1
|
Zierath R, Claggett B, Arthur V, Yang Y, Skali H, Matsushita K, Kitzman D, Konety S, Mosley T, Shah AM. Changes in Pulmonary Artery Pressure Late in Life: The Atherosclerosis Risk in Communities (ARIC) Study. J Am Coll Cardiol 2023; 82:2179-2192. [PMID: 38030347 DOI: 10.1016/j.jacc.2023.09.821] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/25/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Although the prognostic implications of higher pulmonary artery systolic pressure (PASP) are well established, few data exist regarding longitudinal change in pulmonary pressure in late life. OBJECTIVES The aim of this study was to quantify changes in PASP over 6 years and determine the relative contributions of cardiac and pulmonary dysfunction. METHODS Among 1,420 participants in the ARIC (Atherosclerosis Risk in Communities) study with echocardiographic measures of PASP at both the fifth (2011-2013) and seventh (2018-2019) visits, longitudinal changes in PASP over about 6.5 years were quantified. Multivariable regression was used to determine the extent to which cardiac and pulmonary dysfunction were associated with changes in PASP and to define the relationship of changes in PASP with dyspnea development. RESULTS The mean age was 75 ± 5 years at visit 5 and 81 ± 5 years at visit 7, 24% of subjects were Black adults, and 68% were women. Over the 6.5 years, PASP increased by 5 ± 8 mm Hg, from 28 ± 5 to 33 ± 8 mm Hg. PASP increased more in older participants. Predictors of greater increases in PASP included worse left ventricular (LV) systolic and diastolic function, pulmonary function, and renal function. Increases in PASP were associated with concomitant increases in measures of LV filling pressure, including E/e' ratio and left atrial volume index. Each 5 mm Hg increase was associated with 16% higher odds of developing dyspnea (OR: 1.16; 95% CI: 1.07-1.27; P < 0.001). CONCLUSIONS Pulmonary pressure increased over 6.5 years in late life, was associated with concomitant increases in LV filling pressure, and predicted the development of dyspnea. Interventions targeting LV diastolic function may be effective at mitigating age-related increases in PASP.
Collapse
Affiliation(s)
- Rani Zierath
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Brian Claggett
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Yimin Yang
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Hicham Skali
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Dalane Kitzman
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Suma Konety
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Thomas Mosley
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Amil M Shah
- Brigham and Women's Hospital, Boston, Massachusetts, USA; University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| |
Collapse
|
2
|
Kusunose K, Hirata Y, Yamaguchi N, Kosaka Y, Tsuji T, Kotoku J, Sata M. Deep Learning for Detection of Exercise-Induced Pulmonary Hypertension Using Chest X-Ray Images. Front Cardiovasc Med 2022; 9:891703. [PMID: 35783826 PMCID: PMC9240342 DOI: 10.3389/fcvm.2022.891703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/12/2022] [Indexed: 11/28/2022] Open
Abstract
Background Stress echocardiography is an emerging tool used to detect exercise-induced pulmonary hypertension (EIPH). However, facilities that can perform stress echocardiography are limited by issues such as cost and equipment. Objective We evaluated the usefulness of a deep learning (DL) approach based on a chest X-ray (CXR) to predict EIPH in 6-min walk stress echocardiography. Methods The study enrolled 142 patients with scleroderma or mixed connective tissue disease with scleroderma features who performed a 6-min walk stress echocardiographic test. EIPH was defined by abnormal cardiac output (CO) responses that involved an increase in mean pulmonary artery pressure (mPAP). We used the previously developed AI model to predict PH and calculated PH probability in this cohort. Results EIPH defined as ΔmPAP/ΔCO >3.3 and exercise mPAP >25 mmHg was observed in 52 patients, while non-EIPH was observed in 90 patients. The patients with EIPH had a higher mPAP at rest than those without EIPH. The probability of PH based on the DL model was significantly higher in patients with EIPH than in those without EIPH. Multivariate analysis showed that gender, mean PAP at rest, and the probability of PH based on the DL model were independent predictors of EIPH. A model based on baseline parameters (age, gender, and mPAP at rest) was improved by adding the probability of PH predicted by the DL model (AUC: from 0.65 to 0.74; p = 0.046). Conclusion Applying the DL model based on a CXR may have a potential for detection of EIPH in the clinical setting.
Collapse
Affiliation(s)
- Kenya Kusunose
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
- *Correspondence: Kenya Kusunose,
| | - Yukina Hirata
- Ultrasound Examination Center, Tokushima University Hospital, Tokushima, Japan
| | - Natsumi Yamaguchi
- Ultrasound Examination Center, Tokushima University Hospital, Tokushima, Japan
| | - Yoshitaka Kosaka
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Takumasa Tsuji
- Department of Radiological Technology, Graduate School of Medical Care and Technology, Teikyo University, Tokyo, Japan
| | - Jun’ichi Kotoku
- Department of Radiological Technology, Graduate School of Medical Care and Technology, Teikyo University, Tokyo, Japan
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
| |
Collapse
|
3
|
Aurangabadkar GM, Lanjewar AV, Jadhav US, Ali SN, Wagh PB. Evaluation of Pulmonary Hypertension in Chronic Obstructive Pulmonary Disease. Cureus 2022; 14:e21828. [PMID: 35291532 PMCID: PMC8896257 DOI: 10.7759/cureus.21828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 11/08/2022] Open
Abstract
Background: Pulmonary hypertension (PH) is frequently underdiagnosed and under-evaluated in chronic obstructive pulmonary diseases (COPD) patients. As PH is linked to a high rate of mortality from disease-related complications like cor pulmonale, it is critical to have a unified approach to diagnosing and treating it with the aim of improving the patient's quality of life and prognosis in terms of therapeutic considerations. Early identification of this comorbidity in patients with COPD can lead to early initiation of treatment and better prognostic implications. This study was undertaken with the aim of estimating the prevalence of PH in COPD as well as assessing any statistically significant associations between the severity of PH and the severity of COPD. Methods: This was an observational study undertaken at the Department of Respiratory Medicine, Acharya Vinoba Bhave Rural Hospital (AVBRH) in Wardha, Maharastra, India, from August 2019 to September 2021. A total of 100 patients diagnosed with COPD on the basis of spirometry were evaluated with two-dimensional (2D) echocardiography to screen for echocardiographic signs and evidence of PH and severity staging of PH if present. Results: In our study, out of 100 diagnosed cases of COPD, the prevalence of PH was found to be 40% (40 patients) and amongst these, mild, moderate, and severe PH was seen in 26 patients (26%), nine patients (9%), and five patients (5%), respectively. The frequency of PH in moderate COPD was 25% and in severe COPD was 51.5%. Conclusions: PH was found in almost half the COPD patients in the study. Also, the degree and frequency of PH increased with the increase in COPD severity and this was found to be statistically significant.
Collapse
|
4
|
Franco FS, Sousa JDBD, Agostinho PLDS. Effect of parathyroid hormone levels on the functional capacity and pulmonary function of patients on dialysis. FISIOTERAPIA EM MOVIMENTO 2020. [DOI: 10.1590/1980-5918.033.ao63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Chronic kidney disease is characterized as the gradual loss of kidney function, with patients on dialysis experiencing a decline in functional capacity and pulmonary function. One of the non-traditional risk factors is parathyroid hormone (PTH), which influences metabolism and the status of the disease. Objective: Assess the effect of parathyroid hormone levels on functional capacity and pulmonary function in patients on dialysis. Method: Cross-sectional study with hemodynamically stable dialysis patients of both sexes, aged 18 to 59 years, who did not gain more than 2.5kg between dialysis sessions. Two groups were created according to PTH blood levels: PTH (A), with values outside the normal range, and PTH (C), who exhibited normal levels of the hormone. Pulmonary function (PF) was assessed by spirometry and functional capacity (FC) via the six-minute walk test (6MWT). Results: The PTH A group displayed a negative association between PTH levels and PF, based on the values obtained for the spirometric variables forced expiratory volume in 1 second (FEV1) (r = -0.54) and forced vital capacity (FVC) (r= -0.69). The average distance walked by the PTH (C) group was 343.85 ± 98.14 meters. Conclusion: The results suggest that high PTH levels have a negative effect on the PF of patients on dialysis.
Collapse
|
5
|
Ojima S, Kubozono T, Saihara K, Miyauchi T, Kawasoe S, Kubota K, Shigemizu S, Ohtsubo H, Miyata M, Ohishi M. Significant Clinical Indexes of Exercise-Induced Pulmonary Hypertension in Patients With Connective Tissue Disease. Circ Rep 2019; 1:610-616. [PMID: 33693107 PMCID: PMC7897691 DOI: 10.1253/circrep.cr-19-0087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background:
Pulmonary hypertension (PH) is an important cause of morbidity in patients with connective tissue disease (CTD), and an early stage of PH could present as exercise-induced PH (EIPH). This study investigated the significant clinical indexes of EIPH in patients with CTD. Methods and Results:
We enrolled 63 patients with CTD who did not have PH at rest. All patients underwent the 6-min walk test (6MWT), and systolic pulmonary artery pressure (SPAP) was evaluated on echocardiography before and after 6MWT. EIPH was defined as SPAP ≥40 mmHg after 6 WMT. Thirty-five patients had EIPH. On univariate logistic analysis, SPAP at rest, log brain natriuretic peptide (BNP), vital capacity (VC), and forced expiratory volume in 1 s (FEV1.0) were significantly correlated with EIPH. On multiple logistic analysis, SPAP at rest and VC were independent predictors of EIPH, whereas FEV1.0 and log BNP were not significantly associated with EIPH. The area under the receiver operating characteristics curve between EIPH and BNP, SPAP at rest, VC or FEV1.0 was 0.67, 0.76, 0.74, and 0.75, respectively. Conclusions:
SPAP at rest and respiratory function, especially VC, could be independent predictors of EIPH in patients with CTD.
Collapse
Affiliation(s)
- Satoko Ojima
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University Kagoshima Japan
| | - Takuro Kubozono
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University Kagoshima Japan
| | - Keishi Saihara
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University Kagoshima Japan
| | - Takahiro Miyauchi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University Kagoshima Japan
| | - Shin Kawasoe
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University Kagoshima Japan
| | - Kayoko Kubota
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University Kagoshima Japan
| | - Sanae Shigemizu
- Center for Rheumatic Diseases, Japanese Red Cross Kagoshima Hospital Kagoshima Japan
| | - Hideo Ohtsubo
- Center for Rheumatic Diseases, Japanese Red Cross Kagoshima Hospital Kagoshima Japan
| | - Masaaki Miyata
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University Kagoshima Japan
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University Kagoshima Japan
| |
Collapse
|
6
|
Jankowich M, Elston B, Liu Q, Abbasi S, Wu WC, Blackshear C, Godfrey M, Choudhary G. Restrictive Spirometry Pattern, Cardiac Structure and Function, and Incident Heart Failure in African Americans. The Jackson Heart Study. Ann Am Thorac Soc 2018; 15:1186-1196. [PMID: 30011374 PMCID: PMC6321994 DOI: 10.1513/annalsats.201803-184oc] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 06/29/2018] [Indexed: 01/08/2023] Open
Abstract
RATIONALE Although chronic obstructive pulmonary disease has been related to heart failure, the relationship between the restrictive spirometry pattern (forced vital capacity [FVC] < 80% predicted with preserved forced expiratory volume in 1 second [FEV1]/FVC ratio) and heart failure is poorly understood. OBJECTIVES To determine whether having a restrictive spirometry pattern is associated with incident heart failure hospitalization. METHODS Community-dwelling African Americans from the Jackson Heart Study (total n = 5,306; analyzed n = 4,210 with spirometry and heart failure outcome data) were grouped by restrictive spirometry (FEV1/FVC ≥ 0.70, FVC < 80%; n = 840), airflow obstruction (FEV1/FVC < 0.70; n = 341), and normal spirometry (FEV1/FVC ≥ 0.70, FVC ≥ 80%; n = 3,029) at the time of baseline examination in 2000-2004. We assessed relationships of echocardiographic parameters and biomarkers with spirometry patterns using regression models. Incident heart failure was defined as an adjudicated hospitalization for heart failure after January 1, 2005 in subjects with no self-reported heart failure history. We used multivariable-adjusted Poisson regression models and Cox proportional hazards models, with death treated as a competing risk in the Cox models, to test associations between spirometry patterns and incident heart failure. We also modeled the association of FVC% predicted with heart failure hospitalization risk using a restricted cubic spline after excluding subjects with airflow obstruction. RESULTS At the time of baseline spirometry, participants with restrictive spirometry had a median age of 57.2 years (interquartile range, 47.8-64.1); 38.1% were male. Compared with normal spirometry, restrictive spirometry was associated with a higher transmitral early (E) wave velocity to atrial (A) wave velocity ratio, higher pulmonary artery systolic pressure, and higher endothelin levels. After a median follow-up time of 8.0 years, 8.0% of subjects with restrictive spirometry (n = 67) had developed incident heart failure, compared with 3.8% of those with normal spirometry (n = 115) and 10.6% of those with airflow obstruction (n = 36). After risk adjustment, both a restrictive pattern (hazard ratio [HR], 1.5; 95% confidence interval [CI], 1.1-2.0) and airflow obstruction (HR, 1.7; 95% CI, 1.1-2.5) were associated with increased rates of incident heart failure hospitalization compared with normal spirometry. Using flexible modeling, the lowest hazards of heart failure hospitalization were observed around FVC 90-100%, with lower FVC% values associated with an increased incidence of heart failure. CONCLUSIONS Both a restrictive pattern on spirometry and airflow obstruction identify African Americans with impaired lung health at risk for heart failure.
Collapse
Affiliation(s)
- Matthew Jankowich
- Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island
- Division of Pulmonary, Critical Care and Sleep Medicine, and
| | - Beth Elston
- Department of Epidemiology, Brown University, Providence, Rhode Island
| | - Qing Liu
- Department of Epidemiology, Brown University, Providence, Rhode Island
| | - Siddique Abbasi
- Division of Cardiology, Department of Medicine, Alpert Medical School, and
| | - Wen-Chih Wu
- Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island
- Division of Cardiology, Department of Medicine, Alpert Medical School, and
| | - Chad Blackshear
- Department of Data Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, Mississippi; and
| | - Mark Godfrey
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Gaurav Choudhary
- Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island
- Division of Cardiology, Department of Medicine, Alpert Medical School, and
| |
Collapse
|