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Introduction: Chronic Kidney Disease (CKD) is a multifaceted medical condition characterised by the gradual loss of kidney function over time, often leading to a myriad of complications affecting various organ systems in the body. Among these complications, Pulmonary Hypertension (PH) has emerged as a significant yet under-recognised co-morbidity, particularly in patients with advanced CKD stages 4 and 5. PH is defined by elevated mean Pulmonary Arterial Pressure (PAP) and increased Pulmonary Vascular Resistance (PVR). Understanding the intricate relationship between CKD and PH is essential for effective management and improved patient outcomes. Aim: To study the prevalence and severity of PH in patients with CKD stages 4 and 5 and to explore the relationship between PH and co-morbidities such as Type 2 Diabetes Mellitus (DM2) and systemic Hypertension (HTN) in these patients. Materials and Methods: This cross-sectional analysis was performed in the Department of General Medicine at Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India on 100 cases from September 2022 to May 2024. The patients were divided into CKD stages 4 and 5 based on the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. PH was diagnosed based on 2D Echocardiography (ECHO) and categorised into mild, moderate and severe. Quantitative variables were compared using an unpaired t-test between CKD stages 4 and 5. Qualitative variables were compared using the Chi-square or Fisher's-exact test. Results: The mean age of the study participants was 56.25±12.45 years. A total of 66% of the study participants were diagnosed with stage 4 CKD. In this study, a statistically non significant association was seen between the stages of CKD and the grades of PH (p-value=0.74). No significant association was found between diabetes and PH (p-value=0.97) in CKD stages 4 and 5. The median Pulmonary Artery Systolic Pressure (PASP) was found to be higher in non diabetics and non hypertensives in CKD stages 4 and 5 and this was statistically significant (p<0.0001). Conclusion: The prevalence of PH among CKD patients was 78%. However, the severity of PH was not found to be significantly associated with the severity of CKD. Co-morbidities were present in a substantial number of cases, but no significant correlation was identified. [ABSTRACT FROM AUTHOR]

Introduction: Chronic Kidney Disease (CKD) is a multifaceted medical condition characterised by the gradual loss of kidney function over time, often leading to a myriad of complications affecting various organ systems in the body. Among these complications, Pulmonary Hypertension (PH) has emerged as a significant yet under-recognised co-morbidity, particularly in patients with advanced CKD stages 4 and 5. PH is defined by elevated mean Pulmonary Arterial Pressure (PAP) and increased Pulmonary Vascular Resistance (PVR). Understanding the intricate relationship between CKD and PH is essential for effective management and improved patient outcomes. Aim: To study the prevalence and severity of PH in patients with CKD stages 4 and 5 and to explore the relationship between PH and co-morbidities such as Type 2 Diabetes Mellitus (DM2) and systemic Hypertension (HTN) in these patients. Materials and Methods: This cross-sectional analysis was performed in the Department of General Medicine at Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India on 100 cases from September 2022 to May 2024. The patients were divided into CKD stages 4 and 5 based on the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. PH was diagnosed based on 2D Echocardiography (ECHO) and categorised into mild, moderate and severe. Quantitative variables were compared using an unpaired t-test between CKD stages 4 and 5. Qualitative variables were compared using the Chi-square or Fisher’s-exact test. Results: The mean age of the study participants was 56.25±12.45 years. A total of 66% of the study participants were diagnosed with stage 4 CKD. In this study, a statistically non significant association was seen between the stages of CKD and the grades of PH (p-value=0.74). No significant association was found between diabetes and PH (p-value=0.97) in CKD stages 4 and 5. The median Pulmonary Artery Systolic Pressure (PASP) was found to be higher in non diabetics and non hypertensives in CKD stages 4 and 5 and this was statistically significant (p

Background: No convenient, inexpensive, and non-invasive screening tools exist to identify pulmonary hypertension (PH) - left heart disease (LHD) patients during the early stages of the disease course. This study investigated whether different methods of lung ultrasound (LUS) could be used for the initial investigation of PH-LHD. Methods: This was a single-center prospective observational study which was performed in the Zigong Fourth People's Hospital. We consecutively enrolled patients with heart failure (HF) admitted to the emergency intensive care unit from January 2018 to May 2020. Transthoracic echocardiography and LUS were performed within 24 h before discharge. We used the Spearman coefficient for correlation analysis between ultrasound scores and pulmonary arterial systolic pressure (PASP). Bland-Altman plots were generated to inspect possible bias, and receiver operating characteristic (ROC) curves were calculated to assess the relationship between ultrasound scores and an intermediate and high echocardiographic probability of PH-LHD. Results: Seventy-one patients were enrolled in this study, with an overall median age of 79 (interquartile range: 71.5–84.0) years. Among the 71 patients, 36 (50.7%) cases were male, and 26 (36.6%) had an intermediate and high echocardiographic probability of PH. All four LUS scores in patients with an intermediate and high probability of PH were significantly higher than in patients with a low probability of PH (P

Background Rheumatic mitral stenosis is a significant cause of valvular heart disease. Pulmonary arterial systolic pressure (PASP) reflects the hemodynamic consequences of mitral stenosis and is used to determine treatment strategies. However, PASP progression and expected outcomes based on PASP changes in patients with moderately severe mitral stenosis remain unclear. Methods and Results A total of 436 patients with moderately severe rheumatic mitral stenosis (valve area 1.0–1.5 cm2) were enrolled. Composite outcomes included all‐cause mortality and hospitalization for heart failure. Data‐driven phenotyping identified 2 distinct trajectory groups based on PASP progression: rapid (8.7%) and slow (91.3%). Patients in the rapid progression group were older and had more diabetes and atrial fibrillation than those in the slow progression group (all P40 mm Hg was independently associated with allocation to the rapid progression group (odds ratio, 4.95 [95% CI, 2.08–11.99]; P40 mm Hg.

Background: Empyema is a major cause of mortality and hospitalization. Symptoms include difficulty breathing and chest pain. Calcium plays an essential role in the physiology of the cardiovascular system. However, there is little evidence on the role of echocardiography and the serum calcium levels of patients undergoing video-assisted thoracoscopic surgery (VATS) for empyema. This study aimed to investigate the risk factors for postoperative mortality in patients with empyema who required surgery. Methods: This single-institution retrospective study compared the outcomes of VATS for thoracic empyema (in terms of survival and mortality) in 122 patients enrolled between July 2015 and June 2019. Results: This study examined patients with thoracic empyema. The majority of the patients were males (100/122, 81.9%). The in-hospital/30-day mortality rate was 10.6% (13 patients). The calcium levels were 7.82 ± 1.17 mg/dL in the survival group and 6.88 ± 1.88 mg/dL in the mortality group (p = 0.032). In the mortality group, the utilization of echocardiography and serum calcium levels independently contributed to the risk prediction more than clinical variables. Patients in our cohort exhibited elevated pulmonary artery systolic pressure (PASP) and hypocalcemia, which were associated with increased postoperative mortality. Conclusion: Elevated PASP and calcium levels at the low end of the normal range demonstrated significant prognostic value in predicting mortality in patients with thoracic empyema who required surgical intervention. Recognizing this potential is critical in order to obtain better outcomes. [ABSTRACT FROM AUTHOR]

Objective To detect the serum levels of the inflammatory factors TNF-α and IL-6 in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and further study their clinical significance in CTEPH. Methods A retrospective analysis was performed on 59 cases of CTEPH patients admitted to our hospital from January 2015 to January 2020. According to the echocardiography, the patients were divided into the group with normal right heart function (observation group 1) and the group with injured right heart function (observation group 2). A total of 30 patients with no PH who met the standards were selected as the control group. Serum levels of inflammatory cytokines TNF-α, IL-6 and NT-proBNP were detected. Pulmonary artery systolic pressure (PASP) was measured by echocardiography. Results The serum concentrations of TNF-α, IL-6 and NT-proBNP in the control group, observation group 1 and observation group 2 increased successively. The concentrations of TNF-αwere (13.54±6.37) pg/mL, (25.20±11.87) pg/mL and (40.75±1.74) pg/mL, and the concentrations of IL-6 were (6.04±2.89) pg/mL, (8.56±4.25) pg/mL and (4.95±5.24) pg/mL, respectively. The concentrations of NTproBNP were (265.07±132.47) pg/mL, (719.52±345.23) pg/mL and (1 250.00±421.22) pg/mL respectively. There were significant differences in TNF-α, IL-6 and NT-proBNP between groups (P < 0.05). PASP was also increased successively, which were (32.07±6.15) mmHg, (57.04±11.26) mmHg, and (73.22±11.79) mmHg, respectively. Correlation analysis showed that the levels of TNF-α, lL-6 were significantly correlated with NTproBNP and PASP (P < 0.05). Conclusion In patients with CTEPH hypertension, there are high expressions of inflammatory cytokines TNF- and IL-6, and their expression levels can reflect right heart function and pulmonary artery pressure. [ABSTRACT FROM AUTHOR]

Background: No convenient, inexpensive, and non-invasive screening tools exist to identify pulmonary hypertension (PH) - left heart disease (LHD) patients during the early stages of the disease course. This study investigated whether different methods of lung ultrasound (LUS) could be used for the initial investigation of PH-LHD., Methods: This was a single-center prospective observational study which was performed in the Zigong Fourth People's Hospital. We consecutively enrolled patients with heart failure (HF) admitted to the emergency intensive care unit from January 2018 to May 2020. Transthoracic echocardiography and LUS were performed within 24 h before discharge. We used the Spearman coefficient for correlation analysis between ultrasound scores and pulmonary arterial systolic pressure (PASP). Bland-Altman plots were generated to inspect possible bias, and receiver operating characteristic (ROC) curves were calculated to assess the relationship between ultrasound scores and an intermediate and high echocardiographic probability of PH-LHD., Results: Seventy-one patients were enrolled in this study, with an overall median age of 79 (interquartile range: 71.5-84.0) years. Among the 71 patients, 36 (50.7%) cases were male, and 26 (36.6%) had an intermediate and high echocardiographic probability of PH. All four LUS scores in patients with an intermediate and high probability of PH were significantly higher than in patients with a low probability of PH ( P  <0.05). The correlation coefficient ( r ) between different LUS scoring methods and PASP was moderate for the 6-zone ( r =0.455, P  <0.001), 8-zone ( r =0.385, P =0.001), 12-zone ( r =0.587, P  <0.001), and 28-zone ( r =0.535, P  <0.001) methods. In Bland-Altman plots, each of the four LUS scoring methods had a good agreement with PASP ( P  <0.001). The 8-zone and 12-zone methods showed moderately accurate discriminative values in differentiating patients with an intermediate and high echocardiographic probability of PH ( P  <0.05)., Conclusions: LUS is a readily available, inexpensive, and risk-free method that moderately correlates with PASP. LUS is a potential screening tool used for the initial investigation of PH-LHD, especially in emergencies or critical care settings., (© 2023 The Author(s).)

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Echoderived pulmonary arterial systolic pressure (PASP) and right ventricular (RV) tricuspid annular plane systolic excursion (TAPSE; from the end of diastole to end-systole) are of basic relevance in the clinical follow-up of heart failure (HF) patients, carrying two- to threefold increase in cardiac risk when increased and reduced, respectively. We hypothesized that the relationship between TAPSE (longitudinal RV fiber shortening) and PASP (force generated by the RV) provides an index of in vivo RV length-force relationship, with their ratio better disclosing prognosis. Two hundred ninety-three HF patients with reduced (HFrEF, n = 247) or with preserved left ventricular (LV) ejection fraction (HFpEF, n = 46) underwent echo-Doppler studies and N-terminal pro-brain-type natriuretic peptide assessment and were tracked for adverse events. The median follow-up duration was 20.8 mo. TAPSE vs. PASP relationship showed a downward regression line shift in nonsurvivors who were more frequently presenting with higher PASP and lower TAPSE. HFrEF and HFpEF patients exhibited a similar distribution along the regression line. Given the TAPSE, PASP, and TAPSE-to-PASP ratio (TAPSE/PASP) collinearity, separate Cox regression and Kaplan-Meier analyses were performed: one with TAPSE and PASP as individual measures, and the other combining them in ratio form. Hazard ratios for variables retained in the multivariate regression were as follows: TAPSE/PASP

Background Rheumatic mitral stenosis is a significant cause of valvular heart disease. Pulmonary arterial systolic pressure (PASP) reflects the hemodynamic consequences of mitral stenosis and is used to determine treatment strategies. However, PASP progression and expected outcomes based on PASP changes in patients with moderately severe mitral stenosis remain unclear. Methods and Results A total of 436 patients with moderately severe rheumatic mitral stenosis (valve area 1.0-1.5 cm 2 ) were enrolled. Composite outcomes included all-cause mortality and hospitalization for heart failure. Data-driven phenotyping identified 2 distinct trajectory groups based on PASP progression: rapid (8.7%) and slow (91.3%). Patients in the rapid progression group were older and had more diabetes and atrial fibrillation than those in the slow progression group (all P <0.05). The initial mean diastolic pressure gradient and PASP were higher in the rapid progression group than in the slow progression group (6.2±2.4 mm Hg versus 5.1±2.0 mm Hg [ P =0.001] and 42.3±13.3 mm Hg versus 33.0±9.2 mm Hg [ P <0.001], respectively). The rapid progression group had a poorer event-free survival rate than the slow progression group (log-rank P <0.001). Rapid PASP progression was a significant risk factor for composite outcomes even after adjusting for comorbidities (hazard ratio, 3.08 [95% CI, 1.68-5.64]; P <0.001). Multivariate regression analysis revealed that PASP >40 mm Hg was independently associated with allocation to the rapid progression group (odds ratio, 4.95 [95% CI, 2.08-11.99]; P <0.001). Conclusions Rapid PASP progression was associated with a higher risk of the composite outcomes. The main independent predictor for rapid progression group allocation was initial PASP >40 mm Hg.

Abstract: Background: Prognostic implications of echocardiographic assessment of pulmonary hypertension (PH) in non-selected patients hospitalized for acute heart failure (AHF) are not clearly defined. The aim of this study was to evaluate the association between echocardiography-derived PH in AHF and 1-year all-cause mortality. Methods: We prospectively included 1210 consecutive patients admitted for AHF. Patients with significant heart valve disease were excluded. Pulmonary arterial systolic pressure (PASP) was estimated using transthoracic echocardiography during hospitalization (mean time after admission 96±24h). Patients were categorized as follows: non-measurable, normal PASP (PASP≤35mmHg), mild (PASP 36-45mmHg), moderate (PASP 46-60mmHg) and severe PH (PASP >60mmHg). The independent association between PASP and 1-year mortality was assessed with Cox regression analysis. Results: At 1-year follow-up, 232 (19.2%) deaths were registered. PASP was measured in 502 (41.6%) patients with a median of 46 [38–55] mmHg. The distribution of population was: 708 (58.5%), 76 (6.3%), 147 (12.1%), 190 (15.7%) and 89 (7.4%) for non-measurable, normal PASP, mild, moderate and severe PH, respectively. One-year mortality was lower for patients with normal PASP (1.32 per 10 person-years), intermediate for patients with non-measurable, mild and moderate PH (2.48, 2.46 and 2.62 per 10 persons-year, respectively) and higher for those with severe PH (4.89 per 10 person-years). After multivariate adjustment, only patients with PASP >60mmHg displayed significant adjusted increase in the risk of 1-year all-cause mortality, compared to patients with normal PASP (HR=2.56; CI 95%: 1.05–6.22, p=0.038). Conclusions: In AHF, severe pulmonary hypertension derived by echocardiography is an independent predictor of 1-year-mortality. [Copyright &y& Elsevier]

Background: Sarcoidosis-related pulmonary hypertension (SRPH) is an entity associated with significant morbidity and mortality irrespective of disease severity, while the pathogenic mechanisms remain poorly understood. Methods: This cross-sectional study included consecutive patients with biopsy-proven sarcoidosis ( n = 313) who were followed up in an outpatient setting from October 2002 through June 2010. All patients underwent clinical and cardiopulmonary evaluation, including cardiac MRI, to assess prevalence of SRPH and identify possible underlying pathophysiological mechanisms. Results: By Doppler echocardiographic criteria, 37 (11.8 %) patients were found to have pulmonary arterial systolic pressure (PASP) >40 mmHg. Twelve of the 37 patients agreed to undergo right heart catheterization and SRPH was confirmed in nine patients. Compared to patients without SRPH, those with SRPH were significantly older and had greater lung function impairment; disease duration did not differ between patients with and without SRPH. Multiple logistic regression analysis showed that diffusing capacity for carbon monoxide (DLCO) and age were independent determinants of SRPH. Pulmonary fibrosis and left ventricular diastolic dysfunction due to cardiac sarcoidosis or other comorbidities accounted for SRPH in the majority of patients. In the nonpulmonary fibrosis group, DLCO ≤ 50.65 (% predicted) was associated with SRPH (sensitivity = 77.8 %, specificity = 72.2 %; p = 0.031, AUC = 0.759). Conclusion: In a large cohort of sarcoidosis patients, this study found a prevalence of SRPH of about 12 %. Pulmonary fibrosis and left ventricular diastolic dysfunction due to cardiac sarcoidosis or other comorbidities are frequent pathogenic mechanisms. [ABSTRACT FROM AUTHOR]

Abstract: Study objectives: To determine the relationship between pulmonary arterial systolic pressure (PASP) and submaximum capacity of exercise, using the six-minute walk test (6MWT) in patients with cystic fibrosis (CF), and to investigate the relation between echocardiographic findings and results of 6MWT, clinical scores, chest radiograph scores and lung function tests. Design: This was a prospective cross-sectional study in patients with CF (16 years and older) with clinical stability, attending the Adult CF Program at the Hospital de Clínicas de Porto Alegre. The patients had Doppler echocardiography and performed a 6MWT. As well as pulmonary function tests and chest roentgenograms, and a clinical score was obtained for all patients. Results: The study included 39 patients with a mean age of 23.7±6.3 years. There were no significant correlation between the distance walked and PASP, diameter of the right ventricle (DRV) and pulmonary acceleration time (p >0.05). We observed a significant correlation among PASP and the SpO2 at rest (r =−0.73; p <0.001), SpO2 at the end of the 6MWT (r =−0.45; p =0.006), clinical score (r =−0.55; p =0.001), chest radiograph score (r =−0.33; p =0.049), FEV1 (r =−0.63; p < 0.001), and FVC (r =−0.55; p =0.001). Right ventricular outflow tract flow acceleration time (Ac T) was significantly correlated only with the FEV1 (r =0.32; p =0.047). RVD was significantly correlated with SpO2 at rest (r =−0.44; p =0.005) and clinical score (r =−0.38; p =0.017). The SpO2 at rest was the single best predictor of PASP and this effect was independent of the relationship between other independent variables (p =0.001). The declining pulmonary function was significantly associated with PASP (p <0.001), SpO2 at rest (p =0.001), SpO2 at the end of the 6MWT (p =0.007) and difference between peripheral oxygen saturation at resting and at the end of the 6MWT (p =0.025). Conclusion: The PASP was not significantly correlated with the distance walked during the 6MWT in patients with CF. The PASP was strongly correlated with oxygen status at rest. The SpO2 at rest was the best predictor of PASP. Also, PASP was strongly correlated with Shwachman–Kulczycki score, FEV1, and FVC in this population. [Copyright &y& Elsevier]

Background: Qing-Dai (QD) treatment of patients with ulcerative colitis (UC) sometimes causes pulmonary arterial hypertension (PAH). However, the relationship of QD treatment to pulmonary arterial systolic pressure (PASP) in patients with UC has not been clarified., Methods and results: The 27 patients with UC who were screened for PAH by transthoracic echocardiography (TTE) and underwent repeat TTE at 1 year were analyzed in this prospective observational study. Mean age was 44.0 years old, and median follow-up duration was 392. During the follow-up, 21 patients continued QD treatment (continuous group) and 6 patients discontinued the treatment (discontinuous group). In all patients, no significant difference in PASP levels between baseline and at follow-up was observed (21.4 vs. 21.3 mmHg, P=0.802). Furthermore, the mean PASP of patients in the continuous group did not differ from baseline to follow-up (21.4 mmHg to 22.6 mmHg, P=0.212); however, in the discontinuous group mean PASP was significantly decreased (21.5 mmHg to 16.8 mmHg, P=0.005). Moreover, changes in PASP from baseline to follow-up differed between the continuous and discontinuous groups (+1.1 mmHg vs. -4.7 mmHg, P=0.004). In addition, multivariable analyses revealed that only the duration of oral QD at baseline affected the increase of PASP., Conclusions: In patients with UC, QD treatment may have an undesirable association with an increase in PASP.

Despite the fact that tricuspid regurgitation (TR) can result in significant symptoms, patients are rarely referred for isolated surgical repair, or replacement, and most surgeries are performed in the context of other planned cardiac surgery. In this article, we review the different causes of TR, the natural history of untreated severe TR, indications and timing for isolated TR surgery, indications for TR surgery performed at the time of left-sided valve surgery, and surgical approaches for correction of TR., Competing Interests: Disclosure: The author has no conflicts of interest to declare.

Objectives: The characteristic morphologic lesions observed in the lungs of patients with congenital cardiac anomalies have not been closely modeled in rat shunt-related models, except for the reversible grade 1 changes. The present study reported an original rat model of unilateral pulmonary hypertension surgically induced by combined surgery to reproduce more advanced pulmonary vascular lesions., Methods: The right pulmonary artery was ligated through a right posterolateral thoracotomy, and a cervical shunt was established 1 week later. The immediate and chronic effects on the pulmonary hemodynamics were evaluated through right heart catheterization immediately after and at 8 and 12 weeks postoperatively. The morphologic changes in pulmonary vasculature were analyzed after staining with hematoxylin-eosin and modified Weigert's method. The right ventricular hypertrophy index was calculated and artery blood gas analysis performed., Results: A pulmonary hypertensive status was successfully induced immediately after cervical surgery and progressively aggravated into a borderline state with disease course advancing. Pulmonary vasculopathy demonstrated a transition from reversibility (muscularization, intimal proliferation of grade 1-2) at 8 weeks to irreversibility (intimal fibrosis, entirely luminal occlusion, grade 3) at 12 weeks postoperatively. Conspicuous right ventricular hypertrophy and decreasing partial arterial pressure of oxygen were also observed., Conclusions: The present shunt-related model successfully simulated a hypertensive status in pulmonary circulation and reproduced the characteristic transition of pulmonary vasculopathy from reversibility to irreversibility within a relatively short period. Thus, this model could offer an alternative with low mortality and high reproducibility for investigations on the underling mechanisms of shunt-related pulmonary hypertension., (Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.)

Objective: This study assessed the impact of pulmonary hypertension (PH) on morbidity and mortality after the most common cardiac operations and evaluated the accuracy of the Society of Thoracic Surgeons (STS) risk model for patients with PH., Methods: At a single center between 1994 and 2010, all adult cardiac operations performed with recorded preoperative mean pulmonary arterial pressure (MPAP) and STS predicted mortality were reviewed. MPAP was defined as normal (<25 mm Hg) or as mild (25-34 mm Hg), moderate (35-44 mm Hg), or severe (≥ 45 mm Hg) PH. Multivariate analysis was performed to elucidate the contribution of PH to morbidity and mortality., Results: In all, 3343 patient records were reviewed. Coronary artery bypass grafting (CABG) was the most common procedure (67.5%), followed by aortic valve replacement (24.9%) and mitral valve procedures (6.3%). Postoperative complications and mortality increased with increasing MPAP. Multivariable analysis found that both moderate (odds ratio, 7.17; P < .001) and severe (odds ratio, 13.73; P < .001) PH were significantly associated with increased mortality, even after accounting for STS risk. A subset analysis of isolated CABG cases revealed markedly increased mortality for all categories of PH (mild odds ratio, 1.99; moderate odds ratio, 11.5; severe odds ratio, 38.9; P < .001)., Conclusions: Morbidity and mortality were independently associated with PH. Observed mortality was significantly higher than predicted by the STS model for patients with moderate and severe PH, particularly in isolated CABG. Addition of PH to the STS risk model should be considered, or alternative tools should be used to assess risk in these patients., (Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.)