1
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Yogeswaran A, Husain-Seyed F, Tello K, Sommer N, Rako ZA, Ghofrani HA, Seeger W, Richter MJ, Gall H. Body fluid status in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Body fluid status can be determined by plasma volume status and extracellular water to total body water (ECW/TBW) ratio and is a well-known parameter associated with survival in patients with chronic heart failure (1–3). However, its prognostic impact in patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) is not fully understood.
Methods
409 patients with PAH and CTEPH who entered the Giessen PH registry were included in this study (4). Plasma volume status was estimated using Duarte formula (ePVS = (1 − hematocrit) / hemoglobin × 100). ECW was calculated via Peters formula ((−2.47 × 0.842 + 8.76 × body surface area) for men and (−1.96 × 0.572 + 8.05 × body surface area) for women) and TBW via Watson formula ((2.447 − [0.09516 × age] + [0.1073 × height] + [0.3362 × body weight]) for men and (−2.097 + [0.1069 × height] + [0.2466 × body weight]) for women). Statistical analyzes were performed with R (The R Foundation).
Results
Median age of the included patients was 65 [53, 74] years. Median ePVS and ECW/TBW ratio were 4.5 [3.9, 5.5] and 0.39 [0.37, 0.40]. Correlation analyses revealed that ePVS correlates with pulmonary artery wedge pressure (PAWP), pulmonary vascular resistance (PVR), cardiac index, and mixed venous oxygen saturation (SvO2), whereas ECW/TBW ratio did not correlate with pulmonary hemodynamics. Accordingly, univariate Cox regression revealed that ePVS but not ECW/TBW ratio was associated with mortality (HR: 1.18 [1.02, 1.37]). ePVS remained as an independent prognostic parameter in multivariate Cox regression analysis. Patients with high ePVS showed significantly decreased survival rates (log-rank p<0.001).
Conclusion
ePVS but not ECW/TBW ratio is associated with prognostic parameters such as PVR, cardiac index and SvO2. Thus, ePVS may be an independent prognostic parameter in patients with PAH and CTEPH.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Deutsche Forschungsgemeinschaft (DFG, German Research Foundation)
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Affiliation(s)
- A Yogeswaran
- Justus-Liebig University of Giessen, Department of Internal Medicine , Giessen , Germany
| | - F Husain-Seyed
- Justus-Liebig University of Giessen, Department of Internal Medicine , Giessen , Germany
| | - K Tello
- Justus-Liebig University of Giessen, Department of Internal Medicine , Giessen , Germany
| | - N Sommer
- Justus-Liebig University of Giessen, Department of Internal Medicine , Giessen , Germany
| | - Z A Rako
- Justus-Liebig University of Giessen, Department of Internal Medicine , Giessen , Germany
| | - H A Ghofrani
- Justus-Liebig University of Giessen, Department of Internal Medicine , Giessen , Germany
| | - W Seeger
- Justus-Liebig University of Giessen, Department of Internal Medicine , Giessen , Germany
| | - M J Richter
- Justus-Liebig University of Giessen, Department of Internal Medicine , Giessen , Germany
| | - H Gall
- Justus-Liebig University of Giessen, Department of Internal Medicine , Giessen , Germany
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2
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Rosenkranz S, Benza RL, Ghofrani HA, Gruenig E, Hoeper MM, Peacock A, Simonneau G, Vizza D, Meier C, Vogtlaender K, Vonk-Noordegraaf A. Changes in cMRI parameters following a switch to riociguat from phosphodiesterase type 5 inhibitors (PDE5i) in patients with pulmonary arterial hypertension: a REPLACE substudy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The REPLACE study investigated the effect of switching to riociguat (RIO) in patients with pulmonary arterial hypertension receiving PDE5i but still at intermediate risk. The centrally adjudicated composite primary endpoint was clinical improvement in the absence of clinical worsening, where clinical improvement was defined as meeting at least two of the following criteria: 6-minute walk distance (6MWD), increase by ≥10% or ≥30 m from baseline (BL) to Wk 24; World Health Organization functional class (WHO FC) I or II at Wk 24; or N-terminal prohormone of brain natriuretic peptide reduction of ≥30% from BL to Wk 24. Twice as many patients switching to RIO (45/111, 41%) met the primary endpoint compared with those remaining on PDE5i (23/113, 20%); odds ratio (OR): 2.78 (95% confidence interval [CI] 1.53–5.06); p=0.0007.
Purpose
Assess changes in right and left ventricular (RV; LV) function using cardiac magnetic resonance imaging (cMRI) in a subgroup of patients participating in REPLACE.
Methods
REPLACE was a randomised, open-label, 24-week, Phase 4 study (NCT02891850). Patients in WHO FC III, with 6MWD 165–440 m, were randomised to switch to RIO 2.5 mg–max tid or remain on PDE5i. Background endothelin receptor antagonist therapy was permitted in both arms.
cMRI was performed on a subset of patients from the full analysis set as an exploratory substudy. The following parameters were measured at BL and Wk 24: RV and LV end-diastolic and end-systolic volumes (RVEDV; RVESV; LVEDV; LVESV), RV stroke volume and stroke volume index (RVSV; RVSVI), LV stroke volume (LVSV), RV ejection fraction (RVEF), and pericardial effusion.
Results
Twenty-seven patients participated in the cMRI substudy. This comprised 11/111 (10%) patients in the RIO arm (mean [standard deviation {SD}] 40.0 [12.4] years), and 16/113 (14%) patients (mean 44.5 [17.6] years) in the PDE5i arm. Like the main population, the treatment response in the cMRI subpopulation favoured RIO versus PDE5i (OR: 6.11 [95% CI 0.90–41.60]). From BL to Wk 24, RVEDV and RVESV decreased in the RIO treatment arm but increased in the PDE5i treatment arm (Table 1). Similar, but less pronounced, changes were observed for the left ventricle (LVESV, LVEDV). RVSV and RVEF levels were close to normal at BL and did not increase in either arm at Wk 24 (Table 1). Pericardial effusion, which was present in 5 patients in each group at BL, decreased in 1 patient in the RIO arm and no patients in the PDE5i arm.
Conclusions
Decreases in RVEDV and RVESV suggest improvements in cardiac function in the RIO arm compared with the PDE5i arm. Values for RVEF and RVSVI were close to normal at BL and did not change at Wk 24. Improvements in cMRI parameters were in line with the clinical improvement observed in patients switching to RIO in the overall population.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): The REPLACE study was co-funded by Bayer AG (Berlin, Germany) and Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. (Kenilworth, NJ, USA)
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Affiliation(s)
- S Rosenkranz
- Heart Center at the University of Cologne, Cologne, Germany
| | - R L Benza
- Ohio State University Hospital, Ohio, United States of America
| | - H A Ghofrani
- University of Giessen and Marburg Lung Centre, member of the German Centre for Lung Research (DZL), Giessen, Germany
| | - E Gruenig
- Thorax Clinic at the University Hospital, Heidelberg, Germany
| | - M M Hoeper
- Hannover Medical School, member of the German Centre for Lung Research (DZL), Hannover, Germany
| | - A Peacock
- Scottish Pulmonary Vascular Unit, Regional Lung and Heart Centre, Glasgow, United Kingdom
| | - G Simonneau
- Hôpital Bicêtre, Université Paris-Sud, Le Kremlin-Bicêtre, France
| | - D Vizza
- `La Sapienza' University of Rome, Rome, Italy
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3
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Benza R, Farber H, Frost A, Ghofrani H, Corris P, Brockmann B, Nikkho S, Meier C, Hoeper M. Validation of REVEAL Risk Score Calculator 2.0 in Patients with PAH in the Phase III PATENT Study. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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4
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Liebetrau C, Kriechbaum S, Rieth A, Ghofrani HA, Haas M, Rolf A, Hamm CW, Guth S, Mayer E, Wiedenroth CB. 4283Exercise right heart catheterization before and after balloon pulmonary angioplasty in inoperable patients with chronic thromboembolic pulmonary hypertension. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Balloon pulmonary angioplasty (BPA) is an evolving treatment option for inoperable patients with chronic thromboembolic pulmonary hypertension (CTEPH). The main indicator for success is improvement in pulmonary hemodynamics, but outcome data are heterogeneous.
Purpose
The aim of the present study was to evaluate pulmonary hemodynamics not only at rest, but also during exercise before and 6 months after BPA.
Methods
We report a prospective series of 64 consecutive patients with inoperable CTEPH who were treated interventionally with BPA. All patients underwent standardized assessment prior to the first BPA and 6 months after the last intervention. Assessment included WHO FC, Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR), 6-minute walking distance (6MWD), serum levels of the N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP), and exercise RHC.
Results
The mean number of sessions per patient was 5.6 (± 1.3) and the mean number of pulmonary segments targeted in all interventions was 11 (± 3). BPA treatment led to improvements in pulmonary hemodynamics and exercise capacity (6MWD: 416±94 m vs. 463±96 m; p<0.0001) except for CO and CI during RHC at rest; these parameters showed improvements only during exercise RHC. MPAP at rest showed a reduction from 41±9 to 31±9 mmHg (p<0.0001) and PVR at rest decreased from 6.8±2.3 WU to 4.3±1.9 WU (p<0.0001). Further decreases were observed for systolic pulmonary arterial pressure, TPG, PVR, and TPR. Cardiac output (7.0±2.0 L/min vs. 8.3±2.0 L/min; p<0.0001) and cardiac index during exercise RHC (3.8±1.1 L/min/m2 vs. 4.4±1.1 L/min/m2; p<0.0001) improved significantly. Median NT-proBNP concentrations decreased from 741 ng/L (IQR 192–1425 ng/L) to 139 ng/L (IQR 60–266 ng/L) during BPA treatment (p<0.0001). Results from the CAMPHOR questionnaire showed significant improvements in symptoms (11±5.8 vs. 5.5±4.9, p<0.0001), activity limitations (9.2±5.6 vs. 5.2±4.5, p<0.0001), and quality of life (6.4±5.7 vs. 3.5±3.7, p<0.0001).
Conclusion
Significant improvements in pulmonary hemodynamics at rest and during exercise were observed 6 months after BPA. Exercise right heart catheterization offers a more discriminating evaluation of the changes in pulmonary hemodynamics after BPA.
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Affiliation(s)
- C Liebetrau
- Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - S Kriechbaum
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - A Rieth
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - H A Ghofrani
- Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - M Haas
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - A Rolf
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - C W Hamm
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - S Guth
- Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - E Mayer
- Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
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5
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Rosenkranz S, Channick R, Chin K, Jenner B, Gaine S, Galie N, Ghofrani HA, Hoeper MM, McLaughlin VV, Preiss R, Rubin LJ, Simonneau G, Sitbon O, Tapson V, Lang IM. 4973Efficacy and safety of selexipag in pulmonary arterial hypertension (PAH) patients with and without significant cardiovascular (CV) comorbidities. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Many PAH patients today have a number of CV comorbidities, yet data on the efficacy and safety of therapies in such patients remain scarce. Most recent PAH clinical trials also include patients with comorbidities.
Purpose
To assess the long-term efficacy and safety of the oral, selective IP prostacyclin receptor agonist, selexipag, in PAH patients with and without significant CV comorbidities using post hoc analysis of GRIPHON data.
Methods
GRIPHON enrolled 1156 PAH patients randomised 1:1 to placebo:selexipag. The present analysis includes patients with right heart catheterisation within 1 year of randomisation who were categorised as with or without CV comorbidities. Patients with CV comorbidities were defined as having ≥3 of the following: body mass index (BMI) >30 kg/m2, history of essential hypertension, diabetes mellitus, or historical evidence of significant coronary artery disease; if PAWP/LVEDP was >12 but <15 mmHg, pulmonary vascular resistance (PVR) had to be >500 dyn.sec/cm5; if PAWP/LVEDP was <12, then PVR had to be >300 dyn.sec/cm5. Selexipag effect on time to first morbidity/mortality (M/M) event up to end of treatment was assessed for both subgroups. Baseline (BL) adjusted treatment hazard ratios with 95% CIs were calculated using Cox models. Model building involved stepwise backward elimination of BL covariates.
Results
752 PAH patients could be categorised based on these criteria (99 with CV comorbidities, 653 without). At BL, patients with CV comorbidities were older (median [range] 60 [28–80] vs 46 [18–78] yrs), had higher BMI (mean [SD] 33.3 [7.23] vs 26.0 [5.64] kg/m2) and lower 6-minute walk distance (mean [SD] 319 [95.7] vs 354 [79.3] m) vs those without. A greater proportion were from Western Europe/Australia/North America (60.6% vs 38.9%) and in WHO functional class III (69.7% vs 49.9%). At BL, 82.8% of patients with CV comorbidities were receiving PAH therapies vs 75.7% of those without. As expected, at BL a higher proportion of patients with CV comorbidities (vs without) had previous/concomitant cardiac disease (62.6% vs 43.0%), metabolism/nutrition disorders (75.8% vs 31.2%), respiratory/thoracic/mediastinal disorders (59.6% vs 37.5%) and vascular disorders (76.8% vs 37.4%). Selexipag reduced the risk of M/M events vs placebo in both subgroups (Figure), with no evidence of an inconsistent treatment effect (interaction p-value=0.1544). Adverse events leading to treatment discontinuation were reported in 35.4% (25.9% selexipag, 46.7% placebo) of patients with CV comorbidities and 35.0% (32.0% selexipag, 38.0% placebo) of those without. Common prostacyclin associated side effects observed with selexipag (headache, diarrhoea, nausea) were reported at a similar incidence in both subgroups.
Conclusions
Selexipag had a beneficial effect on long-term outcome in PAH patients both with and without CV comorbidities. Safety in both groups was consistent with the known profile of selexipag.
Acknowledgement/Funding
Actelion Pharmaceuticals Ltd
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Affiliation(s)
| | - R Channick
- University of California Los Angeles, Los Angeles, United States of America
| | - K Chin
- UT Southwestern Medical Centre, Dallas, United States of America
| | - B Jenner
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - S Gaine
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - N Galie
- University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, Bologna, Italy
| | - H A Ghofrani
- University of Giessen and Marburg Lung Center, Giessen, Germany, member of the German Center for Lung Research, and Department of Medicine, Imperial College London, London, United Kingdom
| | - M M Hoeper
- Department of Respiratory Medicine, Hannover Medical School and German Center for Lung Research, Hannover, Germany
| | - V V McLaughlin
- University of Michigan, Ann Arbor, United States of America
| | - R Preiss
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - L J Rubin
- Division of Pulmonary and Critical Care Medicine, University of California, San Diego, United States of America
| | - G Simonneau
- Hopital Universitaire de Bicetre, Universite Paris-Sud, Le Kremlin Bicetre, France
| | - O Sitbon
- Hopital Universitaire de Bicetre, Universite Paris-Sud, Le Kremlin Bicetre, France
| | - V Tapson
- Cedars-Sinai Medical Center, Los Angeles, United States of America
| | - I M Lang
- Division of Cardiology, Medical University of Vienna, Vienna, Austria
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6
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Sommer N, Droege F, Gamen KE, Geisthoff U, Gall H, Tello K, Richter MJ, Deubner LM, Schmiedel R, Hecker M, Spiekerkoetter E, Wirsching K, Seeger W, Ghofrani HA, Pullamsetti S. Treatment with low-dose tacrolimus inhibits bleeding complications in a patient with hereditary hemorrhagic telangiectasia and pulmonary arterial hypertension. Pulm Circ 2018; 9:2045894018805406. [PMID: 30260738 PMCID: PMC6432681 DOI: 10.1177/2045894018805406] [Citation(s) in RCA: 28] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) can be found in patients suffering from a
loss-of-function mutation of the gene encoding for the activin receptor-like
kinase 1 (ALK-1), a bone morphogenetic protein (BMP) type 1 receptor.
Interestingly, ALK-1 mutations also lead to hereditary hemorrhagic
telangiectasia (HHT), an autosomal dominant disease characterized by
arteriovenous malformations (AVMs) leading to potentially life-threatening
bleeding complications such as epistaxis. Current therapeutic options for both
diseases are limited and often only temporary or accompanied by severe side
effects. Here, we report of a patient with a mutation of the ALK-1 gene
suffering from both HHT and PAH. Recently, it was shown that tacrolimus
increased ALK-1 signaling and had beneficial effects in selected end-stage PAH
patients. We thus hypothesized that treatment with tacrolimus may prevent
disease progression in this patient. Surprisingly, treatment with low-dose
tacrolimus dramatically improved his HHT-associated epistaxis but did not
attenuate progression of PAH.
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Affiliation(s)
- N Sommer
- 1 Excellence Cluster Cardiopulmonary System, University of Giessen and Marburg Lung Center (UGMLC), member of the German Center for Lung Research (DZL), Justus-Liebig-University, Giessen, Germany
| | - F Droege
- 2 Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - K E Gamen
- 3 Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - U Geisthoff
- 4 Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Giessen and Marburg, Philipps Universitðt Marburg, Marburg
| | - H Gall
- 1 Excellence Cluster Cardiopulmonary System, University of Giessen and Marburg Lung Center (UGMLC), member of the German Center for Lung Research (DZL), Justus-Liebig-University, Giessen, Germany
| | - K Tello
- 1 Excellence Cluster Cardiopulmonary System, University of Giessen and Marburg Lung Center (UGMLC), member of the German Center for Lung Research (DZL), Justus-Liebig-University, Giessen, Germany
| | - M J Richter
- 1 Excellence Cluster Cardiopulmonary System, University of Giessen and Marburg Lung Center (UGMLC), member of the German Center for Lung Research (DZL), Justus-Liebig-University, Giessen, Germany
| | - L M Deubner
- 1 Excellence Cluster Cardiopulmonary System, University of Giessen and Marburg Lung Center (UGMLC), member of the German Center for Lung Research (DZL), Justus-Liebig-University, Giessen, Germany
| | | | - M Hecker
- 1 Excellence Cluster Cardiopulmonary System, University of Giessen and Marburg Lung Center (UGMLC), member of the German Center for Lung Research (DZL), Justus-Liebig-University, Giessen, Germany
| | - E Spiekerkoetter
- 6 Division of Pulmonary and Critical Care Medicine, Dept. of Medicine, Stanford University, Stanford, CA, USA
| | - K Wirsching
- 7 Department of Otorhinolaryngology, University Medical Center Regensburg, Regensburg
| | - W Seeger
- 1 Excellence Cluster Cardiopulmonary System, University of Giessen and Marburg Lung Center (UGMLC), member of the German Center for Lung Research (DZL), Justus-Liebig-University, Giessen, Germany.,3 Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - H A Ghofrani
- 8 Department of Medicine, Imperial College London, UK
| | - S Pullamsetti
- 3 Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
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7
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Marra AM, Benjamin N, Eichstaedt C, Egenlauf B, Fischer C, Gall H, Ghofrani HA, Halank M, Hoeper MM, Lange T, Olsson K, Gruenig E. 3020Effects on Right Ventricular size and function by Riociguat in Pulmonary Arterial Hypertension and Chronic Thromboembolic Pulmonary Hypertension (The RIVER Study). Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A M Marra
- Centre for Pulmonary Hypertension, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - N Benjamin
- Centre for Pulmonary Hypertension, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - C Eichstaedt
- Centre for Pulmonary Hypertension, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - B Egenlauf
- Centre for Pulmonary Hypertension, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - C Fischer
- University Hospital of Heidelberg, Institute of Human Genetics, Heidelberg, Germany
| | - H Gall
- Justus-Liebig University of Giessen, Internal Medicine, Giessen, Germany
| | - H A Ghofrani
- Justus-Liebig University of Giessen, Internal Medicine, Giessen, Germany
| | - M Halank
- University Hospital Dresden, Department of Internal Medicine I, Dresden, Germany
| | - M M Hoeper
- Hannover Medical School, Department of Respiratory Medicine,, Hannover, Germany
| | - T Lange
- University Hospital Regensburg, Internal Medicine II, Division of Pneumology, Regensburg, Germany
| | - K Olsson
- Hannover Medical School, Department of Respiratory Medicine,, Hannover, Germany
| | - E Gruenig
- Centre for Pulmonary Hypertension, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
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8
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Galie N, Gaine S, Channick R, Ghofrani HA, Hoeper M, Lang I, McLaughlin V, Preiss R, Rubin L, Shiraga Y, Simonneau G, Sitbon O, Tapson V, Chin K. 3016Long-term survival and safety with selexipag in patients with pulmonary arterial hypertension: results from the GRIPHON study and its open-label extension. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- N Galie
- Bologna University Hospital, Department of Experimental, Diagnostic, and Specialty Medicine, Bologna, Italy
| | - S Gaine
- Mater Misericordiae University Hospital, National Pulmonary Hypertension Unit, Dublin, Ireland
| | - R Channick
- Massachusetts General Hospital, Pulmonary and Critical Care, Boston, United States of America
| | - H A Ghofrani
- University of Giessen and Marburg Lung Center (UGMLC) and German Center of Lung Research, Giessen, Germany; Imperial College London, Department of Medicine, London, United Kingdom
| | - M Hoeper
- Hannover Medical School and German Centre for Lung Research, Department of Respiratory Medicine, Hannover, Germany
| | - I Lang
- Medical University of Vienna, Division of Cardiology, Vienna, Austria
| | - V McLaughlin
- University of Michigan Health System, Department of Internal Medicine, Ann Arbor, United States of America
| | - R Preiss
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - L Rubin
- University of California San Diego, Department of Medicine, San Diego, United States of America
| | - Y Shiraga
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - G Simonneau
- Assistance Publique–Hôpitaux de Paris, Service de Pneumologie, Hôpital Bicêtre and, Laboratoire d'Excellence en Recherche sur le Médicament et Innovation Thérapeutique, Université Paris-Sud, Le Kremlin–Bicêtre; Inserm Unité 999, Le Plessis Robinson, France
| | - O Sitbon
- Assistance Publique–Hôpitaux de Paris, Service de Pneumologie, Hôpital Bicêtre and, Laboratoire d'Excellence en Recherche sur le Médicament et Innovation Thérapeutique, Université Paris-Sud, Le Kremlin–Bicêtre; Inserm Unité 999, Le Plessis Robinson, France
| | - V Tapson
- Cedars-Sinai Medical Center, Los Angeles, United States of America
| | - K Chin
- University of Texas Southwestern Medical Center, Dallas, United States of America
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9
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Götte M, Gall H, Bunniger G, Tello K, Richter M, Sommer N, Ghofrani HA, Müller V, Enzensberger C, Axt-Fliedner R. Rechtes Herz bei Risikoschwangerschaften – Erste Ergebnisse der EVA-Studie. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1660640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- M Götte
- Zentrum für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Gießen und Marburg, Abteilung für Pränatalmedizin, Gießen
| | - H Gall
- University of Gießen and Marburg Lung Center (UGMLC), member of the German Center for Lung Research, Gießen
| | - G Bunniger
- University of Gießen and Marburg Lung Center (UGMLC), member of the German Center for Lung Research, Gießen
| | - K Tello
- University of Gießen and Marburg Lung Center (UGMLC), member of the German Center for Lung Research, Gießen
| | - M Richter
- University of Gießen and Marburg Lung Center (UGMLC), member of the German Center for Lung Research, Gießen
| | - N Sommer
- University of Gießen and Marburg Lung Center (UGMLC), member of the German Center for Lung Research, Gießen
| | - HA Ghofrani
- University of Gießen and Marburg Lung Center (UGMLC), member of the German Center for Lung Research, Gießen
| | - V Müller
- Zentrum für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Gießen und Marburg, Abteilung für Pränatalmedizin, Gießen
| | - C Enzensberger
- Zentrum für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Gießen und Marburg, Abteilung für Pränatalmedizin, Gießen
| | - R Axt-Fliedner
- Zentrum für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Gießen und Marburg, Abteilung für Pränatalmedizin, Gießen
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10
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Benza R, Zhang J, Parsley E, Klassen P, Torres F, Gomberg-Maitland M, Sitbon O, Ghofrani H. Ralinepag, an Oral, Selective, Prostacyclin (IP) Receptor Agonist Consistently Improved Mortality Risk Scores Derived From PAH Registries Across Three Regions: Phase 2 Study Analysis. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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11
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Sommer N, Richter MJ, Tello K, Grimminger F, Seeger W, Ghofrani HA, Gall H. [Update pulmonary arterial hypertension : Definitions, diagnosis, therapy]. Internist (Berl) 2017; 58:937-957. [PMID: 28819824 DOI: 10.1007/s00108-017-0301-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 01/02/2023]
Abstract
The term pulmonary arterial hypertension comprises a group of pulmonary vascular diseases of different etiologies that are characterized by similar precapillary vascular remodeling processes and result in exertional dyspnea and right heart insufficiency. The specific pharmacological treatment approach considers the risk of mortality and phenotypical properties and includes treatment with phosphodiesterase type 5 inhibitors, endothelin receptor antagonists and prostanoids, as well as with more novel substances, such as a soluble guanylyl cyclase stimulator and an oral prostacyclin receptor agonist. The prognosis of the disease is mainly determined by the right heart insufficiency for which there is currently no specific pharmacological treatment. Lung transplantation may be offered as a last option. This review provides an overview of the current European guidelines from 2015 and the recommendations of the Cologne Consensus Conference for pulmonary hypertension from 2016.
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Affiliation(s)
- N Sommer
- Medizinische Klinik II, Universitätsklinikum Gießen und Marburg, Standort Gießen, Deutsches Zentrum für Lungenforschung (DZL), Excellence Cluster Cardiopulmonary System (ECCPS), Klinikstr. 33, 35392, Gießen, Deutschland.
| | - M J Richter
- Medizinische Klinik II, Universitätsklinikum Gießen und Marburg, Standort Gießen, Deutsches Zentrum für Lungenforschung (DZL), Excellence Cluster Cardiopulmonary System (ECCPS), Klinikstr. 33, 35392, Gießen, Deutschland
| | - K Tello
- Medizinische Klinik II, Universitätsklinikum Gießen und Marburg, Standort Gießen, Deutsches Zentrum für Lungenforschung (DZL), Excellence Cluster Cardiopulmonary System (ECCPS), Klinikstr. 33, 35392, Gießen, Deutschland
| | - F Grimminger
- Medizinische Klinik II, Universitätsklinikum Gießen und Marburg, Standort Gießen, Deutsches Zentrum für Lungenforschung (DZL), Excellence Cluster Cardiopulmonary System (ECCPS), Klinikstr. 33, 35392, Gießen, Deutschland
| | - W Seeger
- Medizinische Klinik II, Universitätsklinikum Gießen und Marburg, Standort Gießen, Deutsches Zentrum für Lungenforschung (DZL), Excellence Cluster Cardiopulmonary System (ECCPS), Klinikstr. 33, 35392, Gießen, Deutschland
- Max-Planck-Institut für Herz- und Lungenforschung, Bad Nauheim, Deutschland
| | - H A Ghofrani
- Medizinische Klinik II, Universitätsklinikum Gießen und Marburg, Standort Gießen, Deutsches Zentrum für Lungenforschung (DZL), Excellence Cluster Cardiopulmonary System (ECCPS), Klinikstr. 33, 35392, Gießen, Deutschland
- Kerckhoff-Klinik, Bad Nauheim, Deutschland
- Department of Medicine, Imperial College London, London, Großbritannien
| | - H Gall
- Medizinische Klinik II, Universitätsklinikum Gießen und Marburg, Standort Gießen, Deutsches Zentrum für Lungenforschung (DZL), Excellence Cluster Cardiopulmonary System (ECCPS), Klinikstr. 33, 35392, Gießen, Deutschland
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12
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Coghlan G, Gaine S, Channick R, Scala LD, Galiè N, Ghofrani HA, Hoeper MM, Lang I, McLaughlin V, Preiss R, Rubin LJ, Simonneau G, Sitbon O, Tapson VF, Chin K. S109 Targeting the prostacyclin pathway in the treatment of connective tissue disease associated pulmonary arterial hypertension (pah): insights from the randomised controlled griphon trial with selexipag. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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13
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Hachulla E, Gaine S, Channick R, Discala L, Galiè N, Ghofrani H, Hoeper M, Lang I, Mclaughlin V, Preiss R, Rubin L, Simonneau G, Sitbon O, Tapson V, Chin K. Cibler la voie de la prostacycline dans le traitement des HTAP associées aux connectivites : expérience de Griphon – étude contrôlée, randomisée avec le selexipag. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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14
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Hoeper MM, Apitz C, Grünig E, Halank M, Ewert R, Kaemmerer H, Kabitz HJ, Kähler C, Klose H, Leuchte H, Ulrich S, Olsson KM, Distler O, Rosenkranz S, Ghofrani HA. [Targeted therapy of pulmonary arterial hypertension: Recommendations of the Cologne Consensus Conference 2016]. Dtsch Med Wochenschr 2016; 141:S33-S41. [PMID: 27760448 DOI: 10.1055/s-0042-114526] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The 2015 European Guidelines on Diagnosis and Treatment of Pulmonary Hypertension are also valid for Germany. The guidelines contain detailed recommendations for the targeted treatment of pulmonary arterial hypertension (PAH). However, the practical implementation of the European Guidelines in Germany requires the consideration of several country-specific issues and already existing novel data. This requires a detailed commentary to the guidelines, and in some aspects an update already appears necessary. In June 2016, a Consensus Conference organized by the PH working groups of the German Society of Cardiology (DGK), the German Society of Respiratory Medicine (DGP) and the German Society of Pediatric Cardiology (DGPK) was held in Cologne, Germany. This conference aimed to solve practical and controversial issues surrounding the implementation of the European Guidelines in Germany. To this end, a number of working groups was initiated, one of which was specifically dedicated to the targeted therapy of PAH. This article summarizes the results and recommendations of the working group on targeted treatment of PAH.
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Kramm T, Guth S, Wiedenroth CB, Ghofrani HA, Mayer E. [Treatment of acute and chronic right ventricular failure]. Med Klin Intensivmed Notfmed 2016; 111:463-80. [PMID: 27241776 DOI: 10.1007/s00063-016-0181-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 03/17/2016] [Accepted: 04/04/2016] [Indexed: 11/28/2022]
Abstract
Acute or chronic right ventricular failure is an often misdiagnosed cause of cardiopulmonary insufficiency. In addition to clinical symptoms or laboratory testing, echocardiography and invasive hemodynamic measurement by means of right-heart catheterization are essential for diagnosis and treatment control. In case of acute right ventricular failure, adequate symptomatic treatment of the life-threatening situation is important. Main issues are maintenance of coronary artery perfusion pressure and myocardial oxygen delivery as well as reduction of right ventricular afterload. In persistent right ventricular failure extracorporeal or intracorporeal assist devices are increasingly used as bridging or destination therapy. On a long-term basis, the targeted therapy of the underlying disease is crucial.
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Affiliation(s)
- T Kramm
- Abteilung für Thoraxchirurgie, Kerckhoff Klinik gGmbH, Benekestr. 2‑8, 61231, Bad Nauheim, Deutschland.
| | - S Guth
- Abteilung für Thoraxchirurgie, Kerckhoff Klinik gGmbH, Benekestr. 2‑8, 61231, Bad Nauheim, Deutschland
| | - C B Wiedenroth
- Abteilung für Thoraxchirurgie, Kerckhoff Klinik gGmbH, Benekestr. 2‑8, 61231, Bad Nauheim, Deutschland
| | - H A Ghofrani
- Abteilung für allgemeine Pneumologie, Kerckhoff-Klinik gGmbH, Bad Nauheim, Deutschland.,Medizinische Klinik II, Mitglied des Deutschen Zentrums für Lungenforschung (DZL), Universitätsklinikum Gießen und Marburg GmbH, Gießen, Deutschland
| | - E Mayer
- Abteilung für Thoraxchirurgie, Kerckhoff Klinik gGmbH, Benekestr. 2‑8, 61231, Bad Nauheim, Deutschland
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Tapson V, Channick R, Chin K, Di Scala L, Farber H, Gaine S, Galiè N, Ghofrani H, Lang I, McLaughlin V, Preiss R, Rubin L, Simonneau G, Sitbon O, Hoeper M. Anticoagulant Therapy Is Not Associated with Long Term Outcome in Patients with Pulmonary Arterial Hypertension (PAH): Insights from the GRIPHON Study. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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17
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Esfandiary A, Sommer N, Pak O, Kojonazarov B, Sydykov A, Haag D, Hecker M, Seeger W, Ghofrani HA, Schermuly R, Weissmann N, Schulz R, Schreckenberg R, Schlüter KD. Preserved right ventricular function in mitochondrial uncoupling protein 2 deficient mice in pressure overload induced right ventricular insufficiency. Pneumologie 2015. [DOI: 10.1055/s-0035-1556635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Coghlan J, Galiè N, Barbera J, Frost A, Ghofrani H, Hoeper M, Mclaughlin V, Peacock A, Simonneau G, Vachiery J, Blair C, Gillies H, Harris J, Langley J, Rubin L. OP0267 Initial Combination Therapy of Ambrisentan and Tadalafil in Connective Tissue Disease Associated Pulmonary Arterial Hypertension (CTD-PAH): Subgroup Analysis from the Ambition Trial. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Denton C, Coghlan J, Ghofrani HA, Grimminger F, He J, Riemekasten G, Vizza C, Boeckenhoff A, Meier C, Nikkho S, Pena J, Humbert M. FRI0445 Efficacy and Safety of Riociguat in Patients with Pulmonary Arterial Hypertension (PAH) Associated with Connective Tissue Disease (CTD): Results from Patent-1 and Patent-2. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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20
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Apitz C, Ghofrani H, Beghetti M, Ivy D, Frey R, Fritsch A, Weimann G, Saleh S, Rosenkranz S. Riociguat Treatment for Pulmonary Arterial Hypertension (PAH) Associated with Congenital Heart Disease (CHD): A Subgroup Analysis from the PATENT Studies. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1555984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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21
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Bandorski D, Erkapic D, Stempfl J, Höltgen R, Grünig E, Schmitt J, Chasan R, Grimminger J, Neumann T, Hamm CW, Seeger W, Ghofrani HA, Gall H. Ventricular tachycardias in patients with pulmonary hypertension: an underestimated prevalence? A prospective clinical study. Herzschrittmacherther Elektrophysiol 2015; 26:155-162. [PMID: 26031512 DOI: 10.1007/s00399-015-0364-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 03/10/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Sudden cardiac death (SCD) accounts for approximately 30 % in patients with pulmonary arterial hypertension (PAH). The exact circumference for SCD in this patient population is still unclear. Malignant cardiac arrhythmias are reported to be rarely present. There are no systematic data concerning long-term electrocardiographic (ECG) recording in patients with PAH. OBJECTIVES We sought to investigate the rate of potentially relevant arrhythmias in patients with pulmonary hypertension (PH). METHODS Consecutive patients without diagnosis of known cardiac arrhythmias followed in our outpatient clinic for PH were enrolled in the study. All patients underwent a 72-h Holter ECG. Clinical data, 6-min walk distance, laboratory values, and echocardiography were collected/performed. RESULTS Ninety-two consecutive patients (New York Heart Association class (NYHA) III/IV: 65.2 %/5.4 %, PH Group 1: 35.9 %, Group 3: 10.9 %, Group 4: 28.3 %, Group 5: 2.2 %) were investigated. Relevant arrhythmias were newly detected in 17 patients: non-sustained ventricular tachycardia (n = 12), intermittent second-degree heart block (n = 1), intermittent third-degree heart block (n= 3), and atrial flutter (n = 1). Echocardiographic systolic pulmonary pressure and diameter of the right heart were elevated in patients with relevant arrhythmias. Right heart catheterization revealed higher pulmonary vascular resistance (672 vs. 542 dyn · s · cm(-5), p = 0.247) and lower cardiac index (2.46 vs. 2.82 l/min/m(2), p = 0.184). CONCLUSIONS Ventricular tachycardias occur more often in PH patients than previously reported. However, the prognostic relevance of non-sustained ventricular tachycardias in this cohort remains unclear. As a large number of PH patients die from SCD, closer monitoring, e.g., using implantable event recorders, might be useful to identify patients at high risk.
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Affiliation(s)
- Dirk Bandorski
- University of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany,
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22
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Richter MJ, Gall H, Tello K, Sommer N, Seeger W, Grimminger F, Ghofrani HA. [Medical treatment of pulmonary hypertension: what's new?]. Internist (Berl) 2015; 56:573-82. [PMID: 25924799 DOI: 10.1007/s00108-015-3693-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pulmonary hypertension (PH) is a chronic progressive disease of the pulmonary circulation of multifactorial causes. The current diagnostic classification of PH distinguishes five main groups, which have as a common feature an increased pulmonary arterial pressure and pulmonary resistance. The classification differentiates pulmonary arterial hypertension (PAH), PH due to left heart disease, PH in lung diseases and/or hypoxia, chronic thromboembolic pulmonary hypertension (CTEPH), and PH with unclear/multifactorial mechanisms. Recent advances in basic research with the approval of new drugs and the establishment of therapeutic strategies, mainly in PAH and CTEPH, require a differentiated view of the disease, a careful diagnosis and initiation of therapy, and regular follow-ups. In this article, we provide an overview of the complex drug therapy currently available for PAH patients.
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Affiliation(s)
- M J Richter
- Abteilung für Allgemeine Pneumologie, Lungenzentrum, Kerckhoff-Klinik Bad Nauheim, Kerckhoff-Klinik GmbH, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland
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23
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Leuchte HH, Behr J, Ewert R, Ghofrani HA, Grünig E, Halank M, Held M, Klose H, Rosenkranz S, Schermuly RT, Wilkens H, Hoeper MM. [Riociguat: stimulator of soluble guanylate-cyclase. New mode of action for the treatment of pulmonary arterial and non operable chronic thromboembolic pulmonary hypertension]. Pneumologie 2015; 69:135-43. [PMID: 25750094 DOI: 10.1055/s-0034-1391435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Riociguat is the first clinically available soluble Guanylate-cyclase stimulator (sGC) and representative of a completely new class of drugs. Riociguat is approved for pulmonary arterial hypertension (PAH) and non-operable or recurrent/persistent chronic thromboembolic pulmonary hypertension (CTEPH). Moreover, Riociguat is currently under investigation for a wider spectrum of diseases. This article focusses on its mode of action and clinical trial data. Finally, based on these data, the status of approval, as well as the costs a proposal is given how Riociguat can be integrated in the current treatment of PAH and CTEPH.
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Affiliation(s)
- H H Leuchte
- Innere Medizin II, KH Neuwittelsbach, Akademisches Lehrkrankenhaus LMU, München
| | - J Behr
- Medizinische Klinik und Polklinik V, Klinikum der Universität München und Asklepios Fachkliniken München-Gauting, Comprehensive Pneumology Center, Mitglied des Deutschen Zentrums für Lungenforschung
| | - R Ewert
- Bereich Pneumologie/Infektiologie und Weaningzentrum Klinik und Poliklinik für Innere Medizin B Universitätsmedizin Greifswald
| | - H A Ghofrani
- Medizinische Klinik II, Universitätsklinikum Gießen Marburg, Deutsches Zentrum für Lungenforschung. Kerckhoff Klinik Bad Nauheim
| | - E Grünig
- Zentrum Pulmonale Hypertonie der Thoraxklinik Heidelberg am Universitätsklinikum Heidelberg. Mitglied Deutsches Zentrum für Lungenforschung
| | - M Halank
- Medizinische Klinik und Poliklinik I; Universitätsklinikum Carl Gustav Carus an der TU Dresden, Dresden
| | - M Held
- Innere Medizin. Missionsärztliche Klinik Würzburg
| | - H Klose
- Sektion Pneumologie Onkologisches Zentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | | | - R T Schermuly
- Pulmonale Pharmakotherapie Justus Liebig Universität Gießen
| | - H Wilkens
- Innere Medizin V - Pneumologie, Allergologie, Beatmungs- und Umweltmedizin Universitätsklinikum des Saarlandes, Homburg Saar
| | - M M Hoeper
- Klinik für Pneumologie, Medizinische Hochschule Hannover und Deutsches Zentrum für Lungenforschung (DZL)
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Grünig E, Rubin LJ, Galiè N, Grimminger F, Humbert M, Jing ZC, Keogh A, Langleben D, Fritsch A, Menezes F, Davie N, Ghofrani HA. Riociguat zur Behandlung der pulmonal arteriellen Hypertonie (PAH): 2-Jahres-Ergebnisse aus der Folgestudie zur Langzeitbeobachtung PATENT-2. Pneumologie 2015. [DOI: 10.1055/s-0035-1544810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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25
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Pichl A, Seimetz M, Fysikopoulos A, Bednorz M, Parajuli N, Haag D, Reiter R, Grimminger J, Seeger W, Schermuly R, Grimminger F, Ghofrani HA, Weissmann N. A possible role of serotonin for the development of tobacco smoke-induced lung emphysema and pulmonary hypertension. Pneumologie 2014. [DOI: 10.1055/s-0034-1376815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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26
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Mascher I, Tanislav C, Kaps M, Tiede H, Voswinckel R, Ghofrani HA, Seeger W, Reichenberger F. Relevanz eines persistierenden Foramen ovale bei Patienten mit PAH und vasoaktiver Therapie. Pneumologie 2014. [DOI: 10.1055/s-0034-1367991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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27
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Grünig E, Galiè N, Grimminger F, Humbert M, Jing ZC, Keogh AM, Langleben D, Rubin LJ, Kilama MO, Fritsch A, Davie N, Ghofrani HA. Korrelation der hämodynamischen Verbesserung mit der körperlichen Leistungsfähigkeit bei Patienten mit PAH: Ergebnisse der Phase-III-Studie PATENT-1. Pneumologie 2014. [DOI: 10.1055/s-0034-1368073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Rosenkranz S, Simonneau G, D'Armini AM, Ghofrani HA, Grimminger F, Hoeper MM, Jansa P, Kim NH, Wang C, Wilkins MR, Fritsch A, Davie N, Weimann G, Mayer E. Eine Zwischenanalyse der Phase-III-Langzeit-Extension-Studie mit Riociguat bei CTEPH (CHEST-2). Pneumologie 2014. [DOI: 10.1055/s-0034-1367756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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29
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Richter M, Tiede H, Voswinckel R, Seeger W, Ghofrani HA, Reichenberger F. Inspiratorische Kapazität als prognostischer Faktor bei der pulmonal arteriellen Hypertonie. Pneumologie 2014. [DOI: 10.1055/s-0034-1368079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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30
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Pak O, Kressig F, Esfandiary A, Sydykov A, Kojonazarov B, Veit F, Schermuly RT, Grimminger F, Ghofrani HA, Seeger W, Weissmann N, Sommer N. Defizienz des mitochondrialen Entkopplungsproteins „Uncoupling Protein 2“ als neues Modell der pulmonalen Hypertonie. Pneumologie 2014. [DOI: 10.1055/s-0033-1363109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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31
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Grünig E, Grimminger F, Hoeper M, Rosenkranz S, Ghofrani HA. Die Bedeutung von Riociguat in der Behandlung der pulmonal-arteriellen Hypertonie. Pneumologie 2013. [DOI: 10.1055/s-0033-1344972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- E. Grünig
- Zentrum für Pulmonale Hypertonie an der Thoraxklinik am Universitätsklinikum Heidelberg
| | - F. Grimminger
- Med. Klinik IV und V, Innere Medizin, Universitätsklinikum Gießen und Marburg
| | - M. Hoeper
- Klinik für Pneumologie, Medizinische Hochschule Hannover
| | - S. Rosenkranz
- Klinik und Poliklinik für Kardiologie, Pneumologie, Angiologie und internistische Intensivmedizin an der Universitätsklinik Köln
| | - H.-A. Ghofrani
- Med. Klinik II, Innere Medizin, Universitätsklinikum Gießen und Marburg
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32
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Ghofrani HA, Grimminger F, Halank M, Grünig E, Mayer E, Neurohr C, Wilkens H, Hoeper M. Riociguat zur Therapie der inoperablen chronisch thromboembolischen pulmonalen Hypertonie: Eine randomisierte, doppelblinde, placebokontrollierte Phase-III-Studie (CHEST-1). Pneumologie 2013. [DOI: 10.1055/s-0033-1344974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- H.-A. Ghofrani
- Med. Klinik II, Innere Medizin, Universitätsklinikum Gießen und Marburg, Gießen
| | - F. Grimminger
- Med. Klinik IV und V, Innere Medizin, Universitätsklinikum Gießen und Marburg; Gießen
| | - M. Halank
- Med. Klinik I, Bereich Pneumologie, Universitätsklinikum Dresden
| | - E. Grünig
- Zentrum für Pulmonale Hypertonie an der Thoraxklinik am Universitätsklinikum Heidelberg
| | - E. Mayer
- Abteilung für Thoraxchirurgie Kerckhoff Klinik Bad Nauheim
| | - C. Neurohr
- Med. Klinik I und Poliklinik, Klinikum d. Universität München
| | - H. Wilkens
- Med. Klinik und Poliklinik, Abt. Pneumologie, Universitätsklinikum des Saarlandes, Homburg
| | - M. Hoeper
- Klinik für Pneumologie, Medizinische Hochschule Hannover
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Weisel F, Kloepping C, Pichl A, Sydykov A, Kojonazarov B, Wilhelm J, Roth M, Ridge K, Ghofrani HA, Schermuly R, Grimminger F, Seeger W, Weißmann N, Kwapiszewska G. Die Rolle von AMD-1 in vaskulären Umbauprozessen bei pulmonaler Hypertonie. Pneumologie 2013. [DOI: 10.1055/s-0033-1344711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- F. Weisel
- Universities of Giessen and Marburg Lung Center (UGMLC), Deutsches Zentrum für Lungenforschung (DZL), Excellence Cluster Cardio-Pulmonary System (ECCPS), Giessen, Deutschland,
| | - C. Kloepping
- Universities of Giessen and Marburg Lung Center (UGMLC), Deutsches Zentrum für Lungenforschung (DZL), Excellence Cluster Cardio-Pulmonary System (ECCPS), Giessen, Deutschland,
| | - A. Pichl
- Universities of Giessen and Marburg Lung Center (UGMLC), Deutsches Zentrum für Lungenforschung (DZL), Excellence Cluster Cardio-Pulmonary System (ECCPS), Giessen, Deutschland,
| | - A. Sydykov
- Universities of Giessen and Marburg Lung Center (UGMLC), Deutsches Zentrum für Lungenforschung (DZL), Excellence Cluster Cardio-Pulmonary System (ECCPS), Giessen, Deutschland,
| | - B. Kojonazarov
- Universities of Giessen and Marburg Lung Center (UGMLC), Deutsches Zentrum für Lungenforschung (DZL), Excellence Cluster Cardio-Pulmonary System (ECCPS), Giessen, Deutschland,
| | - J. Wilhelm
- Universities of Giessen and Marburg Lung Center (UGMLC), Deutsches Zentrum für Lungenforschung (DZL), Excellence Cluster Cardio-Pulmonary System (ECCPS), Giessen, Deutschland,
| | - M. Roth
- Universities of Giessen and Marburg Lung Center (UGMLC), Deutsches Zentrum für Lungenforschung (DZL), Excellence Cluster Cardio-Pulmonary System (ECCPS), Giessen, Deutschland,
| | - K. Ridge
- Division of Pulmonary and Critical Care Medicine Northwestern University, Chicago, Illinois, USA,
| | - H.-A. Ghofrani
- Universities of Giessen and Marburg Lung Center (UGMLC), Deutsches Zentrum für Lungenforschung (DZL), Excellence Cluster Cardio-Pulmonary System (ECCPS), Giessen, Deutschland,
| | - R. Schermuly
- Universities of Giessen and Marburg Lung Center (UGMLC), Deutsches Zentrum für Lungenforschung (DZL), Excellence Cluster Cardio-Pulmonary System (ECCPS), Giessen, Deutschland,
| | - F. Grimminger
- Universities of Giessen and Marburg Lung Center (UGMLC), Deutsches Zentrum für Lungenforschung (DZL), Excellence Cluster Cardio-Pulmonary System (ECCPS), Giessen, Deutschland,
| | - W. Seeger
- Universities of Giessen and Marburg Lung Center (UGMLC), Deutsches Zentrum für Lungenforschung (DZL), Excellence Cluster Cardio-Pulmonary System (ECCPS), Giessen, Deutschland,
| | - N. Weißmann
- Universities of Giessen and Marburg Lung Center (UGMLC), Deutsches Zentrum für Lungenforschung (DZL), Excellence Cluster Cardio-Pulmonary System (ECCPS), Giessen, Deutschland,
| | - G. Kwapiszewska
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Österreich
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Kojonazarov B, Lang M, Tian X, Kalymbetov A, Weißmann N, Grimminger F, Kretschmer A, Stasch JP, Ghofrani HA, Seeger W, Schermuly R. Wirkung des sGC-Stimulators Riociguat auf das pulmonalvaskuläre und rechtsventrikuläre Remodeling bei schwerer pulmonal-arterieller Hypertonie. Pneumologie 2013. [DOI: 10.1055/s-0033-1344748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- B. Kojonazarov
- Universities of Giessen and Marburg Lung Center, Excellence Cluster Cardio-Pulmonary System, Member of the German Center for Lung Research, Giessen
| | - M. Lang
- Universities of Giessen and Marburg Lung Center, Excellence Cluster Cardio-Pulmonary System, Member of the German Center for Lung Research, Giessen
| | - X. Tian
- Universities of Giessen and Marburg Lung Center, Excellence Cluster Cardio-Pulmonary System, Member of the German Center for Lung Research, Giessen
| | - A. Kalymbetov
- Universities of Giessen and Marburg Lung Center, Excellence Cluster Cardio-Pulmonary System, Member of the German Center for Lung Research, Giessen
| | - N. Weißmann
- Universities of Giessen and Marburg Lung Center, Excellence Cluster Cardio-Pulmonary System, Member of the German Center for Lung Research, Giessen
| | - F. Grimminger
- Universities of Giessen and Marburg Lung Center, Excellence Cluster Cardio-Pulmonary System, Member of the German Center for Lung Research, Giessen
| | | | | | - H.-A. Ghofrani
- Universities of Giessen and Marburg Lung Center, Excellence Cluster Cardio-Pulmonary System, Member of the German Center for Lung Research, Giessen
| | - W. Seeger
- Universities of Giessen and Marburg Lung Center, Excellence Cluster Cardio-Pulmonary System, Member of the German Center for Lung Research, Giessen
| | - R. Schermuly
- Universities of Giessen and Marburg Lung Center, Excellence Cluster Cardio-Pulmonary System, Member of the German Center for Lung Research, Giessen
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Richter MJ, Voswinkel R, Tiede H, Seeger W, Schulz R, Ghofrani HA, Reichenberger F. [Dynamic hyperinflation in pulmonary arterial hypertension: "hyperinflator" and "non-hyperinflator"]. Pneumologie 2013; 67:280-7. [PMID: 23677553 DOI: 10.1055/s-0033-1343148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The dynamic decrease in inspiratory capacity (IC) during exercise with restriction of tidal volume (VT) is known as dynamic hyperinflation (DH) and is described mostly in patients with COPD differentiating between a "hyperinflator" and a "non-hyperinflator". Recent studies have revealed DH in patients with idiopathic pulmonary arterial hypertension (iPAH), but the influence of the DH on the reduced exercise capacity with exertional dyspnoae is still being debated. METHODS We analysed flow-volume curves during cardiopulmonary exercise testing (CPET) in idiopathic PAH (n = 19), in COPD (n = 17), in idiopathic pulmonary fibrosis (IPF) (n = 19) and a control group (n = 30). We measured IC at rest and during maximal exercise and furthermore ventilation, VT and oxygen uptake (VO2 peak). In iPAH a right heart catheter test and a 6-minute walk test (6MWT) were performed, also the B-type naturetic peptide (BNP) and the NYHA/WHO functional class were determined. RESULTS The IC decreased significantly in 11 PAH "hyperinflators" (PAH-H) (Δ IC: - 0.34 ± 0.14 L, p < 0.001) compared to 8 PAH "non-hyperinflators" (PAH-NH) (Δ IC: 0.08 ± 0.2 L). COPD patients exhibited a characteristic hyperinflation pattern with a decrease in IC throughout exercise (Δ IC: - 0.61 ± 0.3 L, p < 0.001), while patients with IPF (Δ IC: 0.03 ± 0.15 L) and the control group responsed to exercise with a non-hyperinflator pattern (Δ IC: 0.1 ± 0.2 L). Both PAH collectives showed a reduced IC/TLC, while VT/IC was elevated with a decreased peak VO2 and max. performance compared to the control group. Correlations of the IC rest/max (L) were shown in PAH-H and PAH-NH with the VO2 peak, max. performance and VT. CONCLUSION The analysis of flow-volume curves during CPET can indentify DH in a subgroup of patients with iPAH. The DH contributes significantly but slightly to the development of exertional limitations and dyspnoe in a subgroup of iPAH. Further studies with a larger sample size will be required to definitively measure the impact of the DH seen in these patients.
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Affiliation(s)
- M J Richter
- Abteilung für allgemeine Pneumologie, Kerckhoff-Klinik Bad Nauheim, Bad Nauheim, Germany.
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Post S, Tiede H, Voswinckel R, Lehndeckel F, Thamm M, Sommer N, Schulz R, Seeger W, Ghofrani HA, Reichenberger F. Entitäten der PH bei neu diagnostizierten Patienten - Bericht aus einem pneumologisch orientiertem PH-Zentrum. Pneumologie 2013. [DOI: 10.1055/s-0033-1334744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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37
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Richter MJ, Voswinckel R, Tiede H, Seeger W, Ghofrani HA, Reichenberger F. Inspiratorische Kapazität unter Belastung im Follow-up bei stabilen Patienten mit pulmonal arterieller Hypertonie. Pneumologie 2013. [DOI: 10.1055/s-0033-1334745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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38
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Uwira S, Weismann S, Grünig E, Olschewski H, Tiede H, Voswinckel R, Köster M, Ghofrani HA, Seeger W, Reichenberger F. Nicht-invasive Evaluation der pulmonalen Zirkulation bei Angehörigen von Patienten mit idiopathischer pulmonalarterieller Hypertonie. Pneumologie 2013. [DOI: 10.1055/s-0033-1334739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Right-sided heart failure is a severe and often life-threatening complication of chronic pulmonary hypertension. The detection of trigger factors that induce right heart failure in previously stable patients is important to initiate a causal therapeutic strategy. Pulmonary embolism (PE) is a frequent cause of acute right heart failure and therapeutic strategies for PE are well documented in the current guidelines. Treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH) is surgical pulmonary endarterectomy (PEA) and patients with possible CTEPH should be referred to an experienced PEA surgeon without delay. Intensive care management for overt right heart failure is complex and includes the use of pulmonary vasodilators, individual adjustment of diuretic or volume therapy, augmentation of myocardial contractility and left ventricular afterload. Therapeutic regimens aim at optimized filling of the right ventricle, improvement of myocardial perfusion by avoiding tachycardia, elevating systemic pressure and reducing right ventricular afterload. Early communication with a specialized center for pulmonary hypertension is recommended.
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Affiliation(s)
- R Voswinckel
- Medizinische Klinik II/V, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Mitglied des Deutschen Zentrums für Lungenforschung (DZL), Klinikstrasse 33, Gießen, Germany.
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Luitel H, Sydykov A, Pradhan K, Kojonazarov B, Janssen W, Weissmann N, Seeger W, Grimminger F, Ghofrani HA, Schermuly RT. Mast cells in chronic pressure overload induced right ventricular hypertrophy. Pneumologie 2012. [DOI: 10.1055/s-0032-1315543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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41
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Szelepusa K, Kojonazarov B, Janssen W, Ghofrani HA, Weissmann N, Grimminger F, Seeger W, Schermuly RT. Echocardiographic assessment of right ventricular structure and function in hypoxic induced pulmonary hypertension - effects of Riociguat and Sildenafil. Pneumologie 2012. [DOI: 10.1055/s-0032-1315534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Veith C, Wygrecka M, Rutschmann K, Ghofrani HA, Seeger W, Grimminger F, Schermuly RT, Weissmann N, Kwapiszewska G. Regulation of pulmonary arterial smooth muscle cell function in pulmonary hypertension via Paxillin. Pneumologie 2012. [DOI: 10.1055/s-0032-1315542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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43
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Al-Tamari HM, Eschenhagen M, Schmall A, Savai R, Ghofrani HA, Grimminger F, Seeger W, Schermuly RT, Pullamsetti SS. The role of Forkhead Box O 3a (FoxO3a) Transcription Factors in the Pathogenesis of Pulmonary Fibrosis. Pneumologie 2012. [DOI: 10.1055/s-0032-1315520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Neumann J, Janssen W, Kojonazarov B, Döbele C, Ghofrani HA, Weissmann N, Grimminger F, Seeger W, Dimmeler S, Schermuly RT. Role of microRNA-21 in right ventricular hypertrophy and fibrosis. Pneumologie 2012. [DOI: 10.1055/s-0032-1315533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Tretyn A, Schlüter KD, Janssen W, Ghofrani HA, Grimminger F, Seeger W, Schermuly RT, Pullamsetti SS. Wnt Signaling Pathway in Right Ventricular Remodeling. Pneumologie 2012. [DOI: 10.1055/s-0032-1315541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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46
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Dabral S, Pullamsetti SS, Lang M, Ghofrani HA, Weissmann N, Grimminger F, Seeger W, Schermuly RT. Role of Notch Signaling in Pulmonary Hypertension. Pneumologie 2012. [DOI: 10.1055/s-0032-1315544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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47
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Pichl A, Parajuli N, Seimetz M, Stasch JP, Frey R, Schermuly RT, Seeger W, Grimminger F, Ghofrani HA, Weissmann N. Stimulation of Soluble Guanylate Cyclase by Riociguat prevents Tobacco smoke-induced Pulmonary Hypertension in mice. Pneumologie 2012. [DOI: 10.1055/s-0032-1315498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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48
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Mittal M, Gu XQ, Pak O, Pamenter ME, Haag D, Fuchs DB, Schermuly RT, Ghofrani HA, Brandes RP, Seeger W, Grimminger F, Haddad GG, Weissmann N. Hypoxia induces Kv channel current inhibition by increased NADPH oxidase-derived reactive oxygen species. Free Radic Biol Med 2012; 52:1033-42. [PMID: 22222468 DOI: 10.1016/j.freeradbiomed.2011.12.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 11/23/2011] [Accepted: 12/03/2011] [Indexed: 10/24/2022]
Abstract
There is current discussion whether reactive oxygen species are up- or downregulated in the pulmonary circulation during hypoxia, from which sources (i.e., mitochondria or NADPH oxidases) they are derived, and what the downstream targets of ROS are. We recently showed that the NADPH oxidase homolog NOX4 is upregulated in hypoxia-induced pulmonary hypertension in mice and contributes to the vascular remodeling in pulmonary hypertension. We here tested the hypothesis that NOX4 regulates K(v) channels via an increased ROS formation after prolonged hypoxia. We showed that (1) NOX4 is upregulated in hypoxia-induced pulmonary hypertension in rats and isolated rat pulmonary arterial smooth muscle cells (PASMC) after 3days of hypoxia, and (2) that NOX4 is a major contributor to increased reactive oxygen species (ROS) after hypoxia. Our data indicate colocalization of K(v)1.5 and NOX4 in isolated PASMC. The NADPH oxidase inhibitor and ROS scavenger apocynin as well as NOX4 siRNA reversed the hypoxia-induced decrease in K(v) current density whereas the protein levels of the channels remain unaffected by siNOX4 treatment. Determination of cysteine oxidation revealed increased NOX4-mediated K(v)1.5 channel oxidation. We conclude that sustained hypoxia decreases K(v) channel currents by a direct effect of a NOX4-derived increase in ROS.
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Affiliation(s)
- Manish Mittal
- Excellence Cluster Cardio-Pulmonary System, University of Giessen Lung Center, Justus-Liebig-University, Medical Clinic II/V, Aulweg 130, Giessen 35392, Germany
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Becker-Grünig T, Ehlken N, Lichtblau M, Ghofrani HA, Klose H, Gorenflo M, Sorichter S, Meyer A, Halank M, Grünig E. Atem- und Bewegungstherapie bei Patienten mit assoziierter pulmonal-arterieller Hypertonie bei angeborenem Herzfehler. Pneumologie 2012. [DOI: 10.1055/s-0032-1302572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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50
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Kwapiszewska G, Markart P, Marsh LM, Dahal B, Schermuly RT, Taube C, Meinhardt A, Ghofrani HA, Steinhoff M, Seeger W, Preissner KT, Weißmann N, Wygrecka M. PAR-2 depletion protects against development of pulmonary hypertension. Pneumologie 2012. [DOI: 10.1055/s-0032-1302546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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