Echocardiographic evaluation of pulmonary arterial hypertension in patients with progressive systemic sclerosis and related syndromes.

Murata, Ichirô; Kihara, Hidetoshi; Shinohara, Satoshi; Itō, Kōji

doi:10.1253/jcj.56.983

Cited by 69 publications

(46 citation statements)

References 16 publications

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“…The prevalence of resting PAH in CTD is ϳ2.3-10 cases per million (5), typically mostly SSc patients (5-50%) (6)(7)(8)(9)(10)(11)(12), patients with mixed CTD (21-29%) (13), and patients with systemic lupus erythematosus (5-43%) (14)(15)(16). Based on right heart catheterization, the prevalence of resting PAH in SSc is likely 7.9-20% (7,17).…”

Section: Methodsmentioning

confidence: 99%

Exercise‐induced pulmonary hypertension associated with systemic sclerosis: Four distinct entities

Saggar

Khanna

Fürst

et al. 2010

Arthritis & Rheumatism

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Objective. Exercise-induced pulmonary hypertension (PH) may represent an early but clinically relevant phase in the spectrum of pulmonary vascular disease. There are limited data on the prevalence of exerciseinduced PH determined by right heart catheterization in scleroderma spectrum disorders. We undertook this study to describe the hemodynamic response to exercise in a homogeneous population of patients with scleroderma spectrum disorders at risk of developing pulmonary vascular disease. Methods.Patients with normal resting hemodynamics underwent supine lower extremity exercise testing. A classification and regression tree (CART) analysis was used to assess combinations of variables collected during resting right heart catheterization that best predicted abnormal exercise physiology, applicable to each individual subject.Results. Fifty-seven patients who had normal resting hemodynamics underwent subsequent exercise right heart catheterization. Four distinct hemodynamic groups were identified during exercise: a normal group, an exercise-induced pulmonary venous hypertension (ePVH) group, an exercise out of proportion PH (eoPH) group, and an exercise-induced PH (ePH) group. The eoPH and ePVH groups had higher pulmonary capillary wedge pressure (PCWP) than the ePH group (P < 0.05). The normal and ePH groups had exercise PCWP <18 mm Hg, which was lower than that in the ePVH and eoPH groups (P < 0.05). During submaximal exercise, the transpulmonary gradient and pulmonary vascular resistance (PVR) were elevated in the ePH and eoPH groups as compared with the normal and ePVH groups (P < 0.05). CART analysis suggested that resting mean pulmonary artery pressure (mPAP) >14 mm Hg and PVR >160 dynes/seconds/cm ؊5 were associated with eoPH and ePH (positive predictive value 89% for mPAP 14-20 mm Hg and 100% for mPAP >20 mm Hg).Conclusion. We characterized the exercise hemodynamic response in at-risk patients with scleroderma spectrum disorders who did not have resting PH. Four distinct hemodynamic groups were identified during exercise. These groups may have potentially different prognoses and treatment options.

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Section: Methodsmentioning

confidence: 99%

Exercise‐induced pulmonary hypertension associated with systemic sclerosis: Four distinct entities

Saggar

Khanna

Fürst

et al. 2010

Arthritis & Rheumatism

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“…Triküspit yetersizlik jeti hastaların %39-86'ında analiz edilebilir (18,19). Doruk triküspit yetersizlik hızını ölçmenin güç olduğu olgularda (önemsiz/hafif triküspit kaçağı), ajite serum ile kontrast ekokardiyografi kullanılması Doppler sinyallerini anlamlı ölçüde arttırarak triküspit yetersizlik akım trasesinin daha doğru değer-lendirilmesine olanak vermektedir.…”

Section: Sağ Ventrikül Miyokardiyal Performans Indeksi (Tei Indeksi)unclassified

Echocardiography and other imaging modalities in pulmonary arterial hypertension

Özben

Başaran²

2010

Anadolu Kardiyol Derg

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It is essential to diagnose pulmonary arterial hypertension in early stages of the disease. However, most patients have late diagnosis due to the lack of disease-specific symptoms and prominent findings. Although cardiac catheterization is the gold standard in the diagnosis of pulmonary arterial hypertension, noninvasive diagnostic modalities do also have major roles in the diagnosis, risk assessment and follow-up of the patients with pulmonary arterial hypertension. The focus of the present review is the clinical role of echocardiography and other imaging modalities in pulmonary arterial hypertension. ÖZETPrognozu oldukça kötü olan pulmoner arteriyel hipertansiyonda tanının hastalığın erken dönemlerinde konulması oldukça önemlidir. Ancak semptomların spesifik olmaması ve hastalık bulgularının silik olması nedeniyle, birçok hastada tanıyı koymada geç kalınmaktadır. Tanıda altın standart olarak kardiyak kateterizasyon kabul edilse de, pulmoner arteriyel hipertansiyon tanı, risk değerlendirmesi ve tedavi takibinde noninvazif tanı yöntemlerinin yeri büyüktür. Bu derlemenin konusu pulmoner arteriyel hipertansiyon tanısında kullanılan ekokardiyografi ve diğer görüntüleme yöntemleridir.

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“…This method makes the presence of TR necessary to measure the SPAP, the occurrence of which is related directly to the severity of PAP (80% in PAP > 35, 95% in PAP > 50); 10 even in the presence of TR, the body habitus, and the presence of lung pathology like chronic obstructive pulmonary disease make it difficult to obtain proper acoustic window for the alignment of TR jet, 32 causing limitations to this method of deriving MPAP. In a study by Murata et al, 33 analyzable TR jet was obtained in only 39% of the population, whereas in the study by Arcasoy et al, 19 only 44% of patients with lung disease had acoustic window for echocardiographic evaluation. Even though in our study proper alignment of the TR jet was obtained in TEE, the peak velocity of TR jet showed poor correlation with MPAP measured invasively.…”

Section: Discussionmentioning

confidence: 93%

Derivation and Validation of Formula relating Pulmonary Acceleration Time and Mean Pulmonary Artery Pressure in Indian Population

Ganesan¹

2017

Journal of Perioperative Echocardiography

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Background: Pulmonary acceleration time (PAT) forms a valuable echocardiographic parameter in deriving the mean pulmonary artery pressure (MPAP). The present study aims to derive and validate a formula relating MPAP and PAT in an Indian population. Materials and methods:Preoperative echocardiography was performed in 22 adult cardiac surgery patients undergoing coronary artery bypass grafting (CABG) and/or mitral valve replacement. The PAT, PAT/right ventricular ejection time (RVET), PAT corrected for heart rate [(HR) HRcPAT], and tricuspid regurgitation (TR) peak velocity were correlated with MPAP measured from pulmonary artery (PA) catheter, and a new formula relating MPAP and PAT was derived and subsequently validated in another cohort of 21 patients. Results:The PAT, HRcPAT, and PAT/RVET correlated well (r 2 = 0.69, 0.68 and 0.47 respectively, p < 0.0001), while TR velocity correlated poorly with MPAP (r 2 = 0.20, p = 0.046). The cutoff values of PAT and HRcPAT for diagnosing pulmonary artery hypertension (PAH) (MPAP = 25 mm Hg) were 74 and 99 respectively, with 92% sensitivity and 100% specificity. The derived formula (MPAP = 62.4 − 0.3 PAT) correlated well with the standard formula (79−0.45 PAT) on applying in the validation cohort (Bland-Altman plot, bias <10%). In subgroup analysis, patients with severe PAH (MPAP = 50 mm Hg) showed better correlation than patients with less than severe PAH (r 2 =0.633, p=0.038 and r 2 = 0.46, p = 0.108 respectively). Similarly, the formula for deriving pulmonary vascular resistance index (PVRI) from PAT [(PVRI = 14.9−0.09 pulmonary artery acceleration time (PAAT)] correlated well with the existing formula (PVRI = 9 − 0.07 PAAT). The inter-and intraobserver variabilities were not significant. Conclusion:The indexed formula is better in predicting MPAP from PAT in Indian population, particularly in patients with severe PAH (MPAP = 50 mm Hg) and the cutoffs of PAT and HRcPAT in predicting PAH (MPAP = 25 mm Hg) in an Indian population are 74 and 99 msec respectively.

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Echocardiographic evaluation of pulmonary arterial hypertension in patients with progressive systemic sclerosis and related syndromes.

Cited by 69 publications

References 16 publications

Exercise‐induced pulmonary hypertension associated with systemic sclerosis: Four distinct entities

Exercise‐induced pulmonary hypertension associated with systemic sclerosis: Four distinct entities

Echocardiography and other imaging modalities in pulmonary arterial hypertension

Derivation and Validation of Formula relating Pulmonary Acceleration Time and Mean Pulmonary Artery Pressure in Indian Population

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