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Asari Y, Yamasaki Y, Tsuchida K, Suzuki K, Akashi YJ, Okazaki T, Ozaki S, Yamada H, Kawahata K. Hemodynamic heterogeneity of connective tissue disease patients with borderline mean pulmonary artery pressure and its distinctive characters from those with normal pulmonary artery pressure: a retrospective study. Clin Rheumatol 2018; 37:3373-3380. [PMID: 29777409 DOI: 10.1007/s10067-018-4142-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/02/2018] [Accepted: 05/08/2018] [Indexed: 11/30/2022]
Abstract
To clarify whether patients with connective tissue disease (CTD)-associated borderline mean pulmonary artery pressure (mPAP) have distinctive hemodynamic characteristics from those with normal mPAP and whether pathogenesis is as heterogeneous as manifest pulmonary hypertension (PH). Seventy-five CTD patients who underwent right heart catheterization (RHC) from 2008 through 2016 were retrospectively analyzed. We compared between-group differences in clinical and hemodynamic findings: normal mPAP (n = 35), borderline mPAP (n = 15), and PH (n = 25). A therapeutic intervention trial based on RHC results was performed in nine patients. The values of tricuspid regurgitation pressure gradient (TRPG) in patients with borderline mPAP were comparable at rest but became higher after exercise compared to those with a normal mPAP (P = 0.01). Pulmonary artery wedge pressure in patients with borderline mPAP was higher than in those with normal mPAP (P < 0.0001) and comparable to those with PH. Each of the three patients was treated for pre-capillary and post-capillary disease and two for interstitial lung disease (ILD). During the mean follow-up period of 40 months, mPAP or TRPG normalized in all patients treated for pre-capillary and post-capillary disease. One patient with severe ILD developed to PH and died from it. CTD patients with borderline mPAP, the underlining pathogenesis of which is heterogeneous as PH, have distinctive hemodynamic characteristics from those with normal mPAP. Whether a specific treatment targeting the inflammatory process or local hemodynamics may alter the clinical course to PH is a topic for future research.
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Affiliation(s)
- Yusa Asari
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae, Kawasaki City, Kanagawa, 216-8511, Japan
| | - Yoshioki Yamasaki
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae, Kawasaki City, Kanagawa, 216-8511, Japan.
| | - Kosei Tsuchida
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae, Kawasaki City, Kanagawa, 216-8511, Japan
| | - Kengo Suzuki
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae, Kawasaki City, Kanagawa, 216-8511, Japan
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae, Kawasaki City, Kanagawa, 216-8511, Japan
| | - Takahiro Okazaki
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae, Kawasaki City, Kanagawa, 216-8511, Japan
| | - Shoichi Ozaki
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae, Kawasaki City, Kanagawa, 216-8511, Japan
| | - Hidehiro Yamada
- Medical Center for Rheumatic Diseases, Seirei Yokohama Hospital, 215, Iwaicho, Hodogaya, Yokohama City, Kanagawa, 240-8521, Japan
| | - Kimito Kawahata
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae, Kawasaki City, Kanagawa, 216-8511, Japan
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Yamasaki Y, Suzuki K, Kamijima R, Asari Y, Tsuchida K, Mizushima M, Okazaki T, Akashi YJ, Ozaki S, Yamada H. Combined disease with pulmonary arterial hypertension and pulmonary venous hypertension revealed after treatment of heart failure with preserved ejection fraction in a case with primary Sjögren syndrome. Mod Rheumatol 2015; 28:193-196. [DOI: 10.3109/14397595.2015.1059989] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Yoshioki Yamasaki
- Division of Rheumatology and Allergology, St. Marianna University School of Medicine, Sugao, Miyamae, Kawasaki City, Kanagawa Prefecture, Japan
| | - Kengo Suzuki
- Division of Cardiology, St. Marianna University School of Medicine, Sugao, Miyamae, Kawasaki City, Kanagawa Prefecture, Japan
| | - Ryo Kamijima
- Division of Cardiology, St. Marianna University School of Medicine, Sugao, Miyamae, Kawasaki City, Kanagawa Prefecture, Japan
| | - Yusa Asari
- Division of Rheumatology and Allergology, St. Marianna University School of Medicine, Sugao, Miyamae, Kawasaki City, Kanagawa Prefecture, Japan
| | - Kosei Tsuchida
- Division of Rheumatology and Allergology, St. Marianna University School of Medicine, Sugao, Miyamae, Kawasaki City, Kanagawa Prefecture, Japan
| | - Machiko Mizushima
- Division of Rheumatology and Allergology, St. Marianna University School of Medicine, Sugao, Miyamae, Kawasaki City, Kanagawa Prefecture, Japan
| | - Takahiro Okazaki
- Division of Rheumatology and Allergology, St. Marianna University School of Medicine, Sugao, Miyamae, Kawasaki City, Kanagawa Prefecture, Japan
| | - Yoshihiro J. Akashi
- Division of Cardiology, St. Marianna University School of Medicine, Sugao, Miyamae, Kawasaki City, Kanagawa Prefecture, Japan
| | - Shoichi Ozaki
- Division of Rheumatology and Allergology, St. Marianna University School of Medicine, Sugao, Miyamae, Kawasaki City, Kanagawa Prefecture, Japan
| | - Hidehiro Yamada
- Division of Rheumatology and Allergology, St. Marianna University School of Medicine, Sugao, Miyamae, Kawasaki City, Kanagawa Prefecture, Japan
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