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Bartolo MA, Qureshi MU, Colebank MJ, Chesler NC, Olufsen MS. Numerical predictions of shear stress and cyclic stretch in pulmonary hypertension due to left heart failure. Biomech Model Mechanobiol 2022; 21:363-381. [PMID: 35037114 PMCID: PMC10174274 DOI: 10.1007/s10237-021-01538-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 11/24/2021] [Indexed: 12/15/2022]
Abstract
Isolated post-capillary pulmonary hypertension (Ipc-PH) occurs due to left heart failure, which contributes to 1 out of every 9 deaths in the United States. In some patients, through unknown mechanisms, Ipc-PH transitions to combined pre-/post-capillary PH (Cpc-PH) and is associated with a dramatic increase in mortality. Altered mechanical forces and subsequent biological signaling in the pulmonary vascular bed likely contribute to the transition from Ipc-PH to Cpc-PH. However, even in a healthy pulmonary circulation, the mechanical forces in the smallest vessels (the arterioles, capillary bed, and venules) have not been quantitatively defined. This study is the first to examine this question via a computational fluid dynamics model of the human pulmonary arteries, arterioles, venules, and veins. Using this model, we predict temporal and spatial dynamics of cyclic stretch and wall shear stress with healthy and diseased hemodynamics. In the normotensive case for large vessels, numerical simulations show that large arteries have higher pressure and flow than large veins, as well as more pronounced changes in area throughout the cardiac cycle. In the microvasculature, shear stress increases and cyclic stretch decreases as vessel radius decreases. When we impose an increase in left atrial pressure to simulate Ipc-PH, shear stress decreases and cyclic stretch increases as compared to the healthy case. Overall, this model predicts pressure, flow, shear stress, and cyclic stretch that providing a way to analyze and investigate hypotheses related to disease progression in the pulmonary circulation.
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Affiliation(s)
- Michelle A Bartolo
- Department of Mathematics, North Carolina State University, Raleigh, NC, 27695, USA
| | - M Umar Qureshi
- Department of Mathematics, North Carolina State University, Raleigh, NC, 27695, USA
| | - Mitchel J Colebank
- Edwards Lifesciences Foundation Cardiovascular Innovation and Research Center, University of California, Irvine, CA, 92697, USA
| | - Naomi C Chesler
- Edwards Lifesciences Foundation Cardiovascular Innovation and Research Center, University of California, Irvine, CA, 92697, USA
| | - Mette S Olufsen
- Department of Mathematics, North Carolina State University, Raleigh, NC, 27607, USA.
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2
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Ibn Hadj Amor H, Touil I, Chebbi R, Bouchareb S, Bouchnak S, Brahem Y, Boussoffara L, Boudawara N, Kneni J. Assessment of right ventricular remodeling and dysfunction in obstructive sleep apnea syndrome: a prospective monocentric study. Sleep Breath 2021; 26:663-674. [PMID: 34275098 DOI: 10.1007/s11325-021-02432-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/03/2021] [Accepted: 06/30/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a common sleep-related disorder that has been implicated in many serious cardiovascular diseases including cardiac remodeling and dysfunction. Since most investigations have focused on the left heart, little is known on right ventricular (RV) involvement in OSA. The role of the RV in the management of cardiovascular outcomes has become increasingly recognized. Early detection of subtle signs of RV dysfunction and remodeling in patients with OSA is crucial for optimal medical care. PURPOSE We aimed to investigate the effect of OSA and its severity on the RV structure and function using conventional echocardiography. METHODS We conducted a cross-sectional analytical study including patients with OSA who did not have heart failure or chronic pulmonary disease comparing them to controls without OSA. All patients underwent respiratory polygraphy at the Pneumology Department and standard echocardiography performed by the same blinded cardiologist at the Cardiology Department of Taher Sfar University Hospital. RESULTS A total of 139 patients with OSA and 45 controls were enrolled in the study. Amonth the patients, there were 32% (n = 44) with mild, 20% (n = 28) with moderate, and 48% (n = 67) with severe OSA. Sixty-three percent of the study population were women. The mean age was 54.1 ± 11.0 years. Early RV dilatation was present in the mild disease stage (RVID = 42.0 ± 7.7 mm vs. 32.4 ± 5.5 mm in controls; p < 0.0001) without obvious RVH. The systolic pulmonary artery pressure was significantly higher in patients with OSA (31.2 ± 8.2 vs. 20.9 ± 9.8; p < 0.0001). Tricuspid annular plane systolic excursion was borderline normal and significantly lower in patients with OSA (17.7 ± 4.7 vs. 26.0 ± 5.7, p < 0.0001). In multivariate analysis, an OSA was independently associated with RV remodeling (OR: 0.257, 95% CI [0.114-0.582], p = 0.001) but not with RV dysfunction. CONCLUSION OSA was independently associated with structural alterations of RV early in the disease course, suggesting that the reversibility of these deleterious effects requires earlier detection and initiation of treatment.
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Affiliation(s)
| | - Imen Touil
- Pneumology Department, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Rihab Chebbi
- Cardiology Department, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Soumaya Bouchareb
- Pneumology Department, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Skander Bouchnak
- Cardiology Department, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Yosra Brahem
- Pneumology Department, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Leila Boussoffara
- Pneumology Department, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Nedia Boudawara
- Pneumology Department, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Jalel Kneni
- Pneumology Department, Taher Sfar University Hospital, Mahdia, Tunisia
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Wu X, You W, Wu Z, Ye F, Chen S. Serum biomarker analysis at the protein level on pulmonary hypertension secondary to old anterior myocardial infarction. Pulm Circ 2020; 10:2045894020969079. [PMID: 33282196 PMCID: PMC7691928 DOI: 10.1177/2045894020969079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/06/2020] [Indexed: 01/06/2023] Open
Abstract
Pulmonary hypertension (PH) related to old anterior myocardial infarction (OAMI)
always accompanies a bad prognosis, and thus, we aimed to screen serum
biomarkers related to PH in OAMI patients. According to right ventricular
systolic pressure, we divided mice into sham, OAMI, and PH-OAMI groups and
evaluated body, heart and lung weight, heart function, pulmonary blood flow
velocity, cardiac fibrotic area, and pulmonary arteriole condition. Lung and
serum were under the proteomic analysis. Levels of three identified proteins
were measured. Compared with sham and OAMI mice, PH-OAMI mice showed heart
dysfunction, low pulmonary blood flow, high right ventricular systolic pressure,
heavy heart and lung weight, large cardiac fibrotic area, and pathological
pulmonary arteriole remodeling (P<0.05 or
P<0.01). Haptoglobin, annexin A5, and Ig mu chain C region
of lung and serum were changed significantly in PH-OAMI mice
(P<0.01). Then, we collected serum and clinical data,
measured three serum protein levels, and performed multivariate regression and
receiver operating characteristic curve in patients (normal, OAMI, and PH-OAMI
groups). Compared with normal and OAMI patients, serum levels of three proteins
in PH-OAMI patients were also altered notably (P<0.01).
These three proteins can predict PH in OAMI patients
(P<0.01). Receiver operating characteristic curve analysis
revealed haptoglobin (cut-off value: 78.295, sensitivity: 62.8%, specificity:
94.4%), annexin A5 (cut-off value: 151.925, sensitivity: 41.9%, specificity:
82.4%), and Ig mu chain C region (cut-off value: 168.885, sensitivity: 86.0%,
specificity: 79.6%) (P<0.01). Three circulating serum
proteins can be useful for the categorization of OAMI patients with and without
PH.
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Affiliation(s)
- Xiangqi Wu
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Wei You
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhiming Wu
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Fei Ye
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Shaoliang Chen
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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Philip JL, Murphy TM, Schreier DA, Stevens S, Tabima DM, Albrecht M, Frump AL, Hacker TA, Lahm T, Chesler NC. Pulmonary vascular mechanical consequences of ischemic heart failure and implications for right ventricular function. Am J Physiol Heart Circ Physiol 2019; 316:H1167-H1177. [PMID: 30767670 DOI: 10.1152/ajpheart.00319.2018] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Left heart failure (LHF) is the most common cause of pulmonary hypertension, which confers an increase in morbidity and mortality in this context. Pulmonary vascular resistance has prognostic value in LHF, but otherwise the mechanical consequences of LHF for the pulmonary vasculature and right ventricle (RV) remain unknown. We sought to investigate mechanical mechanisms of pulmonary vascular and RV dysfunction in a rodent model of LHF to address the knowledge gaps in understanding disease pathophysiology. LHF was created using a left anterior descending artery ligation to cause myocardial infarction (MI) in mice. Sham animals underwent thoracotomy alone. Echocardiography demonstrated increased left ventricle (LV) volumes and decreased ejection fraction at 4 wk post-MI that did not normalize by 12 wk post-MI. Elevation of LV diastolic pressure and RV systolic pressure at 12 wk post-MI demonstrated pulmonary hypertension (PH) due to LHF. There was increased pulmonary arterial elastance and pulmonary vascular resistance associated with perivascular fibrosis without other remodeling. There was also RV contractile dysfunction with a 35% decrease in RV end-systolic elastance and 66% decrease in ventricular-vascular coupling. In this model of PH due to LHF with reduced ejection fraction, pulmonary fibrosis contributes to increased RV afterload, and loss of RV contractility contributes to RV dysfunction. These are key pathologic features of human PH secondary to LHF. In the future, novel therapeutic strategies aimed at preventing pulmonary vascular mechanical changes and RV dysfunction in the context of LHF can be tested using this model. NEW & NOTEWORTHY In this study, we investigate the mechanical consequences of left heart failure with reduced ejection fraction for the pulmonary vasculature and right ventricle. Using comprehensive functional analyses of the cardiopulmonary system in vivo and ex vivo, we demonstrate that pulmonary fibrosis contributes to increased RV afterload and loss of RV contractility contributes to RV dysfunction. Thus this model recapitulates key pathologic features of human pulmonary hypertension-left heart failure and offers a robust platform for future investigations.
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Affiliation(s)
- Jennifer L Philip
- Department of Biomedical Engineering, University of Wisconsin-Madison College of Engineering , Madison, Wisconsin.,Department of Surgery, University of Wisconsin-Madison , Madison, Wisconsin
| | - Thomas M Murphy
- Department of Biomedical Engineering, University of Wisconsin-Madison College of Engineering , Madison, Wisconsin
| | - David A Schreier
- Department of Biomedical Engineering, University of Wisconsin-Madison College of Engineering , Madison, Wisconsin
| | - Sydney Stevens
- Department of Medicine, Indiana University School of Medicine , Indianapolis, Indiana
| | - Diana M Tabima
- Department of Biomedical Engineering, University of Wisconsin-Madison College of Engineering , Madison, Wisconsin
| | - Margie Albrecht
- Department of Medicine, Indiana University School of Medicine , Indianapolis, Indiana
| | - Andrea L Frump
- Department of Medicine, Indiana University School of Medicine , Indianapolis, Indiana
| | - Timothy A Hacker
- Department of Medicine, University of Wisconsin-Madison , Madison, Wisconsin
| | - Tim Lahm
- Department of Medicine, Indiana University School of Medicine , Indianapolis, Indiana.,Department of Cellular and Integrative Physiology, Indiana University School of Medicine, Indianapolis, Indiana.,Richard L. Roudebush Veterans Affairs Medical Center , Indianapolis, Indiana
| | - Naomi C Chesler
- Department of Biomedical Engineering, University of Wisconsin-Madison College of Engineering , Madison, Wisconsin.,Department of Medicine, University of Wisconsin-Madison , Madison, Wisconsin
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Duarte JD, Kansal M, Desai AA, Riden K, Arwood MJ, Yacob AA, Stamos TD, Cavallari LH, Zamanian RT, Shah SJ, Machado RF. Endothelial nitric oxide synthase genotype is associated with pulmonary hypertension severity in left heart failure patients. Pulm Circ 2018; 8:2045894018773049. [PMID: 29718770 PMCID: PMC5946646 DOI: 10.1177/2045894018773049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The biological mechanisms behind the development of pulmonary hypertension in the setting of left heart failure (HF-PH), including combined pre- and post-capillary pulmonary hypertension (Cpc-PH), remains unclear. This study aimed to use candidate polymorphisms in nitric oxide synthase (NOS) genes to explore the role of NOS in HF-PH. DNA samples from 118 patients with HF-PH were genotyped for the NOS3 rs1799983 and NOS2 rs3730017 polymorphisms. A multiple regression model was used to compare hemodynamic measurements between genotype groups. Patients with the T/T genotype at rs1799983 possessed a nearly 10 mmHg increased transpulmonary gradient (TPG) compared to those with other genotypes (P = 0.006). This finding was replicated in an independent cohort of 94 HF-PH patients (P = 0.005). However, when tested in a cohort of 162 pre-capillary pulmonary arterial hypertension patients, no association was observed. In a combined analysis of both HF-PH cohorts, mean pulmonary artery pressure (mPAP), diastolic pulmonary gradient (DPG), and CpcPH status were also associated with rs1799983 genotype (P = 0.005, P = 0.03, and P = 0.02, respectively). In patients with HF-PH, the NOS3 rs1799983 polymorphism is associated with TPG, and potentially mPAP and DPG as well. These findings suggest that endothelial NOS (encoded by NOS3) may be involved in the pulmonary vascular remodeling observed in Cpc-PH and warrants further study.
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Affiliation(s)
- Julio D Duarte
- 1 Center for Pharmacogenomics, Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Mayank Kansal
- 2 12247 Division of Cardiology, University of Illinois College of Medicine, Chicago, IL, USA
| | - Ankit A Desai
- 3 Department of Medicine and Sarver Heart Center, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Katherine Riden
- 1 Center for Pharmacogenomics, Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Meghan J Arwood
- 1 Center for Pharmacogenomics, Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Alex A Yacob
- 4 Division of Pulmonary & Critical Care Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Thomas D Stamos
- 2 12247 Division of Cardiology, University of Illinois College of Medicine, Chicago, IL, USA
| | - Larisa H Cavallari
- 1 Center for Pharmacogenomics, Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Roham T Zamanian
- 4 Division of Pulmonary & Critical Care Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Sanjiv J Shah
- 5 Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Roberto F Machado
- 6 Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Left Heart Disease and Pulmonary Hypertension: Are We Seeing the Full Picture? Heart Lung Circ 2018; 27:301-309. [DOI: 10.1016/j.hlc.2017.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 09/12/2017] [Accepted: 09/18/2017] [Indexed: 12/13/2022]
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Left Atrium Maximal Axial Cross-Sectional Area is a Specific Computed Tomographic Imaging Biomarker of World Health Organization Group 2 Pulmonary Hypertension. J Thorac Imaging 2017; 32:121-126. [PMID: 28009778 DOI: 10.1097/rti.0000000000000252] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE Left heart disease is associated with left atrial enlargement and is a common cause of pulmonary hypertension (PH). We investigated the relationship between left atrium maximal axial cross-sectional area (LA-MACSA), as measured on chest computed tomography (CT), and PH due to left heart disease (World Health Organization group 2) in patients with right heart catheterization-proven PH. MATERIALS AND METHODS A total of 165 patients with PH who had undergone right heart catheterization with pulmonary artery pressure and pulmonary capillary wedge pressure (PCWP) measurements and nongated chest CTs were included. LA-MACSA, LA anterior-posterior, and LA transverse measurements were independently obtained using the hand-drawn region-of-interest and distance measurement tools on standard PACS by 2 blinded cardiothoracic radiologists. Nonparametric statistical analyses and receiver operating characteristic curve were performed. RESULTS Forty-three patients had group 2 PH (PCWP>15 mm Hg), and 122 had nongroup 2 PH (PCWP≤15 mm Hg). Median LA-MACSA was significantly different between the group 2 PH and nongroup 2 PH patients (2312 vs. 1762 mm, P<0.001). Interobserver concordance correlation for LA-MACSA was high at 0.91 (P<0.001). At a threshold of 2400 mm, LA-MACSA demonstrated 93% specificity for classifying group 2 PH (area under the curve, 0.73; P<0.001). CONCLUSIONS LA-MACSA is a readily obtainable and reproducible measurement of left atrial enlargement on CT and can distinguish between group 2 and nongroup 2 PH with high specificity.
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8
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de Asua I, Rosenberg A. On the right side of the heart: Medical and mechanical support of the failing right ventricle. J Intensive Care Soc 2017; 18:113-120. [PMID: 28979557 DOI: 10.1177/1751143716684357] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Acute right ventricular failure remains an immensely challenging clinical condition associated with a high mortality rate. In this narrative review, we highlight the pathophysiological mechanisms underlying right ventricular failure and suggest an initial diagnostic approach to this critically ill group of patients. Based on the best available evidence and our cumulative clinical experience as a national cardiothoracic centre, we summarize the basic principles of medical management and mechanical salvage therapy, finalizing with a series of recommendations for the management of right ventricular failure in specific clinical scenarios.
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Affiliation(s)
- Ignacio de Asua
- Department of Intensive Care, Harefield Hospital, London, UK
| | - Alex Rosenberg
- Department of Intensive Care, Harefield Hospital, London, UK
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Ben-Yehuda O, Rubin LJ. Pulmonary Hypertension Overlap Syndromes. J Am Coll Cardiol 2016; 68:379-81. [DOI: 10.1016/j.jacc.2016.05.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 05/23/2016] [Indexed: 11/26/2022]
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