LA Volume by CMR Distinguishes Idiopathic From Pulmonary Hypertension Due to HFpEF

Crawley, Stephen F.; Johnson, Martin K.; Dargie, Henry J.; Peacock, Andrew J.

doi:10.1016/j.jcmg.2013.05.014

Cited by 38 publications

(31 citation statements)

References 4 publications

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“…Simple noninvasive parameters such as signs of left ventricular hypertrophy on ECG, assessment of left atrial size on echocardiography and medical history can help to discriminate between left heart disease-related pulmonary hypertension and PAH [30]. The finding that left atrial size is a strong discriminator is in line with an earlier study [31].…”

Section: Pulmonary Hypertension Due To Left Heart Diseasesupporting

confidence: 80%

Pulmonary hypertension

2016

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In 2015, more than 800 papers were published in the field of pulmonary hypertension. A Clinical Year in Review article cannot possibly incorporate all this work and needs to be selective. The recently published European guidelines for the diagnosis and treatment of pulmonary hypertension contain an inclusive summary of all published clinical studies conducted until very recently. Here, we provide an overview of papers published after the finalisation of the guideline. In addition, we summarise recent advances in pulmonary vasculature science. The selection we made from the enormous amount of published work undoubtedly reflects our personal views and may not include all papers with a significant impact in the near or more distant future. The focus of this paper is on the diagnosis of pulmonary arterial hypertension, understanding the success of combination therapy on the right ventricle and scientific breakthroughs. @ERSpublicationsThe review summarises advances in pulmonary hypertension since the publication of the recent ESC/ERS guidelines http://ow.ly/WUwoeThe global picture of pulmonary arterial hypertension Table 1 summarises the recent classification of pulmonary hypertension [1,2]. Based on data from the large European and North American registries, the most common types of pulmonary arterial hypertension (PAH) are idiopathic PAH and PAH associated with connective tissue disease. Less is known of the epidemiology of PAH in other parts of the world. Using the data from a large reference centre in Brazil, ALVES et al. [3] showed that schistosomiasis is among the top three of causes of PAH in that country. These global epidemiological data emphasise the importance of accounting for such differences in future clinical trials. Pulmonary veno-occlusive diseaseAn important change from the previous classification is that significant progress has been made in the field of pulmonary veno-occlusive disease (PVOD). Several causes of PVOD have been identified in recent years, including genetics, drugs and radiation therapy. The finding of the EIF2AK4 (eukaryotic translation initiation factor 2α kinase 4) mutation in familial PVOD and pulmonary capillary haemangiomatosis (PCH) might boost further research [4,5]. By the discovery of this gene, it is possible to confirm the diagnosis of PVOD or PCH by demonstrating the presence of the mutation instead of a histological diagnosis [5]. Of interest is the recent study by PERROS et al. [6] showing not only that mitomycin is a risk factor for the development of PVOD, but also that mitomycin induces pulmonary vascular disease in rats that resembles the pathological features of PVOD. This finding not only offers a representative animal model to study the disease but also sheds new light on the possible role of alkylating chemotherapy on the development of pulmonary hypertension [7]. New associations between drugs and disease were not only made in PVOD; in PAH, a possible relationship between a drug and the disease also was found. A recent

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Section: Pulmonary Hypertension Due To Left Heart Diseasesupporting

confidence: 80%

Pulmonary hypertension

2016

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“…Increased LA volume and higher pulmonary artery‐to‐aorta ratio measured by cardiac magnetic resonance, as well as higher size ratio of left atrium to right atrium measured by non‐gated CT angiography (CTA), may be additional diagnostic features for identifying patients with PH‐HFpEF, although none of these have been sufficiently validated (Crawley et al . ; Karakus et al . ; Huis In ’t Veld et al .…”

Section: Definitions Classification Of Subtypes and Diagnostic Factomentioning

confidence: 99%

Insights into the pulmonary vascular complications of heart failure with preserved ejection fraction

Lai

Wang

Gladwin

2018

The Journal of Physiology

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Pulmonary hypertension in the setting of heart failure with preserved ejection fraction (PH-HFpEF) is a growing public health problem that is increasing in prevalence. While PH-HFpEF is defined by a high mean pulmonary artery pressure, high left ventricular end-diastolic pressure and a normal ejection fraction, some HFpEF patients develop PH in the presence of pulmonary Yen-Chun (Charly) Lai is an Assistant Professor at Indiana University. Her lab focuses primarily on investigating pathogenesis and development of alternative therapies for effective treatment of cardiopulmonary diseases, with the particular emphasis of metabolic syndrome, pulmonary hypertension and heart failure with preserved ejection fraction. Mark Gladwin is a Jack D. Myers Professor and Chair at University of Pittsburgh. He is recognized internationally as an expert in pulmonary hypertension, having described the pathobiology and clinical characteristics of pulmonary hypertension in patients with sickle cell disease and other chronic hereditary and acquired haemolytic diseases. He served on the Dana Point Pulmonary Hypertension Classification Committee and co-authored the report. He served on the NHLBI advisory committee to develop the 'Strategic Plan for Lung Vascular Research' . He has authored more than 10 textbook chapters on pulmonary vascular disease and has published over 100 papers on the topic of pulmonary hypertension alone. vascular remodelling with a high transpulmonary pressure gradient or pulmonary vascular resistance. Ageing, increased left atrial pressure and stiffness, mitral regurgitation, as well as features of metabolic syndrome, which include obesity, diabetes and hypertension, are recognized as risk factors for PH-HFpEF. Qualitative studies have documented that patients with PH-HFpEF develop more severe symptoms than those with HFpEF and are associated with more significant exercise intolerance, frequent hospitalizations, right heart failure and reduced survival. Currently, there are no effective therapies for PH-HFpEF, although a number of candidate drugs are being evaluated, including soluble guanylate cyclase stimulators, phosphodiesterase type 5 inhibitors, sodium nitrite and endothelin receptor antagonists. In this review we attempt to provide an updated overview of recent findings pertaining to the pulmonary vascular complications in HFpEF in terms of clinical definitions, epidemiology and pathophysiology. Mechanisms leading to pulmonary vascular remodelling in HFpEF, a summary of pre-clinical models of HFpEF and PH-HFpEF, and new candidate therapeutic strategies for the treatment of PH-HFpEF are summarized. Abstract figure legendPrevalence and pathophysiology of pulmonary hypertension (PH) in patients with heart failure with preserved ejection fraction (HFpEF). LA, left atrium; LV, left ventricle; LVEDP, left ventricular end-diastolic pressure; PA, pulmonary artery/arterial; PV, pulmonary vein; PVR, pulmonary vascular resistance; RV, right ventricle. Definitions, classification of subtypes and diagnostic factors of...

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“…LVH is a feature of left heart disease, whereas in PAH, left ventricular atrophy can be present [29]. Left atrial dilation on MRI has high predictive value when comparing PAH and left heart failure [30]. However, echocardiography underestimates cardiovascular magnetic resonance-derived left atrial volume [31].…”

Section: Figurementioning

confidence: 99%

Noninvasive identification of left-sided heart failure in a population suspected of pulmonary arterial hypertension

et al. 2015

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Exclusion of pulmonary hypertension secondary to left-sided heart disease (left heart failure (LHF)) is pivotal in the diagnosis of pulmonary arterial hypertension (PAH). In case of doubt, invasive measurements are recommended. The aim of the present study was to investigate whether it is possible to diagnose LHF using noninvasive parameters in a population suspected of PAH. 300 PAH and 80 LHF patients attended our pulmonary hypertension clinic before August 2010, and were used to build the predictive model. 79 PAH and 55 LHF patients attended our clinic from August 2010, and were used for prospective validation.A medical history of left heart disease, S deflection in V1 plus R deflection in V6 in millimetres on ECG, and left atrial dilation or left valvular heart disease that is worse than mild on echocardiography were independent predictors of LHF. The derived risk score system showed good predictive characteristics: R 2 =0.66 and area under the curve 0.93. In patients with a risk score ⩾72, there is 100% certainty that the cause of pulmonary hypertension is LHF. Using this risk score system, the number of right heart catheterisations in LHF may be reduced by 20%.In a population referred under suspicion of PAH, a predictive model incorporating medical history, ECG and echocardiography data can diagnose LHF noninvasively in a substantial percentage of cases. @ERSpublications A risk score system can identify left-heart failure as alternative PH cause in patients suspected of PAH clinically http://ow.ly/JAIkR

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LA Volume by CMR Distinguishes Idiopathic From Pulmonary Hypertension Due to HFpEF

Cited by 38 publications

References 4 publications

Pulmonary hypertension

Pulmonary hypertension

Insights into the pulmonary vascular complications of heart failure with preserved ejection fraction

Noninvasive identification of left-sided heart failure in a population suspected of pulmonary arterial hypertension

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