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Fernandes CJ, Calderaro D, Assad APL, Salibe-Filho W, Kato-Morinaga LT, Hoette S, Piloto B, Castro MA, Lisboa RP, da Silva TAF, Martins MDA, Alves-Jr JL, Jardim C, Terra-Filho M, de Souza R. Update on the Treatment of Pulmonary Arterial Hypertension. Arq Bras Cardiol 2021; 117:750-764. [PMID: 34709302 PMCID: PMC8528352 DOI: 10.36660/abc.20200702] [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] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/13/2020] [Accepted: 11/04/2020] [Indexed: 11/28/2022] Open
Abstract
In the last decades, important advances have been made in the treatment of pulmonary arterial hypertension (PAH), a severe, progressive, incurable, and potentially fatal disease. For an adequate therapy, correct hemodynamic diagnosis and etiology classification are fundamental. Many etiologies - rheumatic disease, portal hypertension, congenital heart diseases, schistosomiasis - require specific measures, in addition to drug therapy for PAH. The specific therapy for PAH is based on medications that act on three pathophysiological pathways - prostacyclin, endothelin, and nitric oxide pathways. These drugs have multiple presentations (oral, intravenous, subcutaneous, and inhaled) and have changed the history of PAH. This review presents an overview of drug therapy strategies and different forms and peculiarities of PAH.
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Affiliation(s)
- Caio J. Fernandes
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Instituto do CâncerFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Câncer da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasilHospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Daniela Calderaro
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Medicina Interdisciplinar - Divisão de Cardiologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Ana Paula Luppino Assad
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasilHospital Sírio-Libanês, São Paulo, SP - Brasil
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilDisciplina de Reumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - William Salibe-Filho
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Luciana Tamie Kato-Morinaga
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasilHospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Susana Hoette
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Bruna Piloto
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasilHospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Marcela Araújo Castro
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasilHospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Roberta Pontes Lisboa
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasilHospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Taysa Antonia Felix da Silva
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasilHospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Murillo de Araújo Martins
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Jose L. Alves-Jr
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Instituto do CâncerFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Câncer da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasilHospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Carlos Jardim
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasilHospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Mario Terra-Filho
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasilHospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Rogerio de Souza
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasilHospital Sírio-Libanês, São Paulo, SP - Brasil
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Hovnanian ALD, Costa ELV, Hoette S, Fernandes CJCS, Jardim CVP, Dias BA, Morinaga LTK, Amato MBP, Souza R. Electrical impedance tomography in pulmonary arterial hypertension. PLoS One 2021; 16:e0248214. [PMID: 33730110 PMCID: PMC7968654 DOI: 10.1371/journal.pone.0248214] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 02/22/2021] [Indexed: 02/06/2023] Open
Abstract
The characterization of pulmonary arterial hypertension (PAH) relies mainly on right heart catheterization (RHC). Electrical impedance tomography (EIT) provides a non-invasive estimation of lung perfusion that could complement the hemodynamic information from RHC. To assess the association between impedance variation of lung perfusion (ΔZQ) and hemodynamic profile, severity, and prognosis, suspected of PAH or worsening PAH patients were submitted simultaneously to RHC and EIT. Measurements of ΔZQ were obtained. Based on the results of the RHC, 35 patients composed the PAH group, and eight patients, the normopressoric (NP) group. PAH patients showed a significantly reduced ΔZQ compared to the NP group. There was a significant correlation between ΔZQ and hemodynamic parameters, particularly with stroke volume (SV) (r = 0.76; P < 0.001). At 60 months, 15 patients died (43%) and 1 received lung transplantation; at baseline they had worse hemodynamics, and reduced ΔZQ when compared to survivors. Patients with low ΔZQ (≤154.6%.Kg) presented significantly worse survival (P = 0.033). ΔZQ is associated with hemodynamic status of PAH patients, with disease severity and survival, demonstrating EIT as a promising tool for monitoring patients with pulmonary vascular disease.
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Affiliation(s)
- André L. D. Hovnanian
- Pulmonary Divison, Heart Institute, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
- * E-mail:
| | - Eduardo L. V. Costa
- Pulmonary Divison, Heart Institute, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Susana Hoette
- Pulmonary Divison, Heart Institute, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Caio J. C. S. Fernandes
- Pulmonary Divison, Heart Institute, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Carlos V. P. Jardim
- Pulmonary Divison, Heart Institute, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Bruno A. Dias
- Pulmonary Divison, Heart Institute, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Luciana T. K. Morinaga
- Pulmonary Divison, Heart Institute, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Marcelo B. P. Amato
- Pulmonary Divison, Heart Institute, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Rogério Souza
- Pulmonary Divison, Heart Institute, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
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Sibomana JP, Campeche A, Carvalho-Filho RJ, Correa RA, Duani H, Pacheco Guimaraes V, Hilton JF, Kassa B, Kumar R, Lee MH, Loureiro CMC, Mazimba S, Mickael C, Oliveira RKF, Ota-Arakaki JS, Rezende CF, Silva LCS, Sinkala E, Ahmed HY, Graham BB. Schistosomiasis Pulmonary Arterial Hypertension. Front Immunol 2020; 11:608883. [PMID: 33362796 PMCID: PMC7758287 DOI: 10.3389/fimmu.2020.608883] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/03/2020] [Indexed: 12/18/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a disease of the lung blood vessels that results in right heart failure. PAH is thought to occur in about 5% to 10% of patients with hepatosplenic schistosomiasis, particularly due to S. mansoni. The lung blood vessel injury may result from a combination of embolization of eggs through portocaval shunts into the lungs causing localized Type 2 inflammatory response and vessel remodeling, triggering of autonomous pathology that becomes independent of the antigen, and high cardiac output as seen in portopulmonary hypertension. The condition is likely underdiagnosed as there is little systematic screening, and risk factors for developing PAH are not known. Screening is done by echocardiography, and formal diagnosis requires invasive right heart catheterization. Patients with Schistosoma-associated PAH show reduced functional capacity and can be treated with pulmonary vasodilators, which improves symptoms and may improve survival. There are animal models of this disease that might help in understanding disease pathogenesis and identify novel targets to screen and treatment. Pathogenic mechanisms include Type 2 immunity and activation and signaling in the TGF-β pathway. There are still major uncertainties regarding Schistosoma-associated PAH development, course and treatment.
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Affiliation(s)
- Jean Pierre Sibomana
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Tikur Anbessa Specialized Hospital, College of Health Sciences, University of Addis Ababa, Addis Ababa, Ethiopia
- Department of Medicine, Butare University Teaching Hospital, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Aloma Campeche
- Division of Gastroenterology, Department of Medicine, Santa Casa Hospital, Salvador, Bahia, Brazil
| | - Roberto J. Carvalho-Filho
- Division of Gastroenterology, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Ricardo Amorim Correa
- Internal Medicine/Pulmonary Division, Medical School, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Helena Duani
- Internal Medicine/Infectious Diseases Division, Medical School, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Virginia Pacheco Guimaraes
- Pulmonary Department, Hospital Júlia Kubistchek, Fundação Hospitalar of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Joan F. Hilton
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States
| | - Biruk Kassa
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
- Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Rahul Kumar
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
- Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Michael H. Lee
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
- Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | | | - Sula Mazimba
- Division of Cardiology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Claudia Mickael
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Rudolf K. F. Oliveira
- Division of Respiratory Diseases, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Jaquelina S. Ota-Arakaki
- Division of Respiratory Diseases, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Camila Farnese Rezende
- Pulmonary Medicine, Hospital das Clinicas, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Luciana C. S. Silva
- Internal Medicine Department, Medical School, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Edford Sinkala
- Hepatology Clinic, Department of Medicine, University of Zambia Teaching Hospital, Lusaka, Zambia
| | - Hanan Yusuf Ahmed
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Tikur Anbessa Specialized Hospital, College of Health Sciences, University of Addis Ababa, Addis Ababa, Ethiopia
| | - Brian B. Graham
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
- Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
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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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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 Jornal Brasileiro de Pneumologia - JBP - Brasília (DF) Brasil
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Freitas CSG, Baldi BG, Jardim C, Araujo MS, Sobral JB, Heiden GI, Kairalla RA, Souza R, Carvalho CRR. Pulmonary hypertension in lymphangioleiomyomatosis: prevalence, severity and the role of carbon monoxide diffusion capacity as a screening method. Orphanet J Rare Dis 2017; 12:74. [PMID: 28427470 PMCID: PMC5399314 DOI: 10.1186/s13023-017-0626-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 04/05/2017] [Indexed: 01/23/2023] Open
Abstract
Background Lymphangioleiomyomatosis (LAM) is included within group 5 of the current PH classification (unclear multifactorial mechanisms). However, data regarding the occurrence of PH in LAM are scarce. The aims of the study were to describe the prevalence and characteristics of PH in a large cohort of LAM patients with different levels of severity, and to evaluate the role of echocardiography and carbon monoxide diffusion capacity (DLCO) as screening methods for PH in LAM. Methods One hundred five LAM patients underwent transthoracic echocardiography, pulmonary function tests (PFTs) and 6-min walk test (6MWT). Patients with a suspicion of PH on echocardiography, defined by the presence of estimated systolic pulmonary artery pressure (PAP) over 35 mmHg or PFT showing DLco below 40% of the predicted value, underwent right heart catheterisation to confirm the diagnosis of PH. Results Eight patients (7.6%) had PH confirmed on right heart catheterisation, six patients (5.7%) had a pre-capillary pattern and two patients (1.9%) had a post-capillary profile. Only one patient (1%) had mean PAP over 35 mmHg. Patients with PH had lower FEV1 and DLCO in PFTs and greater oxygen desaturation and dyspnea intensity during 6MWT compared with those without PH. In 63% of the patients with confirmed PH, the right heart catheterisation was performed based only on DLCO result. Conclusions The prevalence of PH is low in LAM patients. Pulmonary hypertension in LAM is typically mild and significantly associated with pulmonary parenchymal involvement. Carbon monoxide diffusion capacity significantly improved the identification of PH in LAM patients.
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Affiliation(s)
- Carolina S G Freitas
- Pulmonary Division, Heart Institute (InCor), University of São Paulo Medical School, Av Dr Enéas de Carvalho Aguiar, 44, 5° andar - sala 1, São Paulo, 05403-900, Brazil
| | - Bruno G Baldi
- Pulmonary Division, Heart Institute (InCor), University of São Paulo Medical School, Av Dr Enéas de Carvalho Aguiar, 44, 5° andar - sala 1, São Paulo, 05403-900, Brazil.
| | - Carlos Jardim
- Pulmonary Division, Heart Institute (InCor), University of São Paulo Medical School, Av Dr Enéas de Carvalho Aguiar, 44, 5° andar - sala 1, São Paulo, 05403-900, Brazil
| | - Mariana S Araujo
- Pulmonology Department, Federal University of Paraná, Curitiba, Brazil
| | - Juliana Barbosa Sobral
- Echocardiography Laboratory, Radiology Institute (InRad), University of São Paulo Medical School, São Paulo, Brazil
| | - Gláucia I Heiden
- Pulmonary Division, Heart Institute (InCor), University of São Paulo Medical School, Av Dr Enéas de Carvalho Aguiar, 44, 5° andar - sala 1, São Paulo, 05403-900, Brazil
| | - Ronaldo A Kairalla
- Pulmonary Division, Heart Institute (InCor), University of São Paulo Medical School, Av Dr Enéas de Carvalho Aguiar, 44, 5° andar - sala 1, São Paulo, 05403-900, Brazil
| | - Rogério Souza
- Pulmonary Division, Heart Institute (InCor), University of São Paulo Medical School, Av Dr Enéas de Carvalho Aguiar, 44, 5° andar - sala 1, São Paulo, 05403-900, Brazil
| | - Carlos R R Carvalho
- Pulmonary Division, Heart Institute (InCor), University of São Paulo Medical School, Av Dr Enéas de Carvalho Aguiar, 44, 5° andar - sala 1, São Paulo, 05403-900, Brazil
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Affiliation(s)
- Rogerio Souza
- Disciplina de Pneumologia, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo (SP) Brasil.,Editor-Chefe do Jornal Brasileiro de Pneumologia
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Gualandro DM, Yu PC, Caramelli B, Marques AC, Calderaro D, Fornari LS, Pinho C, Feitosa ACR, Polanczyk CA, Rochitte CE, Jardim C, Vieira CLZ, Nakamura DYM, Iezzi D, Schreen D, Adam EL, D'Amico EA, Lima EQD, Burdmann EDA, Mateo EIP, Braga FGM, Machado FS, Paula FJD, Carmo GALD, Feitosa-Filho GS, Prado GF, Lopes HF, Fernandes JRC, Lima JJGD, Sacilotto L, Drager LF, Vacanti LJ, Rohde LEP, Prada LFL, Gowdak LHW, Vieira MLC, Monachini MC, Macatrão-Costa MF, Paixão MR, Oliveira MTD, Cury P, Villaça PR, Farsky PS, Siciliano RF, Heinisch RH, Souza R, Gualandro SFM, Accorsi TAD, Mathias W. 3rd Guideline for Perioperative Cardiovascular Evaluation of the Brazilian Society of Cardiology. Arq Bras Cardiol 2017; 109:1-104. [PMID: 29044300 PMCID: PMC5629911 DOI: 10.5935/abc.20170140] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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10
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Affiliation(s)
- Rogério Souza
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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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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Abstract
PURPOSE OF REVIEW This review highlights the prevalence of pulmonary hypertension as a chronic complication of sickle cell disease (SCD) and its importance in the prognosis. RECENT FINDINGS In recent years, the limitations of echocardiogram for the appropriate diagnosis of SCD-associated pulmonary hypertension have been demonstrated, emphasizing the need of invasive hemodynamics assessment before any specific treatment for pulmonary hypertension is considered. The hemodynamic profile observed in this clinical situation is characterized by elevated cardiac output and low pulmonary vascular resistance that differs considerably from what is seen in pulmonary arterial hypertension. Furthermore, both hemodynamic profiles, precapillary and postcapillary, can be equally found in this setting stressing the need for a better understanding of the multiple pathophysiological mechanisms involved in the development of pulmonary hypertension before considering those patients for targeted therapies. Nevertheless, the presence of any form of pulmonary hypertension clearly denotes worse prognosis in SCD. SUMMARY Pulmonary hypertension is an important and prevalent complication of SCD with multiple associated mechanisms. A more aggressive approach of the baseline condition might be necessary, although the data supporting this assumption and also the use of targeted pulmonary arterial hypertension therapy are still lacking.
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Hoette S, Figueiredo C, Dias B, Alves JL, Gavilanes F, Prada LF, Jasinowodolinski D, Morinaga LTK, Jardim C, Fernandes CJC, Souza R. Pulmonary artery enlargement in schistosomiasis associated pulmonary arterial hypertension. BMC Pulm Med 2015; 15:118. [PMID: 26459359 PMCID: PMC4603807 DOI: 10.1186/s12890-015-0115-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 09/30/2015] [Indexed: 11/14/2022] Open
Abstract
Background Schistosomiasis associated pulmonary arterial hypertension (Sch-PAH) might represent the most prevalent form of PAH worldwide. In Sch-PAH, the presence of aneurismal dilation of the pulmonary artery has been described, although it is still a matter of debate whether on average the pulmonary artery is more enlarged in Sc-PAH than IPAH. Methods We retrospectively evaluated patients with IPAH (n = 25) and Sch-PAH (n = 22) who underwent computed tomography pulmonary angiogram and right heart catheterization. Results Sch-PAH patients were older and presented less severe hemodynamic profiles. Main pulmonary artery diameter (MPAD) was greater in Sch-PAH than IPAH (4.5 ± 1.8 vs 3.7 ± 1.1 cm, p = 0.018). For the same level of mean pulmonary artery pressure, the MPAD in Sch-PAH was 0.89 cm larger than in IPAH (Covariance model p = 0.02). Conclusion This study demonstrated that pulmonary artery enlargement is more pronounced in Sch-PAH than IPAH, independently of mean pulmonary artery pressure level, suggesting that this is more likely a feature of Sch-PAH.
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Affiliation(s)
- Susana Hoette
- Pulmonary Department - Heart Institute, University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Sao Paulo, 05403-000, Brazil.
| | - Claudia Figueiredo
- Pulmonary Department - Heart Institute, University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Sao Paulo, 05403-000, Brazil.
| | - Bruno Dias
- Pulmonary Department - Heart Institute, University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Sao Paulo, 05403-000, Brazil.
| | - Jose Leonidas Alves
- Pulmonary Department - Heart Institute, University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Sao Paulo, 05403-000, Brazil.
| | - Francisca Gavilanes
- Pulmonary Department - Heart Institute, University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Sao Paulo, 05403-000, Brazil.
| | - Luis Felipe Prada
- Pulmonary Department - Heart Institute, University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Sao Paulo, 05403-000, Brazil.
| | - Dany Jasinowodolinski
- Pulmonary Department - Heart Institute, University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Sao Paulo, 05403-000, Brazil.
| | - Luciana Tamie Kato Morinaga
- Pulmonary Department - Heart Institute, University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Sao Paulo, 05403-000, Brazil.
| | - Carlos Jardim
- Pulmonary Department - Heart Institute, University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Sao Paulo, 05403-000, Brazil.
| | - Caio Julio Cesar Fernandes
- Pulmonary Department - Heart Institute, University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Sao Paulo, 05403-000, Brazil.
| | - Rogério Souza
- Pulmonary Department - Heart Institute, University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Sao Paulo, 05403-000, Brazil.
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14
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Prada LFL, Gavilanes F, Souza R. Incidence of spontaneous subdural hematoma in incident cases of pulmonary arterial hypertension: a registry of cases occurring over a five-year period. J Bras Pneumol 2015; 41:101-2. [PMID: 25750681 PMCID: PMC4350832 DOI: 10.1590/s1806-37132015000100014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 06/30/2014] [Indexed: 11/22/2022] Open
Affiliation(s)
- Luis Felipe Lopes Prada
- University of São Paulo, School of Medicine, Hospital das Clínicas, São Paulo, Brazil, Heart Institute, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
| | - Francisca Gavilanes
- University of São Paulo, School of Medicine, Hospital das Clínicas, São Paulo, Brazil, Heart Institute, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
| | - Rogério Souza
- University of São Paulo, School of Medicine, São Paulo, Brazil, University of São Paulo School of Medicine, São Paulo, Brazil
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15
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Jardim C, Souza R. Biomarkers and Prognostic Indicators in Pulmonary Arterial Hypertension. Curr Hypertens Rep 2015; 17:556. [DOI: 10.1007/s11906-015-0556-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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16
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Souza R. Bringing the JBP and its readers closer together. J Bras Pneumol 2015. [PMCID: PMC4541754 DOI: 10.1590/s1806-37132015000300001] [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
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