Pulmonary Circulation最新文献

Pulmonary endarterectomy (PEA) is a highly effective treatment for chronic thromboembolic pulmonary hypertension (CTEPH). However, persistent or recurrent pulmonary hypertension (persistent/recurrent PH) following surgery can adversely impact patients' outcomes. This study investigated the predictive value of preoperative SPECT ventilation/perfusion (V/Q) imaging for post-PEA persistent/recurrent PH. Between 2016 and 2022, CTEPH patients at our hospital underwent PEA after right heart catheterization (RHC) and SPECT V/Q imaging and were followed for 2 years. Postoperative mean pulmonary artery pressure (mPAP) ≥ 25 mmHg indicates persistent/recurrent PH. Correlations were explored between the occurrence of postoperative persistent/recurrent PH and preoperative parameters, including systolic pulmonary artery pressure (sPAP), mPAP, pulmonary vascular resistance (PVR), and parameters of the SPECT V/Q scan. Seventy-four patients were enrolled, including 52 males (71.6%). Seventeen patients (23%) developed persistent/recurrent PH within 2-80 weeks after surgery. The persistent/recurrent PH and non-persistent/recurrent PH groups exhibited statistically significant preoperative differences in preoperative mPAP, sPAP, PVR, Begic's score, and V/Q mismatched volume percentage (p < 0.05 for all). ROC curve analysis identified the optimal cut-off values: mPAP-44.5 mmHg, sPAP-79.5 mmHg, PVR-944 dyn × s × cm^-5, Begic's score-16.5, and V/Q mismatched percentage-35.58%. Cox regression analysis showed that preoperative mPAP and V/Q mismatched percentage were significant predictors of persistent/recurrent PH-free survival time, with relative hazards of 3.29 (95% CI: 1.08-10.01) (p = 0.036) and 3.94 (95% CI: 1.25-12.42) (p = 0.019), respectively. These findings indicate that metrics derived from SPECT V/Q scans can effectively stratify post-PEA patients by the risk of persistent/recurrent PH. Quantitative parameters could provide complementary information that enhances predictive accuracy of postoperative persistent/recurrent PH at the individual level. This may support the optimization of clinical management strategies, particularly by guiding patient-specific therapeutic interventions, such as balloon pulmonary angioplasty for patients with persistent/recurrent PH after PEA.

Right ventricular (RV) dysfunction is a critical yet often underrecognized determinant of prognosis in patients with advanced interstitial lung disease (ILD) undergoing lung transplant evaluation. The tricuspid annular plane systolic excursion to pulmonary arterial systolic pressure (TAPSE/PASP) ratio has emerged as a promising noninvasive echocardiographic surrogate of RV-pulmonary arterial (RV-PA) coupling, offering a dynamic estimate of RV function relative to afterload. In this single-center retrospective cohort study, we assessed the prognostic association of the TAPSE/PASP ratio in 65 lung transplant candidates with advanced ILD. All patients underwent comprehensive transthoracic echocardiography and right heart catheterization as part of pre-transplant evaluation. The primary endpoint was a composite of all-cause mortality or lung transplantation. Over a median follow-up of 24 months, 33 patients (50.8%) reached this endpoint. Receiver operating characteristic (ROC) curve analysis identified an optimal TAPSE/PASP cutoff value of 0.55 (AUC: 0.763, p < 0.001), with a sensitivity of 70% and specificity of 75% for predicting adverse outcomes. Patients with TAPSE/PASp < 0.55 exhibited significantly worse transplant-free survival (log-rank p = 0.0057), more pronounced RV structural and functional impairment, and elevated pulmonary vascular resistance. In multivariable Cox regression analysis, TAPSE/PASP was the sole independent predictor of the primary outcome (HR: 0.09, p = 0.01). These findings suggest that the TAPSE/PASP ratio may constitute a feasible and reproducible noninvasive surrogate of RV-pulmonary arterial uncoupling and could facilitate the identification of high-risk individuals among lung transplant candidates with advanced interstitial lung disease. However, in light of the retrospective and single-center nature of this study, the results should be interpreted with caution as hypothesis-generating, and further validation in large-scale, prospective, multicenter cohorts is warranted.

The resistance-compliance (RC) relationship between pulmonary vascular resistance (PVR) and pulmonary arterial compliance (PAC) provides an integrative measure of global right ventricular (RV) afterload. However, debate persists regarding the clinical utility of PAC calculated using the empiric formula (PAC_empiric), and the ideal method for calculating PAC. We analysed haemodynamic and pulmonary pressure waveform data from 156 patients with pulmonary hypertension (PH). PAC was calculated using three methods: PAC_empiric, as well as two established waveform analysis methods, area-under-the-curve (PAC_AUC), and diastolic decay (PAC_DD). Generalized linear mixed models were used to evaluate the relationship between PVR and PAC across these three methods. Model performance was assessed using Akaike and Bayesian Information Criteria (AIC/BIC). The diagnostic performance of each method was evaluated using ROC analysis. Cox regression was applied to assess the association with long term mortality. All three PAC methods demonstrated a strong inverse hyperbolic correlation with PVR. PAC_empiric provided stronger model performance (AIC -504.3; R² = 0.968), and best discriminated PH subtypes (AUC = 0.91), outperforming PAC_AUC (AUC = 0.88) and PAC_DD (AUC = 0.75). PAC_empiric was also a stronger predictor of mortality than PAC_AUC, PAC_DD or PVR (c-statistic = 0.747, compared to 0.737, 0.709 and 0.741 respectively). PAC_empiric is a robust and accessible method for assessing the pulsatile component of RV loading. This study supports its use as a physiologically meaningful parameter that together with PVR provides a comprehensive estimation of global RV afterload.

Current in vivo imaging techniques for cardiopulmonary vascular evaluation in Sprague-Dawley (SD) rats face limitations, including structural disruption, inadequate contrast filling, and invasiveness. This study developed a reliable, minimally invasive computed tomography angiography (CTA) technique via jugular vein catheterization for enhanced cardiopulmonary vascular imaging in live SD rats. Jugular vein catheterization was performed in 22 anesthetized healthy male SD rats (320-480 g), followed by dual-source CT angiography with iopamidol contrast. Three-dimensional vascular reconstruction was performed, and pulmonary artery width alongside left and right ventricular diameters was measured. CT-derived measurements were compared with ultrasound data using Bland-Altman analysis. CTA achieved clear visualization of pulmonary arteries, cardiac chambers, and aortic structures, demonstrating complete contrast filling and anatomical detail. Three-dimensional reconstructions precisely delineated mediastinal and vascular relationships. Pulmonary artery widths measured by CT and ultrasound showed strong agreement (p > 0.05), validating reliability. Jugular catheterization enabled stable contrast delivery with minimal trauma. Jugular vein catheterization combined with CT angiography provides a safe, accurate, and minimally invasive method for in vivo cardiopulmonary vascular imaging in SD rats. This technique offers high anatomical resolution, compatibility with hemodynamic assessments, and reduced experimental trauma, establishing this approach as a valuable tool for cardiopulmonary disease model research. CT-derived measurements were compared with ultrasound data using Bland-Altman analysis. CTA achieved clear visualization of cardiac chambers and pulmonary arteries, demonstrating complete contrast filling and anatomical detail. Three-dimensional reconstructions precisely delineated mediastinal and vascular relationships. Pulmonary artery widths measured by CT and ultrasound showed strong agreement (p > 0.05), validating reliability. Jugular catheterization enabled stable contrast delivery with minimal trauma. Jugular vein catheterization combined with CT angiography provides a safe, accurate, and minimally invasive method for in vivo cardiopulmonary vascular imaging in SD rats. This technique offers high anatomical resolution, compatibility with hemodynamic assessments, and reduced experimental trauma, establishing this approach as a valuable tool for cardiopulmonary disease model research.

This letter to the editor revisits the origins of high-dose calcium channel blocker use in pulmonary arterial hypertension (PAH) in light of bedside vasoreactivity testing, reaffirming its present-day relevance for a selected subgroup. Integrating historical insights with modern tools, the authors highlight: the "responder" phenotype as an expression of precision medicine; ion channels as pathobiological targets; the value of real-world registries and benchmarks for high-quality care pathways; attention to special contexts (interstitial lung disease in connective-tissue diseases, and sex differences in diastolic dysfunction/HFpEF). In sum, we propose a personalized approach that pairs careful high-dose titration in appropriate candidates with molecular phenotyping and standardized follow-up.