1
|
Nossent EJ, Smits J, Seegers C, Meijboom LJ, Boonstra A, Aman J, De Man FS, Bogaard HJ, Radonic T, Dorfmüller P, Vonk Noordegraaf A. Clinical correlates of a non- plexiform vasculopathy in patients diagnosed with idiopathic pulmonary arterial hypertension. Chest 2024:S0012-3692(24)00280-0. [PMID: 38432552 DOI: 10.1016/j.chest.2024.02.046] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 02/09/2024] [Accepted: 02/22/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND The clinical phenotype of idiopathic pulmonary arterial hypertension (IPAH) patients has changed. . Whether or not subgroups of IPAH patients have different vascular phenotypes is a subject of debate. RESEARCH QUESTION What are the histological patterns and their clinical correlates in patients diagnosed with IPAH or hereditary PAH? STUDY DESIGN AND METHODS In this this cross-sectional registry study lung histology of 50 IPAH patients was qualitatively assessed by two experienced pathologists. In addition, quantitative analysis by means of histopathological morphometry using immunohistochemistry was performed. Histopathological characteristics were correlated with clinical and hemodynamic parameters. RESULTS In this cohort of 50 IPAH patients, a plexiform vasculopathy was observed in 26/50 (52%) of patients, while 24/50 (48%) patients had a non-plexiform vasculopathy. The non-plexiform vasculopathy was characterized by prominent pulmonary microvascular (arterioles and venules) remodeling and vascular rarefaction. While hemodynamic parameters were comparable in plexiform versus non-plexiform vasculopathy, patients with non-plexiform vasculopathy were older, more often male, had a stronger history of cigarette smoking and lower diffusing capacity for carbon monoxide (DLCO) at diagnosis No mutations in established PAH genes were found in the non-plexiform group. INTERPRETATION This study reveals different vascular phenotypes within the current spectrum of patients diagnosed with IPAH, separated by clinical characteristics (age, sex, , history of cigarette smoking, and DLCO at diagnosis). Potential differences in underlying pathobiological mechanisms between patients with plexiform and non-plexiform / microvascular disease should be taken into account in future research strategies unravelling the pathophysiology of pulmonary hypertension and developing biology-targeted treatment approaches.
Collapse
Affiliation(s)
- Esther J Nossent
- Department of Pulmonary Medicine, Amsterdam UMC, Free University Amsterdam, Cardiovascular Sciences Research Institute, Amsterdam, the Netherlands
| | - Josien Smits
- Department of Pulmonary Medicine, Amsterdam UMC, Free University Amsterdam, Cardiovascular Sciences Research Institute, Amsterdam, the Netherlands
| | - Celine Seegers
- Department of Pulmonary Medicine, Amsterdam UMC, Free University Amsterdam, Cardiovascular Sciences Research Institute, Amsterdam, the Netherlands
| | - Lilian J Meijboom
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Free University Amsterdam, Cardiovascular Sciences Research Institute, The Netherlands
| | - Anco Boonstra
- Department of Pulmonary Medicine, Amsterdam UMC, Free University Amsterdam, Cardiovascular Sciences Research Institute, Amsterdam, the Netherlands
| | - J Aman
- Department of Pulmonary Medicine, Amsterdam UMC, Free University Amsterdam, Cardiovascular Sciences Research Institute, Amsterdam, the Netherlands
| | - F S De Man
- Department of Pulmonary Medicine, Amsterdam UMC, Free University Amsterdam, Cardiovascular Sciences Research Institute, Amsterdam, the Netherlands
| | - Harm Jan Bogaard
- Department of Pulmonary Medicine, Amsterdam UMC, Free University Amsterdam, Cardiovascular Sciences Research Institute, Amsterdam, the Netherlands
| | - Teodora Radonic
- Department of Pathology, Amsterdam UMC, Free University Amsterdam, Amsterdam, The Netherlands
| | - Peter Dorfmüller
- Department of Pathology, University Hospital Giessen and Marburg (UKGM), and German Centre for Lung Research (DZL), Giessen, Germany
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Medicine, Amsterdam UMC, Free University Amsterdam, Cardiovascular Sciences Research Institute, Amsterdam, the Netherlands.
| |
Collapse
|