Pulmonary artery

About: Pulmonary artery is a research topic. Over the lifetime, 27278 publications have been published within this topic receiving 595835 citations. The topic is also known as: pulmonary arterial tree & pulmonary arteries.

Pulmonary arterial hypertension

Abstract: Pulmonary arterial hypertension (PAH) is a chronic and progressive disease leading to right heart failure and ultimately death if untreated. The first classification of PH was proposed in 1973. In 2008, the fourth World Symposium on PH held in Dana Point (California, USA) revised previous classifications. Currently, PH is devided into five subgroups. Group 1 includes patients suffering from idiopathic or familial PAH with or without germline mutations. Patients with a diagnosis of PAH should systematically been screened regarding to underlying mutations of BMPR2 gene (bone morphogenetic protein receptor type 2) or more rarely of ACVRL1 (activine receptor-like kinase type 1), ENG (endogline) or Smad8 genes. Pulmonary veno occusive disease and pulmonary capillary hemagiomatosis are individualized and designated as clinical group 1'. Group 2 'Pulmonary hypertension due to left heart diseases' is divided into three sub-groups: systolic dysfonction, diastolic dysfonction and valvular dysfonction. Group 3 'Pulmonary hypertension due to respiratory diseases' includes a heterogenous subgroup of respiratory diseases like PH due to pulmonary fibrosis, COPD, lung emphysema or interstitial lung disease for exemple. Group 4 includes chronic thromboembolic pulmonary hypertension without any distinction of proximal or distal forms. Group 5 regroup PH patients with unclear multifactorial mechanisms. Invasive hemodynamic assessment with right heart catheterization is requested to confirm the definite diagnosis of PH showing a resting mean pulmonary artery pressure (mPAP) of ≥ 25 mmHg and a normal pulmonary capillary wedge pressure (PCWP) of ≤ 15 mmHg. The assessment of PCWP may allow the distinction between pre-capillary and post-capillary PH (PCWP > 15 mmHg). Echocardiography is an important tool in the management of patients with underlying suspicion of PH. The European Society of Cardiology and the European Respiratory Society (ESC-ERS) guidelines specify its role, essentially in the screening proposing criteria for estimating the presence of PH mainly based on tricuspid regurgitation peak velocity and systolic artery pressure (sPAP). The therapy of PAH consists of non-specific drugs including oral anticoagulation and diuretics as well as PAH specific therapy. Diuretics are one of the most important treatment in the setting of PH because right heart failure leads to fluid retention, hepatic congestion, ascites and peripheral edema. Current recommendations propose oral anticoagulation aiming for targeting an International Normalized Ratio (INR) between 1.5-2.5. Target INR for patients displaying chronic thromboembolic PH is between 2–3. Better understanding in pathophysiological mechanisms of PH over the past quarter of a century has led to the development of medical therapeutics, even though no cure for PAH exists. Several specific therapeutic agents were developed for the medical management of PAH including prostanoids (epoprostenol, trepoprostenil, iloprost), endothelin receptor antagonists (bosentan, ambrisentan) and phosphodiesterase type 5 inhibitors (sildenafil, tadalafil). This review discusses the current state of art regarding to epidemiologic aspects of PH, diagnostic approaches and the current classification of PH. In addition, currently available specific PAH therapy is discussed as well as future treatments.

Accuracy of Doppler echocardiography in the hemodynamic assessment of pulmonary hypertension.

Abstract: Rationale: Transthoracic Doppler echocardiography is recommended for screening for the presence of pulmonary hypertension (PH). However, some recent studies have suggested that Doppler echocardiographic pulmonary artery pressure estimates may frequently be inaccurate.Objectives: Evaluate the accuracy of Doppler echocardiography for estimating pulmonary artery pressure and cardiac output.Methods: We conducted a prospective study on patients with various forms of PH who underwent comprehensive Doppler echocardiography within 1 hour of a clinically indicated right-heart catheterization to compare noninvasive hemodynamic estimates with invasively measured values.Measurements and Main Results: A total of 65 patients completed the study protocol. Using Bland-Altman analytic methods, the bias for the echocardiographic estimates of the pulmonary artery systolic pressure was −0.6 mm Hg with 95% limits of agreement ranging from +38.8 to −40.0 mm Hg. Doppler echocardiography was inaccurate (defined as being greater ...

Exercise Hemodynamics Enhance Diagnosis of Early Heart Failure with Preserved Ejection Fraction

Abstract: Background—When advanced, heart failure with preserved ejection fraction (HFpEF) is readily apparent. However, diagnosis of earlier disease may be challenging because exertional dyspnea is not specific for heart failure, and biomarkers and hemodynamic indicators of volume overload may be absent at rest. Methods and Results—Patients with exertional dyspnea and ejection fraction >50% were referred for hemodynamic catheterization. Those with no significant coronary disease, normal brain natriuretic peptide assay, and normal resting hemodynamics (mean pulmonary artery pressure <25 mm Hg and pulmonary capillary wedge pressure [PCWP] <15 mm Hg) (n=55) underwent exercise study. The exercise PCWP was used to classify patients as having HFpEF (PCWP ≥25 mm Hg) (n=32) or noncardiac dyspnea (PCWP <25 mm Hg) (n=23). At rest, patients with HFpEF had higher resting pulmonary artery pressure and PCWP, although all values fell within normal limits. Exercise-induced elevation in PCWP in HFpEF was confirmed by greater incre...

Chronic thromboembolic pulmonary hypertension.

Abstract: The description of organized thrombus in major pulmonary arteries can be found in autopsy reports dating back to the late nineteenth and early twentieth centuries. Not until the 1950s was the antemortem diagnosis and clinical syndrome of chronic thrombotic obstruction of the major pulmonary arteries better characterized. The first surgical attempt to remove the adherent thrombus from the vessel wall occurred in 1958. This operation provided the conceptual foundation for the distinction between acute and chronic thromboembolic disease of the pulmonary vascular bed, and established that an endarterectomy, and not an embolectomy, would be necessary if a surgical remedy for this disease was to be successful.

Echocardiographic assessment of pulmonary hypertension in patients with advanced lung disease.

Abstract: Doppler echocardiography is commonly used to estimate systolic nose PH in patients with advanced lung disease is preferable. pulmonary artery pressure and to diagnose pulmonary hypertension, Doppler echocardiography (DE) has gained popularity in but data relating to its utility in patients with advanced lung disease the last 2 decades for noninvasive estimation of systolic pulare limited. In a cohort study of 374 lung transplant candidates, the monary artery pressure (sPAP) from the peak velocity of a performance characteristics of echocardiography compared with tricuspid regurgitant jet. Studies in patients with cardiac disright heart catheterization in the determination of systolic pulmo- ease have revealed a significant statistical correlation benary artery pressure and diagnosis of pulmonary hypertension were tween sPAP estimated by DE and that measured by RHC investigated. The prevalence of pulmonary hypertension was 25% (6‐9). However, in patients with chronic pulmonary disease, in the study population. Estimation of systolic pulmonary artery pres- DE has been reported to perform variably in the assessment sure by echocardiography was possible in 166 patients (44%). The of sPAP (10‐12). Despite a close correlation between DEcorrelation between systolic pulmonary artery pressure estimated estimated and directly measured sPAP, several studies have by echocardiography and measured by cardiac catheterization was revealed that such estimations were possible in only a minorgood (r 0.69, p 0.0001). However, 52% of pressure estimations ity of patients with chronic lung disease (11‐14). More imporwere found to be inaccurate (more than 10 mm Hg difference tantly, by focusing exclusively on the correlation between compared with measured pressure), and 48% of patients were mis- estimated and measured pressures, previous studies have classified as having pulmonary hypertension by echocardiography. largely ignored the important issue of the true accuracy of Sensitivity, specificity, and positive and negative predictive values DE estimation of sPAP. That is, if DE were to consistently of systolic pulmonary artery pressure estimation for diagnosis of overestimate or underestimate sPAP by a constant value, pulmonary hypertension were 85%, 55%, 52%, and 87%, respectively. correlation would be high, but the accuracy of the estimation In conclusion, despite a statistically significant correlation with directly measured values, estimation of systolic pulmonary artery pres- would be dictated by the magnitude of discrepancy. It is the sure by echocardiography is frequently inaccurate in patients with accuracy of estimation that defines the clinical utility of DE in advanced lung disease and leads to considerable overdiagnosis of such circumstances as evaluation of patients for lung volume pulmonary hypertension. reduction surgery or lung transplantation. Patients with advanced lung disease referred for lung