EDITORIAL | |
1. | Editorial Saide Aytekin, Meral Kayıkçıoğlu, Mehmet Akbulut PMID: 37861267 Page 439 Abstract | |
ORIGINAL ARTICLE | |
2. | Bendopnea Predicts Right Ventricular Energy Failure in Patients with Pulmonary Hypertension Dursun Akaslan, Emre Aslanger, Chasan İsmail Basa, Ruken Kübra Öztürk, Halil Ataş, Bülent Mutlu PMID: 37861252 doi: 10.5543/tkda.2023.47077 Pages 440 - 446 Objective: The development of right ventricular failure has a significant adverse prognostic impact on the course of pulmonary hypertension. Right ventricular energy failure has been shown to double the mortality of pulmonary hypertension even after correction for many established risk predictors. We hypothesize that bendopnea may indicate right ventricular energy failure in patients with pulmonary hypertension. Methods: We prospectively enrolled patients with pulmonary hypertension who were admitted to our pulmonary hypertension outpatient clinic between January 2021 and June 2021. Bendopnea was assessed by asking patients to bend forward and report any shortness of breath within 30 seconds. Routine physical examination, laboratory tests, echocardiography, and right heart catheterization parameters were collected. Results: A total of 167 patients were enrolled into the study. Bendopnea and right ventricular energy failure was present in 79 (47.3%) and 43 (25.7%) patients, respectively. Bendopnea accurately predicted the presence of right ventricular energy failure (area under the curve, 0.667; 95% CI, 0.574-0.760; P < 0.001) and had a significantly superior diagnostic power compared with many other symptoms and signs. Conclusions: Our study shows that bendopnea predicts right ventricular energy failure in patients with pulmonary hypertension and can be added to our physical examination armamentarium as an easy, rapid, and noninvasive prognostic tool. |
3. | Hoarseness as a Predictor for Pulmonary Arterial Aneurysm and Extrinsic Left Main Coronary Artery Compression in Patients with Severe Pulmonary Hypertension Hacer Ceren Tokgöz, Seda Tanyeri, Ahmet Sekban, Aykun Hakgör, Barkın Kültürsay, Berhan Keskin, Ali Karagöz, Ayhan Tosun, Çağdaş Buluş, Şeyhmus Külahçıoğlu, İbrahim Halil Tanboğa, Nihal Özdemir, Cihangir Kaymaz PMID: 37861257 doi: 10.5543/tkda.2023.63828 Pages 447 - 453 Objective: Pulmonary artery (PA) enlargement is a common finding in patients with severe pulmonary hypertension (PH) and may be associated with extrinsic compression of the left main coronary artery (LMCA-Co) and/or compression of the left recurrent laryngeal nerve resulting in hoarseness named as Ortner syndrome (OS). In this study, we evaluated the diagnostic impact of OS in predicting the PA aneurysm and significant LMCA-Co in patients with PH. Methods: Our study population comprised retrospectively evaluated 865 with PH confirmed with the right heart catheterization between 2006 and 2022. Patients underwent coronary angiography due to several indications, including the presence of a PA aneurysm on echocardiography, angina symptoms, or the incidental discovery of LMCA-Co on multidetector computed tomography. The LMCA-Co is defined as diameter stenosis ³ 50% in reference distal LMCA segment on two consecutive angiographic planes. Results: The LMCA-Co and hoarseness were documented in 3.8% and 4.3% of patients with PH, respectively. Increasing PA diameter was significantly associated with worse clinical, hemodynamic, laboratory, and echocardiographic parameters. The receiver operating curves revealed that the PA diameter >41 mm was cutoff for hoarseness (AUC: 0.834; sensitivity 69%, specificity 84%, and negative predictive value 98%), and PA diameter >35 mm was cutoff for LMCA-Co >50% (AUC: 0.794; sensitivity 89%, specificity 58 %, and negative predictive value 99%). An odds ratio of hoarseness for LMCA-Co was 83.3 (95% confidence interval; 36.5–190, P < 0.001) with 3.2% sensitivity, 98.7% specificity, and 59% positive and 98% negative predictive values. Conclusion: In this study, a close relationship was found between the presence of hoarseness and the probability of extrinsic LMCA-Co by enlarged PA in patients with severe PH. Therefore, the risk of LMCA-Co should be taken into account in patients with PH suffering from hoarseness. |
4. | Could Heart Rate Variability Serve as a Prognostic Factor in Patients with Pulmonary Hypertension? A Single-center Pilot Study Ogtay Musayev, Meral Kayıkçıoğlu, Shafa Shahbazova, Sanem Nalbantgil, Nesrin Moğulkoç, Firdovsi Ibrahimov, Hakan Kültürsay PMID: 37861265 doi: 10.5543/tkda.2023.27078 Pages 454 - 463 Objective: Heart rate variability (HRV), which is defined as cyclic changes in sinus rate with time, is used as a measure of cardiac autonomic tone. Our aim was to determine the impact of HRV on short-term prognosis in pulmonary hypertension (PH). Methods: We enrolled 64 PH patients and 69 healthy subjects (control group). Patients were evaluated by Holter-ECG, echocardiography, and laboratory tests. 24-h Holter-ECG monitoring was used for HRV. The development of adverse events (right heart failure, hospitalization, syncope, and death) during the 6-month follow-up was evaluated in PH group. Results: PH group (39 ± 16 years, 37.5% males) comprised of 16 patients with idiopathic pulmonary arterial hypertension (PAH) (25%), 36 patients with PAH associated with congenital heart disease (56.3%), 3 PAH associated with connective tissue disease (4.7%), 1 with portopulmonary (1.6%), and 8 chronic thromboembolic PH (12.5%). The time-dependent (standard deviation of all NN intervals for a selected time period [SDNN], standard deviation of the 5-min mean R–R intervals tabulated over an entire day [SDANN], SDNN Index, and Triangular Index) and frequency-dependent HRV indices (low frequency, high-frequency power, and total power,) were significantly reduced in those with PH. Functional class was negatively associated with SDNN, SDANN, SDNN Index, and Triangular Index. Adverse events developed in 25% of the patients during the 6-month follow-up period (200 ± 92 days) (7 patients had right-heart failure, 5 syncope, 12 patients were hospitalized, and 9 had died). All the time and frequency-dependent indices significantly associated with adverse events. Mortality correlated with SDNN (rS = −0.354, P = 0.005), SDANN (rS = −0.368, P = 0.004), SDNN Index (rS = −0.257, P = 0.045), Triangular Index (rS = −0.310, P = 0.014), and VLF (rS = −0.265, P = 0.039). Conclusion: HRV is significantly depressed in patients with PH and is associated with the clinical status. HRV indices might predict clinical deterioration, adverse events, and mortality for 6 months. Non-invasive assessment of HRV through Holter-ECG may be a valuable and practical tool in risk stratification of patients with PH for short-term outcomes. |
5. | The Relationship of Systolic Pulmonary Artery Pressure with Perioperative Mortality and Morbidity in Patients Undergoing Non-Cardiac Surgery: A Single-Center Experience Betül Cengiz Elçioglu, Erol Gürsoy, Fusun Helvacı, Nihal Tefik, Onur Baydar, Alparslan Kılıç, Yasemin Demirci, Gamze Aslan, Ece Yurtseven, Vedat Aytekin, Saide Aytekin PMID: 37861256 doi: 10.5543/tkda.2023.60670 Pages 464 - 469 Objective: Pulmonary hypertension (PH) is associated with adverse perioperative events in patients undergoing non-cardiac surgery. In this study, we aimed to investigate the relationship between systolic pulmonary artery pressure (sPAP), evaluated by transthoracic echocardiography (TTE) before surgery, and perioperative mortality and morbidity in patients who underwent non-cardiac surgery in our center. Methods: Of the 3425 retrospectively screened patients who underwent non-cardiac surgery, 3049 patients whose estimated sPAP values were previously determined by TTE were included in the study. Patients were classified into 3 groups according to their estimated sPAP levels. sPAP <35 mmHg formed group 1, 35–39 mmHg group 2, and ≥ 40 mmHg group 3. All demographic and perioperative data obtained from the database of our institute were compared in three groups. Results: Of the 3049 patients enrolled in the study, 2406 (78.9%) were in group 1, 259 (8.5%) in group 2, and 384 (12.6%) in group 3. Thirty-day all-cause mortality was observed in 82 (2.7%) patients, cardiac mortality occurred in 9 patients (0.3%). In the group with sPAP ≥40 mmHg, cardiac mortality was 0.5% and all-cause mortality was 7.3%. Thirty-day all-cause mortality, acute pulmonary edema, and acute renal failure were significantly higher in group 3 than in the other groups. Cardiac mortality did not differ significantly between the groups. Age, sPAP value, and chronic obstructive pulmonary disease history were revealed as independent predictors of all-cause mortality in multivariate logistic regression analysis. Conclusion: In conclusion, increased sPAP is associated with adverse postoperative outcomes. The evaluation of sPAP with TTE before non-cardiac surgery in patients whose clinical features and examination findings suggest PH may contribute to preoperative risk assessment. |
6. | The Usefulness of the TAPSE/sPAP Ratio for Predicting Survival in Medically Treated Chronic Thromboembolic Pulmonary Hypertension Ayşe Çolak, Zeynep Kumral, Mehmet Kış, Bihter Şentürk, Dilek Sezgin, Gökçen Ömeroğlu Şimşek, Can Sevinç, Bahri Akdeniz PMID: 37861261 doi: 10.5543/tkda.2023.78074 Pages 470 - 477 Objective: The ventriculoarterial uncoupling has been linked with unfavorable results as measured noninvasively by tricuspid annular plane systolic excursion divided by systolic pulmonary artery pressure (TAPSE/sPAP). However, its prognostic importance in chronic thromboembolic pulmonary hypertension (CTEPH) is limited. Thus, we determine the effect of the TAPSE/sPAP ratio on outcomes and predictors of all-cause mortality in these patients. Methods: We analyzed 56 subjects with medically treated CTEPH. Two-dimensional echocardiographic examination and right heart catheterization findings were recorded from the hospital database. Baseline New York Heart Association functional class (NYHA-FC), 6-min walk distance (6MWD), and brain natriuretic peptide (BNP) test results were recorded. Results: The median age was 65.5 years. Over a median follow-up time of 27 months, 29 (51.8%) patients died. BNP values were higher (P = 0.008), 6MWD values were lower (P = 0.004), and NHYA-FC (P = 0.0001) was worse in the non-survivor group. TAPSE (P = 0.0001) and TAPSE/sPAP ratio (P = 0.001) were significantly lower and pulmonary vascular resistance (PVR) was higher in the non-survivor group (P = 0.03). The best cut-off value for the TAPSE/sPAP ratio for predicting mortality was 0.20 mm/mmHg and the survival rates were significantly lower in the TAPSE/sPAP ratio ≤0.20 group (log-rank P = 0.012). 6MWD (P = 0.005), NHYA-FC III-IV (P = 0.0001), TAPSE/sPAP ratio ≤0.20 (P = 0.017), PVR (P = 0.008), and TAPSE/sPAP ratio ≤0.20 combined with NYHA-FC III-IV (P = 0.0001) were significant determinants and TAPSE/sPAP ratio ≤0.20 combined with NYHA-FC III-IV was the only independent predictor of mortality (P = 0.003). Conclusion: Medically treated CTEPH patients with a TAPSE/sPAP ratio ≤0.20 had lower survival rates. TAPSE/sPAP ratio≤0.20 combined with NYHA-FC III-IV was the independent predictor of poor prognosis. |
7. | Long-Term Natural Course of Patients with Pulmonary Artery Pressures in the Range of 21–24 mmHg: Insights from a Single-Center Study Burcu Yağmur, Meral Kayıkçıoğlu, Evrim Şimşek, Sanem Nalbantgil, Hakan Kültürsay PMID: 37861260 doi: 10.5543/tkda.2023.65724 Pages 478 - 485 Objective: Slightly elevated mean pulmonary artery pressure (mPAP) was previously termed as ‘’borderline pulmonary hypertension (PH)’’. We examined the long-term prognosis of patients with mPAP values between 21 and 24 mmHg, who were referred with the suspicion of pulmonary hypertension. Methods: Our retrospective study included patients with moderate-to-high echocardiographic risk who underwent right heart catheterization (RHC) between 2008 and 2021 and were followed for at least 1 year. Patients with mPAP <21 mmHg and mPAP 21–24 mmHg were compared. Demographic and clinical characteristics and prognoses of the groups were compared. All-cause mortality over a mean follow-up of 5 years (min 1–max 13 years) was evaluated. Results: A total of 140 patients (mean age 53.1 ± 14.8 years, female 74.5%) with mPAP values <25 mmHg measured of the 395 diagnostic RHCs. Mean follow-up was 4.92 ± 3.13 years. NT-pro-BNP and 6-min walking distance were better in patients with mPAP <21 mmHg. Echocardiographic findings suggestive of PH were more common in mPAP 21–24 mmHg group (P < 0.05). Both the pulmonary artery wedge pressure and cardiac index values were significantly deteriorated in individuals with mPAP 21–24 mmHg (P = 0.001). All-cause mortality tended to be higher in the borderline PH group but did not reach to statistical significance. Conclusion: Our single-center observational study revealed that the individuals with an mPAP of 21–24 mmHg tended to have a worser prognosis than those with mPAP of <21 mmHg for up to 13-year follow-up. |
LETTER TO EDITOR | |
8. | The Impact of the New Hemodynamic Definition on the Prevalence of Pre-Capillary Pulmonary Hypertension Ümit Yaşar Sinan, Kemal Engin, Mehmet Serdar Küçükoğlu PMID: 37861264 doi: 10.5543/tkda.2023.36866 Pages 486 - 487 Abstract | |
CASE REPORT | |
9. | A Breathtaking Case of Pulmonary Hypertension with Frightening Complications and Intertwining Different Etiologies Hidayet Ozan Arabacı, Aybike Gül Taşdelen, İdil Buğday, Attila Ülkücü, Ümit Yaşar Sinan, Bedrettin Yıldızeli, Mehmet Serdar Küçükoğlu PMID: 37861255 doi: 10.5543/tkda.2023.22477 Pages 488 - 492 Pulmonary hypertension (PH) is a major health problem with increasing awareness. Although most common cause of PH is left heart disease (Group 2 PH), life-threatening complications occur mostly in Group 1 (pulmonary arterial hypertension) and Group 4 (chronic thromboembolic PH) patients. Although external compression of the left main coronary artery (LMCA) due to pulmonary artery dilatation is rare, it is a life-threatening complication since it causes myocardial ischemia and sudden cardiac death. In addition, PH is more than a single clinical entity due to its complex mechanism in which more than one subgroup may develop over time in the same patient. This complex mechanism challenges us when diagnosing the patient and faces us with life-threatening complications. In this case; we report a pulmonary arterial hypertension patient applied to our clinic with progressive dyspnea and recent angina, after detection of LMCA ostial stenosis, the patient was treated with intravascular ultrasound-guided stent implantation. In the further follow-ups, the patient underwent the pulmonary endarterectomy operation due to the diagnosis of chronic thromboembolic pulmonary hypertension secondary to newly diagnosed primary antiphospholipid syndrome. |
10. | Pulmonary Hypertension Due to High-Output Heart Failure: Hereditary Hemorrhagic Telangiectasia Burçak Kılıçkıran Avcı, Ali Uğur Soysal, Emir Cerme, Osman Aykan Kargın, Ali İbrahim Hatemi, Muhlis Cem Ar, Zeki Öngen PMID: 37861254 doi: 10.5543/tkda.2023.13614 Pages 493 - 497 Pulmonary hypertension (PH) is a complex disorder that should be managed with a multidisciplinary approach. Although most of the underlying causes of left heart disease can be easily diagnosed with cardiac imaging, some pathologies might necessitate careful investigation to go beyond the obvious. High-output heart failure (HF) due to arteriovenous malformation (AVMs) is an unnoticeable cause for HF and PH. Patients with hepatic AVMs should always be carefully evaluated with regard to hereditary hemorrhagic telangiectasia (HHT) since they can have multiple signs related to the other systems without any symptoms. In this case report, we discussed a patient who was initially diagnosed as PH associated with HF with preserved ejection fraction but eventually was found to have PH associated with high-output HF due to hereditary hemorrhagic telangiectasia (HHT, or Osler Weber Rendu syndrome) after detailed evaluation. |
11. | Heritable Pulmonary Arterial Hypertension Diagnosed during the Postpartum Period: A Case Report and Literature Review Ayşe Çolak, Zeynep Kumral, Ebru Özpelit, Bahri Akdeniz PMID: 37861253 doi: 10.5543/tkda.2023.92263 Pages 498 - 501 Approximately one-third of bone morphogenic protein receptor-2 (BMPR2) mutation carriers develop pulmonary arterial hypertension (PAH), which indicates that additional risk factors are needed for the manifestation of the disease. It is questionable whether pregnancy is a risk factor for PAH development in these patients. We represent a 30-year-old woman with a heterozygous BMPR2 mutation who was diagnosed with PAH during the postpartum period and reviewed the literature in this report. We also discussed the possible underlying mechanisms that might have resulted in PAH development during pregnancy in BMPR2 mutation carriers. |
12. | Evaluation of Pulmonary Hypertension with Exercise Right Heart Catheterization in an Adult Patient with Cor Triatriatum Sinister Emre Aslanger, Dursun Akaslan, Hatice Kaya, Ahmet Cem Nizam, Redwan Seid Busery, Bülent Mutlu PMID: 37861258 doi: 10.5543/tkda.2023.36177 Pages 502 - 506 Cor triatriatum sinister (CTS) is a rare adult congenital heart disease. The usual presentation may vary according to the size of the hole in the membrane in the left atrium and the pressure gradient. In addition to acute clinical presentations including acute pulmonary edema and sudden cardiac death, patients may present with chronic findings such as right heart failure due to pulmonary hypertension. The development of pulmonary hypertension is an important indicator of mortality. In cases where non-invasive methods are not sufficient for the diagnosis of pulmonary hypertension, exercise right heart catheterization may also be used. We present a patient with CTS, in whom the final decision was made with the help of an exercise right heart catheterization. |
13. | Intravascular Ultrasound-Guided Stent Implantation in the Left Main Coronary Artery Extrinsic Compression by Pulmonary Artery Aneurysm Due to Eisenmenger Syndrome Ahmet Sekban, Barkın Kültürsay, Hacer Ceren Tokgöz, Mustafa Furkan Kılıçarslan, Cihangir Kaymaz PMID: 37861262 doi: 10.5543/tkda.2023.56585 Pages 507 - 511 Pulmonary arterial hypertension (PAH) is a profoundly destructive condition marked by the gradual narrowing and restructuring of small pulmonary arteries, leading to a rise in pulmonary vascular resistance (PVR), causing right-sided heart failure and, ultimately, mortality. During more advanced stages of this disease, patients may present with rare manifestations of pulmonary artery aneurysm (PAA) which are exertional chest pain, and hoarseness. The left main coronary artery compression (LMCA-Co) has been an increasingly recognized and possibly life-threatening entity in patients with severe PAH. The lack of well-established decision-making strategies for the management of both PAA and LMCA-Co has been remained as an unsolved issue in this setting. In this report, we present a case of percutaneous intervention of LMCA-Co with the guidance of intracoronary imaging in a patient with patent ductus arteriosus-Eisenmenger syndrome. Percutaneous intervention with intravascular guidance appears to be a safe and effective option for relieving symptoms and achieving positive clinical outcomes in patients with LMCA-Co. |
14. | Unusual Case of Pulmonary Hypertension due to Acquired Arteriovenous Fistula İbrahim Başarıcı, Mehdi Onaç PMID: 37861259 doi: 10.5543/tkda.2023.67362 Pages 512 - 515 Pulmonary hypertension is a disease process affecting pulmonary circulation and is defined by an increase in pulmonary artery pressure subsequently causing right ventricular failure. Vascular complications, including arteriovenous (AV) fistula, are recognized, but are uncommon complications of spinal surgery. AV fistula increases venous return to the right heart and can promote a volume overload related high-output cardiac state, pulmonary hypertension, and right heart failure. Hereby, we describe a rare pulmonary hypertension case with severe right heart failure, lower leg edema, and progressive dyspnea caused by an AV fistula between the left common iliac artery and vein as a complication of a lumbar spinal/disk surgery. Pulmonary hypertension was confirmed by hemodynamic assessments and the etiology was established by both abdominal computed tomography and conventional peripheric angiography. After closure of the AV-fistula by stent-graft implantation, the right heart failure resolved completely. |
HOW TO? | |
15. | Six-Minute Walk Test: How to do Guide for Performing a Reliable Test, Interpretation, and Prognostication in Pulmonary Hypertension Murat Meriç, Çağlar Emre Çağlıyan, Rabia Eker Akıllı, Burçak Kılıçkıran Avcı, Ümit Yaşar Sinan, Pelin Duru Çetinkaya, Rengin Demir, İbrahim Başarıcı, Mehmet Akbulut PMID: 37861263 doi: 10.5543/tkda.2023.52279 Pages 516 - 520 Six-minute walk test (6MWT) is the most widely used exercise capacity measurement worldwide in patients with pulmonary hypertension (PH). Although cardiopulmonary exercise testing (CPET) is the gold standard for the assessment of exercise capacity in cardiovascular diseases; the limited accessibility of the device, the need for experience in interpreting the results, and the difficulties in performing CPET in advanced PH have aroused the interest in the application of easier methods for the measurement of exercise capacity. Since then, accumulated data proved that; 6-minutes walking distance (6MWD) can be used to determine exercise capacity and is highly correlated with maximum oxygen consumption (peak VO2) detected by CPET in patients with heart failure and/or PH. Moreover, 6MWT is very easy and practical to apply in all PH subgroups. This review is focused on the application of a reliable 6MWT and the interpretation of the results in patients with PH. |
EDITORIAL | |
16. | Comments on Cardiology Ertan Ural PMID: 37861266 Pages 521 - 522 Abstract | |
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