Ventilatory power, a cardiopulmonary exercise testing parameter for the prediction of pulmonary hypertension at right heart catheterization.

BACKGROUND: Several cardiopulmonary exercise test (CPET) parameters (peak VO2, PetCO2 and VE/VCO2) emerged as tools for the prediction of pulmonary arterial hypertension (PAH). Less is known on ventilatory power (VP) in patients with suspect PAH. AIM: To ascertain possible correlations between VP derived at CPET and hemodynamic parameters at right heart catheterization (RHC) indicative of PH. METHODS: Forty-seven consecutive outpatients with suspect of PAH were assessed by CPET and RHC; VP was defined as peak SBP divided by the minute ventilation-CO2 production slope at CPET and Diastolic Pressure Gradient (DPG), Trans-pulmonary Pressure Gradient (TPG), mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR) at RHC were also assessed and compared with VP. RESULTS: VP values were inversely related to mPAP (r -0.427, p 0.003), DPG (r -0.36, p 0.019), TPG (r: -0.43, p 0.004), and PVR (r -0.52, p 0.001). Correlations remained significant even after correction at multivariate analysis for age and gender. VP values below median identified subjects with mPAP ≥ 25 mmHg with an odds ratio of 4.5 (95% confidence interval 1.05-19.36, p < 0.05), an accuracy of 0.712 at ROC curve analysis (95% confidence interval 0.534-0.852, p < 0.05) and a positive predictive power 82%. CONCLUSIONS: In patients with suspected PAH, VP assessed at CPET might provide further information in predicting PAH at RHC. Correlations with PVR and DPG may be helpful in differentiating patients with isolated post-capillary PH from those with combined post-capillary and pre-capillary.

Drug-Induced Pulmonary Arterial Hypertension: Mechanisms and Clinical Management.

Pulmonary arterial hypertension is a rare disease, with drug-induced causes even more uncommon, accounting for only 10% of cases in large registry series. Predisposing factors for drug-induced PAH have not been completely defined. This review summarizes drugs with definite, possible, or likely association to pulmonary hypertension and possible mechanisms involved in the occurrence of pulmonary hypertension. Controversies on mechanisms and on their role in pathophysiology were also shown. The possible synergism between drug abuse and HIV was discussed and the possible interactions of antiretroviral therapy in HIV subjects were analyzed. Furthermore, we reported clinical findings and possible management, specific for each class of drugs, in case of drug-induced PAH. Finally, we summarized into a unified algorithm possible management of drug-induced PAH.

Hospitalization cost reduction with sacubitril-valsartan implementation in a cohort of patients from the Daunia Heart Failure Registry.

INTRODUCTION: Aim of this study was to assess the impact of the introduction of new class of drugs (ARNI: angiotensin receptor-neprilysin inhibitor) on hospital related costs in a real world cohort of patients with chronic heart failure (CHF). METHODS: Seventy-three consecutive patients with CHF and systolic dysfunction eligible for the treatment with ARNIs from the Daunia Heart Failure Registry were enrolled. Incidence of hospitalizations before and after treatment with ARNI, costs for drug and hospitalization for HF were recorded, indexed per year and compared. RESULTS: Indexed mean number of hospitalizations per year was 0.93 ±â€¯1.70 before and 0.19 ±â€¯0.70 after introduction of ARNI (p < 0.001, -80%), 2.26 ±â€¯1.95 before and 0.38 ±â€¯1.2 after ARNI in the subgroup of patients with at least one hospitalization for HF in the year before treatment with ARNI (p < 0.001, -83%).Mean indexed cost for hospitalization was 2067 ±â€¯3715 euros before and 1847 ±â€¯1549 after ARNI (p n.s., -11%); in the subgroup with at least one hospitalization for HF 5175 ±â€¯4345 before and 2311 ±â€¯2308 after ARNI (p < 0.001, -55%). Cost reduction increased with the number of indexed hospitalization per year before ARNI from 11% to 66%. CONCLUSION: In a real world scenario, treatment with ARNI is associated with lower indexed rates of hospitalizations and hospitalization related costs. Cost reduction increases with at least one indexed hospitalization for heart failure before treatment with ARNI.