Clinical and haemodynamic evaluation of chronic thromboembolic pulmonary hypertension patients scheduled for pulmonary thromboendarterectomy. Is schistosomiasis hypertension an important confounding factor?

Abstract

INTRODUCTION:Chronic thromboembolic pulmonary hypertension is a disease affecting approximately 4,000 people per year in the United States. The incidence rate in Brazil, however, is unknown. The estimated survival for patients with chronic thromboembolic pulmonary hypertension without treatment is approximately three years. Pulmonary thromboendarterectomy for select patients is a potentially curative procedure when correctly applied. In Brazil, the clinical and hemodynamic profiles of chronic thromboembolic pulmonary hypertension patients have yet to be described.OBJECTIVES:To evaluate the clinical and hemodynamic characteristics of chronic thromboembolic pulmonary hypertension patients scheduled for pulmonary thromboendarterectomy in a referral center for chronic thromboembolic pulmonary hypertension treatment in Brazil.METHODS:From December 2006 to November 2009, patients were evaluated and scheduled for pulmonary thromboendarterectomy. The subjects were classified according to gender, age and functional class and were tested for thrombofilia and brain natriuretic peptide levels.RESULTS:Thirty‐five consecutive chronic thromboembolic pulmonary hypertension patients were evaluated. Two patients tested positive for schistosomiasis, and 31 were enrolled in the study (19 female, 12 male). The majority of patients were categorized in functional classes III and IV. Hemodynamic data showed a mean pulmonary vascular resistance (PVR) of 970.8 ± 494.36 dynas·s·cm‐5 and a low cardiac output of 3.378 ± 1.13 L/min. Linear regression revealed a direct relation between cardiac output and pulmonary vascular resistance. Paradoxical septal movement was strongly correlated with pulmonary vascular resistance and cardiac output (p = 0.001). Brain natriuretic peptide serum levels were elevated in 19 of 27 patients.CONCLUSIONS:In a referral center for pulmonary hypertension in Brazil, chronic thromboembolic pulmonary hypertension patients evaluated for pulmonary thromboendarterectomy had a hemodynamically severe status and had elevated brain natriuretic peptide serum levels. There was a predominance of females in our cohort, and the prevalence of hematological disorders and schistosomiasis was low (less than 10%).

Cardiology in Brazilian scientific journals: an overview

“…An article on Lung surgery was frequently cited: TerraFilho et al [23] evaluated the clinical and hemodynamic characteristics of 35 chronic thromboembolic pulmonary hypertension patients scheduled for pulmonary thromboendarterectomy in a referral center for chronic thromboembolic pulmonary hypertension treatment. They concluded that chronic thromboembolic pulmonary hypertension patients evaluated for pulmonary thromboendarterectomy had a hemodynamically severe status and elevated brain natriuretic peptide serum levels.…”

Schistosoma mansoni in Brazil in 2015: retrieval of deaths and characteristics of patients that evolved to death

“…ed., 13 besides scientific articles that are duly referenced. [14][15][16][17][18][19][20][21][22][23][24][25][26] We analyzed the death certificate lines and their clinical correlation in order to identify if schistosomiasis would be the basic cause of death, based on the disease physiopathology.…”

Avaliação dos artigos de pneumologia publicados em periódicos Brasileiros além do Jornal Brasileiro de Pneumologia

“…(2) The presence of associated diseases, such as rhinitis (symptoms are present in 90% of cases), gastroesophageal Sleep 5 [16][17][18][19][20] Physiology, exercise, and rehabilitation 12 [21][22][23][24][25][26][27][28][29][30][31][32] COPD 8 [33][34][35][36][37][38][39][40] Pathology 3 [41][42][43] CT 2 [44][45] Occupational medicine 1 46 Pulmonary thromboembolism 2 [47][48] Pulmonary hypertension 3 [49][50][51] Lung cancer 3 [52][53][54] Smoking 2 [55][56] Evaluation of articles on pulmonology published in Brazilian In their study involving patients with severe OSAS, Neves et al found that the use of sildenafil worsens OSAS, as well as causing deleterious cardiovascular effects because of the increased parasympathetic tone and affecting the HR variability. (19) Pires et al, in a study of drivers engaged in night shift work, contradicted the notion that the sleep pattern of older individuals is more negatively affected than that of younger individuals.…”

“…Most patients had significant functional limitation and severely compromised hemodynamic status, with increased levels of brain natriuretic peptide. (47) The other article, published by Volschan et al, described a model for stratifying the risk of in-hospital mortality in hemodynamically stable patients with PTE, with good specificity and sensitivity. (48) …”