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Platelets and chronic thromboembolic pulmonary hypertension 血小板和慢性血栓栓塞性肺动脉高压
Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa1444
T. Oliveira, Luciana Tamie Kato-Morinaga, A. P. Assad, E. Oliveira, C. Jardim, J. Alves-Jr, R. Souza, C. Fernandes
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引用次数: 2
Activation of de novo NAD synthesis in the lung of pulmonary hypertension 肺动脉高压患者肺部新生NAD合成的激活
Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa1419
Zongye Cai, Claude van der Ley, M. Faassen, I. Kema, D. Duncker, D. Merkus
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引用次数: 0
NTP42, an antagonist of the thromboxane receptor, attenuates experimentally-induced pulmonary arterial hypertension NTP42是一种血栓素受体拮抗剂,可减轻实验诱导的肺动脉高压
Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa5048
B. Kinsella, E. Mulvaney, H. Reid
NTP42 is a novel antagonist of the thromboxane (TX)A2 receptor (TP), in development for treatment of pulmonary arterial hypertension (PAH). PAH is a devastating disease with multiple pathophysiological hallmarks including excessive pulmonary vasoconstriction, vascular remodelling, fibrosis, inflammation, thrombosis and right ventricular hypertrophy. Signalling through the TP, TXA2 is a potent vasoconstrictor, is a driver of platelet aggregation, a pro-mitogenic and a pro-inflammatory mediator. Mechanistically, TP antagonists should treat many of the hallmarks of PAH, including the excess vasoconstriction, remodelling, in situ thrombosis, fibrosis and inflammation. This study investigated the efficacy of NTP42 in a monocrotaline (MCT)-induced PAH rat model. PAH was induced by subcutaneous injection of 60 mg/kg MCT. Rats were assigned to the groups: 1) No MCT, 2) MCT Only, 3) MCT+NTP42, 4) MCT+Sildenafil and 5) MCT+Selexipag, where 28-day treatment was initiated 24hr post-MCT. From hemodynamic measurements, NTP42 reduced MCT-induced PAH including mean pulmonary arterial pressure (mPAP) and right systolic ventricular pressure (RSVP). Moreover, NTP42 was superior to standard-of-care (SoC) drugs Sildenafil or Selexipag in reducing vessel remodelling, inflammation and fibrosis. A multiparameter score of key disease indices, including mPAP, RVSP, Fulton’s index, vessel remodelling, inflammation and fibrosis, shows that NTP42 has significant treatment benefits and superior to the SoCs tested. These findings suggest that NTP42 and antagonism of TP signalling may alleviate PAH pathophysiology, representing a novel therapeutic target with marked benefits over existing therapies.
NTP42是一种新型的血栓素(TX)A2受体(TP)拮抗剂,正在开发用于治疗肺动脉高压(PAH)。PAH是一种具有多种病理生理特征的毁灭性疾病,包括肺血管过度收缩、血管重构、纤维化、炎症、血栓形成和右心室肥厚。通过TP信号传导,TXA2是一种有效的血管收缩剂,是血小板聚集的驱动因素,促有丝分裂和促炎症介质。从机制上讲,TP拮抗剂可以治疗PAH的许多特征,包括血管过度收缩、重构、原位血栓形成、纤维化和炎症。本研究探讨了NTP42在MCT诱导的PAH大鼠模型中的作用。皮下注射60 mg/kg MCT诱导PAH。将大鼠分为3组:1)No MCT, 2) Only MCT, 3) MCT+NTP42, 4) MCT+西地那非和5)MCT+Selexipag,在MCT 24小时后开始28天的治疗。从血流动力学测量来看,NTP42降低了mct诱导的PAH,包括平均肺动脉压(mPAP)和右收缩压(RSVP)。此外,NTP42在减少血管重构、炎症和纤维化方面优于标准护理(SoC)药物西地那非或Selexipag。mPAP、RVSP、Fulton指数、血管重构、炎症和纤维化等关键疾病指标的多参数评分显示,NTP42具有显著的治疗益处,优于所测试的soc。这些发现表明,NTP42和TP信号的拮抗作用可能减轻PAH的病理生理,代表了一种新的治疗靶点,比现有的治疗方法有明显的好处。
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引用次数: 0
Hemodynamical effects of metformin and sildenafil in the treatment of experimental pulmonary hypertension 二甲双胍和西地那非治疗实验性肺动脉高压的血流动力学影响
Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa4752
Vicente Benavides, Melissa Silva-Medina Weil, S. Castaño, Mauricio Palacios
Metformin has been reported to have experimental effects that could be beneficial in the treatment of PH (pulmonary hypertension), though the specific mechanism of action is still under speculation. The current management of this condition is sildenafil, even in patients that requiere metformin as part of the treatment for other comorbilities. Both metformin and sildenafil effectively lower the systolic pressure in the right ventricle, however there are no reports comparing the hemodynamical effects of the two treatments. The goal of this study was to do so using a monocrotaline-induced PH rat model. The rats were divided in 5 groups, consisting of 3 treatment groups (metformin, sildenafil and combination therapy) and two control groups (positive and negative). They were followed for 60 days, at day 30 and 60 an echocardiogram was performed (ventricular ejection fraction was measured), and at day 60 cardiac catheterism was carried out, and Fulton index was estimated. No treatment scheme was effective using the right ventricle ejection fraction as a parameter. The three treatment groups had a positive response using the other outcome variables. The RVSP was improved compared to the positive (PH) controls, without reaching the negative control’s pressure regardless of the group. Fulton’s index remained pathological, but demonstrated a therapeutical effect of the pharmacological treatments. Metformin was not inferior to sildenafil in a PH rat model, interestingly combination treatment shows no hemodynamical synergy between these drugs. Safety evaluation of the kidney and liver showed no pathological or functional differences between the groups.
据报道,二甲双胍的实验效果可能有利于治疗肺动脉高压,但具体的作用机制仍在推测中。目前这种情况的治疗是西地那非,即使是那些需要二甲双胍作为其他合并症治疗的一部分的患者。二甲双胍和西地那非都能有效降低右心室的收缩压,但没有比较两种治疗对血流动力学影响的报道。本研究的目的是使用一种单苦杏仁碱诱导的PH大鼠模型来做到这一点。将大鼠分为5组,分为3个治疗组(二甲双胍、西地那非及联合治疗)和2个对照组(阳性和阴性)。随访60天,在第30天和第60天进行超声心动图(测量心室射血分数),第60天进行心导管插管,并估计Fulton指数。以右心室射血分数作为参数,没有有效的治疗方案。使用其他结果变量,三个治疗组有积极的反应。与阳性(PH)对照组相比,RVSP得到了改善,无论在何种组,RVSP都没有达到阴性对照组的压力。富尔顿指数仍然是病理性的,但显示出药物治疗的治疗效果。在PH大鼠模型中,二甲双胍并不逊于西地那非,有趣的是,联合治疗显示这些药物之间没有血流动力学协同作用。肾脏和肝脏的安全性评估显示两组之间没有病理或功能差异。
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引用次数: 0
Factors associated with daily physical activity in patients with Pulmonary arterial hypertension 肺动脉高压患者日常体力活动的相关因素
Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa5465
Layse N G Lima, F. Mendes, M. M. Moreira, D. Oliveira, M. C. Pereira
Background: Pulmonary arterial hypertension (PAH) reduces daily physical activity (DLPA) but the underlying mechanisms are not fully understood. The aim of this study was to evaluate DLPA and to determine its relationship to functional capacity and psychological factors in patients with PAH. Methods: This was a single-center prospective study of DLPA conducted in a Brazilian University hospital. Twenty stable PAH subjects mean age 44.3 ± 13.2 yrs, 80% Idiopathic PAH and 20% PAH associated to collagen disease, functional class (CF-NYHA I/II/III: N=7/10/3) completed a 7-day monitoring of daily walking steps by accelerometer and performed pulmonary function tests, 6-minute walk test (6MWT), 1-min sit-to-stand test (STST), and echocardiogram. They also answered 3 questionnaires (quality of life [SF-36], hospital anxiety and depression scale [HADS], and Manchester Respiratory Activities of Daily Living [MRADL]). Results: The mean number of daily steps was 4,280 ± 2,351, and the mean activity time was 41.6 ± 19.3minutes. The mean number of daily steps correlated positively (p Conclusion: DLPA is reduced in PAH and is associated to limitation of daily living activities, functional capacity and depression symptoms, but not with echo variables. These findings reinforce the multifactorial nature of exercise limitation in PAH. Also, they suggest that objective measurement of habitual activity might provide additive value in PAH assessment.
背景:肺动脉高压(PAH)降低了日常身体活动(DLPA),但其潜在机制尚不完全清楚。本研究的目的是评估PAH患者的DLPA,并确定其与功能能力和心理因素的关系。方法:这是一项在巴西大学医院进行的DLPA单中心前瞻性研究。20例稳定型PAH患者平均年龄44.3±13.2岁,80%特发性PAH和20%与胶原蛋白疾病相关的PAH,功能分类(CF-NYHA I/II/III: N=7/10/3),通过加速度计完成7天的每日步行步数监测,并进行肺功能测试、6分钟步行测试(6MWT)、1分钟坐站立测试(STST)和超声心动图。同时填写3份问卷(生活质量[SF-36]、医院焦虑抑郁量表[HADS]、曼彻斯特日常生活呼吸活动量表[MRADL])。结果:平均日步数为4280±2351步,平均活动时间为41.6±19.3分钟。结论:PAH患者DLPA降低,与日常生活活动限制、功能能力和抑郁症状有关,但与回声变量无关。这些发现强化了运动限制在PAH中的多因素性质。此外,他们认为,对习惯性活动的客观测量可能为PAH评估提供附加价值。
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引用次数: 2
Pulmonary vascular disease (PVD) in patients with Sjögren syndrome - a prospective cross-sectional study Sjögren综合征患者的肺血管疾病(PVD) -一项前瞻性横断面研究
Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa5455
P. Douschan, J. Horwath-winter, J. Hermann, M. Stradner, T. Sassmann, V. Foris, A. Avian, H. Olschewski, G. Kovacs
Background: Sjogren syndrome may be complicated by pulmonary hypertension (PH). However, there are no data available from prospective studies regarding its prevalence. Aims: We aimed to assess the prevalence of PVD including PH, borderline mPAP (20-24mmHg) and exercise PH (EPH) in patients with primary and secondary Sjogren syndrome. Methods: Consecutive patients with Sjogren syndrome underwent echocardiography at rest and during exercise. They were assigned to a low-, intermediate- or high-risk group according to their resting SPAP and their mPAP/CO slope during exercise. In high-risk patients (SPAP≥38mmHg, suspected PH) right heart catheterization (RHC) was suggested. Intermediate-risk patients (SPAP 30-37mmHg [suspected borderline mPAP] or exerciseSPAP≥46mmHg + TPR>3WU [suspected EPH]) RHC was advised in case of symptoms or significantly decreased peakVO2. Results: 86 patients were screened (female N=81, age 58±10yrs, primary Sjogren N=46). N=6 patients had a resting SPAP≥38mmHg, all of them meeting criteria for suspected EPH. N=9 and N=18 fulfilled criteria for suspected borderline mPAP and/or EPH, respectively. RHC was performed in 10 patients. EPH was diagnosed in N=8, borderline mPAP in N=1. No patient had PH. Patients with suspected EPH were older (64±10 vs 55±10, p Conclusions: In this first prospective study evaluating the prevalence of PVD in Sjogren syndrome, 0/86 patients had manifest PH, N=8 had EPH and N=1 had mild PAP elevation. These findings were associated with older age and diastolic LV-dysfunction.
背景:干燥综合征可能并发肺动脉高压(PH)。然而,尚无关于其患病率的前瞻性研究数据。目的:我们旨在评估原发性和继发性干燥综合征患者的PVD患病率,包括PH、边缘性mPAP (20-24mmHg)和运动PH (EPH)。方法:连续的干燥综合征患者在休息和运动时进行超声心动图检查。根据他们的静息SPAP和运动时的mPAP/CO斜率,将他们分为低、中、高风险组。高危患者(SPAP≥38mmHg,怀疑PH)建议行右心导管(RHC)。中度危险患者(SPAP 30-37mmHg[疑似边缘性mPAP]或运动espap≥46mmHg + TPR>3WU[疑似EPH])出现症状或峰值vo2明显降低时建议使用RHC。结果:共筛选86例患者(女性81例,年龄58±10岁,原发性干燥症46例)。6例患者静息SPAP≥38mmHg,均符合疑似EPH标准。N=9和N=18分别符合疑似边缘性mPAP和/或EPH的标准。10例患者行RHC。8例诊断为EPH, 1例诊断为边缘性mPAP。结论:在这项评估干燥综合征PVD患病率的首次前瞻性研究中,0/86例患者有明显的PH, N=8例有EPH, N=1例有轻度PAP升高。这些发现与老年和舒张期左室功能障碍有关。
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引用次数: 0
An observational analysis of exercise capacity in CTEPH patients after pulmonary endarterectomy 肺内膜切除术后CTEPH患者运动能力的观察分析
Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.oa5163
D. Ruigrok, P. Symersky, E. Nossent, A. Boonstra, A. Noordegraaf, L. Meijboom, H. Bogaard
Introduction: Although pulmonary endarterectomy (PEA) in chronic thromboembolic pulmonary hypertension (CTEPH) is a highly effective treatment with significant improvements in hemodynamics and right ventricular function, persistent exercise limitation is frequent with many unknowns regarding its mechanisms. Aims: In an observational analysis we aimed to analyze the changes in exercise parameters post-PEA and identify persistent exercise pathology typical for CTEPH. Methods: We analyzed 68 CTEPH patients with cardiopulmonary exercise testing 6 months post-PEA. Results: 6 months post-PEA max load and peakVO2 significantly improved compared to baseline; circulatory and gas exchange parameters (O2 pulse, PETCO2, VE/VCO2, SpO2) improved, while ventilatory parameters remained unchanged. 42/68 (62%) had persistent exercise limitation 6 months post-PEA (peakVO2 Conclusions: In 68 CTEPH patients exercise capacity significantly improved after PEA; improvements were mainly in the circulatory and gas exchange domain. Persistent exercise limitation was frequent and mainly due to cardiocirculatory pathology. Signs typical of pulmonary vascular limitation during exercise were frequent after PEA in CTEPH.
虽然肺动脉内膜切除术(PEA)治疗慢性血栓栓塞性肺动脉高压(CTEPH)是一种非常有效的治疗方法,可以显著改善血液动力学和右心室功能,但持续运动限制是常见的,其机制尚不清楚。目的:在一项观察性分析中,我们旨在分析pea后运动参数的变化,并确定CTEPH典型的持续运动病理。方法:对68例CTEPH患者在pea术后6个月进行心肺运动试验进行分析。结果:与基线相比,pea后6个月最大负荷和峰值vo2显著改善;循环和气体交换参数(O2脉冲、PETCO2、VE/VCO2、SpO2)改善,而通气参数保持不变。42/68(62%)患者在PEA后6个月持续运动受限。改进主要在循环和气体交换领域。持续的运动限制是常见的,主要是由于心脏循环病理。典型的运动期间肺血管受限的征象在CTEPH的PEA后很常见。
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引用次数: 0
Long Non-coding RNA H19 in Right Ventricular Failure associated with Pulmonary Arterial Hypertension 长链非编码RNA H19在肺动脉高压相关右心衰中的作用
Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa5040
J. Omura, K. Habbout, S. Martineau, S. Breuils-bonnet, V. Nadeau, F. Potus, Stephen L. Archer, R. Paulin, S. Provencher, O. Boucherat, S. Bonnet
Background: Right ventricular failure (RVF) is the major prognostic factor in pulmonary arterial hypertension (PAH). Recent Omics analyses have demonstrated the deregulation of several long non-coding RNAs (LncRNAs) in left heart failure, but their role in RVF remains unknown. The LncRNA H19 and its encoded miR-675 have been implicated in both cardiac hypertrophy and fibrosis (2 features of RVF) but never been studied in RVF. Methods and Results: By qRT-PCR, we showed in human RV biopsies obtained from control donors, compensated RV hypertrophy patients (CRVH, Cardiac index > 2.2) and decompensated RV hypertrophy patients (DRVH, PAH patients that died from RVF), that H19 and miR-675 were specifically up-regulated (p Conclusions: We demonstrated for the first time that H19 is implicated in the transition from CRVH to DRVH in human RVF. Circulating H19 represents a putative biomarker of RV function in PAH patients.
背景:右心室衰竭(RVF)是肺动脉高压(PAH)的主要预后因素。最近的组学分析表明,在左心衰过程中,一些长链非编码rna (LncRNAs)被解除管制,但它们在裂谷热中的作用尚不清楚。LncRNA H19及其编码的miR-675与心脏肥大和纤维化(裂谷热的两个特征)有关,但从未在裂谷热中进行过研究。方法和结果:通过qRT-PCR,我们发现从对照供体、代偿性右心室肥大患者(CRVH, Cardiac index > 2.2)和失代偿性右心室肥大患者(DRVH,死于RVF的PAH患者)获得的人类右心室活检中,H19和miR-675特异性上调(p结论:我们首次证明H19参与了人类RVF从CRVH向DRVH的转变。循环H19是PAH患者RV功能的推定生物标志物。
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引用次数: 3
The total cross-sectional area of bronchial arteries predicts the extent of persistent PH after endarterectomy 支气管动脉总横截面积预测动脉内膜切除术后持续PH的程度
Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.oa5162
Ayumi Sekine, X. Jais, Y. Taniguchi, M. Jevnikar, A. Boucly, L. Savale, D. Montani, O. Sitbon, N. Tanabe, M. Humbert, G. Simonneau
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引用次数: 0
Novel evaluation of pulmonary hypertension with chronic lung disease by perfusion SPECT/CT 灌注SPECT/CT对慢性肺病肺动脉高压的新评价
Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa1432
Kenichiro Atsumi, H. Hayashi, Shunichi Nishima, Toru Tanaka, Takeru Kashiwada, Yoshinobu Saito, M. Seike, A. Gemma, Y. Kubota, Y. Fukushima, H. Kimura
{"title":"Novel evaluation of pulmonary hypertension with chronic lung disease by perfusion SPECT/CT","authors":"Kenichiro Atsumi, H. Hayashi, Shunichi Nishima, Toru Tanaka, Takeru Kashiwada, Yoshinobu Saito, M. Seike, A. Gemma, Y. Kubota, Y. Fukushima, H. Kimura","doi":"10.1183/13993003.congress-2019.pa1432","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa1432","url":null,"abstract":"","PeriodicalId":20724,"journal":{"name":"Pulmonary hypertension","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88503830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Pulmonary hypertension
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