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Horvat D, Agoston-Coldea L. A spotlight on the aged pulmonary artery. Adv Clin Chem 2024; 123:157-177. [PMID: 39181621 DOI: 10.1016/bs.acc.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
The ever-increasing life expectancy of the global population introduces a critical perspective on the impact of aging as an immutable cardiovascular risk factor, particularly manifesting in the alterations observed in the pulmonary artery (PA). Mechanisms contributing to aging-induced changes in PA include endothelial dysfunction, chronic inflammation, and structural changes in the arterial wall over time. These alterations extend beyond mere elasticity, exerting profound effects on pulmonary hemodynamics. The propensity of PAs to develop atherosclerotic plaques underscores an intriguing facet of vascular aging, although the available literature is currently insufficient to comprehensively assess their true incidence. While recognizing the inherent risk of periprocedural complications, right heart catheterization (RHC) stands out as the gold standard for precise hemodynamic evaluation. Echocardiography, a widely employed method, proves valuable for screening pulmonary hypertension (PH), yet falls short of diagnostic capability. Technological advancements usher in a new era with non-invasive modalities such as cardiac magnetic resonance (CMR) imaging emerging as promising tools. These innovations demonstrate their prowess in providing accurate assessments of PA stiffness and hemodynamics, offering a glimpse into the future landscape of diagnostic methodologies. As we navigate the intersection of aging and pulmonary vascular health, this review aims to address mechanisms and techniques for assessing PA aging, highlighting the need for comprehensive assessments to guide clinical decision making in an increasingly aging population.
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Affiliation(s)
- Dalma Horvat
- 2nd Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Lucia Agoston-Coldea
- 2nd Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; 2nd Department of Internal Medicine, Emergency County Hospital, Cluj-Napoca, Romania.
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Liao HC, Lin C, Wang CH, Fang WH. The deep learning algorithm estimates chest radiograph-based sex and age as independent risk factors for future cardiovascular outcomes. Digit Health 2023; 9:20552076231191055. [PMID: 37529539 PMCID: PMC10388631 DOI: 10.1177/20552076231191055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 07/13/2023] [Indexed: 08/03/2023] Open
Abstract
Objectives Chest X-rays (CXRs) convey much illegible physiological information that deep learning model (DLM) has been reported interpreting successfully. Since the electrocardiogram age established by DLM was revealed as a heart biological marker, we hypothesize that CXR age has similar potential to describe the heart and lung states. Therefore, we developed a DLM to predict sex and age through CXR and analyzed its relation with future cardiovascular diseases (CVD). Methods A total of 90,396 CXRs aged 20 to 90 were collected and separated into a development set with 53,102 CXRs and demographic information pairs, a tuning set with 7073 pairs, an internal validation set with 17,364 pairs, and an external validation set with 12,857 pairs. The study trained DLM with development set for estimating age and sex and compared them to actual information. Results The mean absolute errors of predicted age were 4.803 and 4.313 years in the internal and external validation sets, respectively. The area under the curve of sex analysis was 0.9993 and 0.9988 in the internal and external validation sets, respectively. Patients whose CXR age was 5 years older than chronologic age lead to higher risk of all-cause mortality (hazard ratio (HR): 2.42, 95% confidence interval (CI): 2.00-2.92), cardiovascular (CV)-cause mortality (HR: 7.57, 95% CI: 4.55-12.60), new-onset heart failure (HR: 2.07, 95% CI: 1.56-2.76), new-onset chronic kidney disease (HR: 1.73, 95% CI: 1.46-2.05), new-onset acute myocardial infarction (HR: 1.80, 95% CI: 1.12-2.92), new-onset stroke (HR: 1.45, 95% CI: 1.10-1.90), new-onset coronary artery disease (HR: 1.26, 95% CI: 1.04-1.52), and new-onset atrial fibrillation (HR: 1.43, 95% CI: 1.01-2.02). Conclusions Using DLM to predict CXR age provided additional information for future CVDs. Older CXR age is an accessible risk classification tool for clinician use.
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Affiliation(s)
- Hao-Chun Liao
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Republic of China
| | - Chin Lin
- Artificial Intelligence of Things Center, Tri-Service General Hospital, National Defense Medical Center, Taipei, Republic of China
- Medical Technology Education Center, School of Medicine, National Defense Medical Center, Taipei, Republic of China
| | - Chih-Hung Wang
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Republic of China
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Republic of China
| | - Wen-Hui Fang
- Artificial Intelligence of Things Center, Tri-Service General Hospital, National Defense Medical Center, Taipei, Republic of China
- Department of Family and Community Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Republic of China
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3
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Hermann EA, Motahari A, Hoffman EA, Allen N, Bertoni AG, Bluemke DA, Eskandari A, Gerard SE, Guo J, Hiura GT, Kaczka DW, Michos ED, Nagpal P, Pankow J, Shah S, Smith BM, Stukovsky KH, Sun Y, Watson K, Barr RG. Pulmonary Blood Volume Among Older Adults in the Community: The MESA Lung Study. Circ Cardiovasc Imaging 2022; 15:e014380. [PMID: 35938411 PMCID: PMC9387743 DOI: 10.1161/circimaging.122.014380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The pulmonary vasculature is essential for gas exchange and impacts both pulmonary and cardiac function. However, it is difficult to assess and its characteristics in the general population are unknown. We measured pulmonary blood volume (PBV) noninvasively using contrast enhanced, dual-energy computed tomography to evaluate its relationship to age and symptoms among older adults in the community. METHODS The MESA (Multi-Ethnic Study of Atherosclerosis) is an ongoing community-based, multicenter cohort. All participants attending the most recent MESA exam were selected for contrast enhanced dual-energy computed tomography except those with estimated glomerular filtration rate <60 mL/min per 1.73 m2. PBV was calculated by material decomposition of dual-energy computed tomography images. Multivariable models included age, sex, race/ethnicity, education, height, weight, smoking status, pack-years, and scanner model. RESULTS The mean age of the 727 participants was 71 (range 59-94) years, and 55% were male. The race/ethnicity distribution was 41% White, 29% Black, 17% Hispanic, and 13% Asian. The mean±SD PBV in the youngest age quintile was 547±180 versus 433±194 mL in the oldest quintile (P<0.001), with an approximately linear decrement of 50 mL per 10 years of age ([95% CI, 32-67]; P<0.001). Findings were similar with multivariable adjustment. Lower PBV was associated independently with a greater dyspnea after a 6-minute walk (P=0.04) and greater composite dyspnea symptom scores (P=0.02). Greater PBV was also associated with greater height, weight, lung volume, Hispanic race/ethnicity, and nonsmoking history. CONCLUSIONS Pulmonary blood volume was substantially lower with advanced age and was associated independently with greater symptoms scores in the elderly.
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Affiliation(s)
- Emilia A. Hermann
- 1. Department of Medicine, Columbia University Medical Center, New York, NY
| | | | | | | | | | | | | | | | | | - Grant T. Hiura
- 1. Department of Medicine, Columbia University Medical Center, New York, NY
| | | | | | - Prashant Nagpal
- 2. University of Iowa, Iowa City, IA
- 5. University of Wisconsin-Madison, Madison WI
| | - Jim Pankow
- 7. University of Minnesota, Minneapolis, MN
| | | | - Benjamin M Smith
- 1. Department of Medicine, Columbia University Medical Center, New York, NY
| | | | - Yifei Sun
- 9. Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, NY
| | - Karol Watson
- 10. University of California, Los Angeles, Los Angeles, CA
| | - R. Graham Barr
- 1. Department of Medicine, Columbia University Medical Center, New York, NY
- 11. Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY
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Dieffenbach PB, Aravamudhan A, Fredenburgh LE, Tschumperlin DJ. The Mechanobiology of Vascular Remodeling in the Aging Lung. Physiology (Bethesda) 2022; 37:28-38. [PMID: 34514871 PMCID: PMC8742727 DOI: 10.1152/physiol.00019.2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Aging is accompanied by declining lung function and increasing susceptibility to lung diseases. The role of endothelial dysfunction and vascular remodeling in these changes is supported by growing evidence, but underlying mechanisms remain elusive. In this review we summarize functional, structural, and molecular changes in the aging pulmonary vasculature and explore how interacting aging and mechanobiological cues may drive progressive vascular remodeling in the lungs.
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Affiliation(s)
- Paul B. Dieffenbach
- 1Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Aja Aravamudhan
- 2Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Laura E. Fredenburgh
- 1Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Daniel J. Tschumperlin
- 2Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
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5
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Transvascular endosonographic-guided needle biopsy of intrathoracic lesions. J Thorac Cardiovasc Surg 2020; 159:2057-2065. [DOI: 10.1016/j.jtcvs.2019.10.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 10/07/2019] [Accepted: 10/09/2019] [Indexed: 12/25/2022]
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Medarov BI, Jogani S, Sun J, Judson MA. Readdressing the entity of exercise pulmonary arterial hypertension. Respir Med 2017; 124:65-71. [PMID: 28284324 DOI: 10.1016/j.rmed.2017.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 01/25/2017] [Accepted: 02/13/2017] [Indexed: 01/09/2023]
Abstract
Exercise pulmonary hypertension (EPH) indicates an abnormally elevated pulmonary artery pressure (PAP) during exercise. The physiological range of PAP during exercise remains poorly defined and, therefore, a universally accepted definition of EPH remains elusive. Nevertheless, previous data concerning the distribution of PAP in normal populations and more recent retrospective clinical data enhanced our ability to define EPH. EPH can impair exercise capacity and cause dyspnea. The underlying pathophysiology of the arterial form of EPH (EPAH) appears to be similar to that seen in resting pulmonary arterial hypertension (PAH), and EPAH individuals are at risk of developing resting PAH. Patients with collagen vascular disease, especially scleroderma, are at risk for EPAH and its presence indicates a relatively poor prognosis. The prevalence of EPAH in scleroderma may be as high as 50%. The utility of pulmonary vasodilator therapy for EPAH is not well defined; however, a sizable subgroup of EPAH patients will achieve an improvement in symptoms.
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Affiliation(s)
- Boris I Medarov
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA.
| | - Sidharth Jogani
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA
| | - Johnathan Sun
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA
| | - Marc A Judson
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA
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7
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Krzesiński P, Stańczyk A, Gielerak G, Piotrowicz K. The hemodynamic patterns in hypertensive men and women of different age. J Hum Hypertens 2015; 30:177-85. [DOI: 10.1038/jhh.2015.63] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 05/02/2015] [Accepted: 05/14/2015] [Indexed: 11/09/2022]
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8
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Izumo M, Shiota M, Nalawadi S, Das J, Dohad S, Kuwahara E, Fukuoka Y, Siegel RJ, Shiota T. Determinants of Secondary Pulmonary Hypertension in Patients with Takotsubo Cardiomyopathy. Echocardiography 2015; 32:1608-13. [DOI: 10.1111/echo.12949] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Masaki Izumo
- The Heart Institute at Cedars-Sinai Medical Center; Los Angeles California
| | - Maiko Shiota
- Stanford University Medical Center; Stanford California
| | - Smruti Nalawadi
- The Heart Institute at Cedars-Sinai Medical Center; Los Angeles California
| | - Jayanta Das
- The Heart Institute at Cedars-Sinai Medical Center; Los Angeles California
| | - Sohail Dohad
- The Heart Institute at Cedars-Sinai Medical Center; Los Angeles California
| | - Eiji Kuwahara
- The Heart Institute at Cedars-Sinai Medical Center; Los Angeles California
| | - Yoko Fukuoka
- The Heart Institute at Cedars-Sinai Medical Center; Los Angeles California
| | - Robert J Siegel
- The Heart Institute at Cedars-Sinai Medical Center; Los Angeles California
| | - Takahiro Shiota
- The Heart Institute at Cedars-Sinai Medical Center; Los Angeles California
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9
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Taylor BJ, Carlson AR, Miller AD, Johnson BD. Exercise-induced interstitial pulmonary edema at sea-level in young and old healthy humans. Respir Physiol Neurobiol 2014; 191:17-25. [PMID: 24200644 PMCID: PMC3951121 DOI: 10.1016/j.resp.2013.10.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 10/22/2013] [Accepted: 10/28/2013] [Indexed: 12/20/2022]
Abstract
We asked whether aged adults are more susceptible to exercise-induced pulmonary edema relative to younger individuals. Lung diffusing capacity for carbon monoxide (DLCO), alveolar-capillary membrane conductance (Dm) and pulmonary-capillary blood volume (Vc) were measured before and after exhaustive discontinuous incremental exercise in 10 young (YNG; 27±3 years) and 10 old (OLD; 69±5 years) males. In YNG subjects, Dm increased (11±7%, P=0.031), Vc decreased (-10±9%, P=0.01) and DLCO was unchanged (30.5±4.1 vs. 29.7±2.9mL/min/mmHg, P=0.44) pre- to post-exercise. In OLD subjects, DLCO and Dm increased (11±14%, P=0.042; 16±14%, P=0.025) but Vc was unchanged (58±23 vs. 56±23mL, P=0.570) pre- to post-exercise. Group-mean Dm/Vc was greater after vs. before exercise in the YNG and OLD subjects. However, Dm/Vc was lower post-exercise in 2 of the 10 YNG (-7±4%) and 2 of the 10 OLD subjects (-10±5%). These data suggest that exercise decreases interstitial lung fluid in most YNG and OLD subjects, with a small number exhibiting evidence for exercise-induced pulmonary edema.
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Affiliation(s)
- Bryan J Taylor
- Cardiorespiratory Research Laboratory, Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic & Foundation, Rochester, MN 55905, USA.
| | - Alex R Carlson
- Cardiorespiratory Research Laboratory, Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic & Foundation, Rochester, MN 55905, USA
| | - Andrew D Miller
- Cardiorespiratory Research Laboratory, Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic & Foundation, Rochester, MN 55905, USA
| | - Bruce D Johnson
- Cardiorespiratory Research Laboratory, Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic & Foundation, Rochester, MN 55905, USA
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10
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Avierinos JF, Tribouilloy C, Grigioni F, Suri R, Barbieri A, Michelena HI, Ionico T, Rusinaru D, Ansaldi S, Habib G, Szymanski C, Giorgi R, Mahoney DW, Enriquez-Sarano M. Impact of ageing on presentation and outcome of mitral regurgitation due to flail leaflet: a multicentre international study. Eur Heart J 2013; 34:2600-9. [DOI: 10.1093/eurheartj/eht250] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Francesco Grigioni
- Cardiovascular Department, University Hospital of Bologna, Bologna, Italy
| | - Rakesh Suri
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Andrea Barbieri
- Department of Cardiology, University of Modena, Modena, Italy
| | - Hector I. Michelena
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Teresa Ionico
- Cardiovascular Department, University Hospital of Bologna, Bologna, Italy
| | - Dan Rusinaru
- Department of Cardiology, INSERM, ERI 12 and University Hospital, Amiens, France
| | - Sébastien Ansaldi
- Department of Cardiology, University Hospital of Marseille, Marseille, France
| | - Gilbert Habib
- Department of Cardiology, University Hospital of Marseille, Marseille, France
| | - Catherine Szymanski
- Department of Cardiology, INSERM, ERI 12 and University Hospital, Amiens, France
| | - Roch Giorgi
- Lertim, EA 3283, Aix-Marseille University, Marseille, France
| | - Douglas W. Mahoney
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN, USA
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11
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Evaluation of hemodynamic changes by use of phase-contrast MRI for patients with interstitial pneumonia, with special focus on blood flow reduction after breath-holding and bronchopulmonary shunt flow. Jpn J Radiol 2012; 31:197-203. [DOI: 10.1007/s11604-012-0171-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 11/27/2012] [Indexed: 11/25/2022]
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12
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De Bruaene AV, Delcroix M, Pasquet A, De Backer J, Paelinck B, Morissens M, Budts W. The importance of pulmonary artery pressures on late atrial arrhythmia in transcatheter and surgically closed ASD type secundum. Int J Cardiol 2011; 152:192-5. [DOI: 10.1016/j.ijcard.2010.07.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 06/15/2010] [Accepted: 07/03/2010] [Indexed: 10/19/2022]
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13
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Taylor BJ, Johnson BD. The pulmonary circulation and exercise responses in the elderly. Semin Respir Crit Care Med 2010; 31:528-38. [PMID: 20941654 DOI: 10.1055/s-0030-1265894] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Aging is associated with a progressive deterioration in the structure and function of the pulmonary circulation. Remodeling of the pulmonary vasculature occurs from maturity to senescence that is characterized by an increase in pulmonary vascular stiffness, pulmonary vascular pressures, and pulmonary vascular resistance along with increased heterogeneity of alveolar ventilation and pulmonary perfusion and decreased pulmonary capillary blood volume and membrane diffusing capacity that is consistent with a reduction in alveolar-capillary surface area. In theory, the aforementioned age-related changes in the pulmonary circulation may conspire to make elderly individuals more susceptible to gas exchange abnormalities during exercise. However, despite the erosion in ventilatory reserve with aging, the healthy older adult appears able to maintain alveolar ventilation at a level that allows maintenance of arterial blood gases within normal limits, even during heavy exercise. This ability to maintain adequate gas exchange likely occurs because age-related reductions in the maximal metabolic demand of exercise occur at a rate equal to or greater than the rate of deterioration in ventilatory reserve. A more prominent aspect of aging is the loss of lung elastic recoil that is associated with a modest reduction in the expiratory boundary of the maximal flow-volume envelope. This in turn increases the severity of expiratory airflow limitation and induces dynamic lung hyperinflation during exercise. The consequences of this age-associated decrease in elastic recoil on the pulmonary circulation are speculative, but an age-associated decline in elastic recoil may influence pulmonary vascular resistance and cardiac output, in addition to its impact on the work and oxygen cost of breathing.
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Affiliation(s)
- Bryan J Taylor
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA
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14
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[Chest CT: spectrum of normal findings]. ACTA ACUST UNITED AC 2010; 90:1776-88. [PMID: 19953071 DOI: 10.1016/s0221-0363(09)73282-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A fundamental issue in the interpretation of chest CT lies in the ability to determine normality. Technical advances have resulted in an increasing number of submillimeter sections which in turn has resulted in the identification of a large number of minor abnormalities with no significant pathophysiological consequence. These images should be properly interpreted in order to avoid unnecessary follow-up examinations and radiation exposure. Often they are due to respiratory or cardiac motion artifacts. Others are explained by aging, anatomic variants, physiological phenomenon or tobacco use. These borderline imaging features detected on chest CT are described according to the main anatomical compartments of the thorax: lung and vessels, airways, pleura and chest wall, mediastinum and heart.
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15
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Ilsar R, Bailey BP, Dobbins TA, Celermajer DS. The Relationship Between Pulmonary Artery and Pulmonary Capillary Wedge Pressure for the Diagnosis of Pulmonary Vascular Disease. Heart Lung Circ 2010; 19:38-42. [DOI: 10.1016/j.hlc.2009.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Revised: 08/05/2009] [Accepted: 08/05/2009] [Indexed: 01/22/2023]
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16
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Podlutsky A, Ballabh P, Csiszar A. Oxidative stress and endothelial dysfunction in pulmonary arteries of aged rats. Am J Physiol Heart Circ Physiol 2009; 298:H346-51. [PMID: 19966046 DOI: 10.1152/ajpheart.00972.2009] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Aging in the systemic circulation is associated with generalized endothelial dysfunction and increased oxidative stress, which are thought to contribute to the increased morbidity and mortality of cardiovascular diseases in the elderly. Previous studies have shown that pulmonary artery pressure and vascular resistance increase with normal aging in humans, yet age-related functional and phenotypic changes in the pulmonary arteries have not been characterized. To determine whether in the pulmonary circulation aging elicits endothelial dysfunction and oxidative stress, isolated pulmonary arteries of young (3 mo old) and aged (28 mo old) F344 rats were compared. We found that aging in rat pulmonary arteries is associated with impaired acetylcholine-induced relaxation and vascular oxidative stress [assessed by dihydroethidine and 5 (and 6)-chloromethyl-2',7'-dichlorodihydrofluorescein diacetate-acetyl ester fluorescence assays]. Endothelial dysfunction in the aged pulmonary vessels is reversed by the inhibition of NAD(P)H oxidase. The expressions of gp91(phox) (both mRNA and protein), NAD(P)H oxidase isoform type 1 (Nox-1; mRNA), and Nox-4 (mRNA) tend to increase in aged vessels; however, only changes in Nox-4 reached statistical significance. In pulmonary arteries of aged rats, the protein expression of endothelial nitric oxide synthase, Cu,Zn-SOD, Mn-SOD, and glutathione peroxidase is unaltered, whereas the expression of catalase is significantly decreased. Our results suggest that aging is associated with oxidative stress and endothelial dysfunction in the pulmonary arteries, which may contribute to the age-related functional alterations in the pulmonary circulation.
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Affiliation(s)
- Andrej Podlutsky
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
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Lam CSP, Borlaug BA, Kane GC, Enders FT, Rodeheffer RJ, Redfield MM. Age-associated increases in pulmonary artery systolic pressure in the general population. Circulation 2009; 119:2663-70. [PMID: 19433755 DOI: 10.1161/circulationaha.108.838698] [Citation(s) in RCA: 327] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In contrast to the wealth of data on isolated systolic hypertension involving the systemic circulation in the elderly, much less is known about age-related change in pulmonary artery systolic pressure (PASP) and its prognostic impact in the general population. We sought to define the relationship between PASP and age, to evaluate which factors influence PASP, and to determine whether PASP is independently predictive of mortality in the community. METHODS AND RESULTS A random sample of the Olmsted County, Minn, general population (n=2042) underwent echocardiography and spirometry and was followed up for a median of 9 years. PASP was measured from the tricuspid regurgitation velocity. Left ventricular diastolic pressure was estimated with Doppler echocardiography (E/e' ratio), and arterial stiffening was assessed from the brachial artery pulse pressure. Among 1413 subjects (69%) with measurable PASP (age, 63+/-11 years; 43% male), median PASP was 26 mm Hg (25th to 75th percentile, 24 to 30 mm Hg) and increased with age (r=0.31, P<0.001). Independent predictors of PASP were age, pulse pressure, and mitral E/e' (all P< or =0.003). Increasing PASP was associated with higher mortality (hazard ratio, 2.73 per 10 mm Hg; P<0.001). In subjects without cardiopulmonary disease (any heart failure, coronary artery disease, hypertension, diabetes mellitus, or chronic obstructive lung disease), the age-adjusted hazard ratio was 2.74 per 10 mm Hg (P=0.016). CONCLUSIONS We provide the first population-based evidence of age-related increase in pulmonary artery pressure, its association with increasing left heart diastolic pressures and systemic vascular stiffening, and its negative impact on survival. Pulmonary artery pressure may serve as a novel cardiovascular risk factor and potential therapeutic target.
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Affiliation(s)
- Carolyn S P Lam
- Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, MN 55905, USA
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18
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CT angiography in suspected pulmonary embolism: impact of patient characteristics and different venous lines on vessel enhancement and image quality. AJR Am J Roentgenol 2008; 190:W351-9. [PMID: 18492877 DOI: 10.2214/ajr.07.3402] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The objective of our study was to compare image quality, patient characteristics, and different catheters in pulmonary CT angiography (CTA) performed with bolus tracking and z-axis automated tube current modulation (ATCM) in patients with suspected pulmonary embolism. SUBJECTS AND METHODS One hundred twenty-six patients were referred to undergo pulmonary CTA with bolus tracking and ATCM. Besides patient characteristics, the type, position, size, and side of venous catheters were documented. Pulmonary vessel enhancement and image noise were quantified; signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Subjective vessel contrast was assessed by two radiologists in consensus. RESULTS Patient age showed a moderate but significant positive correlation to vessel enhancement (r = 0.244, p = 0.006), CNR (r = 0.178, p = 0.046), and subjective image quality (r = 0.344, p < 0.001). Patient weight revealed a significant negative correlation to vessel enhancement (r = -0.496, p < 0.001), SNR (r = -0.446, p < 0.001), CNR (r = -0.425, p < 0.001), and subjective image quality (r = -0.422, p < 0.001). In univariate analysis, SNR and CNR were significantly higher in patients who received contrast medium through peripheral catheters (30 +/- 13 and 27 +/- 13, respectively) than in those in whom central catheters were used (22 +/- 8 and 19 +/- 7, p = 0.041 and p = 0.029, respectively). Neither patient sex nor catheter size, position, or side had any significant impact on image quality. CONCLUSION Patient age and weight showed significant impact on vascular attenuation and image quality in pulmonary CTA with bolus tracking and ATCM, whereas patient sex and different peripheral catheters did not significantly influence image parameters.
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Arakawa H, Kohno T, Hiki T, Kaji Y. CT pulmonary angiography and CT venography: factors associated with vessel enhancement. AJR Am J Roentgenol 2007; 189:156-61. [PMID: 17579166 DOI: 10.2214/ajr.06.1240] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The objective of our study was to determine factors associated with enhancement on CT pulmonary angiography and CT venography. MATERIALS AND METHODS Two hundred forty-two cases (83 men and 159 women; mean age, 63 years; age range, 21-92 years) underwent CT pulmonary angiography using a bolus-tracking technique; 189 cases subsequently underwent CT venography 3 minutes after the start of the contrast injection. Two different amounts of nonionic iodine contrast medium were administered: patients weighing > 50 kg who were undergoing both CT pulmonary angiography and CT venography received 450 mg I (group B), whereas all other patients received 300 mg I (group A). The enhancement of vessels was subjectively estimated using a four-point scale, and attenuation values were measured at predetermined levels. Multiple regression analyses were performed with attenuation as the dependent variable and patient age, sex, and weight; amount of contrast medium; scanning delay; and presence of embolism as the independent variables. RESULTS The scanning delay for CT pulmonary angiography ranged from 10 to 31 seconds (mean, 19 seconds; SD, 3.3). Subjective estimates of enhancement quality on CT venography were significantly better for group B than for group A (p < 0.001). Multiple regression analyses revealed that body weight and age were the only significant and consistent independent variables associated with enhancement of the pulmonary arteries. The amount of contrast medium, body weight, and scanning delay were the independent variables that were consistently associated with enhancement of the deep veins. CONCLUSION The bolus-tracking technique showed relatively small variations in the scanning delay time. Patient age, body weight, and the amount of contrast medium were the important factors associated with vessel enhancement in combined CT pulmonary angiography and CT venography.
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Affiliation(s)
- Hiroaki Arakawa
- Department of Radiology, Dokkyo Medical University, 880, Kita-Kobayashi, Mibu, Tochigi, 321-0293 Japan
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Cheng CP, Herfkens RJ, Taylor CA, Feinstein JA. Proximal pulmonary artery blood flow characteristics in healthy subjects measured in an upright posture using MRI: The effects of exercise and age. J Magn Reson Imaging 2005; 21:752-8. [PMID: 15906332 DOI: 10.1002/jmri.20333] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To use MRI to quantify blood flow conditions in the proximal pulmonary arteries of healthy children and adults at rest and during exercise in an upright posture. MATERIALS AND METHODS Cine phase-contrast MRI was used to calculate mean flow and reverse flow index (RFI) in the main (MPA), right (RPA), and left (LPA) pulmonary arteries in healthy children and adults in an open-MRI magnet equipped with an upright MRI-compatible ergometer. RESULTS From rest to exercise (150% resting heart rate), blood flow (liters/minute/m2) increased in the RPA (1.4+/-0.3 vs. 2.5+/-0.4; P<0.001), LPA (1.1+/-0.3 vs. 2.2+/-0.6; P<0.001), and MPA (2.7+/-0.5 vs. 4.9+/-0.5; P<0.001). RFI decreased in the LPA (0.040+/-0.030 vs. 0.017+/-0.018; P<0.02) and MPA (0.025+/-0.024 vs. 0.008+/-0.007; P<0.03). Adults experienced greater retrograde flow in the MPA than the children (0.042+/-0.029 vs. 0.014+/-0.012; P<0.02). CONCLUSION It appears that at both rest and during exercise, in children and adults alike, RPA/LPA mean blood flow distribution is predominantly determined by distal vascular resistance, while retrograde flow is affected by proximal pulmonary bifurcation geometry.
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Affiliation(s)
- Christopher P Cheng
- Department of Mechanical Engineering, Stanford University, Stanford, California 94305-4038, USA.
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Finkelhor RS, Yang SX, Bosich G, Bahler RC. Unexplained pulmonary hypertension is associated with systolic arterial hypertension in patients undergoing routine Doppler echocardiography. Chest 2003; 123:711-5. [PMID: 12628867 DOI: 10.1378/chest.123.3.711] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVE To determine the validity of the association between systemic hypertension (HTN) and unexplained pulmonary hypertension (PHTN) as identified with Doppler echocardiography. METHODS All patients with a reported systolic pulmonary artery pressure (SPAP) on routine Doppler echocardiography from our 1997 echocardiographic database were identified. Exclusions included all diseases known to be associated with PHTN. Of 1,174 patients, 503 had PHTN (defined as a SPAP of >/= 40 mm Hg), of whom 42 (8.4%) had unexplained PHTN. These PHTN patients were matched for age (mean [+/- SD] age, 70 +/- 11 years) with 84 randomly selected patients from the same database who had normal SPAP values and no diseases associated with PHTN. RESULTS The mean SPAP of those patients with unexplained PHTN was 48 +/- 9 mm Hg vs 31 +/- 5 mm Hg for those without unexplained PHTN. HTN was more prevalent in those with PHTN (98% vs 72%, respectively; p = 0.0008). Patients with unexplained PHTN had significantly higher mean systolic BP, as routinely measured at the end of the echo (154 +/- 26 vs 138 +/- 21 mm Hg, respectively; p = 0.0006), but they did not differ in diastolic BP (80 +/- 14 vs 78 +/- 11 mm Hg, respectively; p = 0.39). PHTN patients and control subjects did not differ with respect to gender (women, 74% vs 70%, respectively), race (white, 64% vs 65%, respectively), body mass index (30 +/- 8 vs 28 +/- 8 kg/m(2), respectively), or left ventricular ejection fraction (64 +/- 6% vs 63 +/- 7%, respectively). When only those with known HTN were considered, PHTN patients still had higher systolic arterial BP (155 +/- 25 vs 143 +/- 21 mm Hg, respectively; p = 0.013) and tended to be on more BP medications (1.6 +/- 1.1 vs 1.2 +/- 0.9, respectively; p = 0.09). CONCLUSIONS Unexplained PHTN occurs mostly in the elderly, is associated with systolic HTN, and those hypertensive patients with concomitant PHTN have higher systolic arterial pressures.
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Affiliation(s)
- Robert S Finkelhor
- Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH 44109, USA.
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Abergel E, Tache A, Cohen A, Raffoul H, Diebold B, Chatellier G. Determinants of right ventricular pressure in mild hypertension. J Hypertens 2001; 19:2055-61. [PMID: 11677372 DOI: 10.1097/00004872-200111000-00017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Doppler echocardiography was used to define reference values and determinants of tricuspid regurgitation peak velocity (TRV) in hypertensive patients. A TRV value > 2.5 m/s is the threshold usually defining abnormal right ventricular systolic pressure. DESIGN AND PATIENTS Doppler echocardiography was performed in 320 consecutive uncomplicated hypertensive patients, without overt pulmonary or heart disease. Doppler echocardiography included LV mass measurement, LV inflow and pulmonary venous flow analysis, LV systolic function and TRV measurements. RESULTS Among 320 patients, 255 had normal TRV < 2.5 m/s and 65 had elevated TRV > or = 2.5 m/s. Compared with the normal TRV group, the elevated TRV group was older (60 versus 50 years, P < 0.0001), systolic blood pressure was higher (156 versus 151 mmHg, P = 0.02) and antihypertensive therapy was more frequent (68 versus 51%, P = 0.02); indexed LV mass was higher (45.4 versus 40.6 g/m2.7, P = 0.001), pulmonary D wave peak velocity was higher (42 versus 38 cm/s, P = 0.03). In univariate analysis, age was the most predictive variable of TRV (r = 0.36). In multivariate analysis, three variables were independently related to TRV: age, LV mass, pulmonary D wave (multiple r = 0.47). CONCLUSION In mild hypertension, TRV is independently related to age, and to a lesser extent, to LV morphology and LV filling pressure. In clinical practice, age should be taken into account to interpret TRV.
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Affiliation(s)
- E Abergel
- Service de Cardiologie, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75908 Paris Cédex 15, France.
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Dib JC, Abergel E, Rovani C, Raffoul H, Diebold B. The age of the patient should be taken into account when interpreting Doppler assessed pulmonary artery pressures. J Am Soc Echocardiogr 1997; 10:72-3. [PMID: 9046496 DOI: 10.1016/s0894-7317(97)80035-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The impact of aging on the systolic artery pressure (SPAP) value is not well known. We selected 134 echocardiographic Doppler examinations considered as normal (presence of a sinus rhythm, absence of chronic obstructive pulmonary disease or pulmonary embolism, normal global or segmental wall motion, no right or left ventricular hypertrophy or dilatation, no significant valvular disease, no pericarditis), with a clearly measurable tricuspid insufficiency allowing us to measure the SPAP with the simplified Bernoulli equation. There was a highly significant (p = 0.0001) correlation (r = 0.47) between SPAP values and the age of the patient. SPAP increased progressively with age from 23 +/- 5 mm Hg between 20 to 29 years old to 32 +/- 6 mm Hg when 80 years old or more. The interpretation of the SPAP should take into account the age.
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Affiliation(s)
- J C Dib
- Department of Cardiology, Broussais Hospital, Paris, France
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Abergel E, Chatellier G, Toussaint P, Dib JC, Menard J, Diebold B. Doppler-derived pulmonary arterial systolic pressure in patients with known systemic arterial pressures. Am J Cardiol 1996; 77:767-9. [PMID: 8651133 DOI: 10.1016/s0002-9149(97)89216-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In the present study, we evaluated Doppler-derived systolic pulmonary artery pressure in 476 hypertensive patients. Clinical interpretation of systolic pulmonary arterial pressure should take into account age, body size, and systolic blood pressure values.
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Affiliation(s)
- E Abergel
- Service de Cardiologie, Centre d'Investigations Cliniques, Hôpital Broussais, Paris, France
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Sganzerla P, Moruzzi P, Pepi M, Perego GB, Passaretti B, Muratori M, Guazzi MD. Control of pulmonary vasomotility in congestive heart failure. Int J Cardiol 1993; 38:25-32. [PMID: 8444498 DOI: 10.1016/0167-5273(93)90200-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Although enhanced sympathetic tone is a well-known component of the autonomic imbalance of heart failure, its influence on pulmonary vasomotility is undefined. We investigated the pulmonary circulation in 12 patients with congestive heart failure in NYHA functional class III and in a control group of 10 normal subjects. Sympathetic influence on pulmonary vessels was studied through adrenergic activation by the arithmetic test and the cold pressor test. A rubber balloon was distended in the inferior vena cava to reduce transpulmonary flow and its influence on vascular tone. In normal individuals the arithmetic test caused pulmonary vasodilation, probably because of the mechanical effect of a largely enhanced flow: in fact, caval obstruction unmasked a neurogenic vasoconstrictor response to the arithmetic test by simply reducing the amount of cardiac output increase. In patients with heart failure, cardiac output and pulmonary arteriolar resistance remained steady during the arithmetic test, no matter what the condition of the venous return was. The cold pressor test was always a vasoconstrictor stimulus, but only in normal subjects was vasoconstriction potentiated by reducing, with caval obstruction, transpulmonary flow and its vasodilatory influence. From these data an attenuation of the sympathetic influence on pulmonary vessels in congestive heart failure seems to be likely. This might be explained as the result of modifications of pulmonary vessels rather than of reduced sympathetic excitability since circulating catecholamine levels varied to similar extents in the two groups during the tests. In congestive heart failure interstitial edema and vascular wall imbibition might increase pulmonary vessel tone and decrease vascular receptor availability. Lower reactivity to sympathetic stimuli, particularly to the vasoconstrictor ones, would ensue.
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Affiliation(s)
- P Sganzerla
- Istituto di Cardiologia dell'Università, Fondazione I. Monzino, Milan, Italy
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