Incorporation of pulmonary vascular resistance measurement into standard echocardiography: implications for assessment of pulmonary hypertension

Doppler estimation of pulmonary artery systolic pressure (PASP) from tricuspid regurgitation velocity is a simple approach to the detection of pulmonary hypertension but may be influenced by right ventricular stroke volume. We sought the clinical utility of incorporating Doppler calculation of pulmonary vascular resistance (PVR) into determination of pulmonary hypertension in 578 consecutive patients with tricuspid regurgitation. Right atrial pressure was estimated from vena caval dimensions and collapsibility. Pulmonary hypertension was classified on the basis of a) PASP >35mmHg, b) age-/ gender normalized PASP, c) PVR > 2 Wood units. The mean PASP was 40 +/- 13 mmHg and PVR was 1.9 +/- 0.8 Wood units. Standard PASP identified pulmonary hypertension in 58%, compared with 36% by age-/ gender normalized PASP (P < 0.0001), and 31% by PVR (P < 0.0001). Of patients who had pulmonary hypertension by PASP, 33% were reclassified as normal on the basis of PVR and 6% were reclassified from normal to pulmonary hypertension. PVR is easy to incorporate into a standard echo exam, and identifies a small group with normal PASP as having PAH, and a larger group of apparently increased PASP as normal

Exercise training programmes improve survival and delay hospital admission in people with chronic heart failure

Question. Do exercise training programmes improve survival in people with chronic heart failure? Study design. Systematic review with meta-analysis. Main results. Fewer deaths occurred in the exercise group compared with control at a median follow-up of about 2 years (exercise: 22% [88/395]; control 26% [105/406]; hazard ratio 0.65, 95% CI 0.46 to 0.92). Fewer deaths or hospital admissions occurred in the exercise group compared with control (exercise: 32% [127/395]; control 43% [173/406]; hazard ratio HR 0.72, 95% CI 0.56 to 0.93). Authors' conclusions. Exercise training improves survival and time to death or admission to hospital in people with chronic heart failure due to left ventricular systolic dysfunction