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ABSTRACT: Iloprost has been used to test acute pulmonary vasoreactivity in idiopathic pulmonary arterial hypertension (PAH). We aimed to investigate the acute hemodynamic and oxygenation responses and tolerability to 20 µg aerosolized Iloprost in Chinese patients with pulmonary hypertension.
Between March 2005 and May 2010, 212 pulmonary hypertension patients inhaled a single dose of 20 µg Iloprost over 10 - 15 minutes for vasoreactivity testing. The acute hemodynamic and oxygenation responses and adverse events were recorded.
Iloprost decreased total pulmonary resistance ((1747 ± 918) dyn×s×cm(-5) vs. (1581 ± 937) dyn×s×cm(-5), P < 0.001), increased stroke volume ((45.0 ± 22.1) ml vs. (47.0 ± 24.2) ml, P = 0.002), and cardiac output ((3.7 ± 1.7) L/ml vs. (3.9 ± 1.9) L/min, P = 0.009). Heart rate and systemic vascular resistance remained stable during inhalation. However, systemic arterial blood oxygen saturation fell slightly ((91.0 ± 6.8)% vs. (90.3 ± 6.7)%, P = 0.002). Pulmonary and systemic arterial blood pressures declined within 1 - 3 minutes after inhalation initiation and reached their lowest levels within 10 - 15 minutes. Idiopathic PAH responded more favorably than pulmonary hypertension due to other causes (P £0.001) and patients with less severe pulmonary hypertension have better responses to Iloprost. No adverse events requiring medical care or leading to termination of inhalation occurred.
Inhalation of 20 µg Iloprost showed potent and selective pulmonary hemodynamic effects and was well tolerated in the Chinese pulmonary hypertension patients. Patients with idiopathic PAH and less severe pulmonary hypertension responded more favorably to inhalation of Iloprost.
Chinese medical journal 08/2012; 125(16):2826-31. · 0.86 Impact Factor
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ABSTRACT: Pulmonary angiography is widely performed in pulmonary hypertension patients, but its immediate effects on right heart hemodynamics and safety are not well known. The objective of this study was to investigate the right heart hemodynamic effects and safety of pulmonary angiography in Chinese patients with pulmonary hypertension.
Between January 2008 and June 2009, pulmonary hypertension patients undergoing pulmonary angiography were consecutively enrolled. Pulmonary angiography was performed during breath-holding after deep breathing. The baseline clinical data, hemodynamic measurements before and after pulmonary angiography and complications occurring within 48 hours after angiography were recorded.
Ninety-five patients were included. All received non-ionic contrast medium with a volume of (75.7 ± 29.8) ml. Angiography reduced heart rate in patients with baseline mean pulmonary arterial pressure ≥ 60 mmHg (change of heart rate: (-3.1 ± 7.0) beats/min, P = 0.005), increased mean right atrial pressure, diastolic and end-diastolic right ventricular pressure in patients with baseline mean pulmonary arterial pressure < 60 mmHg (all P < 0.05). Patients with decreased mean pulmonary arterial pressure (change of mean pulmonary arterial pressure ≤ -10 mmHg) had the highest total pulmonary resistance (P = 0.009 vs. no change in mean pulmonary arterial pressure (change of mean pulmonary arterial pressure, -10 mmHg to 10 mmHg); P = 0.03 vs. increased mean pulmonary arterial pressure (change of mean pulmonary arterial pressure ≥ 10 mmHg)) and the lowest cardiac output (P = 0.018 vs. no change in mean pulmonary arterial pressure; P = 0.013 vs. increased mean pulmonary arterial pressure). There were 7 complications (7%), with 6 related to catheter and only 1 directly related to angiography. All complications were mild and no death occurred.
Pulmonary angiography has minimal effect on right heart hemodynamics and is safe in pulmonary hypertension patients.
Chinese medical journal 10/2011; 124(20):3232-7. · 0.86 Impact Factor
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ABSTRACT: N-Terminal Pro-Brain Natriuretic Peptide (NTproBNP) is a predictor of adverse short-term clinical outcomes in patients with acute pulmonary embolism (APE), but its long-term prognostic value remains largely undefined. The aim of this study was to assess the value of plasma NTproBNP with regard to recurrent venous thromboembolism (VTE).
NTproBNP levels were measured in 224 consecutive patients with the first episode of acute pulmonary embolism occurring from January 2005 through October 2010. Patients were categorized into two groups by NTproBNP reference range. Follow-ups were performed at 3, 6, and 12months and yearly thereafter. The primary end point was symptomatic, recurrent fatal or nonfatal VTE.
NTproBNP was elevated in 158 (70.5%) patients and not elevated in 66 (29.5%) patients. After a mean follow-up period of 31.0±19.4months, patients with elevated NTproBNP showed an increased risk of recurrent VTE (20 patients, 12.7%) compared to those without elevated NTproBNP (only 1 patient, 1.5%) (P=0.009). Of the 7 deaths related to pulmonary embolism, 6 occurred in patients with elevated NTproBNP compared to patients with normal NTproBNP (1 of 7 deaths). In a multivariate analysis stratified by oral anticoagulant treatment duration, elevated NTproBNP was an independent predictor of recurrent VTE (hazard ratio, 9.32; P=0.02).
Elevated NTproBNP is associated with recurrent VTE in acute pulmonary embolism patients.
Thrombosis Research 09/2011; 129(6):688-92. · 2.44 Impact Factor
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ABSTRACT: D-dimer can be used to exclude acute pulmonary embolism (PE) for its high negative predictive value (NPV). Also, it is a predictor of recurrent venous thromboembolism (VTE) after anticoagulation withdrawal. The aim of the present study was to assess the predictive value of D-dimer for recurrent VTE when tested at hospital discharge. Plasma D-dimer levels were repeatedly measured at hospital discharge in 204 consecutive patients with the first episode of acute pulmonary embolism. Patients were categorized to two groups by D-dimer levels at hospital discharge and followed up at 3, 6, and 12 months and yearly thereafter. The primary end point was symptomatic, recurrent fatal or nonfatal VTE. D-dimer levels were persistently abnormal in 66 patients (32%). After 31±19 months follow-up, patients with persistently abnormal D-dimer level levels showed a higher rate of of recurrent VTE (14 patients, 21%) compared to those with D-dimer regression (8 patients, 6%) (P = 0.001). At the multivariate analysis, after adjustment for other relevant factors, persistently abnormal D-dimer level levels were an independent predictor of recurrent VTE in all subjects investigated, (hazard ratio, 4.10; 95% CI, 1.61-10.39; P = 0.003), especially in those with unprovoked PE (hazard ratio, 4.61; 95% CI, 1.85-11.49; P = 0.001). The negative predictive value of D-dimer was 94.2 and 92.9% in all subjects or those with unprovoked PE, respectively. Persistently abnormal D-dimer level levels at hospital discharge have a high negative predictive value for recurrence in patients with acute pulmonary embolism, especially in subjects with an unprovoked previous event.
Journal of Thrombosis and Thrombolysis 08/2011; 32(4):410-6. · 1.48 Impact Factor
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ABSTRACT: This study, in optimally treated CAD patients with newly diagnosed OSA, focused on (1) The relationships between OSA and serum biomarkers of four potential pathways of cardiovascular injury in OSA: high-sensitivity C-reactive protein (hs-CRP), endothelin-1 (ET-1), N terminal pro B type natriuretic peptide (NT-proBNP) and fibrinogen; and (2) The effect of continuous positive airway pressure (CPAP) therapy on these markers. 151 Chinese patients with proven CAD and standard medication were enrolled. After polysomnography, patients were classified into four groups according to apnea-hypopnea index (AHI): no OSA (n = 25); mild OSA (n = 50); moderate OSA (n = 43); severe OSA (n = 33). Morning levels of hs-CRP, ET-1, NT-proBNP and fibrinogen were assayed and repeated in severe OSA patients after 3-months CPAP treatment. Hs-CRP was greater in patients with severe OSA than those with no OSA or mild OSA (P = 0.001, P = 0.003; respectively). After adjustment for confounders, the hs-CRP levels correlated most strongly with AHI and oxygen desturation index (ODI) (r = 0.439, P < 0.001; r = 0.445, P < 0.001; respectively). In stepwise multiple linear regressions, the strongest predictor of hs-CRP levels was ODI (P < 0.001). After 3 months of CPAP treatment, the hs-CRP levels deceased (P = 0.005) in CAD patients with severe OSA. In CAD patients on current optimal medications, hs-CRP is significantly correlated with the severity of OSA, and the elevated hs-CRP levels can be decreased by CPAP. This suggests that OSA could activate vascular inflammation in CAD patients despite current best practice medications.
Respiratory medicine 06/2011; 105(10):1557-64. · 2.33 Impact Factor
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ABSTRACT: Continuous positive airway pressure (CPAP) is an effective therapy for obstructive sleep apnea (OSA). However, for patients who already have OSA and coronary heart diseases (CHD) with optimal medications, whether CPAP can reduce the blood pressure (BP) is not clear. This is a controlled study to evaluate the effects of CPAP on BP in Chinese cohorts with CHD under optimal medications.
Twenty-four patients with CHD and moderate to severe OSA were treated with CPAP and standard care for 1 month. Twenty-four matched control patients were only treated with standard care alone. Baseline demographic data as well as sleep study data was recorded in all patients. Office blood pressure, heart rate, Epworth sleepiness scale (ESS) score, and quality of life (SF-36) of the two groups were compared after 1-month treatment.
Compared with control group, CPAP treatment markedly reduced the morning diastolic BP (Δ -0.8 ± 6.0 vs. Δ -5.1 ± 6.5, respectively, P = 0.023) and improved ESS scores (Δ -0.5 ± 3.2 vs. Δ -5.2 ± 3.1, P < 0.001). In contrast, there were no significant changes in systolic BP (Δ -0.3 ± 7.3 vs. Δ -3.8 ± 11.8, P = 0.225), heart rate, and quality of life.
CPAP treatment for 1 month was associated with significant reduction in diastolic BP and improvement in ESS score. For patients with moderate to severe OSA and CHD under optimal medications, CPAP treatment leads to effective reduction in diastolic blood pressure and improvement in daytime sleepiness.
Sleep And Breathing 02/2011; 16(2):341-7. · 1.84 Impact Factor
