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Rijnierse MT, Groeneveldt JA, van Campen JSJA, de Boer K, van der Bruggen CEE, Harms HJ, Raijmakers PG, Lammertsma AA, Knaapen P, Bogaard HJ, Westerhof BE, Vonk Noordegraaf A, Allaart CP, de Man FS. Bisoprolol therapy does not reduce right ventricular sympathetic activity in pulmonary arterial hypertension patients. Pulm Circ 2020; 10:2045894019873548. [PMID: 32363028 PMCID: PMC7187746 DOI: 10.1177/2045894019873548] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 07/29/2019] [Indexed: 11/27/2022] Open
Abstract
Right ventricular (RV) function and autonomic dysfunction are important
determinants of morbidity and mortality in patients with pulmonary arterial
hypertension (PAH). Although successful in animal studies, effects of
beta-blocker therapy on RV function in clinical trials were disappointing. To
understand this discrepancy, we studied whether beta-blocker therapy changes RV
sympathetic activity. Idiopathic PAH (IPAH) patients received beta-blocker
therapy (uptitrated to a maximal tolerated dose) and underwent cardiac magnetic
resonance imaging, right heart catheterization, and a
[11C]-hydroxyephedrine positron emission tomography
([11C]HED PET) scan at baseline to determine, respectively, RV
ejection fraction (RVEF), RV pressures, and sympathetic activity.
[11C]HED, a norepinephrine analogue, allows determination of
sympathetic innervation of the RV. [11C]HED retention index reflects
norepinephrine transporter activity. As a consequence of excessive catecholamine
levels in the synaptic cleft, this transporter may be downregulated. Therefore,
low [11C]HED retention index indicates high sympathetic activity. 13
IPAH patients underwent [11C]HED PET scans at baseline and after
bisoprolol treatment. Although heart rate was reduced, systemic modulation of
autonomic activity by bisoprolol did not affect local RV sympathetic nerve
activity, RV function, or RV wall tension. In PAH patients, RV
[11C]HED retention index was lower compared to LV tracer uptake
(p<0.01) and was related to systolic wall tension (R2 = 0.4731,
p<0.01) and RV function (R2 = 0.44, p = 0.01). In RV failure, the
tolerated dosage of bisoprolol did not result in an improvement of RV function
nor in a reduction in RV sympathetic activity.
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Affiliation(s)
- Mischa T Rijnierse
- Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Joanne A Groeneveldt
- Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jasmijn S J A van Campen
- Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Karin de Boer
- Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Cathelijne E E van der Bruggen
- Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Hendrik J Harms
- Radiology and Nuclear Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Pieter G Raijmakers
- Radiology and Nuclear Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Adriaan A Lammertsma
- Radiology and Nuclear Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Paul Knaapen
- Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Harm Jan Bogaard
- Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Berend E Westerhof
- Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Medical Biology, Section of Systems Physiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Anton Vonk Noordegraaf
- Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Cornelis P Allaart
- Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Frances S de Man
- Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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3
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van de Veerdonk MC, Huis In T Veld AE, Marcus JT, Westerhof N, Heymans MW, Bogaard HJ, Vonk-Noordegraaf A. Upfront combination therapy reduces right ventricular volumes in pulmonary arterial hypertension. Eur Respir J 2017; 49:49/6/1700007. [PMID: 28663315 DOI: 10.1183/13993003.00007-2017] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 03/11/2017] [Indexed: 11/05/2022]
Abstract
In pulmonary arterial hypertension (PAH), upfront combination therapy is associated with better clinical outcomes and a greater reduction in N-terminal pro-brain natriuretic peptide (NT-proBNP) than monotherapy. NT-proBNP levels reflect right ventricular (RV) wall stress, which increases when the right ventricle dilates. This study explored the impact of upfront combination therapy on RV volumes compared with monotherapy in PAH patients.This retrospective study involved 80 incident PAH patients (New York Heart Association class II and III) who were treated with upfront combination therapy (n=35) (i.e. endothelin receptor antagonists (ERAs) plus phosphodiesterase-5-inhibitors (PDE5Is)) or monotherapy (n=45) (i.e. either ERAs or PDE5Is). All patients underwent right-sided heart catheterisation and cardiac magnetic resonance imaging at baseline and after 1-year follow-up.Combination therapy resulted in more significant reductions in pulmonary vascular resistance and pulmonary pressures than monotherapy. NT-proBNP was decreased by ∼77% in the combination therapy group compared with a ∼51% reduction after monotherapy (p<0.001). RV volumes and calculated RV wall stress improved after combination therapy (both p<0.001) but remained unchanged after monotherapy (both p=NS). RV ejection fraction improved more in the combination therapy group than in the monotherapy group (p<0.001).In PAH patients, upfront combination therapy was associated with improved RV volumes.
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Affiliation(s)
- Mariëlle C van de Veerdonk
- Department of Pulmonary Diseases, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands.,Department of Cardiology, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands
| | - Anna E Huis In T Veld
- Department of Pulmonary Diseases, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands
| | - J Tim Marcus
- Department of Physics and Medical Technologies, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands
| | - Nico Westerhof
- Department of Pulmonary Diseases, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Biostatistics, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands
| | - Harm-Jan Bogaard
- Department of Pulmonary Diseases, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands
| | - Anton Vonk-Noordegraaf
- Department of Pulmonary Diseases, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands
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6
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Sato Y, Saeki N, Asakura T, Aoshiba K, Kotani T. Effects of extrathoracic mechanical ventilation on pulmonary hypertension secondary to lung disease. J Anesth 2016; 30:663-70. [PMID: 27090795 PMCID: PMC4956720 DOI: 10.1007/s00540-016-2172-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 04/03/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Biphasic cuirass ventilation (BCV) is a form of non-invasive extrathoracic positive and negative pressure mechanical ventilation. The present study was conducted to quantify our positive experience using BCV to dramatically improve gas exchange and cardiac function in patients with acute exacerbation of chronic respiratory failure and secondary pulmonary hypertension (PH). METHODS BCV was applied for 2 weeks in 17 patients with PH caused by lung disease. Ventilation sessions were limited to 1 h per day to prevent exhaustion. To assess respiratory and circulatory effects, percutaneous arterial oxygen saturation (SpO2) was measured before and after each daily BCV session, and right heart catheter test [mean pulmonary artery pressure (mPAP), right atrium pressure (RAP), pulmonary artery occlusion pressure (PAOP) and cardiac index (CI)] and serum N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured before and after a series of BCV sessions. RESULTS SpO2 transiently improved after each BCV session. After a series of BCV, mPAP decreased from 27.2 to 22.4 mmHg (p = 0.0007). PAOP, CI and serum NT-proBNP levels decreased compared with baseline. No patients were treated with epoprostenol, iloprost, bosentan or sildenafil for PH. CONCLUSION BCV may improve circulatory function in patients with PH caused by lung disease.
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Affiliation(s)
- Yoko Sato
- Department of Anesthesiology and Intensive Care Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Noriyuki Saeki
- Synthesis Shinkawabashi Hospital, 1-15 Shinkawadori, Kawasaki-Ku, Kawasaki, Kanagawa, 210-0013, Japan
| | - Takuma Asakura
- Synthesis Shinkawabashi Hospital, 1-15 Shinkawadori, Kawasaki-Ku, Kawasaki, Kanagawa, 210-0013, Japan.,Nitta Central Clinic, 1-20-19 Yaguchi, Ohta-ku, Tokyo, 146-0093, Japan
| | - Kazutetsu Aoshiba
- Department of Respiratory Medicine, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395, Japan
| | - Toru Kotani
- Department of Anesthesiology and Intensive Care Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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8
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Peacock AJ, Crawley S, McLure L, Blyth KG, Vizza CD, Poscia R, Francone M, Iacucci I, Olschewski H, Kovacs G, vonk Noordegraaf A, Marcus JT, van de Veerdonk MC, Oosterveer FP. Changes in Right Ventricular Function Measured by Cardiac Magnetic Resonance Imaging in Patients Receiving Pulmonary Arterial Hypertension–Targeted Therapy. Circ Cardiovasc Imaging 2014; 7:107-14. [DOI: 10.1161/circimaging.113.000629] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Most measures that predict survival in pulmonary hypertension (PH) relate directly to, or correlate with, right ventricular (RV) function. Direct assessment of RV function using noninvasive techniques such as cardiac MRI may therefore be an appropriate way of determining response to therapy and monitoring disease progression in PH.
Methods and Results—
In this pan-European study, 91 patients with PH (mean pulmonary arterial pressure 46±15 mm Hg) underwent clinical and cardiac MRI assessments at baseline and after 12 months of disease-targeted therapy (predominantly endothelin receptor antagonists [47.3%] or phosphodiesterase type-5 inhibitors [25.3%]). At month 12, functional class had improved in 21 patients, was unchanged in 63 patients, and had deteriorated in 7 patients. Significant improvements were achieved in RV and left ventricular ejection fraction (
P
<0.001 and
P
=0.0007, respectively), RV stroke volume index (
P
<0.0001), and left ventricular end-diastolic volume index (
P
=0.0015). Increases in 6-minute walk distance were significant (
P
<0.0001) and correlated with change in RV ejection fraction and left ventricular end-diastolic volume, although correlation coefficients were low (r=0.28,
P
=0.01 and r=0.26,
P
=0.02, respectively).
Conclusions—
On-treatment changes in cardiac MRI–derived variables from left and right sides of the heart reflected changes in functional class and survival in patients with PH. Direct measurement of RV function using cardiac MRI can fully assess potential benefits of treatment in PH.
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Affiliation(s)
- Andrew J. Peacock
- From the Scottish Pulmonary Vascular Unit, Glasgow, United Kingdom (A.J.P., S.C., L.M., K.G.B.); Pulmonary Hypertension Center, Department of Cardiovascular and Respiratory Diseases (C.D.V., R.P.), and Department of Radiological, Oncological and Pathological Sciences (M.F., I.I.), Sapienza University of Rome, Rome, Italy; Division of Pulmonology, Medical University of Graz, Graz, Austria (H.O., G.K.); Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria (H.O., G.K.); and Departments
| | - Stephen Crawley
- From the Scottish Pulmonary Vascular Unit, Glasgow, United Kingdom (A.J.P., S.C., L.M., K.G.B.); Pulmonary Hypertension Center, Department of Cardiovascular and Respiratory Diseases (C.D.V., R.P.), and Department of Radiological, Oncological and Pathological Sciences (M.F., I.I.), Sapienza University of Rome, Rome, Italy; Division of Pulmonology, Medical University of Graz, Graz, Austria (H.O., G.K.); Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria (H.O., G.K.); and Departments
| | - Lindsey McLure
- From the Scottish Pulmonary Vascular Unit, Glasgow, United Kingdom (A.J.P., S.C., L.M., K.G.B.); Pulmonary Hypertension Center, Department of Cardiovascular and Respiratory Diseases (C.D.V., R.P.), and Department of Radiological, Oncological and Pathological Sciences (M.F., I.I.), Sapienza University of Rome, Rome, Italy; Division of Pulmonology, Medical University of Graz, Graz, Austria (H.O., G.K.); Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria (H.O., G.K.); and Departments
| | - Kevin G. Blyth
- From the Scottish Pulmonary Vascular Unit, Glasgow, United Kingdom (A.J.P., S.C., L.M., K.G.B.); Pulmonary Hypertension Center, Department of Cardiovascular and Respiratory Diseases (C.D.V., R.P.), and Department of Radiological, Oncological and Pathological Sciences (M.F., I.I.), Sapienza University of Rome, Rome, Italy; Division of Pulmonology, Medical University of Graz, Graz, Austria (H.O., G.K.); Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria (H.O., G.K.); and Departments
| | - Carmine Dario Vizza
- From the Scottish Pulmonary Vascular Unit, Glasgow, United Kingdom (A.J.P., S.C., L.M., K.G.B.); Pulmonary Hypertension Center, Department of Cardiovascular and Respiratory Diseases (C.D.V., R.P.), and Department of Radiological, Oncological and Pathological Sciences (M.F., I.I.), Sapienza University of Rome, Rome, Italy; Division of Pulmonology, Medical University of Graz, Graz, Austria (H.O., G.K.); Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria (H.O., G.K.); and Departments
| | - Roberto Poscia
- From the Scottish Pulmonary Vascular Unit, Glasgow, United Kingdom (A.J.P., S.C., L.M., K.G.B.); Pulmonary Hypertension Center, Department of Cardiovascular and Respiratory Diseases (C.D.V., R.P.), and Department of Radiological, Oncological and Pathological Sciences (M.F., I.I.), Sapienza University of Rome, Rome, Italy; Division of Pulmonology, Medical University of Graz, Graz, Austria (H.O., G.K.); Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria (H.O., G.K.); and Departments
| | - Marco Francone
- From the Scottish Pulmonary Vascular Unit, Glasgow, United Kingdom (A.J.P., S.C., L.M., K.G.B.); Pulmonary Hypertension Center, Department of Cardiovascular and Respiratory Diseases (C.D.V., R.P.), and Department of Radiological, Oncological and Pathological Sciences (M.F., I.I.), Sapienza University of Rome, Rome, Italy; Division of Pulmonology, Medical University of Graz, Graz, Austria (H.O., G.K.); Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria (H.O., G.K.); and Departments
| | - Ilaria Iacucci
- From the Scottish Pulmonary Vascular Unit, Glasgow, United Kingdom (A.J.P., S.C., L.M., K.G.B.); Pulmonary Hypertension Center, Department of Cardiovascular and Respiratory Diseases (C.D.V., R.P.), and Department of Radiological, Oncological and Pathological Sciences (M.F., I.I.), Sapienza University of Rome, Rome, Italy; Division of Pulmonology, Medical University of Graz, Graz, Austria (H.O., G.K.); Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria (H.O., G.K.); and Departments
| | - Horst Olschewski
- From the Scottish Pulmonary Vascular Unit, Glasgow, United Kingdom (A.J.P., S.C., L.M., K.G.B.); Pulmonary Hypertension Center, Department of Cardiovascular and Respiratory Diseases (C.D.V., R.P.), and Department of Radiological, Oncological and Pathological Sciences (M.F., I.I.), Sapienza University of Rome, Rome, Italy; Division of Pulmonology, Medical University of Graz, Graz, Austria (H.O., G.K.); Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria (H.O., G.K.); and Departments
| | - Gabor Kovacs
- From the Scottish Pulmonary Vascular Unit, Glasgow, United Kingdom (A.J.P., S.C., L.M., K.G.B.); Pulmonary Hypertension Center, Department of Cardiovascular and Respiratory Diseases (C.D.V., R.P.), and Department of Radiological, Oncological and Pathological Sciences (M.F., I.I.), Sapienza University of Rome, Rome, Italy; Division of Pulmonology, Medical University of Graz, Graz, Austria (H.O., G.K.); Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria (H.O., G.K.); and Departments
| | - Anton vonk Noordegraaf
- From the Scottish Pulmonary Vascular Unit, Glasgow, United Kingdom (A.J.P., S.C., L.M., K.G.B.); Pulmonary Hypertension Center, Department of Cardiovascular and Respiratory Diseases (C.D.V., R.P.), and Department of Radiological, Oncological and Pathological Sciences (M.F., I.I.), Sapienza University of Rome, Rome, Italy; Division of Pulmonology, Medical University of Graz, Graz, Austria (H.O., G.K.); Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria (H.O., G.K.); and Departments
| | - J. Tim Marcus
- From the Scottish Pulmonary Vascular Unit, Glasgow, United Kingdom (A.J.P., S.C., L.M., K.G.B.); Pulmonary Hypertension Center, Department of Cardiovascular and Respiratory Diseases (C.D.V., R.P.), and Department of Radiological, Oncological and Pathological Sciences (M.F., I.I.), Sapienza University of Rome, Rome, Italy; Division of Pulmonology, Medical University of Graz, Graz, Austria (H.O., G.K.); Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria (H.O., G.K.); and Departments
| | - Marielle C. van de Veerdonk
- From the Scottish Pulmonary Vascular Unit, Glasgow, United Kingdom (A.J.P., S.C., L.M., K.G.B.); Pulmonary Hypertension Center, Department of Cardiovascular and Respiratory Diseases (C.D.V., R.P.), and Department of Radiological, Oncological and Pathological Sciences (M.F., I.I.), Sapienza University of Rome, Rome, Italy; Division of Pulmonology, Medical University of Graz, Graz, Austria (H.O., G.K.); Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria (H.O., G.K.); and Departments
| | - Frank P.T. Oosterveer
- From the Scottish Pulmonary Vascular Unit, Glasgow, United Kingdom (A.J.P., S.C., L.M., K.G.B.); Pulmonary Hypertension Center, Department of Cardiovascular and Respiratory Diseases (C.D.V., R.P.), and Department of Radiological, Oncological and Pathological Sciences (M.F., I.I.), Sapienza University of Rome, Rome, Italy; Division of Pulmonology, Medical University of Graz, Graz, Austria (H.O., G.K.); Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria (H.O., G.K.); and Departments
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