Risk factors and basic mechanisms of chronic thromboembolic pulmonary hypertension: a current understanding
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TLDR
There exists no animal model for CTEPH; therefore, experimentation in the future must include human tissues and clinical data in parallel, and based on available data one may speculate that PE may be followed by a pulmonary vascular remodelling process modified by infection, immune phenomena, inflammation and thyroid hormone replacement or malignancy.Abstract:
All available evidence today indicates that chronic thromboembolic pulmonary hypertension (CTEPH) is primarily caused by venous thromboembolism, as opposed to primary pulmonary vascular in situ thrombosis. Both the initial magnitude of clot and pulmonary embolism (PE) recurrence may contribute to the development of CTEPH. Only few specific thrombophilic factors, such as phospholipid antibodies, lupus anticoagulant and elevated factor VIII, are statistically associated with CTEPH.
A mechanistic view of CTEPH as a disease caused by obliteration of central pulmonary arteries by pulmonary emboli is too simplistic. Based on available data one may speculate that PE may be followed by a pulmonary vascular remodelling process modified by infection, immune phenomena, inflammation, circulating and vascular-resident progenitor cells, thyroid hormone replacement or malignancy. Both plasmatic factors (hypercoagulation, “sticky” red blood cells, high platelet counts and uncleavable fibrinogens) and a misguided vascular remodelling process contribute to major vessel and small vessel obliteration. Endothelial dysfunction and endothelial–mesenchymal transition may be important, but their precise roles remain obscure. There exists no animal model for CTEPH; therefore, experimentation in the future must include human tissues and clinical data in parallel.read more
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Journal ArticleDOI
2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT).
Nazzareno Galiè,Marc Humbert,Jean-Luc Vachiery,Simon Gibbs,Irene Lang,Adam Torbicki,Gérald Simonneau,Andrew Peacock,Anton Vonk Noordegraaf,Maurice Beghetti,Ardeschir Ghofrani,Miguel Angel Gomez Sanchez,Georg Hansmann,Walter Klepetko,Patrizio Lancellotti,Marco Matucci,Theresa McDonagh,Luc Pierard,Pedro T. Trindade,Maurizio Zompatori,Marius M. Hoeper +20 more
TL;DR: In this paper, the authors defined the following terms: ALAT, alanine aminotransferase, ASAT, aspartate AMINOTE, and APAH, associated pulmonary arterial hypertension.
Journal ArticleDOI
Special article2015 ESC/ERS Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension
Nazzareno Galiè,Marc Humbert,Jean-Luc Vachiery,Simon Gibbs,Irene Lang,Adam Torbicki,Gérald Simonneau,Andrew J. Peacock,Anton Vonk Noordegraaf,Maurice Beghetti,Ardeschir Ghofrani,Miguel Angel Gomez Sanchez,Georg Hansmann,Walter Klepetko,Patrizio Lancellotti,Marco Matucci,Theresa McDonagh,Luc Pierard,Marius M. Hoeper +18 more
TL;DR: This article is being published concurrently in the European Heart Journal and the European Respiratory Journal and is identical except for minor stylistic and spelling differences in keeping with each journal’s style.
Journal ArticleDOI
[2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension].
Nazzareno Galiè,Marc Humbert,Jean-Luc Vachiery,Simon Gibbs,Irene Lang,Adam Torbicki,Gérald Simonneau,Andrew J. Peacock,Anton Vonk Noordegraaf,Maurice Beghetti,Ardeschir Ghofrani,Miguel Angel Gomez Sanchez,Georg Hansmann,Walter Klepetko,Patrizio Lancellotti,Marco Matucci,Theresa McDonagh,Luc Pierard,Pedro T. Trindade,Maurizio Zompatori,Marius M. Hoeper +20 more
TL;DR: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS) is constituted.
Journal ArticleDOI
2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism
Stavros Konstantinides,Adam Torbicki,David Fitzmaurice,Simón J,R. Gibbs,Menno V. Huisman,Marc Humbert,John Lekakis,Nicolas Meneveau,Lars Hvilsted Rasmussen,Thomas H. Schindler,Anton Vonk Noordegraaf,José Luis Zamorano,Maurizio Zompatori +13 more
TL;DR: Guidelines summarize and evaluate all available evidence at the time of the writing process, on a particular issue with the aim of assisting health professionals in selecting the best management strategies for an individual patient, with a given condition, taking into account the impact on outcome.
Journal ArticleDOI
2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT).
Nazzareno Galiè,Marc Humbert,Jean-Luc Vachiery,Simon Gibbs,Irene Lang,Adam Torbicki,Gérald Simonneau,Andrew Peacock,Anton Vonk Noordegraaf,Maurice Beghetti,Ardeschir Ghofrani,Miguel Angel Gomez Sanchez,Georg Hansmann,Walter Klepetko,Patrizio Lancellotti,Marco Matucci,Theresa McDonagh,Luc Pierard,Pedro T. Trindade,Maurizio Zompatori,Marius M. Hoeper +20 more
TL;DR: In this article, guidelines summarize and evaluate all available evidence on a particular issue, with the aim of assisting health professionals in selecting the best management strategies for an individual patient with a given condition, taking into account the impact on outcome, as well as the risk-benefit ratio of particular diagnostic or therapeutic means.
References
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Journal ArticleDOI
Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism.
Vittorio Pengo,Anthonie W. A. Lensing,Martin H. Prins,Antonio Marchiori,Bruce L. Davidson,Francesca Tiozzo,Paolo Albanese,Alessandra Biasiolo,Cinzia Pegoraro,Sabino Iliceto,Paolo Prandoni +10 more
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TL;DR: The natural history of chronic thromboembolic disease is reviewed and a suggested diagnostic approach to determine whether a patient with chronic thROMboembolism might be an appropriate surgical candidate is outlined.
Journal ArticleDOI
Longterm Follow-up of Patients with Pulmonary Thromboembolism: Late Prognosis and Evolution of Hemodynamic and Respiratory Data
TL;DR: In this paper, the authors follow-up patients with various forms of pulmonary thromboembolic disease for 1 to 15 years and find no correlation between the longterm changes of pulmonary artery pressure and age, duration of disease, interval between catheterizations, PaO2, or cardiac output.
Journal ArticleDOI
Chronic Thromboembolic Pulmonary Hypertension (CTEPH) Results From an International Prospective Registry
Joanna Pepke-Zaba,Marion Delcroix,Irene Lang,Eckhard Mayer,Pavel Jansa,David Ambroz,Carmen M. Treacy,Andrea Maria D'Armini,Marco Morsolini,Repke J. Snijder,Paul Bresser,Adam Torbicki,Bent Bruun Kristensen,Jerzy Lewczuk,Iveta Simkova,Joan Albert Barberà,Marc de Perrot,Marius M. Hoeper,Sean Gaine,Rudolf Speich,Miguel Ángel Gómez-Sánchez,Gabor Kovacs,A. Hamid,Xavier Jaïs,Gérald Simonneau +24 more
TL;DR: Despite similarities in clinical presentation, operable and nonoperable CTEPH patients may have distinct associated medical conditions.
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