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Kourek C, Zachariou A, Karatzanos E, Antonopoulos M, Soulele T, Karabinis A, Nanas S, Dimopoulos S. Effects of combined aerobic, resistance and inspiratory training in patients with pulmonary hypertension: A systematic review. World J Crit Care Med 2024; 13:92585. [PMID: 38855278 PMCID: PMC11155510 DOI: 10.5492/wjccm.v13.i2.92585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/29/2024] [Accepted: 05/21/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) is a serious progressive disorder of the modern world, characterized by endothelial dysfunction and impaired vasoreactivity. Patients with PH usually present exercise intolerance from the very early stages and reduced exercise capacity. Exercise training has been shown to have beneficial effects in patients with cardiovascular comorbidities. However, data regarding the effects of combined exercise training programs in patients with PH still remains limited. AIM To investigate the effects of combined exercise training programs on exercise capacity and quality of life in patients with PH. METHODS Our search included all available randomized controlled trials (RCTs) regarding combined aerobic, resistance and inspiratory training programs in patients with PH in 4 databases (Pubmed, PEDro, Embase, CINAHL) from 2012 to 2022. Five RCTs were included in the final analysis. Functional capacity, assessed by peak VO2 or 6-min walking test (6MWT), as well as quality of life, assessed by the SF-36 questionnaire, were set as the primary outcomes in our study. RESULTS Peak VO2 was measured in 4 out of the 5 RCTs while 6MWT was measured in all RCTs. Both indices of functional capacity were significantly increased in patients with PH who underwent combined exercise training compared to the controls in all of the included RCTs (P < 0.05). Quality of life was measured in 4 out of 5 RCTs. Although patients improved their quality of life in each group, however, only 2 RCTs demonstrated further improvement in patients performing combined training compared to controls. CONCLUSION By this systematic review, we have demonstrated that combined aerobic, resistance and inspiratory exercise training is safe and has beneficial effects on aerobic capacity and quality of life in patients with PH. Such exercise training regimen may be part of the therapeutic strategy of the syndrome.
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Affiliation(s)
- Christos Kourek
- Department of Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Department of Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens 10676, Greece
- Department of Cardiology, 417 Army Share Fund Hospital of Athens, Athens 11521, Greece
| | - Antonia Zachariou
- Department of Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Department of Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens 10676, Greece
| | - Eleftherios Karatzanos
- Department of Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Department of Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens 10676, Greece
| | - Michalis Antonopoulos
- Department of Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Department of Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens 10676, Greece
- Cardiac Surgery ICU, Onassis Cardiac Surgery center, Athens 17674, Attica, Greece
| | - Theodora Soulele
- Cardiac Surgery ICU, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Andreas Karabinis
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Serafim Nanas
- Department of Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, National and Kapodistrian University of Athens, Athens 10676, Greece
| | - Stavros Dimopoulos
- Department of Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Department of Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens 10676, Greece
- Cardiac Surgery ICU, Onassis Cardiac Surgery Center, Athens 17674, Greece
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Schulze KM, Horn AG, Weber RE, Behnke BJ, Poole DC, Musch TI. Pulmonary hypertension alters blood flow distribution and impairs the hyperemic response in the rat diaphragm. Front Physiol 2023; 14:1281715. [PMID: 38187132 PMCID: PMC10766809 DOI: 10.3389/fphys.2023.1281715] [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: 08/22/2023] [Accepted: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
Pulmonary hypertension (PH) is characterized by pulmonary vascular remodeling, respiratory muscle and cardiac impairments, and exercise intolerance. Specifically, impaired gas exchange increases work of the diaphragm; however, compromised contractile function precludes the diaphragm from meeting the increased metabolic demand of chronic hyperventilation in PH. Given that muscle contractile function is in part, dependent upon adequate blood flow (Q ˙ ), diaphragmatic dysfunction may be predicated by an inability to match oxygen delivery with oxygen demand. We hypothesized that PH rats would demonstrate a decreased hyperemic response to contractions compared to healthy controls. Methods: Sprague-Dawley rats were randomized into healthy (HC, n = 7) or PH (n = 7) groups. PH rats were administered monocrotaline (MCT) while HC rats received vehicle. Disease progression was monitored via echocardiography. Regional and total diaphragm blood flow and vascular conductance at baseline and during 3 min of electrically-stimulated contractions were determined using fluorescent microspheres. Results: PH rats displayed morphometric and echocardiographic criteria for disease (i.e., acceleration time/ejection time, right ventricular hypertrophy). In all rats, total costal diaphragm Q ˙ increased during contractions and did not differ between groups. In HC rats, there was a greater increase in medial costal Q ˙ compared to PH rats (55% ± 3% vs. 44% ± 4%, p < 0.05), who demonstrated a redistribution of Q ˙ to the ventral costal region. Conclusion: These findings support a redistribution of regional diaphragm perfusion and an impaired medial costal hyperemic response in PH, suggesting that PH alters diaphragm vascular function and oxygen delivery, providing a potential mechanism for PH-induced diaphragm contractile dysfunction.
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Affiliation(s)
- Kiana M. Schulze
- Department of Kinesiology, Kansas State University, Manhattan, KS, United States
| | - Andrew G. Horn
- Department of Kinesiology, Kansas State University, Manhattan, KS, United States
| | - Ramona E. Weber
- Department of Kinesiology, Kansas State University, Manhattan, KS, United States
| | - Bradley J. Behnke
- Department of Kinesiology, Kansas State University, Manhattan, KS, United States
| | - David C. Poole
- Department of Kinesiology, Kansas State University, Manhattan, KS, United States
- Department of Anatomy and Physiology, Kansas State University, Manhattan, KS, United States
| | - Timothy I. Musch
- Department of Kinesiology, Kansas State University, Manhattan, KS, United States
- Department of Anatomy and Physiology, Kansas State University, Manhattan, KS, United States
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Drummond FR, Soares LL, Leal TF, Leite LB, Rezende LMT, Fidelis MR, Lavorato VN, Miranda DC, Carneiro-Júnior MA, Neves MM, Alberici LC, Carlo Reis EC, Neves CA, Natali AJ. Effects of voluntary running on the skeletal muscle of rats with pulmonary artery hypertension. Front Physiol 2023; 14:1206484. [PMID: 37469567 PMCID: PMC10352770 DOI: 10.3389/fphys.2023.1206484] [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: 04/15/2023] [Accepted: 06/19/2023] [Indexed: 07/21/2023] Open
Abstract
The effects of voluntary running on the skeletal muscle of rats with pulmonary arterial hypertension (PAH) were tested in the present study. PAH was induced in rats by a single injection of monocrotaline (MCT, 60 mg/kg). Rats in the sedentary hypertension (HS) group had their tolerance to physical exertion reduced throughout the experiment, while those in the sedentary control (SC), exercise control (EC), exercise hypertension (EH) and median exercise (EM) groups maintained or increased. Despite that, the muscular citrate synthase activity was not different between groups. The survival time was higher in the EH (32 days) than in the SH (28 days) (p = 0.0032). SH and EH groups showed a lower percentage of muscle fiber and a higher percentage of extracellular matrix compared to control groups (p < 0.0001). However, the EM and EH groups presented higher percentage of muscle fiber and lower percentage of extracellular matrix than SH group (p < 0.0001). Regarding muscular gene expression, the SH and EM groups showed a lower expression of PGC1-α (p = 0.0024) and a higher expression of VEGF (p = 0.0033) compared to SC, while PGC1-α was elevated in the EH. No difference between groups was found for the carbonylated protein levels (p > 0.05), while the TNF-α/IL-10 ratio was augmented in the EH (p = 0.0277). In conclusion, voluntary running augments the proportion of fiber and affects the gene expression of inflammatory and mitochondrial biogenesis' markers in the skeletal muscle of rats with MCT-induced PAH, which benefits their survival and tolerance to physical effort.
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Affiliation(s)
- Filipe Rios Drummond
- Department of General Biology, Laboratory of Structural Biology, Federal University of Viçosa, Viçosa, Brazil
| | - Leôncio Lopes Soares
- Department of Physical Education, Laboratory of Exercise Biology Federal University of Viçosa, Viçosa, Brazil
| | - Tiago Ferreira Leal
- Department of Physical Education, Laboratory of Exercise Biology Federal University of Viçosa, Viçosa, Brazil
| | - Luciano Bernardes Leite
- Department of Physical Education, Laboratory of Exercise Biology Federal University of Viçosa, Viçosa, Brazil
| | | | - Meilene Ribeiro Fidelis
- Department of Physical Education, Laboratory of Exercise Biology Federal University of Viçosa, Viçosa, Brazil
| | - Victor Neiva Lavorato
- Department of Physical Education, Governador Ozanam Coelho University Center (UNIFAGOC), Ubá, Minas Gerais, Brazil
| | - Denise Coutinho Miranda
- Department of Physical Education, Governador Ozanam Coelho University Center (UNIFAGOC), Ubá, Minas Gerais, Brazil
| | | | - Mariana Machado Neves
- Department of General Biology, Laboratory of Structural Biology, Federal University of Viçosa, Viçosa, Brazil
| | - Luciane Carla Alberici
- Faculty of Pharmaceutical Sciences of Ribeirão Preto, University of Sao Paulo, Ribeirão Preto, Brazil
| | | | - Clovis Andrade Neves
- Department of General Biology, Laboratory of Structural Biology, Federal University of Viçosa, Viçosa, Brazil
| | - Antônio José Natali
- Department of Physical Education, Laboratory of Exercise Biology Federal University of Viçosa, Viçosa, Brazil
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Pepplinkhuizen S, Eshuis G, Zijlstra WMH, Timmer CY, Ploegstra MJ, Lelieveld OTHM, Hepping AM, Beenakker EAC, Berger RMF. Muscle strength is reduced in children with pulmonary arterial hypertension. Pulm Circ 2023; 13:e12246. [PMID: 37284521 PMCID: PMC10241349 DOI: 10.1002/pul2.12246] [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: 09/08/2022] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/08/2023] Open
Abstract
Muscle strength is decreased in adults with pulmonary arterial hypertension (PAH). We aim to investigate muscle strength in children with PAH in relation to a cohort of healthy children, and investigate correlations with disease severity markers. This prospective study included children with PAH aged 4-18 years, who visited the Dutch National Referral Center for Pulmonary Hypertension in Childhood between October 2015 and March 2016. Muscle strength was assessed using handgrip strength and maximum voluntary isometric contractility (MVIC) of four peripheral muscles. Dynamic muscle function was evaluated with the Bruininks-Oseretsky test of motor proficiency (BOT-2). These measurements were compared with those in two cohorts of healthy children and correlated with 6-minute walk distance (6MWD), World Health Organization functional class (WHO-FC), N-terminal pro-brain natriuretic peptide (NT-proBNP), and time since diagnosis. Eighteen children with PAH aged 14.0 [interquartile range: 9.9-16.0] years showed reduced muscle strength. Handgrip strength z-score -2.4 ± 1.2, p < 0.001, total MVIC z-score -2.9 ± 1.2, p < 0.001, and BOT-2 z-score -1.0 ± 0.9, p < 0.001. 6MWD (67 ± 11% predicted) correlated with most muscle measurements (r = 0.49-0.71, p = 0.001). Dynamic muscle function (BOT-2) differed between WHO-FC, whereas handgrip strength and MVIC did not. NT-proBNP and time since diagnosis did not show significant correlations with muscle strength measurements. Muscle strength was significantly reduced in children with PAH and correlated with 6MWD, but not with disease severity markers WHO-FC and NT-pro-BNP. The nature of this reduced muscle strength is yet unclear, but its occurrence in children with seemingly mild or well-controlled PAH supports the concept of PAH being a systemic syndrome involving peripheral skeletal muscles.
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Affiliation(s)
- Shari Pepplinkhuizen
- Department of Pediatric Cardiology, Center for Congenital Heart Disease, Beatrix Children's Hospital, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Graziella Eshuis
- Department of Pediatric Cardiology, Center for Congenital Heart Disease, Beatrix Children's Hospital, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Willemijn M. H. Zijlstra
- Department of Pediatric Cardiology, Center for Congenital Heart Disease, Beatrix Children's Hospital, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Carola Y. Timmer
- Department of Rehabilitation, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Mark Jan Ploegstra
- Department of Pediatric Cardiology, Center for Congenital Heart Disease, Beatrix Children's Hospital, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Otto T. H. M. Lelieveld
- Department of Rehabilitation, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Ann Marjolein Hepping
- Department of Orthopedics, University Medical Center GroningenUniversity of Groningen, GroningenThe Netherlands
- Roessingh Center for RehabilitationEnschedeThe Netherlands
| | | | - Rolf M. F. Berger
- Department of Pediatric Cardiology, Center for Congenital Heart Disease, Beatrix Children's Hospital, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
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Long GM, Troutman AD, Gray DA, Fisher AJ, Lahm T, Coggan AR, Brown MB. Skeletal muscle blood flow during exercise is reduced in a rat model of pulmonary hypertension. Am J Physiol Regul Integr Comp Physiol 2022; 323:R561-R570. [PMID: 36036455 PMCID: PMC9602702 DOI: 10.1152/ajpregu.00327.2021] [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: 12/21/2021] [Revised: 08/18/2022] [Accepted: 08/18/2022] [Indexed: 11/22/2022]
Abstract
Pulmonary arterial hypertension (PAH) is characterized by exercise intolerance. Muscle blood flow may be reduced during exercise in PAH; however, this has not been directly measured. Therefore, we investigated blood flow during exercise in a rat model of monocrotaline (MCT)-induced pulmonary hypertension (PH). Male Sprague-Dawley rats (∼200 g) were injected with 60 mg/kg MCT (MCT, n = 23) and vehicle control (saline; CON, n = 16). Maximal rate of oxygen consumption (V̇o2max) and voluntary running were measured before PH induction. Right ventricle (RV) morphology and function were assessed via echocardiography and invasive hemodynamic measures. Treadmill running at 50% V̇o2max was performed by a subgroup of rats (MCT, n = 8; CON, n = 7). Injection of fluorescent microspheres determined muscle blood flow via photo spectroscopy. MCT demonstrated a severe phenotype via RV hypertrophy (Fulton index, 0.61 vs. 0.31; P < 0.001), high RV systolic pressure (51.5 vs. 22.4 mmHg; P < 0.001), and lower V̇o2max (53.2 vs. 71.8 mL·min-1·kg-1; P < 0.0001) compared with CON. Two-way ANOVA revealed exercising skeletal muscle blood flow relative to power output was reduced in MCT compared with CON (P < 0.001), and plasma lactate was increased in MCT (10.8 vs. 4.5 mmol/L; P = 0.002). Significant relationships between skeletal blood flow and blood lactate during exercise were observed for individual muscles (r = -0.58 to -0.74; P < 0.05). No differences in capillarization were identified. Skeletal muscle blood flow is significantly reduced in experimental PH. Reduced blood flow during exercise may be, at least in part, consequent to reduced exercise intensity in PH. This adds further evidence of peripheral muscle dysfunction and exercise intolerance in PAH.
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Affiliation(s)
- Gary Marshall Long
- Department of Kinesiology, University of Indianapolis, Indianapolis, Indiana
| | - Ashley D Troutman
- Department of Kinesiology, Indiana University Purdue University Indianapolis, Indianapolis, Indiana
| | - Derrick A Gray
- Department of Kinesiology, Indiana University Purdue University Indianapolis, Indianapolis, Indiana
| | - Amanda J Fisher
- Department of Kinesiology, Indiana University Purdue University Indianapolis, Indianapolis, Indiana
| | - Tim Lahm
- Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Indiana University, Indianapolis, Indiana
- Richard L. Roudebush Veteran Affairs Medical Center, Indianapolis, Indiana
| | - Andrew R Coggan
- Department of Kinesiology, Indiana University Purdue University Indianapolis, Indianapolis, Indiana
| | - Mary Beth Brown
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
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6
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Effects of pulmonary hypertension on microcirculatory hemodynamics in rat skeletal muscle. Microvasc Res 2022; 141:104334. [PMID: 35104507 PMCID: PMC8928216 DOI: 10.1016/j.mvr.2022.104334] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/12/2022] [Accepted: 01/25/2022] [Indexed: 11/20/2022]
Abstract
Pulmonary hypertension (PH) has previously been characterized as a disease of the pulmonary vasculature that subsequently results in myocardial dysfunction. Heart failure compromises skeletal muscle microvascular function, which contributes to exercise intolerance. Therefore, we tested the hypothesis that such changes might be present in PH. Thus, we investigated skeletal muscle oxygen (O2) transport in the rat model of PH to determine if O2 delivery (Q̇O2) is impaired at the level of the microcirculation as evidenced via reduced red blood cell (RBC) flux, velocity, hematocrit, and percentage of capillaries flowing in quiescent muscle. Adult male Sprague-Dawley rats were randomized into healthy (n = 9) and PH groups (n = 9). Progressive PH was induced via a one-time intraperitoneal injection of monocrotaline (MCT; 50 mg/kg) and rats were monitored weekly via echocardiography. Intravital microscopy in the spinotrapezius muscle was performed when echocardiograms confirmed moderate PH (preceding right ventricular (RV) failure). At 25 ± 9 days post-MCT, PH rats displayed RV hypertrophy (RV/(Left ventricle + Septum): 0.28 ± 0.05 vs. 0.44 ± 0.11), pulmonary congestion, and increased right ventricular systolic pressure (21 ± 8 vs. 55 ± 14 mm Hg) compared to healthy rats (all P < 0.05). Reduced capillary RBC velocity (403 ± 140 vs. 227 ± 84 μm/s; P = 0.01), RBC flux (33 ± 12 vs. 23 ± 5 RBCs/s; P = 0.04) and % of capillaries supporting continuous RBC flux at rest (79 ± 8 vs. 56 ± 13%; P = 0.01) were evident in PH rats compared to healthy rats. When Q̇O2 within a given field of view was quantified (RBC flux x % of capillaries supporting continuous RBC flux), PH rats demonstrated lower overall Q̇O2 (↓ 50%; P = 0.002). These data support that microcirculatory hemodynamic impairments (↓ Q̇O2 and therefore altered Q̇O2-to-V̇O2 matching) may compromise blood-myocyte O2 transport in PH. The mechanistic bases for decreased capillary RBC flux, velocity, and percentage of capillaries supporting RBC flow remains an important topic.
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Schulze KM, Weber RE, Colburn TD, Horn AG, Ade CJ, Hsu WW, Poole DC, Musch TI. The effects of pulmonary hypertension on skeletal muscle oxygen pressures in contracting rat spinotrapezius muscle. Exp Physiol 2021; 106:2070-2082. [PMID: 34469618 DOI: 10.1113/ep089631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/26/2021] [Indexed: 01/02/2023]
Abstract
NEW FINDINGS What is the central question of this study? Does impairment in the dynamics of O2 transport in skeletal muscle during a series of contractions constitute a potential mechanism underlying reduced exercise capacity in pulmonary hypertension? What is the main finding and its importance? Pulmonary hypertension compromises the dynamic matching of skeletal muscle O2 delivery-to-utilization following contraction onset in the rat spinotrapezius muscle. These results implicate a role for vascular dysfunction in the slow V ̇ O 2 kinetics and exercise intolerance present in pulmonary hypertension. ABSTRACT Pulmonary hypertension (PH) is characterized by pulmonary vascular dysfunction and exercise intolerance due, in part, to compromised pulmonary and cardiac function. We tested the hypothesis that there are peripheral (i.e., skeletal muscle) aberrations in O2 delivery ( Q ̇ O 2 )-to-O2 utilization ( V ̇ O 2 ) matching and vascular control that might help to explain poor exercise tolerance in PH. Furthermore, we investigated the peripheral effects of nitric oxide (NO) in attenuating these decrements. Male Sprague-Dawley rats (n = 21) were administered monocrotaline (MCT; 50 mg/kg, i.p.) to induce PH. Disease progression was monitored via echocardiography. Phosphorescence quenching determined the O2 partial pressure in the interstitial space ( P O 2 is ) in the spinotrapezius muscle at rest and during contractions under control (SNP-) and NO-donor (sodium nitroprusside, SNP+) conditions. MCT rats displayed right ventricular (RV) hypertrophy (right ventricle/(left ventricle + septum): 0.44 (0.13) vs. 0.28 (0.05)), pulmonary congestion, increased RV systolic pressure (48 (18) vs. 20 (8) mmHg) and arterial hypoxaemia ( P a O 2 : 64 (9) vs. 82 (9) mmHg) compared to healthy controls (HC) (P < 0.05). P O 2 is was significantly lower in MCT rats during the first 30 s of SNP- contractions. SNP superfusion elevated P O 2 is in both groups; however, MCT rats demonstrated a lower P O 2 is throughout SNP+ contractions versus HC (P < 0.05). Thus, for small muscle mass exercise in MCT rats, muscle oxygenation is impaired across the rest-to-contractions transition and exogenous NO does not raise the Q ̇ O 2 -to- V ̇ O 2 ratio in contracting muscle to the same levels as HC. These data support muscle Q ̇ O 2 -to- V ̇ O 2 mismatch as a potential contributor to slow V ̇ O 2 kinetics and therefore exercise intolerance in PH and suggest peripheral vascular dysfunction or remodelling as a possible mechanism.
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Affiliation(s)
- Kiana M Schulze
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA
| | - Ramona E Weber
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA
| | - Trenton D Colburn
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA
| | - Andrew G Horn
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA
| | - Carl J Ade
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA
| | - Wei-Wen Hsu
- Department of Environmental and Public Health Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - David C Poole
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA.,Department of Anatomy and Physiology, Kansas State University, Manhattan, KS, USA
| | - Timothy I Musch
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA.,Department of Anatomy and Physiology, Kansas State University, Manhattan, KS, USA
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Avitabile CM, Saavedra S, Sivakumar N, Goldmuntz E, Paridon SM, Zemel BS. Marked skeletal muscle deficits are associated with 6-minute walk distance in paediatric pulmonary hypertension. Cardiol Young 2021; 31:1426-1433. [PMID: 33568240 DOI: 10.1017/s1047951121000342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Poor growth is common in children with pulmonary hypertension; however, skeletal muscle deficits have not been described and the association between muscle deficits and functional status is unknown. METHODS Patients aged 8-18 years with pulmonary hypertension (diagnostic Groups 1, 2, or 3) and World Health Organization functional class I or II underwent dual-energy absorptiometry to measure leg lean mass Z-score (a surrogate for skeletal muscle). Muscle strength was assessed using dynamometry. Physical activity questionnaires were administered. Clinical data, including 6-minute walk distance, were reviewed. Relationships between skeletal muscle, physical activity score, and 6-minute walk distance were assessed by correlations and linear regression. RESULTS Sixteen patients (12.1 ± 3.2 years, 50% female, 56% Group 1, 56% functional class II) were enrolled. Leg lean mass Z-score was significantly less than reference data (-1.40 ± 1.12 versus 0.0 ± 0.9, p < 0.001) and worse in those with functional class II versus I (-2.10 ± 0.83 versus -0.50 ± 0.73, p < 0.01). Leg lean mass Z-score was positively associated with right ventricular systolic function by tricuspid annular plane systolic Z-score (r = 0.54, p = 0.03) and negatively associated with indexed pulmonary vascular resistance (r = -0.78, p < 0.001). Leg lean mass Z-score and forearm strength were positively associated with physical activity score. When physical activity score was held constant, leg lean mass Z-score independently predicted 6-minute walk distance (R2 = 0.39, p = 0.03). CONCLUSIONS Youth with pulmonary hypertension demonstrate marked skeletal muscle deficits in association with exercise intolerance. Future studies should investigate whether low leg lean mass is a marker of disease severity or an independent target that can be improved.
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Affiliation(s)
- Catherine M Avitabile
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sofia Saavedra
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nithya Sivakumar
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Elizabeth Goldmuntz
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Stephen M Paridon
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Babette S Zemel
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Arvanitaki A, Giannakoulas G, Triantafyllidou E, Feloukidis C, Boutou A, Garyfallos A, Karvounis H, Diller GP, Gatzoulis MA, Dimitroulas T. Peripheral microangiopathy in Eisenmenger syndrome: A nailfold video capillaroscopy study. Int J Cardiol 2021; 336:54-59. [PMID: 33741426 DOI: 10.1016/j.ijcard.2021.03.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Eisenmenger syndrome (ES) comprises a severe phenotype of pulmonary arterial hypertension characterized by angiopathy of the lung circulation. The aim of the present study was to demonstrate the presence of systemic microvascular abnormalities in patients with ES using nailfold video-capillaroscopy (NVC) and to identify potential correlations of nailfold capillaroscopic characteristics with non-invasive markers of systemic organ function. METHODS Α cross-sectional NVC study was performed in 17 consecutive patients with ES and 17 healthy controls matched for age and sex. NVC quantitative (capillary density, capillary dimensions, haemorrhages, thrombi, shape abnormalities) and qualitative (normal, non-specific or scleroderma pattern) parameters were evaluated. RESULTS Patients with ES [median age 40 (18-65) years, 11 women] presented reduced capillary density [8.8 (7.2-10.2) loops/mm vs. 9.9 (8.3-10.9) loops/mm, p = .004] and increased loop width [15.9 (10.3-21.7) μm vs. 12.3 (7.6-15.2) μm, p < .001], while they had significantly more abnormal capillaries than healthy controls [2.5 (0.9-5.4) abnormal loops/mm vs. 1.0 (0.0-1.7) abnormal loops/mm, p < .001]. NVC shape abnormalities in ES were positively correlated with NT-proBNP (r = 0.52, p = .03) and were negatively associated with estimated glomerular filtration rate (r = -0.60, p = .02). Additionally, capillary loop diameter was positively correlated with increased haemoglobin levels (r = 0.55, p = .03) and negatively correlated with reduced peripheral oxygen saturation (r = - 0.56, p = .02). CONCLUSIONS This study supports the hypothesis of peripheral microvascular involvement in ES parallel to pulmonary microangiopathy detected by NVC. Further longitudinal studies are needed to confirm our preliminary results.
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Affiliation(s)
- Alexandra Arvanitaki
- First Department of Cardiology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 1 St. Kyriakidi Street, 54636 Thessaloniki, Greece; Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, 54642 Thessaloniki, Greece; Department of Cardiology III, Adult Congenital and Valvular Heart Centre, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany; Adult Congenital Heart Centre, National Centre for Pulmonary Arterial Hypertension, Royal Brompton Hospital, Imperial College, London, UK.
| | - George Giannakoulas
- First Department of Cardiology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 1 St. Kyriakidi Street, 54636 Thessaloniki, Greece.
| | - Eva Triantafyllidou
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, 54642 Thessaloniki, Greece.
| | - Christos Feloukidis
- First Department of Cardiology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 1 St. Kyriakidi Street, 54636 Thessaloniki, Greece.
| | - Afroditi Boutou
- Department of Respiratory Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece.
| | - Alexandros Garyfallos
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, 54642 Thessaloniki, Greece.
| | - Haralambos Karvounis
- First Department of Cardiology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 1 St. Kyriakidi Street, 54636 Thessaloniki, Greece.
| | - Gerhard-Paul Diller
- Department of Cardiology III, Adult Congenital and Valvular Heart Centre, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany.
| | - Michael A Gatzoulis
- Adult Congenital Heart Centre, National Centre for Pulmonary Arterial Hypertension, Royal Brompton Hospital, Imperial College, London, UK.
| | - Theodoros Dimitroulas
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, 54642 Thessaloniki, Greece.
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10
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Dara A, Arvanitaki A, Theodorakopoulou M, Athanasiou C, Pagkopoulou E, Boutou A. Non-Invasive Assessment of Endothelial Dysfunction in Pulmonary Arterial Hypertension. Mediterr J Rheumatol 2021; 32:6-14. [PMID: 34386697 PMCID: PMC8314877 DOI: 10.31138/mjr.32.1.6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 01/01/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) is characterised by an increased pressure in the pulmonary arterial circulation, resulting in the elevation of pulmonary vascular resistance. Pulmonary endothelial dysfunction and inflammation, triggered by shear stress and hypoxia, constitute the hallmarks of pulmonary vasculopathy by promoting endothelial and smooth muscle cells proliferation, vasoconstriction, and thrombosis. While research was predominantly focused on pulmonary vasculature, the investigation of peripheral endothelial damage in different vascular beds has attracted the interest over the last years. As a result, effective non-invasive methods that can assess the endothelial function and the architectural integrity have been utilized for the evaluation of pulmonary and peripheral vasculature. Non-invasive plethysmography, pulmonary flow reserve, nailfold videocapillaroscopy, near-infrared spectroscopy, and imaging techniques such as magnetic resonance angiography and perfusion imaging coupled by a number of biomarkers can be used for the assessment of peripheral vascular function in PAH individuals. In this review, we summarise and critically approach the current evidence of more systemic derangement of vascular function in PAH defined by novel, non-invasive methods employed for functional and morphological assessment of endothelium and microcirculation.
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Affiliation(s)
- Athanasia Dara
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexandra Arvanitaki
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.,First Department of Cardiology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Adult Congenital Heart Centre and National Centre for Pulmonary Arterial Hypertension, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, Imperial College, London, UK
| | | | - Christos Athanasiou
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Pagkopoulou
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Afroditi Boutou
- Department of Respiratory Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece
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11
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Arvanitaki A, Giannakoulas G, Triantafyllidou E, Feloukidis C, Boutou AK, Garyfallos A, Karvounis H, Dimitroulas T. Peripheral microangiopathy in precapillary pulmonary hypertension: a nailfold video capillaroscopy prospective study. Respir Res 2021; 22:27. [PMID: 33478514 PMCID: PMC7819216 DOI: 10.1186/s12931-021-01622-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/10/2021] [Indexed: 12/21/2022] Open
Abstract
Background Although pulmonary vascular bed has been the main subject of research for many years in pulmonary hypertension (PH), interest has recently started to divert towards the possibility of a co-existing peripheral microangiopathy. The aim of the current study was to investigate the presence of nailfold video-capillaroscopic (NVC) structural changes in patients with precapillary PH and to identify possible associations of NVC measurements with markers of disease severity. Methods Α prospective case–control study was performed in 28 consecutive patients with precapillary PH [14 with idiopathic pulmonary arterial hypertension (IPAH) and 14 with chronic thromboembolic pulmonary hypertension (CTEPH)] and 30 healthy controls. NVC quantitative and qualitative parameters were evaluated using Optilia Digital Capillaroscope. To ensure inter-observer repeatability capillaroscopic images were reviewed by two independent investigators. For multiple comparisons among continuous variables, one-way ANOVA or the Kruskal–Wallis test were used. Differences between the groups were tested with post-hoc analysis with adjustment for multiple comparisons (Bonferroni test). Results Both IPAH (71.4% were women, mean age 53.1 ± 13.4 years) and CTEPH (64.3% women, mean age 60.9 ± 14.4 years) groups presented reduced capillary density compared to healthy controls (8.4 ± 1.2 loops/mm and 8.0 ± 1.2 loops/mm vs. 9.7 ± 0.81 loops/mm, p < 0.001) and increased loop width (15.7 ± 3.9 μm and 15.8 ± 1.9 μm vs. 11.5 ± 2.3 μm, p < 0.001). More than half of patients with IPAH presented microhaemorrhages on capillary nailfold, while increased shape abnormalities in capillary morphology and more capillary thrombi per linear mm were detected in patients with CTEPH compared to patients with IPAH and healthy controls. All PH patients presented a non-specific NVC pattern compared to controls (p < 0.001). Conclusion The findings of the study reveal a degree of significant peripheral microvascular alterations in patients with IPAH and CTEPH, suggesting a generalized impairment of peripheral microvasculature in pulmonary vascular disease.
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Affiliation(s)
- Alexandra Arvanitaki
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.,Department of Cardiology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 1 St. Kyriakidi Street, 54636, Thessaloniki, Greece.,Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, 54642, Thessaloniki, Greece
| | - George Giannakoulas
- Department of Cardiology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 1 St. Kyriakidi Street, 54636, Thessaloniki, Greece
| | - Eva Triantafyllidou
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, 54642, Thessaloniki, Greece
| | - Christos Feloukidis
- Department of Cardiology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 1 St. Kyriakidi Street, 54636, Thessaloniki, Greece
| | - Afroditi K Boutou
- Department of Respiratory Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Alexandros Garyfallos
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, 54642, Thessaloniki, Greece
| | - Haralambos Karvounis
- Department of Cardiology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 1 St. Kyriakidi Street, 54636, Thessaloniki, Greece
| | - Theodoros Dimitroulas
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, 54642, Thessaloniki, Greece.
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12
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Joseph P, Oliveira RKF, Eslam RB, Agarwal M, Waxman AB, Systrom DM. Fick principle and exercise pulmonary hemodynamic determinants of the six-minute walk distance in pulmonary hypertension. Pulm Circ 2020; 10:2045894020957576. [PMID: 32994925 PMCID: PMC7502687 DOI: 10.1177/2045894020957576] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 08/13/2020] [Indexed: 01/12/2023] Open
Abstract
The six-minute walk test is widely used to assess the severity and prognosis of
pulmonary hypertension. However, the pathophysiology underlying a compromised
six-minute walk distance is incompletely characterized. The purpose of this
study is to evaluate the Fick principle and pulmonary hemodynamic determinants
of the six-minute walk distance in patients with suspected pulmonary
hypertension. Twenty-nine patients were retrospectively studied and underwent a
right heart catheterization for the evaluation of suspected pulmonary
hypertension. With the pulmonary artery catheter in place, patients were moved
to a treadmill and completed a six-minute walk test. Fick cardiac output and
indices of right heart afterload were calculated using continuous measurements
of pulmonary vascular pressures, gas exchange, and mixed venous blood samples.
Fifteen subjects who walked ≤ 348 m were compared to 14 subjects who
walked > 348 m. Systemic oxygen delivery was impaired in six-minute walk
distance ≤ 348 m compared to six-minute walk distance > 348 m (15.2 ± 6.2 vs.
23.2 ± 6.8 mL/kg/min, p < 0.01). Impaired oxygen delivery
was due to a depressed cardiac index and decreased cardiac reserve demonstrated
by the change in the stroke volume index (3.0 ± 14 vs.
17 ± 15 mL/min/m2, p = 0.02). The six-minute
walk distance positively correlated with oxygen delivery
(r = 0.501, p = 0.006) and inversely
correlated with oxygen extraction (r = 0.369,
p = 0.049). A decreased six-minute walk distance was
associated with an increased total pulmonary resistance
(r = 0.502, p = 0.006) and pulmonary vascular
resistance (r = 0.530, p = 0.003). In patients
with suspected pulmonary hypertension, a decreased six-minute walk distance is
due to compromised oxygen delivery, decreased cardiac reserve, and increased
right ventricular afterload.
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Affiliation(s)
- Phillip Joseph
- Department of Medicine, Yale School of Medicine/Yale New Haven Hospital, New Haven, CT, USA
| | - Rudolf K F Oliveira
- Department of Medicine, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Roza B Eslam
- Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Manyoo Agarwal
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Aaron B Waxman
- Department of Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - David M Systrom
- Department of Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
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13
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Arvanitaki A, Giannakoulas G, Triantafyllidou E, Karvounis H, Garyfallos A, Kitas G, Dimitroulas T. Nailfold videocapillaroscopy: a novel possible surrogate marker for the evaluation of peripheral microangiopathy in pulmonary arterial hypertension. Scand J Rheumatol 2020; 50:85-94. [PMID: 32909481 DOI: 10.1080/03009742.2020.1786854] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Nailfold videocapillaroscopy (NVC) changes in systemic sclerosis (SSc) are correlated with vascular complications, such as pulmonary arterial hypertension (PAH), supporting a potential link between peripheral and internal organ vasculopathy. The current stage of knowledge regarding NVC and PAH is discussed, focusing on the assessment of peripheral microangiopathy and a potential relationship with functional, echocardiographic, and haemodynamic markers of cardiac dysfunction. A comprehensive literature search was carried out to identify all studies focusing on NVC findings in patients with PAH, diagnosed with right heart catheterization. The majority of the studies examined NVC findings in patients with SSc-PAH, while three studies reported NVC abnormalities in patients with idiopathic PAH. Besides the pulmonary vasculature, a systemic component of microangiopathy seems to be involved in PAH. Well-designed prospective trials are warranted to validate NVC as a biomarker, with clinical implications in the diagnostic evaluation, risk stratification, and overall management of PAH in the daily clinical setting.
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Affiliation(s)
- A Arvanitaki
- First Department of Cardiology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany
| | - G Giannakoulas
- First Department of Cardiology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - E Triantafyllidou
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - H Karvounis
- First Department of Cardiology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Garyfallos
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - G Kitas
- Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS FT, Dudley, UK
| | - T Dimitroulas
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS FT, Dudley, UK
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14
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Laveneziana P, Weatherald J. Pulmonary Vascular Disease and Cardiopulmonary Exercise Testing. Front Physiol 2020; 11:964. [PMID: 32848882 PMCID: PMC7425313 DOI: 10.3389/fphys.2020.00964] [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] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/15/2020] [Indexed: 12/11/2022] Open
Abstract
Cardiopulmonary exercise testing (CPET) is of great interest and utility for clinicians dealing Pulmonary Hypertension (PH) in several ways, including: helping with differential diagnosis, evaluating exercise intolerance and its underpinning mechanisms, accurately assessing exertional dyspnea and unmasking its underlying often non-straightforward mechanisms, generating prognostic indicators. Pathophysiologic anomalies in PH can range from reduced cardiac output and aerobic capacity, to inefficient ventilation, dyspnea, dynamic hyperinflation, and locomotor muscle dysfunction. CPET can magnify the PH-related pathophysiologic anomalies and has a major role in the management of PH patients.
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Affiliation(s)
- Pierantonio Laveneziana
- Sorbonne Université, INSERM, UMR S1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Sites Pitié-Salpêtrière, Saint-Antoine et Tenon, Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée (Département R3S), Paris, France
| | - Jason Weatherald
- Division of Respirology, Department of Medicine, University of Calgary, Calgary, AB, Canada.,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
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15
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Malik J, Ikram U, Kamal A, Khalid A, Zahid T. Secundum Atrial Septal Defect With Early Presentation of Eisenmenger Syndrome and Right-Heart Failure: A Rare Case Report and Literature Review. Cureus 2020; 12:e8980. [PMID: 32775062 PMCID: PMC7402440 DOI: 10.7759/cureus.8980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Eisenmenger syndrome, the most advanced form of pulmonary arterial hypertension (PAH), poses a considerable risk to the survival and quality of life of patients. It is more commonly seen in large intra-cardiac defects like ventricular septal defects (VSD) or patent ductus arteriosus (PDA), and rarely in atrial septal defects (ASD). Early diagnosis is the single most important step in the definitive management of the condition; otherwise, only conservative treatment can be offered. In this report, we present the case of a 20-year-old female patient diagnosed with Eisenmenger syndrome secondary to a large secundum ASD. The patient responded well to medical treatment.
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16
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Arvanitaki A, Giannakoulas G, Triantafyllidou E, Karvounis H, Dimitroulas T. Peripheral Microangiopathy in Patients with Precapillary Pulmonary Hypertension: Correlation with Cardiac Function and Patients' Functional Capacity. Study Design and Rationale. Mediterr J Rheumatol 2020; 31:369-373. [PMID: 33163874 PMCID: PMC7641020 DOI: 10.31138/mjr.31.3.369] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 11/17/2022] Open
Abstract
Pulmonary hypertension (PH) is a rare, heterogenous clinical entity characterised by a progressive remodelling of pulmonary arterioles, which leads to obstructive pulmonary arteriopathy, increased pulmonary vascular resistance, and eventually, right heart failure. Inflammation, endothelial dysfunction, and microvascular changes of the pulmonary vasculature constitute the hallmarks of pulmonary arterial hypertension (PAH), explaining much of the pathophysiology and clinical manifestations of the disease. Besides pulmonary vasculature, a systemic component of endothelial dysfunction and microcirculation may be involved in PAH, affecting different vascular beds. Nailfold videocapillaroscopy (NVC) is an established method for the assessment of the microvasculature with clinical implications in the diagnostic assessment of individuals with Raynaud syndrome and systemic sclerosis (SSc). Nowadays, growing amounts of evidence suggest that NVC changes in SSc are correlated with other vascular complications such as PAH, supporting a potential link between peripheral and internal organ vasculopathy. The purpose of the current prospective observational study is to explore: 1. the presence of peripheral microangiopathy in precapillary PH using NVC, 2. possible NVC differences among PH subgroups, 3. a potential relationship between NVC morphological abnormalities and clinical, functional, biochemical, echocardiographic and hemodynamic markers of cardiac dysfunction in precapillary PH.
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Affiliation(s)
- Alexandra Arvanitaki
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Greece.,First Department of Cardiology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany
| | - George Giannakoulas
- First Department of Cardiology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eva Triantafyllidou
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | - Haralambos Karvounis
- First Department of Cardiology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodoros Dimitroulas
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
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17
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Nickel NP, Yuan K, Dorfmuller P, Provencher S, Lai YC, Bonnet S, Austin ED, Koch CD, Morris A, Perros F, Montani D, Zamanian RT, de Jesus Perez VA. Beyond the Lungs: Systemic Manifestations of Pulmonary Arterial Hypertension. Am J Respir Crit Care Med 2020; 201:148-157. [PMID: 31513751 DOI: 10.1164/rccm.201903-0656ci] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a disease characterized by progressive loss and remodeling of the pulmonary arteries, resulting in right heart failure and death. Until recently, PAH was seen as a disease restricted to the pulmonary circulation. However, there is growing evidence that patients with PAH also exhibit systemic vascular dysfunction, as evidenced by impaired brachial artery flow-mediated dilation, abnormal cerebral blood flow, skeletal myopathy, and intrinsic kidney disease. Although some of these anomalies are partially due to right ventricular insufficiency, recent data support a mechanistic link to the genetic and molecular events behind PAH pathogenesis. This review serves as an introduction to the major systemic findings in PAH and the evidence that supports a common mechanistic link with PAH pathophysiology. In addition, it discusses recent studies describing morphological changes in systemic vessels and the possible role of bronchopulmonary anastomoses in the development of plexogenic arteriopathy. On the basis of available evidence, we propose a paradigm in which metabolic abnormalities, genetic injury, and systemic vascular dysfunction contribute to systemic manifestations in PAH. This concept not only opens exciting research possibilities but also encourages clinicians to consider extrapulmonary manifestations in their management of patients with PAH.
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Affiliation(s)
- Nils P Nickel
- Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, California
| | - Ke Yuan
- Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, California
| | - Peter Dorfmuller
- Department of Pathology, University of Giessen, Giessen, Germany
| | - Steeve Provencher
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec, Quebec, Canada
| | - Yen-Chun Lai
- Division of Pulmonary and Critical Care Medicine, Indiana University, Bloomington, Indiana
| | - Sebastien Bonnet
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec, Quebec, Canada
| | - Eric D Austin
- Division of Pediatric Pulmonary and Critical Care Medicine, Vanderbilt University, Nashville Tennessee
| | - Carl D Koch
- Division of Pulmonary and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alison Morris
- Division of Pulmonary and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Frédéric Perros
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec, Quebec, Canada.,Inserm Université Paris Sud-Centre chirurgical Marie Lannelongue 999, Université Paris Sud-Paris Saclay, Hôpital Marie Lannelongue, Le Plessis Robinson, France; and
| | - David Montani
- Inserm Université Paris Sud-Centre chirurgical Marie Lannelongue 999, Université Paris Sud-Paris Saclay, Hôpital Marie Lannelongue, Le Plessis Robinson, France; and.,Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
| | - Roham T Zamanian
- Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, California
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18
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Passive smoking acutely affects the microcirculation in healthy non-smokers. Microvasc Res 2020; 128:103932. [DOI: 10.1016/j.mvr.2019.103932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 08/31/2019] [Accepted: 09/26/2019] [Indexed: 02/02/2023]
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19
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Riou M, Pizzimenti M, Enache I, Charloux A, Canuet M, Andres E, Talha S, Meyer A, Geny B. Skeletal and Respiratory Muscle Dysfunctions in Pulmonary Arterial Hypertension. J Clin Med 2020; 9:jcm9020410. [PMID: 32028638 PMCID: PMC7073630 DOI: 10.3390/jcm9020410] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/20/2020] [Accepted: 01/28/2020] [Indexed: 12/18/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a rare disease, which leads to the progressive loss and remodeling of the pulmonary vessels, right heart failure, and death. Different clinical presentations can be responsible for such a bad prognosis disease and the underlying mechanisms still need to be further examined. Importantly, skeletal and respiratory muscle abnormalities largely contribute to the decreased quality of life and exercise intolerance observed in patients with PAH. At the systemic level, impaired oxygen supply through reduced cardiac output and respiratory muscle dysfunctions, which potentially result in hypoxemia, is associated with altered muscles vascularization, inflammation, enhanced catabolic pathways, and impaired oxygen use through mitochondrial dysfunctions that are likely participate in PAH-related myopathy. Sharing new insights into the pathological mechanisms of PAH might help stimulate specific research areas, improving the treatment and quality of life of PAH patients. Indeed, many of these muscular impairments are reversible, strongly supporting the development of effective preventive and/or therapeutic approaches, including mitochondrial protection and exercise training.
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Affiliation(s)
- Marianne Riou
- Unistra, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 11 rue Humann, 67000 Strasbourg, France
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg CEDEX, France
- Pulmonology Service, University Hospital of Strasbourg, 1 place de l’Hôpital, 67091 Strasbourg CEDEX, France
| | - Mégane Pizzimenti
- Unistra, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 11 rue Humann, 67000 Strasbourg, France
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg CEDEX, France
| | - Irina Enache
- Unistra, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 11 rue Humann, 67000 Strasbourg, France
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg CEDEX, France
| | - Anne Charloux
- Unistra, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 11 rue Humann, 67000 Strasbourg, France
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg CEDEX, France
| | - Mathieu Canuet
- Pulmonology Service, University Hospital of Strasbourg, 1 place de l’Hôpital, 67091 Strasbourg CEDEX, France
| | - Emmanuel Andres
- Internal Medicine, Diabete and Metabolic Diseases Service, University Hospital of Strasbourg, 1 place de l’Hôpital, 67091 Strasbourg CEDEX, France;
| | - Samy Talha
- Unistra, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 11 rue Humann, 67000 Strasbourg, France
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg CEDEX, France
| | - Alain Meyer
- Unistra, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 11 rue Humann, 67000 Strasbourg, France
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg CEDEX, France
| | - Bernard Geny
- Unistra, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 11 rue Humann, 67000 Strasbourg, France
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg CEDEX, France
- Correspondence:
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20
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Bonnet S, Boucherat O, Paulin R, Wu D, Hindmarch CCT, Archer SL, Song R, Moore JB, Provencher S, Zhang L, Uchida S. Clinical value of non-coding RNAs in cardiovascular, pulmonary, and muscle diseases. Am J Physiol Cell Physiol 2019; 318:C1-C28. [PMID: 31483703 DOI: 10.1152/ajpcell.00078.2019] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Although a majority of the mammalian genome is transcribed to RNA, mounting evidence indicates that only a minor proportion of these transcriptional products are actually translated into proteins. Since the discovery of the first non-coding RNA (ncRNA) in the 1980s, the field has gone on to recognize ncRNAs as important molecular regulators of RNA activity and protein function, knowledge of which has stimulated the expansion of a scientific field that quests to understand the role of ncRNAs in cellular physiology, tissue homeostasis, and human disease. Although our knowledge of these molecules has significantly improved over the years, we have limited understanding of their precise functions, protein interacting partners, and tissue-specific activities. Adding to this complexity, it remains unknown exactly how many ncRNAs there are in existence. The increased use of high-throughput transcriptomics techniques has rapidly expanded the list of ncRNAs, which now includes classical ncRNAs (e.g., ribosomal RNAs and transfer RNAs), microRNAs, and long ncRNAs. In addition, splicing by-products of protein-coding genes and ncRNAs, so-called circular RNAs, are now being investigated. Because there is substantial heterogeneity in the functions of ncRNAs, we have summarized the present state of knowledge regarding the functions of ncRNAs in heart, lungs, and skeletal muscle. This review highlights the pathophysiologic relevance of these ncRNAs in the context of human cardiovascular, pulmonary, and muscle diseases.
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Affiliation(s)
- Sébastien Bonnet
- Pulmonary Hypertension and Vascular Biology Research Group, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Department of Medicine, Université Laval, Quebec City, Quebec, Canada.,Department of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Olivier Boucherat
- Pulmonary Hypertension and Vascular Biology Research Group, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Department of Medicine, Université Laval, Quebec City, Quebec, Canada.,Department of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Roxane Paulin
- Pulmonary Hypertension and Vascular Biology Research Group, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Department of Medicine, Université Laval, Quebec City, Quebec, Canada.,Department of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Danchen Wu
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Charles C T Hindmarch
- Queen's Cardiopulmonary Unit, Translational Institute of Medicine, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Stephen L Archer
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Rui Song
- Lawrence D. Longo, MD Center for Perinatal Biology, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, California
| | - Joseph B Moore
- Diabetes and Obesity Center, University of Louisville, Louisville, Kentucky.,The Christina Lee Brown Envirome Institute, Department of Medicine, University of Louisville, Louisville, Kentucky
| | - Steeve Provencher
- Pulmonary Hypertension and Vascular Biology Research Group, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Department of Medicine, Université Laval, Quebec City, Quebec, Canada.,Department of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Lubo Zhang
- Lawrence D. Longo, MD Center for Perinatal Biology, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, California
| | - Shizuka Uchida
- Diabetes and Obesity Center, University of Louisville, Louisville, Kentucky.,The Christina Lee Brown Envirome Institute, Department of Medicine, University of Louisville, Louisville, Kentucky.,Cardiovascular Innovation Institute, University of Louisville, Louisville, Kentucky
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21
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Vallerand JR, Weatherald J, Laveneziana P. Pulmonary Hypertension and Exercise. Clin Chest Med 2019; 40:459-469. [DOI: 10.1016/j.ccm.2019.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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22
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Barstow TJ. Understanding near infrared spectroscopy and its application to skeletal muscle research. J Appl Physiol (1985) 2019; 126:1360-1376. [PMID: 30844336 DOI: 10.1152/japplphysiol.00166.2018] [Citation(s) in RCA: 203] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Near infrared spectroscopy (NIRS) is a powerful noninvasive tool with which to study the matching of oxygen delivery to oxygen utilization and the number of new publications utilizing this technique has increased exponentially in the last 20 yr. By measuring the state of oxygenation of the primary heme compounds in skeletal muscle (hemoglobin and myoglobin), greater understanding of the underlying control mechanisms that couple perfusive and diffusive oxygen delivery to oxidative metabolism can be gained from the laboratory to the athletic field to the intensive care unit or emergency room. However, the field of NIRS has been complicated by the diversity of instrumentation, the inherent limitations of some of these technologies, the associated diversity of terminology, and a general lack of standardization of protocols. This Cores of Reproducibility in Physiology (CORP) will describe in basic but important detail the most common methodologies of NIRS, their strengths and limitations, and discuss some of the potential confounding factors that can affect the quality and reproducibility of NIRS data. Recommendations are provided to reduce the variability and errors in data collection, analysis, and interpretation. The goal of this CORP is to provide readers with a greater understanding of the methodology, limitations, and best practices so as to improve the reproducibility of NIRS research in skeletal muscle.
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Affiliation(s)
- Thomas J Barstow
- Department of Kinesiology, Kansas State University , Manhattan, Kansas
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23
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Abstract
Pulmonary arterial hypertension (PAH) is characterized by a continuous increase in pre-capillary pulmonary vascular resistance (PVR) with a progressive reduction of cardiac output (CO). Similar to what occurs in left heart failure (HF), this represents the initial phase of a syndrome characterized by the progressive development of dyspnea and fatigue with increasing deterioration of exercise tolerance. Although the therapies introduced in the last two decades have determined a significant improvement of the clinical conditions of PAH patients, they have a little impact on exercise capacity and prognosis. However, as previously demonstrated for HF, recent pilot studies have reported that physical and respiratory rehabilitation may have a specific role in the management of PAH. Despite potential risks, so far all studies agree that exercise training (ET) improves exercise capacity, quality of life (QoL), muscle function and pulmonary circulation. We will review the pathophysiological mechanisms underlying the functional incompetence of PAH patients, the effects of ET on clinical and functional parameters, the selection criteria for inclusion of patients in a training program, the suggested monitoring of beneficial effects or possible side effects induced by ET. Finally, we discuss of the possible exercise induced amelioration of prognosis in PAH.
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Affiliation(s)
| | - Maurizio Bussotti
- Department of Cardiology, Istituti Clinici Scientifici Maugeri SpA SB, Istituto di Milano-IRCCS, Milan, Italy
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24
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Tzanis G, Dimopoulos S, Manetos C, Koroboki E, Manios E, Vasileiadis I, Zakopoulos N, Nanas S. Muscle microcirculation alterations and relation to dipping status in newly diagnosed untreated patients with arterial hypertension-A pilot study. Microcirculation 2017; 24. [PMID: 28585358 DOI: 10.1111/micc.12384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 05/30/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The importance of abnormalities observed in the microcirculation of patients with arterial hypertension (AH) is being increasingly recognized. The authors aimed to evaluate skeletal muscle microcirculation in untreated, newly diagnosed hypertensive patients with NIRS, a noninvasive method that evaluates microcirculation. METHODS We evaluated 34 subjects, 17 patients with AH (13 males, 49±13 years, BMI: 26±2 kg/m2 ) and 17 healthy controls (12 males, 49±15 years, BMI: 25±3 kg/m2 ). The thenar muscle StO2 (%) was measured by NIRS before, during and after 3-minutes vascular occlusion to calculate OCR (%/min), EF (%/min), and RHT (minute). The dipping status of hypertensive patients was assessed. RESULTS The RHT differed between AH patients and healthy subjects (2.6±0.3 vs 2.1±0.3 minutes, P<.001). Dippers had higher EF than nondippers (939±280 vs 710±164%/min, P=.05). CONCLUSIONS The study suggests an impaired muscle microcirculation in newly diagnosed, untreated AH patients.
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Affiliation(s)
- Georgios Tzanis
- 1st Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, National & Kapodistrian University of Athens, Athens, Greece
| | - Stavros Dimopoulos
- 1st Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, National & Kapodistrian University of Athens, Athens, Greece
| | - Chris Manetos
- 1st Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, National & Kapodistrian University of Athens, Athens, Greece
| | - Eleni Koroboki
- Clinical Therapeutics, Hypertensive Center, Alexandra Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Efstathios Manios
- Clinical Therapeutics, Hypertensive Center, Alexandra Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Vasileiadis
- 1st Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, National & Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Zakopoulos
- Clinical Therapeutics, Hypertensive Center, Alexandra Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Serafim Nanas
- 1st Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, National & Kapodistrian University of Athens, Athens, Greece
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25
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Panagiotou M, Johnson MK, Louvaris Z, Baker JS, Church AC, Peacock AJ, Vogiatzis I. A study of clinical and physiological relations of daily physical activity in precapillary pulmonary hypertension. J Appl Physiol (1985) 2017; 123:851-859. [PMID: 28663381 DOI: 10.1152/japplphysiol.00986.2016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 06/22/2017] [Accepted: 06/22/2017] [Indexed: 11/22/2022] Open
Abstract
Daily physical activity is reduced in precapillary pulmonary hypertension (PH), but the underlying mechanisms are inadequately explored. We sought to investigate clinical and physiological relations of daily physical activity and profile differences between less and more active patients with precapillary PH. A prospective, cross-sectional study of 20 patients with precapillary PH who undertook 1) a comprehensive clinical assessment, 2) a preliminary treadmill test, 3) 7-day monitoring of daily walking intensity with triaxial accelerometry, and 4) a personalized treadmill test corresponding to the individual patient mean daily walking intensity with real-time physiological measurements. Significant clinical correlations with individual patient mean walking intensity [1.71 ± 0.27 (SD) m/s2] were observed for log-transformed N-terminal probrain natriuretic peptide (log NT-proBNP; r = -0.75, P = <.001), age (r = -0.70, P = 0.001), transfer factor for carbon monoxide %predicted (r = 0.51, P = 0.022), and 6-min walk distance (r = 0.50, P = 0.026). Significant physiological correlations were obtained for heart rate reserve (r = 0.68, P = 0.001), quadriceps tissue oxygenation index (Q-[Formula: see text]; r = 0.58, P = 0.008), change in Q-[Formula: see text] from rest (r = 0.60, P = 0.006), and ventilatory equivalent for oxygen uptake (r = -0.56, P = 0.013). Stepwise multiple regression analyses retained log NT-proBNP (R2 = 0.55), heart rate reserve (R2 = 0.44), and Q-[Formula: see text] (R2 = 0.13) accounting for a significant variance in individual walking intensity. Less active patients had greater physical activity-induced cardiopulmonary impairment, worse quadriceps oxygenation profile, and compromised health-related quality of life compared with more active patients. These preliminary findings suggest a significant relation between right ventricular and peripheral muscle oxygenation status and reduced daily physical activity in precapillary PH. Further research is warranted to unravel the physiological determinants, establish clinical predictors, and identify beneficial interventions.NEW & NOTEWORTHY Daily physical activity holds promise to be a meaningful, patient-related outcome measure in pulmonary hypertension. In this study, novel findings in a representative sample of patients with precapillary pulmonary hypertension link reduced daily walking activity, as measured by triaxial accelerometry, with compromised right ventricular and pulmonary vascular status, peripheral muscle oxygenation, and health-related quality of life, providing a preliminary insight into the physiological mechanisms and clinical predictors of daily physical activity in precapillary pulmonary hypertension.
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Affiliation(s)
- Marios Panagiotou
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom;
| | - Martin K Johnson
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Zafeiris Louvaris
- Faculty of Physical Education and Sports Sciences, National and Kapodistrian University of Athens, Athens, Greece.,Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Division of Respiratory Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - Julien S Baker
- Institute of Clinical Exercise and Health Sciences, University of the West of Scotland, Hamilton, United Kingdom; and
| | - Alistair C Church
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Andrew J Peacock
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Ioannis Vogiatzis
- Faculty of Physical Education and Sports Sciences, National and Kapodistrian University of Athens, Athens, Greece.,School of Health and Life Sciences, Northumbria University Newcastle, Newcastle upon Tyne, United Kingdom
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26
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Tran DL, Lau EM, Celermajer DS, Davis GM, Cordina R. Pathophysiology of exercise intolerance in pulmonary arterial hypertension. Respirology 2017; 23:148-159. [DOI: 10.1111/resp.13141] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 05/15/2017] [Accepted: 06/08/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Derek L. Tran
- Faculty of Health Sciences; The University of Sydney; Sydney NSW Australia
- Department of Clinical Medicine, Faculty of Medicine and Health Sciences; Macquarie University; Sydney NSW Australia
- Pulmonary Hypertension Service; Royal Prince Alfred Hospital; Sydney NSW Australia
| | - Edmund M.T. Lau
- Pulmonary Hypertension Service; Royal Prince Alfred Hospital; Sydney NSW Australia
- Sydney Medical School; The University of Sydney; Sydney NSW Australia
| | - David S. Celermajer
- Pulmonary Hypertension Service; Royal Prince Alfred Hospital; Sydney NSW Australia
- Sydney Medical School; The University of Sydney; Sydney NSW Australia
| | - Glen M. Davis
- Faculty of Health Sciences; The University of Sydney; Sydney NSW Australia
| | - Rachael Cordina
- Pulmonary Hypertension Service; Royal Prince Alfred Hospital; Sydney NSW Australia
- Sydney Medical School; The University of Sydney; Sydney NSW Australia
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27
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Involvement of Ca 2+-activated K + channel 3.1 in hypoxia-induced pulmonary arterial hypertension and therapeutic effects of TRAM-34 in rats. Biosci Rep 2017; 37:BSR20170763. [PMID: 28679649 PMCID: PMC5529208 DOI: 10.1042/bsr20170763] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/02/2017] [Accepted: 07/04/2017] [Indexed: 02/05/2023] Open
Abstract
Pulmonary artery hypertension (PAH) is an incurable disease associated with the proliferation of pulmonary artery smooth muscle cells (PASMCs) and vascular remodeling. The present study examined whether TRAM-34, a highly selective blocker of calcium-activated potassium channel 3.1 (Kca3.1), can help prevent such hypertension by reducing proliferation in PASMCs. Rats were exposed to hypoxia (10% O2) for 3 weeks and treated daily with TRAM-34 intraperitoneally from the first day of hypoxia. Animals were killed and examined for vascular hypertrophy, Kca3.1 expression, and downstream signaling pathways. In addition, primary cultures of rat PASMCs were exposed to hypoxia (3% O2) or normoxia (21% O2) for 24 h in the presence of TRAM-34 or siRNA against Kca3.1. Activation of cell signaling pathways was examined using Western blot analysis. In animal experiments, hypoxia triggered significant medial hypertrophy of pulmonary arterioles and right ventricular hypertrophy, and it significantly increased pulmonary artery pressure, Kca3.1 mRNA levels and ERK/p38 MAP kinase signaling. These effects were attenuated in the presence of TRAM-34. In cell culture experiments, blocking Kca3.1 using TRAM-34 or siRNA inhibited hypoxia-induced ERK/p38 signaling. Kca3.1 may play a role in the development of PAH by activating ERK/p38 MAP kinase signaling, which may then contribute to hypoxia-induced pulmonary vascular remodeling. TRAM-34 may protect against hypoxia-induced PAH.
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28
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Corrado A, Correale M, Mansueto N, Monaco I, Carriero A, Mele A, Colia R, Di Biase M, Cantatore FP. Nailfold capillaroscopic changes in patients with idiopathic pulmonary arterial hypertension and systemic sclerosis-related pulmonary arterial hypertension. Microvasc Res 2017; 114:46-51. [PMID: 28619664 DOI: 10.1016/j.mvr.2017.06.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/10/2017] [Accepted: 06/09/2017] [Indexed: 01/12/2023]
Abstract
Pulmonary arterial hypertension (PAH) represents one of the main clinical expressions of the vascular changes in systemic sclerosis (SSc). Lung microvascular changes can play a role in the pathogenesis of idiopathic PAH (IPAH) also. The aim of this study is to investigate the presence of capillaroscopic abnormalities in patients with IPAH and to evaluate the differences in capillary nailfold changes between patients with IPAH and patients with SSc with and without PAH. METHODS 39 SSc patients (19 with PAH - SSc-PAH and 20 without - SSc-noPAH), 21 subjects with IPAH and 20 healthy subjects were recruited. PAH was diagnosed by right heart catheterization. Nailfold videocapillaroscopy was performed (NVC) in all recruited subjects; capillary quantitative parameters (loops length and width, capillary density, neoangiogenesis) were evaluated and a semiquantitative scoring was used (normal, minor or major abnormalities for healthy controls and IPAH subjects and specific patterns - early, active and late - for SSc subjects) to define microvascular alterations. RESULTS The presence of capillaroscopic abnormalities was detected in 38,1% subjects with IPAH; particularly, compared to healthy controls, capillary density was significantly lower (7,5±1,65loops/mm vs 9±1,37loops/mm p<0,05) and mean capillary width was significantly higher (21±13μm vs 17±3μm p<0,05). A more severe NVC pattern (active/late) was described. SSc-PAH patients compared to SSc-noPAH patients (73,2% vs 50% respectively, p<0,05), with a significantly lower capillary density (5,64±1,9loops/mm vs 6,5±1,3loops/mm p<0,05) and a significantly higher capillary width (55±7μm vs 35±8μm - p<0,05) and mean number of neoangiogenesis (N/mm) (1±0,33 vs 0,2±0,22 respectively p<0,05). CONCLUSIONS These data, beyond to confirm the role of microvascular damage in SSc-related PAH, support the hypothesis of systemic microvascular involvement in IPAH also, which can be detected by NVC, although further studies are needed to establish whether the changes in the systemic microcirculation are causal or consequential to PAH.
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Affiliation(s)
- A Corrado
- Rheumatology Clinic, Department of Medical and Surgical Sciences - University of Foggia, Foggia, Italy
| | - M Correale
- Cardiology Clinic, Department of Medical and Surgical Sciences - University of Foggia, Foggia, Italy
| | - N Mansueto
- Rheumatology Clinic, Department of Medical and Surgical Sciences - University of Foggia, Foggia, Italy
| | - I Monaco
- Cardiology Clinic, Department of Medical and Surgical Sciences - University of Foggia, Foggia, Italy
| | - A Carriero
- Rheumatology Clinic, Department of Medical and Surgical Sciences - University of Foggia, Foggia, Italy
| | - A Mele
- Rheumatology Clinic, Department of Medical and Surgical Sciences - University of Foggia, Foggia, Italy
| | - R Colia
- Rheumatology Clinic, Department of Medical and Surgical Sciences - University of Foggia, Foggia, Italy
| | - M Di Biase
- Cardiology Clinic, Department of Medical and Surgical Sciences - University of Foggia, Foggia, Italy
| | - F P Cantatore
- Rheumatology Clinic, Department of Medical and Surgical Sciences - University of Foggia, Foggia, Italy.
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29
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González-Saiz L, Fiuza-Luces C, Sanchis-Gomar F, Santos-Lozano A, Quezada-Loaiza CA, Flox-Camacho A, Munguía-Izquierdo D, Ara I, Santalla A, Morán M, Sanz-Ayan P, Escribano-Subías P, Lucia A. Benefits of skeletal-muscle exercise training in pulmonary arterial hypertension: The WHOLEi+12 trial. Int J Cardiol 2017; 231:277-283. [DOI: 10.1016/j.ijcard.2016.12.026] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 11/30/2016] [Accepted: 12/08/2016] [Indexed: 10/20/2022]
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30
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Chia KSW, Faux SG, Wong PKK, Holloway C, Assareh H, McLachlan CS, Kotlyar E. Randomised controlled trial examining the effect of an outpatient exercise training programme on haemodynamics and cardiac MR parameters of right ventricular function in patients with pulmonary arterial hypertension: the ExPAH study protocol. BMJ Open 2017; 7:e014037. [PMID: 28167746 PMCID: PMC5293990 DOI: 10.1136/bmjopen-2016-014037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Pulmonary hypertension (PH) is a potentially life-threatening condition characterised by elevated pulmonary artery pressure. Early stage PH patients are often asymptomatic. Disease progression is associated with impairment of right ventricular function and progressive dyspnoea. Current guidelines recommend exercise training (grade IIa, level B). However, many questions remain regarding the mechanisms of improvement, intensity of supervision and optimal frequency, duration and intensity of exercise. This study will assess the effect of an outpatient rehabilitation programme on haemodynamics and cardiac right ventricular function in patients with pulmonary arterial hypertension (PAH), a subgroup of PH. METHODS AND ANALYSIS This randomised controlled trial involves both a major urban tertiary and smaller regional hospital in New South Wales, Australia. The intervention will compare an outpatient rehabilitation programme with a control group (home exercise programme). Participants will be stable on oral PAH-specific therapy. The primary outcome measure will be right ventricular ejection fraction measured by cardiac MRI. Secondary outcomes will include haemodynamics measured by right heart catheterisation, endurance, functional capacity, health-related quality of life questionnaires and biomarkers of cardiac function and inflammation. ETHICS APPROVAL AND DISSEMINATION Ethical approval has been granted by St Vincent's Hospital, Sydney (HREC/14/SVH/341). Results of this study will be disseminated through presentation at scientific conferences and in scientific journals. TRIAL REGISTRATION NUMBER ACTRN12615001041549; pre-results.
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Affiliation(s)
- Karen S W Chia
- University of New South Wales Rural Clinical School, Coffs Harbour, New South Wales, Australia
- Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - Steven G Faux
- Sacred Heart Rehabilitation, St Vincent's Health, Coffs Harbour, New South Wales, Australia
- University of New South Wales, Coffs Harbour, New South Wales, Australia
- St Vincent's Hospital Sydney, Coffs Harbour, New South Wales, Australia
| | - Peter K K Wong
- University of New South Wales Rural Clinical School, Coffs Harbour, New South Wales, Australia
- Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
- Mid-North Coast Arthritis Clinic, Coffs Harbour, New South Wales, Australia
| | - Cameron Holloway
- University of New South Wales, Coffs Harbour, New South Wales, Australia
- St Vincent's Hospital Sydney, Coffs Harbour, New South Wales, Australia
| | - Hassan Assareh
- University of New South Wales Rural Clinical School, Coffs Harbour, New South Wales, Australia
- Epidemiology and Health Analytics Department, Western Sydney Local Health District, Coffs Harbour, New South Wales, Australia
| | - Craig S McLachlan
- University of New South Wales Rural Clinical School, Coffs Harbour, New South Wales, Australia
| | - Eugene Kotlyar
- University of New South Wales, Coffs Harbour, New South Wales, Australia
- St Vincent's Hospital Sydney, Coffs Harbour, New South Wales, Australia
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31
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Panagiotou M, Vogiatzis I, Louvaris Z, Jayasekera G, McKenzie A, Mcglinchey N, Baker JS, Church AC, Peacock AJ, Johnson MK. Dynamic near-infrared spectroscopy assessment as an important tool to explore pulmonary arterial hypertension pathophysiology. Eur Respir J 2017; 49:49/1/1602161. [PMID: 28052962 DOI: 10.1183/13993003.02161-2016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 11/09/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Marios Panagiotou
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Ioannis Vogiatzis
- Faculty of Physical Education and Sports Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Zafeiris Louvaris
- Faculty of Physical Education and Sports Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Geeshath Jayasekera
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Alison McKenzie
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Neil Mcglinchey
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Julien S Baker
- Institute of Clinical Exercise and Health Science, University of the West of Scotland, Hamilton, UK
| | - Alistair C Church
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Andrew J Peacock
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Martin K Johnson
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
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32
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Dimopoulos S, Tzanis G, Karabinis A, Nanas S. Dynamic near-infrared spectroscopy assessment as an important tool to explore pulmonary arterial hypertension pathophysiology. Eur Respir J 2017; 49:49/1/1601932. [PMID: 28052959 DOI: 10.1183/13993003.01932-2016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 10/08/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Stavros Dimopoulos
- Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, National and Kapodistrian University of Athens, Athens, Greece
- 1st Critical Care Medicine Dept, Evaggelismos Hospital, Athens, Greece
- Cardiothoracic Intensive Care Unit, Onassis Cardiac Surgery Center, Athens, Greece
| | - Giorgos Tzanis
- Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, National and Kapodistrian University of Athens, Athens, Greece
- 1st Critical Care Medicine Dept, Evaggelismos Hospital, Athens, Greece
| | - Andreas Karabinis
- Cardiothoracic Intensive Care Unit, Onassis Cardiac Surgery Center, Athens, Greece
| | - Serafim Nanas
- Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, National and Kapodistrian University of Athens, Athens, Greece
- 1st Critical Care Medicine Dept, Evaggelismos Hospital, Athens, Greece
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33
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Panagiotou M, Vogiatzis I, Louvaris Z, Jayasekera G, MacKenzie A, Mcglinchey N, Baker JS, Church AC, Peacock AJ, Johnson MK. Near infrared spectroscopy for the assessment of peripheral tissue oxygenation in pulmonary arterial hypertension. Eur Respir J 2016; 48:1224-1227. [PMID: 27587562 DOI: 10.1183/13993003.01022-2016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/13/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Marios Panagiotou
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Ioannis Vogiatzis
- National and Kapodistrian University of Athens, Dept of Physical Education and Sports Sciences, Athens, Greece
| | - Zafeiris Louvaris
- National and Kapodistrian University of Athens, Dept of Physical Education and Sports Sciences, Athens, Greece
| | - Geeshath Jayasekera
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Alison MacKenzie
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Neil Mcglinchey
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Julien S Baker
- Institute of Clinical Exercise and Health Science, University of the West of Scotland, Hamilton, UK
| | - Alistair C Church
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Andrew J Peacock
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Martin K Johnson
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
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Malenfant S, Potus F, Mainguy V, Leblanc E, Malenfant M, Ribeiro F, Saey D, Maltais F, Bonnet S, Provencher S. Impaired Skeletal Muscle Oxygenation and Exercise Tolerance in Pulmonary Hypertension. Med Sci Sports Exerc 2016; 47:2273-82. [PMID: 25970662 DOI: 10.1249/mss.0000000000000696] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Limb muscle dysfunction is documented in pulmonary arterial hypertension (PAH), but little is known regarding muscle oxygen (O2) supply and its possible effects on exercise tolerance in PAH. METHODS Ten patients with PAH and 10 matched controls underwent progressive maximal cardiopulmonary exercise test, voluntary and nonvolitional dominant quadriceps muscle strength measures, and nondominant quadriceps biopsy to assess maximal oxygen uptake, muscle function, and lower limb fiber type and capillarity, respectively. Both groups then performed normoxic and hyperoxic submaximal intensity exercise protocol at the same absolute workload during which muscle O2 supply was assessed by measuring changes in myoglobin-deoxyhemoglobin level (Δ[Mb-HHb]) and tissue oxygenation index in the dominant quadriceps using near-infrared spectroscopy. Changes in cardiac output, estimated systemic O2 delivery, and systemic O2 saturation were also assessed noninvasively throughout both submaximal exercises. RESULTS Patients with PAH displayed lower maximal oxygen uptake (P < 0.01), skeletal muscle strength (P < 0.05), and capillarity (P = 0.01). Throughout the normoxic submaximal exercise protocol, Δ[Mb-HHb] (P < 0.01) was higher whereas changes in tissue oxygenation index (P < 0.01) and systemic O2 saturation (P = 0.01) were lower in patients with PAH compared with those in controls. Conversely, changes in cardiac output and estimated systemic O2 delivery were similar between groups. Muscle oxygenation remained unchanged with O2 supplementation. Among variables known to influence tissue oxygenation, only quadriceps capillarity density correlated with Δ[Mb-HHb] (r = -0.66, P < 0.01), which in turn correlated with maximal oxygen uptake (r = -0.64, P < 0.01), 6-min walked distance (r = -0.74, P = 0.01), and both voluntary (r = -0.46, P = 0.04) and nonvolitional (r = -0.50, P = 0.02) quadriceps strength. CONCLUSIONS Capillary rarefaction within the skeletal muscle influences exercise tolerance and quadriceps strength at least partly through impaired muscle oxygen supply in PAH.
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Affiliation(s)
- Simon Malenfant
- 1Pulmonary Hypertension Research Group, Québec Heart and Lungs Institute Research Center, Laval University, Québec City, Québec, CANADA; and 2Québec Heart and Lungs Institute Research Center, Laval University, Québec City, Québec, CANADA
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Sanchis-Gomar F, González-Saiz L, Sanz-Ayan P, Fiuza-Luces C, Quezada-Loaiza CA, Flox-Camacho A, Santalla A, Munguía-Izquierdo D, Santos-Lozano A, Pareja-Galeano H, Ara I, Escribano-Subías P, Lucia A. Rationale and Design of a Randomized Controlled Trial Evaluating Whole Muscle Exercise Training Effects in Outpatients with Pulmonary Arterial Hypertension (WHOLEi+12). Cardiovasc Drugs Ther 2015; 29:543-550. [PMID: 26521182 DOI: 10.1007/s10557-015-6623-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Physical exercise is an important component in the management of pulmonary artery hypertension (PAH). The aim of this randomized controlled trial (RCT) is to determine the effects of an 8-week intervention combining muscle resistance, aerobic and inspiratory pressure load exercises in PAH outpatients. METHODS The RCT will be conducted from September 2015 to September 2016 following the recommendations of the Consolidated Standards of Reported Trials (CONSORT), with a total sample size of n ≥ 48 (≥24 participants/group). We will determine the effects of the intervention on: (i) skeletal-muscle power and mass (primary end points); and (ii) NT-proBNP, cardiopulmonary exercise testing variables (VO2peak, ventilatory equivalent for CO2 at the anaerobic threshold (VE/VCO2 at the AT), end-tidal pressure of CO2 at the anaerobic threshold (PETCO2 at the AT), 6-min walking distance (6MWD), maximal inspiratory pressure (PImax), health-related quality of life (HRQoL), objectively-assessed spontaneous levels of physical activity, and safety (secondary end points). CONCLUSIONS AND PERSPECTIVES This trial will provide insight into biological mechanisms of the disease and indicate the potential benefits of exercise in PAH outpatients, particularly on muscle power.
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Affiliation(s)
- Fabian Sanchis-Gomar
- Research Institute Hospital 12 de Octubre ('i + 12'), Edificio actividades ambulatorias, 6ª planta. Avda. de Córdoba s/n, 28041, Madrid, Spain.
| | - Laura González-Saiz
- Research Institute Hospital 12 de Octubre ('i + 12'), Edificio actividades ambulatorias, 6ª planta. Avda. de Córdoba s/n, 28041, Madrid, Spain
| | - Paz Sanz-Ayan
- Department of Rehabilitation, Hospital Universitario 12 de Octubre, Avda. de Córdoba s/n, 28041 Madrid, Spain
| | - Carmen Fiuza-Luces
- Research Institute Hospital 12 de Octubre ('i + 12'), Edificio actividades ambulatorias, 6ª planta. Avda. de Córdoba s/n, 28041, Madrid, Spain
| | - Carlos A Quezada-Loaiza
- Cardiology Department, Hospital Universitario 12 de Octubre, Avda. de Córdoba s/n, 28041 Madrid, Spain
| | - Angela Flox-Camacho
- Cardiology Department, Hospital Universitario 12 de Octubre, Avda. de Córdoba s/n, 28041 Madrid, Spain
| | - Alfredo Santalla
- Research Institute Hospital 12 de Octubre ('i + 12'), Edificio actividades ambulatorias, 6ª planta. Avda. de Córdoba s/n, 28041, Madrid, Spain.,Department of Sports and Computer Science, Section of Physical Education and Sports, Universidad Pablo de Olavide, ES-41013 Seville, Spain
| | - Diego Munguía-Izquierdo
- Department of Sports and Computer Science, Section of Physical Education and Sports, Universidad Pablo de Olavide, ES-41013 Seville, Spain
| | - Alejandro Santos-Lozano
- Research Institute Hospital 12 de Octubre ('i + 12'), Edificio actividades ambulatorias, 6ª planta. Avda. de Córdoba s/n, 28041, Madrid, Spain.,Department of Health Sciences, European University Miguel de Cervantes, C/Padre Julio Chevalier, 47012, Valladolid, Spain
| | - Helios Pareja-Galeano
- Research Institute Hospital 12 de Octubre ('i + 12'), Edificio actividades ambulatorias, 6ª planta. Avda. de Córdoba s/n, 28041, Madrid, Spain.,European University, C/Tajo S/N, Urbanización El Bosque, 28670 Villaviciosa de Odón, Madrid, Spain
| | - Ignacio Ara
- Growth, Exercise, Nutrition and Development (GENUD) Toledo Research Group, Universidad de Castilla-La Mancha, Avda Carlos III s/n, 45071 Toledo, Spain
| | - Pilar Escribano-Subías
- Cardiology Department, Hospital Universitario 12 de Octubre, Avda. de Córdoba s/n, 28041 Madrid, Spain
| | - Alejandro Lucia
- Research Institute Hospital 12 de Octubre ('i + 12'), Edificio actividades ambulatorias, 6ª planta. Avda. de Córdoba s/n, 28041, Madrid, Spain.,European University, C/Tajo S/N, Urbanización El Bosque, 28670 Villaviciosa de Odón, Madrid, Spain
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36
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Panagiotou M, Peacock AJ, Johnson MK. Respiratory and limb muscle dysfunction in pulmonary arterial hypertension: a role for exercise training? Pulm Circ 2015; 5:424-34. [PMID: 26401245 DOI: 10.1086/682431] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 05/04/2015] [Indexed: 11/03/2022] Open
Abstract
Respiratory and limb muscle dysfunction is emerging as an important pathophysiological abnormality in pulmonary arterial hypertension (PAH). Muscle abnormalities appear to occur frequently and promote dyspnea, fatigue, and exercise limitation in patients with PAH. Preliminary data suggest that targeted muscle training may be of benefit, although further evidence is required to consolidate these findings into specific recommendations for exercise training in patients with PAH. This article reviews the current evidence on prevalence, risk factors, and implications of respiratory and limb muscle dysfunction in patients with PAH. It also reviews the impact of exercise rehabilitation on morphologic, metabolic, and functional muscle profile and outcomes in PAH. Future research priorities are highlighted.
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Affiliation(s)
- Marios Panagiotou
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Andrew J Peacock
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Martin K Johnson
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Clydebank, United Kingdom
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Tang LL, Zhang LY, Lao LJ, Hu QY, Gu WZ, Fu LC, Du LZ. Epigenetics of Notch1 regulation in pulmonary microvascular rarefaction following extrauterine growth restriction. Respir Res 2015; 16:66. [PMID: 26040933 PMCID: PMC4486133 DOI: 10.1186/s12931-015-0226-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 05/27/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Extrauterine growth restriction (EUGR) plays an important role in the developmental origin of adult cardiovascular diseases. In an EUGR rat model, we reported an elevated pulmonary arterial pressure in adults and genome-wide epigenetic modifications in pulmonary vascular endothelial cells (PVECs). However, the underlying mechanism of the early nutritional insult that results in pulmonary vascular consequences later in life remains unclear. METHODS A rat model was used to investigate the physiological and structural effect of EUGR on early pulmonary vasculature by evaluating right ventricular systolic pressure and pulmonary vascular density in male rats. Epigenetic modifications of the Notch1 gene in PVECs were evaluated. RESULTS EUGR decreased pulmonary vascular density with no significant impact on right ventricular systolic pressure at 3 weeks. Decreased transcription of Notch1 was observed both at 3 and 9 weeks, in association with decreased downstream target gene, Hes-1. Chromatin immunoprecipitation and bisulfite sequencing were performed to analyze the epigenetic modifications of the Notch1 gene promoter in PVECs. EUGR caused a significantly increased H3K27me3 in the proximal Notch1 gene promoter, and increased methylation of single CpG sites in the distal Notch1 gene promoter, both at 3 and 9 weeks. CONCLUSIONS We conclude that EUGR results in decreased pulmonary vascular growth in association with decreased Notch1 in PVECs. This may be mediated by increased CpG methylation and H3K27me3 in the Notch1 gene promoter region.
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Affiliation(s)
- Li-Li Tang
- Department of Neonatology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310051, People's Republic of China.
| | - Li-Yan Zhang
- Department of Neonatology, The Children's Hospital of Fuzhou, Fujian Medical University, Fuzhou, 350004, People's Republic of China.
| | - Lin-Jiang Lao
- Department of Neonatology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310051, People's Republic of China.
| | - Qiong-Yao Hu
- Department of Neonatology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310051, People's Republic of China.
| | - Wei-Zhong Gu
- Department of Pathology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310051, People's Republic of China.
| | - Lin-Chen Fu
- Department of Neonatology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310051, People's Republic of China.
| | - Li-Zhong Du
- Department of Neonatology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310051, People's Republic of China.
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Marra AM, Arcopinto M, Bossone E, Ehlken N, Cittadini A, Grünig E. Pulmonary arterial hypertension-related myopathy: an overview of current data and future perspectives. Nutr Metab Cardiovasc Dis 2015; 25:131-139. [PMID: 25455722 DOI: 10.1016/j.numecd.2014.10.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 09/18/2014] [Accepted: 10/13/2014] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND AIM Exercise intolerance is one of the key features of pulmonary arterial hypertension (PAH). The main determinants of exercise impairment include hypoxemia, reduced right ventricular output, perfusion/ventilation mismatch, and weakness of skeletal and breathing muscles. The aim of the current review is to describe the findings in the existing literature about respiratory and muscle dysfunction in PAH. Animal and clinical studies regarding both respiratory and peripheral skeletal muscles and the effect of exercise training on muscle function in PAH patients are analyzed. DATA SYNTHESIS PAH myopathy is characterized by reduced skeletal muscle mass, reduced volitional and non-volitional contractility, reduced generated force, a fiber switch from type I to type II, increased protein degradation through ubiquitin-proteasome system (UPS) activation, reduced mitochondrial functioning, and impaired activation-contractility coupling. Increased inflammatory response, impaired anabolic signaling, hypoxemia, and abnormalities of mitochondrial function are involved in the pathophysiology of this process. Exercise training has been shown to improve exercise capacity, peak oxygen uptake, quality of life, and possibly clinical outcomes of PAH patients. CONCLUSIONS The skeletal muscles of PAH patients show a wide spectrum of cellular abnormalities that finally culminate in muscle atrophy and reduced contractility. Exercise training improves muscle function and bears a positive impact on the clinical outcomes of PAH patients.
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Affiliation(s)
- A M Marra
- Pulmonary Hypertension Unit, Thoraxclinic, University Hospital Heidelberg, Heidelberg, Germany; Department of Translational Medical Sciences, "Federico II" University School of Medicine, Naples, Italy
| | - M Arcopinto
- Department of Cardiac Surgery, IRCSS Policlinico San Donato, Milan, Italy
| | - E Bossone
- Department of Cardiology and Cardiac Surgery, University Hospital "Scuola Medica Salernitana", Salerno, Italy
| | - N Ehlken
- Pulmonary Hypertension Unit, Thoraxclinic, University Hospital Heidelberg, Heidelberg, Germany
| | - A Cittadini
- Department of Translational Medical Sciences, "Federico II" University School of Medicine, Naples, Italy; Interdisciplinary Research Centre in Biomedical Materials (CRIB), Federico II University, Naples, Italy.
| | - E Grünig
- Pulmonary Hypertension Unit, Thoraxclinic, University Hospital Heidelberg, Heidelberg, Germany
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Abstract
RATIONALE Pulmonary arterial hypertension (PAH) is a pulmonary vasculopathy that leads to failure of the right ventricle and premature death. OBJECTIVES To determine whether the sublingual microcirculation is affected in patients with PAH compared with healthy age- and sex-matched control subjects. METHODS Using the CapiScope Handheld Video Capillaroscope we measured the sublingual microvasculature density, flow index, tortuosity, and curvature. Videos were acquired immediately after right heart catheterization, and determinations were made off-line by investigators blinded to the group assignment or hemodynamics. MEASUREMENTS AND MAIN RESULTS In this cross-sectional pilot study, we included 26 patients with PAH (age, mean ± SD, 56.7 ± 10 yr; 77% women) and 14 healthy control subjects (age, 53.1 ± 12 yr; 71% women). Sublingual microvasculature flow index was lower (2 ± 0.66 vs. 2.7 ± 0.37, P < 0.001) with higher heterogeneity index (0.63 ± 0.63 vs. 0.25 ± 0.25, P = 0.04) in patients with PAH than control subjects. Microvasculature density was similar between the groups, but tortuosity was more pronounced in patients than control subjects (tort 0: 45 ± 19 vs. 23.6 ± 12, P = 0.001 and tort 1: 0.2 ± 0.16 vs. 0.06 ± 0.04, P < 0.001). CONCLUSIONS Patients with PAH showed lower sublingual microvasculature flow index and higher tortuosity compared with healthy age- and sex-matched control subjects. Further investigations are needed to assess whether this methodology can provide information on disease prognosis and/or response to therapy in this condition.
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40
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Potus F, Malenfant S, Graydon C, Mainguy V, Tremblay È, Breuils-Bonnet S, Ribeiro F, Porlier A, Maltais F, Bonnet S, Provencher S. Impaired angiogenesis and peripheral muscle microcirculation loss contribute to exercise intolerance in pulmonary arterial hypertension. Am J Respir Crit Care Med 2014; 190:318-28. [PMID: 24977625 DOI: 10.1164/rccm.201402-0383oc] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Pulmonary arterial hypertension (PAH) is characterized by significant exercise intolerance, which is multifactorial and involves skeletal muscle alterations. There is growing evidence that microRNAs (miRs) are involved in PAH pathogenesis. OBJECTIVES We hypothesized that miR-126, an endothelial-specific, proangiogenic miR, is down-regulated in the peripheral muscles of patients with PAH, which would account for skeletal muscle microcirculation loss and exercise intolerance. MEASUREMENTS AND MAIN RESULTS Patients with PAH displayed decreases in exercise capacity ([Formula: see text]o2max) and microcirculation loss on quadriceps muscle biopsy (in CD31(+) immunofluorescence experiments) compared to control subjects. Exercise capacity correlated with muscle capillarity (r = 0.84, P < 0.01). At the cellular level, vascular endothelial growth factor (VEGF) and VEGF receptor 2 expression were similar in both groups. Conversely, PAH was associated with a 60% decrease in miR-126 expression in a quantitative reverse transcriptase polymerase chain reaction experiment (P < 0.01), resulting in up-regulation of its targeted protein, Sprouty-related, EVH1 domain-containing protein 1 (SPRED-1), and a marked decrease in the downstream effectors of the VEGF pathway, p-Raf/Raf and p-ERK/ERK, as determined by immunoblot analysis. Using freshly isolated CD31(+) cells from human quadriceps biopsies, we found that the down-regulation of miR-126 in PAH triggered the activation of SPRED-1, impairing the angiogenic response (Matrigel assay). These abnormalities were reversed by treating the PAH cells with miR-126 mimic, whereas inhibition of miR-126 (antagomir) in healthy CD31(+) cells fully mimicked the PAH phenotype. Finally, miR-126 down-regulation in skeletal muscle of healthy rats decreased muscle capillarity in immunofluorescence assays (P < 0.05) and exercise tolerance in treadmill tests (P < 0.05), whereas miR-126 up-regulation increased them in monocrotaline PAH rats. CONCLUSIONS We demonstrate for the first time that exercise intolerance in PAH is associated with skeletal muscle microcirculation loss and impaired angiogenesis secondary to miR-126 down-regulation.
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Affiliation(s)
- François Potus
- Pulmonary Hypertension Research Group, Quebec Heart and Lung Institute Research Center, Laval University, Quebec City, Canada
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