Pulmonary Hypertension

Pulmonary hypertension (PH) is a complex and multifactorial syndrome, partly unknown, characterized by a profound alteration of pulmonary vasculature and, consequentially, a rise in the pulmonary vascular load, leading to hypertrophy and remodeling of the right heart chambers. The World Health Organization assembles the several forms of PH into five clinical groups: group 1 includes pulmonary arterial hypertension, previously defined as idiopathic forms, group 2 is PH due to left-sided heart diseases, group 3 PH due to lung diseases, hypoxia, or both, group 4 due to pulmonary-artery obstruction, and group 5 PH, which includes forms with multifactorial or unclear mechanisms. In this chapter, we would like to delineate the clinical and hemodynamic definitions of PH and, for each group, we will describe the pathophysiological mechanisms, the diagnostic pathway, and the pharmacological approach and treatment. Finally, we would also like to focus on the latest trials and future therapeutic perspectives for this disease

Early discharge after transfemoral transcatheter aortic valve implantation

Background: The aim of this study was to assess the feasibility and the safety of early discharge (within 72 h) after transfemoral transcatheter aortic valve implantation (TAVI) and to identify baseline features and/or periprocedural variables, which may affect post-TAVI lengthofstay (LoS) duration. Methods and results: Patients discharged within 72 h of TAVI (early discharge group) were compared with consecutive patients discharged after 3 days (late discharge group). Propensity-matched cohorts of patients with a 2:1 ratio were created to better control confounding bias. Among 465 patients, 107 (23.0%) were discharged within 3 days of the procedure. Multivariable regression analysis of unmatched patients demonstrated that baseline New York Heart Association (NYHA) class IV (OR:0.22, 95% CI 0.05 to 0.96; p=0.045) and any bleeding (OR:0.31, 95% CI 0.74 to 0.92; p=0.031) were less likely to be associated with early discharge after TAVI. Conversely, the year of procedure (OR:1.66, 95% CI 1.25 to 2.20; p<0.001) and the presence of a permanent pacemaker (PPM) before TAVI (OR:2.80, 95% CI 1.36 to 5.75; p=0.005) were associated with a higher probability of early discharge. In matched populations, patients in the early discharge group reported lower incidence of in-hospital bleeding (7.9% vs 19.4%, p=0.014), major vascular complications (2.3% vs 9.1%, p=0.038) and PPM implantation (7.9% vs18.5%, p=0.021), whereas after discharge, at 30-day, no significant differences were reported between groups in terms of death (2.2% vs 1.7%, p=0.540), bleeding (0.0% vs 1.1%, p=0.444), PPM implantation (1.1% vs 0.0%, p=0.333) and rehospitalisation (1.1% vs 1.1%, p=1.000). Conclusions: Early discharge (within 72 h) after transfemoral TAVI is feasible and does not seem to jeopardise the early safety of the procedure, when performed in a subset of patients selected by clinical judgement. Patients undergoing TAVI in unstable haemodynamic compensation and patients experiencing bleeding after the procedure demonstrated to be poorly suitable to this approach, whereas increasing experience in post-TAVI management was associated with a reduction of LoS

Chronic thromboembolic pulmonary hypertension risk score evaluation and validation (CTEPH Solution). proposal of a study protocol aimed to realize a validated risk score for early diagnosis

Chronic Thromboembolic Pulmonary Hypertension (CTEPH) is the most serious long-term complication of acute pulmonary embolism (PE) though it is the only potentially reversible form of Pulmonary Hypertension (PH). Its incidence is mainly limited to the first 2 years following the embolic event, however it is often underdiagnosed or misdiagnosed