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Ahmed MS, Ghallab M, Ostrow T, Nashawi M, Alagha Z, Levine A, Aronow WS, Lanier GM. Pharmacotherapy of refractory pulmonary arterial hypertension. Expert Opin Pharmacother 2023; 24:1861-1874. [PMID: 37698041 DOI: 10.1080/14656566.2023.2257134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 09/06/2023] [Indexed: 09/13/2023]
Abstract
INTRODUCTION Treatment of refractory pulmonary arterial hypertension (PAH) is challenging and rarely the focus of reviews. The purpose of this review is to discuss current treatment options of refractory PAH, along with the state of research of several new medications. AREAS COVERED We conducted a comprehensive PubMed search on the relevant literature on treating PAH, with a focus on approved and investigational interventions for high-risk patients. Our strategy used keywords 'Treatment' AND 'Pulmonary Hypertension,' without date restrictions, ensuring a thorough survey of available literature for our review. EXPERT OPINION By utilizing serial risk assessment to identify patients remaining intermediate or high-risk, more patients are likely to survive longer. This is done by earlier use of combination or triple therapy with prostacyclin drugs. Current medications for PAH are all essentially vasodilators that improve physiology, but do not truly modify the disease process. The potential application of new investigational medications is exciting as they work by novel pathways likely to change the landscape of refractory PAH treatment.
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Affiliation(s)
- Mahmoud Samy Ahmed
- Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA
| | - Muhammad Ghallab
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Talia Ostrow
- Department of Medicine, New York Medical College, Valhalla, New York, USA
| | - Mouhamed Nashawi
- Department of Medicine, Baylor Scott & White Health, Dallas, TX, USA
| | - Zakaria Alagha
- Department of Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, West Virginia, USA
| | - Avi Levine
- Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA
| | - Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA
| | - Gregg M Lanier
- Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA
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Alhwiesh AK, Abdul-Rahman IS, Alshehri A, Alhwiesh A, Elnokeety M, Essam S, Sakr M, Al-Oudah N, Abdulrahman A, Mohammed AM, Mansour H, El-Salamoni T, Al-Oudah N, Alayoobi L, Aljenaidi H, Al-Harbi A, Mousa D, Abdulnasir A, Skhiri S. The problem of pulmonary arterial hypertension in end-stage renal disease: can peritoneal dialysis be the solution. BMC Nephrol 2022; 23:386. [PMID: 36471276 PMCID: PMC9721065 DOI: 10.1186/s12882-022-02998-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/02/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) in the setting of end-stage renal disease (ESRD) has important prognostic and therapeutic consequences. We estimated the prevalence of PAH among patients with ESRD treated with automated peritoneal dialysis (APD), investigated the effect of different variables and compared pulmonary artery pressure and cardiac function at the beginning and end of the study. METHODS This is a 5-year study in which 31 ESRD patients on APD were recruited after fulfilling inclusion criteria. Blood samples were collected from all patients for the biochemical and hematological data at the beginning of the study and every month and at the study termination. Total body water (TBW) and extracellular water (ECW) were calculated using Watson's and Bird's calculation methods. All patients were followed-up at 3-month interval for cardiac evaluation. Logistic regression analysis was used to assess the relation between different variables and PAH. RESULTS The mean age of the study population (n = 31) was 51.23 ± 15.24 years. PAH was found in 24.2% of the patients. Mean systolic pulmonary artery pressure (sPAP) and mean pulmonary artery pressure (mPAP) were significantly higher in the APD patients at study initiation than at the end of the study (40.75 + 10.61 vs 23.55 + 9.20 and 29.66 + 11.35 vs 18.24 + 6.75 mmHg respectively, p = 0.001). The median ejection fraction was significantly lower in patients with PAH at zero point than at study termination [31% (27-34) vs 50% (46-52), p = 0.002]. Hypervolemia decreased significantly at the end of study (p < 0.001) and correlated positively with the PAP (r = 0.371 and r = 0.369), p = 0.002). sPAP correlated with left ventricular mass index, hemoglobin level, and duration on APD. CONCLUSIONS Long term APD (> 1 years) seemed to decrease pulmonary arterial pressure, right atrial pressure and improve left ventricular ejection fraction (LVEF). Risk factors for PAH in ESRD were hypervolemia, abnormal ECHO findings and low hemoglobin levels. Clinical and echocardiographic abnormalities and complications are not uncommon among ESRD patients with PAH. Identification of those patients on transthoracic echocardiography may warrant further attention to treatment with APD.
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Affiliation(s)
- Abdullah K. Alhwiesh
- grid.411975.f0000 0004 0607 035XNephrology Division, Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, 1952 Saudi Arabia
| | - Ibrahiem Saeed Abdul-Rahman
- grid.411975.f0000 0004 0607 035XNephrology Division, Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, 1952 Saudi Arabia
| | - Abdullah Alshehri
- grid.411975.f0000 0004 0607 035XCardiology Division, Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Amani Alhwiesh
- grid.411975.f0000 0004 0607 035XNephrology Division, Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, 1952 Saudi Arabia
| | - Mahmoud Elnokeety
- grid.411975.f0000 0004 0607 035XNephrology Division, Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, 1952 Saudi Arabia
| | - Syed Essam
- grid.411975.f0000 0004 0607 035XNephrology Division, Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, 1952 Saudi Arabia
| | - Mohamad Sakr
- grid.411975.f0000 0004 0607 035XNephrology Division, Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, 1952 Saudi Arabia
| | - Nadia Al-Oudah
- grid.411975.f0000 0004 0607 035XNephrology Division, Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, 1952 Saudi Arabia
| | - Abdulla Abdulrahman
- grid.410356.50000 0004 1936 8331Department of Electrical Engineering, Queen’s University, Toronto, Kingston, Canada
| | - Abdelgalil Moaz Mohammed
- grid.411975.f0000 0004 0607 035XNephrology Division, Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, 1952 Saudi Arabia
| | - Hany Mansour
- grid.411975.f0000 0004 0607 035XNephrology Division, Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, 1952 Saudi Arabia
| | - Tamer El-Salamoni
- grid.411975.f0000 0004 0607 035XNephrology Division, Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, 1952 Saudi Arabia
| | - Nehad Al-Oudah
- grid.411975.f0000 0004 0607 035XNephrology Division, Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, 1952 Saudi Arabia
| | - Lamees Alayoobi
- grid.411975.f0000 0004 0607 035XNephrology Division, Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, 1952 Saudi Arabia
| | - Hend Aljenaidi
- grid.411975.f0000 0004 0607 035XNephrology Division, Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, 1952 Saudi Arabia
| | - Ali Al-Harbi
- Diaverum Al-Majdoie Dialysis Center, Dammam, Eastern Province Saudi Arabia
| | - Dujanah Mousa
- Diaverum Al-Majdoie Dialysis Center, Dammam, Eastern Province Saudi Arabia
| | | | - Sami Skhiri
- Diaverum Al-Majdoie Dialysis Center, Dammam, Eastern Province Saudi Arabia
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Karauzum K, Karauzum I, Kilic T, Sahin T, Baydemir C, Baris Argun S, Celikyurt U, Bildirici U, Agir A. Bendopnea and Its Clinical Importance in Outpatient Patients with Pulmonary Arterial Hypertension. ACTA CARDIOLOGICA SINICA 2018; 34:518-525. [PMID: 30449993 DOI: 10.6515/acs.201811_34(6).20180528a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose Bendopnea is a recently reported novel symptom in patients with heart failure (HF) defined as shortness of breath when bending forward. It has been demonstrated that bendopnea is associated with advanced symptoms and worse outcomes. The aim of this study was to assess the presence of bendopnea and its clinical importance with regards to functional status, hemodynamic and echocardiographic characteristics in outpatient pulmonary arterial hypertension (PAH) patients. Methods We conducted this prospective observational study of 53 patients who were admitted to our PAH clinic for routine control visits. We determined the presence of bendopnea and analyzed hemodynamic parameters, World Heart Organization (WHO) functional class, transcutaneous oxygen saturation, 6-minute walking distance (6-MWD), N-terminal pro-brain natriuretic peptide (NT-proBNP) and right ventricular (RV) function indicators in patients with and without bendopnea. Results Bendopnea was present 33.9% of the PAH patients. The mean age was higher in the patients with bendopnea than in those without bendopnea, but the difference was not significant (p = 0.201). The patients with bendopnea had a lower 6-MWD and higher NT-proBNP level (p < 0.001), and worse WHO functional class symptoms (p = 0.010). Mean right atrial pressure, pulmonary artery pressure, and pulmonary vascular resistance were higher in the patients with bendopnea. The patients with bendopnea had a more dilated RV end-diastolic diameter and lower tricuspid annular plane systolic excursion value (p < 0.001 and p = 0.001, respectively). Conclusions Bendopnea was associated with worse functional capacity status, hemodynamic characteristics and RV function in our outpatient PAH patients.
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Affiliation(s)
| | | | | | | | | | - Serap Baris Argun
- Department of Pulmonary Diseases, Medical Faculty, Kocaeli University, Kocaeli, Turkey
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Nowak J, Hudzik B, Niedziela J, Rozentryt P, Zembala M, Gąsior M. Role of Pro-Brain Natriuretic Peptide Serum Concentration in the Detection of Pulmonary Hypertension in Patients With End-Stage Lung Diseases Referred for Lung Transplantation. Transplant Proc 2018; 50:2044-2047. [PMID: 30177106 DOI: 10.1016/j.transproceed.2018.02.149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 02/19/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Serum N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration is elevated in patients with pulmonary hypertension (PH); however, its role in the detection of PH associated with lung disease is not well established. AIM The aim of this study was to assess the value of NT-proBNP in the detection of PH in patients with end-stage lung disease (esLD) referred for lung transplantation. MATERIALS AND METHODS The study population consisted of 65 patients: 37 with idiopathic pulmonary fibrosis (IPF), 20 with chronic obstructive pulmonary disease, and 8 patients with other interstitial lung diseases (75% men, mean age 53.3 ± 9.5 years). Serum concentration of NT-proBNP was assessed with an immunoradiometric assay kit. The mean pulmonary artery pressure (mPAP) was measured using a Swan-Ganz catheter. PH was defined as mPAP ≥ 25 mm Hg. RESULTS Median NT-proBNP concentrations were significantly higher in patients with PH than in patients without PH: 139 (49-1236) pg/mL vs 67 (38-116) pg/mL, respectively; P = .016. Receiver operating characteristic (ROC) analysis revealed that NT-proBNP concentration higher than 131.5 pg/mL was a predictor of PH with good specificity (81%) and positive predictive value (78.9%) but low sensitivity (55.6%) and negative predictive value (58.6%). The area under the ROC curve of serum NT-proBNP concentration for PH was 0.71 (95% confidence interval 0.57-0.85, P = .039). CONCLUSION Serum concentration of NT-proBNP may be useful in the diagnosis of PH in patients with esLD referred for lung transplantation.
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Affiliation(s)
- J Nowak
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Silesian Centre for Heart Disease, Zabrze, Poland.
| | - B Hudzik
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Silesian Centre for Heart Disease, Zabrze, Poland; Department of Nutrition-Related Disease Prevention, School of Public Health, Medical University of Silesia, Bytom, Poland
| | - J Niedziela
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Silesian Centre for Heart Disease, Zabrze, Poland
| | - P Rozentryt
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Silesian Centre for Heart Disease, Zabrze, Poland; Department of Social Medicine and Prevention, School of Public Health in Bytom, Medical University of Silesia, Katowice, Poland
| | - M Zembala
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Poland, Medical University of Silesia, Katowice, Poland
| | - M Gąsior
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Silesian Centre for Heart Disease, Zabrze, Poland
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Han B, Wang Q. Study on the clinical efficacy of specific phosphodiesterase inhibitor in patients with pulmonary hypertension due to left heart disease. Exp Ther Med 2018; 16:1175-1186. [PMID: 30112056 PMCID: PMC6090457 DOI: 10.3892/etm.2018.6310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 05/24/2018] [Indexed: 11/19/2022] Open
Abstract
Pulmonary hypertension due to left heart disease (PH-LHD) is caused by left ventricular (LV) systolic and/or diastolic dysfunction and left heart valve disease. LV diseases lead to left ventricular filling pressure increases, pulmonary venous obstruction and pulmonary venous pressure increases, and thus to secondary PH. Exercise tolerance is lower and fatality rates are higher in patients with PH-LHD than those in subjects with normal pulmonary arterial pressure. In spite of the progress in the study of the mechanisms of PH-LHD in recent years, no specific treatment is currently available. The efficacy and safety of targeted therapies for pulmonary arterial hypertension remain to be fully established. In the present study, PH-LHD patients were treated with milrinone injection. It was concluded that milrinone significantly reduces pulmonary artery systolic pressure (PASP) in patients with PH-LHD, and significantly improves the cardiac structure, cardiac function and biochemical indexes. PASP was significantly correlated with the left atrial diameter, LV end diastolic diameter, LV ejection fraction, tricuspid annular plane systolic excursion, right ventricular fractional area change, N-terminal pro-B-type natriuretic peptide and hypersensitive C-reactive protein.
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Affiliation(s)
- Bing Han
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, The State and Shandong Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China.,Intensive Care Unit, The Sixth People's Hospital of Jinan, Jinan, Shandong 250200, P.R. China
| | - Qingli Wang
- Internal Medicine Cardiovascular Department, The Sixth People's Hospital of Jinan, Jinan, Shandong 250200, P.R. China
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Dai Z, Zhang Y, Ye H, Zhang G, Jin H, Chen Z, Yao Y, Tian X, Zhou J, Li P, Liang X, Xie H, Ge S, Zhang Z. Adiponectin is valuable in the diagnosis of acute heart failure with renal insufficiency. Exp Ther Med 2018; 16:2725-2734. [PMID: 30210613 DOI: 10.3892/etm.2018.6511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 03/27/2018] [Indexed: 01/06/2023] Open
Abstract
Acute heart failure (AHF) is a major public health issue due to its high incidence and poor prognosis; thus, efficient and timely diagnosis is critical for improving the prognosis and lowering the mortality rate. Amino-terminal pro-brain natriuretic peptide (NT-proBNP) is widely used in the diagnosis of AHF; however, its efficacy is controversial in diagnosing AHF with renal insufficiency. There were numerous studies reporting the association of adiponectin (ADPN) and heart diseases. Therefore, the present study aimed to investigate whether ADPN is helpful in identifying AHF with renal insufficiency. A total of 407 participants (218 AHF patients and 189 controls) were enrolled into the current study. The plasma levels of ADPN and NT-proBNP were measured using a sandwich enzyme-linked immunosorbent assay and an electrochemiluminescence immunoassay, respectively. In addition, these levels were compared among the various New York Health Association classes, as well as the ischemic and non-ischemic AHF cases. The correlation between the two biomarkers and the renal function was analyzed by Spearman's correlation, while the diagnostic efficiency of ADPN and NT-proBNP was evaluated in AHF patients with and without renal insufficiency. The results revealed that NT-proBNP exhibited a higher diagnostic efficiency as compared with ADPN in patients without renal insufficiency [area under the receiver operating characteristic curve (AUC), 0.905 vs. 0.775]. By contrast, the ADPN presented a better diagnostic value in comparison with NT-proBNP in AHF with renal insufficiency (AUC, 0.872 vs. 0.828). Therefore, a combination of these two biomarkers may provide an excellent efficacy in the diagnosis of AHF with renal insufficiency (AUC, 0.904; sensitivity, 71.2%; specificity, 98.3%). In conclusion, ADPN is a valuable biomarker for diagnosing AHF, particularly in patients with impaired renal function.
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Affiliation(s)
- Zhang Dai
- Department of Clinical Laboratory, Zhongshan Hospital Xiamen University, Xiamen, Fujian 361001, P.R. China
| | - Yan Zhang
- Department of Clinical Laboratory, Zhongshan Hospital Xiamen University, Xiamen, Fujian 361001, P.R. China
| | - Huiming Ye
- State Key Laboratory of Molecular Vaccine and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian 361002, P.R. China.,Department of Clinical Laboratory, Xiamen Maternal and Child Health Hospital, Teaching Hospital of Medical College Xiamen University, Xiamen, Fujian 361003, P.R. China
| | - Guoqiang Zhang
- Department of Clinical Laboratory, Zhongshan Hospital Xiamen University, Xiamen, Fujian 361001, P.R. China
| | - Hongwei Jin
- Department of Clinical Laboratory, Zhongshan Hospital Xiamen University, Xiamen, Fujian 361001, P.R. China
| | - Ziming Chen
- Department of Reagent Research, Xiamen Innovax Biotech Co., Ltd., Xiamen, Fujian 361022, P.R. China
| | - Yihui Yao
- Department of Clinical Laboratory, Zhongshan Hospital Xiamen University, Xiamen, Fujian 361001, P.R. China
| | - Xuebing Tian
- Department of Clinical Laboratory, Xiamen Cardiovascular Hospital, Medical College Xiamen University, Xiamen, Fujian 361001, P.R. China
| | - Jianfeng Zhou
- Department of Clinical Laboratory, Zhongshan Hospital Xiamen University, Xiamen, Fujian 361001, P.R. China
| | - Peihua Li
- Department of Clinical Laboratory, Zhongshan Hospital Xiamen University, Xiamen, Fujian 361001, P.R. China
| | - Xianming Liang
- Department of Clinical Laboratory, Zhongshan Hospital Xiamen University, Xiamen, Fujian 361001, P.R. China
| | - Huabing Xie
- Department of Clinical Laboratory, Xiamen Cardiovascular Hospital, Medical College Xiamen University, Xiamen, Fujian 361001, P.R. China
| | - Shengxiang Ge
- State Key Laboratory of Molecular Vaccine and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian 361002, P.R. China
| | - Zhongying Zhang
- Department of Clinical Laboratory, Zhongshan Hospital Xiamen University, Xiamen, Fujian 361001, P.R. China.,State Key Laboratory of Molecular Vaccine and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian 361002, P.R. China.,Department of Clinical Laboratory, Zhongshan Teaching Hospital, Fujian Medical University, Xiamen, Fujian 361001, P.R. China
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Raina A, Humbert M. Risk assessment in pulmonary arterial hypertension. Eur Respir Rev 2017; 25:390-398. [PMID: 27903661 PMCID: PMC9487550 DOI: 10.1183/16000617.0077-2016] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 10/13/2016] [Indexed: 11/23/2022] Open
Abstract
Regular patient assessment is essential for the management of chronic diseases, such as pulmonary arterial hypertension (PAH). Comprehensive patient assessment and risk stratification in PAH are important to guide treatment decisions and to monitor disease progression as well as patients' response to treatment. Approaches for assessing risk in PAH patients include the use of risk variables, as recommended in the 2015 European Society of Cardiology (ESC)/European Respiratory Society (ERS) pulmonary hypertension (PH) guidelines, and the application of risk equations and scores, such as the French registry risk equation and the REVEAL registry risk score. Risk stratification and risk scores are both useful predictors of survival on a population basis, and provide an estimate for individual patients' risk. The 2015 ESC/ERS PH guidelines recommend regular assessment of multiple variables at an expert centre. The respective merits and limitations of different risk assessment methods in PAH are discussed in this article, as well as some considerations that can be taken into account in the future development of risk assessment tools. Regular risk assessment with multiple parameters evaluates PAH disease progression and treatment responsehttp://ow.ly/Nq0I305kgpU
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Affiliation(s)
- Amresh Raina
- Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PN, USA
| | - Marc Humbert
- Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,AP-HP, Service de Pneumologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.,Inserm UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France
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Pattathu J, Gorenflo M, Hilgendorff A, Koskenvuo JW, Apitz C, Hansmann G, Alastalo TP. Genetic testing and blood biomarkers in paediatric pulmonary hypertension. Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension. The European Paediatric Pulmonary Vascular Disease Network, endorsed by ISHLT and DGPK. Heart 2016; 102 Suppl 2:ii36-41. [PMID: 27053696 DOI: 10.1136/heartjnl-2014-307238] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 02/13/2015] [Indexed: 11/04/2022] Open
Abstract
Childhood-onset pulmonary arterial hypertension (PAH) is considered complex and multifactorial, with relatively poor estimates of the natural history of the disease. Strategies allowing earlier detection, establishment of disease aetiology together with more accurate and sensitive biomarkers could enable better estimates of prognosis and individualise therapeutic strategies. Evidence is accumulating that genetic defects play an important role in the pathogenesis of idiopathic and hereditary forms of PAH. Altogether nine genes have been reported so far to be associated with childhood onset PAH suggesting that comprehensive multigene diagnostics can be useful in the assessment. Identification of disease-causing mutations allows estimates of prognosis and forms the most effective way for risk stratification in the family. In addition to genetic determinants the analysis of blood biomarkers are increasingly used in clinical practice to evaluate disease severity and treatment responses. As in genetic diagnostics, a multiplex approach can be helpful, as a single biomarker for PAH is unlikely to meet all requirements. This consensus statement reviews the current evidence for the use of genetic diagnostics and use of blood biomarkers in the assessment of paediatric patients with PAH.
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Affiliation(s)
- Joseph Pattathu
- Department of Paediatric Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Matthias Gorenflo
- Department of Paediatric Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Anne Hilgendorff
- Perinatal Center Grosshadern, Dr. von Haunersches Children`s Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Juha W Koskenvuo
- Department of Clinical Physiolology, University Hospital Helsinki, University of Helsinki, Helsinki, Finland Blueprint Genetics, Biomedicum Helsinki, Helsinki, Finland
| | - Christian Apitz
- Paediatric Heart Centre, University Hopsital of Giessen and Marburg, Giessen, Germany
| | - Georg Hansmann
- Department of Paediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany
| | - Tero-Pekka Alastalo
- Blueprint Genetics, Biomedicum Helsinki, Helsinki, Finland Department of Paediatric Cardiology, Childrens Hospital Helsinki, University of Helsinki, Helsinki, Finland
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Zeng Y, Yang D, Feng S, Shen H, Wang Z, Jiang S, Shi Y, Fu J. Risk factors for pulmonary hypertension in patients receiving maintenance peritoneal dialysis. Braz J Med Biol Res 2016; 49:S0100-879X2016000300703. [PMID: 26840710 PMCID: PMC4763813 DOI: 10.1590/1414-431x20154733] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 06/16/2015] [Indexed: 11/21/2022] Open
Abstract
We investigated the risk factors for pulmonary hypertension (PH) in patients receiving maintenance peritoneal dialysis (MPD). A group of 180 end-stage renal disease patients (124 men and 56 women; mean age: 56.43±8.36) were enrolled in our study, which was conducted between January 2009 and June 2014. All of the patients received MPD treatment in the Dialysis Center of the Second Affiliated Hospital of Soochow University. Clinical data, laboratory indices, and echocardiographic data from these patients were collected, and follow-ups were scheduled bi-monthly. The incidence and relevant risk factors of PH were analyzed. The differences in measurement data were compared by t-test and enumeration data were compared with the χ2 test. Among the 180 patients receiving MPD, 60 were diagnosed with PH. The remaining 120 were regarded as the non-PH group. Significant differences were observed in the clinical data, laboratory indices, and echocardiographic data between the PH and non-PH patients (all P<0.05). Furthermore, hypertensive nephropathy patients on MPD showed a significantly higher incidence of PH compared with non-hypertensive nephropathy patients (P<0.05). Logistic regression analysis showed that the proportion of internal arteriovenous fistula, C-reactive protein levels, and ejection fraction were the highest risk factors for PH in patients receiving MPD. Our study shows that there is a high incidence of PH in patients receiving MPD and hypertensive nephropathy patients have an increased susceptibility to PH.
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Affiliation(s)
- Y. Zeng
- Department of Nephrology, The Second Affiliated Hospital of Soochow
University, Suzhou, China
| | - D.D. Yang
- Department of Nephrology, The Second Affiliated Hospital of Soochow
University, Suzhou, China
| | - S. Feng
- Department of Nephrology, The Second Affiliated Hospital of Soochow
University, Suzhou, China
| | - H.Y. Shen
- Department of Nephrology, The Second Affiliated Hospital of Soochow
University, Suzhou, China
| | - Z. Wang
- Department of Nephrology, The Second Affiliated Hospital of Soochow
University, Suzhou, China
| | - S. Jiang
- Department of Nephrology, The Second Affiliated Hospital of Soochow
University, Suzhou, China
| | - Y.B. Shi
- Department of Nephrology, The Second Affiliated Hospital of Soochow
University, Suzhou, China
| | - J.X. Fu
- Department of Hematology, The Second Affiliated Hospital of Soochow
University, Suzhou, China
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Reque J, Quiroga B, Ruiz C, Villaverde MT, Vega A, Abad S, Panizo N, López-Gómez JM. [Pulmonary hypertension in hemodialysis patients: Prevalence and associated factors]. Med Clin (Barc) 2016; 146:143-7. [PMID: 26602311 DOI: 10.1016/j.medcli.2015.06.019] [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: 03/18/2015] [Revised: 06/20/2015] [Accepted: 06/25/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Pulmonary hypertension (PH) is a progressive disorder that can be caused by several underlying conditions or an intrinsic alteration of the pulmonary vasculature. Chronic increased pressure in the pulmonary vasculature leads to changes in the architecture of the vessels that can perpetuate PH and produce right ventricular dysfunction. These structural and functional alterations can decrease survival and quality of life of patients on hemodialysis; however, there is a lack of evidence about this problem in this population. The aim of this study is to establish the prevalence of PH in patients on hemodialysis and its association with specific factors related to this patient population. MATERIAL AND METHODS We included 202 prevalent patients on hemodialysis for at least 6 months and who were clinically stable. We collected demographic data, routine laboratory parameters and data of 2D Doppler-echocardiography. PH was defined as a systolic pulmonary artery pressure (SPAP) estimated by Doppler ultrasound above 35mmHg. Hydration status was assessed by determining the plasma concentration of N-terminal pro brain natriuretic peptide (Nt-proBNP). RESULTS PH prevalence was 37.1% (75 patients). The average SPAP in the entire study population was 32±12mmHg and in the group with PH it was 45±11mmHg. We found a direct and statistically significant correlation between the presence of PH and age (P=.001), time on renal replacement therapy (P=.04), the presence of systolic dysfunction (P=.007), diastolic dysfunction (P= 01), mitral valve disease (P=.01) and double mitral and aortic disease (P=.007). Volume overload was closely associated with PH, as demonstrated by the correlation between the SPAP and Nt-proBNP levels (P=.001). CONCLUSION We conclude that prevalence of PH in hemodialysis patients is high. And one of the most important associated factors is volume overload. More studies are needed to establish the impact of PH on morbidity and mortality of patients and to assess whether a better volume control improves PH.
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Affiliation(s)
- Javier Reque
- Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - Borja Quiroga
- Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Caridad Ruiz
- Clínica de hemodiálisis DIALCENTRO, Madrid, España
| | | | - Almudena Vega
- Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Soraya Abad
- Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Nayara Panizo
- Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J Manuel López-Gómez
- Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, España
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MacKenzie AM, Peacock AJ. Medical Therapies for the Treatment of Pulmonary Arterial Hypertension: How Do We Choose? Curr Hypertens Rep 2015; 17:56. [DOI: 10.1007/s11906-015-0560-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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