The combination of TTE and chest CT is better than either imaging technique alone in identifying patients with PH in a heterogeneous population and may exclude PH.

Purpose:Acute and late toxicity from chemotherapy, targeted therapy, and radiation therapy can cause significant morbidity among survivors of Hodgkin lymphoma (HL), including pulmonary dysfunction. Improved dosimetry may influence pulmonary function tests (PFTs), an objective and clinically significant measure of pulmonary toxicity. The present study investigates the impact of proton therapy on PFTs among HL survivors.Patients and Methods:We monitored 15 patients with mediastinal HL who were enrolled in an institutional HL trial. All patients were treated with combination chemotherapy plus involved-node proton therapy. All patients were to undergo PFTs before starting treatment and at approximately 6 and 12 months after completing proton therapy.Results:Twelve patients were included in the analysis and 3 excluded. The mean forced vital capacity (FVC) was 96.2% ± 16.5% (mean ± SD) predicted at baseline and 98.2% ± 19.4% predicted at 12 months. The mean forced expiratory volume in 1 second (FEV1) was 96.7% ± 17.2% predicted at baseline and 97% ± 15.1% predicted at 12 months. The mean FEV1/FVC ratio was 99.5 ± 8.29 at baseline and 97.8 ± 8.02 at 12 months. The mean diffusing capacity of the lung for carbon monoxide was 81.4% ± 18.4% predicted at baseline and 95.7% ± 23.5% predicted at 12 months.Conclusion:No unexpected changes were observed to the lungs as illustrated through follow-up PFTs. Long-term follow-up and validation in a larger cohort are needed.

The use of PAH-specific therapy in selected patients with PH secondary to lung diseases, OSA, or sarcoidosis may result in significant improvement in 6-minute walk distance, particularly in patients with OSA or severe PH.

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Pulmonary hypertension (PH) in overweight or obese patients with obstructive sleep apnea (OSA) may be multifactorial. The effect of pulmonary artery hypertension (PAH)-specific drugs on PH and exercise capacity in such patients is unknown. We performed a retrospective review of overweight or obese patients with OSA and PH who were treated with PAH-specific therapy in our PH clinic. We identified 9 female and 2 male patients. The mean age AE SD was 54.9 AE 9.3 years. The mean pulmonary artery pressure at the time of diagnosis of PH was 39.8 AE 16.1 mmHg. The right atrial pressure was 11.1 AE 4.5 mmHg, the pulmonary artery wedge pressure was 14.1 AE 2.9 mmHg, the cardiac index was 2.6 AE 0.5 L/min/m 2 , and the pulmonary vascular resistance index was 10.6 AE 7.1 Wood units/m 2 . The indications for use of PAHspecific therapy were dyspnea in association with right heart failure (n ¼ 4), persistent PH despite compliance with nocturnal positive airway pressure (PAP) therapy (n ¼ 4), or inability to tolerate PAP therapy (n ¼ 3). PH was treated with an endothelin receptor antagonist (n ¼ 8) or a phosphodiesterase-5 inhibitor (n ¼ 3). The 6-minute walk distance (6MWD) improved significantly, from 234 AE 49.7 to 258 AE 54.6 m (24 m [95% confidence interval (CI): 6.5-341.5 m]; P ¼ 0.014) over a period of 4.4 AE 1.8 months (n ¼ 8) and from 241.7 AE 48.5 to 289.9 AE 91 m (48 m [95% CI: 5.5-90.8 m]; P ¼ 0.033) in those with a longer follow-up period of 12.1 AE 6.4 months (n ¼ 7). The systolic pulmonary artery pressure dropped significantly, from 64 AE 25.2 to 42 AE 10.4 mmHg (22 mmHg [95% CI: 4 -40 mmHg]; P ¼ 0.024) over a period of 6.1 AE 4.1 months (n ¼ 7). In conclusion, PAH-specific therapy resulted in significant improvement in both PH and 6MWD.

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