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Yogeswaran A, Gall H, Fünderich M, Wilkins MR, Howard L, Kiely DG, Lawrie A, Hassoun PM, Sirenklo Y, Torbas O, Sweatt AJ, Zamanian RT, Williams PG, Frauendorf M, Arvanitaki A, Giannakoulas G, Saleh K, Sabbour H, Cajigas HR, Frantz R, Al Ghouleh I, Chan SY, Brittain E, Annis JS, Pepe A, Ghio S, Orfanos S, Anthi A, Majeed RW, Wilhelm J, Ghofrani HA, Richter MJ, Grimminger F, Sahay S, Tello K, Seeger W. Comparison of Contemporary Risk Scores in All Groups of Pulmonary Hypertension: A Pulmonary Vascular Research Institute GoDeep Meta-Registry Analysis. Chest 2024:S0012-3692(24)00309-X. [PMID: 38508334 DOI: 10.1016/j.chest.2024.03.018] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/22/2024] [Accepted: 03/08/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) is a heterogeneous disease with a poor prognosis. Accurate risk stratification is essential for guiding treatment decisions in pulmonary arterial hypertension (PAH). Although various risk models have been developed for PAH, their comparative prognostic potential requires further exploration. Additionally, the applicability of risk scores in PH groups beyond group 1 remains to be investigated. RESEARCH QUESTION Are risk scores originally developed for PAH predictive in PH groups 1 through 4? STUDY DESIGN AND METHODS We conducted a comprehensive analysis of outcomes among patients with incident PH enrolled in the multicenter worldwide Pulmonary Vascular Research Institute GoDeep meta-registry. Analyses were performed across PH groups 1 through 4 and further subgroups to evaluate the predictive value of PAH risk scores, including REVEAL Lite 2, REVEAL 2.0, ESC/ERS 2022, COMPERA 3-strata, and COMPERA 4-strata. RESULTS Eight thousand five hundred sixty-five patients were included in the study, of whom 3,537 patients were assigned to group 1 PH, whereas 1,807 patients, 1,635 patients, and 1,586 patients were assigned to group 2 PH, group 3 PH, and group 4 PH, respectively. Pulmonary hemodynamics were impaired with median mean pulmonary arterial pressure of 42 mm Hg (33-52 mm Hg) and pulmonary vascular resistance of 7 WU (4-11 WU). All risk scores were prognostic in the entire PH population and in each of the PH groups 1 through 4. The REVEAL scores, when used as continuous prediction models, demonstrated the highest statistical prognostic power and granularity; the COMPERA 4-strata risk score provided subdifferentiation of the intermediate-risk group. Similar results were obtained when separately analyzing various subgroups (PH subgroups 1.1, 1.4.1, and 1.4.4; PH subgroups 3.1 and 3.2; group 2 with isolated postcapillary PH vs combined precapillary and postcapillary PH; patients of all groups with concomitant cardiac comorbidities; and severe [> 5 WU] vs nonsevere PH). INTERPRETATION This comprehensive study with real-world data from 15 PH centers showed that PAH-designed risk scores possess predictive power in a large PH cohort, whether considered as common to the group or calculated separately for each PH group (1-4) and various subgroups.
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Affiliation(s)
- Athiththan Yogeswaran
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany; Institute for Lung Health, Cardio-Pulmonary Institute (CPI), Giessen, Germany
| | - Henning Gall
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany; Institute for Lung Health, Cardio-Pulmonary Institute (CPI), Giessen, Germany
| | - Meike Fünderich
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany
| | - Martin R Wilkins
- National Heart and Lung Institute, Imperial College London, London
| | - Luke Howard
- National Heart and Lung Institute, Imperial College London, London
| | - David G Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, University of Sheffield and National Institute for Health and Care Research Sheffield Biomedical Research Centre, Sheffield, England
| | - Allan Lawrie
- National Heart and Lung Institute, Imperial College London, London; Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, University of Sheffield and National Institute for Health and Care Research Sheffield Biomedical Research Centre, Sheffield, England
| | - Paul M Hassoun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Yuriy Sirenklo
- National Scientific Center M.D. Strazhesko Institute of Cardiology, Clinical and Regenerative Medicine, The National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | - Olena Torbas
- National Scientific Center M.D. Strazhesko Institute of Cardiology, Clinical and Regenerative Medicine, The National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | - Andrew J Sweatt
- Division of Pulmonary, Allergy, and Critical Care and the Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University, Palo Alto, CA
| | - Roham T Zamanian
- Division of Pulmonary, Allergy, and Critical Care and the Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University, Palo Alto, CA
| | | | | | - Alexandra Arvanitaki
- First Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Giannakoulas
- First Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Khaled Saleh
- Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Hani Sabbour
- Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Hector R Cajigas
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Robert Frantz
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | - Stefano Ghio
- Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | | | | | - Raphael W Majeed
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany; Institute of Medical Informatics, RWTH Aachen University, Aachen, Germany
| | - Jochen Wilhelm
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany; Institute for Lung Health, Cardio-Pulmonary Institute (CPI), Giessen, Germany
| | - Hossein Ardeschir Ghofrani
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany; Institute for Lung Health, Cardio-Pulmonary Institute (CPI), Giessen, Germany
| | - Manuel J Richter
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany; Institute for Lung Health, Cardio-Pulmonary Institute (CPI), Giessen, Germany
| | - Friedrich Grimminger
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany; Institute for Lung Health, Cardio-Pulmonary Institute (CPI), Giessen, Germany
| | | | - Khodr Tello
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany; Institute for Lung Health, Cardio-Pulmonary Institute (CPI), Giessen, Germany
| | - Werner Seeger
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany; Institute for Lung Health, Cardio-Pulmonary Institute (CPI), Giessen, Germany.
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2
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Balasubramanian A, Larive B, Horn EM, DuBrock HM, Mehra R, Jacob M, Hemnes AR, Leopold JA, Radeva MK, Hill NS, Erzurum SC, Berman-Rosenzweig E, Frantz R, Rischard FP, Beck G, Hassoun PM, Mathai SC. Health-Related Quality of Life Across the Spectrum of Pulmonary Hypertension. Chest 2024:S0012-3692(24)00155-7. [PMID: 38354903 DOI: 10.1016/j.chest.2024.02.009] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 01/05/2024] [Accepted: 02/08/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Health-related quality of life (HRQOL) is frequently impaired in pulmonary arterial hypertension. However, little is known about HRQOL in other forms of pulmonary hypertension (PH). RESEARCH QUESTION Does HRQOL vary across groups of the World Symposium on Pulmonary Hypertension (WSPH) classification system? STUDY DESIGN AND METHODS This cross-sectional study included patients with PH from the Pulmonary Vascular Disease Phenomics (PVDOMICS) cohort study. HRQOL was assessed by using emPHasis-10 (e-10), the 36-item Medical Outcomes Survey Short Form survey (physical component score [PCS] and mental component score), and the Minnesota Living with Heart Failure Questionnaire. Pearson correlations between HRQOL and demographic, physiological, and imaging characteristics within each WSPH group were tested. Multivariable linear regressions compared HRQOL across WSPH groups, adjusting for demographic characteristics, disease prevalence, functional class, and hemodynamics. Cox proportional hazards models were used to assess associations between HRQOL and survival across WSPH groups. RESULTS Among 691 patients with PH, HRQOL correlated with functional class and 6 min walk distance but not hemodynamics. HRQOL was severely depressed across WSPH groups for all measures except the 36-item Medical Outcomes Survey Short Form survey mental component score. Compared with Group 1 subjects, Group 2 subjects had significantly worse HRQOL (e-10 score, 29 vs 24 [P = .001]; PCS, 32.9 ± 8 vs 38.4 ± 10 [P < .0001]; and Minnesota Living with Heart Failure Questionnaire score, 50 vs 38 [P = .003]). Group 3 subjects similarly had a worse e-10 score (31 vs 24; P < .0001) and PCS (33.3 ± 9 vs 38.4 ± 10; P < .0001) compared with Group 1 subjects, which persisted in multivariable models (P < .05). HRQOL was associated in adjusted models with survival across Groups 1, 2, and 3. INTERPRETATION HRQOL was depressed in PH and particularly in Groups 2 and 3 despite less severe hemodynamics. HRQOL is associated with functional capacity, but the severity of hemodynamic disease poorly estimates the impact of PH on patients' lives. Further studies are needed to better identify predictors and treatments to improve HRQOL across the spectrum of PH.
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Affiliation(s)
- Aparna Balasubramanian
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MA
| | - Brett Larive
- Department of Quantitative Health Sciences, , Cleveland Clinic, Cleveland, OH
| | - Evelyn M Horn
- Division of Cardiology, Weill Cornell Medicine, New York, NY
| | - Hilary M DuBrock
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Reena Mehra
- Neurologic and Respiratory Institutes, Cleveland Clinic, Cleveland, OH
| | - Miriam Jacob
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Anna R Hemnes
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Jane A Leopold
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Milena K Radeva
- Department of Quantitative Health Sciences, , Cleveland Clinic, Cleveland, OH
| | - Nicholas S Hill
- Division of Pulmonary, Critical Care, and Sleep Medicine, Tufts Medical Center, Boston, MA
| | | | | | - Robert Frantz
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Franz P Rischard
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Arizona, Tucson, AZ
| | - Gerald Beck
- Department of Quantitative Health Sciences, , Cleveland Clinic, Cleveland, OH
| | - Paul M Hassoun
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MA
| | - Stephen C Mathai
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MA.
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3
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Naranjo M, Rosenzweig EB, Hemnes AR, Jacob M, Desai A, Hill NS, Larive AB, Finet JE, Leopold J, Horn E, Frantz R, Rischard F, Erzurum S, Beck G, Mathai SC, Hassoun PM. Frequency of acute vasodilator response (AVR) in incident and prevalent patients with pulmonary arterial hypertension: Results from the pulmonary vascular disease phenomics study. Pulm Circ 2023; 13:e12281. [PMID: 37614830 PMCID: PMC10442608 DOI: 10.1002/pul2.12281] [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: 04/19/2023] [Revised: 07/07/2023] [Accepted: 08/09/2023] [Indexed: 08/25/2023] Open
Abstract
The prevalence of acute vasodilator response (AVR) to inhaled nitric oxide (iNO) during right heart catheterization (RHC) is 12% in idiopathic pulmonary arterial hypertension (IPAH). AVR, however, is reportedly lower in other disease-associated pulmonary arterial hypertension (PAH), such as connective tissue disease (CTD). The prevalence of AVR in patients on PAH therapy (prevalent cases) is unknown. We sought to determine AVR prevalence in Group 1 PH in the PVDOMICS cohort of incident and prevalent patients undergoing RHC. AVR was measured in response to 100% O2 and O2 plus iNO, with positivity defined as (1) decrease in mean pulmonary artery pressure (mPAP) by ≥10 mmHg to a value ≤40 mmHg, with no change or an increase in cardiac output (definition 1); or (2) decrease in mPAP by ≥12% and pulmonary vascular resistance by ≥30% (definition 2). AVR rates and cumulative survival were compared between incident and prevalent patients. In 338 mainly prevalent (86%) patients, positive AVR to O2-only was <2%, and 5.1% to 16.9%, based on definition 1 and 2 criteria, respectively; following O2 + iNO. IPAH AVR prevalence (4.1%-18.7%) was similar to prior reports. AVR positivity was 7.7% to 15.4% in mostly CTD-PAH prevalent cases, and 2.6% to 11.8% in other PAH groups. Survival was 89% in AVR responders versus 77% in nonresponders from PAH diagnosis, and 91% versus 86% from PVDOMICS enrollment (log-rank test p = 0.04 and p = 0.05, respectively). In conclusion, AVR in IPAH patients is similar to prior studies. AVR in non-IPAH patients was higher than previously reported. The relationship between PAH therapy, AVR response, and survival warrants further investigation.
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Affiliation(s)
- Mario Naranjo
- Division of Pulmonary and Critical Care Medicine, Department of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | | | - Anna R. Hemnes
- Division of Allergy, Pulmonary and Critical Care MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Miriam Jacob
- Department of Cardiovascular MedicineCleveland ClinicClevelandOhioUSA
| | - Ankit Desai
- Department of Medicine, College of MedicineThe University of ArizonaTucsonArizonaUSA
| | - Nicholas S. Hill
- Division of Pulmonary, Critical Care, and Sleep MedicineTufts Medical CenterBostonMassachusettsUSA
| | - A. Brett Larive
- Department of Quantitative Health SciencesCleveland ClinicClevelandOhioUSA
| | - J. Emanuel Finet
- Department of Cardiovascular MedicineCleveland ClinicClevelandOhioUSA
| | - Jane Leopold
- Department of Cardiovascular Medicine, Brigham and Women's HospitalHarvard UniversityBostonMassachusettsUSA
| | - Evelyn Horn
- Division of CardiologyWeill Cornell UniversityNew YorkNew YorkUSA
| | - Robert Frantz
- Department of Cardiovascular MedicineMayo ClinicRochesterMinnesotaUSA
| | - Franz Rischard
- Department of Medicine, College of MedicineThe University of ArizonaTucsonArizonaUSA
| | - Serpil Erzurum
- Department of Inflammation and ImmunityCleveland ClinicClevelandOhioUSA
| | - Gerald Beck
- Department of Quantitative Health SciencesCleveland ClinicClevelandOhioUSA
| | - Stephen C. Mathai
- Division of Pulmonary and Critical Care Medicine, Department of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Paul M. Hassoun
- Division of Pulmonary and Critical Care Medicine, Department of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
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4
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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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5
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Majeed RW, Wilkins MR, Howard L, Hassoun PM, Anthi A, Cajigas HR, Cannon J, Chan SY, Damonte V, Elwing J, Förster K, Frantz R, Ghio S, Al Ghouleh I, Hilgendorff A, Jose A, Juaneda E, Kiely DG, Lawrie A, Orfanos SE, Pepe A, Pepke‐Zaba J, Sirenko Y, Swett AJ, Torbas O, Zamanian RT, Marquardt K, Michel‐Backofen A, Antoine T, Wilhelm J, Barwick S, Krieb P, Fuenderich M, Fischer P, Gall H, Ghofrani H, Grimminger F, Tello K, Richter MJ, Seeger W. Pulmonary Vascular Research Institute GoDeep: A meta-registry merging deep phenotyping datafrom international PH reference centers. Pulm Circ 2022; 12:e12123. [PMID: 36034404 PMCID: PMC9399782 DOI: 10.1002/pul2.12123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/10/2022] [Revised: 07/20/2022] [Accepted: 07/23/2022] [Indexed: 11/08/2022] Open
Abstract
The Pulmonary Vascular Research Institute GoDeep meta-registry is a collaboration of pulmonary hypertension (PH) reference centers across the globe. Merging worldwide PH data in a central meta-registry to allow advanced analysis of the heterogeneity of PH and its groups/subgroups on a worldwide geographical, ethnical, and etiological landscape (ClinTrial. gov NCT05329714). Retrospective and prospective PH patient data (diagnosis based on catheterization; individuals with exclusion of PH are included as a comparator group) are mapped to a common clinical parameter set of more than 350 items, anonymized and electronically exported to a central server. Use and access is decided by the GoDeep steering board, where each center has one vote. As of April 2022, GoDeep comprised 15,742 individuals with 1.9 million data points from eight PH centers. Geographic distribution comprises 3990 enrollees (25%) from America and 11,752 (75%) from Europe. Eighty-nine perecent were diagnosed with PH and 11% were classified as not PH and provided a comparator group. The retrospective observation period is an average of 3.5 years (standard error of the mean 0.04), with 1159 PH patients followed for over 10 years. Pulmonary arterial hypertension represents the largest PH group (42.6%), followed by Group 2 (21.7%), Group 3 (17.3%), Group 4 (15.2%), and Group 5 (3.3%). The age distribution spans several decades, with patients 60 years or older comprising 60%. The majority of patients met an intermediate risk profile upon diagnosis. Data entry from a further six centers is ongoing, and negotiations with >10 centers worldwide have commenced. Using electronic interface-based automated retrospective and prospective data transfer, GoDeep aims to provide in-depth epidemiological and etiological understanding of PH and its various groups/subgroups on a global scale, offering insights for improved management.
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Affiliation(s)
- Raphael W. Majeed
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
- Institute of Medical InformaticsRWTH Aachen UniversityAachenGermany
| | - Martin R. Wilkins
- National Heart and Lung Institute and Imperial CollegeLondon NHS Healthcare TrustLondonUK
| | - Luke Howard
- National Heart and Lung Institute and Imperial CollegeLondon NHS Healthcare TrustLondonUK
| | - Paul M. Hassoun
- Department of MedicineDivision of Pulmonary and Critical Care Medicine, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Anastasia Anthi
- 1st Department of Critical CareNational & Kapodistrian University of Athens Medical School and Pulmonary Hypertension Clinic, Evangelismos General HospitalAthensGreece
| | - Hector R. Cajigas
- Division of Pulmonary and Critical Care MedicineMayo ClinicRochesterNew YorkUSA
| | - John Cannon
- Pulmonary Vascular Diseases Unit, Royal Papworth Hospital, Cambridge Biomedical CampusCambridgeUK
| | - Stephen Y. Chan
- Department of Medicine, Division of Cardiology, Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine InstituteUniversity of Pittsburgh School of Medicine and University of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Victoria Damonte
- Hospital de Niños, Hospital Privado Universitario, Clinica Universitaria Reina Fabiola and Instituto Oulton‐Catholic, University of CórdobaCórdobaArgentina
| | - Jean Elwing
- Division of Pulmonary, Critical Care and Sleep MedicineUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Kai Förster
- Ludwig‐Maximilians University of MunichMunchenGermany
| | - Robert Frantz
- Department of CardiologyMayo ClinicRochesterNew YorkUSA
| | | | - Imad Al Ghouleh
- Department of Medicine, Division of Cardiology, Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine InstituteUniversity of Pittsburgh School of Medicine and University of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | | | - Arun Jose
- Division of Pulmonary, Critical Care and Sleep MedicineUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Ernesto Juaneda
- Hospital de Niños, Hospital Privado Universitario, Clinica Universitaria Reina Fabiola and Instituto Oulton‐Catholic, University of CórdobaCórdobaArgentina
| | - David G. Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital and University of SheffieldSheffieldUK
| | - Allan Lawrie
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital and University of SheffieldSheffieldUK
| | - Stylianos E. Orfanos
- 1st Department of Critical CareNational & Kapodistrian University of Athens Medical School and Pulmonary Hypertension Clinic, Evangelismos General HospitalAthensGreece
| | | | - Joanna Pepke‐Zaba
- Pulmonary Vascular Diseases Unit, Royal Papworth Hospital, Cambridge Biomedical CampusCambridgeUK
| | - Yuriy Sirenko
- Department of Symptomatic Hypertension“National Scientific Center ‘The M.D. Strazhesko Institute of Cardiology’” of National Academy of Medical ScienceKyivUkraine
| | - Andrew J. Swett
- Division of Pulmonary, Allergy, and Critical Care, and Vera Moulton Wall Center for Pulmonary Vascular DiseaseStanford UniversityStanfordCaliforniaUSA
| | - Olena Torbas
- Department of Symptomatic Hypertension“National Scientific Center ‘The M.D. Strazhesko Institute of Cardiology’” of National Academy of Medical ScienceKyivUkraine
| | - Roham T. Zamanian
- Division of Pulmonary, Allergy, and Critical Care, and Vera Moulton Wall Center for Pulmonary Vascular DiseaseStanford UniversityStanfordCaliforniaUSA
| | - Kurt Marquardt
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
| | - Achim Michel‐Backofen
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
| | - Tobiah Antoine
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
| | - Jochen Wilhelm
- Institute for Lung Health (ILH), Cardio‐Pulmonary Institute (CPI)GiessenGermany
| | | | - Phillipp Krieb
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
| | - Meike Fuenderich
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
| | - Patrick Fischer
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
| | - Henning Gall
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
| | - Hossein‐Ardeschir Ghofrani
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
- Institute for Lung Health (ILH), Cardio‐Pulmonary Institute (CPI)GiessenGermany
| | - Friedrich Grimminger
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
- Institute for Lung Health (ILH), Cardio‐Pulmonary Institute (CPI)GiessenGermany
| | - Khodr Tello
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
- Institute for Lung Health (ILH), Cardio‐Pulmonary Institute (CPI)GiessenGermany
| | - Manuel J. Richter
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
- Institute for Lung Health (ILH), Cardio‐Pulmonary Institute (CPI)GiessenGermany
| | - Werner Seeger
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
- Institute for Lung Health (ILH), Cardio‐Pulmonary Institute (CPI)GiessenGermany
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Schettle S, Frantz R, Stulak J, Villavicencio M, Rosenbaum A. HeartWare Thrombosis After mRNA COVID-19 Vaccination. Mayo Clin Proc 2022; 97:1399-1401. [PMID: 35787869 PMCID: PMC9110650 DOI: 10.1016/j.mayocp.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/22/2022] [Accepted: 05/09/2022] [Indexed: 11/24/2022]
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Jellis CL, Park MM, Abidov A, Borlaug BA, Brittain EL, Frantz R, Hassoun PM, Horn EM, Jaber WA, Jiwon K, Karas MG, Kwon D, Leopold JA, Maron B, Mathai SC, Mehra R, Rischard F, Rosenzweig EB, Tang WHW, Vanderpool R, Thomas JD. Comprehensive echocardiographic evaluation of the right heart in patients with pulmonary vascular diseases: the PVDOMICS experience. Eur Heart J Cardiovasc Imaging 2022; 23:958-969. [PMID: 34097027 PMCID: PMC9212349 DOI: 10.1093/ehjci/jeab065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 03/07/2021] [Accepted: 03/24/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS There is a wide spectrum of diseases associated with pulmonary hypertension, pulmonary vascular remodelling, and right ventricular dysfunction. The NIH-sponsored PVDOMICS network seeks to perform comprehensive clinical phenotyping and endophenotyping across these disorders to further evaluate and define pulmonary vascular disease. METHODS AND RESULTS Echocardiography represents the primary non-invasive method to phenotype cardiac anatomy, function, and haemodynamics in these complex patients. However, comprehensive right heart evaluation requires the use of multiple echocardiographic parameters and optimized techniques to ensure optimal image acquisition. The PVDOMICS echo protocol outlines the best practice approach to echo phenotypic assessment of the right heart/pulmonary artery unit. CONCLUSION Novel workflow processes, methods for quality control, data for feasibility of measurements, and reproducibility of right heart parameters derived from this study provide a benchmark frame of reference. Lessons learned from this protocol will serve as a best practice guide for echocardiographic image acquisition and analysis across the spectrum of right heart/pulmonary vascular disease.
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Affiliation(s)
- Christine L Jellis
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Margaret M Park
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Aiden Abidov
- Wayne State University, 4646 John R Street, Detroit, MI 48201USA
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55902USA
| | - Evan L Brittain
- Vanderbilt University Medical Center and Vanderbilt Translational and Clinical Cardiovascular Research Center2525 West End Avenue, Suite 300A, Nashville, TN 37203USA
| | - Robert Frantz
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55902USA
| | - Paul M Hassoun
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 E. Monument St, Room 540, Baltimore, MD 21205USA
| | - Evelyn M Horn
- Weill Cornell Medicine, Division of Cardiology, 520 East 70th Street, Starr 443, New York, NY 10021USA
| | - Wael A Jaber
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Kim Jiwon
- Weill Cornell Medicine, Division of Cardiology, 520 East 70th Street, Starr 443, New York, NY 10021USA
| | - Maria G Karas
- Weill Cornell Medicine, Division of Cardiology, 520 East 70th Street, Starr 443, New York, NY 10021USA
| | - Deborah Kwon
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Jane A Leopold
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Department of Cardiology, VA Boston Healthcare system, 77 Ave Louis Pasteur, NRB 0630-N, Boston MA 02115USA
| | - Bradley Maron
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Department of Cardiology, VA Boston Healthcare system, 77 Ave Louis Pasteur, NRB 0630-N, Boston MA 02115USA
| | - Stephen C Mathai
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 E. Monument St, Room 540, Baltimore, MD 21205USA
| | - Reena Mehra
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue Cleveland, OH 44195USA
| | - Franz Rischard
- Department of Medicine, University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724
| | - Erika B Rosenzweig
- Division of Pediatric Cardiology, Department of Pediatrics and Medicine, Columbia University Medical Center-New York Presbyterian Hospital, 3959 Broadway, New York, NY 10032USA
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Rebecca Vanderpool
- Department of Medicine, University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724
| | - James D Thomas
- Bluhm Cardiovascular Institute, Northwestern University, 676 N Saint Clair, Chicago Illinois 60611USA
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McGlothlin D, Granton J, Klepetko W, Beghetti M, Rosenzweig EB, Corris P, Horn E, Kanwar M, McRae K, Roman A, Tedford R, Badagliacca R, Bartolome S, Benza R, Caccamo M, Cogswell R, Dewachter C, Donahoe L, Fadel E, Farber HW, Feinstein J, Franco V, Frantz R, Gatzoulis M, Hwa (Anne) Goh C, Guazzi M, Hansmann G, Hastings S, Heerdt P, Hemnes A, Herpain A, Hsu CH, Kerr K, Kolaitis N, Kukreja J, Madani M, McCluskey S, McCulloch M, Moser B, Navaratnam M, Radegran G, Reimer C, Savale L, Shlobin O, Svetlichnaya J, Swetz K, Tashjian J, Thenappan T, Vizza CD, West S, Zuckerman W, Zuckermann A, De Marco T. ISHLT CONSENSUS STATEMENT: Peri-operative Management of Patients with Pulmonary Hypertension and Right Heart Failure Undergoing Surgery. J Heart Lung Transplant 2022; 41:1135-1194. [DOI: 10.1016/j.healun.2022.06.013] [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: 05/31/2022] [Accepted: 06/13/2022] [Indexed: 10/17/2022] Open
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9
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Frantz R, Chukwuma O, Sokumbi O, Satcher K, Kallis P, Vincek V, Motaparthi K. Identifying histopathologic features of erythema elevatum diutinum and granuloma faciale. J Cutan Pathol 2021; 49:323-326. [PMID: 34939211 DOI: 10.1111/cup.14191] [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: 09/05/2021] [Revised: 12/14/2021] [Accepted: 12/19/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Robert Frantz
- University of Florida College of Medicine, Gainesville, Florida, USA
| | - Olivia Chukwuma
- University of Florida College of Medicine, Gainesville, Florida, USA
| | - Olayemi Sokumbi
- Department of Dermatology, Mayo Clinic-Florida, Jacksonville, Florida, USA
| | - Kerrie Satcher
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Penelope Kallis
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Vladimir Vincek
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
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Guy CR, Schoch BS, Frantz R, Wright TW, Struk AM, Farmer KW, King JJ. Revision Reverse Total Shoulder Arthroplasty in Patients 65 Years Old and Younger: Outcome Comparison to Older Patients. JSES Int 2021; 6:229-235. [PMID: 35252918 PMCID: PMC8888161 DOI: 10.1016/j.jseint.2021.11.012] [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] [Indexed: 11/10/2022] Open
Abstract
Background Reverse total shoulder arthroplasty (RTSA) is a procedure growing in prevalence among younger populations. Consequently, its use in revision arthroplasty is growing in this demographic. However, studies examining the functional outcomes of revision RTSA in younger populations compared with older populations are lacking. The primary purpose of this study is to evaluate the functional outcomes of revision RTSA in patients 65 years old and younger compared with older patients who underwent revision RTSA. We hypothesized that younger patients would have similar outcomes to older patients and both groups would demonstrate improvement in outcomes. Methods A retrospective review was conducted on a prospectively collected research database at a single tertiary referral center of all patients who underwent RTSA between 2007 and 2018. Patients 65 years old or younger who underwent a revision RTSA and had minimum 2-year follow-up were evaluated. A control group of patients ≥70 years old who underwent revision RTSA were also evaluated. Demographics, surgical factors, active range of motion (ROM), and patient-reported outcomes (PROMs) were compared. The ROM parameters measured were forward elevation, abduction, external rotation, and level of internal rotation. The PROMs collected included American Shoulder and Elbow Surgeons score, Simple Shoulder Test score, University of California–Los Angeles score, Constant score, normalized Constant, and Shoulder Pain and Disability Index 130. The differences in outcomes were compared against the minimal clinically important difference and substantial clinical benefit reported for primary reverse shoulder arthroplasty. Results A total of 81 patients undergoing revision RTSA were evaluated at a mean follow-up of 4.5 years with 42 patients in the study group and 39 patients in the control group. Both groups demonstrated similar demographics and rates of prior surgeries. Preoperative outcome scores were lower in the study group (≤65 years old) than those in the older control group with American Shoulder and Elbow Surgeons score, Simple Shoulder Test score, and Shoulder Pain and Disability Index 130 remaining worse postoperatively. Both groups experienced statistically significant improvements in ROM from before operation to after operation, with slightly higher improvements in overhead motion in the younger cohort. Both the study group and the control group demonstrated statistically significant improvements in all PROMs with improvement above the substantial clinical benefit for the Constant and Simple Shoulder Test scores. Despite lower functional outcomes reported in the study group postoperatively, the improvement from before operation to after operation in all PROMs was similar between groups. Conclusion Revision RTSA is a viable option for patients ≤65 years old with a poorly functioning shoulder arthroplasty. ROM and outcome improvements are similar compared with older patients undergoing revision RTSA, but the preoperative and postoperative functional outcomes are worse in the younger patients.
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Frantz R, Huang S, Are A, Motaparthi K. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Review of Diagnosis and Management. Medicina (Kaunas) 2021; 57:895. [PMID: 34577817 PMCID: PMC8472007 DOI: 10.3390/medicina57090895] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 12/15/2022]
Abstract
Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are rare diseases that are characterized by widespread epidermal necrosis and sloughing of skin. They are associated with significant morbidity and mortality, and early diagnosis and treatment is critical in achieving favorable outcomes for patients. In this scoping review, Excerpta Medica dataBASE and PubMed were searched for publications that addressed recent advances in the diagnosis and management of the disease. Multiple proteins (galectin 7 and RIP3) were identified that are promising potential biomarkers for SJS/TEN, although both are still in early phases of research. Regarding treatment, cyclosporine is the most effective therapy for the treatment of SJS, and a combination of intravenous immunoglobulin (IVIg) and corticosteroids is most effective for SJS/TEN overlap and TEN. Due to the rare nature of the disease, there is a lack of prospective, randomized controlled trials and conducting these in the future would provide valuable insights into the management of this disease.
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Affiliation(s)
- Robert Frantz
- College of Medicine, University of Florida, Gainesville, FL 32606, USA; (R.F.); (A.A.)
| | - Simo Huang
- Department of Dermatology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA;
| | - Abhirup Are
- College of Medicine, University of Florida, Gainesville, FL 32606, USA; (R.F.); (A.A.)
| | - Kiran Motaparthi
- College of Medicine, University of Florida, Gainesville, FL 32606, USA; (R.F.); (A.A.)
- Department of Dermatology, College of Medicine, University of Florida, Gainesville, FL 32606, USA
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12
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Min J, Badesch D, Chakinala M, Elwing J, Frantz R, Horn E, Klinger J, Lammi M, Mazimba S, Sager J, Shlobin O, Simon M, Thenappan T, Grinnan D, Ventetuolo C, Al-Naamani N. Prediction of Health-related Quality of Life and Hospitalization in Pulmonary Arterial Hypertension: The Pulmonary Hypertension Association Registry. Am J Respir Crit Care Med 2021; 203:761-764. [PMID: 33211974 DOI: 10.1164/rccm.202010-3967le] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jeff Min
- Perelman School of Medicine at the University of Pennsylvania Philadelphia, Pennsylvania
| | | | | | | | | | | | - James Klinger
- Rhode Island Hospital Pulmonary Hypertension Center East Providence, Rhode Island
| | | | - Sula Mazimba
- University of Virginia Charlottesville, Virginia
| | - Jeffrey Sager
- Cottage Health Pulmonary Hypertension Center Santa Barbara, California
| | | | - Marc Simon
- University of Pittsburgh Medical Center Pittsburgh, Pennsylvania
| | | | | | - Corey Ventetuolo
- Alpert Medical School of Brown University Providence, Rhode Island and
| | - Nadine Al-Naamani
- Perelman School of Medicine at the University of Pennsylvania Philadelphia, Pennsylvania
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13
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Frantz R, Howard L, McLaughlin V, Sitbon O, Zamanian R, Benza R, Chin K, Channick R, Cravets M, Bruey J, Roscigno R, Mottola D, Zisman L, Ghofrani H. Phase 2 Clinical Study to Evaluate the Efficacy and Safety of Inhaled GB002 for the Treatment of World Health Organization Group 1 Pulmonary Arterial Hypertension. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.346] [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] [Indexed: 11/28/2022] Open
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14
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Frantz R, Larive A, Rosenzweig EB, Hassoun P, Hemnes A, Horn E, Leopold J, Rischard F, Tang WH. ACUTE VASOREACTIVITY TESTING DURING RIGHT HEART CATHETERIZATION IN CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION: RESULTS FROM THE PULMONARY VASCULAR DISEASE OMICS PROJECT. Chest 2020. [DOI: 10.1016/j.chest.2020.08.1856] [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] [Indexed: 11/28/2022] Open
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15
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Pfeifle D, Braun C, Koubek R, Cajigas H, Frantz R, Dubrock H. PARENTERAL PROSTACYCLIN THERAPY IN PATIENTS WITH PULMONARY HYPERTENSION IN THE SETTING OF INTERSTITIAL LUNG DISEASE. Chest 2020. [DOI: 10.1016/j.chest.2020.08.1916] [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] [Indexed: 10/23/2022] Open
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16
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Chin K, Kim N, McLaughlin V, Frantz R, Rodriguez-Lopez J, Brand M, Flynn M, Leroy S, Morganti A, Channick R. MACITENTAN IN THE ELDERLY POPULATION WITH PULMONARY ARTERIAL HYPERTENSION: REAL-WORLD EVIDENCE FROM THE COMBINED OPUS REGISTRY AND ORPHEUS COHORT. Chest 2019. [DOI: 10.1016/j.chest.2019.08.376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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17
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Ivy D, Rosenzweig EB, Elliott C, Farber H, Frantz R, Gomberg-Maitland M, Mu Y, Zhao C, Kenny E, Selej M, Benza R. RISK ASSESSMENT IN PEDIATRIC PATIENTS WITH PULMONARY ARTERIAL HYPERTENSION (PAH): APPLICATION OF THE REVEAL 2.0 RISK CALCULATOR. Chest 2019. [DOI: 10.1016/j.chest.2019.08.243] [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] [Indexed: 10/25/2022] Open
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18
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Asleh R, Alnsasra H, Schettle SD, Taher R, Dunlay S, Stulak J, Daly R, Behfar A, Pereira N, Clavell A, Maltais S, Frantz R, Edwards B, Kushwaha S. PREDICTORS AND CLINICAL OUTCOMES OF VASOPLEGIA IN PATIENTS BRIDGED TO HEART TRANSPLANTATION WITH CONTINUOUS FLOW LEFT VENTRICULAR ASSIST DEVICES. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31584-0] [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: 11/15/2022]
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McLaughlin V, Chin K, Kim N, Sulica R, Frantz R, Brand M, Muros-Le Rouzic E, Selej M, Channick R. P3560Real-world experience with concomitant macitentan and riociguat treatment in patients with pulmonary hypertension (PH) in the OPsumit USers (OPUS) registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3560] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- V McLaughlin
- University of Michigan, Division of Cardiovascular Medicine, Ann Arbor, United States of America
| | - K Chin
- University of Texas Southwestern Medical Center, Department of Internal Medicine, Dallas, United States of America
| | - N Kim
- University of California San Diego, Division of Pulmonary & Critical Care Medicine, La Jolla, United States of America
| | - R Sulica
- Division Pulmonary, Critical Care and Sleep Medicine, New York University Langone Health, New York, United States of America
| | - R Frantz
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, United States of America
| | - M Brand
- Actelion Pharmaceuticals Ltd, Global Clinical Science & Epidemiology, Allschwil, Switzerland
| | - E Muros-Le Rouzic
- Actelion Pharmaceuticals Ltd, Global Clinical Science & Epidemiology, Allschwil, Switzerland
| | - M Selej
- Actelion Pharmaceuticals US, Inc, Medical Affairs, South San Francisco, United States of America
| | - R Channick
- Massachusetts General Hospital, Pulmonary and Critical Care, Boston, United States of America
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Joyce D, Frantz R, Kushwaha S, Lahr B, Joyce L. Should Right Heart Hemodynamics be the Primary Guide for Operability for Pulmonary Thromboendarterectomy? J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1271] [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] [Indexed: 10/17/2022] Open
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Asleh R, Briasoulis A, Pereira N, Edwards B, Clavell A, Boilson B, Frantz R, Schirger J, Rodeheffer R, Maltais S, Stulak J, Daly R, Lerman A, Kushwaha S. DIFFERENTIAL EFFECTS OF SIROLIMUS- AND CALCINEURIN INHIBITOR-ASSOCIATED HYPERLIPIDEMIA ON CARDIAC ALLOGRAFT VASCULOPATHY PROGRESSION AND OUTCOMES AFTER HEART TRANSPLANTATION. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31211-7] [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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McLaughlin V, Bacchetta M, Badesch D, Benza R, Burger C, Chin K, Frantz R, Frost A, Hemnes A, Kim NH, Rosenzweig EB, Rubin L. Update on pulmonary arterial hypertension research: proceedings from a meeting of experts. Curr Med Res Opin 2018; 34:263-273. [PMID: 29132217 DOI: 10.1080/03007995.2017.1404974] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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] [Indexed: 12/16/2022]
Abstract
BACKGROUND While pulmonary arterial hypertension (PAH) remains a progressive, symptomatic condition characterized by increased pulmonary vascular resistance, ultimately leading to right heart failure, great strides have been made in its understanding and treatment over the past two decades. REVIEW Continued research in pre-clinical, clinical, and health economic areas of research, in addition to registry analyses and technology advances, is critical for understanding the pathophysiology of the disease and devising the best ways to monitor and manage patients. On December 3, 2016, the latest pre-clinical, clinical, health economic outcome, and registry data on PAH was presented in a symposium sponsored by Actelion. This paper reviews the published research and insight into upcoming research that was presented at this interactive meeting.
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Affiliation(s)
- Vallerie McLaughlin
- a Division of Cardiovascular Medicine, Department of Internal Medicine , University of Michigan , Ann Arbor , MI , USA
| | - Matthew Bacchetta
- b Department of Surgery , New York Presbyterian Hospital-Columbia University Medical Center , New York , NY , USA
| | - David Badesch
- c Division of Pulmonary Sciences and Critical Care Medicine , University of Colorado Anschutz Medical Campus , Aurora , CO , USA
| | - Raymond Benza
- d Allegheny General Hospital, Cardiovascular Diseases , Pittsburgh , PA , USA
| | - Charles Burger
- e Department of Internal Medicine, Division of Pulmonary , Critical Care, and Sleep Medicine, Mayo Clinic , Jacksonville , FL , USA
| | - Kelly Chin
- f Internal Medicine, UT Southwestern Medical Center , Dallas , TX , USA
| | - Robert Frantz
- g Division of Cardiovascular Diseases , Mayo Clinic , Rochester , MN , USA
| | - Adaani Frost
- h The Lung Center, Houston Methodist Hospital , Houston , TX , USA
| | - Anna Hemnes
- i Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine or Division of Cardiovascular Medicine , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Nick H Kim
- j Division of Pulmonary and Critical Care Medicine , University of California San Diego , La Jolla , CA , USA
| | - Erika B Rosenzweig
- k Department of Pediatrics, Division of Cardiology , Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital , New York , NY , USA
| | - Lewis Rubin
- l Division of Pulmonary and Critical Care Medicine , University of California, San Diego Medical School , San Diego , CA , USA
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Gomberg-Maitland M, Frost A, Frantz R, Humbert M, McGoon M, Benza R. Development of prognostic tools in pulmonary arterial hypertension: Lessons from modern day registries. Thromb Haemost 2017; 108:1049-60. [DOI: 10.1160/th11-11-0821] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 07/03/2012] [Indexed: 01/08/2023]
Abstract
SummaryPulmonary arterial hypertension (PAH) is characterised by increased pressure in the pulmonary arteries leading to right-sided ventricular failure, and death. Identification of factors that affect patient survival is important to improve patient management and outcomes. The first registry to evaluate survival and develop a prognostic model was the National Institutes of Health (NIH) registry in 1981. Importantly this prognostic model is based on data collected prior to availability of PAH-targeted therapies and does not reflect survival rates for treated patients. Since the 1980s, however, four modern registries of PAH now exist which compensate for the NIH equations shortcomings and include the French National registry, Pulmonary Hypertension Connection registry, the Mayo registry, and the Registry to Evaluate Early and Long-Term PAH Disease Management (REVEAL). The similarities and difference in these registries are highlighted in this review and although similar in many respects, the four registries vary in patient population, including the numbers of newly and previously diagnosed patients, as well as the era of observation, period of survival, and timing of assessment of potential predictive factors. Despite this, the predictive factors identified in each registry and described in detail within the body of this manuscript share surprising homology in that disease aetiology, patient gender and factors reflective of right heart failure are integral in depicting survival. Future modifications of modern prognostic equations should be an ongoing goal of the PAH community in order to provide increased accuracy with identification of novel risk factors and prediction of disease course.
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Yanagisawa R, Fetterly K, Johnson G, Foley T, Williamson E, Gulati R, Sandhu G, Frantz R. INTEGRATED USE OF PERFUSION SPECT/CTA FUSION IMAGING AND PULMONARY BALLOON ANGIOPLASTY FOR CHRONIC PULMONARY THROMBOEMBOLISM. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35790-x] [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: 10/20/2022]
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Farber H, Badesch D, Benza R, Elliott CG, Frantz R, McGoon M, Selej M, Zhao C, Frost A. Home Oxygen Use Characteristics and Outcomes in Patients With PAH: Data From the Reveal Registry. Chest 2016. [DOI: 10.1016/j.chest.2016.08.1263] [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] [Indexed: 10/20/2022] Open
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26
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Park M, Ewald G, Franco V, Garcia-Ferrer J, Hage A, Horn E, Mandras S, Mathier M, Rame E, Selej M, Wang IW, Frantz R. SOPRANO: Study of Macitentan in Patients with Pulmonary Hypertension (PH) Post-Left Ventricular Assist Device (LVAD) Implantation. J Card Fail 2016. [DOI: 10.1016/j.cardfail.2016.06.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Grogan M, Gertz M, McCurdy A, Roeker L, Kyle R, Kushwaha S, Daly R, Dearani J, Rodeheffer R, Frantz R, Lacy M, Hayman S, McGregor C, Edwards B, Dispenzieri A. Long term outcomes of cardiac transplant for immunoglobulin light chain amyloidosis: The Mayo Clinic experience. World J Transplant 2016; 6:380-388. [PMID: 27358783 PMCID: PMC4919742 DOI: 10.5500/wjt.v6.i2.380] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/14/2016] [Accepted: 04/11/2016] [Indexed: 02/05/2023] Open
Abstract
AIM: To determine the outcome of orthotopic heart transplantation (OHT) in immunoglobulin light chain (AL) amyloidosis.
METHODS: The medical records of patients with AL who underwent orthotopic heart transplantation at the Mayo Clinic in Rochester Minnesota from 1992 to 2011 were reviewed. Patients met at least one of the following at: New York Heart Association class IV heart failure, ventricular thickness > 15 mm, ejection fraction < 40%. Selection guidelines for heart transplant included age < 60 years, absence of multiple myeloma and significant extra-cardiac organ involvement. Baseline characteristics including age, gender, organ involvement, and New York Heart Association functional class were recorded. Laboratory data, waiting time until heart transplant, and type of treatment of the underlying plasma cell disorder were recorded. Survival from the time of OHT was calculated using Kaplan-Meier survival curves. Survival of patients undergoing OHT for AL was compared to that of non-amyloid patients undergoing OHT during the same time period.
RESULTS: Twenty-three patients (median age 53 years) with AL received OHT. There were no deaths in the immediate perioperative period. Twenty patients have died post OHT. For the entire cohort, the median overall survival was 3.5 years (95%CI: 1.2, 8.2 years). The 1-year survival post OHT was 77%, the 2-year survival 65%, and the 5-year survival 43%. The 5-year survival for non-amyloid patients undergoing OHT during the same era was 85%. Progressive amyloidosis contributed to death in twelve patients. Of those without evidence of progressive amyloidosis, the cause of death included complications of autologous hematopoietic stem cell transplantation for 3 patients, post-transplant lymphoproliferative disorder for 2 patients; and for the remaining one death was related to each of the following causes: acute rejection; cardiac vasculopathy; metastatic melanoma; myelodysplastic syndrome; and unknown. Eight patients had rejection at a median of 1.8 mo post OHT (range 0.4 to 4.9 mo); only one patient died of rejection. Median survival of seven patients who achieved a complete hematologic response to either chemotherapy or autologous hematopoietic stem cell transplantation was 10.8 years.
CONCLUSION: Our data demonstrate that long term survival after heart transplant is feasible in AL patients with limited extra-cardiac involvement who achieve complete hematologic response.
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Lyle M, Fenstad E, Crespo-Diaz R, Osborn T, Behefar A, Kane G, Frantz R. Pulmonary Hypertension in the Setting of Sjögren’s Syndrome. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.386] [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] [Indexed: 11/29/2022] Open
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29
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Lyle M, Fenstad E, McGoon M, Frantz R, Krowka M, Kane G, Swanson K. ELECTROCARDIOGRAPHIC CHARACTERISTICS OF PULMONARY HYPERTENSION IN THE SETTING OF HEREDITARY HEMORRHAGIC TELANGIECTASIA. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61565-0] [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: 11/27/2022]
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30
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Farha S, Dweik R, Rahaghi F, Benza R, Hassoun P, Frantz R, Torres F, Quinn DA, Comhair S, Erzurum S, Asosingh K. Imatinib in pulmonary arterial hypertension: c-Kit inhibition. Pulm Circ 2015; 4:452-5. [PMID: 25621158 DOI: 10.1086/677359] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [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: 01/07/2014] [Accepted: 02/13/2014] [Indexed: 02/05/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) is a progressive disease characterized by severe remodeling of the pulmonary artery resulting in increased pulmonary artery pressure and right ventricular hypertrophy and, ultimately, failure. Bone marrow-derived progenitor cells play a critical role in vascular homeostasis and have been shown to be involved in the pathogenesis of PAH. A proliferation of c-Kit(+) hematopoietic progenitors and mast cells has been noted in the remodeled vessels in PAH. Imatinib, a tyrosine kinase inhibitor that targets c-Kit, has been shown to be beneficial for patients with PAH. Here we hypothesize that the clinical benefit of imatinib in PAH could be related to c-Kit inhibition of progenitor cell mobilization and maturation into mast cells. As a corollary to the phase 3 study using imatinib in PAH, blood samples were collected from 12 patients prior to starting study drug (baseline) and while on treatment at weeks 4 and 24. Eight were randomized to imatinib and 4 to placebo. Circulating c-Kit(+) and CD34(+)CD133(+) hematopoietic progenitors as well as biomarkers of mast cell numbers and activation were measured. Circulating CD34(+)CD133(+) and c-Kit(+) progenitor cells as well as c-Kit(+)/CD34(+)CD133(+) decreased with imatinib therapy (all P < 0.05). In addition, total tryptase, a marker of mast cell load, dropped with imatinib therapy (P = 0.02) and was related to pulmonary vascular resistance (R = 0.7, P = 0.02). The findings support c-Kit inhibition as a potential mechanism of action of imatinib in PAH and suggest that tryptase is a potential biomarker of response to therapy.
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Affiliation(s)
- Samar Farha
- Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA ; Department of Pathobiology, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Raed Dweik
- Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA ; Department of Pathobiology, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Franck Rahaghi
- Department of Allergy and Critical Care Medicine, Cleveland Clinic Florida, Weston, Florida, USA
| | - Raymond Benza
- Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Paul Hassoun
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert Frantz
- Division of Cardiovascular Diseases, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Fernando Torres
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Suzy Comhair
- Department of Pathobiology, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Serpil Erzurum
- Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA ; Department of Pathobiology, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kewal Asosingh
- Department of Pathobiology, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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31
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May A, Kane G, Yi E, Frantz R, Vassallo R. Dramatic and sustained responsiveness of pulmonary Langerhans cell histiocytosis-associated pulmonary hypertension to vasodilator therapy. Respir Med Case Rep 2014; 14:13-5. [PMID: 26029568 PMCID: PMC4356044 DOI: 10.1016/j.rmcr.2014.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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] [Indexed: 11/24/2022] Open
Abstract
Pulmonary Langerhans cell histiocytosis (PLCH) is an uncommon diffuse lung disease characterized by the abnormal accumulation of Langerhans' cells around small airways and other distal lung compartments. Although pulmonary hypertension (PH) is a frequent complication of PLCH, the role of advanced PH therapies for PLCH-related PH is not well-established. We describe a PLCH patient with severe, disease-related PH that responded unexpectedly well to advanced PH therapy with sustained improvement over a 10 year follow-up period. This case indicates that PLCH-associated PH may, in certain instances, be highly responsive to advanced PH therapies and emphasizes the importance of trialing these therapies among patients with PLCH-related PH.
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Affiliation(s)
- Adam May
- Department of Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Garvan Kane
- Division of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Eunhee Yi
- Department of Laboratory Medicine and Anatomic Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Robert Frantz
- Division of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Robert Vassallo
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, 55905, USA
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32
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Hoeper MM, Bogaard HJ, Condliffe R, Frantz R, Khanna D, Kurzyna M, Langleben D, Manes A, Satoh T, Torres F, Wilkins MR, Badesch DB. [Definitions and diagnosis of pulmonary hypertension]. Turk Kardiyol Dern Ars 2014; 42 Suppl 1:55-66. [PMID: 25697034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
Pulmonary hypertension (PH) is defined by a mean pulmonary artery pressure 25 mm Hg at rest, measured during right heart catheterization. There is still insufficient .evidence to add an exercise criterion to this definition. The term pulmonary arterial hypertension (PAH) describes a subpopulation of patients with PH characterized hemodynamically by the presence of pre-capillary PH including an end-expiratory pulmonary artery wedge pressure (PAWP) 15 mm Hg and a pulmonary vascular resistance >3 Wood units. Right heart catheterization remains essential for a diagnosis of PH or PAH. This procedure requires further standardization, including uniformity of the pressure transducer zero level at the midthoracic line, which is at the level of the left atrium. One of the most common problems in the diagnostic workup of patients with PH is the distinction between PAH and PH due to left heart failure with preserved ejection fraction (HFpEF). A normal PAWP does not rule out the presence of HFpEF. Volume or exercise challenge during right heart catheterization may be useful to unmask the presence of left heart disease, but both tools require further evaluation before their use in general practice can be recommended. Early diagnosis of PAH remains difficult, and screening programs in asymptomatic patients are feasible only in high-risk populations, particularly in patients with systemic sclerosis, for whom recent data suggest that a combination of clinical assessment and pulmonary function testing including diffusion capacity for carbon monoxide, biomarkers, and echocardiography has a higher predictive value than echocardiography alone. (J Am Coll Cardiol 2013;62: D42-50) ©2013 by the American College of Cardiology Foundation.
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33
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Larsen C, Frantz R, Kane G. High-Density Lipoprotein Cholesterol Is a Significant Predictor of Survival in Pulmonary Arterial Hypertension. Chest 2014. [DOI: 10.1378/chest.1989171] [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] [Indexed: 11/01/2022] Open
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34
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Bourge R, Waxman A, Gomberg-Maitland M, Shapiro S, Tarver J, Zwicke D, Feldman J, Chakinala M, Frantz R, Torres F, Cerkvenik J, Morris M, Thalin M, Peterson L, Rubin L. Treprostinil Administered Using a Fully Implantable Programmable Intravascular Delivery System: Results of the Delivery for PAH Trial. Chest 2014. [DOI: 10.1378/chest.1992942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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35
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McElderry T, Waxman A, Gomberg-Maitland M, Burke M, Ross E, Bersohn M, Tarver J, Zwicke D, Feldman J, Chakinala M, Frantz R, Torres F, Li P, Morris M, Peterson L, Bourge R. Totally Implantable IV Treprostinil Therapy in Pulmonary Arterial Hypertension: Assessment of the Implantation Procedure. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.601] [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] [Indexed: 10/25/2022] Open
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36
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Hoeper MM, Bogaard HJ, Condliffe R, Frantz R, Khanna D, Kurzyna M, Langleben D, Manes A, Satoh T, Torres F, Wilkins MR, Badesch DB. Definitions and diagnosis of pulmonary hypertension. J Am Coll Cardiol 2014; 62:D42-50. [PMID: 24355641 DOI: 10.1016/j.jacc.2013.10.032] [Citation(s) in RCA: 1188] [Impact Index Per Article: 118.8] [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: 10/11/2013] [Accepted: 10/22/2013] [Indexed: 12/19/2022]
Abstract
Pulmonary hypertension (PH) is defined by a mean pulmonary artery pressure ≥ 25 mm Hg at rest, measured during right heart catheterization. There is still insufficient evidence to add an exercise criterion to this definition. The term pulmonary arterial hypertension (PAH) describes a subpopulation of patients with PH characterized hemodynamically by the presence of pre-capillary PH including an end-expiratory pulmonary artery wedge pressure (PAWP) ≤ 15 mm Hg and a pulmonary vascular resistance >3 Wood units. Right heart catheterization remains essential for a diagnosis of PH or PAH. This procedure requires further standardization, including uniformity of the pressure transducer zero level at the midthoracic line, which is at the level of the left atrium. One of the most common problems in the diagnostic workup of patients with PH is the distinction between PAH and PH due to left heart failure with preserved ejection fraction (HFpEF). A normal PAWP does not rule out the presence of HFpEF. Volume or exercise challenge during right heart catheterization may be useful to unmask the presence of left heart disease, but both tools require further evaluation before their use in general practice can be recommended. Early diagnosis of PAH remains difficult, and screening programs in asymptomatic patients are feasible only in high-risk populations, particularly in patients with systemic sclerosis, for whom recent data suggest that a combination of clinical assessment and pulmonary function testing including diffusion capacity for carbon monoxide, biomarkers, and echocardiography has a higher predictive value than echocardiography alone.
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Affiliation(s)
- Marius M Hoeper
- Department of Respiratory Medicine and German Center for Lung Research, Hannover Medical School, Hannover, Germany.
| | - Harm Jan Bogaard
- Department of Pulmonary Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Robin Condliffe
- Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Robert Frantz
- College of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Dinesh Khanna
- University of Michigan Scleroderma Program, Ann Arbor, Michigan
| | - Marcin Kurzyna
- Department of Pulmonary Circulation and Thromboembolic Diseases, Medical Centre of Postgraduate Medication, Warsaw, Poland
| | - David Langleben
- Center for Pulmonary Vascular Disease, Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Alessandra Manes
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Bologna University Hospital, Bologna, Italy
| | - Toru Satoh
- Division of Cardiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Fernando Torres
- Pulmonary Hypertension Program, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Martin R Wilkins
- Experimental Medicine, Imperial College London, London, United Kingdom
| | - David B Badesch
- Division of Pulmonary Sciences and Critical Care Medicine and Cardiology, University of Colorado, Denver, Colorado
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37
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Gomberg-Maitland M, Glassner-Kolmin C, Watson S, Frantz R, Park M, Frost A, Benza RL, Torres F. Survival in pulmonary arterial hypertension patients awaiting lung transplantation. J Heart Lung Transplant 2013; 32:1179-86. [DOI: 10.1016/j.healun.2013.08.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 08/12/2013] [Accepted: 08/15/2013] [Indexed: 10/26/2022] Open
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38
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Smetana MR, Taylor B, Frantz R, O'Malley K, Johnson B. Exercise pulmonary gas exchange differentiates type and severity of pulmonary hypertension in heart failure. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.1182.6] [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] [Indexed: 11/11/2022]
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39
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Gomberg-Maitland M, Glassner-Kolmin C, Watson S, Frantz R, Park M, Frost A, Benza R, Torres F. Survival in Pulmonary Arterial Hypertension Patients Awaiting Transplant. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.314] [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] [Indexed: 10/27/2022] Open
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40
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Frantz R, Chakinala M, Barst R, Schilz R, Chin K, Hemnes A, Miller D, Benton W, Hartline B, Farber H. Bloodstream Infection Rates in Patients With Pulmonary Arterial Hypertension Treated With Epoprostenol for Injection: A PROSPECT Registry Analysis. Chest 2012. [DOI: 10.1378/chest.1387084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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41
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Gomberg-Maitland M, Oudiz R, Shapiro S, Keogh A, Badesch D, Frantz R, Gregory Elliott C, Gillies H, Walker G, Waxman A. Cicletanine as Add-on Therapy for Pulmonary Arterial Hypertension. Chest 2012. [DOI: 10.1378/chest.1386552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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42
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Hasin T, Kamath P, Kremers W, Topilsky Y, Schirger J, Boilson B, Clavell A, Rodeheffer R, Frantz R, Edwards B, Pereira N, Joyce L, Daly R, park S, Kushwaha S. HYPERBILIRUBINEMIA AFTER AXIAL FLOW LEFT VENTRICULAR ASSIST DEVICE IMPLANTATION IS ASSOCIATED WITH INCREASED MORTALITY. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)60875-4] [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: 11/15/2022]
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43
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Murawski M, Frantz R, Gomberg-Maitland M, Chen H, Fain J, Cwengros J, Sanders K. Fatigue in Pulmonary Arterial Hypertension: Defining and Measuring a Key Symptom for Instrument Development. Chest 2011. [DOI: 10.1378/chest.1119902] [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] [Indexed: 11/01/2022] Open
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44
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McConnell J, Nathan S, Hobbs K, Villanueva D, Hartline B, Frantz R. A Multicenter, Retrospective Study of Patients With Pulmonary Arterial Hypertension Who Received Inhaled Iloprost for More Than One Year. Chest 2011. [DOI: 10.1378/chest.1118151] [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] [Indexed: 11/01/2022] Open
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45
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Barst R, Ivy DD, Frantz R, Frost A, Rosenzweig E, Foreman A, Shapiro S, Taichman D, McGoon M. Impact of Functional Class Change on Survival in Patients With Pulmonary Arterial Hypertension Associated With Congenital Heart Disease: Insights From REVEAL. Chest 2011. [DOI: 10.1378/chest.1118232] [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] [Indexed: 11/01/2022] Open
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46
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Murawski M, Frantz R, Gomberg-Maitland M, Chen H, Fain J, Cwengros J, Sanders K. Establishing the Need for Development of a Patient Reported Outcome Instrument in Pulmonary Arterial Hypertension. Chest 2011. [DOI: 10.1378/chest.1119980] [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] [Indexed: 11/01/2022] Open
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47
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Hardegree E, Sachdev A, Villarraga H, Ammash N, Frantz R, McGoon M, McCully R, Miller F, Pellikka P, Oh J, Kane G. Prognostic Significance of Ventricular Interdependence in Right Ventricular Pressure Overload: Reduction in Left Ventricular Systolic Strain Predicts Early Mortality in Pulmonary Arterial Hypertension. Chest 2011. [DOI: 10.1378/chest.1119706] [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] [Indexed: 11/01/2022] Open
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48
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Gandhi M, De Goey S, Periera N, Kushwaha S, Edwards B, Park S, Clavell A, Schirger J, Rodeheffer R, Frantz R. 483: Significance of Pre Transplant Donor Specific HLA Antibodies and Post Transplant Cardiac Allograft Vasculopathy. J Heart Lung Transplant 2010. [DOI: 10.1016/j.healun.2009.11.499] [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] [Indexed: 11/25/2022] Open
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49
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Banzali FM, Tiwari AK, Frantz R, D'Attellis N. Valvular heart disease caused by carcinoid syndrome: emphasis on the use of intraoperative transesophageal echocardiography. J Cardiothorac Vasc Anesth 2007; 21:855-7. [PMID: 18068066 DOI: 10.1053/j.jvca.2007.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2007] [Indexed: 11/11/2022]
Affiliation(s)
- Franklin M Banzali
- Department of Anesthesiology, University of California, Irvine Medical Center, Orange, CA, USA
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50
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Garfinkel RA, Berinstein DM, Frantz R. Treatment of choroidal neovascularization through the implantable miniature telescope. Am J Ophthalmol 2006; 141:766-7. [PMID: 16564826 DOI: 10.1016/j.ajo.2005.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 02/02/2005] [Revised: 11/09/2005] [Accepted: 11/10/2005] [Indexed: 10/24/2022]
Abstract
PURPOSE To report a case of thermal laser photocoagulation of a choroidal neovasacular membrane through the implantable miniature telescope (IMT). DESIGN Interventional case report. METHODS Focal thermal laser photocoagulation was performed. Complete ablation of the neovascular lesion, visual acuity, and integrity of the IMT were assessed. RESULTS An 81-year-old woman with a history of IMT implantation for advanced geographic atrophy related to age-related macular degeneration developed an extrafoveal choroidal neovascular lesion. The patient underwent focal laser photocoagulation through the telescope without complication. Three months after treatment, no evidence of recurrence was noted, and visual acuity remained at 20/200. The IMT was not altered by the treatment. CONCLUSIONS Focal thermal laser photocoagulation through an IMT can successfully treat choroidal neovascularization without damaging the device.
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