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
Hauptverfasser: 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
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container_issue 4
container_start_page 817
container_title European journal of heart failure
container_volume 26
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
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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 &lt; 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 &amp; 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 &lt; 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 &amp; 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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 &lt; 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 &amp; 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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