Showing papers on "Pulmonary artery published in 2023"
TL;DR: In this article , the authors evaluated the acute safety and effectiveness of mechanical thrombectomy for intermediate-and high-risk pulmonary embolism in a large real-world population, and reported improvements in haemodynamics and functional outcomes.
Abstract: Evidence supporting interventional pulmonary embolism (PE) treatment is needed.We aimed to evaluate the acute safety and effectiveness of mechanical thrombectomy for intermediate- and high-risk PE in a large real-world population.FLASH is a multicentre, prospective registry enrolling up to 1,000 US and European PE patients treated with mechanical thrombectomy using the FlowTriever System. The primary safety endpoint is a major adverse event composite including device-related death and major bleeding at 48 hours, and intraprocedural adverse events. Acute mortality and 48-hour outcomes are reported. Multivariate regression analysed characteristics associated with pulmonary artery pressure and dyspnoea improvement.Among 800 patients in the full US cohort, 76.7% had intermediate-high risk PE, 7.9% had high-risk PE, and 32.1% had thrombolytic contraindications. Major adverse events occurred in 1.8% of patients. All-cause mortality was 0.3% at 48-hour follow-up and 0.8% at 30-day follow-up, with no device-related deaths. Immediate haemodynamic improvements included a 7.6 mmHg mean drop in mean pulmonary artery pressure (-23.0%; p<0.0001) and a 0.3 L/min/m2 mean increase in cardiac index (18.9%; p<0.0001) in patients with depressed baseline values. Most patients (62.6%) had no overnight intensive care unit stay post-procedure. At 48 hours, the echocardiographic right ventricle/left ventricle ratio decreased from 1.23±0.36 to 0.98±0.31 (p<0.0001 for paired values) and patients with severe dyspnoea decreased from 66.5% to 15.6% (p<0.0001). Conclusions: Mechanical thrombectomy with the FlowTriever System demonstrates a favourable safety profile, improvements in haemodynamics and functional outcomes, and low 30-day mortality for intermediate- and high-risk PE.
11 citations
TL;DR: In this paper , the authors assess sex-related differences regarding clinical characteristics and the outcome of patients with severe tricuspid regurgitation (TR) undergoing transcatheter tricusid valve intervention (TTVI).
Abstract: Men and women differ regarding comorbidities, pathophysiology, and the progression of valvular heart diseases.This study sought to assess sex-related differences regarding clinical characteristics and the outcome of patients with severe tricuspid regurgitation (TR) undergoing transcatheter tricuspid valve intervention (TTVI).All 702 patients in this multicenter study underwent TTVI for severe TR. The primary outcome was 2-year all-cause mortality.Among 386 women and 316 men in this study, men were more often diagnosed with coronary artery disease (52.9% in men vs 35.5% in women; P = 5.6 × 10-6). Subsequently, the underlying etiology for TR in men was predominantly secondary ventricular (64.6% in men vs 50.0% in women; P = 1.4 × 10-4), whereas women more often presented with secondary atrial etiology (41.7% in women vs 24.4% in men, P = 2.0 × 10-6). Notably, 2-year survival after TTVI was similar in women and men (69.9% in women vs 63.7% in men; P = 0.144). Multivariate regression analysis identified dyspnea expressed as New York Heart Association functional class, tricuspid annulus plane systolic excursion (TAPSE), and mean pulmonary artery pressure (mPAP) as independent predictors for 2-year mortality. The prognostic significance of TAPSE and mPAP differed between sexes. Consequently, we looked at right ventricular-pulmonary arterial coupling expressed as TAPSE/mPAP and identified sex-specific thresholds to best predict survival; women with a TAPSE/mPAP ratio <0.612 mm/mm Hg displayed a 3.43-fold increased HR for 2-year mortality (P < 0.001), whereas men with a TAPSE/mPAP ratio <0.434 mm/mm Hg displayed a 2.05-fold increased HR for 2-year mortality (P = 0.001).Even though men and women differ in the etiology of TR, both sexes show similar survival rates after TTVI. The TAPSE/mPAP ratio can improve prognostication after TTVI, and sex-specific thresholds should be applied to guide future patient selection.
6 citations
TL;DR: In this paper , the authors evaluated the short and long-term survival and local recurrence rate of pulmonary artery sarcoma cases operated on at their institution using an anatomic resection approach for the pulmonary trunk and main pulmonary arteries rather than endarterectomy.
5 citations
TL;DR: The MONITOR-HF trial as mentioned in this paper was an open-label, randomised trial, done in 25 centers in the Netherlands, and the primary endpoint was the mean difference in the Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary score at 12 months.
4 citations
TL;DR: In this paper , the 3D structure of the pulmonary arterial tree in rabbits with a surgically induced diaphragmatic hernia (DH) was examined using CT images.
Abstract: Congenital diaphragmatic hernia (CDH) is a major cause of severe lung hypoplasia and pulmonary hypertension in the newborn. While the pulmonary hypertension is thought to result from abnormal vascular development and arterial vasoreactivity, the anatomical changes in vascular development are unclear. We have examined the 3D structure of the pulmonary arterial tree in rabbits with a surgically induced diaphragmatic hernia (DH). Fetal rabbits (n = 6) had a left-sided DH created at gestational day 23 (GD23), delivered at GD30, and briefly ventilated; sham-operated litter mates (n = 5) acted as controls. At postmortem the pulmonary arteries were filled with a radio-opaque resin before the lungs were scanned using computed tomography (CT). The 3D reconstructed images were analyzed based on vascular branching hierarchy using the software Avizo 2020.2. DH significantly reduced median number of arteries (2,579 (8440) versus 576 (442), p = .017), artery numbers per arterial generation, mean total arterial volume (43.5 ± 8.4 vs. 19.9 ± 3.1 μl, p = .020) and mean total arterial cross-sectional area (82.5 ± 2.3 vs. 28.2 ± 6.2 mm2 , p =.036). Mean arterial radius was increased in DH kittens between the eighth and sixth branching generation and mean arterial length between the sixth and 28th branching generation. A DH in kittens resulted in threefold reduction in pulmonary arterial cross-sectional area, primarily due to reduced arterial branching. Thus, the reduction in arterial cross-sectional area could be a major contributor to pulmonary hypertension infants with CDH.
3 citations
TL;DR: In this article , the authors investigated if differences in PAC and RC time exist between pulmonary hypertension subgroups and examined whether PAC is an independent predictor of transplant-free survival in PAH.
Abstract: Objective Pulmonary artery compliance (PAC), estimated as stroke volume (SV) divided by pulmonary artery pulse pressure (PP), may be a predictor of survival in pulmonary arterial hypertension (PAH). Resistance–compliance (RC) time, the product of PAC and pulmonary vascular resistance, is reported to be a physiological constant. We investigated if differences in PAC and RC time exist between pulmonary hypertension (PH) subgroups and examined whether PAC is an independent predictor of transplant-free survival in PAH. Methods This was a retrospective analysis of adult PAH (n=532) and chronic thromboembolic PH (CTEPH, n=84) patients enrolled in the US Pulmonary Hypertension Association Registry from 2015 to 2019. PAC and RC time were compared between PH subgroups (connective tissue disease-PAH (CTD-PAH), idiopathic/heritable-PAH (i/h-PAH), drug/toxin-PAH (d/t-PAH)). Cox proportional hazards models were constructed for transplant-free survival, adjusting for REVEAL 2.0 risk score. Results There were no differences in estimated PAC between PAH subgroups, nor between PAH and CTEPH. RC time was shorter in CTEPH compared with PAH (median 0.55 (IQR 0.45–0.64) vs 0.62 (0.52–0.73) s, p<0.0001). RC time was shortest in CTD-PAH when compared with i/h-PAH and d/t-PAH ((0.59±0.18) vs (0.65±0.20) vs (0.73±0.25) s, p=0.0001). PAC was associated with transplant-free survival (HR 0.72, 95% CI 0.55 to 0.94, p=0.02) but was not an independent predictor of outcome after adjustment for REVEAL 2.0 score. Conclusion PAC was similar between PH groups and was not an independent predictor of transplant-free survival in PAH. RC time was different between PH subgroups, challenging RC time constancy. Trial registration number NCT04071327
3 citations
TL;DR: In this paper , the authors evaluated the predictive role of tricuspid annular plane systolic excursion/systolic pulmonary artery pressure (TAPSE/sPAP) ratio for pulmonary hypertension diagnosis and mortality in the European Scleroderma Trials and Research (EUSTAR) cohort.
3 citations
TL;DR: In this paper , the authors characterize the pathophysiology of disproportionate exercise-induced pulmonary hypertension in relation to CO and its prognostic impact in patients with preserved ejection fraction (HFpEF).
Abstract: Pulmonary hypertension (PH) and pulmonary vascular remodelling are common in patients with heart failure with preserved ejection fraction (HFpEF). Many patients with HFpEF demonstrate an abnormal pulmonary haemodynamic response to exercise that is not identifiable at rest. This can be estimated non‐invasively by the mean pulmonary artery pressure–cardiac output relationship (mPAP/CO slope). We sought to characterize the pathophysiology of disproportionate exercise‐induced PH in relation to CO (DEi‐PH) and its prognostic impact in patients with HFpEF.
3 citations
TL;DR: In this article , the role of circRNA calmodulin 4 (circ-calm4) on regulation of hypoxic PH autophagy has not been reported, but it has been shown for the first time that hypoxia-mediated upregulated circ-calmedion4 expression has a key regulatory effect on autophagia in pulmonary artery smooth muscle cells (PASMCs) and hypoxic hypertension mouse models.
3 citations
TL;DR: Wang et al. as discussed by the authors studied the light propagation in human thoracic tissues and explored the possibility of near-infrared spectroscopy (NIRS) in noninvasive detection of pulmonary embolisms.
Abstract: SignificanceIn recent years, the incidence rate of pulmonary embolism (PE) has increased dramatically. Currently, the correct diagnosis rate of PE in China is relatively low, and the diagnosis error rate and missed diagnosis rate were as high as about 80%. The most standard method of PE detection is pulmonary artery digital subtraction angiography (DSA), but pulmonary artery DSA is an invasive examination, and patients can have certain risks and discomfort. Noninvasive monitoring of PE remains challenging in cardiovascular medicine.AimWe attempt to study the light propagation in human thoracic tissues and explore the possibility of near-infrared spectroscopy (NIRS) in noninvasive detection of PE.ApproachIn this study, by utilizing the Monte Carlo simulation method for voxelized media and the Visible Chinese Human dataset, we quantified and visualized the photon migration in human thoracic region. The influence of the development (three levels) of PE on the light migration was observed.ResultsResults showed that around 4.6% light fluence was absorbed by the pulmonary tissue. The maximum signal sensitivity distribution reached 0.073% at the 2.8- to 3.1-cm light source–detector separation. The normalized light intensity was significantly different among different PE levels and formed a linear relationship (r2 = 0.998, p < 10 − 5).ConclusionsThe study found that photons could reach the pulmonary artery tissue, the light intensity was linearly related to the degrees of embolism, PE could be quantitatively diagnosed by NIRS. Meanwhile, the optimized distance in between the light source and detector, 2.8 to 3.1 cm, was recommended to be used in future potential noninvasive optical diagnosis of PE.
2 citations
TL;DR: In this paper , the authors evaluated the relationship between left atrial volume and pulmonary arterial haemodynamics in patients with preserved ejection fraction (HFpEF) and showed that LA enlargement may impair LA function and increase pulmonary pressures.
Abstract: Elevated left atrial (LA) pressure is a pathophysiologic hallmark of heart failure with preserved ejection fraction (HFpEF). Chronically elevated LA pressure leads to LA enlargement, which may impair LA function and increase pulmonary pressures. We sought to evaluate the relationship between LA volume and pulmonary arterial haemodynamics in patients with HFpEF.
TL;DR: Pulmonary artery aneurysm (PAA) is the focal dilation of a blood vessel involving all 3 layers of the vessel wall; they have a diameter greater than 4 cm measured in the trunk of the pulmonary artery as discussed by the authors .
TL;DR: In this paper , the authors used Mixed-effects linear regression to estimate changes over time at 3 to 9 months, 1 to 5 years, and >5 years after extracardiac Fontan.
TL;DR: In this paper , the effect of pulmonary hypertension on right ventricular (RV) afterload is defined by elevation of pulmonary artery (PA) pressure or pulmonary vascular resistance (PVR), which expresses opposition of the PA to pulsatile blood flow.
Abstract: The effect of pulmonary hypertension (PH) on right ventricular (RV) afterload is commonly defined by elevation of pulmonary artery (PA) pressure or pulmonary vascular resistance (PVR). In humans however, one‐third to half of the hydraulic power in the PA is contained in pulsatile components of flow. Pulmonary impedance (Zc) expresses opposition of the PA to pulsatile blood flow. We evaluate pulmonary Zc relationships according to PH classification using a cardiac magnetic resonance (CMR)/right heart catheterization (RHC) method.
TL;DR: In this paper , non-invasive electrical cardiometry (EC) was used to measure cardiac output (CO) and other hemodynamic variables in healthy anesthetized dogs during acute blood volume manipulation.
Abstract: Simple Summary Using general anesthesia on animals causes significant changes to the heart and blood vessels that disrupt normal cardiovascular performance. Blood pressure (BP) is used for closely monitoring hemodynamics in anesthetized animals. However, BP is affected by various factors and may not always accurately correlate with the total body blood flow. Pulmonary artery thermodilution (PATD) is the gold standard for cardiac output (CO) measurements, but, due to the high risks associated with its invasiveness, it is not performed in clinical settings. This study evaluates noninvasive electrical cardiometry’s (EC) performance in measuring CO and other hemodynamic variables in healthy anesthetized dogs during acute blood volume manipulation. The EC measurements consistently underpredict the CO values as compared with PATD, but have a better performance when acute blood loss occurs. Even though the EC readings have a slightly higher error than the accepted error, this method is very good at showing trends in the CO measured using PATD. Other EC-derived variables are able to closely track the changes in the CO measured using PATD. In clinics, noninvasive EC may benefit the patient care quality for anesthetized dogs by monitoring the trends in hemodynamics and guiding anesthetists to diagnose and treat cardiovascular complications. Abstract In animals, invasive pulmonary artery thermodilution (PATD) is a gold standard for cardiac output (CO) monitoring, but it is impractical in clinical settings. This study evaluates the agreement between PATD and noninvasive electrical cardiometry (EC) for measuring CO and analyzes the other EC-derived hemodynamic variables in six healthy anesthetized dogs subjected to four different hemodynamic events in a sequential order: (1) euvolemia (baseline); (2) hemorrhage (33% blood volume loss); (3) autologous blood transfusion; and (4) 20 mL/kg colloid bolus. The CO measurements obtained using PATD and EC are compared using Bland–Altman analysis, Lin’s concordance correlation (LCC), and polar plot analysis. Values of p < 0.05 are considered significant. The EC measurements consistently underpredict the CO values as compared with PATD, and the LCC is 0.65. The EC’s performance is better during hemorrhage, thus indicating its capability in detecting absolute hypovolemia in clinical settings. Even though the percentage error exhibited by EC is 49.4%, which is higher than the standard (<30%), EC displays a good trending ability. Additionally, the EC-derived variables display a significant correlation with the CO measured using PATD. Noninvasive EC may have a potential in monitoring trends in hemodynamics in clinical settings.
TL;DR: Wang et al. as discussed by the authors used Weighted gene co-expression network analysis (WGCNA) to detect gene modules related to pulmonary arterial hypertension (PAH), based on the GSE15197, GSE113439, and GSE117261.
Abstract: Pulmonary arterial hypertension (PAH) is a group of severe, progressive, and debilitating diseases with limited therapeutic options. This study aimed to explore novel therapeutic targets in PAH through bioinformatics and experiments. Weighted gene co-expression network analysis (WGCNA) was applied to detect gene modules related to PAH, based on the GSE15197, GSE113439, and GSE117261. GSE53408 was applied as validation set. Subsequently, the validated most differentially regulated hub gene was selected for further ex vivo and in vitro assays. PARM1, TSHZ2, and CCDC80 were analyzed as potential intervention targets for PAH. Consistently with the bioinformatic results, our ex vivo and in vitro data indicated that PARM1 expression increased significantly in the lung tissue and/or pulmonary artery of the MCT-induced PAH rats and hypoxia-induced PAH mice in comparison with the respective controls. Besides, a similar expression pattern of PARM1 was found in the hypoxia- and PDGF--treated isolated rat primary pulmonary arterial smooth muscle cells (PASMCs). In addition, hypoxia/PDGF--induced PARM1 protein expression could promote the elevation of phosphorylation of AKT, phosphorylation of FOXO3A and PCNA, and finally the proliferation of PASMCs in vitro, whereas PARM1 siRNA treatment inhibited it. Mechanistically, PARM1 promoted PAH via AKT/FOXO3A/PCNA signaling pathway-induced PASMC proliferation.
TL;DR: In this paper , the authors evaluated the pulmonary flow hemodynamics using 4D-flow magnetic resonance imaging (MRI) for characterizing altered blood flow, viscous energy loss (EL), wall shear stress (WSS), pressure drop (PD), and ventricular flow analysis (VFA) in rTOF patients.
Abstract: Patients with Tetralogy of Fallot (TOF) have multiple surgical sequelae altering the pulmonary flow hemodynamics. Repaired TOF (rTOF) adults frequently develop pulmonary regurgitation impacting the blood flow pressure, right ventricle load, and pulmonary hemodynamics. We aimed to evaluate the pulmonary flow hemodynamics using 4D-flow magnetic resonance imaging (MRI) for characterizing altered blood flow, viscous energy loss (EL), wall shear stress (WSS), pressure drop (PD), and ventricular flow analysis (VFA) in rTOF patients. We hypothesized that 4D-flow based parameters can identify pulmonary blood flow alterations. A total of 17 rTOF patients (age: 29 ± 10 years, 35% women) and 20 controls (age: 36 ± 12 years, 25% women) were scanned using a dedicated cardiac MRI protocol. Peak velocity and regurgitant fraction were significantly higher for rTOF patients (p < 0.001). WSS was consistently elevated along the PA in the rTOF (p ≤ 0.05). The rTOF average circumferential WSS was higher than axial WSS at the main pulmonary artery (p ≤ 0.001). PD and EL were consistently higher in the rTOF as compared with controls (p < 0.05). For VFA, delayed ejection increased and retained inflow decreased in rTOF patients (p < 0.001). To conclude, this study demonstrated that 4D-flow MRI pulmonary flow in the rTOF can exhibit altered peak velocity, valvular regurgitation, WSS, EL, PD, and VFA.
TL;DR: In this article , the authors evaluated pulmonary artery global longitudinal strain (GLS) as a prognostic marker in patients with pulmonary arterial hypertension (PAH) and found that GLS provided 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.
Abstract: Current cardiac magnetic resonance (CMR) imaging in pulmonary arterial hypertension (PAH) focuses on measures of ventricular function and coupling. The purpose of this study was to evaluate pulmonary artery (PA) global longitudinal strain (GLS) as a prognostic marker in patients with PAH. The authors included 169 patients with PAH from the Assessing the Spectrum of Pulmonary hypertension Identified at a REferral centre (ASPIRE) and Integrated computatioNal modelIng of righT heart mechanIcs and blood flow dynAmics in congeniTal hEart disease (INITIATE) 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 Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management (REVEAL) 2.0 and Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA) 2.0 scores. 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). 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.
TL;DR: In this paper , the fetal pulmonary artery Doppler indices of pregnant women with autoimmune diseases such as systemic lupus erythematosus (SLE), Sjögren's syndrome (SS), and antiphospholipid syndrome (APS) were compared with healthy pregnant women.
Abstract: To compare the fetal pulmonary artery Doppler indices of pregnant women with autoimmune diseases such as systemic lupus erythematosus (SLE), Sjögren's syndrome (SS), and antiphospholipid syndrome (APS) with healthy pregnant women.
TL;DR: In this paper , structural changes to the lung vasculature clarify PH pathophysiologic features in patients with hypertrophic cardiomyopathy (HCM) with progressive heart failure, where patients were included based on the availability of lung tissue and recorded mPAP.
TL;DR: In this article , the authors highlight a key event in early stages of PAH progression, namely, the occurrence of pulmonary arterial smooth muscle cell (PASMC) phenotypic switching.
TL;DR: Wang et al. as mentioned in this paper conducted a retrospective study to investigate recurrent artery crossing intersegmental planes and their associated pulmonary anatomical features by analyzing the incidence and types of the right upper lobe (RUL) bronchus and the artery composition of the posterior segment.
Abstract: Background With the prevalence of three-dimensional computed tomography bronchography and angiography (3D-CTBA) and the development of anatomical segmentectomy, studies have confirmed the increased incidence of anomalous veins in patients with tracheobronchial abnormalities. Nevertheless, the characteristic anatomical correlation between bronchus and artery variation remains unknown. Thus, we conducted a retrospective study to investigate recurrent artery crossing intersegmental planes and their associated pulmonary anatomical features by analyzing the incidence and types of the right upper lobe (RUL) bronchus and the artery composition of the posterior segment. Materials and Methods A total of 600 patients with ground-glass opacity who had undergone 3D-CTBA preoperatively at Hebei General Hospital between September 2020 and September 2022 were included. We reviewed the anatomical variations of the RUL bronchus and artery in these patients using 3D-CTBA images. Results Among all 600 cases, the defective and splitting B2 contained four types of the RUL bronchial structure: B1 + BX2a, B2b, B3 (11/600, 1.8%); B1, B2a, BX2b + B3 (3/600, 0.5%); B1 + BX2a, B3 + BX2b (18/600, 3%); B1, B2a, B2b, B3 type (29/600, 4.8%). The incidence of recurrent artery crossing intersegmental planes was 12.7% (70/600). The incidence of recurrent artery crossing intersegmental planes with and without the defective and splitting B2 was 26.2% (16/61) and 10.0% (54/539), respectively (p < 0.005). Conclusions In patients with defective and splitting B2, the incidence of recurrent artery crossing intersegmental planes was increased. Our study provides certain references that surgeons can use to plan and perform RUL segmentectomy.
TL;DR: In this paper , the authors used a pressure-strain loop (RVPSL) to assess right ventricular myocardial work (rVMW) using echocardiography.
Abstract: Abstract Background Non-invasive right ventricular (RV) myocardial work (RVMW) is the latest indicator used to assess RV function. Nevertheless, the physiological determinants of RVMW have not been studied, and reference ranges for normal RVMW indices have yet to be established. Methods A total of 263 healthy volunteers (median age: 34 years, males: 38%) were prospectively enrolled. RVMW indices were analysed by an RV pressure-strain loop (RVPSL) in specific software. Results The lowest values of the RVMW indices in males and females were 133 mmHg% and 206 mmHg% for RV global work index (RVGWI), 165 mmHg% and 241 mmHg% for RV global constructive work (RVGCW) and 78% and 83% for RV global work efficiency (RVGWE), respectively. The highest values for RV global wasted work (RVGWW) in males and females were 67 mmHg% and 69 mmHg%, respectively. RVGWI and RVGCW were significantly lower in males than those in females. RVGWW significantly increased with age in males and females. RVGWE significantly decreased with age in females. Multivariable analysis revealed that RVGWI, RVGCW and RVGWE increased as pulmonary artery systolic pressure (PASP) increased. Conclusions Normal reference values of non-invasive RVMW were obtained by echocardiography. Quantitative data on RVMW could be essential in clinical work and clinical experiments.
TL;DR: In this article , a secondary analysis of participant-level data from randomized clinical trials of investigational pulmonary arterial hypertension (PAH) therapies conducted between 1998 and 2014 and provided by the U.S. Food and Drug Administration was conducted.
Abstract: Rationale: Sex-based differences in pulmonary arterial hypertension (PAH) are known, but the contribution to disease measures is understudied. Objectives: We examined whether sex was associated with baseline 6-minute-walk distance (6MWD), hemodynamics, and functional class. Methods: We conducted a secondary analysis of participant-level data from randomized clinical trials of investigational PAH therapies conducted between 1998 and 2014 and provided by the U.S. Food and Drug Administration. Outcomes were modeled as a function of an interaction between sex and age or sex and body mass index (BMI), respectively, with generalized mixed modeling. Results: We included a total of 6,633 participants from 18 randomized clinical trials. A total of 5,197 (78%) were female, with a mean age of 49.1 years and a mean BMI of 27.0 kg/m2. Among 1,436 males, the mean age was 49.7 years, and the mean BMI was 26.4 kg/m2. The most common etiology of PAH was idiopathic. Females had shorter 6MWD. For every 1 kg/m2 increase in BMI for females, 6MWD decreased 2.3 (1.6–3.0) meters (P < 0.001), whereas 6MWD did not significantly change with BMI in males (0.31 m [−0.30 to 0.92]; P = 0.32). Females had lower right atrial pressure (RAP) and mean pulmonary artery pressure, and higher cardiac index than males (all P < 0.03). Age significantly modified the sex by RAP and mean pulmonary artery pressure relationships. For every 10-year increase in age, RAP was lower in males (0.5 mm Hg [0.3–0.7]; P < 0.001), but not in females (0.13 [−0.03 to 0.28]; P = 0.10). There was a significant decrease in pulmonary vascular resistance (PVR) with increasing age regardless of sex (P < 0.001). For every 1 kg/m2 increase in BMI, there was a 3% decrease in PVR for males (P < 0.001), compared with a 2% decrease in PVR in females (P < 0.001). Conclusions: Sexual dimorphism in subjects enrolled in clinical trials extends to 6MWD and hemodynamics; these relationships are modified by age and BMI. Sex, age, and body size should be considered in the evaluation and interpretation of surrogate outcomes in PAH.
TL;DR: In this paper , a simple method to obtain pulmonary vein smooth muscle cells (PVSMCs) was introduced, where the primary pulmonary veins were removed by puncture needle cannula guidance.
Abstract: Abstract Background Although the pressure of pulmonary vein increases before pulmonary artery in pulmonary hypertension due to left heart disease (PH-LHD), only a few studies have assessed pulmonary vein smooth muscle cells (PVSMCs) because of the lack of a simple and feasible isolation method. Methods In this study, we introduced a simple method to obtain PVSMCs. Primary pulmonary veins were removed by puncture needle cannula guidance. Then, PVSMCs were cultured by the tissue explant method and purified by the differential adhesion method. The cells were characterized by hematoxylin-eosin (HE) staining, immunohistochemistry, western blotting, and immunofluorescence to observe the morphology and verify the expression of alpha-smooth muscle actin (α-SMA). Results The HE staining results showed that the pulmonary vein media was thinner than the pulmonary artery, the intima and adventitia of the pulmonary vein were removed by this method, and the obtained cells with good activity exhibited morphological characteristics of smooth muscle cells. In addition, higher α-SMA expression was observed in the cells obtained by our isolation method than in the traditional method. Conclusion This study established a simple and feasible method to isolate and culture PVSMCs that might facilitate the cytological experiments for PH-LHD.
TL;DR: In this article , the authors showed that pulmonary arterial elastance in patients with repaired tetralogy of fallot with low RV pressure was negatively correlated with pulmonary regurgitation (PR) severity.
Abstract: Author's summary Pulmonary arterial elastance in repaired TOF with low RV pressure was negatively correlated with pulmonary regurgitation (PR) severity, which may prevent PR, right ventricular (RV) dilatation, and left ventricular dilatation in the absence of significant pulmonary stenosis. Although many previous studies focused primarily on RV volume, the situation in patients with repaired tetralogy of Fallot is more complicated because pulmonary arterial elastance and compliance affect PR severity and RV volume. Our study showed that in low pulmonary arterial elastance group among repaired Tetralogy of Fallot with low RV pressure, RV and LV stroke volume is increased after pulmonary valve replacement and related to increased exercise capacity.
TL;DR: In this article , structural and functional right heart echocardiographic variables were associated with pulmonary stenosis severity in dogs with PCA, and a multiparametric approach is advised to better assess PS severity.
Abstract: Abstract Background Pulmonary stenosis (PS) usually is evaluated using echocardiography. A multiparametric approach, in addition to the maximum pressure gradient (PG), might be indicated to better characterize PS severity and address its management. Hypothesis/Objectives Our hypothesis was that right heart size and function are associated with echocardiographic and clinical severity of pulmonary stenosis in dogs. Animals Client‐owned dogs with PS. Methods Prospective, multicenter, observational study. Enrolled dogs underwent complete echocardiographic examination. Associations among right heart echocardiographic variables, PS transvalvular PG >80 mm Hg and presence of clinical signs (exercise intolerance, syncope, right‐sided congestive failure, or some combination of these) were assessed using logistic regression analysis. Results Eighty‐eight dogs with PS. Twenty‐eight dogs were symptomatic. Increased right ventricular end‐diastolic free wall thickness (odds ratio [OR] > 100; 95% confidence interval [95%CI], 50‐ > 100; P = .01) and decreased aorta‐to‐pulmonary artery velocity time integral ratio (OR, < 0.001; 95%CI, 0.0‐0.001; P = .005) were independently associated with PS PG >80 mm Hg. Decreased tricuspid annular plane systolic excursion (OR, 0.35; 95%CI, 0.15‐0.77; P = .01) and increased right ventricular end‐diastolic area (OR, 1.4; 95%CI, 1.08‐2.02; P = .01) were independently associated with clinical severity. Conclusion and Clinical Importance Structural and functional right heart echocardiographic variables are associated with echocardiographic and clinical severity in dogs with PS. A multiparametric approach is advised to better assess PS severity.
TL;DR: In this article , the authors performed a meta-analysis comparing pre and post pulmonary artery denervation (PADN) in different PH groups and found that PADN showed a significant reduction in mean pulmonary artery pressure (WMD -6.51, 95% CI (-9.87, -3.15), p = 0.02] and increased cardiac output.
TL;DR: In this paper , fetal pulmonary artery Doppler parameters in pregnant women with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) were investigated.
Abstract: To investigate fetal pulmonary artery Doppler parameters in pregnant women with rheumatoid arthritis (RA) and ankylosing spondylitis (AS).
TL;DR: In this article , the first successful bilateral transcatheter implantation of bilateral pulmonary artery flow restrictors in a case series of three infants with severe DCM based on left-ventricular non-compaction morphology associated with Barth syndrome in one and a non-classified syndrome in another was reported.
Abstract: Abstract Background Dilated cardiomyopathy (DCM) is a leading cause of heart transplantation (HTx) in children. Surgical pulmonary artery banding (PAB) is used worldwide to achieve functional heart regeneration and remodelling. Case summary We report for the first-time successful bilateral transcatheter implantation of bilateral pulmonary artery flow restrictors in a case series of three infants with severe DCM based on left-ventricular non-compaction morphology associated with Barth syndrome in one and a non-classified syndrome in another. Functional cardiac regeneration was observed in two patients after almost 6 months of endoluminal banding, and in the neonate with Barth syndrome already after 6 weeks. Accompanied by an improvement in functional class (Class IV to Class I), the left ventricular end-diastolic dimensions z-score normalized, as did the elevated serum brain natriuretic peptide levels. A listing for HTx could be avoided. Discussion Percutaneous bilateral endoluminal PAB is a novel minimally invasive approach that enables functional cardiac regeneration in infants with severe DCM and preserved right ventricular function. Interruption of the ventriculo-ventricular interaction, the key mechanism for recovery, is avoided. Intensive care for these critically ill patients is reduced to a minimum. However, investing in ‘heart regeneration to avoid transplantation’ remains a challenge.