Chest
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Randomized Controlled Trial Multicenter Study
Nocturnal Cardiac Arrhythmias in Heart Failure with Obstructive and Central Sleep Apnea.
Both obstructive and central sleep apnea (CSA) may contribute to nocturnal cardiac arrhythmias (NCAs). Data are scarce regarding the prevalence of clinically important nocturnal atrial and ventricular arrythmias in patients with heart failure with reduced ejection fraction (HFrEF) and OSA or CSA. ⋯ gov.
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Multicenter Study
Association of Cardiopulmonary Hemodynamics and Outcomes in Pulmonary Hypertension Following Kidney Transplant: A Multicenter Retrospective Cohort Study.
Pulmonary hypertension (PH) frequently complicates the evaluation of kidney transplantation (KT) candidates, and is associated with increased adverse outcomes (mortality, delayed graft function [DGF], and major adverse cardiovascular event) following KT. ⋯ Precapillary pulmonary hypertension and an mPAP of ≥ 30 mm Hg on RHC, but not echocardiographic evidence of PH, was associated with mortality and major adverse cardiovascular event following KT. These data suggest that RHC hemodynamics are superior to echocardiographic measures of PH in association with outcomes following KT, and RHC-derived mPAP in particular may have value in predicting major adverse cardiovascular event and mortality post-KT.
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Multiple biomarkers are equivalent to clinical pulmonary arterial hypertension survival risk models.
Risk assessment in pulmonary arterial hypertension (PAH) is fundamental to guiding treatment and improved outcomes. Clinical models are excellent at identifying high-risk patients, but leave uncertainty amongst moderate-risk patients. ⋯ In this study, a multibiomarker model alone was equivalent to current PAH clinical mortality risk prediction models and improved performance when combined and added to NT-proBNP. Clinical risk scores offer excellent predictive models, but require multiple tests; adding blood biomarkers to models can improve prediction or can enable more frequent, noninvasive monitoring of risk in PAH to support therapeutic decision-making.
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Combined pulmonary fibrosis and emphysema (CPFE) is an underdiagnosed syndrome in which individuals have variable degrees of pulmonary fibrosis and emphysema. Patients with CPFE have high morbidity, including poor exercise tolerance and increased development of comorbidities. CPFE mortality also seems to outpace that of lone emphysema and pulmonary fibrosis. A major limitation to rigorous, large-scale studies of CPFE has been the lack of a precise definition for this syndrome. A 2022 American Thoracic Society/European Respiratory Society/Japanese Respiratory Society/Latin American Thoracic Association research statement called attention to fundamental gaps in our understanding of CPFE and highlighted the potential use of quantitative imaging techniques to better define CPFE. ⋯ This review is structured into three primary themes, starting with early imaging studies, then evaluating the use of quantitative methods and imaging-based thresholds, both in large population studies and single-center cohorts to define CPFE and assess patient outcomes. It concludes by discussing current challenges and how to focus our efforts so that quantitative imaging methods can effectively address the most pressing clinical dilemmas in CPFE.