IF 1.7 4区医学

Herz Pub Date : 2023-08-01 Epub Date: 2023-04-21 DOI: 10.1007/s00059-023-05179-1

Tobias J Lange

{"title":"Refined risk stratification, current treatment, and new therapeutic approaches in pulmonary arterial hypertension.","authors":"Tobias J Lange","doi":"10.1007/s00059-023-05179-1","DOIUrl":"10.1007/s00059-023-05179-1","url":null,"abstract":"The 2022 European Society of Cardiology/European Respiratory Society (ESC/ERS) guidelines for pulmonary hypertension have introduced a refined risk stratification to guide both initial and subsequent treatment of pulmonary arterial hypertension (PAH). The risk stratification at PAH diagnosis still comprises three risk categories (low, intermediate, high) and lists some new parameters. As the estimated 1‑year mortality is more than 20% in high-risk patients after diagnosis, an initial triple-combination therapy including parenteral prostacyclin analogues is recommended for this group. All other patients should receive a dual-combination therapy with an endothelin receptor antagonist and a phosphodiesterase‑5 inhibitor. However, this approach of initial combination therapy is only recommended for classic PAH, while monotherapy followed by regular follow-up and individualized therapy should be used for patients with cardiopulmonary comorbidities. For PAH patients without cardiopulmonary comorbidities, it is recommended to assess their risk at follow-up with a new 4‑strata classification, where the intermediate-risk group is split on the basis of three noninvasive parameters. Importantly, changes from intermediate-high to intermediate-low risk have been shown to be associated with a better prognosis. In addition, the recommendations on treatment escalation became more precise with the addition of a prostacyclin receptor agonist or switching a phosphodiesterase‑5 inhibitor to a soluble guanylate cyclase stimulator for intermediate-low risk and proceeding to triple-combination therapy with parenteral prostacyclin analogues already for intermediate-high risk. With sotatercept, the first non-vasodilator PAH treatment will become available in the near future to further enrich our treatment options for this chronic and still severe disease.","PeriodicalId":12863,"journal":{"name":"Herz","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9897664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

[Cardiovascular pharmacotherapy in old age]. 【老年心血管药物治疗】。

IF 1.7 4区医学

Herz Pub Date : 2023-08-01 Epub Date: 2023-06-12 DOI: 10.1007/s00059-023-05191-5

Martin Schulz, Dietmar Trenk, Ulrich Laufs

引用次数: 0

Pulmonary hypertension associated with left heart disease. 肺动脉高压与左心疾病相关。

IF 1.7 4区医学

Herz Pub Date : 2023-08-01 DOI: 10.1007/s00059-023-05189-z

Max Wissmüller, Johannes Dohr, Joana Adler, Laurin Ochs, Tobias Tichelbäcker, Christopher Hohmann, Stephan Baldus, Stephan Rosenkranz

{"title":"Pulmonary hypertension associated with left heart disease.","authors":"Max Wissmüller, Johannes Dohr, Joana Adler, Laurin Ochs, Tobias Tichelbäcker, Christopher Hohmann, Stephan Baldus, Stephan Rosenkranz","doi":"10.1007/s00059-023-05189-z","DOIUrl":"https://doi.org/10.1007/s00059-023-05189-z","url":null,"abstract":"Pulmonary hypertension (PH) is a common condition in patients with left heart disease (LHD) that is highly relevant for morbidity and mortality. While post-capillary in nature, the pathophysiology of PH in patients with LHD (heart failure/cardiomyopathy, valvular heart disease; other: congenital/acquired) is complex, and decisions about management strategies are challenging. Recently, the updated European Society of Cardiology/European Respiratory Society guidelines on the diagnosis and treatment of PH revisited hemodynamic definitions and the sub-classification of post-capillary PH, and provided numerous new recommendations on the diagnosis and management of PH associated with various types of LHD. Here, we review several novel aspects that focus on: (a) updated hemodynamic definitions, including the distinction between isolated post-capillary PH (IpcPH) and combined post- and pre-capillary PH (CpcPH); (b) the pathogenesis of PH-LHD, considering various components contributing to PH, such as pulmonary congestion, vasoconstriction, and vascular remodeling; (c) the prognostic relevance of PH and hemodynamic markers; (d) the diagnostic approach to PH-LHD; (e) management strategies in PH-LHD, distinguishing between targeting the underlying left heart condition, the pulmonary circulation, and/or impaired right ventricular function. In conclusion, precise clinical and hemodynamic characterization and detailed phenotyping are essential for prognostication and the management of patients with PH-LHD.","PeriodicalId":12863,"journal":{"name":"Herz","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9917336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Erratum to: Right ventricular failure in pulmonary hypertension: recent insights from experimental models. 勘误表：肺动脉高压右心室衰竭：实验模型的最新见解。

IF 1.7 4区医学

Herz Pub Date : 2023-08-01 DOI: 10.1007/s00059-023-05190-6

Athiththan Yogeswaran, Argen Mamazhakypov, Ralph T Schermuly, Astrid Weiß

引用次数: 0

Right ventricular failure in pulmonary hypertension: recent insights from experimental models. 肺动脉高压的右心室衰竭：实验模型的最新见解。

IF 1.7 4区医学

Herz Pub Date : 2023-08-01 Epub Date: 2023-04-20 DOI: 10.1007/s00059-023-05180-8

Athiththan Yogeswaran, Argen Mamazhakypov, Ralph T Schermuly, Astrid Weiß

{"title":"Right ventricular failure in pulmonary hypertension: recent insights from experimental models.","authors":"Athiththan Yogeswaran, Argen Mamazhakypov, Ralph T Schermuly, Astrid Weiß","doi":"10.1007/s00059-023-05180-8","DOIUrl":"10.1007/s00059-023-05180-8","url":null,"abstract":"Right ventricular (RV) function is a critical determinant of the prognosis of patients with pulmonary hypertension (PH). Upon establishment of PH, RV dysfunction develops, leading to a gradual worsening of the condition over time, culminating in RV failure and premature mortality. Despite this understanding, the underlying mechanisms of RV failure remain obscure. As a result, there are currently no approved therapies specifically targeting the right ventricle. One contributing factor to the lack of RV-directed therapies is the complexity of the pathogenesis of RV failure as observed in animal models and clinical studies. In recent years, various research groups have begun utilizing multiple models, including both afterload-dependent and afterload-independent models, to investigate specific targets and pharmacological agents in RV failure. In this review, we examine various animal models of RV failure and the recent advancements made utilizing these models to study the mechanisms of RV failure and the potential efficacy of therapeutic interventions, with the ultimate goal of translating these findings into clinical practice to enhance the management of individuals with PH.","PeriodicalId":12863,"journal":{"name":"Herz","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9954984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Early echocardiographic evaluation of right ventricular load adaptability after sequential combination treatment in pulmonary arterial hypertension. 肺动脉高压序贯联合治疗后右心室负荷适应性的早期超声心动图评价。

IF 1.7 4区医学

Herz Pub Date : 2023-08-01 DOI: 10.1007/s00059-022-05139-1

Kadriye Memic Sancar, Mustafa Yildiz, Serkan Kahraman, Begum Uygur, Umit Bulut, Meltem Tekin, Arda Guler, Nail Guven Serbest, Seda Tukenmez Karakurt, Banu Sahin Yildiz, Ahmet Yasar Cizgici, Muhammed Bayram, Mehmet Erturk

{"title":"Early echocardiographic evaluation of right ventricular load adaptability after sequential combination treatment in pulmonary arterial hypertension.","authors":"Kadriye Memic Sancar, Mustafa Yildiz, Serkan Kahraman, Begum Uygur, Umit Bulut, Meltem Tekin, Arda Guler, Nail Guven Serbest, Seda Tukenmez Karakurt, Banu Sahin Yildiz, Ahmet Yasar Cizgici, Muhammed Bayram, Mehmet Erturk","doi":"10.1007/s00059-022-05139-1","DOIUrl":"https://doi.org/10.1007/s00059-022-05139-1","url":null,"abstract":"Background: Using the tricuspid annular plane systolic excursion (TAPSE)/pulmonary arterial systolic pressure (PASP) ratio as an index of right ventricular load adaptability, we aimed to evaluate early changes in right heart contractile function of patients with group 1 pulmonary artery hypertension (PAH) after sequential combination PAH-specific therapy.Methods: A total of 49 patients with group 1 PAH and 31 control participants were included in the study. The baseline clinical and echocardiographic data of the control and PAH group were compared. Subsequently, clinical and echocardiographic data of PAH patients before treatment and at 6 months after PAH-specific treatment were analyzed.Results: A significant increase in the TAPSE/PASP ratio was found in patients at 6 months of PAH-specific treatment (0.25 ± 0.14; 0.33 ± 0.16, p < 0.001). Right atrial pressure (8 mm Hg [5-10]; 5 mm Hg [3-8], p < 0.001) and PASP (80.8 ± 30.6 mm Hg; 65.9 ± 25.7 mm Hg, p < 0.001) were significantly lower after sequential combination PAH-specific therapy. Negative correlations were found between the TAPSE/PASP ratio and N‑terminal pro-B-type natriuretic peptide (r = -0.524, p < 0.001), tricuspid regurgitation velocity (r = -0.749, p < 0.001), right atrial area (r = -0.298, p = 0.037), and right atrial pressure (r = -0.463, p = 0.001).Conclusion: In patients with group 1 PAH, echocardiographic evaluation at the early stage of treatment (6 months) shows a significant improvement in the TAPSE/PASP ratio indicating right ventricular load adaptation. Comprehensive studies are needed on the routine use of the TAPSE/PASP ratio in the risk assessment of PAH patients.","PeriodicalId":12863,"journal":{"name":"Herz","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9911992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Outcome of a polymer-free drug-coated coronary stent in bifurcation lesions-Pilot registry with serial OCT imaging. 分叉病变中不含聚合物药物涂层冠状动脉支架的结果——系列OCT成像的初步登记。

IF 1.7 4区医学

Herz Pub Date : 2023-08-01 Epub Date: 2022-04-09 DOI: 10.1007/s00059-022-05109-7

Hendrik Wienemann, Felix Meincke, Marius Vach, Christian-Hendrik Heeger, Annika Meyer, Tobias Spangenberg, Karl Heinz Kuck, Alexander Ghanem

{"title":"Outcome of a polymer-free drug-coated coronary stent in bifurcation lesions-Pilot registry with serial OCT imaging.","authors":"Hendrik Wienemann, Felix Meincke, Marius Vach, Christian-Hendrik Heeger, Annika Meyer, Tobias Spangenberg, Karl Heinz Kuck, Alexander Ghanem","doi":"10.1007/s00059-022-05109-7","DOIUrl":"10.1007/s00059-022-05109-7","url":null,"abstract":"Background: Polymer-free and carrier-free drug-coated stents (DCS) represent a novel therapeutic option for the treatment of coronary artery disease. The objective of this pilot registry is to evaluate the safety and efficacy of DCS implantation in bifurcation lesions.Methods: Overall, 23 consecutive patients with 24 lesions received a Biolimus A9-coated DCS for coronary bifurcation lesions. Patients were examined with quantitative coronary angiography (QCA) and optical coherence tomography (OCT) at 3-6 months of follow-up.Results: A total of 23 patients with 24 bifurcation lesions were included in this study. Nine (33.3%) lesions of eight patients revealed angiographical target lesion failure due to in-stent restenosis (ISR). In total, 19 patients with 20 bifurcation lesions were suitable for OCT analysis. A total of 2936 struts were analyzed and 14 struts (0.47%) were classified as malapposed. The mean luminal area (mm2) was not different in lesions with ISR vs. lesions with no ISR (5.07 ± 2.0 vs. 5.73 ± 1.34, p = 0.39) at follow-up. Lesions with ISR showed higher mean neointimal burden (27.11 ± 10.59 vs. 13.93 ± 9.16%, respectively; p = 0.009). All of the patients who presented with significant ISR required percutaneous re-intervention.Conclusions: We observed a high rate of DCS ISR in bifurcation lesions, possibly related to increased inflammation and neoatherosclerosis. The small size of the study warrants careful interpretation of our results. Larger trials are necessary to expand knowledge of these findings.","PeriodicalId":12863,"journal":{"name":"Herz","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10275175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Relationship between platelet mass index and postoperative atrial fibrillation after elective coronary artery bypass surgery: a retrospective study. 选择性冠状动脉搭桥术后血小板质量指数与心房颤动的关系：一项回顾性研究。

IF 1.7 4区医学

Herz Pub Date : 2023-08-01 Epub Date: 2022-09-05 DOI: 10.1007/s00059-022-05136-4

Ozge Guzelburc, Ahmet Zengin, Mehmet Baran Karatas, Sevinc Bayer Erdogan, Ayse Emre

{"title":"Relationship between platelet mass index and postoperative atrial fibrillation after elective coronary artery bypass surgery: a retrospective study.","authors":"Ozge Guzelburc, Ahmet Zengin, Mehmet Baran Karatas, Sevinc Bayer Erdogan, Ayse Emre","doi":"10.1007/s00059-022-05136-4","DOIUrl":"10.1007/s00059-022-05136-4","url":null,"abstract":"Background: Atrial fibrillation (AF) is the most common complication after cardiac surgery. The pathogenesis of postoperative atrial fibrillation (POAF) is multifactorial and one of the known factors is inflammation. Platelet mass index (PMI) is an indicator of platelet activation and a better inflammatory marker than mean platelet volume (MPV). In this retrospective study, we investigated the relationship between POAF and PMI.Methods: The study included 848 consecutive patients (655 male and 193 female) who had elective isolated coronary artery by-pass grafting (CABG) or combined CABG and valvular surgery. Platelet count and MPV were measured from preoperative blood samples to calculate PMI. Post-operative atrial fibrillation was defined as irregular and fibrillatory P waves occurring 48-96 h after cardiac surgery and lasting at least 30 s. The PMI values in patients who developed POAF were compared with those in patients who did not develop POAF.Results: Patients who developed POAF had higher PMI values (2549.3 ± 1077.1) when compared with patients in sinus rhythm (2248.1 ± 683.4; p < 0.01). In multivariate regression analysis, age (OR: 1.05; 95% CI: 1.02-1.09; p = 0.01), left atrial diameter (OR: 1.05; 95% CI: 1.03-1.09; p = 0.02), hs-CRP (OR: 1.09; 95%CI: 1.05-1.13; p < 0.01), EuroSCORE II (OR: 1.27; 95% CI: 1.14-1.41; p < 0.01), and PMI (OR: 1.01; 95% CI: 1.001-1.02; p < 0.01) were independent predictors of POAF. In ROC analysis, PMI ≥ 2286 predicted POAF development with a sensitivity of 69% and a specificity of 58% (AUC: 0.66; p < 0.01) CONCLUSION: A significant relationship was found between preoperatively calculated PMI and POAF. We showed that PMI may be used to predict patients who are at high risk of developing POAF.","PeriodicalId":12863,"journal":{"name":"Herz","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10257205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

Pulmonary hypertension. 肺动脉高压。

IF 1.7 4区医学

Herz Pub Date : 2023-08-01 DOI: 10.1007/s00059-023-05188-0

Johann Bauersachs, Stephan Rosenkranz

引用次数: 6

[Pulmonary hypertension associated with lung disease]. [肺动脉高压与肺部疾病相关]。

IF 1.7 4区医学

Herz Pub Date : 2023-08-01 DOI: 10.1007/s00059-023-05173-7

Manuel J Richter, Khodr Tello

{"title":"[Pulmonary hypertension associated with lung disease].","authors":"Manuel J Richter, Khodr Tello","doi":"10.1007/s00059-023-05173-7","DOIUrl":"https://doi.org/10.1007/s00059-023-05173-7","url":null,"abstract":"Pulmonary hypertension (PH) is a multifactorial pulmonary vascular disease. PH associated with pre-existing lung disease is common and classified as group 3 in the clinical classification. Patients with chronic obstructive or interstitial lung disease are most likely to develop PH, with up to 20% of patients showing signs of PH. Distinguishing between the symptoms of the underlying lung disease and concomitant PH can be difficult. Clinical assessment, lung function tests, laboratory tests, and echocardiography can be helpful. The hemodynamic definition of PH has recently been changed. PH associated with lung disease is a pre-capillary form by definition. A special sub-stratification in group 3 is the differentiation of hemodynamic severity. Severe PH in group 3 is defined as a pulmonary vascular resistance (PVR) greater than 5 Wood units (WU). This pulmonary vascular phenotype is characterized by rather mild to moderate impairment of lung function or lung parenchymal destruction but with severe pulmonary vascular disease or right heart strain. Currently, there are no specific PH medications approved for group 3. However, the use of specific PH medications for the pulmonary vascular phenotype is being discussed in studies or on a case-by-case basis, while in patients with a PVR below 5 WU treatment focuses on the underlying disease.","PeriodicalId":12863,"journal":{"name":"Herz","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10274130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

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