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Harada D, Noto T, Takagawa J. Multifaced risk factors and clinical impact of a deep Y descent in patients with heart failure irrespective of RV-PA coupling. IJC HEART & VASCULATURE 2024; 53:101439. [PMID: 38939016 PMCID: PMC11209010 DOI: 10.1016/j.ijcha.2024.101439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 05/21/2024] [Accepted: 06/01/2024] [Indexed: 06/29/2024]
Abstract
Background A deep Y descent in the jugular venous pulse (JVP) is associated with diseases such as a decrease in right ventricular (RV) preload reserve. The present study investigated the relationship between RV-pulmonary arterial (PA) coupling and a deep Y descent, examined risk factors for a deep Y descent and clarified whether a deep Y descent was an independent risk factor for cardiac events irrespective of RV-PA coupling in patients with heart failure (HF). Methods We enrolled 350 patients with HF who underwent echocardiography and JVP examination. A deep Y descent was identified by a deeper 'Y' descent than 'X' descent in the JVP waveform. We defined cardiac events of HF as follows: sudden death, death from HF, the emergent infusion of loop diuretics, or hospitalization for decompensated HF. Results and Conclusions A deep Y descent and cardiac events were observed in 129 and 83 patients, respectively. The prevalence of a deep Y descent increased with decreases in the tricuspid annular plane systolic excursion (TAPSE)/systolic pulmonary arterial pressure (SPAP) ratio. Not only the TAPSE/SPAP ratio (odds ratio,0.756 per0.1 mm/mmHg, 95 %confidence interval [CI], 0.660-0.866, p < 0.001), but also age, atrial fibrillation, and the use of beta-blockers were independent factors for a deep Y descent in multivariate logistic model. Multivariate Cox hazard model demonstrated that a deep Y descent was for cardiac events in patients with HF (Hazard ratio,2.682, 95 %CI, 1.599-4.497, p < 0.001) irrespective of the TAPSE/SPAP ratio. The development of therapeutic strategies based on central venous waveform may be needed for patients with HF.
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Affiliation(s)
- Daisuke Harada
- The Cardiology Division, Imizu Municipal Hospital, Toyama, Japan
| | - Takahisa Noto
- The Cardiology Division, Imizu Municipal Hospital, Toyama, Japan
| | - Junya Takagawa
- The Cardiology Division, Imizu Municipal Hospital, Toyama, Japan
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2
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Choudhury P, Dasgupta S, Bhattacharyya P, Roychowdhury S, Chaudhury K. Understanding pulmonary hypertension: the need for an integrative metabolomics and transcriptomics approach. Mol Omics 2024; 20:366-389. [PMID: 38853716 DOI: 10.1039/d3mo00266g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Pulmonary hypertension (PH), characterised by mean pulmonary arterial pressure (mPAP) >20 mm Hg at rest, is a complex pathophysiological disorder associated with multiple clinical conditions. The high prevalence of the disease along with increased mortality and morbidity makes it a global health burden. Despite major advances in understanding the disease pathophysiology, much of the underlying complex molecular mechanism remains to be elucidated. Lack of a robust diagnostic test and specific therapeutic targets also poses major challenges. This review provides a comprehensive update on the dysregulated pathways and promising candidate markers identified in PH patients using the transcriptomics and metabolomics approach. The review also highlights the need of using an integrative multi-omics approach for obtaining insight into the disease at a molecular level. The integrative multi-omics/pan-omics approach envisaged to help in bridging the gap from genotype to phenotype is outlined. Finally, the challenges commonly encountered while conducting omics-driven studies are also discussed.
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Affiliation(s)
- Priyanka Choudhury
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur, 721302, West Bengal, India.
| | - Sanjukta Dasgupta
- Department of Biotechnology, Brainware University, Barasat, West Bengal, India
| | | | | | - Koel Chaudhury
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur, 721302, West Bengal, India.
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Chen X, Yan Z, Pan Q, Zhang C, Chen Y, Liang X, Li S, Wang L. Bibliometric analysis of T-cells immunity in pulmonary hypertension from 1992 to 2022. Immun Inflamm Dis 2024; 12:e1280. [PMID: 38967362 PMCID: PMC11225084 DOI: 10.1002/iid3.1280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 04/25/2024] [Accepted: 05/03/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Adaptive immunity is an important disease mediator of pulmonary vascular remodeling during pulmonary hypertension (PH) development, especially T-cells lymphocytes. However, data for bibliometric analysis of T cell immunity in PH is currently vacant. This aimed to provide a comprehensive and visualized view of T-cells research in PH pathogenesis and to lay a solid foundation for further studies. METHODS The data was acquired from the Web of Science Core Collection database. Web of Science analytic tool was used to analysis the publication years, authors, journals, countries, and organizations. CiteSpace 6.2.R3, VOSviewer 1.6.16, and Scimago Graphica 1.0.35.0 were applied to conduct a visualization bibliometric analysis about authors, countries, institutions, journals, references, and keywords. RESULTS Nine hundred and eight publications from 1992 to 2022 were included in the analysis. The results showed that Humbert Marc was the most prolific author. American Journal of Physiology Lung Cellular and Molecular Physiology had the most related articles. The institution with the most articles was Udice French Research University. The United States was far ahead in the article output. Keywords analysis showed that "Pulmonary hypertension" was the most usually appeared keyword in the relevant literature, and included "T-cells", "Regulatory T cells", and "Activated T cell." "miRNA" of reference co-citation clustering analysis demonstrated the possible T-cell immunity activation mechanisms in PH. The most cited literature was published in the European Heart Journal by Galie N in 2016. The strongest citation burst of keyword is "gene expression" and terms such as "vascular remodeling," "growth," "proliferation," and "fibrosis" are among the list, indicating that T-cells interact with stromal vascular cells to induce pulmonary vascular remodeling. The strongest burst of cited reference is "Galie N, 2016." CONCLUSIONS T-cell immunity is an important pathogenesis mechanism for PH development, which may have interaction with miRNAs and stromal vascular cells, but the possible T-cell immunity activation mechanisms in PH need to be investigated further.
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Affiliation(s)
- Xian Chen
- Department of NephrologySecond Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Zhe Yan
- Department of NephrologySecond Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Qing Pan
- Department of NephrologySecond Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Chunxia Zhang
- Department of NephrologySecond Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Yakun Chen
- Department of NephrologySecond Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Xuzhi Liang
- Department of NephrologySecond Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Shaomei Li
- Department of NephrologySecond Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Lei Wang
- Department of Pulmonary and Critical Care MedicineSecond Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
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Barberà JA, Peinado VI, Blanco I. Untangling severe pulmonary hypertension in chronic obstructive pulmonary disease. J Heart Lung Transplant 2024; 43:1102-1104. [PMID: 38522763 DOI: 10.1016/j.healun.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 03/26/2024] Open
Affiliation(s)
- Joan Albert Barberà
- Department of Respiratory Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Madrid, Spain.
| | - Víctor Ivo Peinado
- Department of Respiratory Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Madrid, Spain; Department of Experimental Pathology, Instituto de Investigaciones Biomédicas de Barcelona (IIBB-CSIC), Barcelona, Spain
| | - Isabel Blanco
- Department of Respiratory Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Madrid, Spain
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Hoyos R, Lichtblau M, Cajamarca E, Mayer L, Schwarz EI, Ulrich S. Characteristics and risk profiles of patients with pulmonary arterial or chronic thromboembolic pulmonary hypertension living permanently at >2500 m of high altitude in Ecuador. Pulm Circ 2024; 14:e12404. [PMID: 38974936 PMCID: PMC11224915 DOI: 10.1002/pul2.12404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 05/09/2024] [Accepted: 06/12/2024] [Indexed: 07/09/2024] Open
Abstract
Over 80 Mio people worldwide live >2500 m, including at least as many patients with pulmonary vascular disease (PVD), defined as pulmonary arterial or chronic thromboembolic pulmonary hypertension (PAH/CTEPH), as elsewhere (estimated 0.1‰). Whether PVD patients living at high altitude have altered disease characteristics due to hypobaric hypoxia is unknown. In a cross-sectional study conducted at the Hospital Carlos Andrade Marin in Quito, Ecuador, located at 2840 m, we included 36 outpatients with PAH or CTEPH visiting the clinic from January 2022 to July 2023. We collected data on diagnostic right heart catheterization, treatment, and risk factors, including NYHA functional class (FC), 6-min walk distance (6MWD), and NT-brain natriuretic peptide (BNP) at baseline and at last follow-up. Thirty-six PVD patients (83% women, 32 PAH, 4 CTEPH, mean ± SD age 44 ± 13 years, living altitude 2831 ± 58 m) were included and had the following baseline values: PaO2 8.2 ± 1.6 kPa, PaCO2 3.9 ± 0.5 kPa, SaO2 91 ± 3%, mean pulmonary artery pressure 53 ± 16 mmHg, pulmonary vascular resistance 16 ± 4 WU, 50% FC II, 50% FC III, 6MWD 472 ± 118 m, BNP 490 ± 823 ng/L. Patients were treated for 1628 ± 1186 days with sildenafil (100%), bosentan (33%), calcium channel blockers (33%), diuretics (69%), and oxygen (nocturnal 53%, daytime 11%). Values at last visit were: FC (II 75%, III 25%), 6MWD of 496 ± 108 m, BNP of 576 ± 5774 ng/L. Compared to European PVD registries, ambulatory PVD patients living >2500 m revealed similar blood gases and relatively low and stable risk factor profiles despite severe hemodynamic compromise, suggesting that favorable outcomes are achievable for altitude residents with PVD. Future studies should focus on long-term outcomes in PVD patients dwelling >2500 m.
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Affiliation(s)
| | - Mona Lichtblau
- Department of PulmonologyUniversity Hospital ZurichZurichSwitzerland
| | | | - Laura Mayer
- Department of PulmonologyUniversity Hospital ZurichZurichSwitzerland
| | | | - Silvia Ulrich
- Department of PulmonologyUniversity Hospital ZurichZurichSwitzerland
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Ilonze OJ, Ebong IA, Guglin M, Nair A, Rich J, McLaughlin V, Tedford RJ, Mazimba S. Considerations in the Diagnosis and Management of Pulmonary Hypertension Associated With Left Heart Disease. JACC. HEART FAILURE 2024:S2213-1779(24)00436-0. [PMID: 38970588 DOI: 10.1016/j.jchf.2024.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 03/04/2024] [Accepted: 04/08/2024] [Indexed: 07/08/2024]
Abstract
Pulmonary hypertension associated with left heart disease (PH-LHD) remains the most common cause of pulmonary hypertension globally. Etiologies include heart failure with reduced and preserved ejection fraction and left-sided valvular heart diseases. Despite the increasing prevalence of PH-LHD, there remains a paucity of knowledge about the hemodynamic definition, diagnosis, treatment modalities, and prognosis among clinicians. Moreover, clinical trials have produced mixed results on the usefulness of pulmonary vasodilator therapies for PH-LHD. In this expert review, we have outlined the critical role of meticulous hemodynamic evaluation and provocative testing for cases of diagnostic uncertainty. Therapeutic strategies-pharmacologic, device-based, and surgical therapies used for managing PH-LHD-are also outlined. PH-LHD in advanced heart failure, and the role of mechanical circulatory support in PH-LHD is briefly explored. An in-depth understanding of PH-LHD by all clinicians is needed for improved recognition and outcomes among patients with PH-LHD.
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Affiliation(s)
- Onyedika J Ilonze
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, Indianapolis, Indiana, USA.
| | - Imo A Ebong
- Division of Cardiology, University of California Davis, Sacramento, California, USA
| | - Maya Guglin
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, Indianapolis, Indiana, USA
| | - Ajith Nair
- Winters Center for Heart Failure Research, Michael E. DeBakey VA Medical Center, Texas Heart Institute, Baylor College of Medicine, Houston, Texas, USA
| | - Jonathan Rich
- Division of Cardiology, Bluhm Cardiovascular Institute Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Vallerie McLaughlin
- University of Michigan Hospital and Health Systems, Ann Arbor, Michigan, USA
| | - Ryan J Tedford
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sula Mazimba
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, Virginia, USA; AdventHealth, Orlando, Florida, USA
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Papolos AI, Kenigsberg BB, Austin DR, Barnett CF. Management of the peri-intubation period in patients with pulmonary arterial hypertension and respiratory failure. Curr Cardiol Rep 2024:10.1007/s11886-024-02081-y. [PMID: 38913233 DOI: 10.1007/s11886-024-02081-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE OF REVIEW The endotracheal intubation of patients with pulmonary arterial hypertension (PAH) in respiratory distress is a highly morbid procedure that can precipitate hemodynamic collapse. Here we review our strategy for confronting this difficult clinical situation. RECENT FINDINGS There are no clinical trials that explore best practices in the management of patients with PAH and respiratory failure. Here we provide a practical approach to respiratory support, inopressor and pulmonary vasodilator selection, hemodynamic considerations, point-of-care ultrasound monitoring, and endotracheal intubation in patients with PAH in respiratory failure.
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Affiliation(s)
- Alexander I Papolos
- Department of Critical Care, MedStar Washington Hospital Center, Washington, DC, USA.
- Division of Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
| | - Benjamin B Kenigsberg
- Department of Critical Care, MedStar Washington Hospital Center, Washington, DC, USA
- Division of Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Daniel R Austin
- Department of Critical Care, MedStar Washington Hospital Center, Washington, DC, USA
- Department of Anesthesiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Christopher F Barnett
- Division of Cardiology, University of California-San Francisco School of Medicine, San Francisco, CA, USA
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8
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Tuttle M, Sarnak MJ, Navaneethan SD. Therapeutic approaches for pulmonary hypertension in patients with chronic kidney disease. Curr Opin Nephrol Hypertens 2024:00041552-990000000-00170. [PMID: 38899951 DOI: 10.1097/mnh.0000000000001008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
PURPOSE OF REVIEW Pulmonary hypertension is a common comorbidity in patients with chronic kidney disease (CKD), but therapeutic options are limited. We discuss the epidemiology of pulmonary hypertension in patients with CKD and review therapies for pulmonary hypertension with a focus on emerging treatments for pulmonary arterial hypertension (PAH). RECENT FINDINGS The definition of pulmonary hypertension has been updated to a lower threshold of mean pulmonary artery pressures of more than 20 mmHg, potentially leading to more patients with CKD to qualify for the diagnosis of pulmonary hypertension. Endothelin receptor antagonists, a class of medications, which demonstrated efficacy in patients with PAH, have been shown to slow progression of CKD, but their efficacy in lowering pulmonary artery pressures and their effects on reducing cardiovascular mortality in this population remains unproven. Sotatercept, a novel activin signaling inhibitor, which was previously studied in dialysis patients has been shown to increase exercise capacity in patients with PAH. These studies may lead to new specific therapies for pulmonary hypertension in patients with CKD. SUMMARY Pulmonary hypertension is common in patients with CKD. Although our understanding of factors leading to pulmonary hypertension in this population have evolved, evidence supporting disease-specific therapy in CKD is limited arguing for larger, long-term studies.
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Affiliation(s)
- Marcelle Tuttle
- Nephrology Division, Department of Medicine, Tufts Medical Center
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts
| | - Mark J Sarnak
- Nephrology Division, Department of Medicine, Tufts Medical Center
| | - Sankar D Navaneethan
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine
- Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center
- Veterans Affairs Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety
- Institute of Clinical and Translational Research Baylor College of Medicine, Houston, Texas, USA
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Zeder K, Siew ED, Kovacs G, Brittain EL, Maron BA. Pulmonary hypertension and chronic kidney disease: prevalence, pathophysiology and outcomes. Nat Rev Nephrol 2024:10.1038/s41581-024-00857-7. [PMID: 38890546 DOI: 10.1038/s41581-024-00857-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2024] [Indexed: 06/20/2024]
Abstract
Pulmonary hypertension (PH) is common in patients with chronic kidney disease (CKD) or kidney failure, with an estimated prevalence of up to 78% in those referred for right-heart catheterization. PH is independently associated with adverse outcomes in CKD, raising the possibility that early detection and appropriate management of PH might improve outcomes in at-risk patients. Among patients with PH, the prevalence of CKD stages 3 and 4 is estimated to be as high as 36%, and CKD is also independently associated with adverse outcomes. However, the complex, heterogenous pathophysiology and clinical profile of CKD-PH requires further characterization. CKD is often associated with elevated left ventricular filling pressure and volume overload, which presumably leads to pulmonary vascular stiffening and post-capillary PH. By contrast, a distinct subgroup of patients at high risk is characterized by elevated pulmonary vascular resistance and right ventricular dysfunction in the absence of pulmonary venous hypertension, which may represent a right-sided cardiorenal syndrome defined in principle by hypervolaemia, salt avidity, low cardiac output and normal left ventricular function. Current understanding of CKD-PH is limited, despite its potentially important ramifications for clinical decision making. In particular, whether PH should be considered when determining the suitability and timing of kidney replacement therapy or kidney transplantation is unclear. More research is urgently needed to address these knowledge gaps and improve the outcomes of patients with or at risk of CKD-PH.
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Affiliation(s)
- Katarina Zeder
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- The University of Maryland-Institute for Health Computing, Bethesda, MD, USA
| | - Edward D Siew
- Division of Nephrology and Hypertension, Vanderbilt Center for Kidney Disease and Integrated Program for Acute Kidney Injury, Nashville, TN, USA
| | - Gabor Kovacs
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Evan L Brittain
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bradley A Maron
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
- The University of Maryland-Institute for Health Computing, Bethesda, MD, USA.
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Yokokawa T, Boucherat O, Martineau S, Lemay SE, Breuils-Bonnet S, Krishna V, Kalyana-Sundaram S, Jeyaseelan J, Potus F, Bonnet S, Provencher S. Prognostic Significance of Proteomics-Discovered Circulating Inflammatory Biomarkers in Patients With Pulmonary Arterial Hypertension. J Am Heart Assoc 2024; 13:e032888. [PMID: 38874078 DOI: 10.1161/jaha.123.032888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 05/15/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) ultimately leads to right ventricular failure and premature death. The identification of circulating biomarkers with prognostic utility is considered a priority. As chronic inflammation is recognized as key pathogenic driver, we sought to identify inflammation-related circulating proteins that add incremental value to current risk stratification models for long-term survival in patients with PAH. METHODS AND RESULTS Plasma levels of 384 inflammatory proteins were measured with the proximity extension assay technology in patients with PAH (n=60) and controls with normal hemodynamics (n=28). Among these, 51 analytes were significantly overexpressed in the plasma of patients with PAH compared with controls. Cox proportional hazard analyses and C-statistics were performed to assess the prognostic value and the incremental prognostic value of differentially expressed proteins. A panel of 6 proteins (CRIM1 [cysteine rich transmembrane bone morphogenetic protein regulator 1], HGF [hepatocyte growth factor], FSTL3 [follistatin-like 3], PLAUR [plasminogen activator, urokinase receptor], CLSTN2 [calsyntenin 2], SPON1 [spondin 1]) were independently associated with death/lung transplantation at the time of PAH diagnosis after adjustment for the 2015 European Society of Cardiology/European Respiratory Society guidelines, the REVEAL (Registry to Evaluate Early and Long-Term PAH Disease Management) 2.0 risk scores, and the refined 4-strata risk assessment. CRIM1, PLAUR, FSTL3, and SPON1 showed incremental prognostic value on top of the predictive models. As determined by Western blot, FSTL3 and SPON1 were significantly upregulated in the right ventricle of patients with PAH and animal models (monocrotaline-injected and pulmonary artery banding-subjected rats). CONCLUSIONS In addition to revealing new actors likely involved in cardiopulmonary remodeling in PAH, our screening identified promising circulating biomarkers to improve risk prediction in PAH, which should be externally confirmed.
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Affiliation(s)
- Tetsuro Yokokawa
- Pulmonary Hypertension Research Group Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec Québec City Québec Canada
- Department of Cardiovascular Medicine Fukushima Medical University Fukushima Japan
| | - Olivier Boucherat
- Pulmonary Hypertension Research Group Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec Québec City Québec Canada
- Department of Medicine Université Laval Québec City Québec Canada
| | - Sandra Martineau
- Pulmonary Hypertension Research Group Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec Québec City Québec Canada
| | - Sarah-Eve Lemay
- Pulmonary Hypertension Research Group Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec Québec City Québec Canada
| | - Sandra Breuils-Bonnet
- Pulmonary Hypertension Research Group Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec Québec City Québec Canada
| | | | | | | | - François Potus
- Pulmonary Hypertension Research Group Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec Québec City Québec Canada
- Department of Medicine Université Laval Québec City Québec Canada
| | - Sébastien Bonnet
- Pulmonary Hypertension Research Group Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec Québec City Québec Canada
- Department of Medicine Université Laval Québec City Québec Canada
| | - Steeve Provencher
- Pulmonary Hypertension Research Group Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec Québec City Québec Canada
- Department of Medicine Université Laval Québec City Québec Canada
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Liu Z, Fu Q, Yu Q, Ma X, Yang R. Assessing causal associations of blood counts and biochemical indicators with pulmonary arterial hypertension: a Mendelian randomization study and results from national health and nutrition examination survey 2003-2018. Front Endocrinol (Lausanne) 2024; 15:1418835. [PMID: 38952391 PMCID: PMC11215008 DOI: 10.3389/fendo.2024.1418835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 05/27/2024] [Indexed: 07/03/2024] Open
Abstract
Background Blood counts and biochemical markers are among the most common tests performed in hospitals and most readily accepted by patients, and are widely regarded as reliable biomarkers in the literature. The aim of this study was to assess the causal relationship between blood counts, biochemical indicators and pulmonary arterial hypertension (PAH). Methods A two-sample Mendelian randomization (MR) analysis was performed to assess the causal relationship between blood counts and biochemical indicators with PAH. The genome-wide association study (GWAS) for blood counts and biochemical indicators were obtained from the UK Biobank (UKBB), while the GWAS for PAH were sourced from the FinnGen Biobank. Inverse variance weighting (IVW) was used as the primary analysis method, supplemented by three sensitivity analyses to assess the robustness of the results. And we conducted an observational study using data from National Health and Nutrition Examination Survey (NHANES) 2003-2018 to verify the relationship. Results The MR analysis primarily using the IVW method revealed genetic variants of platelet count (OR=2.51, 95% CI 1.56-4.22, P<0.001), platelet crit(OR=1.87, 95% CI1.17-7.65, P=0.022), direct bilirubin (DBIL)(OR=1.71, 95%CI 1.18-2.47,P=0.004), insulin-like growth factor (IGF-1)(OR=0.51, 95% CI 0.27-0.96, P=0.038), Lipoprotein A (Lp(a))(OR=0.66, 95% CI 0.45-0.98, P=0.037) and total bilirubin (TBIL)(OR=0.51, 95% CI 0.27-0.96, P=0.038) were significantly associated with PAH. In NHANES, multivariate logistic regression analyses revealed a significant positive correlation between platelet count and volume and the risk of PAH, and a significant negative correlation between total bilirubin and PAH. Conclusion Our study reveals a causal relationship between blood counts, biochemical indicators and pulmonary arterial hypertension. These findings offer novel insights into the etiology and pathological mechanisms of PAH, and emphasizes the important value of these markers as potential targets for the prevention and treatment of PAH.
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Affiliation(s)
- Zhekang Liu
- Cardiovascular Medicine Department, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Rheumatology and Immunology Department, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Qingan Fu
- Cardiovascular Medicine Department, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Qingyun Yu
- Cardiovascular Medicine Department, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiaowei Ma
- Cardiovascular Medicine Department, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Renqiang Yang
- Cardiovascular Medicine Department, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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12
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Sedlář A, Vrbata D, Pokorná K, Holzerová K, Červený J, Kočková O, Hlaváčková M, Doubková M, Musílková J, Křen V, Kolář F, Bačáková L, Bojarová P. Glycopolymer Inhibitors of Galectin-3 Suppress the Markers of Tissue Remodeling in Pulmonary Hypertension. J Med Chem 2024; 67:9214-9226. [PMID: 38829964 PMCID: PMC11181325 DOI: 10.1021/acs.jmedchem.4c00341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 05/16/2024] [Accepted: 05/24/2024] [Indexed: 06/05/2024]
Abstract
Pulmonary hypertension is a cardiovascular disease with a low survival rate. The protein galectin-3 (Gal-3) binding β-galactosides of cellular glycoproteins plays an important role in the onset and development of this disease. Carbohydrate-based drugs that target Gal-3 represent a new therapeutic strategy in the treatment of pulmonary hypertension. Here, we present the synthesis of novel hydrophilic glycopolymer inhibitors of Gal-3 based on a polyoxazoline chain decorated with carbohydrate ligands. Biolayer interferometry revealed a high binding affinity of these glycopolymers to Gal-3 in the subnanomolar range. In the cell cultures of cardiac fibroblasts and pulmonary artery smooth muscle cells, the most potent glycopolymer 18 (Lac-high) caused a decrease in the expression of markers of tissue remodeling in pulmonary hypertension. The glycopolymers were shown to penetrate into the cells. In a biodistribution and pharmacokinetics study in rats, the glycopolymers accumulated in heart and lung tissues, which are most affected by pulmonary hypertension.
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Affiliation(s)
- Antonín Sedlář
- Laboratory
of Biomaterials and Tissue Engineering, Institute of Physiology of the Czech Academy of Sciences, Vídeňská 1083, Prague 4 CZ-142 00, Czech Republic
| | - David Vrbata
- Laboratory
of Biotransformation, Institute of Microbiology
of the Czech Academy of Sciences, Vídeňská 1083, Prague 4 CZ-142 00, Czech Republic
| | - Kateřina Pokorná
- Laboratory
of Biomaterials and Tissue Engineering, Institute of Physiology of the Czech Academy of Sciences, Vídeňská 1083, Prague 4 CZ-142 00, Czech Republic
| | - Kristýna Holzerová
- Laboratory
of Developmental Cardiology, Institute of
Physiology of the Czech Academy of Sciences, Vídeňská 1083, Prague 4 CZ-142 00, Czech Republic
| | - Jakub Červený
- Laboratory
of Biotransformation, Institute of Microbiology
of the Czech Academy of Sciences, Vídeňská 1083, Prague 4 CZ-142 00, Czech Republic
- Department
of Analytical Chemistry, Faculty of Science, Charles University, Hlavova 8, Prague 2 CZ-128
43, Czech Republic
| | - Olga Kočková
- Laboratory
of Analytical Chemistry, Institute of Macromolecular
Chemistry of the Czech Academy of Sciences, Heyrovského nám. 1888, Prague 6 CZ-162 00, Czech Republic
| | - Markéta Hlaváčková
- Laboratory
of Developmental Cardiology, Institute of
Physiology of the Czech Academy of Sciences, Vídeňská 1083, Prague 4 CZ-142 00, Czech Republic
| | - Martina Doubková
- Laboratory
of Biomaterials and Tissue Engineering, Institute of Physiology of the Czech Academy of Sciences, Vídeňská 1083, Prague 4 CZ-142 00, Czech Republic
| | - Jana Musílková
- Laboratory
of Biomaterials and Tissue Engineering, Institute of Physiology of the Czech Academy of Sciences, Vídeňská 1083, Prague 4 CZ-142 00, Czech Republic
| | - Vladimír Křen
- Laboratory
of Biotransformation, Institute of Microbiology
of the Czech Academy of Sciences, Vídeňská 1083, Prague 4 CZ-142 00, Czech Republic
| | - František Kolář
- Laboratory
of Developmental Cardiology, Institute of
Physiology of the Czech Academy of Sciences, Vídeňská 1083, Prague 4 CZ-142 00, Czech Republic
| | - Lucie Bačáková
- Laboratory
of Biomaterials and Tissue Engineering, Institute of Physiology of the Czech Academy of Sciences, Vídeňská 1083, Prague 4 CZ-142 00, Czech Republic
| | - Pavla Bojarová
- Laboratory
of Biotransformation, Institute of Microbiology
of the Czech Academy of Sciences, Vídeňská 1083, Prague 4 CZ-142 00, Czech Republic
- Department
of Health Care Disciplines and Population Protection, Faculty of Biomedical
Engineering, Czech Technical University
in Prague, nám.
Sítná 3105, Kladno CZ-272 01, Czech Republic
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13
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Rachedi NS, Tang Y, Tai YY, Zhao J, Chauvet C, Grynblat J, Akoumia KKF, Estephan L, Torrino S, Sbai C, Ait-Mouffok A, Latoche JD, Al Aaraj Y, Brau F, Abélanet S, Clavel S, Zhang Y, Guillermier C, Kumar NVG, Tavakoli S, Mercier O, Risbano MG, Yao ZK, Yang G, Ouerfelli O, Lewis JS, Montani D, Humbert M, Steinhauser ML, Anderson CJ, Oldham WM, Perros F, Bertero T, Chan SY. Dietary intake and glutamine-serine metabolism control pathologic vascular stiffness. Cell Metab 2024; 36:1335-1350.e8. [PMID: 38701775 PMCID: PMC11152997 DOI: 10.1016/j.cmet.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/15/2024] [Accepted: 04/12/2024] [Indexed: 05/05/2024]
Abstract
Perivascular collagen deposition by activated fibroblasts promotes vascular stiffening and drives cardiovascular diseases such as pulmonary hypertension (PH). Whether and how vascular fibroblasts rewire their metabolism to sustain collagen biosynthesis remains unknown. Here, we found that inflammation, hypoxia, and mechanical stress converge on activating the transcriptional coactivators YAP and TAZ (WWTR1) in pulmonary arterial adventitial fibroblasts (PAAFs). Consequently, YAP and TAZ drive glutamine and serine catabolism to sustain proline and glycine anabolism and promote collagen biosynthesis. Pharmacologic or dietary intervention on proline and glycine anabolic demand decreases vascular stiffening and improves cardiovascular function in PH rodent models. By identifying the limiting metabolic pathways for vascular collagen biosynthesis, our findings provide guidance for incorporating metabolic and dietary interventions for treating cardiopulmonary vascular disease.
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Affiliation(s)
- Nesrine S Rachedi
- Université Côte d'Azur, CNRS, INSERM, IPMC, IHU-RespirERA, Valbonne, France
| | - Ying Tang
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, and Blood Vascular Medicine Institute, Pittsburgh, PA, USA; Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine and UPMC, Pittsburgh, PA, USA
| | - Yi-Yin Tai
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, and Blood Vascular Medicine Institute, Pittsburgh, PA, USA; Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine and UPMC, Pittsburgh, PA, USA
| | - Jingsi Zhao
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, and Blood Vascular Medicine Institute, Pittsburgh, PA, USA; Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine and UPMC, Pittsburgh, PA, USA
| | - Caroline Chauvet
- Université Côte d'Azur, CNRS, INSERM, IPMC, IHU-RespirERA, Valbonne, France
| | - Julien Grynblat
- Université Paris-Saclay, AP-HP, INSERM UMR_S 999, Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital de Bicêtre, Le Kremlin Bicêtre, France; Pôle Thoracique, Vasculaire et Transplantations, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Kouamé Kan Firmin Akoumia
- Université Paris-Saclay, AP-HP, INSERM UMR_S 999, Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
| | - Leonard Estephan
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, and Blood Vascular Medicine Institute, Pittsburgh, PA, USA; Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine and UPMC, Pittsburgh, PA, USA
| | - Stéphanie Torrino
- Université Côte d'Azur, CNRS, INSERM, IPMC, IHU-RespirERA, Valbonne, France
| | - Chaima Sbai
- Université Côte d'Azur, CNRS, INSERM, IPMC, IHU-RespirERA, Valbonne, France
| | - Amel Ait-Mouffok
- Université Côte d'Azur, CNRS, INSERM, IPMC, IHU-RespirERA, Valbonne, France
| | - Joseph D Latoche
- Hillman Cancer Center, University of Pittsburgh School of Medicine and UPMC, Pittsburgh, PA, USA
| | - Yassmin Al Aaraj
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, and Blood Vascular Medicine Institute, Pittsburgh, PA, USA; Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine and UPMC, Pittsburgh, PA, USA
| | - Frederic Brau
- Université Côte d'Azur, CNRS, INSERM, IPMC, IHU-RespirERA, Valbonne, France
| | - Sophie Abélanet
- Université Côte d'Azur, CNRS, INSERM, IPMC, IHU-RespirERA, Valbonne, France
| | - Stephan Clavel
- Université Côte d'Azur, CNRS, INSERM, IPMC, IHU-RespirERA, Valbonne, France
| | - Yingze Zhang
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, and Blood Vascular Medicine Institute, Pittsburgh, PA, USA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine and UPMC, Pittsburgh, PA, USA
| | - Christelle Guillermier
- Center for NanoImaging, Division of Genetics, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Naveen V G Kumar
- Aging Institute, Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine and UPMC, Pittsburgh, PA, USA
| | - Sina Tavakoli
- Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine and UPMC, Pittsburgh, PA, USA; Department of Radiology, University of Pittsburgh School of Medicine and UPMC, Pittsburgh, PA, USA
| | - Olaf Mercier
- Université Paris-Saclay, AP-HP, INSERM UMR_S 999, Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital de Bicêtre, Le Kremlin Bicêtre, France; Assistance PubliqueHôpitaux de Paris (AP-HP), Service de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence de l'Hypertension Pulmonaire, Hôpital Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - Michael G Risbano
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, and Blood Vascular Medicine Institute, Pittsburgh, PA, USA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine and UPMC, Pittsburgh, PA, USA
| | - Zhong-Ke Yao
- Molecular Pharmacology and Chemistry Program and Organic Synthesis Core Facility, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Guangli Yang
- Molecular Pharmacology and Chemistry Program and Organic Synthesis Core Facility, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ouathek Ouerfelli
- Molecular Pharmacology and Chemistry Program and Organic Synthesis Core Facility, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jason S Lewis
- Molecular Pharmacology and Chemistry Program and Organic Synthesis Core Facility, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David Montani
- Pôle Thoracique, Vasculaire et Transplantations, Hôpital Marie Lannelongue, Le Plessis-Robinson, France; Assistance PubliqueHôpitaux de Paris (AP-HP), Service de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence de l'Hypertension Pulmonaire, Hôpital Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - Marc Humbert
- Université Paris-Saclay, AP-HP, INSERM UMR_S 999, Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital de Bicêtre, Le Kremlin Bicêtre, France; Assistance PubliqueHôpitaux de Paris (AP-HP), Service de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence de l'Hypertension Pulmonaire, Hôpital Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - Matthew L Steinhauser
- Center for NanoImaging, Division of Genetics, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Aging Institute, Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine and UPMC, Pittsburgh, PA, USA
| | | | - William M Oldham
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Frédéric Perros
- Université Paris-Saclay, AP-HP, INSERM UMR_S 999, Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital de Bicêtre, Le Kremlin Bicêtre, France; Laboratoire CarMeN, UMR INSERM U1060/INRA U1397, Université Claude Bernard Lyon1, 69310 Pierre-Bénite, France
| | - Thomas Bertero
- Université Côte d'Azur, CNRS, INSERM, IPMC, IHU-RespirERA, Valbonne, France.
| | - Stephen Y Chan
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, and Blood Vascular Medicine Institute, Pittsburgh, PA, USA; Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine and UPMC, Pittsburgh, PA, USA.
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14
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Luo T, Wu H, Zhu W, Zhang L, Huang Y, Yang X. Emerging therapies: Potential roles of SGLT2 inhibitors in the management of pulmonary hypertension. Respir Med 2024; 227:107631. [PMID: 38631526 DOI: 10.1016/j.rmed.2024.107631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 04/01/2024] [Accepted: 04/07/2024] [Indexed: 04/19/2024]
Abstract
Pulmonary hypertension (PH) is a pathophysiological disorder that may involve multiple clinical conditions and may be associated with a variety of cardiovascular and respiratory diseases. Pulmonary hypertension due to left heart disease (PH-LHD) currently lacks targeted therapies, while Pulmonary arterial hypertension (PAH), despite approved treatments, carries considerable residual risk. Metabolic dysfunction has been linked to the pathogenesis and prognosis of PH through various studies, with emerging metabolic agents offering a potential avenue for improving patient outcomes. Sodium-glucose cotransporter 2 inhibitor (SGLT-2i), a novel hypoglycemic agent, could ameliorate metabolic dysfunction and exert cardioprotective effects. Recent small-scale studies suggest SGLT-2i treatment may improve pulmonary artery pressure in patients with PH-LHD, and the PAH animal model shows that SGLT-2i can reduce pulmonary vascular remodeling and prevent progression in PAH, suggesting potential benefits for patients with PH-LHD and perhaps PAH. This review aims to succinctly review PH's pathophysiology, and the connection between metabolic dysfunction and PH, and investigate the prospective mechanisms of action of SGLT-2i in PH-LHD and PAH management.
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Affiliation(s)
- Taimin Luo
- Department of Pharmacy, Chengdu Seventh People's Hospital (Affiliated Cancer Hospital of Chengdu Medical College), Chengdu, 610000, China
| | - Hui Wu
- Department of Pharmacy, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, China; School of Pharmacy, Southwest Medical University, Luzhou, 646000, China
| | - Wanlong Zhu
- Department of Pharmacy, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, China; Department of Pharmacy, Panzhihua Second People's Hospital, Panzhihua, 617000, China
| | - Liaoyun Zhang
- Department of Pharmacy, Sichuan Provincial Maternity and Child Health Care Hospital & Women's and Children's Hospital, Chengdu, 610000, China
| | - Yilan Huang
- Department of Pharmacy, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, China; School of Pharmacy, Southwest Medical University, Luzhou, 646000, China.
| | - Xuping Yang
- Department of Pharmacy, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, China; School of Pharmacy, Southwest Medical University, Luzhou, 646000, China.
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15
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Choudhury P, Dasgupta S, Kar A, Sarkar S, Chakraborty P, Bhattacharyya P, Roychowdhury S, Chaudhury K. Bioinformatics analysis of hypoxia associated genes and inflammatory cytokine profiling in COPD-PH. Respir Med 2024; 227:107658. [PMID: 38704051 DOI: 10.1016/j.rmed.2024.107658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 04/08/2024] [Accepted: 04/29/2024] [Indexed: 05/06/2024]
Abstract
Pulmonary hypertension (PH) in chronic obstructive pulmonary disease (COPD) is associated with worse clinical outcomes and decreased survival rates. In absence of disease specific diagnostic/therapeutic targets and unclear pathophysiology, there is an urgent need for the identification of potential genetic/molecular markers and disease associated pathways. The present study aims to use a bioinformatics approach to identify and validate hypoxia-associated gene signatures in COPD-PH patients. Additionally, hypoxia-related inflammatory profile is also explored in these patients. Microarray dataset obtained from the Gene Expression Omnibus repository was used to identify differentially expressed genes (DEGs) in a hypoxic PH mice model. The top three hub genes identified were further validated in COPD-PH patients, with chemokine (C-X-C motif) ligand 9 (CXCL9) and CXCL12 showing significant changes in comparison to healthy controls. Furthermore, multiplexed analysis of 10 inflammatory cytokines, tumor necrosis factor alpha (TNF-α), transforming growth factor β (TGF-β), interleukin 1-beta (IL-1β), IL-4, IL-5, IL-6, IL-13, IL-17, IL-18 and IL-21 was also performed. These markers showed significant changes in COPD-PH patients as compared to controls. They also exhibited the ability to differentially diagnose COPD-PH patients in comparison to COPD. Additionally, IL-6 and IL-17 showed significant positive correlation with systolic pulmonary artery pressure (sPAP). This study is the first report to assess the levels of CXCL9 and CXCL12 in COPD-PH patients and also explores their link with the inflammatory profile of these patients. Our findings could be extended to better understand the underlying disease mechanism and possibly used for tailoring therapies exclusive for the disease.
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Affiliation(s)
- Priyanka Choudhury
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur, West Bengal, India
| | - Sanjukta Dasgupta
- Department of Biotechnology, Brainware University, Barasat, West Bengal, India
| | - Abhik Kar
- Department of Zoology, University of Calcutta, Kolkata, West Bengal, India
| | - Sagartirtha Sarkar
- Department of Zoology, University of Calcutta, Kolkata, West Bengal, India
| | | | | | | | - Koel Chaudhury
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur, West Bengal, India.
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16
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Arif W, Bhimani RK, Ali Shah M, Tausif Z, Nisar U, Kumar R, Bhimani PD, Shoaibullah S, Naveed MA, Raja A, Raja S, Deepak F, Shafique MA, Mustafa MS. Unraveling disparities: Probing gender, race, and geographic inequities in pulmonary heart disease mortality in the United States: An extensive longitudinal examination (1999-2020) leveraging CDC WONDER data. Curr Probl Cardiol 2024; 49:102527. [PMID: 38492618 DOI: 10.1016/j.cpcardiol.2024.102527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 03/18/2024]
Abstract
This comprehensive study delves into the epidemiological landscape of Pulmonary Heart Disease (PHD) mortality in the United States from 1999 to 2020, leveraging the extensive CDC WONDER database. PHD encompasses conditions affecting the right side of the heart due to lung disorders or elevated pressure in the pulmonary arteries, including pulmonary hypertension, pulmonary embolism, and chronic thromboembolic pulmonary hypertension (CTEPH). Analyzing data from death certificates, demographic characteristics, and geographical segmentation, significant trends emerge. The age-adjusted mortality rates (AAMRs) for PHD-related deaths show a fluctuating pattern, initially decreasing from 1999 to 2006, followed by a steady increase until 2020. Male patients consistently exhibit higher AAMRs than females, with notable disparities observed among racial/ethnic groups and geographic regions. Non-hispanic (NH) Black or African American individuals, residents of specific states like Colorado and the District of Columbia, and those in the Midwest region demonstrate elevated AAMRs. Furthermore, nonmetropolitan areas consistently manifest higher AAMRs than metropolitan areas. These findings underscore the urgent need for intensified prevention and treatment strategies to address the rising mortality associated with PHD, particularly among vulnerable populations. Insights from this study offer valuable guidance for public health initiatives aimed at reducing PHD-related mortality and improving outcomes nationwide.
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Affiliation(s)
- Waqar Arif
- Dow International Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Mohsin Ali Shah
- Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
| | | | - Umer Nisar
- Dow International Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Rohet Kumar
- Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
| | | | - Syed Shoaibullah
- Dow International Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Adarsh Raja
- Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan.
| | - Sandesh Raja
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Fnu Deepak
- Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
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17
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Koike H, Nishimura T, Morikawa M. Quantitative evaluation of pulmonary hypertension using 4D flow MRI: A retrospective study. Heliyon 2024; 10:e31177. [PMID: 38813238 PMCID: PMC11133668 DOI: 10.1016/j.heliyon.2024.e31177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/01/2024] [Accepted: 05/12/2024] [Indexed: 05/31/2024] Open
Abstract
Background Pulmonary hypertension (PH) is a severe vascular disorder that may affect 50 % of patients with heart failure. Currently, right-sided heart catheterization is required to definitively diagnose PH. However, this method is invasive and thus may not be appropriate for repeated, long-term monitoring of PH patients. This retrospective study's aim was to evaluate whether 4D flow magnetic resonance imaging (MRI) can be used to quantitively measure flow parameters to identify patients with PH. Methods The study cohort included 97 patients recruited from a single institution and divided into three groups based on echocardiographic estimate of pulmonary artery systolic pressure (PASP): normal group with PASP<36 mmHg, borderline PH group with PASP of 37-50 mmHg, and PH group with PASP>50 mmHg. 4D flow MRI was used to quantitively assess blood flow and velocity, regurgitation, wall shear stress (WSS) and kinetic energy in the pulmonary artery trunk, right main pulmonary artery, and left pulmonary artery. Two experienced radiologists independently analyzed the MR images, blinded to clinical details. Results We found a significant difference in WSS in the pulmonary artery trunk, right main pulmonary artery and left main pulmonary artery among the three patient groups. We also found significant differences in the kinetic energy and average through velocity in the pulmonary artery trunk and right main pulmonary artery, and significant differences in the flow rate in the right main pulmonary artery. Conclusion These data suggest that 4D flow MRI can quantitate pulmonary artery flow parameters and distinguish between patients with and without PH.
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Affiliation(s)
- Hirofumi Koike
- Department of Radiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Takamasa Nishimura
- Department of Radiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Minoru Morikawa
- Department of Radiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
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18
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Salahuddin A, Harris IS, Sabanayagam A. Double Whammy Complicating Management of Pulmonary Hypertension. Circulation 2024; 149:1770-1774. [PMID: 38805576 DOI: 10.1161/circulationaha.123.066807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Affiliation(s)
- Ayesha Salahuddin
- Department of Medicine, Division of Cardiology, University of California San Francisco
| | - Ian S Harris
- Department of Medicine, Division of Cardiology, University of California San Francisco
| | - Aarthi Sabanayagam
- Department of Medicine, Division of Cardiology, University of California San Francisco
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19
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David N, Lakha S, Walsh S, Fried E, DeMaria S. Novel inhaled pulmonary vasodilators in adult cardiac surgery: a scoping review. Can J Anaesth 2024:10.1007/s12630-024-02770-w. [PMID: 38782851 DOI: 10.1007/s12630-024-02770-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/08/2024] [Accepted: 02/18/2024] [Indexed: 05/25/2024] Open
Abstract
PURPOSE Pulmonary hypertension (PH) is a common cause of postoperative mortality in cardiac surgery that is commonly treated with conventional inhaled therapies, specifically nitric oxide and prostacyclin. Alternative therapies include inhaled milrinone and levosimendan, which are receiving more research interest and are increasing in clinical use as they may cut costs while allowing for easier administration. We sought to conduct a scoping review to appraise the evidence base for the use of these two novel inhaled vasodilators as an intervention for PH in cardiac surgery. SOURCE We searched Embase and MEDLINE for relevant articles from 1947 to 2022. PRINCIPAL FINDINGS We identified 17 studies including 969 patients. The included studies show that inhaled milrinone and levosimendan are selective pulmonary vasodilators with potential benefits ranging from ease of weaning from cardiopulmonary bypass to reduction in ventricular dysfunction. Nevertheless, high-quality data are limited, and study design and comparators are extremely heterogeneous, limiting the potential validity and generalizability of findings. CONCLUSION The findings of this scoping review suggest that milrinone and levosimendan may be effective alternatives to current inhaled therapies for cardiac dysfunction in the setting of PH. Nevertheless, randomized trials have focused on specific agents and consistent outcome measures are needed to better validate the early-stage promise of these agents. STUDY REGISTRATION Open Science Framework ( https://osf.io/z3k6f/ ); first posted 21 July 2022.
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Affiliation(s)
- Navindra David
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, 10029, USA.
| | - Sameer Lakha
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samantha Walsh
- Hunter College, City University of New York, New York, NY, USA
| | - Eric Fried
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samuel DeMaria
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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20
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Balcan B, Akdeniz B, Peker Y, Collaborators TTURCOSACT. Obstructive Sleep Apnea and Pulmonary Hypertension: A Chicken-and-Egg Relationship. J Clin Med 2024; 13:2961. [PMID: 38792502 PMCID: PMC11122166 DOI: 10.3390/jcm13102961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/12/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
Obstructive sleep apnea (OSA) is characterized by repeated episodes of upper airway obstruction during sleep, and it is closely linked to several cardiovascular issues due to intermittent hypoxia, nocturnal hypoxemia, and disrupted sleep patterns. Pulmonary hypertension (PH), identified by elevated pulmonary arterial pressure, shares a complex interplay with OSA, contributing to cardiovascular complications and morbidity. The prevalence of OSA is alarmingly high, with studies indicating rates of 20-30% in males and 10-15% in females, escalating significantly with age and obesity. OSA's impact on cardiovascular health is profound, particularly in exacerbating conditions like systemic hypertension and heart failure. The pivotal role of hypoxemia increases intrathoracic pressure, inflammation, and autonomic nervous system dysregulation in this interplay, which all contribute to PH's pathogenesis. The prevalence of PH among OSA patients varies widely, with studies reporting rates from 15% to 80%, highlighting the variability in diagnostic criteria and methodologies. Conversely, OSA prevalence among PH patients also remains high, often exceeding 25%, stressing the need for careful screening and diagnosis. Treatment strategies like continuous positive airway pressure (CPAP) therapy show promise in mitigating PH progression in OSA patients. However, this review underscores the need for further research into long-term outcomes and the efficacy of these treatments. This review provides comprehensive insights into the epidemiology, pathophysiology, and treatment of the intricate interplay between OSA and PH, calling for integrated, personalized approaches in diagnosis and management. The future landscape of OSA and PH management hinges on continued research, technological advancements, and a holistic approach to improving patient outcomes.
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Affiliation(s)
- Baran Balcan
- Department of Pulmonary Medicine, Koç University School of Medicine, Istanbul 34450, Turkey;
| | - Bahri Akdeniz
- Department of Cardiology, Dokuz Eylül University Faculty of Medicine, Izmir 35340, Turkey;
| | - Yüksel Peker
- Department of Pulmonary Medicine, Koç University School of Medicine, Istanbul 34450, Turkey;
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
- Department of Clinical Sciences, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, 22185 Lund, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
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21
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Hu T, Mu C, Li Y, Hao W, Yu X, Wang Y, Han W, Li Q. GPS2 ameliorates cigarette smoking-induced pulmonary vascular remodeling by modulating the ras-Raf-ERK axis. Respir Res 2024; 25:210. [PMID: 38755610 PMCID: PMC11100185 DOI: 10.1186/s12931-024-02831-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/01/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Mitogen-activated protein kinase (MAPK)signaling-mediated smoking-associated pulmonary vascular remodeling (PVR) plays an important role in the pathogenesis of group 3 pulmonary hypertension (PH). And G protein pathway suppressor 2 (GPS2) could suppress G-protein signaling such as Ras and MAPK, but its role in cigarette smoking -induced PVR (CS-PVR) is unclear. METHODS An in vivo model of smoke-exposed rats was constructed to assess the role of GPS2 in smoking-induced PH and PVR. In vitro, the effects of GPS2 overexpression and silencing on the function of human pulmonary arterial smooth cells (HPASMCs) and the underlying mechanisms were explored. RESULTS GPS2 expression was downregulated in rat pulmonary arteries (PAs) and HPASMCs after CS exposure. More importantly, CS-exposed rats with GPS2 overexpression had lower right ventricular systolic pressure (RVSP), right ventricular hypertrophy index (RVHI), and wall thickness (WT%) than those without. And enhanced proliferation and migration of HPASMCs induced by cigarette smoking extract (CSE) can be evidently inhibited by overexpressed GPS2. Besides, GPS2siRNA significantly enhanced the proliferation, and migration of HPASMCs as well as activated Ras and Raf/ERK signaling, while these effects were inhibited by zoledronic acid (ZOL). In addition, GPS2 promoter methylation level in rat PAs and HPASMCs was increased after CS exposure, and 5-aza-2-deoxycytidine (5-aza) inhibited CSE-induced GPS2 hypermethylation and downregulation in vitro. CONCLUSIONS GPS2 overexpression could improve the CS-PVR, suggesting that GPS2 might serve as a novel therapeutic target for PH-COPD in the future.
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Affiliation(s)
- Ting Hu
- Department of Respiratory and Critical Care Medicine, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
- Qingdao Key Lab of Common Diseases, Qingdao Municipal Hospital, University of Health and Rehabilitation Sciences, 5 Donghai Middle Road, Qingdao, 266071, China
| | - Chaohui Mu
- Department of Respiratory and Critical Care Medicine, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
- Qingdao Key Lab of Common Diseases, Qingdao Municipal Hospital, University of Health and Rehabilitation Sciences, 5 Donghai Middle Road, Qingdao, 266071, China
| | - Yanmiao Li
- Department of Respiratory and Critical Care Medicine, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
- Qingdao Key Lab of Common Diseases, Qingdao Municipal Hospital, University of Health and Rehabilitation Sciences, 5 Donghai Middle Road, Qingdao, 266071, China
| | - Wanming Hao
- Qingdao Key Lab of Common Diseases, Qingdao Municipal Hospital, University of Health and Rehabilitation Sciences, 5 Donghai Middle Road, Qingdao, 266071, China
- Department of Respiratory and Critical Care Medicine, Qingdao Municipal Hospital, University of Health and Rehabilitation Sciences, 5 Donghai Middle Road, Qingdao, 266071, China
| | - Xinjuan Yu
- Qingdao Key Lab of Common Diseases, Qingdao Municipal Hospital, University of Health and Rehabilitation Sciences, 5 Donghai Middle Road, Qingdao, 266071, China
- Department of Respiratory and Critical Care Medicine, Qingdao Municipal Hospital, University of Health and Rehabilitation Sciences, 5 Donghai Middle Road, Qingdao, 266071, China
| | - Yixuan Wang
- Qingdao Key Lab of Common Diseases, Qingdao Municipal Hospital, University of Health and Rehabilitation Sciences, 5 Donghai Middle Road, Qingdao, 266071, China
- Department of Respiratory and Critical Care Medicine, Qingdao Municipal Hospital, University of Health and Rehabilitation Sciences, 5 Donghai Middle Road, Qingdao, 266071, China
| | - Wei Han
- Qingdao Key Lab of Common Diseases, Qingdao Municipal Hospital, University of Health and Rehabilitation Sciences, 5 Donghai Middle Road, Qingdao, 266071, China.
- Department of Respiratory and Critical Care Medicine, Qingdao Municipal Hospital, University of Health and Rehabilitation Sciences, 5 Donghai Middle Road, Qingdao, 266071, China.
| | - Qinghai Li
- Qingdao Key Lab of Common Diseases, Qingdao Municipal Hospital, University of Health and Rehabilitation Sciences, 5 Donghai Middle Road, Qingdao, 266071, China.
- Department of Respiratory and Critical Care Medicine, Qingdao Municipal Hospital, University of Health and Rehabilitation Sciences, 5 Donghai Middle Road, Qingdao, 266071, China.
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22
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Ubben T, Frerker C, Fujita B, Rosenkranz S, Pfister R, Baldus S, Alessandrini H, Kuck KH, Willems S, Eitel I, Schmidt T. Association of pulmonary hypertension with the outcome in patients undergoing edge-to-edge mitral valve repair. Heart 2024; 110:800-807. [PMID: 38388469 DOI: 10.1136/heartjnl-2023-323473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/25/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVES The association of pulmonary hypertension (PH) with the outcome after mitral transcatheter edge-to-edge repair (M-TEER) focusing on the new ESC/ERS guidelines definition for PH. BACKGROUND PH is frequently found in patients with mitral regurgitation and is associated with lower survival rates. Recent studies were based on echocardiographic parameters, but results based on invasive haemodynamics differentiating distinct types of PH using the new definition for PH are missing. METHODS 449 consecutive M-TEER-treated patients from December 2009 to February 2015 were included in this retrospective analysis. All patients were stratified by the distinct types of PH (no PH, precapillary PH, isolated postcapillary PH, combined post-PH and precapillary PH) according to the definitions of the ESC/ERS guidelines for the diagnosis of PH from 2015 (meanPA cut-off <25 mm Hg, pulmonary capillary wedge pressure (PCWP) cut-off ≤15 mm Hg, diastolic pulmonary gradient cut-off ≥7 mm Hg or pulmonary vascular resistance (PVR) >3 WU) and 2022 (meanPA cut-off ≤20 mm Hg, PCWP cut-off ≤15 mm Hg, PVR cut-off ≥3 WU). RESULTS Patients with any type of PH (2015: meanPA cut-off 25 mm Hg; 2022: meanPA cut-off >20 mm Hg) showed a higher risk of death after M-TEER compared with patients with no PH (2015: HR 1.61 (95% CI 1.25 to 2.07); p<0.001 and 2022: HR 2.09 (95% CI 1.54 to 2.83); p<0.001). Based on the new PH definition, each PH subgroup showed a lower survival after M-TEER compared with patients with no PH. Echocardiographic estimated systolic PAP showed a correlation with invasively measured mean pulmonary artery pressure (mPAP) (r=0.29, p<0.001) and systolic pulmonary arterial pressure (r=0.34,p<0.001). Cox-regression analysis showed higher invasive diastolic, systolic and mean pulmonary pressures were associated with higher all-cause mortality (p<0.001). In addition, invasive measured higher right atrial pressure, lower pulmonary arterial compliance, higher PVR and higher wedge pressure were identified as predictors of all-cause mortality after M-TEER. CONCLUSIONS The new PH definition discriminates PH groups and mortality better than the old definition. The lower threshold of mPAP of 20mmHg improved prognostication in this cohort of patients.
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Affiliation(s)
- Timm Ubben
- Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Christian Frerker
- Department of Cardiology, University Heart Center Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research, Lübeck, Germany
| | - Buntaro Fujita
- Department of Cardiac and Thoracic Vascular Surgery, University Heart Center Lübeck, Lübeck, Germany
| | - Stephan Rosenkranz
- Department of Cardiology, University Heart Center Cologne, Cologne, Germany
| | - Roman Pfister
- Department of Cardiology, University Heart Center Cologne, Cologne, Germany
| | - Stephan Baldus
- Department of Cardiology, University Heart Center Cologne, Cologne, Germany
| | - Hannes Alessandrini
- Department of Cardiology, University Heart Center Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research, Lübeck, Germany
| | | | | | - Ingo Eitel
- Department of Cardiology, University Heart Center Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research, Lübeck, Germany
| | - Tobias Schmidt
- Department of Cardiology, University Heart Center Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research, Lübeck, Germany
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Chen YJ, Li HF, Zhao FR, Yu M, Pan SY, Sun WZ, Yin YY, Zhu TT. Spermidine attenuates monocrotaline-induced pulmonary arterial hypertension in rats by inhibiting purine metabolism and polyamine synthesis-associated vascular remodeling. Int Immunopharmacol 2024; 132:111946. [PMID: 38552292 DOI: 10.1016/j.intimp.2024.111946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/26/2024] [Accepted: 03/26/2024] [Indexed: 05/01/2024]
Abstract
Ensuring the homeostatic integrity of pulmonary artery endothelial cells (PAECs) is essential for combatting pulmonary arterial hypertension (PAH), as it equips the cells to withstand microenvironmental challenges. Spermidine (SPD), a potent facilitator of autophagy, has been identified as a significant contributor to PAECs function and survival. Despite SPD's observed benefits, a comprehensive understanding of its protective mechanisms has remained elusive. Through an integrated approach combining metabolomics and molecular biology, this study uncovers the molecular pathways employed by SPD in mitigating PAH induced by monocrotaline (MCT) in a Sprague-Dawley rat model. The study demonstrates that SPD administration (5 mg/kg/day) significantly corrects right ventricular impairment and pathological changes in pulmonary tissues following MCT exposure (60 mg/kg). Metabolomic profiling identified a purine metabolism disorder in MCT-treated rats, which SPD effectively normalized, conferring a protective effect against PAH progression. Subsequent in vitro analysis showed that SPD (0.8 mM) reduces oxidative stress and apoptosis in PAECs challenged with Dehydromonocrotaline (MCTP, 50 μM), likely by downregulating purine nucleoside phosphorylase (PNP) and modulating polyamine biosynthesis through alterations in S-adenosylmethionine decarboxylase (AMD1) expression and the subsequent production of decarboxylated S-adenosylmethionine (dcSAM). These findings advocate SPD's dual inhibitory effect on PNP and AMD1 as a novel strategy to conserve cellular ATP and alleviate oxidative injuries, thus providing a foundation for SPD's potential therapeutic application in PAH treatment.
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Affiliation(s)
- Yu-Jing Chen
- College of Pharmacy, Xinxiang Medical University, Xinxiang 453003, China; Henan International Joint Laboratory of Cardiovascular Remodeling and Drug Intervention, Xinxiang 453003, China; Xinxiang Key Laboratory of Cascular Remodeling Intervention and Molecular Targeted Therapy Drug Development, 453003, China
| | - Han-Fei Li
- College of Pharmacy, Xinxiang Medical University, Xinxiang 453003, China; Henan International Joint Laboratory of Cardiovascular Remodeling and Drug Intervention, Xinxiang 453003, China; Xinxiang Key Laboratory of Cascular Remodeling Intervention and Molecular Targeted Therapy Drug Development, 453003, China
| | - Fan-Rong Zhao
- College of Pharmacy, Xinxiang Medical University, Xinxiang 453003, China; Henan International Joint Laboratory of Cardiovascular Remodeling and Drug Intervention, Xinxiang 453003, China; Xinxiang Key Laboratory of Cascular Remodeling Intervention and Molecular Targeted Therapy Drug Development, 453003, China
| | - Miao Yu
- College of Pharmacy, Xinxiang Medical University, Xinxiang 453003, China; Henan International Joint Laboratory of Cardiovascular Remodeling and Drug Intervention, Xinxiang 453003, China; Xinxiang Key Laboratory of Cascular Remodeling Intervention and Molecular Targeted Therapy Drug Development, 453003, China
| | - Si-Yu Pan
- College of Pharmacy, Xinxiang Medical University, Xinxiang 453003, China; Henan International Joint Laboratory of Cardiovascular Remodeling and Drug Intervention, Xinxiang 453003, China; Xinxiang Key Laboratory of Cascular Remodeling Intervention and Molecular Targeted Therapy Drug Development, 453003, China
| | - Wen-Ze Sun
- College of Pharmacy, Xinxiang Medical University, Xinxiang 453003, China; Henan International Joint Laboratory of Cardiovascular Remodeling and Drug Intervention, Xinxiang 453003, China; Xinxiang Key Laboratory of Cascular Remodeling Intervention and Molecular Targeted Therapy Drug Development, 453003, China
| | - Yan-Yan Yin
- College of Pharmacy, Xinxiang Medical University, Xinxiang 453003, China; Henan International Joint Laboratory of Cardiovascular Remodeling and Drug Intervention, Xinxiang 453003, China; Xinxiang Key Laboratory of Cascular Remodeling Intervention and Molecular Targeted Therapy Drug Development, 453003, China
| | - Tian-Tian Zhu
- College of Pharmacy, Xinxiang Medical University, Xinxiang 453003, China; Department of Pharmacy, The first Affiliated Hospital of Xinxiang Medical University, Xinxiang 453100, China; Henan International Joint Laboratory of Cardiovascular Remodeling and Drug Intervention, Xinxiang 453003, China; Xinxiang Key Laboratory of Cascular Remodeling Intervention and Molecular Targeted Therapy Drug Development, 453003, China.
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24
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Liu W, Xu Y, Yang L, Zhan S, Pang K, Lin H, Qin H, Zhang P. Risk factors associated with pulmonary hypertension in patients with active tuberculosis and tuberculous destroyed lung: a retrospective study. Sci Rep 2024; 14:10108. [PMID: 38698005 PMCID: PMC11066008 DOI: 10.1038/s41598-024-59679-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 04/13/2024] [Indexed: 05/05/2024] Open
Abstract
Pulmonary tuberculosis (TB) can result in irreversible damage and lead to tuberculous destructive lung (TDL), a severe chronic lung disease that is associated with a high mortality rate. Additionally, pulmonary hypertension (PH) is a hemodynamic disorder that can be caused by lung diseases. The objective of this study is to investigate the risk factors associated with PH in active TB patients diagnosed with TDL. We conducted a retrospective review of the medical records of 237 patients who were diagnosed with TDL, active pulmonary tuberculosis, and underwent echocardiography at the Third People' Hospital of Shenzhen from January 1, 2016, to June 30, 2023. Univariate and multivariate logistic regression analyses were performed to identify factors that correlated with the development of pulmonary hypertension. Univariate and multivariate logistic regression analyses revealed that several factors were associated with an increased risk of pulmonary hypertension (PH) in individuals with tuberculosis destroyed lung (TDL). These factors included age (OR = 1.055), dyspnea (OR = 10.728), D-dimer (OR = 1.27), PaCO2 (OR = 1.040), number of destroyed lung lobes (OR = 5.584), bronchiectasis (OR = 3.205), and chronic pleuritis (OR = 2.841). When age, D-dimer, PaCO2, and number of destroyed lung lobes were combined, the predictive value for PH in patients with TDL was found to be 80.6% (95% CI 0.739-0.873),with a sensitivity of 76.6% and specificity of 73.2%. Advanced age, elevated D-dimer levels, hypercapnia, and severe lung damage were strongly correlated with the onset of PH in individuals with active pulmonary tuberculosis (PTB) and TDL. Furthermore, a model incorporating age, D-dimer, PaCO2, and the number of destroyed lung lobes might be valuable in predicting the occurrence of PH in patients with active PTB and TDL.
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Affiliation(s)
- Weijian Liu
- Department of Pulmonary Medicine and Tuberculosis, The Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Disease, Southern University of Science and Technology, Shenzhen, China
| | - Yuxiang Xu
- Department of Pulmonary Medicine and Tuberculosis, The Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Disease, Southern University of Science and Technology, Shenzhen, China
| | - Liangzi Yang
- Department of Pulmonary Medicine and Tuberculosis, The Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Disease, Southern University of Science and Technology, Shenzhen, China
| | - Senlin Zhan
- Department of Pulmonary Medicine and Tuberculosis, The Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Disease, Southern University of Science and Technology, Shenzhen, China
| | - Kaihua Pang
- Department of Pulmonary Medicine and Tuberculosis, The Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Disease, Southern University of Science and Technology, Shenzhen, China
| | - Hao Lin
- Department of Pulmonary Medicine and Tuberculosis, The Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Disease, Southern University of Science and Technology, Shenzhen, China
| | - Hongjuan Qin
- Department of Pulmonary Medicine and Tuberculosis, The Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Disease, Southern University of Science and Technology, Shenzhen, China.
| | - Peize Zhang
- Department of Pulmonary Medicine and Tuberculosis, The Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Disease, Southern University of Science and Technology, Shenzhen, China.
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25
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Lin JL, Hsu CH. Pulmonary Arterial Hypertension Therapy in Pulmonary Hypertension Associated With Lung Diseases. JACC. ASIA 2024; 4:418-420. [PMID: 38765658 PMCID: PMC11099818 DOI: 10.1016/j.jacasi.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Affiliation(s)
- Jia-Ling Lin
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Hsin Hsu
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Division of Critical Care, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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26
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Chen X, Yu X, Lian G, Tang H, Yan Y, Gao G, Huang B, Luo L, Xie L. Canagliflozin inhibits PASMCs proliferation via regulating SGLT1/AMPK signaling and attenuates artery remodeling in MCT-induced pulmonary arterial hypertension. Biomed Pharmacother 2024; 174:116505. [PMID: 38574614 DOI: 10.1016/j.biopha.2024.116505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/14/2024] [Accepted: 03/27/2024] [Indexed: 04/06/2024] Open
Abstract
Pulmonary arterial hypertension (PAH) was a devastating disease characterized by artery remodeling, ultimately resulting in right heart failure. The aim of this study was to investigate the effects of canagliflozin (CANA), a sodium-glucose cotransporter 2 inhibitor (SGLT2i) with mild SGLT1 inhibitory effects, on rats with PAH, as well as its direct impact on pulmonary arterial smooth muscle cells (PASMCs). PAH rats were induced by injection of monocrotaline (MCT) (40 mg/kg), followed by four weeks of treatment with CANA (30 mg/kg/day) or saline alone. Pulmonary artery and right ventricular (RV) remodeling and dysfunction in PAH were alleviated with CANA, as assessed by echocardiography. Hemodynamic parameters and structural of pulmonary arteriole, including vascular wall thickness and wall area, were reduced by CANA. RV hypertrophy index, cardiomyocyte hypertrophy, and fibrosis were decreased with CANA treatment. PASMCs proliferation was inhibited by CANA under stimulation by platelet-derived growth factor (PDGF)-BB or hypoxia. Activation of AMP kinase (AMPK) was induced by CANA treatment in cultured PASMCs in a time- and concentration-dependent manner. These effects of CANA were attenuated when treatment with compound C, an AMPK inhibitor. Abundant expression of SGLT1 was observed in PASMCs and pulmonary arteries, while SGLT2 expression was undetectable. SGLT1 increased in response to PDGF-BB or hypoxia stimulation, while PASMCs proliferation was inhibited and beneficial effects of CANA were counteracted by knockdown of SGLT1. Our research demonstrated for the first time that CANA inhibited the proliferation of PASMCs by regulating SGLT1/AMPK signaling and thus exerted an anti-proliferative effect on MCT-induced PAH.
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Affiliation(s)
- Xiaojun Chen
- Department of Geriatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Fujian Hypertension Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Clinical Research Center for Geriatric Hypertension Disease of Fujian Province, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Branch of National Clinical Research Center for Aging and Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Department of Geriatrics, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Xing Yu
- Department of Geriatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Fujian Hypertension Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Clinical Research Center for Geriatric Hypertension Disease of Fujian Province, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Branch of National Clinical Research Center for Aging and Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Department of Geriatrics, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Guili Lian
- Department of Geriatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Fujian Hypertension Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Clinical Research Center for Geriatric Hypertension Disease of Fujian Province, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Branch of National Clinical Research Center for Aging and Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Department of Geriatrics, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Huibin Tang
- Department of Geriatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Fujian Hypertension Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Clinical Research Center for Geriatric Hypertension Disease of Fujian Province, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Branch of National Clinical Research Center for Aging and Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Department of Geriatrics, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yan Yan
- Department of Geriatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Fujian Hypertension Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Clinical Research Center for Geriatric Hypertension Disease of Fujian Province, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Branch of National Clinical Research Center for Aging and Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Department of Geriatrics, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Gufeng Gao
- Department of Geriatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Fujian Hypertension Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Clinical Research Center for Geriatric Hypertension Disease of Fujian Province, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Branch of National Clinical Research Center for Aging and Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Department of Geriatrics, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Bangbang Huang
- Department of Geriatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Fujian Hypertension Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Clinical Research Center for Geriatric Hypertension Disease of Fujian Province, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Branch of National Clinical Research Center for Aging and Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Department of Geriatrics, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Li Luo
- Department of Geriatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Fujian Hypertension Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Clinical Research Center for Geriatric Hypertension Disease of Fujian Province, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Branch of National Clinical Research Center for Aging and Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Department of Geriatrics, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Liangdi Xie
- Department of Geriatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Fujian Hypertension Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Clinical Research Center for Geriatric Hypertension Disease of Fujian Province, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Branch of National Clinical Research Center for Aging and Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Department of Geriatrics, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
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27
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Rudienė V, Kaplerienė L, Laukytė-Slėnienė M, Žebrauskienė D, Averjanovaitė V, Šileikienė V, Zeleckienė I, Matačiūnas M, Gumbienė L, Grigonienė E. The Impact of COVID-19 Infection on Patients with Severe Chronic Pulmonary Hypertension: A Prospective Study from a Single Referral Center. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:750. [PMID: 38792933 PMCID: PMC11123014 DOI: 10.3390/medicina60050750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/26/2024] [Accepted: 04/28/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives. COVID-19 infection has a significant burden on global morbidity and mortality, especially in elderly people and in patients with chronic respiratory and cardiovascular diseases, such as pulmonary hypertension (PH). We aimed to evaluate the impact of COVID-19 infection on patients diagnosed with severe chronic PH. Materials and Methods. A single-center prospective cohort study was performed. Patients were enrolled from 1 November 2020 to 31 December 2022. Follow-up was until 31 December 2023. Data were collected on PH diagnosis, clinical presentation, outcomes, brain natriuretic peptide (BNP) levels, pulmonary function test with lung diffusion capacity for carbon monoxide (DLCO), and computed tomography pulmonary angiography (CTPA) analysis. Results. During the 26 months of our study, 51 PH patients were diagnosed with COVID-19 infection. The majority, 44 (86.3%) of all COVID-19 infected patients, were treated on an outpatient basis, and 7 (13.7%) required hospitalization. During the follow-up period, 8 (15.7%) patients died: 4 (7.8%) due to complications of COVID-19 infection, and the other 4 (7.8%) died in the later stages of the follow-up period after recovery from acute COVID-19 infection. Therefore, the in-hospital mortality in our study was 43% (n = 3). As mentioned above, the overall mortality was 7.8% (n = 4). Higher BNP levels in the third month after COVID-19 were associated with higher mortality rates (p = 0.028). Lung function, including DLCO, did not significantly worsen with COVID-19. In our study, 24 patients (47.1%) were referred for a follow-up CTPA scan and one of them developed typical fibrotic lung changes after COVID-19. Conclusions. The incidence of COVID-19 infection in patients diagnosed with PH was 34%. In our patients with severe chronic PH, the overall mortality rate due to COVID-19 infection was low. Pulmonary fibrosis was a rare complication in our cohort. COVID-19 infection in severe PH may increase the risk of worsening chronic heart failure.
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Affiliation(s)
- Virginija Rudienė
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, 08661 Vilnius, Lithuania
| | - Lina Kaplerienė
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, 08661 Vilnius, Lithuania
| | - Monika Laukytė-Slėnienė
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, 08661 Vilnius, Lithuania
| | - Dovilė Žebrauskienė
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, 08661 Vilnius, Lithuania
| | - Vaida Averjanovaitė
- Clinic of Chest Diseases, Immunology and Allergology, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, 03101 Vilnius, Lithuania
| | - Virginija Šileikienė
- Clinic of Chest Diseases, Immunology and Allergology, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, 03101 Vilnius, Lithuania
| | - Ingrida Zeleckienė
- Department of Radiology, Nuclear Medicine and Medical Physics, Faculty of Medicine, Institute of Biomedical Sciences, Vilnius University, 03101 Vilnius, Lithuania
| | - Mindaugas Matačiūnas
- Department of Radiology, Nuclear Medicine and Medical Physics, Faculty of Medicine, Institute of Biomedical Sciences, Vilnius University, 03101 Vilnius, Lithuania
| | - Lina Gumbienė
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, 08661 Vilnius, Lithuania
| | - Eglė Grigonienė
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, 08661 Vilnius, Lithuania
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Sun H, Du Z, Zhang X, Gao S, Ji Z, Luo G, Pan S. Neutrophil extracellular traps promote proliferation of pulmonary smooth muscle cells mediated by CCDC25 in pulmonary arterial hypertension. Respir Res 2024; 25:183. [PMID: 38664728 PMCID: PMC11046914 DOI: 10.1186/s12931-024-02813-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Previous studies have indicated that neutrophil extracellular traps (NETs) play a pivotal role in pathogenesis of pulmonary arterial hypertension (PAH). However, the specific mechanism underlying the impact of NETs on pulmonary artery smooth muscle cells (PASMCs) has not been determined. The objective of this study was to elucidate underlying mechanisms through which NETs contribute to progression of PAH. METHODS Bioinformatics analysis was employed in this study to screen for potential molecules and mechanisms associated with occurrence and development of PAH. These findings were subsequently validated in human samples, coiled-coil domain containing 25 (CCDC25) knockdown PASMCs, as well as monocrotaline-induced PAH rat model. RESULTS NETs promoted proliferation of PASMCs, thereby facilitating pathogenesis of PAH. This phenomenon was mediated by the activation of transmembrane receptor CCDC25 on PASMCs, which subsequently activated ILK/β-parvin/RAC1 pathway. Consequently, cytoskeletal remodeling and phenotypic transformation occur in PASMCs. Furthermore, the level of NETs could serve as an indicator of PAH severity and as potential therapeutic target for alleviating PAH. CONCLUSION This study elucidated the involvement of NETs in pathogenesis of PAH through their influence on the function of PASMCs, thereby highlighting their potential as promising targets for the evaluation and treatment of PAH.
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Affiliation(s)
- Hongxiao Sun
- Heart Center, Women and Children's Hospital, Qingdao University, Qingdao, China
| | - Zhanhui Du
- Heart Center, Women and Children's Hospital, Qingdao University, Qingdao, China
| | - Xu Zhang
- Heart Center, Women and Children's Hospital, Qingdao University, Qingdao, China
| | - Shuai Gao
- Heart Center, Women and Children's Hospital, Qingdao University, Qingdao, China
| | - Zhixian Ji
- Heart Center, Women and Children's Hospital, Qingdao University, Qingdao, China
| | - Gang Luo
- Heart Center, Women and Children's Hospital, Qingdao University, Qingdao, China
| | - Silin Pan
- Heart Center, Women and Children's Hospital, Qingdao University, Qingdao, China.
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29
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Nemati N, Burton T, Fathieh F, Gillins HR, Shadforth I, Ramchandani S, Bridges CR. Pulmonary Hypertension Detection Non-Invasively at Point-of-Care Using a Machine-Learned Algorithm. Diagnostics (Basel) 2024; 14:897. [PMID: 38732312 PMCID: PMC11083349 DOI: 10.3390/diagnostics14090897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/10/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Artificial intelligence, particularly machine learning, has gained prominence in medical research due to its potential to develop non-invasive diagnostics. Pulmonary hypertension presents a diagnostic challenge due to its heterogeneous nature and similarity in symptoms to other cardiovascular conditions. Here, we describe the development of a supervised machine learning model using non-invasive signals (orthogonal voltage gradient and photoplethysmographic) and a hand-crafted library of 3298 features. The developed model achieved a sensitivity of 87% and a specificity of 83%, with an overall Area Under the Receiver Operator Characteristic Curve (AUC-ROC) of 0.93. Subgroup analysis showed consistent performance across genders, age groups and classes of PH. Feature importance analysis revealed changes in metrics that measure conduction, repolarization and respiration as significant contributors to the model. The model demonstrates promising performance in identifying pulmonary hypertension, offering potential for early detection and intervention when embedded in a point-of-care diagnostic system.
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Affiliation(s)
- Navid Nemati
- Analytics for Life, Toronto, ON M5X 1C9, Canada; (N.N.); (F.F.)
| | - Timothy Burton
- Analytics for Life, Toronto, ON M5X 1C9, Canada; (N.N.); (F.F.)
| | - Farhad Fathieh
- Analytics for Life, Toronto, ON M5X 1C9, Canada; (N.N.); (F.F.)
| | - Horace R. Gillins
- Analytics for Life, Bethesda, MD 20814, USA; (H.R.G.); (I.S.); (C.R.B.)
| | - Ian Shadforth
- Analytics for Life, Bethesda, MD 20814, USA; (H.R.G.); (I.S.); (C.R.B.)
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30
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Wang E, Zhang B, Huang L, Li P, Han R, Zhou S, Zeng D, Wang R. LncRNA MIR210HG promotes phenotype switching of pulmonary arterial smooth muscle cells through autophagy-dependent ferroptosis pathway. Apoptosis 2024:10.1007/s10495-024-01963-4. [PMID: 38635022 DOI: 10.1007/s10495-024-01963-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2024] [Indexed: 04/19/2024]
Abstract
Hypoxic pulmonary hypertension (HPH) is a pathophysiological syndrome in which pulmonary vascular pressure increases under hypoxic stimulation and there is an urgent need to develop emerging therapies for the treatment of HPH. LncRNA MIR210HG is a long non-coding RNA closely related to hypoxia and has been widely reported in a variety of tumor diseases. But its mechanism in hypoxic pulmonary hypertension is not clear. In this study, we identified for the first time the potential effect of MIR210HG on disease progression in HPH. Furthermore, we investigated the underlying mechanism through which elevated levels of MIR210HG promotes the transition from a contractile phenotype to a synthetic phenotype in PASMCs under hypoxia via activation of autophagy-dependent ferroptosis pathway. While overexpression of HIF-2α in PASMCs under hypoxia significantly reversed the phenotypic changes induced by MIR210HG knockdown. We further investigated the potential positive regulatory relationship between STAT3 and the transcription of MIR210HG in PASMCs under hypoxic conditions. In addition, we established both in vivo and in vitro models of HPH to validate the differential expression of specific markers associated with hypoxia. Our findings suggest a potential mechanism of LncRNA MIR210HG in the progression of HPH and offer potential targets for disease intervention and treatment.
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Affiliation(s)
- Enze Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Binbin Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Ling Huang
- Department of Infectious Diseases, Hefei Second People's Hospital, Hefei, 230001, China
| | - Pulin Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Rui Han
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Sijing Zhou
- Department of Occupational Disease, Hefei Third Clinical College of Anhui Medical University, Hefei, 230022, China.
| | - Daxiong Zeng
- Department of Pulmonary and Critical Care Medicine, Dushu Lake Hospital, Affiliated to Soochow University, Medical Center of Soochow University, Suzhou, 215006, China.
| | - Ran Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China.
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31
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Khan CF, Kamran Ikram M, Terzikhan N, Brusselle GG, Bos D. Revisiting the Clinical Interpretation of CT-Measured Pulmonary Artery-to-Aorta Ratio-The Rotterdam Study. Acad Radiol 2024:S1076-6332(24)00202-2. [PMID: 38637237 DOI: 10.1016/j.acra.2024.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/20/2024] [Accepted: 03/28/2024] [Indexed: 04/20/2024]
Abstract
RATIONALE The pulmonary artery (PA) diameter-to-aorta ratio (PA:A) ratio is a novel marker in cardiovascular imaging for detecting pulmonary hypertension. However, we question the effect of the varying aorta diameter on the ratio, which complicates the interpretation of the PA:A ratio. OBJECTIVE Investigate the variability of the PA:A ratio by examining the correlation between PA:A ratio and aorta diameter and by comparing the associations of the PA diameter, aorta diameters, and PA:A ratio. METHODS We included 2197 participants from the Rotterdam Study who underwent non-contrast multidetector computed tomography to measure the PA and aorta diameters. Pearson correlation coefficient was calculated between the PA:A ratio and aorta diameter. Multiple linear regression analyses were performed to compare the determinants of the individual diameters and PA:A ratio. RESULTS We found a statistically significant correlation between the PA:A ratio and aorta diameter (r = -0.38, p < 0.001). The PA diameter was statistically significantly associated with, height, weight, diastolic blood pressure, blood pressure medication, prevalence of atrial fibrillation, prevalence of heart failure, and prevalence of stroke (p < 0.05). Except for blood pressure medication, the PA:A ratio had similar determinants compared to the PA diameter but was also statistically significantly associated with sex, and systolic blood pressure (p < 0.05), which were statistically significantly associated with the aorta diameter (p < 0.05). CONCLUSION The PA:A ratio should not be interpreted without taking into account the variability of the individual components (PA and aorta diameter) according to the anthropomorphic and clinical characteristics.
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Affiliation(s)
- C F Khan
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Natalie Terzikhan
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Guy G Brusselle
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Respiratory Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Daniel Bos
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
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32
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Youssef M, Boutros Salama M, Rehman N, Hanna C, Waniss MR, Mbuagbaw L. Pulmonary hypertension survival and hospitalisations in people living with HIV: a systematic review and meta-analysis. BMJ Open Respir Res 2024; 11:e002318. [PMID: 38604738 PMCID: PMC11015238 DOI: 10.1136/bmjresp-2024-002318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/25/2024] [Indexed: 04/13/2024] Open
Abstract
INTRODUCTION People living with HIV (PLHIV) have a higher risk of developing pulmonary hypertension (PH) with subsequent poorer prognosis. This review aimed to determine the (1) survival outcomes and (2) proportion of emergency department (ED) visits and hospitalisations of PLHIV and PH. METHODS We conducted a systematic review and meta-analysis of observational studies reporting survival outcomes for PLHIV and PH. Electronic databases (Medline, EMBASE, PubMed, Web of Science, Global Index Medicus and Cochrane Library), trial registries and conference proceedings were searched until 22 July 2023. We pooled similar measures of effect, assessed apriori subgroups and used meta-regression to determine mortality and associated variables. RESULTS 5248 studies were identified; 28 studies were included with a total of 5459 PLHIV and PH. The mean survival (95% CI) of PLHIV and PH was 37.4 months (29.9 to 44.8). Participants alive at 1, 2 and 3 years were 85.8% (74.1% to 95.0%), 75.2% (61.9% to 86.7%) and 61.9% (51.8% to 71.6%), respectively. ED visits and hospitalisation rates were 73.3% (32.5% to 99.9%) and 71.2% (42.4% to 94.2%), respectively. More severe disease, measured by echocardiogram, was associated with poorer prognosis (β -0.01, 95% CI -0.02 to 0.00, p=0.009). Survival was higher in high-income countries compared with lower-income countries (β 0.50, 95% CI 0.28 to 0.73, p<0.001) and in Europe compared with the America (β 0.56, 95% CI 0.37 to 0.75, p<0.001). CONCLUSION Our study confirms poor prognosis and high healthcare utilisation for PLHIV and PH. Prognosis is associated with country income level, geographic region and PH severity. This highlights the importance of screening in this population. PROSPERO REGISTRATION NUMBER CRD42023395023.
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Affiliation(s)
- Mark Youssef
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marina Boutros Salama
- Health Science Education MSc Program, McMaster University, Hamilton, Ontario, Canada
- McMaster Okanagan Office of Health and Well-being, McMaster University, Hamilton, Ontario, Canada
| | - Nadia Rehman
- Department of Health, Research, Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Christina Hanna
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mary Rose Waniss
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lawrence Mbuagbaw
- Department of Health, Research, Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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McEvoy MD, Heerdt PM, Morton V, Bartz RR, Miller TE. Essential right heart physiology for the perioperative practitioner POQI IX: current perspectives on the right heart in the perioperative period. Perioper Med (Lond) 2024; 13:27. [PMID: 38594738 PMCID: PMC11003027 DOI: 10.1186/s13741-024-00378-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/18/2024] [Indexed: 04/11/2024] Open
Abstract
As patients continue to live longer from diseases that predispose them to right ventricular (RV) dysfunction or failure, many more patients will require surgery for acute or chronic health issues. Because RV dysfunction results in significant perioperative morbidity if not adequately assessed or managed, understanding appropriate assessment and treatments is important in preventing subsequent morbidity and mortality in the perioperative period. In light of the epidemiology of right heart disease, a working knowledge of right heart anatomy and physiology and an understanding of the implications of right-sided heart function for perioperative care are essential for perioperative practitioners. However, a significant knowledge gap exists concerning this topic. This manuscript is one part of a collection of papers from the PeriOperative Quality Initiative (POQI) IX Conference focusing on "Current Perspectives on the Right Heart in the Perioperative Period." This review aims to provide perioperative clinicians with an essential understanding of right heart physiology by answering five key questions on this topic and providing an explanation of seven fundamental concepts concerning right heart physiology.
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Affiliation(s)
- Matthew D McEvoy
- 1301 Medical Center Drive, Hi-RiSE Preoperative Optimization Clinic, Vanderbilt University Medical Center, TVC 4619, Nashville, TN 37232, USA.
| | - Paul M Heerdt
- Department of Anesthesiology, Yale School of Medicine, New Haven, USA
| | - Vicki Morton
- Providence Anesthesiology Associates, Charlotte, USA
| | - Raquel R Bartz
- Harvard Medical School, Boston, USA
- Department of Anesthesia, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, USA
| | - Timothy E Miller
- Department of Anesthesiology, Duke University School of Medicine, Durham, USA
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Wilson BK, Sadowski CK, Baeten RG. A clinician's guide to pulmonary hypertension. JAAPA 2024; 37:12-18. [PMID: 38484294 DOI: 10.1097/01.jaa.0001007360.09090.5f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
ABSTRACT Despite advances in diagnosis and treatment, pulmonary hypertension has high morbidity and mortality. The presenting symptoms often are vague and may mimic other more common diseases, so patients can be misdiagnosed or missed early in the disease process. Early detection of pulmonary hypertension by primary care providers can play an important role in patient outcomes and survival. Identifying signs and symptoms, understanding the causes and classifications, and knowing the systematic approach to evaluating and diagnosing patients with suspected pulmonary hypertension are key to preventing premature patient decline.
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Affiliation(s)
- Bailey K Wilson
- Bailey K. Wilson practices at Wellstar Colon Rectal in Roswell, Ga. Catherine K. Sadowski is a clinical associate professor in the PA program at Mercer University in Atlanta, Ga. Robert G. Baeten is a clinical assistant professor in the PA program at Mercer University and practices in cardiac critical care at Northside Hospital in Canton, Ga. The authors have disclosed no potential conflicts of interest, financial or otherwise
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35
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Steger M, Canuet M, Enache I, Goetsch T, Labani A, Meyer L, Martin G, Kessler R, Montani D, Riou M. Survival and response to pulmonary vasodilator therapies in patients with chronic obstructive pulmonary disease and pulmonary vascular phenotype. Respir Med 2024; 225:107585. [PMID: 38479707 DOI: 10.1016/j.rmed.2024.107585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 02/13/2024] [Accepted: 03/03/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND The aim of the study was to describe and investigate the effect of pulmonary arterial hypertension (PAH) therapies in a cohort of patients with severe precapillary pulmonary hypertension (PH) associated with chronic obstructive pulmonary disease (COPD; PH-COPD), and to assess factors predictive of treatment response and mortality. MATERIAL AND METHODS We retrospectively included patients with severe incident PH-COPD who received PAH therapy and underwent RHC at diagnosis and on treatment. RESULTS From 2015 to 2022, 35 severe PH-COPD patients, with clinical features of pulmonary vascular phenotype, were included. Seventeen (48.5%) patients were treated with combined PAH therapy. PAH therapy led to a significant improvement in hemodynamics (PVR -3.5 Wood Units (-39.3%); p < 0.0001), and in the simplified four-strata risk-assessment score, which improved by at least one category in 21 (60%) patients. This effect was more pronounced in patients on dual therapy. Kaplan-Meier estimated survival rates at 1, 3 and 5 years were 94%, 65% and 42% respectively. Univariate analysis showed a significant reduction in survival in patients with a higher simplified risk score at follow-up (Hazard ratio (HR) 2.88 [1.16-7.15]; p = 0.02). Hypoxemia <50 mmHg was correlated to mortality in multivariate analysis (HR 4.33 [1.08-17.42]; p = 0.04). CONCLUSIONS Our study confirms the poor prognosis of patients with COPD and a pulmonary vascular phenotype and the potential interest of combined PAH therapy in this population, with good tolerability and greater clinical and hemodynamic improvement than monotherapy. Using the simplified risk score during follow-up could be of interest in this population.
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Affiliation(s)
- Mathilde Steger
- Chest Diseases Department, Nouvel Hôpital Civil, University Hospital of Strasbourg, Strasbourg, France
| | - Matthieu Canuet
- Chest Diseases Department, Nouvel Hôpital Civil, University Hospital of Strasbourg, Strasbourg, France
| | - Irina Enache
- Department of Physiology and Functional Exploration, Nouvel Hôpital Civil, University Hospital of Strasbourg, Strasbourg, France; University of Strasbourg, Translational Medicine Federation of Strasbourg (FMTS), CRBS, Team 3072 "Mitochondria, Oxidative Stress and Muscle Protection", 1 rue Eugène Boeckel, CS 60026, 67084, Strasbourg, France
| | - Thibaut Goetsch
- Department of Public Health, University Hospital of Strasbourg, Strasbourg, France
| | - Aissam Labani
- Radiology Department, Nouvel Hôpital Civil, University Hospital of Strasbourg, Strasbourg, France
| | - Léo Meyer
- Radiology Department, Nouvel Hôpital Civil, University Hospital of Strasbourg, Strasbourg, France
| | - Guillaume Martin
- Chest Diseases Department, Nouvel Hôpital Civil, University Hospital of Strasbourg, Strasbourg, France
| | - Romain Kessler
- Chest Diseases Department, Nouvel Hôpital Civil, University Hospital of Strasbourg, Strasbourg, France; INSERM-UNISTRA, UMR 1260 'Regenerative NanoMedicine', University of Strasbourg, 1 rue Eugène Boeckel, CS, 60026, 67084, Strasbourg, France
| | - David Montani
- University of Paris-Saclay, AP-HP, Chest Diseases Department, Hospital of Bicêtre, DMU 5 Thorinno, Inserm UMR_S999, Le Kremlin Bicêtre, France
| | - Marianne Riou
- Chest Diseases Department, Nouvel Hôpital Civil, University Hospital of Strasbourg, Strasbourg, France; Department of Physiology and Functional Exploration, Nouvel Hôpital Civil, University Hospital of Strasbourg, Strasbourg, France; University of Strasbourg, Translational Medicine Federation of Strasbourg (FMTS), CRBS, Team 3072 "Mitochondria, Oxidative Stress and Muscle Protection", 1 rue Eugène Boeckel, CS 60026, 67084, Strasbourg, France.
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Lichtblau M, Reimann L, Piccari L. Pulmonary vascular disease, environmental pollution, and climate change. Pulm Circ 2024; 14:e12394. [PMID: 38933180 PMCID: PMC11205889 DOI: 10.1002/pul2.12394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/19/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024] Open
Abstract
Pollution and climate change constitute a combined, grave and pervasive threat to humans and to the life-support systems on which they depend. Evidence shows a strong association between pollution and climate change on cardiovascular and respiratory diseases, and pulmonary vascular disease (PVD) is no exception. An increasing number of studies has documented the impact of environmental pollution and extreme temperatures on pulmonary circulation and the right heart, on the severity and outcomes of patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension (PH), on the incidence of pulmonary embolism, and the prevalence and severity of diseases associated with PH. Furthermore, the downstream consequences of climate change impair health care systems' accessibility, which could pose unique obstacles in the case of PVD patients, who require a complex and sophisticated network of health interventions. Patients, caretakers and health care professionals should thus be included in the design of policies aimed at adaptation to and mitigation of current challenges, and prevention of further climate change. The purpose of this review is to summarize the available evidence concerning the impact of environmental pollution and climate change on the pulmonary circulation, and to propose measures at the individual, healthcare and community levels directed at protecting patients with PVD.
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Affiliation(s)
- Mona Lichtblau
- Clinic of Pulmonology, Pulmonary Hypertension UnitUniversity Hospital ZurichZurichSwitzerland
| | - Lena Reimann
- Clinic of Pulmonology, Pulmonary Hypertension UnitUniversity Hospital ZurichZurichSwitzerland
| | - Lucilla Piccari
- Department of Pulmonary MedicineHospital del MarBarcelonaSpain
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37
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Bouchet C, Guibert C, Freund-Michel V. [Nerve growth factor (NGF) in pulmonary hypertension (PH)]. Rev Mal Respir 2024; 41:265-268. [PMID: 38461086 DOI: 10.1016/j.rmr.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/05/2024] [Indexed: 03/11/2024]
Abstract
Pulmonary hypertension (PH) is the main pathology in lung circulation, characterized by increased pressure in pulmonary arteries and ultimately resulting in right heart failure with potentially fatal outcomes. Given the current lack of available curative treatments, it is of paramount importance to identify novel therapeutic targets. Due to its involvement in pulmonary arterial remodeling, hyperreactivity, and inflammation, our explorations have focused on the nerve growth factor (NGF), offering promising avenues for innovative therapeutic approaches.
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Affiliation(s)
- C Bouchet
- Inserm U1045, centre de recherche cardio-thoracique de Bordeaux, Bordeaux, France; Université de Bordeaux, Bordeaux, France.
| | - C Guibert
- Inserm U1045, centre de recherche cardio-thoracique de Bordeaux, Bordeaux, France; Université de Bordeaux, Bordeaux, France
| | - V Freund-Michel
- Inserm U1045, centre de recherche cardio-thoracique de Bordeaux, Bordeaux, France; Université de Bordeaux, Bordeaux, France
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Wang Y, Zhao S, Lu M. State-of-the Art Cardiac Magnetic Resonance in Pulmonary Hypertension - An Update on Diagnosis, Risk Stratification and Treatment. Trends Cardiovasc Med 2024; 34:161-171. [PMID: 36574866 DOI: 10.1016/j.tcm.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/13/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022]
Abstract
Pulmonary hypertension (PH) is a globally under-recognized but life-shortening disease with a poor prognosis if untreated, delayed or inappropriately treated. One of the most important issues for PH is to improve patient quality of life and survival through timely and accurate diagnosis, precise risk stratification and prognosis prediction. Cardiac magnetic resonance (CMR), a non-radioactive, non-invasive image-based examination with excellent tissue characterization, provides a comprehensive assessment of not only the disease severity but also secondary changes in cardiac structure, function and tissue characteristics. The purpose of this review is to illustrate an updated status of CMR for PH assessment, focusing on the application of both conventional and emerging technologies as well as the latest clinical trials.
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Affiliation(s)
- Yining Wang
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167, Beilishi Road, Xicheng District, Beijing 100037, China
| | - Shihua Zhao
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167, Beilishi Road, Xicheng District, Beijing 100037, China
| | - Minjie Lu
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167, Beilishi Road, Xicheng District, Beijing 100037, China; Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China.
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Celestin BE, Bagherzadeh SP, Ichimura K, Santana EJ, Sanchez PA, Tobore T, Hemnes AR, Noordegraaf AV, Salerno M, Zamanian RT, Sweatt AJ, Haddad F. Identifying consistent echocardiographic thresholds for risk stratification in pulmonary arterial hypertension. Pulm Circ 2024; 14:e12361. [PMID: 38800494 PMCID: PMC11116946 DOI: 10.1002/pul2.12361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/08/2024] [Indexed: 05/29/2024] Open
Abstract
Several indices of right heart remodeling and function have been associated with survival in pulmonary arterial hypertension (PAH). Outcome analysis and physiological relationships between variables may help develop a consistent grading system. Patients with Group 1 PAH followed at Stanford Hospital who underwent right heart catheterization and echocardiography within 2 weeks were considered for inclusion. Echocardiographic variables included tricuspid annular plane systolic excursion (TAPSE), right ventricular (RV) fractional area change (RVFAC), free wall strain (RVFWS), RV dimensions, and right atrial volumes. The main outcome consisted of death or lung transplantation at 5 years. Mathematical relationships between variables were determined using weighted linear regression and severity thresholds for were calibrated to a 20% 1-year mortality risk. PAH patients (n = 223) had mean (SD) age of 48.1 (14.1) years, most were female (78%), with a mean pulmonary arterial pressure of 51.6 (13.8) mmHg and pulmonary vascular resistance index of 22.5(6.3) WU/m2. Measures of right heart size and function were strongly related to each other particularly RVFWS and RVFAC (R 2 = 0.82, p < 0.001), whereas the relationship between TAPSE and RVFWS was weaker (R 2 = 0.28, p < 0.001). Death or lung transplantation at 5 years occurred in 78 patients (35%). Guided by outcome analysis, we ascertained a uniform set of parameter thresholds for grading the severity of right heart adaptation in PAH. Using these quantitative thresholds, we, then, validated the recently reported REVEAL-echo score (AUC 0.68, p < 0.001). This study proposes a consistent echocardiographic grading system for right heart adaptation in PAH guided by outcome analysis.
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Affiliation(s)
- Bettia E. Celestin
- Department of Medicine, Division of PathologyStanford UniversityStanfordCaliforniaUSA
- Stanford Cardiovascular InstituteStanford UniversityStanfordCaliforniaUSA
- Department of Medicine, Division of Cardiovascular MedicineStanford UniversityStanfordCaliforniaUSA
| | - Shadi P. Bagherzadeh
- Stanford Cardiovascular InstituteStanford UniversityStanfordCaliforniaUSA
- Department of Medicine, Division of Cardiovascular MedicineStanford UniversityStanfordCaliforniaUSA
| | - Kenzo Ichimura
- Stanford Cardiovascular InstituteStanford UniversityStanfordCaliforniaUSA
- Vera Moulton Wall Center for Pulmonary Vascular DiseaseStanford School of MedicineStanfordCaliforniaUSA
| | - Everton J. Santana
- Department of Medicine, Division of Cardiovascular MedicineStanford UniversityStanfordCaliforniaUSA
- Department of Cardiovascular Sciences, Research Unit Hypertension and Cardiovascular EpidemiologyUniversity of LeuvenLeuvenBelgium
| | - Pablo Amador Sanchez
- Department of Medicine, Division of Cardiovascular MedicineStanford UniversityStanfordCaliforniaUSA
| | - Tobore Tobore
- Pulmonary Hypertension section, Janssen and JanssenTitusvilleNew JerseyUSA
| | - Anna R. Hemnes
- Division of allergy, Pulmonary and Critical Care MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Anton Vonk Noordegraaf
- Pulmonary Hypertension section, Janssen and JanssenTitusvilleNew JerseyUSA
- Department of Pulmonary DiseasesVU University Medical CenterAmsterdamthe Netherlands
| | - Michael Salerno
- Stanford Cardiovascular InstituteStanford UniversityStanfordCaliforniaUSA
- Department of Medicine, Division of Cardiovascular MedicineStanford UniversityStanfordCaliforniaUSA
| | - Roham T. Zamanian
- Department of Medicine, Division of PathologyStanford UniversityStanfordCaliforniaUSA
- Vera Moulton Wall Center for Pulmonary Vascular DiseaseStanford School of MedicineStanfordCaliforniaUSA
| | - Andrew J. Sweatt
- Department of Medicine, Division of PathologyStanford UniversityStanfordCaliforniaUSA
- Vera Moulton Wall Center for Pulmonary Vascular DiseaseStanford School of MedicineStanfordCaliforniaUSA
| | - Francois Haddad
- Stanford Cardiovascular InstituteStanford UniversityStanfordCaliforniaUSA
- Department of Medicine, Division of Cardiovascular MedicineStanford UniversityStanfordCaliforniaUSA
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Zuo Y, Li B, Gao M, Xiong R, He R, Li N, Geng Q. Novel insights and new therapeutic potentials for macrophages in pulmonary hypertension. Respir Res 2024; 25:147. [PMID: 38555425 PMCID: PMC10981837 DOI: 10.1186/s12931-024-02772-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 03/13/2024] [Indexed: 04/02/2024] Open
Abstract
Inflammation and immune processes underlie pulmonary hypertension progression. Two main different activated phenotypes of macrophages, classically activated M1 macrophages and alternatively activated M2 macrophages, are both involved in inflammatory processes related to pulmonary hypertension. Recent advances suggest that macrophages coordinate interactions among different proinflammatory and anti-inflammatory mediators, and other cellular components such as smooth muscle cells and fibroblasts. In this review, we summarize the current literature on the role of macrophages in the pathogenesis of pulmonary hypertension, including the origin of pulmonary macrophages and their response to triggers of pulmonary hypertension. We then discuss the interactions among macrophages, cytokines, and vascular adventitial fibroblasts in pulmonary hypertension, as well as the potential therapeutic benefits of macrophages in this disease. Identifying the critical role of macrophages in pulmonary hypertension will contribute to a comprehensive understanding of this pathophysiological abnormality, and may provide new perspectives for pulmonary hypertension management.
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Affiliation(s)
- Yifan Zuo
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, China
| | - Boyang Li
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, China
| | - Minglang Gao
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, China
| | - Rui Xiong
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, China
| | - Ruyuan He
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, China
| | - Ning Li
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, China.
| | - Qing Geng
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, China.
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Tatsuoka Y, Carr ZJ, Jayakumar S, Lin HM, He Z, Farroukh A, Heerdt P. Pulmonary Hypertension and the Risk of 30-Day Postoperative Pulmonary Complications after Gastrointestinal Surgical or Endoscopic Procedures: A Retrospective Propensity Score-Weighted Cohort Analysis. J Clin Med 2024; 13:1996. [PMID: 38610760 PMCID: PMC11012853 DOI: 10.3390/jcm13071996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/24/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Pulmonary hypertension (PH) patients are at higher risk of postoperative complications. We analyzed the association of PH with 30-day postoperative pulmonary complications (PPCs). Methods: A single-center propensity score overlap weighting (OW) retrospective cohort study was conducted on 164 patients with a mean pulmonary artery pressure (mPAP) of >20 mmHg within 24 months of undergoing elective inpatient abdominal surgery or endoscopic procedures under general anesthesia and a control cohort (N = 1981). The primary outcome was PPCs, and the secondary outcomes were PPC sub-composites, namely respiratory failure (RF), pneumonia (PNA), aspiration pneumonia/pneumonitis (ASP), pulmonary embolism (PE), length of stay (LOS), and 30-day mortality. Results: PPCs were higher in the PH cohort (29.9% vs. 11.2%, p < 0.001). When sub-composites were analyzed, higher rates of RF (19.3% vs. 6.6%, p < 0.001) and PNA (11.2% vs. 5.7%, p = 0.01) were observed. After OW, PH was still associated with greater PPCs (RR 1.66, 95% CI (1.05-2.71), p = 0.036) and increased LOS (median 8.0 days vs. 4.9 days) but not 30-day mortality. Sub-cohort analysis showed no difference in PPCs between pre- and post-capillary PH patients. Conclusions: After covariate balancing, PH was associated with a higher risk for PPCs and prolonged LOS. This elevated PPC risk should be considered during preoperative risk assessment.
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Affiliation(s)
- Yoshio Tatsuoka
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06510, USA; (Y.T.)
- Department of Anesthesiology, Yale New Haven Hospital, New Haven, CT 06510, USA
| | - Zyad J. Carr
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06510, USA; (Y.T.)
- Department of Anesthesiology, Yale New Haven Hospital, New Haven, CT 06510, USA
| | - Sachidhanand Jayakumar
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Hung-Mo Lin
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06510, USA; (Y.T.)
- Department of Anesthesiology, Yale New Haven Hospital, New Haven, CT 06510, USA
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT 06520, USA
| | - Zili He
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT 06520, USA
| | - Adham Farroukh
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA 01803, USA
| | - Paul Heerdt
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06510, USA; (Y.T.)
- Department of Anesthesiology, Yale New Haven Hospital, New Haven, CT 06510, USA
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Heath-Freudenthal A, Estrada A, von Alvensleben I, Julian CG. Surviving birth at high altitude. J Physiol 2024. [PMID: 38520695 DOI: 10.1113/jp284554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 03/11/2024] [Indexed: 03/25/2024] Open
Abstract
This Symposium Review examines challenges to surviving birth and infancy at high altitudes. Chronic exposure to the environmental hypoxia of high altitudes increases the incidence of maternal vascular disorders of pregnancy characterized by placental insufficiency, restricted fetal growth and preterm delivery, and impairs pulmonary vascular health during infancy. While each condition independently contributes to excess morbidity and mortality in early life, evidence indicates vascular disorders of pregnancy and infantile pulmonary vascular dysfunction are intertwined. By integrating our recent scientific and clinical observations in Bolivia with existing literature, we propose potential avenues to reduce the infant mortality burden at high altitudes and reduce pulmonary vascular disease in highland neonates, and emphasize the need for further research to address unresolved questions.
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Affiliation(s)
| | | | | | - Colleen G Julian
- Department of Biomedical Informatics, University of Colorado School of Medicine, Aurora, Colorado, USA
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Chen T, Ding L, Zhao M, Song S, Hou J, Li X, Li M, Yin K, Li X, Wang Z. Recent advances in the potential effects of natural products from traditional Chinese medicine against respiratory diseases targeting ferroptosis. Chin Med 2024; 19:49. [PMID: 38519984 PMCID: PMC10958864 DOI: 10.1186/s13020-024-00918-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 03/07/2024] [Indexed: 03/25/2024] Open
Abstract
Respiratory diseases, marked by structural changes in the airways and lung tissues, can lead to reduced respiratory function and, in severe cases, respiratory failure. The side effects of current treatments, such as hormone therapy, drugs, and radiotherapy, highlight the need for new therapeutic strategies. Traditional Chinese Medicine (TCM) offers a promising alternative, leveraging its ability to target multiple pathways and mechanisms. Active compounds from Chinese herbs and other natural sources exhibit anti-inflammatory, antioxidant, antitumor, and immunomodulatory effects, making them valuable in preventing and treating respiratory conditions. Ferroptosis, a unique form of programmed cell death (PCD) distinct from apoptosis, necrosis, and others, has emerged as a key area of interest. However, comprehensive reviews on how natural products influence ferroptosis in respiratory diseases are lacking. This review will explore the therapeutic potential and mechanisms of natural products from TCM in modulating ferroptosis for respiratory diseases like acute lung injury (ALI), asthma, pulmonary fibrosis (PF), chronic obstructive pulmonary disease (COPD), lung ischemia-reperfusion injury (LIRI), pulmonary hypertension (PH), and lung cancer, aiming to provide new insights for research and clinical application in TCM for respiratory health.
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Affiliation(s)
- Tian Chen
- College of Integrated Traditional Chinese and Western Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Lu Ding
- Northeast Asia Research Institute of Traditional Chinese Medicine, Key Laboratory of Active Substances and Biological Mechanisms of Ginseng Efficacy, Ministry of Education, Jilin Provincial Key Laboratory of Bio-Macromolecules of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin, 130117, China
- Research Center of Traditional Chinese Medicine, College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin, 130021, China
| | - Meiru Zhao
- College of Integrated Traditional Chinese and Western Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Siyu Song
- Northeast Asia Research Institute of Traditional Chinese Medicine, Key Laboratory of Active Substances and Biological Mechanisms of Ginseng Efficacy, Ministry of Education, Jilin Provincial Key Laboratory of Bio-Macromolecules of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin, 130117, China
| | - Juan Hou
- College of Integrated Traditional Chinese and Western Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Xueyan Li
- College of Integrated Traditional Chinese and Western Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Min Li
- College of Integrated Traditional Chinese and Western Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Kai Yin
- College of Integrated Traditional Chinese and Western Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Xiangyan Li
- Northeast Asia Research Institute of Traditional Chinese Medicine, Key Laboratory of Active Substances and Biological Mechanisms of Ginseng Efficacy, Ministry of Education, Jilin Provincial Key Laboratory of Bio-Macromolecules of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin, 130117, China.
| | - Zeyu Wang
- Northeast Asia Research Institute of Traditional Chinese Medicine, Key Laboratory of Active Substances and Biological Mechanisms of Ginseng Efficacy, Ministry of Education, Jilin Provincial Key Laboratory of Bio-Macromolecules of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin, 130117, China.
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Yogeswaran A, Gall H, Fünderich M, Wilkins MR, Howard L, Kiely DG, Lawrie A, Hassoun PM, Sirenklo Y, Torbas O, Sweatt AJ, Zamanian RT, Williams PG, Frauendorf M, Arvanitaki A, Giannakoulas G, Saleh K, Sabbour H, Cajigas HR, Frantz R, Al Ghouleh I, Chan SY, Brittain E, Annis JS, Pepe A, Ghio S, Orfanos S, Anthi A, Majeed RW, Wilhelm J, Ghofrani HA, Richter MJ, Grimminger F, Sahay S, Tello K, Seeger W. Comparison of Contemporary Risk Scores in All Groups of Pulmonary Hypertension: A Pulmonary Vascular Research Institute GoDeep Meta-Registry Analysis. Chest 2024:S0012-3692(24)00309-X. [PMID: 38508334 DOI: 10.1016/j.chest.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/22/2024] [Accepted: 03/08/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) is a heterogeneous disease with a poor prognosis. Accurate risk stratification is essential for guiding treatment decisions in pulmonary arterial hypertension (PAH). Although various risk models have been developed for PAH, their comparative prognostic potential requires further exploration. Additionally, the applicability of risk scores in PH groups beyond group 1 remains to be investigated. RESEARCH QUESTION Are risk scores originally developed for PAH predictive in PH groups 1 through 4? STUDY DESIGN AND METHODS We conducted a comprehensive analysis of outcomes among patients with incident PH enrolled in the multicenter worldwide Pulmonary Vascular Research Institute GoDeep meta-registry. Analyses were performed across PH groups 1 through 4 and further subgroups to evaluate the predictive value of PAH risk scores, including REVEAL Lite 2, REVEAL 2.0, ESC/ERS 2022, COMPERA 3-strata, and COMPERA 4-strata. RESULTS Eight thousand five hundred sixty-five patients were included in the study, of whom 3,537 patients were assigned to group 1 PH, whereas 1,807 patients, 1,635 patients, and 1,586 patients were assigned to group 2 PH, group 3 PH, and group 4 PH, respectively. Pulmonary hemodynamics were impaired with median mean pulmonary arterial pressure of 42 mm Hg (33-52 mm Hg) and pulmonary vascular resistance of 7 WU (4-11 WU). All risk scores were prognostic in the entire PH population and in each of the PH groups 1 through 4. The REVEAL scores, when used as continuous prediction models, demonstrated the highest statistical prognostic power and granularity; the COMPERA 4-strata risk score provided subdifferentiation of the intermediate-risk group. Similar results were obtained when separately analyzing various subgroups (PH subgroups 1.1, 1.4.1, and 1.4.4; PH subgroups 3.1 and 3.2; group 2 with isolated postcapillary PH vs combined precapillary and postcapillary PH; patients of all groups with concomitant cardiac comorbidities; and severe [> 5 WU] vs nonsevere PH). INTERPRETATION This comprehensive study with real-world data from 15 PH centers showed that PAH-designed risk scores possess predictive power in a large PH cohort, whether considered as common to the group or calculated separately for each PH group (1-4) and various subgroups.
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Affiliation(s)
- Athiththan Yogeswaran
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany; Institute for Lung Health, Cardio-Pulmonary Institute (CPI), Giessen, Germany
| | - Henning Gall
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany; Institute for Lung Health, Cardio-Pulmonary Institute (CPI), Giessen, Germany
| | - Meike Fünderich
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany
| | - Martin R Wilkins
- National Heart and Lung Institute, Imperial College London, London
| | - Luke Howard
- National Heart and Lung Institute, Imperial College London, London
| | - David G Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, University of Sheffield and National Institute for Health and Care Research Sheffield Biomedical Research Centre, Sheffield, England
| | - Allan Lawrie
- National Heart and Lung Institute, Imperial College London, London; Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, University of Sheffield and National Institute for Health and Care Research Sheffield Biomedical Research Centre, Sheffield, England
| | - Paul M Hassoun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Yuriy Sirenklo
- National Scientific Center M.D. Strazhesko Institute of Cardiology, Clinical and Regenerative Medicine, The National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | - Olena Torbas
- National Scientific Center M.D. Strazhesko Institute of Cardiology, Clinical and Regenerative Medicine, The National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | - Andrew J Sweatt
- Division of Pulmonary, Allergy, and Critical Care and the Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University, Palo Alto, CA
| | - Roham T Zamanian
- Division of Pulmonary, Allergy, and Critical Care and the Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University, Palo Alto, CA
| | | | | | - Alexandra Arvanitaki
- First Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Giannakoulas
- First Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Khaled Saleh
- Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Hani Sabbour
- Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Hector R Cajigas
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Robert Frantz
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | - Stefano Ghio
- Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | | | | | - Raphael W Majeed
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany; Institute of Medical Informatics, RWTH Aachen University, Aachen, Germany
| | - Jochen Wilhelm
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany; Institute for Lung Health, Cardio-Pulmonary Institute (CPI), Giessen, Germany
| | - Hossein Ardeschir Ghofrani
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany; Institute for Lung Health, Cardio-Pulmonary Institute (CPI), Giessen, Germany
| | - Manuel J Richter
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany; Institute for Lung Health, Cardio-Pulmonary Institute (CPI), Giessen, Germany
| | - Friedrich Grimminger
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany; Institute for Lung Health, Cardio-Pulmonary Institute (CPI), Giessen, Germany
| | | | - Khodr Tello
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany; Institute for Lung Health, Cardio-Pulmonary Institute (CPI), Giessen, Germany
| | - Werner Seeger
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany; Institute for Lung Health, Cardio-Pulmonary Institute (CPI), Giessen, Germany.
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Khezerlouy‐Aghdam N, Toufan Tabrizi M, Seyed Toutounchi K, Jabbaripour Sarmadian A, Masoumi S. Challenging in pulmonary thromboembolism diagnosis in patients with disproportionate pulmonary hypertension and severe mitral stenosis: Report of two cases. Clin Case Rep 2024; 12:e8597. [PMID: 38464564 PMCID: PMC10920307 DOI: 10.1002/ccr3.8597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/08/2024] [Accepted: 02/18/2024] [Indexed: 03/12/2024] Open
Abstract
Key Clinical Message Before valvular interventions, echocardiography, especially the TEE or the ventilation/perfusion scan, should be performed to detect silent PTE and set a more accurate treatment and surgical plan. Abstract Pulmonary hypertension (PH) is a progressive and critical disease that can be caused by mitral stenosis (MS). Some of these patients present with disproportionate PH, which is an uncommon phenomenon and is considered a challenging diagnostic and treatment process. In these patients, other causes may also play a role in developing PH. This report presented two cases with disproportionate PH and severe MS who were scheduled for percutaneous mitral valvuloplasty (PMV). The pre-procedural echocardiography revealed systolic pulmonary artery pressure (sPAP) of 90 and 120 mmHg, mitral valve area of 0.80 and 0.55 cm2 by three-dimensional (3D) planimetry, and diastolic pressure gradient (DPG) of 13 and 18.8 mmHg, respectively. Furthermore, in the first patient, 3D transesophageal echocardiography (TEE) revealed multiple saddle-type organized thrombi in the proximal parts of the right and left pulmonary arteries, extending to the distal branches. In the second patient, 3D TEE revealed a large, relatively fresh, flow-limiting thrombosis in the proximal part of the right pulmonary artery. The diagnosis of pulmonary thromboembolism (PTE) in both patients was confirmed by CT angiography. In both patients, the valves were surgically repaired, while all thrombi were removed from the cardiac chambers and pulmonary vessels during surgery. In addition, patients underwent warfarin therapy orally. They were followed up 6 months after the intervention, and their clinical symptoms had improved significantly.
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Affiliation(s)
| | | | | | | | - Shahab Masoumi
- Cardiovascular Research CenterTabriz University of Medical SciencesTabrizIran
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46
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Kitahara K, Omura J, Wada S, Kim SW. Patient and Therapeutic Profiles of Pulmonary Hypertension in Chronic Lung Diseases in Japan: A Cohort Study Using a Claims Database. Pulm Ther 2024; 10:21-49. [PMID: 37950789 PMCID: PMC10881911 DOI: 10.1007/s41030-023-00243-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/30/2023] [Indexed: 11/13/2023] Open
Abstract
INTRODUCTION Pulmonary hypertension (PH) is often complicated by chronic lung diseases (CLDs) such as chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD). Differentiating between PH associated with CLD (group 3 PH) and pulmonary arterial hypertension (PAH) in CLD is often difficult and reporting on the efficacy of PAH-specific therapies is inconsistent as a result of the lack of understanding of the heterogeneity of patients with PH. METHODS A retrospective observational cohort study was conducted to understand the baseline characteristics, comorbidities, and treatment profiles of patients with PH in CLD in a real-world setting using a large-scale claims database (Medical Data Vision). Administrative and clinical data for patients admitted to acute-care hospitals in Japan between April 2008 and January 2021 were analyzed. RESULTS A total of 115,921 patients with CLD (109,578 with COPD and 6343 with ILD, of whom 569 and 176 had PH, respectively) were analyzed. This study found lower PH diagnosis rates among patients with COPD and patients with ILD than in previous studies. The majority of PH with CLD patients were elderly (mean age 75.7 years) and male (80.81%). Among patients with CLD prescribed PAH-specific therapies (105 patients with COPD; 64 patients with ILD), most received these as monotherapy (COPD, 84.76%; ILD, 75.56%); the most common were phosphodiesterase 5 inhibitors (COPD, 42.70%; ILD, 18.37%), prostacyclins (oral; COPD, 48.31%; ILD, 24.49%), and endothelin receptor antagonists (ERA) (COPD, 8.99%; ILD, 18.37%). Comorbidities (e.g., pulmonary, cardiac, kidney), home oxygen therapy (HOT), and echocardiography (ECHO) were factors associated with the diagnosis of PH. CONCLUSION This is the first study using an administrative database that provides real-world data on patients with PH in CLD in Japan. Our results indicate that PH may be misdiagnosed or underdiagnosed in Japan which may lead to suboptimal treatment for patients, and supports the need for further evidence to guide appropriate treatment.
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Affiliation(s)
- Kazuki Kitahara
- Medical Affairs, Janssen Pharmaceutical K.K., 3-5-2 Nishikanda, Chiyoda-ku, Tokyo, 101-0065, Japan.
| | - Junichi Omura
- Medical Affairs, Janssen Pharmaceutical K.K., 3-5-2 Nishikanda, Chiyoda-ku, Tokyo, 101-0065, Japan
| | - Shingo Wada
- Real World Evidence Solutions, IQVIA Solutions Japan K.K., 4-10-18 Takanawa, Minato-ku, Tokyo, 108-0074, Japan
| | - Seok-Won Kim
- Real World Evidence Solutions, IQVIA Solutions Japan K.K., 4-10-18 Takanawa, Minato-ku, Tokyo, 108-0074, Japan
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Provencher S, Mai V, Bonnet S. Managing Pulmonary Arterial Hypertension With Cardiopulmonary Comorbidities. Chest 2024; 165:682-691. [PMID: 38461018 DOI: 10.1016/j.chest.2023.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/10/2023] [Accepted: 08/25/2023] [Indexed: 03/11/2024] Open
Abstract
Pulmonary arterial hypertension (PAH) and pulmonary hypertension associated with left-sided heart and lung diseases are most commonly easily discriminated and treated accordingly. With the changing epidemiology of PAH, however, a growing proportion of patients at the time of diagnosis present with comorbidities of varying severity. In addition to classical PAH, two distinct phenotypes have emerged: a heart failure with preserved ejection fraction-like phenotype and a lung phenotype. Importantly, the evidence supporting the currently proposed treatment algorithm for PAH has been generated mainly from PAH trials in which patients with cardiopulmonary comorbidities have been underrepresented or excluded. As a consequence, the best therapeutic approach for patients with common PAH with cardiopulmonary comorbidities remains largely unknown and requires further investigation. The present article reviews the relevant literature on the topic and describes the authors' views on the current therapeutic approach for these patients.
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Affiliation(s)
- Steeve Provencher
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Université Laval, Quebec City, QC, Canada; Pulmonary Hypertension Research Group, Université Laval, Quebec City, QC, Canada; Department of Medicine, Université Laval, Quebec City, QC, Canada.
| | - Vicky Mai
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Université Laval, Quebec City, QC, Canada; Pulmonary Hypertension Research Group, Université Laval, Quebec City, QC, Canada; Department of Medicine, Université Laval, Quebec City, QC, Canada
| | - Sebastien Bonnet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Université Laval, Quebec City, QC, Canada; Pulmonary Hypertension Research Group, Université Laval, Quebec City, QC, Canada; Department of Medicine, Université Laval, Quebec City, QC, Canada
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Miao H, Hui H, Fan W, Lin Y, Li H, Li D, Luo M, Qiu F, Jiang B, Zhang Y. Overexpressed pigment epithelium-derived factor alleviates pulmonary hypertension in two rat models induced by monocrotaline and SU5416/hypoxia. Biomed Pharmacother 2024; 172:116303. [PMID: 38377738 DOI: 10.1016/j.biopha.2024.116303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/16/2024] [Accepted: 02/17/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) is a progressive and fatal cardiopulmonary disease characterized by vascular remodeling and is associated with endothelial-to-mesenchymal transition (EndoMT). The pigment epithelium-derived factor (PEDF), a secretory protein widely distributed in multiple organs, has been shown to demonstrate anti-EndoMT activity in cardiovascular diseases. In the present study, the role of PEDF in PH was investigated. METHODS For PEDF overexpression, Sprague Dawley rats were infected with an adeno-associated virus through injection via the internal jugular vein. To establish PH models, the animals were subjected to monocrotaline or Sugen/hypoxia. Four weeks later, pulmonary artery angiography was performed, and hemodynamic parameters, right ventricular function, and vascular remodeling were evaluated. EndoMT and cell proliferation in the pulmonary arteries were assessed via immunofluorescence staining. Moreover, pulmonary artery endothelial cells (PAECs) isolated from experimental PH rats were cultured to investigate the underlying molecular mechanisms involved. RESULTS PEDF expression was significantly downregulated in PAECs from PH patients and PH model rats. Overexpressed PEDF alleviated the development of PH by improving pulmonary artery morphology and perfusion, reducing pulmonary artery pressure, improving right ventricular function, and alleviating vascular remodeling. PEDF inhibits EndoMT and reduces excessive PAEC proliferation. Moreover, PEDF overexpression reduced EndoMT in cultured PAECs by competitively inhibiting the binding of wnt to LRP6 and downregulating phosphorylation at the 1490 site of LRP6. CONCLUSIONS Our findings suggest that PEDF may be a potential therapeutic target for PH. We also found that PEDF can inhibit EndoMT in PAECs and may exert these effects by inhibiting the Wnt/LRP6/β-catenin pathway.
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Affiliation(s)
- Haoran Miao
- Department of Thoracic Cardiovascular Surgery, China
| | - Hongliang Hui
- Department of Thoracic Cardiovascular Surgery, China
| | - Wenbin Fan
- Department of Thoracic Cardiovascular Surgery, China
| | - Yangui Lin
- Department of Thoracic Cardiovascular Surgery, China
| | - Huaming Li
- Department of Thoracic Cardiovascular Surgery, China
| | - Dan Li
- Community Health Center, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Min Luo
- Department of Thoracic Cardiovascular Surgery, China
| | - Fan Qiu
- Department of Thoracic Cardiovascular Surgery, China.
| | - Bo Jiang
- Department of Thoracic Cardiovascular Surgery, China.
| | - Yiqian Zhang
- Department of Thoracic Cardiovascular Surgery, China.
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Lenka J, Foley R, Metersky M, Salmon A. Relationship between obstructive sleep apnea and pulmonary hypertension: past, present and future. Expert Rev Respir Med 2024; 18:85-97. [PMID: 38646681 DOI: 10.1080/17476348.2024.2345684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 04/17/2024] [Indexed: 04/23/2024]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is a widely prevalent condition with consequent multiple organ systems complications. There is consensus that OSA is associated with negative effects on pulmonary hemodynamics but whether it contributes to development of clinical pulmonary hypertension (PH) is unclear. AREAS COVERED In this review, we (1) highlight previous studies looking into the possible bidirectional association of OSA and PH, focusing on those that explore clinical prognostic implications, (2) explore potential pathophysiology, (3) discuss the new metrics in OSA, (4) describe endo-phenotyping of OSA, (5) recommend possible risk assessment and screening pathways. EXPERT OPINION Relying only on symptoms to consider a sleep study in PH patients is a missed opportunity to detect OSA, which, if present and not treated, can worsen outcomes. The potential prognostic role of sleep study metrics such as oxygen desaturation index (ODI), hypoxic burden (HB) and ventilatory burden (VB) in OSA should be studied in prospective trials to identify patients at risk for PH. AHI alone has not provided clarity. In those with PH, we should consider replacing ambulatory overnight pulse oximetry (OPO) with home sleep studies (HST). In PH patients, mild OSA should be sufficient to consider PAP therapy.
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Affiliation(s)
- Jyotirmayee Lenka
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Connecticut, Farmington, CT, USA
| | - Raymond Foley
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Connecticut, Farmington, CT, USA
| | - Mark Metersky
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Connecticut, Farmington, CT, USA
| | - Adrian Salmon
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Connecticut, Farmington, CT, USA
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Zhang H, Leng S, Gao F, Kovalik JP, Wee HN, Chua KV, Ching J, Allen JC, Zhao X, Tan RS, Wu Q, Leiner T, Koh AS, Zhong L. Characteristics of pulmonary artery strain assessed by cardiovascular magnetic resonance imaging and associations with metabolomic pathways in human ageing. Front Cardiovasc Med 2024; 11:1346443. [PMID: 38486706 PMCID: PMC10937542 DOI: 10.3389/fcvm.2024.1346443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/20/2024] [Indexed: 03/17/2024] Open
Abstract
Background Pulmonary artery (PA) strain is associated with structural and functional alterations of the vessel and is an independent predictor of cardiovascular events. The relationship of PA strain to metabolomics in participants without cardiovascular disease is unknown. Methods In the current study, community-based older adults, without known cardiovascular disease, underwent simultaneous cine cardiovascular magnetic resonance (CMR) imaging, clinical examination, and serum sampling. PA global longitudinal strain (GLS) analysis was performed by tracking the change in distance from the PA bifurcation to the pulmonary annular centroid, using standard cine CMR images. Circulating metabolites were measured by cross-sectional targeted metabolomics analysis. Results Among n = 170 adults (mean age 71 ± 6.3 years old; 79 women), mean values of PA GLS were 16.2 ± 4.4%. PA GLS was significantly associated with age (β = -0.13, P = 0.017), heart rate (β = -0.08, P = 0.001), dyslipidemia (β = -2.37, P = 0.005), and cardiovascular risk factors (β = -2.49, P = 0.001). Alanine (β = -0.007, P = 0.01) and proline (β = -0.0009, P = 0.042) were significantly associated with PA GLS after adjustment for clinical risk factors. Medium and long-chain acylcarnitines were significantly associated with PA GLS (C12, P = 0.027; C12-OH/C10-DC, P = 0.018; C14:2, P = 0.036; C14:1, P = 0.006; C14, P = 0.006; C14-OH/C12-DC, P = 0.027; C16:3, P = 0.019; C16:2, P = 0.006; C16:1, P = 0.001; C16:2-OH, P = 0.016; C16:1-OH/C14:1-DC, P = 0.028; C18:1-OH/C16:1-DC, P = 0.032). Conclusion By conventional CMR, PA GLS was associated with aging and vascular risk factors among a contemporary cohort of older adults. Metabolic pathways involved in PA stiffness may include gluconeogenesis, collagen synthesis, and fatty acid oxidation.
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Affiliation(s)
- Hongzhou Zhang
- Department of Cardiovascular Medicine, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Shuang Leng
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Fei Gao
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Jean-Paul Kovalik
- Duke-NUS Medical School, Singapore, Singapore
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | | | | | - Jianhong Ching
- Duke-NUS Medical School, Singapore, Singapore
- KK Research Centre, KK Women’s and Children’s Hospital, Singapore, Singapore
| | | | - Xiaodan Zhao
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Ru-San Tan
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Qinghua Wu
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Tim Leiner
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Angela S. Koh
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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