Pulmonary Hypertension in Hereditary Hemorrhagic Telangiectasia
Autor: | Garvan C. Kane, Karen L. Swanson, Michael J. Krowka, Robert P. Frantz, Melissa A. Lyle, Michael D. McGoon, Eric R. Fenstad |
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Rok vydání: | 2016 |
Předmět: |
Male
Pulmonary and Respiratory Medicine Cardiac Catheterization medicine.medical_specialty Hypertension Pulmonary Hemodynamics 030204 cardiovascular system & hematology Critical Care and Intensive Care Medicine 03 medical and health sciences Folic Acid 0302 clinical medicine Internal medicine medicine.artery medicine Humans Pulmonary Wedge Pressure Telangiectasia Pulmonary wedge pressure Vinca Alkaloids Retrospective Studies business.industry Central venous pressure Middle Aged medicine.disease Pulmonary hypertension medicine.anatomical_structure 030228 respiratory system Heart catheterization Pulmonary artery Ventricular Function Right Vascular resistance Cardiology Female Telangiectasia Hereditary Hemorrhagic Vascular Resistance medicine.symptom Cardiology and Cardiovascular Medicine business Follow-Up Studies |
Zdroj: | Chest. 149:362-371 |
ISSN: | 0012-3692 |
Popis: | Background A subset of patients with hereditary hemorrhagic telangiectasia (HHT) develops pulmonary hypertension (PH) by mechanisms including pulmonary arterial hypertension, high flow, and elevated pulmonary arterial wedge pressure (PAWP). We aimed to describe echocardiographic and hemodynamic characteristics of patients with coexisting HHT and PH. Methods We conducted a single-center cohort study of patients with confirmed HHT who underwent right-sided heart catheterization (RHC) and transthoracic two-dimensional echocardiography for suspected PH between June 1, 2003 and September 1, 2013 at Mayo Clinic Rochester, Minnesota. Results Of 38 patients with confirmed HHT who underwent RHC and echocardiography, 28 (74%) had a mean pulmonary artery pressure (MPAP) ≥ 25 mm Hg. Of those 28, 12 (43%) had pulmonary arterial hypertension. Two patients had normal PAWP and pulmonary vascular resistance (PVR), with PH secondary to either an atrial septal defect or high cardiac flow. Fourteen patients (50%) had elevated PAWP (≥ 15 mm Hg), nine with evidence of high flow. RHC in all 28 patients demonstrated a MPAP of 41 ± 11 mm Hg, PAWP of 17 ± 10 mm Hg, and PVR of 4.5 ± 4.2 Wood units. Echocardiography demonstrated moderate/severe right ventricular dysfunction in nine patients (32%). The presence of PH trended toward worse survival ( P = .06). Conclusions PH in patients with HHT occurs by different mechanisms, and there is a trend toward worse survival in patients who develop PH despite the mechanism. The equal predilection toward all subtypes of PH illustrates the necessity of RHC to clarify the hemodynamics. |
Databáze: | OpenAIRE |
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