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Han QJ, Forfia P, Vaidya A, Ramani G, deKemp RA, Mach RH, Mankoff DA, Bravo PE, DiCarli M, Chan SY, Waxman AB, Han Y. Effects of ranolazine on right ventricular function, fluid dynamics, and metabolism in patients with precapillary pulmonary hypertension: insights from a longitudinal, randomized, double-blinded, placebo controlled, multicenter study. Front Cardiovasc Med 2023; 10:1118796. [PMID: 37383703 PMCID: PMC10293744 DOI: 10.3389/fcvm.2023.1118796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/22/2023] [Indexed: 06/30/2023] Open
Abstract
Introduction Right ventricular (RV) function is a major determinant of outcome in patients with precapillary pulmonary hypertension (PH). We studied the effect of ranolazine on RV function over 6 months using multi-modality imaging and biochemical markers in patients with precapillary PH (groups I, III, and IV) and RV dysfunction [CMR imaging ejection fraction (EF) < 45%] in a longitudinal, randomized, double-blinded, placebo-controlled, multicenter study of ranolazine treatment. Methods Enrolled patients were assessed using cardiac magnetic resonance (CMR) imaging, 11C-acetate and 18-F-FDG positron emission tomography (PET), and plasma metabolomic profiling, at baseline and at the end of treatment. Results Twenty-two patients were enrolled, and 15 patients completed all follow-up studies with 9 in the ranolazine arm and 6 in the placebo arm. RVEF and RV/Left ventricle (LV) mean glucose uptake were significantly improved after 6 months of treatment in the ranolazine arm. Metabolomic changes in aromatic amino acid metabolism, redox homeostasis, and bile acid metabolism were observed after ranolazine treatment, and several changes significantly correlated with changes in PET and CMR-derived fluid dynamic measurements. Discussion Ranolazine may improve RV function by altering RV metabolism in patients with precapillary PH. Larger studies are needed to confirm the beneficial effects of ranolazine.
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Affiliation(s)
- Q. Joyce Han
- Cardiovascular Division, Massachusetts General Hospital, Boston, MA, United States
| | - Paul Forfia
- Pulmonary Hypertension, Right Heart Failure, and CTEPH Program, Department of Cardiology, Temple University Hospital, Philadelphia, PA, United States
| | - Anjali Vaidya
- Pulmonary Hypertension, Right Heart Failure, and CTEPH Program, Department of Cardiology, Temple University Hospital, Philadelphia, PA, United States
| | - Gautam Ramani
- Cardiovascular Division, University of Maryland, Baltimore, MD, United States
| | - Robert A. deKemp
- Cardiac PET Center, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Robert H. Mach
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - David A. Mankoff
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Paco E. Bravo
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
- Cardiovascular Division, University of Pennsylvania, Philadelphia, PA, United States
| | - Marcelo DiCarli
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA, United States
| | - Stephen Y. Chan
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center and University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Aaron B. Waxman
- Center for Pulmonary Heart Disease, Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA, United States
| | - Yuchi Han
- Cardiovascular Division, University of Pennsylvania, Philadelphia, PA, United States
- Cardiovascular Division, Wexner Medical Center, The Ohio State University, Columbus, OH, United States
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Ro SK, Sato K, Ijuin S, Sela D, Fior G, Heinsar S, Kim JY, Chan J, Nonaka H, Lin ACW, Bassi GL, Platts DG, Obonyo NG, Suen JY, Fraser JF. Assessment and diagnosis of right ventricular failure-retrospection and future directions. Front Cardiovasc Med 2023; 10:1030864. [PMID: 37324632 PMCID: PMC10268009 DOI: 10.3389/fcvm.2023.1030864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 05/17/2023] [Indexed: 06/17/2023] Open
Abstract
The right ventricle (RV) has a critical role in hemodynamics and right ventricular failure (RVF) often leads to poor clinical outcome. Despite the clinical importance of RVF, its definition and recognition currently rely on patients' symptoms and signs, rather than on objective parameters from quantifying RV dimensions and function. A key challenge is the geometrical complexity of the RV, which often makes it difficult to assess RV function accurately. There are several assessment modalities currently utilized in the clinical settings. Each diagnostic investigation has both advantages and limitations according to its characteristics. The purpose of this review is to reflect on the current diagnostic tools, consider the potential technological advancements and propose how to improve the assessment of right ventricular failure. Advanced technique such as automatic evaluation with artificial intelligence and 3-dimensional assessment for the complex RV structure has a potential to improve RV assessment by increasing accuracy and reproducibility of the measurements. Further, noninvasive assessments for RV-pulmonary artery coupling and right and left ventricular interaction are also warranted to overcome the load-related limitations for the accurate evaluation of RV contractile function. Future studies to cross-validate the advanced technologies in various populations are required.
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Affiliation(s)
- Sun Kyun Ro
- Department of Thoracic and Cardiovascular Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Kei Sato
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Shinichi Ijuin
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
| | - Declan Sela
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Gabriele Fior
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Silver Heinsar
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Intensive Care Unit, St. Andrews War Memorial Hospital, Brisbane, QLD, Australia
- Department of Intensive Care, North Estonia Medical Centre, Tallinn, Estonia
| | - Ji Young Kim
- Department of Nuclear Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jonathan Chan
- Division of Cardiology, The Prince Charles Hospital, Brisbane, QLD, Australia
- School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Hideaki Nonaka
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Aaron C. W. Lin
- Division of Cardiology, The Prince Charles Hospital, Brisbane, QLD, Australia
- School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Gianluigi Li Bassi
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Intensive Care Unit, St. Andrews War Memorial Hospital, Brisbane, QLD, Australia
| | - David G. Platts
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Division of Cardiology, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Nchafatso G. Obonyo
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Wellcome Trust Centre for Global Health Research, Imperial College London, London, United Kingdom
- Initiative to Develop African Research Leaders (IDeAL)/KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Jacky Y. Suen
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - John F. Fraser
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Intensive Care Unit, St. Andrews War Memorial Hospital, Brisbane, QLD, Australia
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Hahn RT, Lerakis S, Delgado V, Addetia K, Burkhoff D, Muraru D, Pinney S, Friedberg MK. Multimodality Imaging of Right Heart Function: JACC Scientific Statement. J Am Coll Cardiol 2023; 81:1954-1973. [PMID: 37164529 DOI: 10.1016/j.jacc.2023.03.392] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 05/12/2023]
Abstract
Right ventricular (RV) size and function assessed by multimodality imaging are associated with outcomes in a variety of cardiovascular diseases. Understanding RV anatomy and physiology is essential in appreciating the strengths and weaknesses of current imaging methods and gives these measurements greater context. The adaptation of the right ventricle to different types and severity of stress, particularly over time, is specific to the cardiovascular disease process. Multimodality imaging parameters, which determine outcomes, reflect the ability to image the initial and longitudinal RV response to stress. This paper will review the standard and novel imaging methods for assessing RV function and the impact of these parameters on outcomes in specific disease states.
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Affiliation(s)
- Rebecca T Hahn
- Department of Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA.
| | | | - Victoria Delgado
- Hospital University Germans Trias i Pujol Hospital, Badalona, Barcelona, Spain
| | - Karima Addetia
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | | | - Denisa Muraru
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Sean Pinney
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
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Kazimierczyk R, Szumowski P, Nekolla SG, Malek LA, Blaszczak P, Hladunski M, Sobkowicz B, Mysliwiec J, Kaminski KA. The impact of specific pulmonary arterial hypertension therapy on cardiac fluorodeoxyglucose distribution in PET/MRI hybrid imaging-follow-up study. EJNMMI Res 2023; 13:20. [PMID: 36892707 PMCID: PMC9998792 DOI: 10.1186/s13550-023-00971-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/28/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND PET/MRI hybrid imaging in pulmonary arterial hypertension (PAH) provides important prognostic information identifying patients who might benefit from early therapy escalation, as right ventricle (RV) metabolic alterations are linked with hemodynamics and might precede clinical deterioration. Now, we hypothesize that adequate PAH therapy escalation may result in reversal of unfavourable increased glucose uptake of RV, which is associated with improved prognosis. METHODS Out of twenty-six initially clinically stable PAH patients who had baseline PET/MRI scans, twenty (49.9 ± 14.9 years) had second PET/MRI after 24 months. SUVRV/SUVLV ratio was used to estimate and compare cardiac glucose uptake. Occurrences of clinical endpoints (CEP), defined as death or clinical deterioration, were assessed during 48-month follow-up from baseline. RESULTS In first 24 months of observation, sixteen patients had CEP and needed PAH therapy escalation. At follow-up visits, we observed significant improvement of RV ejection fraction (45.1 ± 9.6% to 52.4 ± 12.9%, p = 0.01), mean pulmonary artery pressure (50.5 ± 18.3 to 42.8 ± 18.6 mmHg, p = 0.03), and SUVRV/SUVLV, which tended to decrease (mean change -0.20 ± 0.74). Patients with baseline SUVRV/SUVLV value higher than 0.54 had worse prognosis in 48 months observation (log-rank test, p = 0.0007); follow up SUVRV/SUVLV > 1 predicted CEP in the following 24 months, regardless of previously escalated treatment. CONCLUSIONS PAH therapy escalation may influence RV glucose metabolism, what seems to be related with patients' prognosis. PET/MRI assessment may predict clinical deterioration regardless of previous clinical course, however its clinical significance in PAH requires further studies. Importantly, even mild alterations of RV glucose metabolism predict clinical deterioration in long follow-up. Clinical Trial Registration ClinicalTrials.gov, NCT03688698, 05/01/2016, https://clinicaltrials.gov/ct2/show/study/NCT03688698?term=NCT03688698&draw=2&rank=1.
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Affiliation(s)
- Remigiusz Kazimierczyk
- Department of Cardiology, Medical University of Bialystok, Curie-Sklodowskiej 24a, 15-276, Bialystok, Poland
| | - Piotr Szumowski
- Department of Nuclear Medicine, Medical University of Bialystok, Curie-Sklodowskiej 24a, 15-276, Bialystok, Poland
| | - Stephan G Nekolla
- Department of Nuclear Medicine, Technical University Munich, Ismaninger Str., 81675, Munich, Germany
| | - Lukasz A Malek
- Faculty of Rehabilitation, University of Physical Education, Marymoncka 34, 00-968, Warsaw, Poland
| | - Piotr Blaszczak
- Department of Cardiology, Cardinal Wyszynski' Hospital, Krasnicka Ave 100, 20-718, Lublin, Poland
| | - Marcin Hladunski
- Department of Nuclear Medicine, Medical University of Bialystok, Curie-Sklodowskiej 24a, 15-276, Bialystok, Poland
| | - Bozena Sobkowicz
- Department of Cardiology, Medical University of Bialystok, Curie-Sklodowskiej 24a, 15-276, Bialystok, Poland
| | - Janusz Mysliwiec
- Department of Nuclear Medicine, Medical University of Bialystok, Curie-Sklodowskiej 24a, 15-276, Bialystok, Poland
| | - Karol A Kaminski
- Department of Cardiology, Medical University of Bialystok, Curie-Sklodowskiej 24a, 15-276, Bialystok, Poland. .,Department of Population Medicine and Civilization Diseases Prevention, Medical University of Bialystok, Curie-Sklodowskiej 24a, 15-276, Bialystok, Poland.
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Bousseau S, Sobrano Fais R, Gu S, Frump A, Lahm T. Pathophysiology and new advances in pulmonary hypertension. BMJ MEDICINE 2023; 2:e000137. [PMID: 37051026 PMCID: PMC10083754 DOI: 10.1136/bmjmed-2022-000137] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/02/2023] [Indexed: 04/14/2023]
Abstract
Pulmonary hypertension is a progressive and often fatal cardiopulmonary condition characterised by increased pulmonary arterial pressure, structural changes in the pulmonary circulation, and the formation of vaso-occlusive lesions. These changes lead to increased right ventricular afterload, which often progresses to maladaptive right ventricular remodelling and eventually death. Pulmonary arterial hypertension represents one of the most severe and best studied types of pulmonary hypertension and is consistently targeted by drug treatments. The underlying molecular pathogenesis of pulmonary hypertension is a complex and multifactorial process, but can be characterised by several hallmarks: inflammation, impaired angiogenesis, metabolic alterations, genetic or epigenetic abnormalities, influence of sex and sex hormones, and abnormalities in the right ventricle. Current treatments for pulmonary arterial hypertension and some other types of pulmonary hypertension target pathways involved in the control of pulmonary vascular tone and proliferation; however, these treatments have limited efficacy on patient outcomes. This review describes key features of pulmonary hypertension, discusses current and emerging therapeutic interventions, and points to future directions for research and patient care. Because most progress in the specialty has been made in pulmonary arterial hypertension, this review focuses on this type of pulmonary hypertension. The review highlights key pathophysiological concepts and emerging therapeutic directions, targeting inflammation, cellular metabolism, genetics and epigenetics, sex hormone signalling, bone morphogenetic protein signalling, and inhibition of tyrosine kinase receptors.
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Affiliation(s)
- Simon Bousseau
- Division of Pulmonary, Sleep, and Critical Care Medicine, National Jewish Health, Denver, CO, USA
| | - Rafael Sobrano Fais
- Division of Pulmonary, Sleep, and Critical Care Medicine, National Jewish Health, Denver, CO, USA
| | - Sue Gu
- Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Cardiovascular Pulmonary Research Lab, University of Colorado School of Medicine, Aurora, CO, USA
| | - Andrea Frump
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Tim Lahm
- Division of Pulmonary, Sleep, and Critical Care Medicine, National Jewish Health, Denver, CO, USA
- Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Rocky Mountain Regional Veteran Affairs Medical Center, Aurora, CO, USA
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Butcher SC, Feloukidis C, Kamperidis V, Yedidya I, Stassen J, Fortuni F, Vrana E, Mouratoglou SA, Boutou A, Giannakoulas G, Playford D, Ajmone Marsan N, Bax JJ, Delgado V. Right Ventricular Myocardial Work Characterization in Patients With Pulmonary Hypertension and Relation to Invasive Hemodynamic Parameters and Outcomes. Am J Cardiol 2022; 177:151-161. [PMID: 35691706 DOI: 10.1016/j.amjcard.2022.04.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/17/2022] [Accepted: 04/23/2022] [Indexed: 11/01/2022]
Abstract
Noninvasive evaluation of indexes of right ventricular (RV) myocardial work (RVMW) derived from RV pressure-strain loops may provide novel insights into RV function in precapillary pulmonary hypertension. This study was designed to evaluate the association between the indexes of RVMW and invasive parameters of right heart catheterization and all-cause mortality. Noninvasive analysis of RVMW was completed in 51 patients (mean age 58.1 ± 12.7 years, 31% men) with group I or group IV pulmonary hypertension. RV global work index (RVGWI), RV global constructive work (RVGCW), RV global wasted work (RVGWW), and RV global work efficiency (RVGWE) were compared with parameters derived invasively during right heart catheterization. Patients were followed-up for the occurrence of all-cause death. The median RVGWI, RVGCW, RVGWW, and RVGWE were 620 mm Hg%, 830 mm Hg%, 105 mm Hg% and 87%, respectively. Compared with conventional echocardiographic parameters of RV systolic function, RVGCW and RVGWI correlated more closely with invasively derived RV stroke work index (R = 0.63, p <0.001 and R = 0.60, p <0.001, respectively). Invasively derived pulmonary vascular resistance correlated with RVGWW (R = 0.63, p <0.001), RVGWE (R = 0.48, p <0.001), and RV global longitudinal strain (R = 0.58, p <0.001). RVGCW (hazard ratio 1.42 per 100 mm Hg% <900 mm Hg%, 95% confidence interval 1.12 to 1.81, p = 0.004) and RVGWI (hazard ratio 1.46 per 100 mm Hg% <650 mm Hg%, 95% confidence interval 1.09 to 1.94, p = 0.010) were significantly associated with all-cause mortality, whereas RV global longitudinal strain, RVGWE, and RVGWW were not. In conclusion, indexes of RVMW were more closely correlated with invasively derived RV stroke work index and peripheral vascular resistance than conventional echocardiographic parameters of RV systolic function. Decreased values of RVGCW and RVGWI were associated with all-cause mortality, whereas conventional echocardiographic parameters of RV function were not.
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Affiliation(s)
- Steele C Butcher
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Christos Feloukidis
- Department of Cardiology, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece
| | - Vasileios Kamperidis
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece
| | - Idit Yedidya
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, Rabin Medical Center, Petah-Tikva, Israel
| | - Jan Stassen
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Federico Fortuni
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Division of Cardiology, "Città della Salute della Scienza" University Hospital, Turin, Italy
| | - Elena Vrana
- Department of Cardiology, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece
| | - Sophia A Mouratoglou
- Department of Cardiology, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece
| | - Afroditi Boutou
- Department of Cardiology, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece
| | - George Giannakoulas
- Department of Cardiology, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece
| | - David Playford
- School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
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Farrell C, Balasubramanian A, Hays AG, Hsu S, Rowe S, Zimmerman SL, Hassoun PM, Mathai SC, Mukherjee M. A Clinical Approach to Multimodality Imaging in Pulmonary Hypertension. Front Cardiovasc Med 2022; 8:794706. [PMID: 35118142 PMCID: PMC8804287 DOI: 10.3389/fcvm.2021.794706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/22/2021] [Indexed: 11/24/2022] Open
Abstract
Pulmonary hypertension (PH) is a clinical condition characterized by progressive elevations in mean pulmonary artery pressures and right ventricular dysfunction, associated with significant morbidity and mortality. For resting PH to develop, ~50-70% of the pulmonary vasculature must be affected, suggesting that even mild hemodynamic abnormalities are representative of advanced pulmonary vascular disease. The definitive diagnosis of PH is based upon hemodynamics measured by right heart catheterization; however this is an invasive and resource intense study. Early identification of pulmonary vascular disease offers the opportunity to improve outcomes by instituting therapies that slow, reverse, or potentially prevent this devastating disease. Multimodality imaging, including non-invasive modalities such as echocardiography, computed tomography, ventilation perfusion scans, and cardiac magnetic resonance imaging, has emerged as an integral tool for screening, classifying, prognosticating, and monitoring response to therapy in PH. Additionally, novel imaging modalities such as echocardiographic strain imaging, 3D echocardiography, dual energy CT, FDG-PET, and 4D flow MRI are actively being investigated to assess the severity of right ventricular dysfunction in PH. In this review, we will describe the utility and clinical application of multimodality imaging techniques across PH subtypes as it pertains to screening and monitoring of PH.
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Affiliation(s)
- Christine Farrell
- Division of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Aparna Balasubramanian
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Allison G. Hays
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Steven Hsu
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Steven Rowe
- Division of Radiology, Johns Hopkins University, Baltimore, MD, United States
| | - Stefan L. Zimmerman
- Division of Radiology, Johns Hopkins University, Baltimore, MD, United States
| | - Paul M. Hassoun
- Division of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Stephen C. Mathai
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Monica Mukherjee
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
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Butcher SC, Fortuni F, Montero-Cabezas JM, Abou R, El Mahdiui M, van der Bijl P, van der Velde ET, Ajmone Marsan N, Bax JJ, Delgado V. Right ventricular myocardial work: proof-of-concept for non-invasive assessment of right ventricular function. Eur Heart J Cardiovasc Imaging 2021; 22:142-152. [PMID: 33184656 DOI: 10.1093/ehjci/jeaa261] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/04/2020] [Indexed: 01/22/2023] Open
Abstract
AIMS Right ventricular myocardial work (RVMW) is a novel method for non-invasive assessment of right ventricular (RV) function utilizing RV pressure-strain loops. This study aimed to explore the relationship between RVMW and invasive indices of right heart catheterization (RHC) in a cohort of patients with heart failure with reduced left ventricular ejection fraction (HFrEF), and to compare values of RVMW with those of a group of patients without cardiovascular disease. METHODS AND RESULTS Non-invasive analysis of RVMW was performed in 22 HFrEF patients [median age 63 (59-67) years] who underwent echocardiography and invasive RHC within 48 h. Conventional RV functional measurements, RV global constructive work (RVGCW), RV global work index (RVGWI), RV global wasted work (RVGWW), and RV global work efficiency (RVGWE) were analysed and compared with invasively measured stroke volume and stroke volume index. Non-invasive analysis of RVMW was also performed in 22 patients without cardiovascular disease to allow for comparison between groups. None of the conventional echocardiographic parameters of RV systolic function were significantly correlated with stroke volume or stroke volume index. In contrast, one of the novel indices derived non-invasively by pressure-strain loops, RVGCW, demonstrated a moderate correlation with invasively measured stroke volume and stroke volume index (r = 0.63, P = 0.002 and r = 0.59, P = 0.004, respectively). RVGWI, RVGCW, and RVGWE were significantly lower in patients with HFrEF compared to a healthy cohort, while values of RVGWW were significantly higher. CONCLUSION RVGCW is a novel parameter that provides an integrative analysis of RV systolic function and correlates more closely with invasively measured stroke volume and stroke volume index than other standard echocardiographic parameters.
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Affiliation(s)
- Steele C Butcher
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300RC Leiden, The Netherlands.,Department of Cardiology, Royal Perth Hospital, 197 Wellington St, Perth WA 6000, Australia
| | - Federico Fortuni
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300RC Leiden, The Netherlands.,Department of Molecular Medicine, Unit of Cardiology, University of Pavia, via Forlanini, 27100 Pavia, Italy
| | - Jose M Montero-Cabezas
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300RC Leiden, The Netherlands
| | - Rachid Abou
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300RC Leiden, The Netherlands
| | - Mohammed El Mahdiui
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300RC Leiden, The Netherlands
| | - Pieter van der Bijl
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300RC Leiden, The Netherlands
| | - Enno T van der Velde
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300RC Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300RC Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300RC Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300RC Leiden, The Netherlands
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Sharma M, Burns AT, Yap K, Prior DL. The role of imaging in pulmonary hypertension. Cardiovasc Diagn Ther 2021; 11:859-880. [PMID: 34295710 DOI: 10.21037/cdt-20-295] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 07/17/2020] [Indexed: 01/10/2023]
Abstract
Pulmonary hypertension (PH) is a debilitating and potentially life threatening condition in which increased pressure in the pulmonary arteries may result from a variety of pathological processes. These can include disease primarily involving the pulmonary vasculature, but more commonly PH may result from left-sided heart disease, including valvular heart disease. Chronic thromboembolic pulmonary hypertension (CTEPH) is an important disease to identify because it may be amenable to surgical pulmonary artery endarterectomy or balloon pulmonary angioplasty. Parenchymal lung diseases are also widespread in the community. Any of these disease processes may result in adverse remodeling of the right ventricle and progressive right heart (RH) failure as a common final pathway. Because of the breadth of pathological processes which cause PH, multiple imaging modalities play vital roles in ensuring accurate diagnosis and classification, which will lead to application of the most appropriate therapy. Multimodality imaging may also provide important prognostic information and has a role in the assessment of response to therapies which ultimately dictate clinical outcomes. This review provides an overview of the wide variety of established imaging techniques currently in use, but also examines many of the novel imaging techniques which may be increasingly utilized in the future to guide comprehensive care of patients with PH.
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Affiliation(s)
- Meenal Sharma
- Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Andrew T Burns
- Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Kelvin Yap
- Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - David L Prior
- Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Australia.,Department of Medicine, The University of Melbourne at St Vincent's Hospital (Melbourne), Melbourne, Australia
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10
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Minamimoto R. Series of myocardial FDG uptake requiring considerations of myocardial abnormalities in FDG-PET/CT. Jpn J Radiol 2021; 39:540-557. [PMID: 33517516 PMCID: PMC8175248 DOI: 10.1007/s11604-021-01097-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/16/2021] [Indexed: 12/18/2022]
Abstract
Distinct from cardiac PET performed with preparation to control physiological FDG uptake in the myocardium, standard FDG-PET/CT performed with 4-6 h of fasting will show variation in myocardial FDG uptake. For this reason, important signs of myocardial and pericardial abnormality revealed by myocardial FDG uptake tend to be overlooked. However, recognition of possible underlying disease will support further patient management to avoid complications due to the disease. This review demonstrates the mechanism of FDG uptake in the myocardium, discusses the factors affecting uptake, and provides notable image findings that may suggest underlying disease.
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Affiliation(s)
- Ryogo Minamimoto
- Division of Nuclear Medicine, Department of Radiology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjyuku-ku, Tokyo, 162-8655, Japan.
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11
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Satoh K. Drug discovery focused on novel pathogenic proteins for pulmonary arterial hypertension. J Cardiol 2021; 78:1-11. [PMID: 33563508 DOI: 10.1016/j.jjcc.2021.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Abstract
Pulmonary arterial hypertension (PAH) is a fatal disease in which the wall thickening and narrowing of pulmonary microvessels progress due to complicated interactions among processes such as endothelial dysfunction, the proliferation of pulmonary artery smooth muscle cells (PASMCs) and adventitial fibrocytes, and inflammatory cell infiltration. Early diagnosis of patients with PAH is difficult and lung transplantation is the only last choice to save severely ill patients. However, the number of donors is limited. Many patients with PAH show rapid progression and a high degree of pulmonary arterial remodeling characterized by the abnormal proliferation of PASMCs, which makes treatment difficult even with multidrug therapy comprising pulmonary vasodilators. Thus, it is important to develop novel therapy targeting factors other than vasodilation, such as PASMC proliferation. In the development of PAH, inflammation and oxidative stress are deeply involved in its pathogenesis. Excessive proliferation and apoptosis resistance in PASMCs are key mechanisms underlying PAH. Based on those characteristics, we recently screened novel pathogenic proteins and have performed drug discovery targeting those proteins. To confirm the clinical significance of this, we used patient-derived blood samples to evaluate biomarker potential for diagnosis and prognosis. Moreover, we conducted high throughput screening and found several inhibitors of the pathogenic proteins. In this review, we introduce the recent progress on basic and clinical PAH research, focusing on the screening of pathogenic proteins and drug discovery.
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Affiliation(s)
- Kimio Satoh
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan.
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12
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Harder EM, Vanderpool R, Rahaghi FN. Advanced Imaging in Pulmonary Vascular Disease. Clin Chest Med 2021; 42:101-112. [PMID: 33541604 DOI: 10.1016/j.ccm.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Although the diagnosis of pulmonary hypertension requires invasive testing, imaging serves an important role in the screening, classification, and monitoring of patients with pulmonary vascular disease (PVD). The development of advanced imaging techniques has led to improvements in the understanding of disease pathophysiology, noninvasive assessment of hemodynamics, and stratification of patient risk. This article discusses the current role of advanced imaging and the emerging novel techniques for visualizing the lung parenchyma, mediastinum, and heart in PVD.
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Affiliation(s)
- Eileen M Harder
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, 15 Francis Street, Boston, MA 02115, USA.
| | - Rebecca Vanderpool
- Division of Translational and Regenerative Medicine, Department of Medicine, University of Arizona, 1656 East Mabel Street, Tucson, AZ 85721, USA. https://twitter.com/rrvdpool
| | - Farbod N Rahaghi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, 15 Francis Street, Boston, MA 02115, USA
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13
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Gropler RJ. Imaging Myocardial Metabolism. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00083-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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14
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Kazimierczyk R, Szumowski P, Nekolla SG, Blaszczak P, Malek LA, Milosz-Wieczorek B, Misko J, Jurgilewicz D, Hladunski M, Knapp M, Sobkowicz B, Mysliwiec J, Grzywna R, Musial WJ, Kaminski KA. Prognostic role of PET/MRI hybrid imaging in patients with pulmonary arterial hypertension. Heart 2020; 107:54-60. [PMID: 32522819 DOI: 10.1136/heartjnl-2020-316741] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/22/2020] [Accepted: 05/05/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Right ventricular (RV) function is a major determinant of survival in patients with pulmonary arterial hypertension (PAH). Metabolic alterations may precede haemodynamic and clinical deterioration. Increased RV fluorodeoxyglucose (FDG) uptake in positron emission tomography (PET) was recently associated with progressive RV dysfunction in MRI, but the prognostic value of their combination has not been established. METHODS Twenty-six clinically stable patients with PAH (49.9±15.2 years) and 12 healthy subjects (control group, 44.7±13.5 years) had simultaneous PET/MRI scans. FDG uptake was quantified as mean standardised uptake value (SUV) for both left ventricle (LV) and RV. Mean follow-up time of this study was 14.2±7.3 months and the clinical end point was defined as death or clinical deterioration. RESULTS Median SUVRV/SUVLV ratio was 1.02 (IQR 0.42-1.21) in PAH group and 0.16 (0.13-0.25) in controls, p<0.001. In PAH group, SUVRV/SUVLV significantly correlated with RV haemodynamic deterioration. In comparison to the stable ones, 12 patients who experienced clinical end point had significantly higher baseline SUVRV/SUVLV ratio (1.21 (IQR 0.87-1.95) vs 0.53 (0.24-1.08), p=0.01) and lower RV ejection fraction (RVEF) (37.9±5.2 vs 46.8±5.7, p=0.03). Cox regression revealed that SUVRV/SUVLV ratio was significantly associated with the time to clinical end point. Kaplan-Meier analysis showed that combination of RVEF from MRI and SUVRV/SUVLV assessment may help to predict prognosis. CONCLUSIONS Increased RV glucose uptake in PET and decreased RVEF identify patients with PAH with worse prognosis. Combining parameters from PET and MRI may help to identify patients at higher risk who potentially benefit from therapy escalation, but this hypothesis requires prospective validation.
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Affiliation(s)
| | - Piotr Szumowski
- Department of Nuclear Medicine, Medical University of Bialystok, Bialystok, Poland.,Laboratory of Molecular Imaging, Medical University of Bialystok, Bialystok, Poland
| | - Stephan G Nekolla
- Department of Nuclear Imaging, Technical University of Munich, Munich, Germany
| | - Piotr Blaszczak
- Department of Cardiology, Wyszynski Hospital, Lublin, Poland
| | - Lukasz A Malek
- Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, National Institute of Cardiology, Warsaw, Poland
| | | | - Jolanta Misko
- Department of Radiology, Institute of Cardiology, Warsaw, Poland
| | - Dorota Jurgilewicz
- Department of Nuclear Medicine, Medical University of Bialystok, Bialystok, Poland.,Laboratory of Molecular Imaging, Medical University of Bialystok, Bialystok, Poland
| | - Marcin Hladunski
- Department of Nuclear Medicine, Medical University of Bialystok, Bialystok, Poland.,Laboratory of Molecular Imaging, Medical University of Bialystok, Bialystok, Poland
| | - Malgorzata Knapp
- Department of Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Bozena Sobkowicz
- Department of Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Janusz Mysliwiec
- Department of Nuclear Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Ryszard Grzywna
- Department of Cardiology, Wyszynski Hospital, Lublin, Poland
| | | | - Karol A Kaminski
- Department of Cardiology, Medical University of Bialystok, Bialystok, Poland .,Department of Population Medicine and Civilization Diseases Prevention, Medical University of Bialystok, Bialystok, Poland
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15
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Aljizeeri A, Small G, Malhotra S, Buechel R, Jain D, Dwivedi G, Al-Mallah MH. The role of cardiac imaging in the management of non-ischemic cardiovascular diseases in human immunodeficiency virus infection. J Nucl Cardiol 2020; 27:801-818. [PMID: 30864047 DOI: 10.1007/s12350-019-01676-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/07/2019] [Indexed: 10/27/2022]
Abstract
Infection with human immunodeficiency virus (HIV) has become the pandemic of the new century. About 36.9 million people are living with HIV worldwide. The introduction of antiretroviral therapy in 1996 has dramatically changed the global landscape of HIV care, resulting in significantly improved survival and changing HIV to a chronic disease. With near-normal life expectancy, contemporary cardiac care faces multiple challenges of cardiovascular diseases, disorders specific to HIV/AIDS, and those related to aging and higher prevalence of traditional risk factors. Non-ischemic cardiovascular diseases are major components of cardiovascular morbidity and mortality in HIV/AIDS. Non-invasive cardiac imaging plays a pivotal role in the management of these diseases. This review summarizes the non-ischemic presentation of the HIV cardiovascular spectrum focusing on the role of cardiac imaging in the management of these disorders.
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Affiliation(s)
- Ahmed Aljizeeri
- King Abdulaziz Cardiac Center, Ministry of National Guard-Health Affaire, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Gary Small
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Saurabh Malhotra
- Division of Cardiology, Cook County Health, Chicago, IL, USA
- Division of Cardiology, Rush Medical College, Chicago, IL, USA
| | - Ronny Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Diwakar Jain
- Division of Cardiology and Nuclear Medicine, New York Medical College/Westchester Medical Center, Hawthorne, NY, USA
| | - Girish Dwivedi
- Fiona Stanley Hospital, Murdoch, WA, Australia
- Harry Perkins Institute of Medical Research, Murdoch, WA, Australia
- The University of Western Australia, Crawley, WA, Australia
| | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, 6565 Fannin Street, Smith-19, Houston, TX, 77030, USA.
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16
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Chiba T, Nakano M, Hasebe Y, Kimura Y, Fukasawa K, Miki K, Morosawa S, Takanami K, Ota H, Fukuda K, Shimokawa H. Prognosis and risk stratification in cardiac sarcoidosis patients with preserved left ventricular ejection fraction. J Cardiol 2020; 75:34-41. [DOI: 10.1016/j.jjcc.2019.04.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 03/25/2019] [Accepted: 04/25/2019] [Indexed: 10/26/2022]
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17
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Hung G, Mercurio V, Hsu S, Mathai SC, Shah AA, Mukherjee M. Progress in Understanding, Diagnosing, and Managing Cardiac Complications of Systemic Sclerosis. Curr Rheumatol Rep 2019; 21:68. [PMID: 31813082 DOI: 10.1007/s11926-019-0867-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF THE REVIEW Systemic sclerosis (scleroderma) is a complex autoimmune disease that commonly involves the cardiovascular system. Even if often subclinical, cardiac involvement is considered a poor prognostic factor as it is a leading cause of death in scleroderma patients. We review the cardiac manifestations of scleroderma, the diagnostic methods useful in detection, and current advances in therapeutic management. RECENT FINDINGS Beside the routine exams for the assessment of cardiac status (including EKG, standard echocardiography, provocative tests) novel techniques such as myocardial strain imaging on echocardiography, cardiac magnetic resonance imaging, invasive hemodynamic assessment, and endomyocardial biopsy have been demonstrated to be useful in understanding the cardiac alterations that typically affect scleroderma patients. Recent application of novel cardiac detection strategies is providing increased insight into the breadth and pathogenesis of cardiac complications of scleroderma. Further studies coupling exercise provocation, invasive and imaging assessment, and mechanistic studies in scleroderma cardiac tissue are needed to develop the optimal approach to early detection of cardiac disease in scleroderma and targeted therapies.
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Affiliation(s)
- George Hung
- Division of Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Valentina Mercurio
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Steven Hsu
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Stephen C Mathai
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Ami A Shah
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 4100, Baltimore, MD, 21224, USA
| | - Monica Mukherjee
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, USA.
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18
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Koop AMC, Bossers GPL, Ploegstra MJ, Hagdorn QAJ, Berger RMF, Silljé HHW, Bartelds B. Metabolic Remodeling in the Pressure-Loaded Right Ventricle: Shifts in Glucose and Fatty Acid Metabolism-A Systematic Review and Meta-Analysis. J Am Heart Assoc 2019; 8:e012086. [PMID: 31657265 PMCID: PMC6898858 DOI: 10.1161/jaha.119.012086] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Right ventricular (RV) failure because of chronic pressure load is an important determinant of outcome in pulmonary hypertension. Progression towards RV failure is characterized by diastolic dysfunction, fibrosis and metabolic dysregulation. Metabolic modulation has been suggested as therapeutic option, yet, metabolic dysregulation may have various faces in different experimental models and disease severity. In this systematic review and meta‐analysis, we aimed to identify metabolic changes in the pressure loaded RV and formulate recommendations required to optimize translation between animal models and human disease. Methods and Results Medline and EMBASE were searched to identify original studies describing cardiac metabolic variables in the pressure loaded RV. We identified mostly rat‐models, inducing pressure load by hypoxia, Sugen‐hypoxia, monocrotaline (MCT), pulmonary artery banding (PAB) or strain (fawn hooded rats, FHR), and human studies. Meta‐analysis revealed increased Hedges’ g (effect size) of the gene expression of GLUT1 and HK1 and glycolytic flux. The expression of MCAD was uniformly decreased. Mitochondrial respiratory capacity and fatty acid uptake varied considerably between studies, yet there was a model effect in carbohydrate respiratory capacity in MCT‐rats. Conclusions This systematic review and meta‐analysis on metabolic remodeling in the pressure‐loaded RV showed a consistent increase in glucose uptake and glycolysis, strongly suggest a downregulation of beta‐oxidation, and showed divergent and model‐specific changes regarding fatty acid uptake and oxidative metabolism. To translate metabolic results from animal models to human disease, more extensive characterization, including function, and uniformity in methodology and studied variables, will be required.
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Affiliation(s)
- Anne-Marie C Koop
- Department of Pediatric Cardiology University Medical Center Groningen Center for Congenital Heart Diseases University of Groningen The Netherlands
| | - Guido P L Bossers
- Department of Pediatric Cardiology University Medical Center Groningen Center for Congenital Heart Diseases University of Groningen The Netherlands
| | - Mark-Jan Ploegstra
- Department of Pediatric Cardiology University Medical Center Groningen Center for Congenital Heart Diseases University of Groningen The Netherlands
| | - Quint A J Hagdorn
- Department of Pediatric Cardiology University Medical Center Groningen Center for Congenital Heart Diseases University of Groningen The Netherlands
| | - Rolf M F Berger
- Department of Pediatric Cardiology University Medical Center Groningen Center for Congenital Heart Diseases University of Groningen The Netherlands
| | - Herman H W Silljé
- Department of Cardiology University Medical Center Groningen University of Groningen The Netherlands
| | - Beatrijs Bartelds
- Department of Pediatric Cardiology University Medical Center Groningen Center for Congenital Heart Diseases University of Groningen The Netherlands
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19
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Involvement of fatty acid synthase in right ventricle dysfunction in pulmonary hypertension. Exp Cell Res 2019; 383:111569. [DOI: 10.1016/j.yexcr.2019.111569] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 08/09/2019] [Accepted: 08/20/2019] [Indexed: 10/26/2022]
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20
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Affiliation(s)
- Lai-Ming Yung
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Paul B Yu
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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21
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Satoh K, Shimokawa H. Recent Advances in the Development of Cardiovascular Biomarkers. Arterioscler Thromb Vasc Biol 2019; 38:e61-e70. [PMID: 29695533 DOI: 10.1161/atvbaha.118.310226] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Kimio Satoh
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Shimokawa
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
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22
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Hur DJ, Sugeng L. Non-invasive Multimodality Cardiovascular Imaging of the Right Heart and Pulmonary Circulation in Pulmonary Hypertension. Front Cardiovasc Med 2019; 6:24. [PMID: 30931315 PMCID: PMC6427926 DOI: 10.3389/fcvm.2019.00024] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 02/20/2019] [Indexed: 12/13/2022] Open
Abstract
Pulmonary hypertension (PH) is defined as resting mean pulmonary arterial pressure (mPAP) ≥25 millimeters of mercury (mmHg) via right heart (RH) catheterization (RHC), where increased afterload in the pulmonary arterial vasculature leads to alterations in RH structure and function. Mortality rates have remained high despite therapy, however non-invasive imaging holds the potential to expedite diagnosis and lead to earlier initiation of treatment, with the hope of improving prognosis. While historically the right ventricle (RV) had been considered a passive chamber with minimal role in the overall function of the heart, in recent years in the evaluation of PH and RH failure the anatomical and functional assessment of the RV has received increased attention regarding its performance and its relationship to other structures in the RH-pulmonary circulation. Today, the RV is the key determinant of patient survival. This review provides an overview and summary of non-invasive imaging methods to assess RV structure, function, flow, and tissue characterization in the setting of imaging's contribution to the diagnostic, severity stratification, prognostic risk, response of treatment management, and disease surveillance implications of PH's impact on RH dysfunction and clinical RH failure.
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Affiliation(s)
- David J Hur
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States.,Division of Cardiology, Department of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States
| | - Lissa Sugeng
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States.,Echocardiography Laboratory, Yale New Haven Hospital, New Haven, CT, United States
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23
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Boutagy NE, Feher A, Alkhalil I, Umoh N, Sinusas AJ. Molecular Imaging of the Heart. Compr Physiol 2019; 9:477-533. [PMID: 30873600 DOI: 10.1002/cphy.c180007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Multimodality cardiovascular imaging is routinely used to assess cardiac function, structure, and physiological parameters to facilitate the diagnosis, characterization, and phenotyping of numerous cardiovascular diseases (CVD), as well as allows for risk stratification and guidance in medical therapy decision-making. Although useful, these imaging strategies are unable to assess the underlying cellular and molecular processes that modulate pathophysiological changes. Over the last decade, there have been great advancements in imaging instrumentation and technology that have been paralleled by breakthroughs in probe development and image analysis. These advancements have been merged with discoveries in cellular/molecular cardiovascular biology to burgeon the field of cardiovascular molecular imaging. Cardiovascular molecular imaging aims to noninvasively detect and characterize underlying disease processes to facilitate early diagnosis, improve prognostication, and guide targeted therapy across the continuum of CVD. The most-widely used approaches for preclinical and clinical molecular imaging include radiotracers that allow for high-sensitivity in vivo detection and quantification of molecular processes with single photon emission computed tomography and positron emission tomography. This review will describe multimodality molecular imaging instrumentation along with established and novel molecular imaging targets and probes. We will highlight how molecular imaging has provided valuable insights in determining the underlying fundamental biology of a wide variety of CVDs, including: myocardial infarction, cardiac arrhythmias, and nonischemic and ischemic heart failure with reduced and preserved ejection fraction. In addition, the potential of molecular imaging to assist in the characterization and risk stratification of systemic diseases, such as amyloidosis and sarcoidosis will be discussed. © 2019 American Physiological Society. Compr Physiol 9:477-533, 2019.
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Affiliation(s)
- Nabil E Boutagy
- Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, Section of Cardiovascular Medicine, New Haven, Connecticut, USA
| | - Attila Feher
- Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, Section of Cardiovascular Medicine, New Haven, Connecticut, USA
| | - Imran Alkhalil
- Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, Section of Cardiovascular Medicine, New Haven, Connecticut, USA
| | - Nsini Umoh
- Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, Section of Cardiovascular Medicine, New Haven, Connecticut, USA
| | - Albert J Sinusas
- Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, Section of Cardiovascular Medicine, New Haven, Connecticut, USA.,Yale University School of Medicine, Department of Radiology and Biomedical Imaging, New Haven, Connecticut, USA
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24
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Johns CS, Wild JM, Rajaram S, Swift AJ, Kiely DG. Current and emerging imaging techniques in the diagnosis and assessment of pulmonary hypertension. Expert Rev Respir Med 2019; 12:145-160. [PMID: 29261337 DOI: 10.1080/17476348.2018.1420478] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Pulmonary hypertension (PH) is a challenging condition to diagnose and treat. Over the last two decades, there have been significant advances in therapeutic approaches and imaging technologies. Current guidelines emphasize the importance of cardiac catheterization; however, the increasing availability of non-invasive imaging has the potential to improve diagnostic rates, whilst providing additional information on patient phenotypes. Areas covered: This review discusses the role of imaging in the diagnosis, prognostic assessment and follow-up of patients with PH. Imaging methods, ranging from established investigations (chest radiography, echocardiography, nuclear medicine and computerized tomography (CT)), to emerging modalities (dual energy CT, magnetic resonance imaging (MRI), optical coherence tomography and positron emission tomography (PET)) are reviewed. The value and limitations of the clinical utility of these imaging modalities and their potential clinical application are reviewed. Expert commentary: Imaging plays a key role in the diagnosis and classification of pulmonary hypertension. It also provides valuable prognostic information and emerging evidence supports a role for serial assessments. The authors anticipate an increasing role for imaging in the pulmonary hypertension clinic. This will reduce the need for invasive investigations, whilst providing valuable insights that will improve our understanding of disease facilitate a more targeted approach to treatment.
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Affiliation(s)
| | - Jim M Wild
- a Academic Radiology , The University of Sheffield , Sheffield , UK
| | - Smitha Rajaram
- b Sheffield Pulmonary Vascular Disease Unit , Sheffield Teaching Hospitals , Sheffield , UK
| | - Andy J Swift
- a Academic Radiology , The University of Sheffield , Sheffield , UK
| | - David G Kiely
- b Sheffield Pulmonary Vascular Disease Unit , Sheffield Teaching Hospitals , Sheffield , UK
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25
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Rengier F, Melzig C, Derlin T, Marra AM, Vogel-Claussen J. Advanced imaging in pulmonary hypertension: emerging techniques and applications. Int J Cardiovasc Imaging 2018; 35:1407-1420. [DOI: 10.1007/s10554-018-1448-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 08/24/2018] [Indexed: 02/07/2023]
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26
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Jiang YY, He GW. Early Diagnostic Features of Left-to-Right Shunt-Induced Pulmonary Arterial Hypertension in Piglets. Ann Thorac Surg 2018; 106:1396-1405. [PMID: 29966591 DOI: 10.1016/j.athoracsur.2018.05.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/11/2018] [Accepted: 05/16/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND We aimed to establish early diagnostic characteristics of left-to-right shunt-induced pulmonary arterial hypertension (PAH) in a piglet model. METHODS A shunt-induced PAH in piglets (n = 9) was successfully established by anastomosis of vascular prosthesis from aorta to pulmonary artery with follow-up for 6 months by a number of diagnostic procedures. RESULTS PAH developed with mean pulmonary arterial pressure [PAP] of 30.2 ± 6.0 mm Hg immediately after operation and 33.5 ± 8.7 mm Hg at 3 months after operation with pulmonary vascular resistance increased to 4.0 ± 0.9 Wood units. There was a weak correlation on systolic PAP between catheterization and echocardiography but the Tei index was significantly correlated to systolic PAP. Magnetic resonance imaging demonstrated that the end-diastolic volume index, systolic volume index, ejection fraction of the ventricle, and ventricular mass index were sensitive indices. Technetium-99m single-photon emission computed tomography indicated increased blood flow in the upper and middle zones of both lungs. Positron emission tomography-computed tomography (PET-CT) demonstrated a higher kilo count (kct) of 18F-fluorodeoxyglucose in the right ventricular wall and both chambers at 3 months postoperatively (right ventricular wall: 5,708.3 ± 428.4 versus 3,965.5 ± 138.6 preoperatively, p = 0.003; both chambers: 2,963.6 ± 219.4 versus 1,710.1 ± 35.4 preoperatively, p < 0.05) as well as at 6 months for both chambers (p < 0.05). CONCLUSIONS In this successful left-to-right shunt-induced PAH model in piglets, sensitive indices including the Tei index, systolic volume index, ejection fraction, ventricular mass index, lung perfusion, and glycometabolism by PET-CT in early PAH are determined. For the first time, we report that glycometabolism by PET-CT is useful in early diagnosis. These indices may be used for the early diagnosis in the left-to-right shunt-induced PAH.
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Affiliation(s)
- Yi-Yao Jiang
- Department of Cardiovascular Surgery and Center for Basic Medical Research, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences and Nankai University, Tianjin, China
| | - Guo-Wei He
- Department of Cardiovascular Surgery and Center for Basic Medical Research, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences and Nankai University, Tianjin, China; Department of Surgery, Oregon Health and Science University, Portland, Oregon.
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27
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Abstract
Pulmonary hypertension (PH) is characterized by elevated pulmonary arterial pressure caused by a broad spectrum of congenital and acquired disease processes, which are currently divided into five groups based on the 2013 WHO classification. Imaging plays an important role in the evaluation and management of PH, including diagnosis, establishing etiology, quantification, prognostication and assessment of response to therapy. Multiple imaging modalities are available, including radiographs, computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine, echocardiography and invasive catheter angiography (ICA), each with their own advantages and disadvantages. In this article, we review the comprehensive role of imaging in the evaluation of PH.
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Affiliation(s)
- Harold Goerne
- IMSS Centro Medico Nacional De Occidente, Guadalajara, Jalisco, Mexico.,CID Imaging and Diagnostic Center, Guadalajara, Jalisco, Mexico
| | - Kiran Batra
- Radiology Department, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Prabhakar Rajiah
- Radiology Department, UT Southwestern Medical Center, Dallas, Texas, USA
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28
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Sirajuddin A, Donnelly EF, Crabtree TP, Henry TS, Iannettoni MD, Johnson GB, Kazerooni EA, Maldonado F, Olsen KM, Wu CC, Mohammed TL, Kanne JP. ACR Appropriateness Criteria ® Suspected Pulmonary Hypertension. J Am Coll Radiol 2018; 14:S350-S361. [PMID: 28473092 DOI: 10.1016/j.jacr.2017.01.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 01/19/2017] [Accepted: 01/23/2017] [Indexed: 11/15/2022]
Abstract
Pulmonary hypertension may be idiopathic or related to a large variety of diseases. Various imaging examinations that may be helpful in diagnosing and determining the etiology of pulmonary hypertension are discussed. Imaging examinations that may aid in the diagnosis of pulmonary hypertension include chest radiography, ultrasound echocardiography, ventilation/perfusion scans, CT, MRI, right heart catheterization, pulmonary angiography, and fluorine-18-2-fluoro-2-deoxy-d-glucose PET/CT. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Edwin F Donnelly
- Panel Vice-Chair, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Traves P Crabtree
- Southern Illinois University School of Medicine, Springfield, Illinois; Society of Thoracic Surgeons
| | - Travis S Henry
- University of California, San Francisco, San Francisco, California
| | | | | | | | - Fabien Maldonado
- Vanderbilt University Medical Center, Nashville, Tennessee; American College of Chest Physicians
| | | | - Carol C Wu
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tan-Lucien Mohammed
- Specialty Chair, University of Florida College of Medicine, Gainesville, Florida
| | - Jeffrey P Kanne
- Panel Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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29
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Jansa P, Pulido T. Macitentan in Pulmonary Arterial Hypertension: A Focus on Combination Therapy in the SERAPHIN Trial. Am J Cardiovasc Drugs 2018; 18:1-11. [PMID: 29280064 PMCID: PMC5772137 DOI: 10.1007/s40256-017-0260-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
SERAPHIN was a double-blind, placebo-controlled, event-driven phase III trial that evaluated the effects of long-term treatment with macitentan, an oral endothelin receptor antagonist, in patients with pulmonary arterial hypertension (PAH). The majority of patients were receiving PAH therapy at enrollment, providing the opportunity to evaluate the efficacy and safety of macitentan in combination with other PAH therapies (predominantly phosphodiesterase type 5 inhibitors [PDE-5i]). In patients receiving background therapy, macitentan reduced the risk of morbidity/mortality by 38% compared with placebo (hazard ratio [HR] 0.62; 95% confidence level [CL] 0.43-0.89; p = 0.009). Furthermore, patients receiving macitentan and background therapy had a 37% reduction in the risk of being hospitalized for PAH (HR 0.63; 95% CL 0.41-0.96) compared with patients receiving background therapy only (placebo arm). Macitentan treatment in combination with background therapy was also associated with improvements in exercise capacity, functional class, cardiopulmonary hemodynamics, and health-related quality of life compared with background therapy alone. The safety profile of macitentan as part of a combination therapy regimen was consistent with that of macitentan in the overall SERAPHIN population. The SERAPHIN study has provided evidence that combination therapy with macitentan and a PDE-5i is effective and well tolerated in the management of PAH. Based on these data, and those from subsequent long-term trials, combination therapy is increasingly recognized as an important treatment option for improving long-term outcomes in PAH. CLINICAL TRIAL REGISTRATION NUMBER NCT00660179.
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30
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Current Knowledge and Recent Advances of Right Ventricular Molecular Biology and Metabolism from Congenital Heart Disease to Chronic Pulmonary Hypertension. BIOMED RESEARCH INTERNATIONAL 2018; 2018:1981568. [PMID: 29581963 PMCID: PMC5822779 DOI: 10.1155/2018/1981568] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 12/20/2017] [Indexed: 11/18/2022]
Abstract
Studies about pulmonary hypertension and congenital heart diseases have introduced the concept of right ventricular remodeling leading these pathologies to a similar outcome: right ventricular failure. However right ventricular remodeling is also a physiological process that enables the normal fetal right ventricle to adapt at birth and gain its adult phenotype. The healthy mature right ventricle is exposed to low pulmonary vascular resistances and is compliant. However, in the setting of chronic pressure overload, as in pulmonary hypertension, or volume overload, as in congenital heart diseases, the right ventricle reverts back to a fetal phenotype to sustain its function. Mechanisms include angiogenic changes and concomitant increased metabolic activity to maintain energy production. Eventually, the remodeled right ventricle cannot resist the increased afterload, leading to right ventricular failure. After comparing the fetal and adult healthy right ventricles, we sought to review the main metabolic and cellular changes occurring in the setting of PH and CHD. Their association with RV function and potential impact on clinical practice will also be discussed.
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31
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Chan SY, Rubin LJ. Metabolic dysfunction in pulmonary hypertension: from basic science to clinical practice. Eur Respir Rev 2017; 26:26/146/170094. [PMID: 29263174 PMCID: PMC5842433 DOI: 10.1183/16000617.0094-2017] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 10/28/2017] [Indexed: 01/29/2023] Open
Abstract
Pulmonary hypertension (PH) is an often-fatal vascular disease of unclear molecular origins. The pulmonary vascular remodelling which occurs in PH is characterised by elevated vasomotor tone and a pro-proliferative state, ultimately leading to right ventricular dysfunction and heart failure. Guided in many respects by prior evidence from cancer biology, recent investigations have identified metabolic aberrations as crucial components of the disease process in both the pulmonary vessels and the right ventricle. Given the need for improved diagnostic and therapeutic options for PH, the development or repurposing of metabolic tracers and medications could provide an effective avenue for preventing or even reversing disease progression. In this review, we describe the metabolic mechanisms that are known to be dysregulated in PH; we explore the advancing diagnostic testing and imaging modalities that are being developed to improve diagnostic capability for this disease; and we discuss emerging drugs for PH which target these metabolic pathways. Understanding metabolic pathways in PH provides opportunities for improved diagnostic and therapeutic optionshttp://ow.ly/pFQb30guez6
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Affiliation(s)
- Stephen Y Chan
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Division of Cardiology, Dept of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Lewis J Rubin
- University of California, San Diego School of Medicine, La Jolla, CA, USA
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32
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Feher A, Sinusas AJ. Assessment of right ventricular metabolism: An emerging tool for monitoring pulmonary artery hypertension. J Nucl Cardiol 2017; 24:1990-1993. [PMID: 27864729 PMCID: PMC5505806 DOI: 10.1007/s12350-016-0695-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 09/06/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Attila Feher
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, P.O. Box 208017, Dana 3, New Haven, CT, 06520-8017, USA
| | - Albert J Sinusas
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, P.O. Box 208017, Dana 3, New Haven, CT, 06520-8017, USA.
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA.
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33
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Abstract
Cyclophilin A (CyPA) is secreted from vascular smooth muscle cells, inflammatory cells, activated platelets, and cardiac fibroblasts in response to oxidative stress. Excessive and continuous activation of the RhoA/Rho-kinase system promotes the secretion of CyPA, resulting in the development of multiple cardiovascular diseases. Basigin (Bsg), a transmembrane glycoprotein that activates matrix metalloproteinases, is an extracellular receptor for CyPA that promotes cell proliferation and inflammation. Thus, the CyPA/Bsg system is potentially a novel therapeutic target for cardiovascular diseases. Importantly, plasma CyPA levels are increased in patients with coronary artery disease, abdominal aortic aneurysms, pulmonary hypertension, and heart failure. Moreover, plasma CyPA levels can predict all-cause death in patients with coronary artery disease and pulmonary hypertension. Additionally, plasma soluble Bsg levels are increased and predict all-cause death in patients with heart failure, suggesting that CyPA and Bsg are novel biomarkers for cardiovascular diseases. To discover further novel molecules targeting the CyPA/Bsg system, high-throughput screening of compounds found molecules that ameliorate the development of cardiovascular diseases. In addition to CyPA and Bsg, novel therapeutic targets and their inhibitors for patients with pulmonary arterial hypertension have been recently screened and identified. Ultimately, the final goal is to develop novel biomarkers and medications that will be useful for improving the prognosis and quality of life in patients with cardiovascular diseases.
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Affiliation(s)
- Kimio Satoh
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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34
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Li Y, Wang Y, Li H, Zhu W, Meng X, Lu X. Evaluation of the hemodynamics and right ventricular function in pulmonary hypertension by echocardiography compared with right-sided heart catheterization. Exp Ther Med 2017; 14:3616-3622. [PMID: 29042956 PMCID: PMC5639404 DOI: 10.3892/etm.2017.4953] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 03/17/2017] [Indexed: 11/24/2022] Open
Abstract
The present study aimed to evaluate hemodynamics and right ventricular function in patients with pulmonary hypertension (PH) using transthoracic echocardiography and to compare these results with measurements obtained using right-sided heart catheterization (RHC). A total of 75 patients with PH were examined using echocardiography and RHC. Patients were divided into the following two groups according to their difference between SPAPecho and SPAPRHC measurement: The overestimated group and underestimated group. The overestimated group included the subgroups groupover-A (difference <20 mmHg) and groupover-B (difference ≥20 mmHg), and the underestimated group included groupunder-A (absolute value of the difference <20 mmHg) and groupunder-B (absolute value of the difference ≥20 mmHg). SPAPecho measurements were revealed to be significantly positively correlated with SPAPRHC measurements (r=0.794; P<0.01). Among all echocardiographic measurements, only tricuspid annular plane systolic excursion (TAPSE) was significantly different between groups; it was increased in groupover-A and groupunder-A compared with groupover-B (P<0.01). Although SPAP measurements obtained using echocardiography were significantly positively correlated with those obtained using RHC, a high proportion of overestimation or underestimation of SPAP by echocardiography remained.
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Affiliation(s)
- Yidan Li
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Yidan Wang
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Hong Li
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Weiwei Zhu
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Xiangli Meng
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Xiuzhang Lu
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing 100020, P.R. China
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35
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Saygin D, Highland KB, Farha S, Park M, Sharp J, Roach EC, Tang WHW, Thomas JD, Erzurum SC, Neumann DR, DiFilippo FP. Metabolic and Functional Evaluation of the Heart and Lungs in Pulmonary Hypertension by Gated 2-[18F]-Fluoro-2-deoxy-D-glucose Positron Emission Tomography. Pulm Circ 2017; 7:428-438. [PMID: 28597761 PMCID: PMC5467932 DOI: 10.1177/2045893217701917] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pulmonary hypertension (PH) is associated with a metabolic shift towards glycolysis in both the right ventricle and lung. This results in increased glucose uptake to compensate for the lower energy yield of glycolysis, which creates a potential for 2-[18F] fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) to be a useful tool in the evaluation of participants with PH. We investigated the utility of PET for PH by comparing FDG-PET uptake in the right ventricle and lungs in 30 participants with PH and eight healthy controls and correlating these measurements with echocardiographic (ECHO) measurements and other traditional assessments commonly used in PH. All participants underwent gated FDG-PET scanning in the fasting state, ECHO, six-minute walk test (6MWT), and blood draw for NT-proBNP. Participants also completed the CAMPHOR questionnaire. Right ventricular (RV) end-diastolic and end-systolic volumes, RV ejection fraction, and FDG uptake by PET were significantly different between PH and healthy controls and strongly correlated with plasma NT-proBNP levels and RV ECHO parameters including TAPSE, RV systolic pressure, Tei index, and global peak systolic strain. In addition, lung standardized uptake value (SUV) was also found to be significantly higher in participants with PH than healthy controls. However, lung SUV did not show any significant correlations with NT-proBNP levels, 6MWT, or functional and pressure measurements by ECHO. In this study, we demonstrated the ability to evaluate both lung and right heart metabolism and function in PH by using a single gated FDG-PET scan.
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Affiliation(s)
- Didem Saygin
- 1 Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Samar Farha
- 1 Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Margaret Park
- 3 Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jacqueline Sharp
- 3 Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Emir Charles Roach
- 1 Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - W H Wilson Tang
- 3 Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - James D Thomas
- 4 Heart and Vascular Institute, Northwestern University Hospital, Chicago, IL, USA
| | - Serpil C Erzurum
- 1 Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.,2 Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Donald R Neumann
- 5 Department of Nuclear Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Frank P DiFilippo
- 5 Department of Nuclear Medicine, Cleveland Clinic, Cleveland, OH, USA
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36
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Wang L, Zhou W, Liang Y, Yang Y, Garcia EV, Chen J, Fang W. Right ventricular dyssynchrony in pulmonary hypertension: Phase analysis using FDG-PET imaging. J Nucl Cardiol 2017; 24:69-78. [PMID: 26715598 PMCID: PMC10959236 DOI: 10.1007/s12350-015-0341-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 11/06/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Right ventricular (RV) performance in patients of pulmonary hypertension (PH) requires optimal assessment. The objective of this study is to develop phase analysis using 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging as a feasible tool for evaluation of RV dyssynchrony in PH. METHODS AND RESULTS Fifty-four PH patients with well-characterized hemodynamic parameters were enrolled. All subjects performed FDG-PET imaging for RV phase analysis and RV function evaluation. Two-dimensional echocardiography with speckle tracking analysis was conducted to obtain RV time to peak systolic strain (PSST) as a comparison. The median contraction delay difference between RV middle free wall and septum measured by PET phase analysis (RVPDPET) was 20.12° (interquartile range, 4.99°-30.10°). The median difference of PSST between RV middle free wall and middle septal wall (RVPDEcho) measured by echocardiography was 43.98° (interquartile range, 6.25°-72.00°). RVPDPET was well correlated with RVPDEcho (r = 0.685, P < .001). RV phase standard deviation (RVSD) and histogram bandwidth (RVBW) derived from PET phase histogram were significantly correlated with cardiac index, RV ejection fraction, 6-minute walking distance, and serum N-terminal pro B-type natriuretic peptide (NT-proBNP) (RVSD: r = -0.532, P < .001; r = -0.551, P < .001; r = -0.544, P < .001; r = 0.404, P < .01; respectively, RVBW: r = -0.492, P < .001; r = -0.466, P < .001; r = -0.544, P < .001; r = 0.349, P = .01, respectively), while there were no significant correlations between RVSD and RVBW with hemodynamic parameters (right atrial pressure, right ventricular systolic pressure, right ventricular end-diastolic pressure, mean pulmonary artery pressure, and total pulmonary resistance). CONCLUSIONS Contraction delays between RV free wall and septum in PH measured by phase analysis and speckle tracking echocardiography were well correlated. RV dyssynchrony measured by phase analysis of FDG-PET was significantly related to RV dysfunction. Phase analysis of FDG-PET is feasible to evaluate RV mechanical dyssynchrony in patients of PH.
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Affiliation(s)
- Lei Wang
- Department of Nuclear Medicine, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China
- Centre for Pharmacology and Therapeutics, Experimental Medicine, Imperial College London, London, United Kingdom
| | - Weihua Zhou
- School of Computing, University of Southern Mississippi, 730 East Beach Blvd, Long Beach, MS, 39560, USA.
| | - Yu Liang
- Department of Echocardiography, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Yong Yang
- Department of Nuclear Medicine, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China
| | - Ernest V Garcia
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Ji Chen
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Wei Fang
- Department of Nuclear Medicine, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China.
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37
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Wang L, Ma X, Xiang L, Lu M, Yan C, Zhao S, Fang W. The characterization and prognostic significance of right ventricular glucose metabolism in non-ischemic dilated cardiomyopathy. J Nucl Cardiol 2016; 23:758-67. [PMID: 26253326 DOI: 10.1007/s12350-015-0165-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 04/23/2015] [Indexed: 11/28/2022]
Abstract
AIMS In dilated cardiomyopathy (DCM), there are limited data on right ventricular (RV) glucose metabolism assessed by [(18)F]fludeoxyglucose positron emission tomography ((18)F-FDG PET) imaging. We aimed to characterize RV glucose metabolism and investigate the prognostic significance of RV FDG uptake in DCM. METHODS AND RESULTS (18)F-FDG PET imaging and cardiac magnetic resonance imaging (MRI) were performed in 63 consecutive DCM patients within an interval of 3-7 days. There was a significant correlation between RVEF and RV FDG uptake whether corrected RV standard uptake value (cRVSUV) (r = -0.571, P < .001) or the relative RV FDG uptake determined as the ratio of RV to left ventricular (LV) corrected SUV (cR/L) (r = -0.405, P < .001) was used. During a median follow-up period of 804 days, 15 patients (23.8%) reached the primary endpoint of all-cause mortality or heart transplantation. On univariate Cox analysis, cRVSUV > 7.01 and cR/L > 0.795 were significantly associated with the overall survival (hazard ratio [HR] 5.415, 95% confidence interval [CI] 1.945-15.078, P < .001; HR 6.422, 95% CI 2.250-18.332, P < .001). Patients with increased RV FDG uptake had a worse outcome (cRVSUV > 7.01 vs cRVSUV ≤ 7.01, log-rank 13.085, P < .001; cR/L > 0.795 vs cR/L ≤ 0.795, log-rank 15.695, P < .001). On multivariate analysis, cR/L > 0.795 remained a significant independent predictor of the endpoint (HR 5.001, 95% CI 1.641-15.239, P = .004), while cRVSUV > 7.01 showed no significance (HR 2.611; 95% CI 0.797-8.558; P = .113). CONCLUSIONS Increased RV FDG uptake was associated with RV dysfunction and may be a prognostic predictor of all-cause mortality or heart transplantation in patients with DCM.
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Affiliation(s)
- Lei Wang
- Department of Nuclear Medicine, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China
- Centre for Pharmacology and Therapeutics, Experimental Medicine, Imperial College London, London, UK
| | - Xinghong Ma
- Department of Nuclear Medicine, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China
| | - Liwei Xiang
- Department of Radiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China
| | - Minjie Lu
- Department of Radiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China
| | - Chaowu Yan
- Department of Radiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China
| | - Shihua Zhao
- Department of Radiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China.
| | - Wei Fang
- Department of Nuclear Medicine, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China.
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38
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Neglia D. Positron emission tomography: An additional prognostic tool in dilated cardiomyopathy? J Nucl Cardiol 2016; 23:768-72. [PMID: 26293359 DOI: 10.1007/s12350-015-0254-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 07/24/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Danilo Neglia
- Fondazione G. Monasterio CNR-Regione Toscana and CNR Institute of Clinical Physiology, Via G. Moruzzi 1, 56126, Pisa, Italy.
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39
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von Siebenthal C, Aubert JD, Mitsakis P, Yerly P, Prior JO, Nicod LP. Pulmonary Hypertension and Indicators of Right Ventricular Function. Front Med (Lausanne) 2016; 3:23. [PMID: 27376066 PMCID: PMC4891340 DOI: 10.3389/fmed.2016.00023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 05/10/2016] [Indexed: 02/04/2023] Open
Abstract
Pulmonary hypertension (PH) is a rare disease, whose underlying mechanisms are not fully understood. It is characterized by pulmonary arterial vasoconstriction and vessels wall thickening, mainly intimal and medial layers. Several molecular pathways have been studied, but their respective roles remain unknown. Cardiac repercussions of PH are hypertrophy, dilation, and progressive right ventricular dysfunction. Multiple echocardiographic parameters are being used, in order to assess anatomy and cardiac function, but there are no guidelines edited about their usefulness. Thus, it is now recommended to associate the best-known parameters, such as atrial and ventricular diameters or tricuspid annular plane systolic excursion. Cardiac catheterization remains necessary to establish the diagnosis of PH and to assess pulmonary hemodynamic state. Concerning energetic metabolism, free fatty acids, normally used to provide energy for myocardial contraction, are replaced by glucose uptake. These abnormalities are illustrated by increased (18)F-fluorodeoxyglucose ((18)F-FDG) uptake on positron emission tomography/computed tomography, which seems to be correlated with echocardiographic and hemodynamic parameters.
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Affiliation(s)
| | - John-David Aubert
- Pneumology, Centre Hospitalier Universitaire Vaudois , Lausanne , Switzerland
| | - Periklis Mitsakis
- Nuclear Medicine and Molecular Imaging, Centre Hospitalier Universitaire Vaudois , Lausanne , Switzerland
| | - Patrick Yerly
- Cardiology, Centre Hospitalier Universitaire Vaudois , Lausanne , Switzerland
| | - John O Prior
- Nuclear Medicine and Molecular Imaging, Centre Hospitalier Universitaire Vaudois , Lausanne , Switzerland
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Frille A, Steinhoff KG, Hesse S, Grachtrup S, Wald A, Wirtz H, Sabri O, Seyfarth HJ. Thoracic [18F]fluorodeoxyglucose uptake measured by positron emission tomography/computed tomography in pulmonary hypertension. Medicine (Baltimore) 2016; 95:e3976. [PMID: 27336898 PMCID: PMC4998336 DOI: 10.1097/md.0000000000003976] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Positron emission tomography (PET) visualizes increased cellular [F]fluorodeoxyglucose ([F]FDG) uptake. Pulmonary hypertension (PH) is conceived of a proliferative disease of the lung vessels. Increased glucose uptake can be quantified as pulmonary [F]FDG uptake via PET imaging. Because the angioproliferative mechanisms in PH are still in need of further description, the aim of the present study was to investigate whether [F]FDG PET/CT imaging can elucidate these pathophysiologic mechanisms in different etiologies of PH.Patients (n = 109) with end-stage pulmonary disease being evaluated for lung transplant were included in this observational study. Mean standardized uptake value (SUVmean) of predefined regions of interest in lung parenchyma (LP), left (LV), and right ventricle (RV) of the heart, and SUVmax in pulmonary artery (PA) were determined and normalized to liver uptake. These SUV ratios (SUVRs) were compared with results from right heart catheterization (mean pulmonary artery pressure [mPAP], pulmonary vascular resistance [PVR]), and serum N-terminal pro-brain natriuretic peptide. Group comparisons were performed and Pearson correlation coefficients (r) were calculated.The [F]FDG uptake ratios in LP, RV, RV/LV, and PA, but not in LV, were found to be significantly higher in both patients with mPAP ≥25 mm Hg (P = 0.013, P = 0.006, P = 0.049, P = 0.002, P = 0.68, respectively) and with PVR ≥480 dyn·s/cm (P < 0.001, P = 0.045, P < 0.001, P < 0.001, P = 0.26, respectively). The [F]FDG uptake in these regions positively correlated also with mPAP, PVR, and N-terminal pro-brain natriuretic peptide. The SUVR of PA positively correlated with the SUVR of LP and RV (r = 0.55, r = 0.42, respectively).Pulmonary and cardiac [F]FDG uptake in PET imaging positively correlated with the presence and severity of PH in patients with end-stage pulmonary disease. Increased glucose metabolism in the central PAs seems to play a certain role in terms of severity of PH. These results suggest that [F]FDG-PET imaging can help understand the pathophysiology of PH as a proliferative pulmonary disease.
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Affiliation(s)
- Armin Frille
- Department of Respiratory Medicine, University of Leipzig, Leipzig, Germany
| | | | - Swen Hesse
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Leipzig, Germany
| | - Sabine Grachtrup
- Department of Respiratory Medicine, University of Leipzig, Leipzig, Germany
| | - Alexandra Wald
- Department of Respiratory Medicine, University of Leipzig, Leipzig, Germany
| | - Hubert Wirtz
- Department of Respiratory Medicine, University of Leipzig, Leipzig, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
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Sato H, Ota H, Sugimura K, Aoki T, Tatebe S, Miura M, Yamamoto S, Yaoita N, Suzuki H, Satoh K, Takase K, Shimokawa H. Balloon Pulmonary Angioplasty Improves Biventricular Functions and Pulmonary Flow in Chronic Thromboembolic Pulmonary Hypertension. Circ J 2016; 80:1470-7. [PMID: 27097557 DOI: 10.1253/circj.cj-15-1187] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND It remains to be determined whether balloon pulmonary angioplasty (BPA) improves biventricular cardiac functions and pulmonary flow in patients with chronic thromboembolic pulmonary hypertension (CTEPH). METHODS AND RESULTS We enrolled 30 consecutive patients with inoperable CTEPH who underwent BPA, and carried out serial cardiac magnetic resonance imaging (CMR; M/F, 9/21; median age, 65.2 years). No patient died during the treatment or follow-up period. BPA significantly improved WHO functional class (III/IV, 83.0 to 4.0%), 6-min walking distance (330.2±168.7 to 467.3±114.4 m), mean pulmonary artery pressure (40.8±10.7 to 23.2±4.94 mmHg), pulmonary vascular resistance (9.26±4.19 to 3.35±1.40 WU) and cardiac index (2.19±0.64 to 2.50±0.57 L·min·m(2); all P<0.01). CMR also showed improvement of right ventricular (RV) ejection fraction (EF; 41.3±12.4 to 50.7±8.64%), left ventricular (LV) end-diastolic volume index (72.1±14.0 to 81.6±18.6 ml/m(2)) and LV stroke volume index (41.0±9.25 to 47.8±12.3 ml/m(2); all P<0.01). There was a significant correlation between change in RVEF and LVEF (Pearson's r=0.45, P=0.01). Average velocity in the main pulmonary artery was also significantly improved (7.50±2.43 to 9.79±2.92 cm/s, P<0.01). CONCLUSIONS BPA improves biventricular functions and pulmonary flow in patients with inoperable CTEPH. (Circ J 2016; 80: 1470-1477).
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Affiliation(s)
- Haruka Sato
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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Right ventricle dysfunction in pulmonary hypertension: mechanisms and modes of detection. Curr Opin Pulm Med 2015; 21:446-53. [PMID: 26176967 DOI: 10.1097/mcp.0000000000000192] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW This review highlights the right ventricular (RV) involvement in pulmonary hypertension from pathophysiologic changes to current imaging tools used to screen, diagnose and follow up RV function in patients with pulmonary hypertension. RECENT FINDINGS Although right heart catheterization is the gold standard for the diagnosis of pulmonary hypertension, other diagnostic methods such as echocardiography, magnetic resonance and nuclear imaging are of great utility in the assessment of the RV in pulmonary hypertension. Apart from its conventional use as a screening tool for pulmonary hypertension, echocardiography allows assessment of RV size and function and has prognostic value. Among the novel applications of echocardiography, exercise echocardiography and measurements of RV strain might help unveil subclinical pulmonary hypertension, whereas three-dimensional echocardiography allows more accurate measures of RV morphology and function. Cardiac magnetic resonance imaging is currently the gold standard noninvasive imaging method to assess RV volume, mass and function and has prognostic value in the assessment of pulmonary hypertension. Finally, positron emission tomography is a promising tool in the metabolic assessment of the RV and pulmonary circulation. SUMMARY RV assessment is essential in the overall evaluation of pulmonary hypertension. Despite the availability of several methods and measurements for this assessment, there is, however, no standard approach or broad consensus on their application.
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The Prognostic Value of 18F-FDG Uptake Ratio Between the Right and Left Ventricles in Idiopathic Pulmonary Arterial Hypertension. Clin Nucl Med 2015; 40:859-63. [DOI: 10.1097/rlu.0000000000000956] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Gerber BL, Edvardsen T, Pierard LA, Saraste A, Knuuti J, Maurer G, Habib G, Lancellotti P. The year 2014 in the European Heart Journal--Cardiovascular Imaging: part II. Eur Heart J Cardiovasc Imaging 2015; 16:1180-4. [PMID: 26377903 DOI: 10.1093/ehjci/jev223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 08/12/2015] [Indexed: 12/14/2022] Open
Abstract
The European Heart Journal-Cardiovascular Imaging, created in 2012, has become a reference for publishing multimodality cardiovascular imaging scientific and review papers. The impressive 2014 impact factor of 4.105 confirms the important position of our journal. In this part, we summarize the most important studies from the journal's third year, with specific emphasis on cardiomyopathies, congenital heart diseases, valvular heart diseases, and heart failure.
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Affiliation(s)
- Bernhard L Gerber
- Division of Cardiology, Department of Cardiovascular Diseases, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet and University of Oslo, Oslo, Norway Centre of Cardiological Innovation, Oslo, Norway
| | - Luc A Pierard
- Avenue de l'hôpital, 1, Department of Cardiology, University of Liege Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, Imaging Cardiology, CHU Sart Tilman, 4000 Liege, Belgium
| | - Antti Saraste
- Turku PET Centre and Heart Center, Turku University Hospital and University of Turku, Kiinmyllynkatu 4-8, 20520 Turku, Finland
| | - Juhani Knuuti
- Turku PET Centre and Heart Center, Turku University Hospital and University of Turku, Kiinmyllynkatu 4-8, 20520 Turku, Finland
| | - Gerald Maurer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Gilbert Habib
- Aix-Marseille Université, 13284 Marseille, France Department of Cardiology, La Timone Hospital, Bd Jean Moulin, 13005 Marseille, France
| | - Patrizio Lancellotti
- Avenue de l'hôpital, 1, Department of Cardiology, University of Liege Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, Imaging Cardiology, CHU Sart Tilman, 4000 Liege, Belgium GVM Care and Research, E.S. Health Science Foundation, Lugo, RA, Italy
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Ohira H, Beanlands RS, Davies RA, Mielniczuk L. The role of nuclear imaging in pulmonary hypertension. J Nucl Cardiol 2015; 22:141-57. [PMID: 25161042 DOI: 10.1007/s12350-014-9960-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 07/17/2014] [Indexed: 12/14/2022]
Abstract
Pulmonary hypertension (PH) is a disease characterized by a chronic elevation of pulmonary artery pressure from various causes. Pulmonary artery hypertension (PAH) is one of subtype which results in premature death often as a result of right ventricular (RV) dysfunction. In spite of the recent progress in novel cardiac imaging techniques and new drugs for PAH, there remain significant unresolved issues including a need for earlier diagnosis, refinement of risk stratification, and monitoring the effects of treatment. Cardiac and pulmonary imaging with transthoracic echocardiography (TTE) with Doppler, magnetic resonance imaging (MRI), and computed tomography (CT) are done routinely in many clinical centers. However, routine and emerging nuclear techniques may have a pivotal role of assessment of the patient with PH, and is currently the subject of significant research. Potential Roles for Nuclear Imaging in the Evaluation of the PH Patient: (1) Evaluation of cardiac structure and function (RNA) (non-nuclear techniques would include TTE, CT, and MRI). (2) Functional imaging. This includes the use of ventilation-perfusion scintigraphy (V/Q scan) to diagnose chronic thromboembolic pulmonary hypertension (CTEPH), 123l-metaiodobenzylguanidine (MIBG) imaging to evaluate the cardiac sympathetic nervous system (non-nuclear techniques include invasive right heart catheterization and TTE). (3) Measurement of RV perfusion (with gated SPECT studies). (4) Evaluation of cardiac and pulmonary metabolism (PET scans). This review article will summarize the pathophysiology, classification, natural history, and diagnostic approach of PH. Current and emerging nuclear techniques will be discussed under the four themes of evaluation of structure, functional imaging, flow, and metabolism. These will be compared to current and emerging nuclear and non-nuclear diagnostic tests in the evaluation and management of patients with PH. We will also discuss research applications exploring new insights into flow and metabolism in the right heart and lung and the application of new radioligands.
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Affiliation(s)
- H Ohira
- Advanced Heart Disease and Pulmonary Hypertension Programs, National Cardiac PET Centre, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, 40 Ruskin Street, Room 3409, Ottawa, ON, K1Y 4W7, Canada
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Ahmadi A, Ohira H, Mielniczuk LM. FDG PET Imaging for Identifying Pulmonary Hypertension and Right Heart Failure. Curr Cardiol Rep 2014; 17:555. [DOI: 10.1007/s11886-014-0555-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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