Prognostic factors of acute heart failure in patients with pulmonary arterial hypertension

Abstract

Acute right ventricular failure in the setting of pulmonary arterial hypertension (PAH) often requires hospitalisation in intensive care units (ICU) to manage the subsequent low cardiac output and its consequences. There are very few data on these acute events.We recorded demographic, clinical and biological data and therapy in consecutive patients suffering from acute right heart failure requiring catecholamine treatment in the ICU of the French referral centre for pulmonary hypertension. These variables were analysed according to the survival status in ICU.46 patients were included, the mean age was 50.3 yrs. ICU mortality was 41%. We found no difference in terms of demographics, clinical data, last haemodynamic measurements at admission. Systemic arterial pressure was significantly lower in the subgroup of patients whose clinical course was fatal. Plasma brain natriuretic peptide (BNP), C-reactive protein (CRP), serum sodium and creatinine at admission correlated with survival. Demonstration of an infection during the ICU stay was associated with a worse prognosis.These preliminary results underline the importance of some simple clinical and biological parameters in the prognostic evaluation of acute heart failure in the setting of PAH. Whether these parameters can guide therapy needs to be further investigated.

Defend the right ventricle with what you know

“…Unlike SZTRYMF et al [1], the patients in this study had mildmoderate PH, good functional class (I and II575%), a mild-moderate elevation in pulmonary pressure (mean5 43¡12 mmHg) and a normal cardiac performance (cardiac index53.25¡0.68 L?min -1 ?m -2 ). Despite well-compensated PH, nearly one-third of patients (29%) had peri-operative complications (most within 48 h) and 7% had peri-operative mortality.…”

“…In the current issue of the European Respiratory Journal, French clinician-scientists provide descriptive results of the largest database collected to date on patients experiencing acute right heart failure requiring admission to an intensive care unit [1] and patients requiring surgical procedures [2] at their internationally recognised centre. There have been few publications regarding the management of and outcomes from acute decompensated right heart failure or the peri-operative management of patients with PH.…”

“…''Prognostic factors of acute heart failure in patients with pulmonary arterial hypertension,'' by SZTRYMF et al evaluated consecutive PAH patients admitted to the intensive care unit from November 2005 to April 2007 [1]. All patients enrolled had been diagnosed to have had acute deterioration within 1 week of admission and required catecholamine treatment for cardiogenic shock.…”

Different Concentrations of Notoginsenoside Rg1 Attenuate Hypoxic and Hypercapnia Pulmonary Hypertension by Reducing the Expression of ERK in Rat PASMCs

“…Hypoxic and hypercapnia pulmonary hypertension (HHPH) was a disease with poor prognosis, its clinical symptoms were apparent, such as dyspnea, right-sided heart failure, and it was characterized by an increase resistance in pulmonary artery [22]. A large number of researches have devoted much time and energy into revealing the specific mechanisms; however, the results still remain unknown.…”

Non-Tuberculous Mycobacterial Lung Disease (NTMLD) in Patients with Chronic Thromboembolic Pulmonary Hypertension and Idiopathic Pulmonary Arterial Hypertension

“…Infections are a frequent cause of exacerbations of right heart insufficiency in this group of patients, particularly in cases of advanced pulmonary hypertension [32,33]. Infection with non-tuberculous mycobacteria causing a chronic inflammatory condition could undoubtedly have negatively influenced the course of pulmonary hypertension in the study group.…”