Heart failure (HF) with preserved ejection fraction (HFpEF) is characterized by an inability of the heart to perfuse the body without pathologic increases in filling pressure at rest or during exertion. Right heart catheterization provides direct assessment for HF, providing the most robust and direct method to evaluate the central hemodynamic abnormalities, and serves as the gold standard to confirm or refute the presence of HFpEF. This article reviews current understanding of the best practices in the performance and interpretation of hemodynamic assessment, relates important pathophysiologic concepts to clinical care, and discusses current and evidence-based applications of hemodynamics in HFpEF.
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http://dx.doi.org/10.1016/j.ccl.2022.06.010 | DOI Listing |
Int J Cardiol Congenit Heart Dis
September 2024
Royal Brompton Hospital, Part of Guys St Thomas NHS Trust, and National Heart and Lung Institute, Imperial College London, London, United Kingdom.
Pulmonary arterial hypertension (PAH) is defined as increase in mean pulmonary arterial pressure and pulmonary vascular resistance (PVR). It can be associated with congenital heart disease (CHD) with the following subtypes: 1) uncorrected left-to-right (L-R) intracardiac shunt leading to overload of the pulmonary circulation and a progressive increase of PVR; 2) Eisenmenger syndrome, appearing when a large post-tricuspid shunt is left uncorrected and pulmonary vascular disease (PVD) is severe, so the shunt becomes bidirectional or right-to-left, causing cyanosis; 3) PAH after shunt closure, when PVR arises after a defect correction; and 4) PAH associated with small or coincidental defects. While the treatment of patients with Eisenmenger syndrome is well established, the treatment of patients with PAH in whom there is a L-R shunt (with no cyanosis) remains unclear and requires expertise.
View Article and Find Full Text PDFInt J Cardiol Congenit Heart Dis
September 2024
National Pulmonary Hypertension Centre, Royal Papworth Hospital, UK.
Chronic thromboembolic pulmonary disease (CTEPD) with or without pulmonary hypertension (PH) occurs when thromboemboli in pulmonary arteries fail to resolve completely. Pulmonary artery obstructions due to chronic thrombi and secondary microvasculopathy can increase pulmonary arterial pressure and resistance leading to chronic thromboembolic PH (CTEPH). Mechanical interventions and/or PH medications can improve cardiopulmonary haemodynamic, alleviate symptoms, and decrease mortality risk.
View Article and Find Full Text PDFInt J Cardiol Congenit Heart Dis
September 2024
The University of Sydney, Sydney, New South Wales 2006, Australia.
Background: Exercise capacity is reduced in patients with a Fontan circulation compared to their healthy peers secondary to altered haemodynamics of the Fontan circulation. Cardiopulmonary exercise testing is routinely used in Fontan patients to assess their cardiopulmonary response to exercise and help guide management decisions, however their results are routinely compared to normative data derived from healthy individuals.
Method: Using data available from the Pediatric Heart Network, we performed a retrospective study to derive Fontan-specific normative values in a subgroup of well-functioning adolescent patients.
Introduction: Managing cognitive demand is critical for aviation safety. Yet, accurately assessing pilot workload during complex flight maneuvers remains challenging. This study evaluated an integrated methodology combining real-time cognitive engagement indicators to provide a comprehensive assessment and assess the reliability of physiological and subjective measures for monitoring operator state.
View Article and Find Full Text PDFWorld J Pediatr Congenit Heart Surg
December 2024
Penn State Hershey Pediatric Cardiovascular Research Center, Penn State College of Medicine, Hershey, PA, USA.
Background: The study objective was to determine the impact of cardiopulmonary bypass perfusion modalities on cerebral hemodynamics and clinical outcomes in congenital cardiac surgery patients stratified by acyanotic versus cyanotic heart disease.
Methods: A total of 159 pediatric (age <18 years) cardiac surgery patients were prospectively randomized to pulsatile or nonpulsatile cardiopulmonary bypass and stratified by type of congenital heart disease: acyanotic versus cyanotic. Intraoperative cerebral gaseous microemboli counts and middle cerebral artery pulsatility index were assessed.
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