101
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Farha S, Saygin D, Park MM, Cheong HI, Asosingh K, Comhair SA, Stephens OR, Roach EC, Sharp J, Highland KB, DiFilippo FP, Neumann DR, Tang WHW, Erzurum SC. Pulmonary arterial hypertension treatment with carvedilol for heart failure: a randomized controlled trial. JCI Insight 2017; 2:95240. [PMID: 28814664 DOI: 10.1172/jci.insight.95240] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/18/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Right-sided heart failure is the leading cause of death in pulmonary arterial hypertension (PAH). Similar to left heart failure, sympathetic overactivation and β-adrenoreceptor (βAR) abnormalities are found in PAH. Based on successful therapy of left heart failure with β-blockade, the safety and benefits of the nonselective β-blocker/vasodilator carvedilol were evaluated in PAH. METHODS PAH Treatment with Carvedilol for Heart Failure (PAHTCH) is a single-center, double-blind, randomized, controlled trial. Following 1-week run-in, 30 participants were randomized to 1 of 3 arms for 24 weeks: placebo, low-fixed-dose, or dose-escalating carvedilol. Outcomes included clinical measures and mechanistic biomarkers. RESULTS Decreases in heart rate and blood pressure with carvedilol were well tolerated; heart rate correlated with carvedilol dose. Carvedilol-treated groups had no decrease in exercise capacity measured by 6-minute walk, but had lower heart rates at peak and after exercise, and faster heart rate recovery. Dose-escalating carvedilol was associated with reduction in right ventricular (RV) glycolytic rate and increase in βAR levels. There was no evidence of RV functional deterioration; rather, cardiac output was maintained. CONCLUSIONS Carvedilol is likely safe in PAH over 6 months of therapy and has clinical and mechanistic benefits associated with improved outcomes. The data provide support for longer and larger studies to establish guidelines for use of β-blockers in PAH. TRIAL REGISTRATION ClinicalTrials.gov NCT01586156FUNDING. This project was supported by NIH R01HL115008 and R01HL60917 and in part by the National Center for Advancing Translational Sciences, UL1TR000439.
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102
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van der Bruggen CE, Tedford RJ, Handoko ML, van der Velden J, de Man FS. RV pressure overload: from hypertrophy to failure. Cardiovasc Res 2017; 113:1423-1432. [DOI: 10.1093/cvr/cvx145] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 07/31/2017] [Indexed: 01/31/2023] Open
Affiliation(s)
- Cathelijne E.E. van der Bruggen
- Department of Pulmonology, Amsterdam Cardiovascular Sciences, VU University Medical Center Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Ryan J. Tedford
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | | | - Jolanda van der Velden
- Department of Physiology, Amsterdam Cardiovascular Sciences, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Frances S. de Man
- Department of Pulmonology, Amsterdam Cardiovascular Sciences, VU University Medical Center Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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103
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O'Leary JM, Assad TR, Xu M, Birdwell KA, Farber-Eger E, Wells QS, Hemnes AR, Brittain EL. Pulmonary hypertension in patients with chronic kidney disease: invasive hemodynamic etiology and outcomes. Pulm Circ 2017; 7:674-683. [PMID: 28660793 PMCID: PMC5841902 DOI: 10.1177/2045893217716108] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Pulmonary hypertension (PH) is common in patients with chronic kidney disease (CKD) and associated with increased mortality but the hemodynamic profiles, clinical risk factors, and outcomes have not been well characterized. Our objective was to define the hemodynamic profile and related risk factors for PH in CKD patients. We extracted clinical and hemodynamic data from Vanderbilt's de-identified electronic medical record on all patients undergoing right heart catheterization during 1998-2014. CKD (stages III-V) was defined by estimated glomerular filtration rate thresholds. PH was defined as mean pulmonary pressure ≥ 25 mmHg and categorized into pre-capillary and post-capillary according to consensus recommendations. In total, 4635 patients underwent catheterization: 1873 (40%) had CKD; 1518 (33%) stage 3, 230 (5%) stage 4, and 125 (3%) stage 5. PH was present in 1267 (68%) of these patients. Post-capillary (n = 965, 76%) was the predominant PH phenotype among CKD patients versus 302 (24%) for pre-capillary ( P < 0.001). CKD was independently associated with pulmonary hypertension (odds ratio = 1.4, 95% confidence interval = 1.18-1.65). Mortality among CKD patients rose with worsening stage and was significantly increased by PH status. PH is common and independently associated with mortality among CKD patients referred for right heart catheterization. Post-capillary was the most common etiology of PH. These data suggest that PH is an important prognostic co-morbidity among CKD patients and that CKD itself may have a role in the development of pulmonary vascular disease in some patients.
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Affiliation(s)
- Jared M O'Leary
- 1 Vanderbilt University Medical Center Division of Cardiovascular Medicine, Nashville, TN, USA
| | - Tufik R Assad
- 2 Vanderbilt University Medical Center Division of Allergy, Pulmonary and Critical Care Medicine, Nashville, TN, USA
| | - Meng Xu
- 3 Vanderbilt University Department of Biostatistics, Nashville, TN, USA
| | - Kelly A Birdwell
- 4 Vanderbilt University Medical Center Division of Nephrology, Nashville, TN, USA
| | - Eric Farber-Eger
- 1 Vanderbilt University Medical Center Division of Cardiovascular Medicine, Nashville, TN, USA
| | - Quinn S Wells
- 1 Vanderbilt University Medical Center Division of Cardiovascular Medicine, Nashville, TN, USA
| | - Anna R Hemnes
- 2 Vanderbilt University Medical Center Division of Allergy, Pulmonary and Critical Care Medicine, Nashville, TN, USA
| | - Evan L Brittain
- 1 Vanderbilt University Medical Center Division of Cardiovascular Medicine, Nashville, TN, USA
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104
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Liu R, Zhang Q, Luo Q, Qiao H, Wang P, Yu J, Cao Y, Lu B, Qu L. Norepinephrine stimulation of alpha1D-adrenoceptor promotes proliferation of pulmonary artery smooth muscle cells via ERK-1/2 signaling. Int J Biochem Cell Biol 2017; 88:100-112. [PMID: 28476501 DOI: 10.1016/j.biocel.2017.05.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 03/20/2017] [Accepted: 05/02/2017] [Indexed: 11/25/2022]
Abstract
It has been shown that the sympathetic nervous system is activated in pulmonary arterial hypertension (PAH). Norepinephrine (NE) levels are increased by chemoreflex-dependent sympathetic overactivation and involved in pulmonary vascular remodeling. However, the underlying mechanisms of the remodeling induced by NE are poorly understood. In this study, we found that, in vivo, the expression of tyrosine hydroxylase and the concentration of plasma NE were increased in PAH rats compared with normal rats. Increases in ventricular hypertrophy and medial width of the pulmonary arteries were reversed by prazosin, α1-adrenoceptor (α1-AR) antagonists, in PAH rats. Elevated expression of α1D-AR was detected in PAH rats. In addition, prazosin reduced the increasing expression of PCNA, CyclinA and CyclinE induced by hypoxia. In vitro, MTT assay, flow cytometry, Western blotting and immunofluorescence were performed to investigate the effects of NE on proliferation of pulmonary artery smooth muscle cells (PASMCs). We revealed that NE promoted PASMCs viability, increased the expression of PCNA, CyclinA and CyclinE, made more cells from G0/G1 phase to G2/M+S phase and enhanced the microtubule formation. Above NE-induced changes could be suppressed by BMY 7378, an inhibitor of α1D-AR. Furthermore, ERK-1/2 pathway was activated by NE. U0126, a specific inhibitor for ERK-1/2, attenuated the NE-induced proliferation of PASMCs under normoxia and hypoxia. Taken together, our results suggest that NE which stimulates α1D-AR promotes proliferation of PASMCs and the effect is, at least in part, mediated via the ERK-1/2 pathway.
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Affiliation(s)
- Ruxia Liu
- Department of Physiology, College of Basic Medical Sciences, Harbin Medical University-Daqing, Daqing, China
| | - Qianlong Zhang
- Department of Physiology, College of Basic Medical Sciences, Harbin Medical University-Daqing, Daqing, China
| | - Qian Luo
- Department of Physiology, College of Basic Medical Sciences, Harbin Medical University-Daqing, Daqing, China
| | - Hui Qiao
- Department of Physiology, College of Basic Medical Sciences, Harbin Medical University-Daqing, Daqing, China
| | - Peng Wang
- Department of Physiology, College of Basic Medical Sciences, Harbin Medical University-Daqing, Daqing, China
| | - Juan Yu
- Department of Physiology, College of Basic Medical Sciences, Harbin Medical University-Daqing, Daqing, China
| | - Yonggang Cao
- Department of Pharmacology, College of Basic Medical Sciences, Harbin Medical University-Daqing, Daqing, China
| | - Bo Lu
- Department of Genetics and Cell Biology, College of Basic Medical Sciences, Harbin Medical University-Daqing, Daqing, China
| | - Lihui Qu
- Department of Physiology, College of Basic Medical Sciences, Harbin Medical University-Daqing, Daqing, China.
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105
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Perros F, de Man FS, Bogaard HJ, Antigny F, Simonneau G, Bonnet S, Provencher S, Galiè N, Humbert M. Use of β-Blockers in Pulmonary Hypertension. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.116.003703. [DOI: 10.1161/circheartfailure.116.003703] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 02/24/2017] [Indexed: 12/13/2022]
Abstract
Contrasting with the major attention that left heart failure has received, right heart failure remains understudied both at the preclinical and clinical levels. However, right ventricle failure is a major predictor of outcomes in patients with precapillary pulmonary hypertension because of pulmonary arterial hypertension, and in patients with postcapillary pulmonary hypertension because of left heart disease. In pulmonary hypertension, the status of the right ventricle is one of the most important predictors of both morbidity and mortality. Paradoxically, there are currently no approved therapies targeting the right ventricle in pulmonary hypertension. By analogy with the key role of β-blockers in the management of left heart failure, some authors have proposed to use these agents to support the right ventricle function in pulmonary hypertension. In this review, we summarize the current knowledge on the use of β-blockers in pulmonary hypertension.
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Affiliation(s)
- Frédéric Perros
- From the University Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France (F.P., F.A., G.S., M.H.); AP-HP, Service de Pneumologie, Hôpital Bicêtre, Le Kremlin Bicêtre, France (F.P., F.A., G.S., M.H.); Inserm UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France (F.P., F.A., G.S., M.H.); Department of Pulmonology, VU University Medical Centre, Amsterdam, The Netherlands (F.S.d.M., H.J.B.); Pulmonary Hypertension Research Group, Centre de Recherche de
| | - Frances S. de Man
- From the University Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France (F.P., F.A., G.S., M.H.); AP-HP, Service de Pneumologie, Hôpital Bicêtre, Le Kremlin Bicêtre, France (F.P., F.A., G.S., M.H.); Inserm UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France (F.P., F.A., G.S., M.H.); Department of Pulmonology, VU University Medical Centre, Amsterdam, The Netherlands (F.S.d.M., H.J.B.); Pulmonary Hypertension Research Group, Centre de Recherche de
| | - Harm J. Bogaard
- From the University Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France (F.P., F.A., G.S., M.H.); AP-HP, Service de Pneumologie, Hôpital Bicêtre, Le Kremlin Bicêtre, France (F.P., F.A., G.S., M.H.); Inserm UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France (F.P., F.A., G.S., M.H.); Department of Pulmonology, VU University Medical Centre, Amsterdam, The Netherlands (F.S.d.M., H.J.B.); Pulmonary Hypertension Research Group, Centre de Recherche de
| | - Fabrice Antigny
- From the University Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France (F.P., F.A., G.S., M.H.); AP-HP, Service de Pneumologie, Hôpital Bicêtre, Le Kremlin Bicêtre, France (F.P., F.A., G.S., M.H.); Inserm UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France (F.P., F.A., G.S., M.H.); Department of Pulmonology, VU University Medical Centre, Amsterdam, The Netherlands (F.S.d.M., H.J.B.); Pulmonary Hypertension Research Group, Centre de Recherche de
| | - Gérald Simonneau
- From the University Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France (F.P., F.A., G.S., M.H.); AP-HP, Service de Pneumologie, Hôpital Bicêtre, Le Kremlin Bicêtre, France (F.P., F.A., G.S., M.H.); Inserm UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France (F.P., F.A., G.S., M.H.); Department of Pulmonology, VU University Medical Centre, Amsterdam, The Netherlands (F.S.d.M., H.J.B.); Pulmonary Hypertension Research Group, Centre de Recherche de
| | - Sébastien Bonnet
- From the University Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France (F.P., F.A., G.S., M.H.); AP-HP, Service de Pneumologie, Hôpital Bicêtre, Le Kremlin Bicêtre, France (F.P., F.A., G.S., M.H.); Inserm UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France (F.P., F.A., G.S., M.H.); Department of Pulmonology, VU University Medical Centre, Amsterdam, The Netherlands (F.S.d.M., H.J.B.); Pulmonary Hypertension Research Group, Centre de Recherche de
| | - Steeve Provencher
- From the University Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France (F.P., F.A., G.S., M.H.); AP-HP, Service de Pneumologie, Hôpital Bicêtre, Le Kremlin Bicêtre, France (F.P., F.A., G.S., M.H.); Inserm UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France (F.P., F.A., G.S., M.H.); Department of Pulmonology, VU University Medical Centre, Amsterdam, The Netherlands (F.S.d.M., H.J.B.); Pulmonary Hypertension Research Group, Centre de Recherche de
| | - Nazzareno Galiè
- From the University Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France (F.P., F.A., G.S., M.H.); AP-HP, Service de Pneumologie, Hôpital Bicêtre, Le Kremlin Bicêtre, France (F.P., F.A., G.S., M.H.); Inserm UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France (F.P., F.A., G.S., M.H.); Department of Pulmonology, VU University Medical Centre, Amsterdam, The Netherlands (F.S.d.M., H.J.B.); Pulmonary Hypertension Research Group, Centre de Recherche de
| | - Marc Humbert
- From the University Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France (F.P., F.A., G.S., M.H.); AP-HP, Service de Pneumologie, Hôpital Bicêtre, Le Kremlin Bicêtre, France (F.P., F.A., G.S., M.H.); Inserm UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France (F.P., F.A., G.S., M.H.); Department of Pulmonology, VU University Medical Centre, Amsterdam, The Netherlands (F.S.d.M., H.J.B.); Pulmonary Hypertension Research Group, Centre de Recherche de
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106
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Nickel NP, O'Leary JM, Brittain EL, Fessel JP, Zamanian RT, West JD, Austin ED. Kidney dysfunction in patients with pulmonary arterial hypertension. Pulm Circ 2017; 7:38-54. [PMID: 28680564 PMCID: PMC5448543 DOI: 10.1086/690018] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 10/26/2016] [Indexed: 12/19/2022] Open
Abstract
Pulmonary arterial hypertension (PH) and chronic kidney disease (CKD) both profoundly impact patient outcomes, whether as primary disease states or as co-morbid conditions. PH is a common co-morbidity in CKD and vice versa. A growing body of literature describes the epidemiology of PH secondary to chronic kidney disease and end-stage renal disease (ESRD) (WHO group 5 PH). But, there are only limited data on the epidemiology of kidney disease in group 1 PH (pulmonary arterial hypertension [PAH]). The purpose of this review is to summarize the current data on epidemiology and discuss potential disease mechanisms and management implications of kidney dysfunction in PAH. Kidney dysfunction, determined by serum creatinine or estimated glomerular filtration rate, is a frequent co-morbidity in PAH and impaired kidney function is a strong and independent predictor of mortality. Potential mechanisms of PAH affecting the kidneys are increased venous congestion, decreased cardiac output, and neurohormonal activation. On a molecular level, increased TGF-β signaling and increased levels of circulating cytokines could have the potential to worsen kidney function. Nephrotoxicity does not seem to be a common side effect of PAH-targeted therapy. Treatment implications for kidney disease in PAH include glycemic control, lifestyle modification, and potentially Renin-Angiotensin-Aldosterone System (RAAS) blockade.
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Affiliation(s)
- N P Nickel
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.,Division of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - J M O'Leary
- Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - E L Brittain
- Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - J P Fessel
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - R T Zamanian
- Division of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - J D West
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - E D Austin
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
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107
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The Correlation of Decreased Heart Rate Recovery and Chronotropic Incompetence with Exercise Capacity in Idiopathic Pulmonary Arterial Hypertension Patients. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3415401. [PMID: 28286762 PMCID: PMC5329652 DOI: 10.1155/2017/3415401] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 11/11/2016] [Accepted: 12/13/2016] [Indexed: 12/31/2022]
Abstract
We show by this study that a decrease in HRR1 in IPAH patients is associated with severe limitation of exercise capacity. HRR1 < 16 beats and CI just after completion of a CPET could be an indicator of poor prognosis.
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108
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da Silva Gonçalves Bos D, Happé C, Schalij I, Pijacka W, Paton JFR, Guignabert C, Tu L, Thuillet R, Bogaard HJ, van Rossum AC, Vonk-Noordegraaf A, de Man FS, Handoko ML. Renal Denervation Reduces Pulmonary Vascular Remodeling and Right Ventricular Diastolic Stiffness in Experimental Pulmonary Hypertension. JACC Basic Transl Sci 2017; 2:22-35. [PMID: 29034356 PMCID: PMC5628179 DOI: 10.1016/j.jacbts.2016.09.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 09/17/2016] [Accepted: 09/20/2016] [Indexed: 01/20/2023]
Abstract
Neurohormonal overactivation plays an important role in pulmonary hypertension (PH). In this context, renal denervation, which aims to inhibit the neurohormonal systems, may be a promising adjunct therapy in PH. In this proof-of-concept study, we have demonstrated in 2 experimental models of PH that renal denervation delayed disease progression, reduced pulmonary vascular remodeling, lowered right ventricular afterload, and decreased right ventricular diastolic stiffness, most likely by suppression of the renin-angiotensin-aldosterone system.
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Key Words
- AT1, angiotensin II type 1
- Ea, right ventricular afterload
- Eed, right ventricular stiffness
- Ees, right ventricular contractility
- MCT, monocrotaline model
- PH, pulmonary hypertension
- RAAS, renin angiotensin-aldosterone system
- RD, renal denervation
- SNS, sympathetic nervous system
- SuHx, sugen combined with hypoxia model
- pulmonary hypertension
- renin angiotensin system
- right ventricular failure
- sympathetic nervous system
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Affiliation(s)
- Denielli da Silva Gonçalves Bos
- Department of Pulmonology, VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, the Netherlands.,Department of Physiology VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, the Netherlands
| | - Chris Happé
- Department of Pulmonology, VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, the Netherlands.,Department of Physiology VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, the Netherlands
| | - Ingrid Schalij
- Department of Pulmonology, VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, the Netherlands.,Department of Physiology VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, the Netherlands
| | - Wioletta Pijacka
- School of Physiology, Pharmacology & Neuroscience, Biomedical Sciences, University of Bristol, Bristol, United Kingdom
| | - Julian F R Paton
- School of Physiology, Pharmacology & Neuroscience, Biomedical Sciences, University of Bristol, Bristol, United Kingdom
| | - Christophe Guignabert
- University of Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France.,INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Ly Tu
- University of Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France.,INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Raphaël Thuillet
- University of Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France.,INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Harm-Jan Bogaard
- Department of Pulmonology, VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, the Netherlands
| | - Albert C van Rossum
- Department of Cardiology, VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, the Netherlands
| | - Anton Vonk-Noordegraaf
- Department of Pulmonology, VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, the Netherlands
| | - Frances S de Man
- Department of Pulmonology, VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, the Netherlands.,Department of Physiology VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, the Netherlands
| | - M Louis Handoko
- Department of Physiology VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, the Netherlands.,Department of Cardiology, VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, the Netherlands
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109
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Matura LA, Fargo J, Fritz JS, Smith KA, Vaidya A, Pinder D, Archer-Chicko C, Palevsky HI, Pack AI, Sommers MS, Kawut SM. Slow-paced respiration therapy to treat symptoms in pulmonary arterial hypertension. Heart Lung 2016; 46:7-13. [PMID: 27884398 DOI: 10.1016/j.hrtlng.2016.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 11/02/2016] [Accepted: 11/07/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To determine the feasibility of using slow-paced respiration therapy to treat symptoms in women with pulmonary arterial hypertension (PAH). BACKGROUND People with PAH report increased dyspnea, fatigue and sleep disturbance that can impair health-related quality of life (HRQOL). METHODS Ten women with PAH received 8-weeks of daily, 15 min sessions using slow-paced respiration therapy via the RESPeRATE™ device. Participants had baseline and follow up assessments including plasma norepinephrine and interleukin-6 (IL-6), self-report questionnaires to measure dyspnea, fatigue, depressive symptoms, sleep and HRQOL along with 7-day actigraphy and sleep diaries. RESULTS The mean age was 50 years. Adherence to the intervention was 92%. There was decrease in median IL-6 levels [1.3 ± 0.5 to 1.1 ± 0.4, 95% CI (0.03-0.43)] over the study period. Sleep disturbance decreased, depressive symptoms decreased and HRQOL scores decreased (higher scores indicate worse HRQOL). CONCLUSIONS In this pilot study, slow-paced respiration therapy is feasible in patients with PAH and may improve symptoms and lower IL-6.
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Affiliation(s)
- Lea Ann Matura
- University of Pennsylvania, School of Nursing, Philadelphia, PA, USA.
| | | | - Jason S Fritz
- Perelman School of Medicine of the University of Pennsylvania, Pulmonary, Allergy and Critical Care, Philadelphia, PA, USA
| | - Kerri A Smith
- Perelman School of Medicine of the University of Pennsylvania, Pulmonary, Allergy and Critical Care, Philadelphia, PA, USA
| | - Anjali Vaidya
- Perelman School of Medicine of the University of Pennsylvania, Division of Cardiovascular Medicine, Philadelphia, PA, USA
| | - Diane Pinder
- Perelman School of Medicine of the University of Pennsylvania, Pulmonary, Allergy and Critical Care, Philadelphia, PA, USA
| | - Christine Archer-Chicko
- Perelman School of Medicine of the University of Pennsylvania, Pulmonary, Allergy and Critical Care, Philadelphia, PA, USA
| | - Harold I Palevsky
- Perelman School of Medicine of the University of Pennsylvania, Pulmonary, Allergy and Critical Care, Philadelphia, PA, USA
| | - Allan I Pack
- Center for Sleep and Respiratory Neurobiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Marilyn S Sommers
- University of Pennsylvania, School of Nursing, Philadelphia, PA, USA
| | - Steven M Kawut
- Center for Clinical Epidemiology and Biostatistics, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
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110
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cAMP-PKA-CaMKII signaling pathway is involved in aggravated cardiotoxicity during Fuzi and Beimu Combination Treatment of Experimental Pulmonary Hypertension. Sci Rep 2016; 6:34903. [PMID: 27739450 PMCID: PMC5064387 DOI: 10.1038/srep34903] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 09/20/2016] [Indexed: 01/03/2023] Open
Abstract
Aconiti Lateralis Radix Praeparata (Fuzi) and Fritillariae Thunbergii bulbus (Beimu) have been widely used clinically to treat cardiopulmonary related diseases in China. However, according to the classic rules of traditional Chinese medicine, Fuzi and Beimu should be prohibited to use as a combination for their incompatibility. Therefore, it is critical to elucidate the paradox on the use of Fuzi and Beimu combination therapy. Monocrotaline-induced pulmonary hypertension rats were treated with either Fuzi, Beimu, or their combination at different stages of PH. We demonstrated that at the early stage of PH, Fuzi and Beimu combination significantly improved lung function and reduced pulmonary histopathology. However, as the disease progressed, when Fuzi and Beimu combination were used at the late stage of PH, right ventricular chamber dilation was histologically apparent and myocardial apoptosis was significantly increased compared with each drug alone. Western-blotting results indicated that the main chemical ingredient of Beimu could down-regulate the protein phosphorylation levels of Akt and PDE4D, whereas the combination of Fuzi and Beimu could up-regulate PKA and CaMKII signaling pathways. Therefore, we concluded that Fuzi and Beimu combination potentially aggravated the heart injury due to the inhibition of PDK1/Akt/PDE4D axis and subsequent synergistic activation of βAR-Gs-PKA/CaMKII signaling pathway.
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111
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Liu C, Jiang XM, Zhang J, Li B, Li J, Xie DJ, Hu ZY. Pulmonary artery denervation improves pulmonary arterial hypertension induced right ventricular dysfunction by modulating the local renin-angiotensin-aldosterone system. BMC Cardiovasc Disord 2016; 16:192. [PMID: 27724864 PMCID: PMC5057227 DOI: 10.1186/s12872-016-0366-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 09/28/2016] [Indexed: 12/05/2022] Open
Abstract
Background Pulmonary arterial hypertension (PAH) is commonly accompanied with the activation of the renin-angiotensin-aldosterone system (RAAS). Renal sympathetic denervation (RSD) reduces PAH partly through the inhibition of RAAS. Analogically, we hypothesized that pulmonary artery denervation (PADN) could reverse PAH and PAH-induced right ventricular (RV) dysfunction by downregulating the local RAAS activity. Methods Twenty-five beagle dogs were randomized into two groups: control group (intra-atrial injection of N-dimethylacetamide, 3 mg/kg, n = 6) and test group (intra-atrial injection of dehydrogenized-monocrotaline, 3 mg/kg, n = 19). Eight weeks later, dogs in the test group with mean pulmonary arterial pressure (mPAP) ≥25 mmHg (n = 16) were reassigned into the sham (n = 8) and PADN groups (n = 8) by chance. After another 6 weeks, the hemodynamics, pulmonary tissue morphology and the local RAAS expression in lung and right heart tissue were measured. Results PADN reduced the mPAP (25.94 ± 3.67 mmHg vs 33.72 ± 5.76 mmHg, P < 0.05) and the percentage of medial wall thickness (%MWT) (31.0 ± 2.6 % vs 37.9 ± 2.8 %, P < 0.05) compared with the sham group. PADN attenuated RV dysfunction, marked with reduced atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP) and ratio of right ventricular to left ventricular plus septum weight [RV/(LV + S)]. Moreover, the local RAAS expression was activated in PAH dogs while inhibited after PADN. Conclusions PADN improves hemodynamics and relieves RV dysfunction in dogs with PAH, which can be associated with the downregulating RAAS activity in local tissue.
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Affiliation(s)
- Chen Liu
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, 68# Changle Road, Nanjing, 210006, China
| | - Xiao-Min Jiang
- Division of Cardiology, Nanjing First Hospital, 68# Changle Road, Nanjing, 210006, China
| | - Juan Zhang
- Division of Cardiology, Nanjing First Hospital, 68# Changle Road, Nanjing, 210006, China
| | - Bing Li
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, 68# Changle Road, Nanjing, 210006, China
| | - Jing Li
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, 68# Changle Road, Nanjing, 210006, China
| | - Du-Jiang Xie
- Division of Cardiology, Nanjing First Hospital, 68# Changle Road, Nanjing, 210006, China
| | - Zuo-Ying Hu
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, 68# Changle Road, Nanjing, 210006, China.
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112
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Rothman AMK, Arnold ND, Chang W, Watson O, Swift AJ, Condliffe R, Elliot CA, Kiely DG, Suvarna SK, Gunn J, Lawrie A. Pulmonary artery denervation reduces pulmonary artery pressure and induces histological changes in an acute porcine model of pulmonary hypertension. Circ Cardiovasc Interv 2016; 8:e002569. [PMID: 26553697 PMCID: PMC4648184 DOI: 10.1161/circinterventions.115.002569] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pulmonary arterial hypertension is a devastating disease with high morbidity and mortality and limited treatment options. Recent studies have shown that pulmonary artery denervation improves pulmonary hemodynamics in an experimental model and in an early clinical trial. We aimed to evaluate the nerve distribution around the pulmonary artery, to determine the effect of radiofrequency pulmonary artery denervation on acute pulmonary hypertension induced by vasoconstriction, and to demonstrate denervation of the pulmonary artery at a histological level. METHODS AND RESULTS Histological evaluation identified a circumferential distribution of nerves around the proximal pulmonary arteries. Nerves were smaller in diameter, greater in number, and located in closer proximity to the luminal aspect of the pulmonary arterial wall beyond the pulmonary artery bifurcation. To determine the effect of pulmonary arterial denervation acute pulmonary hypertension was induced in 8 pigs by intravenous infusion of thromboxane A2 analogue. Animals were assigned to either pulmonary artery denervation, using a prototype radiofrequency catheter and generator, or a sham procedure. Pulmonary artery denervation resulted in reduced mean pulmonary artery pressure and pulmonary vascular resistance and increased cardiac output. Ablation lesions on the luminal surface of the pulmonary artery were accompanied by histological and biochemical alteration in adventitial nerves and correlated with improved hemodynamic parameters. CONCLUSIONS Pulmonary artery denervation offers the possibility of a new treatment option for patients with pulmonary arterial hypertension. Further work is required to determine the long-term efficacy and safety.
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Affiliation(s)
- Alexander M K Rothman
- From the Department of Cardiovascular Science (A.M.K.R., N.D.A., O.W., S.K.S., J.G., A.L.), Academic Unit of Radiology (A.J.S.), and INSIGNEO, Institute for Insilico Medicine (A.M.K.R., A.J.S., J.G.), University of Sheffield, Sheffield, United Kingdom; Medtronic Inc, Santa Rosa, CA (W.C.); and Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom (R.C., C.A.E., D.G.K.).
| | - Nadine D Arnold
- From the Department of Cardiovascular Science (A.M.K.R., N.D.A., O.W., S.K.S., J.G., A.L.), Academic Unit of Radiology (A.J.S.), and INSIGNEO, Institute for Insilico Medicine (A.M.K.R., A.J.S., J.G.), University of Sheffield, Sheffield, United Kingdom; Medtronic Inc, Santa Rosa, CA (W.C.); and Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom (R.C., C.A.E., D.G.K.)
| | - William Chang
- From the Department of Cardiovascular Science (A.M.K.R., N.D.A., O.W., S.K.S., J.G., A.L.), Academic Unit of Radiology (A.J.S.), and INSIGNEO, Institute for Insilico Medicine (A.M.K.R., A.J.S., J.G.), University of Sheffield, Sheffield, United Kingdom; Medtronic Inc, Santa Rosa, CA (W.C.); and Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom (R.C., C.A.E., D.G.K.)
| | - Oliver Watson
- From the Department of Cardiovascular Science (A.M.K.R., N.D.A., O.W., S.K.S., J.G., A.L.), Academic Unit of Radiology (A.J.S.), and INSIGNEO, Institute for Insilico Medicine (A.M.K.R., A.J.S., J.G.), University of Sheffield, Sheffield, United Kingdom; Medtronic Inc, Santa Rosa, CA (W.C.); and Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom (R.C., C.A.E., D.G.K.)
| | - Andrew J Swift
- From the Department of Cardiovascular Science (A.M.K.R., N.D.A., O.W., S.K.S., J.G., A.L.), Academic Unit of Radiology (A.J.S.), and INSIGNEO, Institute for Insilico Medicine (A.M.K.R., A.J.S., J.G.), University of Sheffield, Sheffield, United Kingdom; Medtronic Inc, Santa Rosa, CA (W.C.); and Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom (R.C., C.A.E., D.G.K.)
| | - Robin Condliffe
- From the Department of Cardiovascular Science (A.M.K.R., N.D.A., O.W., S.K.S., J.G., A.L.), Academic Unit of Radiology (A.J.S.), and INSIGNEO, Institute for Insilico Medicine (A.M.K.R., A.J.S., J.G.), University of Sheffield, Sheffield, United Kingdom; Medtronic Inc, Santa Rosa, CA (W.C.); and Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom (R.C., C.A.E., D.G.K.)
| | - Charlie A Elliot
- From the Department of Cardiovascular Science (A.M.K.R., N.D.A., O.W., S.K.S., J.G., A.L.), Academic Unit of Radiology (A.J.S.), and INSIGNEO, Institute for Insilico Medicine (A.M.K.R., A.J.S., J.G.), University of Sheffield, Sheffield, United Kingdom; Medtronic Inc, Santa Rosa, CA (W.C.); and Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom (R.C., C.A.E., D.G.K.)
| | - David G Kiely
- From the Department of Cardiovascular Science (A.M.K.R., N.D.A., O.W., S.K.S., J.G., A.L.), Academic Unit of Radiology (A.J.S.), and INSIGNEO, Institute for Insilico Medicine (A.M.K.R., A.J.S., J.G.), University of Sheffield, Sheffield, United Kingdom; Medtronic Inc, Santa Rosa, CA (W.C.); and Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom (R.C., C.A.E., D.G.K.)
| | - S Kim Suvarna
- From the Department of Cardiovascular Science (A.M.K.R., N.D.A., O.W., S.K.S., J.G., A.L.), Academic Unit of Radiology (A.J.S.), and INSIGNEO, Institute for Insilico Medicine (A.M.K.R., A.J.S., J.G.), University of Sheffield, Sheffield, United Kingdom; Medtronic Inc, Santa Rosa, CA (W.C.); and Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom (R.C., C.A.E., D.G.K.)
| | - Julian Gunn
- From the Department of Cardiovascular Science (A.M.K.R., N.D.A., O.W., S.K.S., J.G., A.L.), Academic Unit of Radiology (A.J.S.), and INSIGNEO, Institute for Insilico Medicine (A.M.K.R., A.J.S., J.G.), University of Sheffield, Sheffield, United Kingdom; Medtronic Inc, Santa Rosa, CA (W.C.); and Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom (R.C., C.A.E., D.G.K.)
| | - Allan Lawrie
- From the Department of Cardiovascular Science (A.M.K.R., N.D.A., O.W., S.K.S., J.G., A.L.), Academic Unit of Radiology (A.J.S.), and INSIGNEO, Institute for Insilico Medicine (A.M.K.R., A.J.S., J.G.), University of Sheffield, Sheffield, United Kingdom; Medtronic Inc, Santa Rosa, CA (W.C.); and Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom (R.C., C.A.E., D.G.K.)
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Schisler T, Marquez JM, Hilmi I, Subramaniam K. Pulmonary Hypertensive Crisis on Induction of Anesthesia. Semin Cardiothorac Vasc Anesth 2016; 21:105-113. [DOI: 10.1177/1089253216652222] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Anesthesia for lung transplantation remains one of the highest risk surgeries in the domain of the cardiothoracic anesthesiologist. End-stage lung disease, pulmonary hypertension, and right heart dysfunction as well as other comorbid disease factors predispose the patient to cardiovascular, respiratory and metabolic dysfunction during general anesthesia. Perhaps the highest risk phase of surgery in the patient with severe pulmonary hypertension is during the induction of anesthesia when the removal of intrinsic sympathetic tone and onset of positive pressure ventilation can decompensate a severely compromised cardiovascular system. Severe hypotension, cardiac arrest, and death have been reported previously. Here we present 2 high-risk patients for lung transplantation, their anesthetic induction course, and outcomes. We offer suggestions for the safe management of anesthetic induction to mitigate against hemodynamic and respiratory complications.
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Affiliation(s)
- Travis Schisler
- University of Pittsburgh Medical Center Health System, Pittsburgh, PA, USA
| | - Jose M Marquez
- University of Pittsburgh Medical Center Health System, Pittsburgh, PA, USA
| | - Ibtesam Hilmi
- University of Pittsburgh Medical Center Health System, Pittsburgh, PA, USA
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Slingo M, Cole M, Carr C, Curtis MK, Dodd M, Giles L, Heather LC, Tyler D, Clarke K, Robbins PA. The von Hippel-Lindau Chuvash mutation in mice alters cardiac substrate and high-energy phosphate metabolism. Am J Physiol Heart Circ Physiol 2016; 311:H759-67. [PMID: 27422990 PMCID: PMC5142182 DOI: 10.1152/ajpheart.00912.2015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 07/12/2016] [Indexed: 02/07/2023]
Abstract
This is the first integrative metabolic and functional study of the effects of modest hypoxia-inducible factor manipulation within the heart. Of particular note, the combination (and correlation) of perfused heart metabolic flux measurements with the new technique of real-time in vivo magnetic resonance spectroscopy using hyperpolarized pyruvate is a novel development. Hypoxia-inducible factor (HIF) appears to function as a global master regulator of cellular and systemic responses to hypoxia. HIF pathway manipulation is of therapeutic interest; however, global systemic upregulation of HIF may have as yet unknown effects on multiple processes. We used a mouse model of Chuvash polycythemia (CP), a rare genetic disorder that modestly increases expression of HIF target genes in normoxia, to understand what these effects might be within the heart. An integrated in and ex vivo approach was employed. Compared with wild-type controls, CP mice had evidence (using in vivo magnetic resonance imaging) of pulmonary hypertension, right ventricular hypertrophy, and increased left ventricular ejection fraction. Glycolytic flux (measured using [3H]glucose) in the isolated contracting perfused CP heart was 1.8-fold higher. Net lactate efflux was 1.5-fold higher. Furthermore, in vivo 13C-magnetic resonance spectroscopy (MRS) of hyperpolarized [13C1]pyruvate revealed a twofold increase in real-time flux through lactate dehydrogenase in the CP hearts and a 1.6-fold increase through pyruvate dehydrogenase. 31P-MRS of perfused CP hearts under increased workload (isoproterenol infusion) demonstrated increased depletion of phosphocreatine relative to ATP. Intriguingly, no changes in cardiac gene expression were detected. In summary, a modest systemic dysregulation of the HIF pathway resulted in clear alterations in cardiac metabolism and energetics. However, in contrast to studies generating high HIF levels within the heart, the CP mice showed neither the predicted changes in gene expression nor any degree of LV impairment. We conclude that the effects of manipulating HIF on the heart are dose dependent.
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Affiliation(s)
- Mary Slingo
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford, United Kingdom
| | - Mark Cole
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford, United Kingdom
| | - Carolyn Carr
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford, United Kingdom
| | - Mary K Curtis
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford, United Kingdom
| | - Michael Dodd
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford, United Kingdom
| | - Lucia Giles
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford, United Kingdom
| | - Lisa C Heather
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford, United Kingdom
| | - Damian Tyler
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford, United Kingdom
| | - Kieran Clarke
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford, United Kingdom
| | - Peter A Robbins
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford, United Kingdom
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115
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van Campen JSJA, de Boer K, van de Veerdonk MC, van der Bruggen CEE, Allaart CP, Raijmakers PG, Heymans MW, Marcus JT, Harms HJ, Handoko ML, de Man FS, Vonk Noordegraaf A, Bogaard HJ. Bisoprolol in idiopathic pulmonary arterial hypertension: an explorative study. Eur Respir J 2016; 48:787-96. [PMID: 27390285 DOI: 10.1183/13993003.00090-2016] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 05/21/2016] [Indexed: 01/08/2023]
Abstract
While beta-blockers are considered contraindicated in pulmonary arterial hypertension (PAH), the prognostic significance of sympathetic nervous system over-activity suggests a potential benefit of beta-blocker therapy. The aim of this randomised, placebo-controlled, crossover, single centre study was to determine the effects of bisoprolol on right ventricular ejection fraction (RVEF) in idiopathic PAH (iPAH) patients. Additional efficacy and safety parameters were explored.Patients with optimally treated, stable iPAH (New York Heart Association functional class II/III) were randomised to placebo or bisoprolol. Imaging and functional measurements were performed at baseline, crossover and end of study.18 iPAH patients were included, because inclusion faltered before enrolment of the targeted 25 patients. 17 patients completed 6 months of bisoprolol, 15 tolerated bisoprolol, one patient required intravenous diuretics. Bisoprolol was associated with a lower heart rate (17 beats per minute, p=0.0001) but RVEF remained unchanged. A drop in cardiac index (0.5 L·min(-1)·m(-2), p=0.015) was observed, along with a trend towards a decreased 6-min walking distance (6MWD).Although careful up-titration of bisoprolol was tolerated by most patients and resulted in a decreased heart rate, no benefit of bisoprolol in iPAH was demonstrated. Decreases in cardiac index and 6MWD suggest a deteriorated cardiac function. The results do not favour the use of bisoprolol in iPAH patients.
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Affiliation(s)
- Jasmijn S J A van Campen
- Dept of pulmonary medicine, Institute for cardiovascular research, VU University medical center, Amsterdam, The Netherlands Both authors contributed equally
| | - Karin de Boer
- Dept of cardiology, Institute for cardiovascular research, VU University medical center, Amsterdam, The Netherlands Both authors contributed equally
| | - Mariëlle C van de Veerdonk
- Dept of pulmonary medicine, Institute for cardiovascular research, VU University medical center, Amsterdam, The Netherlands Dept of cardiology, Institute for cardiovascular research, VU University medical center, Amsterdam, The Netherlands
| | - Cathelijne E E van der Bruggen
- Dept of pulmonary medicine, Institute for cardiovascular research, VU University medical center, Amsterdam, The Netherlands
| | - Cor P Allaart
- Dept of cardiology, Institute for cardiovascular research, VU University medical center, Amsterdam, The Netherlands
| | - Pieter G Raijmakers
- Dept of nuclear medicine and PET-research, VU University medical center, Amsterdam, The Netherlands
| | - Martijn W Heymans
- Dept of epidemiology, VU University medical center, Amsterdam, The Netherlands
| | - J Tim Marcus
- Dept of physics and medical technology, VU University medical center, Amsterdam, The Netherlands
| | - Hendrik J Harms
- Dept of pulmonary medicine, Institute for cardiovascular research, VU University medical center, Amsterdam, The Netherlands Dept of nuclear medicine and PET-research, VU University medical center, Amsterdam, The Netherlands
| | - M Louis Handoko
- Dept of cardiology, Institute for cardiovascular research, VU University medical center, Amsterdam, The Netherlands
| | - Frances S de Man
- Dept of pulmonary medicine, Institute for cardiovascular research, VU University medical center, Amsterdam, The Netherlands Dept of physiology, Institute for cardiovascular research, VU University medical center, Amsterdam, The Netherlands
| | - Anton Vonk Noordegraaf
- Dept of pulmonary medicine, Institute for cardiovascular research, VU University medical center, Amsterdam, The Netherlands
| | - Harm-Jan Bogaard
- Dept of pulmonary medicine, Institute for cardiovascular research, VU University medical center, Amsterdam, The Netherlands Dept of physiology, Institute for cardiovascular research, VU University medical center, Amsterdam, The Netherlands
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116
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de Man FS, Handoko ML. β-blockers in pulmonary arterial hypertension: evolving concepts of right heart failure. Eur Respir J 2016; 46:619-21. [PMID: 26324694 DOI: 10.1183/09031936.00051215] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Frances S de Man
- Dept of Pulmonology, VU University Medical Center/Institute for Cardiovascular Research, Amsterdam, The Netherlands
| | - M Louis Handoko
- Dept of Cardiology, VU University Medical Center/Institute for Cardiovascular Research, Amsterdam, The Netherlands
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Baggen VJM, Driessen MMP, Post MC, van Dijk AP, Roos-Hesselink JW, van den Bosch AE, Takkenberg JJM, Sieswerda GT. Echocardiographic findings associated with mortality ortransplant in patients with pulmonary arterial hypertension:A systematic review and meta-analysis. Neth Heart J 2016; 24:374-389. [PMID: 27189216 PMCID: PMC4887306 DOI: 10.1007/s12471-016-0845-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background Identification of patients at risk of deterioration is essential to guide clinical management in pulmonary arterial hypertension (PAH). This study aims to provide a comprehensive overview of well-investigated echocardiographic findings that are associated with clinical deterioration in PAH. Methods MEDLINE and EMBASE databases were systematically searched for longitudinal studies published by April 2015 that reported associations between echocardiographic findings and mortality, transplant or clinical worsening. Meta-analysis using random effect models was performed for echocardiographic findings investigated by four or more studies. In case of statistical heterogeneity a sensitivity analysis was conducted. Results Thirty-seven papers investigating 51 echocardiographic findings were included. Meta-analysis of univariable hazard ratios (HRs) and sensitivity analysis showed that presence of pericardial effusion (pooled HR 1.70; 95 % CI 1.44–1.99), right atrial area (pooled HR 1.71; 95 % CI 1.38–2.13) and tricuspid annular plane systolic excursion (TAPSE; pooled HR 1.72; 95 % CI 1.34–2.20) were the most well-investigated and robust predictors of mortality or transplant. Conclusions This meta-analysis substantiates the clinical yield of specific echocardiographic findings in the prognostication of PAH patients in day-to-day practice. In particular, pericardial effusion, right atrial area and TAPSE are of prognostic value. Electronic supplementary material The online version of this article (doi: 10.1007/s12471-016-0845-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- V J M Baggen
- Department of Cardiology, University Medical Centre Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands
- Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - M M P Driessen
- Department of Cardiology, University Medical Centre Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - M C Post
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - A P van Dijk
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J W Roos-Hesselink
- Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - A E van den Bosch
- Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - J J M Takkenberg
- Department of Cardio-Thoracic Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - G T Sieswerda
- Department of Cardiology, University Medical Centre Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
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Ameri P, Bertero E, Meliota G, Cheli M, Canepa M, Brunelli C, Balbi M. Neurohormonal activation and pharmacological inhibition in pulmonary arterial hypertension and related right ventricular failure. Heart Fail Rev 2016; 21:539-47. [DOI: 10.1007/s10741-016-9566-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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119
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Abstract
PURPOSE OF REVIEW The purpose of this review was to evaluate the consequence of obstructive sleep apnea (OSA) in pulmonary hypertension by reviewing the current literature and understanding potential pathophysiological mechanisms. RECENT FINDINGS Small studies have suggested a high prevalence of comorbid OSA in those with known pulmonary hypertension. Pathophysiological mechanisms are highly suggestive of potential deleterious effect of OSA on pulmonary hemodynamics. SUMMARY Clearly, current research work on comorbid OSA and pulmonary hypertension is still in its infancy and the field is ripe for future investigation. The significance of OSA in this population has yet to be fully determined.
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120
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A study on the involvement of GABA-transaminase in MCT induced pulmonary hypertension. Pulm Pharmacol Ther 2016; 36:10-21. [DOI: 10.1016/j.pupt.2015.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 11/04/2015] [Accepted: 11/12/2015] [Indexed: 12/15/2022]
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Mar PL, Nwazue V, Black BK, Biaggioni I, Diedrich A, Paranjape SY, Loyd JE, Hemnes AR, Robbins IM, Robertson D, Raj SR, Austin ED. Valsalva Maneuver in Pulmonary Arterial Hypertension: Susceptibility to Syncope and Autonomic Dysfunction. Chest 2016; 149:1252-60. [PMID: 26836906 DOI: 10.1016/j.chest.2015.11.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 09/22/2015] [Accepted: 11/02/2015] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Patients with pulmonary arterial hypertension (PAH) are routinely instructed to avoid performing the Valsalva maneuver for fear of syncope or sudden cardiac death. The mechanism of this action has not been elucidated. We conducted a case-control trial of nine patients with PAH and 15 healthy control subjects to determine if systemic hemodynamic changes during the Valsalva maneuver in these patients invoke greater susceptibility to syncope than healthy control subjects. Metrics commonly employed in autonomic testing were used to assess the degree of autonomic failure. METHODS Common Valsalva parameters, including adrenergic baroreflex sensitivity, pressure recovery time, systolic BP (SBP) recovery, diastolic BP (DBP) recovery, mean arterial pressure recovery, and the Valsalva ratio, were calculated. Mann-Whitney U tests were used to compare continuous variables. The primary end point was adrenergic baroreflex sensitivity. RESULTS Patients with PAH had lower adrenergic baroreflex sensitivity (9.7 ± 4.6 mm Hg/s vs 18.8 ± 9.2 mm Hg/s; P = .005), longer pressure recovery time (3.6 ± 2.5 s vs 1.7 ± 0.8 s; P = .008), similar SBP recovery (-13 ± 11 mm Hg vs -12 ± 23 mm Hg; P = .640), less DBP recovery (-1 ± 12 mm Hg vs 13 ± 14 mmHg; P = .025), less mean arterial pressure recovery (-5 ± 11 mm Hg vs 5 ± 17 mm Hg; P = .048), and a decreased Valsalva ratio (1.25 ± 0.11 vs 1.60 ± 0.22; P < .001) compared with healthy control subjects. CONCLUSIONS Compared with healthy control subjects, patients with PAH are more susceptible to syncope during the Valsalva maneuver because of autonomic dysfunction causing cerebral hypoperfusion. These study patients with PAH exhibited a degree of susceptibility to syncope similar to a spectrum of patients with intermediate autonomic failure who typically experience a SBP drop of 10 to 30 mm Hg with standing.
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Affiliation(s)
- Philip L Mar
- Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University, Nashville, TN; Division of Cardiovascular Medicine, Department of Medicine, University of Louisville, Louisville, KY
| | - Victor Nwazue
- Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University, Nashville, TN
| | - Bonnie K Black
- Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University, Nashville, TN
| | - Italo Biaggioni
- Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University, Nashville, TN; Department of Pharmacology, Vanderbilt University, Nashville, TN
| | - André Diedrich
- Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University, Nashville, TN; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN
| | - Sachin Y Paranjape
- Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University, Nashville, TN
| | - James E Loyd
- Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University, Nashville, TN
| | - Anna R Hemnes
- Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University, Nashville, TN
| | - Ivan M Robbins
- Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University, Nashville, TN
| | - David Robertson
- Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University, Nashville, TN; Department of Pharmacology, Vanderbilt University, Nashville, TN; Department of Neurology, Vanderbilt University, Nashville, TN
| | - Satish R Raj
- Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University, Nashville, TN; Department of Pharmacology, Vanderbilt University, Nashville, TN; Department of Cardiac Science, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
| | - Eric D Austin
- Department of Pediatrics, Vanderbilt University, Nashville, TN.
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Vicenzi M, Deboeck G, Faoro V, Loison J, Vachiery JL, Naeije R. Exercise oscillatory ventilation in heart failure and in pulmonary arterial hypertension. Int J Cardiol 2016; 202:736-40. [DOI: 10.1016/j.ijcard.2015.09.087] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/09/2015] [Accepted: 09/24/2015] [Indexed: 10/23/2022]
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Zhou L, Zhang J, Jiang XM, Xie DJ, Wang JS, Li L, Li B, Wang ZM, Rothman AM, Lawrie A, Chen SL. Pulmonary Artery Denervation Attenuates Pulmonary Arterial Remodeling in Dogs With Pulmonary Arterial Hypertension Induced by Dehydrogenized Monocrotaline. JACC Cardiovasc Interv 2015; 8:2013-2023. [DOI: 10.1016/j.jcin.2015.09.015] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 09/21/2015] [Accepted: 09/21/2015] [Indexed: 12/24/2022]
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Usselman CW, Steinback CD, Shoemaker JK. Effects of one's sex and sex hormones on sympathetic responses to chemoreflex activation. Exp Physiol 2015; 101:362-7. [PMID: 26582194 DOI: 10.1113/ep085147] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 11/13/2015] [Indexed: 01/17/2023]
Abstract
NEW FINDINGS What is the topic of this review? This review summarizes sex-dependent differences in the sympathetic responses to chemoreflex activation, with a focus on the role of circulating sex hormones on the sympathetic outcomes. What advances does it highlight? The importance of circulating sex hormones for the regulation of sympathetic nerve activity in humans has only recently begun to be elucidated, and few studies have examined this effect during chemoreflex regulation. We review recent studies indicating that changes in circulating sex hormones are associated with alterations to chemoreflex-driven increases in sympathetic activity and highlight those areas which require further study. Sex-dependent differences in baseline sympathetic nerve activity are established, but little information exists on the influence of sex on sympathetic activation during chemoreflex stimulation. In this article, we review the evidence for the effect of sex on chemoreflex-driven increases in sympathetic nerve activity. We also review recent studies which indicate that changes in circulating sex hormones, as initiated by the menstrual cycle and hormonal contraceptive use, elicit notable changes in the muscle sympathetic activation during chemoreflex stimulation.
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Affiliation(s)
- Charlotte W Usselman
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Craig D Steinback
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, Canada
| | - J Kevin Shoemaker
- Neurovascular Research Laboratory, School of Kinesiology, Western University, London, ON, Canada.,Department of Physiology and Pharmacology, Western University, London, ON, Canada
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125
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Novel Therapeutic Strategies for Reducing Right Heart Failure Associated Mortality in Fibrotic Lung Diseases. BIOMED RESEARCH INTERNATIONAL 2015; 2015:929170. [PMID: 26583148 PMCID: PMC4637079 DOI: 10.1155/2015/929170] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 08/26/2015] [Indexed: 11/21/2022]
Abstract
Fibrotic lung diseases carry a significant mortality burden worldwide. A large proportion of these deaths are due to right heart failure and pulmonary hypertension. Underlying contributory factors which appear to play a role in the mechanism of progression of right heart dysfunction include chronic hypoxia, defective calcium handling, hyperaldosteronism, pulmonary vascular alterations, cyclic strain of pressure and volume changes, elevation of circulating TGF-β, and elevated systemic NO levels. Specific therapies targeting pulmonary hypertension include calcium channel blockers, endothelin (ET-1) receptor antagonists, prostacyclin analogs, phosphodiesterase type 5 (PDE5) inhibitors, and rho-kinase (ROCK) inhibitors. Newer antifibrotic and anti-inflammatory agents may exert beneficial effects on heart failure in idiopathic pulmonary fibrosis. Furthermore, right ventricle-targeted therapies, aimed at mitigating the effects of functional right ventricular failure, include β-adrenoceptor (β-AR) blockers, angiotensin-converting enzyme (ACE) inhibitors, antioxidants, modulators of metabolism, and 5-hydroxytryptamine-2B (5-HT2B) receptor antagonists. Newer nonpharmacologic modalities for right ventricular support are increasingly being implemented. Early, effective, and individualized therapy may prevent overt right heart failure in fibrotic lung disease leading to improved outcomes and quality of life.
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Ha D, Fuster M, Ries AL, Wagner PD, Mazzone PJ. Heart Rate Recovery as a Preoperative Test of Perioperative Complication Risk. Ann Thorac Surg 2015; 100:1954-62. [PMID: 26410158 DOI: 10.1016/j.athoracsur.2015.06.085] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 06/09/2015] [Accepted: 06/22/2015] [Indexed: 12/25/2022]
Abstract
The autonomic nervous system plays important physiologic roles in a variety of organ systems. Autonomic dysfunction has been shown to be predictive of increased mortality in patients with cardiovascular disease. Its importance in patients with chronic respiratory disorders has been described in recent years. Here, we summarize the prognostic value of autonomic dysfunction, as reflected by impaired heart rate recovery (HRR), in patients with chronic respiratory disorders, including chronic obstructive pulmonary disease, interstitial lung disease, and lung cancer. We suggest that HRR may be clinically useful in the preoperative physiologic evaluation, specifically in lung cancer patients being considered for surgery.
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Affiliation(s)
- Duc Ha
- Pulmonary and Critical Care Medicine Division, University of California, San Diego, La Jolla, California.
| | - Mark Fuster
- VA San Diego Healthcare System, San Diego, California; Pulmonary and Critical Care Medicine Division, University of California, San Diego, La Jolla, California
| | - Andrew L Ries
- Pulmonary and Critical Care Medicine Division, University of California, San Diego, La Jolla, California
| | - Peter D Wagner
- Pulmonary and Critical Care Medicine Division, University of California, San Diego, La Jolla, California
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Zhao Q, Deng H, Jiang X, Dai Z, Wang X, Wang X, Guo Z, Hu W, Yu S, Yang B, Tang Y, Huang C. Effects of Intrinsic and Extrinsic Cardiac Nerves on Atrial Arrhythmia in Experimental Pulmonary Artery Hypertension. Hypertension 2015; 66:1042-9. [PMID: 26418021 DOI: 10.1161/hypertensionaha.115.05846] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 09/02/2015] [Indexed: 11/16/2022]
Abstract
Atrial arrhythmia, which includes atrial fibrillation (AF) and atrial flutter (AFL), is common in patients with pulmonary arterial hypertension (PAH), who often have increased sympathetic nerve activity. Here, we tested the hypothesis that autonomic nerves play important roles in vulnerability to AF/AFL in PAH. The atrial effective refractory period and AF/AFL inducibility at baseline and after anterior right ganglionated plexi ablation were determined during left stellate ganglion stimulation or left renal sympathetic nerve stimulation in beagle dogs with or without PAH. Then, sympathetic nerve, β-adrenergic receptor densities and connexin 43 expression in atrial tissues were assessed. The sum of the window of vulnerability to AF/AFL was increased in the right atrium compared with the left atrium at baseline in the PAH dogs but not in the controls. The atrial effective refractory period dispersion was increased in the control dogs, but not in the PAH dogs, during left stellate ganglion stimulation. The voltage thresholds for inducing AF/AFL during anterior right ganglionated plexi stimulation were lower in the PAH dogs than in the controls. The AF/AFL inducibility was suppressed after ablation of the anterior right ganglionated plexi in the PAH dogs. The PAH dogs had higher sympathetic nerve and β1-adrenergic receptor densities, increased levels of nonphosphorylated connexin 43, and heterogeneous connexin 43 expression in the right atrium when compared with the control dogs. The anterior right ganglionated plexi play important roles in the induction of AF/AFL. AF/AFL induction was associated with right atrium substrate remodeling in dogs with PAH.
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Affiliation(s)
- Qingyan Zhao
- From the Departments of Cardiology (Q.Z., X.J., Z.D., X.W., X.W., Z.G., S.Y., B.Y., Y.T., C.H.), Thoracic and Cardiovascular Surgery (H.D.), and Ultrasonography (W.H.), Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, Wuchang, Wuhan City, P.R. China
| | - Hongping Deng
- From the Departments of Cardiology (Q.Z., X.J., Z.D., X.W., X.W., Z.G., S.Y., B.Y., Y.T., C.H.), Thoracic and Cardiovascular Surgery (H.D.), and Ultrasonography (W.H.), Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, Wuchang, Wuhan City, P.R. China
| | - Xuejun Jiang
- From the Departments of Cardiology (Q.Z., X.J., Z.D., X.W., X.W., Z.G., S.Y., B.Y., Y.T., C.H.), Thoracic and Cardiovascular Surgery (H.D.), and Ultrasonography (W.H.), Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, Wuchang, Wuhan City, P.R. China
| | - Zixuan Dai
- From the Departments of Cardiology (Q.Z., X.J., Z.D., X.W., X.W., Z.G., S.Y., B.Y., Y.T., C.H.), Thoracic and Cardiovascular Surgery (H.D.), and Ultrasonography (W.H.), Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, Wuchang, Wuhan City, P.R. China
| | - Xiaozhan Wang
- From the Departments of Cardiology (Q.Z., X.J., Z.D., X.W., X.W., Z.G., S.Y., B.Y., Y.T., C.H.), Thoracic and Cardiovascular Surgery (H.D.), and Ultrasonography (W.H.), Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, Wuchang, Wuhan City, P.R. China
| | - Xule Wang
- From the Departments of Cardiology (Q.Z., X.J., Z.D., X.W., X.W., Z.G., S.Y., B.Y., Y.T., C.H.), Thoracic and Cardiovascular Surgery (H.D.), and Ultrasonography (W.H.), Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, Wuchang, Wuhan City, P.R. China
| | - Zongwen Guo
- From the Departments of Cardiology (Q.Z., X.J., Z.D., X.W., X.W., Z.G., S.Y., B.Y., Y.T., C.H.), Thoracic and Cardiovascular Surgery (H.D.), and Ultrasonography (W.H.), Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, Wuchang, Wuhan City, P.R. China
| | - Wei Hu
- From the Departments of Cardiology (Q.Z., X.J., Z.D., X.W., X.W., Z.G., S.Y., B.Y., Y.T., C.H.), Thoracic and Cardiovascular Surgery (H.D.), and Ultrasonography (W.H.), Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, Wuchang, Wuhan City, P.R. China
| | - Shengbo Yu
- From the Departments of Cardiology (Q.Z., X.J., Z.D., X.W., X.W., Z.G., S.Y., B.Y., Y.T., C.H.), Thoracic and Cardiovascular Surgery (H.D.), and Ultrasonography (W.H.), Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, Wuchang, Wuhan City, P.R. China
| | - Bo Yang
- From the Departments of Cardiology (Q.Z., X.J., Z.D., X.W., X.W., Z.G., S.Y., B.Y., Y.T., C.H.), Thoracic and Cardiovascular Surgery (H.D.), and Ultrasonography (W.H.), Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, Wuchang, Wuhan City, P.R. China
| | - Yanhong Tang
- From the Departments of Cardiology (Q.Z., X.J., Z.D., X.W., X.W., Z.G., S.Y., B.Y., Y.T., C.H.), Thoracic and Cardiovascular Surgery (H.D.), and Ultrasonography (W.H.), Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, Wuchang, Wuhan City, P.R. China
| | - Congxin Huang
- From the Departments of Cardiology (Q.Z., X.J., Z.D., X.W., X.W., Z.G., S.Y., B.Y., Y.T., C.H.), Thoracic and Cardiovascular Surgery (H.D.), and Ultrasonography (W.H.), Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, Wuchang, Wuhan City, P.R. China.
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Qingyan Z, Xuejun J, Yanhong T, Zixuan D, Xiaozhan W, Xule W, Zongwen G, Wei H, Shengbo Y, Congxin H. Efectos beneficiosos de la simpatectomía renal sobre el remodelado vascular pulmonar en la hipertensión arterial primaria experimental. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2014.11.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Pulmonary arterial hypertension (PAH) includes a heterogeneous group of diseases characterized by pulmonary vasoconstriction and remodeling of the lung circulation. Although PAH is a disease of the lungs, patients with PAH frequently die of right heart failure. Indeed, survival of patients with PAH depends on the adaptive response of the right ventricle (RV) to the changes in the lung circulation. PAH-specific drugs affect the function of the RV through afterload reduction and perhaps also through direct effects on the myocardium. Prostacyclins, type 5 phosphodiesterase inhibitors, and guanylyl cyclase stimulators may directly enhance myocardial contractility through increased cyclic adenosine and guanosine monophosphate availability. Although this may initially improve cardiac performance, the long-term effects on myocardial oxygen consumption and function are unclear. Cardiac effects of endothelin receptor antagonists may be opposite, as endothelin-1 is known to suppress cardiac contractility. Because PAH is increasingly considered as a disease with quasimalignant growth of cells in the pulmonary vascular wall, therapies are being developed that inhibit hypertrophy and angiogenesis, and promote apoptosis. The inherent danger of these therapies is a further compromise to the already ischemic, fibrotic, and dysfunctional RV. More recently, the right heart has been identified as a direct treatment target in PAH. The effects of well established therapies for left heart failure, such as β-adrenergic receptor blockers, inhibitors of the renin-angiotensin system, exercise training, and assist devices, are currently being investigated in PAH. Future treatment of patients with PAH will likely consist of a multifaceted approaches aiming to reduce the pressure in the lung circulation and improving right heart adaptation simultaneously.
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Poels EM, da Costa Martins PA, van Empel VPM. Adaptive capacity of the right ventricle: why does it fail? Am J Physiol Heart Circ Physiol 2015; 308:H803-13. [DOI: 10.1152/ajpheart.00573.2014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 01/21/2015] [Indexed: 11/22/2022]
Abstract
Only in recent years has the right ventricle (RV) function become appreciated to be equally important to the left ventricle (LV) function to maintain cardiac output. Right ventricular failure is, irrespectively of the etiology, associated with impaired exercise tolerance and poor survival. Since the anatomy and physiology of the RV is distinctly different than that of the LV, its adaptive mechanisms and the pathways involved are different as well. RV hypertrophy is an important mechanism of the RV to preserve cardiac output. This review summarizes the current knowledge on the right ventricle and its response to pathologic situations. We will focus on the adaptive capacity of the right ventricle and the molecular pathways involved, and we will discuss potential therapeutic interventions.
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Affiliation(s)
- Ella M. Poels
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; and
- Department of Cardiology, Heart Vessel Center, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Paula A. da Costa Martins
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; and
| | - Vanessa P. M. van Empel
- Department of Cardiology, Heart Vessel Center, Maastricht University Medical Centre, Maastricht, The Netherlands
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Crnkovic S, Egemnazarov B, Jain P, Seay U, Gattinger N, Marsh LM, Bálint Z, Kovacs G, Ghanim B, Klepetko W, Schermuly RT, Weissmann N, Olschewski A, Kwapiszewska G. NPY/Y₁ receptor-mediated vasoconstrictory and proliferative effects in pulmonary hypertension. Br J Pharmacol 2015; 171:3895-907. [PMID: 24779394 DOI: 10.1111/bph.12751] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 04/14/2014] [Accepted: 04/18/2014] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND AND PURPOSE Pulmonary arteries (PAs) are innervated, but little is known about the role of neuronal axis in pulmonary hypertension (PH). Here, we have examined the role of the neuropeptide Y (NPY) and its Y₁ receptor in PH pathogenesis. EXPERIMENTAL APPROACH NPY was localized by immunofluorescence. Expression of NPY and Y₁ receptor were determined by quantitative PCR. Cellular response to NPY stimulation was assessed by Western blotting, thymidine incorporation and calcium imaging. Wire myography and isolated perfused mouse lung were applied to study pulmonary vasoactive effects of NPY. Selective receptor antagonists were used to assess the contribution of receptor subtypes in mediating NPY effects. KEY RESULTS Samples from PH patients showed increased NPYergic innervation within the PA wall and higher Y₁ receptor expression, compared with donors. However, NPY levels were unchanged in both PA and serum. In the chronic hypoxic mouse model, Y₁ receptor were up-regulated, while expression of both NPY and Y₁ receptor was increased in the lungs of monocrotaline and SU5416-hypoxia rats. On a functional level, NPY acutely increased intracellular calcium levels and enhanced vasoconstriction of lung vessels preconstricted with adrenaline. Furthermore, NPY stimulated proliferation of human pulmonary arterial smooth muscle cells and activated p38 and PKD pathways. Correspondingly, higher phosphorylation of PKD was observed in remodelled vessels from PH patients. The selective Y₁ receptor antagonist, BIBO 3304, concentration-dependently inhibited vasoconstrictive and proliferative effects of NPY. CONCLUSIONS AND IMPLICATIONS NPY and Y₁ receptor are possible mediators of both vasoconstriction and pulmonary vascular remodelling in PH.
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Affiliation(s)
- S Crnkovic
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria; Department of Experimental Anaesthesiology, Medical University of Graz, Graz, Austria
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Beneficial Effects of Renal Denervation on Pulmonary Vascular Remodeling in Experimental Pulmonary Artery Hypertension. ACTA ACUST UNITED AC 2015; 68:562-70. [PMID: 25804321 DOI: 10.1016/j.rec.2014.11.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 11/24/2014] [Indexed: 11/22/2022]
Abstract
INTRODUCTION AND OBJECTIVES Activation of both the sympathetic nervous system and the renin-angiotensin-aldosterone system is closely associated with pulmonary arterial hypertension. We hypothesized that renal denervation decreases renin-angiotensin-aldosterone activity and inhibits the progression of pulmonary arterial hypertension. METHODS Twenty-two beagles were randomized into 3 groups. The dogs' pulmonary dynamics were measured before and 8 weeks after injection of 0.1mL/kg dimethylformamide (control dogs) or 2mg/kg dehydromonocrotaline (pulmonary arterial hypertension and pulmonary arterial hypertension + renal denervation dogs). Eight weeks after injection, neurohormone levels and pulmonary tissue morphology were measured. RESULTS Levels of plasma angiotensin II and endothelin-1 were significantly increased after 8 weeks in the pulmonary arterial hypertension dogs and were higher in the lung tissues of these dogs than in those of the control and renal denervation dogs (mean [standard deviation] angiotensin II: 65 [9.8] vs 38 [6.7], 46 [8.1]; endothelin-1: 96 [10.3] vs 54 [6.2], 67 [9.4]; P < .01). Dehydromonocrotaline increased the mean pulmonary arterial pressure (16 [3.4] mmHg vs 33 [7.3] mmHg; P < .01), and renal denervation prevented this increase. Pulmonary smooth muscle cell proliferation was higher in the pulmonary arterial hypertension dogs than in the control and pulmonary arterial hypertension + renal denervation dogs. CONCLUSIONS Renal denervation attenuates pulmonary vascular remodeling and decreases pulmonary arterial pressure in experimental pulmonary arterial hypertension. The effect of renal denervation may contribute to decreased neurohormone levels.
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Andersen S, Andersen A, de Man FS, Nielsen-Kudsk JE. Sympathetic nervous system activation and β-adrenoceptor blockade in right heart failure. Eur J Heart Fail 2015; 17:358-66. [PMID: 25704592 DOI: 10.1002/ejhf.253] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 01/22/2015] [Accepted: 01/23/2015] [Indexed: 11/07/2022] Open
Abstract
Right heart failure may develop from pulmonary arterial hypertension or various forms of congenital heart disease. Right ventricular adaptation to the increased afterload is the most important prognostic factor in pulmonary hypertension and congenital heart disease, which share important pathophysiological mechanisms, despite having different aetiologies. There is substantial evidence of increased sympathetic nervous system activation in right heart failure related to both pulmonary hypertension and congenital heart disease. It is unknown to which degree this activation is an adaptive response, a maladaptive response, or if it mainly reflects disease progression. Several experimental studies and clinical trials have been conducted to answer these questions. Here, we review the existing knowledge on sympathetic nervous system activation and the effects of β-adrenoceptor blockade in experimental and clinical right heart failure. This review identifies important gaps in our understanding of the right ventricle and discusses the potential of β-blockers in the treatment of right heart failure.
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Affiliation(s)
- Stine Andersen
- Department of Cardiology - Research, Institute of Clinical Medicine, Aarhus University Hospital, Brendstrupgaardsvej 100, 8200, Aarhus N, Denmark
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Enhanced endothelium-dependent relaxation of rat pulmonary artery following β-adrenergic overstimulation: involvement of the NO/cGMP/VASP pathway. Life Sci 2015; 125:49-56. [PMID: 25640757 DOI: 10.1016/j.lfs.2015.01.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 01/12/2015] [Accepted: 01/13/2015] [Indexed: 11/21/2022]
Abstract
AIMS The aim of this study was to investigate whether β-adrenoceptor (β-AR) overstimulation induced by in vivo treatment with isoproterenol (ISO) alters vascular reactivity and nitric oxide (NO) production and signaling in pulmonary arteries. MAIN METHODS Vehicle or ISO (0.3mgkg(-1)day(-1)) was administered daily to male Wistar rats. After 7days, the jugular vein was cannulated to assess right ventricular (RV) systolic pressure (SP) and end diastolic pressure (EDP). The extralobar pulmonary arteries were isolated to evaluate the relaxation responses, protein expression (Western blot), NO production (diaminofluorescein-2 fluorescence), and cyclic guanosine 3',5'-monophosphate (cGMP) levels (enzyme immunoassay kit). KEY FINDINGS ISO treatment induced RV hypertrophy; however, no differences in RV-SP and EDP were observed. The pulmonary arteries from the ISO-treated group showed enhanced relaxation to acetylcholine that was abolished by the NO synthase (NOS) inhibitor N(ω)-nitro-l-arginine methyl ester (l-NAME); whereas relaxation elicited by sodium nitroprusside, ISO, metaproterenol, mirabegron, or KCl was not affected by ISO treatment. ISO-treated rats displayed enhanced endothelial NOS (eNOS) and vasodilator-stimulated phosphoprotein (VASP) expression in the pulmonary arteries, while phosphodiesterase-5 protein expression decreased. ISO treatment increased NO and cGMP levels and did not induce eNOS uncoupling. SIGNIFICANCE The present data indicate that β-AR overactivation enhances the endothelium-dependent relaxation of pulmonary arteries. This effect was linked to an increase in eNOS-derived NO production, cGMP formation and VASP content and to a decrease in phosphodiesterase-5 expression. Therefore, elevated NO bioactivity through cGMP/VASP signaling could represent a protective mechanism of β-AR overactivation on pulmonary circulation.
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Andersen S, Schultz JG, Andersen A, Ringgaard S, Nielsen JM, Holmboe S, Vildbrad MD, de Man FS, Bogaard HJ, Vonk-Noordegraaf A, Nielsen-Kudsk JE. Effects of Bisoprolol and Losartan Treatment in the Hypertrophic and Failing Right Heart. J Card Fail 2014; 20:864-73. [DOI: 10.1016/j.cardfail.2014.08.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 08/07/2014] [Accepted: 08/08/2014] [Indexed: 11/16/2022]
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Ploegstra MJ, Douwes JM, Roofthooft MT, Zijlstra WM, Hillege HL, Berger RM. Identification of treatment goals in paediatric pulmonary arterial hypertension. Eur Respir J 2014; 44:1616-26. [DOI: 10.1183/09031936.00030414] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
To be able to design goal-oriented treatment strategies in paediatric pulmonary arterial hypertension (PAH), we aimed to identify treatment goals by investigating the prognostic value of treatment-induced changes in noninvasive predictors of transplant-free survival.66 consecutive, treatment-naïve paediatric PAH patients in the Dutch National Network for Paediatric Pulmonary Hypertension who started taking PAH-targeted drugs between January 2000 and April 2013 underwent prospective, standardised follow-up. Clinical, biochemical and echocardiographic measures were longitudinally collected at treatment initiation and follow-up, and their respective predictive values for transplant-free survival were assessed. Furthermore, the predictive values of treatment-induced changes were assessed.From the identified set of baseline predictors, the variables World Health Organization functional class (WHO-FC), N-terminal pro-brain natriuretic peptide (NT-proBNP) and tricuspid annular plane systolic excursion (TAPSE) were identified as follow-up predictors in which treatment-induced changes were associated with survival. Patients in whom these variables improved after treatment showed better survival (p<0.002).Therefore, WHO-FC, NT-proBNP and TAPSE are not only predictors of transplant-free survival in paediatric PAH but can also be used as treatment goals, as treatment-induced improvements in these variables are associated with improved survival. The identification of these variables allows for the introduction of goal-oriented treatment strategies in paediatric PAH.
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Tonelli AR, Wang XF, Alkukhun L, Zhang Q, Dweik RA, Minai OA. Heart rate slopes during 6-min walk test in pulmonary arterial hypertension, other lung diseases, and healthy controls. Physiol Rep 2014; 2:2/6/e12038. [PMID: 24920122 PMCID: PMC4208645 DOI: 10.14814/phy2.12038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Six-minute walk test (6MWT) continues to be a useful tool to determine the functional capacity in patients with vascular and other lung diseases; nevertheless, it has a limited ability to predict prognosis in this context. We tested whether the heart rate (HR) acceleration and decay slopes during the 6-m walk test are different in patients with pulmonary arterial hypertension (PAH), other lung diseases, and healthy controls. In addition, we assessed whether the HR slopes are associated with clinical worsening. Using a portable, signal-morphology-based, impedance cardiograph (PhysioFlow Enduro, Paris, France) with real-time wireless monitoring via a Bluetooth USB adapter we determined beat-by-beat HR. We included 50 subjects in this pilot study, 20 with PAH (all on PAH-specific treatment), 17 with other lung diseases (obstructive [n = 12, 71%] or restrictive lung diseases [5, 29%]), and 13 healthy controls. The beat-by-beat HR curves were significantly different among all three groups of subjects either during the activity or recovery of the 6MWT. HR curves were less steep in PAH than the other two groups (P < 0.001). HR acceleration rates were slower in patients with PAH or other lung diseases with progression of their disease (P < 0.001). In conclusion, the acceleration and decay slopes during 6MWT are different among patients with PAH, other lung diseases, and healthy controls. The HR slopes during 6MWT were steeper in patients without clinical worsening.
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Affiliation(s)
- Adriano R Tonelli
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Xiao-Feng Wang
- Respiratory Institute Biostatistics Core, Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Laith Alkukhun
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Qi Zhang
- Respiratory Institute Biostatistics Core, Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Raed A Dweik
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Omar A Minai
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
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Wong YY, Westerhof N, Ruiter G, Lubberink M, Raijmakers P, Knaapen P, Marcus JT, Boonstra A, Lammertsma AA, van der Laarse WJ, Vonk-Noordegraaf A. Systolic pulmonary artery pressure and heart rate are main determinants of oxygen consumption in the right ventricular myocardium of patients with idiopathic pulmonary arterial hypertension. Eur J Heart Fail 2014; 13:1290-5. [DOI: 10.1093/eurjhf/hfr140] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yeun Ying Wong
- Department of Physiology, Institute of Cardiovascular Research; VU University Medical Center; Amsterdam The Netherlands
| | - Nico Westerhof
- Department of Physiology, Institute of Cardiovascular Research; VU University Medical Center; Amsterdam The Netherlands
| | - Gerrina Ruiter
- Department of Physiology, Institute of Cardiovascular Research; VU University Medical Center; Amsterdam The Netherlands
| | - Mark Lubberink
- Department of Nuclear Medicine & PET-Research; Institute of Cardiovascular Research, VU University Medical Center; Amsterdam The Netherlands
| | - Pieter Raijmakers
- Department of Nuclear Medicine & PET-Research; Institute of Cardiovascular Research, VU University Medical Center; Amsterdam The Netherlands
| | - Paul Knaapen
- Department of Cardiology and Department of Physics & Medical Technology; Institute of Cardiovascular Research, VU University Medical Center; Amsterdam The Netherlands
| | - J. Tim Marcus
- Department of Cardiology and Department of Physics & Medical Technology; Institute of Cardiovascular Research, VU University Medical Center; Amsterdam The Netherlands
| | - Anco Boonstra
- Department of Pulmonology; VU University Medical Center; De Boelelaan 1117, 1081 HV Amsterdam The Netherlands
| | - Adriaan A. Lammertsma
- Department of Nuclear Medicine & PET-Research; Institute of Cardiovascular Research, VU University Medical Center; Amsterdam The Netherlands
| | - Willem J. van der Laarse
- Department of Physiology, Institute of Cardiovascular Research; VU University Medical Center; Amsterdam The Netherlands
| | - Anton Vonk-Noordegraaf
- Department of Pulmonology; VU University Medical Center; De Boelelaan 1117, 1081 HV Amsterdam The Netherlands
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Na S, Kim OS, Ryoo S, Kweon TD, Choi YS, Shim HS, Oh YJ. Cervical Ganglion Block Attenuates the Progression of Pulmonary Hypertension via Nitric Oxide and Arginase Pathways. Hypertension 2014; 63:309-15. [DOI: 10.1161/hypertensionaha.113.01979] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It has been recognized that the sympathetic nervous system is activated in pulmonary arterial hypertension (PAH), and abnormal sympathetic hyperactivity leads to worsening of PAH via endothelial dysfunction. The purpose of this study was to examine whether sympathetic ganglion block (SGB) can treat PAH by increasing the availability of nitric oxide (NO). PAH was induced in rats by 50 mg/kg of subcutaneous monocrotaline. After 2 weeks, daily injections of ropivacaine into the left superior cervical ganglion were repeated for 14 days (monocrotaline-SGB group). Monocrotaline group received sham SGB with saline, whereas control group received saline instead of monocrotaline. PAH was evident in monocrotaline group, with right ventricular systolic pressures (47±4 mm Hg) that were higher than those of controls (17±2 mm Hg), whereas SGB significantly attenuated monocrotaline-induced PAH (35±4 mm Hg). The right/left ventricular mass ratios exhibited similar changes to those seen with right ventricular pressures. Heart rate variability showed significantly higher sympathetic activity in the monocrotaline group. Microscopy revealed a higher proportion of muscular arteries with thicker medial walls in the monocrotaline group, which was attenuated by SGB. Monocrotaline induced arginase hyperactivity, which was in turn decreased by SGB-induced endothelial NO synthase activation. SGB restored monocrotaline-induced hypoactivity of superoxide dismutase. In conclusion, SGB could suppress PAH and the remodeling of pulmonary arteries via inactivation of arginase and reciprocal elevation of NO bioavailability, thus attenuating disproportionate hyperactivation of the sympathetic nervous system.
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Affiliation(s)
- Sungwon Na
- From the Department of Anesthesiology and Pain Medicine (S.N., T.D.K., Y.S.C., Y.J.O.), Anesthesia and Pain Research Institute (S.N., T.D.K., Y.S.C., Y.J.O.), Severance Biomedical Science Institute (O.S.K.), and Department of Pathology (H.S.S.), Yonsei University College of Medicine, Seoul, Republic of Korea; and Department of Biology, College of Natural Sciences, Kangwon National University, Chuncheon, Republic of Korea (S.R.)
| | - Ok Soo Kim
- From the Department of Anesthesiology and Pain Medicine (S.N., T.D.K., Y.S.C., Y.J.O.), Anesthesia and Pain Research Institute (S.N., T.D.K., Y.S.C., Y.J.O.), Severance Biomedical Science Institute (O.S.K.), and Department of Pathology (H.S.S.), Yonsei University College of Medicine, Seoul, Republic of Korea; and Department of Biology, College of Natural Sciences, Kangwon National University, Chuncheon, Republic of Korea (S.R.)
| | - Sungwoo Ryoo
- From the Department of Anesthesiology and Pain Medicine (S.N., T.D.K., Y.S.C., Y.J.O.), Anesthesia and Pain Research Institute (S.N., T.D.K., Y.S.C., Y.J.O.), Severance Biomedical Science Institute (O.S.K.), and Department of Pathology (H.S.S.), Yonsei University College of Medicine, Seoul, Republic of Korea; and Department of Biology, College of Natural Sciences, Kangwon National University, Chuncheon, Republic of Korea (S.R.)
| | - Tae Dong Kweon
- From the Department of Anesthesiology and Pain Medicine (S.N., T.D.K., Y.S.C., Y.J.O.), Anesthesia and Pain Research Institute (S.N., T.D.K., Y.S.C., Y.J.O.), Severance Biomedical Science Institute (O.S.K.), and Department of Pathology (H.S.S.), Yonsei University College of Medicine, Seoul, Republic of Korea; and Department of Biology, College of Natural Sciences, Kangwon National University, Chuncheon, Republic of Korea (S.R.)
| | - Yong Seon Choi
- From the Department of Anesthesiology and Pain Medicine (S.N., T.D.K., Y.S.C., Y.J.O.), Anesthesia and Pain Research Institute (S.N., T.D.K., Y.S.C., Y.J.O.), Severance Biomedical Science Institute (O.S.K.), and Department of Pathology (H.S.S.), Yonsei University College of Medicine, Seoul, Republic of Korea; and Department of Biology, College of Natural Sciences, Kangwon National University, Chuncheon, Republic of Korea (S.R.)
| | - Hyo Sup Shim
- From the Department of Anesthesiology and Pain Medicine (S.N., T.D.K., Y.S.C., Y.J.O.), Anesthesia and Pain Research Institute (S.N., T.D.K., Y.S.C., Y.J.O.), Severance Biomedical Science Institute (O.S.K.), and Department of Pathology (H.S.S.), Yonsei University College of Medicine, Seoul, Republic of Korea; and Department of Biology, College of Natural Sciences, Kangwon National University, Chuncheon, Republic of Korea (S.R.)
| | - Young Jun Oh
- From the Department of Anesthesiology and Pain Medicine (S.N., T.D.K., Y.S.C., Y.J.O.), Anesthesia and Pain Research Institute (S.N., T.D.K., Y.S.C., Y.J.O.), Severance Biomedical Science Institute (O.S.K.), and Department of Pathology (H.S.S.), Yonsei University College of Medicine, Seoul, Republic of Korea; and Department of Biology, College of Natural Sciences, Kangwon National University, Chuncheon, Republic of Korea (S.R.)
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Kimmerly DS, Morris BL, Floras JS. Apnea-induced cortical BOLD-fMRI and peripheral sympathoneural firing response patterns of awake healthy humans. PLoS One 2013; 8:e82525. [PMID: 24358198 PMCID: PMC3865029 DOI: 10.1371/journal.pone.0082525] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 11/03/2013] [Indexed: 12/30/2022] Open
Abstract
End-expiratory breath-holds (BH) and Mueller manoeuvres (MM) elicit large increases in muscle sympathetic nerve activity (MSNA). In 16 healthy humans (9♀, 35±4 years) we used functional magnetic resonance imaging with blood oxygen level-dependent (BOLD) contrast to determine the cortical network associated with such sympathoexcitation. We hypothesized that increases in MSNA evoked by these simulated apneas are accompanied by BOLD contrast changes in the insular cortex, thalamus and limbic cortex. A series of 150 whole-brain images were collected during 3 randomly performed 16-second end-expiratory BHs and MMs (-30 mmHg). The identical protocol was repeated separately with MSNA recorded from the fibular nerve. The time course of the sympathoexcitatory response to both breathing tasks were correlated with whole-brain BOLD signal changes. Brain sites demonstrating both positive (activation) and negative (deactivation) correlations with the MSNA time course were identified. Sympathetic burst incidence increased (p<0.001) from 29±6 (rest) to 49±6 (BH) and 47±6 bursts/100 heartbeats (MM). Increased neural activity (Z-scores) was identified in the right posterior and anterior insular cortices (3.74, 3.64), dorsal anterior cingulate (3.42), fastigial and dentate cerebellar nuclei (3.02, 3.34). Signal intensity decreased in the left posterior insula (3.28) and ventral anterior cingulate (3.01). Apnea both activates and inhibits elements of a cortical network involved in the generation of sympathetic outflow. These findings identify a neuroanatomical substrate to guide future investigations into central mechanisms contributing to disorders characterized by elevated basal MSNA and exaggerated sympathetic responses to simulated apneas such as sleep apnea and heart failure.
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Affiliation(s)
- Derek S. Kimmerly
- Clinical Cardiovascular Physiology Laboratory, University Health Network and Mount Sinai Hospital Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- School of Health and Human Performance, Faculty of Health Professions, Dalhousie University, Halifax, Nova Scotia, Canada
- * E-mail:
| | - Beverley L. Morris
- Clinical Cardiovascular Physiology Laboratory, University Health Network and Mount Sinai Hospital Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - John S. Floras
- Clinical Cardiovascular Physiology Laboratory, University Health Network and Mount Sinai Hospital Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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141
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Tonelli AR, Alkukhun L, Arelli V, Ramos J, Newman J, McCarthy K, Pichurko B, Minai OA, Dweik RA. Value of impedance cardiography during 6-minute walk test in pulmonary hypertension. Clin Transl Sci 2013; 6:474-80. [PMID: 24330692 PMCID: PMC4286797 DOI: 10.1111/cts.12090] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Methods that predict prognosis and response to therapy in pulmonary hypertension (PH) are lacking. We tested whether the noninvasive estimation of hemodynamic parameters during 6-minute walk test (6MWT) in PH patients provides information that can improve the value of the test. METHODS We estimated hemodynamic parameters during the 6MWT using a portable, signal-morphology-based, impedance cardiograph (PhysioFlow Enduro) with real-time wireless monitoring via a bluetooth USB adapter. RESULTS We recruited 48 subjects in the study (30 with PH and 18 healthy controls). PH patients had significantly lower maximum stroke volume (SV) and CI and slower cardiac output (CO) acceleration and decelerations slopes during the test when compared with healthy controls. In PH patients, CI change was associated with total distance walked (R = 0.62; P < 0.001) and percentage of predicted (R = 0.4, P = 0.03), HR recovery at 1 minute (0.57, P < 0.001), 2 minutes (0.65, P < 0.001), and 3 minutes (0.66, P < 0.001). Interestingly, in PH patients CO change during the test was predominantly related to an increase in SV instead of HR. CONCLUSIONS Estimation of hemodynamic parameters such as cardiac index during 6-minute walk test is feasible and may provide useful information in patients with PH. Clin Trans Sci 2013; Volume #: 1-7.
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Affiliation(s)
- Adriano R Tonelli
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
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142
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Groepenhoff H, Vonk-Noordegraaf A, van de Veerdonk MC, Boonstra A, Westerhof N, Bogaard HJ. Prognostic relevance of changes in exercise test variables in pulmonary arterial hypertension. PLoS One 2013; 8:e72013. [PMID: 24039732 PMCID: PMC3764059 DOI: 10.1371/journal.pone.0072013] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 07/04/2013] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Exercise variables determined in patients with pulmonary arterial hypertension (PAH) at the time of diagnosis, predict survival. It is unknown whether upon treatment, subsequent changes in these exercise variables reflect improvements in survival. The aim of this study was to determine changes in exercise variables in PAH patients and to relate these changes to survival. METHODS Baseline cardiopulmonary exercise test (CPET) variables and six-minute-walk-distance (6MWD) were available from 65 idiopathic PAH patients (50 females; mean age 45±2yrs). The same variables were determined after treatment (13months) in a sub group of 43 patients. To estimate the association between changes in exercise variables and changes in cardiac function, right-ventricle ejection fraction (RVEF) was measured by cardiac MRI at baseline and after treatment in 34 patients. Mean follow-up time after the second CPET was 53 (range: 4-111) months. Kaplan-Meier analysis was used to relate survival to baseline and treatment-associated changes in exercise variables. RESULTS Survivors showed a significantly greater change in maximal oxygen uptake than non-survivors and this change in aerobic capacity was significantly related to changes in RVEF. From baseline until the end of the study period, two patients underwent a lung transplantation and 19 patients died. Survival analysis showed that baseline 6MWD (p<0.0001), maximal heart rate (p<0.0001) and the slope relating ventilation with carbon dioxide production (p≤0.05) were significant predictors of survival, whereas baseline oxygen uptake and oxygen pulse held no predictive value. Treatment associated changes in 6MWD (p<0.01), maximal heart rate (p<0.05), oxygen uptake (p<0.001) and oxygen pulse predicted survival (p<0.05), whereas changes in the slope relating ventilation with carbon dioxide production did not. CONCLUSION Exercise variables with prognostic significance when determined at baseline, retain their prognostic relevance after treatment. However, when changes in exercise variables upon treatment are considered, a different set of variables provides prognostic information.
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Affiliation(s)
- Herman Groepenhoff
- Department of Pulmonology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
- * E-mail:
| | - Anton Vonk-Noordegraaf
- Department of Pulmonology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Mariëlle C. van de Veerdonk
- Department of Pulmonology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Anco Boonstra
- Department of Pulmonology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Nico Westerhof
- Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Harm J. Bogaard
- Department of Pulmonology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
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143
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Chemla D, Castelain V, Hoette S, Creuzé N, Provencher S, Zhu K, Humbert M, Herve P. Strong linear relationship between heart rate and mean pulmonary artery pressure in exercising patients with severe precapillary pulmonary hypertension. Am J Physiol Heart Circ Physiol 2013; 305:H769-77. [DOI: 10.1152/ajpheart.00258.2013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The contribution of heart rate (HR) to pulmonary artery hemodynamics has been suggested in pulmonary hypertension (PH). Our high-fidelity pressure, retrospective study tested the hypothesis that HR explained the majority of mean pulmonary artery pressure (mPAP) and pulse pressure (PApp) variation in 12 severe precapillary PH patients who performed incremental-load cycling while in the supine position. Seven idiopathic pulmonary arterial hypertension patients and five chronic thromboembolic PH patients were studied. Four to five PAP-thermodilution cardiac output (CO) points (mean: 4.4) were obtained. At rest, mPAP was 57 ± 9 mmHg, PApp was 51 ± 11 mmHg, HR was 90 ± 12 beats/min, and stroke volume (SV) was 50 ± 22 ml. At peak exercise, mPAP was 76 ± 10 mmHg, PApp was 67 ± 11 mmHg, and HR was 123 ± 18 beats/min (i.e., 71 ± 10% of maximum HR, each P < 0.05), whereas SV was 51 ± 20 ml ( P = not significant). The input resistance did not change (mPAP/CO = 14.1 ± 4.1 vs. 13.5 ± 4.4 mmHg·min·l−1). The relative increase in mPAP was related to the relative increase in HR ( n = 12, r2 = 0.74) but not in CO. mPAP was linearly related to CO in 8 of 12 patients (median r2 = 0.83) and to HR in 12 of 12 patients (median r2 = 0.985). The parsimony principle favored the latter fit. PApp was linearly related to mPAP in 12 of 12 patients (median r2 = 0.985), HR in 10 of 12 patients (median r2 = 0.97), CO in 7 of 12 patients (median r2 = 0.87), and SV in 1 of 12 patients. A strong linear relationship between HR and mPAP was consistently documented in severe precapillary PH patients who performed supine exercise. The limited value of thermodilution CO to predict mPAP could be explained by unavoidable precision errors in CO measurements, unchanged/decreased SV on exercise, curvilinearity of the mPAP-CO relationship at high flow, or flow-independent additional mechanisms increasing mPAP on exercise.
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Affiliation(s)
- Denis Chemla
- Physiology Department, Université Paris Sud-Faculté de Médecine-EA4533-APHP, Le Kremlin Bicêtre, France
| | - Vincent Castelain
- Hôpitaux Universitaires de Strasbourg, Service de Réanimation Médicale, Strasbourg, France
| | - Susana Hoette
- Pulmonary Division, University of Sao Paulo, Sao Paulo, Brazil
| | - Nicolas Creuzé
- Physiology Department, Université Paris Sud-Faculté de Médecine-EA4533-APHP, Le Kremlin Bicêtre, France
| | - Steeve Provencher
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada
| | - Kaixian Zhu
- Physiology Department, Université Paris Sud-Faculté de Médecine-EA4533-APHP, Le Kremlin Bicêtre, France
| | - Marc Humbert
- Service de Pneumologie-APHP, Hôpital Bicêtre, Le Kremlin Bicêtre, France
- Institut National de la Santé et de la Recherche Médicale UMR-S999, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France; and
| | - Philippe Herve
- Institut National de la Santé et de la Recherche Médicale UMR-S999, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France; and
- Physiology Department, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France
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Holland AE, Hill CJ, Glaspole I, Goh N, Dowman L, McDonald CF. Impaired chronotropic response to 6-min walk test and reduced survival in interstitial lung disease. Respir Med 2013; 107:1066-72. [PMID: 23669412 DOI: 10.1016/j.rmed.2013.04.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 04/01/2013] [Accepted: 04/07/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Reduced chronotropic response to maximal exercise has been associated with poor survival in people without respiratory disease. The contribution of chronotropic response to exercise limitation and survival in interstitial lung disease (ILD) is not well defined. This study investigated the relationships between chronotropic response during 6-min walk test, exercise capacity and survival in ILD. METHODS Eligible participants had ILD, were ambulant and free of heart failure and beta blocker therapy. Chronotropic response during the 6-min walk test was defined as peak heart rate (HR) minus resting HR. Survival was recorded at four years. RESULTS Sixty-two participants (40 idiopathic pulmonary fibrosis) were included, with mean (SD) TLCO 50(18)% predicted and 6-min walk distance (6MWD) 377 (127) metres. A smaller chronotropic response was associated with reduced 6MWD (r = 0.65, p < 0.001). Independent predictors of 6MWD were chronotropic response, peak oxygen uptake on cardiopulmonary exercise test; right ventricular systolic pressure on echocardiogram; and age. This model explained 83% of the variance in 6MWD, with 24% of the variance attributable to chronotropic response. A chronotropic response during 6-min walk test of less than 20 beats per minute was an independent predictor of death at four years (odds ratio 10.71, 95% confidence interval 2.67-42.94) in a model that also included oxygen desaturation and forced vital capacity. CONCLUSIONS Impaired chronotropic response to 6-min walk test is associated with reduced 6MWD and reduced survival in ILD, independent of physical fitness and pulmonary hypertension. Investigation of the mechanisms underlying attenuated HR response to exercise in ILD is warranted.
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Affiliation(s)
- Anne E Holland
- Alfred Health, VIC 3004, Australia; La Trobe University, VIC 3086, Australia; Institute for Breathing and Sleep, VIC 3084, Australia.
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Muller MD, Sauder CL, Ray CA. Mental Stress Elicits Sustained and Reproducible Increases in Skin Sympathetic Nerve Activity. Physiol Rep 2013; 1. [PMID: 23750321 PMCID: PMC3673729 DOI: 10.1002/phy2.2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Mental stress (MS) is a known trigger of myocardial infarction and sudden death. By activating the sympathetic nervous system, MS may have deleterious effect on the cardiovascular system but this process is not completely understood. The primary aim of this study was to quantify the effect of MS on skin sympathetic nerve activity (SSNA). The secondary aim was to determine the reproducibility of SSNA to MS within a given day and ∼1 week later. Ten subjects (26 ± 1 year) performed two bouts of mental arithmetic lasting 3 min. The bouts were separated by 45 min. One week later the subjects returned to repeat MS. All experiments were conducted in the supine posture during the morning hours. To maintain neutral skin temperature, each subject wore a custom suit (34–35°C). Skin blood flow and sweat rate were measured on the dorsal foot. MS elicited a marked increase in SSNA within the first 10 sec (184 ± 42%; P < 0.01) in all subjects, which was less during the remaining period of MS, but remained elevated (87 ± 20; P < 0.01). The pattern of responses to MS was unchanged during the second bout (10 sec, 247 ± 55%; 3 min average, 133 ± 29%) and during the retest 1 week later (10 sec, 196 ± 55%; 3 min average, 117 ± 36%). MS did not significantly affect cutaneous vascular conductance or sweat rate during any trial. In summary, MS elicits robust and reproducible increases in SSNA in humans, which may be followed over time to observe alterations in the regulation of the autonomic nervous system.
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Affiliation(s)
- Matthew D Muller
- Penn State Heart & Vascular Institute, Department of Cellular and Molecular Physiology, Clinical Research Center, Pennsylvania State University College of Medicine, The Milton S. Hershey Medical Center, Hershey, PA 17033
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146
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de Man FS, Handoko ML, Guignabert C, Bogaard HJ, Vonk-Noordegraaf A. Neurohormonal Axis in Patients with Pulmonary Arterial Hypertension. Am J Respir Crit Care Med 2013; 187:14-9. [DOI: 10.1164/rccm.201209-1663pp] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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147
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de Man FS, Tu L, Handoko ML, Rain S, Ruiter G, François C, Schalij I, Dorfmüller P, Simonneau G, Fadel E, Perros F, Boonstra A, Postmus PE, van der Velden J, Vonk-Noordegraaf A, Humbert M, Eddahibi S, Guignabert C. Dysregulated renin-angiotensin-aldosterone system contributes to pulmonary arterial hypertension. Am J Respir Crit Care Med 2012; 186:780-9. [PMID: 22859525 PMCID: PMC5104838 DOI: 10.1164/rccm.201203-0411oc] [Citation(s) in RCA: 240] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
RATIONALE Patients with idiopathic pulmonary arterial hypertension (iPAH) often have a low cardiac output. To compensate, neurohormonal systems such as the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system are up-regulated, but this may have long-term negative effects on the progression of iPAH. OBJECTIVES Assess systemic and pulmonary RAAS activity in patients with iPAH and determine the efficacy of chronic RAAS inhibition in experimental PAH. METHODS We collected 79 blood samples from 58 patients with iPAH in the VU University Medical Center Amsterdam (between 2004 and 2010) to determine systemic RAAS activity. MEASUREMENTS AND MAIN RESULTS We observed increased levels of renin, angiotensin (Ang)I, and AngII, which were associated with disease progression (P < 0.05) and mortality (P < 0.05). To determine pulmonary RAAS activity, lung specimens were obtained from patients with iPAH (during lung transplantation, n = 13) and control subjects (during lobectomy or pneumonectomy for cancer, n = 14). Local RAAS activity in pulmonary arteries of patients with iPAH was increased, demonstrated by elevated angiotensin-converting enzyme activity in pulmonary endothelial cells and increased AngII type 1 (AT(1)) receptor expression and signaling. In addition, local RAAS up-regulation was associated with increased pulmonary artery smooth muscle cell proliferation via enhanced AT(1) receptor signaling in patients with iPAH compared with control subjects. Finally, to determine the therapeutic potential of RAAS activity, we assessed the chronic effects of an AT(1) receptor antagonist (losartan) in the monocrotaline PAH rat model (60 mg/kg). Losartan delayed disease progression, decreased right ventricular afterload and pulmonary vascular remodeling, and restored right ventricular-arterial coupling in rats with PAH. CONCLUSIONS Systemic and pulmonary RAAS activities are increased in patients with iPAH and are associated with increased pulmonary vascular remodeling. Chronic inhibition of RAAS by losartan is beneficial in experimental PAH.
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Affiliation(s)
- Frances S de Man
- VU University Medical Center, Department of Pulmonology, De Boelelaan 1117, Amsterdam, The Netherlands.
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148
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Barrier M, Meloche J, Jacob MH, Courboulin A, Provencher S, Bonnet S. Today's and tomorrow's imaging and circulating biomarkers for pulmonary arterial hypertension. Cell Mol Life Sci 2012; 69:2805-31. [PMID: 22446747 PMCID: PMC11115077 DOI: 10.1007/s00018-012-0950-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 02/18/2012] [Accepted: 02/20/2012] [Indexed: 01/04/2023]
Abstract
The pathobiology of pulmonary arterial hypertension (PAH) involves a remodeling process in distal pulmonary arteries, as well as vasoconstriction and in situ thrombosis, leading to an increase in pulmonary vascular resistance, right heart failure and death. Its etiology may be idiopathic, but PAH is also frequently associated with underlying conditions such as connective tissue diseases. During the past decade, more than welcome novel therapies have been developed and are in development, including those increasingly targeting the remodeling process. These therapeutic options modestly increase the patients' long-term survival, now approaching 60% at 5 years. However, non-invasive tools for confirming PAH diagnosis, and assessing disease severity and response to therapy, are tragically lacking and would help to select the best treatment. After exclusion of other causes of pulmonary hypertension, a final diagnosis still relies on right heart catheterization, an invasive technique which cannot be repeated as often as an optimal follow-up might require. Similarly, other techniques and biomarkers used for assessing disease severity and response to treatment generally lack specificity and have significant limitations. In this review, imaging as well as current and future circulating biomarkers for diagnosis, prognosis, and follow-up are discussed.
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Affiliation(s)
- Marjorie Barrier
- Pulmonary Hypertension Research Group, Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Ste-Foy, Québec, QC G1V 4G5 Canada
| | - Jolyane Meloche
- Pulmonary Hypertension Research Group, Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Ste-Foy, Québec, QC G1V 4G5 Canada
| | - Maria Helena Jacob
- Pulmonary Hypertension Research Group, Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Ste-Foy, Québec, QC G1V 4G5 Canada
| | - Audrey Courboulin
- Pulmonary Hypertension Research Group, Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Ste-Foy, Québec, QC G1V 4G5 Canada
| | - Steeve Provencher
- Pulmonary Hypertension Research Group, Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Ste-Foy, Québec, QC G1V 4G5 Canada
| | - Sébastien Bonnet
- Pulmonary Hypertension Research Group, Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Ste-Foy, Québec, QC G1V 4G5 Canada
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149
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Mak S, Witte KK, Al-Hesayen A, Granton JJ, Parker JD. Cardiac sympathetic activation in patients with pulmonary arterial hypertension. Am J Physiol Regul Integr Comp Physiol 2012; 302:R1153-7. [DOI: 10.1152/ajpregu.00652.2011] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Patients with congestive heart failure (CHF) due to left ventricular (LV) dysfunction have sympathetic activation specifically directed to the myocardium. Although pulmonary arterial hypertension (PAH) is associated with increased systemic sympathetic activity, its impact on sympathetic drive to ventricular myocardium is unknown. Fifteen patients with PAH (9 women; 54 ± 12 years) were studied: 10 with idiopathic PAH and 5 with a connective tissue disorder. We measured hemodynamics, as well as radiolabeled and endogenous concentrations of arterial and coronary sinus norepinephrine (NE). These measures were repeated after inhaled nitric oxide (NO). Measurement of transcardiac NE concentrations and the cardiac extraction of radiolabeled NE allowed calculation of the corrected transcardiac gradient of NE (CTCG of NE). Comparative data were collected from 15 patients (9 women: 55 ± 12 yr) with normal LV function and 15 patients with CHF (10 women; 53 ± 12 yr). PAH patients had elevated arterial NE concentrations compared with those with normal LV function but were similar to those with CHF. The CTCG of NE was higher in those with PAH than in the normal LV group (3.6 ± 2.2 vs. 1.5 ± 0.9 pmol/ml; P < 0.01) but similar to that seen in those with CHF (3.3 ± 1.4; P = NS). Inhaled NO, which reduced pulmonary artery pressure and increased cardiac output, had no effect on cardiac sympathetic activity. Therefore, cardiac sympathetic activation occurs in PAH. The mechanism of this activation remains uncertain but does not involve elevations in left heart filling pressure.
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Affiliation(s)
- Susanna Mak
- Division of Cardiology, Department of Medicine, Mount Sinai Hospital, University Health Network, Toronto, Canada
| | - Klaus K. Witte
- Institute of Membrane and Systems Biology, Leeds General Infirmary, Leeds, United Kingdom
| | - Abdul Al-Hesayen
- Division of Cardiology, St. Michael's Hospital, Toronto, Canada; and
| | - John J. Granton
- Division of Respirology, Department of Medicine, Mount Sinai, University Health Network, Toronto, Canada
| | - John D. Parker
- Division of Cardiology, Department of Medicine, Mount Sinai Hospital, University Health Network, Toronto, Canada
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150
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Suzuki R, Maehara R, Kobuchi S, Tanaka R, Ohkita M, Matsumura Y. Beneficial effects of γ-aminobutyric acid on right ventricular pressure and pulmonary vascular remodeling in experimental pulmonary hypertension. Life Sci 2012; 91:693-8. [PMID: 22542556 DOI: 10.1016/j.lfs.2012.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 03/27/2012] [Accepted: 04/04/2012] [Indexed: 10/28/2022]
Abstract
AIMS It has been reported that activation of the sympathetic nervous system and increase in plasma norepinephrine (NE) levels are observed in patients with pulmonary hypertension (PH). γ-Aminobutyric acid (GABA) is one of the major inhibitory neurotransmitters in the central nervous system and suppresses peripheral sympathetic neurotransmission. This study investigated whether chronic treatment with GABA prevents the development of monocrotaline (MCT)-induced PH. To elucidate the relationship between the development of PH and sympathetic nerve activity, hemodynamic parameters, cardiac functions, and plasma NE concentrations as well as cardiac endothelin-1 (ET-1) contents of MCT-induced PH rats were evaluated with or without GABA treatment. MAIN METHODS Rats were injected with MCT (60 mg/kg) or saline subcutaneously and these rats were randomly divided into GABA (500 mg/kg/day for 4 weeks)- or vehicle-treated groups, respectively. KEY FINDING MCT-treated rats had higher right ventricular systolic pressures, right ventricle-to-left ventricle plus septum weight ratios, pulmonary arterial medial thickening, and plasma NE levels than those of saline-injected rats. MCT-induced alternations were significantly attenuated by treatment with GABA. In MCT-induced PH rats with or without GABA treatment, plasma NE levels were positively correlated with right ventricular systolic pressure. Right ventricular endothelin-1 (ET-1) contents were increased by MCT injection, but these increments were not affected by treatment with GABA. SIGNIFICANCE These results suggest that plasma NE levels play an important role in the development of MCT-induced PH in rats and that GABA exerts a preventive effect against MCT-induced PH by suppressing the sympathetic nervous system but not the cardiac ET-1 system.
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Affiliation(s)
- Rie Suzuki
- Laboratory of Pathological and Molecular Pharmacology, Osaka University of Pharmaceutical Sciences, 4-20-1 Nasahara, Takatsuki, Osaka, Japan
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