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Vaidy A, Vahdatpour CA, Mazurek J. Exercise Testing in Patients with Pulmonary Hypertension. J Clin Med 2024; 13:795. [PMID: 38337493 PMCID: PMC10855991 DOI: 10.3390/jcm13030795] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
Pulmonary hypertension (PH), defined by a mean pulmonary artery pressure of >20 mm Hg, often presents with non-specific symptoms such as dyspnea and exercise intolerance, making it difficult to diagnose early before the onset of right heart dysfunction. Therefore, exercise testing can be of great utility for clinicians who are evaluating patients with an unclear etiology of exercise intolerance by helping identify the underlying mechanisms of their disease. The presence of PH is associated with adverse clinical outcomes, with distinct differences and patterns in the cardiovascular and ventilatory responses to exercise across various PH phenotypes. We discuss the role of exercise-invasive hemodynamic testing, cardiopulmonary exercise testing, and exercise stress echocardiography modalities across the spectrum of PH.
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Affiliation(s)
- Anika Vaidy
- Division of Cardiology, School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Cyrus A. Vahdatpour
- Division of Pulmonary Medicine, School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Jeremy Mazurek
- Division of Cardiology, School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
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Vaidy A, O'Corragain O, Vaidya A. Diagnosis and Management of Pulmonary Hypertension and Right Ventricular Failure in the Cardiovascular Intensive Care Unit. Crit Care Clin 2024; 40:121-135. [PMID: 37973349 DOI: 10.1016/j.ccc.2023.05.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Pulmonary hypertension (PH) encompasses a broad range of conditions, including pulmonary artery hypertension, left-sided heart disease, and pulmonary and thromboembolic disorders. Successful diagnosis and management rely on an integrated clinical assessment of the patient's physiology and right heart function. Right ventricular (RV) heart failure is often a result of PH, but may result from varying abnormalities in preload, afterload, and intrinsic myocardial dysfunction, which require distinct management strategies. Consideration of an individual's hemodynamic phenotype and physiologic circumstances is paramount in management of PH and RV failure, particularly when there is clinical instability in the intensive care setting.
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Affiliation(s)
- Anika Vaidy
- Pulmonary Hypertension, Right Heart Failure, CTEPH Program, Division of Cardiology, Temple University Hospital, 9th floor Parkinson Pavilion, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | | | - Anjali Vaidya
- Pulmonary Hypertension, Right Heart Failure, CTEPH Program, Division of Cardiology, Temple University Hospital, 9th floor Parkinson Pavilion, 3401 North Broad Street, Philadelphia, PA 19140, USA.
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Labrada L, Vaidy A, Vaidya A. Right ventricular assessment in pulmonary hypertension. Curr Opin Pulm Med 2023; 29:348-354. [PMID: 37410491 PMCID: PMC10408730 DOI: 10.1097/mcp.0000000000000980] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an overview of assessment of right ventricular function in the context of pulmonary hypertension and pulmonary arterial hypertension (PAH). We will review unique features of right ventricular anatomy, delineation of cause of pulmonary hypertension through careful right ventricular assessment, echocardiographic and hemodynamic evaluation, and the importance of this assessment in prognosis. RECENT FINDINGS The importance of performance in prognosis and risk assessment in patients with pulmonary hypertension has been continually emphasized in ongoing research. Representative parameters of right ventricular function have been shown to be predictive of prognosis in patients with pulmonary hypertension. Further, the importance of serial right ventricular assessment in risk assessment and prognosis has remained an emerging theme. SUMMARY Careful evaluation of right ventricular function is paramount in assessing the cause of pulmonary hypertension and severity of disease. Further, it has prognostic significance, as many representative parameters of right ventricular function have been linked with mortality. In our opinion, right ventricular function should be assessed serially throughout the course of treatment in pulmonary hypertension, and baseline parameters in addition to dynamic changes should be incorporated into risk assessment. Achieving normal or near-normal right ventricular performance may serve as a principal goal in the treatment of pulmonary hypertension.
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Affiliation(s)
- Lyana Labrada
- Pulmonary Hypertension, Right Heart Failure, CTEPH Program, Division of Cardiology, Temple University Hospital, Philadelphia, Pennsylvania, USA
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Vaidy A, Sesay I, Delfiner MS, O'Murchu B, Patil P, Afari-Armah N, Hamad E, Rakita V. Invasive Hemodynamic Study Unmasks Intracardiac Shunt With Ventricular Assist Device. Circ Heart Fail 2022; 15:e008720. [PMID: 35078325 DOI: 10.1161/circheartfailure.121.008720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Anika Vaidy
- Lewis Katz School of Medicine, Temple Heart and Vascular Institute (A.V., M.S.D., P.P.), Temple University Hospital, Philadelphia, PA
| | - Isata Sesay
- Section of Advanced Heart Failure and Transplant (I.S., E.H., V.R.), Temple University Hospital, Philadelphia, PA
| | - Matthew S Delfiner
- Lewis Katz School of Medicine, Temple Heart and Vascular Institute (A.V., M.S.D., P.P.), Temple University Hospital, Philadelphia, PA
| | - Brian O'Murchu
- Section of Interventional Cardiology, Temple University, Philadelphia, PA (B.O.)
| | - Pravin Patil
- Lewis Katz School of Medicine, Temple Heart and Vascular Institute (A.V., M.S.D., P.P.), Temple University Hospital, Philadelphia, PA
| | | | - Eman Hamad
- Section of Advanced Heart Failure and Transplant (I.S., E.H., V.R.), Temple University Hospital, Philadelphia, PA
| | - Val Rakita
- Section of Advanced Heart Failure and Transplant (I.S., E.H., V.R.), Temple University Hospital, Philadelphia, PA
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Al-Otaibi M, Vaidy A, Vaidya A, Zlotshewer B, Oliveros E, Zhao H, Lakhter V, Auger WR, Forfia PR, Bashir R. May-Thurner Anatomy in Patients With Chronic Thromboembolic Pulmonary Hypertension: An Important Clinical Association. JACC Cardiovasc Interv 2021; 14:1940-1946. [PMID: 34503745 DOI: 10.1016/j.jcin.2021.06.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/01/2021] [Accepted: 06/29/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the incidence of May-Thurner anatomy (MTA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and identify its predictors. BACKGROUND MTA is an anatomical variant characterized by compression of left common iliac vein by the overlying right iliac artery. Over time, this leads to venous intimal scarring, blood flow stasis, and the development of deep vein thrombosis (DVT). DVT is a known risk factor for the development of CTEPH. The prevalence of this anatomical variation in patients with CTEPH is unknown. METHODS A retrospective chart review was conducted in patients referred to Temple University Hospital's cardiac catheterization laboratory for the evaluation of CTEPH between January 2016 and June 2020. Among these patients, those who underwent invasive venography were evaluated for the presence of angiographic MTA. Multivariate regression was used to identify factors associated with presence of MTA. RESULTS A total of 193 patients with CTEPH were referred for pulmonary angiography, of whom 148 patients underwent invasive venography. MTA was identified in 44 patients (29.7%). Factors associated with the presence of MTA were lower extremity DVT (odds ratio: 3.5; 95% confidence interval: 1.58-7.8; P = 0.002), and left lower extremity post-thrombotic syndrome (odds ratio: 2.0; 95% confidence interval: 0.98-4.1; P = 0.05). Patients with MTA were more likely to undergo pulmonary thromboendarterectomy than patients without MTA (79.5% vs 58.7%; P = 0.015). CONCLUSIONS MTA is very common in patients with CTEPH. History of lower extremity DVT and or left lower extremity post-thrombotic syndrome was associated with the presence of MTA.
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Affiliation(s)
- Mohamad Al-Otaibi
- Department of Internal Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Anika Vaidy
- Division of Cardiovascular Disease, Pulmonary Hypertension, Right Heart Failure, and CTEPH Program, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Anjali Vaidya
- Division of Cardiovascular Disease, Pulmonary Hypertension, Right Heart Failure, and CTEPH Program, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Brooke Zlotshewer
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Estefania Oliveros
- Division of Cardiovascular Disease, Pulmonary Hypertension, Right Heart Failure, and CTEPH Program, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Huaqing Zhao
- Department of Clinical Sciences, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Vladimir Lakhter
- Division of Cardiovascular Disease, Pulmonary Hypertension, Right Heart Failure, and CTEPH Program, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - William R Auger
- Division of Cardiovascular Disease, Pulmonary Hypertension, Right Heart Failure, and CTEPH Program, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Paul R Forfia
- Division of Cardiovascular Disease, Pulmonary Hypertension, Right Heart Failure, and CTEPH Program, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Riyaz Bashir
- Division of Cardiovascular Disease, Pulmonary Hypertension, Right Heart Failure, and CTEPH Program, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.
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Vaidy A, Forfia P, Mazurek J, Vaidya A. Improvement after bariatric surgery in chronic thromboembolic pulmonary hypertension: a novel treatment target. BMJ Case Rep 2021; 14:14/3/e228358. [PMID: 33746114 PMCID: PMC7986860 DOI: 10.1136/bcr-2018-228358] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 66-year-old man with a medical history significant for multiple pulmonary embolism and morbid obesity was evaluated for chronic thromboembolic pulmonary hypertension. Echocardiogram and right heart catheterisation were significant for severe pulmonary hypertension. Therefore, he was started on pulmonary hypertension medical therapy with riociguat and ambrisentan, in addition to anticoagulation. He experienced a dramatic clinical response to medical therapy. Despite haemodynamic improvement, the patient remained symptomatic with significant fatigue, exertional dyspnea and poor functional status as highlighted by a 6 min walk distance of only 128 m. Patient was referred for bariatric surgery with a gastric sleeve, after which he successfully lost 95 lbs in 6 months. Postoperative right heart catheterisation demonstrated normal pulmonary vascular resistance and cardiac output. His echocardiogram revealed normal right ventricular size and function. His 6 min walk distance also nearly quadrupled from 128 to 512 m, consistent with WHO Functional Class I.
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Affiliation(s)
- Anika Vaidy
- Internal Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Paul Forfia
- Division of Cardiology, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jeremy Mazurek
- Division of Cardiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Anjali Vaidya
- Division of Cardiology, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
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Noory A, Jain D, Kelly M, Vaidy A, Toyoda Y. CARDIAC MASS IN A PATIENT WITH FEVER AND STROKE. Chest 2020. [DOI: 10.1016/j.chest.2020.08.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Vaidy A, Forfia P, Vaidya A. Improvement after Bariatric Surgery in Chronic Thromboembolic Pulmonary Hypertension: A Novel Treatment Target. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Vaidy A, Bashir R, Forfia P, Vaidya A. A SIGNIFICANT PORTION OF PATIENT WITH CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION WERE DIAGNOSED WITH MAY-THURNER SYNDROME USING SCREENING VENOGRAPHY. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32530-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Acheson A, Vaidy A, Stomieroski K, Thompson DR, Maiden KM, Ehrenthal DB, Yezdani S, Bhat AM, Locke R, Bartoshesky LE. Surveillance of ventricular septal defects in Delaware. ACTA ACUST UNITED AC 2016; 106:888-893. [DOI: 10.1002/bdra.23574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 09/07/2016] [Accepted: 09/08/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Amy Acheson
- Center for Women's, Infants' and Children's Health Research; Christiana Care Health System; Newark Delaware
| | - Anika Vaidy
- Sidney Kimmel Medical College at Thomas Jefferson University; Philadelphia Pennsylvania
| | - Kathleen Stomieroski
- Center for Women's, Infants' and Children's Health Research; Christiana Care Health System; Newark Delaware
| | - Dana R. Thompson
- Center for Women's, Infants' and Children's Health Research; Christiana Care Health System; Newark Delaware
| | - Kristin M. Maiden
- Division of Health and Prevention Services; Nemours Children's Health System; Wilmington Delaware
| | - Deborah B. Ehrenthal
- Obstetrics & Gynecology and Population Health Sciences, School of Medicine and Public Health; University of Wisconsin-Madison; Madison Wisconsin
| | - Samir Yezdani
- The Lewis Katz School of Medicine at Temple University; Philadelphia Pennsylvania
| | | | - Robert Locke
- Neonatology, Christiana Care Health System, Newark; Delaware and Sidney Kimmel Medical College at Thomas Jefferson University; Philadelphia Pennsylvania
| | - Louis E. Bartoshesky
- Pediatrics, Christiana Care Health System, Newark; Delaware and Sidney Kimmel Medical College at Thomas Jefferson University; Philadelphia Pennsylvania
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