Effects of Hemodynamics on Global and Regional Lung Perfusion

Cao, Jie J; Wang, Yi; McLaughlin, Jeannette; Rhee, Peter; Passick, Michael; Ngai, Nora; Cheng, Joshua; Gulotta, Ronald J; Berke, Andrew; Petrossian, George; Reichek, Nathaniel

doi:10.1161/circimaging.112.973206

Cited by 14 publications

(6 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Whether due to LVSD37, 38 or IPF,39, 40, 41 pulmonary hypertension is associated with significantly increased morbidity and mortality. In addition to the postulated role of pulmonary hypertension, there is evidence demonstrating extensive redistribution of pulmonary blood flow in individuals with hemodynamically significant LVSD, underscoring a complex heart–lung interaction 42. Fundamentally, it is the intricate interplay of the heart and lung function that determines clinical outcomes among patients with LVSD.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular and Mortality Outcomes in the Elderly With Impaired Cardiac and Pulmonary Function: The Cardiovascular Health Study (CHS)

Waheed

Chaves

Gardin

et al. 2015

JAHA

View full text Add to dashboard Cite

BackgroundImpaired pulmonary function (IPF) and left ventricular systolic dysfunction (LVSD) are prevalent in the elderly and are associated with significant morbidity and mortality. The main objectives of this study were to examine the relative impact and joint association of IPF and LVSD with heart failure, cardiovascular mortality and all‐cause mortality, and their impact on risk classification using a continuous net reclassification index.Methods and ResultsWe followed 2342 adults without prevalent cardiovascular disease (mean age, 76 years) from the Cardiovascular Health Study for a median of 12.6 years. LVSD was defined as LV ejection fraction <55%. IPF was defined as: forced expiratory volume in 1 second:forced vital capacity <70%, and predicted forced expiratory volume in 1 second <80%. Outcomes included heart failure hospitalization, cardiovascular mortality, all‐cause mortality, and composite outcome. LVSD was detected in 128 subjects (6%), IPF in 441 (19%) and both in 38 (2%). Compared to those without LVSD or IPF, there was a significantly increased cardiovascular risk for groups of LVSD only, IPF only, and LVSD plus IPF, adjusted hazard ratio (95% CI) 2.1 (1.5–3.0), 1.7 (1.4–2.1), and 3.2 (2.0–5.1) for HF; 1.8 (1.2–2.6), 1.4 (1.1–1.8), and 2.8 (1.7–4.7) for cardiovascular mortality; 1.3 (1.0–1.8), 1.7 (1.4–1.9), and 2.1 (1.5–3.0) for all‐cause mortality, and 1.6 (1.3–2.1), 1.7 (1.5–1.9), and 2.4 (1.7–3.3) for composite outcome, respectively. Risk classification improved significantly for all outcomes when IPF was added to the adjusted model with LVSD or LVSD to IPF.ConclusionsWhile risk of cardiovascular outcomes was the highest among elderly with both LVSD and IPF, risk was comparable between subjects with IPF alone and those with LVSD alone. This observation, combined with improved risk classification by adding IPF to LVSD or LVSD to IPF, underscore the importance of comprehensive heart and lung evaluation in cardiovascular outcome assessment.

show abstract

Section: Discussionmentioning

confidence: 99%

Cardiovascular and Mortality Outcomes in the Elderly With Impaired Cardiac and Pulmonary Function: The Cardiovascular Health Study (CHS)

Waheed

Chaves

Gardin

et al. 2015

JAHA

View full text Add to dashboard Cite

show abstract

“…To explain this phenomenon, they suggested an increased pulmonary vasoconstriction due to an increased pressure in the pulmonary vasculature with sympathetic activation, eventually leading to no significant changes in pulmonary blood volume. Cao et al, 9 using MRI in a more recent study, found a decrease in Full paper: Dual-energy CT pulmonary angiography in pulmonary venous congestion BJR global pulmonary perfusion with decreasing cardiac index and underlined the complexity of cardiopulmonary interactions in determining pulmonary haemodynamics in left heart failure.…”

Section: Discussionmentioning

confidence: 99%

Dual-energy CT pulmonary angiography in patients with suspected pulmonary embolism: value for the detection and quantification of pulmonary venous congestion

Thieme¹,

Meinel²,

Graef³

et al. 2014

BJR

View full text Add to dashboard Cite

CT pulmonary angiography in patients with suspected pulmonary embolism: value for the detection and quantification of pulmonary venous congestion. Br J Radiol 2014;87:20140079. FULL PAPER Dual-energy CT pulmonary angiography in patients with suspected pulmonary embolism: value for the detection and quantification of pulmonary venous congestion S F THIEME, F G MEINEL, A GRAEF, A D HELCK, M F REISER and T RC JOHNSON Results: No significant difference of PBV but significant differences of mean PA and LA enhancement and individual enhancement differences (PA 2 LA) were found between the populations. PA 2 LA was higher in patients with elevated BNP and proBNP and was positively correlated with these values. Receiver operating characteristic analysis revealed a moderate discriminatory power of the PA 2 LA difference for the presence of cardiac biomarker elevations. Conclusion: PBV in DE-CTPA is not altered in patients with signs of congestive heart failure. However, differences in enhancement values in the pre-and postpulmonary vessels were found in comparison with the control population. Advances in knowledge: Altered pulmonary vascular haemodynamics in pulmonary venous congestion are not reflected in dual-energy-derived PBV maps. In the diagnosis of left heart failure in patients with chest pain and dyspnoea, density measurements in the pulmonary artery and in the left atrium in CTPA images may be a helpful diagnostic tool.In the diagnostic algorithms for patients with acute dyspnoea, CT pulmonary angiography (CTPA) plays a major role, specifically in cases when pulmonary embolism (PE) is suspected. Whenever no PE can be detected, radiologists face the challenge to detect alternative pathological thoracic findings. An undiagnosed acute or chronic left heart failure with pulmonary congestion can be an alternative cause of acute dyspnoea. Although there are some direct and indirect CT criteria that suggest the diagnosis of congestive heart failure with pulmonary venous hypertension (e.g. dilated pulmonary veins with a blurry appearance of the vessel walls, thickening of the interlobular septal lines, ground-glass opacities/alveolar oedema, pleural effusions and an enlargement of the left atrium and/or ventricle), the diagnosis of left heart failure on the basis of CT findings is often equivocal and rather rater dependent. For suspected left heart failure, chest radiography represents the primary diagnostic tool rather than CT. Still, if CTPA is performed in chest pain workup, an improved, more objective diagnosis of congestive heart failure would be desirable. Dual-energy CTPA (DE-CTPA) can quantify the iodinerelated pulmonary beam absorption and thus allow an automated, reader-independent, software-based quantification of the pulmonary content of iodinated contrast material [termed "perfused blood volume" (PBV)].1 Based on the assumption that an impaired left heart function leads to variances in the pulmonary blood content and in the dynamics of the pulmonary passage of the contrast bolus, we tried to find out if ...

show abstract

“…Thus, it is reassuring that Cao et al 8 found that the perfusion of the lungs is directly related to the cardiac output. More importantly, they examined the relative perfusion of lungs in the supine position.…”

Section: Article See P 693mentioning

confidence: 97%

“…In addition, in HF, an expansion and central redistribution of blood volume from the periphery with prolonged time in the supine position results in paroxysmal nocturnal dyspnea and contributes to central sleep apnea. 12 In this regard, studies using the technique of Cao et al 8 comparing the gravitational distribution of flow after a prolonged period in the supine position will also be valuable. There may also be shifts in the distribution of blood volume and alteration of the distribution of pulmonary perfusion during exercise.…”

Section: Circ Cardiovasc Imagingmentioning

confidence: 99%

See 1 more Smart Citation

Heart Failure

Little

Vasu

2012

Circ: Cardiovascular Imaging

View full text Add to dashboard Cite

Dyspnea is the major symptom experienced by patients with heart failure (HF) and points to the important role of the lungs in this syndrome. Article see p 693Normal left ventricular diastolic function keeps the left atrial and pulmonary venous pressures low (<12 mm Hg), both at rest and during submaximal exercise.1 With this normal low pulmonary venous pressure, only a small amount of fluid and protein are filtered through gaps in the pulmonary capillary endothelial cells and into the alveolar interstitial space because the hydrostatic pressure is mostly offset by the protein osmotic pressure.2 Thus, normally the small amount of fluid and protein entering the interstitial space is cleared by lymphatic drainage into the venous circulation.An elevation of left ventricular diastolic and pulmonary venous pressures is a characteristic of HF, regardless of the ejection fraction.3 Mild elevations of pulmonary venous pressure (18-25 mm Hg) increase the flow into the interstitial space.2 When this flow exceeds the clearance ability of the lymphatics, edema accumulates in the lung interstitial space. This can be seen on a chest x-ray as Kerley B lines. The accumulation of interstitial fluid enhances the stiffness of the lungs, leading to an increase in work required to breathe, and produces the perception of dyspnea. With higher pulmonary venous pressures (>25 mm Hg), the accumulating fluid enters the alveolar space, producing pulmonary edema. This interferes with gas exchange and results in intrapulmonary shunting, leading to hypoxia. In this way, acute pulmonary edema can produce life-threatening respiratory failure.Chronic elevation of pulmonary venous pressures, as occurs in mitral stenosis, stimulates fibrosis, which decreases fluid transudation. This impairs pulmonary function, but makes it possible for some patients to chronically tolerate high pulmonary venous pressures without developing overt pulmonary edema. 4 The elevated pulmonary venous pressure in HF also increases the pressure in the pulmonary arteries, both due to the passive effects of increased downstream pressure and due to pulmonary vasoconstriction. 5,6 In addition, the elevated pulmonary venous pressure contributes to the pulsatile load, raising systolic pulmonary artery pressure. 7 The resulting pulmonary hypertension increases the load on the right ventricle, contributes to exercise intolerance, and indicates a poor prognosis.The study by Cao et al 8 in this issue of Circulation: Cardiovascular Imaging used an innovative magnetic resonance technique to provide detailed information on the important interaction of the heart and lungs in HF. Using gadolinium first-pass perfusion imaging, the time variations in signal intensity were converted to a contrast concentration time curve. With the assumption that pulmonary perfusion is a linear system, indicator dilution theory was used to assess the pulmonary blood flow by assessing the maximum signal intensity and the time course of the signal change. The rate of blood flow (perfusion) into small regions o...

show abstract

Effects of Hemodynamics on Global and Regional Lung Perfusion

Cited by 14 publications

References 21 publications

Cardiovascular and Mortality Outcomes in the Elderly With Impaired Cardiac and Pulmonary Function: The Cardiovascular Health Study (CHS)

Cardiovascular and Mortality Outcomes in the Elderly With Impaired Cardiac and Pulmonary Function: The Cardiovascular Health Study (CHS)

Dual-energy CT pulmonary angiography in patients with suspected pulmonary embolism: value for the detection and quantification of pulmonary venous congestion

Heart Failure

Contact Info

Product

Resources

About