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Villas Bôas HJ, Paschoal IA, Pereira MC. Impulse oscillometry in patients with pulmonary arterial hypertension: an exploratory study. Clinics (Sao Paulo) 2024; 79:100313. [PMID: 38490138 PMCID: PMC10951447 DOI: 10.1016/j.clinsp.2023.100313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/06/2023] [Accepted: 11/24/2023] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION Studies suggest peripheral airway abnormalities in Pulmonary Arterial Hypertension (PAH). Impulse Oscillometry (IOS) is a noninvasive and sensitive technique for assessing the small airways. It evaluates the impedance of the respiratory system ‒ Resistance (R) and reactance (X) ‒ to a pulse of sound waves sent to the lungs, in a range of frequencies (5‒20 Hz). METHOD Resistance variables: R5, R20, R5-R20 and reactance variables: AX (reactance area) and Fres (resonance frequency). The aim is to evaluate R and X in patients with idiopathic PAH (IPAH) and to investigate whether there is a correlation between IOS and spirometry. RESULTS Thirteen IPAH patients and 11 healthy subjects matched for sex and age underwent IOS and spirometry. IPAH patients had lower FVC and FEV1 values (p < 0.001), VEF1/CVF (p = 0.049) and FEF 25-75 (p = 0.006) than healthy patients. At IOS, IPAH patients showed lower tidal volumes and higher AX (p < 0.05) compared to healthy individuals, and 53.8 of patients had R5-R20 values ≥ 0.07 kPa/L/s. Correlation analysis: X5, AX, R5-R20 and Fres showed moderate correlation with FVC (p = 0.036 r = 0.585, p = 0.001 r = -0.687, p = 0.005 r = -0.726 and p = 0.027 r = -0.610); Fres (p = 0.012 r = -0.669) and AX (p = 0.006 r = -0.711) correlated with FEV1; [R5 and R20, (R5-R20)] also correlated with FEV1 (p < 0.001 r = -0.573, p = 0.020 r = -0.634 and p = 0.010 r = -0.683, respectively) in the IPAH group. There were also moderate correlations of FEF 25-75 % with Z5 (p = 0.041), R5 (p = 0.018), Fres (p = 0.043) and AX (p = 0.023). DISCUSSION Patients showed changes suggestive of increased resistance and reactance in the IOS compared to healthy individuals, and the IOS findings showed a good correlation with spirometry variables.
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Affiliation(s)
| | | | - Mônica Corso Pereira
- Departamento de Medicina Interna, Universidade de Campinas (UNICAMP), Campinas, SP, Brazil.
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2
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Baldi BG, dos Santos Fernandes CJC, Heiden GI, Freitas CSG, Sobral JB, Kairalla RA, Carvalho CRR, Souza R. Association between pulmonary artery to aorta diameter ratio with pulmonary hypertension and outcomes in diffuse cystic lung diseases. Medicine (Baltimore) 2021; 100:e26483. [PMID: 34160461 PMCID: PMC8238321 DOI: 10.1097/md.0000000000026483] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/28/2021] [Indexed: 01/04/2023] Open
Abstract
To investigate the importance of pulmonary vascular measurements on computed tomography (CT) in predicting pulmonary hypertension (PH) and worse outcomes in diffuse cystic lung diseases (DCLDs).We conducted a cross-sectional study of patients with DCLDs. Patients underwent pulmonary function tests, a six-minute walk test (6MWT), chest CT, transthoracic echocardiography, and right heart catheterization. Pulmonary artery (PA) diameter and PA-ascending aorta ratio (PA-Ao ratio) were obtained from CT. Mean pulmonary artery pressure (mPAP) from right heart catheterization was correlated with tomographic, functional, and echocardiographic variables. The association between the PA-Ao ratio with outcomes was determined by Kaplan-Meier curves.Thirty-four patients were included (18 with pulmonary Langerhans cell histiocytosis and 16 with lymphangioleiomyomatosis, mean age 46 ± 9 years). Forced expiratory volume in the first second and lung diffusing capacity for carbon monoxide were 47 ± 20% and 38 ± 21% predicted, respectively. PA diameter and PA-Ao ratio were 29 ± 6 mm and 0.95 ± 0.24, respectively. PA-Ao ratio > 1 occurred in 38.2% of patients. PA-Ao ratio was a good predictor of PH. mPAP correlated best with PA-Ao ratio, PA diameter, oxygen desaturation during six-minute walk test, and echocardiographic variables. Patients with PA-Ao ratio > 1 had greater mPAP, and a higher risk of death or lung transplantation (log-rank, P < .001) than those with PA-Ao ratio ≤ 1.The PA-Ao ratio measured on CT scan has a potential role as a non-invasive tool to predict the presence of PH and as a prognostic parameter in patients with DCLDs.
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Affiliation(s)
| | | | | | | | - Juliana Barbosa Sobral
- Laboratório de Ecocardiografia, Instituto de Radiologia (InRad), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Rogério Souza
- Divisão de Pneumologia, Instituto do Coração (InCor)
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3
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Ferreira AC, Serejo JS, Durans R, Pereira Costa JM, Maciel AWS, Vieira ASM, Dias-Filho CAA, Dias CJ, Bomfim MRQ, Mostarda CT, Brito-Monzani JDO. Dose-related Effects of Resveratrol in Different Models of Pulmonary Arterial Hypertension: A Systematic Review. Curr Cardiol Rev 2020; 16:231-240. [PMID: 31797762 PMCID: PMC7536808 DOI: 10.2174/1573403x15666191203110554] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/18/2019] [Accepted: 11/05/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Pulmonary Arterial Hypertension (PAH) is a severe and progressive disease of pulmonary arterioles. This pathology is characterized by elevation of the pulmonary vascular resistance and pulmonary arterial pressure, leading to right heart failure and death. Studies have demonstrated that resveratrol possesses a protective effect on the mechanisms related to the genesis of the PAH-induced by different models. OBJECTIVE This study aimed to investigate the dose-related effects of resveratrol in different models of pulmonary arterial hypertension. METHODS To identify eligible papers, we performed a systematic literature search on Scielo, Pub- Med, and Scholar Google. The research was limited to articles written in English in the last 10 years. We used the following descriptors to search: Pulmonary Arterial Hypertension and Resveratrol, OR Resveratrol, and Animal models of Pulmonary Arterial Hypertension, OR Resveratrol, and in vitro models of Pulmonary Arterial Hypertension. RESULTS 1724 studies were identified through the descriptors used, fifty-five studies with different models of pulmonary arterial hypertension were selected for the full review, forty-four were excluded after application of exclusion and inclusion criteria, totalizing eleven studies included in this systematic review. CONCLUSION The results showed that resveratrol, at low and high doses, protects in a dosedependent manner against the development of PAH induced through monocrotaline, normoxia and hypoxia models. In addition to having chemopreventive, anti-inflammatory, antioxidant and antiproliferative properties. In the case of PAH-related myocardial injury, resveratrol protects cells from apoptosis, thus working as an antiapoptotic agent.
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Affiliation(s)
- Andressa C Ferreira
- Department of Physical Education, Universidade Federal do Maranhão, São Luís, MA, Brazil
| | - Jerdianny S Serejo
- Department of Physical Education, Universidade Federal do Maranhão, São Luís, MA, Brazil
| | - Rafael Durans
- Department of Physical Education, Universidade Federal do Maranhão, São Luís, MA, Brazil
| | - Jadna M Pereira Costa
- Department of Physical Education, Universidade Federal do Maranhão, São Luís, MA, Brazil
| | - Antonio W S Maciel
- Department of Physical Education, Universidade Federal do Maranhão, São Luís, MA, Brazil
| | - Adeilson S M Vieira
- Department of Physical Education, Universidade Federal do Maranhão, São Luís, MA, Brazil
| | - Carlos A A Dias-Filho
- Department of Physical Education, Universidade Federal do Maranhão, São Luís, MA, Brazil
| | - Carlos J Dias
- Department of Physical Education, Universidade Federal do Maranhão, São Luís, MA, Brazil
| | | | - Cristiano T Mostarda
- Department of Physical Education, Universidade Federal do Maranhão, São Luís, MA, Brazil
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4
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Chang Z, Wang JL, Jing ZC, Ma P, Xu QB, Na JR, Tian J, Ma X, Zhou W, Zhou R. Protective effects of isorhamnetin on pulmonary arterial hypertension: in vivo and in vitro studies. Phytother Res 2020; 34:2730-2744. [PMID: 32452118 DOI: 10.1002/ptr.6714] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/15/2020] [Accepted: 04/18/2020] [Indexed: 12/14/2022]
Abstract
Pulmonary arterial hypertension (PAH) is a malignant disease with high mortality and closely involves the bone morphogenetic protein (BMP) pathway. Mutations in BMPR2 caused proliferation of pulmonary artery smooth muscle cells (PASMCs) leading to PAH. Isorhamnetin, one of the main naturally occurring flavonoids extracted from Hippophae rhamnoides L, shows antiinflammatory and anti-proliferative properties. Nevertheless, the effects of isorhamnetin on PAH remain unclear. This study aimed to investigate whether isorhamnetin has protective effects against PAH and explore possible mechanisms. An in vivo model of PAH induced by monocrotaline (MCT) was employed, and sildenafil and isorhamnetin were orally administered for 21 consecutive days. An in vitro model induced by TNF-α was employed, and cell proliferation of HPASMCs was detected. Results indicated that isorhamnetin significantly improved hemodynamic, histopathological, and echocardiographic changes in MCT-induced PAH in rats. In vitro, isorhamnetin suppressed TNF-α-induced HPASMCs proliferation. Furthermore, isorhamnetin improved protein expression of BMPR2 and suppressed protein expression of TNF-α and IL-6 in rat lungs. Isorhamnetin improved protein expression of BMPR2 and p-smad1/5 and mRNA expression of Id1 and Id3 in HPASMCs. Isorhamnetin ameliorated MCT-induced PAH in rats and inhibited TNF-α-induced HPASMCs proliferation by a mechanism likely involving the regulation of the BMP signaling pathway.
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Affiliation(s)
- Zhi Chang
- Department of Pharmacology, College of Pharmacy, Ningxia Medical University, Yinchuan, China
| | - Jia-Ling Wang
- Department of Pharmacology, College of Pharmacy, Ningxia Medical University, Yinchuan, China
| | - Zhi-Cheng Jing
- Department of Cardiology, Peking Union Medical College Hospital, Key Lab of Pulmonary Vascular Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ping Ma
- Department of Cardiology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Qing-Bing Xu
- Department of Cardiology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Jian-Rong Na
- Respiratory and critical care medicine, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Jie Tian
- Respiratory and critical care medicine, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Xuan Ma
- Respiratory and critical care medicine, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Wei Zhou
- Respiratory and critical care medicine, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Ru Zhou
- Department of Pharmacology, College of Pharmacy, Ningxia Medical University, Yinchuan, China.,Key Laboratory of Hui Ethnic Medicine Modernization, Ministry of Education, Ningxia Medical University, Yinchuan, China.,Ningxia Characteristic Traditional Chinese Medicine Modernization Engineering Technology Research Center, Ningxia Medical University, Yinchuan, China
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Calderaro D, Alves Junior JL, Fernandes CJCDS, Souza R. Pulmonary Hypertension in General Cardiology Practice. Arq Bras Cardiol 2019; 113:419-428. [PMID: 31621783 PMCID: PMC6882397 DOI: 10.5935/abc.20190188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 03/20/2019] [Indexed: 12/23/2022] Open
Abstract
The finding of pulmonary hypertension (PH) by echocardiography is common and of
concern. However, echocardiography is just a suggestive and non-diagnostic
assessment of PH. When direct involvement of pulmonary circulation is suspected,
invasive hemodynamic monitoring is recommended to establish the diagnosis. This
assessent provides, in addition to the diagnostic confirmation, the correct
identification of the vascular territory predominantly involved (arterial
pulmonary or postcapillary). Treatment with specific medication for PH
(phosphodiesterase type 5 inhibitors, endothelin receptor antagonists and
prostacyclin analogues) has been proven effective in patients with pulmonary
arterial hypertension, but its use in patients with PH due to left heart disease
can even be damaging. In this review, we discuss the diagnosis criteria, how
etiological investigation should be carried out, the clinical classification
and, finally, the therapeutic recommendations for PH.
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Affiliation(s)
- Daniela Calderaro
- Instituto do Coração - Hospital das Clínicas HCFMUSP - Faculdade de Medicina - Universidade de São Paulo, São Paulo, SP - Brazil
| | - José Leonidas Alves Junior
- Instituto do Coração - Hospital das Clínicas HCFMUSP - Faculdade de Medicina - Universidade de São Paulo, São Paulo, SP - Brazil
| | | | - Rogério Souza
- Instituto do Coração - Hospital das Clínicas HCFMUSP - Faculdade de Medicina - Universidade de São Paulo, São Paulo, SP - Brazil
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6
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Abstract
PURPOSE OF REVIEW To understand the global distribution of different forms of pulmonary hypertension. RECENT FINDINGS Different registries have explored the epidemiological characteristics of pulmonary hypertension. Interestingly, there is a clear difference in the prevalence of different forms of pulmonary hypertension in developed regions in comparison with less developed countries. This finding suggests not only that extrapolation of data should be avoided but also that the known prevalence of pulmonary hypertension might be underestimated. SUMMARY Pulmonary hypertension might be more prevalent than what is currently believed. Specific forms of pulmonary hypertension distributed worldwide might characterize an unrecognized burden that still have to be properly approached. This highlights the heterogeneity of pulmonary hypertension around the world. It is clear that more epidemiological data are still needed as well as studies addressing management alternatives in these specific regions.
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Fernandes CJCDS, Jardim CVP, Alves JL, Oleas FAG, Morinaga LTK, de Souza R. Reperfusion in acute pulmonary thromboembolism. J Bras Pneumol 2018; 44:0. [PMID: 29898007 PMCID: PMC6188696 DOI: 10.1590/s1806-37562017000000204] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 01/19/2018] [Indexed: 01/03/2023] Open
Abstract
Acute pulmonary thromboembolism (APTE) is a highly prevalent condition (104-183 cases per 100,000 person-years) and is potentially fatal. Approximately 20% of patients with APTE are hypotensive, being considered at high risk of death. In such patients, immediate lung reperfusion is necessary in order to reduce right ventricular afterload and to restore hemodynamic stability. To reduce pulmonary vascular resistance in APTE and, consequently, to improve right ventricular function, lung reperfusion strategies have been developed over time and widely studied in recent years. In this review, we focus on advances in the indication and use of systemic thrombolytic agents, as well as lung reperfusion via endovascular and classical surgical approaches, in APTE.
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Affiliation(s)
- Caio Julio Cesar dos Santos Fernandes
- . Unidade de Circulação Pulmonar, Disciplina de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
- . Instituto do Câncer, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Carlos Vianna Poyares Jardim
- . Unidade de Circulação Pulmonar, Disciplina de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - José Leonidas Alves
- . Unidade de Circulação Pulmonar, Disciplina de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
- . Instituto do Câncer, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Francisca Alexandra Gavilanes Oleas
- . Unidade de Circulação Pulmonar, Disciplina de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Luciana Tamie Kato Morinaga
- . Unidade de Circulação Pulmonar, Disciplina de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Rogério de Souza
- . Unidade de Circulação Pulmonar, Disciplina de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
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8
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Souza R. Momentum. J Bras Pneumol 2017; 43:327-328. [PMID: 29160377 PMCID: PMC5790649 DOI: 10.1590/s1806-37562017000500001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Rogério Souza
- . Disciplina de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil.,. Editor-Chefe do JBP - Jornal Brasileiro de Pneumologia, Brasília (DF) Brasil
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9
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Sidney-Filho LA, Watte G, Dos Santos PAR, Marcelo Schio S, Camargo SM, Perin FA, Hochhegger B, Felicetti JC, Camargo JDJP, Moreira JDS. What is expected in lung function after lung transplantation due to end-stage pulmonary silicosis? Clin Transplant 2017; 31. [PMID: 28871617 DOI: 10.1111/ctr.13105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2017] [Indexed: 11/28/2022]
Abstract
In this study, we aimed to determine the impact of lung transplantation (LTx) on pulmonary function tests (PFTs) and survival among patients with end-stage silicosis. We included patients with end-stage silicosis on the wait list for LTx, between January 1989 and July 2015 (N = 26). Sixteen of these patients received LTx; 10 were eligible, but did not undergo LTx (non-LTx) during the study period. Retrospective information on PFTs (spirometry [volumes and flows], 6-minute walking test [6MWT], and DLCO) was retrieved from patients' medical charts, including baseline information for all patients and follow-up information for the LTx. At baseline, most patients presented with spirometric and 6MWT values that were suggestive of severe disease (FEV1 /FVC 76.5 ± 29.7; 6MWT 267.4 ± 104.5 m). Significant increases in these values were observed at follow-up in the LTx (P = .036 and .151, respectively). The overall median survival of patients in the LTx and non-LTx was 3.35 years (95% CI: 0.16-14.38) and 0.78 years (95% confidence interval [CI]: 0.12-3.65) (P = 0.002), respectively. For patients with end-stage silicosis, LTx offers significant benefits regarding pulmonary function and survival when compared to non-LTx, and is a reliable tool to help this critical population of patients, whose only treatment option is LTx.
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Affiliation(s)
| | - Guilherme Watte
- Department of Respiratory Medicine and Thoracic Surgery, Pavilhao Pereira Filho - Irmandade da Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil.,Post-Graduation Program in Chest Medicine Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Pedro Augusto Reck Dos Santos
- Department of Respiratory Medicine and Thoracic Surgery, Pavilhao Pereira Filho - Irmandade da Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
| | - Sadi Marcelo Schio
- Department of Respiratory Medicine and Thoracic Surgery, Pavilhao Pereira Filho - Irmandade da Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
| | - Spencer Marcantonio Camargo
- Department of Respiratory Medicine and Thoracic Surgery, Pavilhao Pereira Filho - Irmandade da Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
| | - Fabíola Adélia Perin
- Department of Respiratory Medicine and Thoracic Surgery, Pavilhao Pereira Filho - Irmandade da Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
| | - Bruno Hochhegger
- Department of Respiratory Medicine and Thoracic Surgery, Pavilhao Pereira Filho - Irmandade da Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
| | - Jose Carlos Felicetti
- Department of Respiratory Medicine and Thoracic Surgery, Pavilhao Pereira Filho - Irmandade da Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
| | - Jose de Jesus Peixoto Camargo
- Department of Respiratory Medicine and Thoracic Surgery, Pavilhao Pereira Filho - Irmandade da Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
| | - Jose da Silva Moreira
- Department of Respiratory Medicine and Thoracic Surgery, Pavilhao Pereira Filho - Irmandade da Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil.,Post-Graduation Program in Chest Medicine Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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10
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Jiang R, Shi Y, Zeng C, Yu W, Zhang A, Du Y. Protein kinase Cα stimulates hypoxia‑induced pulmonary artery smooth muscle cell proliferation in rats through activating the extracellular signal‑regulated kinase 1/2 pathway. Mol Med Rep 2017; 16:6814-6820. [PMID: 28901444 PMCID: PMC5865839 DOI: 10.3892/mmr.2017.7478] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 07/18/2017] [Indexed: 01/11/2023] Open
Abstract
Hypoxic pulmonary hypertension (HPH) may contribute to vascular remodeling, and pulmonary artery smooth muscle cell (PASMC) proliferation has an important role in this process. However, no relevant information concerning the role and mechanism of protein kinase C (PKC)α in hypoxia-induced rat PASMC proliferation has been elucidated. The present study aimed to further investigate this by comparison of rat PASMC proliferation among normoxia for 72 h (21% O2), hypoxia for 72 h (3% O2), hypoxia + promoter 12-myristate 13-acetate control, hypoxia + safingol control, hypoxia + PD98059 control and hypoxia + U0126 control groups. The present study demonstrated that protein expression levels of PKCα in rat PASMCs were elevated. In conclusion, through activating the extracellular signal-regulated 1/2 signaling pathway, PKCα is involved in and initiates PASMC proliferation, thus bringing about pulmonary artery hypertension. These results add to the understanding of the mechanism PKCα in PH formation and lays a theoretical basis for prevention as well as treatment of HPH.
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Affiliation(s)
- Rui Jiang
- Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China
| | - Yiwei Shi
- Department of Respiratory and Critical Care Medicine, Shanxi Medical University Affiliated First Hospital, Taiyuan, Shanxi 030001, P.R. China
| | - Chao Zeng
- Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China
| | - Wenyan Yu
- Respiratory Department, Central Hospital of Zibo, Zibo, Shandong 255036, P.R. China
| | - Aizhen Zhang
- Department of Respiratory and Critical Care Medicine, Shanxi Provincial People's Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi 030012, P.R. China
| | - Yongcheng Du
- Department of Respiratory and Critical Care Medicine, Shanxi Provincial People's Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi 030012, P.R. China
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11
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Protective effects of aloperine on monocrotaline-induced pulmonary hypertension in rats. Biomed Pharmacother 2017; 89:632-641. [DOI: 10.1016/j.biopha.2017.02.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 02/05/2017] [Accepted: 02/10/2017] [Indexed: 01/10/2023] Open
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12
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Gavilanes F, Alves JL, Fernandes C, Prada LFL, Jardim CVP, Morinaga LTK, Dias BA, Hoette S, Souza R. Left ventricular dysfunction in patients with suspected pulmonary arterial hypertension. J Bras Pneumol 2015; 40:609-16. [PMID: 25610501 PMCID: PMC4301245 DOI: 10.1590/s1806-37132014000600004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 12/03/2014] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE: To evaluate the role of right heart catheterization in the diagnosis of pulmonary arterial hypertension (PAH). METHODS: We evaluated clinical, functional, and hemodynamic data from all patients who underwent right heart catheterization because of diagnostic suspicion of PAH-in the absence of severe left ventricular dysfunction (LVD), significant changes in pulmonary function tests, and ventilation/perfusion lung scintigraphy findings consistent with chronic pulmonary thromboembolism-between 2008 and 2013 at our facility. RESULTS: During the study period, 384 patients underwent diagnostic cardiac catheterization at our facility. Pulmonary hypertension (PH) was confirmed in 302 patients (78.6%). The mean age of those patients was 48.7 years. The patients without PH showed better hemodynamic profiles and lower levels of B-type natriuretic peptide. Nevertheless, 13.8% of the patients without PH were categorized as New York Heart Association functional class III or IV. Of the 218 patients who met the inclusion criteria, 40 (18.3%) and 178 (81.7%) were diagnosed with PH associated with LVD (PH-LVD) and with PAH, respectively. The patients in the HP-LVD group were significantly older than were those in the PAH group (p < 0.0001). CONCLUSIONS: The proportional difference between the PAH and PH-LVD groups was quite significant, considering the absence of echocardiographic signs suggestive of severe LVD during the pre-catheterization investigation. Our results highlight the fundamental role of cardiac catheterization in the diagnosis of PAH, especially in older patients, in whom the prevalence of LVD that has gone undiagnosed by non-invasive tests is particularly relevant.
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Affiliation(s)
- Francisca Gavilanes
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, Brazil. Department of Pulmonology, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - InCor/HCFMUSP, Heart Institute/University of São Paulo School of Medicine Hospital das Clínicas - São Paulo, Brazil
| | - José Leonidas Alves
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, Brazil. Pulmonary Hypertension Group, Department of Pulmonology, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - InCor/HCFMUSP, Heart Institute/University of São Paulo School of Medicine Hospital das Clínicas - São Paulo, Brazil
| | - Caio Fernandes
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, Brazil. Pulmonary Hypertension Group, Department of Pulmonology, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - InCor/HCFMUSP, Heart Institute/University of São Paulo School of Medicine Hospital das Clínicas - São Paulo, Brazil
| | - Luis Felipe Lopes Prada
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, Brazil. Pulmonary Hypertension Group, Department of Pulmonology, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - InCor/HCFMUSP, Heart Institute/University of São Paulo School of Medicine Hospital das Clínicas - São Paulo, Brazil
| | - Carlos Viana Poyares Jardim
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, Brazil. Pulmonary Hypertension Group, Department of Pulmonology, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - InCor/HCFMUSP, Heart Institute/University of São Paulo School of Medicine Hospital das Clínicas - São Paulo, Brazil
| | - Luciana Tamie Kato Morinaga
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, Brazil. Pulmonary Hypertension Group, Department of Pulmonology, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - InCor/HCFMUSP, Heart Institute/University of São Paulo School of Medicine Hospital das Clínicas - São Paulo, Brazil
| | - Bruno Arantes Dias
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, Brazil. Pulmonary Hypertension Group, Department of Pulmonology, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - InCor/HCFMUSP, Heart Institute/University of São Paulo School of Medicine Hospital das Clínicas - São Paulo, Brazil
| | - Susana Hoette
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, Brazil. Pulmonary Hypertension Group, Department of Pulmonology, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - InCor/HCFMUSP, Heart Institute/University of São Paulo School of Medicine Hospital das Clínicas - São Paulo, Brazil
| | - Rogerio Souza
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, Brazil. Pulmonary Hypertension Group, Department of Pulmonology, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - InCor/HCFMUSP, Heart Institute/University of São Paulo School of Medicine Hospital das Clínicas - São Paulo, Brazil
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Alves JL, Gavilanes F, Jardim C, Fernandes CJCDS, Morinaga LTK, Dias B, Hoette S, Humbert M, Souza R. Pulmonary Arterial Hypertension in the Southern Hemisphere. Chest 2015; 147:495-501. [DOI: 10.1378/chest.14-1036] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Marjani M, Baghaei P, Malekmohammad M, Tabarsi P, Sharif-Kashani B, Behzadnia N, Mansouri D, Masjedi MR, Velayati AA. Effect of pulmonary hypertension on outcome of pulmonary tuberculosis. Braz J Infect Dis 2014; 18:487-90. [PMID: 24780367 PMCID: PMC9428175 DOI: 10.1016/j.bjid.2014.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 01/16/2014] [Accepted: 02/12/2014] [Indexed: 11/27/2022] Open
Abstract
Background This study performed at the National Research Institute of Tuberculosis and Lung Disease, Tehran, Iran, aimed to evaluate the effect of concomitant pulmonary hypertension on the outcome of pulmonary tuberculosis. Methods New cases of pulmonary tuberculosis were recruited for the study. Pulmonary hypertension was defined as systolic pulmonary arterial pressure ≥35 mm Hg estimated by transthoracic Doppler echocardiography. We assessed the relationship between pulmonary hypertension and mortality during the six-month treatment of tuberculosis. Results Of 777 new cases of pulmonary tuberculosis, 74 (9.5%) had systolic pulmonary arterial pressure ≥35 mm Hg. Ten of them (13.5%) died during treatment compared to 5% of cases with pulmonary arterial pressure less than 35 mm Hg (p = 0.007). Logistic regression analysis showed that pulmonary hypertension and drug abuse remained independently associated with mortality (OR = 3.1; 95% CI: 1.44–6.75 and OR = 4.4; 95% CI: 2.35–8.17, respectively). Conclusion A significant association was found between mortality and presence of pulmonary hypertension and drug abuse among new cases of pulmonary tuberculosis.
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Affiliation(s)
- Majid Marjani
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvaneh Baghaei
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Majid Malekmohammad
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Payam Tabarsi
- Mycobacteriology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Sharif-Kashani
- Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Neda Behzadnia
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Mansouri
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Masjedi
- Telemedicine Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Akbar Velayati
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Fernandes CJCS, Martins BCS, Jardim CVP, Ciconelli RM, Morinaga LK, Breda AP, Hoette S, Souza R. Quality of life as a prognostic marker in pulmonary arterial hypertension. Health Qual Life Outcomes 2014; 12:130. [PMID: 25176512 PMCID: PMC4168058 DOI: 10.1186/s12955-014-0130-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 08/08/2014] [Indexed: 11/12/2022] Open
Abstract
Background Improvement in quality of life together with better survival are the ultimate goals in the treatment of pulmonary arterial hypertension (PAH) patients. The objective of this study was to evaluate the health-related quality of life (HRQL) of pulmonary arterial hypertension (PAH) patients with the SF-36 generic questionnaire and to identify the prognostic implication of this assessment. Methods Fifty-four consecutive newly diagnosed PAH patients (WHO classification group I) in a single PAH reference center were included. Patients were evaluated at baseline for clinical and hemodynamic parameters, and they subsequently received first-line therapy with either an endothelin receptor antagonist or a phosphodiesterase-5 inhibitor. After 16 weeks of specific PAH therapy, all patients were re-evaluated using a 6MWT and a SF 36 questionnaire, and then they were followed up for at least 36 months. Results After treatment, the patients demonstrated an improved 6MWT (414 ± 124 m vs. 440 ± 113 m, p = 0.001). Specific PAH therapy also improved the HRQL scores. Patients with a baseline Physical Component Score (PCS) higher than 32 had a better survival rate than those who had a score under 32 (p = 0.04). Similarly, patients with a PCS of at least a 38 after the 16 week therapy period had a better survival rate when compared with those who did not achieve this value (p = 0.016). Unlike the absolute PCS values, the post-treatment PCS variability was unable to predict better survival rates (p = 0.58). Conclusions Our findings suggest that HRQL is associated with prognosis in PAH. Furthermore, achieving pre-determined PCS scores might represent a specific goal to be reached in treatment-to-target strategies.
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Affiliation(s)
| | | | | | | | | | | | | | - Rogério Souza
- Pulmonary Department, Heart Institute - University of Sao Paulo Medical School, Medical School, Av, Dr, Eneas de Carvalho Aguiar, 44, Sao Paulo, 05403-000, Brazil.
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Abstract
PURPOSE OF REVIEW To understand the rational of establishing a goal-oriented therapy for pulmonary arterial hypertension management. RECENT FINDINGS During the last decades, the development of targeted therapies and the recognition of prognostic markers represented a major step for improving pulmonary arterial hypertension survival. Now, changing the strategy on using these compounds therapies might represent the best way to optimize treatment response. SUMMARY Prespecified goals with regular reassessment should be incorporated as the routine practice for pulmonary arterial hypertension management to provide the best available treatment, aiming to improve or maintain every patient in a clinical and functional status that reflects better long-term survival.
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Polonio IB, Acencio MMP, Pazetti R, Almeida FMD, Silva BSD, Pereira KAB, Souza R. Lodenafil treatment in the monocrotaline model of pulmonary hypertension in rats. J Bras Pneumol 2014; 40:421-4. [PMID: 25210965 PMCID: PMC4201173 DOI: 10.1590/s1806-37132014000400010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 06/18/2014] [Indexed: 11/29/2022] Open
Abstract
We assessed the effects of lodenafil on hemodynamics and inflammation in the rat model of monocrotaline-induced pulmonary hypertension (PH). Thirty male Sprague-Dawley rats were randomly divided into three groups: control; monocrotaline (experimental model); and lodenafil (experimental model followed by lodenafil treatment, p.o., 5 mg/kg daily for 28 days) Mean pulmonary artery pressure (mPAP) was obtained by right heart catheterization. We investigated right ventricular hypertrophy (RVH) and IL-1 levels in lung fragments. The number of cases of RVH was significantly higher in the monocrotaline group than in the lodenafil and control groups, as were mPAP and IL-1 levels. We conclude that lodenafil can prevent monocrotaline-induced PH, RVH, and inflammation.
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Affiliation(s)
- Igor Bastos Polonio
- Department of Pulmonology, Santa Casa School of Medical Sciences in São Paulo, São Paulo, Brazil
| | | | - Rogério Pazetti
- Department of Thoracic Surgery, School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | | | | | - Rogério Souza
- Department of Pulmonology, School of Medicine, University of São Paulo, São Paulo, Brazil
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