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‘Preload dependence’ in pulmonary hypertension (PH) and chronic right heart failure (RHF) theorizes a risk of compromising renal function (RF) or blood pressure (BP) with diuresis. Yet, right heart decongestion is directly beneficial in this context. We examined the effect of aggressive diuresis

May-Thurner syndrome (MTS) is a rare condition in which patients develop left iliofemoral deep venous thrombosis (DVT) due to an anatomical variant in which the right common iliac artery overlies and compresses the left common iliac vein. Currently, there is no evidence in the medical literature to

Survival in patients with pulmonary arterial hypertension (PAH) is closely related to right ventricular (RV) function. Although pulmonary load is an important determinant of RV systolic function in PAH, there remains a significant variability in RV adaptation to pulmonary hypertension. In this report, the authors discuss the emerging concepts of right heart pathobiology in PAH. More specifically, the discussion focuses on the following questions. 1) How is right heart failure syndrome best defined? 2) What are the underlying molecular mechanisms of the failing right ventricle in PAH? 3) How are RV contractility and function and their prognostic implications best assessed? 4) What is the role of targeted RV therapy? Throughout the report, the authors highlight differences between right and left heart failure and outline key areas of future investigation.

After pulmonary thromboendarterectomy (PTE), perfusion improves in obstructed pulmonary segments. Our goal is to identify improvement in perfusion with the improvements in clinical, hemodynamic and right heart function. We performed pre- and post-PTE planar and SPECT/CT ventilation/perfusion (VQ)

The Protek Duo is a novel dual lumen cannula that is inserted percutaneously via internal jugular (IJ) venous access. The proximal inflow lumen is positioned in the right atrium and the distal outflow lumen is positioned in the main pulmonary artery. These lumens are connected with the para

Catheter-directed thrombolysis (CDT) is being increasingly used in the management of acute submassive pulmonary embolism (PE). We sought to evaluate the pre and post-procedural echocardiographic and invasive hemodynamic parameters of patients with submassive PE treated with CDT. We included all

Detection of exercise-induced pulmonary hypertension (PH) and behavior of resting PH with exercise can provide insight into the physiological basis of unexplained dyspnea. We sought to predict this exercise behavior with gas exchange parameters. We reviewed clinical, echocardiographic, hemodynamics

Aim of study is to assess utility of ratio of minute ventilation to CO2 production (VE/VCO2), and end-tidal CO2 pressure (ETCO2) to predict intrinsic pulmonary vascular disease. We reviewed clinical, hemodynamic and CPET data of 21 patients evaluated for PH. All patients were divided into two

Analysis of the right ventricular (RV) outflow tract Doppler flow profile (RVOTDoppler) has been shown to provide important insight into the relationship between RV function and pulmonary arterial load. We hypothesized that baseline and serial examination of the RVOTDoppler profile would serve as an

Background: Pulmonary hypertension (PH) due to heart failure with preserved ejection fraction (HFpEF) is a leading cause of PH. Within this population, the diastolic pressure gradient (DPG) distinguishes those with combined post- and pre-capillary PH (DPG ≥7 mm Hg; CpcPH), and isolated post

Electrocardiographic (ECG) changes track hemodynamic and clinical improvement in pulmonary hypertension. We evaluated those changes predictive of favorable outcomes in a cohort of chronic thromboembolic pulmonary hypertension patients undergoing pulmonary thromboendarterectomy (PTE) at our center

Objectives The aim of this work was to test whether acute phosphodiesterase 5 (PDE5) inhibition via sildenafil (SIL) mimics and/or potentiates cardiorenal effects of exogenous natriuretic peptide (NP) infusion. Background Heart failure (HF) is often accompanied by elevated NP secretion yet blunted responsiveness. Such NP resistance may, in part, relate to increased cyclic guanosine monophosphate (cGMP) catabolism by PDE5. Methods Dogs (n = 7) were studied before and after tachypacing-induced HF. Animals received 30-min infusion of B-type natriuretic peptide (BNP) (2 μg/kg bolus, 0.02 μg/kg/min), and on a separate day SIL (1 mg/kg, intravenous), followed by BNP (SIL + BNP). Phosphodiesterase 5 activity was measured in lung, vasculature, and kidney. Results At baseline (non-failing), BNP lowered central venous, pulmonary capillary wedge, diastolic, mean pulmonary artery, and mean arterial pressure. Sildenafil had no effects, and SIL + BNP was similar to BNP alone. In contrast, SIL lowered these pressures similarly to BNP in dogs with HF, and SIL + BNP was additive in further reducing pulmonary pressures over BNP alone. Plasma cGMP/plasma BNP ratio was markedly reduced with HF, indicating NP resistance. Sildenafil plus BNP increased this ratio in HF, but had no effect in non-failing animals. Sildenafil had no independent diuretic/natriuretic effects nor did it enhance BNP effects under baseline or HF conditions. In HF, PDE5 activity was significantly increased in the systemic and pulmonary vasculature and in the kidney. Conclusions The PDE5 activity in systemic and pulmonary vasculature increases in HF rendering hemodynamic responses to PDE5 inhibition identical to those from BNP infusion. Natriuretic peptide desensitization in HF relates, in part, to increased PDE5 activity, supporting a therapeutic role for PDE5 inhibition.

To the Editor: Pulmonary hypertension (PH) comprises heterogeneous conditions with diverse pathophysiology. Differentiating left-side heart disease from pulmonary vascular disease is critical. The Valsalva maneuver involves forcible exhalation against a closed glottis, causing increased

Differentiating PH with elevated pulmonary vascular resistance (PVR) from PH from elevated left sided filling pressure is critical. We previously developed an “Echocardiographic score” to predict hemodynamics using direct measures of chamber size, RVOT Doppler profile shape, and transmitral

ObjectivesWe examined whether B-type natriuretic peptides (BNP) can serve as noninvasive markers of pulmonary capillary wedge pressure (PCWP) in the setting of critical illness.BackgroundThe BNP and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are highly correlated with left ventricular (LV) filling pressures in patients with depressed LV systolic function. However, their relationship to PCWP in a heterogeneous intensive care unit (ICU) population has not been established.MethodsWe prospectively studied 40 patients in the ICU requiring invasive hemodynamic monitoring. Hemodynamics were recorded simultaneously with blood sampling for BNP and NT-proBNP.ResultsThe BNP (median 420 pg/ml) and NT-proBNP (median 3,304 pg/ml) levels were markedly elevated, but weakly correlated with PCWP (BNP, r = 0.40, NT-proBNP, r = 0.32) and other cardiac parameters. Peptide levels were approximately four-fold greater in patients with impaired (estimated glomerular filtration rate [eGFR] 60 ml/min) renal function, despite similar PCWP, cardiac index, and LV ejection fraction. In addition, both BNP and NT-proBNP showed stronger correlations with PCWP in patients with preserved (BNP, r = 0.58, NT-proBNP, r = 0.73) versus impaired renal function (BNP, r = 0.48, NT-proBNP, r = 0.34). Interaction terms between eGFR and BNP (p = 0.06) and NT-proBNP (p = 0.04) suggest that eGFR modulates the relationship of these peptides to filling pressures.ConclusionsThe BNPs are markedly elevated, yet show only weak correlations to PCWP in ICU patients requiring invasive hemodynamic monitoring. Thus, a single value for BNP or NT-proBNP may not be a clinically useful noninvasive marker of filling pressures in the critically ill patient. This appears to be especially true in patients with impaired renal function.

Pulmonary arterial hypertension (PAH) is associated with a high risk for adverse outcomes. Recent quality metrics have incorporated 30 day all cause readmission (30dRead) rates; little, however, is known about the frequency and predictors of 30dRead after PAH hospitalization. We examined 30dRead