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2.
Zhonghua Yi Xue Za Zhi ; 101(1): 7-10, 2021 Jan 05.
Artigo em Chinês | MEDLINE | ID: mdl-33423444

RESUMO

In recent years, pulmonary hypertension (PH) has attracted increasing attention from scholars worldwide, which involves diverse etiology and complicated pathogenesis. Due to changes in the structure and function of pulmonary vasculatures, it can lead to an increase in pulmonary vascular resistance and pulmonary artery pressure, and then progress to right ventricular heart failure or even death. The diagnosis of PH involves multiple disciplines, which could easily give rise to missed diagnosis and misdiagnosis and non-standardized treatment. Recently, we have made great progress in the field of clinical diagnosis, treatment and research of PH. However, many issues remain to be solved. Accordingly, this article aims to call for further strengthening of multidisciplinary collaboration in PH field and promote the construction of a standardized system for PH in China.


Assuntos
Insuficiência Cardíaca , Hipertensão Pulmonar , Disfunção Ventricular Direita , China , Ventrículos do Coração , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/terapia
3.
Isr Med Assoc J ; 22(12): 752-756, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33381946

RESUMO

BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare, distinct pulmonary vascular disease caused by chronic obstruction of major pulmonary arteries, which can be cured by pulmonary endarterectomy. However, many CTEPH patients are not surgical candidates. Balloon pulmonary angioplasty (BPA) is an emerging technique used to treat inoperable CTEPH. OBJECTIVES: To describe the first Israeli experience with BPA for inoperable CTEPH. METHODS: In 2017 we established a BPA program at our institution. We reviewed the outcomes to date of BPA in our center. RESULTS: Forty-seven BPA procedures were performed in five patients with inoperable CTEPH (4-17 procedures/patient). Mean pulmonary artery pressure improved in all patients (median decrease 17 mmHg, range 10-26 mmHg). Pulmonary vascular resistance also improved (median decrease 11 Woods Units/m2, range 8-16 Woods Units/m2). Cardiac output increased in 4 of 5 patients and decreased in one. Functional capacity improved from New York Heart Association (NYHA) III to II in four patients; one patient was NYHA II at baseline without change after BPA. Six-minute walking distance improved by a median of 97 meters. (range 21-197 meters). Hemodynamic and functional improvements were sustained at follow-up 5-11 months after the last BPA procedure. BPA enabled 2 of 3 patients treated with parenteral prostanoids to be switched to oral therapy. There were no major complications. CONCLUSIONS: We successfully established BPA as a treatment for inoperable CTEPH in our center. BPA resulted in hemodynamic and clinical improvements that were sustained over time.


Assuntos
Angioplastia com Balão , Hipertensão Pulmonar/terapia , Embolia Pulmonar/terapia , Adulto , Angioplastia com Balão/métodos , Feminino , Hemodinâmica , Humanos , Hipertensão Pulmonar/etiologia , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar , Embolia Pulmonar/complicações , Estudos Retrospectivos
4.
Medicina (Kaunas) ; 56(12)2020 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-33352654

RESUMO

The interplay between coronavirus disease 2019 (COVID-19) and pulmonary hypertension (PH) in children is unknown. Adults with PH are at potential risk for severe complications and high mortality due to associated comorbidities. It is difficult to extrapolate the outcomes of COVID-19 in adults to pediatric PH patients. Overall, a small number of COVID-19 cases is reported in patients with preexisting PH. Several factors may be responsible for the low incidence of COVID-19 in children with PH. Pulmonary hypertension is a rare disease, testing is not universal, and patients may have followed more rigorously the Center for Disease Control's guidelines recommended for personal protection with mask-wearing, social distancing, and hand sanitization through ongoing health education. The small number of COVID-19 cases in patients with preexisting PH does not support that PH is protective for COVID-19. However, medications used to treat PH may have some protection against COVID-19. This review discusses the pathophysiology of PH occurring with COVID-19, differences between children and adults with COVID-19, strategies for management of preexisting PH in children during the ongoing pandemic, and its impact within the field of PH.


Assuntos
/complicações , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/fisiopatologia , /epidemiologia , Criança , Humanos , Hipertensão Pulmonar/epidemiologia , Hipertensão Pulmonar/terapia , Incidência , Pandemias
5.
Int Heart J ; 61(5): 999-1004, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32999197

RESUMO

This study aimed to clarify the usefulness of the Ikari-curve left (IL) guiding catheter for balloon pulmonary angioplasty (BPA).The current BPA strategy for chronic thromboembolic pulmonary hypertension is dilation of as many branches as possible to normalize hemodynamics and oxygenation. The shape of the guiding catheter is a major factor in achieving this. However, conventional guiding catheters are difficult to introduce into particular branches. The IL guiding catheter may be suitable; however, its utility remains unclear.We retrospectively analyzed 202 consecutive BPA sessions of 40 patients from November 2016 to October 2019 and divided these sessions into two groups: the IL group where the IL guiding catheter was used and the non-IL group where other catheters were utilized. The occurrence of lung injury was determined by the presence of bloody sputum. We compared the rates of successful introduction into target vessels and assessed for the occurrence of lung injury.The average age of enrolled patients was 60.3 ± 14.4 years, with females comprising 65%. There were 99 sessions in the IL group. The median treated branches per session differed between the 2 groups (IL group: 15 versus non-IL group: 10, P < 0.05). The occurrence of lung injury was lower in the IL group (4.0% versus 11.7%, P = 0.07). The IL group had more successful vessel insertions than the non-IL group (78.8% versus 42.7%, P < 0.01).The IL guiding catheter may be introduced into branches that cannot be accessed by conventional guiding catheters.


Assuntos
Angioplastia com Balão/métodos , Hipertensão Pulmonar/terapia , Embolia Pulmonar/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Angioplastia com Balão/estatística & dados numéricos , Feminino , Humanos , Hipertensão Pulmonar/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
6.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(8): 905-914, 2020 08.
Artigo em Chinês | MEDLINE | ID: mdl-32912401

RESUMO

Pulmonary hypertension (PH) is a common disease. Pulmonary hypertension caused by left heart disease (PH-LHD) and congenital heart disease related pulmonary artery hypertension (PAH-CHD) account for main parts of PH and pulmonary artery hypertension (PAH) respectively. Patients are often complicated with PH before, during and after cardiac surgery. PH can cause right heart failure, and is a high risk factor for cardiac surgery. Accurate evaluation and reasonable treatment on HP can reduce perioperative complications and mortality, hence improve prognosis. This article elaborates the consensus of Chinese experts on the definition, classification, pathophysiology, diagnosis and perioperative treatment of PH related to cardiac surgery.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Hipertensão Pulmonar/diagnóstico , Consenso , Cardiopatias Congênitas , Humanos , Hipertensão , Hipertensão Pulmonar/terapia
7.
Ann Am Thorac Soc ; 17(8): 918-921, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32735170

RESUMO

Amid efforts to care for the large number of patients with coronavirus disease (COVID-19), there has been considerable speculation about whether the lung injury seen in these patients is different than acute respiratory distress syndrome from other causes. One idea that has garnered considerable attention, particularly on social media and in free open-access medicine, is the notion that lung injury due to COVID-19 is more similar to high-altitude pulmonary edema (HAPE). Drawing on this concept, it has also been proposed that treatments typically employed in the management of HAPE and other forms of acute altitude illness-pulmonary vasodilators and acetazolamide-should be considered for COVID-19. Despite some similarities in clinical features between the two entities, such as hypoxemia, radiographic opacities, and altered lung compliance, the pathophysiological mechanisms of HAPE and lung injury due to COVID-19 are fundamentally different, and the entities cannot be viewed as equivalent. Although of high utility in the management of HAPE and acute mountain sickness, systemically delivered pulmonary vasodilators and acetazolamide should not be used in the treatment of COVID-19, as they carry the risk of multiple adverse consequences, including worsened ventilation-perfusion matching, impaired carbon dioxide transport, systemic hypotension, and increased work of breathing.


Assuntos
Doença da Altitude , Infecções por Coronavirus , Hipertensão Pulmonar , Pandemias , Pneumonia Viral , Acetazolamida/farmacologia , Doença da Altitude/fisiopatologia , Doença da Altitude/terapia , Betacoronavirus/isolamento & purificação , Inibidores da Anidrase Carbônica/farmacologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Humanos , Hipertensão Pulmonar/fisiopatologia , Hipertensão Pulmonar/terapia , Lesão Pulmonar/etiologia , Lesão Pulmonar/fisiopatologia , Lesão Pulmonar/terapia , Nifedipino/farmacologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , /fisiopatologia , Vasodilatadores/farmacologia
9.
Life Sci ; 261: 118298, 2020 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-32822717

RESUMO

AIMS: 1) Characterize the progression of exercise intolerance in monocrotaline-induced pulmonary hypertension (PH) in mice and 2) evaluate the therapeutic effect of aerobic exercise training (AET) on counteracting skeletal and cardiac dysfunction in PH. MAIN METHODS: Wild type C57BL6/J mice were studied in two different time points: 2 months and 4 months. Exercise tolerance was evaluated by graded treadmill exercise test. The AET was performed in the last month of treatment of 4 months' time point. Cardiac function was evaluated by echocardiography. Skeletal muscle cross-sectional area was assessed by immunofluorescence. The diameter of cardiomyocytes and pulmonary edema were quantified by staining with hematoxylin-eosin. The variables were compared among the groups by two-way ANOVA or non-paired Student's t-test. Significance level was set at p < 0.05. KEY FINDINGS: After 2 months of MCT treatment, mice presented pulmonary edema, right cardiac dysfunction and left ventricle hypertrophy. After 4 months of MCT treatment, mice showed pulmonary edema, right and left cardiac dysfunction and remodeling associated with exercise intolerance and skeletal muscle atrophy. AET was able to reverse cardiac left ventricle dysfunction and remodeling, prevent exercise intolerance and skeletal muscle dysfunction. Thus, our data provide evidence of skeletal muscle abnormalities on advanced PH. AET was efficient in inducing an anti-cardiac remodeling effect besides preventing exercise intolerance. SIGNIFICANCE: Our study provides a robust model of PH in mice, as well as highlights the importance of AET as a preventive strategy for exercise intolerance and, skeletal and cardiac muscle abnormalities in PH.


Assuntos
Tolerância ao Exercício/fisiologia , Hipertensão Pulmonar/fisiopatologia , Miócitos Cardíacos/metabolismo , Condicionamento Físico Animal/fisiologia , Animais , Progressão da Doença , Teste de Esforço , Hipertensão Pulmonar/terapia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Músculo Esquelético/metabolismo , Atrofia Muscular/patologia , Fatores de Tempo
10.
Lancet Respir Med ; 8(9): 873-884, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32730752

RESUMO

BACKGROUND: In pulmonary hypertension subgroups, elevated pulmonary vascular resistance (PVR) of 3·0 Wood units or more is associated with poor prognosis. However, the spectrum of PVR risk in pulmonary hypertension is not known. To address this area of uncertainty, we aimed to analyse the relationship between PVR and adverse clinical outcomes in pulmonary hypertension. METHODS: We did a retrospective cohort study of all patients undergoing right heart catheterisation (RHC) in the US Veterans Affairs health-care system (Oct 1, 2007-Sep 30, 2016). Patients were included in the analyses if data from a complete RHC and at least 1 year of follow-up were available. Both inpatients and outpatients were included, but individuals with missing mean pulmonary artery pressure (mPAP), pulmonary artery wedge pressure, or cardiac output were excluded. The primary outcome measure was time to all-cause mortality assessed by the Veteran Affairs vital status file. Cox proportional hazards models were used to assess the association between PVR and outcomes, and the mortality hazard ratio was validated in a RHC cohort from Vanderbilt University Medical Center (Sept 24, 1998-June 1, 2016). FINDINGS: The primary cohort (N=40 082; 38 751 [96·7%] male; median age 66·5 years [IQR 61·1-73·5]; median follow-up 1153 days [IQR 570-1971]), included patients with a history of heart failure (23 201 [57·9%]) and chronic obstructive pulmonary disease (13 348 [33·3%]). We focused on patients at risk for pulmonary hypertension based on a mPAP of at least 19 mm Hg (32 725 [81·6%] of 40 082). When modelled as a continuous variable, the all-cause mortality hazard for PVR was increased at around 2·2 Wood units compared with PVR of 1·0 Wood unit. Among patients with a mPAP of at least 19 mm Hg and pulmonary artery wedge pressure of 15 mm Hg or less, the adjusted hazard ratio (HR) for mortality was 1·71 (95% CI 1·59-1·84; p<0·0001) and for heart failure hospitalisation was 1·27 (1·13-1·43; p=0·0001), when comparing PVR of 2·2 Wood units or more to less than 2·2 Wood units. The validation cohort (N=3699, 1860 [50·3%] male, median age 60·4 years [49·5-69·2]; median follow-up 1752 days [IQR 1281-2999]) included 2870 patients [77·6%] with mPAP of at least 19 mm Hg (1418 [49·4%] male). The adjusted mortality HR for patients in the mPAP of 19 mm Hg or more group and with PVR of 2·2 Wood units or more and pulmonary artery wedge pressure of 15 mm or less Hg (1221 [42·5%] of 2870) was 1·81 (95% CI 1·33-2·47; p=0·0002). INTERPRETATION: These data widen the continuum of clinical risk for mortality and heart failure in patients referred for RHC with elevated pulmonary artery pressure to include PVR of around 2.2 Wood units and higher. Testing the generalisability of these findings in at-risk populations with fewer cardiopulmonary comorbidities is warranted. FUNDING: None.


Assuntos
Hipertensão Pulmonar/fisiopatologia , Resistência Vascular , Idoso , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/mortalidade , Hipertensão Pulmonar/terapia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Resistência Vascular/fisiologia
11.
J Card Surg ; 35(8): 2077-2080, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652726

RESUMO

Heart-lung transplant (HLT) is a widely accepted modality for certain patients with advanced and refractory cardiopulmonary disease. Some of these patients are critically ill on the transplant waiting list, and venoarterial extracorporeal membrane oxygenation (VA-ECMO) can be used as a bridge to transplantation. Although the experience with ECMO as a bridge to lung transplant is promising, there is limited evidence to use ECMO as a bridge to HLT. Femoral cannulation remains a concern for ambulation given the risk of bleeding and cannula complications despite studies reporting its safety. We present a case of a 56-year-old male with interstitial lung disease and severe secondary pulmonary hypertension, who was successfully bridged to HLT with ambulatory femoral VA-ECMO.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Transplante de Coração-Pulmão , Hipertensão Pulmonar/terapia , Doenças Pulmonares Intersticiais/terapia , Transplante de Pulmão , Artéria Femoral , Humanos , Hipertensão Pulmonar/etiologia , Doenças Pulmonares Intersticiais/complicações , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Resultado do Tratamento , Listas de Espera
13.
J Cardiovasc Magn Reson ; 22(1): 50, 2020 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-32698897

RESUMO

BACKGROUND: Bronchopulmonary dysplasia (BPD) associated with pulmonary hypertension (PH) is a significant source of morbidity and mortality in premature infants. Recent advances have allowed the use of cardiovascular magnetic resonance (CMR) in the assessment of respiratory and cardiac disease in infants with BPD. In adults and older pediatric patients, decreased CMR interventricular septal curvature correlates with increased mean pulmonary artery pressure and pulmonary vascular resistance. The current study sought to determine the relationship of CMR derived septal curvature in neonates with BPD and BPD-PH with a need for PH therapy. METHODS: Forty moderate or severe BPD and 12 mild BPD or control infants were imaged without contrast between 38 and 47 weeks post-menstrual age on a neonatal-sized, neonatal intensive care unit-sited 1.5 T CMR scanner. CMR indices including eccentricity index (CMR-EI) and septal curvature were measured and compared to BPD severity and clinical outcomes including hospital length of stay (LOS), duration of respiratory support, respiratory support level at discharge and PH therapy. RESULTS: CMR-EI was directly associated and septal curvature was inversely associated with BPD severity. In a univariate analysis, CMR-EI and septal curvature were associated with increased hospital LOS, duration of respiratory support, respiratory support at hospital discharge, and need for PH therapy. In multivariable analysis CMR-EI was associated with hospital LOS and duration of respiratory support and septal curvature was associated with respiratory support at hospital discharge. Septal curvature was the only clinical or CMR variable associated with need for PH therapy (R2 = 0.66, p = 0.0014) in multivariable analysis demonstrating improved discrimination beyond CMR-EI. CONCLUSIONS: CMR derived septal curvature correlates significantly with clinical outcomes including hospital LOS, duration of respiratory support, respiratory support level at hospital discharge, and PH therapy in neonates with BPD and BPD-PH. Further, CMR derived septal curvature demonstrated improved discrimination of need for PH therapy and respiratory support at discharge compared to clinical variables and other CMR indices, supporting septal curvature as a non-invasive marker of PH in this population with potential to guide management strategies.


Assuntos
Pressão Arterial , Displasia Broncopulmonar/diagnóstico por imagem , Hipertensão Pulmonar/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética , Artéria Pulmonar/fisiopatologia , Resistência Vascular , Septo Interventricular/diagnóstico por imagem , Anti-Hipertensivos/uso terapêutico , Pressão Arterial/efeitos dos fármacos , Displasia Broncopulmonar/complicações , Displasia Broncopulmonar/fisiopatologia , Displasia Broncopulmonar/terapia , Feminino , Humanos , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/fisiopatologia , Hipertensão Pulmonar/terapia , Recém-Nascido , Tempo de Internação , Masculino , Valor Preditivo dos Testes , Artéria Pulmonar/efeitos dos fármacos , Terapia Respiratória , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Resistência Vascular/efeitos dos fármacos , Septo Interventricular/efeitos dos fármacos , Septo Interventricular/fisiopatologia
14.
Zhonghua Jie He He Hu Xi Za Zhi ; 43(8): 677-680, 2020 Aug 12.
Artigo em Chinês | MEDLINE | ID: mdl-32727180

RESUMO

Objective: To evaluate the awareness and management status of chronic thromboembolic pulmonary hypertension (CTEPH) among respiratory physicians and therefore to provide for establishing clinical guidelines on CTEPH. Methods: A questionnaire was designed to address the common questions in CTEPH management. The responses were collected online and the data were analyzed. Totally, 1 038 valid questionnaires were collected. Results: 74.1% of the responders were from tertiary hospitals and 88.5% were attending physicians. Only a few hospitals could carry out ventilation-perfusion scintigraphy (31.3%) and right heart catheterization (38.5%). For the treatment of CTEPH, pulmonary endarterectomy and balloon pulmonary angioplasty (BPA) were only performed in 8.0% and 10.4% of the hospitals respectively, and mostly in tertiary hospitals, P<0.01. 49.6% of the physicians were familiar with the interpretation of CTPA, while only 19.9% of V/Q scan. 88.5% of the physicians choose CTPA as the screening tool for CTEPH, but only 3.9% were consistent with the guidelines. 79% of the physicians agreed with lifelong anticoagulation for CTEPH, and 70.8% supported operability should be evaluated in all CTEPH patients. Conclusions: This questionnaire study showed that there was a gap between the guidelines and the real world practice in CTEPH management. Efforts should be made to improve the awareness and standardization of the management of CTEPH.


Assuntos
Angioplastia com Balão/métodos , Conhecimentos, Atitudes e Prática em Saúde , Hipertensão Pulmonar/etiologia , Embolia Pulmonar/complicações , Doença Crônica , Endarterectomia/métodos , Humanos , Hipertensão Pulmonar/terapia , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , Inquéritos e Questionários , Tromboembolia
16.
Sci Rep ; 10(1): 8870, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32483219

RESUMO

Treatment options for chronic thromboembolic pulmonary hypertension (CTEPH) that is not amenable to thromboendarterectomy or is recurrent/persistent after thromboendarterectomy (inoperable CTEPH) include pulmonary vasodilators or balloon pulmonary angioplasty (BPA). We compared efficacy and safety outcomes of BPA with or without pulmonary vasodilators to pulmonary vasodilator therapy alone in patients with inoperable CTEPH. Observational and randomized trial data reporting outcomes for >5 patients with inoperable CTEPH were sought. Single-arm random effects meta-analyses were performed. The primary outcome was change in six-minute walk distance (6MWD). Secondary outcomes included safety; World Health Organization functional class (WHO FC); and change in mean pulmonary arterial pressure (mPAP), pulmonary vascular resistance (PVR), and cardiac index. Thirty-four studies with 1604 patients were eligible for analyses. Both treatments resulted in significant improvement in 6MWD (71.0 meters, 95% CI: 47.4-94.5 meters with BPA versus 47.8 meters, 95% CI: 34.5-61.2 meters with pulmonary vasodilators), PVR [-3.1 Wood Units (WU), 95% CI: -4.9 to -1.4 WU versus -1.6 WU, 95% CI: -2.4 to -0.8 WU] and mPAP (-14.8 mmHg, 95% CI: -18.2 to -11.5 mmHg versus -4.9 mmHg, 95% CI: -6.9 to -2.8 mmHg). Cardiac index was similar and most patients were WHO FC II and III after their respective interventions. More complications occurred in the BPA arm. In conclusion, BPA and pulmonary vasodilators both improve 6MWD and hemodynamics in patients with inoperable CTEPH. While BPA may offer greater functional and hemodynamic improvements, this technique carries the accompanying risks of an invasive procedure.


Assuntos
Angioplastia com Balão , Hipertensão Pulmonar/terapia , Embolia Pulmonar/terapia , Vasodilatadores/uso terapêutico , Doença Crônica , Teste de Esforço , Humanos , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/fisiopatologia , Embolia Pulmonar/complicações , Embolia Pulmonar/fisiopatologia , Resultado do Tratamento
18.
West J Emerg Med ; 21(3): 714-721, 2020 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-32421524

RESUMO

INTRODUCTION: Pulmonary hypertension (PH) is a common, yet under-diagnosed, contributor to morbidity and mortality. Our objective was to characterize the prevalence of PH among adult patients presenting to United States (US) emergency departments (ED) and to identify demographic patterns and outcomes of PH patients in the ED. METHODS: We analyzed the Nationwide Emergency Department Sample (NEDS) database, with a focus on ED patients aged 18 years and older, with any International Classification of Diseases, Clinical Modification (ICD)-9-CM or ICD-10-CM diagnosis code for PH from 2011 to 2015. The primary outcome was inpatient, all-cause mortality. The secondary outcomes were hospital admission rates and hospital length of stay (LOS). RESULTS: From 2011 to 2015, in a sample of 121,503,743 ED visits, representing a weighted estimate of 545,500,486 US ED visits, patients with a diagnosis of PH accounted for 0.78% (95% confidence interval [CI], 0.75-0.80%) of all US ED visits. Of the PH visits, 86.9% were admitted to the hospital, compared to 16.3% for all other ED visits (P <0.001). Likewise, hospital LOS and hospital-based mortality were higher in the PH group than for other ED patients (e.g., inpatient mortality 4.5% vs 2.6%, P < 0.001) with an adjusted odds ratio (aOR) of 1.34 (95% CI, 1.31-1.37). Age had the strongest association with mortality, with an aOR of 10.6 for PH patients over 80 years (95% CI, 10.06-11.22), compared to a reference of ages 18 to 30 years. CONCLUSION: In this nationally representative sample, presentations by patients with PH were relatively common, accounting for nearly 0.8% of US ED visits. Patients with PH were significantly more likely to be admitted to the hospital than all other patients, had longer hospital LOS, and increased risk of inpatient mortality.


Assuntos
Erros de Diagnóstico/prevenção & controle , Serviços Médicos de Emergência , Hospitalização/estatística & dados numéricos , Hipertensão Pulmonar , Adulto , Bases de Dados Factuais/estatística & dados numéricos , Erros de Diagnóstico/estatística & dados numéricos , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Mortalidade Hospitalar , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/mortalidade , Hipertensão Pulmonar/terapia , Tempo de Internação , Masculino , Prevalência , Estados Unidos/epidemiologia
19.
Circ Cardiovasc Imaging ; 13(5): e009825, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32408829

RESUMO

Background Ventricular septal flattening, frequently present in pulmonary hypertension (PH), can be quantified using eccentricity index (EI). EI has not been evaluated by concurrent echocardiography and cardiac catheterization and traditionally does not account for postsystolic septal flattening, often seen in PH. We evaluated left ventricular shape, including a novel measure of maximal EI to account for postsystolic septal flattening, to establish the relationship with concurrent invasive hemodynamics. Methods Echocardiography was performed at 2 institutions in 78 pediatric PH patients during cardiac catheterization and in 78 matched controls. From midpapillary parasternal short-axis views, EI and right-to-left ventricular diameter ratio were assessed. Results EI and right-to-left ventricular measures were significantly increased in PH compared with controls. Shape measures correlated with invasive hemodynamics and PH outcome measures (PH-related hospitalization, functional class, medical therapy escalation, and BNP [brain natriuretic peptide]). End-systolic EI of 1.16 best identified the presence of PH, whereas a maximal EI of 1.42 and 1.94 best identified half-systemic and systemic PH, respectively. A maximal EI of 1.27 was associated with an odds ratio of 16.16 (95% CI, 6.62-39.46) for PH-related hospitalization or escalation of therapy. Conclusions Using simultaneous echocardiography and catheterization in the largest study population to date, we demonstrate that EI and right-to-left ventricular ratio correlate with invasive hemodynamics and outcomes measures, and EI can accurately define those with clinically important PH. These measures strengthen the ability of echocardiography to identify and follow pediatric PH patients, especially in the absence of methods to quantify right ventricular systolic pressures.


Assuntos
Cateterismo Cardíaco , Ecocardiografia , Hemodinâmica , Hipertensão Pulmonar/diagnóstico por imagem , Função Ventricular Esquerda , Remodelação Ventricular , Adolescente , Idade de Início , Estudos de Casos e Controles , Criança , Pré-Escolar , Colorado , Progressão da Doença , Feminino , Humanos , Hipertensão Pulmonar/fisiopatologia , Hipertensão Pulmonar/terapia , Lactente , Recém-Nascido , Masculino , Ontário , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Reprodutibilidade dos Testes , Adulto Jovem
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