Right heart failure as a cause of pulmonary congestion in pulmonary arterial hypertension
Aims Recent studies have shown that lung ultrasound‐assessed pulmonary congestion is worse in heart failure when pulmonary vascular resistance (PVR) is increased, suggesting a paradoxical relationship between right heart failure and increased lung water content. Accordingly, we wondered if lung ultr...
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Veröffentlicht in: | European journal of heart failure 2024-04, Vol.26 (4), p.817-824 |
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creator | D'Alto, Michele Di Maio, Marco Argiento, Paola Romeo, Emanuele Rea, Gaetano Liccardo, Biagio Del Giudice, Carmen Vergara, Andrea Caiazza, Eleonora Del Vecchio, Gerardo Elia Di Vilio, Alessandro Gargani, Luna D'Andrea, Antonello Bossone, Eduardo Golino, Paolo Picano, Eugenio Naeije, Robert |
description | Aims
Recent studies have shown that lung ultrasound‐assessed pulmonary congestion is worse in heart failure when pulmonary vascular resistance (PVR) is increased, suggesting a paradoxical relationship between right heart failure and increased lung water content. Accordingly, we wondered if lung ultrasound would reveal otherwise clinically silent pulmonary congestion in patients with pulmonary arterial hypertension (PAH).
Methods and results
All patients referred for suspicion of PAH in a tertiary centre from January 2020 to December 2022 underwent a complete diagnostic work‐up including echocardiography, lung ultrasound and right heart catheterization. Pulmonary congestion was identified by lung ultrasound B‐lines using an 8‐site scan. The study enrolled 102 patients with idiopathic PAH (mean age 53 ± 13 years; 71% female). World Health Organization functional classes I, II, and III were found in 2%, 52%, and 46% of them, respectively. N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) was 377 pg/ml (interquartile range [IQR] 218–906). B‐lines were identified in 77 out of 102 patients (75%), with a median of 3 [IQR 1–5]. At univariable analysis, B‐lines were positively correlated with male sex, age, NT‐proBNP, systolic pulmonary artery pressure (sPAP), right atrial pressure (RAP), PVR, left ventricular end‐diastolic volume and tricuspid annular plane systolic excursion (TAPSE), and negatively with cardiac output and stroke volume. At multivariable analysis, RAP (p |
doi_str_mv | 10.1002/ejhf.3172 |
format | Article |
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Recent studies have shown that lung ultrasound‐assessed pulmonary congestion is worse in heart failure when pulmonary vascular resistance (PVR) is increased, suggesting a paradoxical relationship between right heart failure and increased lung water content. Accordingly, we wondered if lung ultrasound would reveal otherwise clinically silent pulmonary congestion in patients with pulmonary arterial hypertension (PAH).
Methods and results
All patients referred for suspicion of PAH in a tertiary centre from January 2020 to December 2022 underwent a complete diagnostic work‐up including echocardiography, lung ultrasound and right heart catheterization. Pulmonary congestion was identified by lung ultrasound B‐lines using an 8‐site scan. The study enrolled 102 patients with idiopathic PAH (mean age 53 ± 13 years; 71% female). World Health Organization functional classes I, II, and III were found in 2%, 52%, and 46% of them, respectively. N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) was 377 pg/ml (interquartile range [IQR] 218–906). B‐lines were identified in 77 out of 102 patients (75%), with a median of 3 [IQR 1–5]. At univariable analysis, B‐lines were positively correlated with male sex, age, NT‐proBNP, systolic pulmonary artery pressure (sPAP), right atrial pressure (RAP), PVR, left ventricular end‐diastolic volume and tricuspid annular plane systolic excursion (TAPSE), and negatively with cardiac output and stroke volume. At multivariable analysis, RAP (p < 0.001), TAPSE/sPAP (p = 0.001), and NT‐proBNP (p = 0.04) were independent predictors of B‐lines.
Conclusion
Lung ultrasound commonly discloses pulmonary congestion in PAH. This finding is related to right ventricular to pulmonary artery uncoupling, and may tentatively be explained by increased central venous pressure impeding lymphatic outflow.
Increased mean pulmonary artery pressure (mPAP) in pulmonary arterial hypertension (PAH) may be a cause of increased right atrial pressure (RAP) on right ventricular to pulmonary artery (RV‐PA) uncoupling, which indirectly would impair lung lymphatic drainage into the left jugular‐subclavian confluent, resulting in creased lung water content detected by increased B‐lines at lung ultrasound. CI, cardiac index; FC, functional class; IQR, interquartile range; NT‐proBNP, N‐terminal pro‐brain natriuretic peptide; PVR, pulmonary vascular resistance; sPAP, systolic pulmonary artery pressure; TAPSE, tricuspid annular plane systolic excursion; WHO, World Health Organization.</description><identifier>ISSN: 1388-9842</identifier><identifier>EISSN: 1879-0844</identifier><identifier>DOI: 10.1002/ejhf.3172</identifier><identifier>PMID: 38404257</identifier><language>eng</language><publisher>Oxford, UK: John Wiley & Sons, Ltd</publisher><subject>Echocardiography ; Lung ultrasound ; Pulmonary arterial hypertension ; Pulmonary congestion ; Right heart catheterization ; Right heart failure</subject><ispartof>European journal of heart failure, 2024-04, Vol.26 (4), p.817-824</ispartof><rights>2024 European Society of Cardiology.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3252-b8f6f8a05e70df249cf42acaacfb82732c8354f26652de885b43e6589ad00dc13</citedby><cites>FETCH-LOGICAL-c3252-b8f6f8a05e70df249cf42acaacfb82732c8354f26652de885b43e6589ad00dc13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fejhf.3172$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fejhf.3172$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38404257$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>D'Alto, Michele</creatorcontrib><creatorcontrib>Di Maio, Marco</creatorcontrib><creatorcontrib>Argiento, Paola</creatorcontrib><creatorcontrib>Romeo, Emanuele</creatorcontrib><creatorcontrib>Rea, Gaetano</creatorcontrib><creatorcontrib>Liccardo, Biagio</creatorcontrib><creatorcontrib>Del Giudice, Carmen</creatorcontrib><creatorcontrib>Vergara, Andrea</creatorcontrib><creatorcontrib>Caiazza, Eleonora</creatorcontrib><creatorcontrib>Del Vecchio, Gerardo Elia</creatorcontrib><creatorcontrib>Di Vilio, Alessandro</creatorcontrib><creatorcontrib>Gargani, Luna</creatorcontrib><creatorcontrib>D'Andrea, Antonello</creatorcontrib><creatorcontrib>Bossone, Eduardo</creatorcontrib><creatorcontrib>Golino, Paolo</creatorcontrib><creatorcontrib>Picano, Eugenio</creatorcontrib><creatorcontrib>Naeije, Robert</creatorcontrib><title>Right heart failure as a cause of pulmonary congestion in pulmonary arterial hypertension</title><title>European journal of heart failure</title><addtitle>Eur J Heart Fail</addtitle><description>Aims
Recent studies have shown that lung ultrasound‐assessed pulmonary congestion is worse in heart failure when pulmonary vascular resistance (PVR) is increased, suggesting a paradoxical relationship between right heart failure and increased lung water content. Accordingly, we wondered if lung ultrasound would reveal otherwise clinically silent pulmonary congestion in patients with pulmonary arterial hypertension (PAH).
Methods and results
All patients referred for suspicion of PAH in a tertiary centre from January 2020 to December 2022 underwent a complete diagnostic work‐up including echocardiography, lung ultrasound and right heart catheterization. Pulmonary congestion was identified by lung ultrasound B‐lines using an 8‐site scan. The study enrolled 102 patients with idiopathic PAH (mean age 53 ± 13 years; 71% female). World Health Organization functional classes I, II, and III were found in 2%, 52%, and 46% of them, respectively. N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) was 377 pg/ml (interquartile range [IQR] 218–906). B‐lines were identified in 77 out of 102 patients (75%), with a median of 3 [IQR 1–5]. At univariable analysis, B‐lines were positively correlated with male sex, age, NT‐proBNP, systolic pulmonary artery pressure (sPAP), right atrial pressure (RAP), PVR, left ventricular end‐diastolic volume and tricuspid annular plane systolic excursion (TAPSE), and negatively with cardiac output and stroke volume. At multivariable analysis, RAP (p < 0.001), TAPSE/sPAP (p = 0.001), and NT‐proBNP (p = 0.04) were independent predictors of B‐lines.
Conclusion
Lung ultrasound commonly discloses pulmonary congestion in PAH. This finding is related to right ventricular to pulmonary artery uncoupling, and may tentatively be explained by increased central venous pressure impeding lymphatic outflow.
Increased mean pulmonary artery pressure (mPAP) in pulmonary arterial hypertension (PAH) may be a cause of increased right atrial pressure (RAP) on right ventricular to pulmonary artery (RV‐PA) uncoupling, which indirectly would impair lung lymphatic drainage into the left jugular‐subclavian confluent, resulting in creased lung water content detected by increased B‐lines at lung ultrasound. CI, cardiac index; FC, functional class; IQR, interquartile range; NT‐proBNP, N‐terminal pro‐brain natriuretic peptide; PVR, pulmonary vascular resistance; sPAP, systolic pulmonary artery pressure; TAPSE, tricuspid annular plane systolic excursion; WHO, World Health Organization.</description><subject>Echocardiography</subject><subject>Lung ultrasound</subject><subject>Pulmonary arterial hypertension</subject><subject>Pulmonary congestion</subject><subject>Right heart catheterization</subject><subject>Right heart failure</subject><issn>1388-9842</issn><issn>1879-0844</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNp1kE1LAzEQhoMotlYP_gHJUQ_bZvOxmz1Kaa1SEEQPnkI2O-mm7EfddJH-e1NbxYunGYZnHmZehK5jMo4JoRNYl3bM4pSeoGEs0ywikvPT0DMpo0xyOkAX3q8JidOAn6MBk5xwKtIhen9xq3KLS9DdFlvtqr4DrD3W2OjeA24t3vRV3Ta622HTNivwW9c22DV_5mEXOqcrXO42EPrGB-QSnVldebg61hF6m89ep4to-fzwOL1fRoZRQaNc2sRKTQSkpLCUZ8Zyqo3WxuaSpowayQS3NEkELUBKkXMGiZCZLggpTMxG6Pbg3XTtRx_OU7XzBqpKN9D2XtGMUUKFECSgdwfUdK33HVi16VwdPlAxUfsk1T5JtU8ysDdHbZ_XUPySP9EFYHIAPl0Fu_9Nava0mH8rvwDiv369</recordid><startdate>202404</startdate><enddate>202404</enddate><creator>D'Alto, Michele</creator><creator>Di Maio, Marco</creator><creator>Argiento, Paola</creator><creator>Romeo, Emanuele</creator><creator>Rea, Gaetano</creator><creator>Liccardo, Biagio</creator><creator>Del Giudice, Carmen</creator><creator>Vergara, Andrea</creator><creator>Caiazza, Eleonora</creator><creator>Del Vecchio, Gerardo Elia</creator><creator>Di Vilio, Alessandro</creator><creator>Gargani, Luna</creator><creator>D'Andrea, Antonello</creator><creator>Bossone, Eduardo</creator><creator>Golino, Paolo</creator><creator>Picano, Eugenio</creator><creator>Naeije, Robert</creator><general>John Wiley & Sons, Ltd</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202404</creationdate><title>Right heart failure as a cause of pulmonary congestion in pulmonary arterial hypertension</title><author>D'Alto, Michele ; Di Maio, Marco ; Argiento, Paola ; Romeo, Emanuele ; Rea, Gaetano ; Liccardo, Biagio ; Del Giudice, Carmen ; Vergara, Andrea ; Caiazza, Eleonora ; Del Vecchio, Gerardo Elia ; Di Vilio, Alessandro ; Gargani, Luna ; D'Andrea, Antonello ; Bossone, Eduardo ; Golino, Paolo ; Picano, Eugenio ; Naeije, Robert</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3252-b8f6f8a05e70df249cf42acaacfb82732c8354f26652de885b43e6589ad00dc13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Echocardiography</topic><topic>Lung ultrasound</topic><topic>Pulmonary arterial hypertension</topic><topic>Pulmonary congestion</topic><topic>Right heart catheterization</topic><topic>Right heart failure</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>D'Alto, Michele</creatorcontrib><creatorcontrib>Di Maio, Marco</creatorcontrib><creatorcontrib>Argiento, Paola</creatorcontrib><creatorcontrib>Romeo, Emanuele</creatorcontrib><creatorcontrib>Rea, Gaetano</creatorcontrib><creatorcontrib>Liccardo, Biagio</creatorcontrib><creatorcontrib>Del Giudice, Carmen</creatorcontrib><creatorcontrib>Vergara, Andrea</creatorcontrib><creatorcontrib>Caiazza, Eleonora</creatorcontrib><creatorcontrib>Del Vecchio, Gerardo Elia</creatorcontrib><creatorcontrib>Di Vilio, Alessandro</creatorcontrib><creatorcontrib>Gargani, Luna</creatorcontrib><creatorcontrib>D'Andrea, Antonello</creatorcontrib><creatorcontrib>Bossone, Eduardo</creatorcontrib><creatorcontrib>Golino, Paolo</creatorcontrib><creatorcontrib>Picano, Eugenio</creatorcontrib><creatorcontrib>Naeije, Robert</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of heart failure</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>D'Alto, Michele</au><au>Di Maio, Marco</au><au>Argiento, Paola</au><au>Romeo, Emanuele</au><au>Rea, Gaetano</au><au>Liccardo, Biagio</au><au>Del Giudice, Carmen</au><au>Vergara, Andrea</au><au>Caiazza, Eleonora</au><au>Del Vecchio, Gerardo Elia</au><au>Di Vilio, Alessandro</au><au>Gargani, Luna</au><au>D'Andrea, Antonello</au><au>Bossone, Eduardo</au><au>Golino, Paolo</au><au>Picano, Eugenio</au><au>Naeije, Robert</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Right heart failure as a cause of pulmonary congestion in pulmonary arterial hypertension</atitle><jtitle>European journal of heart failure</jtitle><addtitle>Eur J Heart Fail</addtitle><date>2024-04</date><risdate>2024</risdate><volume>26</volume><issue>4</issue><spage>817</spage><epage>824</epage><pages>817-824</pages><issn>1388-9842</issn><eissn>1879-0844</eissn><abstract>Aims
Recent studies have shown that lung ultrasound‐assessed pulmonary congestion is worse in heart failure when pulmonary vascular resistance (PVR) is increased, suggesting a paradoxical relationship between right heart failure and increased lung water content. Accordingly, we wondered if lung ultrasound would reveal otherwise clinically silent pulmonary congestion in patients with pulmonary arterial hypertension (PAH).
Methods and results
All patients referred for suspicion of PAH in a tertiary centre from January 2020 to December 2022 underwent a complete diagnostic work‐up including echocardiography, lung ultrasound and right heart catheterization. Pulmonary congestion was identified by lung ultrasound B‐lines using an 8‐site scan. The study enrolled 102 patients with idiopathic PAH (mean age 53 ± 13 years; 71% female). World Health Organization functional classes I, II, and III were found in 2%, 52%, and 46% of them, respectively. N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) was 377 pg/ml (interquartile range [IQR] 218–906). B‐lines were identified in 77 out of 102 patients (75%), with a median of 3 [IQR 1–5]. At univariable analysis, B‐lines were positively correlated with male sex, age, NT‐proBNP, systolic pulmonary artery pressure (sPAP), right atrial pressure (RAP), PVR, left ventricular end‐diastolic volume and tricuspid annular plane systolic excursion (TAPSE), and negatively with cardiac output and stroke volume. At multivariable analysis, RAP (p < 0.001), TAPSE/sPAP (p = 0.001), and NT‐proBNP (p = 0.04) were independent predictors of B‐lines.
Conclusion
Lung ultrasound commonly discloses pulmonary congestion in PAH. This finding is related to right ventricular to pulmonary artery uncoupling, and may tentatively be explained by increased central venous pressure impeding lymphatic outflow.
Increased mean pulmonary artery pressure (mPAP) in pulmonary arterial hypertension (PAH) may be a cause of increased right atrial pressure (RAP) on right ventricular to pulmonary artery (RV‐PA) uncoupling, which indirectly would impair lung lymphatic drainage into the left jugular‐subclavian confluent, resulting in creased lung water content detected by increased B‐lines at lung ultrasound. CI, cardiac index; FC, functional class; IQR, interquartile range; NT‐proBNP, N‐terminal pro‐brain natriuretic peptide; PVR, pulmonary vascular resistance; sPAP, systolic pulmonary artery pressure; TAPSE, tricuspid annular plane systolic excursion; WHO, World Health Organization.</abstract><cop>Oxford, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>38404257</pmid><doi>10.1002/ejhf.3172</doi><tpages>8</tpages></addata></record> |
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source | Wiley Online Library Journals Frontfile Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
subjects | Echocardiography Lung ultrasound Pulmonary arterial hypertension Pulmonary congestion Right heart catheterization Right heart failure |
title | Right heart failure as a cause of pulmonary congestion in pulmonary arterial hypertension |
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