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Kianzad A, Baccelli A, Braams NJ, Andersen S, van Wezenbeek J, Wessels JN, Celant LR, Vos AE, Davies R, Lo Giudice F, Haji G, Rinaldo RF, Vigo B, Gopalan D, Symersky P, Winkelman JA, Boonstra A, Nossent EJ, Tim Marcus J, Vonk Noordegraaf A, Meijboom LJ, de Man FS, Andersen A, Howard LS, Bogaard HJ. Long-term effects of pulmonary endarterectomy on pulmonary hemodynamics, cardiac function, and exercise capacity in chronic thromboembolic pulmonary hypertension. J Heart Lung Transplant 2024; 43:580-593. [PMID: 38000764 DOI: 10.1016/j.healun.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 11/06/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Long-term changes in exercise capacity and cardiopulmonary hemodynamics after pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) have been poorly described. METHODS We analyzed the data from 2 prospective surgical CTEPH cohorts in Hammersmith Hospital, London, and Amsterdam UMC. A structured multimodal follow-up was adopted, consisting of right heart catheterization, cardiac magnetic resonance imaging, and cardiopulmonary exercise testing before and after PEA. Preoperative predictors of residual pulmonary hypertension (PH; mean pulmonary artery pressure >20 mm Hg and pulmonary vascular resistance ≥2 WU) and long-term exercise intolerance (VO2max <80%) at 18 months were analyzed. RESULTS A total of 118 patients (61 from London and 57 from Amsterdam) were included in the analysis. Both cohorts displayed a significant improvement of pulmonary hemodynamics, right ventricular (RV) function, and exercise capacity 6 months after PEA. Between 6 and 18 months after PEA, there were no further improvements in hemodynamics and RV function, but the proportion of patients with impaired exercise capacity was high and slightly increased over time (52%-59% from 6 to 18 months). Long-term exercise intolerance was common and associated with preoperative diffusion capacity for carbon monoxide (DLCO), preoperative mixed venous oxygen saturation, and postoperative PH and right ventricular ejection fraction (RVEF). Clinically significant RV deterioration (RVEF decline >3%; 5 [9%] of 57 patients) and recurrent PH (5 [14%] of 36 patients) rarely occurred beyond 6 months after PEA. Age and preoperative DLCO were predictors of residual PH post-PEA. CONCLUSIONS Restoration in exercise tolerance, cardiopulmonary hemodynamics, and RV function occurs within 6 months. No substantial changes occurred between 6 and 18 months after PEA in the Amsterdam cohort. Nevertheless, long-term exercise intolerance is common and associated with postoperative RV function.
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Affiliation(s)
- Azar Kianzad
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Pulmonary Medicine, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, the Netherlands
| | - Andrea Baccelli
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, University of Milan, Milan, Italy
| | - Natalia J Braams
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Pulmonary Medicine, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, the Netherlands
| | - Stine Andersen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - Jessie van Wezenbeek
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Pulmonary Medicine, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, the Netherlands
| | - Jeroen N Wessels
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Pulmonary Medicine, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, the Netherlands
| | - Lucas R Celant
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Pulmonary Medicine, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, the Netherlands
| | - Anna E Vos
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Pulmonary Medicine, Amsterdam, the Netherlands
| | - Rachel Davies
- National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Francesco Lo Giudice
- National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Gulammehdi Haji
- National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Rocco F Rinaldo
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, University of Milan, Milan, Italy
| | - Beatrice Vigo
- Respiratory Unit, ASST Santi Paolo e Carlo, San Carlo Hospital, Department of Health Sciences, University of Milan, Milan, Italy
| | - Deepa Gopalan
- Department of Radiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Petr Symersky
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Cardiothoracic Surgery, Amsterdam, the Netherlands
| | - Jacobus A Winkelman
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Cardiothoracic Surgery, Amsterdam, the Netherlands
| | - Anco Boonstra
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Pulmonary Medicine, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, the Netherlands
| | - Esther J Nossent
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Pulmonary Medicine, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, the Netherlands
| | - J Tim Marcus
- Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, the Netherlands; Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, the Netherlands
| | - Anton Vonk Noordegraaf
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Pulmonary Medicine, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, the Netherlands
| | - Lilian J Meijboom
- Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, the Netherlands; Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, the Netherlands
| | - Frances S de Man
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Pulmonary Medicine, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, the Netherlands
| | - Asger Andersen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - Luke S Howard
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Harm Jan Bogaard
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Pulmonary Medicine, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, the Netherlands.
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Nossent EJ, Smits J, Seegers C, Meijboom LJ, Boonstra A, Aman J, De Man FS, Bogaard HJ, Radonic T, Dorfmüller P, Vonk Noordegraaf A. Clinical correlates of a non-plexiform vasculopathy in patients diagnosed with idiopathic pulmonary arterial hypertension. Chest 2024:S0012-3692(24)00280-0. [PMID: 38432552 DOI: 10.1016/j.chest.2024.02.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 02/09/2024] [Accepted: 02/22/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND The clinical phenotype of idiopathic pulmonary arterial hypertension (IPAH) patients has changed. . Whether or not subgroups of IPAH patients have different vascular phenotypes is a subject of debate. RESEARCH QUESTION What are the histological patterns and their clinical correlates in patients diagnosed with IPAH or hereditary PAH? STUDY DESIGN AND METHODS In this this cross-sectional registry study lung histology of 50 IPAH patients was qualitatively assessed by two experienced pathologists. In addition, quantitative analysis by means of histopathological morphometry using immunohistochemistry was performed. Histopathological characteristics were correlated with clinical and hemodynamic parameters. RESULTS In this cohort of 50 IPAH patients, a plexiform vasculopathy was observed in 26/50 (52%) of patients, while 24/50 (48%) patients had a non-plexiform vasculopathy. The non-plexiform vasculopathy was characterized by prominent pulmonary microvascular (arterioles and venules) remodeling and vascular rarefaction. While hemodynamic parameters were comparable in plexiform versus non-plexiform vasculopathy, patients with non-plexiform vasculopathy were older, more often male, had a stronger history of cigarette smoking and lower diffusing capacity for carbon monoxide (DLCO) at diagnosis No mutations in established PAH genes were found in the non-plexiform group. INTERPRETATION This study reveals different vascular phenotypes within the current spectrum of patients diagnosed with IPAH, separated by clinical characteristics (age, sex, , history of cigarette smoking, and DLCO at diagnosis). Potential differences in underlying pathobiological mechanisms between patients with plexiform and non-plexiform / microvascular disease should be taken into account in future research strategies unravelling the pathophysiology of pulmonary hypertension and developing biology-targeted treatment approaches.
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Affiliation(s)
- Esther J Nossent
- Department of Pulmonary Medicine, Amsterdam UMC, Free University Amsterdam, Cardiovascular Sciences Research Institute, Amsterdam, the Netherlands
| | - Josien Smits
- Department of Pulmonary Medicine, Amsterdam UMC, Free University Amsterdam, Cardiovascular Sciences Research Institute, Amsterdam, the Netherlands
| | - Celine Seegers
- Department of Pulmonary Medicine, Amsterdam UMC, Free University Amsterdam, Cardiovascular Sciences Research Institute, Amsterdam, the Netherlands
| | - Lilian J Meijboom
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Free University Amsterdam, Cardiovascular Sciences Research Institute, The Netherlands
| | - Anco Boonstra
- Department of Pulmonary Medicine, Amsterdam UMC, Free University Amsterdam, Cardiovascular Sciences Research Institute, Amsterdam, the Netherlands
| | - J Aman
- Department of Pulmonary Medicine, Amsterdam UMC, Free University Amsterdam, Cardiovascular Sciences Research Institute, Amsterdam, the Netherlands
| | - F S De Man
- Department of Pulmonary Medicine, Amsterdam UMC, Free University Amsterdam, Cardiovascular Sciences Research Institute, Amsterdam, the Netherlands
| | - Harm Jan Bogaard
- Department of Pulmonary Medicine, Amsterdam UMC, Free University Amsterdam, Cardiovascular Sciences Research Institute, Amsterdam, the Netherlands
| | - Teodora Radonic
- Department of Pathology, Amsterdam UMC, Free University Amsterdam, Amsterdam, The Netherlands
| | - Peter Dorfmüller
- Department of Pathology, University Hospital Giessen and Marburg (UKGM), and German Centre for Lung Research (DZL), Giessen, Germany
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Medicine, Amsterdam UMC, Free University Amsterdam, Cardiovascular Sciences Research Institute, Amsterdam, the Netherlands.
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Torbicki A, Channick R, Galiè N, Kiely DG, Moceri P, Peacock A, Swift AJ, Tawakol A, Vonk Noordegraaf A, Flores D, Martin N, Rosenkranz S. Effect of Macitentan in Pulmonary Arterial Hypertension and the Relationship Between Echocardiography and cMRI Variables: REPAIR Echocardiography Sub-study Results. Cardiol Ther 2024; 13:173-190. [PMID: 38281309 PMCID: PMC10899124 DOI: 10.1007/s40119-023-00345-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/04/2023] [Indexed: 01/30/2024] Open
Abstract
INTRODUCTION The aim of this sub-study was to evaluate the relationship between echocardiography (echo) and cardiac magnetic resonance imaging (cMRI) variables and to utilize echo to assess the effect of macitentan on right ventricle (RV) structure and function. METHODS REPAIR (NCT02310672) was a prospective, multicenter, single-arm, open-label, 52-week, phase 4 study in pulmonary arterial hypertension (PAH) patients, which investigated the effect of macitentan 10 mg as monotherapy, or in combination with a phosphodiesterase 5 inhibitor, on RV structure, function, and hemodynamics using cMRI and right heart catheterization. In this sub-study, patients were also assessed by echo at screening and at weeks 26 and/or 52. Post hoc correlation analyses between echo and cMRI variables were performed using Pearson's correlation coefficient, Spearman's correlation coefficient, and Bland-Altman analyses. RESULTS The Echo sub-study included 45 patients. Improvements in echo-assessed RV stroke volume (RVSV), left ventricular SV (LVSV), LV end-diastolic volume (LVEDV), RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), and in 2D global longitudinal RV strain (2D GLRVS) were observed at weeks 26 and 52 compared to baseline. There was a strong correlation between echo (LVSV, 2D GLRVS, and LVEDV) and cMRI variables, with a moderate correlation for RVSV. Bland-Altman analyses showed a good agreement for LVSV measured by echo versus cMRI, whereas an overestimation in echo-assessed RVSV was observed compared to cMRI (bias of - 15 mL). Hemodynamic and functional variables, as well as safety, were comparable between the Echo sub-study and REPAIR. CONCLUSIONS A good relationship between relevant echo and cMRI parameters was shown. Improvements in RV structure and function with macitentan treatment was observed by echo, consistent with results observed by cMRI in the primary analysis of the REPAIR study. Echo is a valuable complementary method to cMRI, with the potential to non-invasively monitor treatment response at follow-up. TRIAL REGISTRATION NUMBER REPAIR NCT02310672.
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Affiliation(s)
- Adam Torbicki
- Department of Pulmonary Circulation, Thromboembolic Disease and Cardiology, Centre for Postgraduate Medical Education ECZ-Otwock, ERN-LUNG Member, F. Chopin Hospital European Health Centre, ul. Borowa 14/18, 05-400, Otwock, Poland.
| | | | - Nazzareno Galiè
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna and Dipartimento DIMES, Università di Bologna, Bologna, Italy
| | - David G Kiely
- Sheffield Pulmonary Vascular Disease Unit, NIHR Biomedical Research Centre Sheffield and University of Sheffield, Sheffield, UK
| | - Pamela Moceri
- Cardiology Department, UR2CA, Pasteur University Hospital, Côte-d'Azur University, Nice, France
| | | | - Andrew J Swift
- Department of Infection, Immunity & Cardiovascular Disease, National Institute for Health and Care Research Sheffield Biomedical Research Centre, University of Sheffield, Sheffield, UK
| | - Ahmed Tawakol
- Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | | | - Dayana Flores
- Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson & Johnson, Global Medical Affairs, Allschwil, Switzerland
| | - Nicolas Martin
- Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson & Johnson, Statistical Decision Science, Allschwil, Switzerland
| | - Stephan Rosenkranz
- Department of Cardiology, Heart Center, University Hospital Cologne, and Cologne Cardiovascular Research Center (CCRC), University of Cologne, Cologne, Germany
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van de Veerdonk MC, Roosma L, Trip P, Gopalan D, Vonk Noordegraaf A, Dorfmüller P, Nossent EJ. Clinical-imaging-pathological correlation in pulmonary hypertension associated with left heart disease. Eur Respir Rev 2024; 33:230144. [PMID: 38417969 PMCID: PMC10900069 DOI: 10.1183/16000617.0144-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/25/2023] [Indexed: 03/01/2024] Open
Abstract
Pulmonary hypertension (PH) is highly prevalent in patients with left heart disease (LHD) and negatively impacts prognosis. The most common causes of PH associated with LHD (PH-LHD) are left heart failure and valvular heart disease. In LHD, passive backward transmission of increased left-sided filling pressures leads to isolated post-capillary PH. Additional pulmonary vasoconstriction and remodelling lead to a higher vascular load and combined pre- and post-capillary PH. The increased afterload leads to right ventricular dysfunction and failure. Multimodality imaging of the heart plays a central role in the diagnostic work-up and follow-up of patients with PH-LHD. Echocardiography provides information about the estimated pulmonary artery pressure, morphology and function of the left and right side of the heart, and valvular abnormalities. Cardiac magnetic resonance imaging is the gold standard for volumetric measurements and provides myocardial tissue characterisation. Computed tomography of the thorax may show general features of PH and/or LHD and is helpful in excluding other PH causes. Histopathology reveals a spectrum of pre- and post-capillary vasculopathy, including intimal fibrosis, media smooth muscle cell hyperplasia, adventitial fibrosis and capillary congestion. In this paper, we provide an overview of clinical, imaging and histopathological findings in PH-LHD based on three clinical cases.
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Affiliation(s)
- Marielle C van de Veerdonk
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
| | - Lize Roosma
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Free University, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
| | - Pia Trip
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Free University, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
| | - Deepa Gopalan
- Department of Radiology, Imperial College Hospital NHS Trust, London, UK
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Free University, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
| | - Peter Dorfmüller
- Department of Pathology, University Hospital Giessen and Marburg (UKGM), German Centre for Lung Research (DZL) and Institute for Lung Health (ILH), Giessen, Germany
| | - Esther J Nossent
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Free University, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
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5
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van Kan C, Tramper J, Bresser P, J. Meijboom L, Symersky P, Winkelman JA, Nossent EJ, Aman J, Bogaard HJ, Vonk Noordegraaf A, van Es J. Patients with CTEPH and mild hemodynamic severity of disease improve to a similar level of exercise capacity after pulmonary endarterectomy compared to patients with severe hemodynamic disease. Pulm Circ 2024; 14:e12316. [PMID: 38274560 PMCID: PMC10808941 DOI: 10.1002/pul2.12316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 11/06/2023] [Accepted: 11/20/2023] [Indexed: 01/27/2024] Open
Abstract
The correlation between hemodynamics and degree of pulmonary vascular obstruction (PVO) is known to be poor in chronic thromboembolic pulmonary hypertension (CTEPH), which makes the selection of patients eligible for pulmonary endarterectomy (PEA) challenging. It can be postulated that patients with similar PVO but different hemodynamic severity have different postoperative hemodynamics and exercise capacity. Therefore, we aimed to assess the effects of PEA on hemodynamics and exercise physiology in mild and severe CTEPH patients. We retrospectively studied 18 CTEPH patients with a mild hemodynamic profile (mean pulmonary arterial pressure [mPAP] between 25 and 30 mmHg at rest) and CTEPH patients with a more severe hemodynamic profile (mPAP > 30 mmHg), matched by age, gender, and PVO. Cardiopulmonary exercise testing parameters were evaluated at baseline and 18 months following PEA. At baseline, exercise capacity, defined as oxygen uptake, was less severely impaired in the mild CTEPH group compared to the severe CTEPH group. After PEA, in the mild CTEPH group, ventilatory efficiency and oxygen pulse improved significantly (p < 0.05), however, the change in ventilatory efficiency and oxygen pulse was smaller compared to the severe CTEPH group. Only in the severe CTEPH group exercise capacity improved significantly (p < 0.001). Hence, in the present study, postoperative hemodynamic outcome and the CPET-determined recovery of exercise capacity in mild CTEPH patients did not differ from a matched group of severe CTEPH patients.
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Affiliation(s)
- Coen van Kan
- Department of Pulmonary Medicine, Amsterdam UMC, Cardiovascular SciencesVrije UniversiteitAmsterdamThe Netherlands
- Department of Respiratory MedicineOLVGAmsterdamThe Netherlands
| | - Jelco Tramper
- Department of Pulmonary Medicine, Amsterdam UMC, Cardiovascular SciencesVrije UniversiteitAmsterdamThe Netherlands
| | - Paul Bresser
- Department of Respiratory MedicineOLVGAmsterdamThe Netherlands
| | - Lilian J. Meijboom
- Department of Radiology and Nuclear MedicineAmsterdam UMCAmsterdamThe Netherlands
- Department of Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and ThrombosisAmsterdamThe Netherlands
| | - Petr Symersky
- Department of Cardiothoracic SurgeryAmsterdam UMCAmsterdamThe Netherlands
- Department of Cardiothoracic SurgeryOLVGAmsterdamThe Netherlands
| | | | - Esther J. Nossent
- Department of Pulmonary Medicine, Amsterdam UMC, Cardiovascular SciencesVrije UniversiteitAmsterdamThe Netherlands
- Department of Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and ThrombosisAmsterdamThe Netherlands
| | - Jurjan Aman
- Department of Pulmonary Medicine, Amsterdam UMC, Cardiovascular SciencesVrije UniversiteitAmsterdamThe Netherlands
- Department of Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and ThrombosisAmsterdamThe Netherlands
| | - Harm Jan Bogaard
- Department of Pulmonary Medicine, Amsterdam UMC, Cardiovascular SciencesVrije UniversiteitAmsterdamThe Netherlands
- Department of Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and ThrombosisAmsterdamThe Netherlands
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Medicine, Amsterdam UMC, Cardiovascular SciencesVrije UniversiteitAmsterdamThe Netherlands
- Department of Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and ThrombosisAmsterdamThe Netherlands
| | - Josien van Es
- Department of Pulmonary Medicine, Amsterdam UMC, Cardiovascular SciencesVrije UniversiteitAmsterdamThe Netherlands
- Department of Respiratory MedicineOLVGAmsterdamThe Netherlands
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Kiely DG, Channick R, Flores D, Galiè N, MacDonald G, Marcus JT, Mitchell L, Peacock A, Rosenkranz S, Tawakol A, Torbicki A, Vonk Noordegraaf A, Swift AJ. Comparison of cardiac magnetic resonance imaging, functional and haemodynamic variables in pulmonary arterial hypertension: insights from REPAIR. ERJ Open Res 2024; 10:00547-2023. [PMID: 38348238 PMCID: PMC10860210 DOI: 10.1183/23120541.00547-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/11/2023] [Indexed: 02/15/2024] Open
Abstract
Background Measures that can detect large treatment effects are important for monitoring therapeutic effectiveness. The 2022 European Society of Cardiology/European Respiratory Society guidelines highlight the importance of imaging in monitoring disease status and treatment response in pulmonary arterial hypertension (PAH). Are the standardised treatment effect sizes (STES) of cardiac magnetic resonance imaging (cMRI) comparable with functional and haemodynamic variables? Methods REPAIR (ClinicalTrials.gov: NCT02310672) was a prospective, multicentre, single-arm, open-label, 52-week phase 4 study evaluating the effect of macitentan 10 mg, with or without a phosphodiesterase 5 inhibitor (PDE5i), on right ventricular (RV) remodelling, cardiac function and cardiopulmonary haemodynamics. Both cMRI and functional assessments were performed at screening and at weeks 26 and 52; haemodynamic measurements were conducted at screening and week 26. In this post hoc analysis, STES were estimated using the parametric Cohen's d and non-parametric Cliff's delta tests. Results At week 26, large STES (Cohen's d) were observed for 10 of the 20 cMRI variables assessed, including the prognostic measures of RV and left ventricular stroke volume and RV ejection fraction and the haemodynamic trial end-point, pulmonary vascular resistance; medium STES were observed for 6-min walk distance (6MWD). The STES were consistent in treatment-naïve patients and those escalating therapy and maintained at week 52. Similar results were obtained using the non-parametric Cliff's delta method. Conclusions The treatment effect of macitentan, alone or in combination with a PDE5i, was comparable for several cMRI and haemodynamic variables with prognostic value in PAH, and greater than that of 6MWD in patients with PAH, highlighting the emerging relevance of cMRI in PAH.
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Affiliation(s)
- David G. Kiely
- Sheffield Pulmonary Vascular Disease Unit and NIHR Biomedical Research Centre, Royal Hallamshire Hospital and University of Sheffield, Sheffield, UK
- Department of Clinical Medicine, University of Sheffield, Sheffield, UK
| | | | - Dayana Flores
- Global Medical Affairs, Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson & Johnson, Allschwil, Switzerland
| | - Nazzareno Galiè
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Dipartimento di Medicina Specialistica Diagnostica e Sperimentale (DIMES), Università di Bologna, Bologna, Italy
| | - Gwen MacDonald
- Global Medical Affairs, Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson & Johnson, Allschwil, Switzerland
| | - J. Tim Marcus
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lada Mitchell
- Statistical Decision Science, Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson & Johnson, Allschwil, Switzerland
| | - Andrew Peacock
- Statistical Decision Science, Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson & Johnson, Allschwil, Switzerland
| | | | - Ahmed Tawakol
- Department of Cardiology, Heart Center, University Hospital Cologne and Cologne Cardiovascular Research Center, University of Cologne, Cologne, Germany
| | - Adam Torbicki
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Andrew J. Swift
- Department of Clinical Medicine, University of Sheffield, Sheffield, UK
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7
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Celant LR, Wessels JN, Marcus JT, Meijboom LJ, Bogaard HJ, de Man FS, Vonk Noordegraaf A. Toward the Implementation of Optimal Cardiac Magnetic Resonance Risk Stratification in Pulmonary Arterial Hypertension. Chest 2024; 165:181-191. [PMID: 37527773 DOI: 10.1016/j.chest.2023.07.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/06/2023] [Accepted: 07/24/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND The 2022 European Society of Cardiology/European Respiratory Society pulmonary hypertension (PH) guidelines incorporate cardiac magnetic resonance (CMR) imaging metrics in the risk stratification of patients with pulmonary arterial hypertension (PAH). Thresholds to identify patients at estimated 1-year mortality risks of < 5%, 5% to 20%, and > 20% are introduced. However, these cutoff values are mostly single center-based and require external validation. RESEARCH QUESTION What are the discriminative prognostic properties of the current CMR risk thresholds stratifying patients with PAH? STUDY DESIGN AND METHODS We analyzed data from incident, treatment-naïve patients with PAH from the Amsterdam University Medical Centres, Vrije Universiteit, The Netherlands. The discriminative properties of the proposed CMR three risk strata were tested at baseline and first reassessment, using the following PH guideline variables: right ventricular ejection fraction, indexed right ventricular end-systolic volume, and indexed left ventricular stroke volume. RESULTS A total of 258 patients with PAH diagnosed between 2001 and 2022 fulfilled the study criteria and were included in this study. Of these, 172 had follow-up CMR imaging after 3 months to 1.5 years. According to the CMR three risk strata, most patients were classified at intermediate risk (n = 115 [45%]) upon diagnosis. Only 29 (11%) of patients with PAH were classified at low risk, and 114 (44%) were classified at high risk. Poor survival discrimination was seen between risk groups. Appropriate survival discrimination was seen at first reassessment. INTERPRETATION Risk stratifying patients with PAH with the recent proposed CMR cutoffs from the European Society of Cardiology/European Respiratory Society 2022 PH guidelines requires adjustment because post-processing consensus is lacking and general applicability is limited. Risk assessment at follow-up yielded better survival discrimination, emphasizing the importance of the individual treatment response.
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Affiliation(s)
- Lucas R Celant
- Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, The Netherlands; Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam UMC location Vrije Universiteit Amsterdam, The Netherlands
| | - Jeroen N Wessels
- Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, The Netherlands; Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam UMC location Vrije Universiteit Amsterdam, The Netherlands
| | - J Tim Marcus
- Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam UMC location Vrije Universiteit Amsterdam, The Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, The Netherlands
| | - Lilian J Meijboom
- Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam UMC location Vrije Universiteit Amsterdam, The Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, The Netherlands
| | - Harm Jan Bogaard
- Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, The Netherlands; Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam UMC location Vrije Universiteit Amsterdam, The Netherlands
| | - Frances S de Man
- Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, The Netherlands; Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam UMC location Vrije Universiteit Amsterdam, The Netherlands
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, The Netherlands; Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam UMC location Vrije Universiteit Amsterdam, The Netherlands.
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Condliffe R, Dorfmüller P, Gopalan D, Sitbon O, Vonk Noordegraaf A. From the microscopic to the macroscopic: clinical-radiological-pathological correlation in pulmonary hypertension. Eur Respir Rev 2023; 32:230237. [PMID: 38123237 PMCID: PMC10731445 DOI: 10.1183/16000617.0237-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/25/2023] [Indexed: 12/23/2023] Open
Abstract
Pulmonary hypertension (PH) is defined as the presence of a mean pulmonary arterial pressure >20 mmHg [1]. This simple haemodynamic definition encompasses a heterogenous collection of conditions. It is now appreciated that although treatable forms of PH are relatively rare, PH itself is not an uncommon entity, affecting ∼1% of the global population [1]. Current international guidelines describe five classification groups: group 1 (pulmonary arterial hypertension (PAH)), group 2 (PH associated with left heart disease), group 3 (PH associated with lung disease), group 4 (PH associated with pulmonary arterial obstructions) and group 5 (PH with unclear and/or multifactorial causes) figure 1 [1]. These groups are characterised by shared clinical, haemodynamic and radiological features which are underpinned by common histopathological changes. This editorial introduces a new European Respiratory Review series focusing on clinical, radiological and histopathological features in pulmonary hypertension. https://bit.ly/3RtiFVK
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Affiliation(s)
- Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield, UK
- National Institute for Health and Care Research Sheffield Biomedical Research Centre, Sheffield, UK
| | - Peter Dorfmüller
- Department of Pathology, University Hospital of Giessen and Marburg, Giessen, Germany
- Institute for Lung Health, Giessen, Germany
| | - Deepa Gopalan
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - Olivier Sitbon
- INSERM UMR_S 999, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France
- Faculté Médecine, Université Paris Saclay, Le Kremlin-Bicêtre, France
- Service de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence de l'Hypertension Pulmonaire, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France
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Wessels JN, Celant LR, de Man FS, Vonk Noordegraaf A. The Right Ventricle in Pulmonary Hypertension. Semin Respir Crit Care Med 2023; 44:738-745. [PMID: 37487527 DOI: 10.1055/s-0043-1770117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
The right ventricle plays a pivotal role in patients with pulmonary hypertension (PH). Its adaptation to pressure overload determines a patient's functional status as well as survival. In a healthy situation, the right ventricle is part of a low pressure, high compliance system. It is built to accommodate changes in preload, but not very well suited for dealing with pressure overload. In PH, right ventricular (RV) contractility must increase to maintain cardiac output. In other words, the balance between the degree of RV contractility and afterload determines stroke volume. Hypertrophy is one of the major hallmarks of RV adaptation, but it may cause stiffening of the ventricle in addition to intrinsic changes to the RV myocardium. Ventricular filling becomes more difficult for which the right atrium tries to compensate through increased stroke work. Interaction of RV diastolic stiffness and right atrial (RA) function determines RV filling, but also causes vena cava backflow. Assessment of RV and RA function is critical in the evaluation of patient status. In recent guidelines, this is acknowledged by incorporating additional RV parameters in the risk stratification in PH. Several conventional parameters of RV and RA function have been part of risk stratification for many years. Understanding the pathophysiology of RV failure and the interactions with the pulmonary circulation and right atrium requires consideration of the unique RV anatomy. This review will therefore describe normal RV structure and function and changes that occur during adaptation to increased afterload. Consequences of a failing right ventricle and its implications for RA function will be discussed. Subsequently, we will describe RV and RA assessment in clinical practice.
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Affiliation(s)
- Jeroen N Wessels
- PHEniX Laboratory, Department of Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, The Netherlands
- European Reference Network on Rare Pulmonary Diseases (ERN-LUNG), Germany
| | - Lucas R Celant
- PHEniX Laboratory, Department of Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, The Netherlands
- European Reference Network on Rare Pulmonary Diseases (ERN-LUNG), Germany
| | - Frances S de Man
- PHEniX Laboratory, Department of Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, The Netherlands
- European Reference Network on Rare Pulmonary Diseases (ERN-LUNG), Germany
| | - Anton Vonk Noordegraaf
- PHEniX Laboratory, Department of Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, The Netherlands
- European Reference Network on Rare Pulmonary Diseases (ERN-LUNG), Germany
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Celant LR, Wessels JN, Kianzad A, Marcus JT, Meijboom LJ, Bogaard HJ, de Man FS, Vonk Noordegraaf A. Restoration of right ventricular function in the treatment of pulmonary arterial hypertension. Heart 2023; 109:1844-1850. [PMID: 37527919 DOI: 10.1136/heartjnl-2023-322742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/03/2023] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVE A 45% threshold of right ventricular ejection fraction (RVEF) is proposed clinically relevant in patients with pulmonary arterial hypertension (PAH). We aim to determine treatment response, long-term right ventricular (RV) functional stability and prognosis of patients with PAH reaching or maintaining the RVEF 45% threshold. METHODS Incident, treatment-naive, adult PAH patients with cardiac magnetic resonance imaging at baseline and first follow-up were included (total N=127) and followed until date of censoring or death/lung transplantation. Patients were categorised into two groups based on 45% RVEF. Baseline predictors, treatment response and prognosis were assessed with logistic regression analyses, two-way analysis of variance and log-rank tests. RESULTS Patients were 50±17 years old, 73% female, of which N=75 reached or maintained the 45% RVEF threshold at follow-up (RVEF≥45%@FU), while N=52 patients did not (RVEF<45%@FU). RV end-diastolic volume and N-terminal pro-B-type natriuretic peptide at baseline were multivariable predictors of an RVEF ≥45% at follow-up. A 40% pulmonary vascular resistance (PVR) reduction resulted in greater improvement in RV function (ΔRVEF 17±11 vs. 5±8; pinteraction<0.001) compared to a PVR reduction <40%, but did not guarantee an RVEF ≥45%. Finally, the 45% RVEF threshold was associated with stable RV function during long-term follow-up and better survival (HR: 1.91 (95% CI: 1.11 to 3.27)). Patients failing to reach or maintain the 45% RVEF threshold at first follow-up mostly stayed below this threshold over the next consecutive visits. CONCLUSION After treatment initiation, 60% of patients with PAH reach or maintain the 45% RVEF threshold, which is associated with a long-term stable RV function and favourable prognosis.
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Affiliation(s)
- Lucas R Celant
- Department of Pulmonary Medicine, Amsterdam UMC, location Vrije Universiteit, Amsterdam, Netherlands
- Pulmonary Hypertension and Thrombosis, Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Jeroen N Wessels
- Department of Pulmonary Medicine, Amsterdam UMC, location Vrije Universiteit, Amsterdam, Netherlands
- Pulmonary Hypertension and Thrombosis, Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Azar Kianzad
- Department of Pulmonary Medicine, Amsterdam UMC, location Vrije Universiteit, Amsterdam, Netherlands
- Pulmonary Hypertension and Thrombosis, Cardiovascular Sciences, Amsterdam, the Netherlands
| | - J Tim Marcus
- Pulmonary Hypertension and Thrombosis, Cardiovascular Sciences, Amsterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location Vrije Universiteit, Amsterdam, Netherlands
| | - Lilian J Meijboom
- Pulmonary Hypertension and Thrombosis, Cardiovascular Sciences, Amsterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location Vrije Universiteit, Amsterdam, Netherlands
| | - Harm Jan Bogaard
- Department of Pulmonary Medicine, Amsterdam UMC, location Vrije Universiteit, Amsterdam, Netherlands
- Pulmonary Hypertension and Thrombosis, Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Frances S de Man
- Department of Pulmonary Medicine, Amsterdam UMC, location Vrije Universiteit, Amsterdam, Netherlands
- Pulmonary Hypertension and Thrombosis, Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Medicine, Amsterdam UMC, location Vrije Universiteit, Amsterdam, Netherlands
- Pulmonary Hypertension and Thrombosis, Cardiovascular Sciences, Amsterdam, the Netherlands
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Braams NJ, Kianzad A, van Wezenbeek J, Wessels JN, Jansen SM, Andersen S, Boonstra A, Nossent EJ, Marcus JT, Bayoumy AA, Becher C, Goumans MJ, Andersen A, Vonk Noordegraaf A, de Man FS, Bogaard HJ, Meijboom LJ. Long-Term Effects of Pulmonary Endarterectomy on Right Ventricular Stiffness and Fibrosis in Chronic Thromboembolic Pulmonary Hypertension. Circ Heart Fail 2023; 16:e010336. [PMID: 37675561 PMCID: PMC10573098 DOI: 10.1161/circheartfailure.122.010336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 07/17/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Surgical removal of thromboembolic material by pulmonary endarterectomy (PEA) leads within months to the improvement of right ventricular (RV) function in the majority of patients with chronic thromboembolic pulmonary hypertension. However, RV mass does not always normalize. It is unknown whether incomplete reversal of RV remodeling results from extracellular matrix expansion (diffuse interstitial fibrosis) or cellular hypertrophy, and whether residual RV remodeling relates to altered diastolic function. METHODS We prospectively included 25 patients with chronic thromboembolic pulmonary hypertension treated with PEA. Structured follow-up measurements were performed before, and 6 and 18 months after PEA. With single beat pressure-volume loop analyses, we determined RV end-systolic elastance (Ees), arterial elastance (Ea), RV-arterial coupling (Ees/Ea), and RV end-diastolic elastance (stiffness, Eed). The extracellular volume fraction of the RV free wall was measured by cardiac magnetic resonance imaging and used to separate the myocardium into cellular and matrix volume. Circulating collagen biomarkers were analyzed to determine the contribution of collagen metabolism. RESULTS RV mass significantly decreased from 43±15 to 27±11g/m2 (-15.9 g/m2 [95% CI, -21.4 to -10.5]; P<0.0001) 6 months after PEA but did not normalize (28±9 versus 22±6 g/m2 in healthy controls [95% CI, 2.1 to 9.8]; P<0.01). On the contrary, Eed normalized after PEA. Extracellular volume fraction in the right ventricular free wall increased after PEA from 31.0±3.8 to 33.6±3.5% (3.6% [95% CI, 1.2-6.1]; P=0.013) as a result of a larger reduction in cellular volume than in matrix volume (Pinteraction=0.0013). Levels of MMP-1 (matrix metalloproteinase-1), TIMP-1 (tissue inhibitor of metalloproteinase-1), and TGF-β (transforming growth factor-β) were elevated at baseline and remained elevated post-PEA. CONCLUSIONS Although cellular hypertrophy regresses and diastolic stiffness normalizes after PEA, a relative increase in extracellular volume remains. Incomplete regression of diffuse RV interstitial fibrosis after PEA is accompanied by elevated levels of circulating collagen biomarkers, suggestive of active collagen turnover.
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Affiliation(s)
- Natalia J. Braams
- Amsterdam UMC location Vrije Universiteit Amsterdam, PHEniX Laboratory, Department of Pulmonary Medicine, the Netherlands (N.J.B., A.K., J.v.W., J.N.W., S.M.A.J., A.B., E.J.N., A.V.N., F.S.d.M., H.J.B.)
- Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, the Netherlands (N.J.B., A.K., J.v.W., J.N.W., S.M.A.J., E.J.N., J.T.M., A.V.N., F.S.d.M., H.J.B., L.J.M.)
| | - Azar Kianzad
- Amsterdam UMC location Vrije Universiteit Amsterdam, PHEniX Laboratory, Department of Pulmonary Medicine, the Netherlands (N.J.B., A.K., J.v.W., J.N.W., S.M.A.J., A.B., E.J.N., A.V.N., F.S.d.M., H.J.B.)
- Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, the Netherlands (N.J.B., A.K., J.v.W., J.N.W., S.M.A.J., E.J.N., J.T.M., A.V.N., F.S.d.M., H.J.B., L.J.M.)
| | - Jessie van Wezenbeek
- Amsterdam UMC location Vrije Universiteit Amsterdam, PHEniX Laboratory, Department of Pulmonary Medicine, the Netherlands (N.J.B., A.K., J.v.W., J.N.W., S.M.A.J., A.B., E.J.N., A.V.N., F.S.d.M., H.J.B.)
- Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, the Netherlands (N.J.B., A.K., J.v.W., J.N.W., S.M.A.J., E.J.N., J.T.M., A.V.N., F.S.d.M., H.J.B., L.J.M.)
| | - Jeroen N. Wessels
- Amsterdam UMC location Vrije Universiteit Amsterdam, PHEniX Laboratory, Department of Pulmonary Medicine, the Netherlands (N.J.B., A.K., J.v.W., J.N.W., S.M.A.J., A.B., E.J.N., A.V.N., F.S.d.M., H.J.B.)
- Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, the Netherlands (N.J.B., A.K., J.v.W., J.N.W., S.M.A.J., E.J.N., J.T.M., A.V.N., F.S.d.M., H.J.B., L.J.M.)
| | - Samara M.A. Jansen
- Amsterdam UMC location Vrije Universiteit Amsterdam, PHEniX Laboratory, Department of Pulmonary Medicine, the Netherlands (N.J.B., A.K., J.v.W., J.N.W., S.M.A.J., A.B., E.J.N., A.V.N., F.S.d.M., H.J.B.)
- Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, the Netherlands (N.J.B., A.K., J.v.W., J.N.W., S.M.A.J., E.J.N., J.T.M., A.V.N., F.S.d.M., H.J.B., L.J.M.)
| | - Stine Andersen
- Department of Cardiology, Aarhus University Hospital, Denmark (S.A., A.A.)
| | - Anco Boonstra
- Amsterdam UMC location Vrije Universiteit Amsterdam, PHEniX Laboratory, Department of Pulmonary Medicine, the Netherlands (N.J.B., A.K., J.v.W., J.N.W., S.M.A.J., A.B., E.J.N., A.V.N., F.S.d.M., H.J.B.)
| | - Esther J. Nossent
- Amsterdam UMC location Vrije Universiteit Amsterdam, PHEniX Laboratory, Department of Pulmonary Medicine, the Netherlands (N.J.B., A.K., J.v.W., J.N.W., S.M.A.J., A.B., E.J.N., A.V.N., F.S.d.M., H.J.B.)
- Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, the Netherlands (N.J.B., A.K., J.v.W., J.N.W., S.M.A.J., E.J.N., J.T.M., A.V.N., F.S.d.M., H.J.B., L.J.M.)
| | - J. Tim Marcus
- Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, the Netherlands (N.J.B., A.K., J.v.W., J.N.W., S.M.A.J., E.J.N., J.T.M., A.V.N., F.S.d.M., H.J.B., L.J.M.)
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Radiology and Nuclear Medicine, the Netherlands (J.T.M., L.J.M.)
| | - Ahmed A. Bayoumy
- Department of Internal Medicine, Chest Unit, Suez Canal University, School of Medicine, Ismailia, Egypt (A.A.B.)
| | - Clarissa Becher
- Department of Molecular Cell Biology, Leiden University Medical Centre, the Netherlands (C.B., M.-J.G.)
| | - Marie-José Goumans
- Department of Molecular Cell Biology, Leiden University Medical Centre, the Netherlands (C.B., M.-J.G.)
| | - Asger Andersen
- Department of Cardiology, Aarhus University Hospital, Denmark (S.A., A.A.)
| | - Anton Vonk Noordegraaf
- Amsterdam UMC location Vrije Universiteit Amsterdam, PHEniX Laboratory, Department of Pulmonary Medicine, the Netherlands (N.J.B., A.K., J.v.W., J.N.W., S.M.A.J., A.B., E.J.N., A.V.N., F.S.d.M., H.J.B.)
- Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, the Netherlands (N.J.B., A.K., J.v.W., J.N.W., S.M.A.J., E.J.N., J.T.M., A.V.N., F.S.d.M., H.J.B., L.J.M.)
| | - Frances S. de Man
- Amsterdam UMC location Vrije Universiteit Amsterdam, PHEniX Laboratory, Department of Pulmonary Medicine, the Netherlands (N.J.B., A.K., J.v.W., J.N.W., S.M.A.J., A.B., E.J.N., A.V.N., F.S.d.M., H.J.B.)
- Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, the Netherlands (N.J.B., A.K., J.v.W., J.N.W., S.M.A.J., E.J.N., J.T.M., A.V.N., F.S.d.M., H.J.B., L.J.M.)
| | - Harm Jan Bogaard
- Amsterdam UMC location Vrije Universiteit Amsterdam, PHEniX Laboratory, Department of Pulmonary Medicine, the Netherlands (N.J.B., A.K., J.v.W., J.N.W., S.M.A.J., A.B., E.J.N., A.V.N., F.S.d.M., H.J.B.)
- Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, the Netherlands (N.J.B., A.K., J.v.W., J.N.W., S.M.A.J., E.J.N., J.T.M., A.V.N., F.S.d.M., H.J.B., L.J.M.)
| | - Lilian J. Meijboom
- Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, the Netherlands (N.J.B., A.K., J.v.W., J.N.W., S.M.A.J., E.J.N., J.T.M., A.V.N., F.S.d.M., H.J.B., L.J.M.)
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Radiology and Nuclear Medicine, the Netherlands (J.T.M., L.J.M.)
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Wessels JN, van Wezenbeek J, de Rover J, Smal R, Llucià-Valldeperas A, Celant LR, Marcus JT, Meijboom LJ, Groeneveldt JA, Oosterveer FPT, Winkelman TA, Niessen HWM, Goumans MJ, Bogaard HJ, Noordegraaf AV, Strijkers GJ, Handoko ML, Westerhof BE, de Man FS. Right Atrial Adaptation to Precapillary Pulmonary Hypertension: Pressure-Volume, Cardiomyocyte, and Histological Analysis. J Am Coll Cardiol 2023; 82:704-717. [PMID: 37587582 DOI: 10.1016/j.jacc.2023.05.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/25/2023] [Accepted: 05/31/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Precapillary pulmonary hypertension (precPH) patients have altered right atrial (RA) function and right ventricular (RV) diastolic stiffness. OBJECTIVES This study aimed to investigate RA function using pressure-volume (PV) loops, isolated cardiomyocyte, and histological analyses. METHODS RA PV loops were constructed in control subjects (n = 9) and precPH patients (n = 27) using magnetic resonance and catheterization data. RA stiffness (pressure rise during atrial filling) and right atrioventricular coupling index (RA minimal volume / RV end-diastolic volume) were compared in a larger cohort of patients with moderate (n = 39) or severe (n = 41) RV diastolic stiffness. Cardiomyocytes were isolated from RA tissue collected from control subjects (n = 6) and precPH patients (n = 9) undergoing surgery. Autopsy material was collected from control subjects (n = 6) and precPH patients (n = 4) to study RA hypertrophy, capillarization, and fibrosis. RESULTS RA PV loops showed 3 RA cardiac phases (reservoir, passive emptying, and contraction) with dilatation and elevated pressure in precPH. PrecPH patients with severe RV diastolic stiffness had increased RA stiffness and worse right atrioventricular coupling index. Cardiomyocyte cross-sectional area was increased 2- to 3-fold in precPH, but active tension generated by the sarcomeres was unaltered. There was no increase in passive tension of the cardiomyocytes, but end-stage precPH showed reduced number of capillaries per mm2 accompanied by interstitial and perivascular fibrosis. CONCLUSIONS RA PV loops show increased RA stiffness and suggest atrioventricular uncoupling in patients with severe RV diastolic stiffness. Isolated RA cardiomyocytes of precPH patients are hypertrophied, without intrinsic sarcomeric changes. In end-stage precPH, reduced capillary density is accompanied by interstitial and perivascular fibrosis.
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Affiliation(s)
- Jeroen N Wessels
- PHEniX Laboratory, Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Jessie van Wezenbeek
- PHEniX Laboratory, Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Jari de Rover
- Cardiovascular and Respiratory Physiology, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Rowan Smal
- PHEniX Laboratory, Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Aida Llucià-Valldeperas
- PHEniX Laboratory, Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Lucas R Celant
- PHEniX Laboratory, Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - J Tim Marcus
- Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Lilian J Meijboom
- Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Joanne A Groeneveldt
- PHEniX Laboratory, Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Frank P T Oosterveer
- PHEniX Laboratory, Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Toon A Winkelman
- Department of Cardiothoracic Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Hans W M Niessen
- Department of Pathology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Marie-José Goumans
- Department of Cell and Chemical Biology, Leiden UMC, Leiden, the Netherlands
| | - Harm Jan Bogaard
- PHEniX Laboratory, Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Anton Vonk Noordegraaf
- PHEniX Laboratory, Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Gustav J Strijkers
- Department of Biomedical Engineering and Physics, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - M Louis Handoko
- Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; Department of Cardiology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Berend E Westerhof
- PHEniX Laboratory, Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Frances S de Man
- PHEniX Laboratory, Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.
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Arkani M, Kianzad A, Jansen S, Smit J, Post E, Ramaker J, Lagerweij T, In’t Veld SGJG, Noske DP, Vonk Noordegraaf A, Wurdinger T, Best MG, Bogaard H. Discrimination Between Pre- and Postcapillary Pulmonary Hypertension Using Platelet RNA. J Am Heart Assoc 2023; 12:e028447. [PMID: 37345802 PMCID: PMC10356096 DOI: 10.1161/jaha.122.028447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 04/27/2023] [Indexed: 06/23/2023]
Abstract
Background Appropriate treatment of pulmonary hypertension (PH) is critically dependent on accurate discrimination between pre- and postcapillary PH. However, clinical discrimination is challenging and frequently requires a right heart catheterization. Existing risk scores to detect postcapillary PH have suboptimal discriminatory strength. We have previously shown that platelet-derived RNA profiles may have diagnostic value for PH detection. Here, we hypothesize that platelet-derived RNAs can be employed to select unique biomarker panels for the discrimination between pre- and postcapillary PH. Methods and Results Blood platelet RNA from whole blood was isolated and sequenced from 50 patients with precapillary PH (with different PH subtypes) as well as 50 patients with postcapillary PH. RNA panels were calculated by ANOVA statistics, and classifications were performed using a support vector machine algorithm, supported by particle swarm optimization. We identified in total 4279 different RNAs in blood platelets from patients with pre- and postcapillary PH. A particle swarm optimization-selected RNA panel of 1618 distinctive RNAs with differential levels together with a trained support vector machine algorithm accurately discriminated patients with precapillary PH from patients with postcapillary PH with 100% sensitivity, 60% specificity, 80% accuracy, and 0.95 (95% CI, 0.86-1.00) area under the curve in the independent validation series (n=20). Conclusions This proof-of-concept study demonstrates that particle swarm optimization/support vector machine-enhanced classification of platelet RNA panels may be able to discriminate precapillary PH from postcapillary PH. This research provides a foundation for the development of a blood test with a high negative predictive value that would improve early diagnosis of precapillary PH and prevents unnecessary invasive testing in patients with postcapillary PH.
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Affiliation(s)
- Mohammad Arkani
- Amsterdam Cardiovascular SciencesPulmonary Hypertension and ThrombosisAmsterdamThe Netherlands
- Department of PulmonologyAmsterdam UMC Location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Department of NeurosurgeryAmsterdam UMC Location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Cancer Center AmsterdamBrain Tumor Center AmsterdamAmsterdamThe Netherlands
- Department of Biomedical Data SciencesLeiden University Medical CenterLeidenThe Netherlands
| | - Azar Kianzad
- Amsterdam Cardiovascular SciencesPulmonary Hypertension and ThrombosisAmsterdamThe Netherlands
- Department of PulmonologyAmsterdam UMC Location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Samara Jansen
- Amsterdam Cardiovascular SciencesPulmonary Hypertension and ThrombosisAmsterdamThe Netherlands
- Department of PulmonologyAmsterdam UMC Location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Josien Smit
- Amsterdam Cardiovascular SciencesPulmonary Hypertension and ThrombosisAmsterdamThe Netherlands
- Department of PulmonologyAmsterdam UMC Location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Edward Post
- Department of NeurosurgeryAmsterdam UMC Location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Cancer Center AmsterdamBrain Tumor Center AmsterdamAmsterdamThe Netherlands
| | - Jip Ramaker
- Department of NeurosurgeryAmsterdam UMC Location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Cancer Center AmsterdamBrain Tumor Center AmsterdamAmsterdamThe Netherlands
| | - Tonny Lagerweij
- Department of NeurosurgeryAmsterdam UMC Location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Cancer Center AmsterdamBrain Tumor Center AmsterdamAmsterdamThe Netherlands
| | - Sjors G. J. G. In’t Veld
- Department of NeurosurgeryAmsterdam UMC Location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Cancer Center AmsterdamBrain Tumor Center AmsterdamAmsterdamThe Netherlands
| | - David P. Noske
- Department of NeurosurgeryAmsterdam UMC Location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Cancer Center AmsterdamBrain Tumor Center AmsterdamAmsterdamThe Netherlands
| | - Anton Vonk Noordegraaf
- Amsterdam Cardiovascular SciencesPulmonary Hypertension and ThrombosisAmsterdamThe Netherlands
- Department of PulmonologyAmsterdam UMC Location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Thomas Wurdinger
- Department of NeurosurgeryAmsterdam UMC Location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Cancer Center AmsterdamBrain Tumor Center AmsterdamAmsterdamThe Netherlands
| | - Myron G. Best
- Department of NeurosurgeryAmsterdam UMC Location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Cancer Center AmsterdamBrain Tumor Center AmsterdamAmsterdamThe Netherlands
| | - Harm‐Jan Bogaard
- Amsterdam Cardiovascular SciencesPulmonary Hypertension and ThrombosisAmsterdamThe Netherlands
- Department of PulmonologyAmsterdam UMC Location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
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14
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Yoshida K, Axelsen JB, Saku K, Andersen A, de Man FS, Sunagawa K, Vonk Noordegraaf A, Bogaard HJ. How to incorporate tricuspid regurgitation in right ventricular-pulmonary arterial coupling. J Appl Physiol (1985) 2023; 135:53-59. [PMID: 37227183 DOI: 10.1152/japplphysiol.00081.2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/10/2023] [Accepted: 05/19/2023] [Indexed: 05/26/2023] Open
Abstract
Adaptation of the right ventricle (RV) to a progressively increasing afterload is one of the hallmarks of pulmonary arterial hypertension (PAH). Pressure-volume loop analysis provides measures of load-independent RV contractility, i.e., end-systolic elastance, and pulmonary vascular properties, i.e., effective arterial elastance (Ea). However, PAH-induced RV overload potentially results in tricuspid regurgitation (TR). TR makes RV eject to both PA and right atrium; thereby, a ratio of RV end-systolic pressure (Pes) to RV stroke volume (SV) could not correctly define Ea. To overcome this limitation, we introduced a two-parallel compliance model, i.e., Ea = 1/(1/Epa + 1/ETR), while effective pulmonary arterial elastance (Epa = Pes/PASV) represents pulmonary vascular properties and effective tricuspid regurgitant elastance (ETR) represents TR. We conducted animal experiments to validate this framework. First, we performed SV analysis with a pressure-volume catheter in the RV and a flow probe at the aorta in rats with and without pressure-overloaded RV to determine the effect of inferior vena cava (IVC) occlusion on TR. A discordance between the two techniques was found in rats with pressure-overloaded RV, not in sham. This discordance diminished after IVC occlusion, suggesting that TR in pressure-overloaded RV was diminished by IVC occlusion. Next, we performed pressure-volume loop analysis in rats with pressure-overloaded RVs, calibrating RV volume by cardiac magnetic resonance. We found that IVC occlusion increased Ea, suggesting that a reduction of TR increased Ea. Using the proposed framework, Epa was indistinguishable to Ea post-IVC occlusion. We conclude that the proposed framework helps better understanding of the pathophysiology of PAH and associated right heart failure.NEW & NOTEWORTHY This study reveals the impact of tricuspid regurgitation on pressure-volume loop analysis in right ventricle pressure overload. By introducing a novel concept of parallel compliances in the pressure-volume loop analysis, a better description is provided for the right ventricular forward afterload in the presence of tricuspid regurgitation.
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Affiliation(s)
- Keimei Yoshida
- Department of Pulmonary Medicine, Amsterdam University Medical Centre, Vrije Universiteit, Amsterdam, The Netherlands
| | | | - Keita Saku
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Asger Andersen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Frances S de Man
- Department of Pulmonary Medicine, Amsterdam University Medical Centre, Vrije Universiteit, Amsterdam, The Netherlands
| | - Kenji Sunagawa
- Circulatory System Research Foundation, Kyushu University, Fukuoka, Japan
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Medicine, Amsterdam University Medical Centre, Vrije Universiteit, Amsterdam, The Netherlands
| | - Harm Jan Bogaard
- Department of Pulmonary Medicine, Amsterdam University Medical Centre, Vrije Universiteit, Amsterdam, The Netherlands
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15
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Luijten D, Talerico R, Barco S, Cannegieter SC, Delcroix M, Ende-Verhaar YM, Huisman MV, Konstantinidis S, Mairuhu ATA, van Mens TE, Ninaber M, Pruszczyk P, Vonk Noordegraaf A, Klok FA. Incidence of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: an updated systematic review and meta-analysis. Eur Respir J 2023; 62:2300449. [PMID: 37321620 DOI: 10.1183/13993003.00449-2023] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/30/2023] [Indexed: 06/17/2023]
Affiliation(s)
- Dieuwke Luijten
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Rosa Talerico
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Barco
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Suzanne C Cannegieter
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marion Delcroix
- Department of Respiratory Diseases, University Hospital of Leuven, Leuven, Belgium
| | - Yvonne M Ende-Verhaar
- Department of Internal Medicine, Haaglanden Medisch Centrum, The Hague, The Netherlands
| | - Menno V Huisman
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Stavros Konstantinidis
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Albert T A Mairuhu
- Department of Vascular Medicine, Haga Hospital, The Hague, The Netherlands
| | - Thijs E van Mens
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Maarten Ninaber
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Frederikus A Klok
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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16
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Atmowihardjo LN, Schippers JR, Duijvelaar E, Bartelink IH, Bet PM, Swart NEL, van Rein N, Purdy K, Cavalla D, McElroy A, Fritchley S, Vonk Noordegraaf A, Endeman H, van Velzen P, Koopmans M, Bogaard HJ, Heunks L, Juffermans N, Schultz MJ, Tuinman PR, Bos LDJ, Aman J. Efficacy and safety of intravenous imatinib in COVID-19 ARDS: a randomized, double-blind, placebo-controlled clinical trial. Crit Care 2023; 27:226. [PMID: 37291677 DOI: 10.1186/s13054-023-04516-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/31/2023] [Indexed: 06/10/2023] Open
Abstract
PURPOSE A hallmark of acute respiratory distress syndrome (ARDS) is hypoxaemic respiratory failure due to pulmonary vascular hyperpermeability. The tyrosine kinase inhibitor imatinib reversed pulmonary capillary leak in preclinical studies and improved clinical outcomes in hospitalized COVID-19 patients. We investigated the effect of intravenous (IV) imatinib on pulmonary edema in COVID-19 ARDS. METHODS This was a multicenter, randomized, double-blind, placebo-controlled trial. Invasively ventilated patients with moderate-to-severe COVID-19 ARDS were randomized to 200 mg IV imatinib or placebo twice daily for a maximum of seven days. The primary outcome was the change in extravascular lung water index (∆EVLWi) between days 1 and 4. Secondary outcomes included safety, duration of invasive ventilation, ventilator-free days (VFD) and 28-day mortality. Posthoc analyses were performed in previously identified biological subphenotypes. RESULTS 66 patients were randomized to imatinib (n = 33) or placebo (n = 33). There was no difference in ∆EVLWi between the groups (0.19 ml/kg, 95% CI - 3.16 to 2.77, p = 0.89). Imatinib treatment did not affect duration of invasive ventilation (p = 0.29), VFD (p = 0.29) or 28-day mortality (p = 0.79). IV imatinib was well-tolerated and appeared safe. In a subgroup of patients characterized by high IL-6, TNFR1 and SP-D levels (n = 20), imatinib significantly decreased EVLWi per treatment day (- 1.17 ml/kg, 95% CI - 1.87 to - 0.44). CONCLUSIONS IV imatinib did not reduce pulmonary edema or improve clinical outcomes in invasively ventilated COVID-19 patients. While this trial does not support the use of imatinib in the general COVID-19 ARDS population, imatinib reduced pulmonary edema in a subgroup of patients, underscoring the potential value of predictive enrichment in ARDS trials. Trial registration NCT04794088 , registered 11 March 2021. European Clinical Trials Database (EudraCT number: 2020-005447-23).
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Affiliation(s)
- Leila N Atmowihardjo
- Intensive Care, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Job R Schippers
- Department of Pulmonary Medicine, Amsterdam University Medical Centers, Location VUmc, Room number 5A-074, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Erik Duijvelaar
- Department of Pulmonary Medicine, Amsterdam University Medical Centers, Location VUmc, Room number 5A-074, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Imke H Bartelink
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Pierre M Bet
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Noortje E L Swart
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Nienke van Rein
- Department of Clinical Pharmacology and Pharmacy, Leiden UMC, Albinusdreef 2, Leiden, The Netherlands
| | | | | | | | | | - Anton Vonk Noordegraaf
- Department of Pulmonary Medicine, Amsterdam University Medical Centers, Location VUmc, Room number 5A-074, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Henrik Endeman
- Intensive Care, Erasmus University Medical Centre, Doctor Molewaterplein 40, Rotterdam, The Netherlands
| | - Patricia van Velzen
- Intensive Care, Dijklander Hospital, Location Purmerend, Waterlandlaan 250, Purmerend, The Netherlands
| | - Matty Koopmans
- Intensive Care, OLVG Hospital Location Oost, Oosterpark 9, Amsterdam, The Netherlands
| | - Harm Jan Bogaard
- Department of Pulmonary Medicine, Amsterdam University Medical Centers, Location VUmc, Room number 5A-074, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Leo Heunks
- Intensive Care, Erasmus University Medical Centre, Doctor Molewaterplein 40, Rotterdam, The Netherlands
| | - Nicole Juffermans
- Intensive Care, OLVG Hospital Location Oost, Oosterpark 9, Amsterdam, The Netherlands
- Laboratory of Translational Intensive Care, Erasmus University, Rotterdam, The Netherlands
| | - Marcus J Schultz
- Intensive Care, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Research and Development, Hamilton Medical AG, Chur, Switzerland
| | - Pieter R Tuinman
- Intensive Care, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Lieuwe D J Bos
- Intensive Care, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Department of Pulmonary Medicine, Amsterdam University Medical Centers, Location VUmc, Room number 5A-074, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Jurjan Aman
- Department of Pulmonary Medicine, Amsterdam University Medical Centers, Location VUmc, Room number 5A-074, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
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17
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de Man FS, Vonk Noordegraaf A. The right ventricle tamed. Eur Respir J 2023; 61:61/5/2300509. [PMID: 37208035 DOI: 10.1183/13993003.00509-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 03/25/2023] [Indexed: 05/21/2023]
Affiliation(s)
- Frances S de Man
- Amsterdam UMC location Vrije Universiteit Amsterdam, PHEniX laboratory, Department of Pulmonary Medicine, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, The Netherlands
| | - Anton Vonk Noordegraaf
- Amsterdam UMC location Vrije Universiteit Amsterdam, PHEniX laboratory, Department of Pulmonary Medicine, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, The Netherlands
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18
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Zhai Z, Boon GJAM, Staring M, van Dam LF, Kroft LJM, Hernández Girón I, Ninaber MK, Bogaard HJ, Meijboom LJ, Vonk Noordegraaf A, Huisman MV, Klok FA, Stoel BC. Automated quantification of the pulmonary vasculature in pulmonary embolism and chronic thromboembolic pulmonary hypertension. Pulm Circ 2023; 13:e12223. [PMID: 37128354 PMCID: PMC10148047 DOI: 10.1002/pul2.12223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 05/03/2023] Open
Abstract
The shape and distribution of vascular lesions in pulmonary embolism (PE) and chronic thromboembolic pulmonary hypertension (CTEPH) are different. We investigated whether automated quantification of pulmonary vascular morphology and densitometry in arteries and veins imaged by computed tomographic pulmonary angiography (CTPA) could distinguish PE from CTEPH. We analyzed CTPA images from a cohort of 16 PE patients, 6 CTEPH patients, and 15 controls. Pulmonary vessels were extracted with a graph-cut method, and separated into arteries and veins using deep-learning classification. Vascular morphology was quantified by the slope (α) and intercept (β) of the vessel radii distribution. To quantify lung perfusion defects, the median pulmonary vascular density was calculated. By combining these measurements with densities measured in parenchymal areas, pulmonary trunk, and descending aorta, a static perfusion curve was constructed. All separate quantifications were compared between the three groups. No vascular morphology differences were detected in contrast to vascular density values. The median vascular density (interquartile range) was -567 (113), -452 (95), and -470 (323) HU, for the control, PE, and CTEPH group. The static perfusion curves showed different patterns between groups, with a statistically significant difference in aorta-pulmonary trunk gradient between the PE and CTEPH groups (p = 0.008). In this proof of concept study, not vasculature morphology but densities differentiated between patients of three groups. Further technical improvements are needed to allow for accurate differentiation between PE and CTEPH, which in this study was only possible statistically by measuring the density gradient between aorta and pulmonary trunk.
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Affiliation(s)
- Zhiwei Zhai
- Division of Image Processing, Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Gudula J. A. M. Boon
- Department of Medicine ‐ Thrombosis and HemostasisLeiden University Medical CenterLeidenThe Netherlands
| | - Marius Staring
- Division of Image Processing, Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Lisette F. van Dam
- Department of Medicine ‐ Thrombosis and HemostasisLeiden University Medical CenterLeidenThe Netherlands
| | - Lucia J. M. Kroft
- Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Irene Hernández Girón
- Division of Image Processing, Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Maarten K. Ninaber
- Department of PulmonologyLeiden University Medical CenterLeidenThe Netherlands
| | - Harm Jan Bogaard
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Lilian J. Meijboom
- Department of Radiology and Nuclear Medicine, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Menno V. Huisman
- Department of Medicine ‐ Thrombosis and HemostasisLeiden University Medical CenterLeidenThe Netherlands
| | - Frederikus A. Klok
- Department of Medicine ‐ Thrombosis and HemostasisLeiden University Medical CenterLeidenThe Netherlands
| | - Berend C. Stoel
- Division of Image Processing, Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
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19
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Humbert M, Kovacs G, Hoeper MM, Badagliacca R, Berger RMF, Brida M, Carlsen J, Coats AJS, Escribano-Subias P, Ferrari P, Ferreira DS, Ghofrani HA, Giannakoulas G, Kiely DG, Mayer E, Meszaros G, Nagavci B, Olsson KM, Pepke-Zaba J, Quint JK, Rådegran G, Simonneau G, Sitbon O, Tonia T, Toshner M, Vachiery JL, Vonk Noordegraaf A, Delcroix M, Rosenkranz S. [2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension]. G Ital Cardiol (Rome) 2023; 24:e1-e116. [PMID: 36995376 DOI: 10.1714/4014.39906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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20
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Forfia P, Benza R, D'Alto M, De Marco T, Elwing JM, Frantz R, Haddad F, Oudiz R, Preston IR, Rosenkranz S, Ryan J, Schilz R, Shlobin OA, Vachiery J, Vizza CD, Noordegraaf AV, Sketch MR, Broderick M, McLaughlin V. The heart of the matter: Right heart imaging indicators for treatment escalation in pulmonary arterial hypertension. Pulm Circ 2023; 13:e12240. [PMID: 37222992 PMCID: PMC10201108 DOI: 10.1002/pul2.12240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/27/2023] [Accepted: 05/03/2023] [Indexed: 05/25/2023] Open
Abstract
Right heart (RH) structure and function are major determinants of symptoms and prognosis in pulmonary arterial hypertension (PAH). RH imaging provides detailed information, but evidence and guidelines on the use of RH imaging in treatment decisions are limited. We conducted a Delphi study to gather expert opinion on the role of RH imaging in decision-making for treatment escalation in PAH. A panel of 17 physicians with expertise in PAH and RH imaging used three surveys in a modified Delphi process to reach consensus on the role of RH imaging in PAH. Survey 1 used open-ended questions to gather information. Survey 2 contained Likert scale and other questions intended to identify consensus on topics identified in Survey 1. Survey 3 contained Likert scale questions derived from Survey 2 and summary information on the results of Survey 2. The Delphi panel reached consensus that RH imaging is likely to improve the current risk stratification algorithms and help differentiate risk levels in patients at intermediate risk. Tricuspid annular plane systolic excursion, right ventricular fractional area change, right atrial area, tricuspid regurgitation, inferior venae cavae diameter, and pericardial effusion should be part of routine echocardiography in PAH. Cardiac magnetic resonance imaging is valuable but limited by cost and access. A pattern of abnormal RH imaging results should prompt consideration of hemodynamic evaluation and possible treatment escalation. RH imaging is an important tool for decisions about treatment escalation in PAH, but systematically collected evidence is needed to clarify its role.
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Affiliation(s)
- Paul Forfia
- Temple University HospitalPhiladelphiaPennsylvaniaUSA
| | | | | | - Teresa De Marco
- University of California, San FranciscoSan FranciscoCaliforniaUSA
| | | | | | | | - Ronald Oudiz
- Lundquist Institute for Biomedical Research at Harbor‐UCLA Medical CenterTorranceCaliforniaUSA
| | | | | | - John Ryan
- University of UtahSalt Lake CityUtahUSA
| | | | | | | | | | - Anton Vonk Noordegraaf
- Department of Pulmonary MedicineAmsterdam UMC location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Amsterdam Cardiovascular SciencesPulmonary Hypertension and ThrombosisAmsterdamThe Netherlands
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21
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de Jong CMM, Visser C, Bemelmans RHH, Boersma WG, van den Borst B, Burggraaf JLI, Cannegieter SC, Ten Cate-Hoek AJ, Croles FN, Faber HJ, Faber LM, Hellemons ME, Hessels LM, Huisman MV, Kamphuisen PW, Koster SCE, Kroft LJM, van der Lee I, Leentjens J, Meijer K, Ninaber MK, Sondermeijer BM, Stads S, Vonk Noordegraaf A, Winckers K, Kruip MJHA, Klok FA. Chronic thromboembolic pulmonary hypertension and clot resolution after COVID-19-associated pulmonary embolism. Eur Respir J 2023; 61:13993003.00171-2023. [PMID: 37080574 PMCID: PMC10116061 DOI: 10.1183/13993003.00171-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/20/2023] [Indexed: 04/22/2023]
Affiliation(s)
- Cindy M M de Jong
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Chantal Visser
- Department of Haematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Remy H H Bemelmans
- Department of Internal Medicine, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Wim G Boersma
- Department of Pulmonology, North West Hospital Alkmaar, Alkmaar, The Netherlands
| | - Bram van den Borst
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Louise I Burggraaf
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Suzanne C Cannegieter
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Arina J Ten Cate-Hoek
- Thrombosis Expertise Center Maastricht and Department of Internal Medicine, Section Vascular Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), School for Cardiovascular Diseases, Maastricht, The Netherlands
| | - F Nanne Croles
- Department of Internal Medicine, Hospital St. Jansdal, Harderwijk, The Netherlands
| | - Harald J Faber
- Department of Intensive Care, Wilhelmina Hospital Assen, Assen, The Netherlands
| | - Laura M Faber
- Department of Internal Medicine, Rode Kruis Hospital, Beverwijk, The Netherlands
| | - Merel E Hellemons
- Department of Respiratory Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
- Erasmus MC Transplant Institute, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lisa M Hessels
- Department of Pulmonology, North West Hospital Alkmaar, Alkmaar, The Netherlands
| | - Menno V Huisman
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Pieter W Kamphuisen
- Department of Internal Medicine, Tergooi Hospital, Hilversum, The Netherlands
- Department of Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | | | - Lucia J M Kroft
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ivo van der Lee
- Department of Pulmonology, Spaarne Hospital, Haarlem, The Netherlands
| | - Jenneke Leentjens
- Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Karina Meijer
- Department of Haematology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Maarten K Ninaber
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Susanne Stads
- Department of Intensive Care, Ikazia Hospital, Rotterdam, The Netherlands
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Kristien Winckers
- Thrombosis Expertise Center Maastricht and Department of Internal Medicine, Section Vascular Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), School for Cardiovascular Diseases, Maastricht, The Netherlands
| | - Marieke J H A Kruip
- Department of Haematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Frederikus A Klok
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
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22
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Kwant CT, de Man F, van der Horst FAL, Bogaard HJ, Vonk Noordegraaf A. The UPHILL study: A nutrition and lifestyle intervention to improve quality of life for patients with pulmonary arterial hypertension. Pulm Circ 2023; 13:e12243. [PMID: 37252180 PMCID: PMC10224798 DOI: 10.1002/pul2.12243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/03/2023] [Accepted: 05/16/2023] [Indexed: 05/31/2023] Open
Abstract
The aim of the UPHILL study (a nutrition and lifestyle intervention in patients with pulmonary arterial hypertension [PAH]: effect on quality of life [QoL]), was to determine the effect of innovative nutritional interventions on adjustments in nutritional intake and QoL. In this study a group of prevalent PAH patients at a single center in Amsterdam (the Netherlands) was informed about healthy nutrition using a newly designed video e-learning. They were subsequently instructed to follow a healthy diet during dietary intervention. Nutritional intake was assessed using a food frequency questionnaire (HELIUS) and QoL by the short-form (SF)-36 questionnaire. Nutritional parameters were determined in blood samples. Seventeen patients stable under treatment, who had been diagnosed with PAH 7.0 [3.0-14.0] years before, started and completed the intervention (2 males, 15 females; 45.35 ± 13.57 years). Since all patients in the intervention group made behavioral changes in nutritional intake, during study and follow-up, nutritional and lifestyle adaptations persisted. Despite the fact that patients had already high mean scores at baseline for both mental (74.10 [60.51-84.25]) and physical QoL (66.46 [50.21-73.84]), scores improved further during e-learning. Furthermore, patients who realized most nutritional adaptations, had the best improvement in QoL. This pilot study showed that e-learning modules on nutrition provide an unique opportunity to change nutritional intake in PAH patients and by that improve QoL.
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Affiliation(s)
- Chermaine T. Kwant
- Departments of Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit AmsterdamAmsterdam Cardiovascular SciencesAmsterdamThe Netherlands
| | - Frances de Man
- Departments of Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit AmsterdamAmsterdam Cardiovascular SciencesAmsterdamThe Netherlands
| | | | - Harm J. Bogaard
- Departments of Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit AmsterdamAmsterdam Cardiovascular SciencesAmsterdamThe Netherlands
| | - Anton Vonk Noordegraaf
- Departments of Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit AmsterdamAmsterdam Cardiovascular SciencesAmsterdamThe Netherlands
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23
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Aktaa S, Gale CP, Brida M, Giannakoulas G, Kovacs G, Adir Y, Benza RL, Böhm M, Coats A, D'Alto M, Escribano-Subias P, Ferrari P, Galie N, Gibbs JSR, Gin-Sing W, Hoeper MM, Humbert M, Lang IM, Maron BA, Meszaros G, Noordegraaf AV, Price LC, Pepke-Zaba J, Rådegran G, Reis A, Sitbon O, Torbicki A, Ulrich S, Rosenkranz S, Delcroix M. European Society of Cardiology Quality Indicators for the care and outcomes of adults with pulmonary arterial hypertension. Eur J Heart Fail 2023; 25:469-477. [PMID: 36924171 DOI: 10.1002/ejhf.2830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 03/07/2023] [Accepted: 03/12/2023] [Indexed: 03/18/2023] Open
Abstract
AIMS To develop a suite of quality indicators (QIs) for the evaluation of the care and outcomes for adults with pulmonary arterial hypertension (PAH). METHODS AND RESULTS We followed the ESC methodology for the development of QIs. This included the 1) identification of key domains of care for the management of PAH, 2) proposal of candidate QIs following systematic review of the literature, and 3) selection of a set of QIs using a modified-Delphi method. The process was undertaken in parallel with the writing of the 2022 European Society of Cardiology (ESC) / European Respiratory Society (ERS) guidelines for the diagnosis and treatment of pulmonary hypertension and involved Task Force chairs, experts in PAH, Heart Failure Association (HFA) members and patient representatives. We identified five domains of care for patients with PAH; structural framework, diagnosis and risk stratification, initial treatment, follow up, and outcomes. In total, 23 main and one secondary QIs for PAH were selected. CONCLUSION This document presents the ESC QIs for PAH, describes their development process and offers scientific rationale for their selection. The indicators may be used to quantify and improve adherence to guideline-recommended clinical practice and improve patient outcomes. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Suleman Aktaa
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, UK.,Leeds Institute for Data Analytics and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Chris P Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, UK.,Leeds Institute for Data Analytics and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Margarita Brida
- Department of Medical Rehabilitation, Medical Faculty University of Rijeka, Ul. Braće Branchetta 20/1, Rijeka, 51000, Croatia.,Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, Guys and St Thomas' NHS Trust, Sydney Street, London, SW3 6NP, UK
| | - George Giannakoulas
- Cardiology Department, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Gabor Kovacs
- Department of Pulmonology, University Clinic of Internal Medicine, Medical University of Graz, and the Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Yochai Adir
- Pulmonary Division, Lady Davis Carmel Medical Center, Faculty of Medicine Technion Institute of Technology, Haifa, Israel
| | - Raymond L Benza
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany
| | | | - Michele D'Alto
- Department of Cardiology, University "L. Vanvitelli" - Monaldi Hospital, Naples, Italy
| | - Pilar Escribano-Subias
- Pulmonary Hypertension Unit. Department of Cardiology. CIBER-CV. Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - Pisana Ferrari
- Past President and Member of the Board, AIPI, Associazione Ipertensione Polmonare Italiana (Italian Pulmonary Hypertension Association), Italy
| | - Nazzareno Galie
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Dipartimento DIMES, Università di Bologna, Bologna, Italy
| | - J Simon R Gibbs
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Wendy Gin-Sing
- Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Marius M Hoeper
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany, and German Centre of Lung Research, DZL, Hannover, Germany
| | - Marc Humbert
- Université Paris-Saclay, INSERM UMR_S 999, Assistance Publique Hôpitaux de Paris (AP-HP), Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Irene M Lang
- Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Bradley A Maron
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Gergely Meszaros
- European Pulmonary Hypertension Association (PHA Europe), Hungary
| | - Anton Vonk Noordegraaf
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Pulmonary Medicine, De Boelelaan, 1117, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, The Netherlands
| | - Laura C Price
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK.,Honorary Senior Clinical Lecturer, Imperial College London, London, UK
| | - Joanna Pepke-Zaba
- Royal Papworth Hospital, Cambridge University Hospital, Cambridge, UK
| | - Göran Rådegran
- Department of Clinical Sciences Lund, Cardiology, Lund University, Lund, Sweden.,The Hemodynamic Lab, The Section for Heart Failure and Valvular Disease, VO. Heart and Lung Medicine, Skåne University Hospital, Lund, Sweden
| | - Abilio Reis
- Department of Medicine, PVDU, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal.,Department of Cardiovascular Research, UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Olivier Sitbon
- Université Paris-Saclay, INSERM UMR_S 999, Assistance Publique Hôpitaux de Paris (AP-HP), Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Adam Torbicki
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center for Postgraduate Medical Education, ECZ-Otwock, Poland
| | - Silvia Ulrich
- Department of Pulmonology, University and University Hospital of Zurich, Zurich, Switzerland
| | - Stephan Rosenkranz
- Department of Cardiology, Heart Center at the University of Cologne, and Cologne Cardiovascular Research Center (CCRC), Cologne, Germany
| | - Marion Delcroix
- Clinical Department of Respiratory Diseases, University Hospitals of Leuven; Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven - University of Leuven, Leuven, Belgium
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24
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Braams NJ, Kianzad A, Meijboom LJ, Westenberg J, Spruijt OA, Smits J, Vonk Noordegraaf A, Boonstra A, Nossent EJ, Oosterveer F, Handoko ML, Symersky P, de Man FS, Bogaard HJ. Right Ventricular Function During Exercise After Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension. J Am Heart Assoc 2023; 12:e027638. [PMID: 36789863 PMCID: PMC10111481 DOI: 10.1161/jaha.122.027638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Background Pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension improves resting hemodynamics and right ventricular (RV) function. Because exercise tolerance frequently remains impaired, RV function may not have completely normalized after PEA. Therefore, we performed a detailed invasive hemodynamic study to investigate the effect of PEA on RV function during exercise. Methods and Results In this prospective study, all consenting patients with chronic thromboembolic pulmonary hypertension eligible for surgery and able to perform cycle ergometry underwent cardiac magnetic resonance imaging, a maximal cardiopulmonary exercise test, and a submaximal invasive cardiopulmonary exercise test before and 6 months after PEA. Hemodynamic assessment and analysis of RV pressure curves using the single-beat method was used to determine load-independent RV contractility (end systolic elastance), RV afterload (arterial elastance), RV-arterial coupling (end systolic elastance-arterial elastance), and stroke volume both at rest and during exercise. RV rest-to-exercise responses were compared before and after PEA using 2-way repeated-measures analysis of variance with Bonferroni post hoc correction. A total of 19 patients with chronic thromboembolic pulmonary hypertension completed the entire study protocol. Resting hemodynamics improved significantly after PEA. The RV exertional stroke volume response improved 6 months after PEA (79±32 at rest versus 102±28 mL during exercise; P<0.01). Although RV afterload (arterial elastance) increased during exercise, RV contractility (end systolic elastance) did not change during exercise either before (0.43 [0.32-0.58] mm Hg/mL versus 0.45 [0.22-0.65] mm Hg/mL; P=0.6) or after PEA (0.32 [0.23-0.40] mm Hg/mL versus 0.28 [0.19-0.44] mm Hg/mL; P=0.7). In addition, mean pulmonary artery pressure-cardiac output and end systolic elastance-arterial elastance slopes remained unchanged after PEA. Conclusions The exertional RV stroke volume response improves significantly after PEA for chronic thromboembolic pulmonary hypertension despite a persistently abnormal afterload and absence of an RV contractile reserve. This may suggest that at mildly elevated pulmonary pressures, stroke volume is less dependent on RV contractility and afterload and is primarily determined by venous return and conduit function.
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Affiliation(s)
- Natalia J Braams
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Azar Kianzad
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Lilian J Meijboom
- Department of Radiology and Nuclear Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Jesper Westenberg
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Onno A Spruijt
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Josien Smits
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Anco Boonstra
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Esther J Nossent
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Frank Oosterveer
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - M Louis Handoko
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Petr Symersky
- Department of Cardiothoracic Surgery Onze Lieve Vrouwe Gasthuis Amsterdam The Netherlands
| | - Frances S de Man
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Harm Jan Bogaard
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
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25
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Simonneau G, Fadel E, Vonk Noordegraaf A, Toshner M, Lang IM, Klok FA, McInnis MC, Screaton N, Madani MM, Martinez G, Salaunkey K, Jenkins DP, Matsubara H, Brénot P, Hoeper MM, Ghofrani HA, Jaïs X, Wiedenroth CB, Guth S, Kim NH, Pepke-Zaba J, Delcroix M, Mayer E. Highlights from the International Chronic Thromboembolic Pulmonary Hypertension Congress 2021. Eur Respir Rev 2023; 32:32/167/220132. [PMID: 36754432 PMCID: PMC9910339 DOI: 10.1183/16000617.0132-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/14/2022] [Indexed: 02/10/2023] Open
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare complication of acute pulmonary embolism. It is caused by persistent obstruction of pulmonary arteries by chronic organised fibrotic clots, despite adequate anticoagulation. The pulmonary hypertension is also caused by concomitant microvasculopathy which may progress without timely treatment. Timely and accurate diagnosis requires the combination of imaging and haemodynamic assessment. Optimal therapy should be individualised to each case and determined by an experienced multidisciplinary CTEPH team with the ability to offer all current treatment modalities. This report summarises current knowledge and presents key messages from the International CTEPH Conference, Bad Nauheim, Germany, 2021. Sessions were dedicated to 1) disease definition; 2) pathophysiology, including the impact of the hypertrophied bronchial circulation, right ventricle (dys)function, genetics and inflammation; 3) diagnosis, early after acute pulmonary embolism, using computed tomography and perfusion techniques, and supporting the selection of appropriate therapies; 4) surgical treatment, pulmonary endarterectomy for proximal and distal disease, and peri-operative management; 5) percutaneous approach or balloon pulmonary angioplasty, techniques and complications; and 6) medical treatment, including anticoagulation and pulmonary hypertension drugs, and in combination with interventional treatments. Chronic thromboembolic pulmonary disease without pulmonary hypertension is also discussed in terms of its diagnostic and therapeutic aspects.
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Affiliation(s)
- Gérald Simonneau
- AP-HP, Service de Pneumologie, Hôpital Bicêtre, Université Paris-Sud, Laboratoire d'Excellence en Recherche sur le Médicament et Innovation Thérapeutique and Institut National de la Santé et de la Recherche Médicale Unité 999, Le Kremlin-Bicêtre, France
| | - Elie Fadel
- Research and Innovation Unit, INSERM UMR-S 999, Marie Lannelongue Hospital, Université Paris-Sud, Université Paris-Saclay, Le Plessis-Robinson, France,Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital, Université Paris-Sud, Université Paris-Saclay, Le Plessis-Robinson, France,Université Paris-Sud and Université Paris-Saclay, School of Medicine, Kremlin-Bicêtre, France
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Medicine, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Mark Toshner
- Royal Papworth Hospital, University of Cambridge, Cambridge, UK
| | - Irene M. Lang
- Division of Cardiology, Department of Internal Medicine II, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Frederikus A. Klok
- Department of Medicine – Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Micheal C. McInnis
- Department of Medical Imaging, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Michael M. Madani
- Cardiovascular and Thoracic Surgery, University of California-San Diego, La Jolla, CA, USA
| | | | - Kiran Salaunkey
- Royal Papworth Hospital, University of Cambridge, Cambridge, UK
| | | | - Hiromi Matsubara
- National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Philippe Brénot
- Department of Radiology, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Marius M. Hoeper
- Department of Respiratory Medicine, Hannover Medical School and Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Hossein A. Ghofrani
- Pulmonary Vascular Research, Justus-Liebig University and Pulmonary Hypertension Division, University Hospital Giessen, Giessen, Germany,Department of Pneumology, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Xavier Jaïs
- AP-HP, Service de Pneumologie, Hôpital Bicêtre, Université Paris-Sud, Laboratoire d'Excellence en Recherche sur le Médicament et Innovation Thérapeutique and Institut National de la Santé et de la Recherche Médicale Unité 999, Le Kremlin-Bicêtre, France
| | | | - Stefan Guth
- Department of Thoracic Surgery, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Nick H. Kim
- Division of Pulmonary and Critical Care Medicine, University of California-San Diego, La Jolla, CA, USA
| | | | - Marion Delcroix
- Clinical Department of Respiratory Diseases, University Hospitals of Leuven and Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven - University of Leuven, Leuven, Belgium .,M. Delcroix and E. Mayer equal contribution (co-last authors)
| | - Eckhard Mayer
- Department of Thoracic Surgery, Kerckhoff Clinic, Bad Nauheim, Germany,Meeting organiser,M. Delcroix and E. Mayer equal contribution (co-last authors)
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26
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Humbert M, Kovacs G, Hoeper MM, Badagliacca R, Berger RMF, Brida M, Carlsen J, Coats AJS, Escribano-Subias P, Ferrari P, Ferreira DS, Ghofrani HA, Giannakoulas G, Kiely DG, Mayer E, Meszaros G, Nagavci B, Olsson KM, Pepke-Zaba J, Quint JK, Rådegran G, Simonneau G, Sitbon O, Tonia T, Toshner M, Vachiery JL, Vonk Noordegraaf A, Delcroix M, Rosenkranz S. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Respir J 2023; 61:13993003.00879-2022. [PMID: 36028254 DOI: 10.1183/13993003.00879-2022] [Citation(s) in RCA: 345] [Impact Index Per Article: 345.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Marc Humbert
- Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France, Service de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence de l'Hypertension Pulmonaire, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France
| | - Gabor Kovacs
- University Clinic of Internal Medicine, Division of Pulmonology, Medical University of Graz, Graz, Austria
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Marius M Hoeper
- Respiratory Medicine, Hannover Medical School, Hanover, Germany
- Biomedical Research in End-stage and Obstructive Lung Disease (BREATH), member of the German Centre of Lung Research (DZL), Hanover, Germany
| | - Roberto Badagliacca
- Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Roma, Italy
- Dipartimento Cardio-Toraco-Vascolare e Chirurgia dei Trapianti d'Organo, Policlinico Umberto I, Roma, Italy
| | - Rolf M F Berger
- Center for Congenital Heart Diseases, Beatrix Children's Hospital, Dept of Paediatric Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Margarita Brida
- Department of Sports and Rehabilitation Medicine, Medical Faculty University of Rijeka, Rijeka, Croatia
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield Hospitals, Guys and St Thomas's NHS Trust, London, UK
| | - Jørn Carlsen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Andrew J S Coats
- Faculty of Medicine, University of Warwick, Coventry, UK
- Faculty of Medicine, Monash University, Melbourne, Australia
| | - Pilar Escribano-Subias
- Pulmonary Hypertension Unit, Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBER-CV (Centro de Investigaciones Biomédicas En Red de enfermedades CardioVasculares), Instituto de Salud Carlos III, Madrid, Spain
- Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Pisana Ferrari
- ESC Patient Forum, Sophia Antipolis, France
- AIPI, Associazione Italiana Ipertensione Polmonare, Bologna, Italy
| | - Diogenes S Ferreira
- Alergia e Imunologia, Hospital de Clinicas, Universidade Federal do Parana, Curitiba, Brazil
| | - Hossein Ardeschir Ghofrani
- Department of Internal Medicine, University Hospital Giessen, Justus-Liebig University, Giessen, Germany
- Department of Pneumology, Kerckhoff Klinik, Bad Nauheim, Germany
- Department of Medicine, Imperial College London, London, UK
| | - George Giannakoulas
- Cardiology Department, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - David G Kiely
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Insigneo Institute, University of Sheffield, Sheffield, UK
| | - Eckhard Mayer
- Thoracic Surgery, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Gergely Meszaros
- ESC Patient Forum, Sophia Antipolis, France
- European Lung Foundation (ELF), Sheffield, UK
| | - Blin Nagavci
- Institute for Evidence in Medicine, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Karen M Olsson
- Clinic of Respiratory Medicine, Hannover Medical School, member of the German Center of Lung Research (DZL), Hannover, Germany
| | - Joanna Pepke-Zaba
- Pulmonary Vascular Diseases Unit, Royal Papworth Hospital, Cambridge, UK
| | | | - Göran Rådegran
- Department of Cardiology, Clinical Sciences Lund, Faculty of Medicine, Lund, Sweden
- The Haemodynamic Lab, The Section for Heart Failure and Valvular Disease, VO. Heart and Lung Medicine, Skåne University Hospital, Lund, Sweden
| | - Gerald Simonneau
- Faculté Médecine, Université Paris Saclay, Le Kremlin-Bicêtre, France
- Centre de Référence de l'Hypertension Pulmonaire, Hopital Marie-Lannelongue, Le Plessis-Robinson, France
| | - Olivier Sitbon
- INSERM UMR_S 999, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France
- Faculté Médecine, Université Paris Saclay, Le Kremlin-Bicêtre, France
- Service de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence de l'Hypertension Pulmonaire, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Mark Toshner
- Dept of Medicine, Heart Lung Research Institute, University of Cambridge, Royal Papworth NHS Trust, Cambridge, UK
| | - Jean-Luc Vachiery
- Department of Cardiology, Pulmonary Vascular Diseases and Heart Failure Clinic, HUB Hôpital Erasme, Brussels, Belgium
| | | | - Marion Delcroix
- Clinical Department of Respiratory Diseases, Centre of Pulmonary Vascular Diseases, University Hospitals of Leuven, Leuven, Belgium
- The two chairpersons (M. Delcroix and S. Rosenkranz) contributed equally to the document and are joint corresponding authors
| | - Stephan Rosenkranz
- Clinic III for Internal Medicine (Department of Cardiology, Pulmonology and Intensive Care Medicine), and Cologne Cardiovascular Research Center (CCRC), Heart Center at the University Hospital Cologne, Köln, Germany
- The two chairpersons (M. Delcroix and S. Rosenkranz) contributed equally to the document and are joint corresponding authors
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Benza RL, Langleben D, Hemnes AR, Vonk Noordegraaf A, Rosenkranz S, Thenappan T, Hassoun PM, Preston IR, Ghio S, Badagliacca R, Vizza CD, Lang IM, Meier C, Grünig E. Riociguat and the right ventricle in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. Eur Respir Rev 2022; 31:31/166/220061. [PMID: 36198418 DOI: 10.1183/16000617.0061-2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/22/2022] [Indexed: 11/05/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are progressive diseases that can lead to right heart failure and death. Right ventricular dysfunction, hypertrophy and maladaptive remodelling are consequences of increased right ventricular (RV) afterload in PAH and CTEPH and are indicative of long-term outcomes. Because RV failure is the main cause of morbidity and mortality in PAH and CTEPH, successful treatments should lead to improvements in RV parameters. Riociguat is a soluble guanylate cyclase stimulator approved for the treatment of PAH and inoperable or persistent/recurrent CTEPH after pulmonary endarterectomy. This review examines the current evidence showing the effect of riociguat on the right ventricle, with particular focus on remodelling, function and structural parameters in preclinical models and patients with PAH or CTEPH.
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Affiliation(s)
- Raymond L Benza
- Dept of Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - David Langleben
- Center for Pulmonary Vascular Disease, Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Canada
| | - Anna R Hemnes
- Division of Allergy, Pulmonary and Critical Care Medicine, Dept of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Stephan Rosenkranz
- Dept of Cardiology and Cologne Cardiovascular Research Center, Cologne University Heart Center, Cologne, Germany
| | - Thenappan Thenappan
- Cardiovascular Division, Dept of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Paul M Hassoun
- Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ioana R Preston
- Pulmonary, Critical Care and Sleep Medicine Division, Tufts Medical Center, Boston, MA, USA
| | - Stefano Ghio
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | | | - Irene M Lang
- Division of Cardiology, Dept of Internal Medicine II, Medical University of Vienna, Allgemeines Krankenhaus, Vienna, Austria
| | | | - Ekkehard Grünig
- Centre for Pulmonary Hypertension, Thoraxklinik-Heidelberg gGmbH, Heidelberg University Hospital, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
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28
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Mulvaney EP, Renzo F, Adão R, Dupre E, Bialesova L, Salvatore V, Reid HM, Conceição G, Grynblat J, Llucià-Valldeperas A, Michel JB, Brás-Silva C, Laurent CE, Howard LS, Montani D, Humbert M, Vonk Noordegraaf A, Perros F, Mendes-Ferreira P, Kinsella BT. The thromboxane receptor antagonist NTP42 promotes beneficial adaptation and preserves cardiac function in experimental models of right heart overload. Front Cardiovasc Med 2022; 9:1063967. [PMID: 36588576 PMCID: PMC9794752 DOI: 10.3389/fcvm.2022.1063967] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Abstract
Background Pulmonary arterial hypertension (PAH) is a progressive disease characterized by increased pulmonary artery pressure leading to right ventricular (RV) failure. While current PAH therapies improve patient outlook, they show limited benefit in attenuating RV dysfunction. Recent investigations demonstrated that the thromboxane (TX) A2 receptor (TP) antagonist NTP42 attenuates experimental PAH across key hemodynamic parameters in the lungs and heart. This study aimed to validate the efficacy of NTP42:KVA4, a novel oral formulation of NTP42 in clinical development, in preclinical models of PAH while also, critically, investigating its direct effects on RV dysfunction. Methods The effects of NTP42:KVA4 were evaluated in the monocrotaline (MCT) and pulmonary artery banding (PAB) models of PAH and RV dysfunction, respectively, and when compared with leading standard-of-care (SOC) PAH drugs. In addition, the expression of the TP, the target for NTP42, was investigated in cardiac tissue from several other related disease models, and from subjects with PAH and dilated cardiomyopathy (DCM). Results In the MCT-PAH model, NTP42:KVA4 alleviated disease-induced changes in cardiopulmonary hemodynamics, pulmonary vascular remodeling, inflammation, and fibrosis, to a similar or greater extent than the PAH SOCs tested. In the PAB model, NTP42:KVA4 improved RV geometries and contractility, normalized RV stiffness, and significantly increased RV ejection fraction. In both models, NTP42:KVA4 promoted beneficial RV adaptation, decreasing cellular hypertrophy, and increasing vascularization. Notably, elevated expression of the TP target was observed both in RV tissue from these and related disease models, and in clinical RV specimens of PAH and DCM. Conclusion This study shows that, through antagonism of TP signaling, NTP42:KVA4 attenuates experimental PAH pathophysiology, not only alleviating pulmonary pathologies but also reducing RV remodeling, promoting beneficial hypertrophy, and improving cardiac function. The findings suggest a direct cardioprotective effect for NTP42:KVA4, and its potential to be a disease-modifying therapy in PAH and other cardiac conditions.
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Affiliation(s)
- Eamon P. Mulvaney
- ATXA Therapeutics Limited, UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
| | - Fabiana Renzo
- ATXA Therapeutics Limited, UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
| | - Rui Adão
- Department of Surgery and Physiology, Cardiovascular R&D Centre—UnIC@RISE, Faculty of Medicine of the University of Porto, Porto, Portugal
| | | | - Lucia Bialesova
- ATXA Therapeutics Limited, UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
| | - Viviana Salvatore
- ATXA Therapeutics Limited, UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
| | - Helen M. Reid
- ATXA Therapeutics Limited, UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
| | - Glória Conceição
- Department of Surgery and Physiology, Cardiovascular R&D Centre—UnIC@RISE, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Julien Grynblat
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France,INSERM UMR_S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Aida Llucià-Valldeperas
- PHEniX Laboratory, Department of Pulmonary Medicine, Amsterdam UMC (Location VUMC), Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands,Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, Netherlands
| | | | - Carmen Brás-Silva
- Department of Surgery and Physiology, Cardiovascular R&D Centre—UnIC@RISE, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Charles E. Laurent
- IPS Therapeutique Inc., Sherbrooke, QC, Canada,ToxiPharm Laboratories Inc., Ste-Catherine-de-Hatley, QC, Canada
| | - Luke S. Howard
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - David Montani
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France,INSERM UMR_S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Le Plessis-Robinson, France,AP-HP, Dept of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Marc Humbert
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France,INSERM UMR_S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Le Plessis-Robinson, France,AP-HP, Dept of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Anton Vonk Noordegraaf
- PHEniX Laboratory, Department of Pulmonary Medicine, Amsterdam UMC (Location VUMC), Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Frédéric Perros
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France,INSERM UMR_S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Le Plessis-Robinson, France,Paris-Porto Pulmonary Hypertension Collaborative Laboratory (3PH), INSERM UMR_S 999, Université Paris-Saclay, Le Kremlin-Bicêtre, France,INSERM, INRAE, CarMeN Laboratory and Centre de Recherche en Nutrition Humaine Rhône-Alpes (CRNH-RA), Claude Bernard University Lyon 1, University of Lyon, Lyon, France
| | - Pedro Mendes-Ferreira
- Department of Surgery and Physiology, Cardiovascular R&D Centre—UnIC@RISE, Faculty of Medicine of the University of Porto, Porto, Portugal,Paris-Porto Pulmonary Hypertension Collaborative Laboratory (3PH), INSERM UMR_S 999, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - B. Therese Kinsella
- ATXA Therapeutics Limited, UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland,UCD School of Biomolecular and Biomedical Research, UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland,*Correspondence: B. Therese Kinsella,
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Humbert M, Kovacs G, Hoeper MM, Badagliacca R, Berger RMF, Brida M, Carlsen J, Coats AJS, Escribano-Subias P, Ferrari P, Ferreira DS, Ghofrani HA, Giannakoulas G, Kiely DG, Mayer E, Meszaros G, Nagavci B, Olsson KM, Pepke-Zaba J, Quint JK, Rådegran G, Simonneau G, Sitbon O, Tonia T, Toshner M, Vachiery JL, Vonk Noordegraaf A, Delcroix M, Rosenkranz S. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J 2022; 43:3618-3731. [PMID: 36017548 DOI: 10.1093/eurheartj/ehac237] [Citation(s) in RCA: 870] [Impact Index Per Article: 435.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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30
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Kwant CT, van der Horst FAL, Bogaard HJ, de Man FS, Vonk Noordegraaf A. Nutritional status in pulmonary arterial hypertension. Pulm Circ 2022; 12:e12173. [PMID: 36568692 PMCID: PMC9768459 DOI: 10.1002/pul2.12173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/08/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
Nutritional deficiencies have been described in patients with pulmonary arterial hypertension (PAH), such as in iron and vitamin D. However, an extensive description of vitamin and mineral status is lacking and until now there is no data on dietary intake in PAH patients. We analyzed blood samples and determined nutritional intake using a food frequency questionnaire (HELIUS) in a cohort of prevalent PAH patients at a single center in Amsterdam, the Netherlands. Quality of life (QoL) was assessed by the SF-36 questionnaire. In total, 37 patients were included (6 males, 31 females; 48 ± 16 years). The dietary intake of sugar was above 25 g in 87% of the patients and fluid intake was above 1500 ml in 78% of the patients. Sodium intake was below 1800 mg in the majority (56%) of the patients. Sugar and fluid intake were linear related. We confirm previously observed deficiencies of iron and vitamin D in our study population. In addition, we observed a functional vitamin B12 deficiency in 29% of patients, which coincided with an increased expression of methylmalonic acid. 60% of patients had a low vitamin K1 status (<0.8 nmol/L). Finally, 40% of patients had selenium levels below <100 μg/L and low selenium levels associated with reduced vitality in these patients. Besides the known deficiencies in iron and vitamin D levels, we observed in a subset of patients signs of vitamin B12, vitamin K1 and selenium deficiencies. There is room for improving dietary intake. Future research aims to demonstrate the clinical importance and reveal the effect of nutritional interventions.
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Affiliation(s)
- Chermaine T. Kwant
- Departments of Pulmonary MedicineAmsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
| | | | - Harm J. Bogaard
- Departments of Pulmonary MedicineAmsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
| | - Frances S. de Man
- Departments of Pulmonary MedicineAmsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
| | - Anton Vonk Noordegraaf
- Departments of Pulmonary MedicineAmsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
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31
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van der Laarse WJ, Bogaards SJP, Schalij I, Noordegraaf AV, Vaz FM, van Groen D. Work and oxygen consumption of isolated right ventricular papillary muscle in experimental pulmonary hypertension. J Physiol 2022; 600:4465-4484. [PMID: 35993114 DOI: 10.1113/jp282991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 08/12/2022] [Indexed: 11/08/2022] Open
Abstract
Right-sided myocardial mechanical efficiency (work output/metabolic energy input) in pulmonary hypertension can be severely reduced. We determined the contribution of intrinsic myocardial determinants of efficiency using papillary muscle preparations from monocrotaline-induced pulmonary hypertensive (MCT-PH) rats. The hypothesis tested was that efficiency is reduced by mitochondrial dysfunction in addition to increased activation heat reported previously. Right ventricular muscle preparations were subjected to 5 Hz sinusoidal length changes at 37°C. Work and suprabasal oxygen consumption ( V ̇ O 2 ${\dot{V}}_{{{\rm{O}}}_{\rm{2}}}$ ) were measured before and after cross-bridge inhibition by blebbistatin. Cytosolic cytochrome c concentration, myocyte cross-sectional area, proton permeability of the inner mitochondrial membrane and monoamine oxidase and glucose 6-phosphate dehydrogenase activities and phosphatidylglycerol/cardiolipin contents were determined. Mechanical efficiency ranged from 23% to 11% in control (n = 6) and from 22% to 1% in MCT-PH (n = 15) and correlated with work (r2 = 0.68, P < 0.0001) but not with V ̇ O 2 ${\dot{V}}_{{{\rm{O}}}_{\rm{2}}}$ (r2 = 0.004, P = 0.7919). V ̇ O 2 ${\dot{V}}_{{{\rm{O}}}_{\rm{2}}}$ for cross-bridge cycling was proportional to work (r2 = 0.56, P = 0.0005). Blebbistatin-resistant V ̇ O 2 ${\dot{V}}_{{{\rm{O}}}_{\rm{2}}}$ (r2 = 0.32, P = 0.0167) and proton permeability of the mitochondrial inner membrane (r2 = 0.36, P = 0.0110) correlated inversely with efficiency. Together, these variables explained the variance of efficiency (coefficient of multiple determination r2 = 0.79, P = 0.0001). Cytosolic cytochrome c correlated inversely with work (r2 = 0.28, P = 0.0391), but not with efficiency (r2 = 0.20, P = 0.0867). Glucose 6-phosphate dehydrogenase, monoamine oxidase and phosphatidylglycerol/cardiolipin increased in the right ventricular wall of MCT-PH but did not correlate with efficiency. Reduced myocardial efficiency in MCT-PH is a result of activation processes and mitochondrial dysfunction. The variance of work and the ratio of activation heat reported previously and blebbistatin-resistant V ̇ O 2 ${\dot{V}}_{{{\rm{O}}}_{\rm{2}}}$ are discussed. KEY POINTS: Mechanical efficiency of right ventricular myocardium is reduced in pulmonary hypertension. Increased energy use for activation processes has been demonstrated previously, but the contribution of mitochondrial dysfunction is unknown. Work and oxygen consumption are determined during work loops. Oxygen consumption for activation and cross-bridge cycling confirm the previous heat measurements. Cytosolic cytochrome c concentration, proton permeability of the mitochondrial inner membrane and phosphatidylglycerol/cardiolipin are increased in experimental pulmonary hypertension. Reduced work and mechanical efficiency are related to mitochondrial dysfunction. Upregulation of the pentose phosphate pathway and a potential gap in the energy balance suggest mitochondrial dysfunction in right ventricular overload is a resiult of the excessive production of reactive oxygen species.
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Affiliation(s)
- Willem J van der Laarse
- Department of Physiology, Amsterdam Cardiovascular Sciences, VU University Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Sylvia J P Bogaards
- Department of Physiology, Amsterdam Cardiovascular Sciences, VU University Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Ingrid Schalij
- Department of Pulmonology, Amsterdam Cardiovascular Sciences, VU University Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Anton Vonk Noordegraaf
- Department of Pulmonology, Amsterdam Cardiovascular Sciences, VU University Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Frédéric M Vaz
- Amsterdam Cardiovascular Sciences, VU University Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands and Laboratory Genetic Metabolic Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Department of Clinical Chemistry, Amsterdam Gastroentrology Endocrinology Metabolism, Amsterdam, Department of Pediatrics, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Emma Children's Hospital, Amsterdam University Medical Centers, Core Facility Metabolomics, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Duncan van Groen
- Department of Physiology, Amsterdam Cardiovascular Sciences, VU University Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Alblas H, van Kan C, van Het Westeinde SC, Emmering J, Niezen A, Al Butaihi IAM, Noordegraaf AV, van Es J. Persistent dyspnea after acute pulmonary embolism is related to perfusion defects and lower long-term quality of life. Thromb Res 2022; 219:89-94. [PMID: 36152460 DOI: 10.1016/j.thromres.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/01/2022] [Accepted: 09/12/2022] [Indexed: 10/31/2022]
Affiliation(s)
- Heleen Alblas
- Department of Pulmonary Medicine, Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - Coen van Kan
- Department of Pulmonary Medicine, Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Department of Respiratory Medicine, OLVG, Amsterdam, the Netherlands.
| | | | - Jasper Emmering
- Department of Radiology and Nuclear Medicine, Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - André Niezen
- Department of Radiology and Nuclear Medicine, Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - Ibrahim A M Al Butaihi
- Department of Radiology and Nuclear Medicine, Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Medicine, Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - Josien van Es
- Department of Pulmonary Medicine, Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
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33
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Jansen SMA, Huis In 't Veld AE, Tolen PHCG, Jacobs W, Willemsen HM, Grotjohan HP, Waskowsky M, van der Maten J, van der Weerdt A, Hoekstra R, Pérez Matos AJ, Overbeek MJ, Mollema SA, El Bouazzaoui LHH, Vriend JWJ, Roorda JMM, de Nooijer R, van der Lee I, Voogel AJ, Post JC, Macken T, Aerts JM, van de Ven MJT, Bergman H, Bakker-de Boo M, de Boer RC, Vonk Noordegraaf A, de Man FS, Bogaard HJ. Clinical Characteristics of Patients Undergoing Right Heart Catheterizations in Community Hospitals. J Am Heart Assoc 2022; 11:e025143. [PMID: 36062610 PMCID: PMC9496424 DOI: 10.1161/jaha.121.025143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Recognition of precapillary pulmonary hypertension (PH) has significant implications for patient management. However, the low a priori chance to find this rare condition in community hospitals may create a barrier against performing a right heart catheterization (RHC). This could result in misclassification of PH and delayed diagnosis/treatment of precapillary PH. Therefore, we investigated patient characteristics and echocardiographic parameters associated with the decision whether to perform an RHC in patients with incident PH in 12 Dutch community hospitals. Methods and Results In total, 275 patients were included from the OPTICS (Optimizing PH Diagnostic Network in Community Hospitals) registry, a prospective cohort study with patients with incident PH; 157 patients were diagnosed with RHC (34 chronic thromboembolic PH, 38 pulmonary arterial hypertension, 81 postcapillary PH, 4 miscellaneous PH), while 118 patients were labeled as probable postcapillary PH without hemodynamic confirmation. Multivariable analysis showed that older age (>60 years), left ventricular diastolic dysfunction grade 2–3, left atrial dilatation were independently associated with the decision to not perform an RHC, while presence of prior venous thromboembolic events or pulmonary arterial hypertension‐associated conditions, right atrial dilatation, and tricuspid regurgitation velocity ≥3.7 m/s favor an RHC performance. Conclusions Older age and echocardiographic parameters of left heart disease were independently associated with the decision to not perform an RHC, while presence of prior venous thromboembolic events or pulmonary arterial hypertension‐associated conditions, right atrial dilation, and severe PH on echocardiography favored an RHC performance. As such, especially elderly patients may be at an increased risk of diagnostic delays and missed diagnoses of treatable precapillary PH, which could lead to a worse prognosis.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - A J Voogel
- Spaarne Gasthuis Hoofddorp Hoofddorp Netherlands
| | | | | | | | | | | | | | | | | | - Frances S de Man
- Amsterdam UMC, location Vrije Universiteit Amsterdam Netherlands
| | - Harm Jan Bogaard
- Amsterdam UMC, location Vrije Universiteit Amsterdam Netherlands
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Luijten D, Meijer FMM, Boon GJAM, Ende-Verhaar YM, Bavalia R, El Bouazzaoui LH, Delcroix M, Huisman MV, Mairuhu ATA, Middeldorp S, Pruszcyk P, Ruigrok D, Verhamme P, Vonk Noordegraaf A, Vriend JWJ, Vliegen HW, Klok FA. Diagnostic efficacy of ECG-derived ventricular gradient for the detection of chronic thromboembolic pulmonary hypertension in patients with acute pulmonary embolism. J Electrocardiol 2022; 74:94-100. [PMID: 36057190 DOI: 10.1016/j.jelectrocard.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/03/2022] [Accepted: 08/19/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Application of the chronic thromboembolic pulmonary hypertension (CTEPH) rule out criteria (manual electrocardiogram [ECG] reading and N-terminal pro-brain natriuretic peptide [NTproBNP] test) can rule out CTEPH in pulmonary embolism (PE) patients with persistent dyspnea (InShape II algorithm). Increased pulmonary pressure may also be identified using automated ECG-derived ventricular gradient optimized for right ventricular pressure overload (VG-RVPO). METHOD A predefined analysis of the InShape II study was performed. The diagnostic performance of the VG-RVPO for the detection of CTEPH and the incremental diagnostic value of the VG-RVPO as new rule-out criteria in the InShape II algorithm were evaluated. RESULTS 60 patients were included; 5 (8.3%) were ultimately diagnosed with CTEPH. The mean baseline VG-RVPO (at time of PE diagnosis) was -18.12 mV·ms for CTEPH patients and - 21.57 mV·ms for non-CTEPH patients (mean difference 3.46 mV·ms [95%CI -29.03 to 35.94]). The VG-RVPO (after 3-6 months follow-up) normalized in patients with and without CTEPH, without a clear between-group difference (mean Δ VG-RVPO of -8.68 and - 8.42 mV·ms respectively; mean difference of -0.25 mV·ms, [95%CI -12.94 to 12.44]). The overall predictive accuracy of baseline VG-RVPO, follow-up RVPO and Δ VG-RVPO for CTEPH was moderate to poor (ROC AUC 0.611, 0.514 and 0.539, respectively). Up to 76% of the required echocardiograms could have been avoided with VG-RVPO criteria replacing the InShape II rule-out criteria, however at cost of missing up to 80% of the CTEPH diagnoses. CONCLUSION We could not demonstrate (additional) diagnostic value of VG-RVPO as standalone test or as on top of the InShape II algorithm.
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Affiliation(s)
- Dieuwke Luijten
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Fleur M M Meijer
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gudula J A M Boon
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Yvonne M Ende-Verhaar
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Roisin Bavalia
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Marion Delcroix
- Department of Pneumology, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Menno V Huisman
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Albert T A Mairuhu
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, the Netherlands
| | - Saskia Middeldorp
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Piotr Pruszcyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Dieuwertje Ruigrok
- Department of Pulmonology, Amsterdam UMC, VU University Medical Centre, Amsterdam, the Netherlands
| | - Peter Verhamme
- Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology, University Hospitals Leuven, Leuven, Belgium
| | - Anton Vonk Noordegraaf
- Department of Pulmonology, Amsterdam UMC, VU University Medical Centre, Amsterdam, the Netherlands
| | - Joris W J Vriend
- Department of Cardiology, Haga Teaching Hospital, The Hague, the Netherlands
| | - Hubert W Vliegen
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frederikus A Klok
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
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35
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Fukumitsu M, Vonk Noordegraaf A, Westerhof BE. Reply from Masafumi Fukumitsu, Anton Vonk Noordegraaf and Berend E. Westerhof. J Physiol 2022; 600:3635. [PMID: 35818116 DOI: 10.1113/jp283478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Masafumi Fukumitsu
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Japan
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Berend E Westerhof
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Neonatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
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Lichtblau M, Piccari L, Ramjug S, Bokan A, Lechartier B, Jutant EM, Barata M, Garcia AR, Howard LS, Adir Y, Delcroix M, Jara-Palomares L, Bertoletti L, Sitbon O, Ulrich S, Vonk Noordegraaf A. ERS International Congress 2021: highlights from the Pulmonary Vascular Diseases Assembly. ERJ Open Res 2022; 8:00665-2021. [PMID: 35615412 PMCID: PMC9125041 DOI: 10.1183/23120541.00665-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/25/2022] [Indexed: 12/25/2022] Open
Abstract
This article aims to summarise the latest research presented at the virtual 2021 European Respiratory Society (ERS) International Congress in the field of pulmonary vascular disease. In light of the current guidelines and proceedings, knowledge gaps are addressed and the newest findings of the various forms of pulmonary hypertension as well as key points on pulmonary embolism are discussed. Despite the comprehensive coverage of the guidelines for pulmonary embolism at previous conferences, discussions about controversies in the diagnosis and treatment of this condition in specific cases were debated and are addressed in the first section of this article. We then report on an interesting pro–con debate about the current classification of pulmonary hypertension. We further report on presentations on Group 3 pulmonary hypertension, with research exploring pathogenesis, phenotyping, diagnosis and treatment; important contributions on the diagnosis of post-capillary pulmonary hypertension are also included. Finally, we summarise the latest evidence presented on pulmonary vascular disease and COVID-19 and a statement on the new imaging guidelines for pulmonary vascular disease from the Fleischner Society. This article summarises communications from #ERSCongress 2021 on pulmonary embolism diagnosis and treatment, PAH and CTEPH during the COVID-19 pandemic and beyond, novelties in post-capillary PH and in PH associated with respiratory diseaseshttps://bit.ly/3ASDO21
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Affiliation(s)
- Mona Lichtblau
- Dept of Pneumology, University Hospital Zürich, Zürich, Switzerland.,These authors contributed equally
| | - Lucilla Piccari
- Pulmonary Hypertension Unit, Dept of Pulmonary Medicine, Hospital del Mar, Barcelona, Spain.,These authors contributed equally
| | - Sheila Ramjug
- Dept of Respiratory Medicine, Manchester University NHS Foundation Trust, Wythenshawe, UK
| | - Aleksandar Bokan
- SLK Lungenklinik Loewenstein, Medical Clinic I: Pneumology, Respiratory Medicine and Intensive Medicine, Loewenstein, Germany
| | - Benoit Lechartier
- Service de Pneumologie et Soins Intensifs, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France.,Pulmonary Division, Lausanne University Hospital, Lausanne, Switzerland
| | - Etienne-Marie Jutant
- Université de Poitiers, CHU de Poitiers, Service de Pneumologie, Institut National de la Santé et de la Recherche Médicale CIC 1402, Poitiers, France
| | | | - Agustin Roberto Garcia
- Pulmonary Hypertension Unit, Dept of Pulmonary Medicine, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Luke S Howard
- National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Yochai Adir
- Pulmonology Division, Lady Davis-Carmel Medical Center, Haifa, Israel.,Bruce and Ruth Rappaport Faculty of Medicine, The Technion, Haifa, Israel
| | - Marion Delcroix
- Clinical Dept of Respiratory Diseases, University Hospitals of Leuven and Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Dept of Chronic Diseases and Metabolism (CHROMETA), KU Leuven - University of Leuven, Leuven, Belgium
| | - Luis Jara-Palomares
- Medical Surgical Unit of Respiratory Diseases, Instituto de Biomedicina de Sevilla (IBiS). Hospital Universitario Virgen del Rocio, Seville, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Laurent Bertoletti
- CHU de St-Etienne, Service de Médecine Vasculaire et Thérapeutique; Institut National de la Santé et de la Recherche Médicale, UMR1059, Université Jean-Monnet; Institut National de la Santé et de la Recherche Médicale CIC-1408, CHU de Saint-Etienne; INNOVTE, CHU de Saint-Etienne, Saint-Etienne, France
| | - Olivier Sitbon
- Service de Pneumologie et Soins Intensifs, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France.,Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Unité Mixte de Recherche S999, Hôpital Marie Lannelongue-Institut National de la Santé et de la Recherche Médicale, Le Plessis-Robinson, France
| | - Silvia Ulrich
- Dept of Pneumology, University Hospital Zürich, Zürich, Switzerland
| | - Anton Vonk Noordegraaf
- Amsterdam UMC, Vrije Universiteit Amsterdam, Dept of Pulmonary Medicine, Amsterdam, The Netherlands
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Smits AJ, Botros L, Mol MA, Ziesemer KA, Wilkins MR, Vonk Noordegraaf A, Bogaard HJ, Aman J. A Systematic Review with Meta-analysis of Biomarkers for detection of Pulmonary Arterial Hypertension. ERJ Open Res 2022; 8:00009-2022. [PMID: 35651362 PMCID: PMC9149393 DOI: 10.1183/23120541.00009-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/04/2022] [Indexed: 11/20/2022] Open
Abstract
Rationale The blood is a rich source of potential biomarkers for the diagnosis of idiopathic and hereditary pulmonary arterial hypertension (iPAH and hPAH, referred to as “PAH”). While a lot of biomarkers have been identified for PAH, the clinical utility of these biomarkers often remains unclear. Here, we performed an unbiased meta-analysis of published biomarkers to identify biomarkers with the highest performance for detection of PAH. Methods A literature search (in PubMed, Embase.com, Clarivate Analytics/Web of Science Core Collection and Wiley/Cochrane Library) was performed up to 28 January 2021. Primary end points were blood biomarker levels in PAH versus asymptomatic controls or patients suspected of pulmonary hypertension (PH) with proven normal haemodynamic profiles. Results 149 articles were identified by the literature search. Meta-analysis of 26 biomarkers yielded 17 biomarkers that were differentially expressed in PAH and non-PH control subjects. Red cell distribution width, low density lipid-cholesterol, d-dimer, N-terminal prohormone of brain natriuretic protein (NT-proBNP), interleukin-6 (IL-6) and uric acid were biomarkers with the largest observed differences, largest sample sizes and a low risk of publication bias. Receiver operating characteristic curves and sensitivity/specificity analyses demonstrated that NT-proBNP had a high sensitivity, but low specificity for PAH. For the other biomarkers, insufficient data on diagnostic accuracy with receiver operating characteristic curves were available for meta-analysis. Conclusion This meta-analysis validates NT-proBNP as a biomarker with high sensitivity for PAH, albeit with low specificity. The majority of biomarkers evaluated in this meta-analysis lacked either external validation or data on diagnostic accuracy. Further validation studies are required as well as studies that test combinations of biomarkers to improve specificity. Meta-analysis of 26 biomarkers yielded 17 differentially expressed biomarkers in PAH. NT-proBNP had the highest diagnostic accuracy but had a low specificity for PAH. Other markers, including IL-6, RDW, LDL-c, D-dimer and UA, lacked clinical validation.https://bit.ly/3J4YAyC
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Haddad F, Contrepois K, Amsallem M, Denault AY, Bernardo RJ, Jha A, Taylor S, Arthur Ataam J, Mercier O, Kuznetsova T, Vonk Noordegraaf A, Zamanian RT, Sweatt AJ. The Right Heart Network and Risk Stratification in Pulmonary Arterial Hypertension. Chest 2022; 161:1347-1359. [PMID: 34774527 PMCID: PMC9131051 DOI: 10.1016/j.chest.2021.10.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 10/14/2021] [Accepted: 10/22/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Prognosis in pulmonary arterial hypertension (PAH) is closely related to indexes of right ventricular function. A better understanding of their relationship may provide important implications for risk stratification in PAH. RESEARCH QUESTION Can clinical network graphs inform risk stratification in PAH? STUDY DESIGN AND METHODS The study cohort consisted of 231 patients with PAH followed up for a median of 7.1 years. An undirected, correlation network was used to visualize the relationship between clinical features in PAH. This network was enriched for right heart parameters and included N-terminal pro-hormone B-type natriuretic peptide (NT-proBNP), comprehensive echocardiographic parameters, and hemodynamics, as well as 6-min walk distance (6MWD), vital signs, laboratory data, and diffusing capacity for carbon monoxide (Dlco). Connectivity was assessed by using eigenvector and betweenness centrality to reflect global and regional connectivity, respectively. Cox proportional hazards regression was used to model event-free survival for the combined end point of death or lung transplantation. RESULTS A network of closely intertwined features centered around NT-proBNP with 6MWD emerging as a secondary hub were identified. Less connected nodes included Dlco, systolic BP, albumin, and sodium. Over the follow-up period, death or transplantation occurred in 92 patients (39.8%). A strong prognostic model was achieved with a Harrell's C-index of 0.81 (0.77-0.85) when combining central right heart features (NT-proBNP and right ventricular end-systolic remodeling index) with 6MWD and less connected nodes (Dlco, systolic BP, albumin, sodium, sex, connective tissue disease etiology, and prostanoid therapy). When added to the baseline risk model, serial change in NT-proBNP significantly improved outcome prediction at 5 years (increase in C-statistic of 0.071 ± 0.024; P = .003). INTERPRETATION NT-proBNP emerged as a central hub in the intertwined PAH network. Connectivity analysis provides explainability for feature selection and combination in outcome models.
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Affiliation(s)
- Francois Haddad
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA; Vera Moulton Wall Center for Pulmonary Disease at Stanford University, Stanford, CA.
| | - Kevin Contrepois
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA; Department of Genetics, Stanford University School of Medicine, Stanford, CA
| | - Myriam Amsallem
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA; Vera Moulton Wall Center for Pulmonary Disease at Stanford University, Stanford, CA
| | - Andre Y Denault
- Department of Anesthesiology and Division of Critical Care, Montreal Heart Institute, University of Montréal, Montréal, QC, Canada
| | - Roberto J Bernardo
- Vera Moulton Wall Center for Pulmonary Disease at Stanford University, Stanford, CA; Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA
| | - Alokkumar Jha
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Shalina Taylor
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Jennifer Arthur Ataam
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Olaf Mercier
- Department of Cardiovascular and Thoracic Surgery, Centre Chirurgical Marie-Lannelongue, Paris-South University, Paris, France
| | - Tatiana Kuznetsova
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA; Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Roham T Zamanian
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA; Vera Moulton Wall Center for Pulmonary Disease at Stanford University, Stanford, CA; Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA
| | - Andrew J Sweatt
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA; Vera Moulton Wall Center for Pulmonary Disease at Stanford University, Stanford, CA; Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA
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Kianzad A, van Wezenbeek J, Celant LR, Oosterveer FP, Noordegraaf AV, Meijboom LJ, de Man FS, Bogaard HJ, Handoko ML. Idiopathic pulmonary arterial hypertension patients with a high H2FPEF-score: insights from the Amsterdam UMC PAH-cohort. J Heart Lung Transplant 2022; 41:1075-1085. [DOI: 10.1016/j.healun.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 04/19/2022] [Accepted: 05/08/2022] [Indexed: 10/18/2022] Open
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Fukumitsu M, Groeneveldt JA, Braams NJ, Bayoumy AA, Marcus JT, Meijboom LJ, de Man FS, Bogaard HJ, Noordegraaf AV, Westerhof BE. When right ventricular pressure meets volume: the impact of arrival time of reflected waves on right ventricle load in pulmonary arterial hypertension. J Physiol 2022; 600:2327-2344. [PMID: 35421903 PMCID: PMC9321993 DOI: 10.1113/jp282422] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 04/11/2022] [Indexed: 11/20/2022] Open
Abstract
Abstract Right ventricular (RV) wall tension in pulmonary arterial hypertension (PAH) is determined not only by pressure, but also by RV volume. A larger volume at a given pressure generates more wall tension. Return of reflected waves early after the onset of contraction, when RV volume is larger, may augment RV load. We aimed to elucidate: (1) the distribution of arrival times of peak reflected waves in treatment‐naïve PAH patients; (2) the relationship between time of arrival of reflected waves and RV morphology; and (3) the effect of PAH treatment on the arrival time of reflected waves. Wave separation analysis was conducted in 68 treatment‐naïve PAH patients. In the treatment‐naïve condition, 54% of patients had mid‐systolic return of reflected waves (defined as 34–66% of systole). Despite similar pulmonary vascular resistance (PVR), patients with mid‐systolic return had more pronounced RV hypertrophy compared to those with late‐systolic or diastolic return (RV mass/body surface area; mid‐systolic return 54.6 ± 12.6 g m–2, late‐systolic return 44.4 ± 10.1 g m–2, diastolic return 42.8 ± 13.1 g m–2). Out of 68 patients, 43 patients were further examined after initial treatment. At follow‐up, the stiffness of the proximal arteries, given as characteristic impedance, decreased from 0.12 to 0.08 mmHg s mL–1. Wave speed was attenuated from 13.3 to 9.1 m s–1, and the return of reflected waves was delayed from 64% to 71% of systole. In conclusion, reflected waves arrive at variable times in PAH. Early return of reflected waves was associated with more RV hypertrophy. PAH treatment not only decreased PVR, but also delayed the timing of reflected waves. Key points Right ventricular (RV) wall tension in pulmonary arterial hypertension (PAH) is determined not only by pressure, but also by RV volume. Larger volume at a given pressure causes larger RV wall tension. Early return of reflected waves adds RV pressure in early systole, when RV volume is relatively large. Thus, early return of reflected waves may increase RV wall tension. Wave reflection can provide a description of RV load. In PAH, reflected waves arrive back at variable times. In over half of PAH patients, the RV is exposed to mid‐systolic return of reflected waves. Mid‐systolic return of reflected waves is related to RV hypertrophy. PAH treatment acts favourably on the RV not only by reducing resistance, but also by delaying the return of reflected waves. Arrival timing of reflected waves is an important parameter for understanding the relationship between RV load and its function in PAH.
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Affiliation(s)
- Masafumi Fukumitsu
- Department of Pulmonary Medicine, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.,Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Japan
| | - Joanne A Groeneveldt
- Department of Pulmonary Medicine, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Natalia J Braams
- Department of Pulmonary Medicine, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Ahmed A Bayoumy
- Department of Pulmonary Medicine, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.,Department of Internal Medicine, Chest Unit, Suez Canal University Hospitals, Suez Canal University, Ismailia, Egypt
| | - J Tim Marcus
- Department of Radiology and Nuclear Medicine, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Lilian J Meijboom
- Department of Radiology and Nuclear Medicine, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Frances S de Man
- Department of Pulmonary Medicine, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Harm-Jan Bogaard
- Department of Pulmonary Medicine, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Medicine, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Berend E Westerhof
- Department of Pulmonary Medicine, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
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Duijvelaar E, Schippers JR, Smeele PJ, de Raaf MA, Vanhove ALEM, Blok SG, Twisk JWR, Vonk Noordegraaf A, de Man FS, Bogaard HJ, Aman J. Long-term clinical outcomes of COVID-19 patients treated with imatinib. Lancet Respir Med 2022; 10:e34-e35. [PMID: 35183270 PMCID: PMC8853671 DOI: 10.1016/s2213-2600(22)00052-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 12/16/2022]
Affiliation(s)
- Erik Duijvelaar
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, 1081 HV Amsterdam, The Netherlands
| | - Job R Schippers
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, 1081 HV Amsterdam, The Netherlands
| | - Patrick J Smeele
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, 1081 HV Amsterdam, The Netherlands
| | - Michiel Alexander de Raaf
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, 1081 HV Amsterdam, The Netherlands
| | - Arthur L E M Vanhove
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, 1081 HV Amsterdam, The Netherlands
| | - Siebe G Blok
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, 1081 HV Amsterdam, The Netherlands
| | | | - Jos W R Twisk
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, 1081 HV Amsterdam, The Netherlands
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, 1081 HV Amsterdam, The Netherlands
| | - Frances S de Man
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, 1081 HV Amsterdam, The Netherlands
| | - Harm Jan Bogaard
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, 1081 HV Amsterdam, The Netherlands
| | - Jurjan Aman
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, 1081 HV Amsterdam, The Netherlands.
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Ruigrok D, Handoko ML, Meijboom LJ, Nossent EJ, Boonstra A, Braams NJ, van Wezenbeek J, Tepaske R, Tuinman PR, Heunks LM, Vonk Noordegraaf A, de Man FS, Symersky P, Bogaard HJ. Non-invasive follow-up strategy after pulmonary endarterectomy for CTEPH. ERJ Open Res 2022; 8:00564-2021. [PMID: 35586450 PMCID: PMC9108966 DOI: 10.1183/23120541.00564-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 02/16/2022] [Indexed: 11/26/2022] Open
Abstract
Background The success of pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) is usually evaluated by performing a right heart catheterisation (RHC). Here, we investigate whether residual pulmonary hypertension (PH) can be sufficiently excluded without the need for a RHC, by making use of early post-operative haemodynamics, or N-terminal pro-brain natriuretic peptide (NT-proBNP), cardiopulmonary exercise testing (CPET) and transthoracic echocardiography (TTE) 6 months after PEA. Methods In an observational analysis, residual PH after PEA measured by RHC was related to haemodynamic data from the post-operative intensive care unit time and data from a 6-month follow-up assessment including NT-proBNP, TTE and CPET. After dichotomisation and univariate analysis, sensitivity, specificity, positive predictive value, negative predictive value (NPV) and likelihood ratios were calculated. Results Thirty-six out of 92 included patients had residual PH 6 months after PEA (39%). Correlation between early post-operative and 6-month follow-up mean pulmonary artery pressure was moderate (Spearman rho 0.465, p<0.001). Early haemodynamics did not predict late success. NT-proBNP >300 ng·L−1 had insufficient NPV (0.71) to exclude residual PH. Probability for PH on TTE had a moderate NPV (0.74) for residual PH. Peak oxygen consumption (V′O2) <80% predicted had the highest sensitivity (0.85) and NPV (0.84) for residual PH. Conclusions CPET 6 months after PEA, and to a lesser extent TTE, can be used to exclude residual CTEPH, thereby safely reducing the number of patients needing to undergo re-RHC after PEA. In approximately one-third to one-half of CTEPH patients, residual pulmonary hypertension after pulmonary endarterectomy can be excluded based on cardiopulmonary exercise testing or echocardiography, without the need for right heart catheterisationhttps://bit.ly/3pbj2Ge
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van de Bovenkamp AA, Wijkstra N, Oosterveer FPT, Vonk Noordegraaf A, Bogaard HJ, van Rossum AC, de Man FS, Borlaug BA, Handoko ML. The Value of Passive Leg Raise During Right Heart Catheterization in Diagnosing Heart Failure With Preserved Ejection Fraction. Circ Heart Fail 2022; 15:e008935. [PMID: 35311526 PMCID: PMC9009844 DOI: 10.1161/circheartfailure.121.008935] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Because of limited accuracy of noninvasive tests, diastolic stress testing plays an important role in the diagnostic work-up of patients with heart failure with preserved ejection fraction (HFpEF). Exercise right heart catheterization is considered the gold standard and indicated when HFpEF is suspected but left ventricular filling pressures at rest are normal. However, performing exercise during right heart catheterization is not universally available. Here, we examined whether pulmonary capillary wedge pressure (PCWP) during a passive leg raise (PLR) could be used as simple and accurate method to diagnose or rule out occult-HFpEF. METHODS In our tertiary center for pulmonary hypertension and HFpEF, all patients who received a diagnostic right heart catheterization with PCWP-measurements at rest, PLR, and exercise were evaluated (2014-2020). The diagnostic value of PCWPPLR was compared with the gold standard (PCWPEXERCISE). Cut-offs derived from our cohort were subsequently validated in an external cohort (N=74). RESULTS Thirty-nine non-HFpEF, 33 occult-HFpEF, and 37 manifest-HFpEF patients were included (N=109). In patients with normal PCWPREST (<15 mmHg), PCWPPLR significantly improved diagnostic accuracy compared with PCWPREST (AUC=0.82 versus 0.69, P=0.03). PCWPPLR ≥19 mmHg (24% of cases) had a specificity of 100% for diagnosing occult-HFpEF, irrespective of diuretic use. PCWPPLR ≥11 mmHg had a 100% sensitivity and negative predictive value for diagnosing occult-HFpEF. Both cut-offs retained a 100% specificity and 100% sensitivity in the external cohort. Absolute change in PCWPPLR or V-wave derived parameters had no incremental value in diagnosing occult-HFpEF. CONCLUSIONS PCWPPLR is a simple and powerful tool that can help to diagnose or rule out occult-HFpEF.
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Affiliation(s)
- Arno A van de Bovenkamp
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, the Netherlands (A.A.v.d.B., N.W., A.C.v.R., M.L.H.)
| | - Niels Wijkstra
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, the Netherlands (A.A.v.d.B., N.W., A.C.v.R., M.L.H.)
| | - Frank P T Oosterveer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Pulmonology, Amsterdam Cardiovascular Sciences, the Netherlands (F.P.T.O., A.V.N., H.J.B., F.S.d.M.)
| | - Anton Vonk Noordegraaf
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Pulmonology, Amsterdam Cardiovascular Sciences, the Netherlands (F.P.T.O., A.V.N., H.J.B., F.S.d.M.)
| | - Harm Jan Bogaard
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Pulmonology, Amsterdam Cardiovascular Sciences, the Netherlands (F.P.T.O., A.V.N., H.J.B., F.S.d.M.)
| | - Albert C van Rossum
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, the Netherlands (A.A.v.d.B., N.W., A.C.v.R., M.L.H.)
| | - Frances S de Man
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Pulmonology, Amsterdam Cardiovascular Sciences, the Netherlands (F.P.T.O., A.V.N., H.J.B., F.S.d.M.)
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.)
| | - M Louis Handoko
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, the Netherlands (A.A.v.d.B., N.W., A.C.v.R., M.L.H.)
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van de Bovenkamp AA, Wijkstra N, Oosterveer F, Noordegraaf AV, Bogaard HJ, van Rossum AC, De Man FS, Borlaug B, Handoko ML. THE VALUE OF PASSIVE LEG RAISE DURING RIGHT HEART CATHETERIZATION IN DIAGNOSING HEART FAILURE WITH PRESERVED EJECTION FRACTION. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01221-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Manz XD, Szulcek R, Pan X, Symersky P, Dickhoff C, Majolée J, Kremer V, Michielon E, Jordanova ES, Radonic T, Bijnsdorp IV, Piersma SR, Pham TV, Jimenez CR, Vonk Noordegraaf A, de Man FS, Boon RA, Voorberg J, Hordijk PL, Aman J, Bogaard HJ. Epigenetic Modification of the VWF Promotor Drives Platelet Aggregation on the Pulmonary Endothelium in Chronic Thromboembolic Pulmonary Hypertension. Am J Respir Crit Care Med 2022; 205:806-818. [PMID: 35081007 DOI: 10.1164/rccm.202109-2075oc] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Von Willebrand Factor (VWF) mediates platelet adhesion during thrombosis. While chronic thromboembolic pulmonary hypertension (CTEPH) is associated with increased plasma levels of VWF, the role of this protein in CTEPH has remained enigmatic. OBJECTIVE To identify the role of VWF in CTEPH. METHODS CTEPH-specific patient plasma and pulmonary endarterectomy material from CTEPH patients were used to study the relationship between inflammation, VWF expression and pulmonary thrombosis. Cell culture findings were validated in human tissue and proteomics and chromatin immunoprecipitation were used to investigate the underlying mechanism of CTEPH. MEASUREMENTS AND MAIN RESULTS VWF is increased in plasma and in the pulmonary endothelium of CTEPH patients. In vitro, the increase in VWF gene expression and the higher release of VWF protein upon endothelial activation resulted in elevated platelet adhesion to CTEPH endothelium. Proteomic analysis revealed that Nuclear Factor κB 2 (NFκB2) was significantly increased in CTEPH. We demonstrate reduced histone tri-methylation and increased histone acetylation of the VWF promotor in CTEPH endothelium, facilitating binding of NFκB2 to the VWF promotor and driving VWF transcription. Genetic interference of NFκB2 normalized the high VWF RNA expression levels and reversed the pro-thrombotic phenotype observed in CTEPH-PAEC. CONCLUSION Epigenetic regulation of the VWF promotor contributes to the creation of a local environment that favors in situ thrombosis in the pulmonary arteries. It reveals a direct molecular link between inflammatory pathways and platelet adhesion in the pulmonary vascular wall, emphasizing a possible role of in situ thrombosis in the development or progression of CTEPH.
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Affiliation(s)
- Xue D Manz
- Amsterdam UMC Locatie VUmc, 1209, Pulmonary Medicine, Amsterdam, Netherlands
| | - Robert Szulcek
- Charite Universitatsmedizin Berlin, 14903, Physiology, Berlin, Germany
| | - Xiaoke Pan
- Amsterdam UMC Locatie VUmc, 1209, Pulmonary Medicine, Amsterdam, Netherlands
| | - Petr Symersky
- Amsterdam UMC Locatie VUmc, 1209, Cardio-thoracic Surgery, Amsterdam, Netherlands
| | - Chris Dickhoff
- Amsterdam UMC Locatie VUmc, 1209, Cardio-thoracic Surgery, Amsterdam, Netherlands
| | - Jisca Majolée
- Amsterdam UMC Locatie VUmc, 1209, Physiology, Amsterdam, Netherlands
| | - Veerle Kremer
- Amsterdam UMC Locatie VUmc, 1209, Physiology, Amsterdam, Netherlands
| | - Elisabetta Michielon
- Amsterdam UMC Locatie VUmc, 1209, Molecular Cell Biology and Immunology, Amsterdam, Netherlands
| | - Ekaterina S Jordanova
- Amsterdam UMC Locatie VUmc, 1209, Center for Gynecologic Oncology Amsterdam, Amsterdam, Netherlands
| | - Teodora Radonic
- Amsterdam UMC Locatie VUmc, 1209, Pathology, Amsterdam, Netherlands
| | - Irene V Bijnsdorp
- Amsterdam UMC Locatie VUmc, 1209, Medical Oncology, Amsterdam, Netherlands
| | - Sander R Piersma
- Amsterdam UMC Locatie VUmc, 1209, Medical Oncology, Amsterdam, Netherlands
| | - Thang V Pham
- Amsterdam UMC Locatie VUmc, 1209, Medical Oncology, Amsterdam, Netherlands
| | - Connie R Jimenez
- Amsterdam UMC Locatie VUmc, 1209, Medical Oncology, Amsterdam, Netherlands
| | - Anton Vonk Noordegraaf
- Amsterdam UMC Locatie VUmc, 1209, Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Frances S de Man
- Amsterdam UMC Locatie VUmc, 1209, Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Reinier A Boon
- Amsterdam UMC Locatie VUmc, 1209, Physiology, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Jan Voorberg
- Sanquin Research, 159217, Molecular Hematology, Amsterdam, Netherlands
| | | | - Jurjan Aman
- Amsterdam UMC - Locatie VUMC, 1209, Pulmonary Diseases, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Harm Jan Bogaard
- Vrije Universiteit Amsterdam, 1190, Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands;
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van Wezenbeek J, Kianzad A, van de Bovenkamp A, Wessels J, Mouratoglou SA, Braams NJ, Jansen SMA, Meulblok E, Meijboom LJ, Marcus JT, Vonk Noordegraaf A, José Goumans M, Jan Bogaard H, Handoko ML, de Man FS. Right Ventricular and Right Atrial Function Are Less Compromised in Pulmonary Hypertension Secondary to Heart Failure With Preserved Ejection Fraction: A Comparison With Pulmonary Arterial Hypertension With Similar Pressure Overload. Circ Heart Fail 2021; 15:e008726. [PMID: 34937392 PMCID: PMC8843396 DOI: 10.1161/circheartfailure.121.008726] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Heart failure with preserved ejection fraction (HFpEF) is a prevalent disorder for which no effective treatment yet exists. Pulmonary hypertension (PH) and right atrial (RA) and ventricular (RV) dysfunction are frequently observed. The question remains whether the PH with the associated RV/RA dysfunction in HFpEF are markers of disease severity. Methods: To obtain insight in the relative importance of pressure-overload and left-to-right interaction, we compared RA and RV function in 3 groups: 1. HFpEF (n=13); 2. HFpEF-PH (n=33), and; 3. pulmonary arterial hypertension (PAH) matched to pulmonary artery pressures of HFpEF-PH (PH limited to mPAP ≥30 and ≤50 mmHg) (n=47). Patients underwent right heart catheterization and cardiac magnetic resonance imaging. Results: The right ventricle in HFpEF-PH was less dilated and hypertrophied than in PAH. In addition, RV ejection fraction was more preserved (HFpEF-PH: 52±11 versus PAH: 36±12%). RV filling patterns differed: vena cava backflow during RA contraction was observed in PAH only. In HFpEF-PH, RA pressure was elevated throughout the cardiac cycle (HFpEF-PH: 10 [8–14] versus PAH: 7 [5–10] mm Hg), while RA volume was smaller, reflecting excessive RA stiffness (HFpEF-PH: 0.14 [0.10–0.17] versus PAH: 0.08 [0.06–0.11] mm Hg/mL). RA stiffness was associated with an increased eccentricity index (HFpEF-PH: 1.3±0.2 versus PAH: 1.2±0.1) and interatrial pressure gradient (9 [5 to 12] versus 2 [−2 to 5] mm Hg). Conclusions: RV/RA function was less compromised in HFpEF-PH than in PAH, despite similar pressure-overload. Increased RA pressure and stiffness in HFpEF-PH were explained by left atrial/RA-interaction. Therefore, our results indicate that increased RA pressure is not a sign of overt RV failure but rather a reflection of HFpEF-severity.
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Affiliation(s)
- Jessie van Wezenbeek
- Department of Pulmonary Medicine, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands. (J.v.W., S.A.M., N.J.B., S.M.A.J., E.M., A.V.N., H.J.B., F.S.d.M.)
| | | | - Arno van de Bovenkamp
- Department of Cardiology, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands. (A.v.d.B., M.L.H.)
| | | | - Sophia A Mouratoglou
- Department of Pulmonary Medicine, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands. (J.v.W., S.A.M., N.J.B., S.M.A.J., E.M., A.V.N., H.J.B., F.S.d.M.)
| | - Natalia J Braams
- Department of Pulmonary Medicine, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands. (J.v.W., S.A.M., N.J.B., S.M.A.J., E.M., A.V.N., H.J.B., F.S.d.M.)
| | - Samara M A Jansen
- Department of Pulmonary Medicine, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands. (J.v.W., S.A.M., N.J.B., S.M.A.J., E.M., A.V.N., H.J.B., F.S.d.M.)
| | - Eva Meulblok
- Department of Pulmonary Medicine, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands. (J.v.W., S.A.M., N.J.B., S.M.A.J., E.M., A.V.N., H.J.B., F.S.d.M.)
| | - Lilian J Meijboom
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands. (L.J.M., J.T.M.)
| | - J Tim Marcus
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands. (L.J.M., J.T.M.)
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Medicine, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands. (J.v.W., S.A.M., N.J.B., S.M.A.J., E.M., A.V.N., H.J.B., F.S.d.M.)
| | - Marie José Goumans
- Department of Cell and Chemical Biology, Leiden University Medical Centre, the Netherlands (M.J.G.)
| | - Harm Jan Bogaard
- Department of Pulmonary Medicine, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands. (J.v.W., S.A.M., N.J.B., S.M.A.J., E.M., A.V.N., H.J.B., F.S.d.M.)
| | - M Louis Handoko
- Department of Cardiology, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands. (A.v.d.B., M.L.H.)
| | - Frances S de Man
- Department of Pulmonary Medicine, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands. (J.v.W., S.A.M., N.J.B., S.M.A.J., E.M., A.V.N., H.J.B., F.S.d.M.)
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Peters EL, van Campen JSJA, Groepenhoff H, de Man FS, Noordegraaf AV, Bogaard HJ. Bisoprolol and/or hyperoxic breathing do not reduce hyperventilation in pulmonary arterial hypertension patients. Pulm Circ 2021; 11:20458940211057890. [PMID: 34925761 PMCID: PMC8671678 DOI: 10.1177/20458940211057890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/19/2021] [Indexed: 11/17/2022] Open
Abstract
Hyperventilation is common in pulmonary arterial hypertension and may be related to autonomic imbalance. Patients underwent exercise testing and hyperoxic breathing before and after bisoprolol treatment. We found that neither beta blocker treatment nor hyperoxic breathing in patients reduced hyperventilation at rest and during exercise, although it reduced heart rate.
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Affiliation(s)
- Eva L Peters
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jasmijn S J A van Campen
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Herman Groepenhoff
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Frances S de Man
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Harm J Bogaard
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Boon GJAM, van den Hout WB, Barco S, Bogaard HJ, Delcroix M, Huisman MV, Konstantinides SV, Meijboom LJ, Nossent EJ, Symersky P, Vonk Noordegraaf A, Klok FA. A model for estimating the health economic impact of earlier diagnosis of chronic thromboembolic pulmonary hypertension. ERJ Open Res 2021; 7:00719-2020. [PMID: 34853780 PMCID: PMC8628742 DOI: 10.1183/23120541.00719-2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 06/14/2021] [Indexed: 11/06/2022] Open
Abstract
Background Diagnostic delay of chronic thromboembolic pulmonary hypertension (CTEPH)
exceeds 1 year, contributing to higher mortality. Health economic
consequences of late CTEPH diagnosis are unknown. We aimed to develop a
model for quantifying the impact of diagnosing CTEPH earlier on survival,
quality-adjusted life-years (QALYs) and healthcare costs. Material and methods A Markov model was developed to estimate lifelong outcomes, depending on the
degree of delay. Data on survival and quality of life were obtained from
published literature. Hospital costs were assessed from patient records
(n=498) at the Amsterdam UMC – VUmc, which is a Dutch CTEPH
referral center. Medication costs were based on a mix of standard medication
regimens. Results For 63-year-old CTEPH patients with a 14-month diagnostic delay of CTEPH
(median age and delay of patients in the European CTEPH Registry), lifelong
healthcare costs were estimated at EUR 117 100 for a mix of treatment
options. In a hypothetical scenario of maximal reduction of current delay,
improved survival was estimated at a gain of 3.01 life-years and 2.04 QALYs.
The associated cost increase was EUR 44 654, of which 87% was
due to prolonged medication use. This accounts for an incremental
cost–utility ratio of EUR 21 900/QALY. Conclusion Our constructed model based on the Dutch healthcare setting demonstrates a
substantial health gain when CTEPH is diagnosed earlier. According to Dutch
health economic standards, additional costs remain below the deemed
acceptable limit of EUR 50 000/QALY for the particular disease
burden. This model can be used for evaluating cost-effectiveness of
diagnostic strategies aimed at reducing the diagnostic delay. This constructed model based on the Dutch healthcare setting can be used
for evaluating cost-effectiveness of diagnostic strategies aimed at reducing
the diagnostic delay of chronic thromboembolic pulmonary hypertensionhttps://bit.ly/35yXPM3
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Affiliation(s)
- Gudula J A M Boon
- Dept of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilbert B van den Hout
- Dept of Biomedical Data Science - Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands
| | - Stefano Barco
- Center for Thrombosis and Hemostasis, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany.,Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Harm Jan Bogaard
- Dept of Pulmonary Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Marion Delcroix
- Dept of Pneumology, University Hospitals Leuven, Leuven, Belgium
| | - Menno V Huisman
- Dept of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Stavros V Konstantinides
- Center for Thrombosis and Hemostasis, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany.,Dept of Cardiology, Democritus University of Thrace, Xanthi, Greece
| | - Lilian J Meijboom
- Dept of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Esther J Nossent
- Dept of Pulmonary Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Petr Symersky
- Dept of Cardiac Surgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Anton Vonk Noordegraaf
- Dept of Pulmonary Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Frederikus A Klok
- Dept of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.,Center for Thrombosis and Hemostasis, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
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Kaemmerer AS, Gorenflo M, Huscher D, Pittrow D, Ewert P, Pausch C, Delcroix M, Ghofrani HA, Hoeper MM, Kozlik-Feldmann R, Skride A, Stähler G, Vizza CD, Jureviciene E, Jancauskaite D, Gumbiene L, Ewert R, Dähnert I, Held M, Halank M, Skowasch D, Klose H, Wilkens H, Milger K, Jux C, Koestenberger M, Scelsi L, Brunnemer E, Hofbeck M, Ulrich S, Vonk Noordegraaf A, Lange TJ, Bruch L, Konstantinides S, Claussen M, Löffler-Ragg J, Wirtz H, Apitz C, Neidenbach R, Freilinger S, Nemes A, Opitz C, Grünig E, Rosenkranz S. Medical treatment of pulmonary hypertension in adults with congenital heart disease: updated and extended results from the International COMPERA-CHD Registry. Cardiovasc Diagn Ther 2021; 11:1255-1268. [PMID: 35070795 PMCID: PMC8748472 DOI: 10.21037/cdt-21-351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/30/2021] [Indexed: 08/26/2023]
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is common in congenital heart disease (CHD). Because clinical-trial data on PAH associated with CHD (PAH-CHD) remain limited, registry data on the long-term course are essential. This analysis aimed to update information from the COMPERA-CHD registry on management strategies based on real-world data. METHODS The prospective international pulmonary hypertension registry COMPERA has since 2007 enrolled more than 10,000 patients. COMPERA-CHD is a sub-registry for patients with PAH-CHD. RESULTS A total of 769 patients with PAH-CHD from 62 specialized centers in 12 countries were included into COMPERA-CHD from January 2007 through September 2020. At the last follow-up in 09/2020, patients [mean age 45.3±16.8 years; 512 (66%) female] had either post-tricuspid shunts (n=359; 46.7%), pre-tricuspid shunts (n=249; 32.4%), complex CHD (n=132; 17.2%), congenital left heart or aortic valve or aortic disease (n=9; 1.3%), or miscellaneous CHD (n=20; 2.6%). The mean 6-minute walking distance was 369±121 m, and 28.2%, 56.0%, and 3.8% were in WHO functional class I/II, III or IV, respectively (12.0% unknown). Compared with the previously published COMPERA-CHD data, after 21 months of follow-up, the number of included PAH-CHD patients increased by 91 (13.4%). Within this group the number of Eisenmenger patients rose by 39 (16.3%), the number of "Non-Eisenmenger PAH" patients by 45 (26.9%). Currently, among the 674 patients from the PAH-CHD group with at least one follow-up, 450 (66.8%) received endothelin receptor antagonists (ERA), 416 (61.7%) PDE-5 inhibitors, 85 (12.6%) prostacyclin analogues, and 36 (5.3%) the sGC stimulator riociguat. While at first inclusion in the COMPERA-CHD registry, treatment was predominantly monotherapy (69.3%), this has shifted to favoring combination therapy in the current group (53%). For the first time, the nature, frequency, and treatment of significant comorbidities requiring supportive care and medication are described. CONCLUSIONS Analyzing "real life data" from the international COMPERA-CHD registry, we present a comprehensive overview about current management modalities and treatment concepts in PAH-CHD. There was an trend towards more aggressive treatment strategies and combination therapies. In the future, particular attention must be directed to the "Non-Eisenmenger PAH" group and to patients with complex CHD, including Fontan patients. TRIAL REGISTRATION www.clinicaltrials.gov, study identifier: Clinicaltrials.gov NCT01347216.
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Affiliation(s)
- Ann-Sophie Kaemmerer
- Deutsches Herzzentrum München, Klinik für angeborene Herzfehler und Kinderkardiologie, München, Technische Universität München, and Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Munich Heart Alliance, Munich, Germany
| | - Matthias Gorenflo
- Universitätsklinikum Heidelberg, Zentrum für Kinder- und Jugendmedizin, Angelika-Lautenschläger-Klinik, Heidelberg, Germany
| | - Dörte Huscher
- Institute of Biometry and Clinical Epidemiology, and Berlin Institute of Health, Charité-Universitätsmedizin, Berlin, Germany
| | - David Pittrow
- Medical Faculty, Institute for Clinical Pharmacology, Technical University, Dresden, Germany
| | - Peter Ewert
- Deutsches Herzzentrum München, Klinik für angeborene Herzfehler und Kinderkardiologie, München, Technische Universität München, and Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Munich Heart Alliance, Munich, Germany
| | | | - Marion Delcroix
- UZ Leuven, Campus Gasthuisberg, Department of Pneumology, Leuven, Belgium
| | - Hossein A. Ghofrani
- Universitätsklinikum Gießen und Marburg GmbH, Medizinische Klinik II/V, Gießen, Germany
| | - Marius M. Hoeper
- Medizinische Hochschule Hannover, Abt. Pneumologie, Hannover, Germany
| | - Rainer Kozlik-Feldmann
- Universitäres Herzzentrum Hamburg, Klinik und Poliklinik für Kinderherzmedizin und Erwachsene mit angeborenen Herzfehlern, Hamburg, Germany
| | - Andris Skride
- Riga Stradins University, Clinical University Hospital, Riga, Lativa
| | - Gerd Stähler
- Klinik Löwenstein, Medizinische Klinik I, Löwenstein, Germany
| | - Carmine Dario Vizza
- Pulmonary Hypertension Center, Department of Clinical Anestesiologic and Cardiovascular Sciences, University of Rome La Sapienza, Rome, Italy
| | - Elena Jureviciene
- Faculty of Medicine of Vilnius University, Referal Centre of Pulmonary Hypertension, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Dovile Jancauskaite
- Faculty of Medicine of Vilnius University, Referal Centre of Pulmonary Hypertension, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Lina Gumbiene
- Faculty of Medicine of Vilnius University, Referal Centre of Pulmonary Hypertension, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Ralf Ewert
- Universitätsmedizin Greifswald, Zentrum für Innere Medizin, Klinik und Poliklinik für Innere Medizin B, Greifswald, Germany
| | - Ingo Dähnert
- Herzzentrum Leipzig GmbH, Klinik für Kinderkardiologie, Leipzig, Germany
| | - Matthias Held
- Med. Klinik mit Schwerpunkt Pneumologie und Beatmungsmedizin, Klinikum Würzburg Mitte, Standort Missioklinik, Würzburg, Germany
| | - Michael Halank
- Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany
| | - Dirk Skowasch
- Universitätsklinikum Bonn, Medizinische Klinik und Poliklinik II, Innere Medizin - Kardiologie/Pneumologie, Bonn
| | - Hans Klose
- Abteilung für Pneumologie, Zentrum für Onkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Heinrike Wilkens
- Universitätsklinikum des Saarlandes, Innere Medizin V, Homburg, Germany
| | - Katrin Milger
- LMU Klinikum, Medizinische Klinik und Poliklinik V, München, Germany
| | - Christian Jux
- Kinderherzzentrum und Zentrum für angeborene Herzfehler, Justus-Liebig-Universität, Zentrum für Kinderheilkunde, Abteilung Kinderkardiologie, Gießen, Germany
| | - Martin Koestenberger
- LKH - Univ. Klinikum Graz, Universitätsklinik für Kinder- und Jugendheilkunde, Abteilung für Pädiatrische Kardiologie, Graz, Austria
| | - Laura Scelsi
- Fondazione IRCCS Policlinico San Matteo University of Pavia, Pavia, Italy
| | - Eva Brunnemer
- Medizinische Universitätsklinik (Krehl-Klinik), Klinik für Kardiologie, Angiologie und Pneumologie (Innere Medizin III), Heidelberg, Germany
| | - Michael Hofbeck
- Universitätsklinik für Kinder- und Jugendmedizin Tübingen, Kinderkardiologie, Pulmologie, Intensivmedizin, Tübingen, Germany
| | - Silvia Ulrich
- Universitätsspital Zürich, Klinik für Pneumologie, Zürich, Switzerland
| | - Anton Vonk Noordegraaf
- Amsterdam UMC, Vrije Universiteit Amsterdam, dept of Pulmonary Medicine, Amsterdam, Netherlands
| | - Tobias J. Lange
- Universitätsklinikum Regensburg, Medizinische Klinik und Poliklinik II, Regensburg, Germany
| | - Leonhard Bruch
- Unfallkrankenhaus Berlin, Klinik für Innere Medizin, Berlin, Germany
| | | | - Martin Claussen
- LungenClinic Grosshansdorf, Fachabteilung Pneumologie, Großhansdorf, Germany
| | | | - Hubert Wirtz
- Universitätsklinikum Leipzig, Medizinische Klinik und Poliklinik I, Abteilung für Pneumologie, Leipzig, Germany
| | - Christian Apitz
- Universitätsklinik für Kinder- und Jugendmedizin, Sektion Pädiatrische Kardiologie, Ulm, Germany
| | - Rhoia Neidenbach
- Deutsches Herzzentrum München, Klinik für angeborene Herzfehler und Kinderkardiologie, München, Technische Universität München, and Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Munich Heart Alliance, Munich, Germany
| | - Sebastian Freilinger
- Deutsches Herzzentrum München, Klinik für angeborene Herzfehler und Kinderkardiologie, München, Technische Universität München, and Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Munich Heart Alliance, Munich, Germany
| | - Attila Nemes
- University of Szeged, Department of Medicine, Szeged, Hungary
| | - Christian Opitz
- DRK Kliniken Berlin Westend, Klinik für Innere Medizin, Schwerpunkt Kardiologie, Berlin, Germany
| | - Ekkehard Grünig
- Thoraxklinik Heidelberg gGmbH, Zentrum für Pulmonale Hypertonie, Heidelberg, and German Centre for Lung Research, Heidelberg, Germany
| | - Stephan Rosenkranz
- Universitätsklinik Köln – Herzzentrum, Klinik III für Innere Medizin, Köln, Germany
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Wessels JN, Mouratoglou SA, van Wezenbeek J, Handoko ML, Marcus JT, Meijboom LJ, Westerhof BE, Jan Bogaard H, Strijkers GJ, Vonk Noordegraaf A, de Man FS. Right atrial function is associated with RV diastolic stiffness: RA-RV interaction in pulmonary arterial hypertension. Eur Respir J 2021; 59:13993003.01454-2021. [PMID: 34764180 PMCID: PMC9218241 DOI: 10.1183/13993003.01454-2021] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 10/24/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) patients have altered right atrial (RA) function and right ventricular (RV) diastolic stiffness. This study assessed the impact of RV diastolic stiffness on RA-RV interaction. METHODS Low or high end-diastolic elastance (Eed) PAH patients (n=94) were compared to controls (n=31). Treatment response was evaluated in n=62 patients. RV and RA longitudinal strain, RA emptying and RV filling were determined and diastole was divided in a passive and active phase. Vena cava backflow was calculated as RV active filling-RA active emptying; RA stroke work as RA active emptying*RV end-diastolic pressure. RESULTS With increased Eed, RA and RV passive strain were reduced while active strain was preserved. In comparison to controls, patients had lower RV passive filling, but higher RA active emptying and RA stroke work. RV active filling was lower in high Eed patients, resulting in higher vena cava backflow. Upon treatment, Eed reduced in half of high Eedpatients, which coincided with larger reductions in afterload, RV mass and vena cava backflow and greater improvements in RV active filling and stroke volume in comparison to patients in whom Eed remained high. CONCLUSIONS In PAH, RA function is associated with changes in RV function. Despite increased RA stroke work, severe RV diastolic stiffness is associated with reduced RV active filling and increased vena cava backflow. In 50% of high baseline Eed patients, diastolic stiffness remains high, despite treatment. Eed reduction coincided with a large reduction in afterload, increased RV active filling and decreased vena cava backflow.
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Affiliation(s)
- Jeroen N Wessels
- Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sophia A Mouratoglou
- Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jessie van Wezenbeek
- Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M Louis Handoko
- Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J Tim Marcus
- Radiology and Nuclear medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lilian J Meijboom
- Radiology and Nuclear medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Berend E Westerhof
- Cardiovascular and Respiratory Physiology, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Harm Jan Bogaard
- Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Gustav J Strijkers
- Dept of Biomedical Engineering and Physics, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Anton Vonk Noordegraaf
- Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Frances S de Man
- Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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