Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 414
Filter
1.
Arq. bras. cardiol ; 118(6): 1059-1066, Maio 2022. tab, graf
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1383696

ABSTRACT

Resumo Fundamento A hipertensão pulmonar (HP) é uma doença rara e complexa com prognóstico ruim, que exige tratamento pela vida toda. Objetivo Descrever dados de 3 anos de acompanhamento da vida real sobre o tratamento com estimuladores de guanilato ciclase solúvel (Riociguate) de pacientes com HP, medindo parâmetros atuais de avaliação de risco. Métodos Coletamos dados clínicos e epidemiológicos retrospectivamente de pacientes com HP do grupo 1 (hipertensão arterial pulmonar) e do grupo 4 (HP tromboembólica crônica). Parâmetros não invasivos e invasivos correspondentes à avaliação de risco foram analisados na linha de base e no acompanhamento. Foram realizadas análises estatísticas usando o software SPSS 18.0, e os p-valores <0,050 foram considerados estatisticamente significativos. Resultados No total, 41 pacientes tratados com riociguate foram incluídos no estudo. Entre eles, 31 já concluíram 3 anos de tratamento e foram selecionados para a seguinte análise. Na linha de base, 70,7% dos pacientes estavam nas classes funcionais III ou IV da OMS. Depois de 3 anos de tratamento, a classe funcional da OMS melhorou significativamente em todos os pacientes. Além disso, a mediana do teste de caminhada de 6 minutos (TC6M) aumentou significativamente de 394 ± 91 m na linha de base para 458 ± 100 m após 3 anos de acompanhamento (p= 0,014). O índice de sobrevida após três anos foi de 96,7%. Conclusão Em nossa coorte de vida real, a maioria dos pacientes com HP tratados com riociguate demonstraram parâmetros de risco estáveis ou melhores, especialmente no TC6M, aos 3 anos de acompanhamento.


Abstract Background Pulmonary hypertension (PH) is a rare and complex disease with poor prognosis, which requires lifelong treatment. Objective To describe 3-year follow-up real-life data on treatment with soluble guanylate cyclase stimulators (Riociguat) of patients with PH, measuring current risk assessment parameters. Methods This study retrospectively collected clinical and epidemiological data of patients with PH of group 1 (pulmonary arterial hypertension) and group 4 (chronic thromboembolic PH). Non-invasive and invasive parameters corresponding to the risk assessment were analyzed at baseline and follow-up. Statistical analyses were performed using the SPSS 18.0 software, and p-values < 0.050 were considered statistically significant. Results In total, 41 patients receiving riociguat were included in the study. Of them, 31 had already completed 3 years of treatment and were selected for the following analysis. At baseline, 70.7% of patients were in WHO functional class III or IV. After 3 years of treatment, the WHO functional class significantly improved in all patients. In addition, the median of the 6-minute walk test (6MWT) significantly increased from 394 ± 91 m at baseline to 458 ± 100 m after 3 years of follow-up (p= 0.014). The three-year survival rate was 96.7%. Conclusion In our real-life cohort, most patients with PH treated with riociguat showed stable or improved risk parameters, especially in the 6MWT, at 3 years of follow-up.

3.
Chinese Journal of Rheumatology ; (12): 238-242, 2022.
Article in Chinese | WPRIM | ID: wpr-932467

ABSTRACT

Objective:To describe a series of systemic sclerosis (SSc) patients with the combination of scleroderma renal crisis (SRC) and pulmonary arterial hypertension (PAH).Methods:The medical records of 472 SSc patients in Peking Union Medical College Hospital between January 2012 and October 2020 were reviewed and a retrospective analysis of the characteristics of patients with SRC and PAH among SSc patients was conducted.Results:Thirteen patients suffered from SRC and PAH in the SSc patients, 1 case was limited cutaneous SSc, and 12 cases were diffuse cutaneous SSc. Five patients had renal crisis before pulmonary arterial hypertension, 4 patients had pulmonary arterial hypertension before the occurrence of renal crisis, and the remaining 4 patients were found at the same time. Among them, 11 patients had Raynaud's phenomenon, 7 had gastrointestinal bleeding, 6 had pulmonary edema and 3 had telangiectasias. Twelve cases were positive for anti-nuclear antibodies and 4 cases were positive for anti-Scl-70 antibodies. N-terminal pro-brain natriuretic peptide (NT-proBNP)>1 400 ng/L in 11 patients. Two patients had thrombotic microangiopathy (TMA). Among the 13 patients, 3 patients died during hospitalization, 2 patients were lost to follow-up, and 2 patients died within 5 years of follow-up. Six patients survived, and 1 of the 4 patients with regular dialysis were discharged from dialysis.Conclusion:In patients with scleroderma, SRC can occur earlier, later than, or at the same time with SSc-PAH. Patients may have a higher incidence of gastrointestinal bleeding and higher level of NT-proBNP. PDE5i or ERAs may be beneficial.

4.
Article in Chinese | WPRIM | ID: wpr-931703

ABSTRACT

Objective:To investigate the relationship between tumor necrosis factor α (TNF-α) and pulmonary vascular remodeling in rats with chronic thromboembolic pulmonary hypertension (CTEPH).Methods:A total of 104 Wister rats were provided by Laboratory Animal Center, Harbin Medical University between January 2020 and June 2020 and included in this study. They were randomly divided into CTEPH group ( n = 52) and sham-operation group ( n = 52). Rats in the CTEPH group were injected with an embolus via the left external jugular vein to establish rat models of CTEPH. Rats in the sham-operation group were injected with the same amount of 0.9% sodium chloride injection. Relevant indicators were measured after 7 days and 1 month of embolization. Results:After embolization for 7 days and 1 month, plasma TNF-α level in the sham-operation group was (45.62 ± 1.65) ng/L and (46.24 ± 2.82) ng/L, respectively, which were significantly lower than those in the CTEPH group [(47.15 ± 1.58) ng/L, (48.85 ± 2.96) ng/L, t = 3.48, 3.31, both P < 0.05). Mean pulmonary artery pressure in the sham-operation group was significantly lower than that in the CTEPH group ( t = 1.89, 3.11, both P < 0.05). TNF-α mRNA expression in the sham-operation group was significantly lower than that in the CTEPH group ( t = 3.06, 3.36, both P < 0.05). The area/total area of pulmonary artery wall in the sham-operation group was significantly lower than that in the CTEPH group ( t = 1.73, 4.17, both P < 0.05). Plasma TNF-α level was positively correlated with pulmonary artery TNF-α mRNA expression ( r = 0.82, P < 0.05). Plasma TNF-α level and pulmonary artery TNF-α mRNA expression were positively correlated with mean pulmonary artery pressure ( r = 0.62, 0.73, both P < 0.05) and area/total area of pulmonary artery wall ( r = 0.61, 0.63, both P < 0.05). Conclusion:TNF-α may be involved in the pathogenesis of CTEPH by increasing pulmonary artery pressure and vascular remodeling.

5.
Article in Chinese | WPRIM | ID: wpr-931172

ABSTRACT

Objective:To observe the efficacy and safety of mechanical ventilation combined with different doses of sildenafil in the treatment of persistent pulmonary hypertension of newborn (PPHN).Methods:A total of 160 children with PPHN admitted to Dezhou Maternal and Child Health Hospital from January 2018 to December 2019 were selected and divided into group A, B, C and D by random stratification, with 40 cases in each group. All the children in the group were actively corrected for acidosis, provided with intravenous nutrition support, warmth, anti-infection and other measures, and adopted ventilator to assist mechanical ventilation. Group A, B, and C were given different doses of sildenafil 0.5, 1.0, and 2.0 mg/(kg·time) respectively, while group D was not given sildenafil treatment, but only mechanical ventilation. Blood gas analysis indexes including partial arterial oxygenpressure (PaO 2), partial arterial carbon dioxide pressure (PaCO 2), saturationoxygen (SaO 2), and pulmonary artery pressure (SPAP), systemic blood pressure (SBP) of children were tested before the treatment and 72 h after the treatment. The treatment time, hospitalization time, hospitalization expenses and the incidence of adverse reactions of mechanical ventilation in 4 groups were recorded and compared. Results:The effective rate in the group A, B and C was higher than that in the group D: 80.0%(32/40), 85.0%(34/40), 87.5%(35/40) vs. 57.5%(23/40), the difference was statistically significant ( P<0.05). Before treatment, the levels of blood gas analysis indexes in 4 groups had no significant differences ( P>0.05). After treatment, the level of PaO 2 in the group A, B and C was significantly higher than that in the group D ( P<0.05), the level of PaCO 2 in the group B and C was significantly lower than that in group D ( P<0.05), and the level of SaO 2 in the group B and C was significantly higher than that in the group D ( P<0.05). After treatment, the level of SPAP in group B and C was significantly lower than that in the group D: (28.56 ± 3.93), (27.14 ± 3.32) mmHg(1 mmHg = 0.133 kPa) vs. (33.57 ± 4.68) mmHg, P<0.05, and the level of SBP in 4 groups had no significant difference ( P>0.05). The hospitalization time and mechanical ventilation time in group A, B and C were significantly shorter than those in group D ( P<0.05). No drug-related adverse reactions, pulmonary hemorrhage, hypotension, arrhythmia, pneumothorax and other complications occurred during the treatment in the 4 groups. Conclusions:Mechanical ventilation combined with sildenafil can significantly reduce pulmonary artery pressure and improve pulmonary oxygenation in children with PPHN. In the range of 0.5 - 1.0 mg/kg, the efficacy is more obvious when increasing the dose of sildenafil.

6.
Article in Chinese | WPRIM | ID: wpr-931169

ABSTRACT

Objective:To explore the predictive factors of secondary pulmonary hypertension (PH) in patients with chronic obstructive pulmonary disease (COPD).Methods:The patients who were hospitalized and diagnosed with COPD in Huai′an Hospital Affiliated to Xuzhou Medical University from September 2017 to December 2019 were enrolled, and the pulmonary systolic pressure were estimated by echocardiography. The patients were divided into simple COPD group and COPD combined with PH group. The general clinical data, hematology indexes, and pulmonary function indexes of each group were collected and analyzed to explore the predictive value of the above factors on the occurrence of PH in COPD.Results:The levels of average blood platelet volume (MPV), red blood cell distribution width (RDW), and logarithmic functionof amino-terminal brain natriuretic precursor (lgNT-proBNP) in the in the COPD combined with PH group were higher than those in the simple COPD group: (11.91 ± 2.60) fl vs. (10.39 ± 1.44) fl, (14.25 ± 2.49)% vs. (12.56 ± 1.12)%, (2.82 ± 0.54) ng/L vs. (2.22 ± 0.38) ng/L; the ratio of forced expiratory volume in the first second (FEV 1) and force vital capacity (FVC) and the percentage of FEV 1 to the predicted value (FEV 1%) were lower than those in the simple COPD group: (51.43 ± 8.07)% vs. (59.99 ± 8.33)%, (37.00 ± 12.62)% vs. (48.28 ± 15.10)%, the differences were statistically significant ( P<0.05). Logistic regression analysis showed that the changes of MPV( OR = 1.401, P = 0.015), RDW ( OR = 1.769, P = 0.013), lgNT-proBNP ( OR = 6.959, P<0.001), FEV 1/FVC( OR = 0.905, P<0.001) were closely related to the occurrence of PH in COPD. The receiver operating characteristic (ROC) curve analysis showed that the area under the curve of MPV, RDW, NT-proBNP combined detection in diagnosis of PH was the largest (0.873). Conclusions:The changes in NT-proBNP, RDW, MPV, FEV 1/FVC have a certain predictive value for COPD patients with PH. The combined detection of three hematological indicators can better predict the presence of PH in COPD patients than single detection or combined detection.

7.
Chinese Journal of Neonatology ; (6): 245-249, 2022.
Article in Chinese | WPRIM | ID: wpr-931021

ABSTRACT

Objective:To study the correlation of serum tenascin C (TNC) and bronchopulmonary dysplasia (BPD) comorbid pulmonary hypertension (PH) in preterm infants.Methods:From January 2017 to June 2020, preterm infants (gestational age<32 weeks) diagnosed of severe BPD admitted to the Neonatal Intensive Care Unit of our hospital were prospectively studied. Comorbidity of PH was evaluated using echocardiography and the infants were assigned into PH (+) group and PH (-) group. At the same time, serum TNC was examined and the correlation between serum TNC level and PH in infants with severe BPD was analyzed.Results:A total of 59 infants with severe BPD were enrolled, including 21 cases comorbid PH (35.6%). The serum TNC level in the PH (+) group was significantly higher than the PH (-) group [(123.7±41.1) ng/ml vs. (78.2±20.2) ng/ml, P<0.05]. Correlation analysis showed a positive correlation between the serum TNC level and systolic pulmonary artery pressure (sPAP) ( r=0.861, P<0.001).The area under the receiver operating characteristic curve of serum TNC predicting BPD comorbid PH was 0.884. The sensitivity and specificity of serum TNC predicting BPD comorbid PH were 84.0% and 76.9% with TNC≥87.7 ng/ml as the cut-off. Conclusions:Severe BPD comorbid PH is common. The serum TNC level in infants with severe BPD comorbid PH is increased and positively correlated with sPAP. The serum TNC level has certain clinical value in predicting and evaluating the severity of BPD comorbid PH.

8.
Journal of Clinical Hepatology ; (12): 671-675, 2022.
Article in Chinese | WPRIM | ID: wpr-922978

ABSTRACT

Portopulmonary hypertension (POPH) is an increase in pulmonary artery pressure that occurs on the basis of portal hypertension. As a member of the BMP family, bone morphogenetic protein 9 (BMP9) not only has the osteogenic activity, but can also protect endothelial integrity and maintain vascular homeostasis. This article reviews the pathogenesis of POPH, the physiological expression and role of BMP9, and related research advances in the BMP9 signaling pathway and its involvement in pulmonary hypertension and vascular remodeling, thereby exploring the possibility of BMP9 as a new biomarker for POPH to assist in the diagnosis of POPH.

9.
Colomb. med ; 52(4): e2015163, Oct.-Dec. 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1375240

ABSTRACT

Abstract Patients with pulmonary hypertension present limited tolerance to exercise and aerobic capacity; which is reflected in the reduction in peak oxygen consumption and their functional performance. This intolerance to exercise has traditionally been attributed to cardiac and respiratory dysfunction. However, as it happens in other chronic diseases, lower-limb and respiratory muscle alterations are also involved in patients with pulmonary hypertension. Increasing evidence suggests that physical exercise training is an efficient and safe strategy. The recommendation for light and moderate-intensity exercise is made within the framework of pulmonary rehabilitation, and its benefits have been previously described. In diseases such as COPD, lower-limb muscle function, exercise tolerance and quality of life improve following exercise training. And just as with COPD, it is necessary to promote evidence-based interventions with pulmonary hypertension. This narrative review focuses on the evaluation, safety and efficacy of training the respiratory muscles and the muscles of upper and lower extremities in patients with pulmonary hypertension.


Resumen Los pacientes con hipertensión pulmonar presentan tolerancia limitada al ejercicio y disminución de la capacidad aeróbica; lo que se refleja en la reducción del consumo pico de oxígeno y su desempeño funcional. Esta intolerancia al ejercicio se ha atribuido tradicionalmente a disfunciones cardíacas y respiratorias. Sin embargo, al igual que ocurre en otras enfermedades crónicas, las alteraciones de los músculos respiratorios y de los miembros inferiores y superiores también están implicadas en los pacientes con hipertensión pulmonar. La creciente evidencia sugiere que el entrenamiento físico es una estrategia eficiente y segura. La recomendación de ejercicio de intensidad ligera y moderada se realiza en el marco de la rehabilitación pulmonar, y sus beneficios han sido descritos previamente. En enfermedades como la EPOC, la función muscular de las extremidades inferiores, la tolerancia al ejercicio y la calidad de vida mejoran después del entrenamiento físico. Y al igual que con la EPOC, es necesario promover intervenciones basadas en la evidencia con la hipertensión pulmonar. Esta revisión narrativa se centra en la evaluación, seguridad y eficacia del entrenamiento de los músculos respiratorios y de las extremidades superiores e inferiores en pacientes con hipertensión pulmonar.

10.
Säo Paulo med. j ; 139(5): 505-510, May 2021. tab
Article in English | LILACS | ID: biblio-1290253

ABSTRACT

ABSTRACT BACKGROUND: The mechanism of exercise limitation in idiopathic pulmonary arterial hypertension (IPAH) is not fully understood. The role of hemodynamic alterations is well recognized, but mechanical, ventilatory and gasometric factors may also contribute to reduction of exercise capacity in these individuals. OBJECTIVE: To investigate whether there is an association between ventilatory pattern and stress Doppler echocardiography (SDE) variables in IPAH patients. DESIGN AND SETTING: Single-center prospective study conducted in a Brazilian university hospital. METHODS: We included 14 stable IPAH patients and 14 age and sex-matched controls. Volumetric capnography (VCap), spirometry, six-minute walk test and SDE were performed on both the patients and the control subjects. Arterial blood gases were collected only from the patients. The IPAH patients and control subjects were compared with regard to the abovementioned variables. RESULTS: The mean age of the patients was 38.4 years, and 78.6% were women. The patients showed hypocapnia, and in spirometry 42.9% presented forced vital capacity (FVC) below the lower limit of normality. In VCap, IPAH patients had higher respiratory rates (RR) and lower elimination of CO2 in each breath. There was a significant correlation between reduced FVC and the magnitude of increases in tricuspid regurgitation velocity (TRV). In IPAH patients, VCap showed similar tidal volumes and a higher RR, which at least partially explained the hypocapnia. CONCLUSIONS: The patients with IPAH showed hypocapnia, probably related to their higher respiratory rate with preserved tidal volumes; FVC was reduced and this reduction was positively correlated with cardiac output.


Subject(s)
Humans , Female , Adult , Pulmonary Arterial Hypertension , Cross-Sectional Studies , Prospective Studies , Echocardiography, Stress , Exercise Test , Familial Primary Pulmonary Hypertension , Lung/diagnostic imaging
11.
Arq. bras. cardiol ; 116(2): 219-226, fev. 2021. tab, graf
Article in Portuguese | LILACS | ID: biblio-1153005

ABSTRACT

Resumo Fundamento A resistência vascular pulmonar elevada ainda é um grande problema na seleção de candidatos ao transplante cardíaco. Objetivo Nosso objetivo foi avaliar o efeito da administração de sildenafila pré-transplante cardíaco em pacientes com hipertensão pulmonar fixa. Métodos O estudo retrospectivo, de centro único, incluiu 300 candidatos a transplante cardíaco consecutivos tratados entre 2003 e 2013. Destes, 95 pacientes tinham hipertensão pulmonar fixa e, dentre eles, 30 pacientes foram tratados com sildenafila e acabaram passando pelo transplante, formando o Grupo A. O Grupo B incluiu 205 pacientes sem hipertensão pulmonar que passaram pelo transplante cardíaco. A hemodinâmica pulmonar foi avaliada antes do transplante, 1 semana e 1 ano após o transplante. A taxa de sobrevivência foi comparada entre os grupos. Neste estudo, um P valor < 0,05 foi considerado estatisticamente significativo. Resultados Após o tratamento com sildenafila, mas antes do TxC, a RVP (-39%) e a PAPs (-10%) diminuíram significativamente. A PAPs diminuiu após o TxC em ambos os grupos, mas permaneceu significativamente alta no grupo A em relação ao grupo B (40,3 ± 8,0 mmHg versus 36,5 ± 11,5 mmHg, P=0,022). Um ano após o TxC, a PAPs era 32,4 ± 6,3 mmHg no Grupo A versus 30,5 ± 8,2 mmHg no Grupo B (P=0,274). O índice de sobrevivência após o TxC 30 dias (97% no grupo A versus 96% no grupo B), 6 meses (87% versus 93%) e um ano (80% versus 91%) após o TxC não foi estatisticamente significativo (Log-rank P=0,063). Depois do primeiro ano, o índice de mortalidade era similar entre os dois grupos (sobrevivência condicional após 1 ano, Log-rank p=0,321). Conclusão Nos pacientes com HP pré-tratados com sildenafila, a hemodinâmica pós-operatória inicial e o prognóstico são numericamente piores em pacientes sem HP, mas depois de 1 ano, a mortalidade em médio e longo prazo são semelhantes. (Arq Bras Cardiol. 2021; 116(2):219-226)


Abstract Background Elevated pulmonary vascular resistance remains a major problem for heart transplant (HT) candidate selection. Objective This study sought at assess the effect of pre-HT sildenafil administration in patients with fixed pulmonary hypertension. Methods This retrospective, single-center study included 300 consecutive, HT candidates treated between 2003 and 2013, in which 95 patients had fixed PH, and of these, 30 patients were treated with sildenafil and eventually received a transplant, forming Group A. Group B included 205 patients without PH who underwent HT. Pulmonary hemodynamics were evaluated before HT, as well as 1 week after and 1 year after HT. Survival was compared between the groups. In this study, a p value < 0.05 was considered statistically significant. Results After treatment with sildenafil but before HT, PVR (-39%) and sPAP (-10%) decreased significantly. sPAP decreased after HT in both groups, but it remained significantly higher in group A vs. group B (40.3 ± 8.0 mmHg vs 36.5 ± 11.5 mmHg, p=0.022). One year after HT, sPAP was 32.4 ± 6.3 mmHg in group A vs 30.5 ± 8.2 mmHg in group B (p=0.274). The survival rate after HT at 30 days (97% in group A versus 96% in group B), at 6 months (87% versus 93%) and at one year (80% vs 91%) were not statistically significant (Log-rank p=0.063). After this first year, the attrition rate was similar among both groups (conditional survival after 1 year, Log-rank p=0.321). Conclusion In patients with severe PH pre-treated with sildenafil, early post-operative hemodynamics and prognosis are numerically worse than in patients without PH, but after 1 year, the medium to long-term mortality proved to be similar. (Arq Bras Cardiol. 2021; 116(2):219-226)


Subject(s)
Humans , Heart Transplantation , Hypertension, Pulmonary/drug therapy , Retrospective Studies , Treatment Outcome , Sildenafil Citrate , Hemodynamics
13.
Article in Chinese | WPRIM | ID: wpr-911969

ABSTRACT

Pulmonary hypertension associated with congenital heart disease in pregnancy is a complex condition with challenges for both diagnosis and treatment. Echocardiography is the most common method to detect pulmonary arterial pressure and has a high diagnostic value in pulmonary hypertension. Right cardiac catheterization is not a routine examination in pregnancy. Sildenafil may effectively improve the left ventricular ejection fraction and blood oxygen saturation of patients. Prostaglandins have good therapeutic efficacy in patients with pulmonary hypertension and cardiac function grade Ⅲ-Ⅳ. Surgical intervention can be considered when drug therapy fails. The risk factors for death in patients with this disease are inadequate prenatal examination, combined with moderate to severe pulmonary hypertension, Eisenmenger syndrome, cardiac function grade Ⅲ-Ⅳ, and severe hypoxemia. Women with pulmonary hypertension associated with congenital heart disease are carring higher risk in pregnancy, and requiring individualized treatment and multidisciplinary management.

14.
Chinese Journal of Geriatrics ; (12): 853-858, 2021.
Article in Chinese | WPRIM | ID: wpr-910928

ABSTRACT

Objective:To investigate the correlations of stable chronic obstructive pulmonary disease(COPD)with inositol 1, 4, 5-trisphosphate 3-kinase C(ITPKC)and phospholipase C-like 1 protein(PLCL1)single nucleotide polymorphisms(SNPs)in the Han elderly population in Ningxia.Methods:A case-control study was conducted.A total of 250 elderly patients with stable COPD were enrolled and divided into the COPD-related pulmonary hypertension(PH)group(n=103)and the COPD non-PH group(n=147). During the same period, 127 healthy elderly Han subjects were included as the control group.The ITPKC gene SNPs and the PLCL1 gene SNP were detected, and differences in alleles and genotype frequencies were compared between the groups.Results:The allele and genotype frequency distributions of rs2288450 and rs9789480 showed statistical differences between the COPD group and the control group(χ 2=6.09, 5.18, 30.14 and 32.89, P=0.048, 0.020, <0.001, <0.001). There was no difference in the allele and genotype frequency distributions of the ITPKC gene SNPs rs2290692 and rs17713068 between the control group and the COPD group(all P>0.05). The allele and genotype frequency distributions of rs9789480 showed differences between the COPD non-PH group and the COPD-PH group(χ 2=94.50 and 72.76, both P<0.001). There was no significant difference in the allele and genotype frequency distributions of rs2290692, rs17713068, rs2288450 between the COPD-PH group and the COPD non-PH group(all P>0.05). Conclusions:The ITPKC gene SNP rs2288450 CA and AA genotypes and A allele can reduce the incidence of COPD and may be a protective factor for COPD in the elderly.The PLCL1 gene SNP rs9789480 CA and AA genotypes and A allele can reduce the incidence of COPD and COPD-PH and may be a protective factor for COPD and COPD-PH in the elderly.

15.
Article in Chinese | WPRIM | ID: wpr-910807

ABSTRACT

Objective:To investigate the value of 18F-fluorodeoxyglucose (FDG) PET imaging in evaluating the 18F-FDG influx rate of lungs and its relationship with parameters of pulmonary hemodynamics in patients with pulmonary arterial hypertension related to congenital heart disease (PAH-CHD). Methods:From January 2018 to June 2019, a total of 16 PAH-CHD patients (6 males, 10 females, age (29.2±10.6) years) and 22 health controls who received physical examinations (8 males, 14 females, age (45.4±3.8) years) in Fuwai Hospital were respectively enrolled. All cases underwent dynamic 18F-FDG PET imaging for whole lung 18F-FDG influx rate (presented as Ki). Right heart catheterization was performed to evaluate pulmonary hemodynamic parameters such as pulmonary vascular resistance (PVR), mean pulmonary vascular pressure (mPAP) in PAH-CHD patients after imaging within one week. Independent-sample t test was used to compare Ki of 2 groups, and Pearson correlation analysis was used to analyze the relationship between Ki and PVR, mPAP in PAH-CHD patients. Results:Ki of the lungs was significantly higher in PAH-CHD patients than that in controls ((0.000 6±0.000 3) vs (0.000 4±0.000 3) ml·g -1·min -1; t=2.15, P=0.038). Ki was not correlated with PVR ((10.86±4.45) Wood units) or mPAP ((69.75±18.93) mmHg; 1 mmHg=0.133 kPa) in PAH-CHD patients ( r values: 0.202 and 0.006, both P>0.05). Conclusions:Pulmonary vascular remodeling can lead the increasing lung 18F-FDG uptake in patients with PAH-CHD. 18F-FDG PET may have the ability in monitoring and evaluating pulmonary vascular remodeling in PAH-CHD.

16.
Chinese Journal of Anesthesiology ; (12): 1387-1391, 2021.
Article in Chinese | WPRIM | ID: wpr-933262

ABSTRACT

Objective:To evaluate the effects of sevoflurane on right ventricular myocardial fibrosis caused by pulmonary arterial hypertension (PAH) in rats.Methods:Eighteen SPF healthy adult male Wistar rats, weighing 260-300 g, were divided into 3 groups ( n=6 each) by a random number table method: control group (group C), group PAH and PAH plus sevoflurane group (group PS). The PAH model was established by single intraperitoneal injection of monocrotaline 60 mg/kg in group PAH and group PS, while the equal volume of normal saline was intraperitoneally injected in group C. Sevoflurane 1.5 MAC was inhaled for 1 h starting from the end of injection, twice a week for 6 weeks in total, in group PS.Echocardiography was performed at the end of 6th week to measure right ventricular end-diastolic diameter (RVEDD), right ventricular anterior wall end-diastolic thickness (RVWTd), interventricular septal end-diastolic thickness (IVSTd), pulmonary artery inner diameter (PAID) and pulmonary valve orifice maximum peak velocity (PV). At the end of 6th week, the hearts were taken to measure the weight of right ventricle, interventricular septum and left ventricle, and Fulton′s index was calculated, and the tissue of the lower lobe of the right lung was taken, the outer diameter and inner diameter of the vascular wall were measured to calculate the vascular wall thickness index (WT), and total vascular area and lumen area were measured to calculate the vascular wall area index (WA) after HE staining.The myocardial tissue of the right ventricle was obtained to observe the degree of myocardial fibrosis (with a light microscope after Masson staining) and to detect the expression of TGF-β1 (after immunofluorescence staining) and expression of TGF-β1, phosphorylated Smad3 (p-SMad3) and Smad7 (by Western blot). Results:Compared with group C, Fulton′s index, RVEDD, RVWTd, IVSTd, PAID, WT and WA were significantly increased, PV was decreased, the expression of TGF-β1 and pSmad3 in right ventricular myocardial tissues was up-regulated, the expression of Smad7 was down-regulated( P<0.01), and myocardial fibrosis occurred in group PAH.Compared with group PAH, Fulton′s index, RVEDD, RVWTd, IVSTd, PAID, WT and WA were significantly decreased, PV was increased, the expression of TGF-β1 and pSmad3 in right ventricular myocardial tissues was down-regulated, the expression of Smad7 was up-regulated ( P<0.05 or 0.01), and myocardial fibrosis was significantly improved in group PS. Conclusion:Sevoflurane can improve the myocardial fibrosis in right ventricle induced by PAH in rats, and the mechanism may be related to inhibiting activation of TGF-β1/Smad3 signaling pathway.

17.
Autops. Case Rep ; 11: e2021265, 2021. tab, graf
Article in English | LILACS | ID: biblio-1285388

ABSTRACT

Aortopulmonary window (APW) is a rare congenital heart defect with abnormal communication between the ascending aorta and the pulmonary trunk with two separate semilunar valves. We present an autopsy case report wherein a young primigravida woman presented with progressive breathlessness and central cyanosis at 21 weeks of gestation. Echocardiography performed in the emergency room revealed elevated right-sided cardiac pressures suggestive of severe pulmonary hypertension; however, no structural cardiac defect was discernible. The patient succumbed to congestive cardiac failure and progressive hypoxia within 5 days of hospitalization. The autopsy revealed a Type I aortopulmonary window (2 cm) with patent ductus arteriosus. The lungs showed changes of severe pulmonary hypertension with superadded bronchopneumonia. This report underscores a rare presentation of APW, undiagnosed until pregnancy, leading to the Eisenmenger syndrome and death.


Subject(s)
Humans , Female , Pregnancy , Adult , Aortopulmonary Septal Defect , Heart Defects, Congenital , Hypertension, Pulmonary , Autopsy , Fatal Outcome , Heart Failure
18.
Einstein (Säo Paulo) ; 19: eAO5710, 2021. tab, graf
Article in English | LILACS | ID: biblio-1356201

ABSTRACT

ABSTRACT Objective To examine the accuracy of a pulmonary hypertension screening strategy based on a combination of echocardiographic data and tomographic measurements (pulmonary artery diameter and pulmonary artery diameter to ascending aorta diameter ratio) in patients with chronic lung disease referred for lung transplantation. Methods A retrospective observational study with patients with pulmonary emphysema or fibrosis referred for transplantation between 2012 and 2016. Pulmonary hypertension was defined as mean pulmonary artery pressure ≥25mmHg, or between 21 and 24mmHg, with pulmonary vascular resistance >3 Wood units on right heart catheterization. Tomographic measurements were made by two independent radiologists. Results This sample comprised 13 patients with emphysema and 19 patients with pulmonary fibrosis. Of these, 18 had pulmonary hypertension. The level of agreement in tomographic measurements made by radiologists was high (intraclass correlation coefficients 0.936 and 0.940, for pulmonary artery diameter and pulmonary artery diameter to ascending aorta diameter ratio, respectively). Areas under the ROC curves constructed for pulmonary artery diameter, pulmonary artery diameter to ascending aorta diameter ratio, and pulmonary artery systolic pressure as predictors of pulmonary hypertension were 0.540, 0.629 and 0.783, respectively. The sensitivity, specificity and negative predictive value of pulmonary artery systolic pressure ≥40mmHg were 67%, 79% and 65%, respectively. The combined criterion (pulmonary artery diameter to ascending aorta diameter ratio >1 and/or pulmonary artery systolic pressure ≥40mmHg) achieved sensitivity of 72%, specificity of 79%, and a negative predictive value of 69%. Conclusion Measurements of pulmonary artery and ascending aorta diameter were highly reproducible. The association of pulmonary artery and aortic diameter >1 and/or pulmonary artery systolic pressure ≥40mmHg improved the sensitivity and the negative predictive value for pulmonary hypertension screening. This strategy demands prospective validation to assess safety and cost-effectiveness.


RESUMO Objetivo Avaliar a acurácia de uma estratégia de rastreamento de hipertensão pulmonar baseada na combinação de dados de ecocardiograma com as medidas derivadas da tomografia computadorizada (diâmetro da artéria pulmonar e razão entre diâmetro da artéria pulmonar e diâmetro da aorta ascendente) em pacientes pneumopatas crônicos encaminhados para transplante pulmonar. Métodos Estudo observacional retrospectivo realizado com pacientes com enfisema e fibrose pulmonar avaliados para transplante entre 2012 e 2016. Definiu-se hipertensão pulmonar como pressão arterial pulmonar média ≥25mmHg, ou entre 21 a 24mmHg, com resistência vascular pulmonar >3 unidades Wood no cateterismo direito. As medidas tomográficas foram realizadas por dois radiologistas independentes. Resultados Foram incluídos 13 pacientes com enfisema e 19 com fibrose pulmonar, sendo 18 com hipertensão pulmonar. Houve alta concordância entre os radiologistas em relação às medidas tomográficas (coeficientes de correlação intraclasse para diâmetro da artéria pulmonar de 0,936 e diâmetro da artéria pulmonar/diâmetro da aorta ascendente de 0,940). As áreas abaixo da curva ROC de diâmetro da artéria pulmonar, diâmetro da artéria pulmonar/diâmetro da aorta ascendente, e pressão sistólica da artéria pulmonar como preditores de hipertensão pulmonar foram 0,540, 0,629 e 0,783, respectivamente. A sensibilidade, especificidade e valor preditivo negativo da pressão de sistólica de artéria pulmonar ≥40mmHg foram 67%, 79% e 65%, respectivamente. O critério combinado de diâmetro da artéria pulmonar/diâmetro da aorta ascendente >1 e/ou pressão sistólica da artéria pulmonar ≥40mmHg mostrou sensibilidade de 72%, especificidade de 79%, e valor preditivo negativo de 69%. Conclusão Os diâmetros da artéria pulmonar e da aorta ascendente foram altamente reprodutíveis. A associação entre diâmetro da artéria pulmonar e diâmetro da aorta ascendente >1 e/ou pressão sistólica da artéria pulmonar ≥40mmHg melhorou a sensibilidade e o valor preditivo negativo para rastreamento de hipertensão pulmonar. Essa estratégia requer validação prospectiva para se avaliarem segurança e custo-efetividade.


Subject(s)
Humans , Lung Transplantation , Hypertension, Pulmonary/diagnostic imaging , Pulmonary Artery/diagnostic imaging , Echocardiography , Tomography, X-Ray Computed , Retrospective Studies
19.
Article in Chinese | WPRIM | ID: wpr-908474

ABSTRACT

Portopulmonary hypertension is a rare and serious complication of portal hypertension, which is very easy to miss diagnosis in clinic, and relatively difficult to treat. The authors elaborate in depth of the epidemiology, pathogenesis, diagnosis, treatment and prognosis of portopulmonary hypertension.

20.
Int. j. cardiovasc. sci. (Impr.) ; 33(3): 299-302, May-June 2020. tab, graf
Article in English | LILACS | ID: biblio-1134362

ABSTRACT

Abstract The heart and lung are target organs in systemic sclerosis (SSc) and similar symptoms (dyspnea and cough) may make the differential diagnosis between the two lesions difficult. In addition, complete atrioventricular block (CAVB) is a rare complication of this disease. This case report is about a patient with SSc and pulmonary fibrosis who was admitted to the emergency room with CAVB, heart failure (HF) and progressive worsening of the underlying disease.


Subject(s)
Humans , Male , Middle Aged , Pulmonary Fibrosis/complications , Scleroderma, Diffuse/complications , Atrioventricular Block/complications , Pulmonary Fibrosis/diagnosis , Cough , Scleroderma, Diffuse/diagnosis , Scleroderma, Diffuse/drug therapy , Early Diagnosis , Diagnosis, Differential , Dyspnea , Atrioventricular Block/diagnosis , Hypertension, Pulmonary
SELECTION OF CITATIONS
SEARCH DETAIL