Chronic thromboembolic pulmonary hypertension (CTEPH) - potential role of multidetector-row CT (MD-CT) and MR imaging in the diagnosis and differential diagnosis of the disease.

Chronic thromboembolic pulmonary hypertension (CTEPH) can be defined as pulmonary hypertension (resting mean pulmonary arterial pressure of 25 mm Hg or more determined at right heart catheterization) with persistent pulmonary perfusion defects. It is a rare, but underdiagnosed disease with estimated incidences ranging from 0.5% to 3.8% of patients after an acute pulmonary embolism (PE), and in up to 10% of those with a history of recurrent PE. CTEPH is the only form of pulmonary hypertension that can be surgically treated leading to normalization of pulmonary hemodynamics and exercise capacity in the vast majority of patients. The challenges for imaging in patients with suspected CTEPH are fourfold: the imaging modality should have a high diagnostic accuracy with regard to the presence of CTEPH and allow for differential diagnosis. It should enable detection of patients suitable for PEA with great certainty, and allow for quantification of PH by measuring pulmonary hemodynamics (mPAP and PVR), and finally, it can be used for therapy monitoring. This overview tries to elucidate the potential role of ECG-gated multidetector CT pulmonary angiography (MD-CTPA) and MR imaging, and summarizes the most important results that have been achieved so far. Generally speaking, ECG-gated MD-CTPA is superior to MR in the assessment of parenchymal and vascular pathologies of the lung, and allows for the assessment of cardiac structures. The implementation of iodine maps as a surrogate for lung perfusion enables functional assessment of lung perfusion by CT. MR imaging is the reference standard for the assessment of right heart function and lung perfusion, the latter delineating typical wedge-shaped perfusion defects in patients with CTEPH. New developments show that with MR techniques, an estimation of hemodynamic parameters like mean pulmonary arterial pressure and pulmonary vascular resistance will be possible. CT and MR imaging should be considered as complementary investigations providing comprehensive information in patients with CTEPH.

[RIGHT VENTRICULAR DIASTOLIC FUNCTION AND PERIPHERAL HEMODYNAMICS IN PATIENTS WITH CHRONIC COR PULMONALE RECEIVING VARIOUS THERAPY REGIMENS].

Right ventricular diastolic function, pulmonary hemodynamics, and peripheral endothelial vasoregulatory function were studied in patients with chronic cor pulmonale during complex treatment over time. The study confirmed the vasodilatory effect of ozone therapy and amlodipine during standard therapy, which appeared as lower blood pressure and better right ventricular diastolic function.

[Electrostimulation of the skeletal muscles in rehabilitation of patients with chronic cor pulmonale: effects on arrhythmogenesis and vegetative status].

AIM: To investigate effects of electrostimulation of the skeletal muscles (EMS) on vegetative status and arrhythmogenesis in patients with chronic cor pulmonale (CCP). MATERIAL AND METHODS: 101 CCP patients (age 59 +/- 1.2 years) were examined with loading tests, 24-h ECG and blood pressure monitoring to assess disturbances and variability of cardiac rhythm, blood pressure. The study group patients (n = 54) have undergone EMS of large skeletal muscles in addition to standard rehabilitation. The control group (n = 47) received standard treatment. RESULTS: A course of EMS raised strength of the muscles of the upper and lower limbs and exercise tolerance of the lower limb muscles in the study group, bicycle exercise and 6-min walk tolerance, reduced the number of atrial and ventricular extrasystoles. The test group lowered the low-frequency component at night (p = 0.021) and in maximal spectrum power reflecting enhancement of parasympathetic activity in this time. CONCLUSION: EMS had no arrhythmogenic action, but had a positive effect on vegetative status of CCP patients.

[Clinical observation on shufei granule in improving right ventricular function of patients with chronic pulmonary heart disease].

OBJECTIVE: To observe the effect of Shufei Granule (SG) on right ventricular function in patients with chronic pulmonary heart disease (CPHD). METHODS: One hundred CPHD patients were randomly divided into two groups, the control group (n = 40) treated with fleroxacin 0.2 g twice per day by intravenous dripping and diprophylline 0.2 g 3 times per day orally, the treatment group (n = 60) treated with SG 10 g 3 times a day orally additionally besides the treatment given to the control group. The therapeutic course for both groups was 3 weeks. The changes of the cardiac function, the right ventricular function [A peak velocity (VA), E peak velocity (VE), VA/VE, systolic pulmonary artery pressure (SPAP), pre-ejection period (PEP), right ventricular ejection time (RVET), PEP/RVET], and blood-gas analysis were investigated, the condition of clinical symptoms and signs as well as tongue pictures were observed also. RESULTS: The total effective rate was 91.6% in the treated group, significantly higher than that in the control group (70.0%, P < 0.01); the improvements in symptom score, cardiac function and the other laboratory indexes were all superior in the treatment group to those in the control group (P < 0.05, P < 0.01). CONCLUSION: SG is an effective drug for improving right ventricular function in CPHD patients.

[Omega-3 polyunsaturated fatty acids in the correction of hemodynamic disorders in patients with chronic cor pulmonale]. / Omeha-3 polinenasycheni zhyrni kysloty v korektsiï hemodynamichnykh porushen' u khvorykh z khronichnym lehenevym sertsem.

Indices were studied for the right and left ventricular performance in 15 patients with chronic cor pulmonale before and after treatment with tekom containing above 43% of omega-3 polyunsaturated fatty acids. A drop in the pulmonary artery pressure was recordable as was a decline in hyperfunction and dilatation the right ventricule of the heart, which fact can be explained by improvement of the pulmonary ventilation and vasodilatational effect of tekom mediated by a change of the eicosanoids spectrum.

[The long-term effect of nifedipine (control release tablets) in patients with chronic obstructive pulmonary disease and cor pulmonale].

OBJECTIVE: To observe the long-term effect of nifedipine (control release tablets) in patients with chronic obstructive pulmonary disease and cor pulmonale. METHODS: A randomized, double blind, placebo-controlled design was made, two hundred and two patients (FEV1/FVC was 47.35% +/- 8.10%) were divided into two groups: nifedipine group (20 mg Bid) 102 cases, placebo group (one tablet Bid) 100 cases. RESULTS: The equilibrium test between both groups was comparable. Two-year follow-up rates of both groups were 94% and 89%, respectively. The comparision of the nifedipine to placebo group was as follows: in nifedipine group, the improvement of dyspnea, fatigue and exercise capacity showed significantly better results (P < 0.05); FEV1 and PaCO2 deterioration was unremarkable (P > 0.05); the pulmonary impedance plethysmogram B-Y1 that reflects pulmonary vascular compliance appeared significant improvement (P < 0.05) and the mortality of the disease that was the most important observation endpoint was declined (P = 0.051), but some electrocardiographic index reflected right ventricular load became worse (P < 0.05). CONCLUSIONS: Long-term taking controlled release-nifedipine is a safe, effective measure which might improve life quality and decrease mortality in patients with chronic obstructive pulmonary disease and chronic cor pulmonale, however the drug can not slow down or reverse the progress of this illness.

[A quantitative study on the effect of breathing exercises in improving respiratory muscle contration].

To study quantitatively the effect of breathing exercises on the prevention of progression in chronic obstructive pulmonary disease (COPD), 324 patients with stable COPD were randomly assigned to either breathing exercises (BE) or placebo medicine as control. The maximum respiratory pressure (320 cases) and transdiaphragmatic pressure (129 cases) were monitored with RMS-1 and Type-2 gastrointestinal pressure measuring instrument. BE were taught and checked by experienced specialists periodically. Patients in BE group were compared with those in the control group by measuring MIP, MEP, Pdi, and Pdimax after one to 20 months. In BE group MIP increased by 30.42%, MEP 32.10%, Pdi 30.94%, and Pdimax 65.59% (P < 0.001). No significant change was observed in the control group. MIP, MEP, Pdi, and Pdimax increased by 6.95%, 2.92%, 14.63% and 9.05% respectively (P < 0.05) in the control group. It is shown preliminarily that BE had potent and lasting effect on respiratory muscle contraction after studying large number of cases. The methods mentioned above can be used as quantitative indices for the contractile properties of respiratory muscle.

[A study on pulmonary artery compliance and hemodynamics in patients with lung-distention].

A simultaneously comparative study on pulmonary artery compliance (Cpa) and pulmonary artery mean pressure (PAMP) in 89 patients with Lung-Distention in TCM by impedance pulmonary rheogram, tricuspid valve echocardiogram and right heart catheterization. Then according to Syndrome Differentiation of TCM, Lung-Distention was sub-divided into four groups. The results showed that PAMP were gradually increased and Cpa decreased in these groups. It revealed that the pulmonary circulation of Lung-Distention patients has disturbed.

[Clinical and experimental studies of feiyaning in treating pulmonary arterial hypertension in cor pulmonale].

40 Patients with chronic cor pulmonale (CCP) were treated with Feiyaning (FYN), a Yiqi Huoxue compound prescription, and ligustrazine (LT) were reported. The results showed that FYN and LT could lower the pulmonary artery pressure (PAP) significantly; decrease the pulmonary vascular resistance (PVR) as well as the consumption of oxygen in cardiac muscle; increase cardiac output (CO); improve some indices in hemorrheology; while PaO2 and SaO2 didn't change apparently. Moreover, lowering of FYN on PAP and PVR were superior to that of LT. The experimental studies showed that LT and injection of FYN could completely inhibit the hypoxia caused increase of PAP and PVR in rats; reduce the hypoxia caused pulmonary artery hypertension (PAH) and improve PVR of rats, as well as increase CO. The effects of FYN were superior to LT's. Although LT and FYN could decrease systemic arterial pressure to certain extent, they didn't induce systemic artery hypotension. It suggest that LT could reduce PAH definitely.

[Hemodynamic studies of pulmonary heart diseases and the effects of nifedipine].

Swan-Ganz catheterization, blood gas analysis, pulmonary function tests and two-dimensional echocardiography were performed in 10 patients with pulmonary heart disease and the effects of nifedipine were then observed. Mean pulmonary artery pressure (mPAP) correlated significantly to PaO2. PaO2 may be a useful parameter for predicting mPAP. Continuous oxygen breathing can correct hypoxemia, prevent and alleviate pulmonary artery hypertension (PAH). After using nifedipine, PaO2 and blood pressure of systemic circulation decreased significantly, while pulmonary physiological shunt increased and pulmonary artery pressure did not decrease. As a consequence, the use of nifedipine to treat pulmonary heart disease and PAH is not advocated.

[Primary pulmonary hypertension]. / Primäre pulmonale Hypertonie.

In 1% of the patients with cor pulmonale the cause of the high pulmonary artery pressure remains unclear. The underlying severe and mostly progressive pulmonary vascular disease with unknown aetiology is defined as primary pulmonary hypertension (PPH) with three different pathomorphological subtypes, plexogenic pulmonary arteriopathy (PPA), thrombotic pulmonary arteriopathy (TPA) and pulmonary venoocclusive disease (PVOD). The endemic occurrence of PPH after the ingestion of anorexigenic drugs (aminorex fumarate) and toxic rapeseed oil lead to the hypothesis that PPH is a pulmonary vascular reaction to exogenous toxic agents on the base of a genetic disposition. The initial response could be an endothelial cell dysfunction leading to pathological proliferation of vascular smooth muscle cells, vasospasm and local disturbances of haemostasis. The derived therapeutic concepts with vasodilators (high dose calcium channel-blocking therapy, prostacyclin) and with anticoagulant drugs show some encouraging results. The lung and heart-lung transplantation have become real therapeutic options for the patients with PPH considering the mostly still very unfavourable prognosis of PPH.

[The role of prazosin in regulating cardio- and hemodynamics in the early stage of experimental lung-heart failure]. / Rol' prazosina v reguliatsii kardio- i gemodinamiki na rannei stadii éksperimental'noi legochno-serdechnoi nedostatochnosti.

Canine experiments have shown that prazosin used in the course of therapy for pulmonary hypertension and abolition of heart overload substantially enhanced myocardial contractility and relaxing properties of the both ventricles and improved cardiac pump function.

Right ventricular dysfunction in chronic obstructive pulmonary disease. Evaluation and management.

Cor pulmonale is an important consequence of COPD. Although the incidence is not precisely known, it is seen more frequently in patients with hypoxemia, CO2 retention and severely reduced FEV1. When present, it limits peripheral oxygen delivery, increases shortness of breath, and reduces exercise endurance. It is also associated with higher mortality rates independent of other prognostic variables. Numerous factors may contribute to the development of cor pulmonale in patients with COPD, but its primary cause is chronic alveolar hypoxia resulting in pulmonary vasoconstriction, vascular remodeling and pulmonary hypertension. The physical exam, chest radiograph and ECG may be helpful in detecting the presence of cor pulmonale, but because of anatomic changes that occur in the chest, these tests are often insensitive in patients with COPD. Noninvasive diagnostic techniques utilizing Doppler echocardiography and radionuclide angiography allow for detection of RV dysfunction at an earlier stage and in most cases, preclude the need for right heart catheterization. LTO2 is the only therapy shown to improve survival in patients with COPD. However, statistical proof correlating improvements in pulmonary hemodynamics with increased survival is lacking. Bronchodilators, such as the beta 2 agonists and especially theophylline, may have beneficial effects on pulmonary hemodynamics in addition to their effect on respiratory function and are useful in COPD when RV dysfunction is present. Diuretics and phlebotomy are also useful in improving symptoms in appropriate patients. Vasodilators such as calcium channel blockers and ACE-inhibitors may improve pulmonary hemodynamics acutely, but may lower arterial PO2 by worsening ventilation-perfusion matching or blunt the improvement in pulmonary hemodynamics seen with supplemental oxygen. The long-term benefits of these agents have not been proven and their routine use in patients with cor pulmonale due to COPD cannot be recommended.

[Nifangin in the combined treatment of chronic cor pulmonale]. / Nifangin v kompleksnom lechenii khronicheskogo legochnogo serdtsa.

The effect of niphangin (calcium antagonist) on the hemodynamics, gaseous exchange and course of the disease was studied in 65 patients with chronic obstructive bronchitis complicated by cor pulmonale. Synchronous registration of ECG, PCG, tetrapolar rheography, phlebography. It was found that niphangin used in the complex treatment of cor pulmonale allowed to improve the gaseous exchange, central and peripheral hemodynamics and effected favourably the course of the disease.

[The use of hyperbaric oxygenation for the treatment of patients with pneumoconiosis and pulmonary heart failure]. / Primenenie giperbaricheskoi oksigenatsii dlia lecheniia bol'nykh pnevmokoniozom s legochno-serdechnoi nedostatochnost'iu.

Examination of 76 patients with pneumoconiosis (stage I) revealed that hyperbaric oxygenation is increasing the force of cardiac contractions, reduction of the general peripheral resistance and reduction of the lesser circulation hypertension. The therapeutic action of hyperbaric oxygenation is related to its ability to remove the sequels of oxygen.

Anemia depranocítica: nifedipina y funcionalismo pulmonar / Drepanocytic Anemia: nifedipine and pulmonary function

Como es sabido, los pacientes depranocíticos suelen presentar complicaciones respiratorias frecuentes, caracterizadas por alteraciones de la función macánica pulmonar debido a los procesos vasooclusivos que acurren a nivel de la microcirculación, quedando comprometidas la capacidad vital y pulmonar de estos pacientes. Investigaciones realizadas también has reportado que la células depranocíticas se ven favorecidas en su formación por el aumento de calcio (CA++) citoplasmático y la disminución del potasio celular, aunque el mecanismo no ha sido bien dilucionado. basándonos en lo dicho anteriormente, se realizó un trabajo doble ciego y cruzado (nifedipina vs.placebo), en 10 pacientes depranocíticos homocigotos (6 hombres y 4 mujeres), en los cuales se evaluó funcionalismo pulmonar basal (FBP) antes y después de la administración sublingual de nifedipina (10 mg) y placebo a los 15 y 30 minutos de la administración de los mismos. Igualmente se evaluó FBP antes y dos (2) meses después de la administración de nifedipina (10 mg) y placebo, VO, dos veces al día (BID). Despues de anlizados los resultados se evidenció disminución de los fenómenos vasooclusivos y por ende disminución tanto en el número como la severidad de la crisis dolorosas. Igualmente podemos concluir que existe una mejoría significativa del FBP con el uso de nifedipina en los pacientes depranicíticos