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Maurer SJ, Habdank V, Hörer J, Ewert P, Tutarel O. NT-proBNP Is a Predictor of Mortality in Adults with Pulmonary Arterial Hypertension Associated with Congenital Heart Disease. J Clin Med 2023; 12:3101. [PMID: 37176542 PMCID: PMC10179459 DOI: 10.3390/jcm12093101] [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: 01/31/2023] [Revised: 04/17/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND About 5-10% of adults with congenital heart disease (ACHD) will develop pulmonary arterial hypertension (PAH), which is associated with significant mortality. Studies on risk factors for poor outcome in a contemporary cohort of these patients with PAH associated with CHD (PAH-CHD) are rare. METHODS In this retrospective, single-center study, adult patients with the diagnosis PAH-CHD who had at least one contact as an outpatient or inpatient at the German Heart Centre Munich during the period January 2010-September 2019 were included. Patients with PAH without a CHD were excluded. The primary endpoint was all-cause mortality. RESULTS Altogether, 158 patients (mean age 39.9 ± 15.4 years, female 64.6%) were included in the study. A pre-tricuspid shunt was present in 17.7%, other shunts in 51.3%, PAH associated with complex CHD in 22.8%, and segmental PAH in 8.2%. An NT-proBNP measurement at baseline was available in 95 patients (60.1%). During a median follow-up of 5.37 years [IQR 1.76-8.63], the primary endpoint occurred in 10 patients (6.7%). On univariate analysis, CRP (log) (HR 3.35, 95% CI (1.07-10.48), p = 0.037), NT-proBNP (log) (HR: 7.10, 95% CI: 1.57-32.23, p = 0.011), and uric acid (HR: 1.37, 95% CI: 1.05-1.79, p = 0.020) were predictors of the primary endpoint. On multivariate analysis, only NT-proBNP (log) (HR: 6.91, 95% CI: 1.36-35.02, p = 0.0196) remained as an independent predictor. CONCLUSION NT-proBNP is an independent predictor of all-cause mortality in a contemporary cohort of PAH-CHD patients. The role of CRP and uric acid should be further assessed in future studies.
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Affiliation(s)
- Susanne J. Maurer
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, TUM School of Medicine, Technical University of Munich, 80636 Munich, Germany
| | - Veronika Habdank
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, TUM School of Medicine, Technical University of Munich, 80636 Munich, Germany
| | - Jürgen Hörer
- Department of Congenital and Paediatric Heart Surgery, German Heart Centre Munich, Technical University of Munich, 80636 Munich, Germany
- Division of Congenital and Paediatric Heart Surgery, University Hospital Munich, Ludwig-Maximilians Universität, 81377 Munich, Germany
| | - Peter Ewert
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, TUM School of Medicine, Technical University of Munich, 80636 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, 80992 Munich, Germany
| | - Oktay Tutarel
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, TUM School of Medicine, Technical University of Munich, 80636 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, 80992 Munich, Germany
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Hojda SE, Chis IC, Clichici S. Biomarkers in Pulmonary Arterial Hypertension. Diagnostics (Basel) 2022; 12:diagnostics12123033. [PMID: 36553040 PMCID: PMC9776459 DOI: 10.3390/diagnostics12123033] [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: 10/16/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a severe medical condition characterized by elevated pulmonary vascular resistance (PVR), right ventricular (RV) failure, and death in the absence of appropriate treatment. The progression and prognosis are strictly related to the etiology, biochemical parameters, and treatment response. The gold-standard test remains right-sided heart catheterization, but dynamic monitoring of systolic pressure in the pulmonary artery is performed using echocardiography. However, simple and easily accessible non-invasive assays are also required in order to monitor this pathology. In addition, research in this area is in continuous development. In recent years, more and more biomarkers have been studied and included in clinical guidelines. These biomarkers can be categorized based on their associations with inflammation, endothelial cell dysfunction, cardiac fibrosis, oxidative stress, and metabolic disorders. Moreover, biomarkers can be easily detected in blood and urine and correlated with disease severity, playing an important role in diagnosis, prognosis, and disease progression.
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3
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Santos-Gomes J, Gandra I, Adão R, Perros F, Brás-Silva C. An Overview of Circulating Pulmonary Arterial Hypertension Biomarkers. Front Cardiovasc Med 2022; 9:924873. [PMID: 35911521 PMCID: PMC9333554 DOI: 10.3389/fcvm.2022.924873] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/21/2022] [Indexed: 11/16/2022] Open
Abstract
Pulmonary arterial hypertension (PAH), also known as Group 1 Pulmonary Hypertension (PH), is a PH subset characterized by pulmonary vascular remodeling and pulmonary arterial obstruction. PAH has an estimated incidence of 15-50 people per million in the United States and Europe, and is associated with high mortality and morbidity, with patients' survival time after diagnosis being only 2.8 years. According to current guidelines, right heart catheterization is the gold standard for diagnostic and prognostic evaluation of PAH patients. However, this technique is highly invasive, so it is not used in routine clinical practice or patient follow-up. Thereby, it is essential to find new non-invasive strategies for evaluating disease progression. Biomarkers can be an effective solution for determining PAH patient prognosis and response to therapy, and aiding in diagnostic efforts, so long as their detection is non-invasive, easy, and objective. This review aims to clarify and describe some of the potential new candidates as circulating biomarkers of PAH.
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Affiliation(s)
- Joana Santos-Gomes
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Inês Gandra
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Rui Adão
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Frédéric Perros
- Paris-Porto Pulmonary Hypertension Collaborative Laboratory (3PH), UMR_S 999, INSERM, Université Paris-Saclay, Paris, France
- Université Paris–Saclay, AP-HP, INSERM UMR_S 999, Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
| | - Carmen Brás-Silva
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
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4
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Banaszkiewicz M, Gąsecka A, Darocha S, Florczyk M, Pietrasik A, Kędzierski P, Piłka M, Torbicki A, Kurzyna M. Circulating Blood-Based Biomarkers in Pulmonary Hypertension. J Clin Med 2022; 11:jcm11020383. [PMID: 35054082 PMCID: PMC8779219 DOI: 10.3390/jcm11020383] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/01/2022] [Accepted: 01/09/2022] [Indexed: 12/23/2022] Open
Abstract
Pulmonary hypertension (PH) is a serious hemodynamic condition, characterized by increased pulmonary vascular resistance (PVR), leading to right heart failure (HF) and death when not properly treated. The prognosis of PH depends on etiology, hemodynamic and biochemical parameters, as well as on response to specific treatment. Biomarkers appear to be useful noninvasive tools, providing information about the disease severity, treatment response, and prognosis. However, given the complexity of PH, it is impossible for a single biomarker to be adequate for the broad assessment of patients with different types of PH. The search for novel emerging biomarkers is still ongoing, resulting in a few potential biomarkers mirroring numerous pathophysiological courses. In this review, markers related to HF, myocardial remodeling, inflammation, hypoxia and tissue damage, and endothelial and pulmonary smooth muscle cell dysfunction are discussed in terms of diagnosis and prognosis. Extracellular vesicles and other markers with complex backgrounds are also reviewed. In conclusion, although many promising biomarkers have been identified and studied in recent years, there are still insufficient data on the application of multimarker strategies for monitoring and risk stratification in PH patients.
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Affiliation(s)
- Marta Banaszkiewicz
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, 05-400 Warsaw, Poland; (S.D.); (M.F.); (P.K.); (M.P.); (A.T.); (M.K.)
- Correspondence:
| | - Aleksandra Gąsecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.G.); (A.P.)
| | - Szymon Darocha
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, 05-400 Warsaw, Poland; (S.D.); (M.F.); (P.K.); (M.P.); (A.T.); (M.K.)
| | - Michał Florczyk
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, 05-400 Warsaw, Poland; (S.D.); (M.F.); (P.K.); (M.P.); (A.T.); (M.K.)
| | - Arkadiusz Pietrasik
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.G.); (A.P.)
| | - Piotr Kędzierski
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, 05-400 Warsaw, Poland; (S.D.); (M.F.); (P.K.); (M.P.); (A.T.); (M.K.)
| | - Michał Piłka
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, 05-400 Warsaw, Poland; (S.D.); (M.F.); (P.K.); (M.P.); (A.T.); (M.K.)
| | - Adam Torbicki
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, 05-400 Warsaw, Poland; (S.D.); (M.F.); (P.K.); (M.P.); (A.T.); (M.K.)
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, 05-400 Warsaw, Poland; (S.D.); (M.F.); (P.K.); (M.P.); (A.T.); (M.K.)
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5
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Yin X, Xin M, Ding S, Gao F, Wu F, Wang J, Chen J, Jiang L, Wu X, Wang X, Liu J, Zhang J, He S. Predictive role of perioperative neutrophil to lymphocyte ratio in pediatric congenital heart disease associated with pulmonary arterial hypertension. BMC Surg 2021; 21:3. [PMID: 33397333 PMCID: PMC7780205 DOI: 10.1186/s12893-020-01009-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 12/13/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND We aimed to explore the relationship between the neutrophil to lymphocyte ratio (NLR) and the early clinical outcomes in children with congenital heart disease (CHD) associated with pulmonary arterial hypertension (PAH) after cardiac surgery. METHODS A retrospective observational study involving 190 children from January 2013 to August 2019 was conducted. Perioperative clinical and biochemical data were collected. RESULTS We found that pre-operative NLR was significantly correlated with AST, STB, CR and UA (P < 0.05), while post-operative NLR was significantly correlated with ALT, AST, BUN (P < 0.05). Increased post-operative neutrophil count and NLR as well as decreased lymphocyte count could be observed after cardiac surgery (P < 0.05). Level of pre-operative NLR was significantly correlated with mechanical ventilation time, ICU stay time and total length of stay (P < 0.05), while level of post-operative NLR was only significantly correlated to the first two (P < 0.05). By using ROC curve analysis, relevant areas under the curve for predicting prolonged mechanical ventilation time beyond 24 h, 48 h and 72 h by NLR were statistically significant (P < 0.05). CONCLUSION For patients with CHD-PAH, NLR was closely related to early post-operative complications and clinical outcomes, and could act as a novel marker to predict the occurrence of prolonged mechanical ventilation.
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Affiliation(s)
- Xiaoqiang Yin
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
- North Sichuan Medical College, Nanchong, Sichuan, China
| | - Mei Xin
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
| | - Sheng Ding
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
| | - Feng Gao
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
| | - Fan Wu
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
| | - Jian Wang
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
| | - Jie Chen
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
| | - Li Jiang
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
| | - Xiaochen Wu
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
| | - Xianying Wang
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
- North Sichuan Medical College, Nanchong, Sichuan, China
| | - Jingzhen Liu
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
| | - Jinbao Zhang
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China.
- North Sichuan Medical College, Nanchong, Sichuan, China.
| | - Siyi He
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China.
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6
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Zi-yang Y, Kaixun Z, Dongling L, Zhou Y, Chengbin Z, Jimei C, Caojin Z. Carcinoembryonic antigen levels are increased with pulmonary output in pulmonary hypertension due to congenital heart disease. J Int Med Res 2020; 48:300060520964378. [PMID: 33203284 PMCID: PMC7683927 DOI: 10.1177/0300060520964378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/10/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Pulmonary artery hypertension (PAH) is a severe complication of congenital heart disease (CHD). Monitoring of pulmonary arterial pressure (PAP) and pulmonary vascular resistance (PVR) is essential during follow-up. This retrospective study aimed to examine carcinoembryonic antigen (CEA) as an additional marker for evaluation by investigating the correlation between CEA levels and hemodynamics in CHD-PAH. METHODS Seventy-six patients with CHD-PAH (mean PAP [mPAP] >25 mmHg and PVR >3 Wood units, group A), 71 patients with CHD and pulmonary hypertension (CHD-PH, mPAP >25 mmHg and PVR ≤3 Wood units, group B), and 102 patients with CHD without PH (mPAP ≤25 mmHg, group C) were enrolled. Serum CEA levels and the relationships between CEA levels and hemodynamic data were assessed. RESULTS Mean serum CEA levels were 1.99±1.61, 2.44±1.82, and 1.58±1.07 ng/mL, mPAP was 58.66±20.21, 30.2±4.83, and 17.31±4.51 mmHg, and PVR was 10.12±7.01, 2.19±0.56, and 2.2±1.1 Wood units in groups A, B, and C, respectively. Mean pulmonary output (PO) was 7.24±3.07, 15.79±5.49, 10.18±4.72 L/minute, respectively. CEA levels were positively correlated with PO and negatively correlated with PVR in all of the patients. CONCLUSION CEA levels are increased with PO and decreased with PVR in CHD-PH.
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Affiliation(s)
- Yang Zi-yang
- Southern Medical University, The Second School of Clinical Medicine, Guangzhou, China
- Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Guangdong Cardiovascular Institute, Guangzhou, China
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, China
| | - Zhao Kaixun
- Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Guangdong Cardiovascular Institute, Guangzhou, China
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Luo Dongling
- Guangdong General Hospital’s Nanhai Hospital, Foshan, China
| | - Yin Zhou
- Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Guangdong Cardiovascular Institute, Guangzhou, China
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, China
- South China University of echnology School of Medicine, Guangzhou, China
| | - Zhou Chengbin
- Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Guangdong Cardiovascular Institute, Guangzhou, China
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, China
| | - Chen Jimei
- Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Guangdong Cardiovascular Institute, Guangzhou, China
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, China
| | - Zhang Caojin
- Southern Medical University, The Second School of Clinical Medicine, Guangzhou, China
- Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Guangdong Cardiovascular Institute, Guangzhou, China
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, China
- Zhang Caojin, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No. 106 Zhong Shan Er Road, Yue Xiu District, Guangzhou, Guangdong 510080, China.
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7
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Geenen LW, Baggen VJM, van den Bosch AE, Eindhoven JA, Kauling RM, Cuypers JAAE, Roos-Hesselink JW, Boersma E. Prognostic value of C-reactive protein in adults with congenital heart disease. Heart 2020; 107:heartjnl-2020-316813. [PMID: 33060260 PMCID: PMC7925816 DOI: 10.1136/heartjnl-2020-316813] [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: 02/28/2020] [Revised: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND High-sensitivity C reactive protein (hs-CRP) has been associated with outcomes in adult congenital heart disease (ACHD). However, its prognostic value beyond N-terminal pro B type natriuretic peptide (NT-proBNP) or troponin T remains unknown. We studied the temporal evolution of hs-CRP, as well as the relation between hs-CRP and adverse clinical outcomes independent of NT-proBNP and troponin T in patients with ACHD. METHODS In this prospective cohort study, we enrolled 602 patients with ACHD (2011-2013) who underwent baseline and thereafter annual blood sampling during 4 years. Hs-CRP, hs-troponin T and NT-proBNP were measured. The primary endpoint was composed of death or heart failure (HF). Cox regression and Joint Modelling was used to relate 2log hs-CRP levels with the endpoint, with adjustment for baseline characteristics and (repeated) hs-troponin T and NT-proBNP measurements. RESULTS Hs-CRP was measured at baseline in 591 patients, median age 33 years, 58% men, 90% New York Heart Association I with an average of 4.3 measurements per patient. Median follow-up was 5.9 (IQR 5.3-6.3) years (99.2% complete) and 69 patients met the endpoint. Higher baseline hs-CRP was independently associated with higher risk of death or HF (HR 1.36, 95% CI 1.19 to 1.55). Hs-CRP increased over time prior to death or HF, and repeated hs-CRP measurements were associated with the endpoint, independent of repeated NT-proBNP and hs-troponin T (HR 1.54, 95% CI 1.24 to 1.98). CONCLUSIONS Hs-CRP carries incremental prognostic value for the risk of death or HF, beyond NT-proBNP and hs-troponin T. Hs-CRP increased prior to the occurrence of HF or death, supporting the role of inflammation in the clinical deterioration of patients with ACHD.
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Affiliation(s)
- Laurie W Geenen
- Cardiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Vivan J M Baggen
- Cardiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Jannet A Eindhoven
- Cardiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robert M Kauling
- Cardiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Judith A A E Cuypers
- Cardiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Eric Boersma
- Cardiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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8
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Arvanitaki A, Giannakoulas G, Baumgartner H, Lammers AE. Eisenmenger syndrome: diagnosis, prognosis and clinical management. Heart 2020; 106:1638-1645. [PMID: 32690623 DOI: 10.1136/heartjnl-2020-316665] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/01/2020] [Accepted: 06/04/2020] [Indexed: 12/11/2022] Open
Abstract
Eisenmenger syndrome (ES) represents the most severe phenotype of pulmonary arterial hypertension (PAH) associated with congenital heart disease (CHD) and occurs in patients with large unrepaired shunts. Despite early detection of CHD and major advances in paediatric cardiac surgery, ES is still prevalent and requires a multidisciplinary approach by adult CHD experts in tertiary centres. Central cyanosis is the primary clinical manifestation leading to secondary erythrocytosis and various multiorgan complications that increase morbidity and affect quality of life. Close follow-up is needed to early diagnose and timely manage these complications. The primary goal of care is to maintain patients' fragile stability. Although the recent use of advanced PAH therapies has substantially improved functional capacity and increased life expectancy, long-term survival remains poor. Progressive heart failure, infectious diseases and sudden cardiac death comprise the main causes of death in patients with ES. Impaired exercise tolerance, decreased arterial oxygen saturation, iron deficiency, pre-tricuspid shunts, arrhythmias, increased brain natriuretic peptide, echocardiographic indices of right ventricular dysfunction and hospitalisation for heart failure predict mortality. Endothelin receptor antagonists are used as first-line treatment in symptomatic patients, while phosphodiesterase-5 inhibitors may be added. Due to the lack of evidence, current guidelines do not provide a clear therapeutic strategy regarding treatment escalation. Additional well-designed trials are required to assess the comparative efficacy of various PAH agents and the benefit of combination therapy. Finally, the development of a risk score is of utmost importance to guide clinical therapy.
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Affiliation(s)
- Alexandra Arvanitaki
- Department of Cardiology III-Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Nordrhein-Westfalen, Germany.,1st Department of Cardiology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Giannakoulas
- 1st Department of Cardiology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Helmut Baumgartner
- Department of Cardiology III-Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Nordrhein-Westfalen, Germany
| | - Astrid Elisabeth Lammers
- Department of Cardiology III-Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Nordrhein-Westfalen, Germany .,Division of Paediatric Cardiology, University Hospital Muenster, Muenster, Germany
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9
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Carazo MR, Kolodziej MS, DeWitt ES, Kasparian NA, Newburger JW, Duarte VE, Singh MN, Opotowsky AR. Prevalence and Prognostic Association of a Clinical Diagnosis of Depression in Adult Congenital Heart Disease: Results of the Boston Adult Congenital Heart Disease Biobank. J Am Heart Assoc 2020; 9:e014820. [PMID: 32342722 PMCID: PMC7428586 DOI: 10.1161/jaha.119.014820] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background In adults with acquired heart disease, depression is common and associated with adverse outcomes. Depression may also be important in adults with congenital heart disease (CHD). Methods and Results We conducted a cohort study of outpatients with CHD, aged ≥18 years, enrolled in a prospective biobank between 2012 and 2017. Clinical data were extracted from medical records. Survival analysis assessed the relationship between depression, defined by a history of clinical diagnosis of major depression, with all‐cause mortality and a composite outcome of death or nonelective cardiovascular hospitalization. A total of 1146 patients were enrolled (age, 38.5±13.8 years; 49.6% women). Depression had been diagnosed in 219 (prevalence=19.1%), and these patients were more likely to have severely complex CHD (41.3% versus 33.7%; P=0.028), cyanosis (12.1% versus 5.7%; P=0.003), and worse functional class (≥II; 33.3% versus 20.4%; P<0.0001), and to be taking antidepressant medication at time of enrollment (68.5% versus 5.7%; P<0.0001). Depression was associated with biomarkers indicative of inflammation (hsCRP [high‐sensitivity C‐reactive protein], 1.71 [25th–75th percentile, 0.82–4.47] versus 1.10 [0.45–2.40]; P<0.0001) and heart failure (NT‐proBNP [N‐terminal pro‐B‐type natriuretic peptide], 190 [92–501] versus 111 [45–264]; P<0.0001). During follow‐up of 605±547 days, 137 participants (12.0%) experienced the composite outcome, including 33 deaths (2.9%). Depression was associated with increased risk for both all‐cause mortality (multivariable hazard ratio, 3.0; 95% CI, 1.4–6.4; P=0.005) and the composite outcome (multivariable hazard ratio, 1.6; 95% CI, 1.1–2.5; P=0.025), adjusting for age, sex, history of atrial arrhythmia, systolic ventricular function, CHD complexity, and corrected QT interval. Conclusions In adults with CHD, major depression is associated with impaired functional status, heart failure, systemic inflammation, and increased risk for adverse outcomes.
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Affiliation(s)
- Matthew R Carazo
- Department of Cardiology Boston Children's Hospital Boston MA.,Department of Medicine Brigham and Women's Hospital Boston MA.,Harvard Medical School Boston MA
| | - Meghan S Kolodziej
- Department of Psychiatry Brigham and Women's Hospital Boston MA.,Harvard Medical School Boston MA
| | | | - Nadine A Kasparian
- Department of Cardiology Boston Children's Hospital Boston MA.,Harvard Medical School Boston MA.,Discipline of Paediatrics School of Women's and Children's Health The University of New South Wales Sydney NSW Australia
| | | | - Valeria E Duarte
- Department of Cardiology Boston Children's Hospital Boston MA.,Department of Medicine Brigham and Women's Hospital Boston MA.,Harvard Medical School Boston MA
| | - Michael N Singh
- Department of Cardiology Boston Children's Hospital Boston MA.,Department of Medicine Brigham and Women's Hospital Boston MA.,Harvard Medical School Boston MA
| | - Alexander R Opotowsky
- Department of Cardiology Boston Children's Hospital Boston MA.,Department of Medicine Brigham and Women's Hospital Boston MA.,Harvard Medical School Boston MA
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10
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Opotowsky AR, Valente AM, Alshawabkeh L, Cheng S, Bradley A, Rimm EB, Landzberg MJ. Prospective cohort study of C-reactive protein as a predictor of clinical events in adults with congenital heart disease: results of the Boston adult congenital heart disease biobank. Eur Heart J 2019; 39:3253-3261. [PMID: 30010900 DOI: 10.1093/eurheartj/ehy362] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 06/06/2018] [Indexed: 02/07/2023] Open
Abstract
Aims Despite the well-defined association of high-sensitivity hsCRP with cardiovascular outcomes in apparently healthy adults and those with acquired heart disease, the relevance of this inflammatory marker in adults with congenital heart disease (ACHD) remains unclear. We aimed to examine the clinical correlates and prognostic value of high-sensitivity C-reactive protein levels in ACHD. Methods and results We conducted a prospective cohort study of (n = 707) outpatient ACHD (age 39 ± 14 years, 49% women), enrolled mainly at a referral centre, who had serum hsCRP measured in conjunction with a clinical assessment between 2012 and 2016. We analysed clinical correlates of hsCRP and its association with adverse events including the primary combined outcome of all-cause mortality or non-elective cardiovascular hospitalization. Higher hsCRP was strongly associated with measures of functional status including New York Heart Association class and peak V̇O2, and with comorbidities such as atrial arrhythmia. During average follow-up of 815 ± 536 days, 114 patients (16%) experienced the primary outcome, including 29 deaths. Having elevated hsCRP, in the highest (≥2.98 mg/L) compared with the lower three quartiles, conferred increased risk for the primary outcome [30.5% vs. 11.3%, adjusted hazard ratio (HR) = 2.00, 95% confidence interval (CI) 1.35-2.97; P = 0.0006] and all-cause mortality (11.9% vs. 1.5%, adjusted HR = 4.23, 95% CI 1.87-9.59; P = 0.0006). Elevated hsCRP was associated with adverse outcomes across ACHD subgroups and other patient characteristics. Conclusion Adults with congenital heart disease with elevated hsCRP have not only worse functional status and exercise capacity, but also greater risk for death or non-elective cardiovascular hospitalization. Further study is warranted to characterize the role of inflammation in the pathophysiology of ACHD.
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Affiliation(s)
- Alexander R Opotowsky
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, USA.,Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, USA
| | - Anne Marie Valente
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, USA.,Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, USA
| | - Laith Alshawabkeh
- Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, 200 West Arbor Drive, San Diego, CA, USA
| | - Susan Cheng
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, USA.,Framingham Heart Study, 73 Mount Wayte Avenue, Suite 2, Framingham, MA, USA
| | - Allison Bradley
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, USA
| | - Eric B Rimm
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue Boston, MA, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue Boston, MA, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, USA
| | - Michael J Landzberg
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, USA.,Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, USA
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11
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Kikuchi N, Satoh K, Satoh T, Yaoita N, Siddique MAH, Omura J, Kurosawa R, Nogi M, Sunamura S, Miyata S, Misu H, Saito Y, Shimokawa H. Diagnostic and Prognostic Significance of Serum Levels of SeP (Selenoprotein P) in Patients With Pulmonary Hypertension. Arterioscler Thromb Vasc Biol 2019; 39:2553-2562. [PMID: 31665907 DOI: 10.1161/atvbaha.119.313267] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Despite the recent progress in upfront combination therapy for pulmonary arterial hypertension (PAH), useful biomarkers for the disorder still remain to be developed. SeP (Selenoprotein P) is a glycoprotein secreted from various kinds of cells including pulmonary artery smooth muscle cells to maintain cellular metabolism. We have recently demonstrated that SeP production from pulmonary artery smooth muscle cells is upregulated and plays crucial roles in the pathogenesis of PAH. However, it remains to be elucidated whether serum SeP levels could be a useful biomarker for PAH. Approach and Results: We measured serum SeP levels and evaluated their prognostic impacts in 65 consecutive patients with PAH and 20 controls during follow-up (mean, 1520 days; interquartile range, 1393-1804 days). Serum SeP levels were measured using a newly developed sol particle homogeneous immunoassay. The patients with PAH showed significantly higher serum SeP levels compared with controls. Higher SeP levels (cutoff point, 3.47 mg/L) were associated with the outcome (composite end point of all-cause death and lung transplantation) in patients with PAH (hazard ratio, 4.85 [1.42-16.6]; P<0.01). Importantly, we found that the absolute change in SeP of patients with PAH (ΔSeP) in response to the initiation of PAH-specific therapy significantly correlated with the absolute change in mean pulmonary artery pressure, pulmonary vascular resistance (ΔPVR), and cardiac index (ΔCI; R=0.78, 0.76, and -0.71 respectively, all P<0.0001). Moreover, increase in ΔSeP during the follow-up predicted poor outcome of PAH. CONCLUSIONS Serum SeP is a novel biomarker for diagnosis and assessment of treatment efficacy and long-term prognosis in patients with PAH.
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Affiliation(s)
- Nobuhiro Kikuchi
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (N.K., K.S., T.S., N.Y., M.A.H.S., J.O., R.K., M.N., S.S., S.M., H.S.)
| | - Kimio Satoh
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (N.K., K.S., T.S., N.Y., M.A.H.S., J.O., R.K., M.N., S.S., S.M., H.S.)
| | - Taijyu Satoh
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (N.K., K.S., T.S., N.Y., M.A.H.S., J.O., R.K., M.N., S.S., S.M., H.S.)
| | - Nobuhiro Yaoita
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (N.K., K.S., T.S., N.Y., M.A.H.S., J.O., R.K., M.N., S.S., S.M., H.S.)
| | - Mohammad Abdul Hai Siddique
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (N.K., K.S., T.S., N.Y., M.A.H.S., J.O., R.K., M.N., S.S., S.M., H.S.)
| | - Junichi Omura
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (N.K., K.S., T.S., N.Y., M.A.H.S., J.O., R.K., M.N., S.S., S.M., H.S.)
| | - Ryo Kurosawa
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (N.K., K.S., T.S., N.Y., M.A.H.S., J.O., R.K., M.N., S.S., S.M., H.S.)
| | - Masamichi Nogi
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (N.K., K.S., T.S., N.Y., M.A.H.S., J.O., R.K., M.N., S.S., S.M., H.S.)
| | - Shinichiro Sunamura
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (N.K., K.S., T.S., N.Y., M.A.H.S., J.O., R.K., M.N., S.S., S.M., H.S.)
| | - Satoshi Miyata
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (N.K., K.S., T.S., N.Y., M.A.H.S., J.O., R.K., M.N., S.S., S.M., H.S.)
| | - Hirofumi Misu
- Department of Endocrinology and Metabolism, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan (H.M.)
| | - Yoshiro Saito
- Laboratory of Molecular and Biochemical Toxicology, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (Y.S.)
| | - Hiroaki Shimokawa
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (N.K., K.S., T.S., N.Y., M.A.H.S., J.O., R.K., M.N., S.S., S.M., H.S.)
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12
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Brida M, Gatzoulis MA. Pulmonary arterial hypertension in adult congenital heart disease. Heart 2018; 104:1568-1574. [DOI: 10.1136/heartjnl-2017-312106] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 04/10/2018] [Accepted: 04/16/2018] [Indexed: 11/04/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is commonly associated with congenital heart disease (CHD) and relates to type of the underlying cardiac defects and repair history. Large systemic to pulmonary shunts may develop PAH if untreated or repaired late. PAH, when present, markedly increases morbidity and mortality in patients with CHD. Significant progress has been made for patients with Eisenmenger syndrome in pathophysiology, prognostication and disease-targeting therapy (DTT), which needs to be applied to routine patient care. Patients with PAH–CHD and systemic to pulmonary shunting may benefit from late defect closure if pulmonary vascular resistance (PVR) is still normal or near normal. Patients with PAH and coincidental defects, or previous repair of CHD should be managed as those with idiopathic PAH. Patients with a Fontan circulation, despite not strictly fulfilling criteria for PAH, may have elevated PVR; recent evidence suggests that they may also benefit from DTT, but more data are required before general recommendations can be made. CHD–PAH is a lifelong, progressive disease; patients should receive tertiary care and benefit from a proactive DTT approach. Novel biomarkers and genetic advances may identify patients with CHD who should be referred for late defect closure and/or patients at high risk of developing PAH despite early closure in childhood. Ongoing vigilance for PAH and further controlled studies are clearly warranted in CHD.
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13
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Schuijt MTU, Blok IM, Zwinderman AH, van Riel ACMJ, Schuuring MJ, de Winter RJ, Duijnhouwer AL, van Dijk APJ, Mulder BJM, Bouma BJ. Mortality in pulmonary arterial hypertension due to congenital heart disease: Serial changes improve prognostication. Int J Cardiol 2017; 243:449-453. [PMID: 28606655 DOI: 10.1016/j.ijcard.2017.05.101] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 05/24/2017] [Accepted: 05/29/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Adult patients with pulmonary arterial hypertension due to congenital heart disease (PAH-CHD) suffer from high mortality. This underlines the importance of adequate risk stratification to guide treatment decisions. Several baseline parameters are associated with mortality, however, their prognostic value may weaken after years of follow-up. Therefore we investigated the prognostic value of serial changes in standard clinical parameters in PAH-CHD. METHODS In this prospective observational cohort study we included consecutive PAH-CHD adults, between 2005 and 2016. Control visits to the outpatient clinic were standardized, including functional, biochemical and echocardiographic tests, according to the guidelines. The prognostic value of serial changes was determined with time-dependent Cox regression. RESULTS Ninety-two patients with PAH-CHD were included (age 43±15years, 34% male, 38% Down, 73% Eisenmenger). During a median follow-up of 6.0 (IQR 3.7-9.3) years, 35 (38%) patients died. Serial changes in World Health Organization functional classification (WHO-FC, HR 18.34 for onset class IV), six-minute walk distance (6-MWD, HR 0.65 per 50m), oxygen saturation at peak exercise (peak SaO2, HR 0.74 per 5%), NTproBNP (HR 2.25 per 1000ng/l) and echocardiographic right ventricular function (TAPSE, HR 0.80 per 0.5cm) significantly predicted mortality. Moreover, serial changes in these parameters were more potent predictors compared to baseline parameters, based on reduction in -2 log likelihood. CONCLUSIONS Serial changes in standard clinical parameters have more prognostic value compared to baseline parameters in PAH-CHD. Our results emphasize the importance of screening for serial changes since periodical assessment could guide treatment decisions to delay disease progression.
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Affiliation(s)
- M T U Schuijt
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - I M Blok
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands; NL-HI - Netherlands Heart Institute, Utrecht, The Netherlands
| | - A H Zwinderman
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - A C M J van Riel
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands; NL-HI - Netherlands Heart Institute, Utrecht, The Netherlands
| | - M J Schuuring
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands; NL-HI - Netherlands Heart Institute, Utrecht, The Netherlands
| | - R J de Winter
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - A L Duijnhouwer
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A P J van Dijk
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - B J M Mulder
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands; NL-HI - Netherlands Heart Institute, Utrecht, The Netherlands
| | - B J Bouma
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
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14
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Rajpal S, Alshawabkeh L, Opotowsky AR. Current Role of Blood and Urine Biomarkers in the Clinical Care of Adults with Congenital Heart Disease. Curr Cardiol Rep 2017; 19:50. [DOI: 10.1007/s11886-017-0860-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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15
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Kempny A, Hjortshøj CS, Gu H, Li W, Opotowsky AR, Landzberg MJ, Jensen AS, Søndergaard L, Estensen ME, Thilén U, Budts W, Mulder BJ, Blok I, Tomkiewicz-Pająk L, Szostek K, D’Alto M, Scognamiglio G, Prokšelj K, Diller GP, Dimopoulos K, Wort SJ, Gatzoulis MA. Predictors of Death in Contemporary Adult Patients With Eisenmenger Syndrome. Circulation 2017; 135:1432-1440. [DOI: 10.1161/circulationaha.116.023033] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 12/06/2016] [Indexed: 11/16/2022]
Abstract
Background:
Eisenmenger syndrome is associated with substantial morbidity and mortality. There is no consensus, however, on mortality risk stratification. We aimed to investigate survival and predictors of death in a large, contemporary cohort of Eisenmenger syndrome patients.
Methods:
In a multicenter approach, we identified adults with Eisenmenger syndrome under follow-up between 2000 and 2015. We examined survival and its association with clinical, electrocardiographic, echocardiographic, and laboratory parameters.
Results:
We studied 1098 patients (median age, 34.4 years; range, 16.1–84.4 years; 65.1% female; 31.9% with Down syndrome). The majority had a posttricuspid defect (n=643, 58.6%), followed by patients with a complex (n=315, 28.7%) and pretricuspid lesion (n=140, 12.7%). Over a median follow-up of 3.1 years (interquartile range, 1.4–5.9), allowing for 4361.6 patient-years observation, 278 patients died and 6 underwent transplantation. Twelve parameters emerged as significant predictors of death on univariable analysis. On multivariable Cox regression analysis, only age (hazard ratio [HR], 1.41/10 years; 95% confidence interval [CI], 1.24–1.59;
P
<0.001), pretricuspid shunt (HR, 1.56; 95% CI, 1.02–2.39;
P
=0.041), oxygen saturation at rest (HR, 0.53/10%; 95% CI, 0.43–0.65;
P
<0.001), presence of sinus rhythm (HR, 0.53; 95% CI, 0.32–0.88;
P
=0.013), and presence of pericardial effusion (HR, 2.41; 95% CI, 1.59–3.66;
P
<0.001) remained significant predictors of death.
Conclusions:
There is significant premature mortality among contemporary adults with Eisenmenger syndrome. We report, herewith, a multivariable mortality risk stratification model based on 5 simple, noninvasive predictors of death in this population.
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Affiliation(s)
- Aleksander Kempny
- From Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, National Heart and Lung Institute, Biomedical Research Unit, Royal Brompton Hospital, Imperial College, London, UK (A.K., W.L., G.-P.D., K.D., S.T.W., M.A.G.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (C.S.H., A.S.J., L.S.); Beijing Anzhen Hospital, Capital Medical University, China (G.H.); Boston Adult Congenital Heart and Pulmonary Hypertension Service, Boston Children’s Hospital and Brigham and
| | - Cristel Sørensen Hjortshøj
- From Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, National Heart and Lung Institute, Biomedical Research Unit, Royal Brompton Hospital, Imperial College, London, UK (A.K., W.L., G.-P.D., K.D., S.T.W., M.A.G.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (C.S.H., A.S.J., L.S.); Beijing Anzhen Hospital, Capital Medical University, China (G.H.); Boston Adult Congenital Heart and Pulmonary Hypertension Service, Boston Children’s Hospital and Brigham and
| | - Hong Gu
- From Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, National Heart and Lung Institute, Biomedical Research Unit, Royal Brompton Hospital, Imperial College, London, UK (A.K., W.L., G.-P.D., K.D., S.T.W., M.A.G.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (C.S.H., A.S.J., L.S.); Beijing Anzhen Hospital, Capital Medical University, China (G.H.); Boston Adult Congenital Heart and Pulmonary Hypertension Service, Boston Children’s Hospital and Brigham and
| | - Wei Li
- From Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, National Heart and Lung Institute, Biomedical Research Unit, Royal Brompton Hospital, Imperial College, London, UK (A.K., W.L., G.-P.D., K.D., S.T.W., M.A.G.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (C.S.H., A.S.J., L.S.); Beijing Anzhen Hospital, Capital Medical University, China (G.H.); Boston Adult Congenital Heart and Pulmonary Hypertension Service, Boston Children’s Hospital and Brigham and
| | - Alexander R. Opotowsky
- From Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, National Heart and Lung Institute, Biomedical Research Unit, Royal Brompton Hospital, Imperial College, London, UK (A.K., W.L., G.-P.D., K.D., S.T.W., M.A.G.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (C.S.H., A.S.J., L.S.); Beijing Anzhen Hospital, Capital Medical University, China (G.H.); Boston Adult Congenital Heart and Pulmonary Hypertension Service, Boston Children’s Hospital and Brigham and
| | - Michael J. Landzberg
- From Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, National Heart and Lung Institute, Biomedical Research Unit, Royal Brompton Hospital, Imperial College, London, UK (A.K., W.L., G.-P.D., K.D., S.T.W., M.A.G.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (C.S.H., A.S.J., L.S.); Beijing Anzhen Hospital, Capital Medical University, China (G.H.); Boston Adult Congenital Heart and Pulmonary Hypertension Service, Boston Children’s Hospital and Brigham and
| | - Annette Schophuus Jensen
- From Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, National Heart and Lung Institute, Biomedical Research Unit, Royal Brompton Hospital, Imperial College, London, UK (A.K., W.L., G.-P.D., K.D., S.T.W., M.A.G.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (C.S.H., A.S.J., L.S.); Beijing Anzhen Hospital, Capital Medical University, China (G.H.); Boston Adult Congenital Heart and Pulmonary Hypertension Service, Boston Children’s Hospital and Brigham and
| | - Lars Søndergaard
- From Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, National Heart and Lung Institute, Biomedical Research Unit, Royal Brompton Hospital, Imperial College, London, UK (A.K., W.L., G.-P.D., K.D., S.T.W., M.A.G.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (C.S.H., A.S.J., L.S.); Beijing Anzhen Hospital, Capital Medical University, China (G.H.); Boston Adult Congenital Heart and Pulmonary Hypertension Service, Boston Children’s Hospital and Brigham and
| | - Mette-Elise Estensen
- From Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, National Heart and Lung Institute, Biomedical Research Unit, Royal Brompton Hospital, Imperial College, London, UK (A.K., W.L., G.-P.D., K.D., S.T.W., M.A.G.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (C.S.H., A.S.J., L.S.); Beijing Anzhen Hospital, Capital Medical University, China (G.H.); Boston Adult Congenital Heart and Pulmonary Hypertension Service, Boston Children’s Hospital and Brigham and
| | - Ulf Thilén
- From Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, National Heart and Lung Institute, Biomedical Research Unit, Royal Brompton Hospital, Imperial College, London, UK (A.K., W.L., G.-P.D., K.D., S.T.W., M.A.G.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (C.S.H., A.S.J., L.S.); Beijing Anzhen Hospital, Capital Medical University, China (G.H.); Boston Adult Congenital Heart and Pulmonary Hypertension Service, Boston Children’s Hospital and Brigham and
| | - Werner Budts
- From Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, National Heart and Lung Institute, Biomedical Research Unit, Royal Brompton Hospital, Imperial College, London, UK (A.K., W.L., G.-P.D., K.D., S.T.W., M.A.G.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (C.S.H., A.S.J., L.S.); Beijing Anzhen Hospital, Capital Medical University, China (G.H.); Boston Adult Congenital Heart and Pulmonary Hypertension Service, Boston Children’s Hospital and Brigham and
| | - Barbara J. Mulder
- From Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, National Heart and Lung Institute, Biomedical Research Unit, Royal Brompton Hospital, Imperial College, London, UK (A.K., W.L., G.-P.D., K.D., S.T.W., M.A.G.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (C.S.H., A.S.J., L.S.); Beijing Anzhen Hospital, Capital Medical University, China (G.H.); Boston Adult Congenital Heart and Pulmonary Hypertension Service, Boston Children’s Hospital and Brigham and
| | - Ilja Blok
- From Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, National Heart and Lung Institute, Biomedical Research Unit, Royal Brompton Hospital, Imperial College, London, UK (A.K., W.L., G.-P.D., K.D., S.T.W., M.A.G.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (C.S.H., A.S.J., L.S.); Beijing Anzhen Hospital, Capital Medical University, China (G.H.); Boston Adult Congenital Heart and Pulmonary Hypertension Service, Boston Children’s Hospital and Brigham and
| | - Lidia Tomkiewicz-Pająk
- From Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, National Heart and Lung Institute, Biomedical Research Unit, Royal Brompton Hospital, Imperial College, London, UK (A.K., W.L., G.-P.D., K.D., S.T.W., M.A.G.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (C.S.H., A.S.J., L.S.); Beijing Anzhen Hospital, Capital Medical University, China (G.H.); Boston Adult Congenital Heart and Pulmonary Hypertension Service, Boston Children’s Hospital and Brigham and
| | - Kamil Szostek
- From Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, National Heart and Lung Institute, Biomedical Research Unit, Royal Brompton Hospital, Imperial College, London, UK (A.K., W.L., G.-P.D., K.D., S.T.W., M.A.G.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (C.S.H., A.S.J., L.S.); Beijing Anzhen Hospital, Capital Medical University, China (G.H.); Boston Adult Congenital Heart and Pulmonary Hypertension Service, Boston Children’s Hospital and Brigham and
| | - Michele D’Alto
- From Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, National Heart and Lung Institute, Biomedical Research Unit, Royal Brompton Hospital, Imperial College, London, UK (A.K., W.L., G.-P.D., K.D., S.T.W., M.A.G.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (C.S.H., A.S.J., L.S.); Beijing Anzhen Hospital, Capital Medical University, China (G.H.); Boston Adult Congenital Heart and Pulmonary Hypertension Service, Boston Children’s Hospital and Brigham and
| | - Giancarlo Scognamiglio
- From Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, National Heart and Lung Institute, Biomedical Research Unit, Royal Brompton Hospital, Imperial College, London, UK (A.K., W.L., G.-P.D., K.D., S.T.W., M.A.G.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (C.S.H., A.S.J., L.S.); Beijing Anzhen Hospital, Capital Medical University, China (G.H.); Boston Adult Congenital Heart and Pulmonary Hypertension Service, Boston Children’s Hospital and Brigham and
| | - Katja Prokšelj
- From Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, National Heart and Lung Institute, Biomedical Research Unit, Royal Brompton Hospital, Imperial College, London, UK (A.K., W.L., G.-P.D., K.D., S.T.W., M.A.G.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (C.S.H., A.S.J., L.S.); Beijing Anzhen Hospital, Capital Medical University, China (G.H.); Boston Adult Congenital Heart and Pulmonary Hypertension Service, Boston Children’s Hospital and Brigham and
| | - Gerhard-Paul Diller
- From Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, National Heart and Lung Institute, Biomedical Research Unit, Royal Brompton Hospital, Imperial College, London, UK (A.K., W.L., G.-P.D., K.D., S.T.W., M.A.G.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (C.S.H., A.S.J., L.S.); Beijing Anzhen Hospital, Capital Medical University, China (G.H.); Boston Adult Congenital Heart and Pulmonary Hypertension Service, Boston Children’s Hospital and Brigham and
| | - Konstantinos Dimopoulos
- From Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, National Heart and Lung Institute, Biomedical Research Unit, Royal Brompton Hospital, Imperial College, London, UK (A.K., W.L., G.-P.D., K.D., S.T.W., M.A.G.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (C.S.H., A.S.J., L.S.); Beijing Anzhen Hospital, Capital Medical University, China (G.H.); Boston Adult Congenital Heart and Pulmonary Hypertension Service, Boston Children’s Hospital and Brigham and
| | - Stephen J. Wort
- From Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, National Heart and Lung Institute, Biomedical Research Unit, Royal Brompton Hospital, Imperial College, London, UK (A.K., W.L., G.-P.D., K.D., S.T.W., M.A.G.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (C.S.H., A.S.J., L.S.); Beijing Anzhen Hospital, Capital Medical University, China (G.H.); Boston Adult Congenital Heart and Pulmonary Hypertension Service, Boston Children’s Hospital and Brigham and
| | - Michael A. Gatzoulis
- From Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, National Heart and Lung Institute, Biomedical Research Unit, Royal Brompton Hospital, Imperial College, London, UK (A.K., W.L., G.-P.D., K.D., S.T.W., M.A.G.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (C.S.H., A.S.J., L.S.); Beijing Anzhen Hospital, Capital Medical University, China (G.H.); Boston Adult Congenital Heart and Pulmonary Hypertension Service, Boston Children’s Hospital and Brigham and
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Idiopathic Pulmonary Arterial Hypertension in Children: A Review. Pulm Ther 2017. [DOI: 10.1007/s41030-017-0035-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Abstract
OBJECTIVE The present study aims to identify the role of inflammatory markers such as C-reactive protein, interleukin-6, and fractalkine in CHD-associated pulmonary hypertension in children. METHODS This is a prospective review of 37 children with CHD-related pulmonary hypertension, 21 children with congenital heart defects, and 22 healthy children. RESULTS Serum C-reactive protein and interleukin-6 levels were significantly higher in the children with CHD-related pulmonary hypertension (respectively, p=0.049 and 0.026). Serum C-reactive protein concentrations correlated negatively with ejection fraction (r=-0.609, p=0.001) and fractional shortening (r=-0.452, p=0.007) in the pulmonary hypertension group. Serum fractalkine concentrations correlated negatively with ejection fraction (r=-0.522, p=0.002) and fractional shortening (r=-0.395, p=0.021) in the children with pulmonary hypertension. Serum interleukin-6 concentrations also correlated negatively with Qs (r=-0.572, p=0.021), positively with Rs (r=0.774, p=0.001), and positively with pulmonary wedge pressure (r=0.796, p=0.006) in the pulmonary hypertension group. A cut-off value of 2.2 IU/L for C-reactive protein was able to predict pulmonary hypertension with 77.5% sensitivity and 77.5% specificity. When the cut-off point for interleukin-6 concentration was 57.5 pg/ml, pulmonary hypertension could be predicted with 80% sensitivity and 75% specificity. CONCLUSION Inflammation is associated with the pathophysiology of pulmonary hypertension. The inflammatory markers C-reactive protein and interleukin-6 may have a role in the clinical evaluation of paediatric pulmonary hypertension related to CHDs.
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The role of cystatin C as a biomarker for prognosis in pulmonary arterial hypertension due to congenital heart disease. Int J Cardiol 2016; 209:242-7. [DOI: 10.1016/j.ijcard.2016.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 01/23/2016] [Accepted: 02/01/2016] [Indexed: 11/16/2022]
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Zhang L, Zhao S, Ma J, Gong J, Qiu G, Ren Y, Zen Y, Shi Y. Prevalence and risk factors for pulmonary arterial hypertension in end-stage renal disease patients undergoing continuous ambulatory peritoneal dialysis. Ren Fail 2016; 38:815-21. [PMID: 26888091 DOI: 10.3109/0886022x.2015.1103637] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is a major complication in renal failure patients, but very little information is available on the cardiovascular parameters in these patients. The prevalence and risk factors for PAH were systematically evaluated in patients with end-stage renal diseases (ESRD) undergoing continuous ambulatory peritoneal dialysis (CAPD). METHODS Between January 2010 and January 2014, 177 ESRD patients (85 males and 92 females) undergoing CAPD therapy were recruited. General data, biochemical parameters and echocardiographic findings were collected and PAH risk factors studied. RESULTS Study participants consisted of 65 patients (36.52%) with PAH (PAH group) and 112 patients without PAH (non-PAH group). The interdialytic weight gain, systolic blood pressure and diastolic blood pressure (DBP), mean arterial pressure and hypertensive nephropathy incidence in the PAH group were significantly higher than the non-PAH group (all p < 0.05). There were significant differences between PAH group and non-PAH group in C-reactive protein-positive rate, N-terminal pro-brain natriuretic peptide (NT-proBNP), hemoglobin, prealbumin and serum albumin levels (all p < 0.05). Compared with non-PAH group, PAH group showed significant increases in right ventricular internal diameter (RVID), right ventricular outflow tract diameter (RVOTD), main pulmonary artery diameter, left atrial diameter (LAD), left ventricular end-diastolic diameter, interventricular septal thickness, left ventricular mass index, early diastolic mitral annulus velocity and valve calcification incidence (all p < 0.05), and decreased left ventricular ejection fraction (LVEF), tricuspid annulus plane systolic excursion (TAPSE) and early diastolic blood flow peak and mitral annulus velocity (E/E') (all p < 0.05). Logistic regression analysis revealed that DBP, NT-proBNP, LAD, RVID, RVOTD, LVEF, TAPSE and E/E' are major risk factors for PAH. CONCLUSION We observed a high incidence of PAH in ESRD patients undergoing CAPD. Logistic regression analysis revealed that DBP, NT-proBNP, LAD, RVID, RVOTD, LVEF, TAPSE and E/E' are high-risk factors for PAH in ESRD patients undergoing CAPD.
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Affiliation(s)
- Lei Zhang
- a Department of Nephrology , People's Hospital of Linyi, Linyi, China, People's Hospital of Linyi , Linyi , China
| | - Shiqi Zhao
- a Department of Nephrology , People's Hospital of Linyi, Linyi, China, People's Hospital of Linyi , Linyi , China
| | - Jinling Ma
- a Department of Nephrology , People's Hospital of Linyi, Linyi, China, People's Hospital of Linyi , Linyi , China
| | | | - Guizhen Qiu
- c Department of Endocrinology , People's Hospital of Linyi , Linyi , China , and
| | - Yueqin Ren
- a Department of Nephrology , People's Hospital of Linyi, Linyi, China, People's Hospital of Linyi , Linyi , China
| | - Ying Zen
- d Department of Nephrology , The Second Affiliated Hospital of Soochow University , Suzhou , China
| | - Yongbing Shi
- d Department of Nephrology , The Second Affiliated Hospital of Soochow University , Suzhou , China
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Blok IM, van Riel AC, Mulder BJ, Bouma BJ. Management of patients with pulmonary arterial hypertension due to congenital heart disease: recent advances and future directions. Expert Rev Cardiovasc Ther 2015; 13:1377-92. [DOI: 10.1586/14779072.2015.1101341] [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] [Indexed: 12/12/2022]
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