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pulmonary hypertension guideline

D Valenzuela, F Moya, M Luco, J L Tapia
50 years ago, Northway described Broncopulmonary Dysplasia (BPD) in preterm infants exposed to mechanical ventilation. Since then, their survival has increased, nevertheless a "new BPD" has appeared and its incidence has not diminished. One of the characteristics of this pathology is the the abnormal vascular remodeling, which in its most severe expression is known as Pulmonary Hyper tension (PH); with an incidence of 17% in patients with BPD, which is proportional to the severity of the disease (33% in severe BPD), and as mortality factor (up to 48% 2-year mortality in PH-BPD)...
December 2017: Revista Chilena de Pediatría
Duo Huang, Yang-Yang Cheng, Pak-Hei Chan, Jojo Hai, Kai-Hang Yiu, Hung-Fat Tse, Ka-Lam Wong, Katherine Fan, Ying Wah Li, Woon-Leung Ng, Cheuk-Wan Yim, Cheuk-Hon John Wong, Lai-Shan Tam, Priscilla C H Wong, Chi-Yuen Wong, Chup-Hei Ho, Alexander M H Leung, Chi-Chiu Mok, Ho Lam, Chak-Sing Lau, Tommy Cheung, Carmen Ho, Sharon W Y Law, Esther W Chan, Li-Xue Yin, Wen-Sheng Yue, Toi Meng Mok, Mario Alberto Evora, Chung-Wah Siu
Current guideline-recommended screening for pulmonary hypertension in patients with systemic sclerosis has not been evaluated in systemic lupus erythematosus (SLE), which is disproportionately prevalent in Asians. This multicentre, cross-sectional screening study aims to study the prevalence of pulmonary hypertension among SLE patients using these guidelines, and identify independent predictors and develop a prediction model for pulmonary hypertension in SLE patients. SLE patients from participating centres will undergo an echocardiography- and biomarker-based pulmonary hypertension screening procedure as in the DETECT study...
January 2018: ERJ Open Research
Norman R Morris, Menaka Louis, Wendy Strugnell, Julie Harris, Aaron Lin, John Feenstra, Helen Seale
BACKGROUND: Exercise training is an integral component of evidence-based management programs for many chronic cardiac and respiratory conditions. Despite this, there are limited high-quality studies available on the significance of exercise training in pulmonary hypertension (PH). The aim of this study is to evaluate the short and long-term effectiveness of exercise training in PH patients in terms of exercise capacity, quality of life, cardiac function and disease progression. METHODS: This randomized control trial will aim to recruit 50 medically stable PH patients categorised as New York Heart Association functional classification II-III...
March 1, 2018: BMC Pulmonary Medicine
Mark R de Jong, Annemiek F Hoogerwaard, Ahmet Adiyaman, Jaap Jan J Smit, Anand R Ramdat Misier, Jan-Evert Heeg, Boudewijn A A M van Hasselt, Isabelle C Van Gelder, Harry J G M Crijns, Ignacio Fernández Lozano, Jorge E Toquero Ramos, F Javier Alzueta, Borja Ibañez, José M Rubio, Fernando Arribas, José M Porres Aracama, Josep Brugada, Lluís Mont, Arif Elvan
BACKGROUND: Hypertension is an important, modifiable risk factor for the development of atrial fibrillation (AF). Even after pulmonary vein isolation (PVI), 20-40% experience recurrent AF. Animal studies have shown that renal denervation (RDN) reduces AF inducibility. One clinical study with important limitations suggested that RDN additional to PVI could reduce recurrent AF. OBJECTIVE: The goal of this multicenter randomized controlled study is to investigate whether RDN added to PVI reduces AF recurrence...
February 27, 2018: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Deborah Kim, Kyung Min Lee, Marc R Freiman, W Ryan Powell, Elizabeth S Klings, Seppo Rinne, Donald Miller, Adam J Rose, Renda Soylemez Wiener
RATIONALE: Care of patients with pulmonary hypertension (PH) is complex. While pulmonary vasodilators are effective for Group 1 PH, clinical guidelines and the Choosing Wisely Campaign recommend against routine use for Groups 2 and 3 PH (the most common types of PH) due to a lack of benefit, potential for harm, and high cost ($10,000-$13,000 per patient per year treated). Little is known about how these medications are used in practice. OBJECTIVE(S): To determine national patterns of phosphodiesterase-5-inhibitor (PDE5i) prescribing for PH in the Veterans Health Administration (VA)...
February 27, 2018: Annals of the American Thoracic Society
Sean Collins, Jennifer Martindale
PURPOSE OF REVIEW: In spite of advances in our understanding of acute heart failure (AHF) and its different phenotypic expressions, AHF management is still centered on volume removal with intravenous diuretics. This narrative review describes the pathophysiology underlying hypertensive AHF and appraises therapies targeting these mechanisms. RECENT FINDINGS: Vascular redistribution rather than volume overload may be the primary determinant of elevated cardiac filling pressures and subsequent pulmonary congestion in patients with hypertensive AHF; in these patients, vasodilators should be the predominant treatment...
February 24, 2018: Current Hypertension Reports
Joan Albert Barberà, Antonio Román, Miguel Ángel Gómez-Sánchez, Isabel Blanco, Remedios Otero, Raquel López-Reyes, Isabel Otero, Gregorio Pérez-Peñate, Ernest Sala, Pilar Escribano
Pulmonary hypertension is a hemodynamic disorder defined by abnormally high pulmonary artery pressure that can occur in numerous diseases and clinical situations. The causes of pulmonary hypertension are classified into 5 major groups: arterial, due to left heart disease, due to lung disease and/or hypoxemia, chronic thromboembolic, with unclear and/or multifactorial mechanisms. This is a brief summary of the Guidelines on the Diagnostic and Treatment of Pulmonary Hypertension of the Spanish Society of Pulmonology and Thoracic Surgery...
February 19, 2018: Archivos de Bronconeumología
A Dudina, S Lane, M Butler, M-T Cooney, I Graham
Background: Cardiovascular disease (CVD) is the leading cause of death in patients with chronic obstructive pulmonary disease (COPD) and such patients tend to carry a heavy burden of risk factors for CVD. There is little information on the documentation and management of CVD risk factors in COPD patients. Aim: To audit the recording and management of CVD risk factors in 200 COPD patients attending the respiratory out-patient clinics at two University teaching hospitals...
February 8, 2018: QJM: Monthly Journal of the Association of Physicians
Maciej Polak, Agnieszka Doryńska, Krystyna Szafraniec, Andrzej Pająk
BACKGROUND: Decreased lung function is related to higher cardiovascular disease (CVD) incidence and mortality. However, little is known about the relationship between the risk factors of CVD and pulmonary function. AIM: To assess the relationship between the prevalence of cardiovascular risk factors, the total CVD risk and pulmonary function. METHODS: The analysis included 4,104 men and women in the age range of 45-69 years, participants of the Polish part of the HAPIEE Project (Health,Alcohol andPsychosocial factorsInEasternEurope), who provided valid measurements of 1s forced expiratory volume (FEV₁) and forced vital capacity (FVC) using Micro-Medical Microplus spirometer...
February 5, 2018: Kardiologia Polska
Matthew K Hensley, Andrea Levine, Mark T Gladwin, Yen-Chun Lai
Pulmonary hypertension (PH) is a progressive and often fatal illness presenting with nonspecific symptoms of dyspnea, lower extremity edema, and exercise intolerance. Pathologically, endothelial dysfunction leads to abnormal intimal and smooth muscle proliferation along with reduced apoptosis, resulting in increased pulmonary vascular resistance (PVR) and elevated pulmonary pressures. PH is subdivided into five WHO groups based on the disease pathology and specific cause. While there are FDA-approved medications for the treatment of pulmonary arterial hypertension (PAH, Group 1 PH), as well as for chronic thromboembolic pulmonary hypertension (CTEPH, Group 4 PH), the morbidity and mortality remain high...
February 1, 2018: American Journal of Physiology. Lung Cellular and Molecular Physiology
Thomas A Zelniker, Dörte Huscher, Anton Vonk-Noordegraaf, Ralf Ewert, Tobias J Lange, Hans Klose, Daniel Dumitrescu, Michael Halank, Matthis Held, Henning Gall, David Pittrow, Marius M Hoeper, Lutz Frankenstein
BACKGROUND: In patients with pulmonary arterial hypertension, the 6-Minute Walk Test (6MWT) is recommended for risk stratification and follow-up by all guidelines. However, the prognostic value of the 6MWT has been discussed controversially. We sought to compare and validate all published 6MWT cut-off points. METHODS: From the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA)-registry we identified 2391 patients with pulmonary arterial hypertension who had at least one documented 6MWT measurement...
January 24, 2018: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Philippe Gaudard, Claudio Barbanti, Bertrand Rozec, Philippe Mauriat, Mimoun M'rini, Gilles Cambonie, Jean Michel Liet, Claude Girard, Pierre Louis Leger, Ziad Assaf, Pierre Damas, Gauthier Loron, Laurent Lecourt, Julien Amour, Philippe Pouard
BACKGROUND: Nitric oxide (NO) has a well-known efficacy in pulmonary hypertension (PH), with wide use for 20 years in many countries. The objective of this study was to describe the current use of NO in real life and the gap with the guidelines. METHODS: This is a multicenter, prospective, observational study on inhaled NO administered through an integrated delivery and monitoring device and indicated for PH according to the market authorizations. The characteristics of NO therapy and ventilation modes were observed...
January 16, 2018: Anesthesia and Analgesia
Fakir Md Yunus, Safayet Khan, Dipak K Mitra, Sabuj Kanti Mistry, Kaosar Afsana, Mahfuzar Rahman
OBJECTIVES: To investigate the association of total sleep time and presence or absence of snoring with chronic disease among the Bangladeshi adult population. DESIGN: Cross-sectional survey. SETTING: Urban and rural Bangladesh. PARTICIPANTS: A total of 12,338 men and women aged ≥35 years. MEASUREMENTS: Total sleep time was considered as the total hours of sleep in 24 hours. Furthermore, sleep time was categorized into <7, 7-9, and >9 hours according to National Sleep Foundation (2015) guidelines...
February 2018: Sleep Health
Valentin Coirier, Alain Lescoat, Céline Chabanne, Maxime Fournet, Guillaume Coiffier, Stéphane Jouneau, Elisabeth Polard, Patrick Jégo
Pulmonary arterial hypertension (PAH) is a rare disorder that can be drug-induced, mostly following treatment by appetite-suppressant drugs. We report four cases of patients who developed PAH following a treatment by leflunomide for rheumatoid arthritis, psoriatic arthritis or undetermined connective tissue disease. All patients described a progressive dyspnea from grade II to IV of NYHA classification; clinical examination found signs of heart failure. PAH was finally diagnosed and confirmed by right heart catheterisation...
January 9, 2018: Joint, Bone, Spine: Revue du Rhumatisme
Gregory J Keir, S John Wort, Maria Kokosi, Peter M George, Simon L F Walsh, Joseph Jacob, Laura Price, Simon Bax, Elisabetta A Renzoni, Toby M Maher, Peter MacDonald, David M Hansell, Athol U Wells
BACKGROUND AND OBJECTIVE: In interstitial lung disease (ILD), pulmonary hypertension (PH) is a major adverse prognostic determinant. Transthoracic echocardiography (TTE) is the most widely used tool when screening for PH, although discordance between TTE and right heart catheter (RHC) measured pulmonary haemodynamics is increasingly recognized. We evaluated the predictive utility of the updated European Society of Cardiology/European Respiratory Society (ESC/ERS) TTE screening recommendations against RHC testing in a large, well-characterized ILD cohort...
January 12, 2018: Respirology: Official Journal of the Asian Pacific Society of Respirology
Peter Noymer, Assaf Shaked, Kay Newell
BACKGROUND: SMT-101, a novel, proprietary, water-resistant wearable infusion pump prefilled with a preset dosage of treprostinil, was designed to address many of the administration-related shortcomings of existing parenteral therapy for pulmonary arterial hypertension (PAH). The objective of the human factors (HF) program was to demonstrate that the SMT-101 system is safe and effective when used by patients with PAH, their caregivers, or healthcare providers. METHODS: The HF program for SMT-101 consisted of 8 studies (148 participants): an ethnographic study, an online survey of patients with PAH, 4 formative studies, a study of the instructions for use (IFU), and a summative study for validation...
January 9, 2018: Expert Opinion on Drug Delivery
Charles Khouri, Marion Lepelley, Matthieu Roustit, François Montastruc, Marc Humbert, Jean-Luc Cracowski
BACKGROUND: Recent guidelines recommend riociguat, a soluble guanylate cyclase (sGC) stimulator, and the type 5 phosphodiesterase inhibitor (PDE5i) tadalafil or sildenafil as treatments for pulmonary arterial hypertension. We compared the safety profiles of sildenafil, tadalafil, and riociguat in pulmonary hypertension. METHODS: We combined two approaches. First, we performed a meta-analysis of safety data extracted from randomized controlled trials. Second, we conducted a disproportionality analysis of data from VigiBase, the World Health Organization's global database of individual case safety reports, to compare the safety profiles with real-life data...
December 21, 2017: Chest
Christopher S Johns, Jim M Wild, Smitha Rajaram, Andy J Swift, David G Kiely
Pulmonary hypertension (PH) is a challenging condition to diagnose and treat. Over the last two decades, there have been significant advances in therapeutic approaches and imaging technologies. Current guidelines emphasize the importance of cardiac catheterization; however, the increasing availability of non-invasive imaging has the potential to improve diagnostic rates, whilst providing additional information on patient phenotypes. Areas covered: This review discusses the role of imaging in the diagnosis, prognostic assessment and follow-up of patients with PH...
February 2018: Expert Review of Respiratory Medicine
Anna-Maria Hoffmann-Vold, Håvard Fretheim, Øyvind Midtvedt, Karin Kilian, Marianne Angelshaug, Asad Chaudhary, Ragnar Gunnarsson, Cathrine Brunborg, Torhild Garen, Arne K Andreassen, Einar Gude, Øyvind Molberg
Objective: The DETECT algorithm was developed for screening patients with SSc at high risk of pulmonary arterial hypertension (PAH). We evaluated the impact of this algorithm in a SSc population. Methods: Patients from the unselected, prospective Oslo University Hospital SSc study were divided into the Early and DETECT cohorts, respectively, depending on whether an incident right heart catheterization (RHC) was performed before (2009-13) or after (2014-17) the DETECT algorithm was instituted...
December 11, 2017: Rheumatology
Gabriel Altit, Henry C Lee, Susan Hintz, Theresa A Tacy, Jeffrey A Feinstein, Shazia Bhombal
OBJECTIVE: Pulmonary hypertension (PH) is associated with bronchopulmonary dysplasia (BPD). Screening strategies, a thorough investigation of co-morbidities, and multidisciplinary involvement prior to anti-PH medications have been advocated by recent guidelines. We sought to evaluate current practices of neonatologists caring for premature infants with PH. DESIGN: Electronic survey of American Academy of Pediatrics neonatology members. RESULTS: Among 306 neonatologist respondents, 38% had an institutional screening protocol for patients with BPD; 83% screened at 36 weeks for premature neonates on oxygen/mechanical ventilation...
December 12, 2017: Journal of Perinatology: Official Journal of the California Perinatal Association
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