severe pulmonary hypertension

Study Finds Distinct Damage in Explanted Lung Tissue of PH-COPD Patients - MD Magazine
Blacks with scleroderma exhibit more severe pulmonary disease - Healio
Digital Subtraction Pulmonary Angiography in Children With PH Due to BPD - Pulmonology Advisor
Sleep Apnea Severity Linked to Elevated Pulmonary Capillary Wedge Pressure - The Cardiology Advisor

Study Finds Distinct Damage in Explanted Lung Tissue of PH-COPD Patients - MD Magazine

Posted: 20 Mar 2019 06:06 AM PDT

[unable to retrieve full-text content]Study Finds Distinct Damage in Explanted Lung Tissue of PH-COPD Patients MD Magazine

Little is known on the underlying pulmonary arterial lesions in patients with this phenotype of COPD.

Blacks with scleroderma exhibit more severe pulmonary disease - Healio

Posted: 20 Mar 2019 03:04 AM PDT

Black patients with scleroderma demonstrate more severe pulmonary disease and higher unadjusted mortality compared with nonblack patients, according to data published in Arthritis Care & Research.

However, the researchers added that, when adjusted for socioeconomic factors, black race was not an independent factor for increased mortality. According to the researchers, lower median household income more accurately predicted increased mortality, independent of race. However, black patients had lower measures of socioeconomic status by all measured variables.

"While African-American patients with scleroderma have a distinct phenotypic and serologic profile, their experience of and outcomes in the disease may be confounded by socioeconomic factors that correlate with race," Duncan F. Moore, MD, of MedStar Georgetown University Hospital, and colleagues wrote. "Within scleroderma cohorts, African-Americans have decreased educational attainment, increased Medicaid prevalence, decreased household income and decreased vehicle ownership relative to non–African-Americans."

Black patients with scleroderma demonstrate more severe pulmonary disease and higher unadjusted mortality compared with nonblack patients, according to data.

Source: Adobe

"Marital status, employment, educational attainment, insurance status and median income by household have all been examined as covariates in scleroderma mortality research," they added. "Effect sizes have varied, and socioeconomic factors have not fully explained racial disparities in any studies to date."

To evaluate the risks for severe disease and higher mortality among black patients, compared with nonblacks, with scleroderma, Moore and colleagues conducted a retrospective study of 402 participants seen between 2008 and 2016 at MedStar Georgetown University Hospital. Black and nonblack patients with scleroderma were matched by sex, age at first visit, date of first visit, disease duration at first visit and limited vs. diffuse cutaneous disease. The researchers also compared demographic, serologic and clinical features.

In addition, the researchers determined mortality risks using a Cox proportional hazards model, with covariates for race, marital status, education, employment, insurance and household income. Moore and colleagues imputed household income using patients' zip code at first visit, based on U.S. Census data from 2006 to 2010. Among the participants, 202 were black. The 200 nonblack patients included 193 white patients, four Asian patients and three individuals that identified as "other." Of the 12 patients who identified as Latino or Hispanic, 11 were non–black.

According to the researchers, black patients demonstrated more reduced forced vital capacity and diffusing capacity of the lungs for carbon monoxide compared with nonblacks, as well as more severe lung fibrosis, a higher prevalence of pulmonary hypertension and more severe cardiac involvement. In addition, there were statistical differences in the autoantibody profiles between the two groups. During the follow-up period, the mortality rate among blacks was 21%, compared with 11% in the nonblack group (P = .005).

Regarding mortality, black patients demonstrated an unadjusted hazard ratio for death of 2.061 (95% CI, 1.232-3.449) during follow-up. However, after adjusting for socioeconomic covariates, that figure was reduced to 1.256 (95% CI, 0.494-3.191). According to the researchers, only significant covariate associated with increased mortality was median income based on zip code, measured in tens of thousands of dollars (HR = 0.845; 95% CI, 0.723-0.986).

"We have re-demonstrated the unique clinical and serologic profile and increased morbidity and mortality of scleroderma in African-Americans, relative to non–African-Americans, in a large and previously undescribed cohort," Moore and colleagues wrote. "In the US, race is largely a social construct, rather than a biological one, and it is confounded by relative economic deprivation. Thus, in robustly controlling for socioeconomic status, we have demonstrated a relatively diminished magnitude and significance of the mortality effect conferred by race. Nonetheless, race and ethnicity do correlate with differences in fibrosis-related gene expression and also with specific HLA haplotypes and SNPs."

"Higher socioeconomic status may blunt the effects of intrinsic racial differences," they added. "Regardless of the relative magnitudes of the contributory socioeconomic versus genetic factors, it is clear that African-Americans with scleroderma merit more intensive efforts to facilitate timely diagnosis and access to continued evaluation and suppressive treatment, particularly with respect to cardiopulmonary involvement." – by Jason Laday

Disclosure: Moore reports no relevant financial disclosures. Please see the study for all other relevant financial disclosures.

Black patients with scleroderma demonstrate more severe pulmonary disease and higher unadjusted mortality compared with nonblack patients, according to data published in Arthritis Care & Research.

Black patients with scleroderma demonstrate more severe pulmonary disease and higher unadjusted mortality compared with nonblack patients, according to data.

Source: Adobe

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Disclosure: Moore reports no relevant financial disclosures. Please see the study for all other relevant financial disclosures.

Digital Subtraction Pulmonary Angiography in Children With PH Due to BPD - Pulmonology Advisor

Posted: 18 Mar 2019 11:00 PM PDT

Digital subtraction pulmonary angiography (DSPA) is a potentially useful imaging modality for evaluating changes in the pulmonary vasculature of children with pulmonary hypertension (PH) associated with bronchopulmonary dysplasia (BPD), according to study findings published in Medical Sciences (Basel).

Recognizing that BPD is the most common respiratory sequela associated with premature birth, investigators sought to evaluate the pulmonary vasculature of preterm infants undergoing cardiac catheterization for PH in a retrospective pilot study. In each of the 3 newborns, a digital subtraction pulmonary artery angiogram was performed because of its potential benefits of both lower exposure to radiation and the use of a lower dose of radiographic contrast material compared with conventional cineangiography. The procedure was tolerated by all patients and no complications were reported.

Of the 3 infants examined, 2 were born at 22 weeks' and 1 at 24 weeks' gestation. PH was diagnosed via echocardiogram in all 3 newborns after birth and was attributed to their chronic lung disease and continued need for respiratory support. Normal renal function was reported in all 3 infants and no adverse events from the contrast medium were observed after the DSPA was analyzed.

The use of DSPA revealed significant lung perfusion defects in all 3 patients in comparison with DSPA images from a normal child with normal pulmonary artery pressure. Per the study findings, mean pulmonary artery pressure to mean aortic pressure ratios in patients 1, 2, and 3 were 54%, 55%, and 43%, respectively. In a similar fashion, the pulmonary vascular resistance index to systemic vascular index ratios in patients 1, 2, and 3 were 0.36, 0.31, and 0.25, respectively.

The investigators concluded that although only 3 infants were evaluated in this study, the preliminary data imply that a severe perfusion abnormality is associated with the severity of pulmonary vascular disease in children with BPD. Larger studies are warranted to confirm these findings and help to elucidate the pathophysiologic significance of the alteration of pulmonary vasculature in children with BPD born prematurely and thus assist in management and prognostication.

Reference

Das B, Jadotte M-M, Mills J, Chan K-C. Digital subtraction pulmonary angiography in children with pulmonary hypertension due to bronchopulmonary dysplasia. Med Sci (Basel). 2019;7(2). pii:E26.

Topics:

Bronchopulmonary Dysplasia Pulmonary Hypertension

Sleep Apnea Severity Linked to Elevated Pulmonary Capillary Wedge Pressure - The Cardiology Advisor

Posted: 19 Mar 2019 04:26 AM PDT

Sleep apnea severity was associated with cardiovascular comorbidities and elevated pulmonary capillary wedge pressure (PCWP) in adults, according research presented at the 68th Annual Scientific Sessions and Expo of the American College of Cardiology held March 16 to 19, in New Orleans, Louisiana.

Researchers conducted a retrospective analysis of adult patients (n=820) who had undergone an overnight sleep study between 1999 and 2017 and had also undergone native right heart catheterization up to 1 year before or 3 years after the sleep study.

Catheterization parameters, including mean pulmonary artery pressure, PCWP, pulmonary vascular resistance, and cardiac output, were the primary outcomes.

Sleep apnea was classified as absent, mild, moderate, or severe based on the apnea hypopnea index (AHI) recorded in the sleep study reports. The researchers compared catheterization parameters across the levels of sleep apnea severity. Linear regression was used to assess the link between AHI and hemodynamics, adjusting for age, sex, and body mass index (BMI).

The mean AHI in this cohort of patients was 24.8±27.1 events/h. Patients who had more severe sleep apnea were older, more likely to be men, had higher BMI, and had a higher prevalence of diabetes, hypertension, and atherosclerotic disease vs patients who had less severe sleep apnea.

For each 10-unit increase in AHI, PCWP rose by 0.4 mm Hg (95% CI, 0.2-0.6), adjusting for confounding by age, sex, and BMI.

However, AHI was not associated with a significant change in pulmonary vascular resistance (0.04 Woods units per 10-unit AHI, 95% CI, –0.10 to 0.03) or cardiac output (–0.01 L/min per 10-unit AHI, 95% CI, –0.06 to 0.03).

Based on their finding that sleep apnea severity was associated with elevated PCWP, but not [mean pulmonary artery pressure], the researchers concluded that "[s]leep apnea may not be associated with clinically important persistent daytime pulmonary hypertension."

Reference

Genuardi M, Ogilvie RP, Handen A, et al. The association of sleep apnea with invasive cardiopulmonary hemodynamics. Presented at: the 68th Annual Scientific Sessions and Expo of the American College of Cardiology; March 16-19, 2019; New Orleans, LA. Abstract 493.

This article originally appeared on Pulmonology Advisor

Topics:

ACC 2019 Pulmonary Hypertension

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