201
|
Wang J, Zhang C, Liu C, Wang W, Zhang N, Hadadi C, Huang J, Zhong N, Lu W. Functional mutations in 5'UTR of the BMPR2 gene identified in Chinese families with pulmonary arterial hypertension. Pulm Circ 2016; 6:103-8. [PMID: 27162618 PMCID: PMC4860546 DOI: 10.1086/685078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a progressive pulmonary vasculopathy with significant morbidity and mortality. Bone morphogenetic protein receptor type 2 (BMPR2) has been well recognized as the principal gene responsible for heritable and sporadic PAH. Four unrelated Chinese patients with PAH and their family members, both symptomatic and asymptomatic, were genetically evaluated by sequencing all exons and the flanking regions of BMPR2. Functionality of the aberrant mutations at the 5' untranslated region (UTR) of BMPR2 in the families with PAH was determined by site mutation, transient transfection, and promoter-reporter assays. Four individual mutations in the BMPR2 gene were identified in the 4 families, respectively: 10-GGC repeats, 13-GGC repeats, 4-AGC repeats in 5'UTR, and a novel missense mutation in exon 7 (c.961C>T; p.Arg321X). Moreover, we demonstrated that (1) these 5'UTR mutations decreased the transcription of BMPR2 and (2) the GGC repeats and AGC repeats in BMPR2 5'UTR bore functional binding sites of EGR-1 and MYF5, respectively. This is the first report demonstrating the presence of functional BMPR2 5'UTR mutations in familial patients with PAH and further indicating that EGR-1 and MYF5 are potential targets for correcting these genetic abnormalities for PAH therapy.
Collapse
Affiliation(s)
- Jian Wang
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; These authors contributed equally to this work
| | - Chenting Zhang
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; These authors contributed equally to this work
| | - Chunli Liu
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; These authors contributed equally to this work
| | - Wei Wang
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; These authors contributed equally to this work
| | - Nuofu Zhang
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; These authors contributed equally to this work
| | - Cyrus Hadadi
- Department of Cardiology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Junyi Huang
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Nanshan Zhong
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenju Lu
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
202
|
Guth S, Wiedenroth CB, Kramm T, Mayer E. Pulmonary endarterectomy for the treatment of chronic thromboembolic pulmonary hypertension. Expert Rev Respir Med 2016; 10:673-84. [PMID: 27070482 DOI: 10.1080/17476348.2016.1176915] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Pulmonary endarterectomy is a curative treatment option for patients with chronic thromboembolic pulmonary hypertension (CTEPH). There is a growing body of evidence suggesting that not only patients with CTEPH but also patients with pulmonary arterial obstructions and mean pulmonary artery pressures < 25 mmHg should be offered surgery. In this review, the recent literature regarding pathophysiology, diagnostic methods, decision making by an expert CTEPH team, and surgical techniques will be summarized. Novel alternative treatment options for inoperable CTEPH patients will be discussed, i.e. targeted medical therapy and balloon pulmonary angioplasty. For the future the major task will be to define a clear selection process for the optimal treatment of the individual CTEPH patient.
Collapse
Affiliation(s)
- Stefan Guth
- a Department of Thoracic Surgery , Kerckhoff Heart and Lung Center , Bad Nauheim , Germany
| | - Christoph B Wiedenroth
- a Department of Thoracic Surgery , Kerckhoff Heart and Lung Center , Bad Nauheim , Germany
| | - Thorsten Kramm
- a Department of Thoracic Surgery , Kerckhoff Heart and Lung Center , Bad Nauheim , Germany
| | - Eckhard Mayer
- a Department of Thoracic Surgery , Kerckhoff Heart and Lung Center , Bad Nauheim , Germany
| |
Collapse
|
203
|
Coghlan JG, Bogaard HJ. Exercise pulmonary haemodynamics: a test in search of purpose. Eur Respir J 2016; 47:1315-7. [PMID: 27132262 DOI: 10.1183/13993003.00397-2016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 02/23/2016] [Indexed: 01/04/2023]
Affiliation(s)
| | - Harm Jan Bogaard
- Pulmonary Medicine, VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
204
|
Enter DH, Zaki A, Duncan BF, Kruse J, Andrei AC, Li Z, Malaisrie SC, Shah SJ, Thomas JD, McCarthy PM. A contemporary analysis of pulmonary hypertension in patients undergoing mitral valve surgery: Is this a risk factor? J Thorac Cardiovasc Surg 2016; 151:1288-97. [DOI: 10.1016/j.jtcvs.2015.12.063] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 12/18/2015] [Accepted: 12/30/2015] [Indexed: 10/22/2022]
|
205
|
Reeves GEM, Collins N, Hayes P, Knapp J, Squance M, Tran H, Bastian B. SAPHIRE: Stress and Pulmonary Hypertension in Rheumatoid Evaluation-A Prevalence Study. Int J Rheumatol 2016; 2016:4564531. [PMID: 27200094 PMCID: PMC4854985 DOI: 10.1155/2016/4564531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 03/02/2016] [Accepted: 03/16/2016] [Indexed: 11/18/2022] Open
Abstract
Pulmonary artery hypertension (PAH) is a disorder of elevated resistance in the pulmonary arterial vessels, reflected by elevation of measured pulmonary artery pressure (PAP), and presenting with breathlessness and, if untreated, progressing to right heart failure and death. The heightened prevalence of PAH in populations with underlying systemic autoimmune conditions, particularly scleroderma and its variants, is well recognised, consistent with the proposed autoimmune contribution to PAH pathogenesis, along with disordered thrombotic, inflammatory, and mitogenic factors. Rheumatoid arthritis (RA) is one of a group of systemic autoimmune conditions featuring inflammatory symmetrical erosive polyarthropathy as its hallmark. This study explored the prevalence of PAH in a population of unselected individuals with RA, using exercise echocardiography (EchoCG). The high prevalence of EchoCG-derived elevation of PAP (EDEPP) in this population (14%) suggests that, like other autoimmune conditions, RA may be a risk factor for PAH. Patients with RA may therefore represent another population for whom PAH screening with noninvasive tools such as EchoCG may be justified.
Collapse
Affiliation(s)
- G. E. M. Reeves
- John Hunter Hospital, University of Newcastle, Callaghan, NSW 2308, Australia
| | - N. Collins
- Department of Cardiology, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia
| | - P. Hayes
- Department of Cardiology, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia
| | - J. Knapp
- Autoimmune Resource and Research Centre, New Lambton Heights, NSW 2305, Australia
| | - M. Squance
- Autoimmune Resource and Research Centre, New Lambton Heights, NSW 2305, Australia
| | - H. Tran
- Pathology North, New Lambton Heights, NSW 2305, Australia
| | - B. Bastian
- Department of Cardiology, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia
| |
Collapse
|
206
|
Sato Y, Saeki N, Asakura T, Aoshiba K, Kotani T. Effects of extrathoracic mechanical ventilation on pulmonary hypertension secondary to lung disease. J Anesth 2016; 30:663-70. [PMID: 27090795 PMCID: PMC4956720 DOI: 10.1007/s00540-016-2172-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 04/03/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Biphasic cuirass ventilation (BCV) is a form of non-invasive extrathoracic positive and negative pressure mechanical ventilation. The present study was conducted to quantify our positive experience using BCV to dramatically improve gas exchange and cardiac function in patients with acute exacerbation of chronic respiratory failure and secondary pulmonary hypertension (PH). METHODS BCV was applied for 2 weeks in 17 patients with PH caused by lung disease. Ventilation sessions were limited to 1 h per day to prevent exhaustion. To assess respiratory and circulatory effects, percutaneous arterial oxygen saturation (SpO2) was measured before and after each daily BCV session, and right heart catheter test [mean pulmonary artery pressure (mPAP), right atrium pressure (RAP), pulmonary artery occlusion pressure (PAOP) and cardiac index (CI)] and serum N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured before and after a series of BCV sessions. RESULTS SpO2 transiently improved after each BCV session. After a series of BCV, mPAP decreased from 27.2 to 22.4 mmHg (p = 0.0007). PAOP, CI and serum NT-proBNP levels decreased compared with baseline. No patients were treated with epoprostenol, iloprost, bosentan or sildenafil for PH. CONCLUSION BCV may improve circulatory function in patients with PH caused by lung disease.
Collapse
Affiliation(s)
- Yoko Sato
- Department of Anesthesiology and Intensive Care Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Noriyuki Saeki
- Synthesis Shinkawabashi Hospital, 1-15 Shinkawadori, Kawasaki-Ku, Kawasaki, Kanagawa, 210-0013, Japan
| | - Takuma Asakura
- Synthesis Shinkawabashi Hospital, 1-15 Shinkawadori, Kawasaki-Ku, Kawasaki, Kanagawa, 210-0013, Japan.,Nitta Central Clinic, 1-20-19 Yaguchi, Ohta-ku, Tokyo, 146-0093, Japan
| | - Kazutetsu Aoshiba
- Department of Respiratory Medicine, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395, Japan
| | - Toru Kotani
- Department of Anesthesiology and Intensive Care Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| |
Collapse
|
207
|
Mathai SC, Ghofrani HA, Mayer E, Pepke-Zaba J, Nikkho S, Simonneau G. Quality of life in patients with chronic thromboembolic pulmonary hypertension. Eur Respir J 2016; 48:526-37. [PMID: 27076580 PMCID: PMC4967564 DOI: 10.1183/13993003.01626-2015] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 03/06/2016] [Indexed: 01/15/2023]
Abstract
Patients with chronic thromboembolic pulmonary hypertension (CTEPH) experience debilitating symptoms that have a negative impact on their quality of life (QoL) in terms of physical capability, psychological wellbeing and social relationships. The use of QoL measurement tools is important in the assessment of treatment efficacy and in guiding treatment decisions. However, despite the importance of QoL, particularly to the patient, it remains under-reported in clinical studies of CTEPH therapy. CTEPH is unique in pulmonary hypertension in that it is potentially curable by surgery; however, a proportion of patients either have residual PH following surgery or are not operable. Although some patients with CTEPH have been treated off-label with pulmonary arterial hypertension-specific therapies, there have been few randomised controlled trials of these therapies in patients with CTEPH. Moreover, in these trials QoL outcomes are variably assessed, and there is little consistency in the tools used. Here we review the assessment of QoL in patients with CTEPH and the tools that have been used. We also discuss the effect of surgical intervention and medical therapies on QoL. We conclude that further studies of QoL in patients with CTEPH are needed to further validate the optimal QoL tools.
Collapse
Affiliation(s)
- Stephen C Mathai
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hossein-Ardeschir Ghofrani
- University of Giessen and Marburg Lung Center, Giessen, Germany, member of the German Center for Lung Research (DZL)
| | - Eckhard Mayer
- Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | | | - Sylvia Nikkho
- Global Clinical Development, Bayer Pharma AG, Berlin, Germany
| | - Gérald Simonneau
- Assistance Publique-Hôpitaux de Paris, Service de Pneumologie, Hôpital Bicêtre, Université Paris-Sud, Laboratoire d'Excellence en Recherche sur le Médicament et Innovation Thérapeutique, and INSERM Unité 999, Le Kremlin-Bicêtre, France
| |
Collapse
|
208
|
Tai R, Dunne RM, Trotman-Dickenson B, Jacobson FL, Madan R, Kumamaru KK, Hunsaker AR. Frequency and Severity of Pulmonary Hemorrhage in Patients Undergoing Percutaneous CT-guided Transthoracic Lung Biopsy: Single-Institution Experience of 1175 Cases. Radiology 2016; 279:287-96. [DOI: 10.1148/radiol.2015150381] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
209
|
The Clinical Significance of HbA1c in Operable Chronic Thromboembolic Pulmonary Hypertension. PLoS One 2016; 11:e0152580. [PMID: 27031508 PMCID: PMC4816563 DOI: 10.1371/journal.pone.0152580] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 03/16/2016] [Indexed: 01/30/2023] Open
Abstract
Background Glycosylated hemoglobin A1c (HbA1c) has been proposed as an independent predictor of long-term prognosis in pulmonary arterial hypertension. However, the clinical relevance of HbA1c in patients with operable chronic thromboembolic pulmonary hypertension (CTEPH) remains unknown. The aim of the present study was to investigate the clinical significance of HbA1c as a biomarker in CTEPH. Methods Prospectively, 102 patients underwent pulmonary endarterectomy (PEA) in our national referral center between March 2013 and March 2014, of which after exclusion 45 patients were analyzed. HbA1c- levels, hemodynamic and exercise parameters were analyzed prior and one-year post-PEA. Results 45 patients (BMI: 27.3 ± 6.0 kg/m2; age: 62.7 ± 12.3 years) with a mean pulmonary arterial pressure (mPAP) of 43.6 ± 9.4 mmHg, a pulmonary vascular resistance (PVR) of 712.1 ± 520.4 dyn*s/cm5, a cardiac index (CI) of 2.4 ± 0.5 l/min/m2 and a mean HbA1c-level of 39.8 ± 5.6 mmol/mol were included. One-year post-PEA pulmonary hemodynamic and functional status significantly improved in our cohort. Baseline HbA1c-levels were significantly associated with CI, right atrial pressure, peak oxygen uptake and the change of 6-minute walking distance using linear regression analysis. However, using logistic regression analysis baseline HbA1c-levels were not significantly associated with residual post-PEA PH. Conclusions This is the first prospective study to describe an association of HbA1c-levels with pulmonary hemodynamics and exercise capacity in operable CTEPH patients. Our preliminary results indicate that in these patients impaired glucose metabolism as assessed by HbA1c is of clinical significance. However, HbA1c failed as a predictor of the hemodynamic outcome one-year post-PEA.
Collapse
|
210
|
Reque J, Quiroga B, Ruiz C, Villaverde MT, Vega A, Abad S, Panizo N, López-Gómez JM. Pulmonary hypertension is an independent predictor of cardiovascular events and mortality in haemodialysis patients. Nephrology (Carlton) 2016; 21:321-6. [DOI: 10.1111/nep.12595] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 07/22/2015] [Accepted: 08/14/2015] [Indexed: 12/22/2022]
Affiliation(s)
- Javier Reque
- Nephrology Department; Hospital General Universitario Gregorio Marañon; Madrid Spain
| | - Borja Quiroga
- Nephrology Department; Hospital General Universitario Gregorio Marañon; Madrid Spain
| | | | | | - Almudena Vega
- Nephrology Department; Hospital General Universitario Gregorio Marañon; Madrid Spain
| | - Soraya Abad
- Nephrology Department; Hospital General Universitario Gregorio Marañon; Madrid Spain
| | - Nayara Panizo
- Nephrology Department; Hospital General Universitario Gregorio Marañon; Madrid Spain
| | - J. Manuel López-Gómez
- Nephrology Department; Hospital General Universitario Gregorio Marañon; Madrid Spain
| |
Collapse
|
211
|
Spruijt OA, Di Pasqua MC, Bogaard HJ, van der Bruggen CEE, Oosterveer F, Marcus JT, Vonk-Noordegraaf A, Handoko ML. Serial assessment of right ventricular systolic function in patients with precapillary pulmonary hypertension using simple echocardiographic parameters: A comparison with cardiac magnetic resonance imaging. J Cardiol 2016; 69:182-188. [PMID: 27012754 DOI: 10.1016/j.jjcc.2016.02.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 02/08/2016] [Accepted: 02/15/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although cardiac magnetic resonance imaging (CMRI) is the gold standard for the (serial) assessment of right ventricular (RV) function, the technique has several drawbacks: CMRI is relatively expensive, has a limited availability, and the analyses are time consuming. Echocardiography (echo) can overcome several of these issues. The aim of this study was to compare simple echo-derived parameters of RV systolic function with CMRI-derived RV ejection fraction (RVEF) in patients with precapillary pulmonary hypertension (PH) and to determine which echo parameters best followed the change in CMRI-derived-RVEF during follow-up. METHODS CMRI and echo were performed in 96 precapillary PH patients. In 38 patients a second set of a CMRI and echo were available. Retrospectively, echo-derived right ventricular fractional area change (RVFAC), tricuspid annulus plane systolic excursion (TAPSE), fractional transversal (FTWM), and longitudinal wall motion (FLWM) were assessed and compared with CMRI-derived-RVEF. Furthermore, the changes in RVFAC, TAPSE, FTWM, and FLWM during follow-up were compared with the change in CMRI-derived-RVEF. RESULTS All four echo parameters were significantly correlated to CMRI-derived-RVEF. The strongest relationship was seen between CMRI-derived-RVEF and RVFAC (r2=0.567). However, sensitivity for predicting a deterioration in CMRI-derived RVEF was poor for all four echo-derived parameters (ranging from 33% to 56%). CONCLUSIONS Although RVFAC, TAPSE, FTWM, and FLWM were significantly correlated to CMRI-derived-RVEF, all four echo parameters showed a low sensitivity for predicting a deterioration in CMRI-derived RVEF during follow-up. Therefore, RVFAC, TAPSE, FTWM, and FLWM are not suitable parameters for the serial assessment of RV systolic function in patients with precapillary PH.
Collapse
Affiliation(s)
- Onno A Spruijt
- Department of Pulmonary Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Maria C Di Pasqua
- Department of Pulmonary Medicine, VU University Medical Center, Amsterdam, The Netherlands; Department of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - H J Bogaard
- Department of Pulmonary Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - C E E van der Bruggen
- Department of Pulmonary Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Frank Oosterveer
- Department of Pulmonary Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - J Tim Marcus
- Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, The Netherlands
| | - Anton Vonk-Noordegraaf
- Department of Pulmonary Medicine, VU University Medical Center, Amsterdam, The Netherlands.
| | - M Louis Handoko
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
212
|
The role of tyrosine kinase inhibitor "Lapatinib" in pulmonary hypertension. Pulm Pharmacol Ther 2016; 37:81-4. [PMID: 26965087 DOI: 10.1016/j.pupt.2016.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 03/01/2016] [Accepted: 03/06/2016] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Pulmonary Arterial Hypertension (PAH) and cancer share growth factor and protein kinase signaling pathways that result in smooth muscle cell proliferation and vasculopathy. There is little known about the impact of Lapatinib on the pulmonary vasculature. After reporting a case of Lapatinib-induced PAH we investigated the association of Lapatinib with the development of PAH in our institution. METHODS We reviewed charts for all patients treated with Lapatinib at our institution between 2008 and 2013. Patients who had undergone 2D-echocardiogram both prior to and after treatment were included in the analysis. Increase in Pulmonary artery systolic pressure (PASP) was assessed. Patients were also evaluated in terms of risk factors for non-Group 1 PAH. RESULTS A total of 27 patients were found to have 2-D echo done before and after starting treatment with Lapatinib. Six patients were found to have significant increase in their PASP after starting treatment. Right heart catheterization before and after stopping the medication was available in three patient, confirming the diagnosis of PAH with complete resolution after stopping the medication. The median pre-treatment and post treatment PASP in those 6 patients was 29 mmHg and 65.5 mmHg respectively (N = 6; p = 0.027). CONCLUSION Lapatinib might be associated with the development of PAH. PASP should be evaluated in patients who become short of breath while on treatment, and stopping the drug in cases where no other reasons are identified could be associated with reversibility of the elevated pulmonary artery pressure.
Collapse
|
213
|
CXCL13 in idiopathic pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. Respir Res 2016; 17:21. [PMID: 26927848 PMCID: PMC4770535 DOI: 10.1186/s12931-016-0336-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 02/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chemokine CXC ligand 13 (CXCL13) has been implicated in perivascular inflammation and pulmonary vascular remodeling in patients with idiopathic pulmonary artery hypertension (IPAH). We wondered whether CXCL13 may also play a role in chronic thromboembolic pulmonary hypertension (CTEPH) and whether serum levels of CXCL13 might serve as biomarkers in these conditions. METHODS Lung tissue from patients with IPAH or CTEPH was immunostained for CXCL13. Serum samples were obtained from patients with IPAH (n = 42) or CTEPH (n = 50) and from healthy controls (n = 13). Serum CXCL13 concentrations were measured by enzyme-linked immunosorbent assay technology and were evaluated for associations with markers of disease severity and survival. RESULTS CXCL13 was expressed in pulmonary vascular lesions and lymphocytes of patients with IPAH and inoperable CTEPH, respectively. Serum CXCL13 was elevated in patients compared to healthy controls [median, interquartile range, 83 (55,114) pg/ml versus 40 (28, 48) pg/ml; p < 0.001]. Serum CXCL13 showed only weak and inconsistent correlations with markers of inflammation or disease severity. In both populations, patients with serum CXCL13 above the median of the respective groups did not have a higher risk of death than patients with lower serum CXCL13. CONCLUSIONS CXCL13 was overexpressed in pulmonary vascular lesions of patients with IPAH and CTEPH, and increased serum concentrations were found in patients with IPAH and CTEPH, suggesting a potential pathogenic role of CXCL13 in both diseases. However, given the weak associations between serum CXCL13 and markers of disease severity and outcome, CXCL13 is unlikely to become a promising biomarker in these patient populations.
Collapse
|
214
|
Richardson C, Agrawal R, Lee J, Almagor O, Nelson R, Varga J, Cuttica MJ, Dematte JDA, Chang RW, Hinchcliff ME. Esophageal dilatation and interstitial lung disease in systemic sclerosis: A cross-sectional study. Semin Arthritis Rheum 2016; 46:109-14. [PMID: 27033049 DOI: 10.1016/j.semarthrit.2016.02.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 11/25/2015] [Accepted: 02/20/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE A patulous esophagus on high-resolution computed tomography (HRCT) of the thorax is frequently observed in patients with systemic sclerosis (SSc). Microaspiration has been purported to play a role in the development and progression of SSc interstitial lung disease (ILD), but studies examining the role of microaspiration in SSc ILD have yielded conflicting results. This study was conducted to determine the association between esophageal diameter and SSc ILD. METHODS A cross-sectional study of Northwestern Scleroderma Registry patients with available HRCT exams was conducted. The predictor variable was the widest esophageal diameter (WED) on HRCT, and the primary and secondary outcome variables were radiographic ILD and pulmonary function tests respectively. The degree of radiographic ILD was assessed using a semi-quantitative score adapted from published methods. Estimated regression coefficients adjusted for age, sex, race, body mass index, smoking; SSc disease subtype, serum autoantibodies, and disease duration; modified Rodnan skin score, proton pump inhibitor, and immune suppressant medication use and erythrocyte sedimentation rate were calculated. RESULTS A total of 270 subjects were studied. In the adjusted analyses, there were positive associations between WED and total ILD score (β = 0.27; 95% CI: 0.09-0.41), fibrosis (β = 0.15; 95% CI: 0.07-0.23), and ground glass opacities (β = 0.12; 95% CI: 0.04-0.20); there were negative associations between WED and FVC % predicted (β = -0.42; 95% CI: -0.69 to -0.13), and adjusted DLCO % predicted (β = -0.45; 95% CI: -0.80 to -0.09) after adjusting for potential confounders. CONCLUSIONS Increasing esophageal diameter on HRCT in patients with SSc is associated with more severe radiographic ILD, lower lung volumes, and lower DLCO % predicted. Longitudinal studies are needed to determine if esophageal dilatation is associated with the incidence and/or progression of ILD in patients with SSc.
Collapse
Affiliation(s)
- Carrie Richardson
- Department of Medicine, McGaw Medical Center, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Medicine, Division of Rheumatology, Johns Hopkins University, Baltimore, MD
| | - Rishi Agrawal
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jungwha Lee
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Orit Almagor
- Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, 240 E Huron St, Suite M-300, Chicago, IL 60611
| | - Ryan Nelson
- Department of Medicine, McGaw Medical Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - John Varga
- Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, 240 E Huron St, Suite M-300, Chicago, IL 60611
| | - Michael J Cuttica
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jane D Amico Dematte
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Rowland W Chang
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, 240 E Huron St, Suite M-300, Chicago, IL 60611; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Monique E Hinchcliff
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, 240 E Huron St, Suite M-300, Chicago, IL 60611.
| |
Collapse
|
215
|
Grinstein J, Gomberg-Maitland M. Management of pulmonary hypertension and right heart failure in the intensive care unit. Curr Hypertens Rep 2016; 17:32. [PMID: 25833459 DOI: 10.1007/s11906-015-0547-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Management of acute right ventricular failure, both with and without coexisting pulmonary hypertension, is a common challenge encountered in the intensive care setting. Both right ventricular dysfunction and pulmonary hypertension portend a poor prognosis, regardless of the underlying cause and are associated with significant morbidity and mortality. The right ventricle is embryologically distinct from the left ventricle and has unique morphologic and functional properties. Management of right ventricular failure and pulmonary hypertension in the intensive care setting requires tailored hemodynamic management, pharmacotherapy, and often mechanical circulatory support. Unfortunately, our understanding of the management of right ventricular failure lags behind that of the left ventricle. In this review, we will explore the underlying pathophysiology of the failing right ventricle and pulmonary vasculature in patients with and without pulmonary hypertension and discuss management strategies based on evidence-based studies as well as our current understanding of the underlying physiology.
Collapse
Affiliation(s)
- Jonathan Grinstein
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL, USA,
| | | |
Collapse
|
216
|
Mitofusin 2 Downregulation Triggers Pulmonary Artery Smooth Muscle Cell Proliferation and Apoptosis Imbalance in Rats With Hypoxic Pulmonary Hypertension Via the PI3K/Akt and Mitochondrial Apoptosis Pathways. J Cardiovasc Pharmacol 2016; 67:164-74. [DOI: 10.1097/fjc.0000000000000333] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
217
|
Tonelli AR, Alkukhun L, Cikach F, Ahmed M, Dweik RA. Are transcutaneous oxygen and carbon dioxide determinations of value in pulmonary arterial hypertension? Microcirculation 2016; 22:249-56. [PMID: 25641509 DOI: 10.1111/micc.12191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 01/26/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND We hypothesized that transcutaneous gas determinations of O2 and CO2 (TcPO2 and TcPCO2 ) are associated with the severity of PAH. METHODS In this cross-sectional study, we included consecutive patients with PAH (group 1 PH; n = 34). Transcutaneous gas determinations were compared to those of age- and gender-matched healthy controls (n = 14), nongroup 1 PH (n = 19) or patients with high estimated RVSP on echocardiography but without hemodynamic evidence of PH (n = 12). RESULTS In patients with PAH, TcPO2 , and TcPCO2 were significantly associated with PaO2 (R = 0.44, p = 0.03) and PaCO2 (R = 0.77, p < 0.001), respectively. TcPO2 /FiO2 (mean difference: -65.0 [95% CI: -121.3, -8.7]) and TcPCO2 (mean difference: -7.4 [95% CI: -11.6, -3.1]) were significantly lower in patients with PAH than healthy controls. TcPCO2 was useful in discriminating PAH patients from other individuals (AUC: 0.74 [95% CI: 0.62, 0.83]). TcPO2 /FiO2 ratio was significantly associated with mean PAP, TPG, PVR, CI, SVI, DLCO, six-minute walk distance and components of the CAMPHOR questionnaire. CONCLUSIONS Transcutaneous pressure of CO2 was lower in patients with PAH. Transcutaneous pressure of O2 over inspired fraction of O2 ratio was inversely associated with severity of disease in patients with PAH.
Collapse
Affiliation(s)
- Adriano R Tonelli
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | | | | |
Collapse
|
218
|
Rodriguez-Roisin R, Bartolome SD, Huchon G, Krowka MJ. Inflammatory bowel diseases, chronic liver diseases and the lung. Eur Respir J 2016; 47:638-50. [PMID: 26797027 DOI: 10.1183/13993003.00647-2015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 11/12/2015] [Indexed: 12/12/2022]
Abstract
This review is devoted to the distinct associations of inflammatory bowel diseases (IBD) and chronic liver disorders with chronic airway diseases, namely chronic obstructive pulmonary disease and bronchial asthma, and other chronic respiratory disorders in the adult population. While there is strong evidence for the association of chronic airway diseases with IBD, the data are much weaker for the interplay between lung and liver multimorbidities. The association of IBD, encompassing Crohn's disease and ulcerative colitis, with pulmonary disorders is underlined by their heterogeneous respiratory manifestations and impact on chronic airway diseases. The potential relationship between the two most prevalent liver-induced pulmonary vascular entities, i.e. portopulmonary hypertension and hepatopulmonary syndrome, and also between liver disease and other chronic respiratory diseases is also approached. Abnormal lung function tests in liver diseases are described and the role of increased serum bilirubin levels on chronic respiratory problems are considered.
Collapse
Affiliation(s)
- Roberto Rodriguez-Roisin
- Servei de Pneumologia (Institut del Tòrax), Hospital Clínic, Institut Biomédic August Pi i Sunyer (IDIBAPS), Ciber Enfermedades Respiratorias (CIBERES), Universitat de Barcelona, Barcelona, Spain
| | - Sonja D Bartolome
- Pulmonary and Critical Care Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Gérard Huchon
- Service de Pneumologie, Université Paris 5, Paris, France
| | - Michael J Krowka
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
219
|
Ando K, Okada Y, Akiba M, Kondo T, Kawamura T, Okumura M, Chen F, Date H, Shiraishi T, Iwasaki A, Yamasaki N, Nagayasu T, Chida M, Inoue Y, Hirai T, Seyama K, Mishima M. Lung Transplantation for Lymphangioleiomyomatosis in Japan. PLoS One 2016; 11:e0146749. [PMID: 26771878 PMCID: PMC4714890 DOI: 10.1371/journal.pone.0146749] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 12/20/2015] [Indexed: 11/18/2022] Open
Abstract
Background Lung transplantation has been established as the definitive treatment option for patients with advanced lymphangioleiomyomatosis (LAM). However, the prognosis after registration and the circumstances of lung transplantation with sirolimus therapy have never been reported. Methods In this national survey, we analyzed data from 98 LAM patients registered for lung transplantation in the Japan Organ Transplantation Network. Results Transplantation was performed in 57 patients as of March 2014. Survival rate was 86.7% at 1 year, 82.5% at 3 years, 73.7% at 5 years, and 73.7% at 10 years. Of the 98 patients, 21 had an inactive status and received sirolimus more frequently than those with an active history (67% vs. 5%, p<0.001). Nine of twelve patients who remained inactive as of March 2014 initiated sirolimus before or while on a waiting list, and remained on sirolimus thereafter. Although the statistical analysis showed no statistically significant difference, the survival rate after registration tended to be better for lung transplant recipients than for those who awaited transplantation (p = 0.053). Conclusions Lung transplantation is a satisfactory therapeutic option for advanced LAM, but the circumstances for pre-transplantation LAM patients are likely to alter with the use of sirolimus.
Collapse
Affiliation(s)
- Katsutoshi Ando
- Division of Respiratory Medicine, Juntendo University, Faculty of Medicine and Graduate School of Medicine; 2-1-1 Hongo; Bunkyo-Ku; Tokyo, Japan
| | - Yoshinori Okada
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University; Seiryo-machi 4-1, Aoba-ku Sendai, Miyagi, Japan
| | - Miki Akiba
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University; Seiryo-machi 4-1, Aoba-ku Sendai, Miyagi, Japan
| | - Takashi Kondo
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University; Seiryo-machi 4-1, Aoba-ku Sendai, Miyagi, Japan
| | - Tomohiro Kawamura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine; 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Meinoshin Okumura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine; 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Fengshi Chen
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto, Japan
| | - Takeshi Shiraishi
- Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University School of Medicine; 7-45-1 Nanakuma, Jonan-ku, Fukuoka City, Fukuoka, Japan
| | - Akinori Iwasaki
- Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University School of Medicine; 7-45-1 Nanakuma, Jonan-ku, Fukuoka City, Fukuoka, Japan
| | - Naoya Yamasaki
- Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences; 1-7-1 Sakamoto, Nagasaki, Japan
| | - Takeshi Nagayasu
- Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences; 1-7-1 Sakamoto, Nagasaki, Japan
| | - Masayuki Chida
- Department of General Thoracic Surgery, Dokkyo Medical University; 880 Kitakobayashi, Mibu-machi, Shimotsuga-gun, Tochigi, Japan
| | - Yoshikazu Inoue
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center; 1180, Nagasonecho, Kita-Ku, Sakai, Osaka, Japan.,Respiratory Failure Research Group from the Ministry of Health, Labour and Welfare, Japan, (Office) Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University; Kawahara 54, Shogoin, Sakyo-ku, Kyoto, Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University; Kawahara 54, Shogoin, Sakyo-ku, Kyoto, Japan.,Respiratory Failure Research Group from the Ministry of Health, Labour and Welfare, Japan, (Office) Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University; Kawahara 54, Shogoin, Sakyo-ku, Kyoto, Japan
| | - Kuniaki Seyama
- Division of Respiratory Medicine, Juntendo University, Faculty of Medicine and Graduate School of Medicine; 2-1-1 Hongo; Bunkyo-Ku; Tokyo, Japan.,Respiratory Failure Research Group from the Ministry of Health, Labour and Welfare, Japan, (Office) Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University; Kawahara 54, Shogoin, Sakyo-ku, Kyoto, Japan
| | - Michiaki Mishima
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University; Kawahara 54, Shogoin, Sakyo-ku, Kyoto, Japan.,Respiratory Failure Research Group from the Ministry of Health, Labour and Welfare, Japan, (Office) Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University; Kawahara 54, Shogoin, Sakyo-ku, Kyoto, Japan
| | | |
Collapse
|
220
|
Pathophysiology and treatment of pulmonary hypertension in sickle cell disease. Blood 2016; 127:820-8. [PMID: 26758918 DOI: 10.1182/blood-2015-08-618561] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/21/2015] [Indexed: 12/11/2022] Open
Abstract
Pulmonary hypertension affects ∼10% of adult patients with sickle cell disease (SCD), particularly those with the homozygous genotype. An increase in pulmonary artery systolic pressure, estimated noninvasively by echocardiography, helps identify SCD patients at risk for pulmonary hypertension, but definitive diagnosis requires right-heart catheterization. About half of SCD-related pulmonary hypertension patients have precapillary pulmonary hypertension with potential etiologies of (1) a nitric oxide deficiency state and vasculopathy consequent to intravascular hemolysis, (2) chronic pulmonary thromboembolism, or (3) upregulated hypoxic responses secondary to anemia, low O2 saturation, and microvascular obstruction. The remainder have postcapillary pulmonary hypertension secondary to left ventricular dysfunction. Although the pulmonary artery pressure in SCD patients with pulmonary hypertension is only moderately elevated, they have a markedly higher risk of death than patients without pulmonary hypertension. Guidelines for diagnosis and management of SCD-related pulmonary hypertension were published recently by the American Thoracic Society. Management of adults with sickle-related pulmonary hypertension is based on anticoagulation for those with thromboembolism; oxygen therapy for those with low oxygen saturation; treatment of left ventricular failure in those with postcapillary pulmonary hypertension; and hydroxyurea or transfusions to raise the hemoglobin concentration, reduce hemolysis, and prevent vaso-occlusive events that cause additional increases in pulmonary pressure. Randomized trials have not identified drugs to lower pulmonary pressure in SCD patients with precapillary pulmonary hypertension. Patients with hemodynamics of pulmonary arterial hypertension should be referred to specialized centers and considered for treatments known to be effective in other forms of pulmonary arterial hypertension. There have been reports that some of these treatments improve SCD-related pulmonary hypertension.
Collapse
|
221
|
Dhariwal AK, Bavdekar SB. Sildenafil in pediatric pulmonary arterial hypertension. J Postgrad Med 2016; 61:181-92. [PMID: 26119438 PMCID: PMC4943407 DOI: 10.4103/0022-3859.159421] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a life-threatening disease of varied etiologies. Although PAH has no curative treatment, a greater understanding of pathophysiology, technological advances resulting in early diagnosis, and the availability of several newer drugs have improved the outlook for patients with PAH. Sildenafil is one of the therapeutic agents used extensively in the treatment of PAH in children, as an off-label drug. In 2012, the United States Food and Drug Administration (USFDA) issued a warning regarding the of use high-dose sildenafil in children with PAH. This has led to a peculiar situation where there is a paucity of approved therapies for the management of PAH in children and the use of the most extensively used drug being discouraged by the regulator. This article provides a review of the use of sildenafil in the treatment of PAH in children.
Collapse
Affiliation(s)
- A K Dhariwal
- Department of Pediatrics, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
| | | |
Collapse
|
222
|
Kovacs G, Avian A, Olschewski H. Proposed new definition of exercise pulmonary hypertension decreases false-positive cases. Eur Respir J 2016; 47:1270-3. [PMID: 26743486 DOI: 10.1183/13993003.01394-2015] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/26/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Gabor Kovacs
- Dept of Internal Medicine, Division of Pulmonology, Medical University of Graz, Graz, Austria Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Alexander Avian
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Horst Olschewski
- Dept of Internal Medicine, Division of Pulmonology, Medical University of Graz, Graz, Austria Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| |
Collapse
|
223
|
|
224
|
The relationship between pulmonary artery acceleration time and mean pulmonary artery pressure in patients undergoing cardiac surgery. Eur J Anaesthesiol 2016. [DOI: 10.1097/eja.0000000000000314] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
225
|
Xu D, Li Y, Zhang B, Wang Y, Liu Y, Luo Y, Niu W, Dong M, Liu M, Dong H, Zhao P, Li Z. Resveratrol alleviate hypoxic pulmonary hypertension via anti-inflammation and anti-oxidant pathways in rats. Int J Med Sci 2016; 13:942-954. [PMID: 27994500 PMCID: PMC5165688 DOI: 10.7150/ijms.16810] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 09/27/2016] [Indexed: 01/10/2023] Open
Abstract
Resveratrol, a plant-derived polyphenolic compound and a phytoestrogen, was shown to possess multiple protective effects including anti-inflammatory response and anti-oxidative stress. Hypoxic pulmonary hypertension (HPH) is a progressive disease characterized by sustained vascular resistance and marked pulmonary vascular remodeling. The exact mechanisms of HPH are still unclear, but inflammatory response and oxidative stress was demonstrated to participate in the progression of HPH. The present study was designed to investigate the effects of resveratrol on HPH development. Sprague-Dawley rats were challenged by hypoxia exposure for 28 days to mimic hypoxic pulmonary hypertension along with treating resveratrol (40 mg/kg/day). Hemodynamic and pulmonary pathomorphology data were then obtained, and the anti-proliferation effect of resveratrol was determined by in vitro assays. The anti-inflammation and anti-oxidative effects of resveratrol were investigated in vivo and in vitro. The present study showed that resveratrol treatment alleviated right ventricular systolic pressure and pulmonary arterial remodeling induced by hypoxia. In vitro experiments showed that resveratrol notably inhibited proliferation of pulmonary arterial smooth muscle cells in an ER-independent manner. Data showed that resveratrol administration inhibited HIF-1 α expression in vivo and in vitro, suppressed inflammatory cells infiltration around the pulmonary arteries, and decreased ROS production induced by hypoxia in PAMSCs. The inflammatory cytokines' mRNA levels of tumor necrosis factor α, interleukin 6, and interleukin 1β were all suppressed by resveratrol treatment. The in vitro assays showed that resveratrol inhibited the expression of HIF-1 α via suppressing the MAPK/ERK1 and PI3K/AKT pathways. The antioxidant axis of Nuclear factor erythroid-2 related factor 2/ Thioredoxin 1 (Nrf-2/Trx-1) was up-regulated both in lung tissues and in cultured PASMCs. In general, the current study demonstrated that resveratrol may prevent pulmonary hypertension through its anti-proliferation, anti-inflammation and antioxidant effects. Hence, the present data may offer novel targets and promising pharmacological perspective for treating hypoxic pulmonary hypertension.
Collapse
Affiliation(s)
- Dunquan Xu
- Department of Pathophysiology, Fourth Military Medical University, Xi`an, 710032, PR China.; Clinical laboratory, the Eighth Hospital of PLA, Xigaze, 857000, PR China
| | - Yan Li
- Physical Examination Center of Beijing Military Region General Hospital, Beijing, 100700, PR China
| | - Bo Zhang
- Department of Pathophysiology, Fourth Military Medical University, Xi`an, 710032, PR China
| | - Yanxia Wang
- Department of Pathophysiology, Fourth Military Medical University, Xi`an, 710032, PR China
| | - Yi Liu
- Department of Pathophysiology, Fourth Military Medical University, Xi`an, 710032, PR China
| | - Ying Luo
- Department of Pathophysiology, Fourth Military Medical University, Xi`an, 710032, PR China
| | - Wen Niu
- Department of Pathophysiology, Fourth Military Medical University, Xi`an, 710032, PR China
| | - Mingqing Dong
- Department of Pathophysiology, Fourth Military Medical University, Xi`an, 710032, PR China
| | - Manling Liu
- Department of Pathophysiology, Fourth Military Medical University, Xi`an, 710032, PR China
| | - Haiying Dong
- Department of Pathophysiology, Fourth Military Medical University, Xi`an, 710032, PR China
| | - Pengtao Zhao
- Department of Pathophysiology, Fourth Military Medical University, Xi`an, 710032, PR China
| | - Zhichao Li
- Department of Pathophysiology, Fourth Military Medical University, Xi`an, 710032, PR China
| |
Collapse
|
226
|
Cobra SDB, Cardoso RM, Rodrigues MP. Usefulness of the second heart sound for predicting pulmonary hypertension in patients with interstitial lung disease. SAO PAULO MED J 2016; 134:34-9. [PMID: 26786609 PMCID: PMC10496576 DOI: 10.1590/1516-3180.2015.00701207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 04/12/2015] [Accepted: 07/12/2015] [Indexed: 11/21/2022] Open
Abstract
CONTEXT AND OBJECTIVE P2 hyperphonesis is considered to be a valuable finding in semiological diagnoses of pulmonary hypertension (PH). The aim here was to evaluate the accuracy of the pulmonary component of second heart sounds for predicting PH in patients with interstitial lung disease. DESIGN AND SETTING Cross-sectional study at the University of Brasilia and Hospital de Base do Distrito Federal. METHODS Heart sounds were acquired using an electronic stethoscope and were analyzed using phonocardiography. Clinical signs suggestive of PH, such as second heart sound (S2) in pulmonary area louder than in aortic area; P2 > A2 in pulmonary area and P2 present in mitral area, were compared with Doppler echocardiographic parameters suggestive of PH. Sensitivity (S), specificity (Sp) and positive (LR+) and negative (LR-) likelihood ratios were evaluated. RESULTS There was no significant correlation between S2 or P2 amplitude and PASP (pulmonary artery systolic pressure) (P = 0.185 and 0.115; P= 0.13 and 0.34, respectively). Higher S2 in pulmonary area than in aortic area, compared with all the criteria suggestive of PH, showed S = 60%, Sp= 22%; LR+ = 0.7; LR- = 1.7; while P2> A2 showed S= 57%, Sp = 39%; LR+ = 0.9; LR- = 1.1; and P2 in mitral area showed: S= 68%, Sp = 41%; LR+ = 1.1; LR- = 0.7. All these signals together showed: S= 50%, Sp = 56%. CONCLUSIONS The semiological signs indicative of PH presented low sensitivity and specificity levels for clinically diagnosing this comorbidity.
Collapse
Affiliation(s)
- Sandra de Barros Cobra
- MD, MSc. Cardiologist, Hospital de Base do Distrito Federal (HBDF), Brasília, Federal District, Brazil.
| | - Rayane Marques Cardoso
- MD. Resident in General Surgery, Universidade de Brasília (UnB), Brasília, Federal District, Brazil.
| | - Marcelo Palmeira Rodrigues
- MD, MSc, PhD. Professor, School of Medicine, Universidade de Brasília (UnB), Brasília, Federal District, Brazil.
| |
Collapse
|
227
|
Yang S, Yang Y, Zhai Z, Kuang T, Gong J, Zhang S, Zhu J, Liang L, Shen YH, Wang C. Incidence and risk factors of chronic thromboembolic pulmonary hypertension in patients after acute pulmonary embolism. J Thorac Dis 2015; 7:1927-38. [PMID: 26716031 DOI: 10.3978/j.issn.2072-1439.2015.11.43] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Early identification and treatment of chronic thromboembolic pulmonary hypertension (CTEPH) are critical to prevent disease progression. We determined the incidence and risk factors for CTEPH in patients with a first episode of acute pulmonary embolism (PE). METHODS In this study, consecutive patients with first-episode acute PE were followed for ≤5 years. Pulmonary hypertension (PH) was screened for by echocardiography. Suspected cases were evaluated by right heart catheterization (RHC) and pulmonary angiography (PA). If invasive procedures were not permitted, PH was diagnosed by systolic pulmonary artery pressure (SPAP) >50 mmHg. Diagnosis of CTEPH was confirmed by PA, ventilation/perfusion (V/Q) lung scan, or computed tomography (CT) PA (CTPA). RESULTS Overall, 614 patients with acute PE were included (median follow-up, 3.3 years). Ten patients were diagnosed with CTEPH: cumulative incidence 0.8% [95% confidence interval (CI), 0.0-1.6%] at 1 year, 1.3% (95% CI, 0.3-2.3%) at 2 years, and 1.7% (95% CI, 0.7-2.7%) at 3 years. No cases of CTEPH developed after 3 years. History of lower-limb varicose veins [hazard ratio (HR), 4.3; 95% CI, 1.2-15.4; P=0.024], SPAP >50 mmHg at initial PE episode (HR, 23.5; 95% CI, 2.7-207.6; P=0.005), intermediate-risk PE (HR, 1.2; 95% CI, 1.0-1.4; P=0.030), and CT obstruction index over 30% at 3 months after acute PE (HR, 42.5; 95% CI, 4.4-409.8; P=0.001) were associated with increased risk of CTEPH. CONCLUSIONS CTEPH was not rare after acute PE in this Chinese population, especially within 3 years of diagnosis. Lower-limb varicose veins, intermediate-risk PE with elevated SPAP in the acute phase, and residual emboli during follow-up might increase the risk of CTEPH.
Collapse
Affiliation(s)
- Suqiao Yang
- 1 Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China ; 2 Beijing Institute of Respiratory Medicine, Beijing 100020, China ; 3 Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing 100020, China ; 4 Center of Respiratory Medicine, Beijing Hospital, Ministry of Health, Beijing 100730, China ; 5 Department of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas, USA ; 6 Department of Respiratory Medicine, Capital Medical University, Beijing 100069, China ; 7 China-Japan Friendship Hospital, Beijing 100029, China
| | - Yuanhua Yang
- 1 Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China ; 2 Beijing Institute of Respiratory Medicine, Beijing 100020, China ; 3 Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing 100020, China ; 4 Center of Respiratory Medicine, Beijing Hospital, Ministry of Health, Beijing 100730, China ; 5 Department of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas, USA ; 6 Department of Respiratory Medicine, Capital Medical University, Beijing 100069, China ; 7 China-Japan Friendship Hospital, Beijing 100029, China
| | - Zhenguo Zhai
- 1 Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China ; 2 Beijing Institute of Respiratory Medicine, Beijing 100020, China ; 3 Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing 100020, China ; 4 Center of Respiratory Medicine, Beijing Hospital, Ministry of Health, Beijing 100730, China ; 5 Department of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas, USA ; 6 Department of Respiratory Medicine, Capital Medical University, Beijing 100069, China ; 7 China-Japan Friendship Hospital, Beijing 100029, China
| | - Tuguang Kuang
- 1 Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China ; 2 Beijing Institute of Respiratory Medicine, Beijing 100020, China ; 3 Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing 100020, China ; 4 Center of Respiratory Medicine, Beijing Hospital, Ministry of Health, Beijing 100730, China ; 5 Department of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas, USA ; 6 Department of Respiratory Medicine, Capital Medical University, Beijing 100069, China ; 7 China-Japan Friendship Hospital, Beijing 100029, China
| | - Juanni Gong
- 1 Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China ; 2 Beijing Institute of Respiratory Medicine, Beijing 100020, China ; 3 Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing 100020, China ; 4 Center of Respiratory Medicine, Beijing Hospital, Ministry of Health, Beijing 100730, China ; 5 Department of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas, USA ; 6 Department of Respiratory Medicine, Capital Medical University, Beijing 100069, China ; 7 China-Japan Friendship Hospital, Beijing 100029, China
| | - Shuai Zhang
- 1 Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China ; 2 Beijing Institute of Respiratory Medicine, Beijing 100020, China ; 3 Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing 100020, China ; 4 Center of Respiratory Medicine, Beijing Hospital, Ministry of Health, Beijing 100730, China ; 5 Department of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas, USA ; 6 Department of Respiratory Medicine, Capital Medical University, Beijing 100069, China ; 7 China-Japan Friendship Hospital, Beijing 100029, China
| | - Jianguo Zhu
- 1 Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China ; 2 Beijing Institute of Respiratory Medicine, Beijing 100020, China ; 3 Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing 100020, China ; 4 Center of Respiratory Medicine, Beijing Hospital, Ministry of Health, Beijing 100730, China ; 5 Department of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas, USA ; 6 Department of Respiratory Medicine, Capital Medical University, Beijing 100069, China ; 7 China-Japan Friendship Hospital, Beijing 100029, China
| | - Lirong Liang
- 1 Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China ; 2 Beijing Institute of Respiratory Medicine, Beijing 100020, China ; 3 Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing 100020, China ; 4 Center of Respiratory Medicine, Beijing Hospital, Ministry of Health, Beijing 100730, China ; 5 Department of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas, USA ; 6 Department of Respiratory Medicine, Capital Medical University, Beijing 100069, China ; 7 China-Japan Friendship Hospital, Beijing 100029, China
| | - Ying H Shen
- 1 Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China ; 2 Beijing Institute of Respiratory Medicine, Beijing 100020, China ; 3 Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing 100020, China ; 4 Center of Respiratory Medicine, Beijing Hospital, Ministry of Health, Beijing 100730, China ; 5 Department of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas, USA ; 6 Department of Respiratory Medicine, Capital Medical University, Beijing 100069, China ; 7 China-Japan Friendship Hospital, Beijing 100029, China
| | - Chen Wang
- 1 Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China ; 2 Beijing Institute of Respiratory Medicine, Beijing 100020, China ; 3 Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing 100020, China ; 4 Center of Respiratory Medicine, Beijing Hospital, Ministry of Health, Beijing 100730, China ; 5 Department of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas, USA ; 6 Department of Respiratory Medicine, Capital Medical University, Beijing 100069, China ; 7 China-Japan Friendship Hospital, Beijing 100029, China
| |
Collapse
|
228
|
Motoji Y, Tanaka H, Fukuda Y, Sano H, Ryo K, Sawa T, Miyoshi T, Imanishi J, Mochizuki Y, Tatsumi K, Matsumoto K, Emoto N, Hirata KI. Association of Apical Longitudinal Rotation with Right Ventricular Performance in Patients with Pulmonary Hypertension: Insights into Overestimation of Tricuspid Annular Plane Systolic Excursion. Echocardiography 2015; 33:207-15. [PMID: 26710717 DOI: 10.1111/echo.13036] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Current guidelines recommend the routine use of tricuspid annular plane systolic excursion (TAPSE) as a simple method for estimating right ventricular (RV) function. However, when ventricular apical longitudinal rotation (apical-LR) occurs in pulmonary hypertension (PH) patients, it may result in overestimated TAPSE. METHODS We studied 105 patients with PH defined as mean pulmonary artery pressure >25 mmHg at rest measured by right heart cardiac catheterization. TAPSE was defined as the maximum displacement during systole in the RV-focused apical four-chamber view. RV free-wall longitudinal speckle tracking strain (RV-free) was calculated by averaging 3 regional peak systolic strains. The apical-LR was measured at the peak rotation in the apical region including both left and right ventricle. The eccentricity index (EI) was defined as the ratio of the length of 2 perpendicular minor-axis diameters, one of which bisected and was perpendicular to the interventricular septum, and was obtained at end-systole (EI-sys) and end-diastole (EI-dia). Twenty age-, gender-, and left ventricular ejection fraction-matched normal controls were studied for comparison. RESULTS The apical-LR in PH patients was significantly lower than that in normal controls (-3.4 ± 2.7° vs. -1.3 ± 1.9°, P = 0.001). Simple linear regression analysis showed that gender, TAPSE, EI-sys, and EI-dia/EI-sys were associated with apical-LR, but RV-free was not. Multiple regression analysis demonstrated that gender, EI-dia/EI-sys, and TAPSE were independent determinants of apical-LR. CONCLUSIONS TAPSE may be overestimated in PH patients with clockwise rotation resulting from left ventricular compression. TAPSE should thus be evaluated carefully in PH patients with marked apical rotation.
Collapse
Affiliation(s)
- Yoshiki Motoji
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuko Fukuda
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroyuki Sano
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Keiko Ryo
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takuma Sawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tatsuya Miyoshi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Junichi Imanishi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yasuhide Mochizuki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazuhiro Tatsumi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kensuke Matsumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Noriaki Emoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken-ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
229
|
Pérez-Peñate GM, Rúa-Figueroa I, Juliá-Serdá G, León-Marrero F, García-Quintana A, Ortega-Trujillo JR, Erausquin-Arruabarrena C, Rodríguez-Lozano C, Cabrera-Navarro P, Ojeda-Betancor N, Gómez-Sánchez MÁ. Pulmonary Arterial Hypertension in Systemic Lupus Erythematosus: Prevalence and Predictors. J Rheumatol 2015; 43:323-9. [PMID: 26669915 DOI: 10.3899/jrheum.150451] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Pulmonary arterial hypertension (PAH) prevalence has been reported to be between 0.5% and 17% in systemic lupus erythematosus (SLE). This study assessed PAH prevalence and predictors in an SLE cohort. METHODS The Borg dyspnea scale, DLCO, N-terminal pro-brain natriuretic peptide (NT-proBNP), and Doppler echocardiographic (DE) were performed. An echocardiographic Doppler exercise test was conducted in selected patients. When DE systolic pulmonary arterial pressure was ≥ 45 mmHg or increased during exercise > 20 mmHg, a right heart catheterization was performed. Hemodynamic during exercise was measured if rest mean pulmonary arterial pressure was < 25 mmHg. RESULTS Of the 203 patients with SLE, 152 were included. The mean age was 44.9 ± 12.3 years, and 94% were women. Three patients had known PAH. The algorithm diagnosed 1 patient with chronic thromboembolic pulmonary hypertension and 5 with exercise-induced pulmonary artery pressure increase (4 with occult left diastolic dysfunction). These patients had significantly more dyspnea, higher NT-proBNP, and lower DLCO. CONCLUSION These data confirm the low prevalence of PAH in SLE. In our cohort, occult left ventricular diastolic dysfunction was a frequent diagnosis of unexplained dyspnea. Dyspnea, DLCO, and NT-proBNP could be predictors of pulmonary hypertension in patients with SLE.
Collapse
Affiliation(s)
- Gregorio Miguel Pérez-Peñate
- From the Pneumology Service, Rheumatology Service, Cardiology Service, Anesthesiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín," Las Palmas de Gran Canaria; Cardiology Service, Hospital 12 de Octubre, Madrid, Spain.G.M. Pérez-Peñate, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; I. Rúa-Figueroa, MD, Rheumatology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; G. Juliá-Serdá, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; F. León- Marrero, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; A. García-Quintana, MD, Cardiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; J.R. Ortega-Trujillo, MD, Cardiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; C. Erausquin-Arruabarrena, MD, Rheumatology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; C. Rodríguez-Lozano, MD, Rheumatology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; P. Cabrera-Navarro, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; N. Ojeda-Betancor, MD, Anesthesiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; M.Á. Gómez-Sánchez, MD, Cardiology Service, Hospital 12 de Octubre.
| | - Iñigo Rúa-Figueroa
- From the Pneumology Service, Rheumatology Service, Cardiology Service, Anesthesiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín," Las Palmas de Gran Canaria; Cardiology Service, Hospital 12 de Octubre, Madrid, Spain.G.M. Pérez-Peñate, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; I. Rúa-Figueroa, MD, Rheumatology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; G. Juliá-Serdá, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; F. León- Marrero, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; A. García-Quintana, MD, Cardiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; J.R. Ortega-Trujillo, MD, Cardiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; C. Erausquin-Arruabarrena, MD, Rheumatology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; C. Rodríguez-Lozano, MD, Rheumatology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; P. Cabrera-Navarro, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; N. Ojeda-Betancor, MD, Anesthesiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; M.Á. Gómez-Sánchez, MD, Cardiology Service, Hospital 12 de Octubre
| | - Gabriel Juliá-Serdá
- From the Pneumology Service, Rheumatology Service, Cardiology Service, Anesthesiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín," Las Palmas de Gran Canaria; Cardiology Service, Hospital 12 de Octubre, Madrid, Spain.G.M. Pérez-Peñate, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; I. Rúa-Figueroa, MD, Rheumatology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; G. Juliá-Serdá, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; F. León- Marrero, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; A. García-Quintana, MD, Cardiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; J.R. Ortega-Trujillo, MD, Cardiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; C. Erausquin-Arruabarrena, MD, Rheumatology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; C. Rodríguez-Lozano, MD, Rheumatology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; P. Cabrera-Navarro, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; N. Ojeda-Betancor, MD, Anesthesiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; M.Á. Gómez-Sánchez, MD, Cardiology Service, Hospital 12 de Octubre
| | - Fernándo León-Marrero
- From the Pneumology Service, Rheumatology Service, Cardiology Service, Anesthesiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín," Las Palmas de Gran Canaria; Cardiology Service, Hospital 12 de Octubre, Madrid, Spain.G.M. Pérez-Peñate, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; I. Rúa-Figueroa, MD, Rheumatology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; G. Juliá-Serdá, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; F. León- Marrero, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; A. García-Quintana, MD, Cardiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; J.R. Ortega-Trujillo, MD, Cardiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; C. Erausquin-Arruabarrena, MD, Rheumatology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; C. Rodríguez-Lozano, MD, Rheumatology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; P. Cabrera-Navarro, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; N. Ojeda-Betancor, MD, Anesthesiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; M.Á. Gómez-Sánchez, MD, Cardiology Service, Hospital 12 de Octubre
| | - Antonio García-Quintana
- From the Pneumology Service, Rheumatology Service, Cardiology Service, Anesthesiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín," Las Palmas de Gran Canaria; Cardiology Service, Hospital 12 de Octubre, Madrid, Spain.G.M. Pérez-Peñate, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; I. Rúa-Figueroa, MD, Rheumatology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; G. Juliá-Serdá, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; F. León- Marrero, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; A. García-Quintana, MD, Cardiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; J.R. Ortega-Trujillo, MD, Cardiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; C. Erausquin-Arruabarrena, MD, Rheumatology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; C. Rodríguez-Lozano, MD, Rheumatology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; P. Cabrera-Navarro, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; N. Ojeda-Betancor, MD, Anesthesiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; M.Á. Gómez-Sánchez, MD, Cardiology Service, Hospital 12 de Octubre
| | - José Ramón Ortega-Trujillo
- From the Pneumology Service, Rheumatology Service, Cardiology Service, Anesthesiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín," Las Palmas de Gran Canaria; Cardiology Service, Hospital 12 de Octubre, Madrid, Spain.G.M. Pérez-Peñate, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; I. Rúa-Figueroa, MD, Rheumatology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; G. Juliá-Serdá, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; F. León- Marrero, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; A. García-Quintana, MD, Cardiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; J.R. Ortega-Trujillo, MD, Cardiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; C. Erausquin-Arruabarrena, MD, Rheumatology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; C. Rodríguez-Lozano, MD, Rheumatology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; P. Cabrera-Navarro, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; N. Ojeda-Betancor, MD, Anesthesiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; M.Á. Gómez-Sánchez, MD, Cardiology Service, Hospital 12 de Octubre
| | - Celia Erausquin-Arruabarrena
- From the Pneumology Service, Rheumatology Service, Cardiology Service, Anesthesiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín," Las Palmas de Gran Canaria; Cardiology Service, Hospital 12 de Octubre, Madrid, Spain.G.M. Pérez-Peñate, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; I. Rúa-Figueroa, MD, Rheumatology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; G. Juliá-Serdá, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; F. León- Marrero, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; A. García-Quintana, MD, Cardiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; J.R. Ortega-Trujillo, MD, Cardiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; C. Erausquin-Arruabarrena, MD, Rheumatology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; C. Rodríguez-Lozano, MD, Rheumatology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; P. Cabrera-Navarro, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; N. Ojeda-Betancor, MD, Anesthesiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; M.Á. Gómez-Sánchez, MD, Cardiology Service, Hospital 12 de Octubre
| | - Carlos Rodríguez-Lozano
- From the Pneumology Service, Rheumatology Service, Cardiology Service, Anesthesiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín," Las Palmas de Gran Canaria; Cardiology Service, Hospital 12 de Octubre, Madrid, Spain.G.M. Pérez-Peñate, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; I. Rúa-Figueroa, MD, Rheumatology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; G. Juliá-Serdá, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; F. León- Marrero, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; A. García-Quintana, MD, Cardiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; J.R. Ortega-Trujillo, MD, Cardiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; C. Erausquin-Arruabarrena, MD, Rheumatology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; C. Rodríguez-Lozano, MD, Rheumatology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; P. Cabrera-Navarro, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; N. Ojeda-Betancor, MD, Anesthesiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; M.Á. Gómez-Sánchez, MD, Cardiology Service, Hospital 12 de Octubre
| | - Pedro Cabrera-Navarro
- From the Pneumology Service, Rheumatology Service, Cardiology Service, Anesthesiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín," Las Palmas de Gran Canaria; Cardiology Service, Hospital 12 de Octubre, Madrid, Spain.G.M. Pérez-Peñate, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; I. Rúa-Figueroa, MD, Rheumatology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; G. Juliá-Serdá, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; F. León- Marrero, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; A. García-Quintana, MD, Cardiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; J.R. Ortega-Trujillo, MD, Cardiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; C. Erausquin-Arruabarrena, MD, Rheumatology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; C. Rodríguez-Lozano, MD, Rheumatology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; P. Cabrera-Navarro, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; N. Ojeda-Betancor, MD, Anesthesiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; M.Á. Gómez-Sánchez, MD, Cardiology Service, Hospital 12 de Octubre
| | - Nazario Ojeda-Betancor
- From the Pneumology Service, Rheumatology Service, Cardiology Service, Anesthesiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín," Las Palmas de Gran Canaria; Cardiology Service, Hospital 12 de Octubre, Madrid, Spain.G.M. Pérez-Peñate, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; I. Rúa-Figueroa, MD, Rheumatology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; G. Juliá-Serdá, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; F. León- Marrero, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; A. García-Quintana, MD, Cardiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; J.R. Ortega-Trujillo, MD, Cardiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; C. Erausquin-Arruabarrena, MD, Rheumatology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; C. Rodríguez-Lozano, MD, Rheumatology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; P. Cabrera-Navarro, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; N. Ojeda-Betancor, MD, Anesthesiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; M.Á. Gómez-Sánchez, MD, Cardiology Service, Hospital 12 de Octubre
| | - Miguel Ángel Gómez-Sánchez
- From the Pneumology Service, Rheumatology Service, Cardiology Service, Anesthesiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín," Las Palmas de Gran Canaria; Cardiology Service, Hospital 12 de Octubre, Madrid, Spain.G.M. Pérez-Peñate, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; I. Rúa-Figueroa, MD, Rheumatology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; G. Juliá-Serdá, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; F. León- Marrero, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; A. García-Quintana, MD, Cardiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; J.R. Ortega-Trujillo, MD, Cardiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; C. Erausquin-Arruabarrena, MD, Rheumatology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; C. Rodríguez-Lozano, MD, Rheumatology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; P. Cabrera-Navarro, MD, Pneumology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; N. Ojeda-Betancor, MD, Anesthesiology Service, Hospital Universitario General de Gran Canaria "Doctor Negrín"; M.Á. Gómez-Sánchez, MD, Cardiology Service, Hospital 12 de Octubre
| |
Collapse
|
230
|
Borgarelli M, Abbott J, Braz-Ruivo L, Chiavegato D, Crosara S, Lamb K, Ljungvall I, Poggi M, Santilli RA, Haggstrom J. Prevalence and prognostic importance of pulmonary hypertension in dogs with myxomatous mitral valve disease. J Vet Intern Med 2015; 29:569-74. [PMID: 25818210 PMCID: PMC4895522 DOI: 10.1111/jvim.12564] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 12/08/2014] [Accepted: 01/28/2015] [Indexed: 12/31/2022] Open
Abstract
Background Pulmonary hypertension (PH) is common in dogs with myxomatous mitral valve disease (MMVD) but its effect on clinical outcome has not been investigated. Hypothesis/objectives The presence of PH worsens the outcome in dogs with MMVD. To compare survival times of dogs with MMVD and PH to those without PH. Animals Two hundred and twelve client‐owned dogs. Methods Case review study. Medical records of dogs diagnosed with ACVIM stage B2 and C MMVD between January 2010 and December 2011 were retrospectively reviewed. Long‐term outcome was determined by telephone interview or from the medical record. End of the observation period was March 2013. PH was identified if tricuspid regurgitation peak velocity was >3 m/s. Results Two hundred and twelve were identified. Eighty‐three dogs (39%) had PH. PH was more commonly identified in stage C compared to B2 (P < .0001). One hundred and five (49.5%) dogs died during the observation period. Median survival time for the entire study population was 567 days (95% CI 512–743). Stage C (P = .003), the presence of PH (P = .009), left atrial to aortic root ratio (LA/Ao) >1.7 (P = .0002), normalized left‐ventricular end‐diastolic diameter (LVEDn) >1.73 (P = .048), and tricuspid regurgitation pressure gradient (TRPG) >55 mmHg (P = .009) were associated with worse outcomes in the univariate analyses. The presence of TRPG >55 mmHg (HR 1.8 95% CI 1–2.9; P = .05) and LA/Ao > 1.7 (HR 2 95% CI 1.2–3.4; P = .01) remained significant predictors of worse outcome in the multivariate analysis. Conclusions and Clinical Importance In dogs with MMVD, moderate to severe PH worsens outcome.
Collapse
Affiliation(s)
- M Borgarelli
- Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
231
|
Lazzeri C, Cianchi G, Bonizzoli M, Batacchi S, Peris A, Gensini GF. The potential role and limitations of echocardiography in acute respiratory distress syndrome. Ther Adv Respir Dis 2015; 10:136-48. [PMID: 26660667 DOI: 10.1177/1753465815621251] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Bedside use of Doppler echocardiography is being featured as a promising, clinically useful tool in assessing the pulmonary circulation in patients with acute respiratory distress syndrome (ARDS). The present review is aimed at summarizing the available evidence obtained with echocardiography on right ventricle (RV) function and pulmonary circulation in ARDS and to highlight the potential of this technique in clinical practice (only articles in English language were considered). According to the available evidence on echocardiographic findings, the following conclusions can be drawn: (a) echocardiography (transthoracic and transesophageal) has a growing role in the management ARDS patients mainly because of the strict interactions between the lung (and ventilation) and the RV and pulmonary circulation; (b) there may be a continuum of alterations in RV size and function and pulmonary circulation which may end in the development of acute cor pulmonale, probably paralleling ARDS disease severity; and (c) the detection of acute cor pulmonale should prompt intensivists to tailor their ventilatory strategy to the individual patient depending on the echocardiography findings. Bearing in mind the clinical role and growing importance of echocardiography in ARDS and the available evidence on this topic, we present a flow chart including the parameters to be measured and the timing of echo exams in ARDS patients. Despite the important progress that echocardiography has gained in the evaluation of patients with ARDS, several open questions remain and echocardiography still appears to be underused in these patients. A more systematic use of echocardiography (mainly through shared protocols) in ARDS could help intensivists to tailor the optimal treatment in individual patients as well as highlighting the limits and potential of this methodology in patients with ALI.
Collapse
Affiliation(s)
- Chiara Lazzeri
- Intensive Care Unit of Heart and Vessels Department, University of Florence, AOU Careggi, Fondazione Don Carlo Gnocchi IRCCS, viale Morgagni 8550134, Florence, Italy
| | - Giovanni Cianchi
- Intensive Care Unit and Regional ECMO Referral Center, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Manuela Bonizzoli
- Intensive Care Unit and Regional ECMO Referral Center, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Stefano Batacchi
- Intensive Care Unit and Regional ECMO Referral Center, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Adriano Peris
- Intensive Care Unit and Regional ECMO Referral Center, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Gian Franco Gensini
- Intensive Care Unit of Heart and Vessels Department, University of Florence, AOU Careggi, Fondazione Don Carlo Gnocchi IRCCS, Florence, Italy
| |
Collapse
|
232
|
Galiè N, Manes A, Palazzini M. GPs Meet Rare Lung Disorders Task Force factsheet: pulmonary arterial hypertension. Breathe (Sheff) 2015; 11:233-6. [PMID: 26634007 PMCID: PMC4666452 DOI: 10.1183/20734735.111115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
ERS GPs Meet Rare Lung Disorders Task Force factsheet: pulmonary arterial hypertension http://ow.ly/RlcYz.
Collapse
Affiliation(s)
- Nazzareno Galiè
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Alessandra Manes
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Massimiliano Palazzini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| |
Collapse
|
233
|
Madden BP. A Practical Clinical Approach to the Diagnosis and Treatment of Patients with Pulmonary Hypertension. Eur Cardiol 2015; 10:102-107. [PMID: 30310434 PMCID: PMC6159473 DOI: 10.15420/ecr.2015.10.2.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 11/01/2015] [Indexed: 11/04/2022] Open
Abstract
Pulmonary hypertension is defined by a mean pulmonary artery pressure of >25 mmHg at rest or 30 mmHg during exercise. There are many causes and currently diseases causing the condition are classified into five groups. The greatest elevation in pulmonary arterial pressure is found among those disorders in group 1 (known as pulmonary arterial hypertension [PAH]) and research and targeted therapy has focused on this group in particular, although patients in group 4 (chronic thromboembolic PH [CTEPH]) also receive advanced pulmonary vasodilator therapy. The symptoms of PH are often vague and the diagnosis is frequently missed or delayed. Efforts are therefore being made to improve awareness of PH among clinicians to enable prompt referral to a PH unit to confirm the diagnosis and instigate appropriate therapy. Multi-disciplinary team (MDT) discussion is necessary if patients with PH require surgical intervention or become pregnant. For patients in the other PH groups, treatment is usually concentrated on the primary disorder. A small number of patients with PAH will respond to calcium-channel-blocking agents. Specific targeted therapy is often given in combination depending on the patients functional performance status. Available agents include phosphodiesterase type V inhibitors, endothelin receptor antagonists, prostglandin analogues and nitric oxide. Many novel agents are under review. For carefully selected patients surgical options, include lung transplantation, pulmonary thromboendarterectomy and atrial septostomy.
Collapse
|
234
|
Avdeev SN. [Approaches to therapy for pulmonary hypertension: Role of the endothelin receptor antagonist bosentan]. TERAPEVT ARKH 2015; 87:64-71. [PMID: 26591555 DOI: 10.17116/terarkh201587964-71] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pulmonary hypertension (PH) is a specific clinical group of severe and rare diseases with similar morphological, hemodynamic, and therapeutic characteristics. Despite the fact that there have been international conciliative documents and advances in drug therapy for PH, the long-term prognosis of the.disease in these patients remains rather poor. Clinical trials have demonstrated that bosentan therapy in patients with PH improves pulmonary hemodynamics and exercise endurance and delays the development of the disease. According to the data of long-term studies, as compared to the historical control, bosentan used as a first-line drug can improve survival in PH patients.
Collapse
Affiliation(s)
- S N Avdeev
- Research Institute of Pulmonology, Federal Biomedical Agency of Russia, Moscow, Russia
| |
Collapse
|
235
|
Abstract
Nitric oxide (NO) is a critical signaling molecule in the pulmonary vasculature. NO activates soluble guanylate cyclase (sGC) resulting in the synthesis of cyclic guanosine monophosphate (cGMP) - a key mediator of pulmonary artery vasodilatation that may also inhibit smooth muscle proliferation and platelet aggregation. Pulmonary hypertension, a serious, progressive and often fatal disease is characterized by NO-sGC-sGMP pathway dysregulation. Riociguat is a member of a novel therapeutic class known as soluble guanylate stimulators. Riociguat has a dual mode of action, acting in synergy with endogenous NO and also directly stimulating sGC independently of NO availability. Phase 3 randomized control trials have demonstrated that riociguat improves clinical, physiologic and hemodynamic parameters in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. In this review we will discuss the pharmacologic properties of riociguat and its appropriate implementation into clinical practice.
Collapse
Affiliation(s)
- Nathan Hambly
- a Division of Respirology , Firestone Institute for Respiratory Health, McMaster University , Hamilton , Canada
| | - John Granton
- a Division of Respirology , Firestone Institute for Respiratory Health, McMaster University , Hamilton , Canada
| |
Collapse
|
236
|
Richter MJ, Pader P, Gall H, Reichenberger F, Seeger W, Mayer E, Guth S, Kramm T, Grimminger F, Ghofrani HA, Voswinckel R. The prognostic relevance of oxygen uptake in inoperable chronic thromboembolic pulmonary hypertension. CLINICAL RESPIRATORY JOURNAL 2015; 11:682-690. [PMID: 26470843 DOI: 10.1111/crj.12399] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 08/03/2015] [Accepted: 10/05/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Patients with chronic thromboembolic pulmonary hypertension (CTEPH) present with a decreased oxygen uptake, however, the prognostic relevance of oxygen uptake (VO2 ) in inoperable CTEPH is unknown. METHODS Patients with inoperable CTEPH were retrospectively analyzed. All patients were assessed by means of right heart catheterisation and cardio pulmonary exercise testing in semisupine position with a 30 Watt increment step-protocol. RESULTS One-hundred and fifty-one patients (82 female (54.3%), mean age 61 ± 12.4 years) presented with a mean pulmonary arterial pressure of 40.2 ± 14.2 mmHg and pulmonary vascular resistance (PVR) of 641.9 ± 374.8 dyne∗s/cm5 . The peak VO2 (mean 13.1 ± 4.5 mL∗kg-1 ∗min-1 ) was measured at initial referral. Over a follow-up of up to 10 years (mean 4.41 ± 2.57 years), 31 patients had died. Patients with a baseline peak VO2 ≥ 10.7 mL∗kg-1 ∗min-1 [area under the receiver-operating characteristic curve (AUC) = 0.728, P = 0.001] had better survival than those with a peak VO2 ≤ 10.7 mL∗kg-1 ∗min-1 using Kaplan-Meier analysis (88.8% vs 60.1%; log rank P = 0.001). Adjusting for age, gender and PVR, multivariate analysis identified peak VO2 as a predictor of mortality [hazard ratio (HR): 2.78, 95% CI 1.01-7.63, P = 0.047]. In addition, peak VO2 failed as an independent prognostic factor in a stepwise multivariate model including all variables significant in the univariate analysis. CONCLUSIONS In patients with inoperable CTEPH the peak VO2 is a significant predictor of survival, when adjusting for age, gender and PVR. However, peak VO2 failed as an independent prognostic factor when correcting for all significant baseline variables, which is limiting the clinical usability.
Collapse
Affiliation(s)
- Manuel Jonas Richter
- Department of Pneumology, Kerckhoff Heart, Rheuma and Thoracic Center, Bad Nauheim, Germany.,Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL)
| | - Philip Pader
- Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL)
| | - Henning Gall
- Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL)
| | | | - Werner Seeger
- Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL)
| | - Eckhard Mayer
- Department of Thoracic Surgery, Kerckhoff Heart, Rheuma and Thoracic Center, Bad Nauheim, Germany
| | - Stefan Guth
- Department of Thoracic Surgery, Kerckhoff Heart, Rheuma and Thoracic Center, Bad Nauheim, Germany
| | - Thorsten Kramm
- Department of Thoracic Surgery, Kerckhoff Heart, Rheuma and Thoracic Center, Bad Nauheim, Germany
| | - Friedrich Grimminger
- Department of Pneumology, Kerckhoff Heart, Rheuma and Thoracic Center, Bad Nauheim, Germany.,Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL)
| | - Hossein A Ghofrani
- Department of Pneumology, Kerckhoff Heart, Rheuma and Thoracic Center, Bad Nauheim, Germany.,Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL)
| | - Robert Voswinckel
- Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL).,Department of Internal Medicine, Health Center Wetterau, Friedberg, Germany
| |
Collapse
|
237
|
Freund-Michel V, Cardoso Dos Santos M, Guignabert C, Montani D, Phan C, Coste F, Tu L, Dubois M, Girerd B, Courtois A, Humbert M, Savineau JP, Marthan R, Muller B. Role of Nerve Growth Factor in Development and Persistence of Experimental Pulmonary Hypertension. Am J Respir Crit Care Med 2015; 192:342-55. [PMID: 26039706 DOI: 10.1164/rccm.201410-1851oc] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
RATIONALE Pulmonary hypertension (PH) is characterized by a progressive elevation in mean pulmonary arterial pressure, often leading to right ventricular failure and death. Growth factors play significant roles in the pathogenesis of PH, and their targeting may therefore offer novel therapeutic strategies in this disease. OBJECTIVES To evaluate the nerve growth factor (NGF) as a potential new target in PH. METHODS Expression and/or activation of NGF and its receptors were evaluated in rat experimental PH induced by chronic hypoxia or monocrotaline and in human PH (idiopathic or associated with chronic obstructive pulmonary disease). Effects of exogenous NGF were evaluated ex vivo on pulmonary arterial inflammation and contraction, and in vitro on pulmonary vascular cell proliferation, migration, and cytokine secretion. Effects of NGF inhibition were evaluated in vivo with anti-NGF blocking antibodies administered both in rat chronic hypoxia- and monocrotaline-induced PH. MEASUREMENTS AND MAIN RESULTS Our results show increased expression of NGF and/or increased expression/activation of its receptors in experimental and human PH. Ex vivo/in vitro, we found out that NGF promotes pulmonary vascular cell proliferation and migration, pulmonary arterial hyperreactivity, and secretion of proinflammatory cytokines. In vivo, we demonstrated that anti-NGF blocking antibodies prevent and reverse PH in rats through significant reduction of pulmonary arterial inflammation, hyperreactivity, and remodeling. CONCLUSIONS This study highlights the critical role of NGF in PH. Because of the recent development of anti-NGF blocking antibodies as a possible new pain treatment, such a therapeutic strategy of NGF inhibition may be of interest in PH.
Collapse
Affiliation(s)
- Véronique Freund-Michel
- 1 University Bordeaux and.,2 INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France
| | | | - Christophe Guignabert
- 3 Faculté de Médecine, Université Paris-Sud, Le Kremlin-Bicêtre, France.,4 INSERM UMR-S 999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France
| | - David Montani
- 3 Faculté de Médecine, Université Paris-Sud, Le Kremlin-Bicêtre, France.,4 INSERM UMR-S 999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France.,5 Centre de Référence de l'Hypertension Pulmonaire Sévère, Service de Pneumologie et Réanimation Respiratoire, DHU Thorax Innovation, Assistance Publique Hôpitaux de Paris, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France; and
| | - Carole Phan
- 3 Faculté de Médecine, Université Paris-Sud, Le Kremlin-Bicêtre, France.,4 INSERM UMR-S 999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France
| | - Florence Coste
- 1 University Bordeaux and.,2 INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France.,6 CHU de Bordeaux, Bordeaux, France
| | - Ly Tu
- 3 Faculté de Médecine, Université Paris-Sud, Le Kremlin-Bicêtre, France.,4 INSERM UMR-S 999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France
| | - Mathilde Dubois
- 1 University Bordeaux and.,2 INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France
| | - Barbara Girerd
- 3 Faculté de Médecine, Université Paris-Sud, Le Kremlin-Bicêtre, France.,4 INSERM UMR-S 999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France.,5 Centre de Référence de l'Hypertension Pulmonaire Sévère, Service de Pneumologie et Réanimation Respiratoire, DHU Thorax Innovation, Assistance Publique Hôpitaux de Paris, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France; and
| | - Arnaud Courtois
- 1 University Bordeaux and.,2 INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France
| | - Marc Humbert
- 3 Faculté de Médecine, Université Paris-Sud, Le Kremlin-Bicêtre, France.,4 INSERM UMR-S 999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France.,5 Centre de Référence de l'Hypertension Pulmonaire Sévère, Service de Pneumologie et Réanimation Respiratoire, DHU Thorax Innovation, Assistance Publique Hôpitaux de Paris, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France; and
| | - Jean-Pierre Savineau
- 1 University Bordeaux and.,2 INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France
| | - Roger Marthan
- 1 University Bordeaux and.,2 INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France.,6 CHU de Bordeaux, Bordeaux, France
| | - Bernard Muller
- 1 University Bordeaux and.,2 INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France
| |
Collapse
|
238
|
Spruijt OA, Vissers L, Bogaard HJ, Hofman MBM, Vonk-Noordegraaf A, Marcus JT. Increased native T1-values at the interventricular insertion regions in precapillary pulmonary hypertension. Int J Cardiovasc Imaging 2015; 32:451-9. [PMID: 26472581 PMCID: PMC4751160 DOI: 10.1007/s10554-015-0787-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 10/09/2015] [Indexed: 11/25/2022]
Abstract
Cardiac magnetic resonance imaging of the pressure overloaded right ventricle (RV) of precapillary pulmonary hypertension (PH) patients, exhibits late gadolinium enhancement at the interventricular insertion regions, a phenomenon which has been linked to focal fibrosis. Native T1-mapping is an alternative technique to characterize myocardium and has the advantage of not requiring the use of contrast agents. The aim of this study was to characterize the myocardium of idiopathic pulmonary arterial hypertension (IPAH), systemic scleroderma related PH (PAH-Ssc) and chronic thromboembolic PH (CTEPH) patients using native T1-mapping and to see whether native T1-values were related to disease severity. Furthermore, we compared native T1-values between the different precapillary PH categories. Native T1-mapping was performed in 46 IPAH, 14 PAH-SSc and 10 CTEPH patients and 10 control subjects. Native T1-values were assessed using regions of interest at the RV and LV free wall, interventricular septum and interventricular insertion regions. In PH patients, native T1-values of the interventricular insertion regions were significantly higher than the native T1-values of the RV free wall, LV free wall and interventricular septum. Native T1-values at the insertion regions were significantly related to disease severity. Native T1-values were not different between IPAH, PAH-Ssc and CTEPH patients. Native T1-values of the interventricular insertion regions are significantly increased in precapillary PH and are related to disease severity. Native T1-mapping can be developed as an alternative technique for the characterization of the interventricular insertion regions and has the advantage of not requiring the use of contrast agents.
Collapse
Affiliation(s)
- Onno A Spruijt
- Department of Pulmonary Medicine, VU University Medical Center, Amsterdam, The Netherlands.
| | - Loek Vissers
- Department of Pulmonary Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Harm-Jan Bogaard
- Department of Pulmonary Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Mark B M Hofman
- Department of Physics and Medical Technology, ICaR-VU, VU University Medical Center, de Boelelaan 1117, PK-1Y138, 1081HV, Amsterdam, The Netherlands
| | - Anton Vonk-Noordegraaf
- Department of Pulmonary Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - J Tim Marcus
- Department of Physics and Medical Technology, ICaR-VU, VU University Medical Center, de Boelelaan 1117, PK-1Y138, 1081HV, Amsterdam, The Netherlands.
| |
Collapse
|
239
|
Potential Role of CT Metrics in Chronic Obstructive Pulmonary Disease with Pulmonary Hypertension. Lung 2015; 193:911-8. [PMID: 26453478 DOI: 10.1007/s00408-015-9813-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 09/27/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Recent imaging studies demonstrated the usefulness of quantitative computed tomographic (CT) analysis assessing pulmonary hypertension (PH) in patients with chronic obstructive lung disease (COPD-PH). The aim of this study was to investigate whether it would be also valuable for predicting and evaluating the effect of pulmonary vasodilators in patients with COPD-PH. METHODS We analyzed a correlation between the extent of cystic destruction (LAA%) and total cross-sectional areas of small pulmonary vessels less than 5 mm(2) (%CSA <5) in many CT slices from each of four COPD-PH patients before and after the initiation of pulmonary vasodilator. To evaluate those generalized data from patients with COPD, we evaluated multiple slices from 42 patients whose PH was not clinically suspicious. We also selected five PH patients with idiopathic interstitial pneumonia (IIP-PH) and analyzed serial changes of pulmonary artery enlargement (PA:A ratio). RESULTS In 42 COPD patients without PH, LAA% had a statistically significant negative correlation with %CSA <5. However, three of four COPD-PH patients manifested no such correlation. In two patients, clinical findings were dramatically improved after the initiation of pulmonary vasodilator. Notably, LAA% and %CSA <5 in those patients correlated significantly after its treatment. In COPD-PH, the PA:A ratio was significantly decreased after the initiation of pulmonary vasodilator therapy (1.25 ± 0.13 vs. 1.13 ± 0.11, p = 0.019), but not in IIP-PH. CONCLUSIONS Our study demonstrates that the use of quantitative CT analysis is a plausible and beneficial tool for predicting and evaluating the effect of pulmonary vasodilators in patients with COPD-PH.
Collapse
|
240
|
Myocardial inflammation in experimental acute right ventricular failure: Effects of prostacyclin therapy. J Heart Lung Transplant 2015; 34:1334-45. [DOI: 10.1016/j.healun.2015.05.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 03/27/2015] [Accepted: 05/01/2015] [Indexed: 01/24/2023] Open
|
241
|
Low AT, Medford ARL, Millar AB, Tulloh RMR. Lung function in pulmonary hypertension. Respir Med 2015; 109:1244-9. [PMID: 26033642 DOI: 10.1016/j.rmed.2015.05.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 04/18/2015] [Accepted: 05/24/2015] [Indexed: 02/06/2023]
Abstract
Breathlessness is a common symptom in pulmonary hypertension (PH) and an important cause of morbidity. Though this has been attributed to the well described pulmonary vascular abnormalities and subsequent cardiac remodelling, changes in the airways of these patients have also been reported and may contribute to symptoms. Our understanding of these airway abnormalities is poor with conflicting findings in many studies. The present review evaluates these studies for the major PH groups. In addition we describe the role of cardiopulmonary exercise testing in the assessment of pulmonary arterial hypertension (PAH) by evaluating cardiopulmonary interaction during exercise. As yet, the reasons for the abnormalities in lung function are unclear, but potential causes and the possible role of inflammation are discussed. Future research is required to provide a better understanding of this to help improve the management of these patients.
Collapse
Affiliation(s)
- A T Low
- University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, United Kingdom.
| | - A R L Medford
- North Bristol Lung Centre, Southmead Hospital, Southmead Road, Bristol, United Kingdom.
| | - A B Millar
- Academic Respiratory Unit, Southmead Hospital, Southmead Road, Bristol, United Kingdom.
| | - R M R Tulloh
- University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, United Kingdom.
| |
Collapse
|
242
|
Lau EM, Tamura Y, McGoon MD, Sitbon O. The 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: a practical chronicle of progress. Eur Respir J 2015; 46:879-82. [DOI: 10.1183/13993003.01177-2015] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
|
243
|
Ruiter G, Manders E, Happé CM, Schalij I, Groepenhoff H, Howard LS, Wilkins MR, Bogaard HJ, Westerhof N, van der Laarse WJ, de Man FS, Vonk-Noordegraaf A. Intravenous iron therapy in patients with idiopathic pulmonary arterial hypertension and iron deficiency. Pulm Circ 2015; 5:466-72. [PMID: 26401247 DOI: 10.1086/682217] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 02/25/2015] [Indexed: 12/29/2022] Open
Abstract
UNLABELLED In patients with idiopathic pulmonary arterial hypertension (iPAH), iron deficiency is common and has been associated with reduced exercise capacity and worse survival. Previous studies have shown beneficial effects of intravenous iron administration. In this study, we investigated the use of intravenous iron therapy in iron-deficient iPAH patients in terms of safety and effects on exercise capacity, and we studied whether altered exercise capacity resulted from changes in right ventricular (RV) function and skeletal muscle oxygen handling. Fifteen patients with iPAH and iron deficiency were included. Patients underwent a 6-minute walk test, cardiopulmonary exercise tests, cardiac magnetic resonance imaging, and a quadriceps muscle biopsy and completed a quality-of-life questionnaire before and 12 weeks after receiving a high dose of intravenous iron. The primary end point, 6-minute walk distance, was not significantly changed after 12 weeks (409 ± 110 m before vs. 428 ± 94 m after; P = 0.07). Secondary end points showed that intravenous iron administration was well tolerated and increased body iron stores in all patients. In addition, exercise endurance time (P < 0.001) and aerobic capacity (P < 0.001) increased significantly after iron therapy. This coincided with improved oxygen handling in quadriceps muscle cells, although cardiac function at rest and maximal [Formula: see text] were unchanged. Furthermore, iron treatment was associated with improved quality of life (P < 0.05). In conclusion, intravenous iron therapy in iron-deficient iPAH patients improves exercise endurance capacity. This could not be explained by improved RV function; however, increased quadriceps muscle oxygen handling may play a role. ( TRIAL REGISTRATION ClinicalTrials.gov identifier NCT01288651).
Collapse
Affiliation(s)
- Gerrina Ruiter
- Department of Pulmonology, Institute for Cardiovascular Research, Vrije Universiteit (VU) University Medical Center, Amsterdam, The Netherlands ; Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Emmy Manders
- Department of Pulmonology, Institute for Cardiovascular Research, Vrije Universiteit (VU) University Medical Center, Amsterdam, The Netherlands ; Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Chris M Happé
- Department of Pulmonology, Institute for Cardiovascular Research, Vrije Universiteit (VU) University Medical Center, Amsterdam, The Netherlands ; Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Ingrid Schalij
- Department of Pulmonology, Institute for Cardiovascular Research, Vrije Universiteit (VU) University Medical Center, Amsterdam, The Netherlands ; Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Herman Groepenhoff
- Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Luke S Howard
- National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Martin R Wilkins
- National Institute for Health Research-Wellcome Trust Imperial Clinical Research Facility, Imperial Centre for Translational and Experimental Medicine, Imperial College London, London, United Kingdom
| | - Harm J Bogaard
- Department of Pulmonology, Institute for Cardiovascular Research, Vrije Universiteit (VU) University Medical Center, Amsterdam, The Netherlands
| | - Nico Westerhof
- Department of Pulmonology, Institute for Cardiovascular Research, Vrije Universiteit (VU) University Medical Center, Amsterdam, The Netherlands
| | - Willem J van der Laarse
- Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Frances S de Man
- Department of Pulmonology, Institute for Cardiovascular Research, Vrije Universiteit (VU) University Medical Center, Amsterdam, The Netherlands
| | - Anton Vonk-Noordegraaf
- Department of Pulmonology, Institute for Cardiovascular Research, Vrije Universiteit (VU) University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
244
|
Swift AJ, Rajaram S, Capener D, Elliot C, Condliffe R, Wild JM, Kiely DG. Longitudinal and transverse right ventricular function in pulmonary hypertension: cardiovascular magnetic resonance imaging study from the ASPIRE registry. Pulm Circ 2015; 5:557-64. [PMID: 26401257 DOI: 10.1086/682428] [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: 10/15/2014] [Accepted: 03/23/2015] [Indexed: 01/28/2023] Open
Abstract
Right ventricular (RV) function is a strong predictor of outcome in cardiovascular diseases. Two components of RV function, longitudinal and transverse motion, have been investigated in pulmonary hypertension (PH). However, their individual clinical significance remains uncertain. The aim of this study was to determine the factors associated with transverse and longitudinal RV motion in patients with PH. In 149 treatment-naive patients with PH and 16 patients with suspected PH found to have mean pulmonary arterial pressure of <20 mmHg, cardiovascular magnetic resonance imaging was performed within 24 hours of right heart catheterization. In patients with PH, fractional longitudinal motion (fractional tricuspid annulus to apex distance [f-TAAD]) was significantly greater than fractional transverse motion (fractional septum to free wall distance [f-SFD]; P = 0.002). In patients without PH, no significant difference between f-SFD and f-TAAD was identified (P = 0.442). Longitudinal RV motion was singularly associated with RV ejection fraction independent of age, invasive hemodynamics, and cardiac magnetic resonance measurements (P = 0.024). In contrast, transverse RV motion was independently associated with left ventricular eccentricity (P = 0.036) in addition to RV ejection fraction (P = 0.014). In conclusion, RV motion is significantly greater in the longitudinal direction in patients with PH, whereas patients without PH have equal contributions of transverse and longitudinal motion. Longitudinal RV motion is primarily associated with global RV pump function in PH. Transverse RV motion not only reflects global pump function but is independently influenced by ventricular interaction in patients with PH.
Collapse
Affiliation(s)
- Andrew J Swift
- Academic Unit of Radiology, University of Sheffield, Sheffield, United Kingdom ; Institute of Insilico Medicine, University of Sheffield, Sheffield, United Kingdom
| | - Smitha Rajaram
- Academic Unit of Radiology, University of Sheffield, Sheffield, United Kingdom
| | - Dave Capener
- Academic Unit of Radiology, University of Sheffield, Sheffield, United Kingdom
| | - Charlie Elliot
- Sheffield Pulmonary Vascular Clinic, Sheffield Teaching Hospitals Trust, Sheffield, United Kingdom
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Clinic, Sheffield Teaching Hospitals Trust, Sheffield, United Kingdom
| | - Jim M Wild
- Academic Unit of Radiology, University of Sheffield, Sheffield, United Kingdom
| | - David G Kiely
- Sheffield Pulmonary Vascular Clinic, Sheffield Teaching Hospitals Trust, Sheffield, United Kingdom
| |
Collapse
|
245
|
Li Y, Li XH, Yu ZX, Cai JJ, Billiar TR, Chen AF, Lv B, Chen ZY, Huang ZJ, Yang GP, Song J, Liu B, Yuan H. HIV protease inhibitors in pulmonary hypertension: rationale and design of a pilot trial in idiopathic pulmonary arterial hypertension. Pulm Circ 2015; 5:538-46. [PMID: 26401255 DOI: 10.1086/682426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 03/06/2015] [Indexed: 01/05/2023] Open
Abstract
We propose an exploratory clinical study, the first of its kind to our knowledge, to determine the safety and potential clinical benefit of the combination of the HIV protease inhibitors (HIV-PIs) saquinavir and ritonavir (SQV+RIT) in patients with idiopathic pulmonary arterial hypertension (IPAH). This study is based on evidence that (1) HIV-PIs can improve pulmonary hemodynamics in experimental models; (2) both Toll-like receptor 4 and high-mobility group box 1 (HMGB1) participate in the pathogenesis of experimental pulmonary hypertension; and (3) a high-throughput screen for inhibitors of HMGB1-induced macrophage activation yielded HIV-PIs as potent inhibitors of HMGB1-induced cytokine production. In this proposed open-label, pre-post study, micro, low, and standard doses of SQV+RIT will be given to IPAH patients for 14 days. Patients will receive follow-up for the next 14 days. The primary outcome to be evaluated is change in HMGB1 level from baseline at 14 days. The secondary outcome is changes in tumor necrosis factor α, interleukin 1β, interleukin 6, C-reactive protein, pulmonary arterial pressure based on echocardiography parameters and New York Heart Association/World Health Organization functional class, and Brog dyspnea scale index from baseline at 14 days. Other secondary measurements will include N-terminal pro-brain natriuretic peptide, atrial natriuretic peptide, and 6-minute walk distance. We propose that SQV+RIT treatment will improve inflammatory disorders and pulmonary hemodynamics in IPAH patients. If the data support a potentially useful therapeutic effect and suggest that SQV+RIT is safe in IPAH patients, the study will warrant further investigation. (ClinicalTrials.gov identifier: NCT02023450.).
Collapse
Affiliation(s)
- Ying Li
- Center of Clinical Pharmacology, Third Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Xiao-Hui Li
- Department of Pharmacology, School of Pharmaceutical Sciences, Central South University, Changsha, People's Republic of China
| | - Zai-Xin Yu
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Jing-Jing Cai
- Department of Cardiology, Third Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Timothy R Billiar
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Alex F Chen
- Department of Pharmacology, School of Pharmaceutical Sciences, Central South University, Changsha, People's Republic of China ; Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ben Lv
- Department of Hematology, Third Xiangya Hospital, Central South University, Changsha, People's Republic of China; State Key Laboratory of Medical Genetics, Central South University, Changsha, People's Republic of China; and Center of Biomedical Science, Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Zi-Ying Chen
- Center of Clinical Pharmacology, Third Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Zhi-Jun Huang
- Center of Clinical Pharmacology, Third Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Guo-Ping Yang
- Center of Clinical Pharmacology, Third Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Jie Song
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Bin Liu
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Hong Yuan
- Center of Clinical Pharmacology, Third Xiangya Hospital, Central South University, Changsha, People's Republic of China
| |
Collapse
|
246
|
Olsson KM, Meyer B, Hinrichs J, Vogel-Claussen J, Hoeper MM, Cebotari S. Chronic thromboembolic pulmonary hypertension. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 111:856-62. [PMID: 25585582 DOI: 10.3238/arztebl.2014.0856] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 09/18/2014] [Accepted: 09/18/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Chronic thromboembolic pulmonary hypertension (CTEPH) results from inadequate recanalization of the pulmonary circulation after pulmonary thromboembolism. Its 2-year prevalence is 1-4% . If untreated, patients with CTEPH have a mean life expectancy of less than three years. Fortunately, a number of effective treatments are now available. METHODS This review is based on a selective search of PubMed for pertinent articles published from 1980 to 2014. RESULTS The gold-standard test for the exclusion of CTEPH is perfusion scintigraphy: the predictive value of a negative test is nearly 100% . On the other hand, confirmation of a positive diagnosis for treatment planning requires right-heart catheterization and pulmonary angiography. The treatment of first choice for CTEPH is surgical pulmonary endarterectomy (PEA), with which about 70% of patients can be cured. The perioperative mortality of this procedure in experienced centers is now 2-4% . Thirty to 50% of all patients with CTEPH are considered inoperable; for these patients, and for patients with persistent pulmonary hypertension after PEA, the drug riociguat was introduced in Germany in 2014 (the first drug specifically introduced for the treatment of CTEPH). There is also a new interventional treatment option for inoperable patients-pulmonary balloon angioplasty, which is currently being performed in a small number of centers. CONCLUSION The timely diagnosis of CTEPH, followed by referral to a specialized center, is now more important than ever, because treatment options are now available for nearly all of the forms in which this disease can manifest itself.
Collapse
Affiliation(s)
- Karen M Olsson
- Department of Respiratory Medicine, German Center for Lung Research, Hannover Medical School, Institute of Diagnostic and Interventional Radiology, German Center for Lung Research, Hannover Medical School, Department of Cardiothoracic, Vascular and Transplantation Surgery, German Center for Lung Research, Hannover Medical School
| | | | | | | | | | | |
Collapse
|
247
|
Lohani O, Colvin KL, Yeager ME. Biomarkers for pediatric pulmonary arterial hypertension: challenges and recommendations. Paediatr Respir Rev 2015; 16:225-31. [PMID: 26036720 DOI: 10.1016/j.prrv.2015.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 05/06/2015] [Indexed: 10/23/2022]
Abstract
Pediatric pulmonary arterial hypertension (PAH) is an uncommon disease that can occur in neonates, infants, and children, and is associated with high morbidity and mortality. Despite advances in treatment strategies over the last two decades, the underlying structural and functional changes to the pulmonary arterial circulation are progressive and lead eventually to right heart failure. The management of PAH in children is complex due not only to the developmental aspects but also because most evidence-based practices derive from adult PAH studies. As such, the pediatric clinician would be greatly aided by specific characteristics (biomarkers) objectively measured in children with PAH to determine appropriate clinical management. This review highlights the current state of biomarkers in pediatric PAH and looks forward to potential biomarkers, and makes several recommendations for their use and interpretation.
Collapse
Affiliation(s)
- Ozus Lohani
- Department of Bioengineering, University of Colorado Denver; Department of Pediatrics-Critical Care
| | - Kelley L Colvin
- Department of Bioengineering, University of Colorado Denver; Department of Pediatrics-Critical Care; Cardiovascular Pulmonary Research, University of Colorado Denver; Linda Crnic Institute for Down Syndrome, Denver, Colorado
| | - Michael E Yeager
- Department of Bioengineering, University of Colorado Denver; Department of Pediatrics-Critical Care; Cardiovascular Pulmonary Research, University of Colorado Denver; Linda Crnic Institute for Down Syndrome, Denver, Colorado.
| |
Collapse
|
248
|
Limbrey R, Howard L. Developments in the management and treatment of pulmonary embolism. Eur Respir Rev 2015; 24:484-97. [PMID: 26324810 PMCID: PMC9487690 DOI: 10.1183/16000617.00006614] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 11/13/2014] [Indexed: 01/24/2023] Open
Abstract
Pulmonary embolism (PE) is a serious and costly disease for patients and healthcare systems. Guidelines emphasise the importance of differentiating between patients who are at high risk of mortality (those with shock and/or hypotension), who may be candidates for thrombolytic therapy or surgery, and those with less severe presentations. Recent clinical studies and guidelines have focused particularly on risk stratification of intermediate-risk patients. Although the use of thrombolysis has been investigated in these patients, anticoagulation remains the standard treatment approach. Individual risk stratification directs initial treatment. Rates of recurrence differ between subgroups of patients with PE; therefore, a review of provoking factors, along with the risks of morbidity and bleeding, guides the duration of ongoing anticoagulation. The direct oral anticoagulants have shown similar efficacy and, in some cases, reduced major bleeding compared with standard approaches for acute treatment. They also offer the potential to reduce the burden on patients and outpatient services in the post-hospital phase. Rivaroxaban, dabigatran and apixaban have been shown to reduce the risk of recurrent venous thromboembolism versus placebo, when given for >12 months. Patients receiving direct oral anticoagulants do not require regular coagulation monitoring, but follow-up, ideally in a specialist PE clinic in consultation with primary care providers, is recommended.
Collapse
Affiliation(s)
- Rachel Limbrey
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Luke Howard
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
249
|
Hemnes AR, Kiely DG, Cockrill BA, Safdar Z, Wilson VJ, Al Hazmi M, Preston IR, MacLean MR, Lahm T. Statement on pregnancy in pulmonary hypertension from the Pulmonary Vascular Research Institute. Pulm Circ 2015; 5:435-65. [PMID: 26401246 PMCID: PMC4556496 DOI: 10.1086/682230] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 02/25/2015] [Indexed: 01/06/2023] Open
Abstract
Pregnancy outcomes in patients with pulmonary hypertension remain poor despite advanced therapies. Although consensus guidelines recommend against pregnancy in pulmonary hypertension, it may nonetheless occasionally occur. This guideline document sought to discuss the state of knowledge of pregnancy effects on pulmonary vascular disease and to define usual practice in avoidance of pregnancy and pregnancy management. This guideline is based on systematic review of peer-reviewed, published literature identified with MEDLINE. The strength of the literature was graded, and when it was inadequate to support high-level recommendations, consensus-based recommendations were formed according to prespecified criteria. There was no literature that met standards for high-level recommendations for pregnancy management in pulmonary hypertension. We drafted 38 consensus-based recommendations on pregnancy avoidance and management. Further, we identified the current state of knowledge on the effects of sex hormones during pregnancy on the pulmonary vasculature and right heart and suggested areas for future study. There is currently limited evidence-based knowledge about both the basic molecular effects of sex hormones and pregnancy on the pulmonary vasculature and the best practices in contraception and pregnancy management in pulmonary hypertension. We have drafted 38 consensus-based recommendations to guide clinicians in these challenging topics, but further research is needed in this area to define best practices and improve patient outcomes.
Collapse
Affiliation(s)
- Anna R. Hemnes
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - David G. Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals National Health Service (NHS) Foundation Trust, Sheffield, United Kingdom
| | - Barbara A. Cockrill
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, and Harvard University Medical School, Boston, Massachusetts, USA
| | - Zeenat Safdar
- Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Victoria J. Wilson
- Department of Obstetrics and Gynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Manal Al Hazmi
- Section of Pulmonary Diseases, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Ioana R. Preston
- Pulmonary, Critical Care and Sleep Division, Tufts Medical Center, Boston, Massachusetts, USA
| | - Mandy R. MacLean
- Institute of Cardiovascular and Medical Sciences, College of Medical and Veterinary Science, University of Glasgow, Glasgow, United Kingdom
| | - Tim Lahm
- Division of Pulmonary, Allergy, Critical Care, Occupational and Sleep Medicine, Indiana University School of Medicine and Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana, USA
| |
Collapse
|
250
|
Adir Y, Elia D, Harari S. Pulmonary hypertension in patients with chronic myeloproliferative disorders. Eur Respir Rev 2015; 24:400-10. [DOI: 10.1183/16000617.0041-2015] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Pulmonary hypertension (PH) is a major complication of several haematological disorders. Chronic myeloproliferative diseases (CMPDs) associated with pulmonary hypertension have been included in group five of the clinical classification for pulmonary hypertension, corresponding to pulmonary hypertension for which the aetiology is unclear and/or multifactorial. The aim of this review is to discuss the epidemiology, pathogenic mechanism and treatment approaches of the more common forms of pulmonary hypertension in the context of CMPD's: chronic thromboembolic pulmonary hypertension, precapillary pulmonary hypertension and drug-induced PH.
Collapse
|