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Moreno J, Escobedo D, Calhoun C, Le Saux CJ, Han HC. Arterial Wall Stiffening in Caveolin-1 Deficiency-Induced Pulmonary Artery Hypertension in Mice. EXPERIMENTAL MECHANICS 2021; 6:217-228. [PMID: 33776068 PMCID: PMC7993546 DOI: 10.1007/s11340-020-00666-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 09/08/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Pulmonary artery hypertension (PAH) is a complex disorder that can lead to right heart failure. The generation of caveolin-1 deficient mice (CAV-1-/-) has provided an alternative genetic model to study the mechanisms of pulmonary hypertension. However, the vascular adaptations in these mice have not been characterized. OBJECTIVE To determine the histological and functional changes in the pulmonary and carotid arteries in CAV-1-/- induced PAH. METHODS Pulmonary and carotid arteries of young (4-6 months old) and mature (9-12 months old) CAV-1-/- mice were tested and compared to normal wild type mice. RESULTS Artery stiffness increases in CAV-1-/- mice, especially the circumferential stiffness of the pulmonary arteries. Increases in stiffness were quantified by a decrease in circumferential stretch and transition strain, increases in elastic moduli, and an increase in total strain energy at physiologic strains. Changes in mechanical properties for the pulmonary artery correlated with increased collagen content while carotid artery mechanical properties correlated with decreased elastin content. CONCLUSIONS We demonstrated that an increase in artery stiffness is associated with CAV-1 deficiency-induced pulmonary hypertension. These results improve our understanding of artery remodeling in PAH.
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Affiliation(s)
- J. Moreno
- Department of Mechanical Engineering, University of Texas at San Antonio
- Biomedical Engineering Program, UTSA-UTHSCSA
| | - D. Escobedo
- Department of Medicine/Cardiology, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - C. Calhoun
- Department of Medicine/Cardiology, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - C. Jourdan Le Saux
- Department of Medicine/Cardiology, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - H. C. Han
- Department of Mechanical Engineering, University of Texas at San Antonio
- Biomedical Engineering Program, UTSA-UTHSCSA
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Reinero C, Visser LC, Kellihan HB, Masseau I, Rozanski E, Clercx C, Williams K, Abbott J, Borgarelli M, Scansen BA. ACVIM consensus statement guidelines for the diagnosis, classification, treatment, and monitoring of pulmonary hypertension in dogs. J Vet Intern Med 2020; 34:549-573. [PMID: 32065428 PMCID: PMC7097566 DOI: 10.1111/jvim.15725] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 01/30/2020] [Indexed: 01/01/2023] Open
Abstract
Pulmonary hypertension (PH), defined by increased pressure within the pulmonary vasculature, is a hemodynamic and pathophysiologic state present in a wide variety of cardiovascular, respiratory, and systemic diseases. The purpose of this consensus statement is to provide a multidisciplinary approach to guidelines for the diagnosis, classification, treatment, and monitoring of PH in dogs. Comprehensive evaluation including consideration of signalment, clinical signs, echocardiographic parameters, and results of other diagnostic tests supports the diagnosis of PH and allows identification of associated underlying conditions. Dogs with PH can be classified into the following 6 groups: group 1, pulmonary arterial hypertension; group 2, left heart disease; group 3, respiratory disease/hypoxia; group 4, pulmonary emboli/pulmonary thrombi/pulmonary thromboemboli; group 5, parasitic disease (Dirofilaria and Angiostrongylus); and group 6, disorders that are multifactorial or with unclear mechanisms. The approach to treatment of PH focuses on strategies to decrease the risk of progression, complications, or both, recommendations to target underlying diseases or factors contributing to PH, and PH‐specific treatments. Dogs with PH should be monitored for improvement, static condition, or progression, and any identified underlying disorder should be addressed and monitored simultaneously.
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Affiliation(s)
- Carol Reinero
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri
| | - Lance C Visser
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, California
| | - Heidi B Kellihan
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, Wisconsin
| | - Isabelle Masseau
- Department of Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, Quebec, Canada
| | - Elizabeth Rozanski
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, Medford, Massachusetts
| | - Cécile Clercx
- Department of Clinical Sciences of Companion Animals and Equine, University of Liège, Liège, Belgium
| | - Kurt Williams
- Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
| | - Jonathan Abbott
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee
| | - Michele Borgarelli
- Department of Small Animal Clinical Sciences, Virginia Maryland College of Veterinary Medicine, Blacksburg, Virginia
| | - Brian A Scansen
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado
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Image-based computational assessment of vascular wall mechanics and hemodynamics in pulmonary arterial hypertension patients. J Biomech 2017; 68:84-92. [PMID: 29310945 DOI: 10.1016/j.jbiomech.2017.12.022] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 11/30/2017] [Accepted: 12/17/2017] [Indexed: 11/20/2022]
Abstract
Pulmonary arterial hypertension (PAH) is a disease characterized by an elevated pulmonary arterial (PA) pressure. While several computational hemodynamic models of the pulmonary vasculature have been developed to understand PAH, they are lacking in some aspects, such as the vessel wall deformation and its lack of calibration against measurements in humans. Here, we describe a computational modeling framework that addresses these limitations. Specifically, computational models describing the coupling of hemodynamics and vessel wall mechanics in the pulmonary vasculature of a PAH patient and a normal subject were developed. Model parameters, consisting of linearized stiffness E of the large vessels and Windkessel parameters for each outflow branch, were calibrated against in vivo measurements of pressure, flow and vessel wall deformation obtained, respectively, from right-heart catheterization, phase-contrast and cine magnetic resonance images. Calibrated stiffness E of the proximal PA was 2.0 and 0.5 MPa for the PAH and normal models, respectively. Calibrated total compliance CT and resistance RT of the distal vessels were, respectively, 0.32 ml/mmHg and 11.3 mmHg∗min/l for the PAH model, and 2.93 ml/mmHg and 2.6 mmHg∗min/l for the normal model. These results were consistent with previous findings that the pulmonary vasculature is stiffer with more constricted distal vessels in PAH patients. Individual effects on PA pressure due to remodeling of the distal and proximal compartments of the pulmonary vasculature were also investigated in a sensitivity analysis. The analysis suggests that the remodeling of distal vasculature contributes more to the increase in PA pressure than the remodeling of proximal vasculature.
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Malhotra R, Dhakal BP, Eisman AS, Pappagianopoulos PP, Dress A, Weiner RB, Baggish AL, Semigran MJ, Lewis GD. Pulmonary Vascular Distensibility Predicts Pulmonary Hypertension Severity, Exercise Capacity, and Survival in Heart Failure. Circ Heart Fail 2017; 9:CIRCHEARTFAILURE.115.003011. [PMID: 27301469 DOI: 10.1161/circheartfailure.115.003011] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 05/12/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Pulmonary vascular (PV) distensibility, defined as the percent increase in pulmonary vessel diameter per mm Hg increase in pressure, permits the pulmonary vessels to increase in size to accommodate increased blood flow. We hypothesized that PV distensibility is abnormally low in patients with heart failure (HF) and serves as an important determinant of right ventricular performance and exercise capacity. METHODS AND RESULTS Patients with HF with preserved ejection fraction (n=48), HF with reduced ejection fraction (n=55), pulmonary arterial hypertension without left heart failure (n=18), and control subjects (n=30) underwent cardiopulmonary exercise testing with invasive hemodynamic monitoring and first-pass radionuclide ventriculography. PV distensibility was derived from 1257 matched measurements (mean±SD, 8.3±2.8 per subject) of pulmonary arterial pressure, pulmonary arterial wedge pressure and cardiac output. PV distensibility was lowest in the pulmonary arterial hypertension group (0.40±0.24% per mm Hg) and intermediate in the HF with preserved ejection fraction and HF with reduced ejection fraction groups (0.92±0.39 and 0.84±0.33% per mm Hg, respectively) compared to the control group (1.39±0.32% per mm Hg, P<0.0001 for all three). PV distensibility was associated with change in right ventricular ejection fraction (RVEF, ρ=0.39, P<0.0001) with exercise and was an independent predictor of peak VO2. PV distensibility also predicted cardiovascular mortality independent of peak VO2 in HF patients (n=103; Cox hazard ratio, 0.30; 95% confidence interval, 0.10-0.93; P=0.036). In a subset of patients with HF with reduced ejection fraction (n=26), 12 weeks of treatment with the pulmonary vasodilator sildenafil or placebo led to a 24.6% increase in PV distensibility (P=0.015) in the sildenafil group only. CONCLUSIONS PV distensibility is reduced in patients with HF and pulmonary arterial hypertension and is closely related to RV systolic function during exercise, maximal exercise capacity, and survival. Furthermore, PV distensibility is modifiable with selective pulmonary vasodilator therapy and may represent an important target for therapy in selected HF patients with pulmonary hypertension. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00309790.
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Affiliation(s)
- Rajeev Malhotra
- From the Cardiology Division (R.M., B.P.D., A.S.E., R.B.W., A.L.B., M.J.S., G.D.L.) and Pulmonary and Critical Care Unit (P.P.P., A.D., G.D.L.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Bishnu P Dhakal
- From the Cardiology Division (R.M., B.P.D., A.S.E., R.B.W., A.L.B., M.J.S., G.D.L.) and Pulmonary and Critical Care Unit (P.P.P., A.D., G.D.L.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Aaron S Eisman
- From the Cardiology Division (R.M., B.P.D., A.S.E., R.B.W., A.L.B., M.J.S., G.D.L.) and Pulmonary and Critical Care Unit (P.P.P., A.D., G.D.L.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Paul P Pappagianopoulos
- From the Cardiology Division (R.M., B.P.D., A.S.E., R.B.W., A.L.B., M.J.S., G.D.L.) and Pulmonary and Critical Care Unit (P.P.P., A.D., G.D.L.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ashley Dress
- From the Cardiology Division (R.M., B.P.D., A.S.E., R.B.W., A.L.B., M.J.S., G.D.L.) and Pulmonary and Critical Care Unit (P.P.P., A.D., G.D.L.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Rory B Weiner
- From the Cardiology Division (R.M., B.P.D., A.S.E., R.B.W., A.L.B., M.J.S., G.D.L.) and Pulmonary and Critical Care Unit (P.P.P., A.D., G.D.L.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Aaron L Baggish
- From the Cardiology Division (R.M., B.P.D., A.S.E., R.B.W., A.L.B., M.J.S., G.D.L.) and Pulmonary and Critical Care Unit (P.P.P., A.D., G.D.L.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Marc J Semigran
- From the Cardiology Division (R.M., B.P.D., A.S.E., R.B.W., A.L.B., M.J.S., G.D.L.) and Pulmonary and Critical Care Unit (P.P.P., A.D., G.D.L.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Gregory D Lewis
- From the Cardiology Division (R.M., B.P.D., A.S.E., R.B.W., A.L.B., M.J.S., G.D.L.) and Pulmonary and Critical Care Unit (P.P.P., A.D., G.D.L.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
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