Mixed Venous Oxygen Saturation Is a Better Prognosticator Than Cardiac Index in Pulmonary Arterial Hypertension

Khirfan, Ghaleb; Almoushref, Allaa; Naal, Tawfeq; Abuhalimeh, Batool; Dweik, Raed A.; Heresi, Gustavo A.; Tonelli, Adriano R.

doi:10.1016/j.chest.2020.06.053

Cited by 11 publications

(11 citation statements)

References 27 publications

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“…Surprisingly, PvO 2 < 35 mmHg was further validated as a prognostic factor in multivariate analyses adjusted by other parameters in the present study. This finding is consistent with that of Khirfan et al’s study, which was based on ESC/ERS risk stratification and indicated that SvO 2 was more strongly correlated with prognosis than were thermodilution CI and other parameters in patients with IPAH/HPAH [ 16 ]. Tissue oxygenation can be explained using Krogh’s tissue cylinder model [ 27 ] (described in Additional file 1 : Appendix S1), which forms the theoretical basis for understanding the exchange of oxygen and other solutes between the capillaries and tissues [ 28 ].…”

Section: Discussionsupporting

confidence: 91%

“…However, PvO 2 is still an important prognostic factor in univariate analysis. Surprisingly, PvO 2 < 35 mmHg was further validated as a prognostic factor in multivariate analyses adjusted by was more strongly correlated with prognosis than were thermodilution CI and other parameters in patients with IPAH/HPAH [16]. Tissue oxygenation can be explained using Krogh's tissue cylinder model [27] (described in Additional file 1: Appendix S1), which forms the theoretical basis for understanding the exchange of oxygen and other solutes between the capillaries and tissues [28].…”

Section: Discussionmentioning

confidence: 99%

“…However, the relevance of tissue hypoxia (defined by a PvO 2 < 35 mmHg) in PAH and CTEPH pathogenesis has not been reported. Moreover, tissue oxygenation is reportedly superior to cardiac function for assessing the disease severity and predicting survival in PAH [ 16 ]. Kapitan et al [ 17 ] reported that the main cause of hypoxemia in CTEPH was ventilation-perfusion mismatch, and that low PvO 2 , and PEA improved both; nonetheless, these issues remain controversial.…”

Section: Introductionmentioning

confidence: 99%

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Mixed venous oxygen tension is a crucial prognostic factor in pulmonary hypertension: a retrospective cohort study

et al. 2022

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Background The prognostic value of mixed venous oxygen tension (PvO2) at pulmonary hypertension diagnosis treated with selective pulmonary vasodilators remains unclear. This study sought to investigate the association of PvO2 with long-term prognosis in pulmonary arterial hypertension (PAH) and medically treated chronic thromboembolic pulmonary hypertension (CTEPH) and to identify the distinct mechanisms influencing tissue hypoxia in patients with CTEPH or PAH. Methods We retrospectively analyzed data from 138 (age: 50.2 ± 16.6 years, 81.9% women) and 268 (age: 57.4 ± 13.1 years, 72.8% women) patients with PAH and CTEPH, respectively, diagnosed at our institution from 1983 to 2018. We analyzed the survival rates of patients with/without tissue hypoxia (PvO2 < 35 mmHg) and identified their prognostic factors based on the pulmonary hypertension risk stratification guidelines. Results Survival was significantly poorer in patients with tissue hypoxia than in those without it for PAH (P = 0.001) and CTEPH (P = 0.017) treated with selective pulmonary vasodilators. In patients with PAH, PvO2 more strongly correlated with prognosis than other hemodynamic prognostic factors regardless of selective pulmonary vasodilators usage. PvO2 was the only significant prognostic factor in patients with CTEPH treated with pulmonary hypertension medication. Patients with CTEPH experiencing tissue hypoxia exhibited significantly poorer survival than those in the intervention group (P < 0.001). PvO2 more strongly correlated with the cardiac index (CI) than the alveolar-arterial oxygen gradient (A-aDO2) in PAH; whereas in CTEPH, PvO2 was more strongly correlated with A-aDO2 than with CI. Conclusions PvO2 may represent a crucial prognostic factor for pulmonary hypertension. The prognostic impact of tissue hypoxia affects different aspects of PAH and CTEPH, thereby reflecting their distinct pathogenesis.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mixed venous oxygen tension is a crucial prognostic factor in pulmonary hypertension: a retrospective cohort study

et al. 2022

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“…The onset of these findings likely denotes crossing pathophysiologic tipping points of venous hypertension and cardiac output. Two recent studies by Khirfan et al 7 and Shah et al 8 demonstrated that S v O 2 and serum creatinine, respectively, prognosed mortality and adverse outcomes in pulmonary arterial hypertension patients. These markers may be important parameters to detect the transition from compensated PH to decompensated RVF, systemic congestion, and multi-organ failure.…”

Section: Discussionmentioning

confidence: 99%

Progression Toward Decompensated Right Ventricular Failure in the Ovine Pulmonary Hypertension Model

et al. 2021

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Decompensated right ventricular failure (RVF) in patients with pulmonary hypertension (PH) is fatal, with limited treatment options. Novel mechanical circulatory support systems have therapeutic potential for RVF, but the development of these devices requires a large animal disease model that replicates the pathophysiology observed in humans. We previously reported an effective disease model of PH in sheep through ligation of the left pulmonary artery (PA) and progressive occlusion of the main PA. Herein, we report a case of acute decompensation with this model of chronic RVF. Gradual PA banding raised the RV pressure (maximum RV systolic/mean pressure = 95 mmHg/56 mmHg). Clinical findings and laboratory serum parameters suggested appropriate physiologic compensation for 7 weeks. However, mixed venous saturation declined precipitously on week 7, and creatinine increased markedly on week 9. By the 10th week, the animal developed dependent, subcutaneous edema. Subsequently, the animal expired during the induction of general anesthesia. Post-mortem evaluation revealed several liters of pleural effusion and ascites, RV dilatation, eccentric RV hypertrophy, and myocardial fibrosis. The presented case supports this model's relevance to the human pathophysiology of RVF secondary to PH and its value in the development of novel devices, therapeutics, and interventions.

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“…Evidence supporting the use of these parameters in individuals who experience septic shock is quite robust; however, they are also applicable to those who experience cardiogenic shock [2,3]. Although sex and age may affect the course of shock (e.g., different immune response), it seems that these factors do not influence the clinical use of the parameters of tissue perfusion adequacy [12,13].…”

Section: Introductionmentioning

confidence: 99%

Biochemical markers for clinical monitoring of tissue perfusion

Janotka

Ošťádal

2021

Mol Cell Biochem

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The assessment and monitoring of the tissue perfusion is extremely important in critical conditions involving circulatory shock. There is a wide range of established methods for the assessment of cardiac output as a surrogate of oxygen delivery to the peripheral tissues. However, the evaluation of whether particular oxygen delivery is sufficient to ensure cellular metabolic demands is more challenging. In recent years, specific biochemical parameters have been described to indicate the status between tissue oxygen demands and supply. In this review, the authors summarize the application of some of these biochemical markers, including mixed venous oxygen saturation (SvO2), lactate, central venous–arterial carbon dioxide difference (PCO2 gap), and PCO2 gap/central arterial-to-venous oxygen difference (Ca–vO2) for hemodynamic assessment of tissue perfusion. The thorough monitoring of the adequacy of tissue perfusion and oxygen supply in critical conditions is essential for the selection of the most appropriate therapeutic strategy and it is associated with improved clinical outcomes.

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Mixed Venous Oxygen Saturation Is a Better Prognosticator Than Cardiac Index in Pulmonary Arterial Hypertension

Cited by 11 publications

References 27 publications

Mixed venous oxygen tension is a crucial prognostic factor in pulmonary hypertension: a retrospective cohort study

Mixed venous oxygen tension is a crucial prognostic factor in pulmonary hypertension: a retrospective cohort study

Progression Toward Decompensated Right Ventricular Failure in the Ovine Pulmonary Hypertension Model

Biochemical markers for clinical monitoring of tissue perfusion

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