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Patlolla SH, Saran N, Schaff HV, Crestanello J, Pochettino A, Stulak JM, Greason KL, King KS, Lee AT, Daly RC, Dearani JA. Prosthesis choice for tricuspid valve replacement: Comparison of clinical and echocardiographic outcomes. J Thorac Cardiovasc Surg 2024; 167:668-679.e2. [PMID: 36028365 DOI: 10.1016/j.jtcvs.2022.07.003] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 06/10/2022] [Accepted: 07/01/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVES There is limited evidence evaluating valve function and right heart remodeling after tricuspid valve replacement (TVR), as well as whether the choice of prosthesis has an impact on these outcomes. METHODS We reviewed 1043 consecutive adult patients who underwent first-time TVR; 33% had previous aortic and/or mitral valve operations. Severe tricuspid valve regurgitation (TR) was the indication for surgery in 94% patients. A mechanical valve was used in 149 (14%) patients and a bioprosthetic valve in 894 (86%). Concomitant major cardiac procedures were performed in 57% of patients. RESULTS The median age of the cohort was 68.8 (range, 25-94) years, and 57% were female. Overall survival at 5 and 10 years was 50% and 31%, respectively. Adjusted survival and cumulative incidence of reoperation after TVR were similar in patients with bioprosthetic and mechanical valves. Overall, right ventricular (RV) function and dilation improved postoperatively with the estimated proportion of patients with moderate or greater RV systolic dysfunction/dilatation decreasing by around 20% at 3 years follow-up. After adjusting for preoperative degree of dysfunction/dilatation, valve type had no effect on late improvement in RV function and dilation. Bioprosthetic TVR was associated with greater rates of recurrence of moderate or greater TR over late follow-up. Overall, a slight decline in tricuspid valve gradients was observed over time. CONCLUSIONS Mechanical and bioprosthetic valves provide comparable survival, incidence of reoperation, and recovery of RV systolic function and size after TVR. Bioprosthetic valves develop significant TR over time, and mechanical valves may have an advantage for younger patients and those needing anticoagulation.
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Affiliation(s)
| | - Nishant Saran
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
| | | | - Juan Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | | | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Katherine S King
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minn
| | - Alexander T Lee
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minn
| | - Richard C Daly
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
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Lan WF, Deng Y, Dai P, Wu DD, Hu J, Liao J, Meng H. Right ventricular-pulmonary arterial coupling ratio derived from 3-dimensional echocardiography predicts outcomes in systemic lupus erythematosus-associated pulmonary arterial hypertension patients. Lupus 2024; 33:155-165. [PMID: 38182135 DOI: 10.1177/09612033231226352] [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] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a complex autoimmune connective tissue disease (CTD) that is an important cause of devastating pulmonary arterial hypertension (PAH), and persistent progression of PAH can lead to right heart failure, predicting a poor prognosis for SLE patients. Right ventricular-pulmonary arterial (RV-PA) coupling with echocardiography has been demonstrated to be a noninvasive alternative method for evaluating PAH patients' predictive outcomes. Whether the ratio of right ventricular stroke volume (RVSV) to right ventricular end-systolic volume (RVESV) measured by three-dimensional echocardiography (3DE) is a new index of RV-PA coupling has not been discussed as a new predictor for the clinical outcome of systemic lupus erythematosus-associated pulmonary arterial hypertension (SLE-PAH). METHODS From June 2019 to February 2023, 46 consecutive patients with SLE-PAH were enrolled prospectively, and their clinical data and echocardiographs were studied and analyzed. The control group consisted of 30 healthy subjects matched for age, sex, and body surface area (BSA). The main endpoints of this study were a composite of all-cause mortality and adverse clinical events. Baseline clinical characteristics and echocardiographic assessments were analyzed. RESULTS During a median of 24 months (IQR 18-31), 16 of 46 SLE-PAH patients (34.7%) experienced endpoint-related events. At baseline, patients who experienced mortality or adverse events had a worse WHO functional class (WHO FC) and lower anti-double-stranded DNA (dsDNA) antibody levels. The right ventricular (RV) systolic dysfunction in SLE-PAH subjects was significantly worse than that in the healthy control group, especially in SLE-PAH patients in the endpoint event group. Compared to controls, patients with SLE-PAH had a lower RVSV/RVESV ratio. In the group comparison, patients who had experienced an endpoint event had a sequentially worse ratio (1.86 (1.65-2.3) versus 1.30 (1.09-1.46) versus 0.64 (0.59-0.67), p < .001). There were statistically significant associations between the RVSV/RVESV ratio to routine RV systolic function and clinical parameters. The RVSV/RVESV ratio was negatively correlated with the WHO FC (r = -0.621, p < .001) and positively correlated with the anti-dsDNA level. The ROC curve showed that the optimal cutoff for RVSV/RVESV < 0.712 determined a higher risk of poor prognosis. Kaplan‒Meier survival curves showed that an RVSV/RVESV ratio >0.712 was associated with more favorable long-term outcomes. CONCLUSIONS The 3DE-derived SV/ESV ratio as a noninvasive alternative surrogate of RV-PA coupling was an eximious indicator for identifying endpoint events in SLE-PAH patients and can provide a diagnostic basis for clinical intervention.
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Affiliation(s)
- Wei-Fang Lan
- Department of Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yan Deng
- Department of Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ping Dai
- Department of Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Dan-Dan Wu
- Department of Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jie Hu
- Department of Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Juan Liao
- Department of Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hui Meng
- Department of Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Dershowitz L, Lawlor MK, Hamid N, Kampaktsis P, Ning Y, Vahl TP, Nazif T, Khalique O, Ng V, Kurlansky P, Leon M, Hahn R, Kodali S, George I. Right ventricular remodeling and clinical outcomes following transcatheter tricuspid valve intervention. Catheter Cardiovasc Interv 2024; 103:367-375. [PMID: 37890014 DOI: 10.1002/ccd.30850] [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: 04/07/2023] [Revised: 08/20/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023]
Abstract
AIMS Characterize the impact of residual tricuspid regurgitation (TR) on right ventricle (RV) remodeling and clinical outcomes after transcatheter tricuspid valve intervention. METHODS We performed a single-center retrospective analysis of transcatheter tricuspid valve repair (TTVr) or replacement (TTVR) patients. The primary outcomes were longitudinal tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), pulmonary artery systolic pressure (PASP), and RV dimensions (RVd). We used multivariable linear mixed models to evaluate association with replacement versus repair and degree of TR reduction with changes in these echo measures over time. Multivariable Cox regression was used to identify associations between changes in these echo measures and a composite clinical outcome of death, heart failure hospitalization, or re-do tricuspid valve intervention. RESULTS We included a total of 61 patients; mean age was 77.5 ± 11.7 and 62% were female. TTVR was performed in 25 (41%) and TTVr in 36 (59%). Initially, 72% (n = 44) had ≤ severe TR and 28% (n = 17) had massive or torrential TR. The median number of follow up echos was 2: time to 1st follow-up was 50 days (interquartile range [IQR]: 20, 91) and last follow-up was 147 (IQR: 90, 327). Median TR reduction was 1 (IQR: 0, 2) versus 4 (IQR: 3, 6) grades in TTVr versus TTVR (p < 0.0001). In linear mixed modeling, TTVR was associated with decline in TAPSE and PASP, and TR reduction was associated with decreased RVd. In multivariable Cox regression, greater RVd was associated with the clinical outcome (hazard ratio: 9.27, 95% confidence interval: 1.23-69.88, p = 0.03). CONCLUSION Greater TR reduction is achieved by TTVR versus TTVr, which is in turn associated with RV reverse remodeling. RV dimension in follow-up is associated with increased risk of a composite outcome of death, heart failure hospitalization, or re-do tricuspid valve intervention.
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Affiliation(s)
- Lyle Dershowitz
- Division of Internal Medicine, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Matthew K Lawlor
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Nadira Hamid
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Polydoros Kampaktsis
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Yuming Ning
- Department of Surgery, Center for Innovation and Outcomes Research, Columbia University Irving Medical Center, New York City, New York, USA
| | - Torsten P Vahl
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Tamim Nazif
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Omar Khalique
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Vivian Ng
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Paul Kurlansky
- Department of Surgery, Center for Innovation and Outcomes Research, Columbia University Irving Medical Center, New York City, New York, USA
| | - Martin Leon
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Rebecca Hahn
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Susheel Kodali
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Isaac George
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
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Dong J, Jiang XM, Xie DJ, Luo J, Ran H, Li L, Li M, Jiang P, Zhang PY, Zhou L. Establishment of a canine model of pulmonary arterial hypertension induced by dehydromonocrotaline and ultrasonographic study of right ventricular remodeling. Clin Exp Hypertens 2023; 45:2190503. [PMID: 36924239 DOI: 10.1080/10641963.2023.2190503] [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] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Pulmonary arterial hypertension (PAH) means high blood pressure in the lungs. We aimed to observe the right ventricular size, wall thickness and characteristic functional changes and their associations with PAH in an established model of beagle dogs, and to explore convenient, reliable and sensitive ultrasound indicators for assessing right ventricular remodeling. METHODS Twenty healthy beagle dogs (8-10 kg) were randomly divided into control group (N-dimethylformamide, n = 10) and dehydromonocrotaline (DHMCT) group (DHMCT, n = 10). N-dimethylformamide or DHMCT was injected through a catheter into the right atrium, and then right heart catheterization, routine echocardiography and two-dimensional speckle tracking imaging (2D-STI) were performed before modeling (0 weeks) and 8, 14 weeks after modeling. Hemodynamic parameters and right ventricular function-related ultrasound data were acquired. At the end of the experiment, the animals were killed and the lung tissues were taken for HE staining. Left and right ventricular walls were separated and weighed respectively, and right ventricular hypertrophy index (RVHI) was measured. The associations of the routine ultrasound data and 2D-STI data at each time point with hemodynamic parameters and RVHI were analyzed. RESULTS At 0, 8 and 14 weeks, gradual decreases in the right ventricular global longitudinal strain (RVLS) were found in DHMCT group. RVH occurred in DHMCT group, and DHMCT group had a significantly higher RVHI than that of control group (49.83 ± 4.83% vs. 39.80 ± 1.40%, P < .001) and larger pulmonary artery media thickness. RVLS had significant positive correlations with RVSP (r = 0.74, P < .001), mRVP (r = 0.72, P < .001), PASP (r = 0.75, P < .001), mPAP (r = 0.72, P < .001) and PVR (r = 0.68, P < .001). There was a significant positive correlation between RVLS and RVHI (r = 0.74, P < .001). CONCLUSION The right ventricular function in PAH can be effectively assessed by echocardiography, and RVLS measured by 2D-STI sensitively reflects right ventricular remodeling following PAH.
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Affiliation(s)
- Jing Dong
- Department of Cardiovascular Ultrasound, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Xiao-Min Jiang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Du-Jiang Xie
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Jie Luo
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Hong Ran
- Department of Cardiovascular Ultrasound, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Lin Li
- Department of Cardiovascular Ultrasound, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Miao Li
- Department of Cardiovascular Ultrasound, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Pei Jiang
- Department of Cardiovascular Ultrasound, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Ping-Yang Zhang
- Department of Cardiovascular Ultrasound, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Ling Zhou
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
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5
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Zhou YQ, Bonafiglia QA, Zhang H, Heximer SP, Bendeck MP. Comprehensive ultrasound imaging of right ventricular remodeling under surgically induced pressure overload in mice. Am J Physiol Heart Circ Physiol 2023; 324:H391-H410. [PMID: 36607797 DOI: 10.1152/ajpheart.00590.2022] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This study reports a new methodology for right heart imaging by ultrasound in mice under right ventricular (RV) pressure overload. Pulmonary artery constriction (PAC) or sham surgeries were performed on C57BL/6 male mice at 8 wk of age. Ultrasound imaging was conducted at 2, 4, and 8 wk postsurgery using both classical and advanced ultrasound imaging modalities including electrocardiogram (ECG)-based kilohertz visualization, anatomical M-mode, and strain imaging. Based on pulsed Doppler, the PAC group demonstrated dramatically enhanced pressure gradient in the main pulmonary artery (MPA) as compared with the sham group. By the application of advanced imaging modalities in novel short-axis views of the ventricles, the PAC group demonstrated increased thickness of RV free wall, enlarged RV chamber, and reduced RV fractional shortening compared with the sham group. The PAC group also showed prolonged RV contraction, asynchronous interplay between RV and left ventricle (LV), and passive leftward motion of the interventricular septum (IVS) at early diastole. Consequently, the PAC group exhibited prolongation of LV isovolumic relaxation time, without change in LV wall thickness or systolic function. Significant correlations were found between the maximal pressure gradient in MPA measured by Doppler and the RV systolic pressure by catheterization, as well as the morphological and functional parameters of RV by ultrasound.NEW & NOTEWORTHY The established protocol overcomes the challenges in right heart imaging in mice, thoroughly elucidating the changes of RV, the dynamics of IVS, and the impact on LV and provides new insights into the pathophysiological mechanism of RV remodeling.
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Affiliation(s)
- Yu-Qing Zhou
- Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada.,Institute of Biomedical Engineering, Faculty of Applied Science and Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Quinn A Bonafiglia
- Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Hangjun Zhang
- Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada.,Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Scott P Heximer
- Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada.,Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michelle P Bendeck
- Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Galloo X, Stassen J, Hirasawa K, Mertens BJA, Cosyns B, van der Bijl P, Delgado V, Ajmone Marsan N, Bax JJ. Prognostic Implications of Right Ventricular Size and Function in Patients Undergoing Cardiac Resynchronization Therapy. Circ Arrhythm Electrophysiol 2023; 16:e011676. [PMID: 36696369 DOI: 10.1161/circep.122.011676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Xavier Galloo
- Department of Cardiology (X.G., J.S., K.H., P.v.d.B., V.D., N.A.M., J.J.B.), Leiden University Medical Center, the Netherlands.,Department of Cardiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel (X.G., B.C.)
| | - Jan Stassen
- Department of Cardiology (X.G., J.S., K.H., P.v.d.B., V.D., N.A.M., J.J.B.), Leiden University Medical Center, the Netherlands.,Department of Cardiology, Jessa Hospital, Hasselt, Belgium (J.S.)
| | - Kensuke Hirasawa
- Department of Cardiology (X.G., J.S., K.H., P.v.d.B., V.D., N.A.M., J.J.B.), Leiden University Medical Center, the Netherlands
| | - Bart J A Mertens
- Biomedical Data Science (B.J.A.M.), Leiden University Medical Center, the Netherlands
| | - Bernard Cosyns
- Department of Cardiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel (X.G., B.C.)
| | - Pieter van der Bijl
- Department of Cardiology (X.G., J.S., K.H., P.v.d.B., V.D., N.A.M., J.J.B.), Leiden University Medical Center, the Netherlands
| | - Victoria Delgado
- Department of Cardiology (X.G., J.S., K.H., P.v.d.B., V.D., N.A.M., J.J.B.), Leiden University Medical Center, the Netherlands.,Heart Institute, Hospital University Germans Trias i Pujol, Badalona, Spain (V.D.)
| | - Nina Ajmone Marsan
- Department of Cardiology (X.G., J.S., K.H., P.v.d.B., V.D., N.A.M., J.J.B.), Leiden University Medical Center, the Netherlands
| | - Jeroen J Bax
- Department of Cardiology (X.G., J.S., K.H., P.v.d.B., V.D., N.A.M., J.J.B.), Leiden University Medical Center, the Netherlands.,Heart Center, University of Turku & Turku University Hospital, Finland (J.J.B.)
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7
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Keranov S, Widmann L, Jafari L, Liebetrau C, Keller T, Troidl C, Kriechbaum S, Voss S, Bauer P, Richter MJ, Tello K, Gall H, Ghofrani HA, Wiedenroth CB, Guth S, Seeger W, Hamm CW, Nef H, Dörr O. GDF-15 and soluble ST2 as biomarkers of right ventricular dysfunction in pulmonary hypertension. Biomark Med 2022; 16:1193-1207. [PMID: 36790217 DOI: 10.2217/bmm-2022-0395] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
Background: This study analyzed the utility of soluble ST2 (sST2) and GDF-15 as biomarkers of right ventricular (RV) function in patients with pulmonary hypertension (PH). Methods: GDF-15 and sST2 serum concentrations were measured in patients with PH (n = 628), dilated cardiomyopathy (n = 31) and left ventricular hypertrophy (n = 47), and in healthy controls (n = 61). Results: Median sST2 and GDF-15 levels in patients with left ventricular hypertrophy were higher than in patients with PH and dilated cardiomyopathy. In tertile analysis GDF-15 >1363 pg/ml and sST2 >38 ng/ml were associated with higher N-terminal pro-brain natriuretic peptide, RV systolic dysfunction, RV-pulmonary arterial uncoupling and hemodynamic impairment. Conclusion: GDF-15 and sST2 are potential biomarkers of RV dysfunction in patients with PH.
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Affiliation(s)
- Stanislav Keranov
- Department of Cardiology & Angiology, University of Giessen, Giessen, 35392, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Bad Nauheim, 61231, Germany
| | - Laila Widmann
- Department of Cardiology & Angiology, University of Giessen, Giessen, 35392, Germany
| | - Leili Jafari
- Department of Cardiology, Kerckhoff Heart & Lung Center, Bad Nauheim, 61231, Germany
| | | | - Till Keller
- Department of Cardiology & Angiology, University of Giessen, Giessen, 35392, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Bad Nauheim, 61231, Germany
- Department of Cardiology, Kerckhoff Heart & Lung Center, Bad Nauheim, 61231, Germany
| | - Christian Troidl
- German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Bad Nauheim, 61231, Germany
- Department of Cardiology, Kerckhoff Heart & Lung Center, Bad Nauheim, 61231, Germany
| | - Steffen Kriechbaum
- German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Bad Nauheim, 61231, Germany
- Department of Cardiology, Kerckhoff Heart & Lung Center, Bad Nauheim, 61231, Germany
| | - Sandra Voss
- German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Bad Nauheim, 61231, Germany
- Department of Cardiology, Kerckhoff Heart & Lung Center, Bad Nauheim, 61231, Germany
| | - Pascal Bauer
- Department of Cardiology & Angiology, University of Giessen, Giessen, 35392, Germany
| | - Manuel J Richter
- Department of Internal Medicine, Justus Liebig University Giessen, Universities of Giessen & Marburg Lung Center (UGMLC), Institute for Lung Health (ILH), Cardio-Pulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Giessen, 35392, Germany
| | - Khodr Tello
- Department of Internal Medicine, Justus Liebig University Giessen, Universities of Giessen & Marburg Lung Center (UGMLC), Institute for Lung Health (ILH), Cardio-Pulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Giessen, 35392, Germany
| | - Henning Gall
- Department of Internal Medicine, Justus Liebig University Giessen, Universities of Giessen & Marburg Lung Center (UGMLC), Institute for Lung Health (ILH), Cardio-Pulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Giessen, 35392, Germany
| | - Hossein A Ghofrani
- Department of Internal Medicine, Justus Liebig University Giessen, Universities of Giessen & Marburg Lung Center (UGMLC), Institute for Lung Health (ILH), Cardio-Pulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Giessen, 35392, Germany
| | - Christoph B Wiedenroth
- Department of Thoracic Surgery, Kerckhoff Heart & Lung Center, Bad Nauheim, 61231, Germany
| | - Stefan Guth
- Department of Thoracic Surgery, Kerckhoff Heart & Lung Center, Bad Nauheim, 61231, Germany
| | - Werner Seeger
- Department of Internal Medicine, Justus Liebig University Giessen, Universities of Giessen & Marburg Lung Center (UGMLC), Institute for Lung Health (ILH), Cardio-Pulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Giessen, 35392, Germany
| | - Christian W Hamm
- Department of Cardiology & Angiology, University of Giessen, Giessen, 35392, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Bad Nauheim, 61231, Germany
- Department of Cardiology, Kerckhoff Heart & Lung Center, Bad Nauheim, 61231, Germany
| | - Holger Nef
- Department of Cardiology & Angiology, University of Giessen, Giessen, 35392, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Bad Nauheim, 61231, Germany
| | - Oliver Dörr
- Department of Cardiology & Angiology, University of Giessen, Giessen, 35392, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Bad Nauheim, 61231, Germany
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8
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Chen D, Zhang HF, Yuan TY, Sun SC, Wang RR, Wang SB, Fang LH, Lyu Y, Du GH. Puerarin-V prevents the progression of hypoxia- and monocrotaline-induced pulmonary hypertension in rodent models. Acta Pharmacol Sin 2022; 43:2325-2339. [PMID: 35190697 PMCID: PMC9433387 DOI: 10.1038/s41401-022-00865-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/09/2022] [Indexed: 02/06/2023] Open
Abstract
Pulmonary hypertension (PH) is a cardiopulmonary disease characterized by a progressive increase in pulmonary vascular resistance. One of the initial pathogenic factors of PH is pulmonary arterial remodeling under various stimuli. Current marketed drugs against PH mainly relieve symptoms without significant improvement in overall prognosis. Discovering and developing new therapeutic drugs that interfere with vascular remodeling is in urgent need. Puerarin is an isoflavone compound extracted from the root of Kudzu vine, which is widely used in the treatment of cardiovascular diseases. In the present study, we evaluated the efficacy of puerarin in the treatment of experimental PH. PH was induced in rats by a single injection of MCT (50 mg/kg, sc), and in mice by exposure to hypoxia (10% O2) for 14 days. After MCT injection the rats were administered puerarin (10, 30, 100 mg · kg-1 · d-1, i.g.) for 28 days, whereas hypoxia-treated mice were pre-administered puerarin (60 mg · kg-1 · d-1, i.g.) for 7 days. We showed that puerarin administration exerted significant protective effects in both experimental PH rodent models, evidenced by significantly reduced right ventricular systolic pressure (RVSP) and lung injury, improved pulmonary artery blood flow as well as pulmonary vasodilation and contraction function, inhibited inflammatory responses in lung tissues, improved resistance to apoptosis and abnormal proliferation in lung tissues, attenuated right ventricular injury and remodeling, and maintained normal function of the right ventricle. We revealed that MCT and hypoxia treatment significantly downregulated BMPR2/Smad signaling in the lung tissues and PPARγ/PI3K/Akt signaling in the lung tissues and right ventricles, which were restored by puerarin administration. In addition, we showed that a novel crystal type V (Puer-V) exerted better therapeutic effects than the crude form of puerarin (Puer). Furthermore, Puer-V was more efficient than bosentan (a positive control drug) in alleviating the abnormal structural changes and dysfunction of lung tissues and right ventricles. In conclusion, this study provides experimental evidence for developing Puer-V as a novel therapeutic drug to treat PH.
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Affiliation(s)
- Di Chen
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China
- Beijing Key Laboratory of Drug Targets Identification and Drug Screening, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China
| | - Hui-Fang Zhang
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China
- Beijing Key Laboratory of Drug Targets Identification and Drug Screening, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China
| | - Tian-Yi Yuan
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China
- Beijing Key Laboratory of Drug Targets Identification and Drug Screening, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China
| | - Shu-Chan Sun
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China
- Beijing Key Laboratory of Drug Targets Identification and Drug Screening, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China
| | - Ran-Ran Wang
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China
- Beijing Key Laboratory of Drug Targets Identification and Drug Screening, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China
| | - Shou-Bao Wang
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China
- Beijing Key Laboratory of Drug Targets Identification and Drug Screening, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China
| | - Lian-Hua Fang
- Beijing Key Laboratory of Drug Targets Identification and Drug Screening, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China.
| | - Yang Lyu
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China.
- Beijing Key Laboratory of Polymorphic Drugs, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China.
| | - Guan-Hua Du
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China.
- Beijing Key Laboratory of Drug Targets Identification and Drug Screening, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China.
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Whitehead AK, Fried ND, Li Z, Neelamegam K, Pearson CS, LaPenna KB, Sharp TE, Lefer DJ, Lazartigues E, Gardner JD, Yue X. Alpha7 nicotinic acetylcholine receptor mediates chronic nicotine inhalation-induced cardiopulmonary dysfunction. Clin Sci (Lond) 2022; 136:973-987. [PMID: 35678315 PMCID: PMC10199464 DOI: 10.1042/cs20220083] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 02/07/2022] [Revised: 05/27/2022] [Accepted: 06/09/2022] [Indexed: 12/17/2022]
Abstract
Cigarette smoking remains the leading modifiable risk factor for cardiopulmonary diseases; however, the effects of nicotine alone on cardiopulmonary function remain largely unknown. Previously, we have shown that chronic nicotine vapor inhalation in mice leads to the development of pulmonary hypertension (PH) with right ventricular (RV) remodeling. The present study aims to further examine the cardiopulmonary effects of nicotine and the role of the α7 nicotinic acetylcholine receptor (α7-nAChR), which is widely expressed in the cardiovascular system. Wild-type (WT) and α7-nAChR knockout (α7-nAChR-/-) mice were exposed to room air (control) or nicotine vapor daily for 12 weeks. Consistent with our previous study, echocardiography and RV catheterization reveal that male WT mice developed increased RV systolic pressure with RV hypertrophy and dilatation following 12-week nicotine vapor exposure; in contrast, these changes were not observed in male α7-nAChR-/- mice. In addition, chronic nicotine inhalation failed to induce PH and RV remodeling in female mice regardless of genotype. The effects of nicotine on the vasculature were further examined in male mice. Our results show that chronic nicotine inhalation led to impaired acetylcholine-mediated vasodilatory response in both thoracic aortas and pulmonary arteries, and these effects were accompanied by altered endothelial nitric oxide synthase phosphorylation (enhanced inhibitory phosphorylation at threonine 495) and reduced plasma nitrite levels in WT but not α7-nAChR-/- mice. Finally, RNA sequencing revealed up-regulation of multiple inflammatory pathways in thoracic aortas from WT but not α7-nAChR-/- mice. We conclude that the α7-nAChR mediates chronic nicotine inhalation-induced PH, RV remodeling and vascular dysfunction.
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Affiliation(s)
- Anna K. Whitehead
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, LA 70112, U.S.A
| | - Nicholas D. Fried
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, LA 70112, U.S.A
| | - Zhen Li
- Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Sciences Center, New Orleans, LA 70112, U.S.A
- Cardiovascular Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, LA 70112, U.S.A
| | - Kandasamy Neelamegam
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, LA 70112, U.S.A
| | - Charlotte S. Pearson
- Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Sciences Center, New Orleans, LA 70112, U.S.A
| | - Kyle B. LaPenna
- Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Sciences Center, New Orleans, LA 70112, U.S.A
- Cardiovascular Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, LA 70112, U.S.A
| | - Thomas E. Sharp
- Cardiovascular Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, LA 70112, U.S.A
- Department of Medicine Section of Cardiology, Louisiana State University Health Sciences Center, New Orleans, LA 70112, U.S.A
| | - David J. Lefer
- Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Sciences Center, New Orleans, LA 70112, U.S.A
- Cardiovascular Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, LA 70112, U.S.A
| | - Eric Lazartigues
- Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Sciences Center, New Orleans, LA 70112, U.S.A
- Cardiovascular Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, LA 70112, U.S.A
- Southeast Louisiana Veterans Health Care Systems, New Orleans, LA 70119, U.S.A
| | - Jason D. Gardner
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, LA 70112, U.S.A
| | - Xinping Yue
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, LA 70112, U.S.A
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10
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Sharifi Kia D, Shen Y, Bachman TN, Goncharova EA, Kim K, Simon MA. The Effects of Healthy Aging on Right Ventricular Structure and Biomechanical Properties: A Pilot Study. Front Med (Lausanne) 2022; 8:751338. [PMID: 35083230 PMCID: PMC8784691 DOI: 10.3389/fmed.2021.751338] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 12/01/2021] [Indexed: 11/13/2022] Open
Abstract
Healthy aging has been associated with alterations in pulmonary vascular and right ventricular (RV) hemodynamics, potentially leading to RV remodeling. Despite the current evidence suggesting an association between aging and alterations in RV function and higher prevalence of pulmonary hypertension in the elderly, limited data exist on age-related differences in RV structure and biomechanics. In this work, we report our preliminary findings on the effects of healthy aging on RV structure, function, and biomechanical properties. Hemodynamic measurements, biaxial mechanical testing, constitutive modeling, and quantitative transmural histological analysis were employed to study two groups of male Sprague-Dawley rats: control (11 weeks) and aging (80 weeks). Aging was associated with increases in RV peak pressures (+17%, p = 0.017), RV contractility (+52%, p = 0.004), and RV wall thickness (+38%, p = 0.001). Longitudinal realignment of RV collagen (16.4°, p = 0.013) and myofibers (14.6°, p = 0.017) were observed with aging, accompanied by transmural cardiomyocyte loss and fibrosis. Aging led to increased RV myofiber stiffness (+141%, p = 0.003), in addition to a bimodal alteration in the biaxial biomechanical properties of the RV free wall, resulting in increased tissue-level stiffness in the low-strain region, while progressing into decreased stiffness at higher strains. Our results demonstrate that healthy aging may modulate RV remodeling via increased peak pressures, cardiomyocyte loss, fibrosis, fiber reorientation, and altered mechanical properties in male Sprague-Dawley rats. Similarities were observed between aging-induced remodeling patterns and those of RV remodeling in pressure overload. These findings may help our understanding of age-related changes in the cardiovascular fitness and response to disease.
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Affiliation(s)
- Danial Sharifi Kia
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
| | - Yuanjun Shen
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, PA, United States
- Davis School of Medicine Lung Center, University of California, Davis, Davis, CA, United States
| | - Timothy N. Bachman
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Elena A. Goncharova
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, PA, United States
- Davis School of Medicine Lung Center, University of California, Davis, Davis, CA, United States
- Division of Pulmonary, Allergy and Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kang Kim
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, PA, United States
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
- Division of Cardiology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA, United States
- Center for Ultrasound Molecular Imaging and Therapeutics, University of Pittsburgh, Pittsburgh, PA, United States
| | - Marc A. Simon
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
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Shoji H, Yoshida Y, Sanada TJ, Naito A, Maruyama J, Zhang E, Sumi K, Sakao S, Maruyama K, Hidaka H, Tatsumi K. The Isoquinoline-Sulfonamide Compound H-1337 Attenuates SU5416/Hypoxia-Induced Pulmonary Arterial Hypertension in Rats. Cells 2021; 11:66. [PMID: 35011628 PMCID: PMC8750965 DOI: 10.3390/cells11010066] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/17/2021] [Accepted: 12/23/2021] [Indexed: 12/11/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is characterized by elevated pulmonary arterial pressure and right heart failure. Selective pulmonary vasodilators have improved the prognosis of PAH; however, they are not able to reverse pulmonary vascular remodeling. Therefore, a search for new treatment agents is required. H-1337 is an isoquinoline-sulfonamide compound that inhibits multiple serine/threonine kinases, including Rho-associated protein kinase (ROCK) and mammalian target of rapamycin (mTOR). Here, we investigated the effects of H-1337 on pulmonary hypertension and remodeling in the pulmonary vasculature and right ventricle in experimental PAH induced by SU5416 and hypoxia exposure. H-1337 and H-1337M1 exerted inhibitory effects on ROCK and Akt. H-1337 inhibited the phosphorylation of myosin light chain and mTOR and suppressed the proliferation of smooth muscle cells in vitro. H-1337 treatment also suppressed the phosphorylation of myosin light chain and mTOR in the pulmonary vasculature and decreased right ventricular systolic pressure and the extent of occlusive pulmonary vascular lesions. Furthermore, H-1337 suppressed aggravation of right ventricle hypertrophy. In conclusion, our data demonstrated that inhibition of ROCK and mTOR pathways with H-1337 suppressed the progression of pulmonary vascular remodeling, pulmonary hypertension, and right ventricular remodeling.
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Affiliation(s)
- Hiroki Shoji
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan; (H.S.); (A.N.); (S.S.); (K.T.)
- Department of Respiratory Medicine, Tokyo Rosai Hospital, Tokyo 143-0013, Japan
| | - Yoko Yoshida
- D. Western Therapeutics Institute, Inc., Nagoya 460-0003, Japan; (Y.Y.); (K.S.); (H.H.)
- Human Research Promotion and Drug Development, Mie University, Mie 514-8507, Japan
| | - Takayuki Jujo Sanada
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan; (H.S.); (A.N.); (S.S.); (K.T.)
| | - Akira Naito
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan; (H.S.); (A.N.); (S.S.); (K.T.)
| | - Junko Maruyama
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Mie University, Mie 514-8507, Japan; (J.M.); (E.Z.); (K.M.)
- Faculty of Medical Engineering, Suzuka University of Medical Science, Mie 510-0293, Japan
| | - Erquan Zhang
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Mie University, Mie 514-8507, Japan; (J.M.); (E.Z.); (K.M.)
| | - Kengo Sumi
- D. Western Therapeutics Institute, Inc., Nagoya 460-0003, Japan; (Y.Y.); (K.S.); (H.H.)
- Human Research Promotion and Drug Development, Mie University, Mie 514-8507, Japan
| | - Seiichiro Sakao
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan; (H.S.); (A.N.); (S.S.); (K.T.)
| | - Kazuo Maruyama
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Mie University, Mie 514-8507, Japan; (J.M.); (E.Z.); (K.M.)
| | - Hiroyoshi Hidaka
- D. Western Therapeutics Institute, Inc., Nagoya 460-0003, Japan; (Y.Y.); (K.S.); (H.H.)
- Human Research Promotion and Drug Development, Mie University, Mie 514-8507, Japan
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan; (H.S.); (A.N.); (S.S.); (K.T.)
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12
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Gonzaléz-Candia A, Arias PV, Aguilar SA, Figueroa EG, Reyes RV, Ebensperger G, Llanos AJ, Herrera EA. Melatonin Reduces Oxidative Stress in the Right Ventricle of Newborn Sheep Gestated under Chronic Hypoxia. Antioxidants (Basel) 2021; 10:antiox10111658. [PMID: 34829529 PMCID: PMC8614843 DOI: 10.3390/antiox10111658] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 06/07/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 02/07/2023] Open
Abstract
Pulmonary arterial hypertension of newborns (PAHN) constitutes a critical condition involving both severe cardiac remodeling and right ventricle dysfunction. One main cause of this condition is perinatal hypoxia and oxidative stress. Thus, it is a public health concern for populations living above 2500 m and in cases of intrauterine chronic hypoxia in lowlands. Still, pulmonary and cardiac impairments in PAHN lack effective treatments. Previously we have shown the beneficial effects of neonatal melatonin treatment on pulmonary circulation. However, the cardiac effects of this treatment are unknown. In this study, we assessed whether melatonin improves cardiac function and modulates right ventricle (RV) oxidative stress. Ten lambs were gestated, born, and raised at 3600 m. Lambs were divided in two groups. One received daily vehicle as control, and another received daily melatonin (1 mg·kg-1·d-1) for 21 days. Daily cardiovascular measurements were recorded and, at 29 days old, cardiac tissue was collected. Melatonin decreased pulmonary arterial pressure at the end of the experimental period. In addition, melatonin enhanced manganese superoxide dismutase and catalase (CAT) expression, while increasing CAT activity in RV. This was associated with a decrease in superoxide anion generation at the mitochondria and NADPH oxidases in RV. Finally, these effects were associated with a marked decrease of oxidative stress markers in RV. These findings support the cardioprotective effects of an oral administration of melatonin in newborns that suffer from developmental chronic hypoxia.
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Affiliation(s)
- Alejandro Gonzaléz-Candia
- Laboratory of Vascular Function and Reactivity, Pathophysiology Program, ICBM, Faculty of Medicine, Universidad de Chile, Av. Salvador 486, Santiago 7500922, Chile; (A.G.-C.); (P.V.A.); (S.A.A.); (E.G.F.)
- Institute of Health Sciences, University of O’Higgins, Libertador Bernardo O’Higgins 611, Rancagua 2820000, Chile
| | - Pamela V. Arias
- Laboratory of Vascular Function and Reactivity, Pathophysiology Program, ICBM, Faculty of Medicine, Universidad de Chile, Av. Salvador 486, Santiago 7500922, Chile; (A.G.-C.); (P.V.A.); (S.A.A.); (E.G.F.)
| | - Simón A. Aguilar
- Laboratory of Vascular Function and Reactivity, Pathophysiology Program, ICBM, Faculty of Medicine, Universidad de Chile, Av. Salvador 486, Santiago 7500922, Chile; (A.G.-C.); (P.V.A.); (S.A.A.); (E.G.F.)
| | - Esteban G. Figueroa
- Laboratory of Vascular Function and Reactivity, Pathophysiology Program, ICBM, Faculty of Medicine, Universidad de Chile, Av. Salvador 486, Santiago 7500922, Chile; (A.G.-C.); (P.V.A.); (S.A.A.); (E.G.F.)
| | - Roberto V. Reyes
- Pathophysiology Program, ICBM, Faculty of Medicine, Universidad de Chile, Av. Salvador 486, Santiago 7500922, Chile; (R.V.R.); (G.E.); (A.J.L.)
| | - Germán Ebensperger
- Pathophysiology Program, ICBM, Faculty of Medicine, Universidad de Chile, Av. Salvador 486, Santiago 7500922, Chile; (R.V.R.); (G.E.); (A.J.L.)
| | - Aníbal J. Llanos
- Pathophysiology Program, ICBM, Faculty of Medicine, Universidad de Chile, Av. Salvador 486, Santiago 7500922, Chile; (R.V.R.); (G.E.); (A.J.L.)
- International Center for Andean Studies (INCAS), Universidad de Chile, Baquedano s/n, Putre 1070000, Chile
| | - Emilio A. Herrera
- Laboratory of Vascular Function and Reactivity, Pathophysiology Program, ICBM, Faculty of Medicine, Universidad de Chile, Av. Salvador 486, Santiago 7500922, Chile; (A.G.-C.); (P.V.A.); (S.A.A.); (E.G.F.)
- International Center for Andean Studies (INCAS), Universidad de Chile, Baquedano s/n, Putre 1070000, Chile
- Correspondence: ; Tel.: +56-2-2977-0543
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Yuchi Y, Suzuki R, Kanno H, Teshima T, Matsumoto H, Koyama H. Right Ventricular Myocardial Adaptation Assessed by Two-Dimensional Speckle Tracking Echocardiography in Canine Models of Chronic Pulmonary Hypertension. Front Vet Sci 2021; 8:727155. [PMID: 34485446 PMCID: PMC8415444 DOI: 10.3389/fvets.2021.727155] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Pulmonary hypertension (PH) is a life-threatening disease in dogs characterized by an increase in pulmonary arterial pressure (PAP) and/or pulmonary vascular resistance. Right ventricle adapts to its pressure overload through various right ventricular (RV) compensative mechanisms: adaptive and maladaptive remodeling. The former is characterized by concentric hypertrophy and increased compensatory myocardial contractility, whereas the latter is distinguished by eccentric hypertrophy associated with impaired myocardial function. Objectives: To evaluate the RV adaptation associated with the increase of PAP using two-dimensional speckle tracking echocardiography. Animals: Seven experimentally induced PH models. Methods: Dogs were anesthetized and then a pulmonary artery catheter was placed via the right jugular vein. Canine models of PH were induced by the repeated injection of microspheres through the catheter and monitored pulmonary artery pressure. Dogs were performed echocardiography and hemodynamic measurements in a conscious state when baseline and systolic PAP (sPAP) rose to 30, 40, 50 mmHg, and chronic phase. The chronic phase was defined that the sPAP was maintained at 50 mmHg or more for 4 weeks without injection of microspheres. Results: Pulmonary artery to aortic diameter ratio, RV area, end-diastolic RV wall thickness, and RV myocardial performance index were significantly increased in the chronic phase compared with that in the baseline. Tricuspid annular plane systolic excursion was significantly decreased in the chronic phase compared with that in the baseline. The RV longitudinal strain was significantly decreased in the sPAP30 phase, increased in the sPAP40 and sPAP50 phases, and decreased in the chronic phase. Conclusions: Changes in two-dimensional speckle tracking echocardiography-derived RV longitudinal strain might reflect the intrinsic RV myocardial contractility during the PH progression, which could not be detected by conventional echocardiographic parameters.
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Affiliation(s)
- Yunosuke Yuchi
- Laboratory of Veterinary Internal Medicine, Faculty of Veterinary Science, School of Veterinary Medicine, Nippon Veterinary and Life Science University, Musashino, Japan
| | - Ryohei Suzuki
- Laboratory of Veterinary Internal Medicine, Faculty of Veterinary Science, School of Veterinary Medicine, Nippon Veterinary and Life Science University, Musashino, Japan
| | - Haruka Kanno
- Laboratory of Veterinary Internal Medicine, Faculty of Veterinary Science, School of Veterinary Medicine, Nippon Veterinary and Life Science University, Musashino, Japan
| | - Takahiro Teshima
- Laboratory of Veterinary Internal Medicine, Faculty of Veterinary Science, School of Veterinary Medicine, Nippon Veterinary and Life Science University, Musashino, Japan
| | - Hirotaka Matsumoto
- Laboratory of Veterinary Internal Medicine, Faculty of Veterinary Science, School of Veterinary Medicine, Nippon Veterinary and Life Science University, Musashino, Japan
| | - Hidekazu Koyama
- Laboratory of Veterinary Internal Medicine, Faculty of Veterinary Science, School of Veterinary Medicine, Nippon Veterinary and Life Science University, Musashino, Japan
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Touil I, Amor HIH, Kechida M, Boudawara NK, Brahem Y, Bouchareb S, Hasnaoui MT, Boussoffara L, Knani J. Predictive echocardiographic factors of severe obstructive sleep apnea. Pan Afr Med J 2021; 38:359. [PMID: 34367438 PMCID: PMC8308867 DOI: 10.11604/pamj.2021.38.359.28470] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/28/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction obstructive sleep apnea (OSA) is a common chronic pulmonary disease, characterized by repetitive collapse of the upper respiratory airways, leading to oxygen desaturation. This condition is recognized to be associated with cardiovascular disease. Several studies have shown the effects of OSA on both geometry and cardiac function, with conflicting results. We aimed to investigate the relationship between echocardiographic abnormalities and the severity of OSA. Methods this is a cross-sectional single center study including patients, without any cardiovascular or pulmonary comorbidities, with polygraphy proven OSA. All participants underwent a detailed transthoracic echocardiography (TTE). Results a total of 93 patients were included in the study, with 62.2% (n=56) females. According to the apnea hypopnea index (AHI), patients were divided into two groups: mild to moderate OSA (5≤ AHI< 30/H) and severe OSA (AHI≥ 30/H). There were no differences in baseline characteristics between the two groups. The assessment of echocardiographic parameters demonstrated that severe OSA have a higher left ventricular end-systolic (LVES) (47.6±7.2 VS 46.2±4.7), left ventricular end-diastolic (LVED) (31.3±6.2 VS 28.9±4.5) diameters and interventricular septum (IVS) thickness (12.7±2.4 VS11.7±2.5) diameters rather than mild to moderate OSA without a significant difference between the two groups. Furthermore, severe OSA patients had lower mean value of left ventricular ejection fraction (LVEF) and fractional shortening (FS) equal to 62.1±9.7 and 32.5±6.3 respectively. The difference between the two groups was not statistically significant. However, a significant association was shown between severity of OSA and left ventricular (LV) diastolic dysfunction, right ventricular internal diameter (RVID) and systolic pulmonary artery pressure (sPAP), with p=0.05, p=0.05 and p= 0.03 respectively. The RVID was also independently associated to the severity of the OSA (aOR 1.33, 95%CI: 0.99-1.79; p=0.05). Conclusion using bidimensional echocardiography showed a relationship between severe OSA and right ventricular parameters (diastolic dysfunction and RVID) and sPAP.
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Affiliation(s)
- Imen Touil
- Department of Pneumology, Taher Sfar Hospital, Mahdia, Tunisia
| | | | - Melek Kechida
- Department of Internal Medicine, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | | | - Yosra Brahem
- Department of Pneumology, Taher Sfar Hospital, Mahdia, Tunisia
| | | | | | | | - Jalel Knani
- Department of Pneumology, Taher Sfar Hospital, Mahdia, Tunisia
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Gong C, He S, Chen X, Wang L, Guo J, He J, Yin L, Chen C, Han Y, Chen Y. Diverse Right Ventricular Remodeling Evaluated by MRI and Prognosis in Eisenmenger Syndrome With Different Shunt Locations. J Magn Reson Imaging 2021; 55:1478-1488. [PMID: 34152058 DOI: 10.1002/jmri.27791] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Congenital shunt location is related to Eisenmenger syndrome (ES) survival. Moreover, right ventricular (RV) remodeling is associated with poor survival in pulmonary hypertension. PURPOSE To investigate RV remodeling using comprehensive magnetic resonance imaging (MRI) techniques and identify its relationship with prognosis in ES subgroups classified by shunt location. STUDY TYPE Prospective observational study. POPULATION Fifty-four adults with ES (16 with pre-tricuspid shunt and 38 with post-tricuspid shunt). FIELD STRENGTH/SEQUENCE 3.0 T/cine MRI with balanced steady-state free precession sequence, late gadolinium enhancement with inversion recovery segmented gradient echo sequence and phase-sensitive reconstruction, and T1 mapping with modified Look-Locker inversion recovery sequence. ASSESSMENT Demographics, clinical characteristics, hemodynamics, RV remodeling features (morphology, systolic function, RV-pulmonary artery (PA) coupling and myocardial fibrosis), and prognosis were compared between ES subgroups. The adverse endpoint was all-cause mortality or readmission for heart failure. STATISTICAL TESTS The independent samples t-test, Fisher's exact test or Chi-squared test, and the Kaplan-Meier method were used. P < 0.05 was considered significant. RESULTS Compared to patients with post-tricuspid shunt, patients with pre-tricuspid shunt were significantly older and had higher N-terminal pro-B-type natriuretic peptide concentrations and poorer exercise tolerance. Pre-tricuspid shunt showed significantly larger RV dimensions (end-diastolic volume index: 185.81 ± 37.49 vs. 98.20 ± 36.26 mL/m2 ), worse RV ejection fraction (23.54% ± 12.35% vs. 40.82% ± 10.77%), and RV-PA decoupling (0.35 ± 0.31 vs. 0.72 ± 0.29). Biventricular myocardial fibrosis was significantly more severe in pre-tricuspid shunt than post-tricuspid shunt (extracellular volume, left ventricle: 35.85% ± 2.58% vs. 29.10% ± 5.20%; RV free wall: 30.93% ± 5.65% vs. 26.75% ± 5.15%). In addition, pre-tricuspid shunt demonstrated a significantly increased risk of adverse endpoint (hazard ratio: 2.938, 95% confidence interval: 1.204-7.172). DATA CONCLUSION ES with pre-tricuspid shunt might be a unique subtype with worse clinically decompensated RV remodeling and poor prognosis. LEVEL OF EVIDENCE 2 Technical Efficacy Stage: 5.
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Affiliation(s)
- Chao Gong
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Shuai He
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Xiaoling Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Lili Wang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Jiajuan Guo
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Juan He
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Lidan Yin
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Chen Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Yuchi Han
- Department of Medicine (Cardiovascular Division), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yucheng Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
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Imano H, Kato R, Nomura A, Tamura M, Yamaguchi Y, Ijiri Y, Wu H, Nakano T, Okada Y, Yamaguchi T, Izumi Y, Yoshiyama M, Asahi M, Hayashi T. Rivaroxaban Attenuates Right Ventricular Remodeling in Rats with Pulmonary Arterial Hypertension. Biol Pharm Bull 2021; 44:669-677. [PMID: 33612567 DOI: 10.1248/bpb.b20-01011] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Pulmonary arterial hypertension (PAH) is a progressive condition that frequently results in right ventricular (RV) remodeling. The objectives of this study are to investigate effects of rivaroxaban on RV remodeling in a rat model of PAH, created with Sugen5416 and chronic hypoxia, and the in vitro effects of rivaroxaban on human cardiac microvascular endothelial cells (HCMECs). To create the PAH model, male Sprague-Dawley rats were subcutaneously injected with Sugen5416 (20 mg/kg) and exposed to 2 weeks of hypoxia (10% O2), followed by 2 weeks of exposure to normoxia. The animals were then divided into 2 groups with or without administration of rivaroxaban (12 mg/kg/d) for a further 4 weeks. HCMECs were cultured under hypoxic conditions (37 °C, 1% O2, 5% CO2) with Sugen5416 and with or without rivaroxaban. In the model rats, RV systolic pressure and Fulton index increased by hypoxia with Sugen5416 were significantly decreased when treated with rivaroxaban. In HCMECs, hypoxia with Sugen5416 increased the expression of protease-activated receptor-2 (PAR-2) and the phosphorylation of extracellular signal-regulated kinase (ERK), c-Jun N-terminal kinase (JNK), and nuclear factor-kappa B (NF-κB), while treatment with rivaroxaban significantly suppressed the expression of these proteins. Rivaroxaban attenuated RV remodeling in a rat model of PAH by reducing ERK, JNK and NF-κB activation. Rivaroxaban has the possibility of providing additive effects on RV remodeling in patients with PAH.
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Affiliation(s)
- Hideki Imano
- Department of Cardiovascular Pharmacotherapy and Toxicology, Osaka University of Pharmaceutical Sciences
| | - Ryuji Kato
- Department of Cardiovascular Pharmacotherapy and Toxicology, Osaka University of Pharmaceutical Sciences
| | - Atsuo Nomura
- Department of Cardiovascular Pharmacotherapy and Toxicology, Osaka University of Pharmaceutical Sciences
- Department of Pharmacology, Faculty of Medicine, Osaka Medical College
| | - Maki Tamura
- Department of Cardiovascular Pharmacotherapy and Toxicology, Osaka University of Pharmaceutical Sciences
| | - Yudai Yamaguchi
- Department of Cardiovascular Pharmacotherapy and Toxicology, Osaka University of Pharmaceutical Sciences
| | - Yoshio Ijiri
- Department of Cardiovascular Pharmacotherapy and Toxicology, Osaka University of Pharmaceutical Sciences
| | - Hong Wu
- Department of Microbiology and Infection Control, Faculty of Medicine, Osaka Medical College
| | - Takashi Nakano
- Department of Microbiology and Infection Control, Faculty of Medicine, Osaka Medical College
| | - Yoshikatsu Okada
- Department of Pathology, Faculty of Medicine, Osaka Medical College
| | - Takehiro Yamaguchi
- Department of Pharmacology, Osaka City University Graduate School of Medicine
| | - Yasukatsu Izumi
- Department of Pharmacology, Osaka City University Graduate School of Medicine
| | - Minoru Yoshiyama
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine
| | - Michio Asahi
- Department of Pharmacology, Faculty of Medicine, Osaka Medical College
| | - Tetsuya Hayashi
- Department of Cardiovascular Pharmacotherapy and Toxicology, Osaka University of Pharmaceutical Sciences
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17
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Hagdorn QAJ, Kurakula K, Koop AMC, Bossers GPL, Mavrogiannis E, van Leusden T, van der Feen DE, de Boer RA, Goumans MJTH, Berger RMF. Volume Load-Induced Right Ventricular Failure in Rats Is Not Associated With Myocardial Fibrosis. Front Physiol 2021; 12:557514. [PMID: 33716758 PMCID: PMC7952521 DOI: 10.3389/fphys.2021.557514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/30/2020] [Accepted: 01/25/2021] [Indexed: 01/15/2023] Open
Abstract
Background Right ventricular (RV) function and failure are key determinants of morbidity and mortality in various cardiovascular diseases. Myocardial fibrosis is regarded as a contributing factor to heart failure, but its importance in RV failure has been challenged. This study aims to assess whether myocardial fibrosis drives the transition from compensated to decompensated volume load-induced RV dysfunction. Methods Wistar rats were subjected to aorto-caval shunt (ACS, n = 23) or sham (control, n = 15) surgery, and sacrificed after 1 month, 3 months, or 6 months. Echocardiography, RV pressure-volume analysis, assessment of gene expression and cardiac histology were performed. Results At 6 months, 6/8 ACS-rats (75%) showed clinical signs of RV failure (pleural effusion, ascites and/or liver edema), whereas at 1 month and 3 months, no signs of RV failure had developed yet. Cardiac output has increased two- to threefold and biventricular dilatation occurred, while LV ejection fraction gradually decreased. At 1 month and 3 months, RV end-systolic elastance (Ees) remained unaltered, but at 6 months, RV Ees had decreased substantially. In the RV, no oxidative stress, inflammation, pro-fibrotic signaling (TGFβ1 and pSMAD2/3), or fibrosis were present at any time point. Conclusions In the ACS rat model, long-term volume load was initially well tolerated at 1 month and 3 months, but induced overt clinical signs of end-stage RV failure at 6 months. However, no myocardial fibrosis or increased pro-fibrotic signaling had developed. These findings indicate that myocardial fibrosis is not involved in the transition from compensated to decompensated RV dysfunction in this model.
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Affiliation(s)
- Quint A J Hagdorn
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Kondababu Kurakula
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
| | - Anne-Marie C Koop
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Guido P L Bossers
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Emmanouil Mavrogiannis
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Tom van Leusden
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Diederik E van der Feen
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Marie-José T H Goumans
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
| | - Rolf M F Berger
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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18
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Mamazhakypov A, Weiß A, Zukunft S, Sydykov A, Kojonazarov B, Wilhelm J, Vroom C, Petrovic A, Kosanovic D, Weissmann N, Seeger W, Fleming I, Iglarz M, Grimminger F, Ghofrani HA, Pullamsetti SS, Schermuly RT. Effects of macitentan and tadalafil monotherapy or their combination on the right ventricle and plasma metabolites in pulmonary hypertensive rats. Pulm Circ 2020; 10:2045894020947283. [PMID: 33240483 PMCID: PMC7672745 DOI: 10.1177/2045894020947283] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 03/08/2020] [Accepted: 07/10/2020] [Indexed: 12/19/2022] Open
Abstract
Pulmonary arterial hypertension is a severe respiratory disease characterized by pulmonary artery remodeling. RV dysfunction and dysregulated circulating metabolomics are associated with adverse outcomes in pulmonary arterial hypertension. We investigated effects of tadalafil and macitentan alone or in combination on the RV and plasma metabolomics in SuHx and PAB models. For SuHx model, rats were injected with SU5416 and exposed to hypoxia for three weeks and then were returned to normoxia and treated with either tadalafil (10 mg/kg in chow) or macitentan (10 mg/kg in chow) or their combination (both 10 mg/kg in chow) for two weeks. For PAB model, rats were subjected to either sham or PAB surgery for three weeks and treated with above-mentioned drugs from week 1 to week 3. Following terminal echocardiographic and hemodynamic measurements, tissue samples were collected for metabolomic, histological and gene expression analysis. Both SuHx and PAB rats developed RV remodeling/dysfunction with severe and mild plasma metabolomic alterations, respectively. In SuHx rats, tadalafil and macitentan alone or in combination improved RV remodeling/function with the effects of macitentan and combination therapy being superior to tadalafil. All therapies similarly attenuated SuHx-induced changes in plasma metabolomics. In PAB rats, only macitentan improved RV remodeling/function, while only tadalafil attenuated PAB-induced changes in plasma metabolomics.
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Affiliation(s)
- Argen Mamazhakypov
- Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center, Member of the German Lung Center (DZL), Justus-Liebig-University Giessen, Giessen, Germany
| | - Astrid Weiß
- Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center, Member of the German Lung Center (DZL), Justus-Liebig-University Giessen, Giessen, Germany
| | - Sven Zukunft
- Institute for Vascular Signalling, Centre for Molecular Medicine, Goethe University, Frankfurt am Main, Germany & German Center of Cardiovascular Research (DZHK), Partner site RheinMain, Frankfurt am Main, Germany
| | - Akylbek Sydykov
- Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center, Member of the German Lung Center (DZL), Justus-Liebig-University Giessen, Giessen, Germany
| | - Baktybek Kojonazarov
- Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center, Member of the German Lung Center (DZL), Justus-Liebig-University Giessen, Giessen, Germany
| | - Jochen Wilhelm
- Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center, Member of the German Lung Center (DZL), Justus-Liebig-University Giessen, Giessen, Germany
| | - Christina Vroom
- Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center, Member of the German Lung Center (DZL), Justus-Liebig-University Giessen, Giessen, Germany
| | - Aleksandar Petrovic
- Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center, Member of the German Lung Center (DZL), Justus-Liebig-University Giessen, Giessen, Germany
| | - Djuro Kosanovic
- Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center, Member of the German Lung Center (DZL), Justus-Liebig-University Giessen, Giessen, Germany.,Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Norbert Weissmann
- Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center, Member of the German Lung Center (DZL), Justus-Liebig-University Giessen, Giessen, Germany
| | - Werner Seeger
- Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center, Member of the German Lung Center (DZL), Justus-Liebig-University Giessen, Giessen, Germany.,Department of Lung Development and Remodelling, Max-Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Ingrid Fleming
- Institute for Vascular Signalling, Centre for Molecular Medicine, Goethe University, Frankfurt am Main, Germany & German Center of Cardiovascular Research (DZHK), Partner site RheinMain, Frankfurt am Main, Germany
| | - Marc Iglarz
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - Friedrich Grimminger
- Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center, Member of the German Lung Center (DZL), Justus-Liebig-University Giessen, Giessen, Germany
| | - Hossein A Ghofrani
- Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center, Member of the German Lung Center (DZL), Justus-Liebig-University Giessen, Giessen, Germany
| | - Soni S Pullamsetti
- Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center, Member of the German Lung Center (DZL), Justus-Liebig-University Giessen, Giessen, Germany.,Department of Lung Development and Remodelling, Max-Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Ralph T Schermuly
- Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center, Member of the German Lung Center (DZL), Justus-Liebig-University Giessen, Giessen, Germany
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19
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Calafiore AM, Lorusso R, Kheirallah H, Alsaied MM, Alfonso JJ, Di Baldassare A, Gallina S, Gaudino M, Di Mauro M. Late tricuspid regurgitation and right ventricular remodeling after tricuspid annuloplasty. J Card Surg 2020; 35:1891-1900. [PMID: 32652675 DOI: 10.1111/jocs.14840] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 04/18/2020] [Revised: 05/30/2020] [Accepted: 06/04/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of the present retrospective study was to evaluate the influence of preoperative right ventricular (RV) and tricuspid valve (TV) remodeling on the fate of tricuspid annuloplasty (TA) and right ventricle. METHODS From May 2009 to December 2015, 423 patients who had undergone TA for functional tricuspid regurgitation (TR) were included in the study. Residual and recurrent TR were defined as moderate or more TR at discharge and follow-up, respectively. RV remodeling was defined as RV dysfunction and/or dilation. RESULTS Residual TR after TA was recorded in 54 patients (13%). Five-year freedom from TR recurrence was 81% ± 3% in patients without residual TR and 41 ± 8 in patients with residual TR (P < .001). In patients without residual TR, the following risk factors for recurrent TR and late RV remodeling were identified: preoperative systolic pulmonary artery pressure, preoperative RV remodeling, severe preoperative TR or less than severe TR but with TV apparatus remodeling, and etiology of mitral regurgitation. Cox analysis with time-dependent variables confirmed TR recurrence (hazard ratio [HR]: 3.1) and late RV remodeling (HR: 6.5) as risk factors for lower survival. No protective effect of either flexible band or rigid ring TA compared with DeVega procedure was found. Similarly, preoperative atrial fibrillation and pacemaker dependency, late failure of mitral valve surgery did not affect the fate of TR. CONCLUSIONS Prophylactic TA should be encouraged among surgeons. TA at the time of left-sided valve surgery should take into consideration not only annular size, but also tethering severity and RV remodeling.
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Affiliation(s)
- Antonio M Calafiore
- Department of Cardiac Surgery and Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.,Department of Cardiac Surgery, Gemelli Molise, Campobasso, Italy
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Hatim Kheirallah
- Department of Cardiac Surgery and Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Mojtaba Mohammed Alsaied
- Department of Cardiac Surgery and Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Juan J Alfonso
- Department of Clinical Research, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Angela Di Baldassare
- Department of Medicine and Aging Sciences, University "G. d'Annunzio", Chieti-Pescara, Italy
| | - Sabina Gallina
- Department of Medicine and Aging Sciences, University "G. d'Annunzio", Chieti-Pescara, Italy
| | - Mario Gaudino
- Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York City, New York
| | - Michele Di Mauro
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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20
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Sharifi Kia D, Benza E, Bachman TN, Tushak C, Kim K, Simon MA. Angiotensin Receptor-Neprilysin Inhibition Attenuates Right Ventricular Remodeling in Pulmonary Hypertension. J Am Heart Assoc 2020; 9:e015708. [PMID: 32552157 PMCID: PMC7670537 DOI: 10.1161/jaha.119.015708] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [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: 12/11/2022]
Abstract
Background Pulmonary hypertension (PH) results in increased right ventricular (RV) afterload and ventricular remodeling. Sacubitril/valsartan (sac/val) is a dual acting drug, composed of the neprilysin inhibitor sacubitril and the angiotensin receptor blocker valsartan, that has shown promising outcomes in reducing the risk of death and hospitalization for chronic systolic left ventricular heart failure. In this study, we aimed to examine if angiotensin receptor‐neprilysin inhibition using sac/val attenuates RV remodeling in PH. Methods and Results RV pressure overload was induced in Sprague–Dawley rats via banding the main pulmonary artery. Three different cohorts of controls, placebo‐treated PH, and sac/val‐treated PH were studied in a 21‐day treatment window. Terminal invasive hemodynamic measurements, quantitative histological analysis, biaxial mechanical testing, and constitutive modeling were employed to conduct a multiscale analysis on the effects of sac/val on RV remodeling in PH. Sac/val treatment decreased RV maximum pressures (29% improvement, P=0.002), improved RV contractile (30%, P=0.012) and relaxation (29%, P=0.043) functions, reduced RV afterload (35% improvement, P=0.016), and prevented RV‐pulmonary artery uncoupling. Furthermore, sac/val attenuated RV hypertrophy (16% improvement, P=0.006) and prevented transmural reorientation of RV collagen and myofibers (P=0.011). The combined natriuresis and vasodilation resulting from sac/val led to improved RV biomechanical properties and prevented increased myofiber stiffness in PH (61% improvement, P=0.032). Conclusions Sac/val may prevent maladaptive RV remodeling in a pressure overload model via amelioration of RV pressure rise, hypertrophy, collagen, and myofiber reorientation as well as tissue stiffening both at the tissue and myofiber level.
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Affiliation(s)
| | - Evan Benza
- Heart and Vascular InstituteUniversity of Pittsburgh Medical Center (UPMC)Pittsburgh PA
| | - Timothy N Bachman
- Department of BioengineeringUniversity of PittsburghPA.,Pittsburgh Heart, Lung, Blood and Vascular Medicine InstituteUniversity of Pittsburgh and University of Pittsburgh Medical Center (UPMC)Pittsburgh PA
| | - Claire Tushak
- Department of BioengineeringUniversity of PittsburghPA
| | - Kang Kim
- Department of BioengineeringUniversity of PittsburghPA.,Heart and Vascular InstituteUniversity of Pittsburgh Medical Center (UPMC)Pittsburgh PA.,Pittsburgh Heart, Lung, Blood and Vascular Medicine InstituteUniversity of Pittsburgh and University of Pittsburgh Medical Center (UPMC)Pittsburgh PA.,Division of CardiologySchool of MedicineUniversity of PittsburghPA.,McGowan Institute for Regenerative MedicineUniversity of PittsburghPA.,Department of Mechanical Engineering and Materials ScienceUniversity of PittsburghPA.,Center for Ultrasound Molecular Imaging and TherapeuticsUniversity of PittsburghPA
| | - Marc A Simon
- Department of BioengineeringUniversity of PittsburghPA.,Heart and Vascular InstituteUniversity of Pittsburgh Medical Center (UPMC)Pittsburgh PA.,Pittsburgh Heart, Lung, Blood and Vascular Medicine InstituteUniversity of Pittsburgh and University of Pittsburgh Medical Center (UPMC)Pittsburgh PA.,Division of CardiologySchool of MedicineUniversity of PittsburghPA.,McGowan Institute for Regenerative MedicineUniversity of PittsburghPA
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21
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Gual-Capllonch F, Teis A, Ferrer E, Núñez J, Vallejo N, Juncà G, López-Ayerbe J, Lupón J, Bayes-Genis A. Pulmonary vascular resistance versus pulmonary artery pressure for predicting right ventricular remodeling and functional tricuspid regurgitation. Echocardiography 2018; 35:1736-1745. [PMID: 30136745 DOI: 10.1111/echo.14125] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 06/13/2018] [Accepted: 07/26/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) is a common cause of right ventricular (RV) remodeling and functional tricuspid regurgitation (FTR), but incremental pulmonary artery systolic pressure (PASP) does not always correlate with anatomic and functional RV changes. This study aimed to evaluate a noninvasive measure of pulmonary vascular resistance (PVR) for predicting RV dilatation, RV dysfunction, and severity of FTR. METHODS We prospectively analyzed consecutive stable patients with PASP ≥ 35 mm Hg or any degree of RV dilatation or dysfunction secondary to PH. Noninvasive PVR was calculated based on FTR peak velocity and flow in RV outflow tract. RESULTS We included 251 patients, aged 72.1 ± 11.4 years, 53% women, 74.9% with type 2 pulmonary hypertension. The mean PASP was 48.3 ± 12.2 mm Hg. Both PASP and PVR significantly correlated with FTR, RV dilatation, and RV systolic dysfunction. After dichotomizing FTR and RV dilatation and systolic dysfunction as nonsignificant vs significant, FTR and RV dilatation were similarly predicted by PASP and PVR, but RV dysfunction was better predicted by PVR (AUC = 0.78 [0.72-0.84] vs 0.66 [0.60-0.73] for PASP, P < 0.001). Patients with low PASP but high PVR showed worse RV and left ventricular function but lower rates of right heart failure and smaller inferior vena cava, compared to patients with high PASP but low PVR. CONCLUSIONS Noninvasive PVR was superior to PASP for predicting RV systolic dysfunction, but both were similarly associated with RV dilatation or FTR grade. PASP and PVR complement each other to define the echocardiographic findings and clinical status of the patient.
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Affiliation(s)
| | - Albert Teis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Elena Ferrer
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Julio Núñez
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain.,Cardiology Department, Hospital Clínico Universitario, INCLIVA Valencia, Valencia, Spain.,Department of Medicine, Universidad de Valencia, Valencia, Spain
| | - Nuria Vallejo
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Gladys Juncà
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Jorge López-Ayerbe
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Josep Lupón
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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22
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Stam K, van Duin RWB, Uitterdijk A, Cai Z, Duncker DJ, Merkus D. Exercise facilitates early recognition of cardiac and vascular remodeling in chronic thromboembolic pulmonary hypertension in swine. Am J Physiol Heart Circ Physiol 2017; 314:H627-H642. [PMID: 29167118 DOI: 10.1152/ajpheart.00380.2017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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] [Indexed: 11/22/2022]
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) develops in 4% of patients after pulmonary embolism and is accompanied by an impaired exercise tolerance, which is ascribed to the increased right ventricular (RV) afterload in combination with a ventilation/perfusion (V/Q) mismatch in the lungs. The present study aimed to investigate changes in arterial Po2 and hemodynamics in response to graded treadmill exercise during development and progression of CTEPH in a novel swine model. Swine were chronically instrumented and received multiple pulmonary embolisms by 1) microsphere infusion (Spheres) over 5 wk, 2) endothelial dysfunction by administration of the endothelial nitric oxide synthase inhibitor Nω-nitro-l-arginine methyl ester (L-NAME) for 7 wk, 3) combined pulmonary embolisms and endothelial dysfunction (L-NAME + Spheres), or 4) served as sham-operated controls (sham). After a 9 wk followup, embolization combined with endothelial dysfunction resulted in CTEPH, as evidenced by mean pulmonary artery pressures of 39.5 ± 5.1 vs. 19.1 ± 1.5 mmHg (Spheres, P < 0.001), 22.7 ± 2.0 mmHg (L-NAME, P < 0.001), and 20.1 ± 1.5 mmHg (sham, P < 0.001), and a decrease in arterial Po2 that was exacerbated during exercise, indicating V/Q mismatch. RV dysfunction was present after 5 wk of embolization, both at rest (trend toward increased RV end-systolic lumen area, P = 0.085, and decreased stroke volume index, P = 0.042) and during exercise (decreased stroke volume index vs. control, P = 0.040). With sustained pulmonary hypertension, RV hypertrophy (Fulton index P = 0.022) improved RV function at rest and during exercise, but this improvement was insufficient in CTEPH swine to result in an exercise-induced increase in cardiac index. In conclusion, embolization in combination with endothelial dysfunction results in CTEPH in swine. Exercise increased RV afterload, exacerbated the V/Q mismatch, and unmasked RV dysfunction. NEW & NOTEWORTHY Here, we present the first double-hit chronic thromboembolic pulmonary hypertension swine model. We show that embolization as well as endothelial dysfunction is required to induce sustained pulmonary hypertension, which is accompanied by altered exercise hemodynamics and an exacerbated ventilation/perfusion mismatch during exercise.
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Affiliation(s)
- Kelly Stam
- Experimental Cardiology, Department of Cardiology, Thoraxcenter, Cardiovascular Research Institute COEUR, Erasmus Medical Center Rotterdam , Rotterdam , The Netherlands
| | - Richard W B van Duin
- Experimental Cardiology, Department of Cardiology, Thoraxcenter, Cardiovascular Research Institute COEUR, Erasmus Medical Center Rotterdam , Rotterdam , The Netherlands
| | - André Uitterdijk
- Experimental Cardiology, Department of Cardiology, Thoraxcenter, Cardiovascular Research Institute COEUR, Erasmus Medical Center Rotterdam , Rotterdam , The Netherlands
| | - Zongye Cai
- Experimental Cardiology, Department of Cardiology, Thoraxcenter, Cardiovascular Research Institute COEUR, Erasmus Medical Center Rotterdam , Rotterdam , The Netherlands
| | - Dirk J Duncker
- Experimental Cardiology, Department of Cardiology, Thoraxcenter, Cardiovascular Research Institute COEUR, Erasmus Medical Center Rotterdam , Rotterdam , The Netherlands
| | - Daphne Merkus
- Experimental Cardiology, Department of Cardiology, Thoraxcenter, Cardiovascular Research Institute COEUR, Erasmus Medical Center Rotterdam , Rotterdam , The Netherlands
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Penumatsa KC, Toksoz D, Warburton RR, Kharnaf M, Preston IR, Kapur NK, Khosla C, Hill NS, Fanburg BL. Transglutaminase 2 in pulmonary and cardiac tissue remodeling in experimental pulmonary hypertension. Am J Physiol Lung Cell Mol Physiol 2017; 313:L752-L762. [PMID: 28775095 DOI: 10.1152/ajplung.00170.2017] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [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: 04/13/2017] [Revised: 07/25/2017] [Accepted: 07/30/2017] [Indexed: 12/28/2022] Open
Abstract
Tissue matrix remodeling and fibrosis leading to loss of pulmonary arterial and right ventricular compliance are important features of both experimental and clinical pulmonary hypertension (PH). We have previously reported that transglutaminase 2 (TG2) is involved in PH development while others have shown it to be a cross-linking enzyme that participates in remodeling of extracellular matrix in fibrotic diseases in general. In the present studies, we used a mouse model of experimental PH (Sugen 5416 and hypoxia; SuHypoxia) and cultured primary human cardiac and pulmonary artery adventitial fibroblasts to evaluate the relationship of TG2 to the processes of fibrosis, protein cross-linking, extracellular matrix collagen accumulation, and fibroblast-to-myofibroblast transformation. We report here that TG2 expression and activity as measured by serotonylated fibronectin and protein cross-linking activity along with fibrogenic markers are significantly elevated in lungs and right ventricles of SuHypoxic mice with PH. Similarly, TG2 expression and activity, protein cross-linking activity, and fibrogenic markers are significantly increased in cultured cardiac and pulmonary artery adventitial fibroblasts in response to hypoxia exposure. Pharmacological inhibition of TG2 activity with ERW1041E significantly reduced hypoxia-induced cross-linking activity and synthesis of collagen 1 and α-smooth muscle actin in both the in vivo and in vitro studies. TG2 short interfering RNA had a similar effect in vitro. Our results suggest that TG2 plays an important role in hypoxia-induced pulmonary and right ventricular tissue matrix remodeling in the development of PH.
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Affiliation(s)
- Krishna C Penumatsa
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Deniz Toksoz
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Rod R Warburton
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Mousa Kharnaf
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Ioana R Preston
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Navin K Kapur
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts; and
| | - Chaitan Khosla
- Departments of Chemistry and Chemical Engineering, Stanford University, Stanford, California
| | - Nicholas S Hill
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Barry L Fanburg
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Tufts Medical Center, Boston, Massachusetts;
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Badr Eslam R, Croce K, Mangione FM, Musmann R, Leopold JA, Mitchell RN, Waxman AB. Persistence and proliferation of human mesenchymal stromal cells in the right ventricular myocardium after intracoronary injection in a large animal model of pulmonary hypertension. Cytotherapy 2017; 19:668-679. [PMID: 28392314 DOI: 10.1016/j.jcyt.2017.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 12/27/2016] [Revised: 02/10/2017] [Accepted: 03/02/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND AIMS In this study, we demonstrate long-term persistence of human mesenchymal stromal cells (hMSCs) after intracoronary injection in a large animal model of pulmonary hypertension (PH). METHODS Commercially available placenta-derived hMSCs were used. Experiments were conducted on 14 female Yorkshire swine. Four animals served as controls, and 10 underwent pulmonary vein (PV) banding. After 12 ± 2 weeks, PH and PV dysfunction were confirmed by right heart catheterization and cardiac magnetic resonance imaging. hMSCs were injected in the marginal branch of the right coronary artery. Tissues were harvested 6, 9 or 24 days after infusion. RESULTS After 12 ± 2 weeks after PV banding, all subjects had increased mean pulmonary artery pressure (13.6 ± 3.6 versus 30.8 ± 4.5 mm Hg, P < 0.007) and a decrease in right ventricular ejection fraction from 51.7 ± 5.7% versus 30.5 ± 11.3% (P = 0.003). Intracoronary injection of hMSCs was well tolerated. Up to 24 days after hMSC injection, immunohistochemistry revealed extravascular viable human CD105+ mononuclear cells in the right ventricle (RV) that were Ki67+. This was confirmed by fluorescence in situ hybridization. CD45+ porcine inflammatory cells were identified, commonly seen adjacent to areas of healing microscopic infarction that likely dated to the time of the original hMSC injection. Anti-CD31 staining produced strong signals in areas of injected hMSCs. Immunohistochemistry staining for vascular cell adhesion molecule-1 showed upregulation in the clusters, where mononuclear cells were located. CONCLUSIONS hMSCs injected via intracoronary infusion survived up to 24 days and demonstrated proliferative capacity. hMSCs can persist long term in the RV and are potential cell source for tissue repair in RV dysfunction.
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Affiliation(s)
- Roza Badr Eslam
- Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Kevin Croce
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Fernanda Marinho Mangione
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert Musmann
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jane A Leopold
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Richard N Mitchell
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron B Waxman
- Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
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25
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He J, Li X, Luo H, Li T, Zhao L, Qi Q, Liu Y, Yu Z. Galectin-3 mediates the pulmonary arterial hypertension-induced right ventricular remodeling through interacting with NADPH oxidase 4. ACTA ACUST UNITED AC 2017; 11:275-289.e2. [PMID: 28431936 DOI: 10.1016/j.jash.2017.03.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [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: 12/27/2016] [Revised: 03/02/2017] [Accepted: 03/14/2017] [Indexed: 02/06/2023]
Abstract
Pulmonary arterial hypertension (PAH) is a progressive disorder that affects both pulmonary vasculature and the heart. The response of the right ventricle (RV) to the increased afterload is an important determinant of the PAH final outcome. Galectin-3 (Gal-3), a novel biomarker in left cardiac remodeling, takes part in multiple pathophysiological processes including the inflammation, fibrosis, immunity, and oxidative stress. The levels of Gal-3 are elevated in PAH patients, although the exact mechanisms underlie the PAH-induced right ventricular structural changes remain unclear. Our results showed that the serum Gal-3 and NADPH oxidase 4 (Nox4) levels were significantly elevated and correlated in 26 human PAH patients when compared with 14 age- and sex-matched healthy controls. In the monocrotaline-induced PAH rat models of right ventricular hypertrophy and fibrosis, the Gal-3 and Nox4 expressions were both significantly upregulated compared with the controls. Moreover, the Gal-3 positive areas were co-localized with the collagen III-specific staining and the Gal-3 and Nox4 were partly co-localized in the intercellular area. The exogenous Gal-3 recombinant protein stimulated the proliferation, differentiation, collagen deposition, and Nox4 expression of cardiac fibroblasts. These simulations were blocked by the Gal-3 knockdown. The profibrotic effects of transforming growth factor-β1 (TGF-β1) on the cardiac fibroblasts were partially mediated by the Gal-3. Subsequently, our results showed that Gal-3 mediated the TGF-β1-induced cardiac fibrotic process through interacting with the Nox4 and Nox4-derived oxidative stress. Therefore, Gal-3 plays an important role in the PAH-induced right ventricular remodeling through interacting with the Nox4 and Nox4-derived oxidative stress. Gal-3 may become a RV-specific diagnostic and therapeutic target for clinics.
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Affiliation(s)
- Jingni He
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, P.R. China
| | - Xiaohui Li
- Department of Pharmacology, School of Pharmaceutical Sciences, Central South University, Changsha, P.R. China
| | - Hui Luo
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, P.R. China
| | - Tangzhiming Li
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, P.R. China
| | - Lin Zhao
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, P.R. China
| | - Qiangqiang Qi
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, P.R. China
| | - Yuwei Liu
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, P.R. China
| | - Zaixin Yu
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, P.R. China.
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Jiang B, Deng Y, Suen C, Taha M, Chaudhary KR, Courtman DW, Stewart DJ. Marked Strain-Specific Differences in the SU5416 Rat Model of Severe Pulmonary Arterial Hypertension. Am J Respir Cell Mol Biol 2016; 54:461-8. [PMID: 26291195 DOI: 10.1165/rcmb.2014-0488oc] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
We assessed the pulmonary hemodynamic response to vascular endothelial growth factor receptor, type 2, inhibition using SU5416 (SU) with and without chronic hypoxia (CH) in different background strains and colonies of rats. A single subcutaneous injection of SU (20 mg/kg) or vehicle was administered to different substrains of Sprague-Dawley (SD) rats, and they were compared with Lewis and Fischer rats, with and without exposure to CH (10% O2 for 3 wk). Remarkably, a unique colony of SD rats from Charles River Laboratories, termed the SD-hyperresponsive type, exhibited severe pulmonary arterial hypertension (PAH) with SU alone, characterized by increased right ventricular systolic pressure, right ventricular/left ventricular plus septal weight ratio, and arteriolar occlusive lesions at 7-8 weeks (all P < 0.0001 versus vehicle). In contrast, the other SD substrain from Harlan Laboratories, termed SD-typical type, as well as Fischer rats, developed severe PAH only when exposed to SU and CH, whereas Lewis rats showed only a minimal response. All SD-typical type rats survived for up to 13 weeks after SU/CH, whereas SD-hyperresponsive type rats exhibited mortality after SU and SU/CH (35% and 50%, respectively) at 8 weeks. Fischer rats exposed to SU/CH exhibited the greatest mortality at 8 weeks (78%), beginning as early as 4 weeks after SU and preceded by right ventricle enlargement. Of note, a partial recovery of PAH after 8 weeks was observed in the SD-typical type substrain only. In conclusion, variation in strain, even between colonies of the same strain, has a remarkable influence on the nature and severity of the response to SU, consistent with an important role for genetic modifiers of the PAH phenotype.
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Affiliation(s)
- Baohua Jiang
- 1 Sinclair Centre for Regenerative Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; and
| | - Yupu Deng
- 1 Sinclair Centre for Regenerative Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; and
| | - Colin Suen
- 1 Sinclair Centre for Regenerative Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; and.,2 Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Mohamad Taha
- 1 Sinclair Centre for Regenerative Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; and.,2 Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ketul R Chaudhary
- 1 Sinclair Centre for Regenerative Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; and
| | - David W Courtman
- 1 Sinclair Centre for Regenerative Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; and
| | - Duncan J Stewart
- 1 Sinclair Centre for Regenerative Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; and.,2 Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Aguero J, Ishikawa K, Hadri L, Santos-Gallego C, Fish K, Hammoudi N, Chaanine A, Torquato S, Naim C, Ibanez B, Pereda D, García-Alvarez A, Fuster V, Sengupta PP, Leopold JA, Hajjar RJ. Characterization of right ventricular remodeling and failure in a chronic pulmonary hypertension model. Am J Physiol Heart Circ Physiol 2014; 307:H1204-15. [PMID: 25158063 DOI: 10.1152/ajpheart.00246.2014] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [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] [Indexed: 12/11/2022]
Abstract
In pulmonary hypertension (PH), right ventricular (RV) dysfunction and failure is the main determinant of a poor prognosis. We aimed to characterize RV structural and functional differences during adaptive RV remodeling and progression to RV failure in a large animal model of chronic PH. Postcapillary PH was created surgically in swine (n = 21). After an 8- to 14-wk follow-up, two groups were identified based on the development of overt heart failure (HF): PH-NF (nonfailing, n = 12) and PH-HF (n = 8). In both groups, invasive hemodynamics, pressure-volume relationships, and echocardiography confirmed a significant increase in pulmonary pressures and vascular resistance consistent with PH. Histological analysis also demonstrated distal pulmonary arterial (PA) remodeling in both groups. Diastolic dysfunction, defined by a steeper RV end-diastolic pressure-volume relationship and longitudinal strain, was found in the absence of HF as an early marker of RV remodeling. RV contractility was increased in both groups, and RV-PA coupling was preserved in PH-NF animals but impaired in the PH-HF group. RV hypertrophy was present in PH-HF, although there was evidence of increased RV fibrosis in both PH groups. In the PH-HF group, RV sarcoplasmic reticulum Ca(2+)-ATPase2a expression was decreased, and endoplasmic reticulum stress was increased. Aldosterone levels were also elevated in PH-HF. Thus, in the swine pulmonary vein banding model of chronic postcapillary PH, RV remodeling occurs at the structural, histological, and molecular level. Diastolic dysfunction and fibrosis are present in adaptive RV remodeling, whereas the onset of RV failure is associated with RV-PA uncoupling, defective calcium handling, and hyperaldosteronism.
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Affiliation(s)
- Jaume Aguero
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York; Centro Nacional de Investigaciones Cardiovasculares Carlos III-Epidemiology, Atherothrombosis and Imaging Department, Madrid, Spain;
| | - Kiyotake Ishikawa
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lahouaria Hadri
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Carlos Santos-Gallego
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; and
| | - Kenneth Fish
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nadjib Hammoudi
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Antoine Chaanine
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samantha Torquato
- Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Charbel Naim
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Borja Ibanez
- Centro Nacional de Investigaciones Cardiovasculares Carlos III-Epidemiology, Atherothrombosis and Imaging Department, Madrid, Spain
| | - Daniel Pereda
- Centro Nacional de Investigaciones Cardiovasculares Carlos III-Epidemiology, Atherothrombosis and Imaging Department, Madrid, Spain
| | - Ana García-Alvarez
- Centro Nacional de Investigaciones Cardiovasculares Carlos III-Epidemiology, Atherothrombosis and Imaging Department, Madrid, Spain
| | - Valentin Fuster
- Centro Nacional de Investigaciones Cardiovasculares Carlos III-Epidemiology, Atherothrombosis and Imaging Department, Madrid, Spain; Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; and
| | - Partho P Sengupta
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; and
| | - Jane A Leopold
- Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Roger J Hajjar
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York
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28
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Abstract
BACKGROUND Pulmonary hypertension (PH) is known to affect the right ventricular (RV) function. AIMS To assess the extent of global and regional RV dysfunction in PH patients. METHODS We performed a cross-sectional study on 20 controls (age 62 ± 15 years, 7 males) and 35 patients (age 67 ± 12 years, 13 males) with PH of mixed etiologies and assessed RV inflow and outflow tracts (OTs) function, using speckle tracking echocardiography (STE) based myocardial deformation and its time relations. RV inlet and OT dimensions (2D), inlet myocardial velocities (TDI), myocardial strain and strain rate (SR), TAPSE (M-mode), ejection and filling times (pulsed-wave [PW] Doppler), and pulmonary artery acceleration (PAc) were measured. RESULTS RV inlet and OT were dilated (P < 0.001 for both) and TAPSE (P < 0.001), inlet velocities (P < 0.001), basal and mid-cavity strain, SR and longitudinal displacement reduced (P < 0.001 for all). The time to peak systolic SR at basal, mid-cavity (P < 0.001 for both), and RVOT (P = 0.007) was short as was that to peak displacement (P < 0.001 for all). The time to peak pulmonary ejection correlated with time to peak SR at RVOT (r = 0.7, P < 0.001) in controls, but with that of the mid-cavity in patients (r = 0.71, P < 0.001). PAc was faster (P = 0.001) and RV filling time shorter in patients (P = 0.03) with respect to controls. CONCLUSIONS PH has drastic effects on RV structure and intrinsic myocardial function, significantly disturbing its ejection time relations and overall pump performance. Increased RV afterload results in RV configuration changes with the inflow tract determining peak ejection rather than OT.
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Affiliation(s)
- Avin Calcutteea
- Department of Public Health and Clinical Medicine and Heart Center, Umeå University, Umeå, Sweden
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