1
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Maglione PJ, Gereige JD, Lee TK. Consideration of pulmonary hypertension in the evaluation of common variable immunodeficiency. Ann Allergy Asthma Immunol 2021; 127:513. [PMID: 34593104 DOI: 10.1016/j.anai.2021.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/19/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Paul J Maglione
- Section of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Jessica D Gereige
- Section of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Theodore K Lee
- Section of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
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2
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Refini RM, Bettini G, Kacerja E, Cameli P, d'Alessandro M, Bergantini L, De Negri F, Rottoli P, Sestini P, Bargagli E, Mazzei MA. The role of the combination of echo-HRCT score as a tool to evaluate the presence of pulmonary hypertension in idiopathic pulmonary fibrosis. Intern Emerg Med 2021; 16:941-947. [PMID: 33151480 PMCID: PMC8195909 DOI: 10.1007/s11739-020-02539-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/12/2020] [Indexed: 01/29/2023]
Abstract
Pulmonary hypertension (PH) is defined as an elevated mean pulmonary artery pressure at rest (mPAP ≥ 25 mmHg), evaluated by right heart catheterization (RHC). The aim of the present study was to evaluate HRCT findings in relation to transthoracic echocardiographic data to better characterize PH in IPF patients and to identify a non-invasive composite index with high predictive value for PH in these patients. 37 IPF patients were enrolled in this retrospective study. All patients underwent a complete assessment for PH, including transthoracic Doppler echocardiography, HRCT scan and right heart catheterization. Right heart catheterization was done in 19 patients (51.3%) as pre-lung transplant assessment and in 18 patients (48.6%) to confirm PH, suspected on the basis of echocardiography. Twenty out of 37 patients (54%) were confirmed to have PH by RHC. Multivariate regression showed that the combination of sPAP, PA area measured by HRCT and the ratio of the diameter of the segmental artery to that of the adjacent bronchus in the apicoposterior segment of the left upper lobe was strongly correlated with mPAP (R2 = 0.53; p = 0.0009). The ROC analysis showed that 931.6 was the ULN for PA area, with 86% sensitivity and 61% specificity (0.839 AUC); 20.34 was the ULN for the ratio of PA area to ascending aorta diameter, with 100% sensitivity and 50% specificity (0.804 AUC). The composite index proposed in the present study could help early detection of IPF patients suspected of PH requiring confirmation by RHC (if deemed clinically necessary).
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Affiliation(s)
- Rosa Metella Refini
- Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences and Neurosciences, Siena University Hospital, Viale Bracci 1, 53100, Siena, Italy
| | - Gloria Bettini
- Radiology Unit, Department, Azienda Ospedaliera Universitaria Pisana (AOUP), Pisa, Italy
| | - Esmeralda Kacerja
- Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences and Neurosciences, Siena University Hospital, Viale Bracci 1, 53100, Siena, Italy
| | - Paolo Cameli
- Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences and Neurosciences, Siena University Hospital, Viale Bracci 1, 53100, Siena, Italy
| | - Miriana d'Alessandro
- Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences and Neurosciences, Siena University Hospital, Viale Bracci 1, 53100, Siena, Italy.
| | - Laura Bergantini
- Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences and Neurosciences, Siena University Hospital, Viale Bracci 1, 53100, Siena, Italy
| | | | - Paola Rottoli
- Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences and Neurosciences, Siena University Hospital, Viale Bracci 1, 53100, Siena, Italy
| | - Piersante Sestini
- Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences and Neurosciences, Siena University Hospital, Viale Bracci 1, 53100, Siena, Italy
| | - Elena Bargagli
- Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences and Neurosciences, Siena University Hospital, Viale Bracci 1, 53100, Siena, Italy
| | - Maria Antonietta Mazzei
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
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3
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Cardoso DM, Gass R, Sbruzzi G, Berton DC, Knorst MM. Effect of the expiratory positive airway pressure on dynamic hyperinflation and exercise capacity in patients with COPD: a meta-analysis. Sci Rep 2020; 10:13292. [PMID: 32764718 PMCID: PMC7413366 DOI: 10.1038/s41598-020-70250-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 07/13/2020] [Indexed: 11/09/2022] Open
Abstract
Expiratory positive airway pressure (EPAP) is widely applicable, either as a strategy for pulmonary reexpansion, elimination of pulmonary secretion or to reduce hyperinflation. However, there is no consensus in the literature about the real benefits of EPAP in reducing dynamic hyperinflation (DH) and increasing exercise tolerance in subjects with chronic obstructive pulmonary disease (COPD). To systematically review the effects of EPAP application during the submaximal stress test on DH and exercise capacity in patients with COPD. This meta-analysis was performed from a systematic search in the PubMed, EMBASE, PeDRO, and Cochrane databases, as well as a manual search. Studies that evaluated the effect of positive expiratory pressure on DH, exercise capacity, sensation of dyspnea, respiratory rate, peripheral oxygen saturation, sense of effort in lower limbs, and heart rate were included. GRADE was used to determine the quality of evidence for each outcome. Of the 2,227 localized studies, seven studies were included. The results show that EPAP did not change DH and reduced exercise tolerance in the constant load test. EPAP caused a reduction in respiratory rate after exercise (− 2.33 bpm; 95% CI: − 4.56 to − 0.10) (very low evidence) when using a pressure level of 5 cmH2O. The other outcomes analyzed were not significantly altered by the use of EPAP. Our study demonstrates that the use of EPAP does not prevent the onset of DH and may reduce lower limb exercise capacity in patients with COPD. However, larger and higher-quality studies are needed to clarify the potential benefit of EPAP in this population.
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Affiliation(s)
- Dannuey Machado Cardoso
- Centro de Ensino Superior Dom Alberto, Santa Cruz Do Sul, RS, Brazil. .,Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul-UFRGS, Porto Alegre, RS, Brazil.
| | - Ricardo Gass
- Centro de Ensino Superior Dom Alberto, Santa Cruz Do Sul, RS, Brazil.,Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul-UFRGS, Porto Alegre, RS, Brazil
| | - Graciele Sbruzzi
- Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul-UFRGS, Porto Alegre, RS, Brazil.,Programa de Pós-Graduação em Ciências do Movimento Humano, Universidade Federal do Rio Grande do Sul-UFRGS, Porto Alegre, RS, Brazil
| | - Danilo Cortozi Berton
- Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul-UFRGS, Porto Alegre, RS, Brazil.,Serviço de Pneumologia, Hospital de Clínicas de Porto Alegre-HCPA, Porto Alegre, RS, Brazil
| | - Marli Maria Knorst
- Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul-UFRGS, Porto Alegre, RS, Brazil.,Serviço de Pneumologia, Hospital de Clínicas de Porto Alegre-HCPA, Porto Alegre, RS, Brazil
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Yao Y, Gu Y, Yang M, Cao D, Wu F. The Gene Expression Biomarkers for Chronic Obstructive Pulmonary Disease and Interstitial Lung Disease. Front Genet 2019; 10:1154. [PMID: 31824564 PMCID: PMC6879656 DOI: 10.3389/fgene.2019.01154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/22/2019] [Indexed: 01/01/2023] Open
Abstract
COPD (chronic obstructive pulmonary disease) and ILD (interstitial lung disease) are two common respiratory diseases. They share similar clinical traits but require different therapeutic treatments. Identifying the biomarkers that are differentially expressed between them will not only help the diagnosis of COPD and ILD, but also provide candidate drug targets that may facilitate the development of new treatment for COPD and ILD. Due to the irreversible complex pathological changes of COPD, there are very limited therapeutic options for COPD patients. In this study, we analyzed the gene expression profiles of two datasets: one training dataset that includes 144 COPD patients and 194 ILD patients, and one test dataset that includes 75 COPD patients and 61 ILD patients. Advanced feature selection methods, mRMR (minimal Redundancy Maximal Relevance) and incremental feature selection (IFS), were applied to identify the 38-gene biomarker. An SVM (support vector machine) classifier was built based on the 38-gene biomarker. Its accuracy, sensitivity, and specificity on training dataset evaluated by leave one out cross-validation were 0.905, 0.896, and 0.912, respectively. And on independent test dataset, the accuracy, sensitivity, and specificity on were as great as and were 0.904, 0.933, and 0.869, respectively. The biological function analysis of the 38 genes indicated that many of them can be potential treatment targets that may benefit COPD and ILD patients.
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Affiliation(s)
- Yangwei Yao
- Department of Pulmonary and Critical Care Medicine, The Second Hospital of Jiaxing, Jiaxing, China
| | - Yangyang Gu
- Department of Pulmonary and Critical Care Medicine, The Second Hospital of Jiaxing, Jiaxing, China
| | - Meng Yang
- Department of Pulmonary and Critical Care Medicine, The Second Hospital of Jiaxing, Jiaxing, China
| | - Dakui Cao
- Department of Pulmonary and Critical Care Medicine, The Second Hospital of Jiaxing, Jiaxing, China
| | - Fengjie Wu
- Department of Pulmonary and Critical Care Medicine, The Second Hospital of Jiaxing, Jiaxing, China
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5
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Awerbach JD, Stackhouse KA, Lee J, Dahhan T, Parikh KS, Krasuski RA. Outcomes of lung disease-associated pulmonary hypertension and impact of elevated pulmonary vascular resistance. Respir Med 2019; 150:126-130. [PMID: 30961938 DOI: 10.1016/j.rmed.2019.03.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/11/2019] [Accepted: 03/12/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND The clinical characteristics, hemodynamic changes and outcomes of lung disease-associated pulmonary hypertension (LD-PH) are poorly defined. METHODS A prospective cohort of PH patients undergoing initial hemodynamic assessment was collected, from which 51 patients with LD-PH were identified. Baseline characteristics and long-term survival were compared with 83 patients with idiopathic pulmonary arterial hypertension (iPAH). RESULTS Mean age (±standard deviation) of LD-PH patients was 64 ± 10 years, 30% were female and 78% were New York Heart Association class III-IV. The LD-PH group was older than the iPAH group (64 ± 10 vs 56 ± 18 years, respectively, P = 0.003) with a lower percentage of women (30% vs 70%, P = 0.007). LD-PH patients had smaller right ventricular sizes (P = 0.02) and less tricuspid regurgitation (P = 0.03) by echocardiogram, and lower mean pulmonary arterial pressures (mPAP) (P = 0.01) and pulmonary vascular resistance (PVR) (P = 0.001) at catheterization. Despite these findings, mortality was equally high in both groups (P = 0.16). 5-year survival was lower in patients with interstitial lung disease compared to those with obstructive pulmonary disease (P = 0.05). Among the LD-PH population, those with mild to moderately elevated mPAP and those with PVR <7 Wood units demonstrated significantly improved survival (P = 0.04 and P = 0.001, respectively). Vasoreactivity was not associated with improved survival (P = 0.64). A PVR ≥7 Wood units was associated with increased risk of mortality (hazard ratio (95% confidence interval), 3.59 (1.27-10.19), P = 0.02). CONCLUSIONS Despite less severe PH and less right heart sequelae, LD-PH has an equally poor clinical outcome when compared to iPAH. A PVR ≥7 Wood units in LD-PH patients was associated with 3-fold higher mortality.
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Affiliation(s)
- Jordan D Awerbach
- Duke University Medical Center, Division of Cardiovascular Medicine, Durham, NC, USA
| | | | - Joanne Lee
- The Cleveland Clinic, Cleveland, OH, USA
| | - Talal Dahhan
- Duke University Medical Center, Division of Pulmonary and Critical Care Medicine, Durham, NC, USA
| | - Kishan S Parikh
- Duke University Medical Center, Division of Cardiovascular Medicine, Durham, NC, USA
| | - Richard A Krasuski
- Duke University Medical Center, Division of Cardiovascular Medicine, Durham, NC, USA.
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Wang CG, Li C, Lei W, Jiang JH, Huang JA, Zeng DX. The association of neuron-derived orphan receptor 1 with pulmonary vascular remodeling in COPD patients. Int J Chron Obstruct Pulmon Dis 2018; 13:1177-1186. [PMID: 29695901 PMCID: PMC5905847 DOI: 10.2147/copd.s151820] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Chronic hypoxia-induced pulmonary vascular remodeling is a feature of chronic obstructive pulmonary disease (COPD). Our previous reports indicate that neuron-derived orphan receptor 1 (NOR1) promoted pulmonary smooth muscle cell proliferation in vitro. But it remains unclear whether NOR1 participated into hypoxia-induced pulmonary vascular remodeling in COPD patients. Patients and methods For this study, we collected peripheral lung tissues of 26 male COPD patients with or without hypoxemia. We detected the pulmonary vascular remodeling in all the peripheral lung tissues. Primary human pulmonary arterial smooth muscle cells were also cultured in vitro and stimulated with hypoxia or normoxia. Cell proliferation and protein levels were detected. Results COPD patients with hypoxemia showed significantly enlarged pulmonary vessels wall thickness and increased protein levels of HIF-1α, smooth muscle actin, cyclin D1, and NOR1 when compared with those in normoxic patients. Moreover, hypoxia induced human pulmonary arterial smooth muscle cell proliferation and NOR1 overexpression in vitro. The plasmid-based NOR1 gene overexpression markedly promoted DNA synthesis and proliferation in hypoxia or normoxic cells. Human NOR1 gene-specific siRNA intensively suppressed DNA synthesis and proliferation. Transfection of NOR1 overexpression plasmid raised cyclin D1 protein levels, which could be significant inhibited by NOR1-specific siRNA or a CDK4/6 inhibitor PD0332991. Conclusion We concluded that NOR1 upregulation is associated with hypoxia-induced pulmonary vascular remodeling in COPD via promoting human pulmonary arterial smooth muscle cell proliferation.
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Affiliation(s)
- Chang-Guo Wang
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Chang Li
- Department of Thoracic Surgery, First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Wei Lei
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Jun-Hong Jiang
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Jian-An Huang
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Da-Xiong Zeng
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
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7
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Abstract
Pulmonary hypertension that develops in the setting of underlying lung diseases such as COPD or idiopathic pulmonary fibrosis (IPF) is associated with decreased functional status, worsening hypoxemia and quality of life, and increased mortality. This complication of lung disease is complex in its origin and carries a unique set of diagnostic and therapeutic issues. This review attempts to provide an overview of mechanisms associated with the onset of pulmonary hypertension in COPD and IPF, touches on appropriate evaluation, and reviews the state of knowledge on treating pulmonary hypertension related to underlying lung disease.
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Affiliation(s)
- Michael J Cuttica
- Northwestern Pulmonary Hypertension Program, 676 St Claire Suite 1400, Chicago, IL, 60611, USA.
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8
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Roman BL, Cuttica MJ. Classifying Pulmonary Hypertension in Hereditary Hemorrhagic Telangiectasia. Hemodynamics Matter. Am J Respir Crit Care Med 2017; 196:1244-1246. [PMID: 29140123 DOI: 10.1164/rccm.201704-0765ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Beth L Roman
- 1 Department of Human Genetics University of Pittsburgh Graduate School of Public Health Pittsburgh, Pennsylvania and
| | - Michael J Cuttica
- 2 Division of Pulmonary and Critical Care Medicine Northwestern University Feinberg School of Medicine Chicago, Illinois
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9
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Almendros I, Crespo A, Tura-Ceide O, Bonsignore MR. Clinical physiology and sleep: insights from the European Respiratory Society Congress 2017. J Thorac Dis 2017; 9:S1532-S1536. [PMID: 29255634 PMCID: PMC5717356 DOI: 10.21037/jtd.2017.11.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 10/09/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Isaac Almendros
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, 28029-Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Andrea Crespo
- Unidad de Sueño. Hospital Universitario Rio Hortega de Valladolid, Valladolid, Spain
| | - Olga Tura-Ceide
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, 28029-Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Pulmonary Medicine, Hospital Clinic, Barcelona, Spain
| | - Maria R. Bonsignore
- Biomedical Department of Internal and Specialistic Medicine (DiBiMIS), University of Palermo, Palermo, Italy
- Institute of Biomedicine and Molecular Immunology (IBIM), National Research Council (CNR), Palermo, Italy
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10
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Domingo E, Grignola JC, Aguilar R, Messeguer ML, Roman A. Pulmonary arterial wall disease in COPD and interstitial lung diseases candidates for lung transplantation. Respir Res 2017; 18:85. [PMID: 28477618 PMCID: PMC5420403 DOI: 10.1186/s12931-017-0568-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 04/27/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) associated with lung disease has the worst prognosis of all types of PH. Pulmonary arterial vasculopathy is an early event in the natural history of chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD). The present study characterized the alterations in the structure and function of the pulmonary arterial (PA) wall of COPD and ILD candidates for lung transplantation (LTx). METHODS A cohort of 73 patients, 63 pre-LTx (30 COPD, 33 ILD), and ten controls underwent simultaneous right heart catheterisation and intravascular ultrasound (IVUS). Total pulmonary resistance (TPR), capacitance (Cp), and the TPR-Cp relationship were assessed. PA stiffness and the relative area of wall thickness were estimated as pulse PA pressure/IVUS pulsatility and as [(external sectional area-intimal area)/external sectional area] × 100, respectively. RESULTS Twenty-seven percent of patients had pulmonary arterial wedge pressure > 15 mmHg and were not analyzed. PA stiffness and the area of wall thickness were increased in comparison with controls, even in patients without PH (p < 0.05). ILD patients showed a significant higher PA stiffness, and lower Cp beyond mean PA pressure (mPAP) and lower area of wall thickness than COPD patients (p < 0.05). TPR-Cp relationship was shifted downward left for ILD patients. CONCLUSIONS Significant increase of PA stiffness and area of wall thickness were present even in patients without PH and can make the diagnosis of pulmonary vasculopathy at a preclinical stage in PH-lung disease candidates for LTx. ILD patients showed the worst PA stiffness and Cp with respect to COPD.
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Affiliation(s)
- Enric Domingo
- Area del Cor, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Physiology Department, School of Medicine, Universitat Autonoma, Barcelona, Spain
| | - Juan C Grignola
- Pathophysiology Department, School of Medicine, Hospital de Clínicas, Universidad de la República, Avda Italia 2870, PC 11600, Montevideo, Uruguay.
| | - Rio Aguilar
- Cardiology Department, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Antonio Roman
- Department of Neumology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Ciberes, Instituto de Salud Carlos III, Madrid, Spain
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11
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Wang L, Zhao QH, Pudasaini B, Jiang R, Gong SG, He J, Yuan P, Liu JM. Clinical and hemodynamic characteristics of pulmonary hypertension associated with interstitial lung disease in China. CLINICAL RESPIRATORY JOURNAL 2017; 12:915-921. [PMID: 28026153 DOI: 10.1111/crj.12604] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 10/25/2016] [Accepted: 12/20/2016] [Indexed: 01/16/2023]
Affiliation(s)
- Lan Wang
- Department of Pulmonary Circulation; Shanghai Pulmonary Hospital, Tongji University, School of Medicine; Shanghai 200433 People's Republic of China
| | - Qin-Hua Zhao
- Department of Pulmonary Circulation; Shanghai Pulmonary Hospital, Tongji University, School of Medicine; Shanghai 200433 People's Republic of China
| | - Bigyan Pudasaini
- Department of Pulmonary Circulation; Shanghai Pulmonary Hospital, Tongji University, School of Medicine; Shanghai 200433 People's Republic of China
| | - Rong Jiang
- Department of Pulmonary Circulation; Shanghai Pulmonary Hospital, Tongji University, School of Medicine; Shanghai 200433 People's Republic of China
| | - Su-Gang Gong
- Department of Pulmonary Circulation; Shanghai Pulmonary Hospital, Tongji University, School of Medicine; Shanghai 200433 People's Republic of China
| | - Jing He
- Department of Pulmonary Circulation; Shanghai Pulmonary Hospital, Tongji University, School of Medicine; Shanghai 200433 People's Republic of China
| | - Ping Yuan
- Department of Pulmonary Circulation; Shanghai Pulmonary Hospital, Tongji University, School of Medicine; Shanghai 200433 People's Republic of China
| | - Jin-Ming Liu
- Department of Pulmonary Circulation; Shanghai Pulmonary Hospital, Tongji University, School of Medicine; Shanghai 200433 People's Republic of China
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Andersen C, Mellemkjær S, Hilberg O, Bendstrup E. NT-proBNP <95 ng/l can exclude pulmonary hypertension on echocardiography at diagnostic workup in patients with interstitial lung disease. Eur Clin Respir J 2016; 3:32027. [PMID: 27478030 PMCID: PMC4967712 DOI: 10.3402/ecrj.v3.32027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 07/07/2016] [Indexed: 12/03/2022] Open
Abstract
Background Pulmonary hypertension (PH) is a serious complication to interstitial lung disease (ILD) and has a poor prognosis. PH is often diagnosed by screening with echocardiography followed by right heart catheterisation. A previous study has shown that a value of NT-pro-brain natriuretic peptide (NT-proBNP) <95 ng/l could be used to rule out PH in patients with ILD. Aim To evaluate this rule-out test for PH in a new cohort of incident patients with ILD. Methods An established database with data from 148 consecutive patients referred from January 2012 to October 2014 was used to identify patients and obtain data from echocardiography, NT-proBNP, diagnosis and lung function. Signs of PH on echocardiography were defined as a tricuspid pressure gradient (TR) ≥40 mmHg, decreased right ventricular systolic function or dilatation. Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) of NT-proBNP >95 ng/l for signs of PH on echocardiography were calculated. The study was approved by the Danish Health Authority. Results In 118 patients, data from both echocardiography and measurements of NT-proBNP were available. Eleven of these were screened positive for PH on echocardiography. Sensitivity, specificity, NPV and PPV of NT-proBNP <95 ng/l for PH were 100, 44, 16 and 100%, respectively. Furthermore, no patients with left heart failure as the cause of dyspnoea were missed using this cut-off value. Conclusion NT-proBNP <95 ng/l precludes a positive echocardiographic screen for PH in ILD patients at referral for diagnostic workup.
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Affiliation(s)
- Charlotte Andersen
- Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark;
| | - Søren Mellemkjær
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Ole Hilberg
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
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13
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Varga J, Palinkas A, Lajko I, Horváth I, Boda K, Somfay A. Pulmonary Arterial Pressure Response During Exercise in COPD: A Correlation with C-Reactive Protein (hsCRP). Open Respir Med J 2016; 10:1-11. [PMID: 27019674 PMCID: PMC4787317 DOI: 10.2174/1874306401610010001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 10/20/2015] [Accepted: 10/21/2015] [Indexed: 11/22/2022] Open
Abstract
Background: The non-invasive assessment of pulmonary haemodynamics during exercise provides complementary data for the evaluation of exercise tolerance in patients with
COPD.
Methods: Exercise echocardiography in the semi-supine position was performed in 27 patients with COPD (C) with a forced expiratory volume in one second (FEV1) of
36±12% predicted and 13 age and gender-matched non-COPD subjects (NC). COPD patients also underwent cardiopulmonary exercise testing with gas exchange detection (CPET). Furthermore, serum high sensitive C-reactive protein (hsCRP), a marker of
systemic inflammation, was also measured.
Results: The maximal work rate (WRmax) and aerobic capacity (VO2peak) were
significantly reduced (WRmax: 77±33 Watt, VO2peak: 50±14 %pred) in COPD.
Pulmonary arterial systolic pressure (PAPs) was higher in COPD versus controls both at
rest (39±5 vs. 31±2 mmHg, p<0.001), and at peak exercise (72±12 vs. 52±8 mmHg,
p<0.001). In 19 (70%) COPD patients, the increase in PAPs was above 22 mmHg. The
change in pressure (dPAPs) correlated with hsCRP (r2=0.53, p<0.0001) and forced vital
capacity (FVC) (r2=0.18, p<0.001).
Conclusion: PAPs at rest and during exercise were significantly higher in COPD patients
and correlated with higher hsCRP. This may indicate a role for systemic inflammation
and hyperinflation in the pulmonary vasculature in COPD.
The study was registered at ClinicalTrials.gov webpage with NCT00949195 registration number.
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Affiliation(s)
- Janos Varga
- Department of Pulmonology, University of Szeged, Deszk, Hungary; National Koranyi Institute for TB and Pulmonology, Budapest, Hungary
| | - Attila Palinkas
- Department of Internal Medicine, Elisabeth Hospital, Hodmezovasarhely, Hungary
| | - Imre Lajko
- Department of Pulmonology, University of Szeged, Deszk, Hungary
| | - Ildikó Horváth
- National Koranyi Institute for TB and Pulmonology, Budapest, Hungary
| | - Krisztina Boda
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Attila Somfay
- Department of Pulmonology, University of Szeged, Deszk, Hungary
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Terada M, Takehara Y, Isoda H, Uto T, Matsunaga M, Alley M. Low WSS and High OSI Measured by 3D Cine PC MRI Reflect High Pulmonary Artery Pressures in Suspected Secondary Pulmonary Arterial Hypertension. Magn Reson Med Sci 2015; 15:193-202. [PMID: 26567758 PMCID: PMC5600056 DOI: 10.2463/mrms.mp.2015-0038] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Purpose: Institutional Review Board (IRB)-approved prospective study was conducted to test whether objective and quantitative hemodynamic markers wall shear stress (WSS) and oscillatory shear index (OSI) measured by three-dimensional (3D) cine phase-contrast (PC) can reflect pulmonary arterial hypertension (PAH). Patients and Methods: Seventeen consecutive patients of suspected secondary PAH were examined for pulmonary artery pressures (PAPs) with right heart catheterization (RHC) and three-dimensional (3D) cine PC MR. Based on the RHC data, patients were subdivided into two groups of 12 non-PAH (median age of 74.5 years) and 5 PAH (median age of 77 years) patients. Based on 3D cine PC magnetic resonance (MR), hemodynamic parameters including spatially averaged systolic WSS (sWSS), diastolic WSS (dWSS), mean WSS (mWSS), OSI and blood vessel section area (BVSA) at the pulmonary arterial trunk were calculated. Streamline images in the pulmonary arteries were also assessed. All the parameters were compared between non-PAH and PAH groups. Results: sWSS (N/m2) and mWSS (N/m2) of PAH group was lower than that of non-PAH group (0.594 ± 0.067 vs. 0.961 ± 0.590, P = 0.001), (0.365 ± 0.035 vs. 0.489 ± 0.132, P = 0.027). OSI of PAH group was higher than that of non-PAH (0.214 ± 0.026 vs. 0.130 ± 0.046, P = 0.001). sWSS, mWSS, and dWSS were inversely correlated and OSI was positively correlated to mean PAP or systolic PAP with r values of –0.638 (P = 0.005), –0.643 (P = 0.005), –0.485 (P = 0.049), and 0.625 (P = 0.007); or –0.622 (P = 0.008), –0.629 (P = 0.007), –0.484 (P = 0.049), and 0.594 (P = 0.012), respectively. sWSS was also inversely correlated to BVSA with r value of –0.488 (P = 0.049), and OSI was correlated to BVSA with r value of 0.574 (P = 0.016). Vortex or helical flows were observed more frequently in PAH patients. Conclusions: The low sWSS and mWSS as well as high OSI measured with 3D cine PC MR could be potential hemodynamic markers for the increased PAP in suspected secondary PAH patients.
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Affiliation(s)
- Masaki Terada
- Department of Diagnostic Radiological Technology, Iwata City Hospital
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15
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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.
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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.
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16
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Cero FT, Hillestad V, Sjaastad I, Yndestad A, Aukrust P, Ranheim T, Lunde IG, Olsen MB, Lien E, Zhang L, Haugstad SB, Løberg EM, Christensen G, Larsen KO, Skjønsberg OH. Absence of the inflammasome adaptor ASC reduces hypoxia-induced pulmonary hypertension in mice. Am J Physiol Lung Cell Mol Physiol 2015; 309:L378-87. [PMID: 26071556 DOI: 10.1152/ajplung.00342.2014] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 06/08/2015] [Indexed: 12/16/2022] Open
Abstract
Pulmonary hypertension is a serious condition that can lead to premature death. The mechanisms involved are incompletely understood although a role for the immune system has been suggested. Inflammasomes are part of the innate immune system and consist of the effector caspase-1 and a receptor, where nucleotide-binding oligomerization domain-like receptor pyrin domain-containing 3 (NLRP3) is the best characterized and interacts with the adaptor protein apoptosis-associated speck-like protein containing a caspase-recruitment domain (ASC). To investigate whether ASC and NLRP3 inflammasome components are involved in hypoxia-induced pulmonary hypertension, we utilized mice deficient in ASC and NLRP3. Active caspase-1, IL-18, and IL-1β, which are regulated by inflammasomes, were measured in lung homogenates in wild-type (WT), ASC(-/-), and NLRP3(-/-) mice, and phenotypical changes related to pulmonary hypertension and right ventricular remodeling were characterized after hypoxic exposure. Right ventricular systolic pressure (RVSP) of ASC(-/-) mice was significantly lower than in WT exposed to hypoxia (40.8 ± 1.5 mmHg vs. 55.8 ± 2.4 mmHg, P < 0.001), indicating a substantially reduced pulmonary hypertension in mice lacking ASC. Magnetic resonance imaging further supported these findings by demonstrating reduced right ventricular remodeling. RVSP of NLRP3(-/-) mice exposed to hypoxia was not significantly altered compared with WT hypoxia. Whereas hypoxia increased protein levels of caspase-1, IL-18, and IL-1β in WT and NLRP3(-/-) mice, this response was absent in ASC(-/-) mice. Moreover, ASC(-/-) mice displayed reduced muscularization and collagen deposition around arteries. In conclusion, hypoxia-induced elevated right ventricular pressure and remodeling were attenuated in mice lacking the inflammasome adaptor protein ASC, suggesting that inflammasomes play an important role in the pathogenesis of pulmonary hypertension.
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Affiliation(s)
- Fadila Telarevic Cero
- Department of Pulmonary Medicine, Oslo University Hospital Ullevål and University of Oslo, Oslo, Norway; Institute for Experimental Medical Research, Oslo University Hospital Ullevål and University of Oslo, Oslo, Norway; Center for Heart Failure Research, Oslo University Hospital Ullevål and University of Oslo, Oslo, Norway;
| | - Vigdis Hillestad
- Institute for Experimental Medical Research, Oslo University Hospital Ullevål and University of Oslo, Oslo, Norway; Center for Heart Failure Research, Oslo University Hospital Ullevål and University of Oslo, Oslo, Norway
| | - Ivar Sjaastad
- Institute for Experimental Medical Research, Oslo University Hospital Ullevål and University of Oslo, Oslo, Norway; Center for Heart Failure Research, Oslo University Hospital Ullevål and University of Oslo, Oslo, Norway; K.G. Jebsen Inflammation Research Center, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Arne Yndestad
- Center for Heart Failure Research, Oslo University Hospital Ullevål and University of Oslo, Oslo, Norway; Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet and University of Oslo, Oslo, Norway; K.G. Jebsen Inflammation Research Center, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Pål Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet and University of Oslo, Oslo, Norway; K.G. Jebsen Inflammation Research Center, Faculty of Medicine, University of Oslo, Oslo, Norway; Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet and University of Oslo, Oslo, Norway
| | - Trine Ranheim
- Center for Heart Failure Research, Oslo University Hospital Ullevål and University of Oslo, Oslo, Norway; Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet and University of Oslo, Oslo, Norway; K.G. Jebsen Inflammation Research Center, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ida Gjervold Lunde
- Institute for Experimental Medical Research, Oslo University Hospital Ullevål and University of Oslo, Oslo, Norway; Center for Heart Failure Research, Oslo University Hospital Ullevål and University of Oslo, Oslo, Norway; Department of Genetics, Harvard Medical School, Boston, Massachusetts
| | - Maria Belland Olsen
- Center for Heart Failure Research, Oslo University Hospital Ullevål and University of Oslo, Oslo, Norway; Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet and University of Oslo, Oslo, Norway
| | - Egil Lien
- Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; Centre of Inflammation Research, Department of Cancer Research and Molecular Medicine, NTNU, Trondheim, Norway
| | - Lili Zhang
- Institute for Experimental Medical Research, Oslo University Hospital Ullevål and University of Oslo, Oslo, Norway; Center for Heart Failure Research, Oslo University Hospital Ullevål and University of Oslo, Oslo, Norway
| | - Solveig Bjærum Haugstad
- Institute for Experimental Medical Research, Oslo University Hospital Ullevål and University of Oslo, Oslo, Norway; Center for Heart Failure Research, Oslo University Hospital Ullevål and University of Oslo, Oslo, Norway
| | - Else Marit Løberg
- Department of Pathology, Oslo University Hospital Ullevål and University of Oslo, Oslo, Norway
| | - Geir Christensen
- Institute for Experimental Medical Research, Oslo University Hospital Ullevål and University of Oslo, Oslo, Norway; Center for Heart Failure Research, Oslo University Hospital Ullevål and University of Oslo, Oslo, Norway
| | - Karl-Otto Larsen
- Department of Pulmonary Medicine, Oslo University Hospital Ullevål and University of Oslo, Oslo, Norway; Center for Heart Failure Research, Oslo University Hospital Ullevål and University of Oslo, Oslo, Norway
| | - Ole Henning Skjønsberg
- Department of Pulmonary Medicine, Oslo University Hospital Ullevål and University of Oslo, Oslo, Norway
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17
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Terada M, Matsuyoshi K, Yamada E, Anzawa Y, Oosugi M. [Study of scan parameters using three-dimensional cine phase contrast imaging for pulmonary artery velocity measurement]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2014; 70:1219-24. [PMID: 25410327 DOI: 10.6009/jjrt.2014_jsrt_70.11.1219] [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: 11/11/2022]
Abstract
Pulmonary artery flow velocity, flow volume and their derived biomarkers, such as acceleration time (AT), acceleration volume (AV) and peak velocity (PV), vary depending on the severity and type of pulmonary disease. Therefore, accurate measurements of pulmonary artery velocity are very important for assessing the severity of pulmonary disease. The purpose of this study was to optimize the imaging parameters for pulmonary artery flow velocity using 3D cine PC MR, and to evaluate AT, AV, and PV for pulmonary hypertension. We changed the flip angle (FA) and view per segment (VPS). FA influenced the signal intensity, which was calculated from the magnitude images. Smaller VPS improved the accuracy of PV. Consequently, optimal setting of FA and VPS was important for hemodynamic analysis. We established the optimal FA and VPS for use in the hemodynamic analysis. AV and PV at the right pulmonary artery differed significantly between healthy volunteers and patients with pulmonary hypertension. Hemodynamic analysis of 3D cine PC MR imaging was considered promising for the evaluation of pulmonary disease.
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18
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Nuevos agentes para el tratamiento de la hipertensión pulmonar. REVISTA COLOMBIANA DE CARDIOLOGÍA 2014. [DOI: 10.1016/j.rccar.2014.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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19
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Smith MC, Wrobel JP. Epidemiology and clinical impact of major comorbidities in patients with COPD. Int J Chron Obstruct Pulmon Dis 2014; 9:871-88. [PMID: 25210449 PMCID: PMC4154888 DOI: 10.2147/copd.s49621] [Citation(s) in RCA: 236] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Comorbidities are frequent in chronic obstructive pulmonary disease (COPD) and significantly impact on patients’ quality of life, exacerbation frequency, and survival. There is increasing evidence that certain diseases occur in greater frequency amongst patients with COPD than in the general population, and that these comorbidities significantly impact on patient outcomes. Although the mechanisms are yet to be defined, many comorbidities likely result from the chronic inflammatory state that is present in COPD. Common problems in the clinical management of COPD include recognizing new comorbidities, determining the impact of comorbidities on patient symptoms, the concurrent treatment of COPD and comorbidities, and accurate prognostication. The majority of comorbidities in COPD should be treated according to usual practice, and specific COPD management is infrequently altered by the presence of comorbidities. Unfortunately, comorbidities are often under-recognized and under-treated. This review focuses on the epidemiology of ten major comorbidities in patients with COPD. Further, we emphasize the clinical impact upon prognosis and management considerations. This review will highlight the importance of comorbidity identification and management in the practice of caring for patients with COPD.
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Affiliation(s)
| | - Jeremy P Wrobel
- Advanced Lung Disease Unit, Royal Perth Hospital, Perth, WA, Australia
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20
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Al Shehri AM, El-Tahan MR, Al Metwally R, Qutub H, El Ghoneimy YF, Regal MA, Zien H. Right Ventricular Function During One-Lung Ventilation: Effects of Pressure-Controlled and Volume-Controlled Ventilation. J Cardiothorac Vasc Anesth 2014; 28:880-4. [DOI: 10.1053/j.jvca.2013.09.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Indexed: 11/11/2022]
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21
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Pulmonary hypertension and right heart dysfunction in chronic lung disease. BIOMED RESEARCH INTERNATIONAL 2014; 2014:739674. [PMID: 25165714 PMCID: PMC4140123 DOI: 10.1155/2014/739674] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 06/24/2014] [Accepted: 06/29/2014] [Indexed: 11/30/2022]
Abstract
Group 3 pulmonary hypertension (PH) is a common complication of chronic lung disease (CLD), including chronic obstructive pulmonary disease (COPD), interstitial lung disease, and sleep-disordered breathing. Development of PH is associated with poor prognosis and may progress to right heart failure, however, in the majority of the patients with CLD, PH is mild to moderate and only a small number of patients develop severe PH. The pathophysiology of PH in CLD is multifactorial and includes hypoxic pulmonary vasoconstriction, pulmonary vascular remodeling, small vessel destruction, and fibrosis. The effects of PH on the right ventricle (RV) range between early RV remodeling, hypertrophy, dilatation, and eventual failure with associated increased mortality. The golden standard for diagnosis of PH is right heart catheterization, however, evidence of PH can be appreciated on clinical examination, serology, radiological imaging, and Doppler echocardiography. Treatment of PH in CLD focuses on management of the underlying lung disorder and hypoxia. There is, however, limited evidence to suggest that PH-specific vasodilators such as phosphodiesterase-type 5 inhibitors, endothelin receptor antagonists, and prostanoids may have a role in the treatment of patients with CLD and moderate-to-severe PH.
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