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Oldham WM, Hemnes AR, Aldred MA, Barnard J, Brittain EL, Chan SY, Cheng F, Cho MH, Desai AA, Garcia JGN, Geraci MW, Ghiassian SD, Hall KT, Horn EM, Jain M, Kelly RS, Leopold JA, Lindstrom S, Modena BD, Nichols WC, Rhodes CJ, Sun W, Sweatt AJ, Vanderpool RR, Wilkins MR, Wilmot B, Zamanian RT, Fessel JP, Aggarwal NR, Loscalzo J, Xiao L. NHLBI-CMREF Workshop Report on Pulmonary Vascular Disease Classification: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 77:2040-2052. [PMID: 33888254 PMCID: PMC8065203 DOI: 10.1016/j.jacc.2021.02.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/16/2021] [Accepted: 02/22/2021] [Indexed: 12/12/2022]
Abstract
The National Heart, Lung, and Blood Institute and the Cardiovascular Medical Research and Education Fund held a workshop on the application of pulmonary vascular disease omics data to the understanding, prevention, and treatment of pulmonary vascular disease. Experts in pulmonary vascular disease, omics, and data analytics met to identify knowledge gaps and formulate ideas for future research priorities in pulmonary vascular disease in line with National Heart, Lung, and Blood Institute Strategic Vision goals. The group identified opportunities to develop analytic approaches to multiomic datasets, to identify molecular pathways in pulmonary vascular disease pathobiology, and to link novel phenotypes to meaningful clinical outcomes. The committee suggested support for interdisciplinary research teams to develop and validate analytic methods, a national effort to coordinate biosamples and data, a consortium of preclinical investigators to expedite target evaluation and drug development, longitudinal assessment of molecular biomarkers in clinical trials, and a task force to develop a master clinical trials protocol for pulmonary vascular disease.
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Affiliation(s)
- William M Oldham
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
| | - Anna R Hemnes
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - John Barnard
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Evan L Brittain
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephen Y Chan
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Division of Cardiology, Department of Medicine, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Feixiong Cheng
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael H Cho
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ankit A Desai
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Mark W Geraci
- Department of Medicine, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Kathryn T Hall
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Evelyn M Horn
- Weill Cornell Medical Center, New York, New York, USA
| | - Mohit Jain
- University of California at San Diego, San Diego, California, USA
| | - Rachel S Kelly
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jane A Leopold
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - William C Nichols
- Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | - Wei Sun
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Division of Cardiology, Department of Medicine, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Andrew J Sweatt
- Stanford University School of Medicine, Stanford, California, USA
| | - Rebecca R Vanderpool
- Department of Medicine, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Beth Wilmot
- Division of Geriatrics and Clinical Gerontology, National Institute on Aging and the School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Roham T Zamanian
- Stanford University School of Medicine, Stanford, California, USA
| | - Joshua P Fessel
- Division of Lung Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Neil R Aggarwal
- Division of Lung Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Joseph Loscalzo
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Lei Xiao
- Division of Lung Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
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2
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Stam K, Clauss S, Taverne YJHJ, Merkus D. Chronic Thromboembolic Pulmonary Hypertension - What Have We Learned From Large Animal Models. Front Cardiovasc Med 2021; 8:574360. [PMID: 33937352 PMCID: PMC8085273 DOI: 10.3389/fcvm.2021.574360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 03/08/2021] [Indexed: 12/21/2022] Open
Abstract
Chronic thrombo-embolic pulmonary hypertension (CTEPH) develops in a subset of patients after acute pulmonary embolism. In CTEPH, pulmonary vascular resistance, which is initially elevated due to the obstructions in the larger pulmonary arteries, is further increased by pulmonary microvascular remodeling. The increased afterload of the right ventricle (RV) leads to RV dilation and hypertrophy. This RV remodeling predisposes to arrhythmogenesis and RV failure. Yet, mechanisms involved in pulmonary microvascular remodeling, processes underlying the RV structural and functional adaptability in CTEPH as well as determinants of the susceptibility to arrhythmias such as atrial fibrillation in the context of CTEPH remain incompletely understood. Several large animal models with critical clinical features of human CTEPH and subsequent RV remodeling have relatively recently been developed in swine, sheep, and dogs. In this review we will discuss the current knowledge on the processes underlying development and progression of CTEPH, and on how animal models can help enlarge understanding of these processes.
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Affiliation(s)
- Kelly Stam
- Department of Cardiology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Sebastian Clauss
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University Munich, Munich, Germany.,Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital, LMU Munich, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich, Munich Heart Alliance, Munich, Germany
| | - Yannick J H J Taverne
- Department of Cardiothoracic Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Daphne Merkus
- Department of Cardiology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands.,Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital, LMU Munich, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich, Munich Heart Alliance, Munich, Germany
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3
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Tello K, Dalmer A, Vanderpool R, Ghofrani HA, Naeije R, Roller F, Seeger W, Wiegand M, Gall H, Richter MJ. Right ventricular function correlates of right atrial strain in pulmonary hypertension: a combined cardiac magnetic resonance and conductance catheter study. Am J Physiol Heart Circ Physiol 2020; 318:H156-H164. [DOI: 10.1152/ajpheart.00485.2019] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The functional relevance of right atrial (RA) function in pulmonary hypertension (PH) remains incompletely understood. The purpose of this study was to explore the correlation of cardiac magnetic resonance (CMR) feature tracking-derived RA phasic function with invasively measured pressure-volume (P-V) loop-derived right ventricular (RV) end-diastolic elastance ( Eed) and RV-arterial coupling [ratio of end-systolic elastance to arterial elastance ( Ees/ Ea)]. In 54 patients with severe PH, CMR was performed within 24 h of diagnostic right heart catheterization and P-V measurements. RA phasic function was assessed by CMR imaging of RA reservoir, passive, and active strain. The association of RA phasic function with indexes of RV function was evaluated by Spearman’s rank correlation and linear regression analyses. Median [interquartile range] RA reservoir strain, passive strain, and active strain were 19.5% [11.0–24.5], 7.0% [4.0–12.0], and 13.0% [7.0–18.5], respectively. Ees/ Ea was 0.73 [0.48–1.08], and Eed was 0.14 mmHg/mL [0.05–0.22]. RV diastolic impairment [RV end-diastolic pressure (EDP) and Eed] was correlated with RA phasic function, but Ea and Ees were not. In addition, RA phasic function was correlated with inferior vena cava diameter. In multivariate linear regression analysis, adjusting for key P-V loop indexes, Eed and EDP remained significantly associated with RA phasic function. We conclude that RA phasic function is altered in relation to impaired diastolic function of the chronically overloaded right ventricle and contributes to backward venous flow and systemic congestion. These results call for more attention to RA function in the management of patients with PH. NEW & NOTEWORTHY There is growing awareness of the importance of the right atrial (RA)-right ventricular (RV) axis in pulmonary hypertension (PH). Our results uncover alterations in RA phasic function that are related to depressed RV lusitropic function and contribute to backward venous return and systemic congestion in chronic RV overload. Assessment of RA function should be part of the management and follow-up of patients with PH.
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Affiliation(s)
- Khodr Tello
- Department of Internal Medicine, Justus Liebig University Giessen, Universities of Giessen and Marburg Lung Center, German Center for Lung Research, Giessen, Germany
| | - Antonia Dalmer
- Department of Internal Medicine, Justus Liebig University Giessen, Universities of Giessen and Marburg Lung Center, German Center for Lung Research, Giessen, Germany
| | - Rebecca Vanderpool
- Division of Translational and Regenerative Medicine, University of Arizona, Tucson, Arizona
| | - Hossein A. Ghofrani
- Department of Internal Medicine, Justus Liebig University Giessen, Universities of Giessen and Marburg Lung Center, German Center for Lung Research, Giessen, Germany
- Department of Pneumology, Kerckhoff Heart, Rheuma and Thoracic Center, Bad Nauheim, Germany
- Department of Medicine, Imperial College London, London, United Kingdom
| | | | - Fritz Roller
- Department of Radiology, Justus Liebig University Giessen, Universities of Giessen and Marburg Lung Center, German Center for Lung Research, Giessen, Germany
| | - Werner Seeger
- Department of Internal Medicine, Justus Liebig University Giessen, Universities of Giessen and Marburg Lung Center, German Center for Lung Research, Giessen, Germany
| | - Merle Wiegand
- Department of Internal Medicine, Justus Liebig University Giessen, Universities of Giessen and Marburg Lung Center, German Center for Lung Research, Giessen, Germany
| | - Henning Gall
- Department of Internal Medicine, Justus Liebig University Giessen, Universities of Giessen and Marburg Lung Center, German Center for Lung Research, Giessen, Germany
| | - Manuel J. Richter
- Department of Internal Medicine, Justus Liebig University Giessen, Universities of Giessen and Marburg Lung Center, German Center for Lung Research, Giessen, Germany
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Stam K, Cai Z, van der Velde N, van Duin R, Lam E, van der Velden J, Hirsch A, Duncker DJ, Merkus D. Cardiac remodelling in a swine model of chronic thromboembolic pulmonary hypertension: comparison of right vs. left ventricle. J Physiol 2019; 597:4465-4480. [PMID: 31194256 PMCID: PMC6852085 DOI: 10.1113/jp277896] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 06/07/2019] [Indexed: 12/11/2022] Open
Abstract
KEY POINTS Right ventricle (RV) function is the most important determinant of survival and quality of life in patients with chronic thromboembolic pulmonary hypertension (CTEPH). The changes in right and left ventricle gene expression that contribute to ventricular remodelling are incompletely investigated. RV remodelling in our CTEPH swine model is associated with increased expression of the genes involved in inflammation (TGFβ), oxidative stress (ROCK2, NOX1 and NOX4), and apoptosis (BCL2 and caspase-3). Alterations in ROCK2 expression correlated inversely with RV contractile reserve during exercise. Since ROCK2 has been shown to be involved in hypertrophy, oxidative stress, fibrosis and endothelial dysfunction, ROCK2 inhibition may present a viable therapeutic target in CTEPH. ABSTRACT Right ventricle (RV) function is the most important determinant of survival and quality of life in patients with chronic thromboembolic pulmonary hypertension (CTEPH). The present study investigated whether the increased cardiac afterload is associated with (i) cardiac remodelling and hypertrophic signalling; (ii) changes in angiogenic factors and capillary density; and (iii) inflammatory changes associated with oxidative stress and interstitial fibrosis. CTEPH was induced in eight chronically instrumented swine by chronic nitric oxide synthase inhibition and up to five weekly pulmonary embolizations. Nine healthy swine served as a control. After 9 weeks, RV function was assessed by single beat analysis of RV-pulmonary artery (PA) coupling at rest and during exercise, as well as by cardiac magnetic resonance imaging. Subsequently, the heart was excised and RV and left ventricle (LV) tissues were processed for molecular and histological analyses. Swine with CTEPH exhibited significant RV hypertrophy in response to the elevated PA pressure. RV-PA coupling was significantly reduced, correlated inversely with pulmonary vascular resistance and did not increase during exercise in CTEPH swine. Expression of genes associated with hypertrophy (BNP), inflammation (TGFβ), oxidative stress (ROCK2, NOX1 and NOX4), apoptosis (BCL2 and caspase-3) and angiogenesis (VEGFA) were increased in the RV of CTEPH swine and correlated inversely with RV-PA coupling during exercise. In the LV, only significant changes in ROCK2 gene-expression occurred. In conclusion, RV remodelling in our CTEPH swine model is associated with increased expression of genes involved in inflammation and oxidative stress, suggesting that these processes contribute to RV remodelling and dysfunction in CTEPH and hence represent potential therapeutic targets.
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Affiliation(s)
- Kelly Stam
- Department of Cardiology, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Zongye Cai
- Department of Cardiology, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Nikki van der Velde
- Department of Cardiology, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Richard van Duin
- Department of Cardiology, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Esther Lam
- Department of Cardiology, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Jolanda van der Velden
- Amsterdam UMCVrije Universiteit Amsterdam, Physiology, Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
| | - Alexander Hirsch
- Department of Cardiology, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Dirk J Duncker
- Department of Cardiology, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Daphne Merkus
- Department of Cardiology, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
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5
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Cai Z, van Duin RWB, Stam K, Uitterdijk A, van der Velden J, Vonk Noordegraaf A, Duncker DJ, Merkus D. Right ventricular oxygen delivery as a determinant of right ventricular functional reserve during exercise in juvenile swine with chronic pulmonary hypertension. Am J Physiol Heart Circ Physiol 2019; 317:H840-H850. [PMID: 31398061 DOI: 10.1152/ajpheart.00130.2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Assessing right ventricular (RV) functional reserve is important for determining clinical status and prognosis in patients with pulmonary hypertension (PH). In this study, we aimed to establish RV oxygen (O2) delivery as a determinant for RV functional reserve during exercise in swine with chronic PH. Chronic PH was induced by pulmonary vein banding (PVB), with sham operation serving as control. RV function and RV O2 delivery were measured over time in chronically instrumented swine, up to 12 wk after PVB at rest and during exercise. At rest, RV afterload (pulmonary artery pressure and arterial elastance) and contractility (Ees and dP/dtmax) were higher in PH compared with control with preserved cardiac index and RV O2 delivery. However, RV functional reserve, as measured by the exercise-induced relative change (Δ) in cardiac index, dP/dtmax, and end-systolic elastance (Ees), was decreased in PH, and RV pulmonary arterial coupling was lower both at rest and during exercise in PH. Furthermore, the increase in RV O2 delivery was attenuated in PH during exercise principally due to a lower systolic coronary blood flow in combination with an attenuated increase in aorta pressure while arterial O2 content was not significantly altered in PH. Moreover, RV O2 delivery reserve correlated with RV functional reserve, Δcardiac index (r2 = 0.85), ΔdP/dtmax (r2 = 0.49), and ΔEes (r2 = 0.70), all P < 0.05. The inability to sufficiently increase RV O2 supply to meet the increased O2 demand during exercise is principally due to the reduced RV perfusion relative to healthy control values and likely contributes to impaired RV contractile function and thereby to the limited exercise capacity that is commonly observed in patients with PH.NEW & NOTEWORTHY Impaired right ventricular (RV) O2 delivery reserve is associated with reduced RV functional reserve during exercise in a swine model of pulmonary hypertension (PH) induced by pulmonary vein banding. Our data suggest that RV function and exercise capacity might be improved by improving RV O2 delivery.
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Affiliation(s)
- Zongye Cai
- Experimental Cardiology, Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Richard W B van Duin
- Experimental Cardiology, Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Kelly Stam
- Experimental Cardiology, Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - André Uitterdijk
- Experimental Cardiology, Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jolanda van der Velden
- Department of Physiology, Amsterdam University Medical Center, VU University, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Anton Vonk Noordegraaf
- Department of Pulmonology, Amsterdam University Medical Center, VU University, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Dirk J Duncker
- Experimental Cardiology, Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Daphne Merkus
- Experimental Cardiology, Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Validation of 4D flow CMR against simultaneous invasive hemodynamic measurements: a swine study. Int J Cardiovasc Imaging 2019; 35:1111-1118. [PMID: 30963352 PMCID: PMC6534524 DOI: 10.1007/s10554-019-01593-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/28/2019] [Indexed: 12/25/2022]
Abstract
The purpose of this study was to compare invasively measured aorta flow with 2D phase contrast flow and 4D flow measurements by cardiovascular magnetic resonance (CMR) imaging in a large animal model. Nine swine (mean weight 63 ± 4 kg) were included in the study. 4D flow CMR exams were performed on a 1.5T MRI scanner. Flow measurements were performed on 4D flow images at the aortic valve level, in the ascending aorta, and main pulmonary artery. Simultaneously, flow was measured using an invasive flow probe, placed around the ascending aorta. Additionally, standard 2D phase contrast flow and 2D left ventricular (LV) volumetric data were used for comparison. The correlations of cardiac output (CO) between the invasive flow probe, and CMR modalities were strong to very strong. CO measured by 4D flow CMR correlated better with the CO measured by the invasive flow probe than 2D flow CMR flow and volumetric LV data (4D flow CMR: Spearman’s rho = 0.86 at the aortic valve level and 0.90 at the ascending aorta level; 2D flow CMR: 0.67 at aortic valve level; LV measurements: 0.77). In addition, there tended to be a correlation between mean pulmonary artery flow and aorta flow with 4D flow (Spearman’s rho = 0.65, P = 0.07), which was absent in measurements obtained with 2D flow CMR (Spearman’s rho = 0.40, P = 0.33). This study shows that aorta flow can be accurately measured by 4D flow CMR compared to simultaneously measured invasive flow. This helps to further validate the quantitative reliability of this technique.
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7
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Mulchrone A, Kellihan HB, Forouzan O, Hacker TA, Bates ML, Francois CJ, Chesler NC. A Large Animal Model of Right Ventricular Failure due to Chronic Thromboembolic Pulmonary Hypertension: A Focus on Function. Front Cardiovasc Med 2019; 5:189. [PMID: 30687717 PMCID: PMC6333696 DOI: 10.3389/fcvm.2018.00189] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 12/13/2018] [Indexed: 11/13/2022] Open
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a debilitating disease that progresses to right ventricular (RV) failure and death if left untreated. Little is known regarding the progression of RV failure in this disease, greatly limiting effective prognoses, and therapeutic interventions. Large animal models enable the use of clinical techniques and technologies to assess progression and diagnose failure, but the existing large animal models of CTEPH have not been shown to replicate the functional consequences of the RV, i.e., RV failure. Here, we created a canine embolization model of CTEPH utilizing only microsphere injections, and we used a combination of right heart catheterization (RHC), echocardiography (echo), and magnetic resonance imaging (MRI) to quantify RV function. Over the course of several months, CTEPH led to a 6-fold increase in pulmonary vascular resistance (PVR) in four adult, male beagles. As evidenced by decreased cardiac index (0.12 ± 0.01 v. 0.07 ± 0.01 [L/(min*kg)]; p < 0.05), ejection fraction (0.48 ± 0.02 v. 0.31 ± 0.02; p < 0.05), and ventricular-vascular coupling ratio (0.95 ± 0.09 v. 0.45 ± 0.05; p < 0.05), as well as decreased tricuspid annular plane systolic excursion (TAPSE) (1.37 ± 0.06 v. 0.86 ± 0.05 [cm]; p < 0.05) and increased end-diastolic volume index (2.73 ± 0.06 v. 2.98 ± 0.02 [mL/kg]; p < 0.05), the model caused RV failure. The ability of this large animal CTEPH model to replicate the hemodynamic consequences of the human disease suggests that it could be utilized for future studies to gain insight into the pathophysiology of CTEPH development, following further optimization.
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Affiliation(s)
- Ashley Mulchrone
- Department of Biomedical Engineering, Univeristy of Wisconsin-Madison, Madison, WI, United States
| | - Heidi B Kellihan
- School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | - Omid Forouzan
- Department of Biomedical Engineering, Univeristy of Wisconsin-Madison, Madison, WI, United States
| | - Timothy A Hacker
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | - Melissa L Bates
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, United States.,Department of Pediatrics, University of Iowa, Iowa City, IA, United States
| | | | - Naomi C Chesler
- Department of Biomedical Engineering, Univeristy of Wisconsin-Madison, Madison, WI, United States.,Department of Medicine, University of Wisconsin-Madison, Madison, WI, United States
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