AIMS: Patients with obesity frequently present with dyspnoea. Biomarkers that reflect wall stress are often used to evaluate circulatory congestion and help determine whether dyspnoea is of cardiac causes. Patients with obesity display greater external restraint on the heart, which may alter relationships between intravascular pressures and stress markers. METHODS AND RESULTS: Subjects with unexplained dyspnoea (n = 212) underwent cardiac catheterization with simultaneous echocardiography. Blood sampling was performed in a subset (n = 58). Relationships between echocardiographic and blood biomarkers of circulatory congestion and directly-measured haemodynamics were compared between participants with severe obesity [body mass index (BMI) ≥35 kg/m2 , Group B) and those without (BMI <35 kg/m2 , Group A). Circulatory congestion was assessed by pulmonary capillary wedge pressure (PCWP), and vascular distending pressure was assessed by left ventricular transmural pressure (LVTMP). As compared to Group A, participants in Group B displayed higher PCWP relative to N-terminal pro-B-type natriuretic peptide, mid-regional pro-atrial natriuretic peptide, troponin T, and growth differentiation factor-15 (all p < 0.01). In contrast, the relationships between LVTMP and the biomarkers were superimposable. Echocardiographic biomarkers revealed the same pattern: PCWP was higher for any E/e' ratio in Group B compared to Group A, but the relationship between LVTMP and E/e' was similar. In contrast, levels of C-terminal pro-endothelin-1 and mid-regional pro-adrenomedullin were more robustly correlated with PCWP (r = 0.67 and r = 0.62, both p < 0.0001), with no differential relationship based upon BMI. CONCLUSIONS: Non-invasive haemodynamic markers underestimate circulatory congestion in patients with obesity, an effect that appears related to uncoupling between cardiac wall stress and intravascular pressures. This may lead to systematic under-recognition of congestion in patients with obesity.

• Klíčová slova
• Biomarker, Diagnosis, Filling pressure, Heart failure, Obesity, Surrogate marker,
• MeSH
• echokardiografie MeSH
• funkce levé komory srdeční MeSH
• hemodynamika MeSH
• lidé MeSH
• obezita komplikace   MeSH
• plicní tlak v zaklínění MeSH
• srdeční selhání * diagnóza   etiologie   MeSH
• tepový objem MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Extramural MeSH

Atrial fibrillation and atrial tachycardias (AF/AT) have been reported as a common condition in patients with pulmonary hypertension (PH). As yet, limited data exists about the significance of the borderline post-capillary pressure component on the occurrence of AF / AT in patients with isolated pre-capillary PH. We retrospectively studied the prevalence of AF / AT in 333 patients (mean age 61 ± 15 years, 44% males) with pre-capillary idiopathic / familiar pulmonary arterial hypertension, and inoperable chronic thromboembolic pulmonary hypertension. The prevalence of AF / AT was analyzed in different categories of pulmonary artery wedge pressure (PAWP). In the study population overall, the mean PAWP was 10.5 ± 3 mmHg, median of 11 mmHg, range 2-15 mmHg. AF / AT was diagnosed in 79 patients (24%). The proportion of AF / AT among patients with PAWP below the median (?11 mmHg) was lower than in subjects with PAWP between 12 and 15 mmHg, 30 (16%) vs. 46 (35%), p = 0.0001. Compared to the patients with PAWP?11 mmHg, subjects with PAWP between 12 and 15 mmHg were older (65 ± 13 years vs. 58 ± 16), with more prevalent arterial hyperte\nsion [100 (70%) vs. 106 (55%)] and diabetes mellitus [50 (35%) vs. 48 (25%)], showed larger size of the left atrium (42 ± 7 vs. 40 ± 6 mm), and higher values of right atrium pressure (12 ± 5 vs. 8 ± 5 mm Hg), p < 0.05 in all comparisons. The prevalence of AF / AT in the group studied increased with the growing post-capillary component.

• MeSH
• dospělí MeSH
• fibrilace síní epidemiologie   etiologie   MeSH
• incidence MeSH
• lidé středního věku MeSH
• lidé MeSH
• plicní hypertenze komplikace   patofyziologie   MeSH
• plicní tlak v zaklínění * MeSH
• prevalence MeSH
• registrace * MeSH
• retrospektivní studie MeSH
• senioři MeSH
• síňová ektopická tachykardie epidemiologie   etiologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

The purpose of calculating the capillary filtration coefficient is to experimentally evaluate edema formation in models of pulmonary ischemia-reperfusion injury. For many years, the obtaining of this coefficient implies a series of manual maneuvers during ex-vivo reperfusion of pulmonary arterial pressure, venous pressure and weight, as well as the calculation of the Kfc formula. Through automation, the calculation of capillary filtration coefficient could be easier and more efficient. To describe an automatic method designed in our laboratory to calculating the capillary filtration coefficient and compare with traditional determination of capillary filtration coefficient as gold standard method. An automatic three valve perfusion system was constructed, commanded by a mastery module connected to a graphical user interface. To test its accuracy, cardiopulmonary blocks of Wistar rats were harvested and distributed in manual (n=8) and automated (n=8) capillary filtration coefficient determination groups. Physiological parameters as pulmonary arterial pressure, pulmonary venous pressure, weight and capillary filtration coefficient were obtained. Results: Capillary filtration coefficient, pulmonary arterial pressure, venous arterial pressure shown no statistical significance difference between the groups. The automated perfusion system for obtaining Kfc was standardized and validated, giving reliable results without biases and making the process more efficient in terms of time and personal staff.

• MeSH
• arteria pulmonalis fyziologie   MeSH
• kapilární permeabilita fyziologie   MeSH
• kapiláry fyziologie   MeSH
• krysa rodu Rattus MeSH
• orgánové kultury - kultivační techniky MeSH
• perfuze přístrojové vybavení   metody   MeSH
• plicní tlak v zaklínění fyziologie   MeSH
• potkani Wistar MeSH
• venae pulmonales fyziologie   MeSH
• zvířata MeSH
• Check Tag
• krysa rodu Rattus MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

OBJECTIVE: Chronic thromboembolic pulmonary hypertension is surgically treated through pulmonary endarterectomy. Although pulmonary endarterectomy is the treatment of choice for chronic thromboembolic pulmonary hypertension in terms of both functional outcomes and survival, many patients experience persistent pulmonary hypertension after pulmonary endarterectomy. The study objective was to calculate the pooled estimates of outcomes after pulmonary endarterectomy, including persistent pulmonary hypertension. METHODS: Meta-analyses were conducted on published studies reporting residual/persistent/recurrent pulmonary hypertension in 4868 patients with chronic thromboembolic pulmonary hypertension after pulmonary endarterectomy. The rate of persistent pulmonary hypertension and change in mean pulmonary artery pressure, pulmonary vascular resistance, and 6-minute walk distance after pulmonary endarterectomy were outcomes of interest. RESULTS: Twenty-five percent of patients with chronic thromboembolic pulmonary hypertension were diagnosed with persistent pulmonary hypertension after pulmonary endarterectomy. Pulmonary endarterectomy reduced mean pulmonary artery pressure and pulmonary vascular resistance by approximately 21 mm Hg (standardized mean difference, 1.75; 95% confidence interval, -1.62 to 1.88; P < .00001) and 561 dyn.s/cm5 (standardized mean difference, 1.64; 95% confidence interval, -1.58 to 1.70; P < .00001), respectively. Conversely, 6-minute walk distance increased by 96 m (standardized mean difference, -0.83; 95% confidence interval, -0.91 to -0.76; P < .00001) after pulmonary endarterectomy. CONCLUSIONS: Pulmonary endarterectomy is the gold standard treatment for chronic thromboembolic pulmonary hypertension and provides immediate correction of hemodynamic parameters in most patients. However, in up to one quarter of operable cases, pulmonary hypertension persists after surgery. In those patients with persistent pulmonary hypertension, continued medical management with newer agents may be required to improve pulmonary hemodynamics and, therefore, patient outcomes.

• Klíčová slova
• chronic thromboembolic pulmonary hypertension, mean pulmonary artery pressure, pulmonary endarterectomy, pulmonary thromboendarterectomy, pulmonary vascular resistance,
• MeSH
• dospělí MeSH
• endarterektomie škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• plicní embolie chirurgie   MeSH
• plicní hypertenze epidemiologie   etiologie   MeSH
• plicní tlak v zaklínění MeSH
• rizikové faktory MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH

The MELODY-1 study evaluated macitentan for pulmonary hypertension because of left heart disease (PH-LHD) in patients with combined post- and pre-capillary PH.63 patients with PH-LHD and diastolic pressure gradient ≥7 mmHg and pulmonary vascular resistance (PVR) >3WU were randomised to macitentan 10 mg (n=31) or placebo (n=32) for 12 weeks. The main end-point assessed a composite of significant fluid retention (weight gain ≥5% or ≥5 kg because of fluid overload or parenteral diuretic administration) or worsening in New York Heart Association functional class from baseline to end of treatment. Exploratory end-points included changes in N-terminal pro-brain natriuretic peptide (NT-proBNP) and haemodynamics at week 12.Seven macitentan-treated and four placebo-treated patients experienced significant fluid retention/worsening functional class; treatment difference, 10.08% (95% CI -15.07-33.26; p=0.34). The difference, driven by the fluid retention component, was apparent within the first month. At week 12, versus placebo, the macitentan group showed no change in PVR, mean right atrial pressure or pulmonary arterial wedge pressure; a non-significant increase in cardiac index (treatment effect 0.4 (95% CI 0.1-0.7) L·min-1·m-2) and decrease in NT-proBNP (0.77 (0.55-1.08)) was observed. Adverse events and serious adverse events were numerically more frequent with macitentan versus placebo.Macitentan-treated patients were quantitatively more likely to experience significant fluid retention versus placebo. Macitentan resulted in no significant changes in any exploratory end-points.

• MeSH
• cévní rezistence účinky léků   MeSH
• dvojitá slepá metoda MeSH
• dysfunkce levé srdeční komory komplikace   MeSH
• internacionalita MeSH
• krevní tlak účinky léků   MeSH
• lidé MeSH
• natriuretický peptid typu B účinky léků   metabolismus   MeSH
• peptidové fragmenty účinky léků   metabolismus   MeSH
• plicní hypertenze farmakoterapie   patofyziologie   MeSH
• plicní tlak v zaklínění účinky léků   MeSH
• pyrimidiny aplikace a dávkování   MeSH
• senioři MeSH
• sulfonamidy aplikace a dávkování   MeSH
• test chůzí MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• Názvy látek
• macitentan MeSH Prohlížeč
• natriuretický peptid typu B MeSH
• peptidové fragmenty MeSH
• pro-brain natriuretic peptide (1-76) MeSH Prohlížeč
• pyrimidiny MeSH
• sulfonamidy MeSH

AIM: The aim of our study was to assess the course of immediate post-exercise pulmonary capillary wedge pressure (PCWP) changes to identify the optimal time window for the noninvasive diagnostics of exercise-induced PCWP elevation. METHODS AND RESULTS: Seventy-one patients at risk of heart failure with normal left ventricular ejection fraction underwent simultaneous exercise echocardiography and right heart catheterization. The ratio of early left ventricular filling velocity (E) to early diastolic mitral annular velocity (e') was used to predict noninvasively exercise-induced PCWP elevation. Fifty-one patients had exercise-induced PCWP elevation ≥ 8 mmHg and reached peak exercise PCWP ≥ 20 mmHg. Rapid post-exercise recovery of PCWP within 2 min was achieved in 18 (35.3%) patients. Intermediate post-exercise PCWP recovery at 3 and 4 min was found in 16 (31.4%) patients while late post-exercise PCWP recovery (≥ 5 min) was achieved in 17 (33.3%) patients. CONCLUSION: The course of post-exercise PCWP recovery is highly variable, and a significant proportion of patients have only a brief period (≤ 2 min) of exercise-induced PCWP elevation. This fact should be taken into account in noninvasive assessment of exercise-induced PCWP.

• MeSH
• cvičení fyziologie   MeSH
• dopplerovská echokardiografie MeSH
• funkce pravé komory srdeční fyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• obnova funkce * MeSH
• odpočinek fyziologie   MeSH
• plicní tlak v zaklínění fyziologie   MeSH
• progrese nemoci MeSH
• srdeční katetrizace MeSH
• srdeční komory diagnostické zobrazování   patofyziologie   MeSH
• srdeční selhání diagnostické zobrazování   patofyziologie   MeSH
• tepový objem MeSH
• zátěžový test MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

OBJECTIVES: This study sought to evaluate the effect of macitentan on hospitalization of patients with symptomatic pulmonary arterial hypertension (PAH). BACKGROUND: PAH is a progressive, life-threatening disease often requiring hospitalization. METHODS: In the multicenter, double-blind, randomized, event-driven, phase III SERAPHIN (Study with an Endothelin Receptor Antagonist in Pulmonary arterial Hypertension to Improve cliNical outcome) trial, patients with symptomatic PAH were randomized (1:1:1) to receive placebo or 3 mg or 10 mg of macitentan. Effects of macitentan on the risk, rate, and number of hospital days for all-cause and PAH-related hospitalizations were compared with those for placebo. Risk and causes of hospitalizations unrelated to PAH were investigated. RESULTS: Of 742 randomized patients, 250 received placebo, 250 received 3 mg of macitentan, and 242 received 10 mg of macitentan; the overall median duration of treatment was 115 weeks. Risk of all-cause hospitalization was reduced by 18.9% (p = 0.1208) and 32.3% (p = 0.0051) in the macitentan 3-mg and 10-mg arm, respectively. Rates of all-cause hospitalizations and numbers of hospital days were reduced by 20.5% (p = 0.0378) and 30.6% (p = 0.0278), respectively, with 3 mg of macitentan and by 33.1% (p = 0.0005) and 31.0% (p = 0.0336), respectively, with 10 mg of macitentan. Risk of PAH-related hospitalizations were reduced by 42.7% (p = 0.0015) and 51.6% (p < 0.0001) in the macitentan 3-mg and 10-mg arms, respectively. Rate of PAH-related hospitalizations and numbers of hospital days were reduced by 44.5% (p = 0.0004) and 53.3% (p = 0.0001), respectively, with 3 mg of macitentan, and reduced by 49.8% (p < 0.0001) and 52.3% (p = 0.0003), respectively, with 10 mg of macitentan. Risk of non-PAH-related hospitalization was similar between treatment arms. CONCLUSIONS: Macitentan 10 mg significantly reduced the risk and rate of all-cause hospitalization, which was driven by reductions in the risk and rate of PAH-related hospitalization. (Study of Macitentan [ACT-064992] on Morbidity and Mortality in Patients With Symptomatic Pulmonary Arterial Hypertension; NCT00660179).

• Klíčová slova
• hospitalization, macitentan, pulmonary arterial hypertension,
• MeSH
• antagonisté endotelinového receptoru A aplikace a dávkování   MeSH
• aplikace orální MeSH
• dospělí MeSH
• dvojitá slepá metoda MeSH
• familiární plicní arteriální hypertenze farmakoterapie   patofyziologie   MeSH
• hospitalizace trendy   MeSH
• lidé středního věku MeSH
• lidé MeSH
• plicní tlak v zaklínění účinky léků   MeSH
• progrese nemoci MeSH
• pyrimidiny aplikace a dávkování   MeSH
• senioři MeSH
• sulfonamidy aplikace a dávkování   MeSH
• výsledek terapie MeSH
• vztah mezi dávkou a účinkem léčiva MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky, fáze III MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• Názvy látek
• antagonisté endotelinového receptoru A MeSH
• macitentan MeSH Prohlížeč
• pyrimidiny MeSH
• sulfonamidy MeSH

AIM: Post-heart transplant patients are at increased risk of diastolic dysfunction. The aim of this study was to assess the prevalence of isolated only exercise-induced heart failure with normal ejection fraction (HFNEF) in heart transplant recipients. METHODS AND RESULTS: To determine pulmonary capillary wedge pressure (PCWP) at rest and during exercise, 81 patients after orthotopic heart transplantation with normal left ventricular ejection fraction (LVEF) underwent exercise right heart catheterization with simultaneous exercise echocardiography. Based on PCWP values, the patients were divided into three groups. Twenty-one patients had no evidence of HFNEF (PCWP at rest < 15 mmHg, maximal PCWP during exercise < 25 mmHg, prevalence 26%). Forty-seven subjects were found to have only exercise-induced HFNEF (PCWP at rest < 15 mmHg, maximal PCWP during exercise ≥ 25 mmHg, prevalence 58%). Thirteen patients had HFNEF already at rest (PCWP ≥ 15 mmHg at rest, prevalence 16%). Of the noninvasive parameters obtained at rest, multivariate regression analysis identified LV mass index adjusted for allograft age to be an independent predictor of exercise-induced HFNEF. CONCLUSIONS: In heart transplant recipients with normal LVEF, there is a high prevalence of exercise-induced HFNEF. LV mass index adjusted for allograft age is predictive of exercise-induced HFNEF.

• MeSH
• cvičení fyziologie   MeSH
• dospělí MeSH
• dysfunkce levé srdeční komory patologie   patofyziologie   MeSH
• echokardiografie MeSH
• lidé středního věku MeSH
• lidé MeSH
• odpočinek fyziologie   MeSH
• plicní tlak v zaklínění MeSH
• srdeční katetrizace MeSH
• srdeční selhání etiologie   patofyziologie   MeSH
• tepový objem * MeSH
• transplantace srdce škodlivé účinky   MeSH
• velikost orgánu MeSH
• zátěžový test MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

In some patients, heart failure (HF) is associated with increased pulmonary vascular resistance (PVR). The magnitude and the reversibility of PVR elevation affect the HF management. Sildenafil has been recently recognized as potent PVR-lowering drug in HF. The aim of the study was to compare hemodynamic effects and pulmonary selectivity of sildenafil to prostaglandin E(1) (PGE(1)). Right-heart catheterization was performed in 13 euvolemic advanced HF patients with elevated PVR (6.3+/-2 Wood's units). Hemodynamic parameters were measured at the baseline, during i.v. infusion of PGE1 (alprostadil 200 ng · kg(-1) · min(-1)) and after 40 mg oral dose of sildenafil. Both drugs similarly reduced systemic vascular resistance (SVR), but sildenafil had higher effect on PVR (-28 % vs. -49 %, p = 0.05) and transpulmonary pressure gradient than PGE(1). The PVR/SVR ratio--an index of pulmonary selectivity, did not change after PGE(1) (p = 0.7) but it decreased by -32 % (p = 0.004) after sildenafil. Both drugs similarly reduced pulmonary artery mean and wedge pressures and increased cardiac index (+27 % and +28 %). Sildenafil led more often to transplant-acceptable PVR while causing smaller drop of mean systemic pressure than PGE(1). In conclusion, vasodilatatory effects of sildenafil in patients with heart failure are more pronounced in pulmonary than in systemic circulation.

• MeSH
• alprostadil terapeutické užití   MeSH
• arteria pulmonalis účinky léků   MeSH
• cévní rezistence účinky léků   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• minutový srdeční výdej účinky léků   MeSH
• piperaziny terapeutické užití   MeSH
• plicní hypertenze farmakoterapie   etiologie   MeSH
• plicní tlak v zaklínění účinky léků   MeSH
• puriny terapeutické užití   MeSH
• sildenafil citrát MeSH
• srdeční katetrizace MeSH
• srdeční selhání komplikace   farmakoterapie   MeSH
• sulfony terapeutické užití   MeSH
• vazodilatancia terapeutické užití   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky kontrolované MeSH
• práce podpořená grantem MeSH
• Názvy látek
• alprostadil MeSH
• piperaziny MeSH
• puriny MeSH
• sildenafil citrát MeSH
• sulfony MeSH
• vazodilatancia MeSH

The paper is based on the results of an earlier retrospective international WHO study of normal pressure values in the pulmonary circulation and the right heart in 468 healthy individuals. The results of this study suggest that the pulmonary hypertension should be defined by the mean pulmonary artery pressure at rest of > or = 20 mmHg and not > or = 25 mmHg. Pulmonary wedge pressure should be < 12 mmHg. These results have recently been confirmed by the so far largest retrospective international study of normal values published by Kovacs et al and involving 1187 healthy volunteers. However, this study does not include pulmonary wedge pressure values. Normal values ofthe mean pulmonary artery pressure during exercise are determined by age. In healthy individuals younger than 50 years of age, the mean pulmonary artery pressure during exercise increases in parallel with increasing cardiac output. However, the increase in the mean pulmonary artery pressure during exercise is steeper in healthy individuals aged 50 years and over. This results from a sharper increase in the pulmonary wedge pressure caused probably by diastolic dysfunction of the left ventricle in the older population.

• MeSH
• arteria pulmonalis fyziologie   MeSH
• cvičení * MeSH
• dospělí MeSH
• funkce pravé komory srdeční fyziologie   MeSH
• krevní tlak * MeSH
• lidé středního věku MeSH
• lidé MeSH
• minutový srdeční výdej MeSH
• mladý dospělý MeSH
• odpočinek * MeSH
• plicní hypertenze diagnóza   MeSH
• plicní oběh * MeSH
• plicní tlak v zaklínění MeSH
• referenční hodnoty MeSH
• senioři MeSH
• stárnutí fyziologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• senioři MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH