1
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Real C, Pérez-García CN, Galán-Arriola C, García-Lunar I, García-Álvarez A. Right ventricular dysfunction: pathophysiology, experimental models, evaluation, and treatment. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024:S1885-5857(24)00238-X. [PMID: 39068988 DOI: 10.1016/j.rec.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 05/28/2024] [Indexed: 07/30/2024]
Abstract
Interest in the right ventricle has substantially increased due to advances in knowledge of its pathophysiology and prognostic implications across a wide spectrum of diseases. However, we are still far from understanding the multiple mechanisms that influence right ventricular dysfunction, its evaluation continues to be challenging, and there is a shortage of specific treatments in most scenarios. This review article aims to update knowledge about the physiology of the right ventricle, its transition to dysfunction, diagnostic tools, and available treatments from a translational perspective.
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Affiliation(s)
- Carlos Real
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Servicio de Cardiología, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | - Carlos Galán-Arriola
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Inés García-Lunar
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Servicio de Cardiología, Hospital Universitario La Moraleja, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Ana García-Álvarez
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Instituto Clínic Cardiovascular (ICCV), Hospital Clínic, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain.
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2
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Lechuga-Vieco AV, Latorre-Pellicer A, Calvo E, Torroja C, Pellico J, Acín-Pérez R, García-Gil ML, Santos A, Bagwan N, Bonzon-Kulichenko E, Magni R, Benito M, Justo-Méndez R, Simon AK, Sánchez-Cabo F, Vázquez J, Ruíz-Cabello J, Enríquez JA. Heteroplasmy of Wild Type Mitochondrial DNA Variants in Mice Causes Metabolic Heart Disease With Pulmonary Hypertension and Frailty. Circulation 2022; 145:1084-1101. [PMID: 35236094 PMCID: PMC8969846 DOI: 10.1161/circulationaha.121.056286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: In most eukaryotic cells, the mitochondrial DNA (mtDNA) is uniparentally transmitted and present in multiple copies derived from the clonal expansion of maternally inherited mtDNA. All copies are therefore near-identical, or homoplasmic. The presence of more than one mtDNA variant in the same cytoplasm can arise naturally or result from new medical technologies aimed at preventing mitochondrial genetic diseases and improving fertility. The latter is called divergent non-pathological mtDNAs heteroplasmy (DNPH). We hypothesized that DNPH is maladaptive and usually prevented by the cell. Methods: We engineered and characterized DNPH mice throughout their lifespan using transcriptomic, metabolomic, biochemical, physiological and phenotyping techniques. We focused on in vivo imaging techniques for non-invasive assessment of cardiac and pulmonary energy metabolism. Results: We show that DNPH impairs mitochondrial function, with profound consequences in critical tissues that cannot resolve heteroplasmy, particularly cardiac and skeletal muscle. Progressive metabolic stress in these tissues leads to severe pathology in adulthood, including pulmonary hypertension and heart failure, skeletal muscle wasting, frailty, and premature death. Symptom severity is strongly modulated by the nuclear context. Conclusions: Medical interventions that may generate DNPH should address potential incompatibilities between donor and recipient mtDNA.
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Affiliation(s)
- Ana Victoria Lechuga-Vieco
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; The Kennedy Institute of Rheumatology, NDORMS, University of Oxford, Oxford, United Kingdom; Ciber de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Ana Latorre-Pellicer
- Ciber de Fragilidad y Envejecimiento Saludable (CIBERFES) Madrid, Spain; Unit of Clinical Genetics and Functional Genomics, Department of Pharmacology-Physiology, School of Medicine, University of Zaragoza, ISS-Aragon, Zaragoza, Spain
| | - Enrique Calvo
- Ciber de Fragilidad y Envejecimiento Saludable (CIBERFES) Madrid, Spain
| | - Carlos Torroja
- Ciber de Fragilidad y Envejecimiento Saludable (CIBERFES) Madrid, Spain
| | - Juan Pellico
- Ciber de Fragilidad y Envejecimiento Saludable (CIBERFES) Madrid, Spain; Ciber de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Rebeca Acín-Pérez
- Ciber de Fragilidad y Envejecimiento Saludable (CIBERFES) Madrid, Spain
| | - María Luisa García-Gil
- Centro Nacional de Microscopia Electrónica (ICTS-CNME), Universidad Complutense de Madrid, Madrid, Spain
| | - Arnoldo Santos
- Ciber de Enfermedades Respiratorias (CIBERES), Madrid, Spain; ITC, Ingeniería y Técnicas Clínicas, Madrid, Spain
| | - Navratan Bagwan
- Ciber de Fragilidad y Envejecimiento Saludable (CIBERFES) Madrid, Spain
| | - Elena Bonzon-Kulichenko
- Ciber de Fragilidad y Envejecimiento Saludable (CIBERFES) Madrid, Spain; Ciber de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ricardo Magni
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain
| | | | - Raquel Justo-Méndez
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain
| | - Anna Katharina Simon
- The Kennedy Institute of Rheumatology, NDORMS, University of Oxford, Oxford, United Kingdom
| | | | - Jesús Vázquez
- Ciber de Fragilidad y Envejecimiento Saludable (CIBERFES) Madrid, Spain; Ciber de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Jesús Ruíz-Cabello
- CIC biomaGUNE, 2014, Donostia-San Sebastián, Spain; IKERBASQUE, Basque Foundation for Science, Spain; Universidad Complutense de Madrid, Madrid, Spain
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3
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Latus H, Meierhofer C. Role of cardiovascular magnetic resonance in pediatric pulmonary hypertension-novel concepts and imaging biomarkers. Cardiovasc Diagn Ther 2021; 11:1057-1069. [PMID: 34527532 DOI: 10.21037/cdt-20-270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 04/15/2020] [Indexed: 11/06/2022]
Abstract
Pulmonary hypertension (PH) in children is a heterogenous disease of the small pulmonary arteries characterized by a progressive increase in pulmonary vascular resistance. Despite adequate medical therapy, long-term pressure overload is frequently associated with a progressive course leading to right ventricular failure and ultimately death. Invasive hemodynamic assessment by cardiac catheterization is crucial for initial diagnosis, risk stratification and therapeutic strategy. Although echocardiography remains the most important imaging modality for the assessment of right ventricular function and pulmonary hemodynamics, cardiovascular magnetic resonance (CMR) has emerged as a valuable non-invasive imaging technique that enables comprehensive evaluation of biventricular performance, blood flow, morphology and the myocardial tissue. In this review, we summarize the principles and applications of CMR in the evaluation of pediatric PH patients and present an update about novel CMR based concepts and imaging biomarkers that may provide further diagnostic, therapeutic and prognostic information.
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Affiliation(s)
- Heiner Latus
- Clinic for Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Munich, Germany
| | - Christian Meierhofer
- Clinic for Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Munich, Germany
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4
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Stam K, Clauss S, Taverne YJHJ, Merkus D. Chronic Thromboembolic Pulmonary Hypertension - What Have We Learned From Large Animal Models. Front Cardiovasc Med 2021; 8:574360. [PMID: 33937352 PMCID: PMC8085273 DOI: 10.3389/fcvm.2021.574360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 03/08/2021] [Indexed: 12/21/2022] Open
Abstract
Chronic thrombo-embolic pulmonary hypertension (CTEPH) develops in a subset of patients after acute pulmonary embolism. In CTEPH, pulmonary vascular resistance, which is initially elevated due to the obstructions in the larger pulmonary arteries, is further increased by pulmonary microvascular remodeling. The increased afterload of the right ventricle (RV) leads to RV dilation and hypertrophy. This RV remodeling predisposes to arrhythmogenesis and RV failure. Yet, mechanisms involved in pulmonary microvascular remodeling, processes underlying the RV structural and functional adaptability in CTEPH as well as determinants of the susceptibility to arrhythmias such as atrial fibrillation in the context of CTEPH remain incompletely understood. Several large animal models with critical clinical features of human CTEPH and subsequent RV remodeling have relatively recently been developed in swine, sheep, and dogs. In this review we will discuss the current knowledge on the processes underlying development and progression of CTEPH, and on how animal models can help enlarge understanding of these processes.
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Affiliation(s)
- Kelly Stam
- Department of Cardiology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Sebastian Clauss
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University Munich, Munich, Germany.,Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital, LMU Munich, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich, Munich Heart Alliance, Munich, Germany
| | - Yannick J H J Taverne
- Department of Cardiothoracic Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Daphne Merkus
- Department of Cardiology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands.,Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital, LMU Munich, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich, Munich Heart Alliance, Munich, Germany
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5
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Garcia-Lunar I, Blanco I, Fernández-Friera L, Prat-Gonzàlez S, Jordà P, Sánchez J, Pereda D, Pujadas S, Rivas M, Solé-Gonzalez E, Vázquez J, Blázquez Z, García-Picart J, Caravaca P, Escalera N, Garcia-Pavia P, Delgado J, Segovia-Cubero J, Fuster V, Roig E, Barberá JA, Ibanez B, García-Álvarez A. Design of the β3-Adrenergic Agonist Treatment in Chronic Pulmonary Hypertension Secondary to Heart Failure Trial. JACC Basic Transl Sci 2020; 5:317-327. [PMID: 32368692 PMCID: PMC7188870 DOI: 10.1016/j.jacbts.2020.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/02/2020] [Accepted: 01/02/2020] [Indexed: 12/20/2022]
Abstract
CpcPH is a relatively common complication of chronic HF, is associated with poor survival, and has no specific pharmacological treatment. ß3AR stimulation has shown improvement in pulmonary hemodynamics and RV performance in a translational large animal model mimicking this condition. The SPHERE-HF trial is a Phase II randomized, double-blind clinical trial designed to evaluate the efficacy and safety of mirabegron (oral β3 AR agonist) in patients with CpcPH secondary to HF. The SPHERE-HF trial will include 80 patients treated with mirabegron or placebo for 16 weeks. The main outcome is the change in PVR. Secondary outcomes include changes in RV performance, clinical status, NT-proBNP levels, and additional pulmonary hemodynamic parameters.
Combined pre-and post-capillary hypertension (CpcPH) is a relatively common complication of heart failure (HF) associated with a poor prognosis. Currently, there is no specific therapy approved for this entity. Recently, treatment with beta-3 adrenergic receptor (β3AR) agonists was able to improve pulmonary hemodynamics and right ventricular (RV) performance in a translational, large animal model of chronic PH. The authors present the design of a phase II randomized clinical trial that tests the benefits of mirabegron (a clinically available β3AR agonist) in patients with CpcPH due to HF. The effect of β3AR treatment will be evaluated on pulmonary hemodynamics, as well as clinical, biochemical, and advanced cardiac imaging parameters. (Beta3 Agonist Treatment in Chronic Pulmonary Hypertension Secondary to Heart Failure [SPHERE-HF]; NCT02775539)
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Key Words
- CCT, cardiac computed tomography
- CMR, cardiac magnetic resonance
- CpcPH, combined pre- and post-capillary pulmonary hypertension
- ECG, electrocardiography
- HF, heart failure
- ITT, intention to treat
- IpcPH, isolated post-capillary pulmonary hypertension
- LHD, left heart disease
- LV, left ventricular
- LVEF, left ventricular ejection fraction
- NT-proBNP, N-terminal prohormone of brain natriuretic peptide
- NYHA, New York Heart Association
- PAP, pulmonary artery pressure
- PH, pulmonary hypertension
- PP, Per protocol
- PVR, pulmonary vascular resistance
- RV, right ventricle
- adrenoreceptors
- cGMP, cyclic guanosine monophosphate
- imaging
- pulmonary hypertension
- treatment
- β3AR, beta-3 adrenoreceptor
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Affiliation(s)
- Ines Garcia-Lunar
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Hospital Universitario Quirónsalud Madrid, UEM, Madrid, Spain
| | - Isabel Blanco
- Department of Pulmonary Medicine, Hospital Clínic-IDIBAPS, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Leticia Fernández-Friera
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,HM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM-CIEC, Madrid, Spain
| | - Susanna Prat-Gonzàlez
- Institut Clinic Cardiovascular, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Paloma Jordà
- Institut Clinic Cardiovascular, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Javier Sánchez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Philips Healthcare Iberia, Madrid, Spain
| | - Daniel Pereda
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Institut Clinic Cardiovascular, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Sandra Pujadas
- Cardiology Department, Hospital Santa Creu i Sant Pau, IIb-Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Mercedes Rivas
- Cardiology Department, Hospital Santa Creu i Sant Pau, IIb-Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Jorge Vázquez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Cardiology Department, University Hospital Puerta de Hierro, University Autonoma de Madrid, Madrid, Spain
| | - Zorba Blázquez
- Cardiology Department, University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - Juan García-Picart
- Cardiology Department, Hospital Santa Creu i Sant Pau, IIb-Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Pedro Caravaca
- Cardiology Department, University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - Noemí Escalera
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Pablo Garcia-Pavia
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Cardiology Department, University Hospital Puerta de Hierro, University Autonoma de Madrid, Madrid, Spain.,University Francisco de Vitoria (UFV), Pozuelo de Alarcon, Spain
| | - Juan Delgado
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Cardiology Department, University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - Javier Segovia-Cubero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Cardiology Department, University Hospital Puerta de Hierro, University Autonoma de Madrid, Madrid, Spain
| | - Valentín Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eulalia Roig
- Cardiology Department, Hospital Santa Creu i Sant Pau, IIb-Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Joan Albert Barberá
- Department of Pulmonary Medicine, Hospital Clínic-IDIBAPS, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Borja Ibanez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Ana García-Álvarez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Institut Clinic Cardiovascular, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
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6
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Domenech-Ximenos B, Garza MSDL, Prat-González S, Sepúlveda-Martínez Á, Crispi F, Perea RJ, Garcia-Alvarez A, Sitges M. Exercise-induced cardio-pulmonary remodelling in endurance athletes: Not only the heart adapts. Eur J Prev Cardiol 2019; 27:651-659. [PMID: 31423814 DOI: 10.1177/2047487319868545] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The cumulative effects of intensive endurance exercise may induce a broad spectrum of right ventricular remodelling. The mechanisms underlying these variable responses have been scarcely explored, but may involve differential pulmonary vasculature adaptation. Our aim was to evaluate right ventricular and pulmonary circulation in highly trained endurance athletes. METHODS Ninety-three highly trained endurance athletes (>12 h training/week at least during the last five years; age: 36 ± 6 years; 52.7% male) and 72 age- and gender-matched controls underwent resting cardiovascular magnetic resonance imaging to assess cardiac dimensions and function, as well as pulmonary artery dimensions and flow. Pulmonary vascular resistance (PVR) was estimated based on left ventricular ejection fraction and pulmonary artery flow mean velocity. Resting and exercise Doppler echocardiography was also performed in athletes to estimate pulmonary artery pressure. RESULTS Athletes showed larger biventricular and biatrial sizes, slightly reduced systolic biventricular function, increased pulmonary artery dimensions and reduced pulmonary artery flow velocity as compared with controls in both genders (p < 0.05), which resulted in significantly higher estimated PVR in athletes as compared with controls (2.4 ± 1.2 vs. 1.7 ± 1.1; p < 0.05). Substantially high estimated PVR values (>4.2 WU) were found in seven of the 93 (9.3%) athletes: those exhibiting an enlarged pulmonary artery (indexed area cm2/m2: 4.8 ± 0.6 vs. 3.9 ± 0.6, p < 0.05), a decreased pulmonary artery distensibility index (%: 43.0 ± 15.2 vs. 62.0 ± 17.4, p < 0.05) and a reduced right ventricular ejection fraction (%: 49.3 ± 4.5 vs. 53.6 ± 4.6, p < 0.05). CONCLUSIONS Exercise-induced remodelling involves, besides the cardiac chambers, the pulmonary circulation and is associated with an increased estimated PVR. A small subset of athletes exhibited substantial increase of estimated PVR related to pronounced pulmonary circulation remodelling and reduced right ventricular systolic function.
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Affiliation(s)
- Blanca Domenech-Ximenos
- Radiology Department, Hospital Universitari Dr. Josep Trueta, Girona, Spain.,Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Maria Sanz-de la Garza
- Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
| | - Susanna Prat-González
- Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Álvaro Sepúlveda-Martínez
- Barcelona Centre for Maternal-Foetal and Neonatal Medicine Hospital Clínic and Hospital Sant Joan de Deu, Barcelona University, CIBER-ER, Spain.,Foetal Medicine Unit, Department of Obstetrics and Gynaecology, Hospital Clínico Universidad de Chile, Santiago de Chile, Chile
| | - Fatima Crispi
- Barcelona Centre for Maternal-Foetal and Neonatal Medicine Hospital Clínic and Hospital Sant Joan de Deu, Barcelona University, CIBER-ER, Spain
| | | | - Ana Garcia-Alvarez
- Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
| | - Marta Sitges
- Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
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7
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van Duin RWB, Stam K, Uitterdijk A, Bartelds B, Danser AHJ, Reiss IKM, Duncker DJ, Merkus D. Intervening with the Nitric Oxide Pathway to Alleviate Pulmonary Hypertension in Pulmonary Vein Stenosis. J Clin Med 2019; 8:jcm8081204. [PMID: 31409013 PMCID: PMC6723751 DOI: 10.3390/jcm8081204] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 02/06/2023] Open
Abstract
Pulmonary hypertension (PH) as a result of pulmonary vein stenosis (PVS) is extremely difficult to treat. The ideal therapy should not target the high-pressure/low-flow (HP/LF) vasculature that drains into stenotic veins, but only the high-pressure/high-flow (HP/HF) vasculature draining into unaffected pulmonary veins, reducing vascular resistance and pressure without risk of pulmonary oedema. We aimed to assess the activity of the nitric oxide (NO) pathway in PVS during the development of PH, and investigate whether interventions in the NO pathway differentially affect vasodilation in the HP/HF vs. HP/LF territories. Swine underwent pulmonary vein banding (PVB; n = 7) or sham surgery (n = 6) and were chronically instrumented to assess progression of PH. Pulmonary sensitivity to exogenous NO (sodium nitroprusside, SNP) and the contribution of endogenous NO were assessed bi-weekly. The pulmonary vasodilator response to phosphodiesterase-5 (PDE5) inhibition was assessed 12 weeks after PVB or sham surgery. After sacrifice, 12 weeks post-surgery, interventions in the NO pathway on pulmonary small arteries isolated from HP/LF and HP/HF territories were further investigated. There were no differences in the in vivo pulmonary vasodilator response to SNP and the pulmonary vasoconstrictor response to endothelial nitric oxide synthase (eNOS) inhibition up to 8 weeks after PVB as compared to the sham group. However, at 10 and 12 weeks post-PVB, the in vivo pulmonary vasodilation in response to SNP was larger in the PVB group. Similarly, the vasoconstriction to eNOS inhibition was larger in the PVB group, particularly during exercise, while pulmonary vasodilation in response to PDE5 inhibition was larger in the PVB group both at rest and during exercise. In isolated pulmonary small arteries, sensitivity to NO donor SNP was similar in PVB vs. sham groups irrespective of HP/LF and HP/HF, while sensitivity to the PDE5 inhibitor sildenafil was lower in PVB HP/HF and sensitivity to bradykinin was lower in PVB HP/LF. In conclusion, both NO availability and sensitivity were increased in the PVB group. The increased nitric oxide sensitivity was not the result of a decreased PDE5 activity, as PDE5 activity was even increased. Some vasodilators differentially effect HP/HF vs. HP/LF vasculature.
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Affiliation(s)
- Richard W B van Duin
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus MC Rotterdam, 3015 GD Rotterdam, The Netherlands
- Department of Pediatrics/Neonatology, Erasmus MC-Sophia Children's Hospital, 3015 GD Rotterdam, The Netherlands
| | - Kelly Stam
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus MC Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - André Uitterdijk
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus MC Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Beatrijs Bartelds
- Division of Paediatric Cardiology, Department of Paediatrics, Erasmus MC-Sophia Children's Hospital, 3015 GD Rotterdam, The Netherlands
| | - A H Jan Danser
- Department of Pharmacology, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Irwin K M Reiss
- Department of Pediatrics/Neonatology, Erasmus MC-Sophia Children's Hospital, 3015 GD Rotterdam, The Netherlands
| | - Dirk J Duncker
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus MC Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Daphne Merkus
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus MC Rotterdam, 3015 GD Rotterdam, The Netherlands.
- Walter-Brendel Centre of Experimental Medicine, University Hospital, LMU Munich, 80799 Munich, Germany.
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8
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Effect of pulmonary artery denervation in postcapillary pulmonary hypertension: results of a randomized controlled translational study. Basic Res Cardiol 2019; 114:5. [DOI: 10.1007/s00395-018-0714-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 12/27/2018] [Indexed: 10/27/2022]
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9
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Rahaghi FN, Minhas JK, Heresi GA. Diagnosis of Deep Venous Thrombosis and Pulmonary Embolism: New Imaging Tools and Modalities. Clin Chest Med 2018; 39:493-504. [PMID: 30122174 PMCID: PMC6317734 DOI: 10.1016/j.ccm.2018.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Imaging continues to be the modality of choice for the diagnosis of venous thromboembolic disease, particularly when incorporated into diagnostic algorithms. Improvement in imaging techniques as well as new imaging modalities and processing methods have improved diagnostic accuracy and additionally are being leveraged in prognostication and decision making for choice of intervention. In this article, we review the role of imaging in diagnosis and prognostication of venous thromboembolism. We also discuss emerging imaging approaches that may in the near future find clinical usefulness in improving diagnosis and prognostication as well as differentiating disease phenotypes.
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Affiliation(s)
- Farbod N. Rahaghi
- Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School. 15 Francis Street, Boston MA 02115, ; Phone: 617-632-6770
| | - Jasleen K. Minhas
- Department of Medicine, North Shore Medical Center, 81 highland Ave Salem MA 10970, Phone: 978-354-4801
| | - Gustavo A. Heresi
- Respiratory Institute, Cleveland Clinic, Mail code A90, 9500 Euclid Ave, OH 44195, Phone: 216-636-5327
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10
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van Duin RWB, Stam K, Cai Z, Uitterdijk A, Garcia-Alvarez A, Ibanez B, Danser AHJ, Reiss IKM, Duncker DJ, Merkus D. Transition from post-capillary pulmonary hypertension to combined pre- and post-capillary pulmonary hypertension in swine: a key role for endothelin. J Physiol 2018; 597:1157-1173. [PMID: 29799120 PMCID: PMC6375874 DOI: 10.1113/jp275987] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 05/11/2018] [Indexed: 12/31/2022] Open
Abstract
Key points Passive, isolated post‐capillary pulmonary hypertension (PH) secondary to left heart disease may progress to combined pre‐ and post‐capillary or ‘active’ PH This ‘activation’ of post‐capillary PH significantly increases morbidity and mortality, and is still incompletely understood. In this study, pulmonary vein banding gradually produced post‐capillary PH with structural and functional microvascular remodelling in swine. Ten weeks after banding, the pulmonary endothelin pathway was upregulated, likely contributing to pre‐capillary aspects in the initially isolated post‐capillary PH. Inhibition of the endothelin pathway could potentially stop the progression of early stage post‐capillary PH.
Abstract Passive, isolated post‐capillary pulmonary hypertension (IpcPH) secondary to left heart disease may progress to combined pre‐ and post‐capillary or ‘active’ PH (CpcPH) characterized by chronic pulmonary vascular constriction and remodelling. The mechanisms underlying this ‘activation’ of passive pulmonary hypertension (PH) remain incompletely understood. Here we investigated the role of the vasoconstrictor endothelin‐1 (ET) in the progression from IpcPH to CpcPH in a swine model for post‐capillary PH. Swine underwent pulmonary vein banding (PVB; n = 7) or sham‐surgery (Sham; n = 6) and were chronically instrumented 4 weeks later. Haemodynamics were assessed for 8 weeks, at rest and during exercise, before and after administration of the ET receptor antagonist tezosentan. After sacrifice, the pulmonary vasculature was investigated by histology, RT‐qPCR and myograph experiments. Pulmonary arterial pressure and resistance increased significantly over time. mRNA expression of prepro‐endothelin‐1 and endothelin converting enzyme‐1 in the lung was increased, while ETA expression was unchanged and ETB expression was downregulated. This was associated with increased plasma ET levels from week 10 onward and a more pronounced vasodilatation to in vivo administration of tezosentan at rest and during exercise. Myograph experiments showed decreased endothelium‐dependent vasodilatation to Substance P and increased vasoconstriction to KCl in PVB swine consistent with increased muscularization observed with histology. Moreover, maximal vasoconstriction to ET was increased whereas ET sensitivity was decreased. In conclusion, PVB swine gradually developed PH with structural and functional vascular remodelling. From week 10 onward, the pulmonary ET pathway was upregulated, likely contributing to pre‐capillary activation of the initially isolated post‐capillary PH. Inhibition of the ET pathway could thus potentially provide a pharmacotherapeutic target for early stage post‐capillary PH. Passive, isolated post‐capillary pulmonary hypertension (PH) secondary to left heart disease may progress to combined pre‐ and post‐capillary or ‘active’ PH This ‘activation’ of post‐capillary PH significantly increases morbidity and mortality, and is still incompletely understood. In this study, pulmonary vein banding gradually produced post‐capillary PH with structural and functional microvascular remodelling in swine. Ten weeks after banding, the pulmonary endothelin pathway was upregulated, likely contributing to pre‐capillary aspects in the initially isolated post‐capillary PH. Inhibition of the endothelin pathway could potentially stop the progression of early stage post‐capillary PH.
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Affiliation(s)
- Richard W B van Duin
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Kelly Stam
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Zongye Cai
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - André Uitterdijk
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Ana Garcia-Alvarez
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.,Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain
| | - Borja Ibanez
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.,IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain.,CIBERCV, Madrid, Spain
| | - A H Jan Danser
- Department of Pharmacology, Erasmus MC, Rotterdam, The Netherlands
| | - Irwin K M Reiss
- Pediatrics / Neonatology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Dirk J Duncker
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Daphne Merkus
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
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11
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Aguero J, Hammoudi N, Bikou O, Fish KM, Zarragoikoetxea I, Hajjar RJ, Ishikawa K. Chronic Pulmonary Artery Embolization Models in Large Animals. Methods Mol Biol 2018; 1816:353-366. [PMID: 29987834 DOI: 10.1007/978-1-4939-8597-5_28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A wide range of approaches have been described to develop animal models of pulmonary vascular disease (PVD). Clinical heterogeneity in patients with pulmonary hypertension (PH) has prompted development of different techniques to create PH models in several animal species with the objective to recapitulate specific PH/PVD phenotypes. Chronic thromboembolic PH (CTEPH) is a clinically important phenotype of PH with a documented prevalence of 0.4-9.1% in patients with history of pulmonary embolism. A well-established large animal model of CTEPH is thus necessary for studying this disease in preclinical research. Different experimental protocols with inconsistent outcomes have been reported in the literature.We have focused on characterizing PH large animal models in a common framework; pulmonary hemodynamics, right ventricular (RV) function, and histological characterization of PVD. This research framework allows optimal evaluation of novel diagnostic tools, as well as new therapeutic strategies. The purpose of this protocol is to describe approaches to create experimental CTEPH models using recurrent pulmonary embolizations of dextran microspheres in swine. The key features of this experimental modeling approach are (1) nonsurgical, fully percutaneous techniques, (2) a minimum of four embolization procedures, with 1-2 month time period, (3) mild to moderate PH hemodynamics (mean PA pressure increase ~20-60%), (4) severe pulmonary vascular remodeling, (5) mild RV remodeling, and (6) a high reproducibility and low mortality (<10%).
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Affiliation(s)
- Jaume Aguero
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.
- Hospital Universitari i Politecnic La Fe, Valencia, Spain.
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Nadjib Hammoudi
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Olympia Bikou
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kenneth M Fish
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Iratxe Zarragoikoetxea
- Hospital Universitari i Politecnic La Fe, Valencia, Spain
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Roger J Hajjar
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kiyotake Ishikawa
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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12
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Stam K, van Duin RWB, Uitterdijk A, Cai Z, Duncker DJ, Merkus D. Exercise facilitates early recognition of cardiac and vascular remodeling in chronic thromboembolic pulmonary hypertension in swine. Am J Physiol Heart Circ Physiol 2017; 314:H627-H642. [PMID: 29167118 DOI: 10.1152/ajpheart.00380.2017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) develops in 4% of patients after pulmonary embolism and is accompanied by an impaired exercise tolerance, which is ascribed to the increased right ventricular (RV) afterload in combination with a ventilation/perfusion (V/Q) mismatch in the lungs. The present study aimed to investigate changes in arterial Po2 and hemodynamics in response to graded treadmill exercise during development and progression of CTEPH in a novel swine model. Swine were chronically instrumented and received multiple pulmonary embolisms by 1) microsphere infusion (Spheres) over 5 wk, 2) endothelial dysfunction by administration of the endothelial nitric oxide synthase inhibitor Nω-nitro-l-arginine methyl ester (L-NAME) for 7 wk, 3) combined pulmonary embolisms and endothelial dysfunction (L-NAME + Spheres), or 4) served as sham-operated controls (sham). After a 9 wk followup, embolization combined with endothelial dysfunction resulted in CTEPH, as evidenced by mean pulmonary artery pressures of 39.5 ± 5.1 vs. 19.1 ± 1.5 mmHg (Spheres, P < 0.001), 22.7 ± 2.0 mmHg (L-NAME, P < 0.001), and 20.1 ± 1.5 mmHg (sham, P < 0.001), and a decrease in arterial Po2 that was exacerbated during exercise, indicating V/Q mismatch. RV dysfunction was present after 5 wk of embolization, both at rest (trend toward increased RV end-systolic lumen area, P = 0.085, and decreased stroke volume index, P = 0.042) and during exercise (decreased stroke volume index vs. control, P = 0.040). With sustained pulmonary hypertension, RV hypertrophy (Fulton index P = 0.022) improved RV function at rest and during exercise, but this improvement was insufficient in CTEPH swine to result in an exercise-induced increase in cardiac index. In conclusion, embolization in combination with endothelial dysfunction results in CTEPH in swine. Exercise increased RV afterload, exacerbated the V/Q mismatch, and unmasked RV dysfunction. NEW & NOTEWORTHY Here, we present the first double-hit chronic thromboembolic pulmonary hypertension swine model. We show that embolization as well as endothelial dysfunction is required to induce sustained pulmonary hypertension, which is accompanied by altered exercise hemodynamics and an exacerbated ventilation/perfusion mismatch during exercise.
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Affiliation(s)
- Kelly Stam
- Experimental Cardiology, Department of Cardiology, Thoraxcenter, Cardiovascular Research Institute COEUR, Erasmus Medical Center Rotterdam , Rotterdam , The Netherlands
| | - Richard W B van Duin
- Experimental Cardiology, Department of Cardiology, Thoraxcenter, Cardiovascular Research Institute COEUR, Erasmus Medical Center Rotterdam , Rotterdam , The Netherlands
| | - André Uitterdijk
- Experimental Cardiology, Department of Cardiology, Thoraxcenter, Cardiovascular Research Institute COEUR, Erasmus Medical Center Rotterdam , Rotterdam , The Netherlands
| | - Zongye Cai
- Experimental Cardiology, Department of Cardiology, Thoraxcenter, Cardiovascular Research Institute COEUR, Erasmus Medical Center Rotterdam , Rotterdam , The Netherlands
| | - Dirk J Duncker
- Experimental Cardiology, Department of Cardiology, Thoraxcenter, Cardiovascular Research Institute COEUR, Erasmus Medical Center Rotterdam , Rotterdam , The Netherlands
| | - Daphne Merkus
- Experimental Cardiology, Department of Cardiology, Thoraxcenter, Cardiovascular Research Institute COEUR, Erasmus Medical Center Rotterdam , Rotterdam , The Netherlands
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13
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Pereda D, García-Lunar I, Sierra F, Sánchez-Quintana D, Santiago E, Ballesteros C, Encalada JF, Sánchez-González J, Fuster V, Ibáñez B, García-Álvarez A. Magnetic Resonance Characterization of Cardiac Adaptation and Myocardial Fibrosis in Pulmonary Hypertension Secondary to Systemic-To-Pulmonary Shunt. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.116.004566. [PMID: 27601365 DOI: 10.1161/circimaging.116.004566] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 07/21/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pulmonary hypertension (PH) and right ventricular (RV) dysfunction are strong predictors of morbidity and mortality among patients with congenital heart disease. Early detection of RV involvement may be useful in the management of these patients. We aimed to assess progressive cardiac adaptation and quantify myocardial extracellular volume in an experimental porcine model of PH because of aorto-pulmonary shunt using cardiac magnetic resonance (CMR). METHODS AND RESULTS To characterize serial cardiac adaptation, 12 pigs (aorto-pulmonary shunt [n=6] or sham operation [n=6]) were evaluated monthly with right heart catheterization, CMR, and computed tomography during 4 months, followed by pathology analysis. Extracellular volume by CMR in different myocardial regions was studied in 20 animals (aorto-pulmonary shunt [n=10] or sham operation [n=10]) 3 months after the intervention. All shunted animals developed PH. CMR evidenced progressive RV hypertrophy and dysfunction secondary to increased afterload and left ventricular dilatation secondary to volume overload. Shunt flow by CMR strongly correlated with PH severity, left ventricular end-diastolic pressure, and left ventricular dilatation. T1-mapping sequences demonstrated increased extracellular volume at the RV insertion points, the interventricular septum, and the left ventricular lateral wall, reproducing the pattern of fibrosis found on pathology. Extracellular volume at the RV insertion points strongly correlated with pulmonary hemodynamics and RV dysfunction. CONCLUSIONS Prolonged systemic-to-pulmonary shunting in growing piglets induces PH with biventricular remodeling and myocardial fibrosis that can be detected and monitored using CMR. These results may be useful for the diagnosis and management of congenital heart disease patients with pulmonary overcirculation.
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Affiliation(s)
- Daniel Pereda
- From the Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (D.P., I.G.-L., F.S., C.B., V.F., B.I., A.G.-Á.); Hospital Clínic, IDIBAPS, Barcelona, Spain (D.P., E.S., J.F.E., A.G.-Á.); Hospital Universitario Quirón Madrid, UEM, Spain (I.G.-L.); Facultad de Medicina, Universidad de Extremadura, Badajoz, Spain (D.S.-Q.); IIS-Fundación Jiménez Díaz, Madrid, Spain (B.I.); Philips Healthcare, Madrid, Spain (J.S.-G.); and Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York (V.F.)
| | - Inés García-Lunar
- From the Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (D.P., I.G.-L., F.S., C.B., V.F., B.I., A.G.-Á.); Hospital Clínic, IDIBAPS, Barcelona, Spain (D.P., E.S., J.F.E., A.G.-Á.); Hospital Universitario Quirón Madrid, UEM, Spain (I.G.-L.); Facultad de Medicina, Universidad de Extremadura, Badajoz, Spain (D.S.-Q.); IIS-Fundación Jiménez Díaz, Madrid, Spain (B.I.); Philips Healthcare, Madrid, Spain (J.S.-G.); and Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York (V.F.)
| | - Federico Sierra
- From the Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (D.P., I.G.-L., F.S., C.B., V.F., B.I., A.G.-Á.); Hospital Clínic, IDIBAPS, Barcelona, Spain (D.P., E.S., J.F.E., A.G.-Á.); Hospital Universitario Quirón Madrid, UEM, Spain (I.G.-L.); Facultad de Medicina, Universidad de Extremadura, Badajoz, Spain (D.S.-Q.); IIS-Fundación Jiménez Díaz, Madrid, Spain (B.I.); Philips Healthcare, Madrid, Spain (J.S.-G.); and Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York (V.F.)
| | - Damián Sánchez-Quintana
- From the Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (D.P., I.G.-L., F.S., C.B., V.F., B.I., A.G.-Á.); Hospital Clínic, IDIBAPS, Barcelona, Spain (D.P., E.S., J.F.E., A.G.-Á.); Hospital Universitario Quirón Madrid, UEM, Spain (I.G.-L.); Facultad de Medicina, Universidad de Extremadura, Badajoz, Spain (D.S.-Q.); IIS-Fundación Jiménez Díaz, Madrid, Spain (B.I.); Philips Healthcare, Madrid, Spain (J.S.-G.); and Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York (V.F.)
| | - Evelyn Santiago
- From the Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (D.P., I.G.-L., F.S., C.B., V.F., B.I., A.G.-Á.); Hospital Clínic, IDIBAPS, Barcelona, Spain (D.P., E.S., J.F.E., A.G.-Á.); Hospital Universitario Quirón Madrid, UEM, Spain (I.G.-L.); Facultad de Medicina, Universidad de Extremadura, Badajoz, Spain (D.S.-Q.); IIS-Fundación Jiménez Díaz, Madrid, Spain (B.I.); Philips Healthcare, Madrid, Spain (J.S.-G.); and Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York (V.F.)
| | - Constanza Ballesteros
- From the Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (D.P., I.G.-L., F.S., C.B., V.F., B.I., A.G.-Á.); Hospital Clínic, IDIBAPS, Barcelona, Spain (D.P., E.S., J.F.E., A.G.-Á.); Hospital Universitario Quirón Madrid, UEM, Spain (I.G.-L.); Facultad de Medicina, Universidad de Extremadura, Badajoz, Spain (D.S.-Q.); IIS-Fundación Jiménez Díaz, Madrid, Spain (B.I.); Philips Healthcare, Madrid, Spain (J.S.-G.); and Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York (V.F.)
| | - Juan F Encalada
- From the Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (D.P., I.G.-L., F.S., C.B., V.F., B.I., A.G.-Á.); Hospital Clínic, IDIBAPS, Barcelona, Spain (D.P., E.S., J.F.E., A.G.-Á.); Hospital Universitario Quirón Madrid, UEM, Spain (I.G.-L.); Facultad de Medicina, Universidad de Extremadura, Badajoz, Spain (D.S.-Q.); IIS-Fundación Jiménez Díaz, Madrid, Spain (B.I.); Philips Healthcare, Madrid, Spain (J.S.-G.); and Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York (V.F.)
| | - Javier Sánchez-González
- From the Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (D.P., I.G.-L., F.S., C.B., V.F., B.I., A.G.-Á.); Hospital Clínic, IDIBAPS, Barcelona, Spain (D.P., E.S., J.F.E., A.G.-Á.); Hospital Universitario Quirón Madrid, UEM, Spain (I.G.-L.); Facultad de Medicina, Universidad de Extremadura, Badajoz, Spain (D.S.-Q.); IIS-Fundación Jiménez Díaz, Madrid, Spain (B.I.); Philips Healthcare, Madrid, Spain (J.S.-G.); and Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York (V.F.)
| | - Valentín Fuster
- From the Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (D.P., I.G.-L., F.S., C.B., V.F., B.I., A.G.-Á.); Hospital Clínic, IDIBAPS, Barcelona, Spain (D.P., E.S., J.F.E., A.G.-Á.); Hospital Universitario Quirón Madrid, UEM, Spain (I.G.-L.); Facultad de Medicina, Universidad de Extremadura, Badajoz, Spain (D.S.-Q.); IIS-Fundación Jiménez Díaz, Madrid, Spain (B.I.); Philips Healthcare, Madrid, Spain (J.S.-G.); and Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York (V.F.)
| | - Borja Ibáñez
- From the Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (D.P., I.G.-L., F.S., C.B., V.F., B.I., A.G.-Á.); Hospital Clínic, IDIBAPS, Barcelona, Spain (D.P., E.S., J.F.E., A.G.-Á.); Hospital Universitario Quirón Madrid, UEM, Spain (I.G.-L.); Facultad de Medicina, Universidad de Extremadura, Badajoz, Spain (D.S.-Q.); IIS-Fundación Jiménez Díaz, Madrid, Spain (B.I.); Philips Healthcare, Madrid, Spain (J.S.-G.); and Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York (V.F.).
| | - Ana García-Álvarez
- From the Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (D.P., I.G.-L., F.S., C.B., V.F., B.I., A.G.-Á.); Hospital Clínic, IDIBAPS, Barcelona, Spain (D.P., E.S., J.F.E., A.G.-Á.); Hospital Universitario Quirón Madrid, UEM, Spain (I.G.-L.); Facultad de Medicina, Universidad de Extremadura, Badajoz, Spain (D.S.-Q.); IIS-Fundación Jiménez Díaz, Madrid, Spain (B.I.); Philips Healthcare, Madrid, Spain (J.S.-G.); and Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York (V.F.).
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14
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Baillie TJ, Sidharta S, Steele PM, Worthley SG, Willoughby S, Teo K, Sanders P, Nicholls SJ, Worthley MI. The predictive capabilities of a novel cardiovascular magnetic resonance derived marker of cardiopulmonary reserve on established prognostic surrogate markers in patients with pulmonary vascular disease: results of a longitudinal pilot study. J Cardiovasc Magn Reson 2017; 19:3. [PMID: 28065166 PMCID: PMC5220614 DOI: 10.1186/s12968-016-0316-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 12/15/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND No unified method exists to effectively predict and monitor progression of pulmonary arterial hypertension (PAH). We assessed the longitudinal relationship between a novel marker of cardiopulmonary reserve and established prognostic surrogate markers in patients with pulmonary vascular disease. METHODS AND RESULTS Twenty participants with confirmed (n = 14) or at high risk (n = 6) for PAH underwent cardiovascular magnetic resonance (CMR) at baseline and after ~6 months of guideline-appropriate management. Ten PAH participants underwent RHC within 48 h of each CMR. RHC (mean pulmonary arterial pressure, mPAP; pulmonary vascular resistance index, PVRI; cardiac index, CI) and phase-contrast CMR (mean pulmonary arterial blood flow velocity, meanPAvel) measurements were taken at rest and during continuous adenosine infusion (70/140/210 mcg/kg/min). Initial meanPAvel's (rest and hyperemic) were correlated with validated surrogate prognostic parameters (CMR: RV ejection fraction, RVEF; RV end systolic volume indexed, RVESVI; RHC: PVRI, CI; biomarker: NT-pro brain natriuretic peptide, NTpBNP; clinical: 6-min walk distance, 6MWD), a measure of pulmonary arterial stiffness (elastic modulus) and volumetric estimation of RV ventriculoarterial (VA) coupling. Changes in meanPAvel's were correlated with changes in comparator parameters over time. At initial assessment, meanPAvel at rest correlated significantly with PVRI (inversely), CI (positively) and elastic modulus (inversely) (R 2 > 0.37,P < 0.05 for all), whereas meanPAvel at peak hyperemia correlated significantly with PVRI, RVEF, RVESVI, 6MWD, elastic modulus and VA coupling (R 2 > 0.30,P < 0.05 for all). Neither resting or hyperemia-derived meanPAvel correlated with NTpBNP levels. Initial meanPAvel at rest correlated significantly with RVEF, RVESVI, CI and VA coupling at follow up assessment (R 2 > 0.2,P < 0.05 for all) and initial meanPAvel at peak hyperemia correlated with RVEF, RVESVI, PVRI and VA coupling (R 2 > 0.37,P < 0.05 for all). Change in meanPAvel at rest over time did not show statistically significant correlation with change in prognostic parameters, while change in meanPAvel at peak hyperemia did show a significant relationship with ΔRVEF, ΔRVESVI, ΔNTpBNP and ΔCI (R 2 > 0.24,P < 0.05 for all). CONCLUSION MeanPAvel during peak hyperemia correlated with invasive, non-invasive and clinical prognostic parameters at different time points. Further studies with predefined clinical endpoints are required to evaluated if this novel tool is a marker of disease progression in patients with pulmonary vascular disease.
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Affiliation(s)
- Timothy J Baillie
- Cardiovascular Investigational Unit, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia.
- University of Adelaide, Adelaide, Australia.
| | - Samuel Sidharta
- Cardiovascular Investigational Unit, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
- University of Adelaide, Adelaide, Australia
| | - Peter M Steele
- Cardiovascular Investigational Unit, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - Stephen G Worthley
- Cardiovascular Investigational Unit, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
- University of Adelaide, Adelaide, Australia
| | - Scott Willoughby
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Karen Teo
- Cardiovascular Investigational Unit, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - Prashanthan Sanders
- Cardiovascular Investigational Unit, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
- University of Adelaide, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Stephen J Nicholls
- Cardiovascular Investigational Unit, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
- University of Adelaide, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Matthew I Worthley
- Cardiovascular Investigational Unit, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
- University of Adelaide, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
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15
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García-Álvarez A, Pereda D, García-Lunar I, Sanz-Rosa D, Fernández-Jiménez R, García-Prieto J, Nuño-Ayala M, Sierra F, Santiago E, Sandoval E, Campelos P, Agüero J, Pizarro G, Peinado VI, Fernández-Friera L, García-Ruiz JM, Barberá JA, Castellá M, Sabaté M, Fuster V, Ibañez B. Beta-3 adrenergic agonists reduce pulmonary vascular resistance and improve right ventricular performance in a porcine model of chronic pulmonary hypertension. Basic Res Cardiol 2016; 111:49. [PMID: 27328822 PMCID: PMC4916192 DOI: 10.1007/s00395-016-0567-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 06/06/2016] [Indexed: 11/27/2022]
Abstract
Beta-3 adrenergic receptor (β3AR) agonists have been shown to produce vasodilation and prevention of ventricular remodeling in different conditions. Given that these biological functions are critical in pulmonary hypertension (PH), we aimed to demonstrate a beneficial effect of β3AR agonists in PH. An experimental study in pigs (n = 34) with chronic PH created by pulmonary vein banding was designed to evaluate the acute hemodynamic effect and the long-term effect of β3AR agonists on hemodynamics, vascular remodeling and RV performance in chronic PH. Ex vivo human experiments were performed to explore the expression of β3AR mRNA and the vasodilator response of β3AR agonists in pulmonary arteries. Single intravenous administration of the β3AR agonist BRL37344 produced a significant acute reduction in PVR, and two-weeks treatment with two different β3AR selective agonists, intravenous BRL37344 or oral mirabegron, resulted in a significant reduction in PVR (median of −2.0 Wood units/m2 for BRL37344 vs. +1.5 for vehicle, p = 0.04; and −1.8 Wood units/m2 for mirabegron vs. +1.6 for vehicle, p = 0.002) associated with a significant improvement in magnetic resonance-measured RV performance. Histological markers of pulmonary vascular proliferation (p27 and Ki67) were significantly attenuated in β3AR agonists-treated pigs. β3AR was expressed in human pulmonary arteries and β3AR agonists produced vasodilatation. β3AR agonists produced a significant reduction in PVR and improved RV performance in experimental PH, emerging as a potential novel approach for treating patients with chronic PH.
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Affiliation(s)
- Ana García-Álvarez
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain. .,Hospital Clínic, IDIBAPS, Barcelona, Spain.
| | - Daniel Pereda
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.,Hospital Clínic, IDIBAPS, Barcelona, Spain
| | - Inés García-Lunar
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.,Hospital Universitario Quirón Madrid, UEM, Madrid, Spain
| | - David Sanz-Rosa
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Rodrigo Fernández-Jiménez
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.,Hospital Clínico San Carlos, Madrid, Spain
| | - Jaime García-Prieto
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Mario Nuño-Ayala
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Federico Sierra
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | | | | | | | - Jaume Agüero
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Gonzalo Pizarro
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.,Hospital Universitario Quirón Madrid, UEM, Madrid, Spain
| | - Víctor I Peinado
- Hospital Clínic, IDIBAPS, Barcelona, Spain.,Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Respiratorias, Barcelona, Spain
| | - Leticia Fernández-Friera
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.,Hospital Universitario Montepríncipe, Madrid, Spain
| | - José M García-Ruiz
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.,Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Joan A Barberá
- Hospital Clínic, IDIBAPS, Barcelona, Spain.,Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Respiratorias, Barcelona, Spain
| | | | | | - Valentín Fuster
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.,Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, USA
| | - Borja Ibañez
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain. .,Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain.
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16
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Abstract
Pulmonary hypertension (PH) is a life-threatening, multifactorial pathophysiological haemodynamic condition, diagnosed when the mean pulmonary arterial pressure equals or exceeds 25 mmHg at rest during right heart catheterization. Cardiac MRI, in general, and MR phase-contrast (PC) imaging, in particular, have emerged as potential techniques for the standardized assessment of cardiovascular function, morphology and haemodynamics in PH. Allowing the quantification and characterization of macroscopic cardiovascular blood flow, MR PC imaging offers non-invasive evaluation of haemodynamic alterations associated with PH. Techniques used to study the PH include both the routine two-dimensional (2D) approach measuring predominant velocities through an acquisition plane and the rapidly evolving four-dimensional (4D) PC imaging, which enables the assessment of the complete time-resolved, three-directional blood-flow velocity field in a volume. Numerous parameters such as pulmonary arterial mean velocity, vessel distensibility, flow acceleration time and volume and tricuspid regurgitation peak velocity, as well as the duration and onset of vortical blood flow in the main pulmonary artery, have been explored to either diagnose PH or find non-invasive correlates to right heart catheter parameters. Furthermore, PC imaging-based analysis of pulmonary arterial pulse-wave velocities, wall shear stress and kinetic energy losses grants novel insights into cardiopulmonary remodelling in PH. This review aimed to outline the current applications of 2D and 4D PC imaging in PH and show why this technique has the potential to contribute significantly to early diagnosis and characterization of PH.
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Affiliation(s)
- Ursula Reiter
- 1 Division of General Radiology, Department of Radiology, Medical University of Graz, Austria
| | - Gert Reiter
- 2 Research and Development, Siemens Healthcare, Graz, Austria
| | - Michael Fuchsjäger
- 1 Division of General Radiology, Department of Radiology, Medical University of Graz, Austria
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17
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Fabregat-Andrés Ó, Estornell-Erill J, Ridocci-Soriano F, Pérez-Boscá JL, García-González P, Payá-Serrano R, Morell S, Cortijo J. Prognostic Value of Pulmonary Vascular Resistance by Magnetic Resonance in Systolic Heart Failure. Arq Bras Cardiol 2016; 106:226-35. [PMID: 26840055 PMCID: PMC4811278 DOI: 10.5935/abc.20160020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 08/24/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Pulmonary hypertension is associated with poor prognosis in heart failure. However, non-invasive diagnosis is still challenging in clinical practice. OBJECTIVE We sought to assess the prognostic utility of non-invasive estimation of pulmonary vascular resistances (PVR) by cardiovascular magnetic resonance to predict adverse cardiovascular outcomes in heart failure with reduced ejection fraction (HFrEF). METHODS Prospective registry of patients with left ventricular ejection fraction (LVEF) < 40% and recently admitted for decompensated heart failure during three years. PVR were calculated based on right ventricular ejection fraction and average velocity of the pulmonary artery estimated during cardiac magnetic resonance. Readmission for heart failure and all-cause mortality were considered as adverse events at follow-up. RESULTS 105 patients (average LVEF 26.0 ± 7.7%, ischemic etiology 43%) were included. Patients with adverse events at long-term follow-up had higher values of PVR (6.93 ± 1.9 vs. 4.6 ± 1.7 estimated Wood Units (eWu), p < 0.001). In multivariate Cox regression analysis, PVR ≥ 5 eWu(cutoff value according to ROC curve) was independently associated with increased risk of adverse events at 9 months follow-up (HR2.98; 95% CI 1.12-7.88; p < 0.03). CONCLUSIONS In patients with HFrEF, the presence of PVR ≥ 5.0 Wu is associated with significantly worse clinical outcome at follow-up. Non-invasive estimation of PVR by cardiac magnetic resonance might be useful for risk stratification in HFrEF, irrespective of etiology, presence of late gadolinium enhancement or LVEF.
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Affiliation(s)
- Óscar Fabregat-Andrés
- Departamento de Cardiologia, Hospital General Universitario de Valencia, Valencia, Spain
| | - Jordi Estornell-Erill
- Unidad de Imagen Cardiaca - ERESA, Hospital General Universitario de Valencia, Valencia, Spain
| | | | | | - Pilar García-González
- Unidad de Imagen Cardiaca - ERESA, Hospital General Universitario de Valencia, Valencia, Spain
| | - Rafael Payá-Serrano
- Departamento de Cardiologia, Hospital General Universitario de Valencia, Valencia, Spain
| | - Salvador Morell
- Departamento de Cardiologia, Hospital General Universitario de Valencia, Valencia, Spain
| | - Julio Cortijo
- Fundación para la Investigación, Hospital General Universitario de Valencia, Valencia, Spain
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18
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Rossini L, Martinez-Legazpi P, Vu V, Fernández-Friera L, Pérez Del Villar C, Rodríguez-López S, Benito Y, Borja MG, Pastor-Escuredo D, Yotti R, Ledesma-Carbayo MJ, Kahn AM, Ibáñez B, Fernández-Avilés F, May-Newman K, Bermejo J, Del Álamo JC. A clinical method for mapping and quantifying blood stasis in the left ventricle. J Biomech 2015; 49:2152-2161. [PMID: 26680013 DOI: 10.1016/j.jbiomech.2015.11.049] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 11/07/2015] [Indexed: 11/30/2022]
Abstract
In patients at risk of intraventrcular thrombosis, the benefits of chronic anticoagulation therapy need to be balanced with the pro-hemorrhagic effects of therapy. Blood stasis in the cardiac chambers is a recognized risk factor for intracardiac thrombosis and potential cardiogenic embolic events. In this work, we present a novel flow image-based method to assess the location and extent of intraventricular stasis regions inside the left ventricle (LV) by digital processing flow-velocity images obtained either by phase-contrast magnetic resonance (PCMR) or 2D color-Doppler velocimetry (echo-CDV). This approach is based on quantifying the distribution of the blood Residence Time (TR) from time-resolved blood velocity fields in the LV. We tested the new method in illustrative examples of normal hearts, patients with dilated cardiomyopathy and one patient before and after the implantation of a left ventricular assist device (LVAD). The method allowed us to assess in-vivo the location and extent of the stasis regions in the LV. Original metrics were developed to integrate flow properties into simple scalars suitable for a robust and personalized assessment of the risk of thrombosis. From a clinical perspective, this work introduces the new paradigm that quantitative flow dynamics can provide the basis to obtain subclinical markers of intraventricular thrombosis risk. The early prediction of LV blood stasis may result in decrease strokes by appropriate use of anticoagulant therapy for the purpose of primary and secondary prevention. It may also have a significant impact on LVAD device design and operation set-up.
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Affiliation(s)
- Lorenzo Rossini
- Mechanical and Aerospace Engineering Department, University of California San Diego, La Jolla, CA 92093, United States
| | - Pablo Martinez-Legazpi
- Mechanical and Aerospace Engineering Department, University of California San Diego, La Jolla, CA 92093, United States; Department of Cardiology, Hospital General Universitario Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Department of Mechanical Engineering, San Diego State University, San Diego, CA 92182, United States.
| | - Vi Vu
- Department of Mechanical Engineering, San Diego State University, San Diego, CA 92182, United States
| | | | - Candelas Pérez Del Villar
- Department of Cardiology, Hospital General Universitario Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Sara Rodríguez-López
- Biomedical Image Technologies, Universidad Politécnica de Madrid & CIBER-BBN, Spain
| | - Yolanda Benito
- Department of Cardiology, Hospital General Universitario Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - María-Guadalupe Borja
- Mechanical and Aerospace Engineering Department, University of California San Diego, La Jolla, CA 92093, United States
| | | | - Raquel Yotti
- Department of Cardiology, Hospital General Universitario Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | | | - Andrew M Kahn
- Department of Medicine, University of California San Diego, La Jolla, CA 92037, United States
| | - Borja Ibáñez
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Francisco Fernández-Avilés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Karen May-Newman
- Department of Mechanical Engineering, San Diego State University, San Diego, CA 92182, United States
| | - Javier Bermejo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Juan C Del Álamo
- Mechanical and Aerospace Engineering Department, University of California San Diego, La Jolla, CA 92093, United States; Institute for Engineering in Medicine, University of California San Diego, La Jolla, CA 92093, United States
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19
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Santos A, Fernández-Friera L, Villalba M, López-Melgar B, España S, Mateo J, Mota RA, Jiménez-Borreguero J, Ruiz-Cabello J. Cardiovascular imaging: what have we learned from animal models? Front Pharmacol 2015; 6:227. [PMID: 26539113 PMCID: PMC4612690 DOI: 10.3389/fphar.2015.00227] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/22/2015] [Indexed: 12/17/2022] Open
Abstract
Cardiovascular imaging has become an indispensable tool for patient diagnosis and follow up. Probably the wide clinical applications of imaging are due to the possibility of a detailed and high quality description and quantification of cardiovascular system structure and function. Also phenomena that involve complex physiological mechanisms and biochemical pathways, such as inflammation and ischemia, can be visualized in a non-destructive way. The widespread use and evolution of imaging would not have been possible without animal studies. Animal models have allowed for instance, (i) the technical development of different imaging tools, (ii) to test hypothesis generated from human studies and finally, (iii) to evaluate the translational relevance assessment of in vitro and ex-vivo results. In this review, we will critically describe the contribution of animal models to the use of biomedical imaging in cardiovascular medicine. We will discuss the characteristics of the most frequent models used in/for imaging studies. We will cover the major findings of animal studies focused in the cardiovascular use of the repeatedly used imaging techniques in clinical practice and experimental studies. We will also describe the physiological findings and/or learning processes for imaging applications coming from models of the most common cardiovascular diseases. In these diseases, imaging research using animals has allowed the study of aspects such as: ventricular size, shape, global function, and wall thickening, local myocardial function, myocardial perfusion, metabolism and energetic assessment, infarct quantification, vascular lesion characterization, myocardial fiber structure, and myocardial calcium uptake. Finally we will discuss the limitations and future of imaging research with animal models.
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Affiliation(s)
- Arnoldo Santos
- Centro Nacional de Investigaciones Cardiovasculares Carlos III Madrid, Spain ; CIBER de Enfermedades Respiratorias (CIBERES) Madrid, Spain ; Madrid-MIT M+Visión Consortium Madrid, Spain ; Department of Anesthesia, Massachusetts General Hospital, Harvard Medical School Boston, MA, USA
| | - Leticia Fernández-Friera
- Centro Nacional de Investigaciones Cardiovasculares Carlos III Madrid, Spain ; Hospital Universitario HM Monteprincipe Madrid, Spain
| | - María Villalba
- Centro Nacional de Investigaciones Cardiovasculares Carlos III Madrid, Spain
| | - Beatriz López-Melgar
- Centro Nacional de Investigaciones Cardiovasculares Carlos III Madrid, Spain ; Hospital Universitario HM Monteprincipe Madrid, Spain
| | - Samuel España
- Centro Nacional de Investigaciones Cardiovasculares Carlos III Madrid, Spain ; CIBER de Enfermedades Respiratorias (CIBERES) Madrid, Spain ; Madrid-MIT M+Visión Consortium Madrid, Spain
| | - Jesús Mateo
- Centro Nacional de Investigaciones Cardiovasculares Carlos III Madrid, Spain ; CIBER de Enfermedades Respiratorias (CIBERES) Madrid, Spain
| | - Ruben A Mota
- Centro Nacional de Investigaciones Cardiovasculares Carlos III Madrid, Spain ; Charles River Barcelona, Spain
| | - Jesús Jiménez-Borreguero
- Centro Nacional de Investigaciones Cardiovasculares Carlos III Madrid, Spain ; Cardiac Imaging Department, Hospital de La Princesa Madrid, Spain
| | - Jesús Ruiz-Cabello
- Centro Nacional de Investigaciones Cardiovasculares Carlos III Madrid, Spain ; CIBER de Enfermedades Respiratorias (CIBERES) Madrid, Spain ; Universidad Complutense de Madrid Madrid, Spain
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20
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Barbato E, Barton PJ, Bartunek J, Huber S, Ibanez B, Judge DP, Lara-Pezzi E, Stolen CM, Taylor A, Hall JL. Review and Updates in Regenerative and Personalized Medicine, Preclinical Animal Models, and Clinical Care in Cardiovascular Medicine. J Cardiovasc Transl Res 2015; 8:466-74. [DOI: 10.1007/s12265-015-9657-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 09/28/2015] [Indexed: 12/22/2022]
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21
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Yan C, Xu Z, Jin J, Lv J, Liu Q, Zhu Z, Pang K, Shi Y, Fang W, Wang Y. A feasible method for non-invasive measurement of pulmonary vascular resistance in pulmonary arterial hypertension: Combined use of transthoracic Doppler-echocardiography and cardiac magnetic resonance. Non-invasive estimation of pulmonary vascular resistance. IJC HEART & VASCULATURE 2015; 9:22-27. [PMID: 28785701 PMCID: PMC5497332 DOI: 10.1016/j.ijcha.2015.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 06/25/2015] [Accepted: 07/25/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Transthoracic Doppler-echocardiography (TTE) can estimate mean pulmonary arterial pressure (MPAP) and pulmonary capillary wedge pressure (PCWP) reliably, and cardiac magnetic resonance (CMR) is the best modality for non-invasive measurement of cardiac output (CO). We speculated that the combined use of TTE and CMR could provide a feasible method for non-invasive measurement of pulmonary vascular resistance (PVR) in pulmonary arterial hypertension (PAH). METHODS AND RESULTS Right heart catheterization (RHC) was undertaken in 77 patients (17M/60F) with PAH, and simultaneous TTE was carried out to evaluate MPAP, PCWP and CO. Within 2 days, CO was measured again with CMR in similar physiological status. Then, PVR was calculated with the integrated non-invasive method: TTE-derived (MPAP-PCWP)/CMR-derived CO and the isolated TTE method: TTE-derived (MPAP-PCWP)/TTE-derived CO, respectively. The PVR calculated with integrated non-invasive method correlated well with RHC-calculated PVR (r = 0.931, 95% confidence interval 0.893 to 0.956). Between the integrated non-invasive PVR and RHC-calculated PVR, the Bland-Altman analysis showed the satisfactory limits of agreement (mean value: - 0.89 ± 2.59). In comparison, the limits of agreement were less satisfactory between TTE-calculated PVR and RHC-calculated PVR (mean value: - 1.80 ± 3.33). Furthermore, there were excellent intra- and inter-observer correlations for the measurements of TTE and CMR (P < 0.001 for all). CONCLUSIONS The combined use of TTE and CMR provides a clinically reliable method to determine PVR non-invasively. In comparison with RHC, the integrated method shows good accuracy and repeatability, which suggests the potential for the evaluation and serial follow-up in patients with PAH. TRANSLATIONAL PERSPECTIVE In PAH, the non-invasive measurement of PVR is very important in clinical practice. Up to now, however, the widely accepted non-invasive method is still unavailable. Since TTE can estimate (MPAP-PCWP) reliably and CMR is the best image modality for the measurement of CO, the combined use of two modalities has the potential to determine PVR non-invasively. In this research, the integrated non-invasive method showed good diagnostic accuracy and repeatability compared with RHC. Therefore, it might be a feasible method for non-invasive measurement of PVR in patients with PAH.
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Affiliation(s)
- Chaowu Yan
- Department of Radiology, National Center for Cardiovascular Diseases, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Zhongying Xu
- Department of Radiology, National Center for Cardiovascular Diseases, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing 100037, China.,Peking Union Medical College, Beijing 100037, China
| | - Jinglin Jin
- Department of Radiology, National Center for Cardiovascular Diseases, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing 100037, China.,Peking Union Medical College, Beijing 100037, China
| | - Jianhua Lv
- Department of Radiology, National Center for Cardiovascular Diseases, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing 100037, China.,Peking Union Medical College, Beijing 100037, China
| | - Qiong Liu
- Department of Radiology, National Center for Cardiovascular Diseases, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing 100037, China.,Peking Union Medical College, Beijing 100037, China
| | - Zhenhui Zhu
- Department of Echocardiography, National Center for Cardiovascular Diseases, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing 100037, China.,Peking Union Medical College, Beijing 100037, China
| | - Kunjing Pang
- Department of Echocardiography, National Center for Cardiovascular Diseases, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing 100037, China.,Peking Union Medical College, Beijing 100037, China
| | - Yisheng Shi
- Department of Echocardiography, National Center for Cardiovascular Diseases, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing 100037, China.,Peking Union Medical College, Beijing 100037, China
| | - Wei Fang
- Department of Nuclear Medicine, National Center for Cardiovascular Diseases, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing 100037, China.,Peking Union Medical College, Beijing 100037, China
| | - Yang Wang
- Department of Epidemiology, National Center for Cardiovascular Diseases, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing 100037, China.,Peking Union Medical College, Beijing 100037, China
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Santos-Gallego CG, Badimón JJ. Denervación renal por catéter como tratamiento para la hipertensión pulmonar: ¿esperanza o espejismo? Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2015.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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23
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Catheter-based Renal Denervation as a Treatment for Pulmonary Hypertension: Hope or Hype? ACTA ACUST UNITED AC 2015; 68:551-3. [PMID: 26032026 DOI: 10.1016/j.rec.2015.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 03/17/2015] [Indexed: 11/20/2022]
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24
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Aguero J, Ishikawa K, Fish KM, Hammoudi N, Hadri L, Garcia-Alvarez A, Ibanez B, Fuster V, Hajjar RJ, Leopold JA. Combination proximal pulmonary artery coiling and distal embolization induces chronic elevations in pulmonary artery pressure in Swine. PLoS One 2015; 10:e0124526. [PMID: 25923775 PMCID: PMC4414513 DOI: 10.1371/journal.pone.0124526] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 03/15/2015] [Indexed: 11/18/2022] Open
Abstract
Pulmonary hypertension (PH) is associated with aberrant vascular remodeling and right ventricular (RV) dysfunction that contribute to early mortality. Large animal models that recapitulate human PH are essential for mechanistic studies and evaluating novel therapies; however, these models are not readily accessible to the field owing to the need for advanced surgical techniques or hypoxia. In this study, we present a novel swine model that develops cardiopulmonary hemodynamics and structural changes characteristic of chronic PH. This percutaneous model was created in swine (n=6) by combining distal embolization of dextran beads with selective coiling of the lobar pulmonary arteries (2 procedures per lung over 4 weeks). As controls, findings from this model were compared with those from a standard weekly distal embolization model (n=6) and sham animals (n=4). Survival with the combined embolization model was 100%. At 8 weeks after the index procedure, combined embolization procedure animals had increased mean pulmonary artery pressure (mPA) and pulmonary vascular resistance (PVR) compared to the controls with no effect on left heart or systemic pressures. RV remodeling and RV dysfunction were also present with a decrease in the RV ejection fraction, increase in the myocardial performance index, impaired longitudinal function, as well as cardiomyocyte hypertrophy, and interstitial fibrosis, which were not present in the controls. Pulmonary vascular remodeling occurred in both embolization models, although only the combination embolization model had a decrease in pulmonary capacitance. Taken together, these cardiopulmonary hemodynamic and structural findings identify the novel combination embolization swine model as a valuable tool for future studies of chronic PH.
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Affiliation(s)
- Jaume Aguero
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC)- Epidemiology, Atherothrombosis and Imaging Department, Madrid, Spain
- * E-mail:
| | - Kiyotake Ishikawa
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Kenneth M. Fish
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Nadjib Hammoudi
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Lahouaria Hadri
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Ana Garcia-Alvarez
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC)- Epidemiology, Atherothrombosis and Imaging Department, Madrid, Spain
| | - Borja Ibanez
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC)- Epidemiology, Atherothrombosis and Imaging Department, Madrid, Spain
| | - Valentin Fuster
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC)- Epidemiology, Atherothrombosis and Imaging Department, Madrid, Spain
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Roger J. Hajjar
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Jane A. Leopold
- Cardiovascular Medicine Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
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25
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Association of myocardial T1-mapping CMR with hemodynamics and RV performance in pulmonary hypertension. JACC Cardiovasc Imaging 2014; 8:76-82. [PMID: 25592698 DOI: 10.1016/j.jcmg.2014.08.012] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 08/26/2014] [Accepted: 08/27/2014] [Indexed: 11/21/2022]
Abstract
Early detection of right ventricular (RV) involvement in chronic pulmonary hypertension (PH) is essential due to prognostic implications. T1 mapping by cardiac magnetic resonance (CMR) has emerged as a noninvasive technique for extracellular volume fraction (ECV) quantification. We assessed the association of myocardial native T1 time and equilibrium contrast ECV (Eq-ECV) at the RV insertion points with pulmonary hemodynamics and RV performance in an experimental model of chronic PH. Right heart catheterization followed by immediate CMR was performed on 38 pigs with chronic PH (generated by surgical pulmonary vein banding) and 6 sham-operated controls. Native T1 and Eq-ECV values at the RV insertion points were both significantly higher in banded animals than in controls and showed significant correlation with pulmonary hemodynamics, RV arterial coupling, and RV performance. Eq-ECV values also increased before overt RV systolic dysfunction, offering potential for the early detection of myocardial involvement in chronic PH.
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Hayes D, Tobias JD, Mansour HM, Kirkby S, McCoy KS, Daniels CJ, Whitson BA. Pulmonary Hypertension in Cystic Fibrosis with Advanced Lung Disease. Am J Respir Crit Care Med 2014; 190:898-905. [DOI: 10.1164/rccm.201407-1382oc] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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27
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Quantitative magnetic resonance imaging of pulmonary hypertension: a practical approach to the current state of the art. J Thorac Imaging 2014; 29:68-79. [PMID: 24552882 DOI: 10.1097/rti.0000000000000079] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Pulmonary hypertension is a condition of varied etiology, commonly associated with poor clinical outcome. Patients are categorized on the basis of pathophysiological, clinical, radiologic, and therapeutic similarities. Pulmonary arterial hypertension (PAH) is often diagnosed late in its disease course, with outcome dependent on etiology, disease severity, and response to treatment. Recent advances in quantitative magnetic resonance imaging (MRI) allow for better initial characterization and measurement of the morphologic and flow-related changes that accompany the response of the heart-lung axis to prolonged elevation of pulmonary arterial pressure and resistance and provide a reproducible, comprehensive, and noninvasive means of assessing the course of the disease and response to treatment. Typical features of PAH occur primarily as a result of increased pulmonary vascular resistance and the resultant increased right ventricular (RV) afterload. Several MRI-derived diagnostic markers have emerged, such as ventricular mass index, interventricular septal configuration, and average pulmonary artery velocity, with diagnostic accuracy similar to that of Doppler echocardiography. Furthermore, prognostic markers have been identified with independent predictive value for identification of treatment failure. Such markers include large RV end-diastolic volume index, low left ventricular end-diastolic volume index, low RV ejection fraction, and relative area change of the pulmonary trunk. MRI is ideally suited for longitudinal follow-up of patients with PAH because of its noninvasive nature and high reproducibility and is advantageous over other biomarkers in the study of PAH because of its sensitivity to change in morphologic, functional, and flow-related parameters. Further study on the role of MRI image based biomarkers in the clinical environment is warranted.
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28
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Fabregat-Andres O, Estornell-Erill J, Ridocci-Soriano F, Garcia-Gonzalez P, Bochard-Villanueva B, Cubillos-Arango A, Espriella-Juan RDL, Facila L, Morell S, Cortijo J. Prognostic value of pulmonary vascular resistance estimated by cardiac magnetic resonance in patients with chronic heart failure. Eur Heart J Cardiovasc Imaging 2014; 15:1391-9. [DOI: 10.1093/ehjci/jeu147] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pandya B, Quail MA, Steeden JA, McKee A, Odille F, Taylor AM, Schulze-Neick I, Derrick G, Moledina S, Muthurangu V. Real-Time Magnetic Resonance Assessment of Septal Curvature Accurately Tracks Acute Hemodynamic Changes in Pediatric Pulmonary Hypertension. Circ Cardiovasc Imaging 2014; 7:706-13. [DOI: 10.1161/circimaging.113.001156] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Bejal Pandya
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (B.P., M.A.Q., J.A.S., A.M.T., V.M.); Cardiorespiratory Division, Great Ormond Street Hospital for Children, London, United Kingdom (I.S.-N., G.D., S.M.); Adult Congenital Heart Disease Department, The Heart Hospital, University College London Hospitals, London, United Kingdom (B.P.); Pediatric Respiratory Medicine, The Royal Brompton Hospital, London, United Kingdom (A.M.); INSERM, U947,
| | - Michael A. Quail
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (B.P., M.A.Q., J.A.S., A.M.T., V.M.); Cardiorespiratory Division, Great Ormond Street Hospital for Children, London, United Kingdom (I.S.-N., G.D., S.M.); Adult Congenital Heart Disease Department, The Heart Hospital, University College London Hospitals, London, United Kingdom (B.P.); Pediatric Respiratory Medicine, The Royal Brompton Hospital, London, United Kingdom (A.M.); INSERM, U947,
| | - Jennifer A. Steeden
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (B.P., M.A.Q., J.A.S., A.M.T., V.M.); Cardiorespiratory Division, Great Ormond Street Hospital for Children, London, United Kingdom (I.S.-N., G.D., S.M.); Adult Congenital Heart Disease Department, The Heart Hospital, University College London Hospitals, London, United Kingdom (B.P.); Pediatric Respiratory Medicine, The Royal Brompton Hospital, London, United Kingdom (A.M.); INSERM, U947,
| | - Andrea McKee
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (B.P., M.A.Q., J.A.S., A.M.T., V.M.); Cardiorespiratory Division, Great Ormond Street Hospital for Children, London, United Kingdom (I.S.-N., G.D., S.M.); Adult Congenital Heart Disease Department, The Heart Hospital, University College London Hospitals, London, United Kingdom (B.P.); Pediatric Respiratory Medicine, The Royal Brompton Hospital, London, United Kingdom (A.M.); INSERM, U947,
| | - Freddy Odille
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (B.P., M.A.Q., J.A.S., A.M.T., V.M.); Cardiorespiratory Division, Great Ormond Street Hospital for Children, London, United Kingdom (I.S.-N., G.D., S.M.); Adult Congenital Heart Disease Department, The Heart Hospital, University College London Hospitals, London, United Kingdom (B.P.); Pediatric Respiratory Medicine, The Royal Brompton Hospital, London, United Kingdom (A.M.); INSERM, U947,
| | - Andrew M. Taylor
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (B.P., M.A.Q., J.A.S., A.M.T., V.M.); Cardiorespiratory Division, Great Ormond Street Hospital for Children, London, United Kingdom (I.S.-N., G.D., S.M.); Adult Congenital Heart Disease Department, The Heart Hospital, University College London Hospitals, London, United Kingdom (B.P.); Pediatric Respiratory Medicine, The Royal Brompton Hospital, London, United Kingdom (A.M.); INSERM, U947,
| | - Ingram Schulze-Neick
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (B.P., M.A.Q., J.A.S., A.M.T., V.M.); Cardiorespiratory Division, Great Ormond Street Hospital for Children, London, United Kingdom (I.S.-N., G.D., S.M.); Adult Congenital Heart Disease Department, The Heart Hospital, University College London Hospitals, London, United Kingdom (B.P.); Pediatric Respiratory Medicine, The Royal Brompton Hospital, London, United Kingdom (A.M.); INSERM, U947,
| | - Graham Derrick
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (B.P., M.A.Q., J.A.S., A.M.T., V.M.); Cardiorespiratory Division, Great Ormond Street Hospital for Children, London, United Kingdom (I.S.-N., G.D., S.M.); Adult Congenital Heart Disease Department, The Heart Hospital, University College London Hospitals, London, United Kingdom (B.P.); Pediatric Respiratory Medicine, The Royal Brompton Hospital, London, United Kingdom (A.M.); INSERM, U947,
| | - Shahin Moledina
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (B.P., M.A.Q., J.A.S., A.M.T., V.M.); Cardiorespiratory Division, Great Ormond Street Hospital for Children, London, United Kingdom (I.S.-N., G.D., S.M.); Adult Congenital Heart Disease Department, The Heart Hospital, University College London Hospitals, London, United Kingdom (B.P.); Pediatric Respiratory Medicine, The Royal Brompton Hospital, London, United Kingdom (A.M.); INSERM, U947,
| | - Vivek Muthurangu
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (B.P., M.A.Q., J.A.S., A.M.T., V.M.); Cardiorespiratory Division, Great Ormond Street Hospital for Children, London, United Kingdom (I.S.-N., G.D., S.M.); Adult Congenital Heart Disease Department, The Heart Hospital, University College London Hospitals, London, United Kingdom (B.P.); Pediatric Respiratory Medicine, The Royal Brompton Hospital, London, United Kingdom (A.M.); INSERM, U947,
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Swine model of chronic postcapillary pulmonary hypertension with right ventricular remodeling: long-term characterization by cardiac catheterization, magnetic resonance, and pathology. J Cardiovasc Transl Res 2014; 7:494-506. [PMID: 24771313 DOI: 10.1007/s12265-014-9564-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 04/06/2014] [Indexed: 10/25/2022]
Abstract
Pulmonary hypertension (PH) is prevalent and carries high morbidity and mortality, mostly due to right ventricular (RV) dysfunction. Postcapillary PH is the most frequent form but there are no large-animal models available. We developed and characterized a porcine model of postcapillary PH by non-restrictive banding of the confluent of both inferior pulmonary veins (n = 10; sham controls n = 3). Right heart catheterization and magnetic resonance were performed before the procedure and monthly during 4 months. All banded animals developed PH. Compared to controls, banded animals presented higher mean pulmonary artery pressure [median (first to third quartile) 30 mmHg (25-37) vs. 20 mmHg (18-23); p = 0.018] and higher pulmonary vascular resistance [5.2 WU (3.8-7.1) vs. 2.3 WU (2.1-3.5); p = 0.028] after 2 months. Differences in indexed RV end-systolic volume [42 mL/m(2) (36-53) vs. 24 mL/m(2) (24-33); p = 0.028] and RV ejection fraction [59 % (54-63) vs. 66 % (64-68); p = 0.028] were also significant after 2 months. Differences remained significant throughout the study. Histopathology revealed increased lung weight and fibrosis but no increase in average water content. Also, remodeling on pulmonary arteries including increased medial and intimal thickness and fibrosis and RV myocardial disarray and fibrosis was demonstrated. Lung remodeling findings were similar in all pulmonary lobes.
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Roldán-Alzate A, Frydrychowicz A, Johnson KM, Kellihan H, Chesler NC, Wieben O, François CJ. Non-invasive assessment of cardiac function and pulmonary vascular resistance in an canine model of acute thromboembolic pulmonary hypertension using 4D flow cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2014; 16:23. [PMID: 24625242 PMCID: PMC3995608 DOI: 10.1186/1532-429x-16-23] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 03/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to quantify right (RV) and left (LV) ventricular function, pulmonary artery flow (QP), tricuspid valve regurgitation velocity (TRV), and aorta flow (QS) from a single 4D flow cardiovascular magnetic resonance (CMR) (time-resolved three-directionally motion encoded CMR) sequence in a canine model of acute thromboembolic pulmonary hypertension (PH). METHODS Acute PH was induced in six female beagles by microbead injection into the right atrium. Pulmonary arterial (PAP) and pulmonary capillary wedge (PCWP) pressures and cardiac output (CO) were measured by right heart catheterization (RHC) at baseline and following induction of acute PH. Pulmonary vascular resistance (PVRRHC) was calculated from RHC values of PAP, PCWP and CO (PVRRHC = (PAP-PCWP)/CO). Cardiac magnetic resonance (CMR) was performed on a 3 T scanner at baseline and following induction of acute PH. RV and LV end-diastolic (EDV) and end-systolic (ESV) volumes were determined from both CINE balanced steady-state free precession (bSSFP) and 4D flow CMR magnitude images. QP, TRV, and QS were determined from manually placed cutplanes in the 4D flow CMR flow-sensitive images in the main (MPA), right (RPA), and left (LPA) pulmonary arteries, the tricuspid valve (TRV), and aorta respectively. MPA, RPA, and LPA flow was also measured using two-dimensional flow-sensitive (2D flow) CMR. RESULTS Biases between 4D flow CMR and bSSFP were 0.8 mL and 1.6 mL for RV EDV and RV ESV, respectively, and 0.8 mL and 4 mL for LV EDV and LV ESV, respectively. Flow in the MPA, RPA, and LPA did not change after induction of acute PAH (p = 0.42-0.81). MPA, RPA, and LPA flow determined with 4D flow CMR was significantly lower than with 2D flow (p < 0.05). The correlation between QP/TRV and PVRRHC was 0.95. The average QP/QS was 0.96 ± 0.11. CONCLUSIONS Using both magnitude and flow-sensitive data from a single 4D flow CMR acquisition permits simultaneous quantification of cardiac function and cardiopulmonary hemodynamic parameters important in the assessment of PH.
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MESH Headings
- Acute Disease
- Animals
- Aorta/physiopathology
- Blood Flow Velocity
- Cardiac Catheterization
- Disease Models, Animal
- Dogs
- Feasibility Studies
- Female
- Hypertension, Pulmonary/diagnosis
- Hypertension, Pulmonary/etiology
- Hypertension, Pulmonary/physiopathology
- Image Interpretation, Computer-Assisted
- Magnetic Resonance Imaging
- Predictive Value of Tests
- Pulmonary Artery/physiopathology
- Pulmonary Circulation
- Pulmonary Embolism/diagnosis
- Pulmonary Embolism/etiology
- Pulmonary Embolism/physiopathology
- Regional Blood Flow
- Tricuspid Valve/physiopathology
- Tricuspid Valve Insufficiency/diagnosis
- Tricuspid Valve Insufficiency/etiology
- Tricuspid Valve Insufficiency/physiopathology
- Vascular Resistance
- Ventricular Dysfunction, Right/diagnosis
- Ventricular Dysfunction, Right/etiology
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Function, Left
- Ventricular Function, Right
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Affiliation(s)
- Alejandro Roldán-Alzate
- Department of Radiology, Clinical Science Center, University of Wisconsin - Madison, 600 Highland Avenue, Madison, Wisconsin 53792-3252, USA
- Department of Medical Physics, University of Wisconsin – Madison, Madison, WI, USA
| | - Alex Frydrychowicz
- Department of Radiology, Clinical Science Center, University of Wisconsin - Madison, 600 Highland Avenue, Madison, Wisconsin 53792-3252, USA
- Klinik für Radiologie und Nuklearmedizin - Campus Lübeck, Lübeck, Germany
| | - Kevin M Johnson
- Department of Medical Physics, University of Wisconsin – Madison, Madison, WI, USA
| | - Heidi Kellihan
- School of Veterinary Medicine, University of Wisconsin – Madison, Madison, WI, USA
| | - Naomi C Chesler
- Department of Biomedical Engineering, University of Wisconsin – Madison, Madison, WI, USA
| | - Oliver Wieben
- Department of Radiology, Clinical Science Center, University of Wisconsin - Madison, 600 Highland Avenue, Madison, Wisconsin 53792-3252, USA
- Department of Medical Physics, University of Wisconsin – Madison, Madison, WI, USA
| | - Christopher J François
- Department of Radiology, Clinical Science Center, University of Wisconsin - Madison, 600 Highland Avenue, Madison, Wisconsin 53792-3252, USA
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Fernández-Jiménez R, Fernández-Friera L, Sánchez-González J, Ibáñez B. Animal Models of Tissue Characterization of Area at Risk, Edema and Fibrosis. CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-014-9259-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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