Prognostic Value of Mean, Diastolic, and Systolic Pulmonary Artery Pressure in Patients With End-stage Lung Disease Referred for Lung Transplantation

Nowak, Jolanta; Hudzik, Bartosz; Przybyłowski, Piotr; Niedziela, Jacek; Walczak, Piotr; Rozentryt, Piotr; Ochman, Marek; Żegleń, Sławomir; Wojarski, Jacek; Zembala, Marian; Gąsior, Mariusz

doi:10.1016/j.transproceed.2018.02.152

Cited by 7 publications

(3 citation statements)

References 22 publications

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“…PH was found to have a negative effect on survival after lung transplantation (LT) within 90 days of follow-up, compared to non-PH patients (p = 0.043 and p = 0.003, respectively), but at one year after LT only pre-capillary PH versus post-capillary PH remained a negative prognostic factor (p = 0.037 and p = 0.447, respectively) [37]. In patients with end-stage lung disease awaiting LT, PAPm ≥ 30 mmHg, PAPd ≥ 20 mmHg and PAPs ≥ 44 mmHg are associated with worse prognosis with sensitivity = 70%, 70%, 73%, specificity = 76%, 69%, 72% and AUC = 0.67, 0.68, 0.72, respectively [38]. Despite the correlation between mortality in patients awaiting LT and exacerbation of PH, PAH-approved drugs are not recommended due to inhibition of hypoxic pulmonary vasoconstriction [4].…”

Section: Pulmonary Hypertension Due To Lung Diseases And/or Hypoxia (mentioning

confidence: 96%

Diagnostic and Predictive Value of Right Heart Catheterization-Derived Measurements in Pulmonary Hypertension

2021

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Right heart catheterization is a unique tool not only in the diagnosis but also in the management of patients with a wide range of cardiovascular diseases. The technique dates back to the 18th century, but the biggest advances were made in the 20th century. This review focuses on pulmonary hypertension for which right heart catheterization remains the diagnostic gold standard. Right heart catheterization-derived parameters help classify pulmonary hypertension into several subgroups, assess risk of adverse events or mortality and make therapeutic decisions. According to the European Society of Cardiology guidelines pulmonary hypertension (PH) is defined as an increase in mean pulmonary artery pressure (PAPm) > 25 mmHg, whereas a distinction between pre- and post-capillary PH is made based on levels of pulmonary artery wedge pressure (PAWP). Moreover, right atrial pressure (RAP), cardiac index (CI) and mixed venous oxygen saturation (SvO2) are the only parameters recommended to assess prognosis and only in patients with pulmonary arterial hypertension (PAH). Patients with RAP > 14 mmHg, CI < 2.0 l/min/m2 and SvO2 < 60% are at high (> 10%) risk of death within the next year. The purpose of this paper is to show that RHC-derived parameters can be used on a considerably larger scale than currently recommended. Several prognostic parameters, with specific thresholds have been identified for each subtype of pulmonary hypertension and can be helpful in everyday practice for treatment of PH.

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Section: Pulmonary Hypertension Due To Lung Diseases And/or Hypoxia (mentioning

confidence: 96%

Diagnostic and Predictive Value of Right Heart Catheterization-Derived Measurements in Pulmonary Hypertension

2021

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“…valuated the prognostic value of data obtained by the use of a PAC, including mean, diastolic and systolic PAP in patients referred for lung transplant and were able to identify the threshold for each specific value that relates to worse outcomes in this population ( P = 0.005 for mean PAP, P = 0.035 for diastolic PAP, and P < 0.001 for systolic PAP). [ 28 ] As of today, the PAC continues to be widely utilized standard monitor during orthotopic liver transplantation with a prevalence of 94% (85%–97%) among 119 transplant centers in the United States, with a formal benefit level yet to be validated. [ 2 ]…”

Section: Utility Of Pac Beyond Cardiac Surgery and The Icumentioning

confidence: 99%

Pro

Szabó

Betances-Fernandez

Navas-Blanco

et al. 2021

Annals of Cardiac Anaesthesia

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Ever since its clinical introduction, the utilization of the pulmonary artery catheter (PAC) has been surrounded by multiple controversies, mostly related to imprecise clinical indications and the complications derived from its placement. Currently, one of the most important criticisms of the PAC is the ambiguity in the interpretation of its hemodynamic measurements and therefore, in the translation of this data into specific therapeutic interventions. The popularity of the PAC stems from the fact that it provides hemodynamic data that cannot be obtained from clinical examination. The assumption is that this information would allow better understanding of the individual's hemodynamic profile which would trigger therapeutic interventions that improve patient outcomes. Nevertheless, even with the current diversity of hemodynamic devices available, the PAC remains a valuable tool in a wide variety of clinical settings. The authors present a review exposing the benefits of the PAC, current clinical recommendations for its use, mortality and survival profile, its role in goal-directed therapy, and other applications of the PAC beyond cardiac surgery and the intensive care unit.

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“…Reviews specific to LTx in various disease states included idiopathic pulmonary fibrosis, [51][52][53] scleroderma, [54][55][56][57][58] emphysema, 59,60 chronic obstructive pulmonary disease (COPD), 61 pulmonary veno-occlusive disease, 62 CF, 63,64 pulmonary hypertension, [65][66][67] and occupational lung disease. 68 Cystic Fibrosis.…”

Section: Recipient Managementmentioning

confidence: 99%

Noteworthy Literature Published in 2018 for Thoracic Organ Transplantation

Tawil

Adams

Nicoara

et al. 2019

Semin Cardiothorac Vasc Anesth

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Publications of note from 2018 are reviewed for the cardiothoracic transplant anesthesiologist. Strategies to expand the availability of donor organs were highlighted, including improved donor management, accumulating experience with increased-risk donors, ex vivo perfusion techniques, and donation after cardiac death. A number of reports examined posttransplant outcomes, including outcomes other than mortality, with new data-driven risk models. Use of extracorporeal support in cardiothoracic transplantation was a prominent theme. Major changes in adult heart allocation criteria were implemented, aiming to improve objectivity and transparency in the listing process. Frailty and prehabilitation emerged as targets of comprehensive perioperative risk mitigation programs.

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Prognostic Value of Mean, Diastolic, and Systolic Pulmonary Artery Pressure in Patients With End-stage Lung Disease Referred for Lung Transplantation

Cited by 7 publications

References 22 publications

Diagnostic and Predictive Value of Right Heart Catheterization-Derived Measurements in Pulmonary Hypertension

Diagnostic and Predictive Value of Right Heart Catheterization-Derived Measurements in Pulmonary Hypertension

Pro

Noteworthy Literature Published in 2018 for Thoracic Organ Transplantation

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