Discussion on heart transplantation indications in patients with end-stage heart failure complicated with reversible pulmonary artery hypertension / 器官移植

Heart transplantation can save the life and improve the quality of life of patients with end-stage heart failure. Nevertheless, it is not suitable for all patients with end-stage heart failure. As a common complication of end-stage heart failure, pulmonary artery hypertension may increase the incidence of right heart failure after heart transplantation, which is associated with the short- and long-term fatality risk in the recipients after heart transplantation. In clinical practice, different transplant centers have different criteria for heart transplantation indications in patients with end-stage heart failure complicated with pulmonary artery hypertension. Accurate preoperative evaluation of surgical indications plays a critical role in determining the success of heart transplantation. In this article, the definition, pathogenesis and effects on heart transplantation, diagnostic methods and reversibility judgment of pulmonary artery hypertension, diagnostic treatment of reversible pulmonary artery hypertension and indications of heart transplantation in patients with end-stage heart failure complicated with reversible pulmonary hypertension were reviewed.

Study of Prevalence of Pulmonary Artery Hypertension in Portal Hypertensives Patients in RIMS, Ranchi

Background: The development of pulmonary hypertension i.e.mean pulmonary artery pressure (mPAP) above 25 mmHg withnormal capillary wedge pressure and pulmonary vascularresistance(PVR) above 240 dyn/s/cm−5 in association withelevated pressure in portal circulation is known asportopulmonary hypertension (POPH). Comparing withidiopathic PAH, patients with POPH have a worst survivalprofile, with a 3-year survival of only 38% versus78% foridiopathic PAH. Recent evidence from France shows thatPOPH is the fourth most common form of PAH reported overallin the population-based French National Registry, afteridiopathic PAH and PAH associated with connective tissuediseases and con- genital heart disease. The aim of this studyis to evaluate frequency of POPH in portal hypertensivepatient.Materials and Methods: A cross sectional study of patientadmitted in RIMS, medicine department was performedfulfilling features of portal hypertension with ultrasoundshowing splenomegaly, ascites, portal vein diameter more than13 mm, portal vein velocity less than 15 cm/s and uppergastrointestinal endoscopy showing esophageal varices andpatient with connective tissue disease, congenital heartdisease, left ventricular systolic or diastolic dysfunction,valvular heart disease, lungs disease, sleep related breathingdisorder, chronic hemolytic and myeloproliferative disorderwere excluded. All patient underwent screening withechocardiography for measuring pulmonary artery systolicpressure (PASP) and PASP more than 35 mmHg wereconsidered for POPH which was confirmed with right heartcatheterisation by measuring mean pulmonary artery pressure(mPAP) of more than 25 mmHg.Observation: Among forty-two patient in this study, there werethirty-three male patients and nine female patients. POPH wasseen three female and two male patients with total of five out offorty- two with prevalence of 11.9% out of which 7.1% werefemale and 4.8% were male.Conclusion: Portopulmonary hypertension prevalence is 2–6%. In this study pulmonary hypertension is significantly high inportal hypertensive patient with percentage of 11.9% and moreprevalent in female.

The clinical analysis of drug induced acute angle-closure glaucoma / 天津医药

@# Objective Toinvestigatetheroleofpulmonaryvalvepressuregradientintheestimationofpulmonary arterysystolicpressures(PASP)inpatientswithatrialseptaldefect(ASD). Methods SixtyeightpatientswithASDand hospitalizedinTianjinMedicalUniversityGeneralHospitalwereincludedinthisstudy.Thetricuspidregurgitationpressure gradientmethodwasusedformeasuringPASPbeforeinterventionalocclusionoperation.Andpulmonaryvalvepressure gradientwasmeasuredthroughpulmonaryvalvevelocitytocalculatecorrectedvalues(PASP’),whichwerecomparedwith those(PASPr)obtainedbyrightcardiaccatheterization(RHC)respectively.ThepatientsweredividedintogroupA(defect size≤15 mm) and group B (defect size>15 mm) by the size of defect. The measurements obtained by ultrasound echocardiography(UCG)andRHCwerecomparedbetweenthetwogroups. Results Therewerestatisticallysignificant differencesbetweenPASP[(31.66±6.76)mmHg],PASP’ [(26.86±6.66)mmHg]andPASPr[(28.79±6.43)mmHg]ingroupA (P＜0.05).ThePASPwassignificantlyhigherthanPASPr[(45.29±13.49)mmHg vs. (34.56±9.47)mmHg](P＜0.05),but therewasnosignificantdifferencebetweenPASP’[(37.30±12.71)mmHg]andPASPringroupB(P＞0.05).Valuesof PASPrwerepositivelycorrelatedwithPASP(r=0.664,0.588respectively,P＜0.01)ingroupAandgroupB.Thecorrelation coefficients of PASPr and PASP’were improved in two groups after adjusted with pulmonary valve pressure gradient (respectively r =0.700,0.645, P＜0.01). Conclusion TheadjustedPASPcalculatedbytricuspidregurgitationpressure gradientmethodwithpulmonaryvalvepressuregradientcanimprovetheaccuracyofechocardiographicestimatesofPASPin ASDpatientswiththedefectsize>15mm.

Clinical efficacy of rosuvastatin on patients with chronic pulmonary heart disease / 中国综合临床

Objective To observe the influence and safety of rosuvastatin on high sensitive C-reactive protein (hs-CRP),Endothelin-1 (ET-1),N-terminal pro-brain natriuretic peptide (NT-proBNP),pulmonary artery systolic pressure(PASP) and cardiac function in patients with chronic pulmonary heart disease.Methods Eighty patients with chronic pulmonary heart disease were enrolled and divided into the statin group(n =40) and the control group (n =40).All patients were given conventional therapy,while the statin group received additionally rosuvastatin 10 mg/d for 6 months.The control group did not receive any lipid-lowering drugs.The plasma levels of hs-CRP,ET-1,NT-proBNP,liver and kidney functions and creatine kinase (CK),echocardiographic indicators of PASP and right ventricular ejection fraction (RVEF) were measured and compared before and after 6-month treatment.Results The levels of hs-CRP,ET-1,NT-proBNP and PASP were significantly lower after 6-month treatment than before treatment in the two groups (Statin group:hs-CRP:(7.45 ± 1.96) mg/L vs.(20.67 ± 5.12) mg/L,t =9.57,P ＜ 0.01 ; ET-1:(45.72 ± 6.85) ng/L vs.(56.39 ±7.34) ng/L,t =3.78,P ＜ 0.01 ; NT-proBNP:(136.54 ± 20.67) ng/L vs.(182.83 ± 23.27) ng/L,t =4.15,P ＜0.01 ;PASP:(42.6 ± 6.3)mm Hg vs.(52.3 ± 8.4) mm Hg,t =3.54,P ＜ 0.01 ; Control group:hs-CRP:(12.73 ±3.14) mg/L vs.(20.58 ±4.98)mg/L;t =4.96,P ＜0.01 ;ET-1:(51.66 ± 6.42)ng/L vs.(56.43 ±7.81) ng/L,t =3.43,P ＜ 0.01 ; NT-proBNP:(162.74 ± 21.59) ng/L vs.(181.56 ± 22.78) ng/L; t =3.60,P ＜0.01 ;PASP:(45.7 ±6.5) mm Hg vs.(51.8 ± 8.2) mm Hg,t =3.62,P ＜ 0.01),but the statin group reduced even more significantly (t =2.36,2.21,2.25 and 2.09 respectively,P ＜ 0.05).The level of RVEF was significantly higher after 6-month treatment than before treatment in the two groups (Statin group:(50.8 ±7.9) ％ vs.(41.5 ±6.7)％,t =3.69,P ＜0.01 ;Control group:(46.6 ±7.8)％ vs.(42.0 ±6.2)％,t =3.58,P ＜ 0.01),but the statin group increased even more significantly(t =2.18,P ＜ 0.05).Statistical differences of liver and kidney function and serum CK were not found in the two groups before and after treatment(P ＞ 0.05).The adverse reaction in the statin group was few.Conclusion Rosuvastatin can reduce the levels of hs-CRP,ET-1,NT-proBNP and PASP,improve RVEF and cardiac function in patients with chronic pulmonary heart disease,and its security is fine.