Background Echocardiogram is a simple and useful tool in disease assessment.In ventricular septal defect(VSD)patients with severe pulmonary hypertension(PH),it is difficult to judge whether further intervention is nee...Background Echocardiogram is a simple and useful tool in disease assessment.In ventricular septal defect(VSD)patients with severe pulmonary hypertension(PH),it is difficult to judge whether further intervention is needed.Therefore,this study aimed to investigate the application of echocardiogram in predicting the severity of pulmonary hypertension and guide subsequent management.Methods This study included VSD patients who underwent right heart catheterization(RHC)examination in Guangdong Provincial People's Hospital from January2011 to December 2022.An estimated pulmonary artery systolic pressure(e PASP)higher than 60 mm Hg was defined as severe PH in this study.Logistic regression analysis and receiver operating characteristic curve(ROC)analysis were used.Results A total of 186 VSD patients with severe PH(e PASP more than 60 mm Hg)were included in this study,with 158 cases in the non-correctable group and 28 cases in the collectable group.In univariable logistic regression,left atrium dimension(LA),left ventricular end-diastolic dimension(LVDd),left ventricular end-systolic dimension(LVDs),peak velocity of the pulmonary valve(PV),peak velocities from the early phase of the mitral inflow(MVE),bidirectional shunting and pericardial effusion were associated with a correctable shunt.When adjusted in multivariable model,only PV and bidirectional shunting remained statistically significant.The ROC curve found that PV exhibits good discriminative ability for correctable shunt(AUC[area under the curve]:0.779,95%CI:0.676-0.871)with a cut-off value of 1.465 m/s.The predictive performance of bidirectional shunting was not satisfactory,with a low AUC of 0.669(95%CI:0.571-0.766).Conclusions PV and bidirectional shunting are simple and clinically available parameters from echocardiogram in predicting PH severity,which not only avoids the repeated unnecessary cardiac catheterization,but also provides a reference basis for follow-up evaluation.展开更多
Background Transcatheter closure of patent ductus arteriosus （PDA） is a well established procedure and an accepted treatment modality for small to moderate-sized PDA. This study aimed to evaluate the immediate and f...Background Transcatheter closure of patent ductus arteriosus （PDA） is a well established procedure and an accepted treatment modality for small to moderate-sized PDA. This study aimed to evaluate the immediate and follow-up results of transcatheter closure of large PDAs with severe pulmonary arterial hypertension （PAH） in adults.展开更多
Background Pulmonary arterial hypertension(PAH) is a common complication of connective tissue disease(CTD) and confers a worse prognosis. Stress doppler echocardiography(SDE) can detect early pulmonary vasculopathy an...Background Pulmonary arterial hypertension(PAH) is a common complication of connective tissue disease(CTD) and confers a worse prognosis. Stress doppler echocardiography(SDE) can detect early pulmonary vasculopathy and assess right heart function in patients with pulmonary arterial hypertension. In this study, the SDE was applied to analyze the degree of pulmonary vascular lesion and the function of right heart in CTD patients without overt PAH. Methods CTD patients without overt PAH were divided into exercised-induced pulmonary hypertension(EIPH) group and non-EIPH group depending on whether tricuspid regurgitation(TR) exceeded 3.1 m/s during exercise and assessed by echocardiography at rest and during exercise. The data of right ventricular function and the slope of the incremental of the mean pulmonary artery pressure and cardiac output(ΔmPAP/ΔCO) were analyzed. Results Forty-seven CTD patients without overt PAH(35 female, mean age 40.3±12.0 years) were enrolled and divided into EIPH group(n=21) and non-EIPH group(n=26). Patients with systemic sclerosis(SSc) were more likely to have EIPH(47.6% vs. 28.6%, P<0.05) than those with systemic lupus erythematosus(SLE). Patients in EIPH group had a higher value of ΔmPAP/ΔCO than that of the non-EIPH group(4.5±3.1 vs. 2.2±1.3, P<0.05). SSc was more prevalent in CTD patients and the symptoms of dyspnea occurred more often in EIPH group(52.4%), indicating a pressure-flow mismatch induced by exercise. However, the cardiac function demonstrated by left ventricular ejection fraction(LVEF), tricuspid annular plane systolic excursion(TAPSE),DTI-Derived S'-wave velocity(S') and right ventricular fractional area change(RVFAC), as well as functional reserve reflected by the changes of TAPSE, S', RVFAC before and after exercise, did not differ significantly between the two groups. Conclusions Although right ventricular(RV) reserve function does not change much before and after exercise, patients in EIPH group have a higher value of ΔmPAP/ΔCO than that of the non-EIPH group and more likely to have symptoms during exercise. Thus, to assess the potential for pulmonary vascular disease, echocardiography should be performed at rest and during exercise.[S Chin J Cardiol 2019;20(1):31-36]展开更多
基金supported by the Guangdong Peak Project(No.DFJH201802)the National Natural Science Foundation of China(No.82371963)+1 种基金Guangdong Basic and Applied Basic Research Foundation(No.2021A1515012232/No.2023A1515011366)the Natural Science Foundation lauching fund of the Guangdong Provincial People's Hospital(No.8197070830/No.8207070477/No.8227070211)。
文摘Background Echocardiogram is a simple and useful tool in disease assessment.In ventricular septal defect(VSD)patients with severe pulmonary hypertension(PH),it is difficult to judge whether further intervention is needed.Therefore,this study aimed to investigate the application of echocardiogram in predicting the severity of pulmonary hypertension and guide subsequent management.Methods This study included VSD patients who underwent right heart catheterization(RHC)examination in Guangdong Provincial People's Hospital from January2011 to December 2022.An estimated pulmonary artery systolic pressure(e PASP)higher than 60 mm Hg was defined as severe PH in this study.Logistic regression analysis and receiver operating characteristic curve(ROC)analysis were used.Results A total of 186 VSD patients with severe PH(e PASP more than 60 mm Hg)were included in this study,with 158 cases in the non-correctable group and 28 cases in the collectable group.In univariable logistic regression,left atrium dimension(LA),left ventricular end-diastolic dimension(LVDd),left ventricular end-systolic dimension(LVDs),peak velocity of the pulmonary valve(PV),peak velocities from the early phase of the mitral inflow(MVE),bidirectional shunting and pericardial effusion were associated with a correctable shunt.When adjusted in multivariable model,only PV and bidirectional shunting remained statistically significant.The ROC curve found that PV exhibits good discriminative ability for correctable shunt(AUC[area under the curve]:0.779,95%CI:0.676-0.871)with a cut-off value of 1.465 m/s.The predictive performance of bidirectional shunting was not satisfactory,with a low AUC of 0.669(95%CI:0.571-0.766).Conclusions PV and bidirectional shunting are simple and clinically available parameters from echocardiogram in predicting PH severity,which not only avoids the repeated unnecessary cardiac catheterization,but also provides a reference basis for follow-up evaluation.
文摘Background Transcatheter closure of patent ductus arteriosus （PDA） is a well established procedure and an accepted treatment modality for small to moderate-sized PDA. This study aimed to evaluate the immediate and follow-up results of transcatheter closure of large PDAs with severe pulmonary arterial hypertension （PAH） in adults.
基金supported by medical science and technology research fund of Guangdong Province(No.A2016131)
文摘Background Pulmonary arterial hypertension(PAH) is a common complication of connective tissue disease(CTD) and confers a worse prognosis. Stress doppler echocardiography(SDE) can detect early pulmonary vasculopathy and assess right heart function in patients with pulmonary arterial hypertension. In this study, the SDE was applied to analyze the degree of pulmonary vascular lesion and the function of right heart in CTD patients without overt PAH. Methods CTD patients without overt PAH were divided into exercised-induced pulmonary hypertension(EIPH) group and non-EIPH group depending on whether tricuspid regurgitation(TR) exceeded 3.1 m/s during exercise and assessed by echocardiography at rest and during exercise. The data of right ventricular function and the slope of the incremental of the mean pulmonary artery pressure and cardiac output(ΔmPAP/ΔCO) were analyzed. Results Forty-seven CTD patients without overt PAH(35 female, mean age 40.3±12.0 years) were enrolled and divided into EIPH group(n=21) and non-EIPH group(n=26). Patients with systemic sclerosis(SSc) were more likely to have EIPH(47.6% vs. 28.6%, P<0.05) than those with systemic lupus erythematosus(SLE). Patients in EIPH group had a higher value of ΔmPAP/ΔCO than that of the non-EIPH group(4.5±3.1 vs. 2.2±1.3, P<0.05). SSc was more prevalent in CTD patients and the symptoms of dyspnea occurred more often in EIPH group(52.4%), indicating a pressure-flow mismatch induced by exercise. However, the cardiac function demonstrated by left ventricular ejection fraction(LVEF), tricuspid annular plane systolic excursion(TAPSE),DTI-Derived S'-wave velocity(S') and right ventricular fractional area change(RVFAC), as well as functional reserve reflected by the changes of TAPSE, S', RVFAC before and after exercise, did not differ significantly between the two groups. Conclusions Although right ventricular(RV) reserve function does not change much before and after exercise, patients in EIPH group have a higher value of ΔmPAP/ΔCO than that of the non-EIPH group and more likely to have symptoms during exercise. Thus, to assess the potential for pulmonary vascular disease, echocardiography should be performed at rest and during exercise.[S Chin J Cardiol 2019;20(1):31-36]
