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Liu C, Chen J, Gao Y, Deng B, Liu K. Endothelin receptor antagonists for pulmonary arterial hypertension. Cochrane Database Syst Rev 2021; 3:CD004434. [PMID: 33765691 PMCID: PMC8094512 DOI: 10.1002/14651858.cd004434.pub6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Pulmonary arterial hypertension is a devastating disease that leads to right heart failure and premature death. Endothelin receptor antagonists have shown efficacy in the treatment of pulmonary arterial hypertension. OBJECTIVES To evaluate the efficacy of endothelin receptor antagonists (ERAs) in pulmonary arterial hypertension. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and the reference sections of retrieved articles. The searches are current as of 4 November 2020. SELECTION CRITERIA We included randomised trials and quasi-randomised trials involving participants with pulmonary arterial hypertension. DATA COLLECTION AND ANALYSIS Two of five review authors selected studies, extracted data and assessed study quality according to established criteria. We used standard methods expected by Cochrane. The primary outcomes were exercise capacity (six-minute walk distance, 6MWD), World Health Organization (WHO) or New York Heart Association (NYHA) functional class, Borg dyspnoea scores and dyspnoea-fatigue ratings, and mortality. MAIN RESULTS We included 17 randomised controlled trials involving a total of 3322 participants. Most trials were of relatively short duration (12 weeks to six months). Sixteen trials were placebo-controlled, and of these nine investigated a non-selective ERA and seven a selective ERA. We evaluated two comparisons in the review: ERA versus placebo and ERA versus phosphodiesterase type 5 (PDE5) inhibitor. The abstract focuses on the placebo-controlled trials only and presents the pooled results of selective and non-selective ERAs. After treatment, participants receiving ERAs could probably walk on average 25.06 m (95% confidence interval (CI) 17.13 to 32.99 m; 2739 participants; 14 studies; I2 = 34%, moderate-certainty evidence) further than those receiving placebo in a 6MWD. Endothelin receptor antagonists probably improved more participants' WHO functional class (odds ratio (OR) 1.41, 95% CI 1.16 to 1.70; participants = 3060; studies = 15; I2 = 5%, moderate-certainty evidence) and probably lowered the odds of functional class deterioration (OR 0.43, 95% CI 0.26 to 0.72; participants = 2347; studies = 13; I2 = 40%, moderate-certainty evidence) compared with placebo. There may be a reduction in mortality with ERAs (OR 0.78, 95% CI 0.58, 1.07; 2889 participants; 12 studies; I2 = 0%, low-certainty evidence), and pooled data suggest that ERAs probably improve cardiopulmonary haemodynamics and may reduce Borg dyspnoea score in symptomatic patients. Hepatic toxicity was not common, but may be increased by ERA treatment from 37 to 67 (95% CI 34 to 130) per 1000 over 25 weeks of treatment (OR 1.88, 95% CI 0.91 to 3.90; moderate-certainty evidence). Although ERAs were well tolerated in this population, several cases of irreversible liver failure caused by sitaxsentan have been reported, which led the licence holder for sitaxsentan to withdraw the product from all markets worldwide. As planned, we performed subgroup analyses comparing selective and non-selective ERAs, and with the exception of mean pulmonary artery pressure, did not detect any clear subgroup differences for any outcome. AUTHORS' CONCLUSIONS For people with pulmonary arterial hypertension with WHO functional class II and III, endothelin receptor antagonists probably increase exercise capacity, improve WHO functional class, prevent WHO functional class deterioration, result in favourable changes in cardiopulmonary haemodynamic variables compared with placebo. However, they are less effective in reducing dyspnoea and mortality. The efficacy data were strongest in those with idiopathic pulmonary hypertension. The irreversible liver failure caused by sitaxsentan and its withdrawal from global markets emphasise the importance of hepatic monitoring in people treated with ERAs. The question of the effects of ERAs on pulmonary arterial hypertension has now likely been answered.. The combined use of ERAs and phosphodiesterase inhibitors may provide more benefit in pulmonary arterial hypertension; however, this needs to be confirmed in future studies.
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Affiliation(s)
- Chao Liu
- Division of Cardiology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Junmin Chen
- Department of Haematology and Rheumatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yanqiu Gao
- The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Bao Deng
- The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Kunshen Liu
- The First Hospital of Hebei Medical University, Shijiazhuang, China
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Kurakula K, Smolders VFED, Tura-Ceide O, Jukema JW, Quax PHA, Goumans MJ. Endothelial Dysfunction in Pulmonary Hypertension: Cause or Consequence? Biomedicines 2021; 9:biomedicines9010057. [PMID: 33435311 PMCID: PMC7827874 DOI: 10.3390/biomedicines9010057] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/30/2020] [Accepted: 01/03/2021] [Indexed: 12/11/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a rare, complex, and progressive disease that is characterized by the abnormal remodeling of the pulmonary arteries that leads to right ventricular failure and death. Although our understanding of the causes for abnormal vascular remodeling in PAH is limited, accumulating evidence indicates that endothelial cell (EC) dysfunction is one of the first triggers initiating this process. EC dysfunction leads to the activation of several cellular signalling pathways in the endothelium, resulting in the uncontrolled proliferation of ECs, pulmonary artery smooth muscle cells, and fibroblasts, and eventually leads to vascular remodelling and the occlusion of the pulmonary blood vessels. Other factors that are related to EC dysfunction in PAH are an increase in endothelial to mesenchymal transition, inflammation, apoptosis, and thrombus formation. In this review, we outline the latest advances on the role of EC dysfunction in PAH and other forms of pulmonary hypertension. We also elaborate on the molecular signals that orchestrate EC dysfunction in PAH. Understanding the role and mechanisms of EC dysfunction will unravel the therapeutic potential of targeting this process in PAH.
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Affiliation(s)
- Kondababu Kurakula
- Department of Cell and Chemical Biology, Laboratory for CardioVascular Cell Biology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands;
| | - Valérie F. E. D. Smolders
- Department of Surgery, Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, 2300 RC Leiden, The Netherlands; (V.F.E.D.S.); (P.H.A.Q.)
| | - Olga Tura-Ceide
- Department of Pulmonary Medicine, Hospital Clínic-Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain;
- Department of Pulmonary Medicine, Dr. Josep Trueta University Hospital de Girona, Santa Caterina Hospital de Salt and the Girona Biomedical Research Institut (IDIBGI), 17190 Girona, Catalonia, Spain
- Biomedical Research Networking Centre on Respiratory Diseases (CIBERES), 28029 Madrid, Spain
| | - J. Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands;
| | - Paul H. A. Quax
- Department of Surgery, Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, 2300 RC Leiden, The Netherlands; (V.F.E.D.S.); (P.H.A.Q.)
| | - Marie-José Goumans
- Department of Cell and Chemical Biology, Laboratory for CardioVascular Cell Biology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands;
- Correspondence:
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3
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Aleevskaya AM, Vyborov ON, Gramovich VV, Martynyuk TV. [Problematic aspects of pulmonary hypertension due to left heart disease: focus on combined postcapillary and precapillary pulmonary hypertension]. TERAPEVT ARKH 2020; 92:54-62. [PMID: 33346432 DOI: 10.26442/00403660.2020.09.000450] [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: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 11/22/2022]
Abstract
Рulmonary hypertension (PH) is a common complication of left heart diseases. In addition to a passive increase of pressure in the venous bed of the pulmonary circulation, leading to an increase of mean pulmonary pressure, signs of precapillary PH could be detected in some patients. Since 2013, a hemodynamic subtype of PH due to left heart diseases combined post/precapillary PH has been identified, with a more unfavorable prognosis and high mortality.
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Affiliation(s)
| | - O N Vyborov
- National Medical Research Center for Cardiology
| | | | - T V Martynyuk
- National Medical Research Center for Cardiology.,Pirogov Russian National Research Medical University
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4
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The endothelin system as target for therapeutic interventions in cardiovascular and renal disease. Clin Chim Acta 2020; 506:92-106. [DOI: 10.1016/j.cca.2020.03.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/05/2020] [Accepted: 03/05/2020] [Indexed: 12/12/2022]
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5
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Papathanasiou M, Ruhparwar A, Kamler M, Rassaf T, Luedike P. Off-label use of pulmonary vasodilators after left ventricular assist device implantation: Calling in the evidence. Pharmacol Ther 2020; 214:107619. [PMID: 32599009 DOI: 10.1016/j.pharmthera.2020.107619] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/18/2020] [Indexed: 11/26/2022]
Abstract
Left ventricular assist devices (LVAD) are increasingly implanted in advanced heart failure patients to improve survival and quality of life either as a bridge to transplant, bridge to recovery or as destination therapy. LVAD therapy is often accompanied by a profound lowering of pulmonary artery pressure due to mechanical unloading of the left ventricle. Persistent pulmonary hypertension (PH) after LVAD implantation increases the risk of right ventricular failure (RVF). In this context pulmonary vasodilators have been implemented: a) as a strategy to reduce afterload and wean patients with RVF from inotropes in the early postoperative period, b) as long-term therapy aiming to optimize right heart hemodynamics and prevent late RVF and c) in order to lower persistently elevated pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) after LVAD and enable candidacy for heart transplantation. However, considerable uncertainty exists regarding the risks and benefits of these strategies and practices vary widely among institutions. This article provides an overview of the available evidence and existing recommendations regarding the use of pulmonary vasodilators in LVAD recipients.
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Affiliation(s)
- Maria Papathanasiou
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic- and Cardiovascular Surgery, West German Heart and Vascular Center, University Hospital Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Markus Kamler
- Department of Thoracic- and Cardiovascular Surgery, West German Heart and Vascular Center, University Hospital Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Hufelandstrasse 55, 45122 Essen, Germany.
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6
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Ozen G, Benyahia C, Amgoud Y, Patel J, Abdelazeem H, Bouhadoun A, Yung S, Li F, Mahieddine Y, Silverstein AM, Castier Y, Cazes A, Longrois D, Clapp LH, Norel X. Interaction between PGI2 and ET-1 pathways in vascular smooth muscle from Group-III pulmonary hypertension patients. Prostaglandins Other Lipid Mediat 2020; 146:106388. [DOI: 10.1016/j.prostaglandins.2019.106388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/08/2019] [Accepted: 10/24/2019] [Indexed: 12/16/2022]
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Sparrow CT, LaRue SJ, Schilling JD. Intersection of Pulmonary Hypertension and Right Ventricular Dysfunction in Patients on Left Ventricular Assist Device Support: Is There a Role for Pulmonary Vasodilators? Circ Heart Fail 2019; 11:e004255. [PMID: 29321132 DOI: 10.1161/circheartfailure.117.004255] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Left ventricular assist devices (LVADs) improve survival and quality of life in patients with advanced heart failure. Despite these benefits, combined post- and precapillary pulmonary hypertension can be particularly problematic in patients on LVAD support, often exacerbating right ventricular (RV) dysfunction. Both persistently elevated pulmonary vascular resistance and RV dysfunction are associated with adverse outcomes, including death after LVAD. These observations have led to significant interest in the use of pulmonary vasodilators to treat pulmonary hypertension and preserve RV function among LVAD-supported patients. Although pulmonary vasodilators are commonly used for the treatment of pulmonary hypertension and RV dysfunction in LVADs, the benefits of this practice remain unclear. The purpose of this review is to highlight the current challenges in managing pulmonary vascular disease and RV dysfunction in patients with heart failure on LVAD support.
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Affiliation(s)
- Christopher T Sparrow
- From the Division of Cardiology, Department of Medicine (C.T.S., S.J.L., J.D.S.) and Department of Pathology and Immunology (J.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Shane J LaRue
- From the Division of Cardiology, Department of Medicine (C.T.S., S.J.L., J.D.S.) and Department of Pathology and Immunology (J.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Joel D Schilling
- From the Division of Cardiology, Department of Medicine (C.T.S., S.J.L., J.D.S.) and Department of Pathology and Immunology (J.D.S.), Washington University School of Medicine, St. Louis, MO.
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Sumiyoshi M, Maeda T, Miyazaki E, Hotta N, Sato H, Hamaguchi E, Kanazawa H, Ohnishi Y, Kamei M. Accuracy of the ClearSight™ system in patients undergoing abdominal aortic aneurysm surgery. J Anesth 2019; 33:364-371. [DOI: 10.1007/s00540-019-02632-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/16/2019] [Indexed: 11/28/2022]
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9
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Çiftci O, Ünal EN, Dellaloğlu Z, Aydan A, Aksoy G, Karakaş M, Aydınalp A, Sezgin A, Müderrisoğlu İH, Haberal M. Relationship Between Preoperative Diastolic Transpulmonary Gradient With Pulmonary Vascular Resistance and 1-Year and Overall Mortality Rates Among Patients Undergoing Cardiac Transplant. EXP CLIN TRANSPLANT 2018; 17:231-235. [PMID: 30251939 DOI: 10.6002/ect.2018.0237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Cardiac transplant is a life-saving procedure for patients with end-stage heart failure. Preoperative pulmonary vascular resistance is indicative of intrinsic pulmonary vascular disease and correlates with posttransplant survival. However, its measurement is costly and time consuming. Therefore, simpler techniques are required. Diastolic transpulmonary gradient reportedly indicates intrinsic pulmonary vascular disease. Here, we investigated the relationship between preoperative diastolic transpulmonary gradient with preoperative pulmonary vascular resistance and 1-year and overall mortality among cardiac transplant patients. MATERIALS AND METHODS Fifty-one patients who underwent cardiac transplant between 2006 and 2017 were included. All patients underwent preoperative right and left heart catheterization and oxygen study. Among these, diastolic transpulmonary gradient, mean transpulmonary gradient, and pulmonary vascular resistance were correlated with one another and 1st-year and overall mortality rates. Patients were grouped according to whether they received diastolic transpulmonary gradient or not, and both groups were compared with respect to 1-year and overall mortality. Binary logistic regression analysis was done to test whether diastolic transpulmonary gradient was a significant predictor of 1-year and overall mortality. RESULTS Mean patient age was 45.5 ± 9.8 years. The 1-year and overall mortality rates were 21.6% (11/51) and 37.3% (19/51), respectively. Diastolic transpulmonary gradient was significantly correlated with pulmonary vascular resistance, 1-year mortality, and overall mortality (P < .05) and was a significant predictor of 1-year and overall mortality (odds ratio 6.0; 95% confidence interval, 1.4-25.3; P < .05 and odds ratio 4.8; 95% CI, 1.4-17.5; P < .05, respectively). Patients with a diastolic transpulmonary gradient of ≥ 7 mm Hg had significantly higher 1-year and overall mortality (P < .05). CONCLUSIONS Diastolic transpulmonary gradient can be used as a promising easy-to-use parameter of intrinsic pulmonary vascular disease and a predictor of 1-year and overall mortality among patients undergoing cardiac transplant.
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Affiliation(s)
- Orçun Çiftci
- From the Department of Cardiology, Başkent University Faculty of Medicine, Ankara, Turkey
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10
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Ramu B, Houston BA, Tedford RJ. Pulmonary Vascular Disease: Hemodynamic Assessment and Treatment Selection—Focus on Group II Pulmonary Hypertension. Curr Heart Fail Rep 2018; 15:81-93. [DOI: 10.1007/s11897-018-0377-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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11
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Koulova A, Gass AL, Patibandla S, Gupta CA, Aronow WS, Lanier GM. Management of pulmonary hypertension from left heart disease in candidates for orthotopic heart transplantation. J Thorac Dis 2017; 9:2640-2649. [PMID: 28932571 PMCID: PMC5594194 DOI: 10.21037/jtd.2017.07.24] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 06/27/2017] [Indexed: 12/24/2022]
Abstract
Pulmonary hypertension in left heart disease (PH-LHD) commonly complicates prolonged heart failure (HF). When advanced, the PH becomes fixed or out of proportion and is associated with increased morbidity and mortality in patients undergoing orthotopic heart transplant (OHT). To date, the only recommended treatment of out of proportion PH is the treatment of the underlying HF by reducing the pulmonary capillary wedge pressure (PCWP) with medications and often along with use of mechanical circulatory support. Medical therapies typically used in the treatment of World Health Organization (WHO) group 1 pulmonary arterial hypertension (PAH) have been employed off-label in the setting of PH-LHD with varying efficacy and often negative outcomes. We will discuss the current standard of care including treating HF and use of mechanical circulatory support. In addition, we will review the studies published to date assessing the efficacy and safety of PAH medications in patients with PH-LHD being considered for OHT.
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Affiliation(s)
- Anna Koulova
- Division of Cardiology, Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Alan L. Gass
- Division of Cardiology, Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | | | - Chhaya Aggarwal Gupta
- Division of Cardiology, Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Wilbert S. Aronow
- Division of Cardiology, Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Gregg M. Lanier
- Division of Cardiology, Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
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Xiong B, Nie D, Cao Y, Zou Y, Yao Y, Tan J, Qian J, Rong S, Wang C, Huang J. Clinical and Hemodynamic Effects of Endothelin Receptor Antagonists in Patients With Heart Failure. Int Heart J 2017; 58:400-408. [PMID: 28539568 DOI: 10.1536/ihj.16-307] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The clinical benefit of endothelin receptor antagonists (ERA) for the management of heart failure (HF) remains controversial. To examine this question, we performed a meta-analysis of randomized controlled trials (RCTs) to investigate the clinical and hemodynamic effects of ERA in HF patients.We searched the PubMed, Medline, Embase, and Cochrane Library from inception to March 20, 2016 to identify the pertinent studies. Risk ratio (RR) and weighted mean difference (WMD) were calculated using a fixed or random effect model.A total of 15 RCTs with 3,624 HF patients were included. Compared with control groups, ERA might not improve the mortality (RR 1.12, 95%CI 0.81 to 1.54, P = 0.51) or incidence of worsening HF or cardiovascular events (WHF/ CVE) (RR 1.06, 95%CI 0.94 to 1.19, P = 0.35) in HF patients. Subgroup analysis also suggested that neither nonselective nor selective ERAs had an impact on mortality and WHF/CVE. However, the hemodynamic variables of HF patients, including cardiac index (WMD 0.32, 95%CI 0.22 to 0.43, P < 0.01), pulmonary capillary wedge pressure (WMD -3.10, 95%CI -3.99 to -2.20, P < 0.01), mean pulmonary arterial pressure (WMD -4.42, 95%CI -5.50 to -3.33, P < 0.01), systemic vascular resistance (WMD -276.35, 95%CI -399.62 to -153.09, P < 0.01), and pulmonary vascular resistance (WMD -69.42, 95%CI -105.33 to -33.52, P < 0.01) were significantly improved by ERA.In conclusion, this meta-analysis suggests that ERA therapy could effectively improve cardiac output and pulmonary and systemic hemodynamics, but with less benefit to the clinical outcomes of HF patients.
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Affiliation(s)
- Bo Xiong
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University
| | - Dan Nie
- Department of Gastroenterology, The First Affiliated Hospital of Chengdu Medical College
| | - Yin Cao
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University
| | - Yanke Zou
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University
| | - Yuanqing Yao
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University
| | - Jie Tan
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University
| | - Jun Qian
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University
| | - Shunkang Rong
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University
| | - Chunbin Wang
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University
| | - Jing Huang
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University
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Sun YY, Zhang WJ, Dong CL, Zhang XF, Ji J, Wang X, Wang L, Hu WL, Du WJ, Cui CL, Zhang CF, Li F, Wang CZ, Yuan CS. Baicalin Alleviates Nitroglycerin-induced Migraine in Rats via the Trigeminovascular System. Phytother Res 2017; 31:899-905. [DOI: 10.1002/ptr.5811] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 03/07/2017] [Accepted: 03/16/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Yu-Yao Sun
- State Key Laboratory of Natural Medicines; China Pharmaceutical University; Nanjing JS 210009 China
| | - Wen-Jun Zhang
- State Key Laboratory of Natural Medicines; China Pharmaceutical University; Nanjing JS 210009 China
| | - Cui-Lan Dong
- The People's Hospital of Zhangqiu; Zhangqiu 250200 China
| | - Xiao-Fan Zhang
- State Key Laboratory of Natural Medicines; China Pharmaceutical University; Nanjing JS 210009 China
| | - Jun Ji
- State Key Laboratory of Natural Medicines; China Pharmaceutical University; Nanjing JS 210009 China
| | - Xue Wang
- State Key Laboratory of Natural Medicines; China Pharmaceutical University; Nanjing JS 210009 China
| | - Ling Wang
- State Key Laboratory of Natural Medicines; China Pharmaceutical University; Nanjing JS 210009 China
| | - Wan-Li Hu
- State Key Laboratory of Natural Medicines; China Pharmaceutical University; Nanjing JS 210009 China
| | - Wen-Juan Du
- State Key Laboratory of Natural Medicines; China Pharmaceutical University; Nanjing JS 210009 China
| | - Cheng-Long Cui
- State Key Laboratory of Natural Medicines; China Pharmaceutical University; Nanjing JS 210009 China
| | - Chun-Feng Zhang
- State Key Laboratory of Natural Medicines; China Pharmaceutical University; Nanjing JS 210009 China
- Tang Center of Herbal Medicine Research and Department of Anesthesia & Critical Care; The University of Chicago; Chicago IL 60637 USA
| | - Fei Li
- State Key Laboratory of Natural Medicines; China Pharmaceutical University; Nanjing JS 210009 China
| | - Chong-Zhi Wang
- Tang Center of Herbal Medicine Research and Department of Anesthesia & Critical Care; The University of Chicago; Chicago IL 60637 USA
| | - Chun-Su Yuan
- Tang Center of Herbal Medicine Research and Department of Anesthesia & Critical Care; The University of Chicago; Chicago IL 60637 USA
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Abstract
Pulmonary hypertension associated with left heart disease is the most common form of pulmonary hypertension. Although its pathophysiology remains incompletely understood, it is now well recognized that the presence of pulmonary hypertension is associated with a worse prognosis. Right ventricular failure has independent and additive prognostic value over pulmonary hypertension for adverse outcomes in left heart disease. Recently, several new terminologies have been introduced to better define and characterize the nature and severity of pulmonary hypertension. Several new treatment options including the use of pulmonary arterial hypertension specific therapies are being considered, but there is lack of evidence. Here, we review the recent advances in this field and summarize the diagnostic and therapeutic modalities of use in the management of pulmonary hypertension associated with left heart disease.
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Affiliation(s)
- Bhavadharini Ramu
- Cardiovascular Division, Section of Advanced Heart Failure and Pulmonary Hypertension, Lillehei Heart Institute, University of Minnesota, 420 Delaware Street SE, MMC 508, Minneapolis, MN, 55455, USA
| | - Thenappan Thenappan
- Cardiovascular Division, Section of Advanced Heart Failure and Pulmonary Hypertension, Lillehei Heart Institute, University of Minnesota, 420 Delaware Street SE, MMC 508, Minneapolis, MN, 55455, USA.
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Treatment of advanced group 2 PH. Prog Cardiovasc Dis 2016; 59:78-86. [PMID: 27417251 DOI: 10.1016/j.pcad.2016.07.002] [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: 07/07/2016] [Accepted: 07/07/2016] [Indexed: 11/22/2022]
Abstract
Pulmonary hypertension (PH) frequently occurs in patients with left heart disease (LHD), including heart failure with reduced and preserved ejection fraction and valvular heart disease. PH in patients with LHD is associated with worse outcomes making it an attractive target of therapy. Despite the strong rational for treatment, no clear benefits from treating with pulmonary arterial hypertension specific therapies in patients with PH from LHD have been found in clinical trials and some studies have demonstrated harm. Therefore, PH in the setting of LHD should be managed with optimal medical and surgical treatment of LHD and identification and treatment of comorbidities that could contribute to PH. Additionally, significant PH is a contraindication to heart transplantation and, in select patients with left heart failure, left ventricular unloading with prolonged inotrope infusion or left ventricular assist device implantation may successfully reduce pulmonary artery pressures and facilitate transplantation.
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Dayeh NR, Ledoux J, Dupuis J. Lung Capillary Stress Failure and Arteriolar Remodelling in Pulmonary Hypertension Associated with Left Heart Disease (Group 2 PH). Prog Cardiovasc Dis 2016; 59:11-21. [PMID: 27195752 DOI: 10.1016/j.pcad.2016.05.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 05/11/2016] [Indexed: 11/25/2022]
Abstract
Left heart diseases (LHD) represent the most prevalent cause of pulmonary hypertension (PH), yet there are still no approved therapies that selectively target the pulmonary circulation in LHD. The increase in pulmonary capillary pressure due to LHD is a triggering event leading to physical and biological alterations of the pulmonary circulation. Acutely, mechanosensitive endothelial dysfunction and increased capillary permeability combined with reduced fluid resorption lead to the development of interstitial and alveolar oedema. From repeated cycles of such capillary stress failure originate more profound changes with pulmonary endothelial dysfunction causing increased basal and reactive pulmonary vascular tone. This contributes to pulmonary vascular remodelling with increased arterial wall thickness, but most prominently, to alveolar wall remodelling characterized by myofibroblasts proliferation with collagen and interstitial matrix deposition. Although protective against acute pulmonary oedema, alveolar wall thickening becomes maladaptive and is responsible for the development of a restrictive lung syndrome and impaired gas exchanges contributing to shortness of breath and PH. Increasing awareness of these processes is unraveling novel pathophysiologic processes that could represent selective therapeutic targets. Thus, the roles of caveolins, of the intermediate myofilament nestin and of endothelial calcium dyshomeostasis were recently evaluated in pre-clinical models. The pathophysiology of PH due to LHD (group II PH) is distinctive from other groups of PH. Therefore, therapies targeting PH due to LHD must be evaluated in that context.
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Affiliation(s)
- Nour R Dayeh
- Research Center, Montreal Heart Institute, Montreal, QC, Canada; Département de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Jonathan Ledoux
- Research Center, Montreal Heart Institute, Montreal, QC, Canada; Département de Physiologie, Université de Montréal, Montréal, QC, Canada
| | - Jocelyn Dupuis
- Research Center, Montreal Heart Institute, Montreal, QC, Canada; Département de Médecine, Université de Montréal, Montréal, QC, Canada; Département de Physiologie, Université de Montréal, Montréal, QC, Canada.
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Davenport AP, Hyndman KA, Dhaun N, Southan C, Kohan DE, Pollock JS, Pollock DM, Webb DJ, Maguire JJ. Endothelin. Pharmacol Rev 2016; 68:357-418. [PMID: 26956245 PMCID: PMC4815360 DOI: 10.1124/pr.115.011833] [Citation(s) in RCA: 462] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The endothelins comprise three structurally similar 21-amino acid peptides. Endothelin-1 and -2 activate two G-protein coupled receptors, ETA and ETB, with equal affinity, whereas endothelin-3 has a lower affinity for the ETA subtype. Genes encoding the peptides are present only among vertebrates. The ligand-receptor signaling pathway is a vertebrate innovation and may reflect the evolution of endothelin-1 as the most potent vasoconstrictor in the human cardiovascular system with remarkably long lasting action. Highly selective peptide ETA and ETB antagonists and ETB agonists together with radiolabeled analogs have accurately delineated endothelin pharmacology in humans and animal models, although surprisingly no ETA agonist has been discovered. ET antagonists (bosentan, ambrisentan) have revolutionized the treatment of pulmonary arterial hypertension, with the next generation of antagonists exhibiting improved efficacy (macitentan). Clinical trials continue to explore new applications, particularly in renal failure and for reducing proteinuria in diabetic nephropathy. Translational studies suggest a potential benefit of ETB agonists in chemotherapy and neuroprotection. However, demonstrating clinical efficacy of combined inhibitors of the endothelin converting enzyme and neutral endopeptidase has proved elusive. Over 28 genetic modifications have been made to the ET system in mice through global or cell-specific knockouts, knock ins, or alterations in gene expression of endothelin ligands or their target receptors. These studies have identified key roles for the endothelin isoforms and new therapeutic targets in development, fluid-electrolyte homeostasis, and cardiovascular and neuronal function. For the future, novel pharmacological strategies are emerging via small molecule epigenetic modulators, biologicals such as ETB monoclonal antibodies and the potential of signaling pathway biased agonists and antagonists.
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Affiliation(s)
- Anthony P Davenport
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom (A.P.D., J.J.M.); IUPHAR/BPS Guide to PHARMACOLOGY, Centre for Integrative Physiology, University of Edinburgh, Hugh Robson Building, Edinburgh, United Kingdom (C.S.); Division of Nephrology, University of Utah Health Sciences Center, Salt Lake City, Utah (D.E.K.); Cardio-Renal Physiology & Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (K.A.H., J.S.P., D.M.P.); and Department of Renal Medicine, Royal Infirmary of Edinburgh (N.D.) and University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute (D.J.W.N.D.), Edinburgh, Scotland, United Kingdom
| | - Kelly A Hyndman
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom (A.P.D., J.J.M.); IUPHAR/BPS Guide to PHARMACOLOGY, Centre for Integrative Physiology, University of Edinburgh, Hugh Robson Building, Edinburgh, United Kingdom (C.S.); Division of Nephrology, University of Utah Health Sciences Center, Salt Lake City, Utah (D.E.K.); Cardio-Renal Physiology & Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (K.A.H., J.S.P., D.M.P.); and Department of Renal Medicine, Royal Infirmary of Edinburgh (N.D.) and University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute (D.J.W.N.D.), Edinburgh, Scotland, United Kingdom
| | - Neeraj Dhaun
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom (A.P.D., J.J.M.); IUPHAR/BPS Guide to PHARMACOLOGY, Centre for Integrative Physiology, University of Edinburgh, Hugh Robson Building, Edinburgh, United Kingdom (C.S.); Division of Nephrology, University of Utah Health Sciences Center, Salt Lake City, Utah (D.E.K.); Cardio-Renal Physiology & Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (K.A.H., J.S.P., D.M.P.); and Department of Renal Medicine, Royal Infirmary of Edinburgh (N.D.) and University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute (D.J.W.N.D.), Edinburgh, Scotland, United Kingdom
| | - Christopher Southan
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom (A.P.D., J.J.M.); IUPHAR/BPS Guide to PHARMACOLOGY, Centre for Integrative Physiology, University of Edinburgh, Hugh Robson Building, Edinburgh, United Kingdom (C.S.); Division of Nephrology, University of Utah Health Sciences Center, Salt Lake City, Utah (D.E.K.); Cardio-Renal Physiology & Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (K.A.H., J.S.P., D.M.P.); and Department of Renal Medicine, Royal Infirmary of Edinburgh (N.D.) and University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute (D.J.W.N.D.), Edinburgh, Scotland, United Kingdom
| | - Donald E Kohan
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom (A.P.D., J.J.M.); IUPHAR/BPS Guide to PHARMACOLOGY, Centre for Integrative Physiology, University of Edinburgh, Hugh Robson Building, Edinburgh, United Kingdom (C.S.); Division of Nephrology, University of Utah Health Sciences Center, Salt Lake City, Utah (D.E.K.); Cardio-Renal Physiology & Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (K.A.H., J.S.P., D.M.P.); and Department of Renal Medicine, Royal Infirmary of Edinburgh (N.D.) and University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute (D.J.W.N.D.), Edinburgh, Scotland, United Kingdom
| | - Jennifer S Pollock
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom (A.P.D., J.J.M.); IUPHAR/BPS Guide to PHARMACOLOGY, Centre for Integrative Physiology, University of Edinburgh, Hugh Robson Building, Edinburgh, United Kingdom (C.S.); Division of Nephrology, University of Utah Health Sciences Center, Salt Lake City, Utah (D.E.K.); Cardio-Renal Physiology & Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (K.A.H., J.S.P., D.M.P.); and Department of Renal Medicine, Royal Infirmary of Edinburgh (N.D.) and University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute (D.J.W.N.D.), Edinburgh, Scotland, United Kingdom
| | - David M Pollock
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom (A.P.D., J.J.M.); IUPHAR/BPS Guide to PHARMACOLOGY, Centre for Integrative Physiology, University of Edinburgh, Hugh Robson Building, Edinburgh, United Kingdom (C.S.); Division of Nephrology, University of Utah Health Sciences Center, Salt Lake City, Utah (D.E.K.); Cardio-Renal Physiology & Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (K.A.H., J.S.P., D.M.P.); and Department of Renal Medicine, Royal Infirmary of Edinburgh (N.D.) and University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute (D.J.W.N.D.), Edinburgh, Scotland, United Kingdom
| | - David J Webb
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom (A.P.D., J.J.M.); IUPHAR/BPS Guide to PHARMACOLOGY, Centre for Integrative Physiology, University of Edinburgh, Hugh Robson Building, Edinburgh, United Kingdom (C.S.); Division of Nephrology, University of Utah Health Sciences Center, Salt Lake City, Utah (D.E.K.); Cardio-Renal Physiology & Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (K.A.H., J.S.P., D.M.P.); and Department of Renal Medicine, Royal Infirmary of Edinburgh (N.D.) and University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute (D.J.W.N.D.), Edinburgh, Scotland, United Kingdom
| | - Janet J Maguire
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom (A.P.D., J.J.M.); IUPHAR/BPS Guide to PHARMACOLOGY, Centre for Integrative Physiology, University of Edinburgh, Hugh Robson Building, Edinburgh, United Kingdom (C.S.); Division of Nephrology, University of Utah Health Sciences Center, Salt Lake City, Utah (D.E.K.); Cardio-Renal Physiology & Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (K.A.H., J.S.P., D.M.P.); and Department of Renal Medicine, Royal Infirmary of Edinburgh (N.D.) and University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute (D.J.W.N.D.), Edinburgh, Scotland, United Kingdom
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18
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Selby VN, De Marco T. Current Treatment Strategies in Pulmonary Hypertension Associated with Left Heart Disease. CURRENT TRANSPLANTATION REPORTS 2015. [DOI: 10.1007/s40472-015-0075-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Inai K. Can pulmonary vasodilator therapy expand the operative indications for congenital heart disease? Int Heart J 2015; 56 Suppl:S12-6. [PMID: 25787792 DOI: 10.1536/ihj.14-396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The operability of congenital heart disease with left to right shunt depends on the severity of the pulmonary vascular disease induced by the increased pulmonary blood flow. Although some recommendations exist regarding operative indications according to pathological, hemodynamic, and epidemiological factors, the evidence underlying these recommendations is not conclusive. Recently, oral pulmonary vasodilator therapy has been reported to improve outcomes in patients with idiopathic pulmonary arterial hypertension, and this therapy also appears to be effective in patients with congenital heart disease and pulmonary arterial hypertension, including those with postoperative pulmonary hypertension and Eisenmenger syndrome. It is expected that the availability of novel pulmonary vasodilator therapy will expand the operative indications in patients with congenital heart disease with left to right shunt, but there is currently insufficient evidence to definitively determine this. A multicenter double-blind study should be conducted to further examine this issue.
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Affiliation(s)
- Kei Inai
- Department of Pediatric Cardiology, Heart Institute, Tokyo Women's Medical University
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20
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Thenappan T, Prins KW, Cogswell R, Shah SJ. Pulmonary Hypertension Secondary to Heart Failure With Preserved Ejection Fraction. Can J Cardiol 2015; 31:430-9. [DOI: 10.1016/j.cjca.2014.12.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 12/30/2014] [Accepted: 12/30/2014] [Indexed: 12/16/2022] Open
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21
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Jefferson AL, Beiser AS, Himali JJ, Seshadri S, O'Donnell CJ, Manning WJ, Wolf PA, Au R, Benjamin EJ. Low cardiac index is associated with incident dementia and Alzheimer disease: the Framingham Heart Study. Circulation 2015; 131:1333-9. [PMID: 25700178 DOI: 10.1161/circulationaha.114.012438] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 02/11/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cross-sectional epidemiological and clinical research suggests that lower cardiac index is associated with abnormal brain aging, including smaller brain volumes, increased white matter hyperintensities, and worse cognitive performances. Lower systemic blood flow may have implications for dementia among older adults. METHODS AND RESULTS A total of 1039 Framingham Offspring Cohort participants free of clinical stroke, transient ischemic attack, and dementia formed our sample (age, 69±6 years; 53% women). Multivariable-adjusted proportional hazard models adjusting for Framingham Stroke Risk Profile score (age, sex, systolic blood pressure, antihypertensive medication, diabetes mellitus, cigarette smoking, cardiovascular disease history, atrial fibrillation), education, and apolipoprotein E4 status related cardiac magnetic resonance imaging-assessed cardiac index (cardiac output divided by body surface area) to incident all-cause dementia and Alzheimer disease (AD). Over the median 7.7-year follow-up period, 32 participants developed dementia, including 26 cases of AD. Each 1-SD unit decrease in cardiac index increased the relative risk of both dementia (hazard ratio [HR]=1.66; 95% confidence interval [CI], 1.11-2.47; P=0.013) and AD (HR=1.65; 95% CI, 1.07-2.54; P=0.022). Compared with individuals with normal cardiac index, individuals with clinically low cardiac index had a higher relative risk of dementia (HR=2.07; 95% CI, 1.02-4.19; P=0.044). If participants with clinically prevalent cardiovascular disease and atrial fibrillation were excluded (n=184), individuals with clinically low cardiac index had a higher relative risk of both dementia (HR=2.92; 95% CI, 1.34-6.36; P=0.007) and AD (HR=2.87; 95% CI, 1.21-6.80; P=0.016) compared with individuals with normal cardiac index. CONCLUSION Lower cardiac index is associated with an increased risk for the development of dementia and AD.
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Affiliation(s)
- Angela L Jefferson
- From Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN (A.L.J.); Departments of Neurology (A.S.B., J.J.H., S.S., P.A.W., R.A.) and Medicine (E.J.B.), Boston University School of Medicine, Boston, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (A.S.B., J.J.H., S.S., C.J.O., P.A.W., R.A., E.J.B.); Departments of Epidemiology (E.J.B.) and Biostatistics (A.S.B.), Boston University School of Public Health, Boston, MA; and Departments of Medicine (Cardiovascular Division) (W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
| | - Alexa S Beiser
- From Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN (A.L.J.); Departments of Neurology (A.S.B., J.J.H., S.S., P.A.W., R.A.) and Medicine (E.J.B.), Boston University School of Medicine, Boston, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (A.S.B., J.J.H., S.S., C.J.O., P.A.W., R.A., E.J.B.); Departments of Epidemiology (E.J.B.) and Biostatistics (A.S.B.), Boston University School of Public Health, Boston, MA; and Departments of Medicine (Cardiovascular Division) (W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Jayandra J Himali
- From Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN (A.L.J.); Departments of Neurology (A.S.B., J.J.H., S.S., P.A.W., R.A.) and Medicine (E.J.B.), Boston University School of Medicine, Boston, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (A.S.B., J.J.H., S.S., C.J.O., P.A.W., R.A., E.J.B.); Departments of Epidemiology (E.J.B.) and Biostatistics (A.S.B.), Boston University School of Public Health, Boston, MA; and Departments of Medicine (Cardiovascular Division) (W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Sudha Seshadri
- From Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN (A.L.J.); Departments of Neurology (A.S.B., J.J.H., S.S., P.A.W., R.A.) and Medicine (E.J.B.), Boston University School of Medicine, Boston, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (A.S.B., J.J.H., S.S., C.J.O., P.A.W., R.A., E.J.B.); Departments of Epidemiology (E.J.B.) and Biostatistics (A.S.B.), Boston University School of Public Health, Boston, MA; and Departments of Medicine (Cardiovascular Division) (W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Christopher J O'Donnell
- From Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN (A.L.J.); Departments of Neurology (A.S.B., J.J.H., S.S., P.A.W., R.A.) and Medicine (E.J.B.), Boston University School of Medicine, Boston, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (A.S.B., J.J.H., S.S., C.J.O., P.A.W., R.A., E.J.B.); Departments of Epidemiology (E.J.B.) and Biostatistics (A.S.B.), Boston University School of Public Health, Boston, MA; and Departments of Medicine (Cardiovascular Division) (W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Warren J Manning
- From Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN (A.L.J.); Departments of Neurology (A.S.B., J.J.H., S.S., P.A.W., R.A.) and Medicine (E.J.B.), Boston University School of Medicine, Boston, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (A.S.B., J.J.H., S.S., C.J.O., P.A.W., R.A., E.J.B.); Departments of Epidemiology (E.J.B.) and Biostatistics (A.S.B.), Boston University School of Public Health, Boston, MA; and Departments of Medicine (Cardiovascular Division) (W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Philip A Wolf
- From Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN (A.L.J.); Departments of Neurology (A.S.B., J.J.H., S.S., P.A.W., R.A.) and Medicine (E.J.B.), Boston University School of Medicine, Boston, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (A.S.B., J.J.H., S.S., C.J.O., P.A.W., R.A., E.J.B.); Departments of Epidemiology (E.J.B.) and Biostatistics (A.S.B.), Boston University School of Public Health, Boston, MA; and Departments of Medicine (Cardiovascular Division) (W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Rhoda Au
- From Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN (A.L.J.); Departments of Neurology (A.S.B., J.J.H., S.S., P.A.W., R.A.) and Medicine (E.J.B.), Boston University School of Medicine, Boston, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (A.S.B., J.J.H., S.S., C.J.O., P.A.W., R.A., E.J.B.); Departments of Epidemiology (E.J.B.) and Biostatistics (A.S.B.), Boston University School of Public Health, Boston, MA; and Departments of Medicine (Cardiovascular Division) (W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Emelia J Benjamin
- From Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN (A.L.J.); Departments of Neurology (A.S.B., J.J.H., S.S., P.A.W., R.A.) and Medicine (E.J.B.), Boston University School of Medicine, Boston, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (A.S.B., J.J.H., S.S., C.J.O., P.A.W., R.A., E.J.B.); Departments of Epidemiology (E.J.B.) and Biostatistics (A.S.B.), Boston University School of Public Health, Boston, MA; and Departments of Medicine (Cardiovascular Division) (W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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22
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Epidemiology of Pulmonary Hypertension and Right Ventricular Failure in Left Heart Failure. Curr Heart Fail Rep 2014; 11:428-35. [DOI: 10.1007/s11897-014-0216-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Pulmonary hypertension (PH), a common complication of left heart diseases (LHD), negatively impacts symptoms, exercise capacity, and outcome. Although the true prevalence of PH-LHD is unknown, a subset of patients might present significant PH that cannot be explained by a passive increase in left-sided filling pressures. The term "out-of-proportion" PH has been used to identify that population without a clear definition, which has been found less than ideal and created confusion. We propose a change in terminology and a new definition of PH due to LHD. We suggest to abandon "out-of-proportion" PH and to distinguish "isolated post-capillary PH" from "post-capillary PH with a pre-capillary component" on the basis of the pressure difference between diastolic pulmonary artery pressure and pulmonary artery wedge pressure. Although there is no validated treatment for PH-LHD, we provide insights into management and discuss completed and randomized trials in this condition. Finally, we provide recommendations for future clinical trials to establish safety and efficacy of novel compounds to target this area of unmet medical need.
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Kalogeropoulos AP, Georgiopoulou VV, Borlaug BA, Gheorghiade M, Butler J. Left ventricular dysfunction with pulmonary hypertension: part 2: prognosis, noninvasive evaluation, treatment, and future research. Circ Heart Fail 2013; 6:584-93. [PMID: 23694772 PMCID: PMC3662027 DOI: 10.1161/circheartfailure.112.000096] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
| | | | | | - Mihai Gheorghiade
- Center for Cardiovascular Innovation, Northwestern University Feinberg, Chicago, IL
| | - Javed Butler
- Division of Cardiology, Emory University, Atlanta, GA
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Liu C, Chen J, Gao Y, Deng B, Liu K. Endothelin receptor antagonists for pulmonary arterial hypertension. Cochrane Database Syst Rev 2013; 2013:CD004434. [PMID: 23450552 PMCID: PMC6956416 DOI: 10.1002/14651858.cd004434.pub5] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Pulmonary arterial hypertension is a devastating disease, which leads to right heart failure and premature death. Recent evidence suggests that endothelin receptor antagonists may be promising drugs in the treatment of pulmonary arterial hypertension. OBJECTIVES To evaluate the efficacy of endothelin receptor antagonists in pulmonary arterial hypertension. SEARCH METHODS We searched CENTRAL (Cochrane Central Register of Controlled Trials), MEDLINE, EMBASE, and the reference section of retrieved articles. Searches are current as of January 2012. SELECTION CRITERIA We included randomised trials (RCTs) and quasi-randomised trials involving patients with pulmonary arterial hypertension. DATA COLLECTION AND ANALYSIS Five review authors independently selected studies, assessed study quality and extracted data. MAIN RESULTS We included 12 randomised controlled trials involving 1471 patients. All the trials were of relatively short duration (12 weeks to six months). After treatment, patients treated with endothelin receptor antagonists could walk on average 33.71 metres (95% confidence interval (CI) 24.90 to 42.52 metres) further than those treated with placebo in a six-minute walk test. Endothelin receptor antagonists improved more patients' World Health Organization/New York Heart Association (WHO/NYHA) functional class status than placebo (odds ratio (OR) 1.60; 95% CI 1.20 to 2.14), and reduced the odds of functional class deterioration compared with placebo (OR 0.26; 95% CI 0.16 to 0.42). There was a reduction in mortality that did not reach statistical significance on endothelin receptor antagonists (OR 0.57; 95% CI 0.26 to 1.24), and limited data suggest that endothelin receptor antagonists improve the Borg dyspnoea score and cardiopulmonary haemodynamics in symptomatic patients. Hepatic toxicity was not common, and endothelin receptor antagonists were well tolerated in this population. However, several cases of irreversible liver failure caused by sitaxsentan have been reported that led to license holder for sitaxsentan to withdraw the product from all markets worldwide. AUTHORS' CONCLUSIONS Endothelin receptor antagonists can increase exercise capacity, improve WHO/NYHA functional class, prevent WHO/NYHA functional class deterioration, reduce dyspnoea and improve cardiopulmonary haemodynamic variables in patients with pulmonary arterial hypertension with WHO/NYHA functional class II and III. However, there was only a trend towards endothelin receptor antagonists reducing mortality in patients with pulmonary arterial hypertension. Efficacy data are strongest in those with idiopathic pulmonary hypertension. The irreversible liver failure caused by sitaxsentan and its withdrawal from global markets emphasise the importance of hepatic monitoring in patients treated with endothelin receptor antagonists.
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Affiliation(s)
- Chao Liu
- The First Hospital of Hebei Medical University, Shijiazhuang, China. .
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Guazzi M, Vitelli A, Labate V, Arena R. Treatment for pulmonary hypertension of left heart disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2012; 14:319-27. [PMID: 22711417 DOI: 10.1007/s11936-012-0185-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OPINION STATEMENT Pulmonary hypertension (PH) secondary to left heart disease is a largely underestimated target of therapy. Except for a specific focus on PH consequences in patients with advanced heart failure (HF) receiving a left ventricular mechanical assist device or candidates for transplantation, prevention and treatment of initial subclinical forms of PH are not considered a priority in the management of this chronic disease population. Nonetheless, there is recent growing evidence supporting a clinical and prognostic role of PH in the elderly and in HF with preserved ejection fraction (pEF). Studies have defined PH-HFpEF as a new entity typically defining the evolving nature of disease. Although the prevalence of PH in these populations is not well-defined, the potential for effective pharmacological approaches that might impact the natural history of the disease starting from earlier stages is promising. However, it should be recognized that pharmacological studies performed to date with traditional pulmonary vasodilators in cohorts with HF and left-sided PH have not been positive, primarily because of concomitant systemic hypotension and hepatic side effects. This evidence along with the lack of studies specifically performed in the elderly and HFpEF often lead Guidelines to give neutral recommendations or even arbitrary assumptions. Recent availability of selective well-tolerated pulmonary vasodilators, such as phosphodiesterase type 5 (PDE5) inhibitors, however, seem to offer a solid background for treating left-sided PH at both early and later stages of the disease process.
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Affiliation(s)
- Marco Guazzi
- Cardiopulmonary Unit, University of Milano, I.R.C.C.S, Policlinico San Donato, Piazza Malan, 2, 20097, Milano, Italy,
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Fang JC, DeMarco T, Givertz MM, Borlaug BA, Lewis GD, Rame JE, Gomberg-Maitland M, Murali S, Frantz RP, McGlothlin D, Horn EM, Benza RL. World Health Organization Pulmonary Hypertension Group 2: Pulmonary hypertension due to left heart disease in the adult—a summary statement from the Pulmonary Hypertension Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2012; 31:913-33. [DOI: 10.1016/j.healun.2012.06.002] [Citation(s) in RCA: 179] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 06/10/2012] [Accepted: 06/11/2012] [Indexed: 01/08/2023] Open
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Kohan DE, Cleland JG, Rubin LJ, Theodorescu D, Barton M. Clinical trials with endothelin receptor antagonists: what went wrong and where can we improve? Life Sci 2012; 91:528-39. [PMID: 22967485 DOI: 10.1016/j.lfs.2012.07.034] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 07/20/2012] [Accepted: 07/24/2012] [Indexed: 02/07/2023]
Abstract
In the early 1990s, within three years of cloning of endothelin receptors, orally active endothelin receptor antagonists (ERAs) were tested in humans and the first clinical trial of ERA therapy in humans was published in 1995. ERAs were subsequently tested in clinical trials involving heart failure, pulmonary arterial hypertension, resistant arterial hypertension, stroke/subarachnoid hemorrhage and various forms of cancer. The results of most of these trials - except those for pulmonary arterial hypertension and scleroderma-related digital ulcers - were either negative or neutral. Problems with study design, patient selection, drug toxicity, and drug dosing have been used to explain or excuse failures. Currently, a number of pharmaceutical companies who had developed ERAs as drug candidates have discontinued clinical trials or further drug development. Given the problems with using ERAs in clinical medicine, at the Twelfth International Conference on Endothelin in Cambridge, UK, a panel discussion was held by clinicians actively involved in clinical development of ERA therapy in renal disease, systemic and pulmonary arterial hypertension, heart failure, and cancer. This article provides summaries from the panel discussion as well as personal perspectives of the panelists on how to proceed with further clinical testing of ERAs and guidance for researchers and decision makers in clinical drug development on where future research efforts might best be focused.
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Affiliation(s)
- Donald E Kohan
- Division of Nephrology, University of Utah Health Sciences Center, Salt Lake City, UT 84132, USA
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Corte TJ, McDonagh TA, Wort SJ. Pulmonary hypertension in left heart disease: A review. Int J Cardiol 2012; 156:253-8. [DOI: 10.1016/j.ijcard.2011.06.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 04/26/2011] [Accepted: 06/03/2011] [Indexed: 11/26/2022]
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Kalogeropoulos AP, Vega JD, Smith AL, Georgiopoulou VV. Pulmonary Hypertension and Right Ventricular Function in Advanced Heart Failure. ACTA ACUST UNITED AC 2011; 17:189-98. [DOI: 10.1111/j.1751-7133.2011.00234.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Shao D, Park JE, Wort SJ. The role of endothelin-1 in the pathogenesis of pulmonary arterial hypertension. Pharmacol Res 2011; 63:504-11. [DOI: 10.1016/j.phrs.2011.03.003] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 03/09/2011] [Indexed: 02/06/2023]
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Palmer J, Love S. Endothelin receptor antagonists: potential in Alzheimer's disease. Pharmacol Res 2010; 63:525-31. [PMID: 21193044 DOI: 10.1016/j.phrs.2010.12.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 12/17/2010] [Accepted: 12/17/2010] [Indexed: 12/20/2022]
Abstract
Alzheimer's disease (AD) is believed to be initiated by the accumulation of neurotoxic forms of Aβ peptide within the brain. AD patients show reduction of cerebral blood flow (CBF), the extent of the reduction correlating with the impairment of cognition. There is evidence that cerebral hypoperfusion precedes and may even trigger the onset of dementia in AD. Cerebral hypoperfusion impairs neuronal function, reduces the clearance of Aβ peptide and other toxic metabolites from the brain, and upregulates Aβ production. Studies in animal models of AD have shown the reduction in CBF to be more than would be expected for the reduction in neuronal metabolic activity. Aβ may contribute to the reduction in CBF in AD, as both Aβ₁₋₄₀ and Aβ₁₋₄₂ induce cerebrovascular dysfunction. Aβ₁₋₄₀ acts directly on cerebral arteries to cause cerebral smooth muscle cell contraction. Aβ₁₋₄₂ causes increased neuronal production and release of endothelin-1 (ET-1), a potent vasoconstrictor, and upregulation of endothelin-converting enzyme-2 (ECE-2), the enzyme which cleaves ET-1 from its inactive precursor. ET-1 and ECE-2 are also elevated in AD, making it likely that upregulation of the ECE-2-ET-1 axis by Aβ₁₋₄₂ contributes to the chronic reduction of CBF in AD. At present, only a few symptomatic treatment options exist for AD. The involvement of ET-1 in the pathogenesis of endothelial dysfunction associated with elevated Aβ indicates the potential for endothelin receptor antagonists in the treatment of AD. It has already been demonstrated that the endothelin receptor antagonist bosentan, preserves aortic and carotid endothelial function in Tg2576 mice, and our findings suggest that endothelin receptor antagonists may be beneficial in maintaining CBF in AD.
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Affiliation(s)
- Jennifer Palmer
- Dementia Research Group, Institute of Clinical Neurosciences, School of Clinical Sciences, University of Bristol, Frenchay Hospital, Bristol BS16 1LE, United Kingdom.
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Abstract
Pulmonary hypertension (PH) with left-sided heart disease is defined, according to the latest Venice classification, as a Group 2 PH, which includes left-sided ventricular or atrial disease, and left-sided valvular diseases. These conditions are all associated with increased left ventricular filling pressure. Although PH with left-sided heart disease is a common entity, and long-term follow-up trials have provided firm recognition that development of left-sided PH carries a poor outcome, available data on incidence, pathophysiology, and therapy are sparse. Mitral stenosis was reported as the most frequent cause of PH several decades ago, but PH with left-sided heart disease is now usually caused by systemic hypertension and ischemic heart disease. In patients with these conditions, PH develops as a consequence of impaired left ventricular relaxation and distensibility. Chronic sustained elevation of cardiogenic blood pressure in pulmonary capillaries leads to a cascade of untoward retrograde anatomical and functional effects that represent specific targets for therapeutic intervention. The pathophysiological and clinical importance of the hemodynamic consequences of left-sided heart disease, starting with lung capillary injury and leading to right ventricular overload and failure, are discussed in this Review, focusing on PH as an evolving contributor to heart failure that may be amenable to novel interventions.
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Affiliation(s)
- Marco Guazzi
- Cardiopulmonary Unit, University of Milan, San Paolo Hospital, Via A. di Rudinì 8, 20142 Milan, Italy.
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Jefferson AL, Himali JJ, Beiser AS, Au R, Massaro JM, Seshadri S, Gona P, Salton CJ, DeCarli C, O'Donnell CJ, Benjamin EJ, Wolf PA, Manning WJ. Cardiac index is associated with brain aging: the Framingham Heart Study. Circulation 2010; 122:690-7. [PMID: 20679552 DOI: 10.1161/circulationaha.109.905091] [Citation(s) in RCA: 179] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiac dysfunction is associated with neuroanatomic and neuropsychological changes in aging adults with prevalent cardiovascular disease, theoretically because systemic hypoperfusion disrupts cerebral perfusion, contributing to subclinical brain injury. We hypothesized that cardiac function, as measured by cardiac index, would be associated with preclinical brain magnetic resonance imaging (MRI) and neuropsychological markers of ischemia and Alzheimer disease in the community. METHODS AND RESULTS Brain MRI, cardiac MRI, neuropsychological, and laboratory data were collected on 1504 Framingham Offspring Cohort participants free of clinical stroke, transient ischemic attack, or dementia (age, 61+/-9 years; 54% women). Neuropsychological and brain MRI variables were related to cardiac MRI-assessed cardiac index (cardiac output/body surface area). In multivariable-adjusted models, cardiac index was positively related to total brain volume (P=0.03) and information processing speed (P=0.02) and inversely related to lateral ventricular volume (P=0.048). When participants with clinically prevalent cardiovascular disease were excluded, the relation between cardiac index and total brain volume remained (P=0.02). Post hoc comparisons revealed that participants in the bottom cardiac index tertile (values <2.54) and middle cardiac index tertile (values between 2.54 and 2.92) had significantly lower brain volumes (P=0.04) than participants in the top cardiac index tertile (values >2.92). CONCLUSIONS Although observational data cannot establish causality, our findings are consistent with the hypothesis that decreasing cardiac function, even at normal cardiac index levels, is associated with accelerated brain aging.
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Affiliation(s)
- Angela L Jefferson
- Department of Neurology, Alzheimer's Disease Center, Boston University School of Medicine, 72 E Concord St, B-7800, Boston, MA 02118, USA.
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Girgis RE, Dixon RA. Sitaxsentan for the treatment of pulmonary arterial hypertension. Future Cardiol 2010; 3:377-85. [PMID: 19804228 DOI: 10.2217/14796678.3.4.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a life-threatening, progressive condition that eventually leads to right heart failure. Endothelin receptor antagonists (ETRAs) have been shown to be a safe and efficacious treatment for PAH. Sitaxsentan is a highly selective oral ETRA that, in clinical trials, has demonstrated significant improvements in exercise capacity, functional class and pulmonary hemodynamics in PAH. Sitaxsentan has been shown to be a well tolerated and effective agent with a durable response for the treatment of PAH, and is associated with a low incidence of liver toxicity.
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Affiliation(s)
- Reda E Girgis
- Johns Hopkins University, Division of Pulmonary & Critical Care Medicine, School of Medicine, 1830 E Monument St Fl 5, Baltimore, MD 21205-2100, USA.
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Aubert JD, Juillerat-Jeanneret L. Therapeutic potential of endothelin receptor modulators: lessons from human clinical trials. Expert Opin Ther Targets 2009; 13:1069-84. [PMID: 19659448 DOI: 10.1517/14728220903074570] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The endothelin system, and in particular endothelin receptors, are targets for therapeutic intervention in human diseases. Endothelin receptor antagonists have reached clinical use for treating pulmonary arterial hypertension, and are under clinical investigation for several other diseases, such as cancer, vasospasm or fibrogenic diseases. We review the molecules that have been evaluated in the main clinical trials, from the point of view of receptor selectivity and of their chemical characteristics which were important for efficacy in pulmonary hypertension. We will also discuss future use of antagonists to endothelin receptor(s) in several human diseases and what should be the necessary properties of the future molecules for efficacy in diseases where the presently tested molecules displayed suboptimal efficacy.
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Affiliation(s)
- John-David Aubert
- University Institute of Pathology, University of Lausanne (UNIL), Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
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Epstein BJ, Anderson S. Endothelin receptor antagonists as antihypertensives: the next frontier. Expert Rev Cardiovasc Ther 2009; 7:675-87. [PMID: 19505283 DOI: 10.1586/erc.09.24] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The endothelin system is a pivotal player along the continuum of cardiovascular disease. There is convincing evidence that the system not only exerts a potent pressor effect but also promotes end-organ damage independent from blood pressure changes. The role of endothelin receptor antagonists (ERAs) in the treatment of hypertension is rapidly evolving. Recent studies demonstrate a formidable antihypertensive effect. Utility of ERAs is likely to be greatest in patients with resistant hypertension. Beyond blood pressure lowering, ERAs exert several properties that may confer additional protection, including effects on endothelial function, atherosclerosis, arterial stiffening, renal function and proteinuria. The full potential of this class will only be realized when the results of ongoing and future studies in hypertension, heart failure and other forms of cardiovascular disease are completed.
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Affiliation(s)
- Benjamin J Epstein
- Department of Pharmacotherapy and Translational Research, 101 S. Newell Drive, HPNP Building. 212, Room 3315, University of Florida, Gainesville, FL 32610-0486, USA.
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Abstract
BACKGROUND Pulmonary arterial hypertension is a devastating disease, which leads to right heart failure and premature death. Recent evidence suggests that endothelin receptor antagonists may be promising drugs in the treatment of pulmonary arterial hypertension. OBJECTIVES To evaluate the efficacy of endothelin receptor antagonists in pulmonary arterial hypertension. SEARCH STRATEGY We searched CENTRAL (Cochrane Central Register of Controlled Trials), MEDLINE, EMBASE, and the reference section of retrieved articles. Searches are current as of Februray 2008. SELECTION CRITERIA Randomised controlled trials (RCTs) or quasi-randomised controlled trials involving patients with pulmonary arterial hypertension. DATA COLLECTION AND ANALYSIS Five review authors independently selected studies, assessed study quality and extracted data. MAIN RESULTS Five new studies have been added to this updated review, which now includes 11 randomised controlled trials involving 1457 patients. All the trials were of relatively short duration (12 weeks to 6 months). After treatment, patients treated with endothelin receptor antagonists could walk on average 33.7 metres (95% confidence interval [CI] 24.9 to 42.5 metres) further than those treated with placebo in a 6 minute walk test. Endothelin receptor antagonists improved more patients' World Health Organization/New York Heart Association (WHO/NYHA) functional class status than placebo (odds ratio [OR] 1.6; 95% confidence interval [CI] 1.2 to 2.1), and reduced the odds of functional class deterioration compared to placebo (OR 0.26; 95% CI 0.16 to 0.42 ). There was a trend for endothelin receptor antagonists to reduce mortality (OR 0.48; 95% CI 0.21 to 1.09), and limited data suggest that endothelin receptor antagonists improve Borg dyspnoea score and cardiopulmonary haemodynamics in symptomatic patients. Hepatic toxicity was not common, and endothelin receptor antagonists were well tolerated in this population. AUTHORS' CONCLUSIONS Endothelin receptor antagonists can increase exercise capacity, improve WHO/NYHA functional class, prevent WHO/NYHA functional class deterioration, reduce dyspnoea and improve cardiopulmonary haemodynamic variables in patients with pulmonary arterial hypertension with WHO/NYHA functional class II and III. However, there was only a trend towards endothelin receptor antagonists reducing mortality in patients with pulmonary arterial hypertension. Efficacy data are strongest in those with idiopathic pulmonary hypertension.
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Affiliation(s)
- Chao Liu
- The First Hospital of Hebei Medical University, Donggang Road, Shijiazhuang, Hebei Province, China, 050031
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Davie NJ, Schermuly RT, Weissmann N, Grimminger F, Ghofrani HA. The science of endothelin-1 and endothelin receptor antagonists in the management of pulmonary arterial hypertension: current understanding and future studies. Eur J Clin Invest 2009; 39 Suppl 2:38-49. [PMID: 19335746 DOI: 10.1111/j.1365-2362.2009.02120.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Pathological vascular remodelling is a key contributor to the symptomatology of pulmonary arterial hypertension (PAH), and reversing this process may offer the best hope for improving this debilitating condition. The vascular remodelling process is believed to be due to endothelial cell dysfunction and to involve altered production of endothelial cell-derived vasoactive mediators. The observation that circulating plasma levels of the vasoactive peptide endothelin (ET)-1 are raised in patients with PAH, and that ET-1 production is increased in the pulmonary tissue of affected individuals, makes it a particularly interesting target for a therapeutic intervention in PAH. Clinical trials with ET receptor antagonists (ETRAs) show that they provide symptomatic benefit in patients with PAH, thereby proving the clinical relevance of the ET system as a therapeutic target. In this paper, we review the role of ET-1 together with the available data on the roles of the specific ET receptors and ETRAs in PAH. In particular, we discuss the possible role of ET receptor selectivity in the vascular remodelling process in PAH and whether selective ET(A) or nonselective ET(A)/ET(B) blockade offers the greatest potential to improve symptoms and alter the clinical course of the disease.
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Shah RV, Semigran MJ. Pulmonary hypertension secondary to left ventricular systolic dysfunction: contemporary diagnosis and management. Curr Heart Fail Rep 2009; 5:226-32. [PMID: 19032918 DOI: 10.1007/s11897-008-0034-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Pulmonary hypertension secondary to left ventricular systolic dysfunction is often a poor prognostic marker in chronic heart failure. In this article, we review evidence supporting modern strategies addressing pulmonary hypertension in patients with left ventricular systolic dysfunction, including right-sided heart catheterization with vasoreactivity testing and subsequent parenteral, oral, and inhaled therapy. We delineate a diagnostic approach to secondary pulmonary hypertension and outline evidence-based therapeutic strategies for management in acute and chronic heart failure.
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Affiliation(s)
- Ravi V Shah
- Department of Medicine, Massachusetts General Hospital, Grey Bigelow 8, 55 Fruit Street, Boston, MA 02114, USA
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Vizza CD, Letizia C, Petramala L, Badagliacca R, Poscia R, Zepponi E, Crescenzi E, Nona A, Benedetti G, Ferrante F, Sciomer S, Fedele F. Venous endotelin-1 (ET-1) and brain natriuretic peptide (BNP) plasma levels during 6-month bosentan treatment for pulmonary arterial hypertension. ACTA ACUST UNITED AC 2008; 151:48-53. [DOI: 10.1016/j.regpep.2008.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Revised: 07/24/2008] [Accepted: 08/05/2008] [Indexed: 10/21/2022]
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Opitz CF, Ewert R, Kirch W, Pittrow D. Inhibition of endothelin receptors in the treatment of pulmonary arterial hypertension: does selectivity matter? Eur Heart J 2008; 29:1936-48. [PMID: 18562303 PMCID: PMC2515885 DOI: 10.1093/eurheartj/ehn234] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Treatment options for pulmonary arterial hypertension (PAH) have considerably improved in the past few years. Endothelin (ET)-receptor antagonism has been established as a first-line option for the majority of PAH patients. Endothelin-receptor antagonists (ETRAs) comprise sulfonamide and non-sulfonamide agents with different affinities for ET-receptor subtypes (ETA and ETB), and the focus of development has shifted from drugs with less selectivity to those with high selectivity. There is ongoing debate as to whether selective or non-selective ET-receptor antagonism is more beneficial in the treatment of PAH. This paper reviews the current evidence from experimental and clinical studies obtained from a thorough literature search focusing on the three marketed drugs bosentan, sitaxentan, and ambrisentan. A clinically meaningful difference among the three approved ETRAs with respect to their ET-receptor selectivity could not be demonstrated to date. Therefore, in clinical practice, other features are likely to be of greater relevance when considering treatment, such as the potential for serious drug–drug interactions, convenience of dosing schedule, or rates of limiting side effects. These characteristics bear more relation to the chemical or pharmacological properties of the drugs than to receptor selectivity itself.
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Affiliation(s)
- Christian F Opitz
- Department of Internal Medicine, DRK-Kliniken Berlin, Köpenick, Berlin, Germany.
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Epstein BJ. Efficacy and safety of darusentan: a novel endothelin receptor antagonist. Ann Pharmacother 2008; 42:1060-9. [PMID: 18523233 DOI: 10.1345/aph.1l024] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To summarize the role of the endothelin system (ETS) in cardiovascular disease (CVD) and evaluate the potential usefulness of darusentan, a selective endothelin type A (ET(A)) receptor antagonist, in the treatment of hypertension and chronic heart failure (CHF). DATA SOURCES A literature search was conducted in MEDLINE (1966-February 2008), International Pharmaceutical Abstracts (1970-February 2008), and EMBASE (1990-February 2008) using the search terms endothelin, darusentan, LU 135252, hypertension, and heart failure. STUDY SELECTION AND DATA EXTRACTION Studies evaluating the role of the ETS in CVD and the pharmacology, pharmacokinetics, safety, and efficacy of darusentan for the treatment of hypertension and CHF were included. DATA SYNTHESIS Darusentan represents a novel treatment strategy for patients with resistant hypertension. Its safety and efficacy have been evaluated in the treatment of hypertension and CHF. Darusentan selectively blocks the ET(A) receptor, promoting vasodilatation and preventing several proliferative and inflammatory processes, while promoting the actions of the ET(B) receptor. Studies in patients with stage 2 or resistant hypertension concluded that darusentan safely and effectively lowers blood pressure. Darusentan's unique mechanism of action, dose-dependent blood pressure-lowering profile, once-daily dosing regimen, and sustained 24-hour blood pressure-lowering effect are valuable features. Darusentan is well tolerated, with only peripheral edema, headache, and nasal symptoms being reported more frequently than with placebo. Endothelin receptor antagonists, including darusentan, have been associated with a decrease in hemoglobin and hematocrit and are teratogens. Darusentan does not appear to cause hepatotoxicity. Additional studies in CHF are warranted to assess the safety and efficacy of darusentan, especially given its association with peripheral edema and decreased red blood cell count. CONCLUSIONS Given the important role of the ETS in hypertension and available data with darusentan, selective antagonism of the ET(A) receptor represents a promising approach to managing resistant hypertension. Darusentan's role will be more clearly elucidated by ongoing Phase 3 studies.
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Affiliation(s)
- Benjamin J Epstein
- Department of Pharmacy Practice, Division of Internal Medicine, University of Florida, Gainesville, FL 32610, USA.
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46
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Control of pulmonary vascular tone during exercise in health and pulmonary hypertension. Pharmacol Ther 2008; 119:242-63. [PMID: 18586325 DOI: 10.1016/j.pharmthera.2008.04.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Accepted: 04/29/2008] [Indexed: 11/24/2022]
Abstract
Despite the importance of the pulmonary circulation as a determinant of exercise capacity in health and disease, studies into the regulation of pulmonary vascular tone in the healthy lung during exercise are scarce. This review describes the current knowledge of the role of various endogenous vasoactive mechanisms in the control of pulmonary vascular tone at rest and during exercise. Recent studies demonstrate an important role for endothelial factors (NO and endothelin) and neurohumoral factors (noradrenaline, acetylcholine). Moreover, there is evidence that natriuretic peptides, reactive oxygen species and phosphodiesterase activity can influence resting pulmonary vascular tone, but their role in the control of pulmonary vascular tone during exercise remains to be determined. K-channels are purported end-effectors in control of pulmonary vascular tone. However, K(ATP) channels do not contribute to regulation of pulmonary vascular tone, while the role of K(V) and K(Ca) channels at rest and during exercise remains to be determined. Pulmonary hypertension is associated with alterations in pulmonary vascular function and structure, resulting in blunted pulmonary vasodilatation during exercise and impaired exercise capacity. Although there is a paucity of studies pertaining to the regulation of pulmonary vascular tone during exercise in idiopathic pulmonary hypertension, the few studies that have been performed in models of pulmonary hypertension secondary to left ventricular dysfunction suggest altered control of pulmonary vascular tone during exercise. Since the increased pulmonary vascular tone during exercise limits exercise capacity, future studies are needed to investigate the vasomotor mechanisms that are responsible for the blunted exercise-induced pulmonary vasodilatation in pulmonary hypertension.
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Galenko-Yaroshevskii AP, Dukhanin AS, Takhchidi KP, Malyugin BE. Molecular mechanisms of vasoconstrictor action of imidazo[1,2-alpha]benzimidazole derivative RU-1117 possessing local anesthetic properties. Bull Exp Biol Med 2008; 143:595-7. [PMID: 18239777 DOI: 10.1007/s10517-007-0190-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We studied the mechanisms of action of imidazobenzimidazole derivative RU-1117 on calcium homeostasis in myocytes isolated from rat thoracic aorta. In therapeutic concentrations, RU-1117 increased the content of free calcium ions due to their mobilization from intracellular depot via the IP3-dependent mechanisms. Antagonists of angiotensin II AT1-receptors irbesartan and, to greater extent, eprosartan abolished the calcium-mobilizing action of RU-1117. Selective antagonist of endothelin ETA-receptors sitaxsentan and alpha1-adrenoceptor agonist prazosin produced no effect on calcium mobilization caused by novel local anesthetic RU-1117.
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Affiliation(s)
- A P Galenko-Yaroshevskii
- Krasnodar Research Center, Russian Academy of Medical Sciences and Administration of Krasnodar Krai, Moscow, Russia
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Padilla DJ, Epp TS, McDonough P, Marlin DJ, Erickson HH, Poole DC. Effects of a specific endothelin-1A antagonist on exercise-induced pulmonary haemorrhage (EIPH) in thoroughbred horses. Equine Vet J 2007:198-203. [PMID: 17402418 DOI: 10.1111/j.2042-3306.2006.tb05539.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
REASONS FOR PERFORMING STUDY During high intensity exercise, the very high pulmonary artery pressure (Ppa) experienced by Thoroughbred horses is considered a major factor in the aetiology of exercise-induced pulmonary haemorrhage (EIPH). Recently, endothelin-1 (ET-1), a potent vasoconstrictive hormone, has been found to increase Ppa in horses at rest via binding to its ET-1A receptor subtype. In addition, plasma concentrations of ET-1 are increased in horses during and after high intensity exercise. HYPOTHESIS If ET-1 increases Ppa during exercise in the horse, administration of a specific ET-1A antagonist would decrease Ppa and therefore EIPH. METHODS Saline (CON) or an ET-1A receptor antagonist, TBC3214 (3 mg/kg bwt i.v.; ANTAG) was administered to horses 1 h prior to maximal incremental exercise on a high-speed treadmill. Gas exchange measurements were made breath-by-breath and blood samples collected during each 1 min stage to determine blood gases, acid-base status and cardiac output. EIPH was determined via bronchoalveolar lavage (BAL) approximately 30 min after exercise. RESULTS The time to fatigue, gas exchange and cardiovascular responses were not different between groups (P>0.05). Resting and peak Ppa did not differ significantly between treatments. Most importantly, ANTAG did not decrease EIPH. CONCLUSIONS These results do not support a deterministic role for ET-1 in the increased Ppa and therefore EIPH, during maximal exercise in the equine athlete. POTENTIAL RELEVANCE Treatment with an ET-1A receptor antagonist does not appear to be a viable therapeutic intervention in the prevention of EIPH.
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Affiliation(s)
- D J Padilla
- Department of Anatomy and Physiology, Kansas State University, Manhattan, Kansas 66506, USA
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Benedict NJ. Sitaxsentan in the management of pulmonary arterial hypertension. Am J Health Syst Pharm 2007; 64:363-8. [PMID: 17299175 DOI: 10.2146/ajhp060357] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE The pharmacology, pharmacokinetics, clinical trials, adverse effects, drug interactions, and dosing and administration of the endothelin receptor antagonist, sitaxsentan, and its role in the treatment of pulmonary arterial hypertension (PAH) are reviewed. SUMMARY PAH is a serious and potentially devastating chronic disorder of the pulmonary circulation. Bosentan is the first and only approved endothelin receptor antagonist for the treatment of PAH. Endothelin-1, a potent endogenous vasoconstrictor and smooth-muscle mitogen, has been shown to be overexpressed in the plasma and lung tissue of patients with PAH; the reduction or blockade of entothelin-1 may aid in disease symptomatology and progression. Activation of ET(A) leads to vasoconstriction and vascular smooth-muscle-cell proliferation. Sitaxsentan is an orally active, organic nonpeptide that binds competitively to the ET(A) receptor. Sitaxsentan, unlike bosentan, has a high affinity for the ET(A) receptor. In one trial, sitaxsentan was compared with placebo, and the results suggested that sitaxsentan was more effective than placebo. A 12-week, open-label trial demonstrated the safety and efficacy of sitaxsentan in 20 patients. The Sitaxsentan to Relieve Impaired Exercise (STRIDE-1) trial randomized patients to receive placebo, sitaxsentan 100 mg orally once daily, or sitaxsentan 300 mg orally once daily. Significant improvements in exercise capacity and cardiopulmonary hemodynamics were demonstrated. The results of STRIDE-2, the second randomized sitaxsentan trial, demonstrated the efficacy and safety of 100 mg sitaxsentan and the unacceptable safety profile of 300 mg sitaxsentan. CONCLUSION Sitaxsentan is an orally administered endothelin receptor blocker that offers the effective and safe treatment of patients with mild to moderate PAH.
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Affiliation(s)
- Neal J Benedict
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, PA 15213, USA.
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Kelland NF, Webb DJ. Clinical trials of endothelin antagonists in heart failure: publication is good for the public health. Heart 2007; 93:2-4. [PMID: 17170334 PMCID: PMC1861328 DOI: 10.1136/hrt.2006.089250] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The failure of endothelin antagonists to show benefit in heart failure cannot be understood until all the clinical trials are fully published.
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