Fontan循環患者において肝障害は非常に一般的であるが、その有病率には施設間・研究間差が存在する。 術後経過年数、Fontan術式、心室機能低下、PCWP上昇などのリスク因子を考慮したスクリーニングが重要である。→

Should we perform invasive measurements of right atrial #pressure , #PCWP or pulmonary artery pulsatility index prior to emergent #VT #ablation❓️👇 onlinelibrary.wiley.com/doi/…

Strongest bear point imo is that nitrates can lower exercise PCWP in HFpEF but failed on 6mwd or peak VO2 in HFpEF. If exercise PCWP drop isn’t predictive then we are left with the HELP 6mwd signal and KOL comments.

If $TENX had used daily oral levosimendan in Phase 2, they very likely would have hit the primary endpoint Acute 24h IV showed strong exercise PCWP drop 84% responders The miss only happened because they measured at trough

⎐كُـود⎐كوبِون⎐خـِصم⎐ ⎐نون⎐ ⊵S3Q⊴ ⎐ايهرب⎐ايهيرب اهرب ⊵GCA5893⊴ ⊴تيمو ⊴ ⊵TEB72⊴ ❮كارديال❯ A004 ⎐نمشي⎐ ⊵AABN⊴ ⎐ريف⎐للعطور ⎐ ⎐AX140⊴ ماكــس⎐ A9B *** pCWp

7/n HFpEFで明確に奏効するSGLT2阻害薬 CAMEO-DAPA(2024)で運動時の静脈キャパシタンスを改善し推定SBVを低下。吸入イロプロストも運動時のPCWP・右房圧↓。"静脈に効く薬は効く"を示唆する流れです。

SHOCK Classification ⸻ 1️⃣ Cardiogenic Shock ❤️ 🔹 Pump failure → inadequate cardiac output 🔹 Common Causes: • Acute MI • Decompensated heart failure • Severe arrhythmias • Valvular disease • Myocarditis 🔹 Hemodynamics: ⬆️ CVP ⬆️ PCWP ⬆️ SVR ⬇️ Cardiac Output 💡 Think: “Wet & Cold” ⸻ 2️⃣ Hypovolemic Shock 🩸 🔹 Loss of circulating volume → reduced preload 🔹 Common Causes: • Hemorrhage • GI losses (vomiting/diarrhea) • Burns • Dehydration • Third spacing 🔹 Hemodynamics: ⬇️ CVP ⬇️ PCWP ⬆️ SVR ⬇️ Cardiac Output 💡 Treatment = Restore Volume First ⸻ 3️⃣ Distributive Shock 🦠 🔹 Pathological vasodilation → ↓ SVR 🔹 Common Causes: • Septic shock • Anaphylaxis • Neurogenic shock • Adrenal crisis 🔹 Hemodynamics: ⬇️ CVP ⬇️ PCWP ⬇️ SVR ⬆️/Normal CO (early) 💡 Think: Warm Peripheries Low BP ⸻ 4️⃣ Obstructive Shock 🫁 🔹 Mechanical obstruction prevents cardiac filling or outflow 🔹 Common Causes: • Cardiac tamponade • Pulmonary embolism • Tension pneumothorax • Severe aortic stenosis 🔹 Hemodynamics: ⬆️ CVP ⬆️ PCWP ⬆️ SVR ⬇️ Cardiac Output 💡 Think: High Filling Pressures Low Output ⸻ 5️⃣ Shock Hemodynamics at a Glance 📊 ❤️ Cardiogenic → High preload, high SVR, low CO 🩸 Hypovolemic → Low preload, high SVR, low CO 🦠 Distributive → Low SVR, low preload, normal/high CO 🫁 Obstructive → High preload, high SVR, low CO ⸻ 6️⃣ Common Clinical Features ⚠️ • Hypotension • Tachycardia • Tachypnea • Altered mental status • Oliguria • Elevated lactate • Cool extremities (except early distributive shock) ⸻ 📚 Master medical topics with our comprehensive medical books. 🌐 Visit our website for high-yield notes and illustrations: mediconotes.com ⸻ #Shock #CriticalCare #EmergencyMedicine #MedEd #medicaleducation

カテ室で働くすべての人へ👨‍⚕️👩‍⚕️ 【心カテ攻略Vol.6】公開しました🫀✨ 今回は、右心カテーテル検査（Swan-Ganzカテーテル）を徹底解説‼️ ✅ RAP・RVP・PAP・PCWPの波形 ✅ 熱希釈法によるCO測定 ✅ CIの考え方 ✅ Forrester分類と治療方針 「今どこの圧を見ているのか？」 「このデータから何がわかるのか？」 ポリグラフの波形が読めると、右心カテが一気に面白くなります📈 CAG・PCIだけじゃない。 心機能評価の基本を一緒に学びましょう💪 #心カテ #右心カテ #IVR #診療放射線技師 #臨床工学技士 #看護師

PA Catheter Made Simple This one image explains it all: ⬜ How waveforms change from RA to PCWP ⬜ Normal pressure values at each step ⬜ How to spot different types of shock ⬜ Easy guide to treating cardiogenic shock

->considering the consistency in PCWP measurements in placebo, verum, baseline and at 6 weeks I don´t think that placebo or investigator bias influenced the exercise PCWP measurements at responder screening, which means lev does lower excercise PCWP. 5/11

1) This to me reeks of alpha error – where in TENX by chance has found one notable signficant metric in a small study by virtue of testing for enough of them. -> this is true, but what i the delta excluding the three outliers? and how does the KOL commentary about the OLE change any opiniion if they have 1/2 outliers in the ph3. 2) "Levo is dilating the pulmonary vascular system and increasing pressure." -> which hemodynamic data for this? and what do you make of the PCWP reductions unlike the prior selective mPAP reducers (the PAH drugs) 3) what do you think about the splanchnic volume argument, similar to the APEX HF trial with Splanhcnic nerve ablation? 4) "select only responders of the drug, which enriches the results dramatically" ->95% of Ph3 continued into OLE. the prior ph2 selected out 20% of patients. I don;t think the readout is without risk.....But to cite mPAP reductions as why it fails doesn't seem like the right bear thesis. it's also PH, not PAH for Group 2. PAH is group 1. and I would segment ipcPH vs cpcPH because of the sotatercept, relaxin, PAH drug data out there.

Also there were improvements in PCWP and CVP (especially at rest and with legs up)

In HELP data you can see the effect wears off after 3-6 d. At responder screening they measured PCWP right after 24h iv and it dropped at rest, legs up and exercise. For prim endpoint assessment after 6 weeks they waited 3-6 d post iv and PCWP dropped only at rest and legs up…

And 84 % in HELP were responders so this should push it above 84 %. Also, who knows how relevant PCWP really is here.

The first noninvasive, AI-powered tool that provides pulmonary capillary wedge pressure (PCWP) using only a small wearable sensor worn on the chest has received De Novo classification from the U.S. FDA. @CardiosenseInc

We’re thrilled to announce we've received De Novo classification from the U.S. FDA for PCWP Analysis Software, the first AI algorithm to noninvasively provide pulmonary capillary wedge pressure (PCWP) readings for patients w/ heart failure. Read more: bit.ly/3RwF1bK

【鉄欠乏HFpEFへの鉄剤静注は有効？小規模RCT/EJHF】May.18 オランダ、鉄欠乏を呈するHFpEF 45例ランダム化、4カ月観察—— ・「鉄剤静注」と「プラセボ」間で、運動負荷PCWPに差なし。 ・KCCQにも群間差なし。 ・一方、右室EFはプラセボに比べ7％の有意高値。 ・6分間歩行距離は「 6 vs. −13 m」も有意差とならず。

↓ Stroke volume ↓ Cardiac output ↓ Filling pressures (CVP and PCWP) ↑ HR ↑ SVR