Data_Sheet_1_Hepatorenal dysfunction in patients with chronic thromboembolic pulmonary hypertension.docx

BackgroundCardiac interactions with organs such as the liver or kidneys have been described in different cardiovascular diseases. However, the clinical relevance of hepatorenal dysfunction in chronic thromboembolic pulmonary hypertension (CTEPH) remains unclear. We determined the association of hepatorenal dysfunction (measured using the Model for End-stage Liver Disease Sodium [MELDNa] score) with right heart function and survival in patients with CTEPH.MethodsWe analyzed all patients with CTEPH in the Giessen Pulmonary Hypertension Registry who had available MELDNa scores and were not taking vitamin K antagonists. The MELDNa score was calculated as MELD score − serum Na − (0.025 * MELD score * (140 − serum Na)) + 140; the MELD score was calculated as 10*(0.957*ln(creatinine)+0.378*ln(bilirubin)+1.12*ln(International Normalized Ratio))+6.43.ResultsSeventy-two patients were included (74% female; median [Q1, Q3] MELDNa: 9 [6, 11]). MELDNa correlated well with right atrial and ventricular function and pulmonary hemodynamics. Forward regression analysis revealed that hepatorenal dysfunction mainly depends on right atrial strain and tricuspid regurgitation, but not right ventricular systolic dysfunction. Hepatorenal dysfunction predicted mortality at baseline and follow-up (adjusted hazard ratios [95% confidence intervals] per unit increase of MELDNa: 1.6 [1.1, 2.4] and 1.8 [1.1, 2.9], respectively). Changes in hepatorenal function also predicted mortality.ConclusionHepatorenal dysfunction in CTEPH is primarily associated with venous congestion rather than cardiac forward failure. As a surrogate parameter for hepatorenal dysfunction, MELDNa is a simple method to identify at-risk patients at baseline and follow-up.</p

Additional file 1 of Long-term comprehensive cardiopulmonary phenotyping of COVID-19

Additional file 1: Figure S1. A: Lymphocyte counts and subsets over time (timepoint 0: 0–6 weeks, 1: 3 months, 2: 6 months, 3: 9 months, 4: 12 months after COVID-19 diagnosis). B: Exemplary images for the classification of the predominant B-line pattern on lung ultrasound. 0: Normal pattern. Consistently thin pleural line (arrowheads) in between two rib shadows (*). A-lines apparent (arrows) in equidistant intervals (bidirectional arrows). 1: Slightly uneven and irregular illustration of the pleural line (arrowheads). Faint A-line (arrow), beginning discrete B-lines (dashed arrows), which obliterate A-lines. 2: Irregularly thickened pleural line (arrowheads). Numerous discrete B-lines (*) detectable, no A-lines depicted in this area. 3: Distinctly thickened and irregularly altered pleural line (arrowheads) depicted in between two rib shadows (+). Various B-lines (*) are seen emerging from the pleural line that radiate towards the bottom of the image, partly confluent (#). 4: Left basolateral lung zone, pleural line (arrowhead) depicted adjacent to hypoechoic, consolidated atelectasis (*) which is situated next to the diaphragm (parallel double arrow). Hyperechoic lines (arrow) within the consolidation indicate dynamic air bronchograms. Spleen (#) is visible below the diaphragm. C: Available measurements at the pre-defined timepoints