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Background: Acute vasoreactivity testing (AVT) which reflects the compliance of the pulmonary vascular bed has been proven to be of prognostic value. The purpose of the present study is to explore the sex differences of hemodynamics during the AVT and their impact on event‐free survival in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Methods: Eighty‐six patients underwent a right heart catheterization and AVT at Shanghai Pulmonary Hospital from February 2009 to February 2018. Univariate and multiple stepwise regression analysis were performed to determine the predictors of independent event‐free survival, and receiver operating characteristic curve was plotted to determine the cut‐off value of independent parameters in CTEPH. Results: There were no significant differences in both demographics and hemodynamics between male and female patients with CTEPH. Except ΔPVR/PVR showed a significantly higher difference in female than male patients (P = 0.034). Male patients had higher mRAP of pre‐ and post‐AVT than female patients in the event‐free subgroup, while, female patients showed higher PVR of pre‐AVT than male patients in the event subgroup (P < 0.05). The mRAP and SvO2 were independent predictors of event‐free survival in female patients both before and after the AVT, whereas ΔSvO2 was an independent predictor of event‐free survival in male patients. Conclusion: Hemodynamics during the AVT varied between male and female patients with CTEPH. Both sexes displayed unique hemodynamic responses that were independently able to predict event‐free survival. Therefore, better estimates of prognosis in CTEPH can be made when sex differences are also taken into consideration. [ABSTRACT FROM AUTHOR]

Objective: This study intended to explore the relation between heart rate recovery at 1 minutes (HRR1) during the recovery phase of cardiopulmonary exercise test (CPET) and exercise capacity in female systemic lupus erythematosus associated pulmonary arterial hypertension (SLE‐PAH) patients. Methods: Twenty‐one female SLE‐PAH patients underwent right heart catheterization (RHC), pulmonary function test (PFT) and CPET. Forty‐two healthy subjects matched with SLE‐PAH patients in age, sex and BMI were recruited as a control group. The correlations between HRR1 with clinical and CPET parameters were performed. Results: Peak HR, ΔHR, HRR1, Peak HR‐warm HR1min, Peak HR‐warm HR2min and CR were significantly lower in SLE‐PAH than in controls (P < .01). Increased incidence of CRI was seen in SLE‐PAH. Except for the Peak PETO2, which was higher in controls, all other CPET parameters were lower in SLE‐PAH. SLE‐PAH patients with HRR1 ≥ 16 had longer 6MWD, lower NT‐proBNP, better percent of predicted gas transfer index or diffusing capacity for carbon monoxide (DLco% pred) as well as better CO and CI. Peak HR, ΔHR, HRR1, Peak HR‐warm HR1min, Peak HR‐warm HR2min, CR, Peak Load, Peak VO2, Peak PETCO2, OUEP and OUES were lower and duration of exercise was shorter in patients with HRR1 < 16. HRR1 had positive correlation with 6MWD, DLco% pred, CO, CI and some key CPET parameters. Conclusions: HRR1 is an easily obtained auxiliary parameter in SLE‐PAH patients to reflect an altered autonomic tone. SLE‐PAH patients with HRR1 < 16 have more severe hemodynamics, worse clinical findings and marked oxygen uptake inefficiency than those with HRR1 ≥ 16. [ABSTRACT FROM AUTHOR]

Background: Pulmonary hypertension patients with mean pulmonary artery pressure (mPAP) ≥ 25 mm Hg had impaired cardiopulmonary exercise testing (CPET). Borderline mean pulmonary pressures (boPAP; 21‐24 mm Hg) represent early pulmonary vasculopathy. The CPET characteristics of boPAP are a matter of discussion. We aimed to determine the CPET profile of such borderline hemodynamics. Methods: A matched case‐control study was conducted on consecutive boPAP patients at the Shanghai Pulmonary Hospital between Jan 2012 and Jan 2017. Hemodynamics, echocardiography, the pulmonary function test (PFT) and CPET parameters were compared between boPAP patients and normal mPAP patients which were matched 1:1 by sex and age. Conditional logistic regression analysis was performed to determine the efficacy of CPET in detecting boPAP. Results: A total of 48 patients underwent RHC and CPET (24 Normal, 24 boPAP). There were no differences in the demographics, echocardiography and PFT. BoPAP patients had significantly decreased VO2 at the anaerobic threshold and peak VO2/kg (858.4 ± 246.5 mL/min vs 727.9 ± 228.0 mL/min, P = 0.037; 21.1 ± 6.4 mL/min/kg vs. 15.5 ± 5.6 mL/min/kg, P = 0.001, respectively). Significant differences were not observed in ventilation efficiency. A trend of impaired oxygen pulse and submaximal exercise tolerance were observed in boPAP patients. Conditional logistical regression analysis revealed the risk of boPAP increased by 2.493 (95% confident interval: 1.388 to 4.476, P = 0.002) with every 5 mL/min/kg decrease in peak VO2/kg. Conclusions: Patients with boPAP have a greater prevalence of exercise intolerance, a trend of impaired oxygen pulse and submaximal exercise tolerance. [ABSTRACT FROM AUTHOR]

Abstract: Background: Despite using vasoactive and pulmonary hypertension (PH) specific therapies, the in‐hospital mortality of severe PH with right heart failure (RHF) is high. We conducted a prospective analysis evaluating the efficacy and safety of levosimendan in PH patients with severe acute RHF. Methods: Forty‐five PH patients hospitalized between January 2016 and November 2016 were recruited into a single arm, prospective, open‐label study. Levosimendan was administered at the rate of .05–0.1 μg/kg/min, up to a total dose of 12.5 mg. The primary endpoints were changes of World Health Organization Function Class (WHO‐FC) and Borg dyspnoea scores. Secondary endpoints included changes in 6‐min walk distance (6‐MWD), biochemical markers and right heart structure and function together with adverse events on day 7 and incidence of major cardiovascular events (death or readmission due to RHF) on day 30. Results: Forty‐five PH patients were enrolled. On the 7th day after levosimendan infusion, seven out of 13 PH patients with WHO‐FC IV improved by one class (P = .008). Borg dyspnoea scores, 6‐MWD and NT‐proBNP improved significantly (P < .001). Compared with baseline, the right atrial transverse dimension, end‐systolic eccentricity index and tricuspid annular plane systolic excursion improved significantly (58.8 ± 13.1 mm vs 53.7 ± 12.4 mm; 1.50 ± 0.27 vs 1.38 ± 0.23; 15.0 (13.0, 16.0) mm vs 15.8 (14.0, 17.4) mm, P < .005, respectively). One patient occurred sudden death after discharge during follow‐up. Conclusions: Intravenous levosimendan can effectively improve severe RHF of PH patients in hospital and well tolerated. [ABSTRACT FROM AUTHOR]

Abstract: Background: Pulmonary hypertension (PH) is an important complication of interstitial lung disease (ILD). The aim of the present study was to investigate characteristics and prognosis of ILD associated PH in a predominantly Chinese patient cohort. Methods: Consecutive patients with ILD associated PH, confirmed by right heart catheterization at shanghai pulmonary hospital were included in the study. Characteristics at baseline and during follow‐up, as well as survival, were analyzed. Results: This observational study was conducted in 26 patients with a mean age of 60.0 ± 12.2 y old. The 6‐min walking distance was 335.0 ± 190.9 m. The mean pulmonary arterial pressure (PAP) was 42.9 ± 10.9 mmHg, cardiac output was 4.4 ± 1.0 L/min, and pulmonary vascular resistance (PVR) was 8.6 ± 4.1 Wood Units. The mean PAP was ≥35 mmHg in 69.2% of cases. There were no difference in lung function parameters between ILD with PH and ILD without PH. The overall survival rate was 92% at 1 y, 82% at 3 y, and 62% at 5 y. PVR was the only variable significantly associated with death. Conclusions: Severe hemodynamic impairment along with PH can occur in patients with ILD. These patients have more severely impaired exercise capacity and cardiac function than ILD patients without PH. PVR was the only prognostic factor identified in this group of patients. [ABSTRACT FROM AUTHOR]