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Pulmonary Circulation 2021
PubMed: 34631012
DOI: 10.1177/20458940211051188 -
International Journal of Molecular... Sep 2021Currently, no treatment can completely cure pulmonary hypertension (PH), which can lead to right ventricular failure and, consequently, death. Therefore, searching for... (Review)
Review
Currently, no treatment can completely cure pulmonary hypertension (PH), which can lead to right ventricular failure and, consequently, death. Therefore, searching for new therapies remains important. Increased resistance in pulmonary circulation is mainly caused by the excessive contraction and proliferation of small pulmonary arteries. Cannabinoids, a group of lipophilic compounds that all interact with cannabinoid receptors, exert a pulmonary vasodilatory effect through several different mechanisms, including mechanisms that depend on vascular endothelium and/or receptor-based mechanisms, and may also have anti-proliferative and anti-inflammatory properties. The vasodilatory effect is important in regulating pulmonary resistance, which can improve patients' quality of life. Moreover, experimental studies on the effects of cannabidiol (plant-derived, non-psychoactive cannabinoid) in animal PH models have shown that cannabidiol reduces right ventricular systolic pressure and excessive remodelling and decreases pulmonary vascular hypertrophy and pulmonary vascular resistance. Due to the potentially beneficial effects of cannabinoids on pulmonary circulation and PH, in this work, we review whether cannabinoids can be used as an adjunctive therapy for PH. However, clinical trials are still needed to recommend the use of cannabinoids in the treatment of PH.
Topics: Animals; Anti-Inflammatory Agents; Cannabidiol; Cannabinoids; Cell Proliferation; Disease Models, Animal; Endocannabinoids; Heart Ventricles; Humans; Hypertension, Pulmonary; In Vitro Techniques; Ligands; Lung; Nitric Oxide; Pulmonary Circulation; Receptors, Cannabinoid; Receptors, G-Protein-Coupled; Systole; Vasoconstriction; Vasodilation; Ventricular Dysfunction, Right
PubMed: 34576212
DOI: 10.3390/ijms221810048 -
Journal of Thoracic Disease Oct 2020This is the first study to evaluate changes in postpartum pulmonary circulation in a novel pregnant rat model of monocrotaline (MCT)-induced pulmonary arterial...
BACKGROUND
This is the first study to evaluate changes in postpartum pulmonary circulation in a novel pregnant rat model of monocrotaline (MCT)-induced pulmonary arterial hypertension (PAH).
METHODS
Female rats were randomly divided into two groups: the MCT-treated pregnant group, in which rats were injected with MCT (40 mg/kg) at the age of 7 weeks, and the pregnant group, in which rats were injected with the same volume of 0.9% saline at the same age. Rats from both groups were mated at the age of 9 weeks. General condition information, hemodynamic data and pulmonary tissues were collected from pregnant rats from the two groups on the 18th day after successful mating (T1) and the 1st (T2), 3rd (T3), and 7th days after delivery (T4).
RESULTS
The MCT-treated pregnant group exhibited a greater mean pulmonary artery pressure (mPAP) (P<0.01) and Fulton's Index (P<0.01) than the pregnant group at each time point. Lung tissues from the MCT-treated pregnant group showed pulmonary vascular hyperplasia and occlusive changes. The mPAP and the occluded pulmonary artery density in the MCT-treated pregnant group increased after delivery (P<0.01) and significantly increased at T3 compared with T2 (P<0.05) but was not further increased at T4 (P>0.05).
CONCLUSIONS
Pregnant rats with PAH exhibited increased mPAP after delivery accompanied by a significant increase in the occluded pulmonary artery density, which may have contributed to the increased mortality rate of pregnant rats with PAH after delivery.
PubMed: 33209381
DOI: 10.21037/jtd-20-1966 -
Respirology (Carlton, Vic.) Nov 2019
Topics: Biomarkers; Humans; Idiopathic Pulmonary Fibrosis; Lung; Osteopontin; Pulmonary Arterial Hypertension
PubMed: 31486582
DOI: 10.1111/resp.13694 -
Archivos de Bronconeumologia Apr 2022
Topics: COVID-19; Humans; Pulmonary Circulation; Thrombosis
PubMed: 34054194
DOI: 10.1016/j.arbres.2021.05.007 -
Circulation May 2022In REDUCE LAP-HF II (A Study to Evaluate the Corvia Medical, Inc IASD System II to Reduce Elevated Left Atrial Pressure in Patients With Heart Failure), implantation of... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
In REDUCE LAP-HF II (A Study to Evaluate the Corvia Medical, Inc IASD System II to Reduce Elevated Left Atrial Pressure in Patients With Heart Failure), implantation of an atrial shunt device did not provide overall clinical benefit for patients with heart failure with preserved or mildly reduced ejection fraction. However, prespecified analyses identified differences in response in subgroups defined by pulmonary artery systolic pressure during submaximal exercise, right atrial volume, and sex. Shunt implantation reduces left atrial pressures but increases pulmonary blood flow, which may be poorly tolerated in patients with pulmonary vascular disease (PVD). On the basis of these results, we hypothesized that patients with latent PVD, defined as elevated pulmonary vascular resistance during exercise, might be harmed by shunt implantation, and conversely that patients without PVD might benefit.
METHODS
REDUCE LAP-HF II enrolled 626 patients with heart failure, ejection fraction ≥40%, exercise pulmonary capillary wedge pressure ≥25 mm Hg, and resting pulmonary vascular resistance <3.5 Wood units who were randomized 1:1 to atrial shunt device or sham control. The primary outcome-a hierarchical composite of cardiovascular death, nonfatal ischemic stroke, recurrent HF events, and change in health status-was analyzed using the win ratio. Latent PVD was defined as pulmonary vascular resistance ≥1.74 Wood units (highest tertile) at peak exercise, measured before randomization.
RESULTS
Compared with patients without PVD (n=382), those with latent PVD (n=188) were older, had more atrial fibrillation and right heart dysfunction, and were more likely to have elevated left atrial pressure at rest. Shunt treatment was associated with worse outcomes in patients with PVD (win ratio, 0.60 [95% CI, 0.42, 0.86]; =0.005) and signal of clinical benefit in patients without PVD (win ratio, 1.31 [95% CI, 1.02, 1.68]; =0.038). Patients with larger right atrial volumes and men had worse outcomes with the device and both groups were more likely to have pacemakers, heart failure with mildly reduced ejection fraction, and increased left atrial volume. For patients without latent PVD or pacemaker (n=313; 50% of randomized patients), shunt treatment resulted in more robust signal of clinical benefit (win ratio, 1.51 [95% CI, 1.14, 2.00]; =0.004).
CONCLUSIONS
In patients with heart failure with preserved or mildly reduced ejection fraction, the presence of latent PVD uncovered by invasive hemodynamic exercise testing identifies patients who may worsen with atrial shunt therapy, whereas those without latent PVD may benefit.
Topics: Cardiac Catheterization; Female; Heart Atria; Heart Failure; Humans; Male; Pulmonary Circulation; Stroke Volume; Treatment Outcome; Vascular Diseases
PubMed: 35354306
DOI: 10.1161/CIRCULATIONAHA.122.059486 -
Research Square May 2023The role of the lung's microcirculation and capillary endothelial cells in normal physiology and the pathobiology of pulmonary diseases is unequivocally vital. The...
The role of the lung's microcirculation and capillary endothelial cells in normal physiology and the pathobiology of pulmonary diseases is unequivocally vital. The recent discovery of molecularly distinct aerocytes and general capillary (gCaps) endothelial cells by single-cell transcriptomics (scRNAseq) advanced the field in understanding microcirculatory milieu and cellular communications. However, increasing evidence from different groups indicated the possibility of more heterogenic structures of lung capillaries. Therefore, we investigated enriched lung endothelial cells by scRNAseq and identified five novel populations of gCaps with distinct molecular signatures and roles. Our analysis suggests that two populations of gCaps that express Scn7a(Na) and Clic4(Cl) ion transporters form the arterial-to-vein zonation and establish the capillary barrier. We also discovered and named mitotically-active "root" cells (Flot1+) on the interface between arterial, Scn7a+, and Clic4 + endothelium, responsible for the regeneration and repair of the adjacent endothelial populations. Furthermore, the transition of gCaps to a vein requires a venous-capillary endothelium expressing Lingo2. Finally, gCaps detached from the zonation represent a high level of Fabp4, other metabolically active genes, and tip-cell markers showing angiogenesis-regulating capacity. The discovery of these populations will translate into a better understanding of the involvement of capillary phenotypes and their communications in lung disease pathogenesis.
PubMed: 37205391
DOI: 10.21203/rs.3.rs-2887159/v1 -
American Journal of Respiratory and... Aug 2023
Topics: Humans; Hypertension, Pulmonary; Pulmonary Artery; Pulmonary Circulation
PubMed: 37348119
DOI: 10.1164/rccm.202306-0990ED -
Current Opinion in Pulmonary Medicine Sep 2021The coronavirus disease 2019 (COVID-19) pandemic has led to almost 3,000,000 deaths across 139 million people infected worldwide. Involvement of the pulmonary... (Review)
Review
PURPOSE OF REVIEW
The coronavirus disease 2019 (COVID-19) pandemic has led to almost 3,000,000 deaths across 139 million people infected worldwide. Involvement of the pulmonary vasculature is considered a major driving force for morbidity and mortality. We set out to summarize current knowledge on the acute manifestations of pulmonary vascular disease (PVD) resulting from COVID-19 and prioritize long-term complications that may result in pulmonary hypertension (PH).
RECENT FINDINGS
Acute COVID-19 infection can result in widespread involvement of the pulmonary vasculature, myocardial injury, evidence of persistent lung disease, and venous thromboembolism. Post COVID-19 survivors frequently report ongoing symptoms and may be at risk for the spectrum of PH, including group 1 pulmonary arterial hypertension, group 2 PH due to left heart disease, group 3 PH due to lung disease and/or hypoxia, and group 4 chronic thromboembolic PH.
SUMMARY
The impact of COVID-19 on the pulmonary vasculature is central to determining disease severity. Although the long-term PVD manifestations of COVID-19 are currently uncertain, optimizing the care of risk factors for PH and monitoring for the development of PVD will be critical to reducing long-term morbidity and improving the health of survivors.
Topics: COVID-19; Humans; Lung Diseases; Pandemics; Pulmonary Circulation; SARS-CoV-2; Vascular Diseases
PubMed: 34127622
DOI: 10.1097/MCP.0000000000000792 -
PloS One 2022Percutaneous patent ductus arteriosus (PDA) stenting is a therapeutic modality in patients with duct-dependent pulmonary circulation with reported success rates from...
OBJECTIVES
Percutaneous patent ductus arteriosus (PDA) stenting is a therapeutic modality in patients with duct-dependent pulmonary circulation with reported success rates from 80-100%. The current study aims to assess the outcome and the indicators of success for PDA stenting in different ductal morphologies using various approaches.
METHODS
A prospective cohort study from a single tertiary center presented from January 2018 to December 2019 that included 96 consecutive infants with ductal-dependent pulmonary circulation and palliated with PDA stenting. Patients were divided according to PDA origin into 4 groups: Group 1: PDA from proximal descending aorta, Group 2: from undersurface of aortic arch, Group 3: opposite the subclavian artery, Group 4: opposite the innominate/brachiocephalic artery.
RESULTS
The median age of patients was 22 days and median weight was 3 kg. The procedure was successful in 78 patients (81.25%). PDA was tortuous in 70 out of 96 patients. Femoral artery was the preferred approach in Group 1 (63/67), while axillary artery access was preferred in the other groups (6/11 in Group 2, 11/17 in Group 3, 1/1 in Group 4, P <0.0001). The main cause of procedural failure was inadequate parked coronary wire inside one of the branch of pulmonary arteries (14 cases; 77.7%), while 2 cases (11.1%) were complicated by acute stent thrombosis, and another 2 cases with stent dislodgment. Other procedural complications comprised femoral artery thrombosis in 7 cases (7.2%). Patients with straight PDA, younger age at procedure and who had larger PDA at pulmonary end had higher odds for success (OR = 8.01, 2.94, 7.40, CI = 1.011-63.68, 0.960-0.99, 1.172-7.40,respectively, P = 0.048, 0.031,0.022 respectively).
CONCLUSIONS
The approach for PDA stenting and hence the outcome is markedly determined by the PDA origin and morphology. Patients with straight PDA, younger age at procedure and those who had relatively larger PDA at the pulmonary end had better opportunity for successful procedure.
Topics: Cardiac Catheterization; Ductus Arteriosus, Patent; Humans; Infant; Prospective Studies; Pulmonary Circulation; Retrospective Studies; Stents; Treatment Outcome
PubMed: 35421117
DOI: 10.1371/journal.pone.0265031