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Panagiotidou E, Βoutou A, Fouka E, Papakosta D, Chatzopoulos E, Sourla E, Markopoulou A, Kioumis I, Stanopoulos I, Pitsiou G. Phenotyping exercise limitation of patients with Interstitial Fibrosing Lung Disease: the importance of exercise hemodynamics. Pulmonology 2024; 30:104-112. [PMID: 35568651 DOI: 10.1016/j.pulmoe.2022.03.012] [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] [Received: 08/18/2021] [Revised: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE Left-heart dysfunction and pulmonary vasculopathy are increasingly recognized as contributing factors of exercise capacity limitation in interstitial fibrosing lung disease (IFLD). Moreover, the clinical significance of exercise pulmonary hypertension (ePH) in pulmonary and cardiac diseases has been documented, representing a risk factor for decreased exercise capacity and survival, progression to resting pulmonary hypertension (PH) and overall clinical worsening. We conducted a prospective study aiming at: (a) assessing the prevalence of PH and ePH in a cohort of 40 functionally limited patients with IFLD, (b) determining the post-capillary (postC) or pre-capillary (preC) etiology of either PH or ePH in this cohort, and (c) examining the correlations between invasively and non-invasively measured exercise variables among hemodynamic groups. PATIENTS AND METHODS 40 IFLD patients underwent cardiopulmonary evaluation, including: clinical examination, lung function tests, 6-minute walking test, heart ultrasonography, cardiopulmonary exercise test and, finally, right heart catheterization (RHC). Resting hemodynamic evaluation was followed by the exercise protocol proposed by Herve et al, using a bedside cycle ergometer in the supine position. Abnormal elevation of mean pulmonary artery pressure (mPAP) above 30mmHg during exercise, with respect to abnormal elevation of cardiac output (CO) below 10 L/min (mPAP-CO ratio ⩾3 mmHg·min·L-1) was used to define ePH (Herve et al, 2015). Secondary hemodynamic evaluation involved detection of abnormal pulmonary arterial wedge pressure (PAWP) increase at peak exercise in relation to CO. Specifically, ΔPAWP/ΔCO >2 mmHg/L per minute determined an abnormal PAWP elevation (Bentley et al, 2020). RESULTS Among the 40-patient cohort, 25% presented postC PH, 37.5% preC PH, 27.5% ePH, with the remaining 10% recording normal hemodynamics. PAWP evaluation during exercise revealed a postC etiology in 4 out of the 11 patients presenting ePH, and a postC etiology in 6 out of the 15 patients presenting resting preC PH. Mean values of non-invasive variables did not display statistically significant differences among hemodynamic groups, except for: diffusing capacity for carbon monoxide (DLCO), carbon monoxide transfer coefficient (KCO) and the ratio of functional vital capacity to DLCO (FVC%/DLCO%), which were lower in both ePH and PH groups (p < 0.05). Resting values of CO, cardiac index (CI), stroke volume (SV) and pulmonary vascular compliance (PVC) were significantly impaired in ePH, preC-PH and postC-PH groups when compared to the normal group. CONCLUSIONS Both PH and ePH were highly prevalent within the IFLD patient group, suggesting that RHC should be offered more frequently in functionally limited patients. Diffusion capacity markers must thus guide decision making, in parallel to clinical evaluation. ePH was associated to lower resting CO and PVC, in a similar way to resting PH, indicating the relevance of cardiopulmonary function to exercise limitation. Finally, the use of the ΔPAWP/ΔCO>2 criterion further uncovered PH of postcapillary etiology, highlighting the complexity of hemodynamics in IFLD. CLINICALTRIALS gov ID: NCT03706820.
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Affiliation(s)
- E Panagiotidou
- Respiratory Failure Clinic, General Hospital of Thessaloniki "G. Papanikolaou", Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - A Βoutou
- Department of Respiratory Medicine, General Hospital "G. Papanikolaou", Thessaloniki, Greece
| | - E Fouka
- University Department of Respiratory Medicine, General Hospital of Thessaloniki "G. Papanikolaou", Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - D Papakosta
- University Department of Respiratory Medicine, General Hospital of Thessaloniki "G. Papanikolaou", Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - E Chatzopoulos
- Respiratory Failure Clinic, General Hospital of Thessaloniki "G. Papanikolaou", Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - E Sourla
- Respiratory Failure Clinic, General Hospital of Thessaloniki "G. Papanikolaou", Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Markopoulou
- Department of Respiratory Medicine, General Hospital "G. Papanikolaou", Thessaloniki, Greece
| | - I Kioumis
- University Department of Respiratory Medicine, General Hospital of Thessaloniki "G. Papanikolaou", Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - I Stanopoulos
- University Department of Respiratory Medicine, General Hospital of Thessaloniki "G. Papanikolaou", Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - G Pitsiou
- University Department of Respiratory Medicine, General Hospital of Thessaloniki "G. Papanikolaou", Aristotle University of Thessaloniki, Thessaloniki, Greece
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Papiris SA, Veith M, Papaioannou AI, Apollonatou V, Ferrarotti I, Ottaviani S, Tzouvelekis A, Tzilas V, Rovina N, Stratakos G, Gerogianni I, Daniil Z, Kolilekas L, Dimakou K, Pitsidianakis G, Tzanakis N, Tryfon S, Fragopoulos F, Antonogiannaki EM, Lazaratou A, Fouka E, Papakosta D, Emmanouil P, Anagnostopoulos N, Karampitsakos T, Vlami K, Kallieri M, Lyberopoulos P, Loukides S, Bouros D, Bush A, Balduyck M, Lombard C, Cottin V, Mornex JF, Vogelmeier CF, Greulich T, Manali ED. Alpha1-antitrypsin deficiency in Greece: Focus on rare variants. Pulmonology 2024; 30:43-52. [PMID: 36797151 DOI: 10.1016/j.pulmoe.2022.12.007] [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] [Received: 08/08/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 02/16/2023] Open
Abstract
PURPOSE A1Antitrypsin deficiency (AATD) pathogenic mutations are expanding beyond the PI*Z and PI*S to a multitude of rare variants. AIM to investigate genotype and clinical profile of Greeks with AATD. METHODS Symptomatic adult-patients with early-emphysema defined by fixed airway obstruction and computerized-tomography scan and lower than normal serum AAT levels were enrolled from reference centers all over Greece. Samples were analyzed in the AAT Laboratory, University of Marburg-Germany. RESULTS Included are 45 adults, 38 homozygous or compound heterozygous for pathogenic variants and 7 heterozygous. Homozygous were 57.9% male, 65.8% ever-smokers, median (IQR) age 49.0(42.5-58.5) years, AAT-levels 0.20(0.08-0.26) g/L, FEV1(%predicted) 41.5(28.8-64.5). PI*Z, PI*Q0, and rare deficient allele's frequency was 51.3%, 32.9%,15.8%, respectively. PI*ZZ genotype was 36.8%, PI*Q0Q0 21.1%, PI*MdeficientMdeficient 7.9%, PI*ZQ0 18.4%, PI*Q0Mdeficient 5.3% and PI*Zrare-deficient 10.5%. Genotyping by Luminex detected: p.(Pro393Leu) associated with MHeerlen (M1Ala/M1Val); p.(Leu65Pro) with MProcida; p.(Lys241Ter) with Q0Bellingham; p.(Leu377Phefs*24) with Q0Mattawa (M1Val) and Q0Ourem (M3); p.(Phe76del) with MMalton (M2), MPalermo (M1Val), MNichinan (V) and Q0LaPalma (S); p.(Asp280Val) with PLowell (M1Val); PDuarte (M4), YBarcelona (p.Pro39His). Gene-sequencing (46.7%) detected Q0GraniteFalls, Q0Saint-Etienne, Q0Amersfoort(M1Ala), MWürzburg, NHartfordcity and one novel-variant (c.1A>G) named Q0Attikon.Heterozygous included PI*MQ0Amersfoort(M1Ala), PI*MMProcida, PI*Mp.(Asp280Val), PI*MOFeyzin. AAT-levels were significantly different between genotypes (p = 0.002). CONCLUSION Genotyping AATD in Greece, a multiplicity of rare variants and a diversity of rare combinations, including unique ones were observed in two thirds of patients, expanding knowledge regarding European geographical trend in rare variants. Gene sequencing was necessary for genetic diagnosis. In the future the detection of rare genotypes may add to personalize preventive and therapeutic measures.
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Affiliation(s)
- S A Papiris
- 2nd Pulmonary Medicine Department, Medical School, General University Hospital "Attikon", National and Kapodistrian University of Athens, Greece 1 Rimini Street, Haidari 12462, Greece.
| | - M Veith
- Department of Medicine, Pulmonary and Critical Care Medicine, Member of the German Center for Lung Research (DZL), UKGM, Marburg, Germany
| | - A I Papaioannou
- 2nd Pulmonary Medicine Department, Medical School, General University Hospital "Attikon", National and Kapodistrian University of Athens, Greece 1 Rimini Street, Haidari 12462, Greece
| | - V Apollonatou
- 2nd Pulmonary Medicine Department, Medical School, General University Hospital "Attikon", National and Kapodistrian University of Athens, Greece 1 Rimini Street, Haidari 12462, Greece
| | - I Ferrarotti
- Center for Diagnosis of Inherited Alpha1-antitrypsin Deficiency, Department of Internal Medicine and Therapeutics, Pneumonology Unit, Fondazione IRCCS Policlinico San Matteo, Università di Pavia, Pavia, Italy
| | - S Ottaviani
- Center for Diagnosis of Inherited Alpha1-antitrypsin Deficiency, Department of Internal Medicine and Therapeutics, Pneumonology Unit, Fondazione IRCCS Policlinico San Matteo, Università di Pavia, Pavia, Italy
| | - A Tzouvelekis
- Department of Respiratory Medicine, General Hospital of Patras, University of Patras, Greece
| | - V Tzilas
- 5th Pulmonary Department, Athens Chest Hospital "Sotiria", Athens Greece
| | - N Rovina
- 1st Department of Pulmonary Medicine and Intensive Care Unit, Medical School, National and Kapodistrian University of Athens, Athens 115 27, Greece
| | - G Stratakos
- 1st Respiratory Medicine Department of the National, Kapodistrian University of Athens, Athens, Greece
| | - I Gerogianni
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa Greece
| | - Z Daniil
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa Greece
| | - L Kolilekas
- 7thPulmonary Department, Athens Chest Hospital "Sotiria", Athens Greece
| | - K Dimakou
- 5th Pulmonary Department, Athens Chest Hospital "Sotiria", Athens Greece
| | - G Pitsidianakis
- Department of Thoracic Medicine, University Hospital, University of Crete, Heraklion, Crete 71110, Greece
| | - N Tzanakis
- Department of Thoracic Medicine, University Hospital, University of Crete, Heraklion, Crete 71110, Greece
| | - S Tryfon
- General Hospital "G. Papanikolaou", Thessaloniki, Greece
| | - F Fragopoulos
- Pulmonary Department, General Hospital of Nicosia, Cyprus
| | - E M Antonogiannaki
- 4th Pulmonary Department, Athens Chest Hospital "Sotiria", Athens Greece
| | - A Lazaratou
- 2nd Pulmonary Medicine Department, Medical School, General University Hospital "Attikon", National and Kapodistrian University of Athens, Greece 1 Rimini Street, Haidari 12462, Greece
| | - E Fouka
- A Department of Pulmonary Medicine, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Exochi, Thessaloniki, Greece
| | - D Papakosta
- A Department of Pulmonary Medicine, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Exochi, Thessaloniki, Greece
| | | | - N Anagnostopoulos
- 1st Respiratory Medicine Department of the National, Kapodistrian University of Athens, Athens, Greece
| | - T Karampitsakos
- Department of Respiratory Medicine, General Hospital of Patras, University of Patras, Greece
| | - K Vlami
- 2nd Pulmonary Medicine Department, Medical School, General University Hospital "Attikon", National and Kapodistrian University of Athens, Greece 1 Rimini Street, Haidari 12462, Greece
| | - M Kallieri
- 2nd Pulmonary Medicine Department, Medical School, General University Hospital "Attikon", National and Kapodistrian University of Athens, Greece 1 Rimini Street, Haidari 12462, Greece
| | - P Lyberopoulos
- 2nd Pulmonary Medicine Department, Medical School, General University Hospital "Attikon", National and Kapodistrian University of Athens, Greece 1 Rimini Street, Haidari 12462, Greece
| | - S Loukides
- 2nd Pulmonary Medicine Department, Medical School, General University Hospital "Attikon", National and Kapodistrian University of Athens, Greece 1 Rimini Street, Haidari 12462, Greece
| | - D Bouros
- Iatriko Medical Center, Athens, Greece; School of Medicine, National and Kapodistrian University of Athens, Athens Greece
| | - A Bush
- Paediatrics and Paediatric Respirology, Imperial College, Imperial Centre for Paediatrics and Child Health, Royal Brompton Harefield NHS Foundation Trust, London, United Kingdom
| | - M Balduyck
- laboratoire de Biochimie et Biologie Moléculaire (HMNO), Centre de Biologie Pathologie, Faculté de pharmacie et EA 7364 RADEME, Laboratoire de Biochimie et Biologie Moléculaire, CHU de Lille, Université de Lille, Lille, France
| | - C Lombard
- Laboratoire d'Immunologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon and Université Claude Bernard-Lyon 1, Lyon, France
| | - V Cottin
- Service de pneumologie, Centre National Coordinateur de Référence des Maladies Pulmonaires Rares, Hôpital Louis Pradel, Hospices Civils de Lyon, Université de Lyon, Université Claude Bernard Lyon 1, UMR754 INRA, IVPC, Lyon, France
| | - J F Mornex
- Service de pneumologie, Centre National Coordinateur de Référence des Maladies Pulmonaires Rares, Hôpital Louis Pradel, Hospices Civils de Lyon, Université de Lyon, Université Claude Bernard Lyon 1, UMR754 INRA, IVPC, Lyon, France
| | - C F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, Member of the German Center for Lung Research (DZL), UKGM, Marburg, Germany
| | - T Greulich
- Department of Medicine, Pulmonary and Critical Care Medicine, Member of the German Center for Lung Research (DZL), UKGM, Marburg, Germany
| | - E D Manali
- 2nd Pulmonary Medicine Department, Medical School, General University Hospital "Attikon", National and Kapodistrian University of Athens, Greece 1 Rimini Street, Haidari 12462, Greece
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Natsis K, Grammatikopoulou D, Kokkinos P, Fouka E, Totlis T. Isolated tuberculous arthritis of the ankle: a case report and review of the literature. Hippokratia 2017; 21:97-100. [PMID: 30455563 PMCID: PMC6239087] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Isolated ankle joint tuberculous arthritis is extremely rare, comprising an incidence lower than 5 % of skeletal tuberculosis (TB). Description of the case: We present an unusual case of isolated tubercular arthritis of the ankle in a 25-year-old male where the definitive diagnosis was difficult to be reached. The clinical examination revealed slight edema and a slight increase in local skin temperature. Based on magnetic resonance imaging performed, the diagnosis of septic arthritis was made. The arthroscopic appearance of the synovium and polymerase chain reaction analysis (PCR) of the synovial fluid revealed tuberculous arthritis. CONCLUSION TB should be included in the differential diagnosis of inflammatory arthritis in patients with persistent pain and swelling of the ankle. HIPPOKRATIA 2017, 21(2): 97-100.
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Affiliation(s)
- K Natsis
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
- European Interbalkan Medical Center, Thessaloniki, Greece
| | - D Grammatikopoulou
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - P Kokkinos
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - E Fouka
- Pulmonary Department of Aristotle University of Thessaloniki, General Hospital G. Papanikolaou, Thessaloniki, Greece
| | - T Totlis
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
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