Improvement in right ventricular function during reversibility testing in pulmonary arterial hypertension: a case report

A right heart catheterization with reversibility testing is recommended for the diagnosis and treatment of pulmonary arterial hypertension. In this 24 years-old woman, the inhalation of 5 μg iloprost transiently decreased mean pulmonary artery pressure from 62 to 36 mmHg and pulmonary vascular resistance from 11.0 to 4.9 Wood units, meeting the criteria of a "positive response". The echocardiographic examination showed normalization of right heart chamber dimensions and of the right ventricular performance (Tei) index. Pulsed tissue Doppler imaging of the right ventricle showed a decrease in the isovolumic relaxation time from 102 to 73 ms, and an increase of the E/A ratio from 0.72 to 1.38, together with marked improvements in mid-apical free wall systolic strain and strain rate. A positive response to reversibility testing of pulmonary arterial hypertension may be associated with quasi normalization of right ventricular function, in spite of still elevated pulmonary artery pressure

Contribution à l'étude de la circulation pulmonaire et de la fonction ventriculaire droite dans l'hypertension pulmonaire: apports de l'échocardiographie et de l'imagerie par Doppler tissulaire

Chapitre 1. Introduction\Doctorat en sciences médicalesinfo:eu-repo/semantics/nonPublishe

Exercise stress tests for detection and evaluation of pulmonary hypertension

The use of an exercise stress test in the diagnosis or evaluation of pulmonary hypertension rests on the assumption that multipoint mean pulmonary artery pressure (mPpa)-flow (Q) plots are superior to isolated pulmonary vascular resistance determinations for the evaluation of the functional state of the pulmonary circulation. A multipoint mPpa-Q relationship is best described by a linear approximation and, as such, characterized by an extrapolated pressure intercept and by a slope. Both are dependent on the method used to increase flow. The slope is higher and the pressure intercept lower when exercise is used to increase flow, rather than unilateral pulmonary artery balloon occlusion or low-dose dobutamine. This is because of exercise-induced pulmonary vasoconstriction. The steepest slopes, i.e. the highest pressures at a given flow, are obtained by resistive exercise (handgrip) when compared with dynamic exercise (cycling) because of systemic vascular resistance and intrathoracic pressure changes. Since systolic, diastolic, and mean pulmonary artery pressures are tightly correlated and since in experienced hands, systolic pulmonary artery pressures and cardiac output are reliably measured using Doppler echocardiography, mPpa-Q lines can be obtained non-invasively. The exercise stress test for non-invasive diagnosis of pulmonary hypertension may be particularly useful for the detection of early disease and for more accurate quantification of pulmonary vascular changes induced by disease progression and/or therapeutic interventions. © The European Society of Cardiology 2007. All rights reserved.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Right ventricular function in pulmonary hypertension: Physiological concepts

The symptoms of pulmonary hypertension are explained by a decrease in cardiac output caused by an afterload-induced right ventricular (RV) failure. However, the standard haemodynamic evaluation of pulmonary hypertension, with measurements of mean pulmonary vascular pressures and cardiac output, does not capture the determinants of RV function. Right ventricular afterload can be measured either as a hydraulic load calculated from spectral analysis of pulmonary artery pressure and flow waves, or as a maximal wall tension estimated from instantaneous ventricular pressure, volume, and wall thickness measurements. The adequacy of ventricular adaptation to afterload can be assessed by a measurement of the matching of systolic function to arterial elastance. The difficulty in measuring instantaneous RV volume is overcome using a single-beat method, which derives a systolic pressure-volume relationship from instantaneous RV pressure and an integration of pulmonary arterial flow. On such a pressure-volume curve, it is easy to determine graphically end-systolic elastance (Ees, end-systolic pressure on end-systolic volume), as a load-independent measure of contractility, and arterial elastance (E a, end-systolic pressure on stroke volume), as a measure of afterload. The optimal value of the Ees/Ea ratio, compatible with flow output at a minimal energy cost, is between 1 and 2. Patients with severe pulmonary hypertension present with a decreased elastance ratio, in spite of an adaptative increase in systolic function, which underscores that RV failure in the face of increased afterload is a relative notion. Further studies are needed to confirm that right ventriculo-arterial decoupling accounts for a decreased aerobic exercise capacity by a limitation of cardiac output adaptation to peripheral demand. © The European Society of Cardiology 2007. All rights reserved.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Reflections on wave reflections in chronic thromboembolic pulmonary hypertension.

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Problems of High Altitude Medicine and Biology: cardiac limitation to exercise capacity at high altitudes

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Pre-employement examination for low back risk in workers exposesd to manual handling of loads : French guidelines

BACKGROUND: Low back pain (LBP) is a major cause of sickness absence and disability in the working population, and the pre-employment examination should insure that worker\u27s state of health is compatible with the requirements of proposed job. This paper summarizes the main recommendations of the good practice guidelines of the French Society of Occupational Medicine for pre-employment examination in workers exposed to manual handling of loads apart from pre-employment test. METHODS: The recommendations were developed according to the Clinical Practice Guidelines proposed by the French National Health Authority and based on a systematic search of the literature 1990-2012 in several databases. The guidelines were written and reviewed by two multidisciplinary committees. On the basis of the level of evidence in the literature, the proposed guidelines are classified as grade A, B, C or expert consensus. RESULTS: The main recommendations of these guidelines are as follows: (1) medical contraindications alone should not exclude employment in a job associated with a low back risk on the basis of a history of "simple" nonspecific LBP; (2) the relevance of examining a previous history of LBP, which is the best predictor of future LBP due to the recurrent nature of LBP. CONCLUSIONS: These guidelines correspond to a constant concern with prevention of occupational risk. Primarily intended for occupational physicians, they are also intended for general practitioners who carry out pre-employment examinations in many countries and are likely to be increasingly faced with this type of situation because of the combination of increasing work constraints with ageing of the workforce

Utilisation d'une plus grande dilution de la solution de nitrate d'argent pour la mise en évidence des régions organisatrices nucléolaires (Ag NOR).

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How to detect disease progression in pulmonary arterial hypertension.

Pulmonary arterial hypertension (PAH) is a rapidly progressive disease, ultimately leading to right heart failure and death. Accumulating evidence indicates that intervention early in disease progression results in better outcomes than delaying treatment. In this review we will discuss the assessments and strategies that can be used to monitor disease progression and guide clinical management. Many tools, such as symptoms, functional classification, exercise capacity, haemodynamic measures, findings on cardiac imaging and levels of biomarkers, have shown to be prognostic for survival both at diagnosis and during treatment. However, attempts to define goal thresholds have produced a variety of results. Several groups have developed risk calculators to estimate individual patients' mortality risk, but the accuracy of these tools across different patient populations remains unknown. What is clear is the importance of regularly assessing a range of parameters and then tailoring treatment goals to each patient. In addition, the use of a multidisciplinary team approach is crucial in order to support patients through all aspects of managing their condition. There is still an urgent need for prospective collaborative initiatives to assess novel goals and improve treatment strategies that would allow physicians to personalise and optimise clinical management for their patients with PAH.Journal ArticleResearch Support, Non-U.S. Gov'tReviewSCOPUS: ar.jinfo:eu-repo/semantics/publishe