BACKGROUND: Pulmonary arterial hypertension (PAH) presents a significant health burden in Asia and remains a critical challenge. This study aims to delineate the PAH burden in Asia from 1990 to 2021. METHODS: Using the latest data from the Global Burden of Disease 2021, we evaluated and analyzed the distributions and patterns of PAH disease burden among various age groups, sexes, regions, and countries in Asia. Additionally, we examined the associations between PAH disease burden and key health system indicators, including the socio-demographic index (SDI) and the universal health coverage (UHC) index. RESULTS: In 2021, there were 25,989 new PAH cases, 103,382 existing cases, 13,909 PAH-associated deaths, and 385,755 DALYs attributed to PAH in Asia, which accounted for approximately 60% of global PAH cases. The age-standardized rates (ASRs) for prevalence and deaths were 2.05 (95% uncertainty interval [UI]: 1.66-2.52) per 100,000 population and 0.31 (95% UI: 0.23-0.38) per 100,000 population, respectively. From 1990 to 2021, Asia reported the lowest ASRs for PAH prevalence but the highest ASRs for deaths compared to other continents. While the ASRs for prevalence increased slightly, ASRs for mortality and DALYs decreased over time. This increasing burden of PAH was primarily driven by population growth and aging. The burden was especially pronounced among individuals aged ≥60 years and <9 years, who collectively accounted for the majority of deaths and DALYs. Moreover, higher SDI and UHC levels were linked to reduced incidence, but higher prevalence rates. CONCLUSIONS Although progress has been made in reducing PAH-related mortality and DALYs, the disease continues to impose a substantial burden in Asia, particularly among older adults and young children. Region-specific health policies should focus on improving early diagnosis, expanding access to treatment, and effectively addressing the growing PAH burden in the region.
Humans ; Global Burden of Disease ; Male ; Female ; Middle Aged ; Adult ; Asia/epidemiology* ; Prevalence ; Aged ; Pulmonary Arterial Hypertension/mortality* ; Adolescent ; Young Adult ; Child ; Child, Preschool ; Infant ; Hypertension, Pulmonary/epidemiology*

PURPOSE: Peripheral arterial disease (PAD) is a common vascular problem and has serious morbidity and mortality in advanced situations. However, the prevalence and risk factors for PAD in Korea have not been reported. The purpose of this study was to evaluate the prevalence and risk factors of PAD in the Korean population. METHODS: The study was processed by visiting community welfare centers. Inclusion criteria were people who participated in this study. Screening was performed by history taking followed by the measurement of ankle brachial index (ABI). PAD was defined when an ABI of 0.9 or less was found in one or both legs. All statistical analyses were conducted with SPSS ver. 22.0. RESULTS: Between January 2008 and December 2012, a total of 2,044 participants were included with 810 men (39.6%) and 1,234 women (60.4%). PAD was detected in 95 (4.6%). Borderline ABI (0.91–0.99) showed in 212 (10.4%), and severe decreased ABI defined as 0.5 or less showed in 3 (0.1%). Significant risk factors for PAD were old age (odd ratio, 1.952; P = 0.045), hypertension (odd ratio, 1.645; P = 0.050), and cardiovascular disease (odd ratio, 2.047; P = 0.039). Significant risk factors for borderline PAD were old age (odd ratio, 1.019; P = 0.024), hypertension (odd ratio, 1.461; P = 0.038), and chronic obstructive lung disease (odd ratio, 3.393; P = 0.001). CONCLUSION: The prevalence of PAD in the Korean population was 4.6%. Old age, hypertension, and cardiovascular disease were significant risk factors for PAD. Further nationwide study is needed.
Ankle Brachial Index ; Cardiovascular Diseases ; Female ; Humans ; Hypertension ; Korea ; Leg ; Male ; Mass Screening ; Mortality ; Peripheral Arterial Disease ; Prevalence ; Pulmonary Disease, Chronic Obstructive ; Risk Factors

Pulmonary arterial hypertension is a critical manifestation of systemic sclerosis (SSc) and is a main cause of death. Several treatment modalities for SSc have been identified, with effects that improve quality of life and mortality rates. However, whether these drugs can also normalize pulmonary arterial pressure, remains unclear. Here, we report the case of a woman with diffuse SSc with pulmonary arterial hypertension, who had a functional status equivalent to the New York Heart Association class III. The patient was treated with inhaled iloprost. After six years of inhaled iloprost therapy, echocardiography showed that pulmonary arterial pressure normalized, accompanied by improvement in functional capacity. Inhaled iloprost might not only normalize pulmonary arterial pressure, but also improve the functional status of patients with SSc with pulmonary arterial hypertension.
Arterial Pressure ; Cause of Death ; Echocardiography ; Female ; Heart ; Humans ; Hypertension* ; Hypertension, Pulmonary ; Iloprost* ; Mortality ; Quality of Life ; Scleroderma, Systemic*

BACKGROUND AND OBJECTIVES: Despite remarkable advances in pediatric cardiology, pulmonary arterial hypertension associated with congenital heart disease remains a major problem. In the past decade new vasodilators have been introduced and appear to be effective in reducing pulmonary vascular resistance (PVR). SUBJECTS AND METHODS: From 2000 to 2011, we retrospectively reviewed the records of 22 patients who had congenital septal defects and borderline pulmonary vascular disease (PVD). The PVR in these patients was from 6 to 16 wood units . m2, and/or the systolic pulmonary arterial pressure was more than 2/3 of the systemic arterial pressure. RESULTS: The median age was 16 years (range, 9 months-46 years). The median duration of follow-up was 7.4 years (range, 1.4-11.7 years). According to hemodynamic data and clinical symptoms, the initial management comprised targeted medical therapy in four (18%), complete closure in four (18%), and partial closure in 14 patients (63.6%). In the four patients who had a high PVR and negative vasoreactivity, the PVR decreased and vasoreactivity increased after targeted medical therapy; three of these patients underwent cardiac surgery later. Finally, 11 (50%) received targeted medical therapy and 21 patients (95.4%) underwent cardiac surgery. Complete closure resulted in six patients and partial closure in 17 patients. Mortality was observed in two patients. The other 19 patients (91%) had New York Heart Association functional class I. CONCLUSION: Targeted medical therapy may be effective in reducing PVR in patients with congenital heart disease and borderline PVD. A stepwise approach may help to achieve improved outcomes in these patients.
Arterial Pressure ; Cardiology ; Follow-Up Studies ; Heart ; Heart Defects, Congenital* ; Hemodynamics ; Humans ; Hypertension ; Hypertension, Pulmonary ; Mortality ; Retrospective Studies ; Thoracic Surgery ; Vascular Diseases* ; Vascular Resistance ; Vasodilator Agents ; Wood

Early injury to the lung circulation leads to the rapid development of pulmonary hypertension (PH) after premature birth. PH in bronchopulmonary dysplasia (BPD) results from increased vascular tone and abnormal vasoreactivity, hypertensive remodeling, and decreased vascular growth. The development of PH is sometimes a serious complication of BPD that can significantly impact the morbidity and mortality rates of preterm infants. Despite a gradual reduction in pulmonary arterial pressure postnatally, approximately a quarter of BPD infants have echocardiographic evidence of PH later. The pathogenesis of PH in BPD is very complex and multifactorial, often resulting from interactions between genetic and environmental or acquired factors (both prenatal and postnatal). Antenatal risk factors such as intrauterine growth retardation, maternal preeclampsia, and oligohydramnios suggest compelling evidence for the fetal origins of PH. Despite the potential importance of PH in preterm infants, the pathophysiology and the risk factors of PH in infants with BPD are still poorly understood. I have reviewed recent progress in research concerning the pathophysiology including the risk factors of PH in infants with BPD.
Arterial Pressure ; Bronchopulmonary Dysplasia* ; Echocardiography ; Female ; Fetal Growth Retardation ; Humans ; Hydrogen-Ion Concentration ; Hypertension, Pulmonary* ; Infant* ; Infant, Newborn ; Infant, Premature ; Lung ; Mortality ; Oligohydramnios ; Pre-Eclampsia ; Pregnancy ; Premature Birth ; Risk Factors*

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate the clinical characteristics and predictors of the prognosis for patients with severe pulmonary hypertension (PHT). SUBJECTS AND METHODS: A total of 169 patients with severe PHT (systolic pulmonary arterial pressure > or =70 mmHg by Doppler echocardiogram) were divided into two groups according to the mortality during 2.8+/-2.2 year clinical follow-up period: group I (moribund group, 34 patients, 60.0+/-15.7 years, 18 males) and group II (survived group, 135 patients, 57.2+/-16.9 years, 65 males). The clinical, electrocardiographic and echocardiographic variables were analyzed. RESULTS: The three most common etiologies were valvular heart disease (VHD)(n=55: 32.9%), pulmonary thromboembolism (n=29: 17.2%) and ischemic cardiomyopathy (n=17: 10.1%). The common presenting clinical symptoms were dyspnea on exertion, leg edema, cough and chest discomfort. Among the variables, the WHO functional classification at presentation [95% confidence interval (CI) 2.065-221.168, p=0.010], atrial fibrillation (AF)(95% CI 1.014-10.161, p=0.041) and the left ventricular ejection fraction (LVEF)(95% CI 1.011-4.545, p=0.047) were significantly associated with the prognosis. CONSLUSION: VHD was the most common cause of severe PHT. The WHO functional classification at presentation, the presence of AF and low LVEF at presentation were the significant predictors of mortality for patients with severe PHT.
Arterial Pressure ; Atrial Fibrillation ; Cardiomyopathies ; Classification ; Cough ; Dyspnea ; Echocardiography ; Edema ; Electrocardiography ; Follow-Up Studies ; Heart Valve Diseases ; Humans ; Hypertension ; Hypertension, Pulmonary* ; Leg ; Mortality ; Prognosis ; Pulmonary Embolism ; Stroke Volume ; Thorax

PURPOSE:Persistent pulmonary hypertension of the newborn (PPHN) is life threatening neonatal disease. Nitric oxide (NO) has been proven to improve oxygenation, however its usage is limited and 30% of patients with PPHN are NO nonresponders. Milrinone decreases right ventricular afterload and has selective pulmonary vasodilator effect. We studied the effects of milrinone on neonates with respiratory failure originated in PPHN. METHODS:Six neonates, who had oxygen index above 20 and responded poorly to other management, were treated with intravenous milrinone after confirming pulmonary hypertension with echocardiography. We reviewed their medical records retrospectively. Intravenous milrinone was started at a dose of 0.375 microgram/kg/min. Respiratory indices (Oxygenation index [OI], ventilation settings, and arterial blood gas) and cardiovascular stability (mean arterial pressure and heart rate) were documented just before; and at 6, 12, 24, 36, 48, and 72 hours after commencement of milrinone therapy. The primary outcome was the effect of milrinone on oxygenation, which was 40% reduction in OI. RESULTS:Primary cause of PPHN was meconium aspiration syndrome in three infants, respiratory distress syndrome (RDS) in the other three. Milrinone was commenced at a median age of 22.3+/-6.1 hours with a dose of 0.375 microgram/kg/min except one infant (0.5 microgram/kg/min) and infants were treated for median 58.3+/-16.7 hours. OI of all infants showed 40% reduction within 24 hours. There were no mortality, and no infants with hypotension, and intraventricular hemorrhage. CONCLUSION:Milrinone proved to be effective for PPHN by improving oxygenation. It did not cause any complications in clinical trials for newborns. It is suggested that Milrinone can replace NO or can be used as adjunct to NO in the treatment of PPHN.
Arterial Pressure ; Echocardiography ; Heart ; Hemorrhage ; Humans ; Hypertension, Pulmonary* ; Hypotension ; Infant ; Infant, Newborn* ; Meconium Aspiration Syndrome ; Medical Records ; Milrinone* ; Mortality ; Nitric Oxide ; Oxygen ; Respiratory Insufficiency ; Retrospective Studies ; Ventilation

BACKGROUND: Pulmonary embolism is a relatively common disease but may also be manifestated as a lethal disease. Most previous studies on pulmonary embolism included hemodynamically stable patients who were able to tolerate a confirmative diagnostic workup, including ventilation-perfusion lung scan or pulmonary angiography. However, in most cases of acute massive pulmonary embolism, patients are unstable to tolerate a confirmative diagnostic workup. Studies of only stable patients with pulmonary embolism may have a bias on evaluating the clinical course and prognosis of pulmonary embolism. Therefore, we designed a study to observe the clinical manifestations, diagnostic methods, treatment modality, and to investigate the prognostic factors of patients with acute pulmonary embolism who present with overt or impending right heart failure using the diagnostic criteria suggested by MAPPET study. METHODS: Among 103 patients diagnosed as pulmonary embolism from 1990 to 1997, 63 patients(male/female : 21/42, mean age : 56 15) were enrolled as acute major pulmonary embolism by MAPPET's diagnostic criteria. Patients were included in the study if they showed clinical, echocardiographic and cardiac catheterization findings signifying acute right heart failure or pulmonary hypertension due to pulmonary embolism, together with: 1) a diagnostic pulmonary angiogram, or 2) a lung scan indicating high probability of pulmonary embolism, or 3) at least 3 of the followings: 1) syncope; 2) tachycardia (heart rate > 100 beats /min); 3) dyspnea or tachypnea (> 24 breaths/min or need for mechanical ventilation); 4) arterial hypoxemia (partial arterial pressure of oxygen < 70mmHg while breathing room air) in the absence of pulmonary infiltrates on chest x-ray; 5) ECG signs of right heart strain. RESULTS: Among the 63 patients, 15 patients(23.8%) did not have an underlying disease. Eleven patients(17.5%) had malignancy, 8 patients had an operation in the recent 20 days, 6 patients had chronic pulmonary disease, 5 patients had a history of congestive heart failure and cerebrovascular accident respectively, 4 patients had a previous history of pulmonary embolism, 3 patients had vasculitis such as Behcets' disease and systemic lupus erythematosus and a history of venous thrombosis, respectively. The main clinical manifestation on the time of diagnosis was dypnea in 55 patients(87.3%), which was the most frequent, and chest pain in 18 patients(28.6%), syncope in 10 patients(15.9%), and tachycardia in 2 patients(3.2%). The diagnostic methods were echocardiography(43 patients, 68.3%), lung perfusion scan(39 patients, 61.9%), chest computed tomography(16 patients, 26.4%), pulmonary angiography(4 patients, 6.3%) and right heart catherization (2 patients, 3.2%). In order to examine deep vein thrombosis, lower extremity Duplex ultrusonography and venography were performed in 11 patients(17.5%) and 7 patients(11.1%) respectively. The overall in-hospital mortality was 38.1%(24 patients). The factors influencing in-hospital mortality were associated malignancy(p< 0.01) and unstable vital sign(systolic blood pressure of less than 90mmHg)(p< 0.05). CONCLUSION: Acute pulmonary embolism with overt or impending right heart failure is a significant lethal disease with a high in-hospital mortality. The predictors of mortality were associated malignancy and unstable vital sign.
Angiography ; Anoxia ; Arterial Pressure ; Bias (Epidemiology) ; Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Chest Pain ; Diagnosis ; Dyspnea ; Echocardiography ; Electrocardiography ; Heart ; Heart Failure ; Hospital Mortality* ; Humans ; Hypertension, Pulmonary ; Lower Extremity ; Lung ; Lung Diseases ; Lupus Erythematosus, Systemic ; Mortality ; Oxygen ; Perfusion ; Phlebography ; Prognosis ; Pulmonary Embolism* ; Respiration ; Stroke ; Syncope ; Tachycardia ; Tachypnea ; Thorax ; Vasculitis ; Venous Thrombosis ; Vital Signs

PURPOSE: The ratio of time to peak velocity(AT) and right ventricular ejection time(ET) as measured from the pulmonary artery Doppler waveform showed a close inverse correlation with pulmonary arterial pressure. The purpose of this study was to see the pattern of change in pulmonary arterial pressure assessed by AT/ET in preterm infants with respiratory distress syndrome (RDS). METHODS: The changes in pulmonary arterial pressure were assessed by serial AT/ET measurements in 18 preterm infants with RDS. RESULTS: The mean AT/ET was significantly lower in the acute phase of RDS. The pattern of change in AT/ET during recovery from RDS fell into three groups. In group 1(n=11), there was a normalization of AT/ET. Four infants showed a rapid normalization of the ratio within 24 hours of the oxygen requirements falling and the remaining 7 showed a delayed normalization. In group 2(n=4), AT/ET did not rise into the normal range during the time of study. All of the infants developed bronchopulmonary dysplasia(BPD). In 2 of the 4 infants, the ratio rose towards the normal range in the early recovery phase, but fell as the recovery period continued whereas in the remaining 2, the ratio remained at a consistent low level throughout the recovery period. One infant died of severe BPD at 36 days of age and 3 were breathing air at the time of discharge. In group 3(n=3), AT/ET decreased during a relatively short period, leading to death in all infants. CONCLUSION: Pulmonary hypertension in the acute phase of RDS is usually normalized during the recovery period. In infants who develop BPD, however, pulmonary pressure persistently remains high and in those with mortality, it is aggravated during a short-term interval.
Arterial Pressure* ; Echocardiography* ; Humans ; Hypertension, Pulmonary ; Infant ; Infant, Newborn ; Infant, Premature* ; Mortality ; Oxygen ; Pulmonary Artery ; Reference Values ; Respiration

The surgical closure of VSD in patient with severe pulmonary hypertension has been considered a difficult problem for surgeons, because sudden hemodynamic change after closure of the defect could bring on high perioperative mortality. Recently, it was reported that UVP (unidirectional valve patch), which allows some blood to flow from right to left in case of acute right heart failure, is effective in improving the postoperative hemodynamics after closing septal defects. This 42-year old woman had suffered from VSD for 20 years and recently complained of worsening exertional dyspnea for three months, and was diagnosed of a large VSD (2.0 cm in diameter) with severe pulmonary hypertension (116/38 mm Hg), equal to systemic arterial pressure. We could successfully close VSD with severe pulmonary hypertension using one UVP and the other UVP for the creative ASD to be prepared against possible acute right heart failure. She was discharged on the fourteenth postoperative day and has been well for twelve months with spontanenous closure of UVP patch at the ninth postopeative month.
Adult ; Arterial Pressure ; Dyspnea ; Female ; Heart Failure ; Heart Septal Defects ; Heart Septal Defects, Ventricular* ; Hemodynamics ; Humans ; Hypertension, Pulmonary* ; Mortality