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Zhao M, Song L, Zhu J, Zhou T, Zhang Y, Chen SC, Li H, Cao D, Jiang YQ, Ho W, Cai J, Ge R. Non-contrasted computed tomography (NCCT) based chronic thromboembolic pulmonary hypertension (CTEPH) automatic diagnosis using cascaded network with multiple instance learning. Phys Med Biol 2024; 69:185011. [PMID: 39191289 DOI: 10.1088/1361-6560/ad7455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 08/27/2024] [Indexed: 08/29/2024]
Abstract
Objective.The diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) is challenging due to nonspecific early symptoms, complex diagnostic processes, and small lesion sizes. This study aims to develop an automatic diagnosis method for CTEPH using non-contrasted computed tomography (NCCT) scans, enabling automated diagnosis without precise lesion annotation.Approach.A novel cascade network (CN) with multiple instance learning (CNMIL) framework was developed to improve the diagnosis of CTEPH. This method uses a CN architecture combining two Resnet-18 CNN networks to progressively distinguish between normal and CTEPH cases. Multiple instance learning (MIL) is employed to treat each 3D CT case as a 'bag' of image slices, using attention scoring to identify the most important slices. An attention module helps the model focus on diagnostically relevant regions within each slice. The dataset comprised NCCT scans from 300 subjects, including 117 males and 183 females, with an average age of 52.5 ± 20.9 years, consisting of 132 normal cases and 168 cases of lung diseases, including 88 cases of CTEPH. The CNMIL framework was evaluated using sensitivity, specificity, and the area under the curve (AUC) metrics, and compared with common 3D supervised classification networks and existing CTEPH automatic diagnosis networks.Main results. The CNMIL framework demonstrated high diagnostic performance, achieving an AUC of 0.807, accuracy of 0.833, sensitivity of 0.795, and specificity of 0.849 in distinguishing CTEPH cases. Ablation studies revealed that integrating MIL and the CN significantly enhanced performance, with the model achieving an AUC of 0.978 and perfect sensitivity (1.000) in normal classification. Comparisons with other 3D network architectures confirmed that the integrated model outperformed others, achieving the highest AUC of 0.8419.Significance. The CNMIL network requires no additional scans or annotations, relying solely on NCCT. This approach can improve timely and accurate CTEPH detection, resulting in better patient outcomes.
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Affiliation(s)
- Mayang Zhao
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region of China, People's Republic of China
| | - Liming Song
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region of China, People's Republic of China
| | - Jiarui Zhu
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region of China, People's Republic of China
| | - Ta Zhou
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region of China, People's Republic of China
| | - Yuanpeng Zhang
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region of China, People's Republic of China
| | - Shu-Cheng Chen
- School of Nursing, Hong Kong Polytechnic University, Hong Kong Special Administrative Region of China, People's Republic of China
| | - Haojiang Li
- Department of Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Centre, Guangzhou, People's Republic of China
| | - Di Cao
- Department of Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Centre, Guangzhou, People's Republic of China
| | - Yi-Quan Jiang
- Department of Minimally Invasive Interventional Therapy, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Waiyin Ho
- Department of Nuclear Medicine, Queen Mary Hospital, Hong Kong Special Administrative Region of China,People's Republic of China
| | - Jing Cai
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region of China, People's Republic of China
| | - Ren Ge
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region of China, People's Republic of China
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Steiert D, Wittig C, Banerjee P, Preissner R, Szulcek R. An exploration into CTEPH medications: Combining natural language processing, embedding learning, in vitro models, and real-world evidence for drug repurposing. PLoS Comput Biol 2024; 20:e1012417. [PMID: 39264975 DOI: 10.1371/journal.pcbi.1012417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 08/14/2024] [Indexed: 09/14/2024] Open
Abstract
BACKGROUND In the modern era, the growth of scientific literature presents a daunting challenge for researchers to keep informed of advancements across multiple disciplines. OBJECTIVE We apply natural language processing (NLP) and embedding learning concepts to design PubDigest, a tool that combs PubMed literature, aiming to pinpoint potential drugs that could be repurposed. METHODS Using NLP, especially term associations through word embeddings, we explored unrecognized relationships between drugs and diseases. To illustrate the utility of PubDigest, we focused on chronic thromboembolic pulmonary hypertension (CTEPH), a rare disease with an overall limited number of scientific publications. RESULTS Our literature analysis identified key clinical features linked to CTEPH by applying term frequency-inverse document frequency (TF-IDF) scoring, a technique measuring a term's significance in a text corpus. This allowed us to map related diseases. One standout was venous thrombosis (VT), which showed strong semantic links with CTEPH. Looking deeper, we discovered potential repurposing candidates for CTEPH through large-scale neural network-based contextualization of literature and predictive modeling on both the CTEPH and the VT literature corpora to find novel, yet unrecognized associations between the two diseases. Alongside the anti-thrombotic agent caplacizumab, benzofuran derivatives were an intriguing find. In particular, the benzofuran derivative amiodarone displayed potential anti-thrombotic properties in the literature. Our in vitro tests confirmed amiodarone's ability to reduce platelet aggregation significantly by 68% (p = 0.02). However, real-world clinical data indicated that CTEPH patients receiving amiodarone treatment faced a significant 15.9% higher mortality risk (p<0.001). CONCLUSIONS While NLP offers an innovative approach to interpreting scientific literature, especially for drug repurposing, it is crucial to combine it with complementary methods like in vitro testing and real-world evidence. Our exploration with benzofuran derivatives and CTEPH underscores this point. Thus, blending NLP with hands-on experiments and real-world clinical data can pave the way for faster and safer drug repurposing approaches, especially for rare diseases like CTEPH.
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Affiliation(s)
- Daniel Steiert
- Laboratory of in vitro modeling systems of pulmonary and thrombotic diseases, Institute of Physiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Corey Wittig
- Laboratory of in vitro modeling systems of pulmonary and thrombotic diseases, Institute of Physiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Priyanka Banerjee
- Structural Bioinformatics Group, Institute of Physiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Robert Preissner
- Structural Bioinformatics Group, Institute of Physiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Robert Szulcek
- Laboratory of in vitro modeling systems of pulmonary and thrombotic diseases, Institute of Physiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Deutsches Herzzentrum der Charité, Department of Cardiac Anesthesiology and Intensive Care Medicine, Berlin, Germany
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3
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Escal J, Poenou G, Delavenne X, Bezzeghoud S, Mismetti V, Humbert M, Montani D, Bertoletti L. Tailoring oral anticoagulant treatment in the era of multi-drug therapies for PAH and CTEPH. Blood Rev 2024:101240. [PMID: 39245607 DOI: 10.1016/j.blre.2024.101240] [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: 06/26/2024] [Revised: 08/31/2024] [Accepted: 09/02/2024] [Indexed: 09/10/2024]
Abstract
The use of oral anticoagulants in the management of pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) presents distinct therapeutic challenges and benefits. In PAH, the benefits of oral anticoagulation are uncertain, with studies yielding mixed results on their efficacy and safety. Conversely, oral anticoagulants are a cornerstone in the treatment of CTEPH, where their use is consistently recommended to prevent recurrent thromboembolic events. The choice between vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs) remains a significant clinical question, as each type presents advantages and potential drawbacks. Furthermore, drug-drug interactions (DDIs) with concomitant PAH and CTEPH treatments complicate anticoagulant management, necessitating careful consideration of individual patient regimens. This review examines the current evidence on oral anticoagulant use in PAH and CTEPH and discusses the implications of DDIs within a context of multi-drug treatments, including targeted drugs in PAH.
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Affiliation(s)
- Jean Escal
- INSERM UMR1059, Université Jean Monnet, F-42023 Saint-Etienne, France; Laboratoire de Pharmacologie et Toxicologie, CHU de Saint-Etienne, F-42055 Saint-Etienne, France.
| | - Geraldine Poenou
- INSERM UMR1059, Université Jean Monnet, F-42023 Saint-Etienne, France; Service de Médecine Vasculaire et Thérapeutique, CHU de Saint-Etienne, F-42055 Saint-Etienne, France.
| | - Xavier Delavenne
- INSERM UMR1059, Université Jean Monnet, F-42023 Saint-Etienne, France; Laboratoire de Pharmacologie et Toxicologie, CHU de Saint-Etienne, F-42055 Saint-Etienne, France.
| | - Souad Bezzeghoud
- Service de Médecine Vasculaire et Thérapeutique, INSERM CIC-1408, CHU de Saint-Etienne, F-42055 Saint-Etienne, France.
| | - Valentine Mismetti
- INSERM UMR1059, Université Jean Monnet, F-42023 Saint-Etienne, France; Service de Pneumologie, CHU de Saint-Etienne, F-42055 Saint-Etienne, France.
| | - Marc Humbert
- INSERM UMR-S 999, Université Paris-Saclay, Paris, France; Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Bicêtre (APHP), Le Kremlin-Bicêtre, France.
| | - David Montani
- INSERM UMR-S 999, Université Paris-Saclay, Paris, France; Service de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence de L'Hypertension Pulmonaire OrphaLung, Hôpital de Bicêtre (APHP), Le Kremlin-Bicêtre, France.
| | - Laurent Bertoletti
- INSERM UMR1059, Université Jean Monnet, F-42023 Saint-Etienne, France; Service de Médecine Vasculaire et Thérapeutique, INSERM CIC-1408, INNOVTE, CHU de Saint-Etienne, F-42055 SaintEtienne, France.
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Bikdeli B, Sadeghipour P, Lou J, Bejjani A, Khairani CD, Rashedi S, Lookstein R, Lansky A, Vedantham S, Sobieszczyk P, Mena-Hurtado C, Aghayev A, Henke P, Mehdipoor G, Tufano A, Chatterjee S, Middeldorp S, Wasan S, Bashir R, Lang IM, Shishehbor MH, Gerhard-Herman M, Giri J, Menard MT, Parikh SA, Mazzolai L, Moores L, Monreal M, Jimenez D, Goldhaber SZ, Krumholz HM, Piazza G. Developmental or Procedural Vena Cava Interruption and Venous Thromboembolism: A Review. Semin Thromb Hemost 2024; 50:851-865. [PMID: 38176425 DOI: 10.1055/s-0043-1777991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
The inferior vena cava (IVC) and superior vena cava are the main conduits of the systemic venous circulation into the right atrium. Developmental or procedural interruptions of vena cava might predispose to stasis and deep vein thrombosis (DVT) distal to the anomaly and may impact the subsequent rate of pulmonary embolism (PE). This study aimed to review the various etiologies of developmental or procedural vena cava interruption and their impact on venous thromboembolism. A systematic search was performed in PubMed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines per each clinical question. For management questions with no high-quality evidence and no mutual agreements between authors, Delphi methods were used. IVC agenesis is the most common form of congenital vena cava interruption, is associated with an increased risk of DVT, and should be suspected in young patients with unexpected extensive bilateral DVT. Surgical techniques for vena cava interruption (ligation, clipping, and plication) to prevent PE have been largely abandoned due to short-term procedural risks and long-term complications, although survivors of prior procedures are occasionally encountered. Vena cava filters are now the most commonly used method of procedural interruption, frequently placed in the infrarenal IVC. The most agreed-upon indication for vena cava filters is for patients with acute venous thromboembolism and coexisting contraindications to anticoagulation. Familiarity with different forms of vena cava interruption and their local and systemic adverse effects is important to minimize complications and thrombotic events.
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Affiliation(s)
- Behnood Bikdeli
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut
- Cardiovascular Research Foundation (CRF), New York, New York
| | - Parham Sadeghipour
- Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Clinical Trial Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Junyang Lou
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Antoine Bejjani
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Candrika D Khairani
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sina Rashedi
- Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Robert Lookstein
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alexandra Lansky
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Suresh Vedantham
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Piotr Sobieszczyk
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carlos Mena-Hurtado
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Ayaz Aghayev
- Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Peter Henke
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Ghazaleh Mehdipoor
- Cardiovascular Research Foundation (CRF), New York, New York
- Center for Evidence-based Imaging, Brigham and Women's Hospital, Boston, Massachusetts
| | - Antonella Tufano
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Saurav Chatterjee
- Division of Cardiology, Department of Medicine, Zucker School of Medicine, New York, New York
| | - Saskia Middeldorp
- Department of Internal Medicine, Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Suman Wasan
- University of North Carolina, Chapel Hill, North Carolina
| | - Riyaz Bashir
- Departement of Cardiovascular Diseases, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Irene M Lang
- Department of Internal Medicine II, Cardiology and Center of Cardiovascular Medicine, Medical University of Vienna, Vienna, Austria
| | - Mehdi H Shishehbor
- University Hospitals Heath System, Harrington Heart and Vascular Institute, Cleveland, Ohio
| | - Marie Gerhard-Herman
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jay Giri
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Division, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew T Menard
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sahil A Parikh
- Cardiovascular Research Foundation (CRF), New York, New York
- Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Lucia Mazzolai
- Division of Angiology, Heart and Vessel Department, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Lisa Moores
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland
| | | | - David Jimenez
- Respiratory Department, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain
- Medicine Department, Universidad de Alcalá (IRYCIS), Madrid, Spain
- CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Samuel Z Goldhaber
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Harlan M Krumholz
- YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Gregory Piazza
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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5
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Kim NH, D'Armini AM, Delcroix M, Jaïs X, Jevnikar M, Madani MM, Matsubara H, Palazzini M, Wiedenroth CB, Simonneau G, Jenkins DP. Chronic thromboembolic pulmonary disease. Eur Respir J 2024:2401294. [PMID: 39209473 DOI: 10.1183/13993003.01294-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 07/05/2024] [Indexed: 09/04/2024]
Abstract
Chronic thromboembolic pulmonary hypertension is a complication of pulmonary embolism and a treatable cause of pulmonary hypertension. The pathology is a unique combination of mechanical obstruction due to failure of clot resolution, and a variable degree of microvascular disease, that both contribute to pulmonary vascular resistance. Accordingly, multiple treatments have been developed to target the disease components. However, accurate diagnosis is often delayed. Evaluation includes high-quality imaging modalities, necessary for disease confirmation and for appropriate treatment planning. All patients with chronic thromboembolic pulmonary disease, and especially those with pulmonary hypertension, should be referred to expert centres for multidisciplinary team decision on treatment. The first decision remains assessment of operability, and the best improvement in symptoms and survival is achieved by the mechanical therapies, pulmonary endarterectomy and balloon pulmonary angioplasty. With the advances in multimodal therapies, excellent outcomes can be achieved with 3-year survival of >90%.
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Affiliation(s)
- Nick H Kim
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, CA, USA
| | - Andrea M D'Armini
- Department of Cardio-Thoracic and Vascular Surgery, Heart and Lung Transplantation and Pulmonary Hypertension Unit, Foundation IRCCS Policlinico San Matteo, University of Pavia School of Medicine, Pavia, Italy
| | - Marion Delcroix
- Clinical Department of Respiratory Disease, Pulmonary Hypertension Center, UZ Leuven, Leuven, Belgium
| | - Xavier Jaïs
- AP-HP, Department of Respiratory and Intensive Care Medicine, Bicêtre Hospital, University of Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Mitja Jevnikar
- AP-HP, Department of Respiratory and Intensive Care Medicine, Bicêtre Hospital, University of Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Michael M Madani
- Division of Cardiovascular and Thoracic Surgery, University of California San Diego, La Jolla, CA, USA
| | - Hiromi Matsubara
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Massimiliano Palazzini
- Dipartimento DIMEC (Dipartimento di Scienze Mediche e Chirurgiche), Universita di Bologna, Bologna, Italy
| | | | - Gérald Simonneau
- Pneumologie Kremlin Bicetre University Hospital, National Reference Center for Pulmonary Hypertension, Paris Saclay University, Paris, France
| | - David P Jenkins
- Cardiothoracic Surgery and Transplantation, Royal Papworth Hospital, Cambridge, UK
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6
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Mangeshkar S, Borkowski P, Singh N, Zoumpourlis P, Maliha M, Nagraj S, Kharawala A, Faillace R. Sex differences in Chronic Thromboembolic Pulmonary Hypertension. Future Cardiol 2024:1-10. [PMID: 39157860 DOI: 10.1080/14796678.2024.2385872] [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: 05/18/2024] [Accepted: 07/25/2024] [Indexed: 08/20/2024] Open
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is an underdiagnosed sequela of acute pulmonary embolism with varied clinical presentation causing significant morbidity among the affected population. There exist important differences in the occurrence, clinical features and diagnosis of CTEPH between men and women, with women carrying a greater predisposition for the disease. Ongoing studies have also pointed out variations among men and women, in the treatment offered and long-term outcomes including mortality. This focused review article highlights important sex-associated differences in multiple aspects of CTEPH including its epidemiology, clinical features, diagnosis, treatment and outcomes as reported in current literature and highlights the need for future research to facilitate a clearer understanding of these differences.
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Affiliation(s)
- Shaunak Mangeshkar
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, 1400 Pelham Parkway S, Bronx, NY 10461, USA
| | - Pawel Borkowski
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, 1400 Pelham Parkway S, Bronx, NY 10461, USA
| | - Nikita Singh
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, 1400 Pelham Parkway S, Bronx, NY 10461, USA
| | - Panagiotis Zoumpourlis
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, 1400 Pelham Parkway S, Bronx, NY 10461, USA
| | - Maisha Maliha
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, 1400 Pelham Parkway S, Bronx, NY 10461, USA
| | - Sanjana Nagraj
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467, USA
| | - Amrin Kharawala
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, 1400 Pelham Parkway S, Bronx, NY 10461, USA
| | - Robert Faillace
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, 1400 Pelham Parkway S, Bronx, NY 10461, USA
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7
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Barnes H, Niewodowski D, Doi A, Marasco S, Joseph T, Siemienowicz M, Keating D, Yo S, Kaye D, Williams T, McGiffin D, Whitford H. Current surgical management of chronic thromboembolic pulmonary disease. Intern Med J 2024. [PMID: 39087843 DOI: 10.1111/imj.16470] [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: 04/12/2024] [Accepted: 06/04/2024] [Indexed: 08/02/2024]
Abstract
Chronic thromboembolic pulmonary disease (CTEPD) with or without pulmonary hypertension (PH) is an important potential consequence of venous thromboembolic disease. Untreated CTEPD with pulmonary hypertension (CTEPH) is associated with high rates of morbidity and mortality. Several treatment options are now available for patients with CTEPD and CTEPH, including pulmonary endarterectomy (PEA), balloon pulmonary angioplasty, medical therapy or a combination of therapies. Choice of treatment depends on the location of the thromboembolic disease burden, presence and severity of PH and patient factors, including frailty, parenchymal lung disease and other comorbidities. PEA is a complex surgery that can result in excellent outcomes and resolution of disease, but also comes with the risk of serious perioperative complications. This manuscript examines the history of PEA and its place in Australasia, and reports on outcomes from the main Australasian CTEPH expert centre. It provides a summary of up-to-date guidance on how PEA should be utilised in the overall management of these patients and describes opportunities and challenges for the future diagnosis and management of this disease, particularly in the Australasian setting.
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Affiliation(s)
- Hayley Barnes
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
- School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
| | - Daniel Niewodowski
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Atsuo Doi
- Department of Cardiothoracic Surgery, Alfred Hospital, Melbourne, Victoria, Australia
| | - Silvana Marasco
- Department of Cardiothoracic Surgery, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Tim Joseph
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Miranda Siemienowicz
- School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Dominic Keating
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
- School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
| | - Shaun Yo
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| | - David Kaye
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Trevor Williams
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
- School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
| | - David McGiffin
- Department of Cardiothoracic Surgery, Alfred Hospital, Melbourne, Victoria, Australia
| | - Helen Whitford
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
- School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
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8
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Han SA, Han S, Lee J, Kang DY, Lee JS, Kim DH, Park DW, Song J, Ryu JS, Moon DH. Semi-Quantitative Analysis of Lung Perfusion SPECT/CT for Evaluation of Response to Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension. Nucl Med Mol Imaging 2024; 58:291-299. [PMID: 39036460 PMCID: PMC11255175 DOI: 10.1007/s13139-024-00858-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/28/2024] [Accepted: 03/11/2024] [Indexed: 07/23/2024] Open
Abstract
Purpose We aimed to investigate the response to balloon pulmonary angioplasty (BPA) in chronic thromboembolic pulmonary hypertension (CTEPH) using semi-quantitative analysis of lung perfusion SPECT/CT. Methods This is a single-center retrospective study of patients with CTEPH who underwent BPA and pre- and post-BPA lung perfusion SPECT/CT between 2015 and 2022. Segmental defects on SPECT/CT were visually assessed and semi-quantitatively scored as 1 (large defect) or 0.5 (moderate defect) in accordance with modified PIOPED II criteria. The perfusion defect score was defined as (Σ segmental defect scores/18) × 100 (%). Associations between perfusion defect score and hemodynamic or functional parameters including WHO functional class, six-minute walking distance (6MWD), serum B-type natriuretic peptide (BNP), mean arterial pulmonary pressure (mPAP), pulmonary vascular resistance (PVR), and tricuspid regurgitation pressure gradient (TRPG) on echocardiography were statistically analyzed. Results A total of 24 consecutive patients were included. The perfusion defect score significantly improved after BPA (median 58.3% vs. 47.2%, P < 0.001), in conjunction with the WHO functional class, 6MWD, serum BNP, mPAP, and TRPG. Perfusion defect scores were significantly correlated with 6MWD (rho = - 0.583, P < 0.001), serum BNP (rho = 0.514, P < 0.001), mPAP (rho = 0.583, P < 0.001), and PVR (rho = 0.575, P < 0.001). The improvement in the perfusion defect score was significantly associated with improvement in mPAP (rho = 0.844, P < 0.001). Conclusion Our results suggest that semi-quantitative analysis of lung perfusion SPECT/CT can provide a potential imaging biomarker for monitoring the efficacy of BPA. Supplementary Information The online version contains supplementary material available at 10.1007/s13139-024-00858-1.
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Affiliation(s)
- Shin Ae Han
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505 South Korea
| | - Sangwon Han
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505 South Korea
| | - Jinho Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Do-Yoon Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae Seung Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dae-Hee Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jong‑Min Song
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jin-Sook Ryu
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505 South Korea
| | - Dae Hyuk Moon
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505 South Korea
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9
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Masaki K, Hosokawa K, Funakoshi K, Taniguchi Y, Adachi S, Inami T, Yamashita J, Ogino H, Tsujino I, Hatano M, Yaoita N, Ikeda N, Shimokawahara H, Tanabe N, Kubota K, Shigeta A, Ogihara Y, Horimoto K, Dohi Y, Kawakami T, Tamura Y, Tatsumi K, Abe K. Outcomes of Chronic Thromboembolic Pulmonary Hypertension After Balloon Pulmonary Angioplasty and Pulmonary Endarterectomy. JACC. ASIA 2024; 4:577-589. [PMID: 39156509 PMCID: PMC11328766 DOI: 10.1016/j.jacasi.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/17/2024] [Accepted: 05/27/2024] [Indexed: 08/20/2024]
Abstract
Background The contemporary outcome of balloon pulmonary angioplasty (BPA) and pulmonary endarterectomy (PEA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) are unclear. Objectives This study aimed to clarify the characteristics and outcomes of CTEPH patients treated with BPA and PEA in Japan. Methods Among 1,270 participants enrolled between 2018 and 2023 in the CTEPH AC (Chronic Thromboembolic Pulmonary Hypertension Anticoagulant) registry, a Japanese nationwide CTEPH registry, 369 treatment-naive patients (BPA strategy: n = 313; PEA strategy: n = 56) and 690 on-treatment patients (BPA strategy: n = 561; PEA strategy: n = 129) were classified according to the presence of prior reperfusion therapy. Morbidity and mortality events (all-cause death, rescue mechanical reperfusion therapy, and/or initiation of parenteral pulmonary vasodilators), pulmonary hemodynamics, exercise tolerance, and relevant laboratory test results were evaluated. Results The BPA strategy was chosen in older patients than the PEA strategy (mean age, BPA vs PEA: 66.5 ± 12.6 years vs 62.5 ± 11.8 years; P = 0.028). Median follow-up period was 615 (Q1-Q3: 311-997) days in treatment-naive patients and 1,136 (Q1-Q3: 684-1,300) days in on-treatment patients. BPA strategy had as acceptable morbidity and mortality as PEA strategy (5-year morbidity and mortality event rate, BPA vs PEA: 10.2% [95% CI: 5.2%-19.5%] vs 16.1% [95% CI: 4.3%-50.6%] in treatment-naive patients; 9.7% [95% CI: 6.7%-13.8%] vs 6.9% [95% CI: 2.7%-17.3%] in on-treatment patients), with greater improvement of renal function; glomerular filtration rate in propensity score-matched population (difference between change: 4.9 [95% CI: 0.5-9.3] mL/min/1.73 m2; P = 0.030). Conclusions BPA strategy was more frequently chosen in older patients compared with PEA strategy and showed acceptable outcomes for efficacy with greater advantage for improvement in renal function. (Multicenter registry of chronic thromboembolic pulmonary hypertension in Japan; UMIN000033784).
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Affiliation(s)
- Kohei Masaki
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuya Hosokawa
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kouta Funakoshi
- Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan
| | - Yu Taniguchi
- Department of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shiro Adachi
- Department of Cardiology, Nagoya University Hospital, Nagoya, Japan
| | - Takumi Inami
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Jun Yamashita
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
| | - Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Ichizo Tsujino
- Division of Respiratory and Cardiovascular Innovative Research, Hokkaido University, Sapporo, Japan
| | - Masaru Hatano
- Department of Cardiovascular Medicine, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan
| | - Nobuhiro Yaoita
- Department of Cardiovascular Medicine, Tohoku University Hospital, Sendai, Japan
| | - Nobutaka Ikeda
- Department of Cardiovascular Medicine, Toho University Medical Center Ohashi Hospital, Tokyo, Japan
| | - Hiroto Shimokawahara
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Nobuhiro Tanabe
- Department of Pulmonary Hypertension Center, Chibaken Saiseikai Narashino Hospital, Narashino, Japan
| | - Kayoko Kubota
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Ayako Shigeta
- Department of Respirology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshito Ogihara
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Koshin Horimoto
- Department of Cardiovascular Medicine, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Yoshihiro Dohi
- Department of Cardiovascular Medicine, Kure Kyosai Hospital, Kure, Japan
| | - Takashi Kawakami
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yuichi Tamura
- Pulmonary Hypertension Center, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Koichiro Tatsumi
- Department of Respirology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Kohtaro Abe
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
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10
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Zhou YP, Liu C, Jing ZC. Angioplasty for Chronic Thromboembolic Pulmonary Hypertension: 10 Years to Sharpen a Sword. JACC. ASIA 2024; 4:590-593. [PMID: 39156510 PMCID: PMC11328787 DOI: 10.1016/j.jacasi.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Affiliation(s)
- Yu-Ping Zhou
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chao Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provencal People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Zhi-Cheng Jing
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provencal People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
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11
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Perkins SJ, Funes M, Cheah D, Argenti C, Vinales J, Gordon D, Haft JW, Williams DM, Mclaughlin VV, Agarwal PP, Moles VM, Cascino T, Obi A, Pandey A, Shih A, Aggarwal V. Safety Window for Effective Lesion Crossing in Patients With Chronic Thromboembolic Pulmonary Hypertension. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:102142. [PMID: 39166161 PMCID: PMC11330921 DOI: 10.1016/j.jscai.2024.102142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/14/2024] [Accepted: 04/15/2024] [Indexed: 08/22/2024]
Abstract
Background Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension (CTEPH) is limited by a lack of safe and effective tools for crossing these lesions. We aim to identify a safety window for an intraluminal crossing device in this vascular bed by studying the piercing properties of pulmonary arterial vessel walls and intraluminal CTEPH lesion specimens. As a secondary objective, we also describe the histopathologic features of CTEPH lesions. Methods Specimens were procured from 9 patients undergoing pulmonary endarterectomy. The specimens were subsampled and identified grossly as arterial wall or intraluminal CTEPH lesions. The force needed for tissue penetration was measured using a 0.38-mm (0.015-in) diameter probe in an ex vivo experimental model developed in our lab. Concurrent histology was also performed. Results The mean force needed to penetrate the arterial wall and intraluminal CTEPH lesions was 1.75 ± 0.10 N (n = 121) and 0.30 ± 0.04 N (n = 56), respectively (P < .001). Histology confirmed the presence of intimal hyperplasia with calcium and hemosiderin deposition in the arterial wall as well as an old, organized thrombus in the lumen. Conclusions The pulmonary arterial wall is friable and prone to perforation during instrumentation with workhorse coronary guide wires. However, the results of this study demonstrate that a much lower force is needed for the 0.38-mm (0.015-in) probe to penetrate an intraluminal CTEPH lesion compared to pulmonary arterial intima. This finding suggests the existence of a safety window for lesion-crossing devices, enabling effective balloon pulmonary angioplasty.
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Affiliation(s)
- Sidney J. Perkins
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Miguel Funes
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan
| | - Daniel Cheah
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Urbana, Illinois
| | - Christian Argenti
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan
| | - Jorge Vinales
- University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan
| | - David Gordon
- University of Michigan Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Jonathan W. Haft
- University of Michigan Frankel Cardiovascular Center Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - David M. Williams
- University of Michigan Vascular and Interventional Radiology, University of Michigan, Ann Arbor, Michigan
| | - Vallerie V. Mclaughlin
- University of Michigan Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor, Michigan
| | - Prachi P. Agarwal
- University of Michigan Department of Diagnostic Radiology, University of Michigan, Ann Arbor, Michigan
| | - Victor M. Moles
- University of Michigan Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor, Michigan
| | - Thomas Cascino
- University of Michigan Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor, Michigan
| | - Andrea Obi
- University of Michigan Section of Vascular Surgery, University of Michigan, Ann Arbor, Michigan
| | - Aditya Pandey
- University of Michigan Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Albert Shih
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan
| | - Vikas Aggarwal
- Department of Internal Medicine, Division of Cardiology, Henry Ford Hospital, Detroit, Michigan
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12
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Simeone B, Maggio E, Schirone L, Rocco E, Sarto G, Spadafora L, Bernardi M, D’Ambrosio L, Forte M, Vecchio D, Valenti V, Sciarretta S, Vizza CD. Chronic Thromboembolic Pulmonary Hypertension: the therapeutic assessment. Front Cardiovasc Med 2024; 11:1439411. [PMID: 39171327 PMCID: PMC11337617 DOI: 10.3389/fcvm.2024.1439411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 07/16/2024] [Indexed: 08/23/2024] Open
Abstract
Chronic Thromboembolic Pulmonary Hypertension (CTEPH) is a severe and complex condition that evolves from unresolved pulmonary embolism, leading to fibrotic obstruction of pulmonary arteries, pulmonary hypertension, and potential right heart failure. The cornerstone of CTEPH management lies in a multifaceted therapeutic approach tailored to individual patient profiles, reflecting the disease's heterogeneity. This review delves into the current therapeutic strategies for CTEPH, including surgical pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA), and targeted pharmacological treatments such as PDE5 inhibitors, endothelin receptor antagonists, sGC stimulators, and prostanoids. Lifelong anticoagulation is also highlighted as a preventive strategy against recurrent thromboembolism. Special emphasis is placed on the interdisciplinary nature of CTEPH care, necessitating collaboration among PEA surgeons, BPA interventionists, PH specialists, and thoracic radiologists to ensure comprehensive treatment planning and execution. The review underscores the importance of selecting an appropriate treatment modality based on the patient's specific disease characteristics and the evolving landscape of CTEPH treatment, aiming to improve patient outcomes through integrated care strategies.
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Affiliation(s)
- Beatrice Simeone
- Department of Cardiology, ICOT Istituto Marco Pasquali, Latina, Italy
| | - Enrico Maggio
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Erica Rocco
- Department of Cardiology, ICOT Istituto Marco Pasquali, Latina, Italy
| | - Gianmarco Sarto
- Department of Cardiology, ICOT Istituto Marco Pasquali, Latina, Italy
| | - Luigi Spadafora
- Department of Cardiology, ICOT Istituto Marco Pasquali, Latina, Italy
| | - Marco Bernardi
- Department of Cardiology, ICOT Istituto Marco Pasquali, Latina, Italy
| | - Luca D’Ambrosio
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Maurizio Forte
- Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli, Italy
| | - Daniele Vecchio
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Valentina Valenti
- Department of Cardiology, Santa Maria Goretti Hospital, Latina, Italy
| | - Sebastiano Sciarretta
- Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli, Italy
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Carmine Dario Vizza
- Department of Cardiovascular and Respiratory Sciences, Sapienza University of Rome, Rome, Italy
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13
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Kiko T, Asano R, Endo H, Nishi N, Hayashi H, Kotoku A, Horinouchi H, Ueda J, Aoki T, Tsuji A, Fukuda T, Ogo T. Balloon pulmonary angioplasty for chronic thromboembolic pulmonary disease without pulmonary hypertension. Pulm Circ 2024; 14:e12409. [PMID: 38962183 PMCID: PMC11219285 DOI: 10.1002/pul2.12409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/28/2024] [Accepted: 06/22/2024] [Indexed: 07/05/2024] Open
Abstract
Balloon pulmonary angioplasty (BPA) is beneficial for patients with chronic thromboembolic pulmonary disease (CTEPD) with pulmonary hypertension (PH). However, the clinical benefit of BPA for the patients with CTEPD without PH remains unknown. In this study, we aimed to evaluate the efficacy, safety, and long-term outcomes of BPA in patients with CTEPD without PH. We retrospectively analyzed the data from 84 CTEPD patients with mean pulmonary artery pressure (mPAP) < 25 mmHg and 39 CTEPD patients with mPAP ≤ 20 mmHg (without PH). Among the 39 patients with CTEPD without PH, 14 underwent BPA (BPA-treated group), and the remaining 25 received no treatment (untreated group). In the patients with CTEPD without PH, BPA led to improvements in symptoms, pulmonary vascular resistance (3.6 ± 1.6 to 2.6 ± 1.1 Wood units, p < 0.001), peak oxygen consumption (16.1 ± 4.0 to 18.8 ± 4.3 mL/kg/min, p = 0.033), minute ventilation versus carbon dioxide production slope (41.4 ± 12.2 to 35.1 ± 6.7, p = 0.026), and mPAP/cardiac output slope (7.0 ± 2.6 to 4.4 ± 2.0 mmHg/L/min, p = 0.004) and facilitated the discontinuation of home oxygenation therapy, with no serious complications. Kaplan-Meier analysis showed no significant difference in all-cause mortality between the untreated and BPA-treated groups. BPA may be a safe treatment option for the patients with CTEPD without PH that can alleviate symptoms, improve exercise capacity, and facilitate weaning from home oxygen therapy. Further prospective randomized trials are needed to confirm these findings.
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Affiliation(s)
- Takatoyo Kiko
- Division of Pulmonary Circulation, Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaOsakaJapan
| | - Ryotaro Asano
- Division of Pulmonary Circulation, Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaOsakaJapan
- Department of Vascular PhysiologyNational Cerebral and Cardiovascular Center Research InstituteSuitaOsakaJapan
| | - Hiroyuki Endo
- Division of Pulmonary Circulation, Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaOsakaJapan
| | - Naruhiro Nishi
- Division of Pulmonary Circulation, Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaOsakaJapan
| | - Hiroya Hayashi
- Division of Pulmonary Circulation, Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaOsakaJapan
| | - Akiyuki Kotoku
- Department of RadiologyNational Cerebral and Cardiovascular CenterSuitaOsakaJapan
| | - Hiroki Horinouchi
- Department of RadiologyNational Cerebral and Cardiovascular CenterSuitaOsakaJapan
| | - Jin Ueda
- Division of Pulmonary Circulation, Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaOsakaJapan
| | - Tatsuo Aoki
- Division of Pulmonary Circulation, Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaOsakaJapan
| | - Akihiro Tsuji
- Division of Pulmonary Circulation, Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaOsakaJapan
| | - Tetsuya Fukuda
- Department of RadiologyNational Cerebral and Cardiovascular CenterSuitaOsakaJapan
| | - Takeshi Ogo
- Division of Pulmonary Circulation, Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaOsakaJapan
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14
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Issard J, Fadel E, Dolidon S, Gerardin B, Fabre D, Mitilian D, Mercier O, Jevnikar M, Jais X, Humbert M, Brenot P. Balloon pulmonary angioplasty for proximal chronic thromboembolic pulmonary hypertension in patients ineligible for pulmonary endarterectomy. Pulm Circ 2024; 14:e12432. [PMID: 39234392 PMCID: PMC11372088 DOI: 10.1002/pul2.12432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/23/2024] [Accepted: 08/18/2024] [Indexed: 09/06/2024] Open
Abstract
Balloon pulmonary angioplasty (BPA) to treat chronic thromboembolic pulmonary hypertension (CTEPH) is generally reserved for distal obstruction precluding pulmonary endarterectomy (PEA) but can be used in patients with proximal disease who are at high surgical risk or refuse surgery. This single-center retrospective study compared BPA efficacy in patients with proximal versus distal CTEPH. Of the 478 patients, 36 had proximal disease, follow-up was 11.6 months and mean number of BPA 6. After BPA, PVR, and mean pulmonary artery pressure decreased significantly in the proximal and distal groups (from 6.5 to 4.0 WU and 39 to 31 mmHg and from 7.6 to 3.8 WU and 44 to 31 mmHg, respectively, p < 0.001 for all comparisons). NYHA class also improved significantly in both groups, from 3 to 2, whereas the 6-min walk distance, cardiac output, and serum NT pro-BNP showed significant improvements only in the distal group. Thus, when PEA for CTEPH is technically feasible but not performed due to severe comorbidities or patient refusal, BPA can produce significant hemodynamic improvements, albeit less marked than in patients with distal disease. Better patient selection to BPA might improve outcomes in patients with proximal disease who are ineligible for PEA.
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Affiliation(s)
- Justin Issard
- Thoracic Surgery Department Marie Lannelongue Hospital, GHPSJ Le Plessis Robinson France
| | - Elie Fadel
- Thoracic Surgery Department Marie Lannelongue Hospital, GHPSJ Le Plessis Robinson France
| | - Samuel Dolidon
- Thoracic Surgery Department Marie Lannelongue Hospital, GHPSJ Le Plessis Robinson France
| | - Benoit Gerardin
- Thoracic Surgery Department Marie Lannelongue Hospital, GHPSJ Le Plessis Robinson France
| | - Dominique Fabre
- Thoracic Surgery Department Marie Lannelongue Hospital, GHPSJ Le Plessis Robinson France
| | - Delphine Mitilian
- Thoracic Surgery Department Marie Lannelongue Hospital, GHPSJ Le Plessis Robinson France
| | - Olaf Mercier
- Thoracic Surgery Department Marie Lannelongue Hospital, GHPSJ Le Plessis Robinson France
| | - Mitja Jevnikar
- Pulmonology Department, Bicêtre University Hospital Assistance Publique-Hôpitaux de Paris Le Kremlin-Bicêtre France
| | - Xavier Jais
- Pulmonology Department, Bicêtre University Hospital Assistance Publique-Hôpitaux de Paris Le Kremlin-Bicêtre France
| | - Marc Humbert
- Pulmonology Department, Bicêtre University Hospital Assistance Publique-Hôpitaux de Paris Le Kremlin-Bicêtre France
| | - Philippe Brenot
- Thoracic Surgery Department Marie Lannelongue Hospital, GHPSJ Le Plessis Robinson France
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15
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Inácio Cazeiro D, Azaredo Raposo M, Guimarães T, Lousada N, Jenkins D, R Inácio J, Moreira S, Mineiro A, Freitas C, Martins S, Ferreira R, Luís R, Cardim N, Pinto FJ, Plácido R. Chronic thromboembolic pulmonary hypertension: A comprehensive review of pathogenesis, diagnosis, and treatment strategies. Rev Port Cardiol 2024:S0870-2551(24)00187-2. [PMID: 38945473 DOI: 10.1016/j.repc.2024.04.006] [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: 11/22/2023] [Revised: 04/09/2024] [Accepted: 04/17/2024] [Indexed: 07/02/2024] Open
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is part of group 4 of the pulmonary hypertension (PH) classification and generally affects more than a third of patients referred to PH centers. It is a three-compartment disease involving proximal (lobar-to-segmental) and distal (subsegmental) pulmonary arteries that are obstructed by persistent fibrothrombotic material, and precapillary pulmonary arteries that can be affected as in pulmonary arterial hypertension. It is a rare complication of pulmonary embolism (PE), with an incidence of around 3% in PE survivors. The observed incidence of CTEPH in the general population is around six cases per million but could be three times higher than this, as estimated from PE incidence. However, a previous venous thromboembolic episode is not always documented. With advances in multimodality imaging and therapeutic management, survival for CTEPH has improved for both operable and inoperable patients. Advanced imaging with pulmonary angiography helps distinguish proximal from distal obstructive disease. However, right heart catheterization is of utmost importance to establish the diagnosis and hemodynamic severity of PH. The therapeutic strategy relies on a stepwise approach, starting with an operability assessment. Pulmonary endarterectomy (PEA), also known as pulmonary thromboendarterectomy, is the first-line treatment for operable patients. Growing experience and advances in surgical technique have enabled expansion of the distal limits of PEA and significant improvements in perioperative and mid- to long-term mortality. In patients who are inoperable or who have persistent/recurrent PH after PEA, medical therapy and/or balloon pulmonary angioplasty (BPA) are effective treatment options with favorable outcomes that are increasingly used. All treatment decisions should be made with a multidisciplinary team that includes a PEA surgeon, a BPA expert, and a chest radiologist.
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Affiliation(s)
- Daniel Inácio Cazeiro
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculty of Medicine, Lisbon, Portugal
| | - Miguel Azaredo Raposo
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculty of Medicine, Lisbon, Portugal
| | - Tatiana Guimarães
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculty of Medicine, Lisbon, Portugal
| | - Nuno Lousada
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculty of Medicine, Lisbon, Portugal
| | - David Jenkins
- Cardiothoracic Surgery Department, Royal Papworth Hospital, Cambridge, UK
| | - João R Inácio
- Radiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Susana Moreira
- Pulmonology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Ana Mineiro
- Pulmonology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Céline Freitas
- Association for Research and Development of Faculty of Medicine (AIDFM), Cardiovascular Research Support Unit (GAIC), Lisbon, Portugal
| | - Susana Martins
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculty of Medicine, Lisbon, Portugal
| | - Ricardo Ferreira
- Cardiothoracic Surgery Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculty of Medicine, Lisbon, Portugal
| | - Rita Luís
- Pathology Department, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Nuno Cardim
- Cardiology Department, CUF Descobertas Hospital, Lisbon, Portugal
| | - Fausto J Pinto
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculty of Medicine, Lisbon, Portugal
| | - Rui Plácido
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculty of Medicine, Lisbon, Portugal; Cardiology Department, CUF Descobertas Hospital, Lisbon, Portugal.
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16
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Liley J, Newnham M, Bleda M, Bunclark K, Auger W, Barbera JA, Bogaard H, Delcroix M, Fernandes TM, Howard L, Jenkins D, Lang I, Mayer E, Rhodes C, Simpson M, Southgate L, Trembath R, Wharton J, Wilkins MR, Gräf S, Morrell N, Zaba JP, Toshner M. Shared and Distinct Genomics of Chronic Thromboembolic Pulmonary Hypertension and Pulmonary Embolism. Am J Respir Crit Care Med 2024; 209:1477-1485. [PMID: 38470220 PMCID: PMC11208965 DOI: 10.1164/rccm.202307-1236oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 03/11/2024] [Indexed: 03/13/2024] Open
Abstract
Rationale: Chronic thromboembolic pulmonary hypertension involves the formation and nonresolution of thrombus, dysregulated inflammation, angiogenesis, and the development of a small-vessel vasculopathy. Objectives: We aimed to establish the genetic basis of chronic thromboembolic pulmonary hypertension to gain insight into its pathophysiological contributors. Methods: We conducted a genome-wide association study on 1,907 European cases and 10,363 European control subjects. We coanalyzed our results with existing results from genome-wide association studies on deep vein thrombosis, pulmonary embolism, and idiopathic pulmonary arterial hypertension. Measurements and Main Results: Our primary association study revealed genetic associations at the ABO, FGG, F11, MYH7B, and HLA-DRA loci. Through our coanalysis, we demonstrate further associations with chronic thromboembolic pulmonary hypertension at the F2, TSPAN15, SLC44A2, and F5 loci but find no statistically significant associations shared with idiopathic pulmonary arterial hypertension. Conclusions: Chronic thromboembolic pulmonary hypertension is a partially heritable polygenic disease, with related though distinct genetic associations with pulmonary embolism and deep vein thrombosis.
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Affiliation(s)
| | - Michael Newnham
- Institute of Applied Health Research, Birmingham, United Kingdom
| | - Marta Bleda
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | | | - William Auger
- University of California, San Diego, San Diego, California
| | - Joan Albert Barbera
- Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain
| | - Harm Bogaard
- Amsterdam University Medical Center, Amsterdam, the Netherlands
| | | | | | - Luke Howard
- Hammersmith Hospital, London, United Kingdom
| | | | - Irene Lang
- Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | | | | | | | | | | | - John Wharton
- St. George’s, University of London, London, United Kingdom
| | | | - Stefan Gräf
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Nicholas Morrell
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | | | - Mark Toshner
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
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17
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Guo S, Wang D. Novel insights into the potential applications of stem cells in pulmonary hypertension therapy. Respir Res 2024; 25:237. [PMID: 38849894 PMCID: PMC11162078 DOI: 10.1186/s12931-024-02865-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 06/04/2024] [Indexed: 06/09/2024] Open
Abstract
Pulmonary hypertension (PH) refers to a group of deadly lung diseases characterized by vascular lesions in the microvasculature and a progressive increase in pulmonary vascular resistance. The prevalence of PH has increased over time. Currently, the treatment options available for PH patients have limited efficacy, and none of them can fundamentally reverse pulmonary vascular remodeling. Stem cells represent an ideal seed with proven efficacy in clinical studies focusing on liver, cardiovascular, and nerve diseases. Since the potential therapeutic effect of mesenchymal stem cells (MSCs) on PH was first reported in 2006, many studies have demonstrated the efficacy of stem cells in PH animal models and suggested that stem cells can help slow the deterioration of lung tissue. Existing PH treatment studies basically focus on the paracrine action of stem cells, including protein regulation, exosome pathway, and cell signaling; however, the specific mechanisms have not yet been clarified. Apoptotic and afunctional pulmonary microvascular endothelial cells (PMVECs) and alveolar epithelial cells (AECs) are two fundamental promoters of PH although they have not been extensively studied by researchers. This review mainly focuses on the supportive communication and interaction between PMVECs and AECs as well as the potential restorative effect of stem cells on their injury. In the future, more studies are needed to prove these effects and explore more radical cures for PH.
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Affiliation(s)
- Sijia Guo
- Stem Cell Laboratory, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China.
| | - Dachun Wang
- Stem Cell Laboratory, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
- The Brown Foundation Institute of Molecular Medicine for the prevention of Human Diseases, University of Texas Medical School at Houston, Houston, TX, USA
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18
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Beijk MAM, Winkelman JA, Eckmann HM, Samson DA, Widyanti AP, Vleugels J, Bombeld DCM, Meijer CGCM, Bogaard HJ, Noordegraaf AV, de Bruin-Bon HACM, Bouma BJ. Notch ratio in pulmonary flow predicts long-term survival after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. Heart Vessels 2024:10.1007/s00380-024-02422-5. [PMID: 38837085 DOI: 10.1007/s00380-024-02422-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 05/23/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Assessment of the pattern of the RV outflow tract Doppler provides insights into the hemodynamics of chronic thromboembolic pulmonary hypertension (CTEPH). We studied whether pre-operative assessment of timing of the pulmonary flow systolic notch by Doppler echocardiography is associated with long-term survival after pulmonary endarterectomy (PEA) for CTEPH. METHODS Fifty-nine out of 61 consecutive CETPH patients (mean age 53 ± 14 years, 34% male) whom underwent PEA between June 2002 and June 2005 were studied. Clinical, echocardiographic and hemodynamic variables were assessed pre-operatively and repeat echocardiography was performed 3 months after PEA. Notch ratio (NR) was assessed with pulsed Doppler and calculated as the time from onset of pulmonary flow until notch divided by the time from notch until end of pulmonary flow. Long-term follow-up was obtained between May 2021 and February 2022. RESULTS Pre-operative mean pulmonary artery pressure (mPAP) was 45 ± 15 mmHg and pulmonary vascular resistance (PVR) was 646 ± 454 dynes.s.cm-5. Echocardiography before PEA showed that 7 patients had no notch, 33 had a NR < 1.0 and 19 had a NR > 1.0. Three months after PEA, echocardiography revealed a significant decrease in sPAP in long-term survivors with a NR < 1.0 and a NR > 1.0, while a significant increase in TAPSE/sPAP was only observed in the NR < 1.0 group. Mean long-term clinical follow-up was 14 ± 6 years. NR was significantly different between survivors and non-survivors (0.73 ± 0.25 vs. 1.1 ± 0.44, p < 0.001) but no significant differences were observed in mPAP or PVR. Long-term survival at 14 years was significantly better in patients with a NR < 1.0 compared to patients with a NR > 1.0 (83% vs. 37%, p = < 0.001). CONCLUSION Pre-operative assessment of NR is a predictor of long-term survival in CTEPH patients undergoing PEA, with low mortality risk in patients with NR < 1.0. Long-term survivors with a NR < 1.0 and NR > 1.0 had a significant decrease in sPAP after PEA. However, the TAPSE/sPAP only significantly increased in the NR < 1.0 group. In the NR < 1.0 group, the 6-min walk test increased significantly between pre-operative and at 1-year post-operative follow-up. NR is a simple echocardiographic parameter that can be used in clinical decision-making for PEA.
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Affiliation(s)
- M A M Beijk
- Department of Cardiology, Heart Center, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Room B2-250, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - J A Winkelman
- Department of Cardiothoracic Surgery, Heart Center, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - H M Eckmann
- Department of Cardiology, Heart Center, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Room B2-250, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - D A Samson
- Department of Cardiology, Heart Center, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Room B2-250, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - A P Widyanti
- Department of Cardiology, Heart Center, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Room B2-250, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - J Vleugels
- Department of Cardiology, Heart Center, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Room B2-250, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - D C M Bombeld
- Department of Cardiology, Heart Center, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Room B2-250, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - C G C M Meijer
- Department of Cardiology, Heart Center, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Room B2-250, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - H J Bogaard
- Department of Pulmonary Medicine, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - A Vonk Noordegraaf
- Department of Pulmonary Medicine, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - H A C M de Bruin-Bon
- Department of Cardiology, Heart Center, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Room B2-250, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - B J Bouma
- Department of Cardiology, Heart Center, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Room B2-250, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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19
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Gonzalez-Hermosillo LM, Cueto-Robledo G, Navarro-Vergara DI, Garcia-Cesar M, Torres-Rojas MB, Graniel-Palafox LE, Castro-Escalante KY, Castro-Diaz AM. Post-pulmonary embolism syndrome: A reminder for clinicians. Asian Cardiovasc Thorac Ann 2024; 32:336-344. [PMID: 39135401 DOI: 10.1177/02184923241272913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2024]
Abstract
Acute pulmonary embolism (APE) is one of the leading causes of cardiovascular emergencies and the third leading cause of death. Although efforts focus on treating the acute event, patients who survive APE may develop long-term sequelae. Research reveals that approximately half of patients who have suffered an APE do not regain their previous level of function and experience a reduction in their quality of life for several years after the episode. Acute pulmonary embolism can be classified according to the risk of short-term mortality, with most mortality and morbidity concentrated in high-risk and intermediate-risk cases. The first-line treatment for APE is systemic anticoagulation. However, identifying and more aggressively treating people with intermediate to high risk, who have a more favorable risk profile for reperfusion treatments, could reduce short-term mortality and mitigate post-pulmonary embolism syndrome (PPES). Post-pulmonary embolism syndrome refers to a variety of persistent symptoms and functional limitations that occur after an APE. The presence of persistent dyspnea, functional limitations, and/or decreased quality of life after an APE has been recently termed "PPES," although this entity encompasses different manifestations. The most severe cause of persistent dyspnea is chronic thromboembolic pulmonary hypertension, where increased pulmonary artery pressure is due to the fibrotic organization of unresolved APE. Post-PE Syndrome is not always systematically addressed in management guidelines, and its prevalence may be underestimated. More research is needed to fully understand its causes and risk factors. Interventions such as cardiopulmonary rehabilitation have been suggested to improve the quality of life of patients with PPES. A comprehensive, evidence-based approach is essential to effectively prevent and manage PPES and improve the long-term outcomes and well-being of affected patients.
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Affiliation(s)
| | - Guillermo Cueto-Robledo
- Cardiorespiratory Emergencies, Hospital General de México "Dr Eduardo Liceaga", Mexico City, Mexico
- Pulmonary Circulation Clinic, Hospital General de México "Dr Eduardo Liceaga", Mexico City, Mexico
- Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Dulce-Iliana Navarro-Vergara
- Doctorate Program in Biomedical Sciences, Postgraduate Unit, National Autonomous University of Mexico, Mexico City, Mexico
- Cardiorespiratory Emergencies, Hospital General de México "Dr Eduardo Liceaga", Mexico City, Mexico
| | - Marisol Garcia-Cesar
- Doctorate Program in Biomedical Sciences, Postgraduate Unit, National Autonomous University of Mexico, Mexico City, Mexico
- Cardiorespiratory Emergencies, Hospital General de México "Dr Eduardo Liceaga", Mexico City, Mexico
| | - Maria-Berenice Torres-Rojas
- Doctorate Program in Biomedical Sciences, Postgraduate Unit, National Autonomous University of Mexico, Mexico City, Mexico
- Cardiorespiratory Emergencies, Hospital General de México "Dr Eduardo Liceaga", Mexico City, Mexico
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20
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Moore J, Altschul E, Remy-Jardin M, Raoof S. Chronic Thromboembolic Pulmonary Hypertension: Clinical and Imaging Evaluation. Clin Chest Med 2024; 45:405-418. [PMID: 38816096 DOI: 10.1016/j.ccm.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a complication of pulmonary embolism and is an important cause of pulmonary hypertension. As a clinical entity, it is frequently underdiagnosed with prolonged diagnostic delays. This study reviews the clinical and radiographic findings associated with CTEPH to improve awareness and recognition. Strengths and limitations of multiple imaging modalities are reviewed. Accompanying images are provided to supplement the text and provide examples of important findings for the reader.
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Affiliation(s)
- Jonathan Moore
- Department of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, Northwell Health Physician Partners, New York, NY, USA
| | - Erica Altschul
- Department of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, Northwell Health Physician Partners, New York, NY, USA
| | - Martine Remy-Jardin
- Department of Thoracic Imaging, Univ.Lille, CHU Lille, LILLE F-59000, France; Univ.Lille, CHU Lille, ULR 2694 METRICS Evaluation des Technologies de Santé et des Pratiques Médicales, LILLE F-59000, France
| | - Suhail Raoof
- Department of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, Northwell Health Physician Partners, New York, NY, USA.
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21
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Lang IM, Delcroix M. Preexisting Chronic Thromboembolic Pulmonary Hypertension in Acute Pulmonary Embolism? A Case Report and Discussion. Hamostaseologie 2024; 44:193-196. [PMID: 37903615 PMCID: PMC11216777 DOI: 10.1055/a-2173-7712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/07/2023] [Indexed: 11/01/2023] Open
Abstract
A 61-year-old male presented with New York Heart Association class II breathlessness. Three years earlier, he had presented with a swollen leg, had received a diagnosis of deep vein thrombosis on ultrasound and of low-risk acute pulmonary embolism, and had been discharged on a direct oral anticoagulant after 8 hours. The patient also had a history of thyroidectomy and was on levothyroxine substitution. The case illustrates a patient with acute pulmonary embolism who developed chronic thrombotic pulmonary vascular lesions within 3 years after acute pulmonary embolism in the presence of typical risk factors.
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Affiliation(s)
- Irene M. Lang
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Center for Cardiovascular Medicine, Vienna, Austria
| | - Marion Delcroix
- Department of Chronic Diseases and Metabolism (CHROMETA), Clinical Department of Respiratory Diseases, University Hospitals of Leuven, and Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven - University of Leuven, Leuven, Belgium
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22
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Páez-Carpio A, Vollmer I, Zarco FX, Matute-González M, Domenech-Ximenos B, Serrano E, Barberà JA, Blanco I, Gómez FM. Imaging of chronic thromboembolic pulmonary hypertension before, during and after balloon pulmonary angioplasty. Diagn Interv Imaging 2024; 105:215-226. [PMID: 38413273 DOI: 10.1016/j.diii.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 02/29/2024]
Abstract
Balloon pulmonary angioplasty (BPA) has recently been elevated as a class I recommendation for the treatment of inoperable or residual chronic thromboembolic pulmonary hypertension (CTEPH). Proper patient selection, procedural safety, and post-procedural evaluation are crucial in the management of these patients, with imaging work-up playing a pivotal role. Understanding the diagnostic and therapeutic imaging algorithms of CTEPH, the imaging features of patients amenable to BPA, all imaging findings observed during and immediately after the procedure and the changes observed during the follow-up is crucial for all interventional radiologists involved in the care of patients with CTEPH. This article illustrates the imaging work-up of patients with CTEPH amenable to BPA, the imaging findings observed before, during and after BPA, and provides a detailed description of all imaging modalities available for CTEPH evaluation.
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Affiliation(s)
- Alfredo Páez-Carpio
- Department of Radiology, CDI, Hospital Clínic Barcelona, Barcelona 08036, Spain; Department of Medical Imaging, University of Toronto, Toronto M5T 1W7, ON, Canada; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona 08036, Spain.
| | - Ivan Vollmer
- Department of Radiology, CDI, Hospital Clínic Barcelona, Barcelona 08036, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona 08036, Spain
| | - Federico X Zarco
- Department of Radiology, CDI, Hospital Clínic Barcelona, Barcelona 08036, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona 08036, Spain
| | | | | | - Elena Serrano
- Department of Radiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat 08907, Spain
| | - Joan A Barberà
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona 08036, Spain; Department of Pulmonary Medicine, ICR, Hospital Clínic Barcelona, Barcelona 08036, Spain; Biomedical Research Networking Centre on Respiratory Diseases (CIBERES), Madrid 28029, Spain
| | - Isabel Blanco
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona 08036, Spain; Department of Pulmonary Medicine, ICR, Hospital Clínic Barcelona, Barcelona 08036, Spain; Biomedical Research Networking Centre on Respiratory Diseases (CIBERES), Madrid 28029, Spain
| | - Fernando M Gómez
- Interventional Radiology Unit, Department of Radiology, Hospital Universitari i Politècnic La Fe, València 46026, Spain; Interventional Radiology Unit, Department of Radiology, The Netherlands Cancer Institute, Amsterdam 1066 CX, the Netherlands
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23
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Zhang D, Zhang Z, Zhen Y, Liu X, Fan X, Ye Z, Liu P. New-onset postoperative atrial fibrillation after pulmonary endarterectomy is associated with adverse outcomes. Front Surg 2024; 11:1380570. [PMID: 38872724 PMCID: PMC11169783 DOI: 10.3389/fsurg.2024.1380570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/10/2024] [Indexed: 06/15/2024] Open
Abstract
Background New-onset postoperative atrial fibrillation (POAF) is a common complication after pulmonary thromboendarterectomy (PEA), yet the risk factors and their impact on prognosis remain poorly understood. This study aims to investigate the risk factors associated with new-onset POAF after PEA and elucidate its underlying connection with adverse postoperative outcomes. Methods A retrospective analysis included 129 consecutive chronic thromboembolic pulmonary hypertension (CTEPH) patients and 16 sarcoma patients undergoing PEA. Univariate and multivariate analyses were conducted to examine the potential effects of preoperative and intraoperative variables on new-onset POAF following PEA. Propensity score matching (PSM) was then employed to adjust for confounding factors. Results Binary logistic regression revealed that age (odds ratio [OR] = 1.041, 95% confidence interval [CI] = 1.008-1.075, p = 0.014) and left atrial diameter[LAD] (OR = 1.105, 95% CI = 1.025-1.191, p = 0.009) were independent risk factors for new-onset POAF after PEA. The receiver operating characteristic (ROC) curve indicated that the predictive abilities of age and LAD for new-onset POAF were 0.652 and 0.684, respectively. Patients with new-onset POAF, compared with those without, exhibited a higher incidence of adverse outcomes (in-hospital mortality, acute heart failure, acute kidney insufficiency, reperfusion pulmonary edema). Propensity score matching (PSM) analyses confirmed the results. Conclusion Advanced age and LAD independently contribute to the risk of new-onset POAF after PEA. Patients with new-onset POAF are more prone to adverse outcomes. Therefore, heightened vigilance and careful monitoring of POAF after PEA are warranted.
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Affiliation(s)
- Dingkai Zhang
- China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Zhaohua Zhang
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
- Department of Cardiovascular Surgery, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Yanan Zhen
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Xiaopeng Liu
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Xueqiang Fan
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Zhidong Ye
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Peng Liu
- China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
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24
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Carlozzi LN, Lin CH, Steinberg ZL. Balloon Pulmonary Angioplasty for the Treatment of Chronic Thromboembolic Pulmonary Hypertension. Methodist Debakey Cardiovasc J 2024; 20:57-64. [PMID: 38765209 PMCID: PMC11100548 DOI: 10.14797/mdcvj.1347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/23/2024] [Indexed: 05/21/2024] Open
Abstract
Chronic thromboembolic pulmonary hypertension is a rare form of pulmonary hypertension in patients who have evidence of chronic thromboembolic occlusion of the pulmonary vasculature. Historically, surgical pulmonary thromboendarterectomy has been the treatment of choice. However, with up to 40% of patients deemed inoperable, balloon pulmonary angioplasty has emerged as an additional treatment strategy. Balloon pulmonary angioplasty is a complementary strategy alongside surgical pulmonary thromboendarterectomy and offers the opportunity for pulmonary revascularization in patients who have more distal disease, higher comorbidities, or residual obstruction following operative intervention. This review examines the history of balloon pulmonary angioplasty, highlights its effectiveness, discusses important complications and risk reduction strategies, and emphasizes the importance of centers forming a multidisciplinary team of providers to manage the complexity of patients with chronic thromboembolic pulmonary hypertension.
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Affiliation(s)
| | - C. Huie Lin
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
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25
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Bertici RA, Bertici NS, Ridichie A, Fira-Mladinescu O. Comorbidities, Treatment and Survival Rates of Chronic Thromboembolic Pulmonary Hypertension in a Regional Centre. J Clin Med 2024; 13:2754. [PMID: 38792295 PMCID: PMC11122045 DOI: 10.3390/jcm13102754] [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: 04/01/2024] [Revised: 04/24/2024] [Accepted: 05/03/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by a multitude of underlying causes, treatment modalities and prognostic outcomes. Our aim was to evaluate the underlying causes, comorbidities and survival rates of CTEPH patients. Methods: A retrospective analysis was conducted regarding the evolution of CTEPH patients confirmed by right heart catheterization under treatment with specific vasodilator medication in our centre between 2008 and 2023. Results: We treated 14 CTEPH patients, 78.57% female, 52.79 ± 13.64 years at inclusion, representing 11.29% of our pulmonary arterial hypertension registry. Initially, the distribution of patients' NYHA class was II-14.28%, III-71.42% and IV-14.28%. In total, 71.42% of these patients were technically operable due to the central location of the thrombus, but 42.85% presented severe comorbidities and 28.57% refused the surgery or it was financially inaccessible. Only four patients were operated on by pulmonary endarterectomy (PEA). Unfortunately, all the post-PEA patients had persistent pulmonary hypertension and had to continue vasodilator treatment. Overall, 64.28% of patients had monotherapy, 21.42% double therapy and 14.28% triple therapy. Regarding underlying causes and comorbidities, we found the following incidences: 78.57% chronic venous insufficiency, 42.85% obesity, 35.71% thyroid disease, hypertension and hyperuricemia, 21.42% thrombophilia and ischemic heart disease, 14.28% atrial fibrillation, vasculitis and lung disease, and 14.28% neoplastic history and diabetes. Seven patients died (50%), six of whom were unoperated and one of whom was lost (abandoned the program). The survival rates at 1, 3, 5 and 7 years for unoperated patients were 100%, 58.3%, 29.2% and 29.2% versus 100%, 75%, 75% and 75% in post-PEA patients. Conclusions: CTEPH, marked by delayed diagnosis, multiple comorbidities and limited intervention options, requires proactive screening and comprehensive multimodal therapies, including PEA, to improve survival rates.
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Affiliation(s)
- Razvan Adrian Bertici
- Department XIII Pulmonology, Victor Babes University of Medicine and Pharmacy Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania; (R.A.B.); (O.F.-M.)
| | - Nicoleta Sorina Bertici
- Department XIII Pulmonology, Victor Babes University of Medicine and Pharmacy Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania; (R.A.B.); (O.F.-M.)
- Clinical Hospital of Infectious Diseases and Pulmonology Victor Babes Timisoara, Gheorghe Adam Street 13, 300310 Timisoara, Romania
| | - Amalia Ridichie
- Advanced Instrumental Screening Center, Faculty of Pharmacy, Victor Babes University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania;
| | - Ovidiu Fira-Mladinescu
- Department XIII Pulmonology, Victor Babes University of Medicine and Pharmacy Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania; (R.A.B.); (O.F.-M.)
- Clinical Hospital of Infectious Diseases and Pulmonology Victor Babes Timisoara, Gheorghe Adam Street 13, 300310 Timisoara, Romania
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26
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Kayali SM, Dietz BE, Siddiq BS, Ghaly M, Owens TS, Khouzam RN. Chronic thromboembolic pulmonary hypertension and balloon pulmonary angioplasty - Where are we in 2024? Curr Probl Cardiol 2024; 49:102481. [PMID: 38401824 DOI: 10.1016/j.cpcardiol.2024.102481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/20/2024] [Indexed: 02/26/2024]
Abstract
Pulmonary endarterectomy (PEA) is the first-line treatment for patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, some patients with CTEPH are considered inoperable, and in the last decade, balloon pulmonary angioplasty (BPA) has emerged as a viable therapeutic option for these patients with prohibitive surgical risk or recurrent pulmonary hypertension following PEA. Numerous international centers have increased their procedural volume of BPA and have reported improvements in pulmonary hemodynamics, patient functional class and right ventricular function. Randomized controlled trials have also demonstrated similar findings. Recent refinements in procedural technique, increased operator experience and advancements in procedural technology have facilitated marked reduction in the risk of complications following BPA. Current guidelines recommend BPA for patients with inoperable CTEPH and persistent pulmonary hypertension following PEA. The pulmonary arterial endothelium plays a vital role in the pathophysiologic development and progression of CTEPH.
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Affiliation(s)
- Sharif M Kayali
- University of Tennessee Health Sciences Center, Department of Cardiovascular Medicine, Memphis, TN.
| | - Bernhard E Dietz
- University of Tennessee Health Sciences Center, Department of Internal Medicine, Memphis, TN
| | - Bilal S Siddiq
- University of Tennessee Health Sciences Center, College of Medicine, Memphis, TN
| | - Michael Ghaly
- Baptist Memorial Hospital - North Mississippi, Department of Internal Medicine, Oxford, MS
| | - Timothy S Owens
- University of Tennessee Health Sciences Center, College of Medicine, Memphis, TN
| | - Rami N Khouzam
- Interventional Cardiologist at the Grand Strand Medical Center, Myrtle Beach, SC; Professor, School of Medicine, University of South Carolina, Columbia SC; Professor, Edward Via College of Osteopathic Medicine, Blacksburg, VA; Professor, at the Mercer School of Medicine, Savannah, GA; Professor, University of Tennessee College of Medicine, Memphis, TN
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Li X, Zhang Y, Zhao Q, Yang T, Zeng Q, Jin Q, Duan A, Huang Z, Hu M, Zhang S, Gao L, Xiong C, Luo Q, Zhao Z, Liu Z. Usefulness of risk assessment tools in predicting hemodynamic outcome after balloon pulmonary angioplasty: a comparative analysis. Postgrad Med 2024; 136:446-455. [PMID: 38785198 DOI: 10.1080/00325481.2024.2358745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/15/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES Several parameters of widely used risk assessment tools for pulmonary arterial hypertension (PAH) have been linked to hemodynamic outcomes of balloon pulmonary angioplasty (BPA). Therefore, we aimed to determine whether these risk assessment tools could be used to predict hemodynamic outcomes following BPA. METHODS In this retrospective study, we included 139 patients with chronic thromboembolic pulmonary hypertension who had undergone BPA at Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College (Beijing, China). We compared the accuracies of seven well-validated risk assessment tools for predicting hemodynamic outcomes following BPA. A favorable hemodynamic outcome was defined as a mean pulmonary arterial pressure < 30 mmHg at follow-up. RESULTS The baseline risk profiles varied significantly among the risk assessment tools. The US Registry to Evaluate Early and Long-Term PAH Disease Management risk scales and the French risk assessment tools rated most patients as high-risk, while the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA) series and laboratory examination-based risk scales categorized most patients as having intermediate-risk profile. COMPERA 2.0 (4-strata) exhibited the highest predictive power among all risk stratifications. Noninvasive risk stratification (COMPERA 2.0 [3-strata]) showed a comparable predictive ability to that of invasive risk stratification (COMPERA 1.0) (area under the curve 0.649 vs. 0.648). Moreover, incorporating diffusing capacity of the lungs for carbon monoxide and tricuspid regurgitation velocity into COMPERA 2.0 (4-strata) further enhanced its predictive power (net reclassification index 0.153, 95% confidence interval 0.009-0.298, p = 0.038). Additionally, this refined COMPERA version had a high calibration accuracy (slope 0.96). CONCLUSION Although the risk strata distribution varied among different risk assessment tools, the proportion of patients achieving favorable hemodynamics decreased with the escalation of risk stratification in most models. The well-validated risk assessment tools for PAH could also predict hemodynamic outcomes following BPA, and the refined COMPERA 2.0 model exhibited the highest predictive ability among these. Applying risk assessment tools before BPA can facilitate early identification of patients in need of closer monitoring and more intensive interventions, contributing to a better prognosis after BPA.
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Affiliation(s)
- Xin Li
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Zhang
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of ICU, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qing Zhao
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tao Yang
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qixian Zeng
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Jin
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Anqi Duan
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhihua Huang
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meixi Hu
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sicheng Zhang
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Luyang Gao
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Changming Xiong
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qin Luo
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhihui Zhao
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhihong Liu
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Ley L, Messmer F, Vaisnora L, Ghofrani HA, Bandorski D, Kostrzewa M. Electrocardiographic Changes after Endovascular Mechanical Thrombectomy in a Patient with Pulmonary Embolism-A Case Report and Literature Review. J Clin Med 2024; 13:2548. [PMID: 38731076 PMCID: PMC11084833 DOI: 10.3390/jcm13092548] [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: 03/05/2024] [Revised: 03/24/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Pulmonary embolism (PE) is a common disease with an annual incidence of about 1/1000 persons. About every sixth patient dies within the first 30 days after diagnosis. The electrocardiogram (ECG) is one of the first diagnostic tests performed, and is able to confirm the suspicion of PE with typical electrocardiographic signs. Some ECG signs and their regression are also prognostically relevant. Endovascular mechanical thrombectomy is one option for PE treatment, and aims to relieve right heart strain immediately. The first studies on endovascular mechanical thrombectomy using a dedicated device (FlowTriever System, Inari Medical, Irvine, CA, USA) yielded promising results. Methods: In the following, we report the case of a 66-year-old male patient who presented with New York Heart Association III dyspnea in our emergency department. Among typical clinical and laboratory results, he displayed very impressive electrocardiographic and radiological findings at the time of PE diagnosis. Results: After endovascular mechanical thrombectomy, the patient's complaints and pulmonary hemodynamics improved remarkably. In contrast, the ECG worsened paradoxically 18 h after intervention. Nevertheless, control echocardiography 4 days after the intervention no longer showed any signs of right heart strain, and dyspnea had disappeared completely. At a 4-month follow-up visit, the patient presented as completely symptom-free with a high quality of life. His ECG and echocardiography were normal and excluded recurrent right heart strain. Conclusions: Overall, the patient benefitted remarkably from endovascular mechanical thrombectomy, resulting in an almost complete resolution of electrocardiographic PE signs at the 4-month follow-up after exhibiting multiple typical electrocardiographic PE signs at time of diagnosis and initial electrocardiographic worsening 18 h post successful intervention.
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Affiliation(s)
- Lukas Ley
- Department of Radiology, Baden Cantonal Hospital, 5404 Baden, Switzerland; (F.M.); (M.K.)
- Campus Kerckhoff, Justus-Liebig-University Giessen, 61231 Bad Nauheim, Germany
| | - Florian Messmer
- Department of Radiology, Baden Cantonal Hospital, 5404 Baden, Switzerland; (F.M.); (M.K.)
| | - Lukas Vaisnora
- Department of Cardiology, Baden Cantonal Hospital, 5404 Baden, Switzerland;
| | | | - Dirk Bandorski
- Faculty of Medicine, Semmelweis University Campus Hamburg, 20099 Hamburg, Germany;
| | - Michael Kostrzewa
- Department of Radiology, Baden Cantonal Hospital, 5404 Baden, Switzerland; (F.M.); (M.K.)
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Chatzelas DA, Pitoulias AG, Bontinis V, Zampaka TN, Tsamourlidis GV, Bontinis A, Potouridis AG, Tachtsi MD, Pitoulias GA. Can Routine Investigation for Occult Pulmonary Embolism Be Justified in Patients with Deep Vein Thrombosis? Vasc Specialist Int 2024; 40:12. [PMID: 38661144 PMCID: PMC11046297 DOI: 10.5758/vsi.240017] [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: 02/01/2024] [Revised: 03/27/2024] [Accepted: 04/02/2024] [Indexed: 04/26/2024] Open
Abstract
Purpose This study aims to investigate whether routine screening for silent pulmonary embolism (PE) can be justified in patients with deep vein thrombosis (DVT). Materials and Methods We retrospectively analyzed the medical records of 201 patients with lower-extremity DVT admitted to the vascular surgery department of a single tertiary university center between 2019 and 2023. All patients underwent clinical evaluation, basic laboratory exams, a whole-leg colored duplex ultrasound, and a computed tomography pulmonary angiography (CTPA), to screen for an occult, underlying PE. Results The overall incidence of silent PE was 48.8%. The median admission D-dimer level was significantly higher in patients with silent PE than in those without PE (9.60 vs. 5.51 mg/L, P=0.001). A D-dimer value ≥5.14 mg/L was discriminant for predicting silent PE, with a sensitivity of 68.2% and a specificity of 59.3%. Silent PE was significantly more common on the right side, with the embolus located at the main pulmonary, lobar, segmental, and subsegmental arteries in 29.6%, 32.7%, 20.4%, and 17.3%, respectively. A higher incidence of occult PE was observed in patients with iliofemoral DVT (P=0.037), particularly when the thrombus extended to the inferior vena cava (P=0.003). Moreover, iliofemoral DVT was associated with a larger size and a more proximal location of the embolus (P=0.041). Multivariate logistic regression showed that male sex (odds ratio [OR]=2.46, 95% confidence interval [CI]: 1.39-3.53; P=0.026), cancer (OR=2.76, 95% CI: 1.45-4.07; P=0.017), previous venous thromboembolism (VTE) history (OR=2.67, 95% CI: 1.33-4.01; P=0.022), D-dimer value ≥5.14 mg/L (OR=2.24, 95% CI: 1.10-3.38; P=0.033), iliofemoral DVT (OR=2.13, 95% CI: 1.19-3.07; P=0.041), and thrombus extension to the IVC (OR=2.95, 95% CI: 1.43-4.47; P=0.009) served as independent predictors for silent PE. Conclusion A high incidence of silent PE was observed in patients with lower-extremity DVT. Screening of patients with DVT who have the aforementioned predictive risk factors using CTPA for silent PE may be needed and justified for the efficient management of VTE and its long-term complications.
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Affiliation(s)
- Dimitrios A. Chatzelas
- Division of Vascular Surgery, 2nd Department of Surgery, Faculty of Medicine, “G. Gennimatas” General Hospital of Thessaloniki, Greece
| | - Apostolos G. Pitoulias
- Division of Vascular Surgery, 2nd Department of Surgery, Faculty of Medicine, “G. Gennimatas” General Hospital of Thessaloniki, Greece
| | - Vangelis Bontinis
- Department of Vascular Surgery, Faculty of Medicine, “AHEPA” University Hospital of Thessaloniki, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodosia N. Zampaka
- Division of Vascular Surgery, 2nd Department of Surgery, Faculty of Medicine, “G. Gennimatas” General Hospital of Thessaloniki, Greece
| | - Georgios V. Tsamourlidis
- Division of Vascular Surgery, 2nd Department of Surgery, Faculty of Medicine, “G. Gennimatas” General Hospital of Thessaloniki, Greece
| | - Alkis Bontinis
- Department of Vascular Surgery, Faculty of Medicine, “AHEPA” University Hospital of Thessaloniki, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasios G. Potouridis
- Division of Vascular Surgery, 2nd Department of Surgery, Faculty of Medicine, “G. Gennimatas” General Hospital of Thessaloniki, Greece
| | - Maria D. Tachtsi
- Division of Vascular Surgery, 2nd Department of Surgery, Faculty of Medicine, “G. Gennimatas” General Hospital of Thessaloniki, Greece
| | - Georgios A. Pitoulias
- Division of Vascular Surgery, 2nd Department of Surgery, Faculty of Medicine, “G. Gennimatas” General Hospital of Thessaloniki, Greece
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Abdulaal L, Maiter A, Salehi M, Sharkey M, Alnasser T, Garg P, Rajaram S, Hill C, Johns C, Rothman AMK, Dwivedi K, Kiely DG, Alabed S, Swift AJ. A systematic review of artificial intelligence tools for chronic pulmonary embolism on CT pulmonary angiography. FRONTIERS IN RADIOLOGY 2024; 4:1335349. [PMID: 38654762 PMCID: PMC11035730 DOI: 10.3389/fradi.2024.1335349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/26/2024] [Indexed: 04/26/2024]
Abstract
Background Chronic pulmonary embolism (PE) may result in pulmonary hypertension (CTEPH). Automated CT pulmonary angiography (CTPA) interpretation using artificial intelligence (AI) tools has the potential for improving diagnostic accuracy, reducing delays to diagnosis and yielding novel information of clinical value in CTEPH. This systematic review aimed to identify and appraise existing studies presenting AI tools for CTPA in the context of chronic PE and CTEPH. Methods MEDLINE and EMBASE databases were searched on 11 September 2023. Journal publications presenting AI tools for CTPA in patients with chronic PE or CTEPH were eligible for inclusion. Information about model design, training and testing was extracted. Study quality was assessed using compliance with the Checklist for Artificial Intelligence in Medical Imaging (CLAIM). Results Five studies were eligible for inclusion, all of which presented deep learning AI models to evaluate PE. First study evaluated the lung parenchymal changes in chronic PE and two studies used an AI model to classify PE, with none directly assessing the pulmonary arteries. In addition, a separate study developed a CNN tool to distinguish chronic PE using 2D maximum intensity projection reconstructions. While another study assessed a novel automated approach to quantify hypoperfusion to help in the severity assessment of CTEPH. While descriptions of model design and training were reliable, descriptions of the datasets used in training and testing were more inconsistent. Conclusion In contrast to AI tools for evaluation of acute PE, there has been limited investigation of AI-based approaches to characterising chronic PE and CTEPH on CTPA. Existing studies are limited by inconsistent reporting of the data used to train and test their models. This systematic review highlights an area of potential expansion for the field of AI in medical image interpretation.There is limited knowledge of A systematic review of artificial intelligence tools for chronic pulmonary embolism in CT. This systematic review provides an assessment on research that examined deep learning algorithms in detecting CTEPH on CTPA images, the number of studies assessing the utility of deep learning on CTPA in CTEPH was unclear and should be highlighted.
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Affiliation(s)
- Lojain Abdulaal
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, United Kingdom
- Faculty of Applied Medical Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed Maiter
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, United Kingdom
- Respiratory Physiology Department, Sheffield Pulmonary Vascular Disease Unit, Sheffield, United Kingdom
- Department of Clinical Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Mahan Salehi
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, United Kingdom
| | - Michael Sharkey
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, United Kingdom
| | - Turki Alnasser
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, United Kingdom
| | - Pankaj Garg
- Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Smitha Rajaram
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, United Kingdom
- Respiratory Physiology Department, Sheffield Pulmonary Vascular Disease Unit, Sheffield, United Kingdom
- Department of Clinical Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Catherine Hill
- Respiratory Physiology Department, Sheffield Pulmonary Vascular Disease Unit, Sheffield, United Kingdom
- Department of Clinical Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Christopher Johns
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, United Kingdom
- Respiratory Physiology Department, Sheffield Pulmonary Vascular Disease Unit, Sheffield, United Kingdom
- Department of Clinical Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Alex Matthew Knox Rothman
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, United Kingdom
| | - Krit Dwivedi
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, United Kingdom
- Respiratory Physiology Department, Sheffield Pulmonary Vascular Disease Unit, Sheffield, United Kingdom
| | - David G. Kiely
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, United Kingdom
- Faculty of Engineering, INSIGNEO Institute, Institute for in Silico Medicine, The University of Sheffield, Sheffield, United Kingdom
- Sheffield Biomedical Research Centre, National Institute for Health Research, Sheffield, United Kingdom
| | - Samer Alabed
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, United Kingdom
- Department of Clinical Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
- Faculty of Engineering, INSIGNEO Institute, Institute for in Silico Medicine, The University of Sheffield, Sheffield, United Kingdom
| | - Andrew James Swift
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, United Kingdom
- Department of Clinical Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
- Faculty of Engineering, INSIGNEO Institute, Institute for in Silico Medicine, The University of Sheffield, Sheffield, United Kingdom
- Sheffield Biomedical Research Centre, National Institute for Health Research, Sheffield, United Kingdom
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Aggarwal V, Giri J, Visovatti SH, Mahmud E, Matsubara H, Madani M, Rogers F, Gopalan D, Rosenfield K, McLaughlin VV. Status and Future Directions for Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Disease With and Without Pulmonary Hypertension: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e1090-e1107. [PMID: 38450477 DOI: 10.1161/cir.0000000000001197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Balloon pulmonary angioplasty continues to gain traction as a treatment option for patients with chronic thromboembolic pulmonary disease with and without pulmonary hypertension. Recent European Society of Cardiology guidelines on pulmonary hypertension now give balloon pulmonary angioplasty a Class 1 recommendation for inoperable and residual chronic thromboembolic pulmonary hypertension. Not surprisingly, chronic thromboembolic pulmonary hypertension centers are rapidly initiating balloon pulmonary angioplasty programs. However, we need a comprehensive, expert consensus document outlining critical concepts, including identifying necessary personnel and expertise, criteria for patient selection, and a standardized approach to preprocedural planning and establishing criteria for evaluating procedural efficacy and safety. Given this lack of standards, the balloon pulmonary angioplasty skill set is learned through peer-to-peer contact and training. This document is a state-of-the-art, comprehensive statement from key thought leaders to address this gap in the current clinical practice of balloon pulmonary angioplasty. We summarize the current status of the procedure and provide a consensus opinion on the role of balloon pulmonary angioplasty in the overall care of patients with chronic thromboembolic pulmonary disease with and without pulmonary hypertension. We also identify knowledge gaps, provide guidance for new centers interested in initiating balloon pulmonary angioplasty programs, and highlight future directions and research needs for this emerging therapy.
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Vohra AS, Olonoff DA, Ip A, Kirtane AJ, Steinberg Z, Horn E, Krishnan U, Reisman M, Bergman G, Wong S, Feldman DN, Kim LK, Singh HS. Nationwide trends of balloon pulmonary angioplasty and pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension (2012-2019). Pulm Circ 2024; 14:e12374. [PMID: 38736894 PMCID: PMC11082429 DOI: 10.1002/pul2.12374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 03/03/2024] [Accepted: 03/19/2024] [Indexed: 05/14/2024] Open
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a sequela of a pulmonary embolus that occurs in approximately 1%-3% of patients. Pulmonary thromboendoarterectomy (PTE) can be a curative procedure, but balloon pulmonary angioplasty (BPA) has emerged as an option for poor surgical candidates. We used the National Inpatient Sample to query patients who underwent PTE or BPA between 2012 and 2019 with CTEPH. The primary outcome was a composite of in-hospital mortality, myocardial infarction, stroke, tracheostomy, and prolonged mechanical ventilation. Outcomes were compared between low- and high-volume centers, defined as 5 and 10 procedures per year for BPA and PTE, respectively. During our study period, 870 BPA and 2395 PTE were performed. There was a 328% relative increase in the number of PTE performed during the study period. Adverse events for BPA were rare. There was an increase in the primary composite outcome for low-volume centers compared to high-volume centers for PTE (24.4% vs. 12.1%, p = 0.003). Patients with hospitalizations for PTE in low-volume centers were more likely to have prolonged mechanical ventilation (20.0%% vs. 7.2%, p < 0.001) and tracheostomy (7.8% vs. 2.6%, p = 0.017). In summary, PTE rates have been rising over the past 10 years, while BPA rates have remained stable. While adverse outcomes are rare for BPA, patients with hospitalizations at low-volume centers for PTE were more likely to have adverse outcomes. For patients undergoing treatment of CTEPH with BPA or PTE, referral to high-volume centers with multidisciplinary teams should be encouraged for optimal outcomes.
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Affiliation(s)
- Adam S. Vohra
- Department of Medicine, Division of CardiologyWeill Cornell Medical CollegeNew YorkNew YorkUSA
| | | | - Ada Ip
- Department of Medicine, Division of CardiologyWeill Cornell Medical CollegeNew YorkNew YorkUSA
| | - Ajay J. Kirtane
- Department of Medicine, Division of CardiologyColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Zachary Steinberg
- Department of Medicine, Division of CardiologyUniversity of WashingtonSeattleWashingtonUSA
| | - Evelyn Horn
- Department of Medicine, Division of CardiologyWeill Cornell Medical CollegeNew YorkNew YorkUSA
| | - Udhay Krishnan
- Department of Medicine, Division of CardiologyWeill Cornell Medical CollegeNew YorkNew YorkUSA
| | - Mark Reisman
- Department of Medicine, Division of CardiologyWeill Cornell Medical CollegeNew YorkNew YorkUSA
| | - Geoffrey Bergman
- Department of Medicine, Division of CardiologyWeill Cornell Medical CollegeNew YorkNew YorkUSA
| | - Shing‐Chiu Wong
- Department of Medicine, Division of CardiologyWeill Cornell Medical CollegeNew YorkNew YorkUSA
| | - Dmitriy N. Feldman
- Department of Medicine, Division of CardiologyWeill Cornell Medical CollegeNew YorkNew YorkUSA
| | - Luke K. Kim
- Department of Medicine, Division of CardiologyWeill Cornell Medical CollegeNew YorkNew YorkUSA
| | - Harsimran S. Singh
- Department of Medicine, Division of CardiologyWeill Cornell Medical CollegeNew YorkNew YorkUSA
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Loosen G, Taboada D, Ortmann E, Martinez G. How Would I Treat My Own Chronic Thromboembolic Pulmonary Hypertension in the Perioperative Period? J Cardiothorac Vasc Anesth 2024; 38:884-894. [PMID: 37716891 DOI: 10.1053/j.jvca.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/04/2023] [Accepted: 07/14/2023] [Indexed: 09/18/2023]
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) results from an incomplete resolution of acute pulmonary embolism, leading to occlusive organized thrombi, vascular remodeling, and associated microvasculopathy with pulmonary hypertension (PH). A definitive CTEPH diagnosis requires PH confirmation by right-heart catheterization and evidence of chronic thromboembolic pulmonary disease on imaging studies. Surgical removal of the organized fibrotic material by pulmonary endarterectomy (PEA) under deep hypothermic circulatory arrest represents the treatment of choice. One-third of patients with CTEPH are not deemed suitable for surgical treatment, and medical therapy or interventional balloon pulmonary angioplasty presents alternative treatment options. Pulmonary endarterectomy in patients with technically operable disease significantly improves symptoms, functional capacity, hemodynamics, and quality of life. Perioperative mortality is <2.5% in expert centers where a CTEPH multidisciplinary team optimizes patient selection and ensures the best preoperative optimization according to individualized risk assessment. Despite adequate pulmonary artery clearance, patients might be prone to perioperative complications, such as right ventricular maladaptation, airway bleeding, or pulmonary reperfusion injury. These complications can be treated conventionally, but extracorporeal membrane oxygenation has been included in their management recently. Patients with residual PH post-PEA should be considered for medical or percutaneous interventional therapy.
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Affiliation(s)
- Gregor Loosen
- Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Basel, Switzerland
| | - Dolores Taboada
- Pulmonary Vascular Diseases Unit, Cambridge National Pulmonary Hypertension Service, Royal Papworth Hospital NHS, Department of Cardiothoracic Anesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Erik Ortmann
- Department of Anesthesiology, Schuechtermann-Heart-Centre, Bad Rothenfelde, Germany
| | - Guillermo Martinez
- Pulmonary Vascular Diseases Unit, Cambridge National Pulmonary Hypertension Service, Royal Papworth Hospital NHS, Department of Cardiothoracic Anesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom.
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Lichtblau M, Reimann L, Piccari L. Pulmonary vascular disease, environmental pollution, and climate change. Pulm Circ 2024; 14:e12394. [PMID: 38933180 PMCID: PMC11205889 DOI: 10.1002/pul2.12394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/19/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024] Open
Abstract
Pollution and climate change constitute a combined, grave and pervasive threat to humans and to the life-support systems on which they depend. Evidence shows a strong association between pollution and climate change on cardiovascular and respiratory diseases, and pulmonary vascular disease (PVD) is no exception. An increasing number of studies has documented the impact of environmental pollution and extreme temperatures on pulmonary circulation and the right heart, on the severity and outcomes of patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension (PH), on the incidence of pulmonary embolism, and the prevalence and severity of diseases associated with PH. Furthermore, the downstream consequences of climate change impair health care systems' accessibility, which could pose unique obstacles in the case of PVD patients, who require a complex and sophisticated network of health interventions. Patients, caretakers and health care professionals should thus be included in the design of policies aimed at adaptation to and mitigation of current challenges, and prevention of further climate change. The purpose of this review is to summarize the available evidence concerning the impact of environmental pollution and climate change on the pulmonary circulation, and to propose measures at the individual, healthcare and community levels directed at protecting patients with PVD.
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Affiliation(s)
- Mona Lichtblau
- Clinic of Pulmonology, Pulmonary Hypertension UnitUniversity Hospital ZurichZurichSwitzerland
| | - Lena Reimann
- Clinic of Pulmonology, Pulmonary Hypertension UnitUniversity Hospital ZurichZurichSwitzerland
| | - Lucilla Piccari
- Department of Pulmonary MedicineHospital del MarBarcelonaSpain
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Ghofrani HA, Simonneau G, D'Armini AM, Fedullo P, Howard LS, Jaïs X, Jenkins DP, Jing ZC, Madani MM, Martin N, Mayer E, Papadakis K, Richard D, Kim NH. Macitentan for the treatment of inoperable chronic thromboembolic pulmonary hypertension (MERIT-1): results from the multicentre, phase 2, randomised, double-blind, placebo-controlled study. THE LANCET. RESPIRATORY MEDICINE 2024; 12:e21-e30. [PMID: 38548406 DOI: 10.1016/s2213-2600(24)00027-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
BACKGROUND Macitentan is beneficial for long-term treatment of pulmonary arterial hypertension. The microvasculopathy of chronic thromboembolic pulmonary hypertension (CTEPH) and pulmonary arterial hypertension are similar. METHODS The phase 2, double-blind, randomised, placebo-controlled MERIT-1 trial assessed macitentan in 80 patients with CTEPH adjudicated as inoperable. Patients identified as WHO functional class II-IV with a pulmonary vascular resistance (PVR) of at least 400 dyn·s/cm5 and a walk distance of 150-450 m in 6 min were randomly assigned (1:1), via an interactive voice/web response system, to receive oral macitentan (10 mg once a day) or placebo. Treatment with phosphodiesterase type-5 inhibitors and oral or inhaled prostanoids was permitted for WHO functional class III/IV patients. The primary endpoint was resting PVR at week 16, expressed as percentage of PVR measured at baseline. Analyses were done in all patients who were randomly assigned to treatment; safety analyses were done in all patients who received at least one dose of the study drug. This study is registered with ClinicalTrials.gov, number NCT02021292. FINDINGS Between April 3, 2014, and March 17, 2016, we screened 186 patients for eligibility at 48 hospitals across 20 countries. Of these, 80 patients in 36 hospitals were randomly assigned to treatment (40 patients to macitentan, 40 patients to placebo). At week 16, geometric mean PVR decreased to 71·5% of baseline in the macitentan group and to 87·6% in the placebo group (geometric means ratio 0·81, 95% CI 0·70-0·95, p=0·0098). The most common adverse events in the macitentan group were peripheral oedema (9 [23%] of 40 patients) and decreased haemoglobin (6 [15%]). INTERPRETATION In MERIT-1, macitentan significantly improved PVR in patients with inoperable CTEPH and was well tolerated. FUNDING Actelion Pharmaceuticals Ltd.
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Affiliation(s)
- Hossein-Ardeschir Ghofrani
- German Center for Lung Research (DZL), Giessen, Germany; University of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany; Department of Medicine, Imperial College London, London, UK.
| | - Gérald Simonneau
- Assistance Publique-Hôpitaux de Paris, Service de Pneumologie, Hôpital Bicêtre, Université Paris-Sud, Laboratoire d'Excellence en Recherche sur le Médicament et Innovation Thérapeutique, Le Kremlin-Bicêtre, France; INSERM U-999, Le Kremlin-Bicêtre, France
| | - Andrea M D'Armini
- Department of Cardio-Thoracic and Vascular Surgery, Heart and Lung Transplantation and Pulmonary Hypertension Unit, Foundation IRCCS Policlinico San Matteo, University of Pavia School of Medicine, Pavia, Italy
| | - Peter Fedullo
- Division of Pulmonary and Critical Care Medicine, University of California San Diego, La Jolla, CA, USA
| | - Luke S Howard
- National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK; National Heart & Lung Institute, Imperial College London, London, UK
| | - Xavier Jaïs
- Assistance Publique-Hôpitaux de Paris, Service de Pneumologie, Hôpital Bicêtre, Université Paris-Sud, Laboratoire d'Excellence en Recherche sur le Médicament et Innovation Thérapeutique, Le Kremlin-Bicêtre, France; INSERM U-999, Le Kremlin-Bicêtre, France
| | - David P Jenkins
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK
| | - Zhi-Cheng Jing
- State Key Lab of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Michael M Madani
- Division of Cardiovascular and Thoracic Surgery, University of California San Diego Medical Center, San Diego, CA, USA
| | | | - Eckhard Mayer
- Department of Thoracic Surgery, Kerckhoff-Clinic, Bad Nauheim, Germany
| | | | | | - Nick H Kim
- Division of Pulmonary and Critical Care Medicine, University of California San Diego, La Jolla, CA, USA
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Suruga K, Shimokawahara H, Miyagi A, Sugiyama Y, Suetomi T, Ogawa A, Matsubara H. Flow Grade-Based Success Rates, Complication Rates, and Balloon Pulmonary Angioplasty Patency for Total Occlusions. Can J Cardiol 2024; 40:625-633. [PMID: 38081510 DOI: 10.1016/j.cjca.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND The number of successfully recanalized total occlusions affects hemodynamic improvement after balloon pulmonary angioplasty (BPA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). We aimed to clarify the current efficacy, patency, and success rate of BPA for total occlusions. METHODS Between April 2016 and August 2021, 178 BPAs were performed in 100 patients with CTEPH and total occlusions. The primary success and subsequent patency rates immediately before the second BPA procedure (follow-up) were compared between the segmental and subsegmental groups, based on the flow grade, which was defined as follows: 0, no reperfusion; 1, minimal reperfusion; 2, partial reperfusion; and 3, complete reperfusion. RESULTS Total occlusions were mainly located in the right lung (70%) and lower lobes (48%). The primary success rate was 88%, with significant improvements in oxygenation, hemodynamic parameters, and 6-minute walk test. The primary flow grade did not differ between groups. However, the proportion of lesions with a flow grade of 2 or 3 at follow-up was significantly higher in the subsegmental group than in the segmental group (84% vs 45%, respectively; P < 0.01). In multivariate analysis, flow grade in the acute phase (odds ratio [OR], 46.9; 95% confidence interval [CI], 12.54-176.78; P < 0.01) and subsegmental lesions (OR, 13.8; 95% CI, 3.24-58.94; P < 0.01) were independently associated with better patency (flow grade of 2 or 3) at follow-up. CONCLUSIONS Total occlusions can be safely and effectively treated with BPA. BPA for total occlusions may be preferable for subsegmental over segmental lesions.
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Affiliation(s)
- Kazuki Suruga
- Department of Cardiology and Clinical Science, NHO Okayama Medical Center, Okayama, Japan
| | - Hiroto Shimokawahara
- Department of Cardiology and Clinical Science, NHO Okayama Medical Center, Okayama, Japan.
| | - Ayane Miyagi
- Department of Cardiology and Clinical Science, NHO Okayama Medical Center, Okayama, Japan
| | - Yoichi Sugiyama
- Department of Cardiology and Clinical Science, NHO Okayama Medical Center, Okayama, Japan
| | - Takeshi Suetomi
- Department of Cardiology and Clinical Science, NHO Okayama Medical Center, Okayama, Japan
| | - Aiko Ogawa
- Department of Cardiology and Clinical Science, NHO Okayama Medical Center, Okayama, Japan
| | - Hiromi Matsubara
- Department of Cardiology and Clinical Science, NHO Okayama Medical Center, Okayama, Japan
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Wang Y, Guo D, Gong J, Wang J, Yang Y, Zhang X, Hu H, Ma Y, Lv X, Li Y. Efficacy of balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension patients with pulmonary comorbidity. IJC HEART & VASCULATURE 2024; 51:101363. [PMID: 38445233 PMCID: PMC10912838 DOI: 10.1016/j.ijcha.2024.101363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/26/2024] [Accepted: 02/11/2024] [Indexed: 03/07/2024]
Abstract
Background Balloon pulmonary angioplasty (BPA) is an established treatment for inoperable chronic thromboembolic pulmonary hypertension (CTEPH), but its efficacy in CTEPH patients with a pulmonary comorbidity has not been well-studied. Here, we compared post-BPA outcomes between CTEPH patients with and without chronic pulmonary disease at baseline and analyzed predictors of BPA success. Methods From August 2017 to October 2022, 62 patients with inoperable CTEPH who underwent BPA were consecutively enrolled and grouped based on the presence of a pulmonary comorbidity at baseline. All patients underwent transthoracic echocardiography, pulmonary function tests, and right heart catheterization. Pre- and post-BPA data were evaluated to identify factors that influence the success of BPA. Results Among the 62 CTEPH patients, BPA was considered successful in 50 patients and unsuccessful in 12 patients. Responders to BPA had better exercise capacity and right heart function at baseline, but no differences in hemodynamic or respiratory function were detected between the groups. In CTEPH patients with chronic pulmonary disease (n = 14), BPA significantly improved mean pulmonary arterial pressure, pulmonary vascular resistance and right heart function parameters. Only CTEPH patients without chronic pulmonary disease (n = 48) exhibited significant improvement in 6-minute walk distance and respiratory function. Multivariate logistic regression analysis showed that pulmonary comorbidity at baseline was independently associated with the efficacy of BPA. Conclusions BPA provided significantly improvements in hemodynamics and right heart function in CTEPH patients, independent of pulmonary comorbidity at baseline. However, pulmonary comorbidity can negatively impact post-BPA outcomes.
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Affiliation(s)
- Yeqing Wang
- Department of Echocardiography, Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Dichen Guo
- Department of Echocardiography, Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Juanni Gong
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jianfeng Wang
- Department of Intervention, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yuanhua Yang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xinyuan Zhang
- Department of Echocardiography, Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Huimin Hu
- Department of Echocardiography, Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yaning Ma
- Department of Echocardiography, Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiuzhang Lv
- Department of Echocardiography, Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yidan Li
- Department of Echocardiography, Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Estrada RA, Auger WR, Sahay S. Chronic Thromboembolic Pulmonary Hypertension. JAMA 2024; 331:972-973. [PMID: 38407914 DOI: 10.1001/jama.2023.24265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
This JAMA Insights discusses the symptoms, diagnosis, and treatment of chronic thromboembolic pulmonary hypertension.
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Affiliation(s)
- Rodolfo A Estrada
- Division of Pulmonary and Critical Care Medicine, UT Health San Antonio, San Antonio, Texas
| | - William R Auger
- Division of Pulmonary, Critical Care and Sleep Medicine, UC San Diego, La Jolla, California
| | - Sandeep Sahay
- Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Hospital, Houston, Texas
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Öngen HG, Akdeniz B, Düzenli MA, Chernyavsky A, Dabar G, Idrees M, Khludeeva E, Kültürsay H, Lukianchikova V, Martynyuk T, Moğulkoç N, Mukarov MA, Mutlu B, Okumuş G, Omarov A, Önen ZP, Sakkijha H, Shostak N, Simakova M, Tokgözoğlu L, Tomskaya T, Yildirim H, Zateyshchikov D, Hechenbichler K, Kessner S, Schauerte I, Turgut N, Vogtländer K, Aldalaan A. Diagnosis and Treatment Patterns of Chronic Thromboembolic Pulmonary Hypertension in Russia, Kazakhstan, Turkey, Lebanon, and Saudi Arabia: A Registry Study. Drugs Real World Outcomes 2024; 11:149-165. [PMID: 38381283 DOI: 10.1007/s40801-023-00407-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2023] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Patients with chronic thromboembolic pulmonary hypertension (CTEPH) in countries with limited resources have, to date, been poorly represented in registries. OBJECTIVE This work assesses the epidemiology, diagnosis, hemodynamic and functional parameters, and treatment of CTEPH in Russia, Kazakhstan, Turkey, Lebanon, and Saudi Arabia. METHODS A prospective, cohort, phase IV, observational registry with 3-year follow-up (n = 212) in patients aged ≥ 18 years diagnosed with CTEPH was created. Clinical, hemodynamic, and functional parameters were obtained at an initial visit, follow-up visits, and a final visit at the end of 3 years' observation or end of follow-up. Data were recorded on electronic case report forms. Parameters evaluated included 6-minute walking distance (6MWD), use of pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA), pulmonary hypertension (PH)-targeted therapy, and survival. All statistical analyses were exploratory and descriptive, and were performed in the overall population. RESULTS The most common symptoms were typical of those expected for CTEPH. Almost 90% of patients underwent right heart catheterization at diagnosis or initial study visit. In total, 66 patients (31%) underwent PEA before the initial visit; 95 patients (45%) were considered operable, 115 (54%) were inoperable, and two (1%) had no operability data. Only 26 patients (12%) had been assessed for BPA at their initial visit. PH-targeted therapy was documented at diagnosis for 77 patients (36%), most commonly a phosphodiesterase type 5 inhibitor (23%). Use of PH-targeted therapy increased to 142 patients (67%) at the initial visit, remaining similar after 3 years. Use of riociguat increased from 6% of patients at diagnosis to 38% at 3 years. Between baseline and end of observation, results for patients with paired data showed an increase in 6MWD. Survival at the end of observation was 88%. CONCLUSIONS These data highlight the current diagnosis and management of CTEPH in the participating countries. They show that early CTEPH diagnosis remains challenging, and use of off-label PH-targeted therapy is common. CLINICALTRIALS gov: NCT02637050; registered December 2015.
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Affiliation(s)
- Hürrem Gül Öngen
- Cerrahpasa Faculty of Medicine, Istanbul University, 34098, Istanbul, Turkey.
| | - Bahri Akdeniz
- Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | | | - Alexander Chernyavsky
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | | | - Majdy Idrees
- Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Elena Khludeeva
- State Budgetary Healthcare Institution, Primorskaya Regional Clinical Hospital No. 1, Vladivostok, Russia
| | | | - Vera Lukianchikova
- Regional State Budgetary Healthcare Institution, Regional Clinical Hospital No. 1, Khabarovsk, Russia
| | - Tamila Martynyuk
- Federal State Budget Institution, National Medical Center of Cardiology, Moscow, Russia
| | | | - Murat A Mukarov
- National Research Cardiac Surgery Center, Astana, Kazakhstan
| | - Bülent Mutlu
- Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Gülfer Okumuş
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Anuar Omarov
- Institute of Cardiology in Almaty, Almaty, Kazakhstan
| | | | | | - Nadezhda Shostak
- State Budgetary Healthcare Institution, Pirogov City Clinical Hospital No. 1 of Moscow City, Moscow, Russia
| | - Maria Simakova
- Federal State Budgetary Institution, Almazov National Medical Research Center, Saint Petersburg, Russia
| | | | - Tatyana Tomskaya
- State Budgetary Institution of the Republic of Sakha (Yakutia), Republican Hospital No. 1, Yakutsk, Russia
| | | | - Dmitry Zateyshchikov
- State Budgetary Healthcare Institution, City Clinical Hospital No. 51 of Moscow Health Department, Moscow, Russia
| | | | | | | | | | | | - Abdullah Aldalaan
- Department of Pulmonary Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Caspersen CK, Ingemann-Molden S, Grove EL, Højen AA, Andreasen J, Klok FA, Rolving N. Performance-based outcome measures for assessing physical capacity in patients with pulmonary embolism: A scoping review. Thromb Res 2024; 235:52-67. [PMID: 38301376 DOI: 10.1016/j.thromres.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/22/2023] [Accepted: 01/10/2024] [Indexed: 02/03/2024]
Abstract
INTRODUCTION Up to 50 % of patients surviving a pulmonary embolism (PE) report persisting shortness of breath, reduced physical capacity and psychological distress. As the PE population is heterogeneous compared to other cardiovascular patient groups, outcome measures for assessing physical capacity traditionally used in cardiac populations may not be reliable for the PE population as a whole. This scoping review aims to 1) map performance-based outcome measures (PBOMs) used for assessing physical capacity in PE research, and 2) to report the psychometric properties of the identified PBOMs in a PE population. METHODS The review was conducted according to the Joanna Briggs Institute framework for scoping reviews and reported according to the PRISMA-Extension for Scoping Reviews guideline. RESULTS The systematic search of five databases identified 4585 studies, of which 243 studies met the inclusion criteria. Of these, 185 studies focused on a subgroup of patients with chronic thromboembolic pulmonary hypertension. Ten different PBOMs were identified in the included studies. The 6-minute walk test (6MWT) and cardiopulmonary exercise test (CPET) were the most commonly used, followed by the (Modified) Bruce protocol and Incremental Shuttle Walk test. No studies reported psychometric properties of any of the identified PBOMs in a PE population. CONCLUSIONS Publication of studies measuring physical capacity within PE populations has increased significantly over the past 5-10 years. Still, not one study was identified, reporting the validity, reliability, or responsiveness for any of the identified PBOMs in a PE population. This should be a priority for future research in the field.
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Affiliation(s)
| | - Stian Ingemann-Molden
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Denmark
| | - Erik Lerkevang Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Anette Arbjerg Højen
- Department of Health Science and Technology, Aalborg University, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Jane Andreasen
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Denmark; Department of Health Science and Technology, Aalborg University, Denmark; Aalborg Health and Rehabilitation Centre, Aalborg Municipality, Denmark
| | - Frederikus A Klok
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, the Netherlands
| | - Nanna Rolving
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Denmark; Department of Public Health, Aarhus University, Denmark.
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Yang KM, Wang MT, Tao CW, Wu YJ, Hsu CH, Liao WC, Hsu HH, Lin MC, Tsai FT, Fu YJ, Kuo FY, Cheng CC, Hung CC, Wang HC, Yu CJ, Huang WC. The long-term outcome of chronic thromboembolic pulmonary hypertension: Pulmonary endarterectomy and balloon pulmonary angioplasty. J Chin Med Assoc 2024; 87:273-279. [PMID: 38252515 DOI: 10.1097/jcma.0000000000001059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND The long-term outcome on patients with chronic thromboembolic pulmonary hypertension (CTEPH) has not been ideal after standard medical treatment. However, good outcome for patients with CTEPH after interventions such as pulmonary endarterectomy (PEA) and balloon pulmonary angioplasty (BPA) has been reported recently. The aim of this study was to evaluate the impact of PEA or BPA on long-term outcomes for CTEPH patients in Han-Chinese population. METHODS This was a multicenter, prospective case-control study. Patients with CTEPH were enrolled between January, 2018 and March, 2020. They were divided into two groups, including intervention (PEA or BPA) and conservative groups. The followed-up period was 26 months after treatment. The endpoints were all-cause mortality and CTEPH mortality. RESULTS A total of 129 patients were enrolled and assigned to receive PEA/BPA (N = 73), or conservative therapy (N = 56). Overall, the 26-month survival rate of all-cause mortality was significantly higher in intervention group compared to that in conservative group (95.89% vs 80.36%; log-rank p = 0.0164). The similar trend was observed in the 26-month survival rate of CTEPH mortality (97.26% vs 85.71%; log-rank p = 0.0355). Regarding Cox proportional-hazard regression analysis, the hazard ratios (HRs) on patients with CTEPH receiving intervention in the outcome of all-cause mortality and CTEPH mortality were statistically significant (HR = 0.07 and p = 0.0141 in all-cause mortality; HR = 0.11 and p = 0.0461 in CTEPH mortality). CONCLUSION This multicenter prospective case-control study demonstrated that intervention such as PEA and BPA increased the long-term survival rate for patient with CTEPH significantly. Intervention was an independent factor in long-term outcome for patients with CTEPH, including all-cause mortality and CTEPH mortality.
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Affiliation(s)
- Kuo-Ming Yang
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Mei-Tzu Wang
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- School of Medicine, National Yang Ming Chaio Tung University, Taipei, Taiwan, ROC
| | - Chi-Wei Tao
- Division of Pulmonary Medicine, Department of Internal Medicine, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC
| | - Yih-Jer Wu
- Department of Medicine, MacKay Medical College and Cardiovascular Center, MacKay Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Chih-Hsin Hsu
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
- Department of Internal Medicine, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, Taiwan, ROC
| | - Wei-Chih Liao
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Hsao-Hsun Hsu
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, ROC
| | - Meng-Chih Lin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Fu-Ting Tsai
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yun-Ju Fu
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Feng-Yu Kuo
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Chin-Chang Cheng
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan, ROC
| | - Cheng-Chung Hung
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Hao-Chien Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC
- Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan, ROC
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, ROC
| | - Wei-Chun Huang
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- School of Medicine, National Yang Ming Chaio Tung University, Taipei, Taiwan, ROC
- Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan, ROC
- Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
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Ribas Sola J, Sánchez-Corral Mena MÁ, Riera-Mestre A. [Update in the management of chronic thrombo-embolic pulmonary hypertension]. Med Clin (Barc) 2024; 162:126-133. [PMID: 37925273 DOI: 10.1016/j.medcli.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 11/06/2023]
Abstract
Chronic thrombo-embolic pulmonary hypertension (CTEPH) is a potentially curable form of pulmonary hypertension (PH) that develops in up to 3% of patients after pulmonary embolism (PE). In these patients, PE does not resolve, leading to organized fibrotic clots, with the development of precapillary PH as a result of the proximal obstruction of the pulmonary arteries. In addition, a distal microvasculopathy may also develop, contributing to the increase of pulmonary vascular resistance. Transthoracic echocardiography is the diagnostic tool that allows to establish the suspicion of PH. Ventilation-perfusion lung scintigraphy is the fundamental tool in the study of patients with suspected CTEPH; if it is normal, virtually rules out the diagnosis. Right heart catheterization is mandatory for the diagnosis of these patients. CTEPH is defined as the existence of symptoms, residual perfusion defects and precapillary PH after a minimum period of three months of anticoagulation. Pulmonary angiography helps determine the extent and surgical accessibility of thromboembolic lesions. CTEPH patients are candidates for long-term anticoagulation. Pulmonary endarterectomy is the treatment of choice, resulting in significant clinical and hemodynamic improvement. About 25% of patients have residual PH post-endarterectomy. Balloon pulmonary angioplasty is an endovascular technique that targets more distal lesions, being potentially useful for patients with inoperable CTEPH or persistent/recurrent PH post-endarterectomy. Both types of patients may also benefit from pharmacological treatment for PH. These three therapies are the cornerstone of CTEPH treatment, which has evolved towards a multimodal approach.
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Affiliation(s)
- Jesús Ribas Sola
- Unidad de Enfermedades Vasculares Pulmonares, Servicio de Neumología, Hospital Universitari de Bellvitge, Barcelona, España; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, España.
| | - Miguel Ángel Sánchez-Corral Mena
- Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, España; Unidad de Imagen Cardiaca Avanzada, Servicio de Cardiología, Hospital Universitari de Bellvitge, Barcelona, España
| | - Antoni Riera-Mestre
- Unidad de Imagen Cardiaca Avanzada, Servicio de Cardiología, Hospital Universitari de Bellvitge, Barcelona, España; Unidad Funcional de ETV, Servicio de Medicina Interna, Hospital Universitari de Bellvitge, Barcelona, España; Facultad de Medicina y Ciencias de la Salud, Universitat de Barcelona, Barcelona, España.
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Cè M, Oliva G, Rabaiotti FL, Macrì L, Zollo S, Aquila A, Cellina M. Portable Dynamic Chest Radiography: Literature Review and Potential Bedside Applications. Med Sci (Basel) 2024; 12:10. [PMID: 38390860 PMCID: PMC10885043 DOI: 10.3390/medsci12010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 02/01/2024] [Accepted: 02/03/2024] [Indexed: 02/24/2024] Open
Abstract
Dynamic digital radiography (DDR) is a high-resolution radiographic imaging technique using pulsed X-ray emission to acquire a multiframe cine-loop of the target anatomical area. The first DDR technology was orthostatic chest acquisitions, but new portable equipment that can be positioned at the patient's bedside was recently released, significantly expanding its potential applications, particularly in chest examination. It provides anatomical and functional information on the motion of different anatomical structures, such as the lungs, pleura, rib cage, and trachea. Native images can be further analyzed with dedicated post-processing software to extract quantitative parameters, including diaphragm motility, automatically projected lung area and area changing rate, a colorimetric map of the signal value change related to respiration and motility, and lung perfusion. The dynamic diagnostic information along with the significant advantages of this technique in terms of portability, versatility, and cost-effectiveness represents a potential game changer for radiological diagnosis and monitoring at the patient's bedside. DDR has several applications in daily clinical practice, and in this narrative review, we will focus on chest imaging, which is the main application explored to date in the literature. However, studies are still needed to understand deeply the clinical impact of this method.
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Affiliation(s)
- Maurizio Cè
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy; (F.L.R.); (L.M.); (A.A.)
| | - Giancarlo Oliva
- Radiology Department, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, 20121 Milan, Italy; (G.O.); (M.C.)
| | - Francesca Lucrezia Rabaiotti
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy; (F.L.R.); (L.M.); (A.A.)
| | - Laura Macrì
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy; (F.L.R.); (L.M.); (A.A.)
| | - Sharon Zollo
- Konica Minolta Business Solutions Europe GmbH, Capellalaan 65, 2132 JL Hoofddorp, The Netherlands;
| | - Alessandro Aquila
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy; (F.L.R.); (L.M.); (A.A.)
| | - Michaela Cellina
- Radiology Department, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, 20121 Milan, Italy; (G.O.); (M.C.)
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Caguana-Vélez OA, Khilzi K, Piccari L, Rodríguez-Sevilla JJ, Badenes-Bonet D, Gonzalez-Garcia J, Chalela R, Arita M, Rodó-Pin A, Herranz A, Admetlló M, Villar-Garcia J, Molina L, Zuccarino F, Gea J, Balcells E, Rodríguez-Chiaradia DA. Chronic Thromboembolic Pulmonary Hypertension after Pulmonary Embolism in SARS-CoV-2. Respiration 2024; 103:79-87. [PMID: 38325355 DOI: 10.1159/000536064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/28/2023] [Indexed: 02/09/2024] Open
Abstract
INTRODUCTION Chronic thromboembolic pulmonary disease (CTEPD) consists of persistent pulmonary vascular obstruction on imaging and involves long-term functional limitations, with or without chronic thromboembolic pulmonary hypertension (CTEPH). The aim of this study was to evaluate the incidence and risk factors of both persistent pulmonary vascular defects and CTEPH after hospitalization in patients with COVID-19 and PE during a 2-year follow-up. METHODS A prospective observational study was carried out in a tertiary hospital center. Patients were hospitalized between March 2020 and December 2021 with a diagnosis of PE during SARS-CoV-2 infection. Patients received anticoagulant treatment for at least 3 months and were followed up for 2 years. Between the third and fourth months after discharge, all patients were evaluated for the presence of residual thrombotic defects by CTPA and/or perfusion pulmonary scintigraphy. Clinical findings, lung function tests with DLCO, exercise capacity, and echocardiograms were also assessed. RESULTS Of the 133 patients included, 18% had persistent thrombotic defects on lung imaging at follow-up. The incidence of CTEPD was 0.75% at 2 years of follow-up. Patients with persistent defects were significantly older, had a higher prevalence of systemic arterial hypertension, higher D-dimer and NT-proBNP levels, and more severe PE at diagnosis. Furthermore, there was a higher prevalence of right ventricular dysfunction on echocardiogram at diagnosis of PE (25.0% vs. 2.7%, p = 0.006). This was the only variable independently related to persistent defects in multivariate analyses (OR: 8.13 [95% CI: 1.82-36.32], p = 0.006). CONCLUSION The persistence of thrombotic defects after PE is a common finding after SARS-CoV-2 infection, affecting 18% of the population. However, the incidence of CTEPH appears to be lower (0.75%) in COVID-19-related PE compared to that previously observed in PE unrelated to COVID-19.
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Affiliation(s)
- Oswaldo Antonio Caguana-Vélez
- Respiratory Medicine Department, Hospital del Mar, Barcelona, Spain,
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain,
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain,
| | - Karys Khilzi
- Respiratory Medicine Department, Hospital del Mar, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Lucilla Piccari
- Respiratory Medicine Department, Hospital del Mar, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | | | - Diana Badenes-Bonet
- Respiratory Medicine Department, Hospital del Mar, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Jose Gonzalez-Garcia
- Respiratory Medicine Department, Hospital del Mar, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Roberto Chalela
- Respiratory Medicine Department, Hospital del Mar, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Mariela Arita
- Respiratory Medicine Department, Hospital del Mar, Barcelona, Spain
| | - Anna Rodó-Pin
- Respiratory Medicine Department, Hospital del Mar, Barcelona, Spain
| | - Anna Herranz
- Respiratory Medicine Department, Hospital del Mar, Barcelona, Spain
| | - Mireia Admetlló
- Respiratory Medicine Department, Hospital del Mar, Barcelona, Spain
| | - Judit Villar-Garcia
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Infectious Diseases Department, Hospital del Mar, Barcelona, Spain
| | - Lluis Molina
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Cardiology Department, Hospital del Mar, Barcelona, Spain
| | - Flavio Zuccarino
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Radiology Department, Hospital del Mar, Barcelona, Spain
| | - Joaquin Gea
- Respiratory Medicine Department, Hospital del Mar, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias, (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Eva Balcells
- Respiratory Medicine Department, Hospital del Mar, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias, (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Diego A Rodríguez-Chiaradia
- Respiratory Medicine Department, Hospital del Mar, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias, (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
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Zhang J, Zhang Y, Yin Y, Feng Y, Zhang R, Meng H, Wang J. 'Fear, uncertain, tired…...' psychological distress among pulmonary hypertension patients: a qualitative interview study. BMC Psychiatry 2024; 24:100. [PMID: 38317081 PMCID: PMC10840283 DOI: 10.1186/s12888-024-05539-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 01/19/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Patient-centered health care for patients with pulmonary hypertension (PH) is important and requires an understanding of patient experiences. However, there is a lack of approaches to examine what's the effects and how the disease impact patients' psychological well-beings. METHODS We conducted qualitative interviews with PH patient representatives to understand patient psychological experiences and inform patient-centered research and care. Participants were chosen from a tertiary hospital located in northwest China. 20 patients with PH who be treated at the hospital (13 participants were women, aged 18-74 years) were strategically selected and individually interviewed. We used qualitative analysis to identify themes relating to existential psychological distress that would clarify the nature of such concerns. RESULTS We found that patients experience tremendous psychological distress throughout the treatment process. Four categories that describe patients' psychological experiences emerged: burden of PH treatment, fear and uncertainty about the disease, frustration in social and family role, and lack of recognition of the condition. CONCLUSIONS Existential concerns are salient in PH and involve the experience of loss and disruptions to the sense of self and relationships. Healthcare practitioners must work more in collaboration to detect patients' need for support and to develop the patient's own skills to manage daily life. The PH teams should tailor interventions to provide emotional, informational and instrumental support and guidance to patients.
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Affiliation(s)
- Juxia Zhang
- Clinical Educational Department, Gansu Provincial Hospital, Lanzhou, 730000, Gansu, China.
| | - Yiyin Zhang
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu, China
| | - Yuhuan Yin
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu, China
| | - Yuping Feng
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu, China
| | - Rong Zhang
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu, China
| | - Hongyan Meng
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu, China
| | - Jing Wang
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu, China
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Yamasaki Y, Kamitani T, Sagiyama K, Hino T, Kisanuki M, Tabata K, Isoda T, Kitamura Y, Abe K, Hosokawa K, Toyomura D, Moriyama S, Kawakubo M, Yabuuchi H, Ishigami K. Dynamic chest radiography for pulmonary vascular diseases: clinical applications and correlation with other imaging modalities. Jpn J Radiol 2024; 42:126-144. [PMID: 37626168 PMCID: PMC10811043 DOI: 10.1007/s11604-023-01483-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023]
Abstract
Dynamic chest radiography (DCR) is a novel functional radiographic imaging technique that can be used to visualize pulmonary perfusion without using contrast media. Although it has many advantages and clinical utility, most radiologists are unfamiliar with this technique because of its novelty. This review aims to (1) explain the basic principles of lung perfusion assessment using DCR, (2) discuss the advantages of DCR over other imaging modalities, and (3) review multiple specific clinical applications of DCR for pulmonary vascular diseases and compare them with other imaging modalities.
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Affiliation(s)
- Yuzo Yamasaki
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
| | - Takeshi Kamitani
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Koji Sagiyama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Takuya Hino
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Megumi Kisanuki
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
- Department of Hematology, Oncology and Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kosuke Tabata
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Takuro Isoda
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Yoshiyuki Kitamura
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Kohtaro Abe
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuya Hosokawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Daisuke Toyomura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shohei Moriyama
- Department of Hematology, Oncology and Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masateru Kawakubo
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hidetake Yabuuchi
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
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Pepke-Zaba J, Howard L, Kiely DG, Sweeney S, Johnson M. Pulmonary Embolism (PE) to Chronic Thromboembolic Pulmonary Disease (CTEPD): Findings from a Survey of UK Physicians. Adv Respir Med 2024; 92:45-57. [PMID: 38247551 PMCID: PMC10801485 DOI: 10.3390/arm92010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/22/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024]
Abstract
Chronic thromboembolic pulmonary disease (CTEPD) is a complication of pulmonary embolism (PE). We conducted an online survey of UK PE-treating physicians to understand practices in the follow-up of PE and awareness of CTEPD. The physicians surveyed (N = 175) included 50 each from cardiology, respiratory and internal medicine, plus 25 haematologists. Most (89%) participants had local guidelines for PE management, and 65% reported a PE follow-up clinic, of which 69% were joint clinics. Almost half (47%) had a protocol for the investigation of CTEPD. According to participants, 129 (74%) routinely consider a diagnosis of CTEPD and 97 (55%) routinely investigate for CTEPD, with 76% of those 97 participants investigating in patients who are symptomatic at 3 months and 22% investigating in all patients. This survey demonstrated variability in the follow-up of PE and the awareness of CTEPD and its investigation. The findings support the conduct of a national audit to understand the barriers to the timely detection of CTEPD.
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Affiliation(s)
- Joanna Pepke-Zaba
- Pulmonary Vascular Diseases Unit, National Pulmonary Hypertension Service, Royal Papworth Hospital, Cambridge CB2 0AY, UK
| | - Luke Howard
- National Pulmonary Hypertension Service, Hammersmith Hospital, London W12 0HS, UK
| | - David G Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, NIHR Biomedical Research Centre, Sheffield S10 2RX, UK
| | - Shruti Sweeney
- Medical Affairs Department, Janssen-Cilag Ltd., High Wycombe HP12 4EG, UK
| | - Martin Johnson
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow G81 4DY, UK
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Mathavan A, Mathavan A, Ataya A. Progressive Dyspnea on Exertion in an 82-Year-Old. JAMA 2024; 331:158-159. [PMID: 38109147 DOI: 10.1001/jama.2023.22990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
An older patient with hereditary hemorrhagic telangiectasia and right lower lobe segmental pulmonary embolism presented with dyspnea that had worsened over 5 years; physical examination and laboratory testing showed jugular venous distension, a cardiac systolic murmur, right ventricular heave, bilateral lower extremity edema to the knees, and elevated brain-type natriuretic peptide level. What is the diagnosis and what would you do next?
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Affiliation(s)
| | | | - Ali Ataya
- Pulmonary, Critical Care, and Sleep Medicine, University of Florida Health, Gainesville
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González-Hermosillo LM, Cueto-Robledo G, Navarro-Vergara DI, Roldan-Valadez E, Porres-Aguilar M, Garcia-Cesar M, Torres-Rojas MB, Hernández-Villa L, Tapia-Leon IA, Mendoza-Pineda JC. Prevalence and Prognosis of Hypothyroidism in Patients With Chronic Thromboembolic Pulmonary Hypertension: An Updated Review With Description of Case Series. Curr Probl Cardiol 2024; 49:102069. [PMID: 37689379 DOI: 10.1016/j.cpcardiol.2023.102069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 09/11/2023]
Abstract
Hypothyroidism has been shown to have several effects on organs, including derangements in the coagulation system, impairing endothelial function, but data on the importance of hypothyroidism in the pathogenesis and development of chronic thromboembolic pulmonary hypertension (CTEPH) are limited. This report presents an updated review of the prevalence and prognosis of hypothyroidism in patients diagnosed with CTEPH, including a detailed retrospective description of the series. The descriptive case series included 34 adult patients diagnosed with CTEPH, of whom 11 patients were diagnosed with hypothyroidism. The prevalence of hypothyroidism in CTEPH was found to be 32.35%. All patients with hypothyroidism had NYHA functional Class II-III. Hemodynamic values obtained through right heart catheterization (RHC) showed that patients with hypothyroidism had significantly higher mean pulmonary arterial pressures (mPAP), with a mean of 56.91 mm Hg vs 43.93 mm Hg (p = 0.026), and the PVR in dynes/sec/cm5 was 932 vs 541 (p = 0.027). Significant differences in PVR were found in wood units (WU) 11.91 vs 7.11 (p = 0.042). The mean level of brain natriuretic peptide (BNP) between both groups was 797.3 pg/mL for patients with hypothyroidism vs 262.02 pg/mL in patients with euthyroidism (p = .032). Hypothyroidism may significantly affect patients' clinical and hemodynamic outcomes in patients with CTEPH. Hypothyroidism as a risk factor in the evaluation and treatment of these patients is vital to optimize outcomes in CTEPH; further research is warranted whether hypothyroidism therapies could alter such outcomes.
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Affiliation(s)
| | - Guillermo Cueto-Robledo
- Cardiorespiratory Emergencies, Hospital General de México 'Dr Eduardo Liceaga', Mexico City, Mexico; Pulmonary Circulation Clinic, Hospital General de México 'Dr. Eduardo Liceaga', Mexico City, Mexico; Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.
| | - Dulce-Iliana Navarro-Vergara
- Cardiorespiratory Emergencies, Hospital General de México 'Dr Eduardo Liceaga', Mexico City, Mexico; Pulmonary Circulation Clinic, Hospital General de México 'Dr. Eduardo Liceaga', Mexico City, Mexico
| | - Ernesto Roldan-Valadez
- Hospital General de Mexico Dr. Eduardo Liceaga, Mexico City, Mexico; I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Mateo Porres-Aguilar
- Department of Internal Medicine, Divisions of Adult Thrombosis and Hospital Medicine, Texas Tech University Health Sciences Center; El Paso, TX
| | - Marisol Garcia-Cesar
- Cardiorespiratory Emergencies, Hospital General de México 'Dr Eduardo Liceaga', Mexico City, Mexico; Pulmonary Circulation Clinic, Hospital General de México 'Dr. Eduardo Liceaga', Mexico City, Mexico
| | - Maria-Berenice Torres-Rojas
- Cardiorespiratory Emergencies, Hospital General de México 'Dr Eduardo Liceaga', Mexico City, Mexico; Pulmonary Circulation Clinic, Hospital General de México 'Dr. Eduardo Liceaga', Mexico City, Mexico
| | - Lizbeth Hernández-Villa
- Pulmonary Circulation Clinic, Hospital General de México 'Dr. Eduardo Liceaga', Mexico City, Mexico
| | - Ivan-Arturo Tapia-Leon
- Pulmonary Circulation Clinic, Hospital General de México 'Dr. Eduardo Liceaga', Mexico City, Mexico
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Jan K, Pavel J, Renata C, Daniela D, Petra B, Martin Š, Zuzana Z, Tomáš K. The incidence of the thrombophilic SNPs rs6025, rs1799963, rs2066865, rs2289252, and rs8176719 in chronic thromboembolic pulmonary hypertension. Clin Appl Thromb Hemost 2024; 30:10760296241271369. [PMID: 39150410 PMCID: PMC11329958 DOI: 10.1177/10760296241271369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/20/2024] [Accepted: 06/25/2024] [Indexed: 08/17/2024] Open
Abstract
INTRODUCTION Chronic thromboembolic pulmonary hypertension (CTEPH) and venous thromboembolism (VTE) are thought to share many common risk factors. Our study aimed to determine the frequencies of 5 thrombosis-related gene single nucleotide polymorphisms (SNPs) associated with VTE in patients with CTEPH (n 129) compared with a control group of healthy individuals without a history of VTE (n 2637). METHODS The SNPs of the following genes were investigated: F5 (F V Leiden, rs6025), F2 prothrombin (rs1799963), fibrinogen gamma (FGG, rs2066865), F11 (rs2289252) and ABO (non-O, rs8176719) in both groups. RESULTS The study found that the rs1799963 variant was more common in patients with chronic thromboembolic pulmonary hypertension (CTEPH) compared to the control group (p < .0001). The GA heterozygous variant showed a significant increase with an odds ratio (OR) of 4.480 (95% CI: 2.344-8.562) or a finding by maximum likelihood analysis (MLA) with p < .0001. Additionally, there was a notable increase in the rs8176719 variant with p < .0001 in CTEPH patients. Both the homozygous G/G variant and the heterozygous -/G variant also showed an increase, with OR of 4.2317 (95% CI: 2.45571-7.2919) and 2.4324 (95% CI: 1.46435-4.0403) respectively, or MLA (p < .0001 and p .0006). The study also revealed a higher prevalence of the heterozygous C/T variant of rs2289252 in CTEPH patients, with an OR of 1.5543 (95% CI: 1.02503-2.3568) or MLA (p .0379). CONCLUSION The study suggests that the observed gene polymorphisms F2 (rs1799963), ABO (rs8176719), and F11 (rs2289252) may play a role as independent heritable risk factors in the development of CTEPH.
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Affiliation(s)
- Kvasnička Jan
- Thrombotic Centre, Institute of Medical Biochemistry and Laboratory Diagnostics, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
- 1st Department of Medicine, Division of Haematology, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Jansa Pavel
- 2nd Department of Medicine, Division of Cardiovascular Medicine, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Cífková Renata
- Centre for Cardiovascular Prevention, 1st Faculty of Medicine, Charles University and Thomayer University Hospital, Prague, Czech Republic
| | - Dušková Daniela
- 1st Department of Medicine, Division of Haematology, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
- Department of Blood Transfusion, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Bobčíková Petra
- Thrombotic Centre, Institute of Medical Biochemistry and Laboratory Diagnostics, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Ševčík Martin
- Thrombotic Centre, Institute of Medical Biochemistry and Laboratory Diagnostics, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Zenáhlíková Zuzana
- Thrombotic Centre, Institute of Medical Biochemistry and Laboratory Diagnostics, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Kvasnička Tomáš
- Thrombotic Centre, Institute of Medical Biochemistry and Laboratory Diagnostics, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
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