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Ashish S Shah - One of the best experts on this subject based on the ideXlab platform.

  • prognostic value of the pre transplant diastolic pulmonary artery pressure to pulmonary capillary wedge pressure gradient in cardiac transplant recipients with pulmonary hypertension
    Journal of Heart and Lung Transplantation, 2014
    Co-Authors: Ryan J Tedford, Claude A Beaty, Stephen C Mathai, Todd M Kolb, Rachel L Damico, Paul M Hassoun, David A Kass, Peter J Leary, Ashish S Shah
    Abstract:

    Background Although the transpulmonary gradient (TPG) and pulmonary vascular resistance (PVR) are commonly used to differentiate heart failure patients with pulmonary vascular disease from those with passive pulmonary hypertension (PH), elevations in TPG and PVR may not always reflect pre-capillary PH. Recently, it has been suggested an elevated diastolic pulmonary artery pressure–to–pulmonary capillary wedge pressure gradient (DPG) may be a better indicator of pulmonary vascular remodeling, and therefore, may be of added prognostic value in patients with PH being considered for cardiac transplantation. Methods Using the United Network for Organ Sharing (UNOS) database, we retrospectively reviewed all primary adult (age > 17 years) orthotropic heart transplant recipients between 1998 and 2011. All patients with available pre-transplant hemodynamic data and PH (mean pulmonary artery pressure ≥ 25 mm Hg) were included ( n = 16,811). We assessed the prognostic value of DPG on post-transplant survival in patients with PH and an elevated TPG and PVR. Results In patients with PH and a TPG > 12 mm Hg ( n = 5,827), there was no difference in survival at up to 5 years post-transplant between high DPG (defined as ≥3, ≥5, ≥7, or ≥10 mm Hg) and low DPG ( 3 Wood units ( n = 6,270). Defining an elevated TPG as > 15 mm Hg ( n = 3,065) or an elevated PVR > 5 ( n = 1,783) yielded similar results. Conclusions This large analysis investigating the prognostic value of DPG found an elevated DPG had no effect on post-transplant survival in patients with PH and an elevated TPG and PVR.

  • abstract 15865 diastolic pulmonary artery pressure to pulmonary capillary wedge pressure gradient dpg in over 5700 patients with an elevated transpulmonary gradient does not predict survival after cardiac transplantation
    Circulation, 2013
    Co-Authors: Ryan J Tedford, Claude A Beaty, Stephen C Mathai, Todd M Kolb, Rachel L Damico, Paul M Hassoun, David A Kass, Ashish S Shah
    Abstract:

    Background: The transpulmonary gradient (TPG) has been commonly used to differentiate those patients with true pulmonary vascular disease from those with more passive pulmonary hypertension (PH). However, TPG is influenced by elevations in left atrial pressure as well as cardiac output, and therefore, elevation in the TPG may not always reflect pre-capillary PH. Recently, it has been suggested an elevated diastolic pulmonary artery pressure to pulmonary capillary wedge pressure gradient (DPG) may be better indicator of pulmonary vascular remodeling, and therefore, may be of added prognostic value in patients with PH and an elevated TPG. METHODS: Utilizing the United Network for Organ Sharing (UNOS) database, we retrospectively reviewed all primary adult (age >17 years) orthotropic heart transplant recipients between 1998-2011. All patients with available pre-transplant hemodynamic data measured by right heart catheterization were included (n=25,450). We assessed the prognostic value of DPG on post-transplant graft survival in all patients with PH (mean pulmonary artery pressure ≥ 25mmHg) and an elevated TPG. Survival was assessed by Kaplan-Meier analysis. RESULTS: In patients with PH and a TPG > 12mmHg (n=5,777), there was no difference in survival at up to 5 years post-transplant between high (defined as > 3, >5, >7, or >10mmHg) and low DPG groups (≤ 3, ≤5, ≤7, or ≤10mmHg), p = 0.94, 0.76, 0.29, 0.66, respectively (Figure). Similarly, there was no difference in survival between low and high DPG groups if an elevated TPG was defined as > 15mmHg (n=3,037). Pulmonary capillary wedge pressure was higher in the low DPG groups compared to the high DPG groups. CONCLUSIONS: In the largest analysis to date investigating the prognostic value of DPG, an elevated DPG had no impact on post-transplant survival in patients with PH and an elevated TPG. Although retrospective, these findings urge caution before DPG is incorporated into pre-transplant or PH-related clinical decision making.

Ryan J Tedford - One of the best experts on this subject based on the ideXlab platform.

  • prognostic value of the pre transplant diastolic pulmonary artery pressure to pulmonary capillary wedge pressure gradient in cardiac transplant recipients with pulmonary hypertension
    Journal of Heart and Lung Transplantation, 2014
    Co-Authors: Ryan J Tedford, Claude A Beaty, Stephen C Mathai, Todd M Kolb, Rachel L Damico, Paul M Hassoun, David A Kass, Peter J Leary, Ashish S Shah
    Abstract:

    Background Although the transpulmonary gradient (TPG) and pulmonary vascular resistance (PVR) are commonly used to differentiate heart failure patients with pulmonary vascular disease from those with passive pulmonary hypertension (PH), elevations in TPG and PVR may not always reflect pre-capillary PH. Recently, it has been suggested an elevated diastolic pulmonary artery pressure–to–pulmonary capillary wedge pressure gradient (DPG) may be a better indicator of pulmonary vascular remodeling, and therefore, may be of added prognostic value in patients with PH being considered for cardiac transplantation. Methods Using the United Network for Organ Sharing (UNOS) database, we retrospectively reviewed all primary adult (age > 17 years) orthotropic heart transplant recipients between 1998 and 2011. All patients with available pre-transplant hemodynamic data and PH (mean pulmonary artery pressure ≥ 25 mm Hg) were included ( n = 16,811). We assessed the prognostic value of DPG on post-transplant survival in patients with PH and an elevated TPG and PVR. Results In patients with PH and a TPG > 12 mm Hg ( n = 5,827), there was no difference in survival at up to 5 years post-transplant between high DPG (defined as ≥3, ≥5, ≥7, or ≥10 mm Hg) and low DPG ( 3 Wood units ( n = 6,270). Defining an elevated TPG as > 15 mm Hg ( n = 3,065) or an elevated PVR > 5 ( n = 1,783) yielded similar results. Conclusions This large analysis investigating the prognostic value of DPG found an elevated DPG had no effect on post-transplant survival in patients with PH and an elevated TPG and PVR.

  • abstract 15865 diastolic pulmonary artery pressure to pulmonary capillary wedge pressure gradient dpg in over 5700 patients with an elevated transpulmonary gradient does not predict survival after cardiac transplantation
    Circulation, 2013
    Co-Authors: Ryan J Tedford, Claude A Beaty, Stephen C Mathai, Todd M Kolb, Rachel L Damico, Paul M Hassoun, David A Kass, Ashish S Shah
    Abstract:

    Background: The transpulmonary gradient (TPG) has been commonly used to differentiate those patients with true pulmonary vascular disease from those with more passive pulmonary hypertension (PH). However, TPG is influenced by elevations in left atrial pressure as well as cardiac output, and therefore, elevation in the TPG may not always reflect pre-capillary PH. Recently, it has been suggested an elevated diastolic pulmonary artery pressure to pulmonary capillary wedge pressure gradient (DPG) may be better indicator of pulmonary vascular remodeling, and therefore, may be of added prognostic value in patients with PH and an elevated TPG. METHODS: Utilizing the United Network for Organ Sharing (UNOS) database, we retrospectively reviewed all primary adult (age >17 years) orthotropic heart transplant recipients between 1998-2011. All patients with available pre-transplant hemodynamic data measured by right heart catheterization were included (n=25,450). We assessed the prognostic value of DPG on post-transplant graft survival in all patients with PH (mean pulmonary artery pressure ≥ 25mmHg) and an elevated TPG. Survival was assessed by Kaplan-Meier analysis. RESULTS: In patients with PH and a TPG > 12mmHg (n=5,777), there was no difference in survival at up to 5 years post-transplant between high (defined as > 3, >5, >7, or >10mmHg) and low DPG groups (≤ 3, ≤5, ≤7, or ≤10mmHg), p = 0.94, 0.76, 0.29, 0.66, respectively (Figure). Similarly, there was no difference in survival between low and high DPG groups if an elevated TPG was defined as > 15mmHg (n=3,037). Pulmonary capillary wedge pressure was higher in the low DPG groups compared to the high DPG groups. CONCLUSIONS: In the largest analysis to date investigating the prognostic value of DPG, an elevated DPG had no impact on post-transplant survival in patients with PH and an elevated TPG. Although retrospective, these findings urge caution before DPG is incorporated into pre-transplant or PH-related clinical decision making.

Rachel L Damico - One of the best experts on this subject based on the ideXlab platform.

  • prognostic value of the pre transplant diastolic pulmonary artery pressure to pulmonary capillary wedge pressure gradient in cardiac transplant recipients with pulmonary hypertension
    Journal of Heart and Lung Transplantation, 2014
    Co-Authors: Ryan J Tedford, Claude A Beaty, Stephen C Mathai, Todd M Kolb, Rachel L Damico, Paul M Hassoun, David A Kass, Peter J Leary, Ashish S Shah
    Abstract:

    Background Although the transpulmonary gradient (TPG) and pulmonary vascular resistance (PVR) are commonly used to differentiate heart failure patients with pulmonary vascular disease from those with passive pulmonary hypertension (PH), elevations in TPG and PVR may not always reflect pre-capillary PH. Recently, it has been suggested an elevated diastolic pulmonary artery pressure–to–pulmonary capillary wedge pressure gradient (DPG) may be a better indicator of pulmonary vascular remodeling, and therefore, may be of added prognostic value in patients with PH being considered for cardiac transplantation. Methods Using the United Network for Organ Sharing (UNOS) database, we retrospectively reviewed all primary adult (age > 17 years) orthotropic heart transplant recipients between 1998 and 2011. All patients with available pre-transplant hemodynamic data and PH (mean pulmonary artery pressure ≥ 25 mm Hg) were included ( n = 16,811). We assessed the prognostic value of DPG on post-transplant survival in patients with PH and an elevated TPG and PVR. Results In patients with PH and a TPG > 12 mm Hg ( n = 5,827), there was no difference in survival at up to 5 years post-transplant between high DPG (defined as ≥3, ≥5, ≥7, or ≥10 mm Hg) and low DPG ( 3 Wood units ( n = 6,270). Defining an elevated TPG as > 15 mm Hg ( n = 3,065) or an elevated PVR > 5 ( n = 1,783) yielded similar results. Conclusions This large analysis investigating the prognostic value of DPG found an elevated DPG had no effect on post-transplant survival in patients with PH and an elevated TPG and PVR.

  • abstract 15865 diastolic pulmonary artery pressure to pulmonary capillary wedge pressure gradient dpg in over 5700 patients with an elevated transpulmonary gradient does not predict survival after cardiac transplantation
    Circulation, 2013
    Co-Authors: Ryan J Tedford, Claude A Beaty, Stephen C Mathai, Todd M Kolb, Rachel L Damico, Paul M Hassoun, David A Kass, Ashish S Shah
    Abstract:

    Background: The transpulmonary gradient (TPG) has been commonly used to differentiate those patients with true pulmonary vascular disease from those with more passive pulmonary hypertension (PH). However, TPG is influenced by elevations in left atrial pressure as well as cardiac output, and therefore, elevation in the TPG may not always reflect pre-capillary PH. Recently, it has been suggested an elevated diastolic pulmonary artery pressure to pulmonary capillary wedge pressure gradient (DPG) may be better indicator of pulmonary vascular remodeling, and therefore, may be of added prognostic value in patients with PH and an elevated TPG. METHODS: Utilizing the United Network for Organ Sharing (UNOS) database, we retrospectively reviewed all primary adult (age >17 years) orthotropic heart transplant recipients between 1998-2011. All patients with available pre-transplant hemodynamic data measured by right heart catheterization were included (n=25,450). We assessed the prognostic value of DPG on post-transplant graft survival in all patients with PH (mean pulmonary artery pressure ≥ 25mmHg) and an elevated TPG. Survival was assessed by Kaplan-Meier analysis. RESULTS: In patients with PH and a TPG > 12mmHg (n=5,777), there was no difference in survival at up to 5 years post-transplant between high (defined as > 3, >5, >7, or >10mmHg) and low DPG groups (≤ 3, ≤5, ≤7, or ≤10mmHg), p = 0.94, 0.76, 0.29, 0.66, respectively (Figure). Similarly, there was no difference in survival between low and high DPG groups if an elevated TPG was defined as > 15mmHg (n=3,037). Pulmonary capillary wedge pressure was higher in the low DPG groups compared to the high DPG groups. CONCLUSIONS: In the largest analysis to date investigating the prognostic value of DPG, an elevated DPG had no impact on post-transplant survival in patients with PH and an elevated TPG. Although retrospective, these findings urge caution before DPG is incorporated into pre-transplant or PH-related clinical decision making.

Paul M Hassoun - One of the best experts on this subject based on the ideXlab platform.

  • prognostic value of the pre transplant diastolic pulmonary artery pressure to pulmonary capillary wedge pressure gradient in cardiac transplant recipients with pulmonary hypertension
    Journal of Heart and Lung Transplantation, 2014
    Co-Authors: Ryan J Tedford, Claude A Beaty, Stephen C Mathai, Todd M Kolb, Rachel L Damico, Paul M Hassoun, David A Kass, Peter J Leary, Ashish S Shah
    Abstract:

    Background Although the transpulmonary gradient (TPG) and pulmonary vascular resistance (PVR) are commonly used to differentiate heart failure patients with pulmonary vascular disease from those with passive pulmonary hypertension (PH), elevations in TPG and PVR may not always reflect pre-capillary PH. Recently, it has been suggested an elevated diastolic pulmonary artery pressure–to–pulmonary capillary wedge pressure gradient (DPG) may be a better indicator of pulmonary vascular remodeling, and therefore, may be of added prognostic value in patients with PH being considered for cardiac transplantation. Methods Using the United Network for Organ Sharing (UNOS) database, we retrospectively reviewed all primary adult (age > 17 years) orthotropic heart transplant recipients between 1998 and 2011. All patients with available pre-transplant hemodynamic data and PH (mean pulmonary artery pressure ≥ 25 mm Hg) were included ( n = 16,811). We assessed the prognostic value of DPG on post-transplant survival in patients with PH and an elevated TPG and PVR. Results In patients with PH and a TPG > 12 mm Hg ( n = 5,827), there was no difference in survival at up to 5 years post-transplant between high DPG (defined as ≥3, ≥5, ≥7, or ≥10 mm Hg) and low DPG ( 3 Wood units ( n = 6,270). Defining an elevated TPG as > 15 mm Hg ( n = 3,065) or an elevated PVR > 5 ( n = 1,783) yielded similar results. Conclusions This large analysis investigating the prognostic value of DPG found an elevated DPG had no effect on post-transplant survival in patients with PH and an elevated TPG and PVR.

  • abstract 15865 diastolic pulmonary artery pressure to pulmonary capillary wedge pressure gradient dpg in over 5700 patients with an elevated transpulmonary gradient does not predict survival after cardiac transplantation
    Circulation, 2013
    Co-Authors: Ryan J Tedford, Claude A Beaty, Stephen C Mathai, Todd M Kolb, Rachel L Damico, Paul M Hassoun, David A Kass, Ashish S Shah
    Abstract:

    Background: The transpulmonary gradient (TPG) has been commonly used to differentiate those patients with true pulmonary vascular disease from those with more passive pulmonary hypertension (PH). However, TPG is influenced by elevations in left atrial pressure as well as cardiac output, and therefore, elevation in the TPG may not always reflect pre-capillary PH. Recently, it has been suggested an elevated diastolic pulmonary artery pressure to pulmonary capillary wedge pressure gradient (DPG) may be better indicator of pulmonary vascular remodeling, and therefore, may be of added prognostic value in patients with PH and an elevated TPG. METHODS: Utilizing the United Network for Organ Sharing (UNOS) database, we retrospectively reviewed all primary adult (age >17 years) orthotropic heart transplant recipients between 1998-2011. All patients with available pre-transplant hemodynamic data measured by right heart catheterization were included (n=25,450). We assessed the prognostic value of DPG on post-transplant graft survival in all patients with PH (mean pulmonary artery pressure ≥ 25mmHg) and an elevated TPG. Survival was assessed by Kaplan-Meier analysis. RESULTS: In patients with PH and a TPG > 12mmHg (n=5,777), there was no difference in survival at up to 5 years post-transplant between high (defined as > 3, >5, >7, or >10mmHg) and low DPG groups (≤ 3, ≤5, ≤7, or ≤10mmHg), p = 0.94, 0.76, 0.29, 0.66, respectively (Figure). Similarly, there was no difference in survival between low and high DPG groups if an elevated TPG was defined as > 15mmHg (n=3,037). Pulmonary capillary wedge pressure was higher in the low DPG groups compared to the high DPG groups. CONCLUSIONS: In the largest analysis to date investigating the prognostic value of DPG, an elevated DPG had no impact on post-transplant survival in patients with PH and an elevated TPG. Although retrospective, these findings urge caution before DPG is incorporated into pre-transplant or PH-related clinical decision making.

Claude A Beaty - One of the best experts on this subject based on the ideXlab platform.

  • prognostic value of the pre transplant diastolic pulmonary artery pressure to pulmonary capillary wedge pressure gradient in cardiac transplant recipients with pulmonary hypertension
    Journal of Heart and Lung Transplantation, 2014
    Co-Authors: Ryan J Tedford, Claude A Beaty, Stephen C Mathai, Todd M Kolb, Rachel L Damico, Paul M Hassoun, David A Kass, Peter J Leary, Ashish S Shah
    Abstract:

    Background Although the transpulmonary gradient (TPG) and pulmonary vascular resistance (PVR) are commonly used to differentiate heart failure patients with pulmonary vascular disease from those with passive pulmonary hypertension (PH), elevations in TPG and PVR may not always reflect pre-capillary PH. Recently, it has been suggested an elevated diastolic pulmonary artery pressure–to–pulmonary capillary wedge pressure gradient (DPG) may be a better indicator of pulmonary vascular remodeling, and therefore, may be of added prognostic value in patients with PH being considered for cardiac transplantation. Methods Using the United Network for Organ Sharing (UNOS) database, we retrospectively reviewed all primary adult (age > 17 years) orthotropic heart transplant recipients between 1998 and 2011. All patients with available pre-transplant hemodynamic data and PH (mean pulmonary artery pressure ≥ 25 mm Hg) were included ( n = 16,811). We assessed the prognostic value of DPG on post-transplant survival in patients with PH and an elevated TPG and PVR. Results In patients with PH and a TPG > 12 mm Hg ( n = 5,827), there was no difference in survival at up to 5 years post-transplant between high DPG (defined as ≥3, ≥5, ≥7, or ≥10 mm Hg) and low DPG ( 3 Wood units ( n = 6,270). Defining an elevated TPG as > 15 mm Hg ( n = 3,065) or an elevated PVR > 5 ( n = 1,783) yielded similar results. Conclusions This large analysis investigating the prognostic value of DPG found an elevated DPG had no effect on post-transplant survival in patients with PH and an elevated TPG and PVR.

  • abstract 15865 diastolic pulmonary artery pressure to pulmonary capillary wedge pressure gradient dpg in over 5700 patients with an elevated transpulmonary gradient does not predict survival after cardiac transplantation
    Circulation, 2013
    Co-Authors: Ryan J Tedford, Claude A Beaty, Stephen C Mathai, Todd M Kolb, Rachel L Damico, Paul M Hassoun, David A Kass, Ashish S Shah
    Abstract:

    Background: The transpulmonary gradient (TPG) has been commonly used to differentiate those patients with true pulmonary vascular disease from those with more passive pulmonary hypertension (PH). However, TPG is influenced by elevations in left atrial pressure as well as cardiac output, and therefore, elevation in the TPG may not always reflect pre-capillary PH. Recently, it has been suggested an elevated diastolic pulmonary artery pressure to pulmonary capillary wedge pressure gradient (DPG) may be better indicator of pulmonary vascular remodeling, and therefore, may be of added prognostic value in patients with PH and an elevated TPG. METHODS: Utilizing the United Network for Organ Sharing (UNOS) database, we retrospectively reviewed all primary adult (age >17 years) orthotropic heart transplant recipients between 1998-2011. All patients with available pre-transplant hemodynamic data measured by right heart catheterization were included (n=25,450). We assessed the prognostic value of DPG on post-transplant graft survival in all patients with PH (mean pulmonary artery pressure ≥ 25mmHg) and an elevated TPG. Survival was assessed by Kaplan-Meier analysis. RESULTS: In patients with PH and a TPG > 12mmHg (n=5,777), there was no difference in survival at up to 5 years post-transplant between high (defined as > 3, >5, >7, or >10mmHg) and low DPG groups (≤ 3, ≤5, ≤7, or ≤10mmHg), p = 0.94, 0.76, 0.29, 0.66, respectively (Figure). Similarly, there was no difference in survival between low and high DPG groups if an elevated TPG was defined as > 15mmHg (n=3,037). Pulmonary capillary wedge pressure was higher in the low DPG groups compared to the high DPG groups. CONCLUSIONS: In the largest analysis to date investigating the prognostic value of DPG, an elevated DPG had no impact on post-transplant survival in patients with PH and an elevated TPG. Although retrospective, these findings urge caution before DPG is incorporated into pre-transplant or PH-related clinical decision making.

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