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Niedermeyer S, Yun X, Trujillo M, Jiang H, Andrade MR, Kolb TM, Suresh K, Damarla M, Shimoda LA. A novel interaction between aquaporin 1 and caspase-3 in pulmonary arterial smooth muscle cells. Am J Physiol Lung Cell Mol Physiol 2024; 326:L638-L645. [PMID: 38375595 DOI: 10.1152/ajplung.00017.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/12/2024] [Accepted: 02/12/2024] [Indexed: 02/21/2024] Open
Abstract
Pulmonary hypertension (PH) is a condition in which remodeling of the pulmonary vasculature leads to hypertrophy of the muscular vascular wall and extension of muscle into nonmuscular arteries. These pathological changes are predominantly due to the abnormal proliferation and migration of pulmonary arterial smooth muscle cells (PASMCs), enhanced cellular functions that have been linked to increases in the cell membrane protein aquaporin 1 (AQP1). However, the mechanisms underlying the increased AQP1 abundance have not been fully elucidated. Here we present data that establishes a novel interaction between AQP1 and the proteolytic enzyme caspase-3. In silico analysis of the AQP1 protein reveals two caspase-3 cleavage sites on its C-terminal tail, proximal to known ubiquitin sites. Using biotin proximity ligase techniques, we establish that AQP1 and caspase-3 interact in both human embryonic kidney (HEK) 293A cells and rat PASMCs. Furthermore, we demonstrate that AQP1 levels increase and decrease with enhanced caspase-3 activity and inhibition, respectively. Ultimately, further work characterizing this interaction could provide the foundation for novel PH therapeutics.NEW & NOTEWORTHY Pulmonary arterial smooth muscle cells (PASMCs) are integral to pulmonary vascular remodeling, a characteristic of pulmonary arterial hypertension (PAH). PASMCs isolated from robust animal models of disease demonstrate enhanced proliferation and migration, pathological functions associated with increased abundance of the membrane protein aquaporin 1 (AQP1). We present evidence of a novel interaction between the proteolytic enzyme caspase-3 and AQP1, which may control AQP1 abundance. These data suggest a potential new target for novel PAH therapies.
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Affiliation(s)
- Shannon Niedermeyer
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - Xin Yun
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - Marielena Trujillo
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - Haiyang Jiang
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - Manuella R Andrade
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - Todd M Kolb
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - Karthik Suresh
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - Mahendra Damarla
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - Larissa A Shimoda
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
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2
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Borhani A, Porter KK, Umair M, Chu LC, Mathai SC, Kolb TM, Damico RL, Hassoun PM, Kamel IR, Zimmerman SL. Quantifying 4D flow cardiovascular magnetic resonance vortices in patients with pulmonary hypertension: A pilot study. Pulm Circ 2023; 13:e12298. [PMID: 37859803 PMCID: PMC10583650 DOI: 10.1002/pul2.12298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/30/2023] [Accepted: 10/08/2023] [Indexed: 10/21/2023] Open
Abstract
In this 4D flow cardiovascular magnetic resonance (CMR) study, vortical blood flow in the main pulmonary artery (MPA) is quantified using circulation (ᴦ), a metric used in fluid dynamics to quantify the rotational components of flow. Circulation (ᴦ) is a 4D flow CMR metric that quantifies the vortical blood flow pattern in the MPA of patients with pulmonary hypertension (PH), distinguishes them from healthy controls, and shows high correlation with invasive markers of PH severity.
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Affiliation(s)
- Ali Borhani
- The Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Kristin K. Porter
- Department of RadiologyUniversity of Alabama at Birmingham School of MedicineBirminghamAlabamaUSA
| | - Muhammad Umair
- The Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Linda C. Chu
- The Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Stephen C. Mathai
- Division of Pulmonary and Critical Care MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Todd M. Kolb
- Division of Pulmonary and Critical Care MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Rachel L. Damico
- Division of Pulmonary and Critical Care MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Paul M. Hassoun
- Division of Pulmonary and Critical Care MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Ihab R. Kamel
- The Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Stefan L. Zimmerman
- The Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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3
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Simpson CE, Ambade AS, Harlan R, Roux A, Graham D, Klauer N, Tuhy T, Kolb TM, Suresh K, Hassoun PM, Damico RL. Spatial and temporal resolution of metabolic dysregulation in the Sugen hypoxia model of pulmonary hypertension. Pulm Circ 2023; 13:e12260. [PMID: 37404901 PMCID: PMC10315560 DOI: 10.1002/pul2.12260] [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: 04/24/2023] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 07/06/2023] Open
Abstract
Although PAH is partially attributed to disordered metabolism, previous human studies have mostly examined circulating metabolites at a single time point, potentially overlooking crucial disease biology. Current knowledge gaps include an understanding of temporal changes that occur within and across relevant tissues, and whether observed metabolic changes might contribute to disease pathobiology. We utilized targeted tissue metabolomics in the Sugen hypoxia (SuHx) rodent model to investigate tissue-specific metabolic relationships with pulmonary hypertensive features over time using regression modeling and time-series analysis. Our hypotheses were that some metabolic changes would precede phenotypic changes, and that examining metabolic interactions across heart, lung, and liver tissues would yield insight into interconnected metabolic mechanisms. To support the relevance of our findings, we sought to establish links between SuHx tissue metabolomics and human PAH -omics data using bioinformatic predictions. Metabolic differences between and within tissue types were evident by Day 7 postinduction, demonstrating distinct tissue-specific metabolism in experimental pulmonary hypertension. Various metabolites demonstrated significant tissue-specific associations with hemodynamics and RV remodeling. Individual metabolite profiles were dynamic, and some metabolic shifts temporally preceded the emergence of overt pulmonary hypertension and RV remodeling. Metabolic interactions were observed such that abundance of several liver metabolites modulated lung and RV metabolite-phenotype relationships. Taken all together, regression analyses, pathway analyses and time-series analyses implicated aspartate and glutamate signaling and transport, glycine homeostasis, lung nucleotide abundance, and oxidative stress as relevant to early PAH pathobiology. These findings offer valuable insights into potential targets for early intervention in PAH.
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Affiliation(s)
- Catherine E. Simpson
- Johns Hopkins University Division of Pulmonary and Critical Care MedicineBaltimoreMarylandUSA
| | - Anjira S. Ambade
- Johns Hopkins University Division of Pulmonary and Critical Care MedicineBaltimoreMarylandUSA
| | - Robert Harlan
- Johns Hopkins All Children's Hospital Molecular Determinants CoreSt. PetersburgFloridaUSA
| | - Aurelie Roux
- Johns Hopkins All Children's Hospital Molecular Determinants CoreSt. PetersburgFloridaUSA
| | - David Graham
- Johns Hopkins All Children's Hospital Molecular Determinants CoreSt. PetersburgFloridaUSA
| | - Neal Klauer
- Johns Hopkins University Division of Pulmonary and Critical Care MedicineBaltimoreMarylandUSA
| | - Tijana Tuhy
- Johns Hopkins University Division of Pulmonary and Critical Care MedicineBaltimoreMarylandUSA
| | - Todd M. Kolb
- Johns Hopkins University Division of Pulmonary and Critical Care MedicineBaltimoreMarylandUSA
| | - Karthik Suresh
- Johns Hopkins University Division of Pulmonary and Critical Care MedicineBaltimoreMarylandUSA
| | - Paul M. Hassoun
- Johns Hopkins University Division of Pulmonary and Critical Care MedicineBaltimoreMarylandUSA
| | - Rachel L. Damico
- Johns Hopkins University Division of Pulmonary and Critical Care MedicineBaltimoreMarylandUSA
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4
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Simpson CE, Coursen J, Hsu S, Gough EK, Harlan R, Roux A, Aja S, Graham D, Kauffman M, Suresh K, Tedford RJ, Kolb TM, Mathai SC, Hassoun PM, Damico RL. Metabolic profiling of in vivo right ventricular function and exercise performance in pulmonary arterial hypertension. Am J Physiol Lung Cell Mol Physiol 2023; 324:L836-L848. [PMID: 37070742 PMCID: PMC10228670 DOI: 10.1152/ajplung.00003.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/15/2023] [Accepted: 04/07/2023] [Indexed: 04/19/2023] Open
Abstract
Right ventricular (RV) adaptation is the principal determinant of outcomes in pulmonary arterial hypertension (PAH), however, RV function is challenging to assess. RV responses to hemodynamic stressors are particularly difficult to interrogate without invasive testing. This study sought to identify metabolomic markers of in vivo right ventricular function and exercise performance in PAH. Consecutive subjects with PAH (n = 23) underwent rest and exercise right heart catheterization with multibeat pressure volume loop analysis. Pulmonary arterial blood was collected at rest and during exercise. Mass spectrometry-based targeted metabolomics were performed, and metabolic associations with hemodynamics and comprehensive measures of RV function were determined using sparse partial least squares regression. Metabolite profiles were compared with N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) measurements for accuracy in modeling ventriculo-arterial parameters. Thirteen metabolites changed in abundance with exercise, including metabolites reflecting increased arginine bioavailability, precursors of catecholamine and nucleotide synthesis, and branched-chain amino acids. Higher resting arginine bioavailability predicted more favorable exercise hemodynamics and pressure-flow relationships. Subjects with more severe PAH augmented arginine bioavailability with exercise to a greater extent than subjects with less severe PAH. We identified relationships between kynurenine pathway metabolism and impaired ventriculo-arterial coupling, worse RV diastolic function, lower RV contractility, diminished RV contractility with exercise, and RV dilation with exercise. Metabolite profiles outperformed NT-proBNP in modeling RV contractility, diastolic function, and exercise performance. Specific metabolite profiles correspond to RV functional measurements only obtainable via invasive pressure-volume loop analysis and predict RV responses to exercise. Metabolic profiling may inform discovery of RV functional biomarkers.NEW & NOTEWORTHY In this cohort of patients with pulmonary arterial hypertension (PAH), we investigate metabolomic associations with comprehensive right ventricular (RV) functional measurements derived from multibeat RV pressure-volume loop analysis. Our results show that tryptophan metabolism, particularly the kynurenine pathway, is linked to intrinsic RV function and PAH pathobiology. Findings also highlight the importance of arginine bioavailability in the cardiopulmonary system's response to exercise stress. Metabolite profiles selected via unbiased analysis outperformed N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) in predicting load-independent measures of RV function at rest and cardiopulmonary system performance under stress. Overall, this work suggests the potential for select metabolites to function as disease-specific biomarkers, offers insights into PAH pathobiology, and informs discovery of potentially targetable RV-centric pathways.
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Affiliation(s)
- Catherine E Simpson
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Julie Coursen
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Steven Hsu
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Ethan K Gough
- Division of Human Nutrition, Johns Hopkins University School of Public Health, Baltimore, Maryland, United States
| | - Robert Harlan
- Molecular Determinants Core, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, United States
| | - Aurelie Roux
- Molecular Determinants Core, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, United States
| | - Susan Aja
- Molecular Determinants Core, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, United States
| | - David Graham
- Molecular Determinants Core, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, United States
| | - Matthew Kauffman
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Karthik Suresh
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Ryan J Tedford
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Todd M Kolb
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Stephen C Mathai
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Paul M Hassoun
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Rachel L Damico
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
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5
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Del Rosario O, Suresh K, Kallem M, Singh G, Shah A, Zheng L, Yun X, Philip NM, Putcha N, McClure MB, Jiang H, D'Alessio F, Srivastava M, Bera A, Shimoda LA, Merchant M, Rane MJ, Machamer CE, Mock J, Hagan R, Koch AL, Punjabi NM, Kolb TM, Damarla M. MK2 nonenzymatically promotes nuclear translocation of caspase-3 and resultant apoptosis. Am J Physiol Lung Cell Mol Physiol 2023; 324:L700-L711. [PMID: 36976920 PMCID: PMC10190840 DOI: 10.1152/ajplung.00340.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/28/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023] Open
Abstract
We have previously identified mitogen-activated protein kinase-activated protein kinase 2 (MK2) is required for caspase-3 nuclear translocation in the execution of apoptosis; however, little is known of the underlying mechanisms. Therefore, we sought to determine the role of kinase and nonkinase functions of MK2 in promoting nuclear translocation of caspase-3. We identified two non-small cell lung cancer cell lines for use in these experiments based on low MK2 expression. Wild-type, enzymatic and cellular localization mutant MK2 constructs were expressed using adenoviral infection. Cell death was evaluated by flow cytometry. In addition, cell lysates were harvested for protein analyses. Phosphorylation of caspase-3 was determined using two-dimensional gel electrophoresis followed by immunoblotting and in vitro kinase assay. Association between MK2 and caspase-3 was evaluated using proximity-based biotin ligation assays and co-immunoprecipitation. Overexpression of MK2 resulted in nuclear translocation of caspase-3 and caspase-3-mediated apoptosis. MK2 directly phosphorylates caspase-3; however, phosphorylation status of caspase-3 or MK2-dependent phosphorylation of caspase-3 did not alter caspase-3 activity. The enzymatic function of MK2 was dispensable in nuclear translocation of caspase-3. MK2 and caspase-3 associated together and a nonenzymatic function of MK2, chaperoned nuclear trafficking, is required for caspase-3-mediated apoptosis. Taken together, our results demonstrate a nonenzymatic role for MK2 in the nuclear translocation of caspase-3. Furthermore, MK2 may function as a molecular switch in regulating the transition between the cytosolic and nuclear functions of caspase-3.
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Affiliation(s)
- Othello Del Rosario
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Karthik Suresh
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Medha Kallem
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Gayatri Singh
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Anika Shah
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Linda Zheng
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Xin Yun
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Nicolas M Philip
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Nirupama Putcha
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Marni B McClure
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Haiyang Jiang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Franco D'Alessio
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Meera Srivastava
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
| | - Alakesh Bera
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
| | - Larissa A Shimoda
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Michael Merchant
- Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, United States
| | - Madhavi J Rane
- Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, United States
| | - Carolyn E Machamer
- Department of Cell Biology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Jason Mock
- Department of Medicine, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, United States
| | - Robert Hagan
- Department of Medicine, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, United States
| | - Abigail L Koch
- Department of Medicine, University of Miami, School of Medicine, Miami, Florida, United States
| | - Naresh M Punjabi
- Department of Medicine, University of Miami, School of Medicine, Miami, Florida, United States
| | - Todd M Kolb
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Mahendra Damarla
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
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6
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Suresh K, Del Rosario O, Kallem M, Singh G, Shah A, Zheng L, Yun X, Philip NM, Putcha N, McClure MB, Jiang H, D'Alessio F, Srivastava M, Bera A, Shimoda LA, Merchant M, Rane MJ, Machamer CE, Mock J, Hagan R, Koch AL, Punjabi NM, Kolb TM, Damarla M. Tumor MK2 transcript levels are associated with improved response to chemotherapy and patient survival in non-small cell lung cancer. Physiol Genomics 2023; 55:168-178. [PMID: 36878491 PMCID: PMC10042611 DOI: 10.1152/physiolgenomics.00155.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/08/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
Non-small cell lung cancers (NSCLCs) demonstrate intrinsic resistance to cell death, even after chemotherapy. Previous work suggested defective nuclear translocation of active caspase-3 in observed resistance to cell death. We have identified mitogen-activated protein kinase-activated protein kinase 2 (MK2; encoded by the gene MAPKAPK2) is required for caspase-3 nuclear translocation in the execution of apoptosis in endothelial cells. The objective was to determine MK2 expression in NSCLCs and the association between MK2 and clinical outcomes in patients with NSCLC. Clinical and MK2 mRNA data were extracted from two demographically distinct NSCLC clinical cohorts, North American (The Cancer Genome Atlas, TCGA) and East Asian (EA). Tumor responses following first round of chemotherapy were dichotomized as clinical response (complete response, partial response, and stable disease) or progression of disease. Multivariable survival analyses were performed using Cox proportional hazard ratios and Kaplan-Meier curves. NSCLC exhibited lower MK2 expression than SCLC cell lines. In patients, lower tumor MK2 transcript levels were observed in those presenting with late-stage NSCLC. Higher MK2 expression was associated with clinical response following initial chemotherapy and independently associated with improved 2-yr survival in two distinct cohorts, 0.52 (0.28-0.98) and 0.1 (0.01-0.81), TCGA and EA, respectively, even after adjusting for common oncogenic driver mutations. Survival benefit of higher MK2 expression was unique to lung adenocarcinoma when comparing across various cancers. This study implicates MK2 in apoptosis resistance in NSCLC and suggests prognostic value of MK2 transcript levels in patients with lung adenocarcinoma.
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Affiliation(s)
- Karthik Suresh
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Othello Del Rosario
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Medha Kallem
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Gayatri Singh
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Anika Shah
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Linda Zheng
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Xin Yun
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Nicolas M Philip
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Nirupama Putcha
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Marni B McClure
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Haiyang Jiang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Franco D'Alessio
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Meera Srivastava
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
| | - Alakesh Bera
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
| | - Larissa A Shimoda
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Michael Merchant
- Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, United States
| | - Madhavi J Rane
- Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, United States
| | - Carolyn E Machamer
- Department of Cell Biology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Jason Mock
- Department of Medicine, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, United States
| | - Robert Hagan
- Department of Medicine, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, United States
| | - Abigail L Koch
- Department of Medicine, School of Medicine, University of Miami, Miami, Florida, United States
| | - Naresh M Punjabi
- Department of Medicine, School of Medicine, University of Miami, Miami, Florida, United States
| | - Todd M Kolb
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Mahendra Damarla
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
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7
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Hassan HJ, Naranjo M, Ayoub N, Housten T, Hsu S, Balasubramanian A, Simpson CE, Damico RL, Mathai SC, Kolb TM, Hassoun PM. Improved Survival for Patients with Systemic Sclerosis-associated Pulmonary Arterial Hypertension: The Johns Hopkins Registry. Am J Respir Crit Care Med 2023; 207:312-322. [PMID: 36173815 PMCID: PMC9896646 DOI: 10.1164/rccm.202204-0731oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 09/29/2022] [Indexed: 02/03/2023] Open
Abstract
Rationale: To date, it remains unclear whether recent changes in the management of patients with systemic sclerosis-associated pulmonary hypertension (SSc-PH) have improved survival. Objectives: To describe a cohort of patients with SSc-PH and compare their characteristics and survival between the last two decades. Methods: Patients with SSc-PH prospectively enrolled in the Johns Hopkins Pulmonary Hypertension Center Registry were grouped into two cohorts based on the date of diagnostic right heart catheterization: cohort A included patients whose disease was diagnosed between 1999 and 2010, and cohort B included those whose disease was diagnosed between 2010 and 2021. Patients' characteristics were compared between the two cohorts. Measurements and Main Results: Of 504 patients with SSc-PH distributed almost equally between the two cohorts, 308 (61%) had World Symposium on Pulmonary Hypertension group 1, 43 (9%) had group 2, and 151 (30%) had group 3 disease. Patients with group 1 disease in cohort B had significantly better clinical and hemodynamic characteristics at diagnosis, were more likely to receive upfront combination pulmonary arterial hypertension therapy, and had a nearly 4-year increase in median transplant-free survival in univariable analysis than those in cohort A (P < 0.01). Improved transplant-free survival was still observed after adjusting for patients' baseline characteristics. In contrast, for group 2 or 3 patients with SSc-PH, there were no differences in baseline clinical, hemodynamic, or survival characteristics between the two cohorts. Conclusions: This is the largest single-center study that compares clinical characteristics of patients with SSc-PH between the last two decades. Transplant-free survival has improved significantly for those with group 1 disease over the last decade, possibly secondary to earlier detection and better therapeutic management. Conversely, those with group 2 or 3 disease continue to have dismal prognosis.
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Affiliation(s)
| | - Mario Naranjo
- Division of Pulmonary and Critical Care Medicine and
| | - Nour Ayoub
- Division of Pulmonary and Critical Care Medicine and
| | - Traci Housten
- Division of Pulmonary and Critical Care Medicine and
| | - Steven Hsu
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | | | - Todd M. Kolb
- Division of Pulmonary and Critical Care Medicine and
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8
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Hassan HJ, Naranjo M, Kazzi B, Housten-Harris T, Hsu S, Balasubramanian A, Simpson CE, Damico RL, Kolb TM, Mathai SC, Hassoun PM. Risk assessment of systemic sclerosis-associated pulmonary arterial hypertension: cardiac index versus stroke volume index. Eur Respir J 2022; 60:13993003.00801-2022. [PMID: 35896206 DOI: 10.1183/13993003.00801-2022] [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: 04/20/2022] [Accepted: 07/06/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Hussein J Hassan
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mario Naranjo
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brigitte Kazzi
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Traci Housten-Harris
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Steven Hsu
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aparna Balasubramanian
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Catherine E Simpson
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rachel L Damico
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Todd M Kolb
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Stephen C Mathai
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paul M Hassoun
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Mercurio V, Hassan HJ, Naranjo M, Cuomo A, Mazurek JA, Forfia PR, Balasubramanian A, Simpson CE, Damico RL, Kolb TM, Mathai SC, Hsu S, Mukherjee M, Hassoun PM. Risk Stratification of Patients with Pulmonary Arterial Hypertension: The Role of Echocardiography. J Clin Med 2022; 11:4034. [PMID: 35887800 PMCID: PMC9323074 DOI: 10.3390/jcm11144034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/28/2022] [Accepted: 07/09/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Given the morbidity and mortality associated with pulmonary arterial hypertension (PAH), risk stratification approaches that guide therapeutic management have been previously employed. However, most patients remain in the intermediate-risk category despite initial therapy. Herein, we sought to determine whether echocardiographic parameters could improve the risk stratification of intermediate-risk patients. Methods: Prevalent PAH patients previously enrolled in observational studies at 3 pulmonary hypertension centers were included in this study. A validated PAH risk stratification approach was used to stratify patients into low-, intermediate-, and high-risk groups. Right ventricular echocardiographic parameters were used to further stratify intermediate-risk patients into intermediate-low- and intermediate-high-risk groups based on transplant-free survival. Results: From a total of 146 patients included in our study, 38 patients died over a median follow-up of 2.5 years. Patients with intermediate-/high-risk had worse echocardiographic parameters. Tricuspid annular plane systolic excursion (TAPSE) and the degree of tricuspid regurgitation (TR) were highly associated with survival (p < 0.01, p = 0.04, respectively) and were subsequently used to further stratify intermediate-risk patients. Among intermediate-risk patients, survival was worse for patients with TAPSE < 19 mm compared to those with TAPSE ≥ 19 mm (estimated one-year survival 74% vs. 96%, p < 0.01) and for patients with moderate/severe TR compared to those with no/trace/mild TR (estimated one-year survival 70% vs. 93%, p < 0.01). Furthermore, among intermediate-risk patients, those with both TAPSE < 19 mm and moderate/severe TR had an estimated one-year survival (56%) similar to that of high-risk patients (56%), and those with both TAPSE ≥ 19 mm and no/trace/mild TR had an estimated one-year survival (97%) similar to that of low-risk patients (95%). Conclusions: Echocardiography, a routinely performed, non-invasive imaging modality, plays a pivotal role in discriminating distinct survival phenotypes among prevalent intermediate-risk PAH patients using TAPSE and degree of TR. This can potentially help guide subsequent therapy.
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Affiliation(s)
- Valentina Mercurio
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (H.J.H.); (M.N.); (A.B.); (C.E.S.); (R.L.D.); (T.M.K.); (S.C.M.)
- Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy;
| | - Hussein J. Hassan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (H.J.H.); (M.N.); (A.B.); (C.E.S.); (R.L.D.); (T.M.K.); (S.C.M.)
| | - Mario Naranjo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (H.J.H.); (M.N.); (A.B.); (C.E.S.); (R.L.D.); (T.M.K.); (S.C.M.)
| | - Alessandra Cuomo
- Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy;
| | - Jeremy A. Mazurek
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Paul R. Forfia
- Pulmonary Hypertension, Right Heart Failure and Pulmonary Thromboendarterectomy Program, Temple University Hospital, Philadelphia, PA 19140, USA;
| | - Aparna Balasubramanian
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (H.J.H.); (M.N.); (A.B.); (C.E.S.); (R.L.D.); (T.M.K.); (S.C.M.)
| | - Catherine E. Simpson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (H.J.H.); (M.N.); (A.B.); (C.E.S.); (R.L.D.); (T.M.K.); (S.C.M.)
| | - Rachel L. Damico
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (H.J.H.); (M.N.); (A.B.); (C.E.S.); (R.L.D.); (T.M.K.); (S.C.M.)
| | - Todd M. Kolb
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (H.J.H.); (M.N.); (A.B.); (C.E.S.); (R.L.D.); (T.M.K.); (S.C.M.)
| | - Stephen C. Mathai
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (H.J.H.); (M.N.); (A.B.); (C.E.S.); (R.L.D.); (T.M.K.); (S.C.M.)
| | - Steven Hsu
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (S.H.); (M.M.)
| | - Monica Mukherjee
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (S.H.); (M.M.)
| | - Paul M. Hassoun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (H.J.H.); (M.N.); (A.B.); (C.E.S.); (R.L.D.); (T.M.K.); (S.C.M.)
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10
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Mukherjee M, Mercurio V, Balasubramanian A, Shah AA, Hsu S, Simpson CE, Damico R, Kolb TM, Hassoun PM, Mathai SC. Defining minimal detectable difference in echocardiographic measures of right ventricular function in systemic sclerosis. Arthritis Res Ther 2022; 24:146. [PMID: 35717399 PMCID: PMC9206258 DOI: 10.1186/s13075-022-02835-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 05/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Echocardiography (2DE) is integral for screening and longitudinal evaluation of pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc). In the present study, we sought to establish the reliability, repeatability, and reproducibility of 2DE parameters in SSc patients with and without PAH and to define the minimal detectable difference (MDD), the smallest change detected beyond measurement error. METHODS SSc patients without known PAH and with invasively confirmed PAH on stable therapies underwent 2DE with strain at two time points. Analysis of variance (ANOVA) and coefficients of variation (CV) were calculated to assess for repeatability, reliability, and reproducibility. Intra- and inter-observer agreement were assessed using intraclass correlation. Bland-Altman analysis explored the level of agreement between evaluations. MDD was calculated using the standard error of measurement for each parameter by cohort. RESULTS ANOVA demonstrated few significant differences between evaluations across groups. Global right ventricular longitudinal systolic strain (GRVLSS, 9.7%) and fractional area change (FAC, 21.3%) had the largest CV, while tricuspid annular plane excursion (TAPSE), S' wave, and right ventricular outflow track velocity time integral (RVOT VTI) were 0.87%, 3.2%, and 6.0%, respectively. Intra- and inter-observer agreement was excellent. MDD for TAPSE, FAC, S' wave, RVOT VTI, GRVLSS, and RVSP were 0.11 cm, 0.03%, 1.27 cm/s, 0.81 cm, 1.14%, and 6.5 mmHg, respectively. CONCLUSIONS We demonstrate minimal measurement error in clinically important 2DE-based measures in SSc patients with and without PAH. Defining the MDD in this population has important implications for PAH screening, assessment of therapeutic response, and sample size calculations for future clinical trials.
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Affiliation(s)
- Monica Mukherjee
- Divisions of Cardiology, Johns Hopkins University, 1830 E. Monument Street, Room 540, Baltimore, MD, 21205, USA
| | - Valentina Mercurio
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 E. Monument Street, Room 540, Baltimore, MD, 21205, USA
| | - Aparna Balasubramanian
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 E. Monument Street, Room 540, Baltimore, MD, 21205, USA
| | - Ami A Shah
- Divison of Rheumatology, Johns Hopkins University, 1830 E. Monument Street, Room 540, Baltimore, MD, 21205, USA
| | - Steven Hsu
- Divisions of Cardiology, Johns Hopkins University, 1830 E. Monument Street, Room 540, Baltimore, MD, 21205, USA
| | - Catherine E Simpson
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 E. Monument Street, Room 540, Baltimore, MD, 21205, USA
| | - Rachel Damico
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 E. Monument Street, Room 540, Baltimore, MD, 21205, USA
| | - Todd M Kolb
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 E. Monument Street, Room 540, Baltimore, MD, 21205, USA
| | - Paul M Hassoun
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 E. Monument Street, Room 540, Baltimore, MD, 21205, USA
| | - Stephen C Mathai
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 E. Monument Street, Room 540, Baltimore, MD, 21205, USA.
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11
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Berardi C, Bluemke DA, Houston BA, Kolb TM, Lima JA, Pezel T, Tedford RJ, Rayner SG, Cheng RK, Leary PJ. Association of soluble Flt-1 with heart failure and cardiac morphology: The MESA angiogenesis study. J Heart Lung Transplant 2022; 41:619-625. [PMID: 35184966 PMCID: PMC9038636 DOI: 10.1016/j.healun.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/23/2021] [Accepted: 01/02/2022] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Soluble Fms-like tyrosine kinase 1 (sFlt-1) may inhibit angiogenesis. Higher levels of sFlt-1 are associated with worse prognosis in prevalent heart failure patients. The aim of this study was to better understand the role of sFlt-1 in heart failure pathogenesis by characterizing relationships between sFlt-1, cardiac morphology, and the composite outcome of incident heart failure or cardiovascular (CV) death in in a multiethnic cohort free of CV disease at baseline. METHODS sFlt-1 was measured in 1,381 participants in the Multi-Ethnic Study of Atherosclerosis Angiogenesis sub-study. Linear regression was used to estimate the association between sFlt-1 and cardiac morphology and Cox proportional hazard regression was used to estimate associations with incident heart failure or CV mortality. RESULTS Over a median follow-up of 13.1 years, higher sFlt-1 levels were associated with incident heart failure or CV mortality independent from CV risk factors or NT-proBNP levels (HR 1.17, 95% CI 1.10-1.26, p < 0.001). Higher sFlt-1 levels were also associated with greater baseline left ventricular (LV) mass by cardiac MRI and increased loss of LV mass over the 10 years following the baseline exam (p-value 0.02 for each), but this association was no longer statistically significant after adjustment for baseline NT-proBNP (p = 0.11 and 0.10 respectively). CONCLUSIONS Baseline sFlt-1 levels are associated with incident heart failure and cardiovascular mortality independent of traditional CV risk factors or NT-proBNP. An association was also found with cardiac mass but was no longer significant after adjustment for NT-proBNP.
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Affiliation(s)
- Cecilia Berardi
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington
| | - David A Bluemke
- Department of Radiology, University of Wisconsin, Madison, Wisconsin
| | - Brian A Houston
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Todd M Kolb
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, Maryland
| | - João A Lima
- Departments of Medicine and Radiology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Theo Pezel
- Departments of Medicine and Radiology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Ryan J Tedford
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Samuel G Rayner
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington
| | - Richard K Cheng
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington
| | - Peter J Leary
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington.
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12
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Naranjo M, Mercurio V, Hassan H, Alturaif N, Cuomo A, Attanasio U, Diab N, Sahetya SK, Mukherjee M, Hsu S, Balasubramanian A, Simpson CE, Damico R, Kolb TM, Mathai SC, Hassoun PM. Causes and outcomes of ICU hospitalisations in patients with pulmonary arterial hypertension. ERJ Open Res 2022; 8:00002-2022. [PMID: 35586454 PMCID: PMC9108967 DOI: 10.1183/23120541.00002-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/10/2022] [Indexed: 11/05/2022] Open
Abstract
Rationale Pulmonary arterial hypertension (PAH) is a rare disease characterised by limited survival despite remarkable improvements in therapy. The causes, clinical burden and outcomes of patients admitted to the intensive care unit (ICU) remain poorly characterised. The aim of this study was to describe patient characteristics, causes of ICU hospitalisation, and risk factors for ICU and 1-year mortality. Methods Data from patients enrolled in the Johns Hopkins Pulmonary Hypertension Registry were analysed for the period between January 2010 and December 2020. Clinical, functional, haemodynamic and laboratory data were collected. Measurements and main results 102 adult patients with 155 consecutive ICU hospitalisations were included. The leading causes for admission were right heart failure (RHF, 53.3%), infection (17.4%) and arrhythmia (11.0%). ICU mortality was 27.1%. Mortality risk factors included Na <136 mEq·mL-1 (OR: 3.10, 95% CI: 1.41-6.82), elevated pro-B-type natriuretic peptide (proBNP) (OR: 1.75, 95% CI: 1.03-2.98), hyperbilirubinaemia (OR: 1.40, 95% CI: 1.09-1.80), hyperlactaemia (OR: 1.42, 95% CI: 1.05-1.93), and need for vasopressors/inotropes (OR: 5.29, 95% CI: 2.28-12.28), mechanical ventilation (OR: 3.76, 95% CI: 1.63-8.76) and renal replacement therapy (OR: 5.57, 95% CI: 1.25-24.76). Mortality rates at 3, 6 and 12 months were 17.5%, 27.6% and 39.0%, respectively. Connective tissue disease-associated PAH has lower 1-year survival compared to idiopathic PAH (51.4% versus 79.8%, log-rank test p=0.019). Conclusions RHF is the most common cause for ICU admission. In-hospital and 1-year mortality remain exceedingly high despite improved ICU care. Recognising specific risk factors on admission can help identifying patients at risk for poor outcomes.
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Affiliation(s)
- Mario Naranjo
- Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Johns Hopkins University, Baltimore, MD, USA
- These authors contributed equally
| | - Valentina Mercurio
- Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Dept of Translational Medical Sciences, Federico II University, Naples, Italy
- These authors contributed equally
| | - Hussein Hassan
- Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Noura Alturaif
- Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, VA, USA
| | - Alessandra Cuomo
- Dept of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Umberto Attanasio
- Dept of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Nermin Diab
- Dept of Medicine, Division of Respirology, University of Toronto, Toronto, ON, Canada
| | - Sarina K. Sahetya
- Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Monica Mukherjee
- Division of Cardiology, Dept of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Steven Hsu
- Division of Cardiology, Dept of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Aparna Balasubramanian
- Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Catherine E. Simpson
- Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Rachel Damico
- Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Todd M. Kolb
- Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Stephen C. Mathai
- Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Paul M. Hassoun
- Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Johns Hopkins University, Baltimore, MD, USA
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13
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Boyle TA, Daimee UA, Simpson CE, Kolb TM, Mathai SC, Akhtar T, Nyhan D, Calkins H, Spragg D. Left Atrial Ablation for the Management of Atrial Tachyarrhythmias in Patients with Pulmonary Hypertension: A Case Series. HeartRhythm Case Rep 2022; 8:275-279. [PMID: 35497477 PMCID: PMC9039084 DOI: 10.1016/j.hrcr.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Thomas A. Boyle
- Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland
- Address reprint requests and correspondence: Dr Thomas A. Boyle, Division of Cardiology, Johns Hopkins Hospital, 600 North Wolfe St, Baltimore, MD 21287.
| | - Usama A. Daimee
- Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Catherine E. Simpson
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Todd M. Kolb
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Stephen C. Mathai
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Tauseef Akhtar
- Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Daniel Nyhan
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Hugh Calkins
- Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland
| | - David Spragg
- Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland
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14
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Simpson CE, Kolb TM, Hsu S, Zimmerman SL, Corona‐Villalobos CP, Mathai SC, Damico RL, Hassoun PM. Ventricular mass discriminates pulmonary arterial hypertension as redefined at the Sixth World Symposium on Pulmonary Hypertension. Pulm Circ 2022; 12:e12005. [PMID: 35506079 PMCID: PMC9052971 DOI: 10.1002/pul2.12005] [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: 02/22/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 11/09/2022] Open
Abstract
Cardiac magnetic resonance (CMR) measures of right ventricular (RV) mass, volumes, and function have diagnostic and prognostic value in pulmonary arterial hypertension (PAH). We hypothesized that RV mass-based metrics would discriminate incident PAH as redefined by the lower mean pulmonary arterial pressure (mPAP) threshold of >20 mmHg at the Sixth World Symposium on Pulmonary Hypertension (6th WSPH). Eighty-nine subjects with suspected PAH underwent CMR imaging, including 64 subjects with systemic sclerosis (SSc). CMR metrics, including RV and left ventricular (LV) mass, were measured. All subjects underwent right heart catheterization (RHC) for assessment of hemodynamics within 48 h of CMR. Using generalized linear models, associations between CMR metrics and PAH were assessed, the best subset of CMR variables for predicting PAH were identified, and relationships between mass-based metrics, hemodynamics, and other predictive CMR metrics were examined. Fifty-nine subjects met 6th WSPH criteria for PAH. RV mass metrics, including ventricular mass index (VMI), demonstrated the greatest magnitude difference between subjects with versus without PAH. Overall and in SSc, VMI and RV mass measured by CMR were among the most predictive variables discriminating PAH at RHC, with areas under the receiver operating characteristic curve 0.86 and 0.83. respectively. VMI increased linearly with pulmonary vascular resistance and with mPAP in PAH, including in lower ranges of mPAP associated with mild PAH. VMI ≥ 0.37 yielded a positive predictive value of 90% for discriminating PAH. RV mass metrics measured by CMR, including VMI, discriminate incident, treatment-naïve PAH as defined by 6th WSPH criteria.
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Affiliation(s)
- Catherine E. Simpson
- Department of Medicine, Division of Pulmonary and Critical Care MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Todd M. Kolb
- Department of Medicine, Division of Pulmonary and Critical Care MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Steven Hsu
- Department of Medicine, Division of CardiologyJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Stefan L. Zimmerman
- Department of Radiology and Radiological ScienceJohns Hopkins UniversityBaltimoreMarylandUSA
| | | | - Stephen C. Mathai
- Department of Medicine, Division of Pulmonary and Critical Care MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Rachel L. Damico
- Department of Medicine, Division of Pulmonary and Critical Care MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Paul M. Hassoun
- Department of Medicine, Division of Pulmonary and Critical Care MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
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15
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Sato T, Ambale-Venkatesh B, Zimmerman SL, Tedford RJ, Hsu S, Chamera E, Fujii T, Mullin CJ, Mercurio V, Khair R, Corona-Villalobos CP, Simpson CE, Damico RL, Kolb TM, Mathai SC, Lima JA, Kass DA, Tsujino I, Hassoun PM. Right ventricular function as assessed by cardiac magnetic resonance imaging-derived strain parameters compared to high-fidelity micromanometer catheter measurements. Pulm Circ 2021; 11:20458940211032529. [PMID: 34603686 PMCID: PMC8481729 DOI: 10.1177/20458940211032529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/07/2021] [Accepted: 06/17/2021] [Indexed: 11/16/2022] Open
Abstract
Right ventricular function has prognostic significance in patients with pulmonary hypertension. We evaluated whether cardiac magnetic resonance-derived strain and strain rate parameters could reliably reflect right ventricular systolic and diastolic function in precapillary pulmonary hypertension. End-systolic elastance and the time constant of right ventricular relaxation tau, both derived from invasive high-fidelity micromanometer catheter measurements, were used as gold standards for assessing systolic and diastolic right ventricular function, respectively. Nineteen consecutive precapillary pulmonary hypertension patients underwent cardiac magnetic resonance and right heart catheterization prospectively. Cardiac magnetic resonance data were compared with those of 19 control subjects. In pulmonary hypertension patients, associations between strain- and strain rate-related parameters and invasive hemodynamic parameters were evaluated. Longitudinal peak systolic strain, strain rate, and early diastolic strain rate were lower in PAH patients than in controls; peak atrial-diastolic strain rate was higher in pulmonary hypertension patients. Similarly, circumferential peak systolic strain rate was lower and peak atrial-diastolic strain rate was higher in pulmonary hypertension. In pulmonary hypertension, no correlations existed between cardiac magnetic resonance-derived and hemodynamically derived measures of systolic right ventricular function. Regarding diastolic parameters, tau was significantly correlated with peak longitudinal atrial-diastolic strain rate (r = -0.61), deceleration time (r = 0.75), longitudinal systolic to diastolic time ratio (r = 0.59), early diastolic strain rate (r = -0.5), circumferential peak atrial-diastolic strain rate (r = -0.52), and deceleration time (r = 0.62). Strain analysis of the right ventricular diastolic phase is a reliable non-invasive method for detecting right ventricular diastolic dysfunction in PAH.
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Affiliation(s)
- Takahiro Sato
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bharath Ambale-Venkatesh
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stefan L. Zimmerman
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ryan J. Tedford
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Steven Hsu
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ela Chamera
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tomoki Fujii
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Valentina Mercurio
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rubina Khair
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Celia P. Corona-Villalobos
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Catherine E. Simpson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rachel L. Damico
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Todd M. Kolb
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephen C. Mathai
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joao A.C. Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David A. Kass
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ichizo Tsujino
- First Department of Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Paul M. Hassoun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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16
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Diaz-Rodriguez N, Nyhan SM, Kolb TM, Steppan J. How We Would Treat Our Own Pulmonary Hypertension if We Needed to Undergo Cardiac Surgery. J Cardiothorac Vasc Anesth 2021; 36:1540-1548. [PMID: 34649806 DOI: 10.1053/j.jvca.2021.09.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/18/2021] [Revised: 09/13/2021] [Accepted: 09/19/2021] [Indexed: 01/08/2023]
Abstract
Pulmonary hypertension (PH) is a disease that has many etiologies and is particularly prevalent in patients presenting for cardiac surgery, with which it is linked to poor outcomes. This manuscript is intended to provide a comprehensive review of the impact of PH on the perioperative management of patients who are undergoing cardiac surgery. The diagnosis of PH often involves a combination of noninvasive and invasive testing, whereas preoperative optimization frequently necessitates the use of specific medications that affect anesthetic management of these patients. The authors postulate that a thoughtful, multidisciplinary approach is required to deliver excellent perioperative care. Furthermore, they use an index case to illustrate the implications of managing a patient with pulmonary hypertension who presents for cardiac surgery with cardiopulmonary bypass.
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Affiliation(s)
- Natalia Diaz-Rodriguez
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Sinead M Nyhan
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Todd M Kolb
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Jochen Steppan
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.
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Kolb TM, Johnston L, Damarla M, Kass DA, Hassoun PM. PDE9A deficiency does not prevent chronic-hypoxic pulmonary hypertension in mice. Physiol Rep 2021; 9:e15057. [PMID: 34569183 PMCID: PMC8474007 DOI: 10.14814/phy2.15057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 09/03/2021] [Accepted: 09/04/2021] [Indexed: 12/31/2022] Open
Abstract
Inhibition of cyclic guanosine monophosphate (cGMP)-specific phosphodiesterases (PDEs) is a cornerstone of pulmonary arterial hypertension (PAH)-specific therapy. PDE9A, expressed in the heart and lung tissue, has the highest affinity for cGMP of all known PDEs. PDE9A deficiency protects mice against chronic left ventricular (LV) pressure overload via increased natriuretic peptide (NP)-dependent cGMP signaling. Chronic-hypoxic pulmonary hypertension (CH-PH) is a model of chronic right ventricular (RV) pressure overload, and previous studies have demonstrated a protective role for NPs in the murine model. Therefore, we hypothesized that PDE9A deficiency would promote NP-dependent cGMP signaling and prevent RV remodeling in the CH-PH model, analogous to findings in the LV. We exposed wild-type and PDE9A-deficient (Pde9a-/- ) C57BL/6 mice to CH-PH for 3 weeks. We measured RV pressure, hypertrophy, and levels of lung and RV cGMP, PDE9A, PDE5A, and phosphorylation of the protein kinase G substrate VASP (vasodilatory-stimulated phosphoprotein) after CH-PH. In wild-type mice, CH-PH was associated with increased circulating ANP and lung PDE5A, but no increase in cGMP, PDE9A, or VASP phosphorylation. Downstream effectors of cGMP were not increased in Pde9a-/- mice exposed to CH-PH compared with Pde9a+/+ littermates, and CH-PH induced increases in RV pressure and hypertrophy were not attenuated in knockout mice. Taken together, these findings argue against a prominent role for PDE9A in the murine CH-PH model.
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Affiliation(s)
- Todd M. Kolb
- Division of Pulmonary and Critical Care Medicine PulmonaryJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Laura Johnston
- Division of Pulmonary and Critical Care Medicine PulmonaryJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Mahendra Damarla
- Division of Pulmonary and Critical Care Medicine PulmonaryJohns Hopkins UniversityBaltimoreMarylandUSA
| | - David A. Kass
- Division of CardiologyDepartment of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Paul M. Hassoun
- Division of Pulmonary and Critical Care Medicine PulmonaryJohns Hopkins UniversityBaltimoreMarylandUSA
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18
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Hassan HJ, Housten T, Balasubramanian A, Simpson CE, Damico RL, Mathai SC, Hassoun PM, Steppan J, Leary PJ, Kolb TM. A novel approach to perioperative risk assessment for patients with pulmonary hypertension. ERJ Open Res 2021; 7:00257-2021. [PMID: 34291108 PMCID: PMC8287131 DOI: 10.1183/23120541.00257-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/02/2021] [Indexed: 11/06/2022] Open
Abstract
Rationale Pulmonary hypertension (PH) is associated with significant perioperative morbidity and mortality. We hypothesised that pulmonary arterial hypertension (PAH) composite risk assessment scores could estimate perioperative risk for PH patients when adjusted for inherent procedural risk. Methods We identified patients in the Johns Hopkins PH Center Registry that had noncardiac surgery (including endoscopies) between September 2015 and January 2020. We collected information on preoperative patient-level and procedural variables and used logistic regression to evaluate associations with a composite outcome of death within 30 days or serious postoperative complication. We generated composite patient-level risk assessment scores for each subject and used logistic regression to estimate the association with adverse surgical outcomes. We adjusted multivariable models for inherent procedural risk of major cardiovascular events and used these models to generate a numerical PH perioperative risk (PHPR) score. Results Among 150 subjects, 19 (12.7%) reached the primary outcome, including 7 deaths (4.7%). Individual patient-level and procedural variables were associated with the primary outcome (all p<0.05). A composite patient-level risk assessment score built on three noninvasive parameters was strongly associated with reduced risk for poor outcomes (OR=0.4, p=0.03). This association was strengthened after adjusting the model for procedural risk. A PHPR score derived from the multivariable model stratified patients into low (0%), intermediate (≤10%), or high (>10%) risk of reaching the primary outcome. Conclusion Composite PAH risk assessment scores can predict perioperative risk for PH patients after accounting for inherent procedural risk. Validation of the PHPR score in a multicentre, prospective cohort is warranted. For patients with pulmonary hypertension undergoing noncardiac surgery, perioperative risk can be estimated using a model that combines inherent procedural risk with composite PAH risk assessment scoreshttps://bit.ly/3uTCibP
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Affiliation(s)
- Hussein J Hassan
- Dept of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Traci Housten
- Dept of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Aparna Balasubramanian
- Dept of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Catherine E Simpson
- Dept of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Rachel L Damico
- Dept of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Stephen C Mathai
- Dept of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Paul M Hassoun
- Dept of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jochen Steppan
- Dept of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Peter J Leary
- Dept of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - Todd M Kolb
- Dept of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
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19
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Peplinski BS, Houston BA, Bluemke DA, Kawut SM, Kolb TM, Kronmal RA, Lima JAC, Ralph DD, Rayner SG, Steinberg ZL, Tedford RJ, Leary PJ. Associations of Angiopoietins With Heart Failure Incidence and Severity. J Card Fail 2021; 27:786-795. [PMID: 33872759 DOI: 10.1016/j.cardfail.2021.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/30/2021] [Accepted: 04/02/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Angiopoietin-1 and 2 (Ang1, Ang2) are important mediators of angiogenesis. Angiopoietin levels are perturbed in cardiovascular disease, but it is unclear whether angiopoietin signaling is causative, an adaptive response, or merely epiphenomenon of disease activity. METHODS AND RESULTS In a cohort free of cardiovascular disease at baseline (Multi-Ethnic Study of Atherosclerosis [MESA]), relationships between angiopoietins, cardiac morphology, and subsequent incidence of heart failure or cardiovascular death were evaluated. In cohorts with pulmonary arterial hypertension or left heart disease, associations between angiopoietins, invasive hemodynamics, and adverse clinical outcomes were evaluated. In MESA, Ang2 was associated with a higher incidence of heart failure or cardiovascular death (hazard ratio 1.21 per standard deviation, P < .001). Ang2 was associated with increased right atrial pressure (pulmonary arterial hypertension cohort) and increased wedge pressure and right atrial pressure (left heart disease cohort). Elevated Ang2 was associated with mortality in the pulmonary arterial hypertension cohort. CONCLUSIONS Ang2 was associated with incident heart failure or death among adults without cardiovascular disease at baseline and with disease severity in individuals with existing heart failure. Our finding that Ang2 is increased before disease onset and that elevations reflect disease severity, suggests Ang2 may contribute to heart failure pathogenesis.
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Affiliation(s)
| | - Brian A Houston
- Medical University of South Carolina, Department of Medicine, Charleston, SC
| | - David A Bluemke
- University of Wisconsin, Department of Radiology, Madison, WI
| | - Steven M Kawut
- Perelman School of Medicine at the University of Pennsylvania, Departments of Medicine and Epidemiology, Philadelphia, PA
| | - Todd M Kolb
- Johns Hopkins Hospital, Department of Medicine, Baltimore, MD
| | | | - Joao A C Lima
- Johns Hopkins Hospital, Department of Medicine, Baltimore, MD; Johns Hopkins Hospital, Department of Radiology, Baltimore, MD
| | - David D Ralph
- University of Washington, Department of Medicine, Seattle, WA
| | - Samuel G Rayner
- University of Washington, Department of Medicine, Seattle, WA
| | | | - Ryan J Tedford
- Medical University of South Carolina, Department of Medicine, Charleston, SC
| | - Peter J Leary
- University of Washington, Department of Medicine, Seattle, WA; University of Washington, Department of Epidemiology, Seattle, WA.
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20
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Nyhan SM, Kolb TM, Steppan J. Anesthetic techniques for patients with pulmonary hypertension undergoing ophthalmologic procedures: A case series. J Clin Anesth 2021; 71:110220. [PMID: 33668009 DOI: 10.1016/j.jclinane.2021.110220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 02/19/2021] [Accepted: 02/25/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Sinead M Nyhan
- Department of Anesthesiology and Critical Care Medicine, Division of Adult Cardiothoracic Anesthesia, Division of Adult Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
| | - Todd M Kolb
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Jochen Steppan
- Department of Anesthesiology and Critical Care Medicine, Division of Adult Cardiothoracic Anesthesia, Division of Pediatric Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
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21
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Ireland CG, Damico RL, Kolb TM, Mathai SC, Mukherjee M, Zimmerman SL, Shah AA, Wigley FM, Houston BA, Hassoun PM, Kass DA, Tedford RJ, Hsu S. Exercise right ventricular ejection fraction predicts right ventricular contractile reserve. J Heart Lung Transplant 2021; 40:504-512. [PMID: 33752973 DOI: 10.1016/j.healun.2021.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/08/2021] [Accepted: 02/04/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Right ventricular (RV) contractile reserve shows promise as an indicator of occult RV dysfunction in pulmonary vascular disease. We investigated which measure of RV contractile reserve during exercise best predicts occult RV dysfunction and clinical outcomes. METHODS We prospectively studied RV contractile reserve in 35 human subjects referred for right heart catheterization for known or suspected pulmonary hypertension. All underwent cardiac magnetic resonance imaging, echocardiography, and supine invasive cardiopulmonary exercise testing with concomitant RV pressure-volume catheterization. Event-free survival was prospectively adjudicated from time of right heart catheterization for a 4-year follow-up period. RESULTS RV contractile reserve during exercise, as measured by a positive change in end-systolic elastance (Ees) during exertion, was associated with elevation in pulmonary pressures but preservation of RV volumes. Lack of RV reserve, on the other hand, was tightly coupled with acute RV dilation during exertion (R2 = 0.76, p< 0.001). RV Ees and dilation changes each predicted resting RV-PA dysfunction. RV ejection fraction during exercise, which captured exertional changes in both RV Ees and RV dilation, proved to be a robust surrogate for RV contractile reserve. Reduced exercise RV ejection fraction best predicted occult RV dysfunction among a variety of resting and exercise RV measures, and was also associated with clinical worsening. CONCLUSIONS RV ejection fraction during exercise, as an index of RV contractile reserve, allows for excellent identification of occult RV dysfunction, more so than resting measures of RV function, and may predict clinical outcomes as well.
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Affiliation(s)
- Catherine G Ireland
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rachel L Damico
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Todd M Kolb
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephen C Mathai
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Monica Mukherjee
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stefan L Zimmerman
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ami A Shah
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fredrick M Wigley
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brian A Houston
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Paul M Hassoun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David A Kass
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Ryan J Tedford
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
| | - Steven Hsu
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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22
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Khural JS, Houston BA, Leary PJ, Mathai SC, Kolb TM, Damico R, Hassoun PM, Kass DA, Hsu S, Tedford RJ. Right Atrial Pacing to Improve Acute Hemodynamics in Pulmonary Arterial Hypertension. Am J Respir Crit Care Med 2021; 203:508-511. [PMID: 33026819 PMCID: PMC7885846 DOI: 10.1164/rccm.202006-2278le] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Brian A. Houston
- The Medical University of South CarolinaCharleston, South Carolina
| | | | | | - Todd M. Kolb
- Johns Hopkins School of MedicineBaltimore, Marylandand
| | - Rachel Damico
- Johns Hopkins School of MedicineBaltimore, Marylandand
| | | | - David A. Kass
- Johns Hopkins School of MedicineBaltimore, Marylandand
- Johns Hopkins UniversityBaltimore, Maryland
| | - Steven Hsu
- Johns Hopkins School of MedicineBaltimore, Marylandand
| | - Ryan J. Tedford
- The Medical University of South CarolinaCharleston, South Carolina
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23
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Alkhunaizi FA, Harowicz MR, Ireland CG, Houston BA, Damico RL, Kolb TM, Mathai SC, Zimmerman SL, Hassoun PM, Tedford RJ, Hsu S. Kussmaul's Sign in Pulmonary Hypertension Corresponds With Severe Pulmonary Vascular Pathology Rather Than Right Ventricular Diastolic Dysfunction. Circ Heart Fail 2021; 14:e007461. [PMID: 33356363 PMCID: PMC7855096 DOI: 10.1161/circheartfailure.120.007461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Fatimah A. Alkhunaizi
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael R. Harowicz
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Catherine G. Ireland
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brian A. Houston
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Rachel L. Damico
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Todd M. Kolb
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephen C. Mathai
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stefan L. Zimmerman
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Paul M. Hassoun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ryan J. Tedford
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Steven Hsu
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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24
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Yang J, Griffiths M, Nies MK, Brandal S, Damico R, Vaidya D, Tao X, Simpson CE, Kolb TM, Mathai SC, Pauciulo MW, Nichols WC, Ivy DD, Austin ED, Hassoun PM, Everett AD. Insulin-like growth factor binding protein-2: a new circulating indicator of pulmonary arterial hypertension severity and survival. BMC Med 2020; 18:268. [PMID: 33019943 PMCID: PMC7537100 DOI: 10.1186/s12916-020-01734-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 08/05/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is a fatal disease that results from cardio-pulmonary dysfunction with the pathology largely unknown. Insulin-like growth factor binding protein 2 (IGFBP2) is an important member of the insulin-like growth factor family, with evidence suggesting elevation in PAH patients. We investigated the diagnostic and prognostic value of serum IGFBP2 in PAH to determine if it could discriminate PAH from healthy controls and if it was associated with disease severity and survival. METHODS Serum IGFBP2 levels, as well as IGF1/2 levels, were measured in two independent PAH cohorts, the Johns Hopkins Pulmonary Hypertension program (JHPH, N = 127), NHLBI PAHBiobank (PAHB, N = 203), and a healthy control cohort (N = 128). The protein levels in lung tissues were determined by western blot. The IGFBP2 mRNA expression levels in pulmonary artery smooth muscle cells (PASMC) and endothelial cells (PAEC) were assessed by RNA-seq, secreted protein levels by ELISA. Association of biomarkers with clinical variables was evaluated using adjusted linear or logistic regression and Kaplan-Meier analysis. RESULTS In both PAH cohorts, serum IGFBP2 levels were significantly elevated (p < 0.0001) compared to controls and discriminated PAH from controls with an AUC of 0.76 (p < 0.0001). A higher IGFBP2 level was associated with a shorter 6-min walk distance (6MWD) in both cohorts after adjustment for age and sex (coefficient - 50.235 and - 57.336 respectively). Cox multivariable analysis demonstrated that higher serum IGFBP2 was a significant independent predictor of mortality in PAHB cohort only (HR, 3.92; 95% CI, 1.37-11.21). IGF1 levels were significantly increased only in the PAHB cohort; however, neither IGF1 nor IGF2 had equivalent levels of associations with clinical variables compared with IGFBP2. Western blotting shown that IGFBP2 protein was significantly increased in the PAH vs control lung tissues. Finally, IGFBP2 mRNA expression and secreted protein levels were significantly higher in PASMC than in PAEC. CONCLUSIONS IGFBP2 protein expression was increased in the PAH lung, and secreted by PASMC. Elevated circulating IGFBP2 was associated with PAH severity and mortality and is a potentially valuable prognostic marker in PAH.
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Affiliation(s)
- Jun Yang
- Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University, 720 Rutland Ave. Ross RM 1143, Baltimore, MD, 21205, USA.
| | - Megan Griffiths
- Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University, 720 Rutland Ave. Ross RM 1143, Baltimore, MD, 21205, USA
| | - Melanie K Nies
- Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University, 720 Rutland Ave. Ross RM 1143, Baltimore, MD, 21205, USA
| | - Stephanie Brandal
- Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University, 720 Rutland Ave. Ross RM 1143, Baltimore, MD, 21205, USA
| | - Rachel Damico
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Dhananjay Vaidya
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Xueting Tao
- Depart of Pediatrics, Biostatics Epidemiology and Data Management Core, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Catherine E Simpson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Todd M Kolb
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Stephen C Mathai
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Michael W Pauciulo
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - William C Nichols
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David D Ivy
- Department of Pediatric Cardiology, Children's Hospital Colorado, Denver, CO, USA
| | - Eric D Austin
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Paul M Hassoun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Allen D Everett
- Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University, 720 Rutland Ave. Ross RM 1143, Baltimore, MD, 21205, USA
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25
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Mercurio V, Diab N, Peloquin G, Housten-Harris T, Damico R, Kolb TM, Mathai SC, Hassoun PM. Risk assessment in Scleroderma-associated pulmonary arterial hypertension. Vascul Pharmacol 2020. [DOI: 10.1016/j.vph.2020.106738] [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]
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26
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Hsu S, Simpson CE, Houston BA, Wand A, Sato T, Kolb TM, Mathai SC, Kass DA, Hassoun PM, Damico RL, Tedford RJ. Multi-Beat Right Ventricular-Arterial Coupling Predicts Clinical Worsening in Pulmonary Arterial Hypertension. J Am Heart Assoc 2020; 9:e016031. [PMID: 32384024 PMCID: PMC7660856 DOI: 10.1161/jaha.119.016031] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/17/2020] [Indexed: 11/16/2022]
Abstract
Background Although right ventricular (RV) to pulmonary arterial (RV-PA) coupling is considered the gold standard in assessing RV dysfunction, its ability to predict clinically significant outcomes is poorly understood. We assessed the ability of RV-PA coupling, determined by the ratio of multi-beat (MB) end-systolic elastance (Ees) to effective arterial elastance (Ea), to predict clinical outcomes. Methods and Results Twenty-six subjects with pulmonary arterial hypertension (PAH) underwent same-day cardiac magnetic resonance imaging, right heart catheterization, and RV pressure-volume assessment with MB determination of Ees/Ea. RV ejection fraction (RVEF), stroke volume/end-systolic volume, and single beat-estimated Ees/Ea were also determined. Patients were treated with standard therapies and followed prospectively until they met criteria of clinical worsening (CW), as defined by ≥10% decline in 6-minute walk distance, worsening World Health Organization (WHO) functional class, PAH therapy escalation, RV failure hospitalization, or transplant/death. Subjects were 57±14 years, largely WHO class III (50%) at enrollment, with preserved average RV ejection fraction (RVEF) (47±11%). Mean follow-up was 3.2±1.3 years. Sixteen (62%) subjects met CW criteria. MB Ees/Ea was significantly lower in CW subjects (0.7±0.5 versus 1.3±0.8, P=0.02). The optimal MB Ees/Ea cut-point predictive of CW was 0.65, defined by ROC (AUC 0.78, P=0.01). MB Ees/Ea below this cut-point was significantly associated with time to CW (hazard ratio 5.1, P=0.001). MB Ees/Ea remained predictive of outcomes following multivariate adjustment for timing of PAH diagnosis and PAH diagnosis subtype. Conclusions RV-PA coupling as measured by MB Ees/Ea has prognostic significance in human PAH, even in a cohort with preserved RVEF.
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Affiliation(s)
- Steven Hsu
- Department of MedicineJohns Hopkins UniversityBaltimoreMD
| | | | - Brian A. Houston
- Department of MedicineMedical University of South CarolinaCharlestonSC
| | - Alison Wand
- Department of MedicineJohns Hopkins UniversityBaltimoreMD
| | - Takahiro Sato
- First Department of MedicineHokkaido University HospitalSapporoJapan
| | - Todd M. Kolb
- Department of MedicineJohns Hopkins UniversityBaltimoreMD
| | | | - David A. Kass
- Department of MedicineJohns Hopkins UniversityBaltimoreMD
| | | | | | - Ryan J. Tedford
- Department of MedicineMedical University of South CarolinaCharlestonSC
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27
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Goyanes AM, Moldobaeva A, Marimoutou M, Varela LC, Wang L, Johnston LF, Aladdin MM, Peloquin GL, Kim BS, Damarla M, Suresh K, Sato T, Kolb TM, Hassoun PM, Damico RL. Functional Impact of Human Genetic Variants of COL18A1/Endostatin on Pulmonary Endothelium. Am J Respir Cell Mol Biol 2020; 62:524-534. [PMID: 31922883 PMCID: PMC7110972 DOI: 10.1165/rcmb.2019-0056oc] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 01/08/2020] [Indexed: 12/22/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is an incurable disease characterized by disordered and dysfunctional angiogenesis leading to small-vessel loss and an obliterative vasculopathy. The pathogenesis of PAH is not fully understood, but multiple studies have demonstrated links between elevated angiostatic factors, disease severity, and adverse clinical outcomes. ES (endostatin), one such circulating angiostatic peptide, is the cleavage product of the proteoglycan COL18A1 (collagen α1[XVIII] chain). Elevated serum ES is associated with increased mortality and disease severity in PAH. A nonsynonymous variant of ES (aspartic acid-to-asparagine substitution at amino acid 104; p.D104N) is associated with differences in PAH survival. Although COL18A1/ES expression is markedly increased in remodeled pulmonary vessels in PAH, the impact of ES on pulmonary endothelial cell (PEC) biology and molecular contributions to PAH severity remain undetermined. In the present study, we characterized the effects of exogenous ES on human PEC biology and signaling. We demonstrated that ES inhibits PEC migration, proliferation, and cell survival, with significant differences between human variants, indicating that they are functional genetic variants. ES promotes proteasome-mediated degradation of the transcriptional repressor ID1, increasing expression and release of TSP-1 (thrombospondin 1). ES inhibits PEC migration via an ID1/TSP-1/CD36-dependent pathway, in contrast to proliferation and apoptosis, which require both CD36 and CD47. Collectively, the data implicate ES as a novel negative regulator of ID1 and an upstream propagator of an angiostatic signal cascade converging on CD36 and CD47, providing insight into the cellular and molecular effects of a functional genetic variant linked to altered outcomes in PAH.
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Affiliation(s)
| | - Aigul Moldobaeva
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, and
| | - Mery Marimoutou
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, and
| | - Lidenys C. Varela
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, and
| | - Lan Wang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, and
| | - Laura F. Johnston
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, and
| | - Meena M. Aladdin
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Grace L. Peloquin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, and
| | - Bo S. Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, and
| | - Mahendra Damarla
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, and
| | - Karthik Suresh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, and
| | - Takahiro Sato
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, and
| | - Todd M. Kolb
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, and
| | - Paul M. Hassoun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, and
| | - Rachel L. Damico
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, and
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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Balasubramanian A, Kolb TM, Damico RL, Hassoun PM, McCormack MC, Mathai SC. Diffusing Capacity Is an Independent Predictor of Outcomes in Pulmonary Hypertension Associated With COPD. Chest 2020; 158:722-734. [PMID: 32184109 DOI: 10.1016/j.chest.2020.02.047] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/02/2020] [Accepted: 02/09/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Patients with COPD who experience pulmonary hypertension (PH) have worse mortality than those with COPD alone. Predictors of poor outcomes in COPD-PH are not well-described. Diffusing capacity of the lung (Dlco) assesses the integrity of the alveolar-capillary interface and thus may be a useful prognostic tool among those with COPD-PH. RESEARCH QUESTION Using a single center registry, we sought to evaluate Dlco as a predictor of mortality in a cohort of patients with COPD-PH. STUDY DESIGN AND METHODS This retrospective cohort study analyzed 71 COPD-PH patients from the Johns Hopkins Pulmonary Hypertension Registry with right-sided heart catheterization (RHC)-proven PH and pulmonary function testing data within one year of diagnostic RHC. Transplant-free survival was calculated from index RHC. Adjusted transplant-free survival was modelled using Cox proportional hazard methods; age, pulmonary vascular resistance, FEV1, oxygen use, and N-terminal pro-brain natriuretic peptide were included as covariates. RESULTS Overall unadjusted transplant-free 1-, 3-, and 5-year survivals were 87%, 60%, and 51%, respectively. Survival was associated with reduced Dlco across the observed range of pulmonary artery pressures and pulmonary vascular resistance. Severe Dlco impairment was associated with poorer survival (log-rank χ2 13.07) (P < .001); adjusting for covariates, for every percent predicted decrease in Dlco, mortality rates increased by 4% (hazard ratio, 1.04; 95% CI, 1.01-1.07). INTERPRETATION Among patients with COPD-PH, severe gas transfer impairment is associated with higher mortality, even with adjustment for airflow obstruction and hemodynamics, which suggests that Dlco may be a useful prognostic marker in this population. Future studies are needed to further investigate the association between Dlco and morbidity and to determine the utility of Dlco as a biomarker for disease risk and severity in COPD-PH.
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Affiliation(s)
| | - Todd M Kolb
- Johns Hopkins University Division of Pulmonary and Critical Care, Baltimore, MD
| | - Rachel L Damico
- Johns Hopkins University Division of Pulmonary and Critical Care, Baltimore, MD
| | - Paul M Hassoun
- Johns Hopkins University Division of Pulmonary and Critical Care, Baltimore, MD
| | | | - Stephen C Mathai
- Johns Hopkins University Division of Pulmonary and Critical Care, Baltimore, MD.
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29
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Lahm T, Douglas IS, Archer SL, Bogaard HJ, Chesler NC, Haddad F, Hemnes AR, Kawut SM, Kline JA, Kolb TM, Mathai SC, Mercier O, Michelakis ED, Naeije R, Tuder RM, Ventetuolo CE, Vieillard-Baron A, Voelkel NF, Vonk-Noordegraaf A, Hassoun PM. Assessment of Right Ventricular Function in the Research Setting: Knowledge Gaps and Pathways Forward. An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med 2019; 198:e15-e43. [PMID: 30109950 DOI: 10.1164/rccm.201806-1160st] [Citation(s) in RCA: 191] [Impact Index Per Article: 38.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Right ventricular (RV) adaptation to acute and chronic pulmonary hypertensive syndromes is a significant determinant of short- and long-term outcomes. Although remarkable progress has been made in the understanding of RV function and failure since the meeting of the NIH Working Group on Cellular and Molecular Mechanisms of Right Heart Failure in 2005, significant gaps remain at many levels in the understanding of cellular and molecular mechanisms of RV responses to pressure and volume overload, in the validation of diagnostic modalities, and in the development of evidence-based therapies. METHODS A multidisciplinary working group of 20 international experts from the American Thoracic Society Assemblies on Pulmonary Circulation and Critical Care, as well as external content experts, reviewed the literature, identified important knowledge gaps, and provided recommendations. RESULTS This document reviews the knowledge in the field of RV failure, identifies and prioritizes the most pertinent research gaps, and provides a prioritized pathway for addressing these preclinical and clinical questions. The group identified knowledge gaps and research opportunities in three major topic areas: 1) optimizing the methodology to assess RV function in acute and chronic conditions in preclinical models, human studies, and clinical trials; 2) analyzing advanced RV hemodynamic parameters at rest and in response to exercise; and 3) deciphering the underlying molecular and pathogenic mechanisms of RV function and failure in diverse pulmonary hypertension syndromes. CONCLUSIONS This statement provides a roadmap to further advance the state of knowledge, with the ultimate goal of developing RV-targeted therapies for patients with RV failure of any etiology.
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Mullin CJ, Khair RM, Damico RL, Kolb TM, Hummers LK, Hassoun PM, Steen VD, Mathai SC. Validation of the REVEAL Prognostic Equation and Risk Score Calculator in Incident Systemic Sclerosis-Associated Pulmonary Arterial Hypertension. Arthritis Rheumatol 2019; 71:1691-1700. [PMID: 31066998 DOI: 10.1002/art.40918] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 04/30/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVE A prognostic equation and risk score calculator derived from the Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management (REVEAL) are being used to predict 1-year survival in patients with pulmonary arterial hypertension (PAH), but little is known about the performance of these REVEAL survival prediction tools in systemic sclerosis (SSc)-associated PAH (SSc-PAH). METHODS Prospectively gathered data from the Johns Hopkins Pulmonary Hypertension Program and Pulmonary Hypertension Assessment and Recognition of Outcome in Scleroderma Registries were used to evaluate the predictive accuracy of the REVEAL models for predicting the probability of 1-year survival in patients with SSc-PAH. Model discrimination was assessed by comparison of the Harrell's C-index, model fit was assessed using multivariable regression techniques, and model calibration was assessed by comparing predicted to observed survival estimates. RESULTS The validation cohort consisted of 292 SSc-PAH patients with a 1-year survival rate of 87.4%. The C-index for predictive accuracy of the REVEAL prognostic equation (0.734, 95% confidence interval [95% CI] 0.652-0.816) and for the risk score (0.743, 95% CI 0.663-0.823) demonstrated good discrimination, comparable to that in the model development cohort. The calibration slope was 0.707 (95% CI 0.400-1.014), indicating that the overall model fit was marginal (P = 0.06). The magnitude of risk assigned to low distance on the 6-minute walk test (6MWD) and elevated serum levels of brain natriuretic peptide (BNP) was lower in the validation cohort than was originally seen in the REVEAL derivation cohort. Model calibration was poor, particularly for the highest risk groups. CONCLUSION In predicting 1-year survival in patients newly diagnosed as having SSc-PAH, the REVEAL prognostic equation and risk score provide very good discrimination but poor calibration. REVEAL prediction scores should be interpreted with caution in newly diagnosed SSc-PAH patients, particularly those with higher predicted risk of poor 1-year survival resulting from a low 6MWD or a high BNP serum level.
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Affiliation(s)
| | - Rubina M Khair
- The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rachel L Damico
- The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Todd M Kolb
- The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Laura K Hummers
- The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Paul M Hassoun
- The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Stephen C Mathai
- The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Simpson CE, Damico RL, Hummers L, Khair RM, Kolb TM, Hassoun PM, Mathai SC. Serum uric acid as a marker of disease risk, severity, and survival in systemic sclerosis-related pulmonary arterial hypertension. Pulm Circ 2019; 9:2045894019859477. [PMID: 31384431 PMCID: PMC6664664 DOI: 10.1177/2045894019859477] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/24/2019] [Indexed: 11/16/2022] Open
Abstract
The object of this paper is to assess associations between serum uric acid (UA) and pulmonary arterial hypertension (PAH) risk, disease severity, and mortality in a well-characterized cohort of systemic sclerosis (SSc) patients referred for evaluation of possible PAH. Consecutive SSc patients aged >18 years with serum UA drawn within two weeks of a diagnostic right heart catheterization (RHC) were included. Associations between baseline serum UA and PAH at RHC were examined using logistic regression and receiver operating characteristic curves. Relationships between UA levels and metrics of disease severity were assessed using Pearson and Spearman correlation. Associations between UA and survival were assessed using Kaplan-Meier analysis and Cox proportional hazard modeling. A total of 162 SSc patients were included; 82 received a diagnosis of PAH at RHC. Patients found to have PAH had significantly higher UA than those without PAH. Elevated baseline UA was associated with significantly increased odds of PAH diagnosis at RHC (odds ratio [OR] = 4.07, 95% confidence interval [CI] = 2.11-7.87, P < 0.001). Each mg/dL higher UA was associated with a 14% increase in mortality (hazard ratio [HR] = 1.14, 95% CI = 1.02-1.28, P < 0.05). In multivariable models adjusting for potential confounders of the relationship between UA and survival, UA > 6.3 mg/dL remained significantly associated with increased mortality (HR = 1.84, 95% CI = 1.02-3.32, P < 0.05). Among SSc patients with suspected PAH, elevated serum UA is associated with increased risk of SSc-PAH. Among individuals diagnosed with SSc-PAH by RHC, UA is associated with disease severity and survival. These results indicate UA is a useful predictor of PAH risk and prognosis in SSc.
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Affiliation(s)
- Catherine E Simpson
- Department of Medicine Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Rachel L Damico
- Department of Medicine Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Laura Hummers
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, USA
| | - Rubina M Khair
- Department of Medicine Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Todd M Kolb
- Department of Medicine Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Paul M Hassoun
- Department of Medicine Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Stephen C Mathai
- Department of Medicine Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
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Peloquin GL, Johnston L, Damarla M, Damico RL, Hassoun PM, Kolb TM. SU5416 does not attenuate early RV angiogenesis in the murine chronic hypoxia PH model. Respir Res 2019; 20:123. [PMID: 31208454 PMCID: PMC6580559 DOI: 10.1186/s12931-019-1079-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/20/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Right ventricular (RV) angiogenesis has been associated with adaptive myocardial remodeling in pulmonary hypertension (PH), though molecular regulators are poorly defined. Endothelial cell VEGFR-2 is considered a "master regulator" of angiogenesis in other models, and the small molecule VEGF receptor tyrosine kinase inhibitor SU5416 is commonly used to generate PH in rodents. We hypothesized that SU5416, through direct effects on cardiac endothelial cell VEGFR-2, would attenuate RV angiogenesis in a murine model of PH. METHODS C57 BL/6 mice were exposed to chronic hypoxia (CH-PH) to generate PH and stimulate RV angiogenesis. SU5416 (20 mg/kg) or vehicle were administered at the start of the CH exposure, and weekly thereafter. Angiogenesis was measured after one week of CH-PH using a combination of unbiased stereological measurements and flow cytometry-based quantification of myocardial endothelial cell proliferation. In complementary experiments, primary cardiac endothelial cells from C57 BL/6 mice were exposed to recombinant VEGF (50 ng/mL) or grown on Matrigel in the presence of SU5416 (5 μM) or vehicle. RESULT SU5416 directly inhibited VEGF-mediated ERK phosphorylation, cell proliferation, and Kdr transcription, but not Matrigel tube formation in primary murine cardiac endothelial cells in vitro. SU5416 did not inhibit CH-PH induced RV angiogenesis, endothelial cell proliferation, or RV hypertrophy in vivo, despite significantly altering the expression profile of genes involved in angiogenesis. CONCLUSIONS These findings demonstrate that SU5416 directly inhibited VEGF-induced proliferation of murine cardiac endothelial cells but does not attenuate CH-PH induced RV angiogenesis or myocardial remodeling in vivo.
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Affiliation(s)
- Grace L Peloquin
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, NYU Langone Health, New York, NY, USA
| | - Laura Johnston
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street, 5th Floor, Baltimore, MD, 21205, USA
| | - Mahendra Damarla
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street, 5th Floor, Baltimore, MD, 21205, USA
| | - Rachel L Damico
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street, 5th Floor, Baltimore, MD, 21205, USA
| | - Paul M Hassoun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street, 5th Floor, Baltimore, MD, 21205, USA
| | - Todd M Kolb
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street, 5th Floor, Baltimore, MD, 21205, USA.
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Crnkovic S, Egemnazarov B, Damico R, Marsh LM, Nagy BM, Douschan P, Atsina K, Kolb TM, Mathai SC, Hooper JE, Ghanim B, Klepetko W, Fruhwald F, Lassner D, Olschewski A, Olschewski H, Hassoun PM, Kwapiszewska G. Disconnect between Fibrotic Response and Right Ventricular Dysfunction. Am J Respir Crit Care Med 2019; 199:1550-1560. [PMID: 30557518 PMCID: PMC6580669 DOI: 10.1164/rccm.201809-1737oc] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 12/14/2018] [Indexed: 12/29/2022] Open
Abstract
Rationale: Remodeling and fibrosis of the right ventricle (RV) may cause RV dysfunction and poor survival in patients with pulmonary hypertension. Objectives: To investigate the consequences of RV fibrosis modulation and the accompanying cellular changes on RV function. Methods: Expression of fibrotic markers was assessed in the RV of patients with pulmonary hypertension, the murine pulmonary artery banding, and rat monocrotaline and Sugen5416/hypoxia models. Invasive hemodynamic and echocardiographic assessment was performed on galectin-3 knockout or inhibitor-treated mice. Measurements and Main Results: Established fibrosis was characterized by marked expression of galectin-3 and an enhanced number of proliferating RV fibroblasts. Galectin-3 genetic and pharmacologic inhibition or antifibrotic treatment with pirfenidone significantly diminished RV fibrosis progression in the pulmonary artery banding model, without improving RV functional parameters. RV fibrotic regions were populated with mesenchymal cells coexpressing vimentin and PDGFRα (platelet-derived growth factor receptor-α), but generally lacked αSMA (α-smooth muscle actin) positivity. Serum levels of galectin-3 were increased in patients with idiopathic pulmonary arterial hypertension but did not correlate with cardiac function. No changes of galectin-3 expression were observed in the lungs. Conclusions: We identified extrapulmonary galectin-3 as an important mediator that drives RV fibrosis in pulmonary hypertension through the expansion of PDGFRα/vimentin-expressing cardiac fibroblasts. However, interventions effectively targeting fibrosis lack significant beneficial effects on RV function.
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Affiliation(s)
- Slaven Crnkovic
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | | | - Rachel Damico
- Division of Pulmonary and Critical Care Medicine and
| | - Leigh M. Marsh
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Bence M. Nagy
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Philipp Douschan
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Division of Pulmonology
| | - Kwame Atsina
- Division of Cardiology, University of California, Davis, Davis, California
| | - Todd M. Kolb
- Division of Pulmonary and Critical Care Medicine and
| | | | - Jody E. Hooper
- Department of Pathology, Johns Hopkins, Baltimore, Maryland
| | - Bahil Ghanim
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria; and
| | - Walter Klepetko
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria; and
| | | | - Dirk Lassner
- Institute for Cardiac Diagnostic and Therapy, Berlin, Germany
| | - Andrea Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | | | | | - Grazyna Kwapiszewska
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Otto Loewi Center, Physiology, Medical University of Graz, Graz, Austria
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Mercurio V, Mukherjee M, Tedford RJ, Zamanian RT, Khair RM, Sato T, Minai OA, Torres F, Girgis RE, Chin K, Damico R, Kolb TM, Mathai SC, Hassoun PM. Improvement in Right Ventricular Strain with Ambrisentan and Tadalafil Upfront Therapy in Scleroderma-associated Pulmonary Arterial Hypertension. Am J Respir Crit Care Med 2019; 197:388-391. [PMID: 28661697 DOI: 10.1164/rccm.201704-0789le] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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)
| | - Monica Mukherjee
- 1 Johns Hopkins University School of Medicine Baltimore, Maryland
| | - Ryan J Tedford
- 1 Johns Hopkins University School of Medicine Baltimore, Maryland
| | | | - Rubina M Khair
- 1 Johns Hopkins University School of Medicine Baltimore, Maryland
| | - Takahiro Sato
- 1 Johns Hopkins University School of Medicine Baltimore, Maryland
| | | | - Fernando Torres
- 4 University of Texas Southwestern Medical Center Dallas, Texas and
| | - Reda E Girgis
- 5 Spectrum Health/Michigan State University Grand Rapids, Michigan
| | - Kelly Chin
- 4 University of Texas Southwestern Medical Center Dallas, Texas and
| | - Rachel Damico
- 1 Johns Hopkins University School of Medicine Baltimore, Maryland
| | - Todd M Kolb
- 1 Johns Hopkins University School of Medicine Baltimore, Maryland
| | - Stephen C Mathai
- 1 Johns Hopkins University School of Medicine Baltimore, Maryland
| | - Paul M Hassoun
- 1 Johns Hopkins University School of Medicine Baltimore, Maryland
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35
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Simpson CE, Damico RL, Kolb TM, Mathai SC, Khair RM, Sato T, Bourji K, Tedford RJ, Zimmerman SL, Hassoun PM. Ventricular mass as a prognostic imaging biomarker in incident pulmonary arterial hypertension. Eur Respir J 2019; 53:13993003.02067-2018. [PMID: 30705128 DOI: 10.1183/13993003.02067-2018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 12/22/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Catherine E Simpson
- Johns Hopkins University Dept of Medicine, Division of Pulmonary and Critical Care Medicine, Baltimore, MD, USA.,These authors contributed equally to this article
| | - Rachel L Damico
- Johns Hopkins University Dept of Medicine, Division of Pulmonary and Critical Care Medicine, Baltimore, MD, USA.,These authors contributed equally to this article
| | - Todd M Kolb
- Johns Hopkins University Dept of Medicine, Division of Pulmonary and Critical Care Medicine, Baltimore, MD, USA
| | - Stephen C Mathai
- Johns Hopkins University Dept of Medicine, Division of Pulmonary and Critical Care Medicine, Baltimore, MD, USA
| | - Rubina M Khair
- Johns Hopkins University Dept of Medicine, Division of Pulmonary and Critical Care Medicine, Baltimore, MD, USA
| | - Takahiro Sato
- Hokkaido University Hospital First Dept of Medicine, Sapporo, Hokkaido, Japan
| | - Khalil Bourji
- Sinai Hospital of Baltimore Dept of Medicine, Baltimore, MD, USA
| | - Ryan J Tedford
- Medical University of South Carolina Dept of Medicine, Division of Cardiology, Charleston, SC, USA
| | - Stefan L Zimmerman
- Johns Hopkins University Dept of Radiology and Radiological Science, Baltimore, MD, USA
| | - Paul M Hassoun
- Johns Hopkins University Dept of Medicine, Division of Pulmonary and Critical Care Medicine, Baltimore, MD, USA
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36
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Suresh K, Carino K, Johnston L, Servinsky L, Machamer CE, Kolb TM, Lam H, Dudek SM, An SS, Rane MJ, Shimoda LA, Damarla M. A nonapoptotic endothelial barrier-protective role for caspase-3. Am J Physiol Lung Cell Mol Physiol 2019; 316:L1118-L1126. [PMID: 30908935 DOI: 10.1152/ajplung.00487.2018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Noncanonical roles for caspase-3 are emerging in the fields of cancer and developmental biology. However, little is known of nonapoptotic functions of caspase-3 in most cell types. We have recently demonstrated a disassociation between caspase-3 activation and execution of apoptosis with accompanying cytoplasmic caspase-3 sequestration and preserved endothelial barrier function. Therefore, we tested the hypothesis that nonapoptotic caspase-3 activation promotes endothelial barrier integrity. Human lung microvascular endothelial cells were exposed to thrombin, a nonapoptotic stimulus, and endothelial barrier function was assessed using electric cell-substrate impedance sensing. Actin cytoskeletal rearrangement and paracellular gap formation were assessed using phalloidin staining. Cell stiffness was evaluated using magnetic twisting cytometry. In addition, cell lysates were harvested for protein analyses. Caspase-3 was inhibited pharmacologically with pan-caspase and a caspase-3-specific inhibitor. Molecular inhibition of caspase-3 was achieved using RNA interference. Cells exposed to thrombin exhibited a cytoplasmic activation of caspase-3 with transient and nonapoptotic decrease in endothelial barrier function as measured by a drop in electrical resistance followed by a rapid recovery. Inhibition of caspases led to a more pronounced and rapid drop in thrombin-induced endothelial barrier function, accompanied by increased endothelial cell stiffness and paracellular gaps. Caspase-3-specific inhibition and caspase-3 knockdown both resulted in more pronounced thrombin-induced endothelial barrier disruption. Taken together, our results suggest cytoplasmic caspase-3 has nonapoptotic functions in human endothelium and can promote endothelial barrier integrity.
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Affiliation(s)
- Karthik Suresh
- Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Kathleen Carino
- Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Laura Johnston
- Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Laura Servinsky
- Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Carolyn E Machamer
- Department of Cell Biology, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Todd M Kolb
- Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Hong Lam
- Department of Environmental Health and Engineering, Johns Hopkins University School of Public Health , Baltimore, Maryland
| | - Steven M Dudek
- Department of Medicine, College of Medicine, University of Illinois at Chicago , Chicago, Illinois
| | - Steven S An
- Department of Environmental Health and Engineering, Johns Hopkins University School of Public Health , Baltimore, Maryland
| | - Madhavi J Rane
- Department of Medicine, School of Medicine, University of Louisville , Louisville, Kentucky
| | - Larissa A Shimoda
- Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Mahendra Damarla
- Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland
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37
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Furfaro D, Azadi J, Housten T, Kolb TM, Damico RL, Hassoun PM, Chin K, Mathai SC. Discordance between Imaging Modalities in the Evaluation of Chronic Thromboembolic Pulmonary Hypertension: A Combined Experience from Two Academic Medical Centers. Ann Am Thorac Soc 2019; 16:277-280. [PMID: 30359536 PMCID: PMC6376944 DOI: 10.1513/annalsats.201809-588rl] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- David Furfaro
- Johns Hopkins University School of MedicineBaltimore, Marylandand
| | - Javad Azadi
- Johns Hopkins University School of MedicineBaltimore, Marylandand
| | - Traci Housten
- Johns Hopkins University School of MedicineBaltimore, Marylandand
| | - Todd M. Kolb
- Johns Hopkins University School of MedicineBaltimore, Marylandand
| | - Rachel L. Damico
- Johns Hopkins University School of MedicineBaltimore, Marylandand
| | - Paul M. Hassoun
- Johns Hopkins University School of MedicineBaltimore, Marylandand
| | - Kelly Chin
- University of Texas Southwestern Medical CenterDallas, Texas
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38
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Mercurio V, Diab N, Peloquin G, Housten-Harris T, Damico R, Kolb TM, Mathai SC, Hassoun PM. Risk assessment in scleroderma patients with newly diagnosed pulmonary arterial hypertension: application of the ESC/ERS risk prediction model. Eur Respir J 2018; 52:13993003.00497-2018. [PMID: 30262575 DOI: 10.1183/13993003.00497-2018] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 08/26/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Valentina Mercurio
- Johns Hopkins University, Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Baltimore, MD, USA.,Federico II University, Dept of Translational Medical Sciences, Naples, Italy
| | - Nermin Diab
- Johns Hopkins University, Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Baltimore, MD, USA.,University of Ottawa, Dept of Medicine, Ottawa, ON, Canada
| | - Grace Peloquin
- Johns Hopkins University, Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Baltimore, MD, USA
| | - Traci Housten-Harris
- Johns Hopkins University, Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Baltimore, MD, USA
| | - Rachel Damico
- Johns Hopkins University, Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Baltimore, MD, USA
| | - Todd M Kolb
- Johns Hopkins University, Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Baltimore, MD, USA
| | - Stephen C Mathai
- Johns Hopkins University, Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Baltimore, MD, USA
| | - Paul M Hassoun
- Johns Hopkins University, Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Baltimore, MD, USA
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Kolb TM, Hassoun PM. Supply and Demand: Micro(vascular) Economics of the Right Ventricle in Pulmonary Hypertension. Am J Respir Cell Mol Biol 2018; 59:410-411. [DOI: 10.1165/rcmb.2018-0203ed] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Todd M. Kolb
- Department of MedicineJohns Hopkins University School of MedicineBaltimore, Maryland
| | - Paul M. Hassoun
- Department of MedicineJohns Hopkins University School of MedicineBaltimore, Maryland
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Leary PJ, Kolb TM, Maron BA, Tedford RJ, Zamanian RT. Reply: Can treprostinil-induced early gastrointestinal side effects serve as predictors of pulmonary arterial hypertension prognosis? Int J Cardiol 2018; 264:188. [PMID: 29776569 DOI: 10.1016/j.ijcard.2018.03.130] [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] [Received: 02/16/2018] [Accepted: 03/28/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Peter J Leary
- University of Washington, Division of Pulmonary, Critical Care, and Sleep Medicine, United States.
| | - Todd M Kolb
- Johns Hopkins Hospital, Division of Pulmonary and Critical Care Medicine, United States
| | - Bradley A Maron
- Veterans Affairs Boston Healthcare System, Department of Cardiology, United States; Brigham and Women's Hospital, Division of Cardiology, United States
| | - Ryan J Tedford
- Medical University of South Carolina, Division of Cardiology, United States
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Elinoff JM, Agarwal R, Barnett CF, Benza RL, Cuttica MJ, Gharib AM, Gray MP, Hassoun PM, Hemnes AR, Humbert M, Kolb TM, Lahm T, Leopold JA, Mathai SC, McLaughlin VV, Preston IR, Rosenzweig EB, Shlobin OA, Steen VD, Zamanian RT, Solomon MA. Challenges in Pulmonary Hypertension: Controversies in Treating the Tip of the Iceberg. A Joint National Institutes of Health Clinical Center and Pulmonary Hypertension Association Symposium Report. Am J Respir Crit Care Med 2018; 198:166-174. [PMID: 29425462 PMCID: PMC6058980 DOI: 10.1164/rccm.201710-2093pp] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 02/09/2018] [Indexed: 01/13/2023] Open
Affiliation(s)
| | - Richa Agarwal
- Division of Cardiovascular Disease, Department of Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | | | - Raymond L. Benza
- Division of Cardiovascular Disease, Department of Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Michael J. Cuttica
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ahmed M. Gharib
- National Institute of Diabetes, Digestive, and Kidney Diseases, and
| | | | - Paul M. Hassoun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Anna R. Hemnes
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marc Humbert
- Service de Pneumologie, Hôpital Bicêtre (Assistance Publique–Hôpitaux de Paris), Institut National de la Santé et de la Recherche Médicale U999, University Paris–Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Todd M. Kolb
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Tim Lahm
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Indiana University, Indianapolis, Indiana
- Richard L. Roudebush VA Medical Center, Indianapolis, Indiana
| | - Jane A. Leopold
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stephen C. Mathai
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Vallerie V. McLaughlin
- Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ioana R. Preston
- Department of Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | | | - Oksana A. Shlobin
- Pulmonary Vascular Disease Program, Inova Fairfax Hospital, Falls Church, Virginia
| | - Virginia D. Steen
- Rheumatology Division, Department of Medicine, Georgetown University, Washington, DC; and
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Hsu S, Kokkonen-Simon KM, Kirk JA, Kolb TM, Damico RL, Mathai SC, Mukherjee M, Shah AA, Wigley FM, Margulies KB, Hassoun PM, Halushka MK, Tedford RJ, Kass DA. Right Ventricular Myofilament Functional Differences in Humans With Systemic Sclerosis-Associated Versus Idiopathic Pulmonary Arterial Hypertension. Circulation 2018; 137:2360-2370. [PMID: 29352073 PMCID: PMC5976528 DOI: 10.1161/circulationaha.117.033147] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 01/04/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Patients with systemic sclerosis (SSc)-associated pulmonary arterial hypertension (PAH) have a far worse prognosis than those with idiopathic PAH (IPAH). In the intact heart, SSc-PAH exhibits depressed rest and reserve right ventricular (RV) contractility compared with IPAH. We tested whether this disparity involves underlying differences in myofilament function. METHODS Cardiac myocytes were isolated from RV septal endomyocardial biopsies from patients with SSc-PAH, IPAH, or SSc with exertional dyspnea but no resting PAH (SSc-d); control RV septal tissue was obtained from nondiseased donor hearts (6-7 per group). Isolated myocyte passive length-tension and developed tension-calcium relationships were determined and correlated with in vivo RV function and reserve. RV septal fibrosis was also examined. RESULTS Myocyte passive stiffness from length-tension relations was similarly increased in IPAH and SSc-PAH compared with control, although SSc-PAH biopsies had more interstitial fibrosis. More striking disparities were found between active force-calcium relations. Compared with controls, maximal calcium-activated force (Fmax) was 28% higher in IPAH but 37% lower in SSc-PAH. Fmax in SSc-d was intermediate between control and SSc-PAH. The calcium concentration required for half-maximal force (EC50) was similar between control, IPAH, and SSc-d but lower in SSc-PAH. This disparity disappeared in myocytes incubated with the active catalytic subunit of protein kinase A. Myocyte Fmax directly correlated with in vivo RV contractility assessed by end-systolic elastance (R2 =0.46, P=0.002) and change in end-systolic elastance with exercise (R2 =0.49, P=0.008) and was inversely related with exercise-induced chamber dilation (R2 =0.63, P<0.002), which also was a marker of depressed contractile reserve. CONCLUSIONS A primary defect in human SSc-PAH resides in depressed sarcomere function, whereas this is enhanced in IPAH. These disparities correlate with in vivo RV contractility and contractile reserve and are consistent with worse clinical outcomes in SSc-PAH. The existence of sarcomere disease before the development of resting PAH in patients with SSc-d suggests that earlier identification and intervention may prove useful.
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Affiliation(s)
- Steven Hsu
- Divisions of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Jonathan A. Kirk
- Department of Cell and Molecular Physiology, Loyola University, Chicago, IL
| | - Todd M. Kolb
- Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rachel L. Damico
- Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Stephen C. Mathai
- Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Monica Mukherjee
- Divisions of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ami A. Shah
- Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Fredrick M. Wigley
- Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kenneth B. Margulies
- Division of Cardiology, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Paul M. Hassoun
- Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Marc K. Halushka
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ryan J. Tedford
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - David A. Kass
- Divisions of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD
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Damarla M, Johnston LF, Liu G, Gao L, Wang L, Varela L, Kolb TM, Kim BS, Damico RL, Hassoun PM. XOR inhibition with febuxostat accelerates pulmonary endothelial barrier recovery and improves survival in lipopolysaccharide-induced murine sepsis. Physiol Rep 2018; 5:5/15/e13377. [PMID: 28801519 PMCID: PMC5555900 DOI: 10.14814/phy2.13377] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 07/11/2017] [Accepted: 07/13/2017] [Indexed: 12/29/2022] Open
Abstract
Sepsis is a leading cause of death among patients in the intensive care unit, resulting from multi‐organ failure. Activity of xanthine oxidoreductase (XOR), a reactive oxygen species (ROS) producing enzyme, is known to be elevated in nonsurvivors of sepsis compared to survivors. We have previously demonstrated that XOR is critical for ventilator‐induced lung injury. Using febuxostat, a novel nonpurine inhibitor of XOR, we sought to determine the role of XOR inhibition in a murine model of sepsis‐induced lung injury and mortality. C57BL/6J mice were subjected to intravenous (IV) lipopolysaccharide (LPS) for various time points, and lungs were harvested for analyses. Subsets of mice were treated with febuxostat, pre or post LPS exposure, or vehicle. Separate groups of mice were followed up for mortality after LPS exposure. After 24 hr of IV LPS, mice exhibited an increase in XOR activity in lung tissue and a significant increase in pulmonary endothelial barrier disruption. Pretreatment of animals with febuxostat before exposure to LPS, or treatment 4 h after LPS, resulted in complete abrogation of XOR activity. Inhibition of XOR with febuxostat did not prevent LPS‐induced pulmonary vascular permeability at 24 h, however, it accelerated recovery of the pulmonary endothelial barrier integrity in response to LPS exposure. Furthermore, treatment with febuxostat resulted in significant reduction in mortality. Inhibition of XOR with febuxostat accelerates recovery of the pulmonary endothelial barrier and prevents LPS‐induced mortality, whether given before or after exposure to LPS.
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Affiliation(s)
- Mahendra Damarla
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Laura F Johnston
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gigi Liu
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Li Gao
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lan Wang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lidenys Varela
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Todd M Kolb
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bo S Kim
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rachel L Damico
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Paul M Hassoun
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Tampakakis E, Shah SJ, Borlaug BA, Leary PJ, Patel HH, Miller WL, Kelemen BW, Houston BA, Kolb TM, Damico R, Mathai SC, Kasper EK, Hassoun PM, Kass DA, Tedford RJ. Pulmonary Effective Arterial Elastance as a Measure of Right Ventricular Afterload and Its Prognostic Value in Pulmonary Hypertension Due to Left Heart Disease. Circ Heart Fail 2018; 11:e004436. [PMID: 29643065 PMCID: PMC5901761 DOI: 10.1161/circheartfailure.117.004436] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [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: 07/25/2017] [Accepted: 03/09/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Patients with combined post- and precapillary pulmonary hypertension due to left heart disease have a worse prognosis compared with isolated postcapillary. However, it remains unclear whether increased mortality in combined post- and precapillary pulmonary hypertension is simply a result of higher total right ventricular load. Pulmonary effective arterial elastance (Ea) is a measure of total right ventricular afterload, reflecting both resistive and pulsatile components. We aimed to test whether pulmonary Ea discriminates survivors from nonsurvivors in patients with pulmonary hypertension due to left heart disease and if it does so better than other hemodynamic parameters associated with combined post- and precapillary pulmonary hypertension. METHODS AND RESULTS We combined 3 large heart failure patient cohorts (n=1036) from academic hospitals, including patients with pulmonary hypertension due to heart failure with preserved ejection fraction (n=232), reduced ejection fraction (n=335), and a mixed population (n=469). In unadjusted and 2 adjusted models, pulmonary Ea more robustly predicted mortality than pulmonary vascular resistance and the transpulmonary gradient. Along with pulmonary arterial compliance, pulmonary Ea remained predictive of survival in patients with normal pulmonary vascular resistance. The diastolic pulmonary gradient did not predict mortality. In addition, in a subset of patients with echocardiographic data, Ea and pulmonary arterial compliance were better discriminators of right ventricular dysfunction than the other parameters. CONCLUSIONS Pulmonary Ea and pulmonary arterial compliance more consistently predicted mortality than pulmonary vascular resistance or transpulmonary gradient across a spectrum of left heart disease with pulmonary hypertension, including patients with heart failure with preserved ejection fraction, heart failure with reduced ejection fraction, and pulmonary hypertension with a normal pulmonary vascular resistance.
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Affiliation(s)
- Emmanouil Tampakakis
- Division of Cardiology (E.T., B.W.K., E.K.K., D.A.K., R.J.T.) and Division of Pulmonary and Critical Care Medicine (T.M.K., R.D., S.C.M., P.M.H.), Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S., H.H.P.). Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B., W.L.M.). Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle (P.J.L.). Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston (B.A.H., R.J.T.)
| | - Sanjiv J Shah
- Division of Cardiology (E.T., B.W.K., E.K.K., D.A.K., R.J.T.) and Division of Pulmonary and Critical Care Medicine (T.M.K., R.D., S.C.M., P.M.H.), Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S., H.H.P.). Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B., W.L.M.). Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle (P.J.L.). Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston (B.A.H., R.J.T.)
| | - Barry A Borlaug
- Division of Cardiology (E.T., B.W.K., E.K.K., D.A.K., R.J.T.) and Division of Pulmonary and Critical Care Medicine (T.M.K., R.D., S.C.M., P.M.H.), Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S., H.H.P.). Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B., W.L.M.). Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle (P.J.L.). Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston (B.A.H., R.J.T.)
| | - Peter J Leary
- Division of Cardiology (E.T., B.W.K., E.K.K., D.A.K., R.J.T.) and Division of Pulmonary and Critical Care Medicine (T.M.K., R.D., S.C.M., P.M.H.), Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S., H.H.P.). Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B., W.L.M.). Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle (P.J.L.). Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston (B.A.H., R.J.T.)
| | - Harnish H Patel
- Division of Cardiology (E.T., B.W.K., E.K.K., D.A.K., R.J.T.) and Division of Pulmonary and Critical Care Medicine (T.M.K., R.D., S.C.M., P.M.H.), Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S., H.H.P.). Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B., W.L.M.). Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle (P.J.L.). Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston (B.A.H., R.J.T.)
| | - Wayne L Miller
- Division of Cardiology (E.T., B.W.K., E.K.K., D.A.K., R.J.T.) and Division of Pulmonary and Critical Care Medicine (T.M.K., R.D., S.C.M., P.M.H.), Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S., H.H.P.). Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B., W.L.M.). Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle (P.J.L.). Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston (B.A.H., R.J.T.)
| | - Benjamin W Kelemen
- Division of Cardiology (E.T., B.W.K., E.K.K., D.A.K., R.J.T.) and Division of Pulmonary and Critical Care Medicine (T.M.K., R.D., S.C.M., P.M.H.), Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S., H.H.P.). Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B., W.L.M.). Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle (P.J.L.). Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston (B.A.H., R.J.T.)
| | - Brian A Houston
- Division of Cardiology (E.T., B.W.K., E.K.K., D.A.K., R.J.T.) and Division of Pulmonary and Critical Care Medicine (T.M.K., R.D., S.C.M., P.M.H.), Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S., H.H.P.). Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B., W.L.M.). Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle (P.J.L.). Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston (B.A.H., R.J.T.)
| | - Todd M Kolb
- Division of Cardiology (E.T., B.W.K., E.K.K., D.A.K., R.J.T.) and Division of Pulmonary and Critical Care Medicine (T.M.K., R.D., S.C.M., P.M.H.), Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S., H.H.P.). Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B., W.L.M.). Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle (P.J.L.). Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston (B.A.H., R.J.T.)
| | - Rachel Damico
- Division of Cardiology (E.T., B.W.K., E.K.K., D.A.K., R.J.T.) and Division of Pulmonary and Critical Care Medicine (T.M.K., R.D., S.C.M., P.M.H.), Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S., H.H.P.). Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B., W.L.M.). Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle (P.J.L.). Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston (B.A.H., R.J.T.)
| | - Stephen C Mathai
- Division of Cardiology (E.T., B.W.K., E.K.K., D.A.K., R.J.T.) and Division of Pulmonary and Critical Care Medicine (T.M.K., R.D., S.C.M., P.M.H.), Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S., H.H.P.). Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B., W.L.M.). Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle (P.J.L.). Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston (B.A.H., R.J.T.)
| | - Edward K Kasper
- Division of Cardiology (E.T., B.W.K., E.K.K., D.A.K., R.J.T.) and Division of Pulmonary and Critical Care Medicine (T.M.K., R.D., S.C.M., P.M.H.), Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S., H.H.P.). Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B., W.L.M.). Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle (P.J.L.). Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston (B.A.H., R.J.T.)
| | - Paul M Hassoun
- Division of Cardiology (E.T., B.W.K., E.K.K., D.A.K., R.J.T.) and Division of Pulmonary and Critical Care Medicine (T.M.K., R.D., S.C.M., P.M.H.), Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S., H.H.P.). Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B., W.L.M.). Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle (P.J.L.). Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston (B.A.H., R.J.T.)
| | - David A Kass
- Division of Cardiology (E.T., B.W.K., E.K.K., D.A.K., R.J.T.) and Division of Pulmonary and Critical Care Medicine (T.M.K., R.D., S.C.M., P.M.H.), Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S., H.H.P.). Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B., W.L.M.). Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle (P.J.L.). Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston (B.A.H., R.J.T.)
| | - Ryan J Tedford
- Division of Cardiology (E.T., B.W.K., E.K.K., D.A.K., R.J.T.) and Division of Pulmonary and Critical Care Medicine (T.M.K., R.D., S.C.M., P.M.H.), Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S., H.H.P.). Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B., W.L.M.). Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle (P.J.L.). Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston (B.A.H., R.J.T.).
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Mercurio V, Peloquin G, Bourji KI, Diab N, Sato T, Enobun B, Housten-Harris T, Damico R, Kolb TM, Mathai SC, Tedford RJ, Tocchetti CG, Hassoun PM. Pulmonary arterial hypertension and atrial arrhythmias: incidence, risk factors, and clinical impact. Pulm Circ 2018; 8:2045894018769874. [PMID: 29575972 PMCID: PMC5912291 DOI: 10.1177/2045894018769874] [Citation(s) in RCA: 28] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Atrial arrhythmia (AA) occurrence in pulmonary arterial hypertension (PAH) may determine clinical deterioration and affect prognosis. In this study we assessed AA incidence in idiopathic (IPAH) and systemic sclerosis related PAH (SSc-PAH) and evaluated risk factors, management, and impact on mortality. We collected baseline data from consecutive IPAH or SSc-PAH patients prospectively enrolled in the Johns Hopkins Pulmonary Hypertension Registry between January 2000 and July 2016. During follow-up AA onset, treatment, and outcome were recorded. Among 317 patients (201 SSc-PAH, 116 IPAH), 42 developed AA (19 atrial fibrillation, 10 flutter-fibrillation, 9 atrial flutter, and 4 atrial ectopic tachycardia) with a 13.2% cumulative incidence. Most events were associated with hospitalization (90.5%). Electrical or pharmacological cardioversion was attempted in most cases. Patients with AA had higher right atrial pressure, pulmonary wedge pressure (P < 0.005), NT-proBNP (P < 0.05), and thyroid disease prevalence (P < 0.005). Higher mortality was observed in patients with AA, though not statistically significant (LogRank P = 0.323). Similar long-term mortality between IPAH with AA and SSc-PAH without AA was observed (LogRank P = 0.098). SSc-PAH with AA had the worst prognosis. In PAH patients AA occurrence is a matter of significant concern. Therapeutic strategies aimed at restoring sinus rhythm may represent an important goal.
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Affiliation(s)
- Valentina Mercurio
- 1 Division of Pulmonary and Critical Care Medicine, 1466 Department of Medicine, Johns Hopkins University, Baltimore , MD, USA.,2 Department of Translational Medical Sciences, 1466 Federico II University, Naples, Italy
| | - Grace Peloquin
- 1 Division of Pulmonary and Critical Care Medicine, 1466 Department of Medicine, Johns Hopkins University, Baltimore , MD, USA
| | - Khalil I Bourji
- 1 Division of Pulmonary and Critical Care Medicine, 1466 Department of Medicine, Johns Hopkins University, Baltimore , MD, USA
| | - Nermin Diab
- 3 25802 Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Takahiro Sato
- 1 Division of Pulmonary and Critical Care Medicine, 1466 Department of Medicine, Johns Hopkins University, Baltimore , MD, USA
| | - Blessing Enobun
- 1 Division of Pulmonary and Critical Care Medicine, 1466 Department of Medicine, Johns Hopkins University, Baltimore , MD, USA
| | - Traci Housten-Harris
- 1 Division of Pulmonary and Critical Care Medicine, 1466 Department of Medicine, Johns Hopkins University, Baltimore , MD, USA
| | - Rachel Damico
- 1 Division of Pulmonary and Critical Care Medicine, 1466 Department of Medicine, Johns Hopkins University, Baltimore , MD, USA
| | - Todd M Kolb
- 1 Division of Pulmonary and Critical Care Medicine, 1466 Department of Medicine, Johns Hopkins University, Baltimore , MD, USA
| | - Stephen C Mathai
- 1 Division of Pulmonary and Critical Care Medicine, 1466 Department of Medicine, Johns Hopkins University, Baltimore , MD, USA
| | - Ryan J Tedford
- 4 Division of Cardiology, 1466 Department of Medicine, Johns Hopkins University , Baltimore, MD, USA
| | - Carlo G Tocchetti
- 2 Department of Translational Medical Sciences, 1466 Federico II University, Naples, Italy
| | - Paul M Hassoun
- 1 Division of Pulmonary and Critical Care Medicine, 1466 Department of Medicine, Johns Hopkins University, Baltimore , MD, USA
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46
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Steppan J, Diaz-Rodriguez N, Barodka VM, Nyhan D, Pullins E, Housten T, Damico RL, Mathai SC, Hassoun PM, Berkowitz DE, Maxwell BG, Kolb TM. Focused Review of Perioperative Care of Patients with Pulmonary Hypertension and Proposal of a Perioperative Pathway. Cureus 2018; 10:e2072. [PMID: 29552434 PMCID: PMC5854330 DOI: 10.7759/cureus.2072] [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] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Morbidity and mortality risk increase considerably for patients with pulmonary hypertension (PH) undergoing non-cardiac surgery. Unfortunately, there are no comprehensive, evidence-based guidelines for perioperative evaluation and management of these patients. We present a brief review of the literature on perioperative outcomes for patients with PH and describe the implementation of a collaborative perioperative management program for these high-risk patients at a tertiary academic center.
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Affiliation(s)
- Jochen Steppan
- Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine
| | | | - Viachaslau M Barodka
- Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine
| | - Daniel Nyhan
- Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine
| | - Erica Pullins
- Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine
| | - Traci Housten
- Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine
| | - Rachel L Damico
- Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine
| | - Stephen C Mathai
- Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine
| | - Paul M Hassoun
- Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine
| | - Dan E Berkowitz
- Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine
| | | | - Todd M Kolb
- Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine
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47
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Sato T, Ambale-Venkatesh B, Lima JAC, Zimmerman SL, Tedford RJ, Fujii T, Hulme OL, Pullins EH, Corona-Villalobos CP, Zamanian RT, Minai OA, Girgis RE, Chin K, Khair R, Damico RL, Kolb TM, Mathai SC, Hassoun PM. The impact of ambrisentan and tadalafil upfront combination therapy on cardiac function in scleroderma associated pulmonary arterial hypertension patients: cardiac magnetic resonance feature tracking study. Pulm Circ 2017; 8:2045893217748307. [PMID: 29251556 PMCID: PMC6018906 DOI: 10.1177/2045893217748307] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The aim of this study was to evaluate the effect of upfront combination therapy with ambrisentan and tadalafil on left ventricular (LV) and right ventricular (RV) function in patients with systemic sclerosis-associated pulmonary arterial hypertension (SSc-PAH). LV and RV peak longitudinal and circumferential strain and strain rate (SR), which consisted of peak systolic SR (SRs), peak early diastolic SR (SRe), and peak atrial-diastolic SR (SRa) were analyzed using cardiac magnetic resonance imaging (CMRI) data from the recently published ATPAHSS-O trial (ambrisentan and tadalafil upfront combination therapy in SSc-PAH). Twenty-one patients completed the study protocol. Measures of RV systolic function (RV free wall [RVFW] peak longitudinal strain [pLS], RVFW peak longitudinal SRs [pLSRs]) and RV diastolic function (RVFW peak longitudinal SRa [pLSRa], RVFW peak circumferential SRe) were improved after treatment. LV systolic function (LV peak global longitudinal strain [pGLS]) and diastolic function (LV peak global longitudinal SRe [pGLSRe]) were also significantly improved at follow-up. Increased 6-min walk distance was significantly correlated with RVFW pLS and pLSRs, while the decrease in N-terminal pro-brain natriuretic peptide was correlated with LV pGLS. Increased cardiac index was associated with improved LV pGLSRe, and reduction in mean right atrial pressure was correlated with improved RVFW pLS and pLSRa. Combination therapy was associated with a significant improvement in both RV and LV function as assessed by CMR-derived strain and SR. Importantly, the improvement in RV and LV strain and SR correlated with improvements in known prognostic markers of PAH. (Approved by clinicaltrials.gov [NCT01042158] before patient recruitment.)
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Affiliation(s)
- Takahiro Sato
- 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bharath Ambale-Venkatesh
- 2 Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joao A C Lima
- 3 Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stefan L Zimmerman
- 2 Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ryan J Tedford
- 3 Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tomoki Fujii
- 3 Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Olivia L Hulme
- 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erica H Pullins
- 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Celia P Corona-Villalobos
- 2 Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Roham T Zamanian
- 4 Division of Pulmonary & Critical Care Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Omar A Minai
- 5 Division of Pulmonary and Critical Care Medicine, The Cleveland Clinic, Cleveland, OH, USA
| | - Reda E Girgis
- 6 Division of Pulmonary Medicine, Spectrum Health/Michigan State University, Grand Rapids, MI, USA
| | - Kelly Chin
- 7 Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rubina Khair
- 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rachel L Damico
- 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Todd M Kolb
- 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephen C Mathai
- 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paul M Hassoun
- 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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48
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Mukherjee M, Mercurio V, Tedford RJ, Shah AA, Hsu S, Mullin CJ, Sato T, Damico R, Kolb TM, Mathai SC, Hassoun PM. Right ventricular longitudinal strain is diminished in systemic sclerosis compared with idiopathic pulmonary arterial hypertension. Eur Respir J 2017; 50:50/5/1701436. [PMID: 29167303 DOI: 10.1183/13993003.01436-2017] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 09/01/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Monica Mukherjee
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Ryan J Tedford
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ami A Shah
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Steven Hsu
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Takahiro Sato
- Division of Pulmonary and Critical Care Medicine, Baltimore, MD, USA
| | - Rachel Damico
- Division of Pulmonary and Critical Care Medicine, Baltimore, MD, USA
| | - Todd M Kolb
- Division of Pulmonary and Critical Care Medicine, Baltimore, MD, USA
| | - Stephen C Mathai
- Division of Pulmonary and Critical Care Medicine, Baltimore, MD, USA
| | - Paul M Hassoun
- Division of Pulmonary and Critical Care Medicine, Baltimore, MD, USA
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49
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Mullin CJ, Hsu S, Amancherla K, Wand A, Rhodes P, Leary PJ, Mukherjee M, Damico RL, Kolb TM, Mathai SC, Hassoun PM, Tedford RJ. Evaluation of criteria for exercise-induced pulmonary hypertension in patients with resting pulmonary hypertension. Eur Respir J 2017; 50:50/3/1700784. [PMID: 28931665 DOI: 10.1183/13993003.00784-2017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 06/17/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Christopher J Mullin
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Steven Hsu
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kaushik Amancherla
- Dept of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alison Wand
- Dept of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Parker Rhodes
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter J Leary
- Division of Pulmonary and Critical Care, University of Washington Medicine Center, Seattle, WA, USA
| | - Monica Mukherjee
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rachel L Damico
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Todd M Kolb
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephen C Mathai
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paul M Hassoun
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ryan J Tedford
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA .,Division of Cardiology, Dept of Medicine, Medical University of South Carolina, Charleston, SC, USA
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50
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Kolb TM, Johnston L, Srinath H, Damarla M, Kass DA, Hassoun PM. Abstract 266: Phosphodiesterase 9A Deficiency Does Not Attenuate Chronic-hypoxic Pulmonary Hypertension. Circ Res 2017. [DOI: 10.1161/res.121.suppl_1.266] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Phosphodiesterase (PDE) inhibition is a cornerstone of therapy for pulmonary arterial hypertension. A novel role for PDE9A in natriuretic peptide-mediated left ventricular cyclic guanosine monophosphate (cGMP) signaling and remodeling has recently been described. Since cGMP-signaling can promote vaso-relaxation and prevent vascular smooth muscle cell proliferation and cardiac myocyte hypertrophy, we hypothesized that PDE9A deficiency would attenuate right ventricular (RV) and pulmonary vascular remodeling during chronic RV pressure overload.
Methods:
Chronic-hypoxic pulmonary hypertension (CH-PH) was induced in mice lacking PDE9A expression (
Pde9a
-/-
) and wild-type littermates (
Pde9a
+/+
) by exposure to normobaric hypoxia (FiO2 = 10%) for 3 weeks. RV systolic pressures were measured to quantify PH, and RV hypertrophy was quantified as the ratio of RV free wall mass to LV/septal mass (RV/LV+S). Heart, lung, and serum were flash frozen for biochemical analyses.
Results:
In wild-type mice, exposure to chronic hypoxia resulted in significant increases in RV pressure (30 ± 2.4 vs. 20 ± 3.2 mm Hg;
P
= 0.0006) and RV hypertrophy (0.34 ± 0.04 vs. 0.25 ± 0.02;
P
< 0.0001). Serum ANP levels were increased 5-fold with CH-PH (
P
= <0.0001), associated with a 72% reduction in lung
Npr3
receptor expression (responsible for ANP clearance;
P
< 0.0001) but no increase in RV
Nppa
expression. After 3 weeks of CH-PH, tissue levels of cGMP were not increased in lung (993 ± 502 pg/mg vs. 667 ± 210 pg/mg;
P
= 0.27) or RV (47 ± 18 pg/mg vs. 49 ± 13 pg/mg;
P
= 0.88) homogenates. Accordingly, serine-239 phosphorylation of vasodilatory-stimulated phosphoprotein (VASP; a surrogate for protein kinase G activation) was not increased by CH-PH in lung or RV. Expression of
Pde9a
RNA was not increased by CH-PH in lung or RV.
Pde9a
-/-
mice did not have attenuated CH-PH induced increases in RVH (
P
= 0.27, 2-way ANOVA) or RVSP (
P
= 0.23, 2-way ANOVA) when compared to
Pde9a
+/+
mice. In both
Pde9a
-/-
and
Pde9a
+/+
mice, CH-PH was associated with significant increases in lung PDE5A expression.
Conclusions:
In a murine model of chronic RV pressure overload, PDE9A deficiency does not attenuate RV remodeling or PH, despite robust increases in circulating natriuretic peptide levels.
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