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Mazzola M, Madonna R, Badagliacca R, Caterina RD. Porto-pulmonary arterial hypertension: Translation of pathophysiological concepts to the bedside. Vascul Pharmacol 2022; 145:107022. [PMID: 35738494 DOI: 10.1016/j.vph.2022.107022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/02/2022] [Accepted: 06/10/2022] [Indexed: 11/30/2022]
Abstract
Porto-pulmonary arterial hypertension (PoPAH) is a form of pulmonary arterial hypertension (PAH) that affects patients with cirrhosis, and - to a lesser extent - patients with non-cirrhotic liver diseases. Compared with other forms of PAH, PoPAH is more prevalent in male, in older subjects, and is characterized by lower mean pulmonary arterial pressure (mPAP) and lower pulmonary vascular resistance (PVR) with higher cardiac output. Despite more favorable hemodynamics and functional class, patients with PoPAH have a significantly worse survival than patients with other forms of PAH, likely because of liver-related events and therapeutic barriers to PAH-specific therapy. Furthermore, here cardiopulmonary and hepatic complications may affect treatment efficacy. These patients have been excluded from most randomized clinical trials testing PAH-specific treatments. To date, there is only one study investigating efficacy, safety, tolerability and pharmacokinetics of PAH-specific therapy in patients with PoPAH in a randomized placebo-controlled setting. In this trial the use of the endothelin-1 receptor antagonist macitentan showed clear hemodynamic benefit without safety concerns. However, the drug effects on functional capacity and mortality remain unclear. Here we review the current knowledge on the pathophysiology and management of PoPAH and report a case vignette of a patient with PoPAH due to hepatorenal polycystic disease.
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Affiliation(s)
- Matteo Mazzola
- Cardiovascular Division, Pisa University Hospital and University of Pisa, Pisa, Italy
| | - Rosalinda Madonna
- Cardiovascular Division, Pisa University Hospital and University of Pisa, Pisa, Italy.
| | - Roberto Badagliacca
- Department of Clinical, Anesthesiological and Cardiovascular Sciences, University of Rome La Sapienza, Rome, Italy
| | - Raffaele De Caterina
- Cardiovascular Division, Pisa University Hospital and University of Pisa, Pisa, Italy
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Rossi R, Talarico M, Schepis F, Coppi F, Sgura FA, Monopoli DE, Minici R, Boriani G. Effects of sildenafil on right ventricle remodelling in Portopulmonary hypertension. Pulm Pharmacol Ther 2021; 70:102071. [PMID: 34428597 DOI: 10.1016/j.pupt.2021.102071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/01/2021] [Accepted: 08/16/2021] [Indexed: 02/07/2023]
Abstract
Portopulmonary hypertension (PoPH) is a clinical condition associated with end-stage liver disease, described by the coexistence of pulmonary arterial hypertension (PAH) and portal hypertension. In PoPH patients, there is a right ventricle (RV) remodeling to compensate for the increased resistance in the lung circulation. There are no studies on the effects of the PAH-targeted pharmacological treatment on the RV dimension and function. The present study summarizes our experience in patients with PoPH treated with sildenafil in a period of 6 years (from 2013 to 2019). We enrolled 64 consecutive patients identified as PoPH, all treated with sildenafil (57.6% in monotherapy; in the other cases in association with macitentan; in 19.0% with initial combination therapy). A hemodynamic invasive cardiopulmonary study was performed at baseline and after 6 months of sildenafil treatment. In our population we showed a significative improvement in RV performance, with a significant increase in RV stroke volume (+33%), RV ejection fraction (+31%) and RV stroke work index (+17.5%). We registered the reduction of the RV cavity dimension over time in all patients treated with sildenafil (RV end diastolic diameter decreased by 15% after 6 months of follow-up). Regarding diastolic function, we highlighted a very significant reduction in RV end-diastolic pressure (-50% concerning baseline). Sildenafil was effective both when used as monotherapy and in combination with macitentan. In conclusion, Sildenafil had a positive impact on RV systolic and diastolic function in patients with PoPH and was able to conditionate the reverse remodeling of the RV.
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Affiliation(s)
- Rosario Rossi
- Cardiology Division. Pulmonary Hypertension Program, University of Modena and Reggio Emilia, Policlinico di Modena Hospital, Via del Pozzo, 71 - 41124, Modena, Italy
| | - Marisa Talarico
- Cardiology Division. Pulmonary Hypertension Program, University of Modena and Reggio Emilia, Policlinico di Modena Hospital, Via del Pozzo, 71 - 41124, Modena, Italy.
| | - Filippo Schepis
- Gastroenterology Division, Hepatic Hemodynamic Laboratory, University of Modena and Reggio Emilia, Policlinico of Modena Hospital, Via del Pozzo, 71 - 41124, Modena, Italy
| | - Francesca Coppi
- Cardiology Division. Pulmonary Hypertension Program, University of Modena and Reggio Emilia, Policlinico di Modena Hospital, Via del Pozzo, 71 - 41124, Modena, Italy
| | - Fabio Alfredo Sgura
- Cardiology Division. Pulmonary Hypertension Program, University of Modena and Reggio Emilia, Policlinico di Modena Hospital, Via del Pozzo, 71 - 41124, Modena, Italy
| | - Daniel Enrique Monopoli
- Cardiology Division. Pulmonary Hypertension Program, University of Modena and Reggio Emilia, Policlinico di Modena Hospital, Via del Pozzo, 71 - 41124, Modena, Italy
| | - Roberto Minici
- Radiology Division, Magna Graecia University, Viale Europa, 88100, Catanzaro, Italy
| | - Giuseppe Boriani
- Cardiology Division. Pulmonary Hypertension Program, University of Modena and Reggio Emilia, Policlinico di Modena Hospital, Via del Pozzo, 71 - 41124, Modena, Italy
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