3-year follow-up real-life data on treatment with soluble guanylate cyclase stimulators (Riociguat) of patients with PH, measuring current risk assessment parameters. Methods This study retrospectively collected clinical and epidemiological data of patients with PH of group 1 (pulmonary arterial hypertension) and group 4 (chronic thromboembolic PH). Non-invasive and invasive parameters corresponding to the risk assessment were analyzed at baseline and follow-up. Statistical analyses were performed using the SPSS 18.0 software, and p-values < 0.050 were considered statistically significant. Results In total, 41 patients receiving riociguat were included in the study. Of them, 31 had already completed 3 years of treatment and were selected for the following analysis. At baseline, 70.7% of patients were in WHO functional class III or IV. After 3 years of treatment, the WHO functional class significantly improved in all patients. In addition, the median of the 6-minute walk test (6MWT) significantly increased from 394 ± 91 m at baseline to 458 ± 100 m after 3 years of follow-up (p= 0.014). The three-year survival rate was 96.7%. Conclusion In our real-life cohort, most patients with PH treated with riociguat showed stable or improved risk parameters, especially in the 6MWT, at 3 years of follow-up.
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Purpose The mean pulmonary artery (MPAP) has been widely used as an important parameter to diagnose and evaluate pulmonary hypertension (PH).The purpose of this paper is to compare the efficacy of two methods in evaluating PH,including estimating pulmonary artery systolic pressure (PASP) using Doppler ultrasonography to measure tricuspid regurgitation (TR) velocity,and directly using the peak velocity of TR.Materiasl and Methods From January 2012 to June 2013,eighty patients with left-to-right shunt congenital heart diseases (CHD) planned for closure procedure in Tangdu Hospital of the Fourth Military Medical University and the General Hospital of Shenyang Military region were included in this prospective study,who underwent right heart catheterization to measure pulmonary artery pressure,and underwent Doppler ultrasonography to measure the peak velocity ofTR.Results Using catheter-measured MPAP of≥ 25 mmHg as diagnostic reference,the false positive rate was 62.96％,and the false negative rate 0％ when the estimated PASP of ＞30 mmHg determined by TR method was used to diagnose PH.There was high diagnostic agreement when peak velocity of TR was used to diagnose PH.When 320 cm/s and 340 crn/s were used as diagnostic cutoff values,false positive rates were 14.81％ and 7.41％,and false negative rates were 15.91％ and 20.45％,respectively.Conclusion In patients with left-to-right shunt CHD,peak velocity of TR measured on echocardiography can be used to diagnose PH which overcomes the high false positive rate in estimation method.It is more suitable to diagnose PH when the MPAP is used as the diagnostic criterion.
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Objective To compare the accuracy of stroke volume variation (SVV),central venous pressure (CVP) and puhnonary arterial wedge pressure (PAWP) in monitoring the changes in blood volume in the patients undergoing renal transplantation.Methods Sixteen patients with chronic renal failure,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,aged 18-55 yr,scheduled for elective allograft renal transplantation under general anesthesia,were enrolled in the study.SVV was continuously monitored with the FloTrac/Vigileo monitor,and CVP,PAWP and stroke volume index (SVI) were continuously monitored with the volumetric pulmonary artery catheter during surgery.The parameters of hemodynamics were recorded at 30 min after induction of anesthesia,5 min before renal artery opening,5 and 30 min after renal artery opening,and at the end of surgery.Hydroxyethyl starch 130/0.4 electrolyte solution 6 ml/kg was infused over 15 min via the central venous catheter to perform fluid responsiveness starting from 30 min after induction of anesthesia.Positive fluid responsiveness was defined as the change in SVI ≥ 15％.The relationship between SVV and CVP and between SVV and PAWP was analyzed using the Pearson correlation analysis.The receiver operating characteristic curve for CVP,SVV and PAWP in monitoring the changes in blood volume was drawn,and the area under the curve was calculated.Results Compared with the value at 5 min before renal artery opening,SVV was significantly increased after renal artery opening (P＜0.05),and no significant change was found in CVP and PAWP after renal artery opening (P＞0.05).SVV was negatively correlated with CVP,and r=-0.82 (P＜0.01);SVV was negatively correlated with PAWP,and r=-0.77 (P＜0.01).The area under the curve of SVV in monitoring the changes in blood volume was 0.87,and of CVP and PAWP was 0.69 and 0.66,respectively.Conclusion SVV provides better accuracy than CVP and PAWP in monitoring the changes in blood volume in the patients undergoing renal transplantation.
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AbstractBackground:Right ventricular (RV) afterload is an important risk factor for post-heart transplantation (HTx) mortality, and it results from the interaction between pulmonary vascular resistance (PVR) and pulmonary compliance (CPA). Their product, the RC time, is believed to be constant. An exception is observed in pulmonary hypertension because of elevated left ventricular (LV) filling pressures.Objective:Using HTx as a model for chronic lowering of LV filling pressures, our aim was to assess the variations in RV afterload components after transplantation.Methods:We retrospectively studied 159 patients with right heart catheterization before and after HTx. The effect of Htx on hemodynamic variables was assessed.Results:Most of the patients were male (76%), and the mean age was 53 ± 12 years. HTx had a significant effect on the hemodynamics, with normalization of the LV and RV filling pressures and a significant increase in cardiac output and heart rate (HR). The PVR decreased by 56% and CPA increased by 86%. The RC time did not change significantly, instead of increasing secondary to pulmonary wedge pressure (PWP) normalization after HTx as expected. The expected increase in RC time with PWP lowering was offset by the increase in HR (because of autonomic denervation of the heart). This effect was independent from the decrease of PWP.Conclusion:The RC time remained unchanged after HTx, notwithstanding the fact that pulmonary capillary wedge pressure significantly decreased. An increased HR may have an important effect on RC time and RV afterload. Studying these interactions may be of value to the assessment of HTx candidates and explaining early RV failure after HTx.
ResumoFundamento:A pós-carga do ventrículo direito (VD) é um fator de risco importante para avaliar a mortalidade decorrente de transplante cardíaco (HTx) e resulta da interação entre a resistência vascular pulmonar (RVP) e a complacência pulmonar (CPA). Acredita-se que o produto da interação, o RC-time, seja constante. Entretanto, é exceção a hipertensão pulmonar devido às elevadas pressões de preenchimento do ventrículo esquerdo (VE).Objetivos:Ao utilizar o HTx como modelo para redução crônica das pressões de preenchimento do VE, nosso objetivo foi avaliar as variações nos componentes pós-carga do VD após o transplante.Métodos:Foram estudados, retrospectivamente, 159 pacientes com cateterismo cardíaco direito realizado antes e após o HTx. O impacto do HTx nas variáveis hemodinâmicas foi avaliado.Resultados:A maioria dos pacientes foi do sexo masculino (76%) e a média de idade foi 53 ± 12 anos. O HTx teve um efeito significativo na hemodinâmica, com normalização do VE e das pressões de preenchimento de VD e no aumento significativo do débito cardíaco e da freqüência cardíaca (FC). A RVP diminuiu 56% e a CPA aumentou 86%. Em vez de aumentar como era esperado, o RC-time não alterou significativamente e teve papel secundário em relação à normalização da pressão capilar pulmonar (PECP) após o HTx. O aumento esperado no RC timecom PWP reduzido foi atenuado pelo aumento da FC (devido à denervação autonômica do coração). Esse efeito ocorreu independentemente da diminuição da PCPConclusões:O RC-time permaneceu inalterado após HTx, entretanto a PECP diminuiu significativamente. O aumento da FC pode ter impacto importante no RC-time e na pós-carga do VD. O estudo dessas interações pode ser de grande valor para avaliar os candidatos HTx e explicar a falência do VD ocorrida logo após o HTx.
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Adult , Aged , Female , Humans , Male , Middle Aged , Capillary Resistance/physiology , Heart Transplantation/methods , Lung Compliance/physiology , Pulmonary Wedge Pressure/physiology , Ventricular Function/physiology , Analysis of Variance , Heart Rate/physiology , Postoperative Period , Reference Values , Retrospective Studies , Time FactorsABSTRACT
As the preferred treatment for most patients with hemodynamic instability in the intensive care unit (ICU),the fluid resuscitation can be limited by the cardiac function,that makes the fluid treatment has no responsiveness and may cause the risk of pulmonary edema increase.So,good fluid responsiveness is the basic condition to make fluid therapy successfully.For those patients,in order to lower the risk and correctly evaluate the fluid responsiveness,there are a large number of studies direct at the static and the dynamic pre-load parameters in animals and clinical patients.Those studies show that how to avoid the blindness of fluid expansion,accurately and effectively evaluate and forecast the fluid responsiveness.
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Objective To explore the association between Doppler echocardiography parameters and pulmonary capillary wedge pressure (PCWP) obtained by right heart catheterization (RHC) in patients with pulmonary hypertension (PH).Methods RHC and a simultaneous echocardiography were performed in 86 PH patients.The correlation between the echocardiographic parameters and PCWP was analyzed.Results The early diastolic velocity(E) of mitral valve blood flow was significantly correlated with PCWP ( γ =0.36,P ＜0.01 ).Tissue Doppler imaging measured the diastolic velocity of mitral annulus on the lateral(E'L)and the septal (E'S) wall.Then the average E'M was calculated.The ratio of E to E'L,E'S and E'M showed a strong correlation with PCWP ( γ =0.62,0.34 and 0.47 respectively,P ＜ 0.01 ).E/E'L ＜ 6 accurately predicted 100％ PCWP≤ 15 mm Hg (1 mm Hg =0.133 kPa),and E/E'L ＞ 15 could predict PCWP ＞ 15 nun Hg with specificity of 98.5％.Conclusion There are positive correlation between E/E' and PCWP obtained by RHC in PH patients.
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Objective To investigate the changes of pulmonary capillary wedge pressure(PCWP) before and after off-pump coronary artery bypass graft(OPCABG) using transesophageal echocardiography(TEE). Methods Mitral valve flow(MVF) and pulmonary veinous flow(PVF) were measured in 46 patients before and after OPCAB using TEE and PCWP was detected by cardiac catheter. The correlations between indices derived from TEE and catheterization-measured PCWP and the differences before and after OPCAB were studied. Results There were obvious differences in the indices derived from TEE and PCWP which could reflect the left ventricular function. The most indices measured in PVF and MVF correlated with PCWP(r=(0.30)-(0.76),P
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Objective To study the changes of TNF-??NO in lung of immature rabbits with meconium aspiration and the relationship with right ventricular pressure. Methods (1)We established mild and severe immature rabbits model of meconium aspiration by endotracheal intubation imbuing meconium 0.6 ml/kg and 4 ml/kg. (2)We measured the right ventricular pressure by right ventricular puncture. (3)level of TNF-? in lung was measured by radioimmunoassay and that of NO was detected by Cr deoxidation. Results Meconium caused pulmonary inflammatory response which was reflected in the increase of cell counts in BALF, peaking at 24 h after instillation [WBC counts (6.06? 0.15 ) ?10 8/L,PMN counts (0.484?0.009)?10 8/L] and recovered by 72 h[(1.93?0.08)?10 8/L,(0 082?0 007)?10 8]. (2)The level of TNF-? in lung of mild group (1.41?0 15) ng/ml increased significantly comparing with control group (0 48?0.07) ng/ml, level of NO (31.9?2.4) ng/ml decreased significantly. Peaked at 16~24 h and recovered to normal by 72 h. the changes of severe group [TNF-?(1.85?0.17) ng/ml, NO(26.4?2.4) ng/ml] were significantly different from those in mild group. (3) At mild group,the right ventricular pressure began to increase at 16 h ( 19.28 ? 0.10 ) mm Hg, peaked at 24 h (26.78?0.14) mm Hg and returned to normal level by 72 h ( 14.18 ? 0.04) mm Hg. The pressure of severe group ( 32.70 ? 0.14 ) mm Hg was significantly higher than that of control and mild group. Conclusions (1)After immature rabbits aspirating meconium, there were remarkable pulmonary inflammatory responses. (2)The level of TNF-? in lung increased, and was correlated with right ventricular pressure,which revealed that MAS with PPHN could be associated with inflammatory response. (3)The level of NO decreased after meconium aspiration, and was lower at severe group. The level of NO was negatively correlated with right ventricular pressure, which indicated that the severe meconium aspiration was companied with severe damage of endotheliocyte which promoted and exacerbated PPHN.
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Objective To assess the possibility of using arterial pressure waveform or pulse oximetry plethysmographic waveform variation to estimate the pulmonary arterial wedge pressure (PAWP) Methods Fourteen ASA Ⅰ Ⅱ patients aged 33 69 years and weighing (62 0?9 5)kg scheduled for elective abdominal tumor surgery were studied Their Hb exceeded 120g/L and Hct 35% Anesthesia was induced with midazolam 0 04mg/kg atropine 8?g/kg,fentanyl 2?g/kg,propofol 2mg/kg and vecuronium 0 1mg/kg and maintained with isoflurane The patients were intubated and mechanically ventilated and P ET CO 2 was maintained at 4 67 5 33 kPa Radial artery was connulated for arterial pressure waveform monitoring and Swan Ganz catheter was inserted via right internal jugular vein and connected to continuous cardiac output monitor (VGS2,Baxter,USA) for hemodynamic monitoring Hypervolumic hemodilution was performed after induction of anesthesia and intubation with crystalloid and colloid (1:1) infused at a rate of 0 7ml?kg -1 ?min -1 PAWP, systolic pressure variation (SPV), delta down (dDown), SPV plet and dDown plet and other hemodynamic parameters were measured and recorded when total fluid volume (crystalloid and colloid) infused reached 10ml/kg and 20 ml/kg and at the end of operation, CVP was maintained at 10 12mm/kg during operation Systolic blood pressure at the end of Valsalva maneuver (airway pressure was kept at 30 cmH 2O) and the systolic pressure before the Valsalva maneuver during apnea were used to calculate arterial pressure ratio (APR) Results APR,SPV,dDown,SPV plet and dDown plet all correlated well with PAWP (r=o 7174,-0 6951,-0 680-0 5216 and 0 6237 respectively P
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Objective To assess hemodynamics of pulmonary arterial flow and to count the pulmonary artery diastolic pressure (PADP) by analysis using velocity study of main pulmonary with phase-contrast MR imaging. Methods The diameter、velocity and the maximal retrograde velocity of main pulmonary artery in 45 patients were measured with phase-contrast MR imaging and compared with cardiac catheterization. The accuracy and specificity of PADP measured with phase-contrast MR imaging were evaluated by relativity and regression analysis. Results The PADP measured with phase-contrast MR imaging was (4.82?1.24) mm Hg and that measured with right cardiac catheterization was (4.52?2.00) mm Hg in 40 patients with pulmonary regurgitation. With good correlation the correlation coefficient was 0.94(P
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The effects of diethylcarbamazine citrate (DEC), a lipooxygenase inhibitor, on hypoxic pulmonary vasoconstriction (HPV) in dogs were studied, The results showed that HPV was significantly inhibited after the intravenous administration of DEC, and that the inhibitory effect of DEC on HPV had seemingly no association with the decrease of systemic blood pressure and depression of cardiac function induced by DEC. It is suggested that leukotrienes play a role of mediator in HPV in dogs.
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In this paper, we non-invasively measured PCWP and PAP using the parameters of echocardiography and routine heart film in 21 patients with dilated cardiomyopathy and compared the results with those of Swan-Ganz taken at the near time. The regression formula of PCWP and PAP obtained respeatively from the dimension of left atrium and index of cardiac area for PCWP and the dimension of left atrium, index of cardiac area and width of right inferior pulmonary artery for PAP can correctly reflect the pressures.