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Ulutas Z, Tasolar H, Bayramoglu A, Yigit Y, Kuloglu HE, Karaca Y, Yolbas S, Hidayet S, Akaycan J. The importance of pulmonary pulse transit time in indicating right ventricular dysfunction and pulmonary arterial stiffness in rheumatoid arthritis. J Clin Ultrasound 2023; 51:1321-1328. [PMID: 37530482 DOI: 10.1002/jcu.23531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/03/2023]
Abstract
SUBJECT Rheumatoid arthritis patients are at risk of developing cardiovascular disease such as right heart failure and pulmonary hypertension (PH). Arterial stiffness can be used to assess pulmonary hemodynamics. Noninvasive approaches can also be used to assess pulmonary hemodynamics. Recently, there have been reports that pulmonary pulse transit time (PPTT) may also be a useful measure. This study aims to examine the effects of pulmonary hemodynamic alterations on PPTT in RA patients. METHODS Forty RA patients and 40 healthy controls were included in the study. Sociodemographic characteristics, laboratory data, and echocardiographic examinations were performed in both groups. Conventional echocardiographic examination included left and right ventricular systolic and diastolic diameters, right ventricular myocardial performance index (RVMPI), right ventricular diastolic function, estimated pulmonary artery systolic pressure (sPAP), tricuspid annular plane systolic excursion (TAPSE), pulmonary artery stiffness (PAS), and PPTT. Right ventricular diastolic and systolic volumes, right ventricular ejection fraction (RVEF), and right ventricular fractional area change (RVFAC) were determined by four-dimensional echocardiography (4DE). RESULTS There was no difference between the sPAP values of the patients. RVMPI and PAS were increased in RA patients compared with controls. The PPTT was shortened in RA patients and correlated with RVEF, RVFAC, RVMPI, TAPSE/sPAP, disease duration, and C-reactive protein (CRP). In univariate linear regression analysis, PPTT (p < .001) was thought to be an independent predictor of PAS. RVFAC, disease duration, and PAS were also independent predictors of PPTT. CONCLUSION In RA patients, PPTT may be the first evidence of early abnormalities in pulmonary vascular hemodynamics. PPTT and PAS are the values that may predict each other in RA patients. Due to its more practical application, PPTT can be used instead of PAS to assess pulmonary hemodynamics.
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Affiliation(s)
- Zeynep Ulutas
- Department of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Hakan Tasolar
- Department of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Adil Bayramoglu
- Department of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Yakup Yigit
- Department of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | | | - Yucel Karaca
- Department of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Servet Yolbas
- Department of Rheumatology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Siho Hidayet
- Department of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Julide Akaycan
- Department of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
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Duran M, Uygun T, Kurtipek E. Assessment of Long-Term Sequelae of Pulmonary Dysfunction Associated with COVID-19 Using Pulmonary Pulse Transit Time. J Cardiovasc Echogr 2022; 32:200-204. [PMID: 36994124 PMCID: PMC10041403 DOI: 10.4103/jcecho.jcecho_31_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/16/2022] [Accepted: 07/30/2022] [Indexed: 03/31/2023] Open
Abstract
Background Studies report deleterious impacts of severe acute respiratory syndrome coronavirus 2 on multiple organs in the human body, not only in the acute infection period but also in the long-term sequelae. Recently defined pulmonary pulse transit time (pPTT) was found to be a useful parameter regarding the evaluation of pulmonary hemodynamics. The purpose of this study was to determine whether pPTT might be a favorable tool for detecting the long-term sequelae of pulmonary dysfunction associated with coronavirus disease 2019 (COVID-19). Materials and Methods We evaluated 102 eligible patients with a prior history of laboratory-confirmed COVID-19 hospitalization at least 1 year ago and 100 age- and sex-matched healthy controls. All participants' medical records and clinical and demographic features were analyzed and underwent detailed 12-lead electrocardiography, echocardiographic assessment, and pulmonary function tests. Results According to our study, pPTT was positively correlated with forced expiratory volume in the 1st s, peak expiratory flow, and tricuspid annular plane systolic excursion (r = 0.478, P < 0.001; r = 0.294, P = 0.047; and r = 0.314, P = 0.032, respectively) as well as negatively correlated with systolic pulmonary artery pressure (r = -0.328, P = 0.021). Conclusion Our data indicate that pPTT might be a convenient method for early prediction of pulmonary dysfunction among COVID-19 survivors.
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Affiliation(s)
- Mustafa Duran
- Department of Cardiology, Konya City Hospital, Konya, Turkey
| | - Turgut Uygun
- Department of Cardiology, Konya City Hospital, Konya, Turkey
| | - Ercan Kurtipek
- Department of Pulmonology, Konya City Hospital, Konya, Turkey
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Büber I, Sevgican CI, Davutoglu Y, Avunduk S, Tekin I, Kiliç O, Kiliç ID. Assessment of Pulmonary Pulse Transit Time with Respect to Diastolic and Left Atrial Functions. J Cardiovasc Echogr 2022; 32:160-164. [PMID: 36619772 PMCID: PMC9819601 DOI: 10.4103/jcecho.jcecho_20_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/14/2022] [Accepted: 07/30/2022] [Indexed: 01/10/2023] Open
Abstract
Background and Aim Pulmonary pulse transit time (pPTT) is a new marker of pulmonary hypertension (PH), which shows the time needed for the pulse wave to propagate from the right ventricular outflow tract to the left atrium (LA), but the relationship between pPTT and diastolic-LA function is almost unknown. In this study, we investigated the relationship between pPTT and LA-diastolic functions without PH. Materials and Methods One hundred and fifty-six patients were included in this prospectively designed study. Comprehensive echocardiographic evaluation was performed and pPTT was recorded as the time from the beginning of the R-wave on the electrocardiogram to the peak of the S-wave in the pulmonary veins. Results We found a statistically significant correlation between LA total stroke volume, passive stroke volume, LA max area, LA volume (LAV) max and LA volume index (LAVi) max, and pPTT (r = 0.263** P = 0.003, r = 0.240** P = 0.007, (r = 0.339** P < 0.001, r = 0.307** P < 0.001 r = 0.199*, P = 0.024, LA total stroke volume, passive stroke volume, LA max area, LAV max, LAVi max respectively). Heart rate (HRt) and LAVi were detected as independent predictors of pPTT (hazard ratio: -2.290 P < 0.001, 95% confidence interval (CI): -3.274-1.306, HR: 0.461, P = 0.028, 95% CI: 0.050-0.873, HRt and LAVi, respectively). Conclusion LAVi and HRt also affected pPTT. The dominant effect of HRt on pPTT should be considered in future studies. Larger studies are needed to determine the change and clinical significance of pPTT in left heart disease.
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Affiliation(s)
- Ipek Büber
- Department of Cardiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Cihan Ilyas Sevgican
- Department of Cardiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Yigit Davutoglu
- Department of Cardiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Saadet Avunduk
- Department of Cardiology, Denizli State Hospital, Denizli, Turkey
| | - Isik Tekin
- Department of Cardiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Oğuz Kiliç
- Department of Cardiology, Karaman Training and Research Hospital, Karaman, Turkey
| | - Ismail Dogu Kiliç
- Department of Cardiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
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Erdol MA, Acar B, Ertem AG, Karanfil M, Yayla Ç, Demırtas K, Aladağ P, Sönmezer MÇ, Kiliç EK, Hatipoğlu ÇA, Erdinc FS, Tulek N, Akcay AB. Assessment of Pulmonary Arterial Hemodynamic and Vascular Changes by Pulmonary Pulse Transit Time in Patients with Human Immunodeficiency Virus Infection. J Cardiovasc Echogr 2021; 31:6-10. [PMID: 34221879 PMCID: PMC8230153 DOI: 10.4103/jcecho.jcecho_103_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/21/2020] [Accepted: 12/08/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction Pulmonary arterial hypertension and human immunodeficiency virus (HIV) infection is a well-known association. Pulmonary pulse transit time (pPTT) is a recent echocardiographic marker that might be used for evaluation of pulmonary arterial stiffness (PAS) in patients with HIV infection. We aimed to investigate whether pPTT elevated in patients with HIV infection compared to healthy controls and its association with echocardiographic indices of right ventricular functions. Materials and Methods Fifty HIV (+) patients from infectious disease outpatient clinics and fifty age- and sex-matched HIV (-) healthy volunteers were enrolled in this study. pPTT was measured from pulmonary vein flow velocity as the time interval between the R-wave in the electrocardiography and corresponding peak late systolic was then calculated as the mean from two separate pw-Doppler measurements. Results pPTT, tricuspid annular peak systolic excursion (TAPSE) and right ventricle fractional area change (FAC) were significantly lower in patients with HIV than control patients (177.1 ± 34.9 vs. 215.7 ± 35.7 msn, P < 0.001; 2.33 ± 0.28 vs. 2.19 ± 0.22, P = 0.039; 45 [4.25] vs. 41.1 [4.0], P = 0.032, respectively). pPTT was positively correlated with FAC, TAPSE and cluster of differentiation 4 count (r = 0.210; P = 0.036, r = 0.256; P = 0.041, r = 0.304; P = 0.044, respectively). Conclusion Our study showed that pPTT, TAPSE, and right ventricle FAC levels were lower in patients with HIV infection. pPTT is an important predictor in patients with HIV expected to develop pulmonary vascular pathology.
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Affiliation(s)
- Mehmet Akif Erdol
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Burak Acar
- Department of Cardiology, Kocaeli University, Kocaeli, Turkey
| | - Ahmet Goktug Ertem
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Mustafa Karanfil
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Çağrı Yayla
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Koray Demırtas
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Pelin Aladağ
- Department of Cardiology, Kocaeli University, Kocaeli, Turkey
| | - Meliha Çağla Sönmezer
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University, Ankara, Turkey
| | - Esra Kaya Kiliç
- Department of Infectious Diseases and Clinical Microbiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Çiğdem Ataman Hatipoğlu
- Department of Infectious Diseases and Clinical Microbiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Fatma Sebnem Erdinc
- Department of Infectious Diseases and Clinical Microbiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Necla Tulek
- Department of Infectious Diseases and Clinical Microbiology, Atilim University, Ankara, Turkey
| | - Adnan Burak Akcay
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
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Duran M, Ziyrek M. Effect of Obesity on Pulmonary Vascular Hemodynamics. J Cardiovasc Echogr 2020; 30:75-81. [PMID: 33282644 PMCID: PMC7706374 DOI: 10.4103/jcecho.jcecho_70_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 04/14/2020] [Accepted: 04/28/2020] [Indexed: 11/28/2022] Open
Abstract
CONTEXT Obesity-related pulmonary arterial hypertension (PAH) is associated with hypoxia and metabolic abnormalities. Although right heart catheterization is the gold standard method for the diagnosis of PAH, Doppler echocardiography is more common. On the other hand, there is no definite echocardiographic parameter for PAH diagnosis. Novel echocardiographic parameter, pulmonary pulse transit time (pPTT), is assumed to be a surrogate marker for the assessment of PAH. AIMS The aim was to evaluate whether pPTT might be valuable for evaluating pulmonary vascular hemodynamics in obese patients. SETTINGS AND DESIGN A cross-sectional observational study. METHODS A total of 130 consecutive obese patients and 50 controls were included. Obese patients were divided into three groups according to body mass index (BMI): 25 < BMI <30 kg/m2 formed Group 1, 30 < BMI <35 kg/m2 formed Group 2, and 35 STATISTICAL ANALYSIS USED Intergroup differences were analyzed with analysis of variance or Kruskal-Wallis test. Pearson's or Spearman's correlation analysis was used for correlation, multivariate logistic regression analysis, and regression. RESULTS Statistically significant reduction in pPTT was detected as early as in the first group (361.24 ± 25.54 vs. 391.26 ± 15.07; P = 0.015) and continued throughout Groups 2 and 3 (299.92 ± 35.10 vs. 391.26 ± 15.07; P < 0.0001, and 245.46 ± 11.25 vs. 391.26 ± 15.07; P < 0.0001, respectively). There was a strong negative correlation between pPTT and BMI (r = -0.848, P = 0.001). On linear regression analysis, BMI was found to be an independent risk factor for pPTT (confidence interval: -9.164-6.379, β = -0.525, P = 0.0001). CONCLUSION The results of this study suggest that obesity leads to an increase in PAH, and pPTT allows noninvasive determination of the pulmonary hemodynamics in obese patients. pPTT might be a useful parameter in terms of predicting pulmonary hemodynamics and vascular alterations in obese patients. Further studies are warranted to evaluate the association between obesity and PAH.
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Affiliation(s)
- Mustafa Duran
- Department of Cardiology, Konya Education and Research Hospital, Konya, Turkey
| | - Murat Ziyrek
- Department of Cardiology, Konya Education and Research Hospital, Konya, Turkey
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Gurbuz AS, Ozturk S, Alsancak Y, Saklı B, Duzenli MA. Prolonged pulmonary pulse transit time is associated with symptoms in patients with significant mitral stenosis and sinus rhythm. J Clin Ultrasound 2020; 48:38-44. [PMID: 31297841 DOI: 10.1002/jcu.22758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/23/2019] [Accepted: 07/02/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Pulmonary pulse transit time (pPTT) is a novel noninvasive echocardiographic measure to assess pulmonary arterial hemodynamics. It has been shown to be shorter in precapillary pulmonary hypertension (PHT). Mitral stenosis (MS) is one of the causes of postcapillary PHT. We aimed to investigate pPTT in patients with MS and its relationship with symptoms. METHODS We included 51 patients with MS (25 were asymptomatic, NYHA I, and 26 were symptomatic, NHYA II or III), and 50 controls, and evaluated their demographic characteristics and echocardiographic variables, including pPTT. RESULTS Baseline characteristics, including age, sex, body mass index, and cardiovascular risk factors, were similar between the MS and the control group. The pPTT was longer in the MS group than in the control group (0.21 ± 0.08 vs 0.15 ± 0.05, P < .001). Patients with symptomatic MS had longer pPTT than asymptomatic patients (P = .005). The pPTT was positively correlated with left atrial volume index and systolic pulmonary artery pressure, and negatively with tricuspid annular plane systolic excursion (r = .432; P < .001, r = .319; P = .001, r = -.293; and P = .003, respectively). CONCLUSION The measurement of pPTT appears clinically relevant in patients with PHT. Further studies evaluating whether it is useful in distinguishing precapillary from postcapillary PHT are required.
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Affiliation(s)
- Ahmet S Gurbuz
- Department of Cardiology, Necmettin Erbakan University Meram Medicine Faculty, Konya, Turkey
| | - Semi Ozturk
- Department of Cardiology, Haseki Education and Research Hospital, Istanbul, Turkey
| | - Yakup Alsancak
- Department of Cardiology, Necmettin Erbakan University Meram Medicine Faculty, Konya, Turkey
| | - Beyza Saklı
- Department of Cardiology, Necmettin Erbakan University Meram Medicine Faculty, Konya, Turkey
| | - Mehmet A Duzenli
- Department of Cardiology, Necmettin Erbakan University Meram Medicine Faculty, Konya, Turkey
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