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Desaintjean C, Ahmad K, Traclet J, Gerfaud-Valentin M, Durel CA, Glerant JC, Hot A, Lestelle F, Mainbourg S, Nasser M, Seve P, Turquier S, Devouassoux G, Cottin V. Mepolizumab and benralizumab in patients with severe asthma and a history of eosinophilic granulomatosis with polyangiitis. Front Med (Lausanne) 2024; 11:1341310. [PMID: 38585151 PMCID: PMC10998444 DOI: 10.3389/fmed.2024.1341310] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/26/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction Asthma associated with eosinophilic granulomatosis with polyangiitis (EGPA) is often severe and corticosteroid-dependent, leading to significant morbidity. Mepolizumab and benralizumab are humanized monoclonal antibodies targeting interleukin 5 (IL-5) and its receptor, respectively. They have been shown to be effective in steroid-sparing in patients with severe eosinophilic asthma. Objective Our aim was to evaluate the efficacy and safety of mepolizumab and benralizumab prescribed for severe asthma in patients with EGPA under "real-world" conditions. Methods This was a retrospective analysis of patients with EGPA and persistent asthma who received either mepolizumab 100 or 300 mg administered every 4 weeks, or benralizumab 30 mg administered every 4 weeks for the initial 3 injections and followed by an injection every 8 weeks thereafter, whilst combined with oral glucocorticoids. The follow-up every 6 ± 3 months included an assessment of clinical manifestations, pulmonary function tests and eosinophil cell count. The primary outcome was the proportion of patients at 12 months receiving a daily oral dose of prednisone or equivalent of 4 mg or less with a BVAS of 0. Results Twenty-six patients were included. After 12 months of treatment with mepolizumab or benralizumab, 32% of patients met the primary outcome and were receiving less than 4 mg of prednisone per day with a BVAS of 0. The median dose of prednisone was 10 mg per day at baseline, 9 mg at 6 months, and 5 mg at 12 months (p ≤ 0.01). At 12 months, 23% of patients were weaned off corticosteroids, while an increase or no change in dose was observed in 27% of patients. The median eosinophil count was significantly reduced from 365 cells/mm3 to 55 cells/mm3 at 6 months and 70 cells/mm3 at 12 months, respectively. No significant change was observed in FEV1. After 12 months of treatment, 14% of patients had had an average of 1 exacerbation of asthma, compared with 52% of patients before baseline. The tolerability profile was favorable. Conclusion In this real-world study in patients with severe asthma and a history of EGPA asthma, mepolizumab and benralizumab had a significant steroid-sparing effect and reduced asthma exacerbation, but no significant effect on lung function.
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Affiliation(s)
- Charlene Desaintjean
- Department of Respiratory Medicine, National Reference Centre for Rare Pulmonary Diseases, Member of ERN-LUNG, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - Kaïs Ahmad
- Department of Respiratory Medicine, National Reference Centre for Rare Pulmonary Diseases, Member of ERN-LUNG, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - Julie Traclet
- Department of Respiratory Medicine, National Reference Centre for Rare Pulmonary Diseases, Member of ERN-LUNG, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | | | - Cecile-Audrey Durel
- Department of Internal Medicine, Hôpital Saint-Joseph Saint-Luc, Lyon, France
| | - Jean-Charles Glerant
- Pulmonary Function Tests Department, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - Arnaud Hot
- Department of Internal Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - François Lestelle
- Department of Respiratory Medicine, National Reference Centre for Rare Pulmonary Diseases, Member of ERN-LUNG, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - Sabine Mainbourg
- Department of Internal Medicine and Vascular Medicine, Lyon Sud Hospital, and Lyon Immunopathology Federation (LIFe), Hospices Civils de Lyon, Lyon, France
- UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Claude Bernard University Lyon 1, Lyon, France
| | - Mouhamad Nasser
- Department of Respiratory Medicine, National Reference Centre for Rare Pulmonary Diseases, Member of ERN-LUNG, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - Pascal Seve
- Department of Internal Medicine, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Claude Bernard University Lyon 1, Lyon, France
| | - Ségolène Turquier
- Pulmonary Function Tests Department, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - Gilles Devouassoux
- Department of Respiratory Medicine, CIERA, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
- CRISALIS INSERM, F-CRIN Network, Toulouse, France
- VirPath, INSERM U1111-CNRS UMR 5308-ENS de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Vincent Cottin
- Department of Respiratory Medicine, National Reference Centre for Rare Pulmonary Diseases, Member of ERN-LUNG, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
- UMR 754, INRAE, Claude Bernard University Lyon 1, Lyon, France
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Diesler R, Cottin V, Gallien Y, Turquier S, Traclet J, Ahmad K, Glerant JC. Pulmonary function test results are correlated with 6-minute walk distance, distance-saturation product, and 6-minute walk work in patients with lymphangioleiomyomatosis. Respir Med Res 2023; 85:101071. [PMID: 38141576 DOI: 10.1016/j.resmer.2023.101071] [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: 04/19/2023] [Revised: 10/12/2023] [Accepted: 11/20/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND AND OBJECTIVE Lymphangioleiomyomatosis (LAM) is a rare multicystic lung disease. Although a correlation between pulmonary function test (PFT) results and exercise capacity appears probable, it has not yet been demonstrated. The aim of this study was to assess whether PFT results correlate with 6-minute walk test (6MWT) results in patients with LAM. METHODS We conducted a retrospective study of all patients with a diagnosis of LAM followed in a French reference centre over a 13-year period. PFT and 6MWT data were collected. Distance-saturation product (DSP) and 6-minute walk work (6MWORK) were calculated. RESULTS A total of 62 patients were included. Their median forced expiratory volume in 1 s (FEV1) was 82.7 % predicted and their median forced vital capacity (FVC) was 96.7 % predicted. The median diffusing capacity of the lungs for carbon monoxide (DLCO) was 58.5 % predicted and was decreased in 79 % of the patients. The median 6-minute walk distance was 535 m, which was 90.9 % of the 602 m predicted distance. The median DSP was 497.4 m % and the median 6MWORK was 32,910 kg.m. The distance walked during the 6MWT was significantly correlated with FVC%predicted (R = 0.435), FEV1 %predicted (R = 0.303), TLC%predicted (R = 0.345), FRC%predicted (R = 0.262), RV/TLC ratio (R = -0.271), and DLCO%predicted (R = 0.279). DSP and 6MWORK were each significantly correlated with different PFT results. CONCLUSION The present study shows that PFT results are potential predictors of the exercise capacity in patients with LAM. Additional studies are required to evaluate the interest of DSP and 6MWORK in LAM.
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Affiliation(s)
- Rémi Diesler
- National Reference Center for Rare Pulmonary Diseases, Hôpital Louis Pradel Hospices Civils de Lyon, University of Lyon, INRAE, Lyon, France.
| | - Vincent Cottin
- National Reference Center for Rare Pulmonary Diseases, Hôpital Louis Pradel Hospices Civils de Lyon, University of Lyon, INRAE, Lyon, France
| | - Yves Gallien
- Service de Biostatistique et d'Information Médicale, INSERM U1153, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris, Université de Paris Cité, Paris, France
| | - Ségolène Turquier
- Service d'Explorations Fonctionnelles Respiratoires, Hôpital Louis Pradel, Hospices Civils de Lyon, University of Lyon, Lyon, France
| | - Julie Traclet
- National Reference Center for Rare Pulmonary Diseases, Hôpital Louis Pradel Hospices Civils de Lyon, University of Lyon, INRAE, Lyon, France
| | - Kais Ahmad
- National Reference Center for Rare Pulmonary Diseases, Hôpital Louis Pradel Hospices Civils de Lyon, University of Lyon, INRAE, Lyon, France
| | - Jean-Charles Glerant
- Service d'Explorations Fonctionnelles Respiratoires, Hôpital Louis Pradel, Hospices Civils de Lyon, University of Lyon, Lyon, France
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Provost M, Mornex JF, Nasser M, Zeghmar S, Traclet J, Ahmad K, Lestelle F, Chour A, Diesler R, Cottin V, Turquier S. Changes in the management of chronic thromboembolic pulmonary hypertension over a 10-year period, in a French expert regional competence centre. Respir Med Res 2023; 84:101021. [PMID: 37276770 DOI: 10.1016/j.resmer.2023.101021] [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: 08/24/2022] [Revised: 04/06/2023] [Accepted: 04/15/2023] [Indexed: 06/07/2023]
Abstract
Over the last few years, the advent of balloon pulmonary angioplasty (BPA) had led to changes in the management of chronic thromboembolic pulmonary hypertension (CTEPH). We reviewed data from 98 CTEPH patients diagnosed during the last decade in a pulmonary hypertension (PH) expert centre. The management modalities of 2 periods (Period A: 2011-15 and Period B: 2016-20) were compared. Age (period A: 72 [58-80] years; period B: 69 [62-79] years), clinical (New York Heart Association (NYHA) functional class III-IV: 25/41, 61% vs 39/57, 68%), and hemodynamic assessments (pulmonary vascular resistance: 7.5 [6.2-8.7] WU vs 8.0 [6.0-10.2] WU) at baseline were not significantly different. Pulmonary endarterectomy was performed in less than one third of patients (12, 29.3% vs 15, 26.3%). For patients not eligible for surgery, medical therapy was mostly prescribed alone during period A (medical therapy alone, patients diagnosed in period A: 61% vs in period B: 17.5%) while it was associated with BPA during period B (medical therapy + BPA, 12% vs 61.4%). The 5-year survival rate was excellent for patients who underwent surgery (96.3%) or BPA (95.2%), but was only 42.1% for patients under oral medication only (p < 0.0001). Patients diagnosed with CTEPH who cannot be operated should undergo BPA. The survival rate after BPA is as good as after surgery and significantly better than that of oral medication only.
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Affiliation(s)
- Mathilde Provost
- Centre de compétences de l'hypertension pulmonaire (Pulmo Tension), service de pneumologie, Hospices Civils de Lyon, Hôpital Louis Pradel, Lyon, France
| | - Jean-François Mornex
- Centre de compétences de l'hypertension pulmonaire (Pulmo Tension), service de pneumologie, Hospices Civils de Lyon, Hôpital Louis Pradel, Lyon, France; Centre de référence coordonnateur des maladies pulmonaires rares (RespiFil), service de pneumologie, Hospices Civils de Lyon, Hôpital Louis Pradel, Lyon, France; Université de Lyon, université Lyon 1, INRAE, EPHE, UMR754, IVPC, F-69007 , Lyon, France
| | - Mouhamad Nasser
- Centre de compétences de l'hypertension pulmonaire (Pulmo Tension), service de pneumologie, Hospices Civils de Lyon, Hôpital Louis Pradel, Lyon, France; Centre de référence coordonnateur des maladies pulmonaires rares (RespiFil), service de pneumologie, Hospices Civils de Lyon, Hôpital Louis Pradel, Lyon, France
| | - Sabrina Zeghmar
- Centre de compétences de l'hypertension pulmonaire (Pulmo Tension), service de pneumologie, Hospices Civils de Lyon, Hôpital Louis Pradel, Lyon, France
| | - Julie Traclet
- Centre de compétences de l'hypertension pulmonaire (Pulmo Tension), service de pneumologie, Hospices Civils de Lyon, Hôpital Louis Pradel, Lyon, France; Centre de référence coordonnateur des maladies pulmonaires rares (RespiFil), service de pneumologie, Hospices Civils de Lyon, Hôpital Louis Pradel, Lyon, France
| | - Kais Ahmad
- Centre de compétences de l'hypertension pulmonaire (Pulmo Tension), service de pneumologie, Hospices Civils de Lyon, Hôpital Louis Pradel, Lyon, France; Centre de référence coordonnateur des maladies pulmonaires rares (RespiFil), service de pneumologie, Hospices Civils de Lyon, Hôpital Louis Pradel, Lyon, France
| | - François Lestelle
- Centre de compétences de l'hypertension pulmonaire (Pulmo Tension), service de pneumologie, Hospices Civils de Lyon, Hôpital Louis Pradel, Lyon, France; Centre de référence coordonnateur des maladies pulmonaires rares (RespiFil), service de pneumologie, Hospices Civils de Lyon, Hôpital Louis Pradel, Lyon, France
| | - Ali Chour
- Centre de compétences de l'hypertension pulmonaire (Pulmo Tension), service de pneumologie, Hospices Civils de Lyon, Hôpital Louis Pradel, Lyon, France
| | - Rémi Diesler
- Centre de compétences de l'hypertension pulmonaire (Pulmo Tension), service de pneumologie, Hospices Civils de Lyon, Hôpital Louis Pradel, Lyon, France
| | - Vincent Cottin
- Centre de compétences de l'hypertension pulmonaire (Pulmo Tension), service de pneumologie, Hospices Civils de Lyon, Hôpital Louis Pradel, Lyon, France; Centre de référence coordonnateur des maladies pulmonaires rares (RespiFil), service de pneumologie, Hospices Civils de Lyon, Hôpital Louis Pradel, Lyon, France; Université de Lyon, université Lyon 1, INRAE, EPHE, UMR754, IVPC, F-69007 , Lyon, France
| | - Ségolène Turquier
- Centre de compétences de l'hypertension pulmonaire (Pulmo Tension), service de pneumologie, Hospices Civils de Lyon, Hôpital Louis Pradel, Lyon, France.
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Cottin V, Diesler R, Turquier S, Valenzuela C. Interstitial lung disease-associated pulmonary hypertension - what the future holds. Curr Opin Pulm Med 2023:00063198-990000000-00090. [PMID: 37417835 DOI: 10.1097/mcp.0000000000000992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
PURPOSE OF REVIEW Pulmonary hypertension associated with interstitial lung disease (ILD-PH) is associated with significant alteration of quality of life, exercise capacity, and survival. Over the past 2 years, there were changes in the guideline definition and classification of ILD-PH, and positive randomized controlled trials were published. RECENT FINDINGS Pulmonary hypertension associated with chronic lung disease is now hemodynamically defined as a mean pulmonary artery pressure more than 20 mmHg, with pulmonary artery wedge pressure 15 mmHg or less, and pulmonary vascular resistance (PVR) at least 2 Wood units. Severe ILD-PH is defined by PVR more than 5 Wood units. In the INCREASE trial, patients receiving inhaled treprostinil had favorable significant changes in 6-min walk distance, NT-proBNP level, clinical worsening events, and forced vital capacity, which were maintained in the open label extension study. Promising results were obtained in a placebo-controlled pilot trial using escalated doses of inhaled nitric oxide. According to European guidelines, patients with ILD-PH should be referred to pulmonary hypertension centers, where inhaled treprostinil may be considered; phosphodiesterase type-5 inhibitors may also be considered in patients with severe ILD-PH. SUMMARY Recent changes in the definitions and a new therapeutic option have an impact on the diagnosis and management of ILD-PH.
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Affiliation(s)
- Vincent Cottin
- National Reference Centre for Rare Pulmonary Diseases and Centre for Pulmonary Hypertension, Louis Pradel Hospital, Hospices Civils de Lyon, ERN-LUNG, UMR 754, INRAE, Claude Bernard University Lyon 1
| | - Rémi Diesler
- National Reference Centre for Rare Pulmonary Diseases and Centre for Pulmonary Hypertension, Louis Pradel Hospital, Hospices Civils de Lyon, ERN-LUNG, UMR 754, INRAE, Claude Bernard University Lyon 1
| | - Ségolène Turquier
- National Reference Centre for Rare Pulmonary Diseases and Centre for Pulmonary Hypertension, Louis Pradel Hospital, Hospices Civils de Lyon, ERN-LUNG, UMR 754, INRAE, Claude Bernard University Lyon 1
- Lung Physiology unit, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - Claudia Valenzuela
- Hospital universitario de la Princesa, Universidad Autonoma de Madrid, Madrid, Spain
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Cottin V, Blanchard E, Kerjouan M, Lazor R, Reynaud-Gaubert M, Taille C, Uzunhan Y, Wemeau L, Andrejak C, Baud D, Bonniaud P, Brillet PY, Calender A, Chalabreysse L, Court-Fortune I, Desbaillets NP, Ferretti G, Guillemot A, Hardelin L, Kambouchner M, Leclerc V, Lederlin M, Malinge MC, Mancel A, Marchand-Adam S, Maury JM, Naccache JM, Nasser M, Nunes H, Pagnoux G, Prévot G, Rousset-Jablonski C, Rouviere O, Si-Mohamed S, Touraine R, Traclet J, Turquier S, Vagnarelli S, Ahmad K. French recommendations for the diagnosis and management of lymphangioleiomyomatosis. Respir Med Res 2023; 83:101010. [PMID: 37087906 DOI: 10.1016/j.resmer.2023.101010] [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: 11/18/2022] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND The present article is an English-language version of the French National Diagnostic and Care Protocol, a pragmatic tool to optimize and harmonize the diagnosis, care pathway, management and follow-up of lymphangioleiomyomatosis in France. METHODS Practical recommendations were developed in accordance with the method for developing a National Diagnosis and Care Protocol for rare diseases of the Haute Autorité de Santé and following international guidelines and literature on lymphangioleiomyomatosis. It was developed by a multidisciplinary group, with the help of patient representatives and of RespiFIL, the rare disease network on respiratory diseases. RESULTS Lymphangioleiomyomatosis is a rare lung disease characterised by a proliferation of smooth muscle cells that leads to the formation of multiple lung cysts. It occurs sporadically or as part of a genetic disease called tuberous sclerosis complex (TSC). The document addresses multiple aspects of the disease, to guide the clinicians regarding when to suspect a diagnosis of lymphangioleiomyomatosis, what to do in case of recurrent pneumothorax or angiomyolipomas, what investigations are needed to make the diagnosis of lymphangioleiomyomatosis, what the diagnostic criteria are for lymphangioleiomyomatosis, what the principles of management are, and how follow-up can be organised. Recommendations are made regarding the use of pharmaceutical specialties and treatment other than medications. CONCLUSION These recommendations are intended to guide the diagnosis and practical management of pulmonary lymphangioleiomyomatosis.
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Affiliation(s)
- Vincent Cottin
- Centre de Référence Coordinateur des maladies pulmonaires rares (OrphaLung), Hôpital Louis Pradel, Hospices Civils de Lyon, 28 avenue Doyen Lepine, ERN-LUNG, 69677 Lyon, France; UMR 754, INRAE, Université Claude Bernard Lyon 1, 8 avenue Rockefeller, 69008 Lyon, France.
| | - Elodie Blanchard
- Centre de Compétence des maladies pulmonaires rares (OrphaLung), GH Sud Haut-Lévêque, Avenue Magellan, 33600 Pessac, France
| | - Mallorie Kerjouan
- Centre de Compétence des maladies pulmonaires rares (OrphaLung), CHU Pontchailloux, 2 rue Henri le Guilloux, 35000 Rennes, France
| | - Romain Lazor
- Service de Pneumologie, Centre Hospitalier Universitaire Vaudois, BU44/07.2137, Rue du Bugnon 46, 1011 Lausanne, Suisse
| | - Martine Reynaud-Gaubert
- Centre de Compétence des maladies pulmonaires rares (OrphaLung), Hôpital Nord, Chemin Bourrely, 13015 Marseille, France; URMITE-CNRS-IRD UMR 6236, Aix-Marseille Université, 51 boulevard Pierre Dramard, 13344 Marseille cedex 15, France
| | - Camille Taille
- Centre de Référence Constitutif des maladies pulmonaires rares (OrphaLung), Hôpital Bichat, 46 rue Henri Huchard, 75018 Paris, France; Université Paris-Diderot, 17 rue Jean Antoine de Baïf, 75013 Paris, France
| | - Yurdagül Uzunhan
- Centre de Référence constitutif des maladies pulmonaires rares (OrphaLung), Hôpital Avicenne, 125 rue Stalingrad, 93000 Bobigny, France; Université Sorbonne Paris Nord, INSERM UMR 1272 "Hypoxie et Poumon", 1 rue Chablis, 93000 Bobigny, Paris, France
| | - Lidwine Wemeau
- Centre de Référence constitutif des maladies pulmonaires rares, CHRU, 5 rue Oscar Lambret, 59000 Lille, France
| | - Claire Andrejak
- Service de pneumologie, CHU Amiens, 1 Place Victor Pauchet, 80054 Amiens, France; UFR de médecine, 3 rue Louvels, 80000 Amiens, France
| | - Dany Baud
- Hôpital Suisse de Paris, 10 rue Minard, 92130 Issy les Moulineaux, France
| | - Philippe Bonniaud
- Centre de Référence constitutif des maladies pulmonaires rares, CHU de Dijon, BP 77908, 21079, Dijon, France; INSERM, LNC UMR1231, LipSTIC LabEx Team, 21000 Dijon, France
| | - Pierre-Yves Brillet
- Université Sorbonne Paris Nord, INSERM UMR 1272 "Hypoxie et Poumon", 1 rue Chablis, 93000 Bobigny, Paris, France; Service de radiologie, hôpital Avicenne, 125 rue Stalingrad, 93000 Bobigny, France
| | - Alain Calender
- Département de génétique, Hospices Civils de Lyon, 28 avenue Doyen Lepine, 69677 Lyon, France; IBCP, Université Claude Bernard Lyon 1, 8 avenue Rockefeller, 69008 Lyon, France
| | - Lara Chalabreysse
- Service de pathologie, Groupe hospitalier est, Hospices Civils de Lyon, 28 avenue Doyen Lepine, 69677 Lyon, France; Université Claude Bernard Lyon 1, 8 avenue Rockefeller, 69008 Lyon, France
| | | | | | - Gilbert Ferretti
- Pole imagerie, CHU Grenoble Alpes, Boulevard Chantourne, 38700 La Tronche, France
| | - Anne Guillemot
- Centre de Référence Coordinateur des maladies pulmonaires rares (OrphaLung), Hôpital Louis Pradel, Hospices Civils de Lyon, 28 avenue Doyen Lepine, ERN-LUNG, 69677 Lyon, France
| | - Laurane Hardelin
- Centre de Référence Coordinateur des maladies pulmonaires rares (OrphaLung), Hôpital Louis Pradel, Hospices Civils de Lyon, 28 avenue Doyen Lepine, ERN-LUNG, 69677 Lyon, France
| | - Marianne Kambouchner
- Service d'anatomopatholologie, Hôpital Avicenne, 125 rue Stalingrad, 93000 Bobigny, France
| | - Violette Leclerc
- Association France Lymphangioléiomyomatose, 4, Rue des Vieux-Moulins, 56 680 Plouhinec, France
| | - Mathieu Lederlin
- Service de radiologie, CHU Pontchailloux, 2 rue Henri le Guilloux, 35000 Rennes, France
| | | | - Alain Mancel
- Association France Lymphangioléiomyomatose, 4, Rue des Vieux-Moulins, 56 680 Plouhinec, France
| | - Sylvain Marchand-Adam
- Centre de Compétence des maladies pulmonaires rares (OrphaLung), Hôpital Bretonneau, CHRU Tours, 2 Boulevard Tonnellé, 37000 Tours, France; Université de Tours, CEPR INSERMU1100, 10 Boulevard Tonnellé, 37000 Tours, France
| | - Jean-Michel Maury
- Service de chirurgie thoracique, Hôpital Louis Pradel, Hospices Civils de Lyon, 28 avenue Doyen Lepine, 69677 Lyon, France
| | - Jean-Marc Naccache
- Service de pneumologie, Hôpital Saint Joseph, 185 rue Raymond Losserand, 75014 Paris, France
| | - Mouhamad Nasser
- Centre de Référence Coordinateur des maladies pulmonaires rares (OrphaLung), Hôpital Louis Pradel, Hospices Civils de Lyon, 28 avenue Doyen Lepine, ERN-LUNG, 69677 Lyon, France
| | - Hilario Nunes
- Centre de Référence constitutif des maladies pulmonaires rares (OrphaLung), Hôpital Avicenne, 125 rue Stalingrad, 93000 Bobigny, France; Université Sorbonne Paris Nord, INSERM UMR 1272 "Hypoxie et Poumon", 1 rue Chablis, 93000 Bobigny, Paris, France
| | - Gaële Pagnoux
- Service de radiologie, Hôpital Edouard Herriot, 5 place d'Arsonval, 69008 Lyon, France
| | - Grégoire Prévot
- Centre de Compétence des maladies pulmonaires rares (OrphaLung), service de pneumologie, hôpital Larrey, 24 chemin de Pouvourville, 31059 Toulouse cedex 9, France
| | | | - Olivier Rouviere
- Université Claude Bernard Lyon 1, 8 avenue Rockefeller, 69008 Lyon, France; Service de radiologie, Hôpital Edouard Herriot, 5 place d'Arsonval, 69008 Lyon, France
| | - Salim Si-Mohamed
- Université Claude Bernard Lyon 1, 8 avenue Rockefeller, 69008 Lyon, France; Service d'imagerie, Hôpital Louis Pradel, Hospices Civils de Lyon, 28 avenue Doyen Lepine, 69677 Lyon, France
| | - Renaud Touraine
- Laboratoire de Génétique Chromosomique et Moléculaire, CHU-Hôpital Nord, Laboratoire AURAGEN (Plan France Médecine Génomique 2025), 42270 Saint Priest en Jarest, France
| | - Julie Traclet
- Centre de Référence Coordinateur des maladies pulmonaires rares (OrphaLung), Hôpital Louis Pradel, Hospices Civils de Lyon, 28 avenue Doyen Lepine, ERN-LUNG, 69677 Lyon, France
| | - Ségolène Turquier
- Service d'exploration fonctionnelle respiratoire, Hôpital Louis Pradel, Hospices Civils de Lyon, 28 avenue Doyen Lepine, 69677 Lyon, France
| | - Stéphane Vagnarelli
- Centre de Référence constitutif des maladies pulmonaires rares (OrphaLung), Hôpital Avicenne, 125 rue Stalingrad, 93000 Bobigny, France
| | - Kaïs Ahmad
- Centre de Référence Coordinateur des maladies pulmonaires rares (OrphaLung), Hôpital Louis Pradel, Hospices Civils de Lyon, 28 avenue Doyen Lepine, ERN-LUNG, 69677 Lyon, France
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Si-Mohamed SA, Zumbihl L, Turquier S, Boccalini S, Mornex JF, Douek P, Cottin V, Boussel L. Lung Dual-Energy CT Perfusion Blood Volume as a Marker of Severity in Chronic Thromboembolic Pulmonary Hypertension. Diagnostics (Basel) 2023; 13:diagnostics13040769. [PMID: 36832256 PMCID: PMC9955200 DOI: 10.3390/diagnostics13040769] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 02/22/2023] Open
Abstract
In chronic thromboembolic pulmonary hypertension (CTEPH), assessment of severity requires right heart catheterization (RHC) through cardiac index (CI). Previous studies have shown that dual-energy CT allows a quantitative assessment of the lung perfusion blood volume (PBV). Therefore, the objective was to evaluate the quantitative PBV as a marker of severity in CTEPH. In the present study, thirty-three patients with CTEPH (22 women, 68.2 ± 14.8 years) were included from May 2017 to September 2021. Mean quantitative PBV was 7.6% ± 3.1 and correlated with CI (r = 0.519, p = 0.002). Mean qualitative PBV was 41.1 ± 13.4 and did not correlate with CI. Quantitative PBV AUC values were 0.795 (95% CI: 0.637-0.953, p = 0.013) for a CI ≥ 2 L/min/m2 and 0.752 (95% CI: 0.575-0.929, p = 0.020) for a CI ≥ 2.5 L/min/m2. In conclusion, quantitative lung PBV outperformed qualitative PBV for its correlation with the cardiac index and may be used as a non-invasive marker of severity in CTPEH patients.
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Affiliation(s)
- Salim A. Si-Mohamed
- Radiology Department, Louis Pradel Hospital, 59 Boulevard Pinel, 69500 Bron, France
- INSA-Lyon, University of Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621 Lyon, France
- Correspondence: ; Tel.: +33-04-7235-7335
| | - Léa Zumbihl
- Radiology Department, Louis Pradel Hospital, 59 Boulevard Pinel, 69500 Bron, France
| | - Ségolène Turquier
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, 69677 Lyon, France
- UMR 754, INRAE, Claude Bernard University Lyon, 69007 Lyon, France
- ERN-LUNG, 69500 Bron, France
| | - Sara Boccalini
- Radiology Department, Louis Pradel Hospital, 59 Boulevard Pinel, 69500 Bron, France
- INSA-Lyon, University of Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621 Lyon, France
| | - Jean-Francois Mornex
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, 69677 Lyon, France
- UMR 754, INRAE, Claude Bernard University Lyon, 69007 Lyon, France
- ERN-LUNG, 69500 Bron, France
| | - Philippe Douek
- Radiology Department, Louis Pradel Hospital, 59 Boulevard Pinel, 69500 Bron, France
- INSA-Lyon, University of Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621 Lyon, France
| | - Vincent Cottin
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, 69677 Lyon, France
- UMR 754, INRAE, Claude Bernard University Lyon, 69007 Lyon, France
- ERN-LUNG, 69500 Bron, France
| | - Loic Boussel
- Radiology Department, Louis Pradel Hospital, 59 Boulevard Pinel, 69500 Bron, France
- INSA-Lyon, University of Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621 Lyon, France
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Nasser M, Si-Mohamed S, Turquier S, Traclet J, Ahmad K, Philit F, Bonniaud P, Chalabreysse L, Thivolet-Béjui F, Cottin V. Nintedanib in idiopathic and secondary pleuroparenchymal fibroelastosis. Orphanet J Rare Dis 2021; 16:419. [PMID: 34627338 PMCID: PMC8501734 DOI: 10.1186/s13023-021-02043-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 04/25/2021] [Accepted: 09/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Pleuroparenchymal fibroelastosis (PPFE) has a variable disease course with dismal prognosis in the majority of patients with no validated drug therapy. This study is to evaluate the effect of nintedanib in patients with idiopathic and secondary PPFE. Patients admitted to a tertiary care center (2010–2019) were included into this retrospective analysis if they had a multidisciplinary diagnosis of PPFE, had been followed-up for 3 months or more, and had lung function tests and chest CTs available for review. Changes in pulmonary function tests were assessed using non-parametric tests and linear mixed effect model. Lung volumes were measured with lobar segmentation using chest CT. Results Out of 21 patients with PPFE, nine had received nintedanib, six had received another treatment and another six patients were monitored without drug therapy. Annual FVC (% of predicted) relative decline was − 13.6 ± 13.4%/year before nintedanib and − 1.6 ± 6.02%/year during nintedanib treatment (p = 0.014), whereas no significant change in FVC% relative decline was found in patients receiving another treatment (− 13.25 ± 34 before vs − 16.61 ± 36.2%/year during treatment; p = 0.343). Using linear mixed effect model, the slope in FVC was − 0.97%/month (95% CI: − 1.42; − 0.52) before treatment and − 0.50%/month (95% CI: − 0.88; 0.13) on nintedanib, with a difference between groups of + 0.47%/month (95% CI: 0.16; 0.78), p = 0.004. The decline in the upper lung volumes measured by CT was − 233 mL/year ± 387 mL/year before nintedanib and − 149 mL/year ± 173 mL/year on nintedanib (p = 0.327). Nintedanib tolerability was unremarkable. Conclusion In patients with PPFE, nintedanib treatment might be associated with slower decline in lung function, paving the way for prospective, controlled studies. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-02043-5.
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Affiliation(s)
- Mouhamad Nasser
- Department of Respiratory Medicine, National Coordinating Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, 28 avenue Doyen Lepine, 69677, Lyon, France
| | - Salim Si-Mohamed
- Radiology Department, Hospices Civils de Lyon, Lyon, France.,CREATIS, CNRS UMR 5220, INSERM U1206, INSA-Lyon, University Claude Bernard Lyon1, Lyon, France
| | - Ségolène Turquier
- Department of Respiratory Physiology, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - Julie Traclet
- Department of Respiratory Medicine, National Coordinating Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, 28 avenue Doyen Lepine, 69677, Lyon, France
| | - Kaïs Ahmad
- Department of Respiratory Medicine, National Coordinating Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, 28 avenue Doyen Lepine, 69677, Lyon, France
| | - François Philit
- Department of Respiratory Medicine, Croix Rousse Hospital, Hospices Civil de Lyon, Lyon, France
| | - Philippe Bonniaud
- Department of Pulmonary Medicine and Intensive Care Unit, Constitutive Reference Center for Rare Pulmonary Diseases, François Mitterrand Teaching Hospital, Inserm U1231, University Bourgogne-Franche Comté, Dijon, France
| | - Lara Chalabreysse
- Department of Pathology, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France.,UMR754, INRAE, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Françoise Thivolet-Béjui
- Department of Pathology, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France.,UMR754, INRAE, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Vincent Cottin
- Department of Respiratory Medicine, National Coordinating Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, 28 avenue Doyen Lepine, 69677, Lyon, France. .,UMR754, INRAE, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France.
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Margelidon-Cozzolino V, Cottin V, Dupuis-Girod S, Traclet J, Ahmad K, Mornex JF, Turquier S. Pulmonary hypertension in hereditary haemorrhagic telangiectasia is associated with multiple clinical conditions. ERJ Open Res 2021; 7:00078-2020. [PMID: 33532461 PMCID: PMC7836486 DOI: 10.1183/23120541.00078-2020] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 10/09/2020] [Indexed: 11/23/2022] Open
Abstract
Hereditary haemorrhagic telangiectasia (HHT) is a rare autosomal dominant vascular disorder. The prevalence of pulmonary hypertension (PH) in the course of the disease is considered to be lower than 10% [1–4]. As previously reported, the increase in pulmonary arterial pressure in this setting may result from different mechanisms: isolated high flow state; PH due to left heart disease secondary to high cardiac output in the presence of hepatic arteriovenous malformations (post-capillary PH, clinical classification group 2); or pulmonary vascular remodelling (pre-capillary PH) [1–3]. For the latter mechanism, a diagnosis of heritable pulmonary arterial hypertension (group 1.2) could be applicable, as genetic mutations in the transforming growth factor-β (TGF-β) signalling pathway (ALK1, ENG) are always found [5]. Multiple clinical conditions are combined with genetic mutations to contribute to the development of pulmonary vascular remodelling in hereditary haemorrhagic telangiectasia. A systematic aetiological evaluation is required for these patients.https://bit.ly/34V7HPy
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Affiliation(s)
- Victor Margelidon-Cozzolino
- Dept of Respiratory Physiology, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France.,Competence Centre for Severe Pulmonary Hypertension, Reference Centre for Rare Pulmonary Diseases, Dept of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, UMR754, Claude Bernard University Lyon 1, Lyon, France
| | - Vincent Cottin
- Competence Centre for Severe Pulmonary Hypertension, Reference Centre for Rare Pulmonary Diseases, Dept of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, UMR754, Claude Bernard University Lyon 1, Lyon, France
| | - Sophie Dupuis-Girod
- National Reference Centre for Hereditary Hemorrhagic Telangiectasia, Dept of Genetic Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France and Univ. Grenoble Alpes, Inserm, CEA, BIG-Biologie du Cancer et de l'Infection, Grenoble, France
| | - Julie Traclet
- Competence Centre for Severe Pulmonary Hypertension, Reference Centre for Rare Pulmonary Diseases, Dept of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, UMR754, Claude Bernard University Lyon 1, Lyon, France
| | - Kais Ahmad
- Competence Centre for Severe Pulmonary Hypertension, Reference Centre for Rare Pulmonary Diseases, Dept of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, UMR754, Claude Bernard University Lyon 1, Lyon, France
| | - Jean-François Mornex
- Competence Centre for Severe Pulmonary Hypertension, Reference Centre for Rare Pulmonary Diseases, Dept of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, UMR754, Claude Bernard University Lyon 1, Lyon, France
| | - Ségolène Turquier
- Dept of Respiratory Physiology, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France.,Competence Centre for Severe Pulmonary Hypertension, Reference Centre for Rare Pulmonary Diseases, Dept of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, UMR754, Claude Bernard University Lyon 1, Lyon, France
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Chauvelot L, Gamondes D, Berthiller J, Nieves A, Renard S, Catella-Chatron J, Ahmad K, Bertoletti L, Camara B, Gomez E, Launay D, Montani D, Mornex JF, Prévot G, Sanchez O, Schott AM, Subtil F, Traclet J, Turquier S, Zeghmar S, Habib G, Reynaud-Gaubert M, Humbert M, Cottin V. Hemodynamic Response to Treatment and Outcomes in Pulmonary Hypertension Associated With Interstitial Lung Disease Versus Pulmonary Arterial Hypertension in Systemic Sclerosis: Data From a Study Identifying Prognostic Factors in Pulmonary Hypertension Associated With Interstitial Lung Disease. Arthritis Rheumatol 2020; 73:295-304. [PMID: 32892515 DOI: 10.1002/art.41512] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 08/27/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Patients with systemic sclerosis and both pulmonary hypertension and interstitial lung disease (SSc-PH-ILD) generally carry a worse prognosis than patients with SSc and pulmonary arterial hypertension (SSc-PAH) without ILD. There is no evidence of the efficacy of PAH therapies in SSc-PH-ILD. We undertook this study to compare survival of and response to treatment in patients with SSc-PH-ILD and those with SSc-PAH. METHODS We analyzed 128 patients (66 with SSc-PH-ILD and 62 with SSc-PAH) from 15 centers, in whom PH was diagnosed by right-sided heart catheterization; they were prospectively included in the PH registry. All patients received PAH-specific therapy. Computed tomography of the chest was used to confirm or exclude ILD. RESULTS At baseline, patients with SSc-PH-ILD had less severe hemodynamic impairment than those with SSc-PAH (pulmonary vascular resistance 5.7 Wood units versus 8.7 Wood units; P = 0.0005) and lower diffusing capacity for carbon monoxide (median 25% [interquartile range (IQR) 18%, 35%] versus 40% [IQR 31%, 51%]; P = 0.0005). Additionally, patients with SSc-PH-ILD had increased mortality (8.1% at 1 year, 21.2% at 2 years, and 41.5% at 3 years) compared to those with SSc-PAH (4.1%, 8.7%, and 21.4%, respectively; P = 0.04). Upon treatment with PAH-targeted therapy, no improvement in the 6-minute walk distance was observed in either group. Improvement in the World Health Organization functional class was observed less frequently in patients with SSc-ILD-PH compared to those with SSc-PAH (13.6% versus 33.3%; P = 0.02). Hemodynamics improved similarly in both groups. CONCLUSION ILD confers a worse prognosis to SSc-PH. Response to PAH-specific therapy is clinically poor in SSc-PH-ILD but was not found to be hemodynamically different from the response observed in SSc-PAH.
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Affiliation(s)
- Louis Chauvelot
- Hospices Civils de Lyon, Centre de Référence National des Maladies Pulmonaires Rares, Centre de Compétence de l'Hypertension Pulmonaire, Hôpital Louis Pradel, UMR 754, Université Claude Bernard Lyon 1, OrphaLung, RespiFil, and ERN-LUNG, Lyon, France
| | | | - Julien Berthiller
- Hospices Civils de Lyon, Université Claude Bernard Lyon 1, and Health Services and Performance Research (HESPER) EA7425, Lyon, France
| | - Ana Nieves
- Centre de Compétences des Maladies Pulmonaires Rares, and Hôpital Nord, AP-HM, Marseille, France
| | | | | | - Kais Ahmad
- Hospices Civils de Lyon, Centre de Référence National des Maladies Pulmonaires Rares, Centre de Compétence de l'Hypertension Pulmonaire, Hôpital Louis Pradel, UMR 754, Université Claude Bernard Lyon 1, OrphaLung, RespiFil, and ERN-LUNG, Lyon, France
| | | | - Boubou Camara
- Clinique Universitaire de Pneumologie and CHU de Grenoble Alpes, Grenoble, France
| | | | - David Launay
- Université de Lille, CHU de Lille, and Centre de Référence des Maladies Systémiques et Auto-Immunes Rares, Lille, France
| | - David Montani
- Hôpital Bicêtre, AP-HP, Centre de Référence de l'Hypertension Pulmonaire, INSERM U999, Université Paris-Saclay, Paris, France
| | - Jean-François Mornex
- Hospices Civils de Lyon, Centre de Référence National des Maladies Pulmonaires Rares, Centre de Compétence de l'Hypertension Pulmonaire, Hôpital Louis Pradel, UMR 754, Université Claude Bernard Lyon 1, OrphaLung, RespiFil, and ERN-LUNG, Lyon, France
| | - Grégoire Prévot
- Centre de Compétences des Maladies Pulmonaires Rares, CHU de Toulouse, and Hôpital Larrey, Toulouse, France
| | - Olivier Sanchez
- Hôpital Européen Georges Pompidou, AP-HP, Centre de Compétences des Maladies Pulmonaires Rares, Université Paris Descartes, INSERM U1140, Paris, France
| | - Anne-Marie Schott
- Centre de Compétences des Maladies Pulmonaires Rares, and Hôpital Nord, AP-HM, Marseille, France
| | - Fabien Subtil
- Université de Lyon, Université Claude Bernard Lyon 1, CNRS UMR 5558, Villeurbanne, France, and Hospices Civils de Lyon, Lyon, France
| | - Julie Traclet
- Hospices Civils de Lyon, Centre de Référence National des Maladies Pulmonaires Rares, Centre de Compétence de l'Hypertension Pulmonaire, Hôpital Louis Pradel, UMR 754, Université Claude Bernard Lyon 1, OrphaLung, RespiFil, and ERN-LUNG, Lyon, France
| | - Ségolène Turquier
- Hospices Civils de Lyon, Centre de Référence National des Maladies Pulmonaires Rares, Centre de Compétence de l'Hypertension Pulmonaire, Hôpital Louis Pradel, UMR 754, Université Claude Bernard Lyon 1, OrphaLung, RespiFil, and ERN-LUNG, Lyon, France
| | - Sabrina Zeghmar
- Hospices Civils de Lyon, Centre de Référence National des Maladies Pulmonaires Rares, Centre de Compétence de l'Hypertension Pulmonaire, Hôpital Louis Pradel, UMR 754, Université Claude Bernard Lyon 1, OrphaLung, RespiFil, and ERN-LUNG, Lyon, France
| | | | - Martine Reynaud-Gaubert
- Centre de Compétences des Maladies Pulmonaires Rares, and Hôpital Nord, AP-HM, Marseille, France
| | - Marc Humbert
- Hôpital Bicêtre, AP-HP, Centre de Référence de l'Hypertension Pulmonaire, INSERM U999, Université Paris-Saclay, Paris, France
| | - Vincent Cottin
- Hospices Civils de Lyon, Centre de Référence National des Maladies Pulmonaires Rares, Centre de Compétence de l'Hypertension Pulmonaire, Hôpital Louis Pradel, UMR 754, Université Claude Bernard Lyon 1, OrphaLung, RespiFil, and ERN-LUNG, Lyon, France
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Aussedat PH, Chebib N, Ahmad K, Glerant JC, Drevet G, Grima R, Maury JM, Nasser M, Thivolet-Bejui F, Traclet J, Turquier S, Chalabreysse L, Tronc F, Cottin V. Impact of Lung Biopsy on Lung Function in Idiopathic Pulmonary Fibrosis. Respiration 2020; 99:1101-1108. [PMID: 33260187 DOI: 10.1159/000509557] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/18/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Video-assisted surgical lung biopsy (SLB) is performed in 10-30% of cases to establish the diagnosis of idiopathic pulmonary fibrosis (IPF). OBJECTIVES The aim of the study was to analyze the impact of SLB on lung function in patients eventually diagnosed with IPF. METHODS This is an observational, retrospective, monocentric study of all consecutive patients eventually diagnosed with IPF in multidisciplinary discussion who underwent SLB over 10 years in a specialized center. The primary end point was the variation in forced vital capacity (FVC) before and after the SLB. The secondary end points were the variations in forced expiratory volume in one second (FEV1), total lung capacity (TLC), carbon monoxide diffusion capacity (DLCO), and morbidity and mortality associated with the SLB. RESULTS In 118 patients who underwent SLB and were diagnosed with IPF, a relative decrease in FVC of 4.8% (p < 0.001) was found between measurements performed before and after the procedure. The mean FVC decrease was 156 ± 386 mL in an average period of 185 days, representing an annualized decline of 363 ± 764 mL/year. A significant decrease was also observed after SLB in FEV1, TLC, and DLCO. Complications within 30 days of SLB occurred in 14.4% of patients. Two patients (1.7%) died within 30 days, where one of them had poor lung function. Survival at 1 year was significantly poorer in patients with FVC <50% at baseline. CONCLUSION In this uncontrolled study in patients ultimately diagnosed with IPF, SLB was followed by a significant decline in FVC, which appears to be numerically greater than the average decline in the absence of treatment in the literature. Summary at a Glance: This study evaluated the change in lung function in 118 consecutive patients diagnosed with idiopathic pulmonary fibrosis by surgical lung biopsy. Forced vital capacity decreased by 156 ± 386 mL in a mean of 185 days between the last measurement before and first measurement after biopsy, representing an annualized decline of 363 ± 764 mL/year.
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Affiliation(s)
- Pierre-Henri Aussedat
- Service de pneumologie, Centre national coordinateur de référence des maladies pulmonaires rares, Groupement Hospitalier Est, Hospices civils de Lyon, UMR 754, INRAE, Université Claude Bernard Lyon 1, Lyon, France
| | - Nader Chebib
- Service de pneumologie, Centre national coordinateur de référence des maladies pulmonaires rares, Groupement Hospitalier Est, Hospices civils de Lyon, UMR 754, INRAE, Université Claude Bernard Lyon 1, Lyon, France
| | - Kais Ahmad
- Service de pneumologie, Centre national coordinateur de référence des maladies pulmonaires rares, Groupement Hospitalier Est, Hospices civils de Lyon, UMR 754, INRAE, Université Claude Bernard Lyon 1, Lyon, France
| | | | - Gabrielle Drevet
- Service de chirurgie thoracique, transplantation pulmonaire et cardio-pulmonaire, Groupement Hospitalier Est, Lyon, France
| | - Renaud Grima
- Service de chirurgie thoracique, transplantation pulmonaire et cardio-pulmonaire, Groupement Hospitalier Est, Lyon, France
| | - Jean-Michel Maury
- Service de chirurgie thoracique, transplantation pulmonaire et cardio-pulmonaire, Groupement Hospitalier Est, Lyon, France
| | - Mouhamad Nasser
- Service de pneumologie, Centre national coordinateur de référence des maladies pulmonaires rares, Groupement Hospitalier Est, Hospices civils de Lyon, UMR 754, INRAE, Université Claude Bernard Lyon 1, Lyon, France
| | | | - Julie Traclet
- Service de pneumologie, Centre national coordinateur de référence des maladies pulmonaires rares, Groupement Hospitalier Est, Hospices civils de Lyon, UMR 754, INRAE, Université Claude Bernard Lyon 1, Lyon, France
| | | | | | - François Tronc
- Service de chirurgie thoracique, transplantation pulmonaire et cardio-pulmonaire, Groupement Hospitalier Est, Lyon, France
| | - Vincent Cottin
- Service de pneumologie, Centre national coordinateur de référence des maladies pulmonaires rares, Groupement Hospitalier Est, Hospices civils de Lyon, UMR 754, INRAE, Université Claude Bernard Lyon 1, Lyon, France,
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Bertoletti L, Bouvaist H, Tromeur C, Bezzeghoud S, Dauphin C, Enache I, Bourdin A, Seronde MF, Montani D, Turquier S, Pison C. "Rehab for all!" Is it too early in pulmonary arterial hypertension? Eur Respir J 2019; 54:54/5/1901558. [PMID: 31699779 DOI: 10.1183/13993003.01558-2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 08/07/2019] [Indexed: 11/05/2022]
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Brosseau C, Danger R, Durand M, Durand E, Foureau A, Lacoste P, Tissot A, Roux A, Reynaud-Gaubert M, Kessler R, Mussot S, Dromer C, Brugière O, Mornex JF, Guillemain R, Claustre J, Magnan A, Brouard S, Velly J, Rozé H, Blanchard E, Antoine M, Cappello M, Ruiz M, Sokolow Y, Vanden Eynden F, Van Nooten G, Barvais L, Berré J, Brimioulle S, De Backer D, Créteur J, Engelman E, Huybrechts I, Ickx B, Preiser T, Tuna T, Van Obberghe L, Vancutsem N, Vincent J, De Vuyst P, Etienne I, Féry F, Jacobs F, Knoop C, Vachiéry J, Van den Borne P, Wellemans I, Amand G, Collignon L, Giroux M, Angelescu D, Chavanon O, Hacini R, Martin C, Pirvu A, Porcu P, Albaladejo P, Allègre C, Bataillard A, Bedague D, Briot E, Casez‐Brasseur M, Colas D, Dessertaine G, Francony G, Hebrard A, Marino M, Protar D, Rehm D, Robin S, Rossi‐Blancher M, Augier C, Bedouch P, Boignard A, Bouvaist H, Briault A, Camara B, Chanoine S, Dubuc M, Quétant S, Maurizi J, Pavèse P, Pison C, Saint‐Raymond C, Wion N, Chérion C, Grima R, Jegaden O, Maury J, Tronc F, Flamens C, Paulus S, Philit F, Senechal A, Glérant J, Turquier S, Gamondes D, Chalabresse L, Thivolet‐Bejui F, Barnel C, Dubois C, Tiberghien A, Pimpec‐Barthes F, Bel A, Mordant P, Achouh P, Boussaud V, Méléard D, Bricourt M, Cholley B, Pezella V, Brioude G, D'Journo X, Doddoli C, Thomas P, Trousse D, Dizier S, Leone M, Papazian L, Bregeon F, Coltey B, Dufeu N, Dutau H, Garcia S, Gaubert J, Gomez C, Laroumagne S, Mouton G, Nieves A, Picard C, Rolain J, Sampol E, Secq V, Perigaud C, Roussel J, Senage T, Mugniot A, Danner I, Haloun A, Abbes S, Bry C, Blanc F, Lepoivre T, Botturi‐Cavaillès K, Loy J, Bernard M, Godard E, Royer P, Henrio K, Dartevelle P, Fabre D, Fadel E, Mercier O, Stephan F, Viard P, Cerrina J, Dorfmuller P, Feuillet S, Ghigna M, Hervén P, Le Roy Ladurie F, Le Pavec J, Thomas de Montpreville V, Lamrani L, Castier Y, Mordant P, Cerceau P, Augustin P, Jean‐Baptiste S, Boudinet S, Montravers P, Dauriat G, Jébrak G, Mal H, Marceau A, Métivier A, Thabut G, Lhuillier E, Dupin C, Bunel V, Falcoz P, Massard G, Santelmo N, Ajob G, Collange O, Helms O, Hentz J, Roche A, Bakouboula B, Degot T, Dory A, Hirschi S, Ohlmann‐Caillard S, Kessler L, Schuller A, Bennedif K, Vargas S, Bonnette P, Chapelier A, Puyo P, Sage E, Bresson J, Caille V, Cerf C, Devaquet J, Dumans‐Nizard V, Felten M, Fischler M, Si Larbi A, Leguen M, Ley L, Liu N, Trebbia G, De Miranda S, Douvry B, Gonin F, Grenet D, Hamid A, Neveu H, Parquin F, Picard C, Stern M, Bouillioud F, Cahen P, Colombat M, Dautricourt C, Delahousse M, D'Urso B, Gravisse J, Guth A, Hillaire S, Honderlick P, Lequintrec M, Longchampt E, Mellot F, Scherrer A, Temagoult L, Tricot L, Vasse M, Veyrie C, Zemoura L, Dahan M, Murris M, Benahoua H, Berjaud J, Le Borgne Krams A, Crognier L, Brouchet L, Mathe O, Didier A, Krueger T, Ris H, Gonzalez M, Aubert J, Nicod L, Marsland B, Berutto T, Rochat T, Soccal P, Jolliet P, Koutsokera A, Marcucci C, Manuel O, Bernasconi E, Chollet M, Gronchi F, Courbon C, Hillinger S, Inci I, Kestenholz P, Weder W, Schuepbach R, Zalunardo M, Benden C, Buergi U, Huber L, Isenring B, Schuurmans M, Gaspert A, Holzmann D, Müller N, Schmid C, Vrugt B, Rechsteiner T, Fritz A, Maier D, Deplanche K, Koubi D, Ernst F, Paprotka T, Schmitt M, Wahl B, Boissel J, Olivera‐Botello G, Trocmé C, Toussaint B, Bourgoin‐Voillard S, Séve M, Benmerad M, Siroux V, Slama R, Auffray C, Charron D, Lefaudeux D, Pellet J. Blood CD9 + B cell, a biomarker of bronchiolitis obliterans syndrome after lung transplantation. Am J Transplant 2019; 19:3162-3175. [PMID: 31305014 DOI: 10.1111/ajt.15532] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 12/03/2018] [Revised: 06/12/2019] [Accepted: 07/07/2019] [Indexed: 01/25/2023]
Abstract
Bronchiolitis obliterans syndrome is the main limitation for long-term survival after lung transplantation. Some specific B cell populations are associated with long-term graft acceptance. We aimed to monitor the B cell profile during early development of bronchiolitis obliterans syndrome after lung transplantation. The B cell longitudinal profile was analyzed in peripheral blood mononuclear cells from patients with bronchiolitis obliterans syndrome and patients who remained stable over 3 years of follow-up. CD24hi CD38hi transitional B cells were increased in stable patients only, and reached a peak 24 months after transplantation, whereas they remained unchanged in patients who developed a bronchiolitis obliterans syndrome. These CD24hi CD38hi transitional B cells specifically secrete IL-10 and express CD9. Thus, patients with a total CD9+ B cell frequency below 6.6% displayed significantly higher incidence of bronchiolitis obliterans syndrome (AUC = 0.836, PPV = 0.75, NPV = 1). These data are the first to associate IL-10-secreting CD24hi CD38hi transitional B cells expressing CD9 with better allograft outcome in lung transplant recipients. CD9-expressing B cells appear as a contributor to a favorable environment essential for the maintenance of long-term stable graft function and as a new predictive biomarker of bronchiolitis obliterans syndrome-free survival.
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Affiliation(s)
- Carole Brosseau
- Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France.,Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France.,Institut du thorax, Inserm UMR 1087, CNRS, UMR 6291, Université de Nantes, Nantes, France.,Institut du thorax, CHU de Nantes, Nantes, France
| | - Richard Danger
- Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France.,Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
| | - Maxim Durand
- Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France.,Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France.,Faculté de Médecine, Université de Nantes, Nantes, France
| | - Eugénie Durand
- Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France.,Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
| | - Aurore Foureau
- Institut du thorax, Inserm UMR 1087, CNRS, UMR 6291, Université de Nantes, Nantes, France.,Institut du thorax, CHU de Nantes, Nantes, France
| | - Philippe Lacoste
- Institut du thorax, Inserm UMR 1087, CNRS, UMR 6291, Université de Nantes, Nantes, France.,Institut du thorax, CHU de Nantes, Nantes, France
| | - Adrien Tissot
- Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France.,Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France.,Institut du thorax, Inserm UMR 1087, CNRS, UMR 6291, Université de Nantes, Nantes, France.,Institut du thorax, CHU de Nantes, Nantes, France.,Faculté de Médecine, Université de Nantes, Nantes, France
| | - Antoine Roux
- Hôpital Foch, Suresnes, France.,Université Versailles Saint-Quentin-en-Yvelines, UPRES EA220, Versailles, France
| | | | | | - Sacha Mussot
- Centre Chirurgical Marie Lannelongue, Service de Chirurgie Thoracique, Vasculaire et Transplantation Cardiopulmonaire, Le Plessis Robinson, France
| | | | - Olivier Brugière
- Hôpital Bichat, Service de Pneumologie et Transplantation Pulmonaire, Paris, France
| | | | | | - Johanna Claustre
- Clinique Universitaire Pneumologie, Pôle Thorax et Vaisseaux, CHU Grenoble Alpes, Université Grenoble Alpes, Inserm U1055, Grenoble, France
| | - Antoine Magnan
- Institut du thorax, Inserm UMR 1087, CNRS, UMR 6291, Université de Nantes, Nantes, France.,Institut du thorax, CHU de Nantes, Nantes, France
| | - Sophie Brouard
- Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France.,Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France.,Centre d'Investigation Clinique (CIC) Biothérapie, CHU Nantes, Nantes, France
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Aussedat P, Chebib N, Ahmad K, Glerant J, Maury J, Nasser M, Thivolet-Bejui F, Traclet J, Turquier S, Chalabreysse L, Tronc F, Cottin V. Impact de la biopsie pulmonaire chirurgicale sur la fonction respiratoire dans la fibrose pulmonaire idiopathique. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.104] [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: 11/24/2022]
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Simon C, Margelidon-Cozzolino V, Turquier S, Cottin V, Mornex J, Glerant J. Un gaz du sang en air ambiant peut-il prédire le résultat d’un test d’hyperoxie pour la recherche d’un shunt droit–gauche ? Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.268] [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]
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Margelidon-Cozzolino V, Cottin V, Dupuis-Girod S, Ahmad K, Traclet J, Glérant J, Mornex J, Turquier S. Causes multiples des hypertensions pulmonaires associées à la maladie de Rendu–Osler. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.050] [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]
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Ginoux M, Turquier S, Chebib N, Glerant JC, Traclet J, Philit F, Sénéchal A, Mornex JF, Cottin V. Impact of comorbidities and delay in diagnosis in elderly patients with pulmonary hypertension. ERJ Open Res 2018; 4:00100-2018. [PMID: 30510957 PMCID: PMC6258090 DOI: 10.1183/23120541.00100-2018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 06/29/2018] [Accepted: 09/12/2018] [Indexed: 11/05/2022] Open
Abstract
Patient age at diagnosis of pulmonary hypertension is steadily increasing. The present study sought to analyse clinical characteristics, time to diagnosis and prognosis of pulmonary hypertension in elderly and very elderly patients. A study was conducted in a French regional referral centre for pulmonary hypertension. All consecutive patients diagnosed with pre-capillary pulmonary hypertension were included and categorised according to age: <65 years (“young”), 65–74 years (“elderly”) and ≥75 years (“very elderly”). Over a 4-year period, 248 patients were included: 101 (40.7%) were young, 82 (33.1%) were elderly and 65 (26.2%) were very elderly. The median age at diagnosis among the total population was 68 years. Compared with young patients, elderly and very elderly patients had a longer time to diagnosis (7±48, 9±21 and 16±32 months, respectively; p<0.001). Patients ≥75 years also more often had group 4 pulmonary hypertension. The median overall survival was 46±1.4 months, but was only 37±4.9 months in elderly patients and 28±4.7 months in very elderly patients. Survival from the first symptoms and survival adjusted to comorbidity was similar across age groups. Patient age should be taken into account when diagnosing pulmonary hypertension as it is associated with a specific clinical profile and a worse prognosis. The difference in prognosis is likely to be related to a delay in diagnosis and a greater number of comorbidities. More than a quarter of patients diagnosed with pre-capillary pulmonary hypertension are older than 75 years; they have a poorer prognosis, likely related to a longer delay in diagnosis and a higher burden of comorbiditieshttp://ow.ly/87FQ30m0WM7
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Affiliation(s)
- Marylise Ginoux
- Competence Center for Severe Pulmonary Hypertension, Reference Center for Rare Pulmonary Diseases, Dept of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - Ségolène Turquier
- Dept of Respiratory Physiology, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - Nader Chebib
- Competence Center for Severe Pulmonary Hypertension, Reference Center for Rare Pulmonary Diseases, Dept of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - Jean-Charles Glerant
- Dept of Respiratory Physiology, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - Julie Traclet
- Competence Center for Severe Pulmonary Hypertension, Reference Center for Rare Pulmonary Diseases, Dept of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - François Philit
- Competence Center for Severe Pulmonary Hypertension, Reference Center for Rare Pulmonary Diseases, Dept of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - Agathe Sénéchal
- Competence Center for Severe Pulmonary Hypertension, Reference Center for Rare Pulmonary Diseases, Dept of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - Jean-François Mornex
- Competence Center for Severe Pulmonary Hypertension, Reference Center for Rare Pulmonary Diseases, Dept of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France.,Université Lyon I, INRA, UMR754, Lyon, France
| | - Vincent Cottin
- Competence Center for Severe Pulmonary Hypertension, Reference Center for Rare Pulmonary Diseases, Dept of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France.,Université Lyon I, INRA, UMR754, Lyon, France
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Ginoux M, Cottin V, Glérant JC, Traclet J, Philit F, Sénéchal A, Mornex JF, Turquier S. Safety of right heart catheterization for pulmonary hypertension in very elderly patients. Pulm Circ 2018; 8:2045894018799272. [PMID: 30124132 PMCID: PMC6131314 DOI: 10.1177/2045894018799272] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Right heart catheterization (RHC) is the reference test in diagnosing pulmonary hypertension (PH). The increasing age of patients at the time of diagnosis raises the issue of the morbidity of this invasive test in elderly individuals. We hypothesized that the morbidity associated with RHC would be increased in elderly patients and highlight differences in hemodynamic characteristics compared to younger patients. A retrospective study was conducted in a regional referral center for PH. Data for all consecutive RHCs performed during the study period were analyzed. Over a five-year period, 1060 RHCs were performed. Of the patients, 228 (21.5%) were aged ≥75 years and 832 (78.5%) were aged <75 years. Duration of the procedure and site of puncture did not differ according to age group (all P > 0.05). Nine procedures (0.9%) led to complications: three (1.3%) in patients aged >75 years and six (0.7%) in younger patients aged (P = 0.5). Eight were local vascular injuries, directly related to a femoral vein puncture (P < 0.001). Pulmonary arterial pressure and cardiac output were lower in patients aged >75 years than in younger patients (P = 0.001). RHC may be performed regardless of patient age. The rate of RHC complications is not increased in individuals aged >75 years. As most complications were related to femoral vein puncture, this route should be avoided whenever possible.
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Affiliation(s)
- Marylise Ginoux
- 1 Competence Center for Severe Pulmonary Hypertension, Reference Center for Rare Pulmonary Diseases, Department of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - Vincent Cottin
- 1 Competence Center for Severe Pulmonary Hypertension, Reference Center for Rare Pulmonary Diseases, Department of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France.,2 Université Lyon I, Lyon, France
| | - Jean-Charles Glérant
- 3 Department of Respiratory Physiology, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - Julie Traclet
- 1 Competence Center for Severe Pulmonary Hypertension, Reference Center for Rare Pulmonary Diseases, Department of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - François Philit
- 1 Competence Center for Severe Pulmonary Hypertension, Reference Center for Rare Pulmonary Diseases, Department of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - Agathe Sénéchal
- 1 Competence Center for Severe Pulmonary Hypertension, Reference Center for Rare Pulmonary Diseases, Department of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - Jean-Francois Mornex
- 1 Competence Center for Severe Pulmonary Hypertension, Reference Center for Rare Pulmonary Diseases, Department of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France.,2 Université Lyon I, Lyon, France
| | - Ségolène Turquier
- 3 Department of Respiratory Physiology, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
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Chebib N, Mornex JF, Traclet J, Philit F, Khouatra C, Zeghmar S, Turquier S, Cottin V. Pulmonary hypertension in chronic lung diseases: comparison to other pulmonary hypertension groups. Pulm Circ 2018; 8:2045894018775056. [PMID: 29671674 PMCID: PMC6012471 DOI: 10.1177/2045894018775056] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 11/29/2022] Open
Abstract
Group 3 pulmonary hypertension (PH) is a common complication of advanced chronic lung disease. Our hypothesis was that group 3 PH is associated with a more severe baseline presentation and a more severe prognosis compared to group 1 pulmonary arterial hypertension (PAH), chronic thromboembolic PH (group 4), and group 5 PH. We retrospectively analyzed consecutive incident PH patients in a single center between January 2006 and November 2014. Data were acquired from a prospective database. Clinical, functional, and hemodynamic characteristics, as well as survival, were compared between the four groups of precapillary PH. A total of 363 patients were analyzed; 164 patients (45.2%) belonged to group 1 PAH, 109 (30%) to group 3 PH, 65 (17.9%) to group 4 PH, and 25 (6.9%) to group 5 PH. Group 3 patients were predominantly male and were more frequently in New York Heart Association (NYHA) class III/IV. Patients with group 3 and 4 PH were older, had significantly lower 6-min walking distance (6MWD), higher mean pulmonary arterial pressure, higher pulmonary vascular resistance (PVR), and lower cardiac index (CI) than PAH patients. Group 3 and 5 patients had significantly lower total lung capacity (TLC), forced vital capacity (FVC), and FEV1; group 3 patients had the lowest carbon monoxide transfer coefficient values. PH therapy was used in 90.9% of group 3 patients. Univariate analysis of prognostic factors in the overall population showed that age, male gender, NYHA class, groups 3 and 4 PH (vs. PAH), 6MWD, FVC, TLC, carbon monoxide transfer coefficient (KCO), PVR, CI, and venous oxygen saturation were significantly associated with greater mortality. Multivariate analysis showed that age, PH group 4, 6MWD, and KCO but no longer PH group 3 were significantly associated with mortality. Patients with group 3 PH are older, have more severe baseline presentation and lower survival rates than PAH patients in univariate analysis, that seemed to be related to older age.
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Affiliation(s)
- Nader Chebib
- 1 Hospices Civils de Lyon, National Reference Center for Rare Pulmonary Diseases, Competence Center for Severe Pulmonary Hypertension, Lyon, France
| | - Jean-François Mornex
- 1 Hospices Civils de Lyon, National Reference Center for Rare Pulmonary Diseases, Competence Center for Severe Pulmonary Hypertension, Lyon, France.,2 Claude Bernard Lyon 1 University, University of Lyon, Lyon, France
| | - Julie Traclet
- 1 Hospices Civils de Lyon, National Reference Center for Rare Pulmonary Diseases, Competence Center for Severe Pulmonary Hypertension, Lyon, France
| | - François Philit
- 1 Hospices Civils de Lyon, National Reference Center for Rare Pulmonary Diseases, Competence Center for Severe Pulmonary Hypertension, Lyon, France
| | - Chahera Khouatra
- 1 Hospices Civils de Lyon, National Reference Center for Rare Pulmonary Diseases, Competence Center for Severe Pulmonary Hypertension, Lyon, France
| | - Sabrina Zeghmar
- 1 Hospices Civils de Lyon, National Reference Center for Rare Pulmonary Diseases, Competence Center for Severe Pulmonary Hypertension, Lyon, France
| | - Ségolène Turquier
- 1 Hospices Civils de Lyon, National Reference Center for Rare Pulmonary Diseases, Competence Center for Severe Pulmonary Hypertension, Lyon, France
| | - Vincent Cottin
- 1 Hospices Civils de Lyon, National Reference Center for Rare Pulmonary Diseases, Competence Center for Severe Pulmonary Hypertension, Lyon, France.,2 Claude Bernard Lyon 1 University, University of Lyon, Lyon, France
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Bitker L, Sens F, Payet C, Turquier S, Duclos A, Cottin V, Juillard L. Presence of Kidney Disease as an Outcome Predictor in Patients with Pulmonary Arterial Hypertension. Am J Nephrol 2018; 47:134-143. [PMID: 29471290 DOI: 10.1159/000487198] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 11/29/2017] [Accepted: 01/25/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) may lead to right heart failure and subsequently alter glomerular filtration rates (GFR). Chronic kidney disease (CKD, GFR <60 mL/min/1.73 m2) may also adversely affect PAH prognosis. This study aimed to assess how right heart hemodynamics was associated with reduced estimated GFR (eGFR) and the association of CKD with survival in PAH patients. METHODS In a prospective PAH cohort (2003-2012), invasive hemodynamics and eGFR were collected at diagnosis (179 patients) and during follow-up (159 patients). The prevalence of CKD was assessed at PAH diagnosis. Variables, including hemodynamics, associated with reduced eGFR at diagnosis and during follow-up were tested in multivariate analysis. The association of CKD with survival was evaluated using a multivariate Cox regression model. RESULTS At diagnosis, mean age was 60.4 ± 16.5 years, mean pulmonary arterial pressure was 43 ± 12 mm Hg, and eGFR was 74.4 ± 26.4 mL/min/1.73 m2. CKD was observed in 52 incident patients (29%). Independent determinants of reduced eGFR at diagnosis were age, systemic hypertension, and decreased cardiac index. Independent determinants of reduced eGFR during follow-up were age, female gender, PAH etiology, systemic hypertension, decreased cardiac index, and increased right atrial pressure. Age ≥60 years, female gender, NYHA 4, and CKD at diagnosis were independently associated with decreased survival. The adjusted hazards ratio for death associated with CKD was 1.81 (95% confidence interval [1.01-3.25]). CONCLUSION CKD is frequent at PAH diagnosis and is independently associated with increased mortality. Right heart failure may induce renal hypoperfusion and congestion, and is associated with eGFR decrease.
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Affiliation(s)
- Laurent Bitker
- Nephrology Department, Edouard Herriot Academic Hospital, Hospices Civils de Lyon, Lyon, France
| | - Florence Sens
- Nephrology Department, Edouard Herriot Academic Hospital, Hospices Civils de Lyon, Lyon, France
- Cardiovascular and Renal Clinical Trialists Network (F-CRIN INI-CRCT), Nancy, France
- Pôle Information Médicale, Evaluation, Recherche (IMER), Hospices Civils de Lyon, Lyon, France
- Health Service and Performance Research (HESPER), EA 7425, Université de Lyon, Lyon, France
| | - Cécile Payet
- Pôle Information Médicale, Evaluation, Recherche (IMER), Hospices Civils de Lyon, Lyon, France
- Health Service and Performance Research (HESPER), EA 7425, Université de Lyon, Lyon, France
| | - Ségolène Turquier
- Department of Respiratory Diseases, Louis Pradel Hospital, National Reference Centre for Rare Pulmonary Diseases, Regional Competence Center for Severe Pulmonary Arterial Hypertension, Hospices Civils de Lyon, Lyon, France
| | - Antoine Duclos
- Pôle Information Médicale, Evaluation, Recherche (IMER), Hospices Civils de Lyon, Lyon, France
- Health Service and Performance Research (HESPER), EA 7425, Université de Lyon, Lyon, France
| | - Vincent Cottin
- Department of Respiratory Diseases, Louis Pradel Hospital, National Reference Centre for Rare Pulmonary Diseases, Regional Competence Center for Severe Pulmonary Arterial Hypertension, Hospices Civils de Lyon, Lyon, France
- INRA, UMR754, IFR 128, Université Lyon 1 Claude Bernard, Lyon, France
| | - Laurent Juillard
- Nephrology Department, Edouard Herriot Academic Hospital, Hospices Civils de Lyon, Lyon, France
- Cardiovascular and Renal Clinical Trialists Network (F-CRIN INI-CRCT), Nancy, France
- Cardiovasculaire Métabolisme Diabétologie et Nutrition (CarMeN), INSERM U1060, INRA 1235, Université Lyon 1 Claude Bernard, Lyon, France
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Chebib N, Turquier S, Khouatra C, Philit F, Traclet J, Sénéchal A, Zeghmar S, Mornex J, Cottin V. Hypertension pulmonaire au cours des pneumopathies interstitielles diffuses idiopathiques. Rev Mal Respir 2017. [DOI: 10.1016/j.rmr.2016.10.755] [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]
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Ginoux M, Turquier S, Chébib N, Glérant J, Traclet J, Khouatra C, Philit F, Sénéchal A, Mornex J, Cottin V. Caractéristiques cliniques et hémodynamiques de l’hypertension pulmonaire précapillaire des patients âgés et très âgés. Rev Mal Respir 2017. [DOI: 10.1016/j.rmr.2016.10.752] [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]
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Ginoux M, Cottin V, Glérant J, Traclet J, Khouatra C, Philit F, Sénéchal A, Mornex J, Turquier S. Cathétérisme cardiaque droit : morbidité et résultats chez les patients âgés de 75 ans ou plus. Rev Mal Respir 2017. [DOI: 10.1016/j.rmr.2016.10.753] [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]
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Ginoux M, Turquier S, Glérant JC, Traclet J, Khouatra C, Philit F, Sénéchal A, Mornex JF, Cottin V. Traitement de l’hypertension artérielle pulmonaire chez les patients âgés et très âgés. Rev Mal Respir 2017. [DOI: 10.1016/j.rmr.2016.10.026] [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: 11/16/2022]
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Chebib N, Turquier S, Khouatra C, Philit F, Traclet J, Sénéchal A, Zeghmar S, Cottin V, Mornex JF. Particularités de l’hypertension pulmonaire pré-capillaire du sujet âgé. Rev Mal Respir 2017. [DOI: 10.1016/j.rmr.2016.10.028] [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]
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Chebib N, Turquier S, Khouatra C, Philit F, Traclet J, Sénéchal A, Zeghmar S, Mornex JF, Cottin V. Hypertension pulmonaire associée aux maladies respiratoires chroniques : comparaison avec l’hypertension artérielle pulmonaire. Rev Mal Respir 2017. [DOI: 10.1016/j.rmr.2016.10.027] [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]
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Girard A, Jouneau S, Chabanne C, Khouatra C, Lannes M, Traclet J, Turquier S, Delaval P, Cordier JF, Cottin V. Severe pulmonary hypertension associated with COPD: hemodynamic improvement with specific therapy. Respiration 2015; 90:220-8. [PMID: 26277885 DOI: 10.1159/000431380] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 05/12/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There is no recommendation for treating pulmonary hypertension (PH) when associated with chronic obstructive pulmonary disease (COPD). OBJECTIVE To evaluate the effect of PH-specific therapy in patients with COPD. METHODS All successive patients with severe PH [mean pulmonary arterial pressure (mPAP) ≥35 mm Hg] and COPD, who received specific PH medication and who underwent right heart catheterization at baseline and after 3-12 months of treatment, were analyzed from a prospective database. RESULTS Twenty-six patients were included with a median follow-up of 14 months. Mean forced expiratory volume in 1 s was 57 ± 20% of predicted, and mean forced expiratory volume in 1 s/forced vital capacity was 47 ± 12%. Dyspnea was New York Health Association classification stage (NYHA) II in 15%, NYHA III in 81% and NYHA IV in 4%. First-line treatments were endothelin receptor antagonists in 11 patients, phosphodiesterase-5 inhibitors in 11 patients, calcium blocker in 1 patient, combination therapy in 3 patients including 2 with a prostanoid. After 6 ± 3 months, pulmonary vascular resistance decreased from 8.5 ± 3 to 6.6 ± 2 Wood units (p < 0.001), with significant improvement of cardiac index from 2.44 ± 0.43 to 2.68 ± 0.63 liters × min × m-2 (p = 0.015) and mPAP from 48 ± 9 to 42 ± 10 mm Hg (p = 0.008). There was no significant difference in dyspnea, 6-min walking distance, echocardiographic parameters or N-terminal pro-brain natriuretic peptide levels. There was no significant difference in arterial oxygen saturation after 3-12 months of treatment. CONCLUSIONS Specific PH medications may improve hemodynamic parameters in COPD patients with severe PH. Appropriate prospective randomized studies are needed to evaluate the potential long-term clinical benefit of treatment.
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Affiliation(s)
- Anne Girard
- Service de Pneumologie, Centre de Compx00E9;tences des Maladies Pulmonaires Rares, Centre de Compx00E9;tences de l'Hypertension Pulmonaire, Universitx00E9; de Rennes 1, Rennes, France
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Courand PY, Pina Jomir G, Khouatra C, Scheiber C, Turquier S, Glérant JC, Mastroianni B, Gentil B, Blanchet-Legens AS, Dib A, Derumeaux G, Humbert M, Mornex JF, Cordier JF, Cottin V. Prognostic value of right ventricular ejection fraction in pulmonary arterial hypertension. Eur Respir J 2014; 45:139-49. [PMID: 25537560 DOI: 10.1183/09031936.00158014] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Right ventricle ejection fraction (RVEF) evaluated with magnetic resonance imaging is a strong determinant of patient outcomes in pulmonary arterial hypertension. We evaluated the prognostic value of RVEF assessed with conventional planar equilibrium radionuclide angiography at baseline and change 3-6 months after initiating pulmonary arterial hypertension-specific therapy. In a prospective cohort of newly diagnosed patients with idiopathic, heritable or anorexigen-associated pulmonary arterial hypertension, RVEF was measured at baseline (n=100) and 3-6 months after initiation of therapy (n=78). After a median follow-up of 4.1 years, 41 deaths occurred, including 35 from cardiovascular causes. Patients with a (median) baseline RVEF >25% had better survival than those with a RVEF <25% using Kaplan-Meier analysis (p=0.010). RVEF at baseline was an independent predictor of all-cause and cardiovascular mortality in adjusted Cox regression model (p=0.002 and p=0.007, respectively; HR 0.93 for both). Patients with stable or increased RVEF at 3-6 months had a trend for improved all-cause survival (HR 2.43, p=0.086) and had less cardiovascular mortality (HR 3.25, p=0.034) than those in whom RVEF decreased despite therapy. RVEF assessed with conventional planar equilibrium radionuclide angiography at baseline and change in RVEF 3-6 months after therapy initiation independently predict outcomes in patients with pulmonary arterial hypertension.
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Affiliation(s)
- Pierre-Yves Courand
- Dept of Cardiology, Hospices Civils de Lyon, Croix-Rousse Hospital, Lyon, France
| | - Géraldine Pina Jomir
- Dept of Nuclear Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - Chahéra Khouatra
- Dept of Respiratory Diseases, Hospices Civils de Lyon, Louis Pradel Hospital, Service de pneumologie - National Reference Centre for Rare Pulmonary Diseases, Regional Competence Center for Severe Pulmonary Arterial Hypertension, Lyon, France
| | - Christian Scheiber
- Dept of Nuclear Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - Ségolène Turquier
- Dept of Respiratory Physiology, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - Jean-Charles Glérant
- Dept of Respiratory Physiology, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - Bénédicte Mastroianni
- Dept of Respiratory Diseases, Hospices Civils de Lyon, Louis Pradel Hospital, Service de pneumologie - National Reference Centre for Rare Pulmonary Diseases, Regional Competence Center for Severe Pulmonary Arterial Hypertension, Lyon, France
| | - Béatrice Gentil
- Dept of Respiratory Diseases, Hospices Civils de Lyon, Louis Pradel Hospital, Service de pneumologie - National Reference Centre for Rare Pulmonary Diseases, Regional Competence Center for Severe Pulmonary Arterial Hypertension, Lyon, France
| | - Anne-Sophie Blanchet-Legens
- Dept of Respiratory Diseases, Hospices Civils de Lyon, Louis Pradel Hospital, Service de pneumologie - National Reference Centre for Rare Pulmonary Diseases, Regional Competence Center for Severe Pulmonary Arterial Hypertension, Lyon, France
| | - Alfred Dib
- Dept of Respiratory Diseases, Hospices Civils de Lyon, Louis Pradel Hospital, Service de pneumologie - National Reference Centre for Rare Pulmonary Diseases, Regional Competence Center for Severe Pulmonary Arterial Hypertension, Lyon, France. Claude Bernard University Lyon 1, INRA, UMR754 INRA-Vetagrosup EPHE IFR 128, Lyon, France
| | - Geneviève Derumeaux
- Dept of Echocardiography, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - Marc Humbert
- Univ. Paris-Sud, Le Kremlin-Bicêtre, France. AP-HP, Service de Pneumologie, DHU Thorax Innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France. INSERM U999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
| | - Jean-François Mornex
- Dept of Respiratory Diseases, Hospices Civils de Lyon, Louis Pradel Hospital, Service de pneumologie - National Reference Centre for Rare Pulmonary Diseases, Regional Competence Center for Severe Pulmonary Arterial Hypertension, Lyon, France. Claude Bernard University Lyon 1, INRA, UMR754 INRA-Vetagrosup EPHE IFR 128, Lyon, France
| | - Jean-François Cordier
- Dept of Respiratory Diseases, Hospices Civils de Lyon, Louis Pradel Hospital, Service de pneumologie - National Reference Centre for Rare Pulmonary Diseases, Regional Competence Center for Severe Pulmonary Arterial Hypertension, Lyon, France. Claude Bernard University Lyon 1, INRA, UMR754 INRA-Vetagrosup EPHE IFR 128, Lyon, France
| | - Vincent Cottin
- Dept of Respiratory Diseases, Hospices Civils de Lyon, Louis Pradel Hospital, Service de pneumologie - National Reference Centre for Rare Pulmonary Diseases, Regional Competence Center for Severe Pulmonary Arterial Hypertension, Lyon, France. Claude Bernard University Lyon 1, INRA, UMR754 INRA-Vetagrosup EPHE IFR 128, Lyon, France.
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Girard A, Jouneau S, Lannes M, Khouatra C, Laurent M, Turquier S, Traclet J, Delaval P, Cordier J, Chabanne C, Cottin V. Efficacité du traitement spécifique de l’hypertension pulmonaire sévère associée à une BPCO post-tabagique. Rev Mal Respir 2014. [DOI: 10.1016/j.rmr.2013.10.061] [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: 11/17/2022]
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Turquier S, Freymond N, Hirschi S, Glerant J, Cordier J. Étiologie des bronchopneumopathies chroniques obstructives non tabagiques. Rev Mal Respir 2012. [DOI: 10.1016/j.rmr.2011.10.809] [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: 11/24/2022]
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