-
Clinical and Experimental Hypertension... Dec 2023To explore the correlation between pulmonary vascular performance and hemodynamics in patients with pulmonary arterial hypertension (PAH), using right heart...
OBJECTIVE
To explore the correlation between pulmonary vascular performance and hemodynamics in patients with pulmonary arterial hypertension (PAH), using right heart catheterization (RHC) and intravascular ultrasound (IVUS).
METHOD
A total of 60 patients underwent RHC and IVUS examinations. Of these, 27 patients were diagnosed with PAH associated with connective tissue diseases (PAH-CTD group), 18 patients were diagnosed with other types of PAH (other-types-PAH group), and 15 patients were without PAH (control group). The hemodynamics and morphological parameters of pulmonary vessels in PAH patients were assessed using RHC and IVUS.
RESULTS
There were statistically significant differences in right atrial pressure (RAP), pulmonary artery systolic pressure (sPAP), pulmonary artery diastolic pressure (dPAP), mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR) values between the PAH-CTD group, other-types-PAH group, and the control group (P < .05). No statistically significant difference was noticed in pulmonary artery wedge pressure (PAWP) and cardiac output (CO) values between these three groups (P > .05). The mean wall thickness (MWT), wall thickness percentage (WTP), pulmonary vascular compliance, dilation, elasticity modulus, stiffness index β, and other indicators were significantly different between these three groups (P < .05). Pairwise comparison showed that the average levels of pulmonary vascular compliance and dilation in PAH-CTD group and other-types-PAH group were lower than those in control group, while the average levels of elastic modulus and stiffness index β were higher than those in control group.
CONCLUSION
Pulmonary vascular performance deteriorates in PAH patients, and the performance is better in PAH-CTD patients than in other types of PAH.
Topics: Humans; Pulmonary Arterial Hypertension; Hypertension, Pulmonary; Hemodynamics; Pulmonary Artery; Lung
PubMed: 36906960
DOI: 10.1080/10641963.2023.2185253 -
Interventional Cardiology Clinics Jul 2023Pulmonary arterial hypertension (PAH) is a progressive, life-limiting disease. Despite significant medical progress over the last three decades, the prognosis of PAH... (Review)
Review
Pulmonary arterial hypertension (PAH) is a progressive, life-limiting disease. Despite significant medical progress over the last three decades, the prognosis of PAH remains poor. PAH is associated with sympathetic nervous system over-stimulation and baroreceptor-mediated vasoconstriction, leading to pathologic pulmonary artery (PA) and right ventricular remodeling. PA denervation is a minimally-invasive intervention that ablates local sympathetic nerve fibers and baroreceptors to modulate pathologic vasoconstriction. Preliminary animal and clinical studies have shown improvements in short-term pulmonary hemodynamics and PA remodeling. However, future studies are needed to elucidate appropriate patient selection, timing of intervention, and long-term efficacy before integration into standard of care.
Topics: Animals; Humans; Pulmonary Arterial Hypertension; Pulmonary Artery; Hypertension, Pulmonary; Sympathetic Nervous System; Sympathectomy
PubMed: 37290841
DOI: 10.1016/j.iccl.2023.03.005 -
JACC. Heart Failure Aug 2023
Topics: Humans; Hypertension, Pulmonary; Pulmonary Artery; Heart Failure; Denervation
PubMed: 37480880
DOI: 10.1016/j.jchf.2023.06.015 -
Radiology Jul 2023Background Experience with functional CT in the lungs without additional equipment in clinical routine is limited. Purpose To report initial experience and evaluate the...
Background Experience with functional CT in the lungs without additional equipment in clinical routine is limited. Purpose To report initial experience and evaluate the robustness of a modified chest CT protocol and photon-counting CT (PCCT) for comprehensive analysis of pulmonary vasculature, perfusion, ventilation, and morphologic structure in a single examination. Materials and Methods In this retrospective study, consecutive patients with clinically indicated CT for various known and unknown pulmonary function impairment (six subgroups) were included between November 2021 and June 2022. After administration of an intravenous contrast agent, inspiratory PCCT was followed by expiratory PCCT after a delay of 5 minutes. Advanced automated postprocessing was performed, and CT-derived functional parameters were calculated (regional ventilation, perfusion, late contrast enhancement, and CT angiography). Mean intravascular contrast enhancement in the mediastinal vessels and radiation dose were determined. Using analysis of variance, the mean values of lung volumes, attenuation, ventilation, perfusion, and late contrast enhancement were tested for differences between subgroups of patients. Results In 166 patients (mean age, 63.2 years ± 14.2 [SD]; 106 male patients), all CT-derived parameters could be acquired (84.7% success rate; 166 of 196 patients). At the inspiratory examination, mean density was 325 HU in the pulmonary trunk, 260 HU in the left atrium, and 252 HU in the ascending aorta. The mean dose-length product for inspiration and expiration was 110.32 mGy · cm and 109.47 mGy · cm, respectively; the mean CT dose index for inspiration and expiration was 3.22 mGy and 3.09 mGy, respectively (less than the mean total radiation dose of 8-12 mGy, which is diagnostic reference level). Significant differences ( < .05) between the subgroups were found for all assessed parameters. Visual inspection allowed for voxelwise assessment of morphologic structure and function. Conclusion The proposed PCCT protocol allowed for a dose-efficient and robust simultaneous evaluation of pulmonary morphologic structure, ventilation, vasculature, and parenchymal perfusion in a procedure requiring advanced software but no additional hardware. © RSNA, 2023.
Topics: Humans; Male; Middle Aged; Retrospective Studies; Respiration; Tomography, X-Ray Computed; Pulmonary Artery; Lung
PubMed: 37432088
DOI: 10.1148/radiol.230318 -
International Journal of Biological... 2023Pulmonary and systemic hypertension (PH, SH) are characterized by vasoconstriction and vascular remodeling resulting in increased vascular resistance and... (Review)
Review
Pulmonary and systemic hypertension (PH, SH) are characterized by vasoconstriction and vascular remodeling resulting in increased vascular resistance and pulmonary/aortic artery pressures. The chronic stress leads to inflammation, oxidative stress, and infiltration by immune cells. Roles of metals in these diseases, particularly PH are largely unknown. This review first discusses the pathophysiology of PH including vascular oxidative stress, inflammation, and remodeling in PH; mitochondrial dysfunction and metabolic changes in PH; ion channel and its alterations in the pathogenesis of PH as well as PH-associated right ventricular (RV) remodeling and dysfunctions. This review then summarizes metal general features and essentiality for the cardiovascular system and effects of metals on systemic blood pressure. Lastly, this review explores non-essential and essential metals and potential roles of their dyshomeostasis in PH and RV dysfunction. Although it remains early to conclude the role of metals in the pathogenesis of PH, emerging direct and indirect evidence implicates the possible contributions of metal-mediated toxicities in the development of PH. Future research should focus on comprehensive clinical metallomics study in PH patients; mechanistic evaluations to elucidate roles of various metals in PH animal models; and novel therapy clinical trials targeting metals. These important discoveries will significantly advance our understandings of this rare yet fatal disease, PH.
Topics: Animals; Humans; Hypertension, Pulmonary; Pulmonary Artery; Lung; Hypertension; Inflammation; Ventricular Remodeling
PubMed: 37928257
DOI: 10.7150/ijbs.85590 -
JACC. Cardiovascular Imaging Aug 2023Current cardiac magnetic resonance (CMR) imaging in pulmonary arterial hypertension (PAH) focuses on measures of ventricular function and coupling.
BACKGROUND
Current cardiac magnetic resonance (CMR) imaging in pulmonary arterial hypertension (PAH) focuses on measures of ventricular function and coupling.
OBJECTIVES
The purpose of this study was to evaluate pulmonary artery (PA) global longitudinal strain (GLS) as a prognostic marker in patients with PAH.
METHODS
The authors included 169 patients with PAH from the ASPIRE (Assessing the Spectrum of Pulmonary hypertension Identified at a REferral centre) and INITIATE (Integrated computatioNal modelIng of righT heart mechanIcs and blood flow dynAmics in congeniTal hEart disease) registries, and 82 normal controls with similar age and gender distributions. PA GLS was derived from CMR feature tracking. Right ventricular measurements including volumes, ejection fraction, and right ventricular GLS were also derived from CMR. Patients were followed up a median of 34 months with all-cause mortality as the primary endpoint. Other known risk scores were collected, including the REVEAL (Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management) 2.0 and COMPERA (Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension) 2.0 scores.
RESULTS
Of 169 patients (mean age: 57 ± 15 years; 80% female), 45 (26.6%) died (median follow-up: 34 months). Mean PA GLS was 23% ± 6% in normal controls and 10% ± 5% in patients with PAH (P < 0.0001). Patients with PA GLS <9% had a higher risk of mortality than those with PA GLS ≥9% (P < 0.001), and this was an independent predictor of mortality in PAH on multivariable analysis after adjustment for known risk factors (HR: 2.93; P = 0.010). Finally, in patients with PAH, PA GLS provided incremental prognostic value over the REVEAL 2.0 (global chi-square; P = 0.001; C statistic comparison; P = 0.030) and COMPERA 2.0 (global chi-square; P = 0.001; C statistic comparison; P = 0.048).
CONCLUSIONS
PA GLS confers incremental prognostic utility over the established risk scores for identifying patients with PAH at higher risk of death, who may be targeted for closer monitoring and/or intensified therapy.
Topics: Humans; Female; Adult; Middle Aged; Aged; Male; Pulmonary Arterial Hypertension; Pulmonary Artery; Hypertension, Pulmonary; Magnetic Resonance Imaging, Cine; Predictive Value of Tests; Familial Primary Pulmonary Hypertension; Prognosis; Stroke Volume
PubMed: 37052561
DOI: 10.1016/j.jcmg.2023.02.007 -
Cardiology in the Young Dec 2023In single-ventricle patients undergoing staged-bidirectional Glenn, 36-59% have aorto-pulmonary collateral flow, but risk factors and clinical outcomes are unknown. We...
BACKGROUND
In single-ventricle patients undergoing staged-bidirectional Glenn, 36-59% have aorto-pulmonary collateral flow, but risk factors and clinical outcomes are unknown. We hypothesise that shunt type and catheter haemodynamics may predict pre-bidirectional Glenn aorto-pulmonary collateral burden, which may predict death/transplantation, pulmonary artery or aorto-pulmonary collateral intervention.
METHODS
Retrospective cohort study of patients undergoing a Norwood procedure for single-ventricle anatomy. Covariates included clinical and haemodynamic characteristics up to/including pre-bidirectional Glenn catheterisation and aorto-pulmonary collateral burden at pre-bidirectional Glenn catheterisation. Multivariable models used to evaluate relationships between risk factors and outcomes.
RESULTS
From January 2011 to March 2016, 104 patients underwent Norwood intervention. Male sex (odds ratio 3.36, 95% confidence interval 1.17-11.4), age at pre-bidirectional Glenn assessment (2.12, 1.33-3.39 per month), and pulmonary to systemic flow ratio (1.23, 1.08-1.41 per 0.1 unit) were associated with aorto-pulmonary collateral burden. Aorto-pulmonary collateral burden was not associated with death/transplantation (hazard ratio 1.19, 95% confidence interval 0.37-3.85), pulmonary artery (sub-hazard ratio 1.38, 0.32-2.61), or aorto-pulmonary collateral interventions (sub-hazard ratio 1.11, 0.21-5.76). Longer post-Norwood length of stay was associated with greater risk of death/transplantation (hazard ratio 1.22 per week, 95% confidence interval 1.08-1.38), but lower risk of aorto-pulmonary collateral intervention (sub-hazard ratio 0.86 per week, 95% confidence interval 0.75-0.98). Time to pre-bidirectional Glenn catheterisation was associated with lower risk of pulmonary artery (sub-hazard ratio 0.80 per month, 95% confidence interval 0.65-0.98) and aorto-pulmonary collateral intervention (sub-hazard ratio 0.79, 0.63-0.99). Probability of moderate/severe aorto-pulmonary collateral burden increased with left-to-right shunt (22.5% at <1.0, 57.6% at >1.4) and the age at pre-bidirectional Glenn catheterisation (10.6% at <2 months, 56.9% at >5 months).
CONCLUSIONS
Aorto-pulmonary collateral burden is common after Norwood procedure and increases as age at bidirectional Glenn increases. As expected, higher pulmonary to systemic flow ratio is a marker for greater aorto-pulmonary collateral burden pre-bi-directional Glenn; aorto-pulmonary collateral burden does not confer risk of death/transplantation or pulmonary artery intervention.
Topics: Humans; Male; Infant; Hypoplastic Left Heart Syndrome; Retrospective Studies; Treatment Outcome; Pulmonary Artery; Norwood Procedures; Univentricular Heart; Fontan Procedure; Heart Ventricles
PubMed: 37066762
DOI: 10.1017/S1047951123000665 -
Zhonghua Jie He He Hu Xi Za Zhi =... Sep 2023Pulmonary hypertension is a progressive disease characterized by an increase in pulmonary vascular resistance, leading to unfavorable pulmonary vascular remodeling. This... (Review)
Review
Pulmonary hypertension is a progressive disease characterized by an increase in pulmonary vascular resistance, leading to unfavorable pulmonary vascular remodeling. This condition eventually leads to right ventricular hypertrophy and ultimately death from right ventricular failure. Although the exact pathogenesis of pulmonary hypertension remains unclear, autonomic nervous system dysfunction is recognized as one of the contributing factors. Increasing evidence supports the hypothesis that activation of the sympathetic nervous system plays a role in the development of pulmonary hypertension. In addition, pulmonary artery denervation has shown some effectiveness in the treatment of this condition. This article provides a comprehensive review of the neuroanatomical basis of the pulmonary vessels, the potential mechanisms underlying the onset and progression of pulmonary hypertension in relation to neuromodulation, and the application of neuromodulation techniques in its treatment.
Topics: Humans; Hypertension, Pulmonary; Heart Failure; Pulmonary Artery
PubMed: 37670649
DOI: 10.3760/cma.j.cn112147-20230302-00104 -
Interventional Cardiology Clinics Jul 2023Invasive or selective pulmonary angiography has historically been used as the gold standard diagnostic test for the evaluation of a wide array of pulmonary arterial... (Review)
Review
Invasive or selective pulmonary angiography has historically been used as the gold standard diagnostic test for the evaluation of a wide array of pulmonary arterial conditions, most commonly pulmonary thromboembolic diseases. With the emergence of various noninvasive imaging modalities, the role of invasive pulmonary angiography is shifting to the assistance of advanced pharmacomechanical therapies for such conditions. Components of invasive pulmonary angiography methodology include optimal patient positioning, vascular access, catheter selections, angiographic positioning, contrast settings, and recognition of angiographic patterns of common thromboembolic and nonthromboembolic conditions. We review the pulmonary vascular anatomy, step-by-step performance, and interpretation of invasive pulmonary angiography.
Topics: Humans; Pulmonary Artery; Hypertension, Pulmonary; Pulmonary Embolism; Angiography; Thromboembolism
PubMed: 37290835
DOI: 10.1016/j.iccl.2023.03.002 -
Journal of Translational Medicine Nov 2023Pulmonary hypertension (PH), an infrequent disease, is characterized by excessive pulmonary vascular remodeling and proliferation of pulmonary artery smooth muscle cells...
BACKGROUND
Pulmonary hypertension (PH), an infrequent disease, is characterized by excessive pulmonary vascular remodeling and proliferation of pulmonary artery smooth muscle cells (PASMCs). However, its underlying molecular mechanisms remain unclear. Uncovering its molecular mechanisms will be beneficial to the treatment of PH.
METHODS
Differently expressed genes (DEGs) in the lung tissues of PH patients were analyzed with a GEO dataset GSE113439. From these DEGs, we focused on TRIM59 which was highly expressed in PH patients. Subsequently, the expression of TRIM59 in the pulmonary arteries of PH patients, lung tissues of PH rat model and PASMCs cultured in a hypoxic condition was verified by quantitative real-time PCR (qPCR), western blot and immunohistochemistry. Furthermore, the role of TRIM59 in PAMSC proliferation and pathological changes in PH rats was assessed via gain-of-function and loss-of-function experiments. In addition, the transcriptional regulation of YAP1/TEAD4 on TRIM59 was confirmed by qPCR, western blot, luciferase reporter assay, ChIP and DNA pull-down. In order to uncover the underlying mechanisms of TRIM59, a protein ubiquitomics and a CoIP- HPLC-MS/MS were companied to identify the direct targets of TRIM59.
RESULTS
TRIM59 was highly expressed in the pulmonary arteries of PH patients and lung tissues of PH rats. Over-expression of TRIM59 accelerated the proliferation of PASMCs, while TRIM59 silencing resulted in the opposite results. Moreover, TRIM59 silencing mitigated the injuries in heart and lung and attenuated pulmonary vascular remodeling during PH. In addition, its transcription was positively regulated by YAP1/TEAD4. Then we further explored the underlying mechanisms of TRIM59 and found that TRIM59 overexpression resulted in an altered ubiquitylation of proteins. Accompanied with the results of CoIP- HPLC-MS/MS, 34 proteins were identified as the direct targets of TRIM59.
CONCLUSION
TRIM59 was highly expressed in PH patients and promoted the proliferation of PASMCs and pulmonary vascular remodeling, thus contributing to the pathogenesis of PH. It is indicated that TRIM59 may become a potential target for PH treatment.
Topics: Humans; Rats; Animals; Hypertension, Pulmonary; Vascular Remodeling; Tandem Mass Spectrometry; Signal Transduction; Cell Proliferation; Pulmonary Artery; Hypoxia; Transcription Factors; Ubiquitination; Myocytes, Smooth Muscle; Cells, Cultured; TEA Domain Transcription Factors; Tripartite Motif Proteins
PubMed: 37978515
DOI: 10.1186/s12967-023-04712-4