Assessing right ventricular function and the pulmonary circulation in pulmonary hypertension

Vonk Noordegraaf, A. [Promotor]Bogaard, H.J. [Copromotor]Marcus, J.T. [Copromotor

Pulmonary arterial hypertension combined with a high cardiac output state: Three remarkable cases

A congenital extrahepatic portosystemic venous shunt (CEPVS), also known as an Abernethy malformation, is a rare cause of pulmonary arterial hypertension (PAH). In this case series, we describe three male patients of 30, 23, and 27 years of age with PAH due to a CEPVS. In all three patients, a right heart catheterization revealed a high cardiac output. The aim of this case series is to make pulmonary hypertension physicians aware of the possibility of a CEPVS when PAH is accompanied with a high cardiac output state

Predicting pulmonary hypertension with standard computed tomography pulmonary angiography

The most common feature of pulmonary hypertension (PH) on computed tomography pulmonary angiography (CTPA) is an increased diameter-ratio of the pulmonary artery to the ascending aorta (PA/A

Slag waste incorporation in high early strength concrete as cement replacement: Environmental impact and influence on hydration & durability attributes

This paper investigates the effects of incorporating slag waste (Ground Granulated Blast Furnace Slag; GGBS) as cement replacement in high early strength concrete. GGBS was used in various replacement ratios and resulting properties of the developed concretes were evaluated. Compressive strength, heat of hydration and shrinkage were determined for evaluating hydration attributes while chloride penetrability and carbonation resistance were investigated for studying the durability-related characteristics of the resulting concretes. The optimum ratio of GGBS as SCM has been determined, in this study, as 30% at which there is merely an average strength decline of 11% while reducing the total carbon dioxide emissions by 30%. Similarly, at this replacement level, the decreased chloride ion penetrability (15%) and higher carbonation resistance (3%) further encourage its use in precast concrete incorporating (HESC). Finally, the beneficial effects of using slag waste in concrete were quantified by determining associated CO2 emissions. It is concluded that slag incorporation in concrete significantly reduces the CO2 emissions, (up to 68%) depending on the cement replacement level, thus promoting green construction and sustainable development

Right Heart Score for Predicting Outcome in Idiopathic, Familial, or Drug- and Toxin-Associated Pulmonary Arterial Hypertension

AbstractObjectivesThis study sought to determine whether a simple score combining indexes of right ventricular (RV) function and right atrial (RA) size would offer good discrimination of outcome in patients with pulmonary arterial hypertension (PAH).BackgroundIdentifying a simple score of outcome could simplify risk stratification of patients with PAH and potentially lead to improved tailored monitoring or therapy.MethodsWe recruited patients from both Stanford University (derivation cohort) and VU University Medical Center (validation cohort). The composite endpoint for the study was death or lung transplantation. A Cox proportional hazard with bootstrap CI adjustment model was used to determine independent correlates of death or transplantation. A predictive score was developed using the beta coefficients of the multivariable models.ResultsFor the derivation cohort (n = 95), the majority of patients were female (79%), average age was 43 ± 11 years, mean pulmonary arterial pressure was 54 ± 14 mm Hg, and pulmonary vascular resistance index was 25 ± 12 Wood units × m2. Over an average follow-up of 5 years, the composite endpoint occurred in 34 patients, including 26 deaths and 8 patients requiring lung transplant. On multivariable analysis, RV systolic dysfunction grade (hazard ratio [HR]: 3.4 per grade; 95% confidence interval [CI]: 2.0 to 7.8; p < 0.001), severe RA enlargement (HR: 3.0; 95% CI: 1.3 to 8.1; p = 0.009), and systemic blood pressure <110 mm Hg (HR: 3.3; 95% CI: 1.5 to 9.4; p < 0.001) were independently associated with outcome. A right heart (RH) score constructed on the basis of these 3 parameters compared favorably with the National Institutes of Health survival equation (0.88; 95% CI: 0.79 to 0.94 vs. 0.60; 95% CI: 0.49 to 0.71; p < 0.001) but was not statistically different than the REVEAL (Registry to Evaluate Early and Long-Term PAH Disease Management) score c-statistic of 0.80 (95% CI: 0.69 to 0.88) with p = 0.097. In the validation cohort (n = 87), the RH score remained the strongest independent correlate of outcome.ConclusionsIn patients with prevalent PAH, a simple RH score may offer good discrimination of long-term outcome