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Philip N, Yun X, Pi H, Murray S, Hill Z, Fonticella J, Perez P, Zhang C, Pathmasiri W, Sumner S, Servinsky L, Jiang H, Huetsch JC, Oldham WM, Visovatti S, Leary PJ, Gharib SA, Brittain E, Simpson CE, Le A, Shimoda LA, Suresh K. Fatty acid metabolism promotes TRPV4 activity in lung microvascular endothelial cells in pulmonary arterial hypertension. Am J Physiol Lung Cell Mol Physiol 2024; 326:L252-L265. [PMID: 38226418 DOI: 10.1152/ajplung.00199.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 12/07/2023] [Indexed: 01/17/2024] Open
Abstract
Pulmonary arterial hypertension (PAH) is a morbid disease characterized by significant lung endothelial cell (EC) dysfunction. Prior work has shown that microvascular endothelial cells (MVECs) isolated from animals with experimental PAH and patients with PAH exhibit significant abnormalities in metabolism and calcium signaling. With regards to metabolism, we and others have shown evidence of increased aerobic glycolysis and evidence of increased utilization of alternate fuel sources (such as fatty acids) in PAH EC. In the realm of calcium signaling, our prior work linked increased activity of the transient receptor potential vanilloid-4 (TRPV4) channel to increased proliferation of MVECs isolated from the Sugen/Hypoxia rat model of PAH (SuHx-MVECs). However, the relationship between metabolic shifts and calcium abnormalities was not clear. Specifically, whether shifts in metabolism were responsible for increasing TRPV4 channel activity in SuHx-MVECs was not known. In this study, using human data, serum samples from SuHx rats, and SuHx-MVECs, we describe the consequences of increased MVEC fatty acid oxidation in PAH. In human samples, we observed an increase in long-chain fatty acid levels that was associated with PAH severity. Next, using SuHx rats and SuHx-MVECs, we observed increased intracellular levels of lipids. We also show that increasing intracellular lipid content increases TRPV4 activity, whereas inhibiting fatty acid oxidation normalizes basal calcium levels in SuHx-MVECs. By exploring the fate of fatty acid-derived carbons, we observed that the metabolite linking increased intracellular lipids to TRPV4 activity was β-hydroxybutyrate (BOHB), a product of fatty acid oxidation. Finally, we show that BOHB supplementation alone is sufficient to sensitize the TRPV4 channel in rat and mouse MVECs. Returning to humans, we observe a transpulmonary BOHB gradient in human patients with PAH. Thus, we establish a link between fatty acid oxidation, BOHB production, and TRPV4 activity in MVECs in PAH. These data provide new insight into metabolic regulation of calcium signaling in lung MVECs in PAH.NEW & NOTEWORTHY In this paper, we explore the link between metabolism and intracellular calcium levels in microvascular endothelial cells (MVECs) in pulmonary arterial hypertension (PAH). We show that fatty acid oxidation promotes sensitivity of the transient receptor potential vanilloid-4 (TRPV4) calcium channel in MVECs isolated from a rodent model of PAH.
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Affiliation(s)
- Nicolas Philip
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Xin Yun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Hongyang Pi
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States
| | - Samuel Murray
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Zack Hill
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Jay Fonticella
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Preston Perez
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Cissy Zhang
- Gigantest, Inc., Baltimore, Maryland, United States
| | - Wimal Pathmasiri
- Department of Nutrition, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States
| | - Susan Sumner
- Department of Nutrition, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States
| | - Laura Servinsky
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Haiyang Jiang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - John C Huetsch
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - William M Oldham
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Scott Visovatti
- Department of Cardiology, Ohio State University School of Medicine, Columbus, Ohio, United States
| | - Peter J Leary
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States
| | - Sina A Gharib
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States
| | - Evan Brittain
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States
| | - Catherine E Simpson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Anne Le
- Gigantest, Inc., Baltimore, Maryland, United States
| | - Larissa A Shimoda
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Karthik Suresh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
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Steinberg ZL, Rayner SG, Leary PJ. Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension due to septic emboli. Catheter Cardiovasc Interv 2024; 103:115-118. [PMID: 37994384 DOI: 10.1002/ccd.30919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/04/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023]
Abstract
We present the case of a 28-year-old woman with a history of tricuspid valve endocarditis leading to chronic thromboembolic pulmonary hypertension (CTEPH) with multiple pulmonary artery chronic total occlusions (CTOs) due to septic emboli. Following a multidisciplinary care discussion, the patient was brought forward for balloon pulmonary angioplasty (BPA) with successful revascularization of all chronically occluded territories. This case highlights advances in pulmonary artery CTO interventions and demonstrates the feasibility of BPA for CTEPH patients with a history of septic emboli.
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Affiliation(s)
| | - Samuel G Rayner
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | - Peter J Leary
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
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Fling C, De Marco T, Kime NA, Lammi MR, Oppegard LJ, Ryan JJ, Ventetuolo CE, White RJ, Zamanian RT, Leary PJ. Regional Variation in Pulmonary Arterial Hypertension in the United States: The Pulmonary Hypertension Association Registry. Ann Am Thorac Soc 2023; 20:1718-1725. [PMID: 37683277 PMCID: PMC10704225 DOI: 10.1513/annalsats.202305-424oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/07/2023] [Indexed: 09/10/2023] Open
Abstract
Rationale: Pulmonary arterial hypertension (PAH) is a heterogeneous disease within a complex diagnostic and treatment environment. Other complex heart and lung diseases have substantial regional variation in characteristics and outcomes; however, this has not been previously described in PAH. Objectives: To identify baseline differences between U.S. census regions in the characteristics and outcomes for participants in the Pulmonary Hypertension Association Registry (PHAR). Methods: Adults with PAH were divided into regional groups (Northeast, South, Midwest, and West), and baseline differences between census regions were presented. Kaplan-Meier survival analyses and Cox proportional hazards were used to estimate the association between region and mortality in unadjusted and adjusted models. Results: Substantial differences by census regions were seen in age, race, ethnicity, marital status, employment, insurance payor breakdown, active smoking, and current alcohol use. Differences were also seen in PAH etiology and baseline 6-minute walk distance test results. Treatment characteristics varied by census region, and mortality appeared to be lower in PHAR participants in the West (hazard ratio, 0.60; 95% confidence interval, 0.43-0.83, P = 0.005). This difference was not readily explained by differences in demographic characteristics, PAH etiology, baseline severity, baseline medication regimen, or disease prevalence. Conclusions: The present study suggests significant regional variation among participants at accredited pulmonary vascular disease centers in multiple baseline characteristics and mortality. This variation may have implications for clinical research planning and represent an important focus for further study to better understand whether there are remediable care aspects that can be addressed in the pursuit of providing equitable care in the United States.
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Affiliation(s)
| | - Teresa De Marco
- Division of Cardiology, University of California, San Francisco, San Francisco, California
| | | | - Matthew R. Lammi
- Division of Pulmonary and Critical Care Medicine, Louisiana State University, New Orleans, Louisiana
| | - Laura J. Oppegard
- Division of Pulmonary and Critical Care Medicine, Oregon Health Sciences University, Portland, Oregon
| | - John J. Ryan
- Division of Cardiology, University of Utah, Salt Lake City, Utah
| | - Corey E. Ventetuolo
- Department of Medicine and
- Department of Health Services, Policy & Practice, Brown University, Providence, Rhode Island
| | - R. James White
- Division of Pulmonary and Critical Care Medicine and
- the Mary M. Parkes Center, University of Rochester, Rochester, New York; and
| | - Roham T. Zamanian
- Division of Pulmonary and Critical Care Medicine, Stanford University, Palo Alto, California
| | - Peter J. Leary
- Department of Epidemiology, and
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
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Peplinski BS, Buber J, Gharib SA, Pi H, Raftery D, Leary PJ. Associations of Histamine Metabolites with Disease Severity and Mortality in Pulmonary Arterial Hypertension. Ann Am Thorac Soc 2023; 20:1676-1679. [PMID: 37668470 PMCID: PMC10632929 DOI: 10.1513/annalsats.202304-302rl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/17/2023] [Indexed: 09/06/2023] Open
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Oppegard LJ, Barros LM, Pi H, Kornfield J, Hough CL, Rayner SG, Robinson JC, Leary PJ. Premorbid weight in pulmonary arterial hypertension. Pulm Circ 2023; 13:e12308. [PMID: 38027456 PMCID: PMC10663650 DOI: 10.1002/pul2.12308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/13/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Relationships between obesity and outcomes in pulmonary arterial hypertension (PAH) are complex. Previous work suggested obesity, occurring alongside PAH, may be associated with better survival. In our work, we suggest obesity prior to PAH development is associated with worse survival. This may add a novel temporal element to the "obesity-paradox."
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Affiliation(s)
- Laura J. Oppegard
- Division of Pulmonary, Allergy, and Critical Care MedicineOregon Health & Sciences UniversityPortlandOregonUSA
| | - Lia M. Barros
- Division of Pulmonary Critical, Care and Sleep MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Hongyang Pi
- Division of Pulmonary Critical, Care and Sleep MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - James Kornfield
- Division of Pulmonary, Allergy, and Critical Care MedicineOregon Health & Sciences UniversityPortlandOregonUSA
| | - Catherine L. Hough
- Division of Pulmonary, Allergy, and Critical Care MedicineOregon Health & Sciences UniversityPortlandOregonUSA
| | - Samuel G. Rayner
- Division of Pulmonary Critical, Care and Sleep MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Jeffrey C. Robinson
- Division of Pulmonary, Allergy, and Critical Care MedicineOregon Health & Sciences UniversityPortlandOregonUSA
| | - Peter J. Leary
- Division of Pulmonary Critical, Care and Sleep MedicineUniversity of WashingtonSeattleWashingtonUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
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Michailidou D, Chen DL, Collins BF, George MP, Montani D, Rayner SG, Sirisak C, Leary PJ. Large Vessel Vasculitis in a Young Woman with EIF2AK4-associated Pulmonary Capillary Hemangiomatosis/Pulmonary Veno-Occlusive Disease. Am J Respir Crit Care Med 2023; 208:e29-e31. [PMID: 37311250 DOI: 10.1164/rccm.202212-2260im] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/13/2023] [Indexed: 06/15/2023] Open
Affiliation(s)
| | - Delphine L Chen
- Department of Radiology, University of Washington Medical Center, Seattle, Washington
| | | | - Marjorie P George
- Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, Colorado
| | - David Montani
- Service de Pneumologie et Soins Intensifs Respiratoires, Assistance Publique-Hôpitaux de Paris, Université Paris-Saclay, Hôpital de Bicêtre, DMU 5 Thorinno, Inserm UMR_S999, Le Kremlin-Bicêtre, France; and
| | - Samuel G Rayner
- Division of Pulmonary, Critical Care, and Sleep Medicine, and
| | | | - Peter J Leary
- Division of Pulmonary, Critical Care, and Sleep Medicine, and
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington
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Brown CE, Steiner JM, Leary PJ, Curtis JR, Engelberg RA. A World of Maximalist Medicine: Physician Perspectives on Palliative Care and End-of-life for Patients With Pulmonary Arterial Hypertension. J Pain Symptom Manage 2023; 65:e329-e335. [PMID: 36521765 PMCID: PMC10023342 DOI: 10.1016/j.jpainsymman.2022.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/22/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022]
Abstract
CONTEXT Physicians who specialize in pulmonary arterial hypertension (PAH) care for patients facing a serious, life-limiting illness. Palliative care is underutilized in patients with PAH, and little is known about how best to provide palliative care to this patient population. OBJECTIVES Using a qualitative approach, assess physicians' perspectives on barriers and facilitators to the use of palliative care in PAH. METHODS Participants were board-certified pulmonologists and cardiologists recruited from the Pulmonary Hypertension Association's list of physician specialists and academic center websites. We performed one-on-one semi-structured interviews that were recorded, transcribed, and analyzed using thematic analysis. RESULTS Twelve physicians participated in the study, with a median age of 48.5 years and 20.5 years of clinical experience caring for patients with PAH. We identified the following themes and associated barriers and facilitators to effective implementation of palliative care for patients with PAH: a tailored approach to the individual patient; a PAH-specialist-led culture of care; effective collaboration with palliative care clinicians; and limitations imposed by health systems. CONCLUSION PAH physicians are open to palliative care for their patients and are willing to partner with palliative care clinicians to implement this effectively and in the right setting. Areas for targeted improvement in enhancing palliative care for patients with PAH exist, especially enhancing collaboration between PAH physicians and palliative care specialists and navigating barriers in health systems.
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Affiliation(s)
- Crystal E Brown
- Division of Pulmonary, Critical Care, and Sleep Medicine (C.E.B., J.M.S., P.J.L., J.R.C., R.A.E.), University of Washington Seattle, WA, USA; Cambia Palliative Care Center of Excellence at UW Medicine (C.E.B., J.M.S., J.R.C., R.A.E.), Seattle, WA, USA; Department of Bioethics and Humanities (C.E.B.), University of Washington, Seattle, WA, USA.
| | - Jill M Steiner
- Cambia Palliative Care Center of Excellence at UW Medicine (C.E.B., J.M.S., J.R.C., R.A.E.), Seattle, WA, USA; Division of Cardiology (C.E.B., J.M.S., P.J.L., J.R.C., R.A.E.), University of Washington, Seattle, WA, USA
| | - Peter J Leary
- Division of Pulmonary, Critical Care, and Sleep Medicine (C.E.B., J.M.S., P.J.L., J.R.C., R.A.E.), University of Washington Seattle, WA, USA; Department of Epidemiology (P.J.L.), University of Washington, Seattle, WA, USA
| | - J Randall Curtis
- Division of Pulmonary, Critical Care, and Sleep Medicine (C.E.B., J.M.S., P.J.L., J.R.C., R.A.E.), University of Washington Seattle, WA, USA; Cambia Palliative Care Center of Excellence at UW Medicine (C.E.B., J.M.S., J.R.C., R.A.E.), Seattle, WA, USA
| | - Ruth A Engelberg
- Division of Pulmonary, Critical Care, and Sleep Medicine (C.E.B., J.M.S., P.J.L., J.R.C., R.A.E.), University of Washington Seattle, WA, USA; Cambia Palliative Care Center of Excellence at UW Medicine (C.E.B., J.M.S., J.R.C., R.A.E.), Seattle, WA, USA
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Carlozzi LN, Lee J, Barros LM, Buber Y, Chen DL, Mulligan M, Ordovas K, Ralph DD, Rayner SG, Leary PJ, Steinberg ZL. Establishing a balloon pulmonary angioplasty program for chronic thromboembolic pulmonary hypertension: A United States single-center experience. Respir Med 2023; 211:107215. [PMID: 36934856 DOI: 10.1016/j.rmed.2023.107215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/21/2023]
Abstract
INTRODUCTION Balloon pulmonary angioplasty (BPA) is a less invasive treatment alternative for patients with chronic thromboembolic pulmonary hypertension (CTEPH) who are unable to move forward with pulmonary thromboendarterectomy. This report describes a single-center experience with a nascent BPA program in the United States (US). METHODS All patients who underwent BPA between August 2018-2021 were included in this retrospective, single-center observational cohort. Pre- and post-procedure clinical information was collected, along with procedural characteristics. RESULTS Thirty patients began their BPA series during the study period. The majority of patients had segmental disease (n = 25, 83.3%). A total of 135 BPA procedures were performed on 417 segments. On average, patients completed 4.5 sessions and the majority of patients (n = 23, 76.7%) underwent more than 2. There were 24 episodes of hemoptysis and 20 procedural events that required treatment, typically with either heparin reversal or balloon tamponade. Of 26 participants with completed series, mean PA pressure (-6 mmHg, 95% CI -9 to -4 mmHg, p = 0.0001), PVR (-1.9 Wood units, 95% CI -2.9 to -1.0, p = 0.0002), and pulmonary compliance (-1.0 mL/mmHg, 95% CI -1.5 to -0.5, p = 0.0002) improved. Improvement was also seen in NYHA functional classification and walk distance (p = 0.01). Two deaths occurred, with one death peri-procedurally. CONCLUSION This paper describes an early experience with BPA at a single US center. Improvement in non-invasive and invasive metrics were seen without adding a significant morbidity to an already high-risk patient population.
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Affiliation(s)
| | - Josh Lee
- Critical Care, Pulmonary and Sleep Associates, Denver, CO, USA
| | - Lia M Barros
- University of Washington, Division of Pulmonary, Critical Care, and Sleep Medicine, USA
| | - Yonatan Buber
- University of Washington, Division of Cardiology, USA
| | | | - Michael Mulligan
- University of Washington, Division of Cardiothoracic Surgery, USA
| | - Karen Ordovas
- University of Washington, Department of Radiology, USA
| | - David D Ralph
- University of Washington, Division of Pulmonary, Critical Care, and Sleep Medicine, USA
| | - Samuel G Rayner
- University of Washington, Division of Pulmonary, Critical Care, and Sleep Medicine, USA
| | - Peter J Leary
- University of Washington, Division of Pulmonary, Critical Care, and Sleep Medicine, USA; University of Washington, Department of Epidemiology, USA
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Pi H, Xia L, Ralph DD, Rayner SG, Shojaie A, Leary PJ, Gharib SA. Metabolomic Signatures Associated With Pulmonary Arterial Hypertension Outcomes. Circ Res 2023; 132:254-266. [PMID: 36597887 PMCID: PMC9904878 DOI: 10.1161/circresaha.122.321923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/20/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is a complex disease characterized by progressive right ventricular (RV) failure leading to significant morbidity and mortality. Investigating metabolic features and pathways associated with RV dilation, mortality, and measures of disease severity can provide insight into molecular mechanisms, identify subphenotypes, and suggest potential therapeutic targets. METHODS We collected data from a prospective cohort of PAH participants and performed untargeted metabolomic profiling on 1045 metabolites from circulating blood. Analyses were intended to identify metabolomic differences across a range of common metrics in PAH (eg, dilated versus nondilated RV). Partial least squares discriminant analysis was first applied to assess the distinguishability of relevant outcomes. Significantly altered metabolites were then identified using linear regression, and Cox regression models (as appropriate for the specific outcome) with adjustments for age, sex, body mass index, and PAH cause. Models exploring RV maladaptation were further adjusted for pulmonary vascular resistance. Pathway enrichment analysis was performed to identify significantly dysregulated processes. RESULTS A total of 117 participants with PAH were included. Partial least squares discriminant analysis showed cluster differentiation between participants with dilated versus nondilated RVs, survivors versus nonsurvivors, and across a range of NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels, REVEAL 2.0 composite scores, and 6-minute-walk distances. Polyamine and histidine pathways were associated with differences in RV dilation, mortality, NT-proBNP, REVEAL score, and 6-minute walk distance. Acylcarnitine pathways were associated with NT-proBNP, REVEAL score, and 6-minute walk distance. Sphingomyelin pathways were associated with RV dilation and NT-proBNP after adjustment for pulmonary vascular resistance. CONCLUSIONS Distinct plasma metabolomic profiles are associated with RV dilation, mortality, and measures of disease severity in PAH. Polyamine, histidine, and sphingomyelin metabolic pathways represent promising candidates for identifying patients at high risk for poor outcomes and investigation into their roles as markers or mediators of disease progression and RV adaptation.
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Affiliation(s)
- Hongyang Pi
- University of Washington, Department of Medicine
| | - Lu Xia
- University of Washington, Department of Biostatistics
| | | | | | - Ali Shojaie
- University of Washington, Department of Biostatistics
| | - Peter J. Leary
- University of Washington, Department of Medicine
- University of Washington, Department of Epidemiology
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Brown CE, Steiner JM, Modes M, Lynch Y, Leary PJ, Curtis JR, Engelberg RA. Palliative Care Perspectives of Patients with Pulmonary Arterial Hypertension. Ann Am Thorac Soc 2023; 20:331-334. [PMID: 36416739 PMCID: PMC9989860 DOI: 10.1513/annalsats.202208-721rl] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
| | | | - Matthew Modes
- University of WashingtonSeattle, Washington
- Cedars-Sinai Medical CenterLos Angeles, California
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Hirsch K, Nolley S, Ralph DD, Zheng Y, Altemeier WA, Rhodes CJ, Morrell NW, Wilkins MR, Leary PJ, Rayner SG. Circulating markers of inflammation and angiogenesis and clinical outcomes across subtypes of pulmonary arterial hypertension. J Heart Lung Transplant 2023; 42:173-182. [PMID: 36470771 PMCID: PMC9840657 DOI: 10.1016/j.healun.2022.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 10/09/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Subtypes of pulmonary arterial hypertension (PAH) differ in both fundamental disease features and clinical outcomes. Angiogenesis and inflammation represent disease features that may differ across subtypes and are of special interest in connective tissue disease-associated PAH (CTD-PAH). We compared inflammatory and angiogenic biomarker profiles across different etiologies of PAH and related them to clinical outcomes. METHODS Participants with idiopathic PAH, CTD-PAH, toxin-associated PAH (tox-PAH), or congenital heart disease-associated PAH (CHD-PAH) were enrolled into a prospective observational cohort. Baseline serum concentrations of 33 biomarkers were related to 3-year mortality, echocardiogram, REVEAL score, and 6-minute walk distance (6MWD). Findings were validated using plasma proteomic data from the UK PAH Cohort Study. RESULTS One hundred twelve patients were enrolled: 45 idiopathic, 27 CTD-PAH, 20 tox-PAH, and 20 CHD-PAH. Angiogenic and inflammatory biomarkers were distinctly elevated within the CTD-PAH cohort. Six biomarkers were associated with mortality within the entire PAH cohort: interleukin-6 (IL-6, HR:1.6, 95% CI:1.18-2.18), soluble fms-like tyrosine kinase 1 (sFlt-1, HR:1.35, 95% CI:1.02-1.80), placental growth factor (PlGF, HR:1.55, 95% CI:1.07-2.25), interferon gamma-induced protein 10 (IP-10, HR:1.44, 95% CI:1.04-1.99), tumor necrosis factor-beta (TNF-β, HR:1.81, 95% CI:1.11-2.95), and NT-proBNP (HR:2.19, 95% CI:1.52-3.14). Only IL-6 and NT-proBNP remained significant after controlling for multiple comparisons. IL-6, IP-10, and sFlt-1 significantly associated with mortality in CTD-PAH, but not non-CTD-PAH subgroups. In the UK cohort, IP-10, PlGF, TNF-β, and NT-proBNP significantly associated with 5-year survival. CONCLUSION Levels of angiogenic and inflammatory biomarkers are elevated in CTD-PAH, compared with other etiologies of PAH, and may correlate with clinical outcomes including mortality.
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Affiliation(s)
- Kellen Hirsch
- Department of Medicine, University of Washington, Seattle, Washington
| | - Stephanie Nolley
- Department of Medicine, University of Washington, Seattle, Washington
| | - David D Ralph
- Department of Medicine, University of Washington, Seattle, Washington
| | - Ying Zheng
- Department of Bioengineering, University of Washington, Seattle, Washington
| | - William A Altemeier
- Department of Medicine, University of Washington, Seattle, Washington; Center for Lung Biology, University of Washington, Seattle, Washington
| | - Christopher J Rhodes
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Nicholas W Morrell
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Martin R Wilkins
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Peter J Leary
- Department of Medicine, University of Washington, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington
| | - Samuel G Rayner
- Department of Medicine, University of Washington, Seattle, Washington; Department of Bioengineering, University of Washington, Seattle, Washington; Center for Lung Biology, University of Washington, Seattle, Washington.
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Philip N, Pi H, Gadkari M, Yun X, Huetsch J, Zhang C, Harlan R, Roux A, Graham D, Shimoda L, Le A, Visovatti S, Leary PJ, Gharib SA, Simpson C, Santhanam L, Steppan J, Suresh K. Transpulmonary amino acid metabolism in the sugen hypoxia model of pulmonary hypertension. Pulm Circ 2023; 13:e12205. [PMID: 36873460 PMCID: PMC9978170 DOI: 10.1002/pul2.12205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/26/2023] [Accepted: 02/07/2023] [Indexed: 02/18/2023] Open
Abstract
In pulmonary artery hypertension (PAH), emerging evidence suggests that metabolic abnormalities may be contributing to cellular dysfunction in PAH. Metabolic abnormalities such as glycolytic shift have been observed intracellularly in several cell types in PAH, including microvacular endothelial cells (MVECs). Concurrently, metabolomics of human PAH samples has also revealed a variety of metabolic abnormalities; however the relationship between the intracellular metabolic abnormalities and the serum metabolome in PAH remains under investigation. In this study, we utilize the sugen/hypoxia (SuHx) rodent model of PAH to examine the RV, LV and MVEC intracellular metabolome (using targeted metabolomics) in normoxic and SuHx rats. We additionally validate key findings from our metabolomics experiments with data obtained from cell culture of normoxic and SuHx MVECs, as well as metabolomics of human serum samples from two different PAH patient cohorts. Taken together, our data, spanning rat serum, human serum and primary isolated rat MVECs reveal that: (1) key classes of amino acids (specifically, branched chain amino acids-BCAA) are lower in the pre-capillary (i.e., RV) serum of SuHx rats (and humans); (2) intracellular amino acid levels (in particular BCAAs) are increased in SuHx-MVECs; (3) there may be secretion rather than utilization of amino acids across the pulmonary microvasculature in PAH and (4) an oxidized glutathione gradient is present across the pulmonary vasculature, suggesting a novel fate for increased glutamine uptake (i.e., as a source of glutathione). in MVECs in PAH. In summary, these data reveal new insight into the shifts in amino acid metabolism occurring across the pulmonary circulation in PAH.
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Affiliation(s)
- Nicolas Philip
- Division of Pulmonary/Critical Care MedicineBaltimoreMarylandUSA
| | - Hongyang Pi
- Division of Pulmonary, Critical Care and Sleep MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Mahin Gadkari
- Department of Anesthesiology and Critical Care MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Xin Yun
- Division of Pulmonary/Critical Care MedicineBaltimoreMarylandUSA
| | - John Huetsch
- Division of Pulmonary/Critical Care MedicineBaltimoreMarylandUSA
| | - Cissy Zhang
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Robert Harlan
- Department of Anesthesiology and Critical Care MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Aurelie Roux
- Department of Anesthesiology and Critical Care MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - David Graham
- Department of Anesthesiology and Critical Care MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Larissa Shimoda
- Division of Pulmonary/Critical Care MedicineBaltimoreMarylandUSA
| | - Anne Le
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Scott Visovatti
- Division of CardiologyOhio State University School of MedicineColumbusOhioUSA
| | - Peter J. Leary
- Division of Pulmonary, Critical Care and Sleep MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Sina A. Gharib
- Division of Pulmonary, Critical Care and Sleep MedicineUniversity of WashingtonSeattleWashingtonUSA
| | | | - Lakshmi Santhanam
- Department of Anesthesiology and Critical Care MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Jochen Steppan
- Department of Anesthesiology and Critical Care MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Karthik Suresh
- Division of Pulmonary/Critical Care MedicineBaltimoreMarylandUSA
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13
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Jacobs K, Doerdelmann C, Krietsch J, González-Acosta D, Mathis N, Kushinsky S, Guarino E, Gómez-Escolar C, Martinez D, Schmid JA, Leary PJ, Freire R, Ramiro AR, Eischen CM, Mendez J, Lopes M. Stress-triggered hematopoietic stem cell proliferation relies on PrimPol-mediated repriming. Mol Cell 2022; 82:4176-4188.e8. [PMID: 36152632 DOI: 10.1016/j.molcel.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 07/01/2022] [Accepted: 09/08/2022] [Indexed: 11/17/2022]
Abstract
Stem cell division is linked to tumorigenesis by yet-elusive mechanisms. The hematopoietic system reacts to stress by triggering hematopoietic stem and progenitor cell (HSPC) proliferation, which can be accompanied by chromosomal breakage in activated hematopoietic stem cells (HSCs). However, whether these lesions persist in their downstream progeny and induce a canonical DNA damage response (DDR) remains unclear. Inducing HSPC proliferation by simulated viral infection, we report that the associated DNA damage is restricted to HSCs and that proliferating HSCs rewire their DDR upon endogenous and clastogen-induced damage. Combining transcriptomics, single-cell and single-molecule assays on murine bone marrow cells, we found accelerated fork progression in stimulated HSPCs, reflecting engagement of PrimPol-dependent repriming, at the expense of replication fork reversal. Ultimately, competitive bone marrow transplantation revealed the requirement of PrimPol for efficient HSC amplification and bone marrow reconstitution. Hence, fine-tuning replication fork plasticity is essential to support stem cell functionality upon proliferation stimuli.
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Affiliation(s)
- Kurt Jacobs
- Institute of Molecular Cancer Research, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Cyril Doerdelmann
- Institute of Molecular Cancer Research, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Jana Krietsch
- Institute of Molecular Cancer Research, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Daniel González-Acosta
- Institute of Molecular Cancer Research, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland; DNA Replication Group, Molecular Oncology Programme, Spanish National Cancer Research Centre (CNIO), Melchor Fernández Almagro 3, 28029 Madrid, Spain
| | - Nicolas Mathis
- Institute of Molecular Cancer Research, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Saul Kushinsky
- Department of Cancer Biology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Estrella Guarino
- DNA Replication Group, Molecular Oncology Programme, Spanish National Cancer Research Centre (CNIO), Melchor Fernández Almagro 3, 28029 Madrid, Spain
| | - Carmen Gómez-Escolar
- B Lymphocyte Biology Laboratory, Spanish National Center for Cardiovascular Research (CNIC), Melchor Fernández Almagro 3, 28029 Madrid, Spain
| | - Dolores Martinez
- Flow Cytometry Unit, Biotechnology Programme, Spanish National Cancer Research Centre (CNIO), Melchor Fernández Almagro 3, 28029 Madrid, Spain
| | - Jonas A Schmid
- Institute of Molecular Cancer Research, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Peter J Leary
- Institute of Molecular Cancer Research, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland; Functional Genomic Center Zurich, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Raimundo Freire
- Unidad de Investigación, Hospital Universitario de Canarias, Tenerife, Spain; Instituto de Tecnologías Biomédicas, Universidad de La Laguna, La Laguna, Spain; Universidad Fernando Pessoa Canarias, Las Palmas de Gran Canaria, Spain
| | - Almudena R Ramiro
- B Lymphocyte Biology Laboratory, Spanish National Center for Cardiovascular Research (CNIC), Melchor Fernández Almagro 3, 28029 Madrid, Spain
| | - Christine M Eischen
- Department of Cancer Biology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Juan Mendez
- DNA Replication Group, Molecular Oncology Programme, Spanish National Cancer Research Centre (CNIO), Melchor Fernández Almagro 3, 28029 Madrid, Spain.
| | - Massimo Lopes
- Institute of Molecular Cancer Research, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland.
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14
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Pi H, Carlson SD, Barros LM, Hogl L, Kirkpatrick JN, Nolley S, Ralph DD, Rayner SG, Leary PJ. Risk Prediction and Right Ventricular Dilation in a Single-Institution Pulmonary Arterial Hypertension Cohort. J Am Heart Assoc 2022; 11:e025521. [PMID: 35861845 PMCID: PMC9707840 DOI: 10.1161/jaha.122.025521] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Hongyang Pi
- Department of MedicineUniversity of WashingtonSeattleWA
| | - Selma D. Carlson
- Department of MedicineVeterans Administration MinneapolisMinneapolisMN
| | - Lia M. Barros
- Department of MedicineUniversity of WashingtonSeattleWA
| | - Laurie Hogl
- Department of MedicineUniversity of WashingtonSeattleWA
| | | | | | | | | | - Peter J. Leary
- Department of MedicineUniversity of WashingtonSeattleWA,Department of EpidemiologyUniversity of WashingtonSeattleWA
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15
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Pi H, Rayner SG, Ralph DD, Nolley S, Barros LM, Steinberg ZL, Leary PJ. Thyroid-stimulating hormone and mortality in pulmonary arterial hypertension. BMJ Open Respir Res 2022; 9:e001348. [PMID: 35879020 PMCID: PMC9328089 DOI: 10.1136/bmjresp-2022-001348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/04/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Pulmonary arterial hypertension (PAH) remains a serious and life-threatening illness. Thyroid dysfunction is relatively understudied in individuals with PAH but is known to affect cardiac function and vascular tone in other diseases. The aim of this observational study was to evaluate the association between thyroid-stimulating hormone (TSH), mortal and non-mortal outcomes in individuals with PAH. METHODS The Seattle Right Ventricle Translational Science (Servetus) Study is an observational cohort that enrolled participants with PAH between 2014 and 2016 and then followed them for 3 years. TSH was measured irrespective of a clinical suspicion of thyroid disease for all participants in the cohort. Linear regression was used to estimate the relationships between TSH and right ventricular basal diameter, tricuspid annular plane systolic excursion and 6-minute walk distance. Logistic regression was used to estimate the relationship with New York Heart Association Functional Class, and Cox proportional hazards were used to estimate the relationship with mortality. Staged models included unadjusted models and models accounting for age, sex at birth and aetiology of pulmonary hypertension with or without further adjustment for N-terminal-pro hormone brain natriuretic peptide. RESULTS Among 112 participants with PAH, TSH was strongly associated with mortality irrespective of adjustment. There was no clear consistent association between TSH and other markers of severity in a cohort with PAH. DISCUSSION This report reinforces the important observation that TSH is associated with survival in patients with PAH, and future study of thyroid dysfunction as a potential remediable contributor to mortality in PAH is warranted.
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Affiliation(s)
- Hongyang Pi
- Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | - Samuel G Rayner
- Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | - David D Ralph
- Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | - Stephanie Nolley
- Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | - Lia M Barros
- Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | | | - Peter J Leary
- Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA
- Epidemiology, University of Washington, Seattle, Washington, USA
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16
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Rayner SG, Scholl Z, Mandrycky CJ, Chen J, LaValley KN, Leary PJ, Altemeier WA, Liles WC, Chung DW, López JA, Fu H, Zheng Y. Endothelial-derived von Willebrand factor accelerates fibrin clotting within engineered microvessels. J Thromb Haemost 2022; 20:1627-1637. [PMID: 35343037 PMCID: PMC10581744 DOI: 10.1111/jth.15714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/02/2022] [Accepted: 03/25/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Von Willebrand factor (VWF) is classically associated with primary hemostasis and platelet-rich arterial thromboses, but recently has also been implicated in fibrin clotting and venous thrombosis. Direct interaction between fibrin and VWF may mediate these processes, although prior reports are conflicting. OBJECTIVES We combined two complementary platforms to characterize VWF-fibrin(ogen) interactions and identify their potential physiologic significance. METHODS Engineered microvessels were lined with human endothelial cells, cultured under flow, and activated to release VWF and form transluminal VWF fibers. Fibrinogen, fibrin monomers, or polymerizing fibrin were then perfused, and interactions with VWF evaluated. Thrombin and fibrinogen were perfused into living versus paraformeldahyde-fixed microvessels and the pressure drop across microvessels monitored. Separately, protein binding to tethered VWF was assessed on a single-molecule level using total internal reflection fluorescence (TIRF) microscopy. RESULTS Within microvessels, VWF fibers colocalized with polymerizing fibrin, but not fibrinogen. TIRF microscopy showed no colocalization between VWF and fibrinogen or fibrin monomers in a microfluidic flow chamber across a range of shear rates and protein concentrations. Thrombin-mediated fibrin polymerization within living microvessels triggered endothelial VWF release, increasing the rate and amount of microvessel obstruction compared to fixed vessels with an inert endothelium. CONCLUSIONS We did not identify specific binding between fibrin(ogen) and VWF at a single-molecule level. Despite this, our results suggest that rapid release of endothelial VWF during clotting may provide a physical support for fibrin polymerization and accelerate thrombosis. This interaction may be of fundamental importance for the understanding and treatment of human thrombotic disease.
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Affiliation(s)
- Samuel G. Rayner
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
- Center for Lung Biology, University of Washington, Seattle, Washington, USA
| | - Zackary Scholl
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | | | - Junmei Chen
- Bloodworks Research Institute, Seattle, Washington, USA
| | - Karina N. LaValley
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | - Peter J. Leary
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - William A. Altemeier
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Center for Lung Biology, University of Washington, Seattle, Washington, USA
| | - W. Conrad Liles
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Dominic W. Chung
- Bloodworks Research Institute, Seattle, Washington, USA
- Department of Biochemistry, University of Washington, Seattle, Washington, USA
| | - José A. López
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
- Bloodworks Research Institute, Seattle, Washington, USA
| | - Hongxia Fu
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
- Bloodworks Research Institute, Seattle, Washington, USA
- Institute for Stem Cell and Regenerative Medicine, Seattle, Washington, USA
| | - Ying Zheng
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
- Institute for Stem Cell and Regenerative Medicine, Seattle, Washington, USA
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17
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Berardi C, Bluemke DA, Houston BA, Kolb TM, Lima JA, Pezel T, Tedford RJ, Rayner SG, Cheng RK, Leary PJ. Association of soluble Flt-1 with heart failure and cardiac morphology: The MESA angiogenesis study. J Heart Lung Transplant 2022; 41:619-625. [PMID: 35184966 PMCID: PMC9038636 DOI: 10.1016/j.healun.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/23/2021] [Accepted: 01/02/2022] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Soluble Fms-like tyrosine kinase 1 (sFlt-1) may inhibit angiogenesis. Higher levels of sFlt-1 are associated with worse prognosis in prevalent heart failure patients. The aim of this study was to better understand the role of sFlt-1 in heart failure pathogenesis by characterizing relationships between sFlt-1, cardiac morphology, and the composite outcome of incident heart failure or cardiovascular (CV) death in in a multiethnic cohort free of CV disease at baseline. METHODS sFlt-1 was measured in 1,381 participants in the Multi-Ethnic Study of Atherosclerosis Angiogenesis sub-study. Linear regression was used to estimate the association between sFlt-1 and cardiac morphology and Cox proportional hazard regression was used to estimate associations with incident heart failure or CV mortality. RESULTS Over a median follow-up of 13.1 years, higher sFlt-1 levels were associated with incident heart failure or CV mortality independent from CV risk factors or NT-proBNP levels (HR 1.17, 95% CI 1.10-1.26, p < 0.001). Higher sFlt-1 levels were also associated with greater baseline left ventricular (LV) mass by cardiac MRI and increased loss of LV mass over the 10 years following the baseline exam (p-value 0.02 for each), but this association was no longer statistically significant after adjustment for baseline NT-proBNP (p = 0.11 and 0.10 respectively). CONCLUSIONS Baseline sFlt-1 levels are associated with incident heart failure and cardiovascular mortality independent of traditional CV risk factors or NT-proBNP. An association was also found with cardiac mass but was no longer significant after adjustment for NT-proBNP.
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Affiliation(s)
- Cecilia Berardi
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington
| | - David A Bluemke
- Department of Radiology, University of Wisconsin, Madison, Wisconsin
| | - Brian A Houston
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Todd M Kolb
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, Maryland
| | - João A Lima
- Departments of Medicine and Radiology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Theo Pezel
- Departments of Medicine and Radiology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Ryan J Tedford
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Samuel G Rayner
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington
| | - Richard K Cheng
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington
| | - Peter J Leary
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington.
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18
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Larson SR, Vasbinder AL, Reding KW, Leary PJ, Branch KR, Shadyab AH, Johnson KC, Haring B, Wallace R, Manson JE, Anderson G, Cheng RK. Histamine H 2 Receptor Antagonists and Heart Failure Risk in Postmenopausal Women: The Women's Health Initiative. J Am Heart Assoc 2022; 11:e024270. [PMID: 35191329 PMCID: PMC9075064 DOI: 10.1161/jaha.121.024270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Prior studies suggested lower risk of heart failure (HF) in individuals taking H2 receptor antagonists (H2RA) compared with H2RA nonusers in relatively small studies. We evaluated the association of H2RA use and incident HF in postmenopausal women in the large‐scale WHI (Women’s Health Initiative) study. Methods and Results This study included postmenopausal women from the WHI without a history of HF at baseline. HF was defined as first incident hospitalization for HF and physician adjudicated. Multivariable Cox proportional hazards regression models evaluated the association of H2RA use as a time‐varying exposure with HF risk, after adjustment for demographic, lifestyle, and medical history variables. Sensitivity analyses examined (1) risk of HF stratified by the ARIC (Atherosclerosis Risk in Communities) score, (2) propensity score matching on H2RA use, (3) use of proton pump inhibitors rather than H2RA nonuse as the referent, and (4) exclusion of those taking diuretics at baseline. The primary analysis included 158 854 women after exclusion criteria, of whom 9757 (6.1%) were H2RA users. During median 8.2 years of follow‐up, 376 H2RA users (4.9 events/1000 person‐years) and 3206 nonusers (2.7 events/1000 person‐years) developed incident HF. After multivariable adjustment, there was no association between H2RA use and HF in the primary analysis (hazard ratio, 1.07; 95% CI, 0.94–1.22; P=0.31) or in any of the sensitivity analyses. Conclusions Clinical H2RA use was not associated with incident HF among postmenopausal women. Future studies are needed to evaluate potential effect modification by sex, HF severity, or patterns of use on H2RA exposure and HF risk. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00000611.
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Affiliation(s)
- Sophia R Larson
- Division of Cardiology Department of Medicine University of Washington Seattle WA
| | - Alexi L Vasbinder
- Department of Health Informatics School of Nursing University of Washington Seattle WA
| | - Kerryn W Reding
- Department of Biobehavioral Nursing and Health Informatics School of Nursing University of Washington Seattle WA
| | - Peter J Leary
- Division of Pulmonology and Critical Care Medicine Department of Medicine University of Washington Seattle WA
| | - Kelley R Branch
- Division of Cardiology Department of Medicine University of Washington Seattle WA
| | - Aladdin H Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science University of California, San Diego La Jolla CA
| | - Karen C Johnson
- Department of Preventive Medicine University of Tennessee Health Science Center Memphis TN
| | - Bernhard Haring
- Department of Internal Medicine Saarland University Homburg Germany
| | - Robert Wallace
- Departments of Epidemiology and Medicine University of Iowa Iowa City IA
| | - JoAnn E Manson
- Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston MA
| | - Garnet Anderson
- Public Health Sciences Division Fred Hutchinson Cancer Research Center Seattle WA
| | - Richard K Cheng
- Division of Cardiology Department of Medicine University of Washington Seattle WA
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19
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Johnson K, Leary PJ, Govaere O, Barter MJ, Charlton SH, Cockell SJ, Tiniakos D, Zatorska M, Bedossa P, Brosnan MJ, Cobbold JF, Ekstedt M, Aithal GP, Clément K, Schattenberg JM, Boursier J, Ratziu V, Bugianesi E, Anstee QM, Daly AK. Increased serum miR-193a-5p during non-alcoholic fatty liver disease progression: Diagnostic and mechanistic relevance. JHEP Rep 2022; 4:100409. [PMID: 35072021 PMCID: PMC8762473 DOI: 10.1016/j.jhepr.2021.100409] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 10/08/2021] [Accepted: 11/09/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND & AIMS Serum microRNA (miRNA) levels are known to change in non-alcoholic fatty liver disease (NAFLD) and may serve as useful biomarkers. This study aimed to profile miRNAs comprehensively at all NAFLD stages. METHODS We profiled 2,083 serum miRNAs in a discovery cohort (183 cases with NAFLD representing the complete NAFLD spectrum and 10 population controls). miRNA libraries generated by HTG EdgeSeq were sequenced by Illumina NextSeq. Selected serum miRNAs were profiled in 372 additional cases with NAFLD and 15 population controls by quantitative reverse transcriptase PCR. RESULTS Levels of 275 miRNAs differed between cases and population controls. Fewer differences were seen within individual NAFLD stages, but miR-193a-5p consistently showed increased levels in all comparisons. Relative to NAFL/non-alcoholic steatohepatitis (NASH) with mild fibrosis (stage 0/1), 3 miRNAs (miR-193a-5p, miR-378d, and miR378d) were increased in cases with NASH and clinically significant fibrosis (stages 2-4), 7 (miR193a-5p, miR-378d, miR-378e, miR-320b, miR-320c, miR-320d, and miR-320e) increased in cases with NAFLD activity score (NAS) 5-8 compared with lower NAS, and 3 (miR-193a-5p, miR-378d, and miR-378e) increased but 1 (miR-19b-3p) decreased in steatosis, activity, and fibrosis (SAF) activity score 2-4 compared with lower SAF activity. The significant findings for miR-193a-5p were replicated in the additional cohort with NAFLD. Studies in Hep G2 cells showed that following palmitic acid treatment, miR-193a-5p expression decreased significantly. Gene targets for miR-193a-5p were investigated in liver RNAseq data for a case subgroup (n = 80); liver GPX8 levels correlated positively with serum miR-193a-5p. CONCLUSIONS Serum miR-193a-5p levels correlate strongly with NAFLD activity grade and fibrosis stage. MiR-193a-5p may have a role in the hepatic response to oxidative stress and is a potential clinically tractable circulating biomarker for progressive NAFLD. LAY SUMMARY MicroRNAs (miRNAs) are small pieces of nucleic acid that may turn expression of genes on or off. These molecules can be detected in the blood circulation, and their levels in blood may change in liver disease including non-alcoholic fatty liver disease (NAFLD). To see if we could detect specific miRNA associated with advanced stages of NAFLD, we carried out miRNA sequencing in a group of 183 patients with NAFLD of varying severity together with 10 population controls. We found that a number of miRNAs showed changes, mainly increases, in serum levels but that 1 particular miRNA miR-193a-5p consistently increased. We confirmed this increase in a second group of cases with NAFLD. Measuring this miRNA in a blood sample may be a useful way to determine whether a patient has advanced NAFLD without an invasive liver biopsy.
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Key Words
- ALT, alanine aminotransferase
- AST, aspartate aminotransferase
- AUROC, area under the receiver operating characteristic
- Biomarker
- CPM, counts per million
- Ct, cycle threshold
- ER, endoplasmic reticulum
- FC, fold change
- FIB-4, fibrosis-4
- FLIP, fatty liver inhibition of progression
- GTEx, Genotype-Tissue Expression
- MicroRNA
- NAFL, non-alcoholic fatty liver
- NAFLD, non-alcoholic fatty liver disease
- NAS, NAFLD activity score
- NASH, non-alcoholic steatohepatitis
- Non-alcoholic fatty liver disease
- PCA, principal component analysis
- SAF, steatosis–activity–fibrosis
- Sequencing
- TGF-β, transforming growth factor-beta
- cDNA, complementary DNA
- logFC, log2 fold change
- miRNA, microRNA
- qPCR, quantitative PCR
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Affiliation(s)
- Katherine Johnson
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Peter J. Leary
- Bioinformatics Support Unit, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Olivier Govaere
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Matthew J. Barter
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah H. Charlton
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Simon J. Cockell
- Bioinformatics Support Unit, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Dina Tiniakos
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Michalina Zatorska
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Pierre Bedossa
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - M. Julia Brosnan
- Internal Medicine Research Unit, Pfizer Inc., Cambridge, MA, USA
| | - Jeremy F. Cobbold
- Oxford Liver Unit, NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - Mattias Ekstedt
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden
| | - Guruprasad P. Aithal
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Karine Clément
- Institute of Cardiometabolism and Nutrition, Pitié Salpêtrière Hospital, Paris, France
- Assistance Publique – Hopitaux de Paris, Paris, France
| | - Jörn M. Schattenberg
- Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jerome Boursier
- Hepatology Department, Angers University Hospital, Angers, France
| | - Vlad Ratziu
- Institute of Cardiometabolism and Nutrition, Pitié Salpêtrière Hospital, Paris, France
- Assistance Publique – Hopitaux de Paris, Paris, France
| | - Elisabetta Bugianesi
- Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Quentin M. Anstee
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Ann K. Daly
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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Emmons‐Bell S, Johnson C, Boon‐Dooley A, Corris PA, Leary PJ, Rich S, Yacoub M, Roth GA. Prevalence, incidence, and survival of pulmonary arterial hypertension: A systematic review for the global burden of disease 2020 study. Pulm Circ 2022; 12:e12020. [PMID: 35506069 PMCID: PMC9052982 DOI: 10.1002/pul2.12020] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 10/13/2021] [Accepted: 11/03/2021] [Indexed: 11/13/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is characterized by increased resistance in the pulmonary arterioles as a result of remodeled blood vessels. We sought all available epidemiologic data on population‐based prevalence, incidence, and 1‐year survival of PAH as part of the Global Burden of Disease Study. We performed a systematic review searching Global Index Medicus (GIM) for keywords related to PAH between 1980 and 2021 and identified population‐representative sources of prevalence, incidence, and mortality for clinically diagnosed PAH. Of 6772 articles identified we found 65 with population‐level data: 17 for prevalence, 17 for incidence, and 58 reporting case fatality. Reported prevalence ranged from 0.37 cases/100,000 persons in a referral center of French children to 15 cases/100,000 persons in an Australian study. Reported incidence ranged from 0.008 cases/100,000 person‐years in Finland, to 1.4 cases/100,000 person‐years in a retrospective chart review at a clinic in Utah, United States. Reported 1‐year survival ranged from 67% to 99%. All studies with sex‐specific estimates of prevalence or incidence reported higher levels in females than males. Studies varied in their size, study design, diagnostic criteria, and sampling procedures. Reported PAH prevalence, incidence, and mortality varied by location and study. Prevalence ranged from 0.4 to 1.4 per 100,000 persons. Harmonization of methods for PAH registries would improve efforts at disease surveillance. Results of this search contribute to ongoing efforts to quantify the global burden of PAH.
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Affiliation(s)
- Sophia Emmons‐Bell
- Institute for Health Metrics and Evaluation University of Washington Seattle Washington USA
| | - Catherine Johnson
- Institute for Health Metrics and Evaluation University of Washington Seattle Washington USA
| | - Alexandra Boon‐Dooley
- Institute for Health Metrics and Evaluation University of Washington Seattle Washington USA
| | - Paul A. Corris
- Translational and Clinical Research Institute, Faculty of Medical Sciences Newcastle University Newcastle upon Tyne UK
- Pulmonary Vascular Research Institute UK
| | - Peter J. Leary
- Division of Pulmonary, Critical Care, and Sleep Medicine University of Washington Seattle Washington USA
| | - Stuart Rich
- Division of Cardiology Northwestern Memorial Hospital Chicago Illinois USA
| | - Magdi Yacoub
- Aswan Heart Centre Aswan Egypt
- National Heart & Lung Institute Imperial College London London UK
- Harefield Heart Science Centre London UK
| | - Gregory A. Roth
- Institute for Health Metrics and Evaluation University of Washington Seattle Washington USA
- Division of Cardiology, Department of Medicine University of Washington Seattle Washington USA
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21
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Affiliation(s)
- Raimund H. Pichler
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
| | - Erik R. Swenson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, Washington,Department of Veterans Affairs, Puget Sound Health Care System, Seattle, Washington
| | - Peter J. Leary
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, Washington
| | - Cary H. Paine
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
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22
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Inampudi C, Silverman D, Simon MA, Leary PJ, Sharma K, Houston BA, Vachiéry JL, Haddad F, Tedford RJ. Pulmonary Hypertension in the Context of Heart Failure With Preserved Ejection Fraction. Chest 2021; 160:2232-2246. [PMID: 34391755 PMCID: PMC8727853 DOI: 10.1016/j.chest.2021.08.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/23/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is the most common form of heart failure and frequently is associated with pulmonary hypertension (PH). HFpEF associated with PH may be difficult to distinguish from precapillary forms of PH, although this distinction is crucial because therapeutic pathways are divergent for the two conditions. A comprehensive and systematic approach using history, clinical examination, and noninvasive and invasive evaluation with and without provocative testing may be necessary for accurate diagnosis and phenotyping. After diagnosis, HFpEF associated with PH can be subdivided into isolated postcapillary pulmonary hypertension (IpcPH) and combined postcapillary and precapillary pulmonary hypertension (CpcPH) based on the presence or absence of elevated pulmonary vascular resistance. CpcPH portends a worse prognosis than IpcPH. Despite its association with reduced functional capacity and quality of life, heart failure hospitalizations, and higher mortality, therapeutic options focused on PH for HFpEF associated with PH remain limited. In this review, we aim to provide an updated overview on clinical definitions and hemodynamically characterized phenotypes of PH, pathophysiologic features, therapeutic strategies, and ongoing challenges in this patient population.
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Affiliation(s)
- Chakradhari Inampudi
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Daniel Silverman
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Marc A Simon
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco
| | - Peter J Leary
- Department of Medicine, University of Washington, Seattle, WA
| | - Kavita Sharma
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Brian A Houston
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Jean-Luc Vachiéry
- Département de Cardiologie Cliniques, Universitaires de Bruxelles-Hôpital Erasme, Brussels, Belgium
| | - Francois Haddad
- Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Ryan J Tedford
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC.
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Emmons-Bell S, Johnson C, Boon-Dooley A, Corris P, Leary PJ, Rich S, Yacoub M, Roth G. EXPRESS: Prevalence, Incidence, and Survival of Pulmonary Arterial Hypertension: A Systematic Review for the Global Burden of Disease 2020 Study. Pulm Circ 2021. [DOI: 10.1177/20458940211061473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Pulmonary arterial hypertension (PAH) is characterized by increased resistance in the pulmonary arterioles as a result of remodeled blood vessels. We sought to establish the baseline level of PAH by assembling all available epidemiologic data on population-based prevalence, incidence, and one-year survival of PAH as part of the Global Burden of Disease Study. Methods: We performed a systematic review searching Global Index Medicus (GIM) for key words related to PAH between 1980 and 2021, and identified population-representative sources of prevalence, incidence, and mortality for clinically diagnosed PAH. Results: Of 6,772 identified we found 65 with population-level data: 17 for prevalence, 17 for incidence, and 58 reporting case fatality. Reported prevalence ranged from 0.37 cases/100,000 persons in a referral center of French children to 150 cases/100,000 persons in an Australian echocardiography study. Reported incidence ranged from 0.008 cases/100,000 person-years in a study of hospital discharge records in Finland, to 1.4 cases/100,000 person-years in a retrospective chart review at a clinic in Utah, USA. Reported one-year survival ranged from 67% to 99%. All studies with sex-specific estimates reported higher levels in females than males. Studies varied in their size, study design, diagnostic criteria, and sampling procedures. Conclusions: Reported PAH prevalence, incidence, and mortality varied by location and study. Prevalence ranged from 0.4 to 1.4 per 100,000 persons. Harmonization of methods for PAH registries would improve efforts at disease surveillance. Results of this search contribute to ongoing efforts to quantify the global burden of PAH.
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Affiliation(s)
- Sophia Emmons-Bell
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States
| | - Catherine Johnson
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States
| | | | - Paul Corris
- Newcastle University, Translational and Clinical Research Institute Faculty of Medical Sciences, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
- Pulmonary Vascular Research Institute, Canterbury, Kent, United Kingdom of Great Britain and Northern Ireland
| | - Peter J. Leary
- University of Washington Medical Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Seattle, Washington, United States
| | - Stuart Rich
- Northwestern Memorial Hospital, Division of Cardiology, 676 N. St. Clair, Suite 600, Chicago, Illinois, United States
| | - Magdi Yacoub
- Aswan Heart Centre, Cardiac surgery department, Aswan, Aswan, Egypt
- Imperial College London National Heart and Lung Institute, London, United Kingdom of Great Britain and Northern Ireland
- Harefield Hospital, Heart Science Centre, Middlesex, United Kingdom of Great Britain and Northern Ireland
| | - Gregory Roth
- University of Washington Department of Medicine, Division of Cardiology, Seattle, Washington, United States
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States
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Steinberg ZL, Lombardi WL, Lee J, Mulligan MS, Leary PJ. Balloon Pulmonary Angioplasty in Chronic Totally Occluded Pulmonary Arteries: Applying Lessons Learned From the Treatment of Coronary Artery Chronic Total Occlusions. J Invasive Cardiol 2021; 33:E632-E639. [PMID: 34338653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVES This study aims to describe the safety and efficacy of revascularizing chronic total occlusions (CTOs) of the pulmonary arteries with balloon pulmonary angioplasty (BPA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). BACKGROUND BPA has emerged as an effective treatment for CTEPH patients when surgical treatment is not possible. Experience to date has suggested treating CTOs may be associated with excess risk and less procedural success relative to other lesion types. METHODS This study is a retrospective case series of all BPAs on CTOs for individuals with CTEPH at a single institution. Procedural approach, complications, and success rate over a 6-month period are described. RESULTS During the study period, 6 individuals with 15 CTOs were identified and intervened upon during 21 interventions. Success rate for revascularization was 62% per attempt and 87% per lesion. Techniques used for successful intervention include true to true lumen wiring (n = 7) and subintimal dissection re-entry with subintimal tracking and re-entry (n = 3), Stingray balloon (Boston Scientific) assisted re-entry (n = 2), and direct wire re-entry (n = 1). Wire perforations were relatively common and occurred in 62% of interventions, but rarely resulted in a change in clinical status. CONCLUSIONS Although important barriers to routine intervention on CTOs in CTEPH remain, the current series suggests a higher success rate than previously reported experiences using CTO revascularization techniques including subintimal tracking and re-entry and Stingray balloon-assisted re-entry. Although the frequency of wire perforation was relatively high, the clinical ramifications of these complications were mild.
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Hassan HJ, Housten T, Balasubramanian A, Simpson CE, Damico RL, Mathai SC, Hassoun PM, Steppan J, Leary PJ, Kolb TM. A novel approach to perioperative risk assessment for patients with pulmonary hypertension. ERJ Open Res 2021; 7:00257-2021. [PMID: 34291108 PMCID: PMC8287131 DOI: 10.1183/23120541.00257-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/02/2021] [Indexed: 11/06/2022] Open
Abstract
Rationale Pulmonary hypertension (PH) is associated with significant perioperative morbidity and mortality. We hypothesised that pulmonary arterial hypertension (PAH) composite risk assessment scores could estimate perioperative risk for PH patients when adjusted for inherent procedural risk. Methods We identified patients in the Johns Hopkins PH Center Registry that had noncardiac surgery (including endoscopies) between September 2015 and January 2020. We collected information on preoperative patient-level and procedural variables and used logistic regression to evaluate associations with a composite outcome of death within 30 days or serious postoperative complication. We generated composite patient-level risk assessment scores for each subject and used logistic regression to estimate the association with adverse surgical outcomes. We adjusted multivariable models for inherent procedural risk of major cardiovascular events and used these models to generate a numerical PH perioperative risk (PHPR) score. Results Among 150 subjects, 19 (12.7%) reached the primary outcome, including 7 deaths (4.7%). Individual patient-level and procedural variables were associated with the primary outcome (all p<0.05). A composite patient-level risk assessment score built on three noninvasive parameters was strongly associated with reduced risk for poor outcomes (OR=0.4, p=0.03). This association was strengthened after adjusting the model for procedural risk. A PHPR score derived from the multivariable model stratified patients into low (0%), intermediate (≤10%), or high (>10%) risk of reaching the primary outcome. Conclusion Composite PAH risk assessment scores can predict perioperative risk for PH patients after accounting for inherent procedural risk. Validation of the PHPR score in a multicentre, prospective cohort is warranted. For patients with pulmonary hypertension undergoing noncardiac surgery, perioperative risk can be estimated using a model that combines inherent procedural risk with composite PAH risk assessment scoreshttps://bit.ly/3uTCibP
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Affiliation(s)
- Hussein J Hassan
- Dept of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Traci Housten
- Dept of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Aparna Balasubramanian
- Dept of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Catherine E Simpson
- Dept of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Rachel L Damico
- Dept of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Stephen C Mathai
- Dept of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Paul M Hassoun
- Dept of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jochen Steppan
- Dept of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Peter J Leary
- Dept of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - Todd M Kolb
- Dept of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
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Alba GA, Samokhin AO, Wang RS, Zhang YY, Wertheim BM, Arons E, Greenfield EA, Lundberg Slingsby MH, Ceglowski JR, Haley KJ, Bowman FP, Yu YR, Haney JC, Eng G, Mitchell RN, Sheets A, Vargas SO, Seo S, Channick RN, Leary PJ, Rajagopal S, Loscalzo J, Battinelli EM, Maron BA. NEDD9 Is a Novel and Modifiable Mediator of Platelet-Endothelial Adhesion in the Pulmonary Circulation. Am J Respir Crit Care Med 2021; 203:1533-1545. [PMID: 33523764 PMCID: PMC8483217 DOI: 10.1164/rccm.202003-0719oc] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 01/29/2021] [Indexed: 12/16/2022] Open
Abstract
Rationale: Data on the molecular mechanisms that regulate platelet-pulmonary endothelial adhesion under conditions of hypoxia are lacking, but may have important therapeutic implications. Objectives: To identify a hypoxia-sensitive, modifiable mediator of platelet-pulmonary artery endothelial cell adhesion and thrombotic remodeling. Methods: Network medicine was used to profile protein-protein interactions in hypoxia-treated human pulmonary artery endothelial cells. Data from liquid chromatography-mass spectrometry and microscale thermophoresis informed the development of a novel antibody (Ab) to inhibit platelet-endothelial adhesion, which was tested in cells from patients with chronic thromboembolic pulmonary hypertension (CTEPH) and three animal models in vivo. Measurements and Main Results: The protein NEDD9 was identified in the hypoxia thrombosome network in silico. Compared with normoxia, hypoxia (0.2% O2) for 24 hours increased HIF-1α (hypoxia-inducible factor-1α)-dependent NEDD9 upregulation in vitro. Increased NEDD9 was localized to the plasma-membrane surface of cells from control donors and patients with CTEPH. In endarterectomy specimens, NEDD9 colocalized with the platelet surface adhesion molecule P-selectin. Our custom-made anti-NEDD9 Ab targeted the NEDD9-P-selectin interaction and inhibited the adhesion of activated platelets to pulmonary artery endothelial cells from control donors in vitro and from patients with CTEPH ex vivo. Compared with control mice, platelet-pulmonary endothelial aggregates and pulmonary hypertension induced by ADP were decreased in NEDD9-/- mice or wild-type mice treated with the anti-NEDD9 Ab, which also decreased chronic pulmonary thromboembolic remodeling in vivo. Conclusions: The NEDD9-P-selectin protein-protein interaction is a modifiable target with which to inhibit platelet-pulmonary endothelial adhesion and thromboembolic vascular remodeling, with potential therapeutic implications for patients with disorders of increased hypoxia signaling pathways, including CTEPH.
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Affiliation(s)
- George A. Alba
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, and
| | - Andriy O. Samokhin
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Rui-Sheng Wang
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ying-Yi Zhang
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Elena Arons
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | | | - Frederick P. Bowman
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Yen-Rei Yu
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - John. C. Haney
- Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - George Eng
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | | | - Anthony Sheets
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, and
| | - Sara O. Vargas
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Duke University, Durham, North Carolina
| | - Sachiko Seo
- Department of Pathology, Boston Children’s Hospital, Boston, Massachusetts
| | - Richard N. Channick
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan
| | - Peter J. Leary
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, Los Angeles, California; and
| | - Sudarshan Rajagopal
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, Washington
| | - Joseph Loscalzo
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Bradley A. Maron
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
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27
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Peplinski BS, Houston BA, Bluemke DA, Kawut SM, Kolb TM, Kronmal RA, Lima JAC, Ralph DD, Rayner SG, Steinberg ZL, Tedford RJ, Leary PJ. Associations of Angiopoietins With Heart Failure Incidence and Severity. J Card Fail 2021; 27:786-795. [PMID: 33872759 DOI: 10.1016/j.cardfail.2021.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/30/2021] [Accepted: 04/02/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Angiopoietin-1 and 2 (Ang1, Ang2) are important mediators of angiogenesis. Angiopoietin levels are perturbed in cardiovascular disease, but it is unclear whether angiopoietin signaling is causative, an adaptive response, or merely epiphenomenon of disease activity. METHODS AND RESULTS In a cohort free of cardiovascular disease at baseline (Multi-Ethnic Study of Atherosclerosis [MESA]), relationships between angiopoietins, cardiac morphology, and subsequent incidence of heart failure or cardiovascular death were evaluated. In cohorts with pulmonary arterial hypertension or left heart disease, associations between angiopoietins, invasive hemodynamics, and adverse clinical outcomes were evaluated. In MESA, Ang2 was associated with a higher incidence of heart failure or cardiovascular death (hazard ratio 1.21 per standard deviation, P < .001). Ang2 was associated with increased right atrial pressure (pulmonary arterial hypertension cohort) and increased wedge pressure and right atrial pressure (left heart disease cohort). Elevated Ang2 was associated with mortality in the pulmonary arterial hypertension cohort. CONCLUSIONS Ang2 was associated with incident heart failure or death among adults without cardiovascular disease at baseline and with disease severity in individuals with existing heart failure. Our finding that Ang2 is increased before disease onset and that elevations reflect disease severity, suggests Ang2 may contribute to heart failure pathogenesis.
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Affiliation(s)
| | - Brian A Houston
- Medical University of South Carolina, Department of Medicine, Charleston, SC
| | - David A Bluemke
- University of Wisconsin, Department of Radiology, Madison, WI
| | - Steven M Kawut
- Perelman School of Medicine at the University of Pennsylvania, Departments of Medicine and Epidemiology, Philadelphia, PA
| | - Todd M Kolb
- Johns Hopkins Hospital, Department of Medicine, Baltimore, MD
| | | | - Joao A C Lima
- Johns Hopkins Hospital, Department of Medicine, Baltimore, MD; Johns Hopkins Hospital, Department of Radiology, Baltimore, MD
| | - David D Ralph
- University of Washington, Department of Medicine, Seattle, WA
| | - Samuel G Rayner
- University of Washington, Department of Medicine, Seattle, WA
| | | | - Ryan J Tedford
- Medical University of South Carolina, Department of Medicine, Charleston, SC
| | - Peter J Leary
- University of Washington, Department of Medicine, Seattle, WA; University of Washington, Department of Epidemiology, Seattle, WA.
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28
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Zwicke DL, Restrepo-Jaramillo R, Alnuaimat H, Gordon K, Broderick M, Edwards LD, Allmon A, Leary PJ. A multicenter retrospective study of patients with pulmonary hypertension transitioned from inhaled to oral treprostinil. Pulm Circ 2021; 11:2045894021998203. [PMID: 33738096 PMCID: PMC7934059 DOI: 10.1177/2045894021998203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 02/06/2021] [Indexed: 11/25/2022] Open
Abstract
Oral treprostinil has recently been shown to delay disease progression in patients with pulmonary arterial hypertension in a long-term outcomes study. The potential advantages of an oral formulation have resulted in patients transitioning from inhaled to oral treprostinil. The current study reports a retrospective analysis of patients who transitioned from treatment with inhaled to oral treprostinil. A multicenter retrospective chart review was conducted for 29 patients with pulmonary hypertension that transitioned from inhaled to oral treprostinil. Data were collected from inhaled treprostinil initiation and patients were followed until discontinuation of oral treprostinil or the end of the observation period. Persistence was calculated using Kaplan–Meier estimates. Prior to transition to oral treprostinil, patients had received inhaled treprostinil for a median of 643 (IQR: 322–991) days and 52% of patients were New York Heart Association/World Health Organization Functional Class III. For patients that cross-titrated between formulations, the median time to complete the cross titration was 24 (IQR: 1–57) days. At 16- and 24-weeks post-transition, oral treprostinil persistence was 86 and 76%, respectively. Persistence was 59% at 52 weeks post-transition. Clinical stability for the majority of patients at first follow-up post-transition was suggested based on available New York Heart Association/World Health Organization Functional Classification. Transitions from inhaled to oral treprostinil appeared safe and tolerable in the short-term. Additional prospective studies are needed to fully evaluate the safety and efficacy of transitions from inhaled to oral treprostinil.
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Affiliation(s)
- Diane L Zwicke
- Aurora St. Luke's Medical Center, University of Wisconsin, Milwaukee, WI, USA
| | | | - Hassan Alnuaimat
- Dept of Medicine in the College of Medicine, University of Florida, Gainesville, FL, USA
| | - Kathryn Gordon
- United Therapeutics Corporation, Research Triangle Park, NC, USA
| | | | - Lisa D Edwards
- United Therapeutics Corporation, Research Triangle Park, NC, USA
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29
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Borgese M, Badesch D, Bull T, Chakinala M, DeMarco T, Feldman J, Ford HJ, Grinnan D, Klinger JR, Bolivar L, Shlobin OA, Frantz RP, Sager JS, Mathai SC, Kawut S, Leary PJ, Gray MP, Popat RA, Zamanian RT. EmPHasis-10 as a measure of health-related quality of life in pulmonary arterial hypertension: data from PHAR. Eur Respir J 2021; 57:13993003.00414-2020. [PMID: 33243844 DOI: 10.1183/13993003.00414-2020] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 11/01/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION While the performance of the emPHasis-10 (e10) score has been evaluated against limited patient characteristics within the United Kingdom, there is an unmet need for exploring the performance of the e10 score among pulmonary arterial hypertension (PAH) patients in the United States. METHODS Using the Pulmonary Hypertension Association Registry, we evaluated relationships between the e10 score and demographic, functional, haemodynamic and additional clinical characteristics at baseline and over time. Furthermore, we derived a minimally important difference (MID) estimate for the e10 score. RESULTS We analysed data from 565 PAH (75% female) adults aged mean±sd 55.6±16.0 years. At baseline, the e10 score had notable correlation with factors expected to impact quality of life in the general population, including age, education level, income, smoking status and body mass index. Clinically important parameters including 6-min walk distance and B-type natriuretic peptide (BNP)/N-terminal proBNP were also significantly associated with e10 score at baseline and over time. We generated a MID estimate for the e10 score of -6.0 points (range -5.0--7.6 points). CONCLUSIONS The e10 score was associated with demographic and clinical patient characteristics, suggesting that health-related quality of life in PAH is influenced by both social factors and indicators of disease severity. Future studies are needed to demonstrate the impact of the e10 score on clinical decision-making and its potential utility for assessing clinically important interventions.
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Affiliation(s)
- Marissa Borgese
- Dept of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA
| | - David Badesch
- Division of Pulmonary and Critical Care Medicine, University of Colorado, Denver, CO, USA
| | - Todd Bull
- Division of Pulmonary and Critical Care Medicine, University of Colorado, Denver, CO, USA
| | - Murali Chakinala
- Division of Pulmonary and Critical Care Medicine, Washington University at Barnes-Jewish, Saint Louis, MO, USA
| | - Teresa DeMarco
- Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | | | - H James Ford
- Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dan Grinnan
- Division of Pulmonary and Critical Care Medicine, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - James R Klinger
- Division of Pulmonary and Critical Care Medicine, Brown University, Providence, RI, USA
| | | | | | - Robert P Frantz
- Division of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN, USA
| | - Jeffery S Sager
- Cottage Pulmonary Hypertension Center, Santa Barbara, CA, USA
| | - Stephen C Mathai
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Steven Kawut
- Division of Pulmonary and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter J Leary
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA
| | - Michael P Gray
- Pulmonary Hypertension Association, Silver Spring, MD, USA
| | - Rita A Popat
- Dept of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA
| | - Roham T Zamanian
- Division of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA, USA .,Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, Stanford, CA, USA
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30
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Khural JS, Houston BA, Leary PJ, Mathai SC, Kolb TM, Damico R, Hassoun PM, Kass DA, Hsu S, Tedford RJ. Right Atrial Pacing to Improve Acute Hemodynamics in Pulmonary Arterial Hypertension. Am J Respir Crit Care Med 2021; 203:508-511. [PMID: 33026819 PMCID: PMC7885846 DOI: 10.1164/rccm.202006-2278le] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Brian A. Houston
- The Medical University of South CarolinaCharleston, South Carolina
| | | | | | - Todd M. Kolb
- Johns Hopkins School of MedicineBaltimore, Marylandand
| | - Rachel Damico
- Johns Hopkins School of MedicineBaltimore, Marylandand
| | | | - David A. Kass
- Johns Hopkins School of MedicineBaltimore, Marylandand
- Johns Hopkins UniversityBaltimore, Maryland
| | - Steven Hsu
- Johns Hopkins School of MedicineBaltimore, Marylandand
| | - Ryan J. Tedford
- The Medical University of South CarolinaCharleston, South Carolina
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31
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Amin EK, Austin ED, Parker C, Colglazier E, Nawaytou H, Leary PJ, Hemnes AR, Teitel D, Fineman JR. Novel Documentation of Onset and Rapid Advancement of Pulmonary Arterial Hypertension without Symptoms in BMPR2 Mutation Carriers: Cautionary Tales? Am J Respir Crit Care Med 2020; 202:1587-1589. [PMID: 32692583 DOI: 10.1164/rccm.202005-1611le] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Elena K Amin
- University of California San Francisco, San Francisco, California
| | - Eric D Austin
- Vanderbilt University School of Medicine, Nashville, Tennessee and
| | - Claire Parker
- University of California San Francisco, San Francisco, California
| | | | - Hythem Nawaytou
- University of California San Francisco, San Francisco, California
| | | | - Anna R Hemnes
- Vanderbilt University School of Medicine, Nashville, Tennessee and
| | - David Teitel
- University of California San Francisco, San Francisco, California
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32
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Rahaghi FF, Allen RP, Balasubramanian VP, Chakinala MM, Elwing JM, Feldman J, Leary PJ, Rischard F, Safdar Z, Sood N, Oudiz RJ. An expert panel delphi consensus statement on patient selection and management for transitioning between oral and inhaled treprostinil. Pulm Pharmacol Ther 2020; 66:101979. [PMID: 33259923 DOI: 10.1016/j.pupt.2020.101979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 11/03/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Abstract
Treprostinil, a prostacyclin analogue used in the treatment of pulmonary arterial hypertension (PAH), is available for administration by parenteral, oral, or inhaled routes. Transitioning between routes may be beneficial for appropriate patients; however, there is little published data on transitions between oral and inhaled treprostinil. We used a modified Delphi process to develop expert consensus recommendations on transitions between these formulations. Three questionnaires were used to develop statements about relevant aspects of transition management, which the panelists rated, using a Likert scale, from -5 (strongly disagree) to +5 (strongly agree). Eleven physicians with expertise in PAH treatment modalities, participated in the panel. Of the 492 statements evaluated, consensus was reached on 215 (43.7%). Key consensus recommendations included (1) accurately defining successful transition, as stable or improved PAH with good tolerability and adherence, and (2) patients with stable, low-risk PAH showing insufficient response or tolerability to their existing treprostinil therapy (and due to restrictions in up titration of dosing), as appropriate candidates for transitions between treprostinil formulations. Panelists did not reach consensus for an overall strategy for performing these transitions, mainly because of variability in their practice parameters. Consensus was also achieved on recommendations for adverse event management, including reassurance, administration of oral treprostinil 3 times daily with food, and dosing inhaled treprostinil at intervals ≥3 hours apart. The Delphi process aided in developing expert consensus recommendations that may provide clinically useful guidance for transitioning between treprostinil formulations. However, additional data from centers with high volumes of PAH patients undergoing treprostinil transitions would be optimal for defining more complete and robust strategies to facilitate successful transition.
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Affiliation(s)
| | | | | | - Murali M Chakinala
- Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Jean M Elwing
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | | | - Franz Rischard
- The University of Arizona - College of Medicine, Tucson, AZ, USA
| | | | | | - Ronald J Oudiz
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
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33
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Lee JD, Burger CD, Delossantos GB, Grinnan D, Ralph DD, Rayner SG, Ryan JJ, Safdar Z, Ventetuolo CE, Zamanian RT, Leary PJ. A Survey-based Estimate of COVID-19 Incidence and Outcomes among Patients with Pulmonary Arterial Hypertension or Chronic Thromboembolic Pulmonary Hypertension and Impact on the Process of Care. Ann Am Thorac Soc 2020; 17:1576-1582. [PMID: 32726561 PMCID: PMC7706604 DOI: 10.1513/annalsats.202005-521oc] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/29/2020] [Indexed: 12/20/2022] Open
Abstract
Rationale: Patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) typically undergo frequent clinical evaluation. The incidence and outcomes of coronavirus disease (COVID-19) and its impact on routine management for patients with pulmonary vascular disease is currently unknown.Objectives: To assess the cumulative incidence and outcomes of recognized COVID-19 for patients with PAH/CTEPH followed at accredited pulmonary hypertension centers, and to evaluate the pandemic's impact on clinic operations at these centers.Methods: A survey was e-mailed to program directors of centers accredited by the Pulmonary Hypertension Association. Descriptive analyses and linear regression were used to analyze results.Results: Seventy-seven center directors were successfully e-mailed a survey, and 58 responded (75%). The cumulative incidence of COVID-19 recognized in individuals with PAH/CTEPH was 2.9 cases per 1,000 patients, similar to the general U.S. population. In patients with PAH/CTEPH for whom COVID-19 was recognized, 30% were hospitalized and 12% died. These outcomes appear worse than the general population. A large impact on clinic operations was observed including fewer clinic visits and substantially increased use of telehealth. A majority of centers curtailed diagnostic testing and a minority limited new starts of medical therapy. Most centers did not use experimental therapies in patients with PAH/CTEPH diagnosed with COVID-19.Conclusions: The cumulative incidence of COVID-19 recognized in patients with PAH/CTEPH appears similar to the broader population, although outcomes may be worse. Although the total number of patients with PAH/CTEPH recognized to have COVID-19 was small, the impact of COVID-19 on broader clinic operations, testing, and treatment was substantial.
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Affiliation(s)
| | - Charles D. Burger
- Department of Pulmonary Medicine, Mayo Clinic Florida, Jacksonville, Florida
| | | | - Daniel Grinnan
- Department of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | | | | | - John J. Ryan
- Department of Medicine, University of Utah, Salt Lake City, Utah
| | - Zeenat Safdar
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Corey E. Ventetuolo
- Department of Medicine and Health Services, Policy and Practice, Brown University, Providence, Rhode Island; and
| | | | - Peter J. Leary
- Department of Medicine and
- Department of Epidemiology, University of Washington, Seattle, Washington
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34
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Lahm T, Hess E, Barón AE, Maddox TM, Plomondon ME, Choudhary G, Maron BA, Zamanian RT, Leary PJ. Renin-Angiotensin-Aldosterone System Inhibitor Use and Mortality in Pulmonary Hypertension: Insights From the Veterans Affairs Clinical Assessment Reporting and Tracking Database. Chest 2020; 159:1586-1597. [PMID: 33031831 DOI: 10.1016/j.chest.2020.09.258] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/25/2020] [Accepted: 09/17/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The renin-angiotensin-aldosterone system (RAAS) contributes to pulmonary hypertension (PH) pathogenesis. Although animal data suggest that RAAS inhibition attenuates PH, it is unknown if RAAS inhibition is beneficial in PH patients. RESEARCH QUESTION Is RAAS inhibitor use associated with lower mortality in a large cohort of patients with hemodynamically confirmed PH? STUDY DESIGN AND METHODS We used the Department of Veterans Affairs Clinical Assessment Reporting and Tracking Database to study retrospectively relationships between RAAS inhibitors (angiotensin converting enzyme inhibitors [ACEIs], angiotensin receptor blockers [ARBs], and aldosterone antagonists [AAs]) and mortality in 24,221 patients with hemodynamically confirmed PH. We evaluated relationships in the full and in propensity-matched cohorts. Analyses were adjusted for demographics, socioeconomic status, comorbidities, disease severity, and comedication use in staged models. RESULTS ACEI and ARB use was associated with improved survival in unadjusted Kaplan-Meier survival analyses in the full cohort and the propensity-matched cohort. This relationship was insensitive to adjustment, independent of pulmonary artery wedge pressure, and also was observed in a cohort restricted to individuals with precapillary PH. AA use was associated with worse survival in unadjusted Kaplan-Meier survival analyses in the full cohort; however, AA use was associated less robustly with mortality in the propensity-matched cohort and was not associated with worse survival after adjustment for disease severity, indicating that AAs in real-world practice are used preferentially in sicker patients and that the unadjusted association with increased mortality may be an artifice of confounding by indication of severity. INTERPRETATION ACEI and ARB use is associated with lower mortality in veterans with PH. AA use is a marker of disease severity in PH. ACEIs and ARBs may represent a novel treatment strategy for diverse PH phenotypes.
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Affiliation(s)
- Tim Lahm
- Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, IN; Indiana University School of Medicine, Indianapolis, IN.
| | - Edward Hess
- Veterans Affairs Eastern Colorado Health Care System, Denver, CO
| | - Anna E Barón
- Veterans Affairs Eastern Colorado Health Care System, Denver, CO; Colorado School of Public Health, Denver, CO
| | - Thomas M Maddox
- Washington University School of Medicine Division of Cardiology and Healthcare Innovation Lab, St. Louis, MO
| | - Mary E Plomondon
- Veterans Affairs Eastern Colorado Health Care System, Denver, CO
| | - Gaurav Choudhary
- Providence Veterans Affairs Medical Center, Providence, RI; Alpert Medical School of Brown University, Providence, RI
| | - Bradley A Maron
- Veterans Affairs Boston Healthcare System, Boston, MA; Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Roham T Zamanian
- Stanford University Division of Pulmonary, Allergy, and Critical Care Medicine and Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford, CA
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35
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Li S, Beckman JA, Welch NG, Cheng RK, Rockom SW, Levy WC, O'Brien KD, Dardas TF, Lin S, Leary PJ, Kirkpatrick J, McCabe JM, Bjelkengren J, Chassagne F, Aliseda A, Zimpfer D, Mahr C. Accuracy of Doppler blood pressure measurement in HeartMate 3 ventricular assist device patients. ESC Heart Fail 2020; 7:4241-4246. [PMID: 33001579 PMCID: PMC7754743 DOI: 10.1002/ehf2.13056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/27/2020] [Accepted: 09/22/2020] [Indexed: 12/27/2022] Open
Abstract
Aims Optimal blood pressure (BP) control is imperative to reduce complications, especially strokes, in continuous flow ventricular assist device (VAD) patients. Doppler BP has been shown to be an accurate and reliable non‐invasive BP measurement method in HeartMate II and HVAD patients. We examined whether Doppler BP is also accurate in patients with the HeartMate 3 VAD. Methods and results In a prospective, longitudinal cohort of HeartMate 3 patients, arterial line BP and simultaneously measured Doppler opening pressure were obtained. Correlation and agreement between Doppler opening pressure and arterial line mean arterial pressure (MAP) versus systolic blood pressure (SBP) were analysed, as well as the effect of pulse pressure on the accuracy of Doppler opening pressure. A total of 589 pairs of simultaneous Doppler opening pressure and arterial line pressure readings were obtained in 43 patients. Doppler opening pressure had good correlation with intra‐arterial MAP (r = 0.754) and more closely approximated MAP than SBP (mean error 2.0 vs. −8.6 mmHg). Pulse pressure did not have a clinically significant impact on the accuracy of the Doppler BP method. These results in HeartMate 3 patients are very similar to previous results in HeartMate II and HVAD patients. Conclusions Doppler BP method should be the default non‐invasive BP measurement method in continuous flow VAD patients including patients implanted with the HeartMate 3.
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Affiliation(s)
- Song Li
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Jennifer A Beckman
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Nathan G Welch
- Department of Statistics, University of Washington, Seattle, WA, USA
| | - Richard K Cheng
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Sunny W Rockom
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Wayne C Levy
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Kevin D O'Brien
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Todd F Dardas
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Shin Lin
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Peter J Leary
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - James Kirkpatrick
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - James M McCabe
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Jason Bjelkengren
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Fanette Chassagne
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Alberto Aliseda
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Daniel Zimpfer
- Division of Cardiothoracic Surgery, Department of Cardiac Surgery, University of Vienna, Vienna, Austria
| | - Claudius Mahr
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
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36
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Leary PJ, Jenny NS, Bluemke DA, Kawut SM, Kronmal RA, Lima JA, Maron BA, Ralph DD, Rayner SG, Ryan JJ, Steinberg ZL, Hinckley Stukovsky KD, Tedford RJ. Endothelin-1, cardiac morphology, and heart failure: the MESA angiogenesis study. J Heart Lung Transplant 2020; 39:45-52. [PMID: 31515065 PMCID: PMC6942224 DOI: 10.1016/j.healun.2019.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 06/10/2019] [Accepted: 07/31/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Circulating levels of endothelin-1 (ET1) are elevated in heart failure and predict poor prognosis. However, it is not clear whether ET1 elevation is an adaptive response, maladaptive response, or an epiphenomenon of heart failure. In this study, we evaluated the relationships between ET1, cardiac morphology, and incident heart failure or cardiovascular death in participants with no evidence of clinical cardiovascular disease at the time ET1 was measured. METHODS AND RESULTS ET1 was measured in 1,361 participants in the Multi-Ethnic Study of Atherosclerosis Angiogenesis Sub-Study. As suggested by linear regression, participants with lower circulating ET1 levels tended to be older, non-white, more likely to have smoked heavily, and less likely to report intentional exercise. Participants with higher ET1 levels had smaller left ventricular end-diastolic volumes (8.9 ml smaller per log increase in ET1, 95% confidence interval 17.1-0.7, p = 0.03) with an increased left ventricular ejection fraction (2.8% per log increase in ET1, 95% confidence interval 0.5%-5.2%, p = 0.02). As suggested by Cox Proportional Hazards estimates, participants with higher ET1 levels had a lower risk for the composite outcome of heart failure or cardiovascular death in models that were unadjusted or had limited adjustment (p = 0.03 and p = 0.05, respectively). Lower risk for heart failure with higher ET1 levels could not be clearly shown in a model including health behaviors. CONCLUSIONS These results suggest, but do not confirm, that elevated levels of circulating ET1 are associated with a more favorable cardiac phenotype. The relationship between ET1 and outcomes was not fully independent of one or more covariates.
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Affiliation(s)
- Peter J Leary
- University of Washington, Department of Medicine, Seattle, Washington.
| | - Nancy S Jenny
- University of Vermont, Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, Vermont
| | | | - Steven M Kawut
- Departments of Medicine and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Richard A Kronmal
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Joao A Lima
- Departments of Medicine and Radiology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Bradley A Maron
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts; Department of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts; Division of Cardiology, Harvard Medical School, Boston, Massachusetts
| | - David D Ralph
- University of Washington, Department of Medicine, Seattle, Washington
| | - Samuel G Rayner
- University of Washington, Department of Medicine, Seattle, Washington
| | - John J Ryan
- Department of Medicine, University of Utah, Salt Lake City, Utah
| | | | | | - Ryan J Tedford
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
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37
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Samokhin AO, Hsu S, Yu PB, Waxman AB, Alba GA, Wertheim BM, Hopkins CD, Bowman F, Channick RN, Nikolic I, Faria-Urbina M, Hassoun PM, Leopold JA, Tedford RJ, Ventetuolo CE, Leary PJ, Maron BA. Circulating NEDD9 is increased in pulmonary arterial hypertension: A multicenter, retrospective analysis. J Heart Lung Transplant 2019; 39:289-299. [PMID: 31952977 DOI: 10.1016/j.healun.2019.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 11/11/2019] [Accepted: 12/26/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is a highly morbid disease characterized by elevated pulmonary vascular resistance (PVR) and pathogenic right ventricular remodeling. Endothelial expression of the prometastatic protein NEDD9 is increased in fibrotic PAH arterioles, and NEDD9 inhibition decreases PVR in experimental PAH. We hypothesized that circulating NEDD9 is increased in PAH and informs the clinical profile of patients. METHODS Clinical data and plasma samples were analyzed retrospectively for 242 patients from 5 referral centers (2010-2017): PAH (n = 139; female 82%, 58 [48-67] years), non-PAH pulmonary hypertension (PH) (n = 54; female 56%, 63.4 ± 12.2 years), and dyspnea non-PH controls (n = 36; female 75%, 54.2 ± 14.0 years). RESULTS Compared with controls, NEDD9 was increased in PAH by 1.82-fold (p < 0.0001). Elevated NEDD9 correlated with PVR in idiopathic PAH (ρ = 0.42, p < 0.0001, n = 54), connective tissue disease (CTD)-PAH (ρ = 0.53, p < 0.0001, n = 53), and congenital heart disease-PAH (ρ = 0.68, p < 0.0001, n = 10). In CTD-PAH, NEDD9 correlated with 6-minute walk distance (ρ = -0.35, p = 0.028, n = 39). In contrast to the PAH biomarker N-terminal pro-brain natriuretic peptide (n = 38), NEDD9 correlated inversely with exercise pulmonary artery wedge pressure and more strongly with right ventricular ejection fraction (ρ = -0.41, p = 0.006, n = 45) in a mixed population. The adjusted hazard ratio for lung transplant-free survival was 1.12 (95% confidence interval [CI], 1.02-1.22, p = 0.01) and 1.75 (95% CI, 1.12-2.73, p = 0.01) per 1 ng/ml and 5 ng/ml increase in plasma NEDD9, respectively, by Cox proportional hazard model. CONCLUSIONS In PAH, plasma NEDD9 is increased and associates with key prognostic variables. Prospective studies that include hard end points are warranted to validate NEDD9 as a novel PAH biomarker.
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Affiliation(s)
- Andriy O Samokhin
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Steven Hsu
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Paul B Yu
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Aaron B Waxman
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Bradley M Wertheim
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - C Danielle Hopkins
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Frederick Bowman
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Ivana Nikolic
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Mariana Faria-Urbina
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Paul M Hassoun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jane A Leopold
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ryan J Tedford
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Corey E Ventetuolo
- Division of Pulmonary, Critical Care & Sleep Medicine, Departments of Medicine and Health Services, Policy and Practice, Brown University, Providence, Rhode Island
| | - Peter J Leary
- Division of Pulmonary, Critical Care & Sleep Medicine, University of Washington, Seattle, Washington
| | - Bradley A Maron
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
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38
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Leary PJ, Hess E, Barón AE, Branch KR, Choudhary G, Hough CL, Maron BA, Ralph DD, Ryan JJ, Tedford RJ, Weiss NS, Zamanian RT, Lahm T. H2 Receptor Antagonist Use and Mortality in Pulmonary Hypertension: Insight from the VA-CART Program. Am J Respir Crit Care Med 2019; 197:1638-1641. [PMID: 29437490 DOI: 10.1164/rccm.201801-0048le] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Edward Hess
- 2 Veterans Affairs Eastern Colorado Health Care System Denver, Colorado
| | - Anna E Barón
- 2 Veterans Affairs Eastern Colorado Health Care System Denver, Colorado.,3 Colorado School of Public Health Denver, Colorado
| | | | - Gaurav Choudhary
- 4 Providence Veterans Affairs Medical Center Providence, Rhode Island.,5 Alpert Medical School of Brown University Providence, Rhode Island
| | | | - Bradley A Maron
- 6 Veterans Affairs Boston Healthcare System Boston, Massachusetts.,7 Brigham and Women's Hospital Boston, Massachusetts.,8 Harvard Medical School Boston, Massachusetts
| | | | | | - Ryan J Tedford
- 10 Medical University of South Carolina Charleston, South Carolina
| | | | | | - Tim Lahm
- 12 Richard L. Roudebush Veterans Affairs Medical Center Indianapolis, Indiana and.,13 Indiana University School of Medicine Indianapolis, Indiana
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39
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Crawford TC, Leary PJ, Fraser CD, Suarez-Pierre A, Magruder JT, Baumgartner WA, Zehr KJ, Whitman GJ, Masri SC, Sheikh F, De Marco T, Maron BA, Sharma K, Gilotra NA, Russell SD, Houston BA, Ramu B, Tedford RJ. Impact of the New Pulmonary Hypertension Definition on Heart Transplant Outcomes: Expanding the Hemodynamic Risk Profile. Chest 2019; 157:151-161. [PMID: 31446063 DOI: 10.1016/j.chest.2019.07.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 07/11/2019] [Accepted: 07/20/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND At the recent 6th World Symposium on Pulmonary Hypertension (PH), the definition of PH was redefined to include lower pulmonary artery pressures in the setting of elevated pulmonary vascular resistance (PVR). However, the relevance of this change to subjects with PH due to left-heart disease as well as the preoperative assessment of heart transplant (HT) recipients is unknown. METHODS The United Network for Organ Sharing database was queried to identify adult recipients who underwent primary HT from 1996 to 2015. Recipients were subdivided into those with mean pulmonary artery pressure (mPAP) < 25 mm Hg and ≥ 25 mm Hg. Exploratory univariable analysis was undertaken to identify candidate risk factors associated with 30-day and 1-year survival (conditional on 30-day survival) in recipients with mPAP < 25 mm Hg, and subsequently, parsimonious multivariable Cox proportional hazards models were constructed to assess the independent association with PVR. RESULTS Over the study period, 32,465 patients underwent HT, including 12,257 (38%) with mPAP < 25 mm Hg. The median age was 55 years (interquartile range, 47-62) and the median PVR was 1.5 Wood units (WU) (interquartile range, 1-2.2) in recipients with mPAP < 25 mm Hg. After controlling for confounders, PVR was independently associated with increased risk for 30-day mortality (hazard ratio, 1.16; 95% CI, 1.05-1.27; P < .01), but not conditional 1-year mortality (hazard ratio, 1.03; 95% CI, 0.94-1.12; P = .55). PVR ≥ 3 WU was associated with an absolute 1.9% increase in 30-day mortality in those with mPAP < 25 mm Hg, a similar risk to recipients with PVR ≥ 3 WU and mPAP ≥ 25 mm Hg. CONCLUSIONS Elevated PVR remains associated with a significant increase in the hazard for 30-day mortality after cardiac transplantation, even in the setting of lower pulmonary artery pressures. These data support the validity of the new definition of pulmonary hypertension.
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Affiliation(s)
- Todd C Crawford
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Peter J Leary
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington Medicine, Seattle, WA
| | - Charles D Fraser
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - J Trent Magruder
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - William A Baumgartner
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kenton J Zehr
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Glenn J Whitman
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - S Carolina Masri
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington Medicine, Seattle, WA
| | - Farooq Sheikh
- Advanced Heart Failure program, Mechanical Circulatory Support, and Cardiac Transplantation, MedStar Washington Hospital Center, Washington, DC
| | - Teresa De Marco
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Bradley A Maron
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Cardiology, Boston VA Health Care System, Boston, MA
| | - Kavita Sharma
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nisha A Gilotra
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Stuart D Russell
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Brian A Houston
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Bhavadharini Ramu
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Ryan J Tedford
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC.
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Muslem R, Ong CS, Tomashitis B, Schultz J, Ramu B, Craig ML, Van Bakel AB, Gilotra NA, Sharma K, Hsu S, Whitman GJ, Leary PJ, Cogswell R, Lozonschi L, Houston BA, Zijlstra F, Caliskan K, Bogers AJ, Tedford RJ. Pulmonary Arterial Elastance and INTERMACS-Defined Right Heart Failure Following Left Ventricular Assist Device. Circ Heart Fail 2019; 12:e005923. [DOI: 10.1161/circheartfailure.119.005923] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background:
Acute right heart failure (RHF) after left ventricular assist device implantation remains a major source of morbidity and mortality, yet the definition of RHF and the preimplant variables that predict RHF remain controversial. This study evaluated the ability of (1) INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) RHF classification to predict post-left ventricular assist device survival and (2) preoperative characteristics and hemodynamic parameters to predict severe and severe acute RHF.
Methods and Results:
An international, multicenter study at 4 large academic centers was conducted between 2008 and 2016. All subjects with hemodynamics measured by right heart catheterization within 30 days before left ventricular assist device implantation were included. RHF was defined using the INTERMACS definition for RHF. In total, 375 subjects were included (mean age, 57.4±13.2 years, 54% bridge-to-transplant). Mild RHF was most common (34%), followed by moderate RHF (16%), severe RHF (13%), and severe acute RHF (9%). Estimated on-device survival rates at 2 years were 72%, 71%, and 55% in the patients with none, mild-to-moderate, and severe-to-severe acute RHF, respectively (
P
=0.004). In addition, the independent hazard ratio for mortality was only increased in the patients with severe-to-severe acute RHF (hazard ratio, 3.95; 95% CI, 2.16–7.23;
P
<0.001). INTERMACS-defined RHF was superior to postimplant inotrope duration alone in the prediction of all-cause mortality. In multivariable analysis, older age, lower INTERMACS classes, and higher pulmonary arterial elastance (ratio of systolic pulmonary artery pressure to stroke volume) before left ventricular assist device, were identified as significant predictors of severe-to-severe acute RHF. Stratifying patients by ratio of systolic pulmonary artery pressure to stroke volume and right atrial pressure significantly improved the discrimination between patients at risk for severe-to-severe acute RHF.
Conclusions:
The INTERMACS RHF classification correctly identifies patients at risk for mortality, though this risk is only increased in patients with severe-to-severe acute RHF. Several predictors for RHF were identified, of which ratio of systolic pulmonary artery pressure to stroke volume was the strongest hemodynamic predictor. Coupling ratio of systolic pulmonary artery pressure to stroke volume with right atrial pressure may be most helpful in identifying patients at risk for severe-to-severe acute RHF.
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Affiliation(s)
- Rahatullah Muslem
- Department of Cardiology (R.M., F.Z., K.C.), Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Chin S. Ong
- Department of Cardiac Surgery, Johns Hopkins School of Medicine, Baltimore, MD (C.S.O., G.L.W.)
| | - Brett Tomashitis
- Division of Cardiology, Department of Medicine (B.T., B.R., M.L.C., A.B.V.B., B.A.H., R.J.T.), Medical University of South Carolina, Charleston
| | - Jessica Schultz
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis (J.S., R.C.)
| | - Bhavadharini Ramu
- Division of Cardiology, Department of Medicine (B.T., B.R., M.L.C., A.B.V.B., B.A.H., R.J.T.), Medical University of South Carolina, Charleston
| | - Michael L. Craig
- Division of Cardiology, Department of Medicine (B.T., B.R., M.L.C., A.B.V.B., B.A.H., R.J.T.), Medical University of South Carolina, Charleston
| | - Adrian B. Van Bakel
- Division of Cardiology, Department of Medicine (B.T., B.R., M.L.C., A.B.V.B., B.A.H., R.J.T.), Medical University of South Carolina, Charleston
| | - Nisha A. Gilotra
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (N.A.G., K.S., S.H.)
| | - Kavita Sharma
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (N.A.G., K.S., S.H.)
| | - Steven Hsu
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (N.A.G., K.S., S.H.)
| | - Glenn J. Whitman
- Department of Cardiac Surgery, Johns Hopkins School of Medicine, Baltimore, MD (C.S.O., G.L.W.)
| | - Peter J. Leary
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle (P.J.L.)
| | - Rebecca Cogswell
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis (J.S., R.C.)
| | - Lucian Lozonschi
- Department of Cardiothoracic Surgery (L.L.), Medical University of South Carolina, Charleston
| | - Brian A. Houston
- Division of Cardiology, Department of Medicine (B.T., B.R., M.L.C., A.B.V.B., B.A.H., R.J.T.), Medical University of South Carolina, Charleston
| | - Felix Zijlstra
- Department of Cardiology (R.M., F.Z., K.C.), Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Kadir Caliskan
- Department of Cardiology (R.M., F.Z., K.C.), Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Ad J.J.C. Bogers
- Department of Cardiothoracic Surgery (A.J.J.C.B.), Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Ryan J. Tedford
- Division of Cardiology, Department of Medicine (B.T., B.R., M.L.C., A.B.V.B., B.A.H., R.J.T.), Medical University of South Carolina, Charleston
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Li S, Beckman JA, Welch NG, Bjelkengren J, Masri SC, Minami E, Stempien-Otero A, Levy WC, O'Brien KD, Lin S, Farris SD, Cheng RK, Wood G, Koomalsingh K, Kirkpatrick J, McCabe J, Leary PJ, Chassagne F, Chivukula VK, Aliseda A, Mahr C. Accuracy of Doppler blood pressure measurement in continuous-flow left ventricular assist device patients. ESC Heart Fail 2019; 6:793-798. [PMID: 31099483 PMCID: PMC6676287 DOI: 10.1002/ehf2.12456] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/10/2019] [Accepted: 04/28/2019] [Indexed: 12/21/2022] Open
Abstract
Aims Accurate blood pressure (BP) measurement in continuous‐flow ventricular assist device (CF‐VAD) patients is imperative to reduce stroke risk. This study assesses the accuracy of the Doppler opening pressure method compared with the gold standard arterial line method in CF‐VAD patients. Methods and results In a longitudinal cohort of HeartMate II and HVAD patients, arterial line BP and simultaneously measured Doppler opening pressure were obtained. Overall correlation, agreement between Doppler opening pressure and arterial line mean vs. systolic pressure, and the effect of arterial pulsatility on the accuracy of Doppler opening pressure were analysed. A total of 1933 pairs of Doppler opening pressure and arterial line pressure readings within 1 min of each other were identified in 154 patients (20% women, mean age 55 ± 15, 50% HeartMate II and 50% HVAD). Doppler opening pressure had good correlation with invasive mean arterial pressure (r = 0.742, P < 0.0001) and more closely approximated mean than systolic BP (mean error 2.4 vs. −8.4 mmHg). Arterial pulsatility did not have a clinically significant effect on the accuracy of the Doppler opening pressure method. Conclusions Doppler opening pressure should be the standard non‐invasive method of BP measurement in CF‐VAD patients.
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Affiliation(s)
- Song Li
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Jennifer A Beckman
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Nathan G Welch
- Department of Statistics, University of Washington, Seattle, WA, USA
| | - Jason Bjelkengren
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Sofia Carolina Masri
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Elina Minami
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - April Stempien-Otero
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Wayne C Levy
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Kevin D O'Brien
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Shin Lin
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Stephen D Farris
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Richard K Cheng
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Gregory Wood
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Kevin Koomalsingh
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, WA, USA
| | - James Kirkpatrick
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - James McCabe
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Peter J Leary
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Fanette Chassagne
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | | | - Alberto Aliseda
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Claudius Mahr
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
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42
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Leary PJ, Kolb TM, Maron BA, Tedford RJ, Zamanian RT. Reply: Can treprostinil-induced early gastrointestinal side effects serve as predictors of pulmonary arterial hypertension prognosis? Int J Cardiol 2018; 264:188. [PMID: 29776569 DOI: 10.1016/j.ijcard.2018.03.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 03/28/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Peter J Leary
- University of Washington, Division of Pulmonary, Critical Care, and Sleep Medicine, United States.
| | - Todd M Kolb
- Johns Hopkins Hospital, Division of Pulmonary and Critical Care Medicine, United States
| | - Bradley A Maron
- Veterans Affairs Boston Healthcare System, Department of Cardiology, United States; Brigham and Women's Hospital, Division of Cardiology, United States
| | - Ryan J Tedford
- Medical University of South Carolina, Division of Cardiology, United States
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43
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Affiliation(s)
- Peter J Leary
- From the Department of Medicine, University of Washington, Seattle.
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44
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Tampakakis E, Shah SJ, Borlaug BA, Leary PJ, Patel HH, Miller WL, Kelemen BW, Houston BA, Kolb TM, Damico R, Mathai SC, Kasper EK, Hassoun PM, Kass DA, Tedford RJ. Pulmonary Effective Arterial Elastance as a Measure of Right Ventricular Afterload and Its Prognostic Value in Pulmonary Hypertension Due to Left Heart Disease. Circ Heart Fail 2018; 11:e004436. [PMID: 29643065 PMCID: PMC5901761 DOI: 10.1161/circheartfailure.117.004436] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 03/09/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Patients with combined post- and precapillary pulmonary hypertension due to left heart disease have a worse prognosis compared with isolated postcapillary. However, it remains unclear whether increased mortality in combined post- and precapillary pulmonary hypertension is simply a result of higher total right ventricular load. Pulmonary effective arterial elastance (Ea) is a measure of total right ventricular afterload, reflecting both resistive and pulsatile components. We aimed to test whether pulmonary Ea discriminates survivors from nonsurvivors in patients with pulmonary hypertension due to left heart disease and if it does so better than other hemodynamic parameters associated with combined post- and precapillary pulmonary hypertension. METHODS AND RESULTS We combined 3 large heart failure patient cohorts (n=1036) from academic hospitals, including patients with pulmonary hypertension due to heart failure with preserved ejection fraction (n=232), reduced ejection fraction (n=335), and a mixed population (n=469). In unadjusted and 2 adjusted models, pulmonary Ea more robustly predicted mortality than pulmonary vascular resistance and the transpulmonary gradient. Along with pulmonary arterial compliance, pulmonary Ea remained predictive of survival in patients with normal pulmonary vascular resistance. The diastolic pulmonary gradient did not predict mortality. In addition, in a subset of patients with echocardiographic data, Ea and pulmonary arterial compliance were better discriminators of right ventricular dysfunction than the other parameters. CONCLUSIONS Pulmonary Ea and pulmonary arterial compliance more consistently predicted mortality than pulmonary vascular resistance or transpulmonary gradient across a spectrum of left heart disease with pulmonary hypertension, including patients with heart failure with preserved ejection fraction, heart failure with reduced ejection fraction, and pulmonary hypertension with a normal pulmonary vascular resistance.
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Affiliation(s)
- Emmanouil Tampakakis
- Division of Cardiology (E.T., B.W.K., E.K.K., D.A.K., R.J.T.) and Division of Pulmonary and Critical Care Medicine (T.M.K., R.D., S.C.M., P.M.H.), Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S., H.H.P.). Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B., W.L.M.). Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle (P.J.L.). Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston (B.A.H., R.J.T.)
| | - Sanjiv J Shah
- Division of Cardiology (E.T., B.W.K., E.K.K., D.A.K., R.J.T.) and Division of Pulmonary and Critical Care Medicine (T.M.K., R.D., S.C.M., P.M.H.), Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S., H.H.P.). Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B., W.L.M.). Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle (P.J.L.). Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston (B.A.H., R.J.T.)
| | - Barry A Borlaug
- Division of Cardiology (E.T., B.W.K., E.K.K., D.A.K., R.J.T.) and Division of Pulmonary and Critical Care Medicine (T.M.K., R.D., S.C.M., P.M.H.), Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S., H.H.P.). Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B., W.L.M.). Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle (P.J.L.). Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston (B.A.H., R.J.T.)
| | - Peter J Leary
- Division of Cardiology (E.T., B.W.K., E.K.K., D.A.K., R.J.T.) and Division of Pulmonary and Critical Care Medicine (T.M.K., R.D., S.C.M., P.M.H.), Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S., H.H.P.). Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B., W.L.M.). Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle (P.J.L.). Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston (B.A.H., R.J.T.)
| | - Harnish H Patel
- Division of Cardiology (E.T., B.W.K., E.K.K., D.A.K., R.J.T.) and Division of Pulmonary and Critical Care Medicine (T.M.K., R.D., S.C.M., P.M.H.), Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S., H.H.P.). Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B., W.L.M.). Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle (P.J.L.). Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston (B.A.H., R.J.T.)
| | - Wayne L Miller
- Division of Cardiology (E.T., B.W.K., E.K.K., D.A.K., R.J.T.) and Division of Pulmonary and Critical Care Medicine (T.M.K., R.D., S.C.M., P.M.H.), Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S., H.H.P.). Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B., W.L.M.). Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle (P.J.L.). Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston (B.A.H., R.J.T.)
| | - Benjamin W Kelemen
- Division of Cardiology (E.T., B.W.K., E.K.K., D.A.K., R.J.T.) and Division of Pulmonary and Critical Care Medicine (T.M.K., R.D., S.C.M., P.M.H.), Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S., H.H.P.). Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B., W.L.M.). Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle (P.J.L.). Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston (B.A.H., R.J.T.)
| | - Brian A Houston
- Division of Cardiology (E.T., B.W.K., E.K.K., D.A.K., R.J.T.) and Division of Pulmonary and Critical Care Medicine (T.M.K., R.D., S.C.M., P.M.H.), Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S., H.H.P.). Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B., W.L.M.). Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle (P.J.L.). Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston (B.A.H., R.J.T.)
| | - Todd M Kolb
- Division of Cardiology (E.T., B.W.K., E.K.K., D.A.K., R.J.T.) and Division of Pulmonary and Critical Care Medicine (T.M.K., R.D., S.C.M., P.M.H.), Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S., H.H.P.). Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B., W.L.M.). Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle (P.J.L.). Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston (B.A.H., R.J.T.)
| | - Rachel Damico
- Division of Cardiology (E.T., B.W.K., E.K.K., D.A.K., R.J.T.) and Division of Pulmonary and Critical Care Medicine (T.M.K., R.D., S.C.M., P.M.H.), Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S., H.H.P.). Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B., W.L.M.). Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle (P.J.L.). Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston (B.A.H., R.J.T.)
| | - Stephen C Mathai
- Division of Cardiology (E.T., B.W.K., E.K.K., D.A.K., R.J.T.) and Division of Pulmonary and Critical Care Medicine (T.M.K., R.D., S.C.M., P.M.H.), Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S., H.H.P.). Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B., W.L.M.). Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle (P.J.L.). Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston (B.A.H., R.J.T.)
| | - Edward K Kasper
- Division of Cardiology (E.T., B.W.K., E.K.K., D.A.K., R.J.T.) and Division of Pulmonary and Critical Care Medicine (T.M.K., R.D., S.C.M., P.M.H.), Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S., H.H.P.). Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B., W.L.M.). Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle (P.J.L.). Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston (B.A.H., R.J.T.)
| | - Paul M Hassoun
- Division of Cardiology (E.T., B.W.K., E.K.K., D.A.K., R.J.T.) and Division of Pulmonary and Critical Care Medicine (T.M.K., R.D., S.C.M., P.M.H.), Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S., H.H.P.). Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B., W.L.M.). Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle (P.J.L.). Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston (B.A.H., R.J.T.)
| | - David A Kass
- Division of Cardiology (E.T., B.W.K., E.K.K., D.A.K., R.J.T.) and Division of Pulmonary and Critical Care Medicine (T.M.K., R.D., S.C.M., P.M.H.), Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S., H.H.P.). Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B., W.L.M.). Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle (P.J.L.). Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston (B.A.H., R.J.T.)
| | - Ryan J Tedford
- Division of Cardiology (E.T., B.W.K., E.K.K., D.A.K., R.J.T.) and Division of Pulmonary and Critical Care Medicine (T.M.K., R.D., S.C.M., P.M.H.), Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S., H.H.P.). Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B., W.L.M.). Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle (P.J.L.). Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston (B.A.H., R.J.T.).
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Leary PJ, Kronmal RA, Bluemke DA, Buttrick PM, Jones KL, Kao DP, Kawut SM, Krieger EV, Lima JA, Minobe W, Ralph DD, Tedford RJ, Weiss NS, Bristow MR. Histamine H 2 Receptor Polymorphisms, Myocardial Transcripts, and Heart Failure (from the Multi-Ethnic Study of Atherosclerosis and Beta-Blocker Effect on Remodeling and Gene Expression Trial). Am J Cardiol 2018; 121:256-261. [PMID: 29191567 PMCID: PMC5742297 DOI: 10.1016/j.amjcard.2017.10.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/04/2017] [Accepted: 10/06/2017] [Indexed: 01/11/2023]
Abstract
Myocardial H2 receptor activation contributes to heart failure (HF) in preclinical models, and H2 receptor antagonists are associated with decreased HF incidence. This study evaluated whether H2 histamine receptor (HRH2) single nucleotide polymorphisms (SNPs) are associated with HF incidence and whether myocardial transcript abundance is associated with HF recovery. The association of SNPs in HRH2 with incident HF was characterized using Cox proportional hazards regression among participants in the Multi-Ethnic Study of Atherosclerosis. Differences in myocardial HRH2 transcripts were characterized in participants with dilated cardiomyopathy comparing 6 "super-responders" with 6 nonresponders to β blockade in the Beta-Blocker Effect on Remodeling and Gene Expression Trial. In MESA, no candidate SNP was associated with HF in black, Hispanic, or white participants. The rs2241562 minor allele was present only in Chinese participants and the adjusted HF hazard among those with 1 or more copies of this allele was 3.7, 95% confidence interval 1.0 to 13.4. In BORG, super-responders to β blockade had higher levels of myocardial HRH2 transcript at baseline compared with nonresponders (fragments per kilobase per transcript per million mapped reads: Variant 2, 5.5 ± 1.1 compared with 3.2 ± 0.8 in nonresponders, p = 0.002; Variant 1 + 2, 32.1 ± 7.4 compared with 23.3 ± 4.2 in nonresponders, p = 0.04). In conclusion, the presence of a minor allele at rs2241562 was associated with increased HF incidence in Chinese participants. Differences in myocardial HRH2 transcript abundance were seen in participants with dilated cardiomyopathy who responded to β blockade. These observations support the hypothesis that HRH2 is involved in the pathogenesis of HF.
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Affiliation(s)
| | | | | | | | | | - David P. Kao
- University of Washington, Department of Biostatistics
| | - Steven M. Kawut
- Perelman School of Medicine at the University of Pennsylvania, Departments of Medicine and Epidemiology
| | | | - Joao A. Lima
- Johns Hopkins Hospital, Department of Medicine,Johns Hopkins Hospital, Department of Radiology
| | - Wayne Minobe
- University of Washington, Department of Biostatistics
| | | | | | - Noel S. Weiss
- University of Washington, Department of Epidemiology
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Mullin CJ, Hsu S, Amancherla K, Wand A, Rhodes P, Leary PJ, Mukherjee M, Damico RL, Kolb TM, Mathai SC, Hassoun PM, Tedford RJ. Evaluation of criteria for exercise-induced pulmonary hypertension in patients with resting pulmonary hypertension. Eur Respir J 2017; 50:50/3/1700784. [PMID: 28931665 DOI: 10.1183/13993003.00784-2017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 06/17/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Christopher J Mullin
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Steven Hsu
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kaushik Amancherla
- Dept of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alison Wand
- Dept of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Parker Rhodes
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter J Leary
- Division of Pulmonary and Critical Care, University of Washington Medicine Center, Seattle, WA, USA
| | - Monica Mukherjee
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rachel L Damico
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Todd M Kolb
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephen C Mathai
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paul M Hassoun
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ryan J Tedford
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA .,Division of Cardiology, Dept of Medicine, Medical University of South Carolina, Charleston, SC, USA
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Leary PJ, Tedford RJ, Bluemke DA, Bristow MR, Heckbert SR, Kawut SM, Krieger EV, Lima JA, Masri CS, Ralph DD, Shea S, Weiss NS, Kronmal RA. Histamine H2 Receptor Antagonists, Left Ventricular Morphology, and Heart Failure Risk: The MESA Study. J Am Coll Cardiol 2017; 67:1544-1552. [PMID: 27150686 DOI: 10.1016/j.jacc.2016.01.045] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/15/2016] [Accepted: 01/21/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Myocardial H2 receptor activation may promote cardiac fibrosis and apoptosis in pre-clinical models and histamine H2 receptor antagonist (H2RA) use may improve symptoms in participants with heart failure (HF); however, relationships between H2RA use, incident HF, and longitudinal change in left ventricular (LV) morphology are not known. OBJECTIVES This study sought to determine whether H2RA use is associated with incident HF and change in LV morphology over time. METHODS We included 6,378 men and women from MESA (Multi-Ethnic Study of Atherosclerosis), a multicenter prospective observational cohort of participants without cardiovascular disease at baseline. Cox proportional hazards were used to estimate the association between H2RA use and incident HF in adjusted models. In participants with cardiac magnetic resonance imaging, associations between H2RA use, baseline LV morphology (n = 4,691), and longitudinal change in the LV (n = 2,806) were estimated using linear regression. RESULTS H2RAs were used by 313 participants but not by the other 6,065 individuals. During a median follow-up of 11.2 years, 236 participants developed HF. In adjusted models, baseline H2RA use relative to nonuse was associated with 62% lower risk for incident HF (p = 0.02). H2RA use was associated with preserved stroke volume, LV end-diastolic volume, and mass/volume ratio as measured by cardiac magnetic resonance imaging over approximately 10 years (all p < 0.05). There were no associations between H2RA use and LV mass or ejection fraction. CONCLUSIONS H2RA use was associated with reduced risk for incident HF. Left heart morphology over time suggests less age-related change in H2RA users. These associations suggest histamine signaling may be important in the pathogenesis of HF. (Multi-Ethnic Study of Atherosclerosis [MESA]; NCT00005487).
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Affiliation(s)
- Peter J Leary
- Department of Medicine, University of Washington, Seattle, Washington.
| | - Ryan J Tedford
- Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - David A Bluemke
- National Institutes of Health Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland
| | | | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Steven M Kawut
- Departments of Medicine and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eric V Krieger
- Department of Medicine, University of Washington, Seattle, Washington
| | - Joao A Lima
- Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland; Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Carolina S Masri
- Department of Medicine, University of Washington, Seattle, Washington
| | - David D Ralph
- Department of Medicine, University of Washington, Seattle, Washington
| | - Steven Shea
- Departments of Medicine and Epidemiology, Columbia University, New York City, New York
| | - Noel S Weiss
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Richard A Kronmal
- Department of Biostatistics, University of Washington, Seattle, Washington
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Leary PJ, Kang S, Kolb TM, Maron BA, Ralph DD, Rao Y, Tedford RJ, Zamanian RT. What's in a side effect? The association between pulmonary vasodilator adverse drug events and clinical outcomes in patients with pulmonary arterial hypertension. Int J Cardiol 2017; 240:386-391. [PMID: 28412029 DOI: 10.1016/j.ijcard.2017.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/28/2017] [Accepted: 04/04/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Adverse drug events (ADEs) with pulmonary vasodilator use in pulmonary arterial hypertension (PAH) are common. ADEs may contribute to worse quality of life; however, their relationship to prognosis is unknown. The objective of this study was to determine whether common ADEs after initiating subcutaneous treprostinil were associated with prognosis in PAH. METHODS We assembled a retrospective cohort of participants from four clinical trials of treprostinil for PAH, including 908 participants who received subcutaneous treprostinil and 243 who received placebo at the time ADEs were ascertained. The occurrences of four common early ADEs (infusion reactions, headaches, jaw pain, or gastrointestinal side effects) were assessed during the eight weeks after starting the infusion. We used Cox proportional hazards to estimate associations between ADEs and mortality. RESULTS No ADEs related to placebo were associated with mortality. In participants who received treprostinil, infusion reactions, headaches, and jaw pain were not associated with mortality. Gastrointestinal side effects occurring during the first eight weeks following treprostinil infusion were associated with a 57% increase in the hazard of mortality (95% CI: 14-118%). This relationship was unchanged after adjusting for demographic differences and differences in baseline PAH severity. CONCLUSIONS Gastrointestinal ADEs after starting subcutaneous treprostinil were associated with an increased risk for mortality. Increased mortality was not observed with other early ADEs or with gastrointestinal symptoms in participants who were not receiving treprostinil at the time. This hypothesis-generating association suggests ADEs may identify different phenotypes in PAH.
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Affiliation(s)
- Peter J Leary
- University of Washington, Division of Pulmonary and Critical Care (PCCM), United States.
| | - Suhyun Kang
- North Carolina State University, Department of Statistics & United Therapeutics, United States.
| | - Todd M Kolb
- Johns Hopkins Hospital, Division of PCCM, United States.
| | - Bradley A Maron
- Brigham and Women's Hospital, Division of Cardiology, United States.
| | - David D Ralph
- University of Washington, Division of PCCM, United States.
| | | | - Ryan J Tedford
- Johns Hopkins Hospital, Division of Cardiology, United States.
| | - Roham T Zamanian
- Stanford University Medical Center, Division of PCCM, United States.
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