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Pulmonary arterial hypertension is characterized by progressive pulmonary vascular remodeling and the eventual development of right heart failure. Multiple mechanisms are responsible, including vasoconstriction, metabolic flux, and inflammation. Since the early descriptions of pulmonary hypertension, female sex has been associated with increased prevalence of the disease, with research showing both detrimental and beneficial effects of estrogen and its metabolites. This article aims to describe how the female paradox arises from sex differences in pulmonary hypertension and how this has an impact on pathophysiology and future treatment.

Right ventricular (RV) functional adaptation to afterload determines outcome in pulmonary hypertension (PH). RV afterload is determined by the dynamic interaction between pulmonary vascular resistance (PVR), characteristic impedance (Z(c)), and wave reflection. Pulmonary vascular impedance (PVZ) represents the most comprehensive measure of RV afterload; however, there is an unmet need for an easier bedside measurement of this complex variable. Although a recent study showed that Z(c) and wave reflection can be estimated from RV pressure waveform analysis and cardiac output, this has not been validated. Estimations of Z(c) and wave reflection coefficient (λ) were validated relative to conventional spectral analysis in an animal model. Z(c), λ, and the single-beat ratio of end-systolic to arterial elastance (E(es)/E(a)) to estimate RV-pulmonary arterial (PA) coupling were determined from right heart catheterization (RHC) data. The study included 30 pulmonary artery hypertension (PAH) and 40 heart failure with preserved ejection fraction (HFpEF) patients [20 combined pre- and postcapillary PH (Cpc-PH) and 20 isolated postcapillary PH, (Ipc-PH)]. Also included were 10 age- and sex-matched controls. There was good agreement with minimal bias between estimated and spectral analysis-derived Z(c) and λ. Z(c) in PAH and Cpc-PH groups exceeded that in the Ipc-PH group and controls. λ was increased in Ipc-PH (0.84 ± 0.02), Cpc-PH (0.87 ± 0.05), and PAH groups (0.85 ± 0.04) compared with controls (0.79 ± 0.03); all P values were

Introduction: An abnormal right ventricular (RV) end-diastolic pressure-volume relationship (EDPVR) is an early marker of poor prognosis in pulmonary arterial hypertension (PAH). Prior studies assessing RV diastolic impairment utilized pressure (P) measured at right heart catheterization (RHC) and non-simultaneous volume (V) measured by cardiac magnetic resonance imaging (cMRI), which serves as the current reference standard for V. Our aims were: (a) to validate a single-beat (SB) method to assess RV EDPVR in an animal model against multi-beat (MB) measurements during preload variation, and (b) to use V obtained via transthoracic 3D echocardiography (3DE) during simultaneous RHC. Methods: In six anesthetized swine under an Institutional Animal Care & Use Committee-approved protocol, a SB method was used to derive EDPVR as V 15 , the previously described predicted ventricular V at a theoretical EDP of 15 mmHg. A multi-beat (MB) reference EDPVR was defined using conductance/micromanometer catheter-measured RVP and V during preload variation. The V 15 value derived from the SB method was compared by Bland-Altman analysis to that defined by the reference EDPVR. Clinically, the SB method was applied to 13 patients with PAH and 10 age- and gender-matched controls who underwent RHC with simultaneous transthoracic 3DE. V 15 values between groups were compared by t-test. Results: In the animal model there was strong correlation between MB and SB estimates of V 15 (r=0.95; p15 (166±43 mL vs. 131±30 mL; p=0.04) (Figure 1) . Conclusion: This study demonstrates validity of a SB assessment of RV EDPVR using data obtained from transthoracic 3DE performed during RHC, obviating the need for non-simultaneous cMRI. Further studies are needed to examine SB assessment of RV EDPVR across the spectrum of PH phenotypes.

Functional adaptation of the right ventricle (RV) to its afterload plays an important prognostic role in pulmonary hypertension (PH) [1]. The preferred “multibeat” (MB) method for assessing RV–pulmonary vascular interaction involves the measurement of end-systolic elastance (Ees), the slope of the end-systolic pressure (ESP) to end-systolic volume over sequential heart beats with varying preload. The Ees value is then matched to simultaneous pulmonary arterial (PA) elastance at end systole (Ea), calculated as ESP pressure divided by stroke volume (SV). The ratio of Ees to Ea (Ees/Ea) is termed RV–PA coupling, preservation of which indicates maintenance RV functioning in the face of increasing afterload [1]. However, while the MB method is generally regarded as the reference standard, it requires continuous, accurate measurement of RV volume and is therefore not readily applicable in most clinical settings., Surrogates of right ventricle (RV) end-systolic pressure (ESP) used to determine RV–pulmonary artery coupling vary across studies. ESP using point of maximal time varying elastance provides most accurate estimate of actual ESP. https://bit.ly/3xuqX3B

The objective was to evaluate a multidisciplinary guideline-driven disease management program focused on achievement of asthma control among sustained patients with confirmed asthma in Louisiana and to assess factors affecting achievement of asthma control. Data were extracted from the electronic health records of 1596 adults with confirmed asthma, sustained care for1 year in the outpatient setting, and ≥2 recorded Asthma Control Test (ACT) scores. Multivariable logistic regression modeling was used to assess the association of demographic variables, comorbidities, and process measures with the best achieved asthma control as represented by the highest ACT score. Most subjects were female (81.1%) and African American (63.9%). Approximately half of them (48.9%) were able to achieve asthma control (ACT ≥20). The most prevalent comorbidities were hypertension (79.8%), rhinitis (55.3%), and obesity (50.5%). Most patients received pulmonary function testing (PFT) (88.6%), controller medication therapy (85.5%), or written asthma action plans (92.7%). Asthma control was positively associated with presence of PFT (OR = 1.63, 95% CI: 1.13, 2.37) and being a "never" smoker (OR = 1.49, 95% CI: 1.08, 2.04). Asthma control was less likely to be achieved by patients who were African American (OR = 0.68, 95% CI: 0.52, 0.87), had more comorbidities (OR = 0.89, 95% CI: 0.83, 0.96), or were on more medications (OR = 0.79, 95% CI: 0.72, 0.88). Asthma control was achieved in 48.9% of an adult, primarily African American population with the implementation of comprehensive guideline-driven care. Furthermore, this is the first study to observe that the presence of PFT may be associated with asthma control.

A subset of patients with SARS-CoV-2 infection develoa cytokine release syndrome (CRS) Strategies to mitigate SARS-CoV-2-induced CRS are urgently needed Man