Miron Alexandru BOGDAN

Latest posts by Miron Alexandru BOGDAN (see all)

Predictors of Long-term Mortality after Hospitalization for Severe COPD Exacerbation - July 19, 2019
New Echocardiographic Tehniques in Pulmonary Arterial Hypertension vs. Right Heart Catheterization – A Pilot Study - July 3, 2015
Prevalence and Characteristics of Pulmonary Hypertension Associated with COPD – A Pilot Study in Patients Referred to a Pulmonary Rehabilitation Program Clinic - July 3, 2015

Articles signed on MÆDICA, JCM:

Predictors of Long-term Mortality after Hospitalization for Severe COPD Exacerbation

MÆDICA - a Journal of Clinical Medicine | Vol. 14, No. 2, 2019

Alexandru Tudor STERIADE, Ana DAVIDOIU, Andreea AFRASINEI, Cornelia TUDOSE, Diana RADU, Daniela NECULA, Miron Alexandru BOGDAN and Dragos BUMBACEA

ABSTRACT

Introduction: Chronic obstructive pulmonary disease (COPD) is a global health problem resulting in significant morbidity. Acute exacerbation of COPD (AECOPD) is a severe complication associated with increased short- and long-term mortality. Identifying predictors of long-term mortality after a severe AECOPD may improve management and long-term outcome of this disease.
Materials and methods: A two-year prospective cohort study was undertaken in an academical medical center between 2016 and 2018. Patients with severe AECOPD who required non-invasive ventilation (NIV) were included. Baseline characteristics at inclusion, comorbidities (kidney dysfunction, left heart disease, diabetes), number of prior episodes of AECOPD and indication for long-term oxygen therapy (LTOT) or non-invasive ventilation (LTNIV) were recorded. Patients were monitored for a two-year period after initial admission. Outcomes were six-month, one-year and two-year mortality, irrespective of cause.
Outcomes: 51 patients (31 male, mean age 68.1) were included in the study. Mortality rates at six months, one year and two years were 20, 26 and 36%, respectively. Patients receiving LTOT and LTNIV at discharge had lower mortality at two years versus patients with no indication for LTOT and LTNIV at discharge. Absence of LTOT increased six-month mortality (OR .2, 95% CI, .04 to .90) and one-year mortality (p<.05). FEV1 and BMI were also correlated with long-term mortality in univariate analysis, p<.05. Age, number of prior episodes of AECOPD or the presence of comorbidities had no influence on long-term mortality.
Conclusion: After an episode of severe AECOPD, LTOT is associated with lower long-term mortality when compared to patients with no severe hypoxemia at discharge. A decreased lung function and body mass index increase long-term mortality.
Keywords: COPD exacerbation, mortality, oxygen therapy.

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New Echocardiographic Tehniques in Pulmonary Arterial Hypertension vs. Right Heart Catheterization – A Pilot Study

Tudor CONSTANTINESCU, Stefania Lucia MAGDA, Rodica NICULESCU, Raluca Ileana MINCU, Dragos ZAHARIA, Claudia Lucia TOMA, Mircea CINTEZA and Miron Alexandru BOGDAN

ABSTRACT

Background: Pulmonary arterial hypertension (PAH) represents an emerging pathology in modern medicine. Transthoracic echocardiography is an inexpensive and reproducible method and it is the most commonly used non-invasive diagnostic tool to asses pulmonary artery pressure (PAP) and the function of the right ventricle. Although, the right heart catheterization is still considered as the standard for the diagnosis, according to the last guidelines, the new echocardiographic methods may offer an improved value in the PAH evaluation.

Aim: To evaluate if cardiac ultrasonography data correlate with catheterization results in patients with PAH (Group I Dana Point 2008), and to compare the ultrasonography evaluation of PAH patients with that of normal.

Methods: 15 consecutive patients (pts) (52±15 yrs, 5 men, time from onset of symptoms 1.6±1.7 years) with PAH of different aetiologies (12 pts with idiopathic PAH, 2 pts with PAH associated with scleroderma and one with persistent PAH after atrial septal defect (ASD) closure) were evaluated through: 1. clinical examination (NYHA class); 2. exercise capacity (6 minute walking test – 6MWT); 3. conventional echocardiography (diameter of right ventricle – RVD and right atrium, fractional area shortening – FAS, TAPSE, pulmonary ascension time – PA, systolic and mean PAP -sPAP, mPAP, tricuspid E/A ratio, cardiac index-CI) and 4. Tissue Doppler Imaging – TDI (systolic and diastolic myocardial velocities at the tricuspid annulus – S, D, A); 5. right heart catheterization (sPAP, mPAP, CI, pulmonary vascular resistance – PVR) We compared classical and TDI echo parameters with those obtained from 15 normal subjects, matched in age and sex.

Results: PAH patients had high sPAP and mPAP with right heart dilation (RV - 44.8±7.3 mm), depressed TAPSE (16.2±5.9 mm) and cardiac index and low TDI systolic velocities at tricuspid level (7.3±2.9 cm/s). All parameters differed statistically significant from normal. There were no significant correlations between ultrasonography and catheterization (cath) parameters (sPAP 92±28.2 echo vs. 106.4±25.8 mmHg cath; mPAP 47.9±8.4 echo vs. 65.8±17.3 mmHg cath), excepting for CI 2.3±1.2 l/ min/m2 vs. 2.08±0.3 ml/min/m2 ) and PVR (16.5 ± 15.3 Wood U echo, vs. 19.6 ± 7.9 cath).

Conclusion: Classic and TDI cardiac ultrasonography represents a good screening and monitoring tool for PAH patients, but tends to underestimate the severity of the disease, leaving right heart catheterization as the essential diagnostic method for this rare disease.

Keywords: pulmonary arterial hypertension, echocardiography, Tissue Doppler Imaging, right heart catheterization

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Prevalence and Characteristics of Pulmonary Hypertension Associated with COPD – A Pilot Study in Patients Referred to a Pulmonary Rehabilitation Program Clinic

Daniela GOLOGANU, Cristina STANESCU, Teodora URSICA, Marius I. BALEA, Diana IONITA and Miron Alexandru BOGDAN

ABSTRACT

Objectives: Pulmonary hypertension (PH) is a common complication of chronic obstructive pulmonary disease (COPD); its prevalence is currently unknown. The objectives of the study were: (a) to pro vide data on the prevalence of PH among the COPD patients referred to a pulmonary rehabilitation program; (b) to evaluate possible correlations of PH with the severity of COPD, the presence of hypoxemia and polycythemia.

Material and methods: We retrospectively studied 31 consecutive patients with the diagnosis of COPD hospitalised in our clinic in which echocardiography was performed. Spirometry, peripheral oxygen saturation, haematocrit, echocardiography data, history of exacerbations and cardiac comorbidities were obtained from patients records. PH was defined as systolic pulmonary arterial pressure (sPAP) greater than 35 mmHg or by the presence of right ventricle (RV) abnormalities.

Outcomes: The prevalence of PH was 38.7%. Resting hypoxemia was significantly more frequent in the PH group than in the non PH patients (p=0.019). Other differences were not statistically significant (severity of bronchial obstruction and polycythemia, cardiac comorbidities). The impact of PH on RV was found in only 5 patients with RV enlargement; no patient had RV hypertrophy or RV systolic dysfunction. Suspected “out of proportion” PH (sPAP greater than 50 mmHg) was encountered in 2 out of 12 patients with PH.

Conclusions: The prevalence of PH in patients with COPD was 38.7%. Resting hypoxemia was significantly more frequent in PH patients. As PH has an important role in the prognosis of COPD patients, it should be evaluated in as many COPD patients as possible.

Keywords: pulmonary hypertension, chronic obstructive pulmonary disease, echocardiography

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Complete Therapeutical Approach in Pulmonary Arterial Hypertension: from Vasodilators to Lung Transplantation – Case Report

Tudor CONSTANTINESCU and Miron Alexandru BOGDAN

ABSTRACT

We present the case of a 37 years old patient with idiopathic pulmonary arterial hypertension (PAH). After initial treatment with calcium channel blockers (CCB), based on a positive vasoreactive response at right heart catheterization, due to disease progression, major vasodilator therapies were introduced in a sequential strategy: sildenafil, bosentan and treprostinil. Finally, the patient received double-lung transplantation with eventually favourable evolution despite immediate postoperative significant complications.

Markers of disease progression were monitored before the transplant, and after the intervention the patient was screened according to a specific protocol for bronchiolitis obliterans and infections.

According to our knowledge, this case represents a premiere in Romanian medicine, being the first lung transplant in a PAH patient.

This case represents a model of PAH with a documented evolution of 8 years. We present the progression of the disease and the effective therapeutic strategies according to the current guidelines. This case reinforces the need for upgrading the Romanian National PAH Program with the inclusion of prostanoid therapy, as an option for severe patients.

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Miron Alexandru BOGDAN

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Predictors of Long-term Mortality after Hospitalization for Severe COPD Exacerbation

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