Predicting Bronchopulmonary Dysplasia-Associated Pulmonary Hypertension - The Cardiology Advisor
Predicting Bronchopulmonary Dysplasia-Associated Pulmonary Hypertension - The Cardiology Advisor |
- Predicting Bronchopulmonary Dysplasia-Associated Pulmonary Hypertension - The Cardiology Advisor
- Balloon Atrial Septostomy Can Improve Hemodynamics in PAH - Pulmonology Advisor
- Pulmonary Hypertension and Diabetes: Is There a Link? - Pulmonology Advisor
| Predicting Bronchopulmonary Dysplasia-Associated Pulmonary Hypertension - The Cardiology Advisor Posted: 17 Apr 2019 12:00 AM PDT  Screening echocardiogram performed at the time of bronchopulmonary dysplasia (BPD) diagnosis can help identify infants at higher risk for developing clinically significant, long-term pulmonary hypertension (PH), particularly when coupled with serum brain natriuretic peptide (BNP) values, according to the results of a retrospective longitudinal study published in Pediatric Cardiology.1 As many as 68% of neonates born at less than 29 weeks' gestation are diagnosed with BPD,2 and between 18% and 43% of those neonates develop secondary PH.3-5 Studies have demonstrated poor neurodevelopmental outcomes and 2-year mortality rates in up to 40% in these infants.6,7 Several guidelines have recently been published that encourage echocardiographic screening of lower gestational age and birth weight infants to allow for early detection,4,8,9 but there remains no guidance on how to interpret these data or when to intervene. Thus, researchers assessed the utility of screening serum BNP and echocardiograms performed at the time of BPD diagnosis ("early PH") to predict "late PH" at the last follow-up in 37 premature infants with BPD. Screening evaluation demonstrated early PH in 9 patients; 4 had late PH at an average follow-up interval of 52.7 weeks. Of note, 1 patient without early PH had late PH. At initial screening, infants with late PH were significantly more likely to have elevated BNP values and echocardiographic evidence of right atrial dilatation, right ventricular hypertrophy, lower right ventricular area change percentage, and larger main pulmonary artery Z-scores. "In conclusion, our data suggest that screening echocardiograms performed at the time of BPD diagnosis can help identify those patients at highest risk for developing clinically significant, long-term PH, particularly when coupled with serum BNP values," stated the investigators. References 1. Behere S, Alapati D, McCulloch MA. Screening echocardiography and brain natriuretic peptide levels predict late pulmonary hypertension in infants with bronchopulmonary dysplasia [published online April 1, 2019]. Pediatr Cardiol. doi:10.1007/s00246-019-02100-8 2. Stoll BJ, Hansen NI, Bell EF, et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics. 2010;126(3):443-456. 3. Kim D-H, Kim HS, Choi CW, Kim EK, Kim BI, Choi JH. Risk factors for pulmonary artery hypertension in preterm infants with moderate or severe bronchopulmonary dysplasia. Neonatology. 2012;101(1):40-46. 4. Weismann CG, Asnes JD, Bazzy-Asaad A, Tolomeo C, Ehrenkranz RA, Bizzarro MJ. Pulmonary hypertension in preterm infants: results of a prospective screening program. J Perinatol. 2017;37(5):572-577. 5. Bhat R, Salas AA, Foster C, Ambalavanan N. Prospective analysis of pulmonary hypertension in extremely low birth weight infants. Pediatrics. 2012;129(3):e682-e689. 6. Khemani E, McElhinney DB, Rhein L, et al. Pulmonary artery hypertension in formerly premature infants with bronchopulmonary dysplasia: clinical features and outcomes in the surfactant era. Pediatrics. 2007;120(6):1260-1269. 7. del Cerro MJ, Sabaté Rotés A, Cartón A, et al. Pulmonary hypertension in bronchopulmonary dysplasia: clinical findings, cardiovascular anomalies and outcomes. Pediatr Pulmonol. 2014;49(1):49-59. 8. Krishnan U, Feinstein JA, Adatia I, et al; Pediatric Pulmonary Hypertension Network (PPHNet). Evaluation and management of pulmonary hypertension in children with bronchopulmonary dysplasia. J Pediatr. 2017;188:24-34. 9. Abman SH, Collaco JM, Shepherd EG, et al; Bronchopulmonary Dysplasia Collaborative. Interdisciplinary care of children with severe bronchopulmonary dysplasia. J Pediatr. 2017;181:12-28.e1.  |
| Balloon Atrial Septostomy Can Improve Hemodynamics in PAH - Pulmonology Advisor Posted: 12 Apr 2019 12:00 AM PDT  Balloon atrial septostomy can improve hemodynamic parameters in patients with advanced pulmonary arterial hypertension (PAH), according to a study published in CHEST. Researchers completed a systematic review and meta-analysis to report safety, efficacy, and therapeutic benefits of balloon atrial septostomy in patients with PAH. MEDLINE, Scopus, Cochrane Library, and Clinicaltrials.gov databases were searched for relevant articles that included hemodynamic and clinical outcomes before and after balloon atrial septostomy were performed. Data assessing mean arterial pressure, arterial oxygen saturation, cardiac index, cardiac output, left atrial pressure, mean pulmonary artery pressure, mortality rates, and procedural complications were collected from articles. In total, 204 patients with PAH from 16 observational studies were included in this analysis. Women made up 73.1% of the study population with a mean age of 35.8 years. Overall, 50.6% had a history of syncope and 53.4% had right heart failure. In 9 studies, the researchers found that mean right atrial pressure was significantly reduced (mean difference, –2.77 mm Hg; 95% CI, –3.5 to –2.04; P <.001). In 14 studies, cardiac index was significantly increased (mean difference, 0.62 L/min/m²; 95% CI, 0.48-0.75; P <.001). Left atrial pressure was significantly reduced in 6 studies (mean difference, 1.86 mm Hg; 95% CI, 1.24-2.49; P <.001). In 16 studies, arterial oxygen saturation was significantly reduced (mean difference, –8.45%; 95% CI, –9.93 to –6.97; P <.001). In 15 studies, hypoxemia occurred in 3% of patients 48 hours after the procedure, and spontaneous septostomy closure occurred in 23.8% of patients in 9 studies. There was no significant change in mean pulmonary artery pressure as reported in 7 studies. Across all 16 studies, procedure-related mortality occurred in 4.8% of the patients by 48 hours, 14.6% of the patients within 30 days, and 37.7% of the patients in >30 days postprocedure. A few limitations of this analysis included that none of the studies incorporated a control group, the inability to control confounding variables, and the use of small sample size studies. "Short-term survival supports its [balloon atrial septostomy] consideration as a bridging procedure (ie, to lung transplantation) and longer-term survival may rival contemporary medical treatments in patients with advanced stages of this uniformly fatal disease," the researchers concluded. Disclosures: Dr Krasuski receives research funding from Actelion Pharmaceuticals and has served as an investigator for Edwards Lifesciences, as well as a member of the scientific advisory board for Ventripoint. Reference Khan MS, Memon MM, Amin E, et al. Use of balloon atrial septostomy in patients with advanced pulmonary arterial hypertension: a systematic review and meta-analysis [published online March 22, 2019]. CHEST. doi:10.1016/j.chest.2019.03.003  |
| Pulmonary Hypertension and Diabetes: Is There a Link? - Pulmonology Advisor Posted: 08 Apr 2019 12:00 AM PDT  For patients with type 1 and type 2 diabetes, the lung is often overlooked as a target organ, but there are many respiratory function abnormalities associated with diabetes, according to commentary published in Diabetes Metabolism Research and Review. Currently, the lung is not considered a potential target organ for diabetes. However, increasing evidence has linked diabetes with respiratory abnormalities including lung volumes, pulmonary diffusing capacity, control of ventilation, bronchomotor tone, and neuroadrenergic bronchial innervation. New evidence has also pointed toward a link between diabetes and pulmonary hypertension (PH). The researchers noted that patients with diabetes often have decreased lung volumes. Studies have shown that patients with diabetes have a 1.6-fold higher risk for restrictive lung function impairment compared with those who do not have diabetes. Lung function impairment erodes the pulmonary reserve and can lead to repeated respiratory infections, chronic hypoxia, and volume overload. Other studies have shown that PH is more common among those with diabetes compared with those without. Additionally, patients with diabetes and chronic obstructive pulmonary disease have significantly higher mean pulmonary arterial pressure compared with patients who have chronic obstructive pulmonary disease alone. Patients with diabetes have related abnormalities that the researchers believe can contribute to PH. Patients with diabetes have significantly thicker epithelial and capillary basal laminas of the alveoli as well as thicker basal laminas in renal tubules and muscle capillaries. Autonomic neuropathy may worsen the inflammatory status of the lung. Additionally, hyperglycemia among patients with diabetes upregulates profibrotic mediators. "By the moment, there is matter to conclude that fighting [metabolic syndrome] and diabetes would not only prevent major and well recognized complications such as visual loss or renal failure, but also might improve the lung function reserve and smooth the increase in pulmonary artery pressure, whichever is its primary cause," the researchers wrote. Reference Fuso L, Pitocco D, Incalzi RA. Diabetic lung, an underrated complication from restrictive functional pattern to pulmonary hypertension [published online March 25, 2019]. Diabetes Metab Res Rev. doi: 10.1002/dmrr.3159  |
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