Pulmonary Artery Systolic Pressure is Elevated in the Elderly: Relationships between Echocardiographic and Pathological Findings

Ueda, Ryuji; Yokouchi, Masatoshi; Andou, Harunori; Suzuki, Taiji; Yamaoka, Makoto; Otomo, E; Takahashi, Atushi; Kubo, Takashi

doi:10.2169/internalmedicine.43.374

Cited by 4 publications

(4 citation statements)

References 19 publications

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“…And besides, previous studies demonstrated some hemodynamic changes elevating RLS in elderly patients, the promoting pulmonary-arterial pressure for instance, could contribute to a higher possibility of PTE (Homma, DiTullio, Sacco, Sciacca, & Mohr, 2004;Ueda et al, 2004). We speculated that the importance of PFO in the pathogenesis of stroke was more obvious in aged patients.…”

Section: Discussionmentioning

confidence: 83%

“…In addition, the prevalence of venous thrombosis and pulmonary embolism (Stollberger et al, ), as well as the presence of concomitant atrial septum aneurysm (Handke, Harloff, Bode, & Geibel, ), which may act as important risk factors of PTE when coexistence with PFO (Mas et al, ; Stollberger et al, ), would also increase with age. And besides, previous studies demonstrated some hemodynamic changes elevating RLS in elderly patients, the promoting pulmonary–arterial pressure for instance, could contribute to a higher possibility of PTE (Homma, DiTullio, Sacco, Sciacca, & Mohr, ; Ueda et al, ). We speculated that the importance of PFO in the pathogenesis of stroke was more obvious in aged patients.…”

Section: Discussionmentioning

confidence: 95%

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Clinical and imaging characteristics of PFO‐related stroke with different amounts of right‐to‐left shunt

et al. 2018

Brain and Behavior

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IntroductionRight‐to‐left shunt (RLS) induced by a patent foramen ovale (PFO) is associated with an increased risk of cryptogenic stroke (CS). However, little is known about the relationship between the amount of RLS and the stroke pattern. In this study, we aimed to evaluate the distinct clinical features of PFO‐related CS in different RLS degrees resulting from PFO.MethodsThis is a cohort study of 222 CS patients admitted to the Tongji Hospital from 1st May 2014 to 31st April 2017. All patients underwent contrast transcranial Doppler examination. And then, 121 (54.5%) were classified as non‐RLS group, while 76 (34.2%) were classified as mild RLS group and 25 (11.3%) were large RLS group according to the number of micro‐emboli signals. The groups were compared with respect to their clinical and neuroimaging characteristics.ResultsIn terms of risk factors of stroke, the prevalence of hypertension was lower in mild group (p = 0.002). Regarding the infarct patterns in different CS patients, we found that the multiple cortical lesions were more frequently observed (p<0.001) with increasing RLS in DWI. Moreover, there was a rising trend in the proportion of small lesions (≤1 cm) with an increasing RLS (p < 0.01). And as RLS increased, the posterior circulation was more likely to be influenced (p < 0.05). In addition, the serum cholesterol concentration was lower in the large RLS group, compared to the non‐RLS group (p = 0.003) and mild RLS group (p = 0.008). While the mean platelet volume (MPV) in mild group was significantly higher than that of non‐RLS group (p = 0.013).ConclusionPatients with larger RLS show more infarction in posterior circulation, higher frequency of small lesions or multiple cortical lesions. The results of our study indicate that the infarct patterns might be a clue of PFO‐related stroke.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 95%

Clinical and imaging characteristics of PFO‐related stroke with different amounts of right‐to‐left shunt

et al. 2018

Brain and Behavior

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“…68 Konstantinides et al found a significantly elevated risk of death and arterial embolisms in patients with pulmonary embolism and PFO. 69 The pulmonary-arterial pressure is higher in older than in younger patients 70 and thus probably also the risk of thrombus passage across a PFO.…”

Section: Paradoxical Embolism In Older Patients: Pathophysiological Pmentioning

confidence: 99%

Patent Foramen Ovale and Cryptogenic Stroke: A Matter of Age?

Handke

Harloff

Bode

et al. 2009

Semin Thromb Hemost

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A patent foramen ovale (PFO) enables a right-to-left shunt in about a quarter of the population. The marked association between cryptogenic stroke and PFO supports the hypothesis that paradoxical embolism could be a relevant cause of stroke. Although this association has been described in several studies for patients <55 years of age, only limited data are available on the role of PFO in older patients. Recent studies, however, have also shown a significant association between cryptogenic stroke and PFO in patients >55 years of age. The relationship is especially marked in the presence of atrial septum aneurysm (ASA). This finding is in accordance with previous reports indicating that PFO and concomitant ASA is a high-risk feature. Factors promoting paradoxical embolism, such as deep vein thrombosis (DVT) and elevated right-heart pressure, are more frequently encountered in older than in younger patients. Independent of age, contrast-enhanced transthoracic and transesophageal echocardiography are the methods of choice for the detection and imaging of PFO and atrial septal aneurysm. Transcranial Doppler can be used as a screening method in patients with cryptogenic stroke to detect a right-to-left shunt. Proof of DVT strongly supports the suspicion of paradoxical embolism and should lead to oral anticoagulation. If paradoxical embolism is suspected without proof of DVT, both drug therapy with aspirin or warfarin and percutaneous closure of the PFO are available as therapeutic options. Recent studies have shown that percutaneous closure can be performed safely and with a low rate of recurrence both in older and younger patients. Thus far, however, there is no clear-cut evidence of superiority for either therapeutic strategy.

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“…In a study investigating the relationship between PAPs and age, Ueda et al [12] in healthy aged subjects found an increased value compared with that recorded in younger healthy subjects. This different behaviour seems to be reported to the changes of the senile lungs, characterized by a homogeneous enlargement of the alveolar airspaces without fibrosis or destructions of alveolar walls [13,14].…”

Section: Introductionmentioning

confidence: 88%

Echocardiographic evaluation of right heart function and pulmonary vascular bed

Cacciapuoti

2009

Int J Cardiovasc Imaging

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The aim of this review was to describe the different ultrasonic modalities to non-invasively evaluate right cardiac chambers and pulmonary vascular bed function. M-Mode, 2-D, conventional pulsed doppler, tissue doppler imaging (TDI), strain rate imaging (SRI) and 3D echocardiography are illustrated in order to obtain both regional and global right heart and pulmonary function. The results have a good correlation with other invasive and non-invasive diagnostic techniques, as magnetic resonance imaging (MRI). All these echocardiograpic techniques can be employed to evaluate the morphologic and functional pictures of right heart and pulmonary circulation in presence of pulmonary hypertension (PH). The hemodynamic profile obtained consent to anatomically and functionally characterize PH. But, other experiences performed on more wide range of healthy and PH patients are necessary to confirm the described results.

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Pulmonary Artery Systolic Pressure is Elevated in the Elderly: Relationships between Echocardiographic and Pathological Findings

Cited by 4 publications

References 19 publications

Clinical and imaging characteristics of PFO‐related stroke with different amounts of right‐to‐left shunt

Clinical and imaging characteristics of PFO‐related stroke with different amounts of right‐to‐left shunt

Patent Foramen Ovale and Cryptogenic Stroke: A Matter of Age?

Echocardiographic evaluation of right heart function and pulmonary vascular bed

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