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Manzi G, Papa S, Mariani MV, Scoccia G, Filomena D, Malerba C, Adamo FI, Caputo A, De Lazzari C, De Lazzari B, Cedrone N, Madonna R, Recchioni T, Serino G, Vizza CD, Badagliacca R. Telehealth: A winning weapon to face the COVID-19 outbreak for patients with pulmonary arterial hypertension. Vascul Pharmacol 2022; 145:107024. [PMID: 35716991 PMCID: PMC9212864 DOI: 10.1016/j.vph.2022.107024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 06/12/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND COVID-19 pandemic severely affected national health systems, altering the modality and the type of care of patients with acute and chronic diseases. To minimize the risk of exposure to SARS-CoV2 for patients and health professionals, face-to-face visits were cancelled or postponed and the use of telemedicine was strongly encouraged. This reorganization involved especially patients with rare diseases needing periodic comprehensive assessment, such as pulmonary arterial hypertension (PAH). MAIN BODY The paper reports a proposal of strategy adopted for patients followed at our PAH center in Rome, where patients management was diversified based on clinical risk according to the European Society of Cardiology/European Respiratory Society PH guidelines-derived score and the REVEAL 2.0 score. A close monitoring and support of these patients were made possible by policy changes reducing barriers to telehealth access and promoting the use of telemedicine. Synchronous/asynchronous modalities and remote monitoring were used to collect and transfer medical data in order to guide physicians in therapeutic-decision making. Conversely, the use of implantable monitors providing hemodynamic information and echocardiography-mobile devices wirelessly connecting was limited by the poor experience existing in this setting. Large surveys and clinical trials are welcome to test the potential benefit of the optimal balance between traditional PAH management and telemedicine opportunities. CONCLUSION Italy was found unprepared to manage the dramatic effects caused by COVID-19 on healthcare systems. In this emergency situation telemedicine represented a promising tool especially in rare diseases as PAH, but was limited by its scattered availability and legal and ethical issues. Cohesive partnership of health care providers with regional public health officials is needed to prioritize PAH patients for telemedicine by dedicated tools.
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Affiliation(s)
- Giovanna Manzi
- Department of Clinical, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy.
| | - Silvia Papa
- Department of Clinical, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy.
| | - Marco Valerio Mariani
- Department of Clinical, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy.
| | - Gianmarco Scoccia
- Department of Clinical, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy.
| | - Domenico Filomena
- Department of Clinical, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy.
| | - Claudia Malerba
- Department of Clinical, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy.
| | - Francesca Ileana Adamo
- Department of Clinical, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy.
| | - Annalisa Caputo
- Department of Clinical, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy.
| | - Claudio De Lazzari
- National Research Council, Institute of Clinical Physiology (IFC-CNR), Rome, Italy.
| | - Beatrice De Lazzari
- Università degli Studi di Roma "Foro Italico", P.za Lauro De Bosis, 15, 00135 Rome, Italy.
| | - Nadia Cedrone
- Unità di Medicina Interna, Ospedale S. Pertini, Rome, Italy.
| | - Rosalinda Madonna
- Cardiology Unit, Department of Surgical, Medical and Molecular Pathology and of Critical Sciences, University of Pisa - UNIPI, Pisa, Italy.
| | - Tommaso Recchioni
- Department of Clinical, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy.
| | - Giorgia Serino
- Department of Clinical, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy.
| | - Carmine Dario Vizza
- Department of Clinical, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy.
| | - Roberto Badagliacca
- Department of Clinical, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy.
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Badagliacca R, Rischard F, Giudice FL, Howard L, Papa S, Valli G, Manzi G, Sciomer S, Palange P, Garcia JG, Vanderpool R, Rinaldo R, Vigo B, Insel M, Fedele F, Vizza CD. INCREMENTAL VALUE OF CARDIOPULMONARY EXERCISE TESTING IN INTERMEDIATE-RISK PULMONARY ARTERIAL HYPERTENSION. J Heart Lung Transplant 2022; 41:780-790. [DOI: 10.1016/j.healun.2022.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 02/02/2022] [Accepted: 02/28/2022] [Indexed: 01/29/2023] Open
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Zuur-Telgen MC, Citgez E, Zuur AT, VanderValk P, van der Palen J, Kerstjens HAM, Brusse-Keizer M. Predicting Mortality in COPD with Validated and Sensitive Biomarkers; Fibrinogen and Mid-Range-Proadrenomedullin (MR-proADM). COPD 2021; 18:643-649. [PMID: 34886719 DOI: 10.1080/15412555.2021.2009791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Although fibrinogen is a FDA qualified prognostic biomarker in COPD, it still lacks sufficient resolution to be clinically useful. Next to replication of findings in different cohorts also the combination with other validated biomarkers should be investigated. Therefore, the aim of this study was to confirm in a large well-defined population of COPD patients whether fibrinogen can predict mortality and whether a combination with the biomarker MR-proADM can increase prognostic accuracy. From the COMIC cohort study we included COPD patients with a blood sample obtained in stable state (n = 640) and/or at hospitalization for an acute exacerbation of COPD (n = 262). Risk of death during 3 years of follow up for the separate and combined biomarker models was analyzed with Cox regression. Furthermore, logistic regression models for death after one year were constructed. When both fibrinogen and MR-proADM were included in the survival model, a doubling in fibrinogen and MR-proADM levels gave a 2.2 (95% CI 1.3-3.7) and 2.1 (95% CI 1.5-3.0) fold increased risk of dying, respectively. The prediction model for death after 1 year improved significantly when MR-proADM was added to the model with fibrinogen (AUC increased from 0.78 to 0.83; p = 0.02). However, the combined model was not significantly more adequate than the model with solely MR-proADM (AUC 0.83 vs 0.82; p = 0.34). The study suggests that MR-proADM is more promising than fibrinogen in prediciting mortality. Adding fibrinogen to a model containing MR-proADM does not significantly increase the predictive capacity of the model.
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Affiliation(s)
- Maaike C Zuur-Telgen
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Emanuel Citgez
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Abraham T Zuur
- Department of gastroenterology, Tjongerschans, Heerenveen, The Netherlands
| | - Paul VanderValk
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Job van der Palen
- Department of Research Methodology, Measurement, and Data Analysis, University of Twente, Enschede, The Netherlands.,Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Huib A M Kerstjens
- Department of Pulmonary Medicine, and Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Peripheral Arterial Stiffness in Acute Pulmonary Embolism and Pulmonary Hypertension at Short-Term Follow-Up. J Clin Med 2021; 10:jcm10143008. [PMID: 34300176 PMCID: PMC8307119 DOI: 10.3390/jcm10143008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/24/2021] [Accepted: 06/30/2021] [Indexed: 11/29/2022] Open
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe and under-recognized complication of acute pulmonary embolism (PE). Forty consecutive patients with acute PE (Group 1), predominantly female (22, 55%) with a mean age of 69 ± 15 years, were matched for demographic data with 40 healthy subjects (Group 2), 40 systemic hypertension patients (Group 3) and 45 prevalent idiopathic pulmonary arterial hypertension (IPAH) patients (Group 4). The baseline evaluation included physical examination, NYHA/WHO functional class, right heart catheterization (RHC) limited to IPAH patients, echocardiographic assessment and systemic arterial stiffness measurement by cardio-ankle vascular index (CAVI). Patients with PE underwent an echocardiographic evaluation within 1 month from hospital discharge (median 27 days; IQR 21–30) to assess the echo-derived probability of PH. The CAVI values were significantly higher in the PE and IPAH groups compared with the others (Group 1 vs. Group 2, p < 0.001; Group 1 vs. Group 3, p < 0.001; Group 1 vs. Group 4, p = ns; Group 4 vs. Group 2, p < 0.001; Group 4 vs. Group 3, p < 0.001; Group 2 vs. Group 3, p = ns). The predicted probability of echocardiography-derived high-risk criteria of PH increases for any unit increase of CAVI (OR 9.0; C.I.3.9–20.5; p = 0.0001). The PE patients with CAVI ≥ 9.0 at the time of hospital discharge presented an increased probability of PH. This study highlights a possible positive predictive role of CAVI as an early marker for the development of CTEPH.
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5
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Miotti C, D'Armini AM, Scardovi B, Ghio S, Sinagra G, Serra W, Romaniello A, Galgano G, Roncon L, D'Alto M, Giannazzo D, Vitulo P, Bongarzoni A, Ruzzolini M, Albera C, Casu G, Perazzolo Marra M, Pierdomenico SD, Luongo F, Manzi G, Papa S, Scoccia G, Cedrone N, Badagliacca R, Vizza CD. Chronic thromboembolic pulmonary hypertension risk score evaluation and validation (CTEPH Solution): proposal of a study protocol aimed to realize a validated risk score for early diagnosis. Minerva Cardiol Angiol 2021; 70:545-554. [PMID: 33703863 DOI: 10.23736/s2724-5683.21.05575-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Chronic Thromboembolic Pulmonary Hypertension (CTEPH) is the most serious long-term complication of acute pulmonary embolism (PE) though it is the only potentially reversible form of Pulmonary Hypertension (PH). Its incidence is mainly limited to the first 2 years following the embolic event, however it is often underdiagnosed or misdiagnosed. METHODS This is a multicenter observational cross-sectional and prospective study. Patients with a prior diagnosis of PE will be enrolled and undergo baseline evaluation for prevalent PH detection through a clinical examination and an echocardiogram as first screening exam. All cases of intermediate-high echocardiographic probability of PH will be confirmed by right heart catheterization and then identified as CTEPH through appropriate imaging and functional examinations in order to exclude other causes of PH. A CTEPH Risk Score will be created using retrospective data from this prevalent cohort of patients and will be then validated on an incident cohort of patients with acute PE. RESULTS 1000 retrospective and 218 prospective patients are expected to be enrolled and the study is expected to be completed by the end of 2021. Up to now 841 patients (620 retrospective and 221 prospective) have been enrolled. CONCLUSIONS This study is the first large prospective study for the prediction of CTEPH development in patients with PE. It aims to create a comprehensive scoring tool that includes echocardiographic data which may allow early detection of CTEPH and the application of targeted follow up screening programs in patients with PE.
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Affiliation(s)
- Cristiano Miotti
- Department of Cardiovascular and Respiratory Sciences, Sapienza University of Rome, Rome, Italy
| | - Andrea M D'Armini
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, Sezione di Cardiochirurgia, Policlinico San Matteo Pavia, Pavia, Italy
| | | | - Stefano Ghio
- Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Gianfranco Sinagra
- Dipartimento Cardiovascolare Azienda Ospedaliero-Universitaria Ospedali Riuniti, Trieste, Italy
| | - Walter Serra
- UO Cardiologia, AOU di Parma, Ospedale Maggiore di Parma, Parma, Italy
| | | | - Giuseppe Galgano
- UOC Cardiologia, UTIC, Ospedale Generale Regionale Francesco Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Loris Roncon
- Divisione di Cardiologia, ULSS 18 Rovigo, Ospedale Santa Maria della Misericordia, Rovigo, Italy
| | - Michele D'Alto
- Department of Cardiology, Monaldi Hospital, University L. Vanvitelli, Naples, Italy
| | - Daniela Giannazzo
- AOU Policlinico Vittorio Emanuele, Divisione di Cardiologia, Ospedale Ferrarotto, Catania, Italy
| | - Patrizio Vitulo
- Dipartimento di Pneumologia, Istituto Mediterraneo Trapianti e Terapie Alta Specializzazione ISMETT, Palermo, Italy
| | - Amedeo Bongarzoni
- Dipartimento di Cardiologia, Ospedale San Carlo Borromeo, Milano, Italy
| | - Matteo Ruzzolini
- Unità Operativa Complessa di Cardiologia e UTIC, Ospedale San Giovanni Calibita Fatebenefratelli, Roma, Italy
| | - Carlo Albera
- SC Pneumologia U, Ospedale Molinette, Torino, Italy
| | - Gavino Casu
- UOC Cardiologia, Ospedale San Francesco, Nuoro, Italy
| | - Martina Perazzolo Marra
- Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari, Azienda Ospedaliera, Padova, Italy
| | - Sante D Pierdomenico
- Unità di Malattie dell'apparato Cardiovascolare, Dipartimento di Scienze Mediche, Orali e Biotecnologiche, Università degli Studi G. d'Annunzio, Chieti-Pescara, Italy
| | - Federico Luongo
- Department of Cardiovascular and Respiratory Sciences, Sapienza University of Rome, Rome, Italy
| | - Giovanna Manzi
- Department of Cardiovascular and Respiratory Sciences, Sapienza University of Rome, Rome, Italy
| | - Silvia Papa
- Department of Cardiovascular and Respiratory Sciences, Sapienza University of Rome, Rome, Italy
| | - Gianmarco Scoccia
- Department of Cardiovascular and Respiratory Sciences, Sapienza University of Rome, Rome, Italy
| | - Nadia Cedrone
- Department of Cardiovascular and Respiratory Sciences, Sapienza University of Rome, Rome, Italy
| | - Roberto Badagliacca
- Department of Cardiovascular and Respiratory Sciences, Sapienza University of Rome, Rome, Italy
| | - Carmine D Vizza
- Department of Cardiovascular and Respiratory Sciences, Sapienza University of Rome, Rome, Italy -
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Miotti C, Papa S, Manzi G, Scoccia G, Luongo F, Toto F, Malerba C, Cedrone N, Sciomer S, Ciciarello F, Fedele F, Vizza CD, Badagliacca R. The Growing Role of Echocardiography in Pulmonary Arterial Hypertension Risk Stratification: The Missing Piece. J Clin Med 2021; 10:619. [PMID: 33561999 PMCID: PMC7915820 DOI: 10.3390/jcm10040619] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/29/2021] [Accepted: 02/02/2021] [Indexed: 12/17/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a rare, progressive disease with a poor prognosis. The pathophysiologic model is mainly characterized by an afterload mismatch in which an increased right ventricle afterload, driven by increased pulmonary vascular resistance (PVR), leads to right heart failure. International guidelines recommend optimization of treatment based on regular risk assessments to achieve or maintain a low-risk status. Current risk scores are based on a multi-modality approach, including demographic, clinical, functional, exercise, laboratory, and hemodynamic parameters, which lack significant echocardiographic parameters. The originality of echocardiography relies on the opportunity to assess in a non-invasive way a physiologically meaningful combination of easy to measure variables tightly related to right ventricle adaptation/maladaptation to increased afterload, the main determinant of a patient's prognosis. Echo-derived morphological and functional parameters have been investigated in PAH, proving to have prognostic relevance. Different therapeutic strategies proved to have different effects in reducing PVR. An upfront combination of drugs, including a parenteral prostacyclin, has shown to be associated with right heart reverse remodeling in a greater proportion of patients than other treatment strategies as a function of PVR reduction. Adding echocardiographic data to current risk scores would allow better identification of right ventricle (RV) adaptation in PAH patients' follow-up. This additional information would allow better stratification of the patient, leading to optimized and personalized therapeutic management.
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Affiliation(s)
- Cristiano Miotti
- Department of Cardiovascular and Respiratory Sciences—Sapienza University of Rome, 00161 Rome, Italy; (C.M.); (S.P.); (G.M.); (G.S.); (F.L.); (F.T.); (C.M.); (S.S.); (F.C.); (F.F.); (C.D.V.)
| | - Silvia Papa
- Department of Cardiovascular and Respiratory Sciences—Sapienza University of Rome, 00161 Rome, Italy; (C.M.); (S.P.); (G.M.); (G.S.); (F.L.); (F.T.); (C.M.); (S.S.); (F.C.); (F.F.); (C.D.V.)
| | - Giovanna Manzi
- Department of Cardiovascular and Respiratory Sciences—Sapienza University of Rome, 00161 Rome, Italy; (C.M.); (S.P.); (G.M.); (G.S.); (F.L.); (F.T.); (C.M.); (S.S.); (F.C.); (F.F.); (C.D.V.)
| | - Gianmarco Scoccia
- Department of Cardiovascular and Respiratory Sciences—Sapienza University of Rome, 00161 Rome, Italy; (C.M.); (S.P.); (G.M.); (G.S.); (F.L.); (F.T.); (C.M.); (S.S.); (F.C.); (F.F.); (C.D.V.)
| | - Federico Luongo
- Department of Cardiovascular and Respiratory Sciences—Sapienza University of Rome, 00161 Rome, Italy; (C.M.); (S.P.); (G.M.); (G.S.); (F.L.); (F.T.); (C.M.); (S.S.); (F.C.); (F.F.); (C.D.V.)
| | - Federica Toto
- Department of Cardiovascular and Respiratory Sciences—Sapienza University of Rome, 00161 Rome, Italy; (C.M.); (S.P.); (G.M.); (G.S.); (F.L.); (F.T.); (C.M.); (S.S.); (F.C.); (F.F.); (C.D.V.)
| | - Claudia Malerba
- Department of Cardiovascular and Respiratory Sciences—Sapienza University of Rome, 00161 Rome, Italy; (C.M.); (S.P.); (G.M.); (G.S.); (F.L.); (F.T.); (C.M.); (S.S.); (F.C.); (F.F.); (C.D.V.)
| | - Nadia Cedrone
- Internal Medicine Department, Ospedale S. Pertini, 00157 Rome, Italy;
| | - Susanna Sciomer
- Department of Cardiovascular and Respiratory Sciences—Sapienza University of Rome, 00161 Rome, Italy; (C.M.); (S.P.); (G.M.); (G.S.); (F.L.); (F.T.); (C.M.); (S.S.); (F.C.); (F.F.); (C.D.V.)
| | - Francesco Ciciarello
- Department of Cardiovascular and Respiratory Sciences—Sapienza University of Rome, 00161 Rome, Italy; (C.M.); (S.P.); (G.M.); (G.S.); (F.L.); (F.T.); (C.M.); (S.S.); (F.C.); (F.F.); (C.D.V.)
| | - Francesco Fedele
- Department of Cardiovascular and Respiratory Sciences—Sapienza University of Rome, 00161 Rome, Italy; (C.M.); (S.P.); (G.M.); (G.S.); (F.L.); (F.T.); (C.M.); (S.S.); (F.C.); (F.F.); (C.D.V.)
| | - Carmine Dario Vizza
- Department of Cardiovascular and Respiratory Sciences—Sapienza University of Rome, 00161 Rome, Italy; (C.M.); (S.P.); (G.M.); (G.S.); (F.L.); (F.T.); (C.M.); (S.S.); (F.C.); (F.F.); (C.D.V.)
| | - Roberto Badagliacca
- Department of Cardiovascular and Respiratory Sciences—Sapienza University of Rome, 00161 Rome, Italy; (C.M.); (S.P.); (G.M.); (G.S.); (F.L.); (F.T.); (C.M.); (S.S.); (F.C.); (F.F.); (C.D.V.)
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Badagliacca R, Pezzuto B, Papa S, Poscia R, Manzi G, Pascaretta A, Miotti C, Luongo F, Scoccia G, Ciciarello F, Casu G, Sciomer S, Fedele F, Naeije R, Vizza CD. Right Ventricular Strain Curve Morphology and Outcome in Idiopathic Pulmonary Arterial Hypertension. JACC Cardiovasc Imaging 2020; 14:162-172. [PMID: 33129726 DOI: 10.1016/j.jcmg.2020.08.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 08/24/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The purpose of this study was to explore speckle tracking echocardiographic right ventricular (RV) post-systolic strain patterns and their clinical relevance in idiopathic pulmonary arterial hypertension (PAH). BACKGROUND The imaging of RV diastolic function in PAH remains incompletely understood. METHODS Speckle tracking echocardiography of RV post-systolic strain recordings were examined in 108 consecutive idiopathic patients with PAH. Each of them underwent baseline clinical, hemodynamic, and complete echocardiographic evaluation and follow-up. RESULTS In total, 3 post-systolic strain patterns derived from the mid-basal RV free wall segments were identified. Pattern 1 was characterized by prompt return of strain-time curves to baseline after peak systolic negativity, like in normal control subjects. Pattern 2 was characterized by persisting negativity of strain-time curves well into diastole, before an end-diastolic returning to baseline. Pattern 3 was characterized by a slow return of strain-time curves to baseline during diastole. The 3 patterns corresponded respectively to mild PH, more advanced PH but with still preserved RV function, and PH with obvious end-stage right heart failure. Patterns were characterized by optimal reproducibility when complementary to quantitative measurement of right ventricular longitudinal early diastolic strain rate (RVLSR-E), and right ventricular longitudinal late diastolic strain rate (RVLSR-A) (Cohen's κ = 0.88; p = 0.0001). Multivariable models for clinical worsening prediction demonstrated that the addition of RV post-systolic patterns to clinical and hemodynamic variables significantly increased their prognostic power (0.78 vs. 0.66; p < 0.001). Freedom from clinical worsening rates at 1 and 2 years from baseline were, respectively, 100% and 93% for Pattern 1; 80% and 55% for Pattern 2; and 60% and 33% for Pattern 3. CONCLUSIONS Speckle tracking echocardiography allows for the identification of 3 phenotypically distinct, reproducible, and clinically meaningful RV strain-derived post-systolic patterns.
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Affiliation(s)
- Roberto Badagliacca
- Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, Italy.
| | - Beatrice Pezzuto
- Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, Italy
| | - Silvia Papa
- Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, Italy
| | - Roberto Poscia
- Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, Italy
| | - Giovanna Manzi
- Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, Italy
| | - Antonella Pascaretta
- Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, Italy
| | - Cristiano Miotti
- Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, Italy
| | - Federico Luongo
- Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, Italy
| | - Gianmarco Scoccia
- Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, Italy
| | - Francesco Ciciarello
- Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, Italy
| | - Gavino Casu
- ATS Sardegna-ASSL Nuoro, San Francesco Hospital Nuoro, Nuoro, Italy
| | - Susanna Sciomer
- Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, Italy
| | - Francesco Fedele
- Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, Italy
| | - Robert Naeije
- Department of Pathophysiology, Free University of Brussels, Brussels, Belgium
| | - Carmine Dario Vizza
- Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, Italy
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8
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Öner Ö, Deveci F, Telo S, Kuluöztürk M, Balin M. MR-proADM and MR-proANP levels in patients with acute pulmonary embolism. J Med Biochem 2020; 39:328-335. [PMID: 33269021 PMCID: PMC7682857 DOI: 10.2478/jomb-2019-0049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/07/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The aim of this study was to determine levels of Mid-regional Pro-adrenomedullin (MR-proADM) and Mid-regional Pro-atrial Natriuretic Peptide (MR-proANP) in patients with acute pulmonary embolism (PE), the relationship between these parameters and the risk classification in addition to determining the relationship between 1and 3month mortality. METHODS 82 PE patients and 50 healthy control subjects were included in the study. Blood samples for Mr-proANP and Mr-proADM were obtained from the subjects prior to the treatment. Risk stratification was determined according to sPESI (Simplified Pulmonary Embolism Severity Index). Following these initial measurements, cases with PE were assessed in terms of all causative and PE related mortalities. RESULTS The mean serum Mr-proANP and Mr-proADM levels in acute PE patients were found to be statistically higher compared to the control group (p < 0.001, p < 0.01; respectively) and statistically significantly higher in high-risk patients than low-risk patients (p < 0.01, p < 0.05; respectively). No statistical difference was determined in high-risk patients in case of sPESI compared to low-risk patients while hospital mortality rates were higher. It was determined that the hospital mortality rate in cases with Mr-proANP ≥ 123.30 pmol/L and the total 3-month mortality rate in cases with Mr-proADM ≥ 152.2 pg/mL showed a statistically significant increase. CONCLUSIONS This study showed that Mr-proANP and MRproADM may be an important biochemical marker for determining high-risk cases and predicting the mortality in PE patients and we believe that these results should be supported by further and extensive studies.
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Affiliation(s)
- Önsel Öner
- Firat University, School of Medicine, Department of Pulmonary Medicine, Elazig, Turkey
| | - Figen Deveci
- Firat University, School of Medicine, Department of Pulmonary Medicine, Elazig, Turkey
| | - Selda Telo
- Firat University, School of Medicine, Department of Biochemistry, Elazig, Turkey
| | - Mutlu Kuluöztürk
- Firat University, School of Medicine, Department of Pulmonary Medicine, Elazig, Turkey
| | - Mehmet Balin
- Firat University, School of Medicine, Department of Cardiology, Elazig, Turkey
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Tellİ G, Tel BC, GÜmÜŞel B. The Cardiopulmonary Effects of the Calcitonin Gene-related Peptide Family. Turk J Pharm Sci 2020; 17:349-356. [PMID: 32636714 DOI: 10.4274/tjps.galenos.2019.47123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 06/27/2019] [Indexed: 01/12/2023]
Abstract
Cardiopulmonary diseases are very common among the population. They are high-cost diseases and there are still no definitive treatments. The roles of members of the calcitonin-gene related-peptide (CGRP) family in treating cardiopulmonary diseases have been studied for many years and promising results obtained. Especially in recent years, two important members of the family, adrenomedullin and adrenomedullin2/intermedin, have been considered new treatment targets in cardiopulmonary diseases. In this review, the roles of CGRP family members in cardiopulmonary diseases are investigated based on the studies performed to date.
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Affiliation(s)
- Gökçen Tellİ
- Hacettepe University Faculty of Pharmacy, Department of Pharmacology, Ankara, Turkey
| | - Banu Cahide Tel
- Hacettepe University Faculty of Pharmacy, Department of Pharmacology, Ankara, Turkey
| | - Bülent GÜmÜŞel
- Lokman Hekim University Faculty of Pharmacy, Department of Pharmacology, Ankara, Turkey
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10
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Citgez E, Zuur-Telgen M, van der Palen J, van der Valk P, Stolz D, Brusse-Keizer M. Stable-State Midrange Proadrenomedullin Is Associated With Severe Exacerbations in COPD. Chest 2018; 154:51-57. [DOI: 10.1016/j.chest.2018.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 01/22/2018] [Accepted: 02/01/2018] [Indexed: 11/30/2022] Open
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11
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Zuur-Telgen MC, Brusse-Keizer MGJ, VanderValk PDLPM, van der Palen J, Kerstjens HAM, Hendrix MGR. Stable-State Midrange-Proadrenomedullin Level Is a Strong Predictor of Mortality in Patients With COPD. Chest 2017; 145:534-541. [PMID: 27845633 DOI: 10.1378/chest.13-1063] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 09/02/2013] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Midrange-proadrenomedullin (MR-proADM) has been shown to be elevated in patients hospitalized for an acute exacerbation of COPD (AECOPD) and in patients with community-acquired pneumonia. When measured during AECOPDs, MR-proADM has also been shown to be a predictor of mortality. We hypothesized that MR-proADM levels measured in a stable state could also predict mortality. METHODS We included 181 patients in whom we had paired plasma samples for MR-proADM determinations during a stable state and at hospitalization for an AECOPD when they also produced sputum. Time to death or censoring was compared between patients with MR-proADM above or below the median of 0.71 nmol/L. The predictive value of MR-proADM for survival was determined by calculating the C statistic. RESULTS Patients with COPD and MR-proADM levels > 0.71 nmol/L in the stable state had a threefold-higher risk of dying than did patients with MR-proADM levels < 0.71 nmol/L (hazard ratio, 2.98 [95% CI, 1.51-5.90]; C statistic, 0.76). The corrected OR for 1-year mortality was 8.90 (95% CI, 1.94-44.6) in patients with high MR-proADM levels measured in the stable state, compared with patients with low levels measured in the stable state. CONCLUSIONS MR-proADM measured in the stable state appeared to be a strong predictor of mortality in patients with COPD. MR-proADM is far easier to measure than other predictors of mortality in COPD, such as BMI, airflow obstruction, dyspnea, and exercise capacity score.
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Affiliation(s)
- Maaike C Zuur-Telgen
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede; Department of Internal Medicine, Medisch Spectrum Twente, Enschede.
| | | | | | - Job van der Palen
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede; Department of Pulmonary Medicine University Medical Centre Groningen, University of Groningen, Groningen
| | - Huib A M Kerstjens
- Department of Research Methodology, Measurement, and Data Analysis, University of Twente, Enschede; Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
| | - M G Ron Hendrix
- Regional Laboratory of Public Health, University of Twente, Enschede; Department of Medical Microbiology, University Medical Centre Groningen, University of Groningen, Groningen
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12
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Olschewski A, Papp R, Nagaraj C, Olschewski H. Ion channels and transporters as therapeutic targets in the pulmonary circulation. Pharmacol Ther 2014; 144:349-68. [PMID: 25108211 DOI: 10.1016/j.pharmthera.2014.08.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 07/22/2014] [Indexed: 10/24/2022]
Abstract
Pulmonary circulation is a low pressure, low resistance, high flow system. The low resting vascular tone is maintained by the concerted action of ion channels, exchangers and pumps. Under physiological as well as pathophysiological conditions, they are targets of locally secreted or circulating vasodilators and/or vasoconstrictors, leading to changes in expression or to posttranslational modifications. Both structural changes in the pulmonary arteries and a sustained increase in pulmonary vascular tone result in pulmonary vascular remodeling contributing to morbidity and mortality in pediatric and adult patients. There is increasing evidence demonstrating the pivotal role of ion channels such as K(+) and Cl(-) or transient receptor potential channels in different cell types which are thought to play a key role in vasoconstrictive remodeling. This review focuses on ion channels, exchangers and pumps in the pulmonary circulation and summarizes their putative pathophysiological as well as therapeutic role in pulmonary vascular remodeling. A better understanding of the mechanisms of their actions may allow for the development of new options for attenuating acute and chronic pulmonary vasoconstriction and remodeling treating the devastating disease pulmonary hypertension.
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Affiliation(s)
- Andrea Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria; Experimental Anesthesiology, Department of Anesthesia and Intensive Care Medicine, Medical University of Graz, Austria.
| | - Rita Papp
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Chandran Nagaraj
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Horst Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria; Department of Internal Medicine, Division of Pulmonology, Medical University of Graz, Austria
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Abstract
Study of RNA and proteins in cells of both normal and diseased tissues is providing researchers with new knowledge of disease pathologies. While still in its early stages, high-throughput expression analysis is improving our understanding of the pathogenesis of pulmonary arterial hypertension (PAH). While many studies have used microarray and proteomic analyses as "hypothesis-generating" tools, the technologies also have potential to identify and quantify biomarkers of disease. To date, many of the published studies have examined gene expression profiles of tissue biopsies, others have utilized cells from peripheral blood. Microarray technology has been employed successfully in the investigation of a diverse array of human diseases. The potential of high-throughput expression analysis to improve our understanding of the pathogenesis of PAH is highlighted in this review. Proteomic studies of PAH and pulmonary vascular diseases in general have been little utilized thus far. To date, such studies are few and no consistent biomarker has emerged from studies of either plasma or blood cells from idiopathic pulmonary arterial hypertension (IPAH) patients. The studies of both lung tissue and lymphocytes are perhaps more revealing and suggest that changes in the cytoskeletal machinery may play a role in the pathogenesis of idiopathic pulmonary arterial hypertension. The oncology literature has demonstrated the utility of gene microarray analysis to predict important outcomes such as response to therapy and survival. It is likely that in the near future, gene microarrays and proteomic analyses will also be employed in a pharmacogenomics approach in PAH, helping to identify the most appropriate therapies for individual patients.
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Affiliation(s)
- Mark Geraci
- Pulmonary Sciences and Critical Care Medicine Division, Pulmonary Hypertension Center, University of Colorado Denver, Denver, Colorado, USA
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14
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Vizza CD, Letizia C, Badagliacca R, Poscia R, Pezzuto B, Gambardella C, Nona A, Papa S, Marcon S, Mancone M, Iacoboni C, Riccieri V, Volterrani M, Fedele F. Relationship between baseline ET-1 plasma levels and outcome in patients with idiopathic pulmonary hypertension treated with bosentan. Int J Cardiol 2012; 167:220-4. [PMID: 22265324 DOI: 10.1016/j.ijcard.2011.12.104] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 12/15/2011] [Accepted: 12/20/2011] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To address if baseline endothelin-1 (ET-1) plasma levels might predict clinical worsening (CW) in patients with idiopathic pulmonary hypertension (IPAH) treated with bosentan. METHODS Forty-four consecutive patients with IPAH (WHO classes II-III) were included in this study. After an initial assessment (clinical status, pulmonary hemodynamics, samples for adrenomedullin (ADM), ET-1 and brain natriuretic peptide (BNP) plasma levels), patients were treated with bosentan and followed-up for CW. RESULTS We observed CW in 24 patients. Actuarial rates of freedom from CW were 74% at 1 year, 56% at 2 years, and 43% at 3 years. Patients with CW had a worse WHO functional class (II/III; no-CW 14/6 vs CW 5/19, p=0.002), six-minute walk-test distance (no-CW 439+94 m vs CW 385+82 m, p=0.04), mean pulmonary artery pressure (no-CW 47.4+10.6mm Hg vs CW 56+12.6mm Hg, p=0.02) and pulmonary vascular resistance (PVR no-CW 12.5+4.8 WU vs CW 16.4+6.3 WU, p=0.03) than the no-CW group. Moreover ET-1 (no-CW 14.1+4.2 pg/ml vs CW 21.3+6.3 pg/ml, p=0.0001), ADM (no-CW 14.9+7 pg/ml vs CW 21.5+10.4 pg/ml p=0.002) and BNP (no-CW 82.8+35.3 pg/ml vs CW 115.4+39.6 pg/ml, p=0.007) plasma levels were significantly higher in the CW group than in the no-CW group. The multivariate Cox proportional hazards model identified WHO class III (RR 4.6, 95%CI 14.6-1.45), ET-1 plasma levels (RR 1.1, 95%CI 2.05-1.01) and PVR (RR 1.2, 95%CI 1.3-1.03) as independent risk factors for CW. CONCLUSIONS These data confirm the high rate of CW in patients with IPAH treated with bosentan and document the impact of the endothelin system on CW of these patients.
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Affiliation(s)
- Carmine Dario Vizza
- Dept Cardiovascular and Respiratory Science, University of Rome, La Sapienza, Italy.
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15
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Karpinich NO, Hoopes SL, Kechele DO, Lenhart PM, Caron KM. Adrenomedullin Function in Vascular Endothelial Cells: Insights from Genetic Mouse Models. Curr Hypertens Rev 2011; 7:228-239. [PMID: 22582036 PMCID: PMC3349984 DOI: 10.2174/157340211799304761] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Revised: 08/18/2011] [Accepted: 08/21/2011] [Indexed: 01/29/2023]
Abstract
Adrenomedullin is a highly conserved peptide implicated in a variety of physiological processes ranging from pregnancy and embryonic development to tumor progression. This review highlights past and present studies that have contributed to our current appreciation of the important roles adrenomedullin plays in both normal and disease conditions. We provide a particular emphasis on the functions of adrenomedullin in vascular endothelial cells and how experimental approaches in genetic mouse models have helped to drive the field forward.
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Affiliation(s)
- Natalie O Karpinich
- Department of Cell and Molecular Physiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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16
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Dewachter L, Dewachter C, Naeije R. New therapies for pulmonary arterial hypertension: an update on current bench to bedside translation. Expert Opin Investig Drugs 2010; 19:469-88. [PMID: 20367190 DOI: 10.1517/13543781003727099] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
IMPORTANCE OF THE FIELD Treatments of pulmonary arterial hypertension (PAH) that have so far proven efficacious are all based on the restoration of endothelium control of pulmonary vascular tone and structure, by administration of prostacyclins, endothelin receptor antagonists and phosphodiesterase-5 inhibitors. However, results remain unsatisfactory, with persistent high mortality, insufficient clinical improvement and no convincing report of any reversal of the disease process. AREAS COVERED IN THIS REVIEW New antiproliferative approaches that aim to actively limit pulmonary vascular remodeling are being sought. Several such treatments have shown promise in experimental models and in preliminary clinical studies. Noteworthy among these are dichloroacetate, survivin antagonists, nuclear factor of activated T-cell inhibitors, PPAR-gamma agonists, tyrosine kinase inhibitors, Rho-kinase inhibitors, statins, vasoactive intestinal peptide, soluble guanylate cyclase stimulators/activators, adrenomedullin, elastase inhibitors, serotonin reuptake inhibitors, anti-inflammatory agents, and bone marrow-derived progenitor cells. WHAT THE READER WILL GAIN Update on various strategies targeting proliferative, inflammatory and regenerating processes currently under evaluation in patients with PAH. TAKE HOME MESSAGE In spite of favorable results in experimental models, none of these strategies has achieved the ultimate goal of curing PAH. Further developments will depend on progress made in our pathobiological understanding of the disease and carefully designed randomized, controlled trials.
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Affiliation(s)
- Laurence Dewachter
- Free University of Brussels, Department of Physiology, Faculty of Medicine, Erasme Campus CP 604, Lennik Road 808, B-1070 Brussels, Belgium.
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Abstract
Pulmonary arterial hypertension (PAH) remains a vexing clinical disease with no cure. Despite advances and the discovery of a gene (BMPR2) associated with many of the hereditary forms of the disease, and some cases not previously known to be inherited, the reasons for mutations in this gene as a cause remain somewhat elusive. Clearly, a complex interplay exists between genetic alterations, environmental exposures (including infections), and disease development. This article addresses the advances in the genetics of PAH, including the identification of genetic etiologies and modulators, and the role of genetics in predicting disease progression and targeting therapeutics.
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Potocki M, Breidthardt T, Reichlin T, Morgenthaler NG, Bergmann A, Noveanu M, Schaub N, Uthoff H, Freidank H, Buser L, Bingisser R, Christ M, Mebazaa A, Mueller C. Midregional pro-adrenomedullin in addition to b-type natriuretic peptides in the risk stratification of patients with acute dyspnea: an observational study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2009; 13:R122. [PMID: 19627611 PMCID: PMC2750172 DOI: 10.1186/cc7975] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Revised: 06/16/2009] [Accepted: 07/23/2009] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The identification of patients at highest risk for adverse outcome who are presenting with acute dyspnea to the emergency department remains a challenge. This study investigates the prognostic value of the newly described midregional fragment of the pro-Adrenomedullin molecule (MR-proADM) alone and combined to B-type natriuretic peptide (BNP) or N-terminal proBNP (NT-proBNP) in patients with acute dyspnea. METHODS We conducted a prospective, observational cohort study in the emergency department of a University Hospital and enrolled 287 unselected, consecutive patients (48% women, median age 77 (range 68 to 83) years) with acute dyspnea. RESULTS MR-proADM levels were elevated in non-survivors (n = 77) compared to survivors (median 1.9 (1.2 to 3.2) nmol/L vs. 1.1 (0.8 to 1.6) nmol/L; P < 0.001). The areas under the receiver operating characteristic curve (AUC) to predict 30-day mortality were 0.81 (95% CI 0.73 to 0.90), 0.76 (95% CI 0.67 to 0.84) and 0.63 (95% CI 0.53 to 0.74) for MR-proADM, NT-proBNP and BNP, respectively (MRproADM vs. NTproBNP P = 0.38; MRproADM vs. BNP P = 0.009). For one-year mortality the AUC were 0.75 (95% CI 0.69 to 0.81), 0.75 (95% CI 0.68 to 0.81), 0.69 (95% CI 0.62 to 0.76) for MR-proADM, NT-proBNP and BNP, respectively without any significant difference. Using multivariate linear regression analysis, MR-proADM strongly predicted one-year all-cause mortality independently of NT-proBNP and BNP levels (OR = 10.46 (1.36 to 80.50), P = 0.02 and OR = 24.86 (3.87 to 159.80) P = 0.001, respectively). Using quartile approaches, Kaplan-Meier curve analyses demonstrated a stepwise increase in one-year all-cause mortality with increasing plasma levels (P < 0.0001). Combined levels of MR-proADM and NT-proBNP did risk stratify acute dyspneic patients into a low (90% one-year survival rate), intermediate (72 to 82% one-year survival rate) or high risk group (52% one-year survival rate). CONCLUSIONS MR-proADM alone or combined to NT-proBNP has a potential to assist clinicians in risk stratifying patients presenting with acute dyspnea regardless of the underlying disease.
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Affiliation(s)
- Mihael Potocki
- Department of Internal Medicine, University Hospital, Petersgraben 4, 4031 Basel, Switzerland.
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Boon K, Bailey NW, Yang J, Steel MP, Groshong S, Kervitsky D, Brown KK, Schwarz MI, Schwartz DA. Molecular phenotypes distinguish patients with relatively stable from progressive idiopathic pulmonary fibrosis (IPF). PLoS One 2009; 4:e5134. [PMID: 19347046 PMCID: PMC2661376 DOI: 10.1371/journal.pone.0005134] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Accepted: 03/11/2009] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is a progressive, chronic interstitial lung disease that is unresponsive to current therapy and often leads to death. However, the rate of disease progression differs among patients. We hypothesized that comparing the gene expression profiles between patients with stable disease and those in which the disease progressed rapidly will lead to biomarker discovery and contribute to the understanding of disease pathogenesis. METHODOLOGY AND PRINCIPAL FINDINGS To begin to address this hypothesis, we applied Serial Analysis of Gene Expression (SAGE) to generate lung expression profiles from diagnostic surgical lung biopsies in 6 individuals with relatively stable (or slowly progressive) IPF and 6 individuals with progressive IPF (based on changes in DLCO and FVC over 12 months). Our results indicate that this comprehensive lung IPF SAGE transcriptome is distinct from normal lung tissue and other chronic lung diseases. To identify candidate markers of disease progression, we compared the IPF SAGE profiles in stable and progressive disease, and identified a set of 102 transcripts that were at least 5-fold up regulated and a set of 89 transcripts that were at least 5-fold down regulated in the progressive group (P-value</=0.05). The over expressed genes included surfactant protein A1, two members of the MAPK-EGR-1-HSP70 pathway that regulate cigarette-smoke induced inflammation, and Plunc (palate, lung and nasal epithelium associated), a gene not previously implicated in IPF. Interestingly, 26 of the up regulated genes are also increased in lung adenocarcinomas and have low or no expression in normal lung tissue. More importantly, we defined a SAGE molecular expression signature of 134 transcripts that sufficiently distinguished relatively stable from progressive IPF. CONCLUSIONS These findings indicate that molecular signatures from lung parenchyma at the time of diagnosis could prove helpful in predicting the likelihood of disease progression or possibly understanding the biological activity of IPF.
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Affiliation(s)
- Kathy Boon
- National Institute of Environmental Health Sciences/National Heart Lung and Blood Institute, Research Triangle Park, North Carolina, USA.
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Stolz D, Christ-Crain M, Morgenthaler NG, Miedinger D, Leuppi J, Müller C, Bingisser R, Struck J, Müller B, Tamm M. Plasma Pro-Adrenomedullin But Not Plasma Pro-Endothelin Predicts Survival in Exacerbations of COPD. Chest 2008; 134:263-272. [DOI: 10.1378/chest.08-0047] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Vizza CD, Letizia C, Badagliacca R, Sciomer S, Poscia R, Della Rocca G, Iacoboni C, Leonardo DL, Quattrucci S, Dario C, Luigi P, Fedele F. Plasma adrenomedullin and endothelin-1 concentration during low-dose dobutamine infusion: Relationship between pulmonary uptake and pulmonary vascular pressure/flow characteristics. ACTA ACUST UNITED AC 2006; 136:85-91. [PMID: 16815566 DOI: 10.1016/j.regpep.2006.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2006] [Accepted: 04/28/2006] [Indexed: 02/02/2023]
Abstract
AIM To study the role of endothelin (ET-1) and adrenomedullin (AM) on pulmonary vascular pressure/flow characteristic (pulmonary arterial pressure/cardiac output (Pap/CO)) during low-dose dobutamine infusion. METHODS Case control study of 14 patients (12 men, 2 women) with severe lung disease (chronic obstructive pulmonary disease, COPD n=5; cystic fibrosis, CF n=9) and 5 control subjects (CTRL, 4 men, 1 woman). ET-1 and AM plasma levels in pulmonary artery (mixed venous blood, ven) and aorta or femoral artery (arterial, art), were measured at baseline and during dobutamine infusion (5-10-15 mcg kg(-1) min(-1)). The Ppa/CO coordinates obtained at baseline and during dobutamina infusion for each patients were used to calculate the Slope and Intercept by linear regression analysis. RESULTS Baseline hemodynamics measurements were similar in the three groups with a trend towards a mild elevation in Ppa in CF group (Ppa mm Hg: CTRL 19+/-3.5, COPD 19.4+/-5.5, CF 22.7+/-7.5). Baseline plasma ET-1(ET-1ven pg ml(-1): CTRL 13.9+/-6.7, COPD 20.1+/-14, CF 20.4+/-7.1; ET-1art pg ml(-1): CTRL 16.7+/-6.4, COPD 20.1+/-11.7, CF 18.1+/-3.9) and AM (AMven pg ml(-1): CTRL 15.8+/-5, COPD 31.8+/-17.6, CF 27.7+/-7.6; AMart pg ml(-1): CTRL 15.9+/-1.4, COPD 21.4+/-3.8, CF 27+/-7.6) showed a trend towards higher value among patients' groups compared to the controls. Baseline ET-1 pulmonary gradient did not show significant difference among the three groups as well AM pulmonary gradient. Dobutamine infusion caused a comparable increase of heart rate and CO in the three groups. Mean pulmonary pressure had a trend towards a greater increase in COPD and CF than in controls, consequently, pulmonary Pap/CO relationship showed a steeper slope in patients' groups (Slope mm Hg L(-1) min(-1): CTRL 0.9+/-0.3, COPD 2.1+/-0.8 p<0.02 vs. CTRL, CF 1.9+/-0.9 p<0.03 vs CTRL). During dobutamine plasma ET-1 and AM showed a great individual variability resulting in no significant difference among groups. ET-1 pulmonary gradient showed a trend towards pulmonary uptake in patients' groups (ET-1art-ven pg min(-1): CTRL 2.7+/-2.9, COPD-6.1+/-7.8, CF -4+/-4.8) while AM pulmonary gradient did not show any particular pattern. During dobutamine ET-1 was significantly correlated to Pap/CO characteristics (Slope and ET-1ven, r=-0.59, p<0.05; Slope and ET-1art-ven, r=-0.60, p<0.05; Intercept and ET-1art-ven, r=0.63, p<0.004), and ET-1art-ven was the only independent variable related to Slope and Intercept. CONCLUSIONS In patients with moderate pulmonary vascular impairment, ET-1 pulmonary gradient, but not AM pulmonary gradient, is inversely correlated with pulmonary incremental resistance, suggesting a role of ET-1 in the regulation of pulmonary vascular resistance.
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Affiliation(s)
- Carmine Dario Vizza
- Department of Cardiovascular and Respiratory Sciences, University La Sapienza, Rome, Italy
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Salsano F, Letizia C, Proietti M, Rossi C, Proietti AR, Rosato E, Pisarri S. Significant changes of peripheral perfusion and plasma adrenomedullin levels in N-acetylcysteine long term treatment of patients with sclerodermic Raynauds phenomenon. Int J Immunopathol Pharmacol 2006; 18:761-70. [PMID: 16388726 DOI: 10.1177/039463200501800420] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The unclear pathogenesis of scleroderma vascular lesions makes treatment of Raynaud's phenomenon (RP) in Systemic Sclerosis (SSc) patients very difficult and a new effective treatment is requested. Recently, a powerful antioxidant agent, the N-acetylcysteine (NAC) has been shown to decrease the frequency and severity of RP in SSc patients. Subsequently, using functional infrared imaging, we showed that a single 1-hour NAC infusion in these patients caused a significant increase of skin temperature. The aim of this study was to demonstrate the efficacy of long term therapy with NAC in an open clinical trial evaluating clinical, instrumental and laboratory parameters. Patients started the treatment receiving for two years, from October to May, intravenous NAC infusions of 15 mg/kg per hour each, for 5 consecutive hours, every two weeks. Before and after each infusion, patients underwent both Laser Doppler perfusion Imaging (LDPI) for the evaluation of the digital perfusion and a blood test to ascertain the plasma adrenomedullin (AM) levels. The NAC infusion increased global hands perfusion and induced a significant decreasing of plasma AM concentrations. Side effects were negligible, easy to control and reversible. Reduction of frequency and severity of RP attacks was recorded. In conclusion, NAC seems to act as an effective vasodilatator in the treatment of RP secondary to SSc and, in addition, it induced significant changes in plasma levels of AM, a potent vasodilator endothelial-derived peptide.
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Affiliation(s)
- F Salsano
- Department of Clinical Medicine, U.O.C Clinical Immunology and Allergology, University of Rome, La Sapienza, Italy.
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