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Blanco I, Torres-Castro R, Barberà JA. Pulmonary vascular disease in chronic lung diseases: cause or comorbidity? Curr Opin Pulm Med 2024; 30:437-443. [PMID: 38958570 DOI: 10.1097/mcp.0000000000001091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
PURPOSE OF REVIEW To provide timely and relevant insights into the complex relationship between pulmonary vascular disease (PVD) and chronic lung disease (CLD), focusing on the causative and consequential dynamics between these conditions. RECENT FINDINGS There are shared pathogenic mechanisms between pulmonary arterial hypertension (PAH) and group 3 pulmonary hypertension, including altered expression of mediators and growth factors implicated in both conditions. Factors such as hypoxia, hypoxemia, and hypercapnia also contribute to pulmonary vascular remodelling and endothelial dysfunction. However, the role of hypoxia as the sole driver of pulmonary hypertension in CLD is being reconsidered, particularly in chronic obstructive pulmonary disease (COPD), with evidence suggesting a potential role for cigarette smoke products in initiating pulmonary vascular impairment. On the other hand, interstitial lung disease (ILD) encompasses a group of heterogeneous lung disorders characterized by inflammation and fibrosis of the interstitium, leading to impaired gas exchange and progressive respiratory decline, which could also play a role as a cause of pulmonary hypertension. SUMMARY Understanding the intricate interplay between the pulmonary vascular compartment and the parenchymal and airway compartments in respiratory disease is crucial for developing effective diagnostic and therapeutic strategies for patients with PVD and CLD, with implications for both clinical practice and research.
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Affiliation(s)
- Isabel Blanco
- Department of Pulmonary Medicine, Hospital Clínic, University of Barcelona
- Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona
- Biomedical Research Networking Center on Respiratory Diseases (CIBERES); Madrid, Spain
| | - Rodrigo Torres-Castro
- Department of Pulmonary Medicine, Hospital Clínic, University of Barcelona
- Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Joan Albert Barberà
- Department of Pulmonary Medicine, Hospital Clínic, University of Barcelona
- Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona
- Biomedical Research Networking Center on Respiratory Diseases (CIBERES); Madrid, Spain
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Abstract
PURPOSE OF REVIEW Pulmonary hypertension (PH) is a common complication of chronic obstructive lung disease (COPD), but clinical presentation is variable and not always 'proportional' to the severity of the obstructive disease. This review aims to analyze heterogeneity in clinical features of PH-COPD, providing a guide for diagnosis and management according to phenotypes. RECENT FINDINGS Recent works have focused on severe PH in COPD, providing insights into the characteristics of patients with predominantly vascular disease. The recently recognized 'pulmonary vascular phenotype', characterized by severe PH and mild airflow obstruction with severe hypoxemia, has markedly worse prognosis and may be a candidate for large trials with pulmonary vasodilators. In severe PH, which might be best described by a pulmonary vascular resistance threshold, there may also be a need to distinguish patients with mild COPD (pulmonary vascular phenotype) from those with severe COPD ('Severe COPD-Severe PH' phenotype). SUMMARY Correct phenotyping is key to appropriate management of PH associated with COPD. The lack of evidence regarding the use of pulmonary vasodilators in PH-COPD may be due to the existence of previously unrecognized phenotypes with different responses to therapy. This review offers the clinician caring for patients with COPD and PH a phenotype-focused approach to diagnosis and management, aimed at personalized care.
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Affiliation(s)
| | - Lucilla Piccari
- Department of Pulmonary Medicine, Hospital del Mar, Barcelona, Spain
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Gürsel G, Özdemir U, Güney T, Karaarslan N, Tekin Ö, Öztürk B. The usefulness of subxiphoid view in the evaluation of acceleration time and pulmonary hypertension in ICU patients. Echocardiography 2020; 37:1345-1352. [PMID: 32789889 DOI: 10.1111/echo.14822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/24/2020] [Accepted: 07/24/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pulmonary hypertension (PHT) is very frequent in ICUs. Estimation of systolic pulmonary artery pressure (PASP) by using tricuspid regurgitation velocity (TRV) is impossible in 25% of patients. However, it may be possible to estimate PHT in these patients by obtaining subxiphoid imaging of short axis (SX-SAX) and measuring pulmonary artery diameter (PAD) and right ventricular outflow tract (RVOT) acceleration time (AT). We first aimed to compare the values of AT and PAD measured at the parasternal short axis view (PSAX) and SX-SAX and then to compare AT measurements obtained in the RVOT and pulmonary artery (PA) in ICU patients. METHODS This prospective observational study was conducted in a 7-bed ICU of a tertiary academic teaching hospital. Measurements of TRV, PAD, and AT in parasternal and subxiphoid SAX were obtained. AT was measured in RVOT and PA locations. We measured other echocardiographic signs of PHT to assess the probability of PHT in addition to TRV measurements. RESULTS The study consisted of 61 patients. TRV was measured in 85% of the patients, and SX-SAX was visualized in 78%. The probability of PHT was high (49%) in this study population. There were agreement and no proportional bias between the measurements of PAD and AT at both SX-SAX and PSAX. Measurements of AT in the RVOT and PA were similar, as well. CONCLUSION These results suggested that measurements of AT in the PSAX and SX-SAX and RVOT and PA were similar in the ICU patients.
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Affiliation(s)
- Gül Gürsel
- Department of Pulmonary Critical Care Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - Uğur Özdemir
- Division of Critical Care Medicine, Department of Internal Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - Tuba Güney
- Division of Critical Care Medicine, Department of Neurology, Gazi University School of Medicine, Ankara, Turkey
| | - Nur Karaarslan
- Division of Critical Care Medicine, Department of Anesthesiology, Gazi University School of Medicine, Ankara, Turkey
| | - Ömer Tekin
- Division of Critical Care Medicine, Department of Internal Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - Burcu Öztürk
- Department of Pulmonary Critical Care Medicine, Gazi University School of Medicine, Ankara, Turkey
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Rangelov BA, Young AL, Jacob J, Cahn AP, Lee S, Wilson FJ, Hawkes DJ, Hurst JR. Thoracic Imaging at Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review. Int J Chron Obstruct Pulmon Dis 2020; 15:1751-1787. [PMID: 32801677 PMCID: PMC7385406 DOI: 10.2147/copd.s250746] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 05/03/2020] [Indexed: 01/20/2023] Open
Abstract
Exacerbations of chronic obstructive pulmonary disease (COPD) are currently diagnosed based on changes in respiratory symptoms. Characterizing the imaging manifestation of exacerbations could be useful for objective diagnosis of exacerbations in the clinic and clinical trials, as well as provide a mechanism for monitoring exacerbation treatment and recovery. In this systematic review, we employed a comprehensive search across three databases (Medline, EMBASE, Web of Science) to identify studies that performed imaging of the thorax at COPD exacerbation. We included 51 from a total of 5,047 articles which met all our inclusion criteria. We used an adapted version of the Modified Newcastle-Ottawa Quality Assessment Scale for cohort studies to assess the quality of the included studies. Conclusions were weighted towards higher-quality articles. We identified a total of 36 thoracic imaging features studied at exacerbation of COPD. Studies were generally heterogeneous in their measurements and focus. Nevertheless, considering studies which performed consecutive imaging at stable state and exacerbation, which scored highest for quality, we identified salient imaging biomarkers of exacerbations. An exacerbation is characterized by airway wall and airway calibre changes, hyperinflation, pulmonary vasoconstriction and imaging features suggestive of pulmonary arterial hypertension. Most information was gained from CT studies. We present the first ever composite imaging signature of COPD exacerbations. While imaging during an exacerbation is comparatively new and not comprehensively studied, it may uncover important insights into the acute pathophysiologic changes in the cardiorespiratory system during exacerbations of COPD, providing objective confirmation of events and a biomarker of recovery and treatment response.
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Affiliation(s)
- Bojidar A Rangelov
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Alexandra L Young
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK.,Department of Computer Science, University College London, London, UK.,Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Joseph Jacob
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK.,UCL Respiratory, University College London, London, UK
| | | | | | | | - David J Hawkes
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
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Tousoulis D. Diabetes mellitus: Lessons from the COVID-19 pandemic. Hellenic J Cardiol 2020; 61:1-2. [PMID: 32425483 PMCID: PMC7233205 DOI: 10.1016/j.hjc.2020.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 03/15/2020] [Indexed: 01/20/2023] Open
Affiliation(s)
- Dimitris Tousoulis
- Cardiology Department, National and Kapodistrian University of Athens University Medical School, Hippokration Hospital, Athens, Greece.
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Tousoulis D. Pulmonary hypertension: The diagnostic and prognostic value of novel imaging techniques. Hellenic J Cardiol 2020; 61:71-72. [DOI: 10.1016/j.hjc.2020.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Tang P. Clinical diagnostic value of circulating serum miR-509-3p in pulmonary arterial hypertension with congenital heart disease. Hellenic J Cardiol 2020; 61:26-30. [DOI: 10.1016/j.hjc.2018.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 04/16/2018] [Accepted: 06/01/2018] [Indexed: 02/07/2023] Open
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Incessant and recurrent pericarditis: Corticosteroids or novel immune-suppressants agents. Hellenic J Cardiol 2019; 60:345-346. [PMID: 32252971 DOI: 10.1016/j.hjc.2019.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 12/28/2019] [Indexed: 11/23/2022] Open
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Nashat H, Gatzoulis MA. The importance of left heart disease as a cause of pulmonary hypertension in COPD. Hellenic J Cardiol 2018; 59:166-167. [PMID: 29940220 DOI: 10.1016/j.hjc.2018.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 06/01/2018] [Accepted: 06/08/2018] [Indexed: 11/27/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a common respiratory condition that presents with varying degrees of severity and can be complicated by further comorbidities. Up to a third can also have pulmonary hypertension, which is an important risk factor associated with an increase in morbidity and mortality. The etiology of pulmonary hypertension contributes to diagnosis. Considering and identifying the type of pulmonary hypertension at the right time will influence management and outcome in patients with COPD.
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Affiliation(s)
- H Nashat
- Royal Brompton and Harfield Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, UK.
| | - M A Gatzoulis
- Royal Brompton and Harfield Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, UK
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