High Right Ventricular Afterload during Exercise in Patients with Pulmonary Arterial Hypertension.

The right ventricle (RV) is more sensitive to an increase in afterload than the left ventricle (LV), and RV afterload during exercise increases more easily than LV afterload. Pulmonary arterial hypertension (PAH)-specific therapy has improved pulmonary hemodynamics at rest; however, the pulmonary hemodynamic response to exercise is still abnormal in most patients with PAH. In these patients, RV afterload during exercise could be higher, resulting in a greater increase in RV wall stress. Recently, an increasing number of studies have indicated the short-term efficacy of exercise training. However, considering the potential risk of promoting myocardial maladaptive remodeling, even low-intensity repetitive exercise training could lead to long-term clinical deterioration. Further studies investigating the long-term effects on the RV and pulmonary vasculature are warranted. Although the indications for exercise training for patients with PAH have been expanding, exercise training may be associated with various risks. Training programs along with risk stratification based on the pulmonary hemodynamic response to exercise may enhance the safety of patients with PAH.

Efficacy and safety of balloon pulmonary angioplasty in patients with inoperable chronic thromboembolic pulmonary hypertension.

BACKGROUND: Data on the efficacy and safety of balloon pulmonary angioplasty (BPA) in Taiwanese patients with chronic thromboembolic pulmonary hypertension (CTEPH) are lacking. In this study, we evaluated the effects of BPA on clinical parameters including hemodynamics, echocardiography and functional status in patients with inoperable CTEPH in Taiwan. METHODS: We retrospectively collected the clinical data of inoperable CTEPH patients who underwent ≥3 BPA sessions. Pulmonary hemodynamic parameters of right heart catheterization, echocardiography, 6-min walk distance and World Health Organization (WHO) functional class were collected and analyzed before and after BPA treatment. RESULTS: A total of 59 BPA sessions were performed in 13 inoperable CTEPH patients. No periprocedural deaths or major complications requiring tracheal intubation with mechanical ventilation occurred. WHO functional class significantly improved in all 13 patients (P < 0.001), and 6-min walk distance improved from 344 ± 147 to 450 ± 120 m (P = 0.014). Additionally, the plasma level of N-terminal pro-brain natriuretic peptide significantly decreased (P = 0.007). Hemodynamic data were available in 11 patients after ≥3 BPA sessions. Both mean pulmonary artery pressure and pulmonary vascular resistance significantly decreased from 44.6 ± 11.7 mmHg to 32.6 ± 5.1 mmHg (P = 0.005) and 745 ± 389 dyn·s·cm-5 to 366 ± 120 dyn·s·cm-5 (P = 0.002), respectively. Cardiac output also increased from 3.69 ± 1.12 L/min to 4.33 ± 0.94 L/min (P = 0.021). CONCLUSION: BPA improved both clinical symptoms and hemodynamic data in inoperable CTEPH Taiwanese patients without major periprocedural complications.

Analysis on pulmonary hemodynamic parameters in pneumoconiosis patients by echocardiography / 中国职业医学

OBJECTIVE: To explore the changes of pulmonary hemodynamic parameters in pneumoconiosis patients examined by echocardiography and its clinical significance. METHODS: Using simple random sampling method,102 male patients with pneumoconiosis were chosen and divided into simple pneumoconiosis group( 70 cases) and pneumoconiosis combined with chronic pulmonary heart disease( CPHD) group( 32 cases). Forty healthy male volunteers were chosen as the control group. The right heart morphological indexes including the diameters of main pulmonary artery( MPA),right ventricular outflow tract( RVOT),right ventricle( RV),the tricuspid regurgitation velocity and the time velocity integral of the right ventricular outflow tract were measured with echocardiography. The right atrial pressure was estimated and the pulmonary artery systolic pressure( PASP),the pulmonary vascular resistance( PVR) and the ratio of pulmonary artery acceleration time / right ventricular ejection time( PAAT / RVET) were calculated. RESULTS: The diameters of MPA,RVOT and RV in pneumoconiosis combined CPHD group were longer than those of the control group and simple pneumoconiosis group( P <0. 05). The RVOT diameter of simple pneumoconiosis group was longer than that of the control group( P < 0. 05). The indexes of PASP and PVR in pneumoconiosis combined CPHD group were higher than those of the control group and simple pneumoconiosis group,respectively( P < 0. 05). The indexes of PASP and PVR in simple pneumoconiosis group were higher than those of the control group( P < 0. 05). The indexes of PAAT / RVET in pneumoconiosis combined CPHD group and simple pneumoconiosis group were lower than that of the control group,respectively( P < 0. 05). There was no statistical significance difference found in MPA and RV diameters between simple pneumoconiosis group and the control group( P > 0. 05). CONCLUSION: Our results indicate that monitoring the pulmonary hemodynamic parameters of pneumoconiosis patients by using echocardiography can provide basis for planning early intervention measures in clinic.