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Identification of Diagnostic Biomarkers Causally Associated With Gut Microbiota and Pulmonary Arterial Hypertension. 与肠道微生物群和肺动脉高压相关的诊断性生物标志物的鉴定。
IF 2.5 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-02 eCollection Date: 2025-10-01 DOI: 10.1002/pul2.70219
Ming Sun, Song Wu

Pulmonary arterial hypertension (PAH) is a pulmonary disease associated with alterations in gut microbiota. We aimed to identify potential diagnostic genes causally associated with gut microbiota and PAH. Mendelian randomization (MR) was performed to screen gut microbiota causally associated with PAH and to identify gut microbiota-related genes. A regulatory network was constructed to reveal the relationships among genes, gut microbiota and PAH. Diagnostic genes were screened and used to construct a diagnostic model for PAH. Characteristics of immune infiltration and diagnostic gene expression in each cell type were evaluated at the transcriptome and single-cell levels. Family. Porphyromonadaceae and genus. Eubacteriumfissicatena were risk factors for PAH, whereas phylum. Actinobacteria, class. Bacilli, genus. Erysipelatoclostridium, and genus. Ruminococcaceae were protective factors for PAH. The gene-gut microbiota-PAH network showed causal associations among six gut microbiota taxa, 13 PAH-associated genes and PAH. Copper metabolism MURR1 domain (COMMD) containing 10 (COMMD10), FES proto-oncogene, tyrosine kinase (FES), nuclear casein kinase and cyclin-dependent kinase substrate 1 (NUCKS1), solute carrier family 22 member 4 (SLC22A4), and synaptogyrin 1 (SYNGR1) were identified as diagnostic genes, with Area Under Curve (AUC) values ranging from 0.79 to 0.99. The abundances of activated B cells, activated CD8 T cells, eosinophils, mast cells, and T helper cells were increased, whereas the abundances of activated dendritic cells (DCs), gamma delta T cells, MDSCs, macrophages, neutrophils, plasmacytoid DCs, and regulatory T cells were decreased in PAH. NUCKS1 was expressed in each cell type and was lower in T/NK and NK cells. The study deepens the understanding of PAH pathogenesis, and may provide diagnostic targets for PAH.

肺动脉高压(PAH)是一种与肠道菌群改变相关的肺部疾病。我们旨在确定与肠道微生物群和多环芳烃有因果关系的潜在诊断基因。采用孟德尔随机化(MR)筛选与多环芳烃有因果关系的肠道微生物群,并鉴定肠道微生物群相关基因。构建了基因、肠道菌群与多环芳烃之间的调控网络。筛选诊断基因,构建PAH诊断模型。在转录组和单细胞水平上评估各细胞类型的免疫浸润特征和诊断基因表达。家庭。卟啉菌科及属。裂裂真杆菌是多环芳烃的危险因素,门。放线菌、类。杆菌属。丹毒梭状芽孢杆菌属。瘤胃球菌科是多环芳烃的保护因子。基因-肠道菌群-多环芳烃网络显示6个肠道菌群分类群、13个多环芳烃相关基因与多环芳烃之间存在因果关系。鉴定出铜代谢MURR1结构域(COMMD)含10 (COMMD10)、FES原癌基因、酪氨酸激酶(FES)、核酪蛋白激酶和周期蛋白依赖性激酶底物1 (NUCKS1)、溶质载体家族22成员4 (SLC22A4)和突触gyrin 1 (SYNGR1)为诊断基因,曲线下面积(AUC)范围为0.79 ~ 0.99。活化的B细胞、活化的CD8 T细胞、嗜酸性粒细胞、肥大细胞和T辅助细胞的丰度增加,而活化的树突状细胞(dc)、γ δ T细胞、MDSCs、巨噬细胞、中性粒细胞、浆细胞样dc和调节性T细胞的丰度在PAH中降低。NUCKS1在各细胞类型中均有表达,在T/NK细胞和NK细胞中表达较低。该研究加深了对多环芳烃发病机制的认识,并可能为多环芳烃提供诊断靶点。
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引用次数: 0
Beyond Resistance: Pulmonary Vascular Compromise as a Mechanistic Window Into Pediatric Pulmonary Hypertension. 超越抵抗:肺血管损伤作为儿童肺动脉高压的机制窗口。
IF 2.5 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-01 eCollection Date: 2025-10-01 DOI: 10.1002/pul2.70218
Megan Griffiths
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引用次数: 0
Exploring the Impact of Platelet-Derived Growth Factor D in Pulmonary Hypertension Development. 探讨血小板衍生生长因子D在肺动脉高压发展中的影响。
IF 2.5 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-11-29 eCollection Date: 2025-10-01 DOI: 10.1002/pul2.70216
Philip Tannenberg, Karin Tran-Lundmark, Ya-Ting Chang, Hanna Gladh, Frank Chenfei Ning, Christian Westöö, Christian Norvik, Azra Alajbegovic, Sebastian Albinsson, Hans Brunnström, Ulf Hedin, Erika Folestad

Pulmonary arterial hypertension (PAH) is a life-threatening condition with no cure, making research into its underlying mechanisms critical. The platelet-derived growth factor (PDGF) signaling pathway plays a crucial role in vascular remodeling, a key factor in PAH progression. Anti-PDGF receptor therapies, such as imatinib, show promise but are associated with significant side effects. Recent research identified PDGF-D as a new risk gene in idiopathic PAH, highlighting the need for further investigation into the PDGF pathway in the disease. In this study, we investigated PDGF-D, a specific PDGFRβ ligand, as a potential therapeutic target. RNA-Seq data from healthy lungs indicated that PDGF-D is predominantly expressed in inflammatory cells, whereas in vascular lesions of idiopathic PAH patients, PDGF-D was produced by various cell types. In vitro, PDGF-D induced mitogenic effects on pulmonary arterial smooth muscle cells. However, genetic deletion of PDGF-D in the chronic hypoxia mouse model of pulmonary hypertension showed no significant impact on vascular muscularization, hemodynamic parameters, or right ventricular hypertrophy. But, the absence of hypoxia-induced Pdgfrb upregulation and the lack of increased expression of PAH-regulated genes, Fgf2 and Notch3, in PDGF-D-deficient mice, suggests activation of alternative mechanisms. MicroRNA analyses revealed PDGF-d-related alterations in the expression of miR-21 and miR-451, both important regulators in PAH, further supporting the notion that PDGF-D plays a unique role in PAH development. Taken together, our data suggest that PDGF-D may target a distinct population of PDGFRβ-expressing cells, separate from those stimulated by PDGF-B, positioning PDGF-D as a potentially unique and compelling therapeutic target for PAH.

肺动脉高压(PAH)是一种危及生命且无法治愈的疾病,因此对其潜在机制的研究至关重要。血小板衍生生长因子(PDGF)信号通路在血管重构中起着至关重要的作用,血管重构是PAH进展的关键因素。抗pdgf受体疗法,如伊马替尼,显示出希望,但与显著的副作用相关。最近的研究发现PDGF- d是特发性PAH的一个新的危险基因,强调了PDGF通路在该疾病中的进一步研究的必要性。在这项研究中,我们研究了PDGF-D,一种特定的PDGFRβ配体,作为潜在的治疗靶点。来自健康肺部的RNA-Seq数据表明,PDGF-D主要在炎症细胞中表达,而在特发性PAH患者的血管病变中,PDGF-D由各种细胞类型产生。在体外,PDGF-D诱导肺动脉平滑肌细胞有丝分裂作用。然而,在慢性缺氧肺动脉高压小鼠模型中,PDGF-D基因缺失对血管肌肉化、血流动力学参数或右心室肥厚没有显著影响。但是,在pdgf -d缺乏的小鼠中,缺乏缺氧诱导的Pdgfrb上调和pah调节基因Fgf2和Notch3的表达增加,表明激活了其他机制。MicroRNA分析显示PDGF-D相关的miR-21和miR-451表达改变,两者都是PAH的重要调节因子,进一步支持PDGF-D在PAH发展中起独特作用的观点。综上所述,我们的数据表明PDGF-D可能靶向pdgfr β表达细胞的不同群体,与PDGF-B刺激的细胞分离,将PDGF-D定位为PAH潜在的独特和引人注目的治疗靶点。
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引用次数: 0
Pulmonary Arterial Wedge Oxygen Saturation: Does It Confirm Wedge Position in Patients With Pulmonary Hypertension? 肺动脉楔血氧饱和度:能确定肺动脉高压患者的楔位吗?
IF 2.5 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-11-27 eCollection Date: 2025-10-01 DOI: 10.1002/pul2.70214
Ambalavanan Arunachalam, Fernando Martinez Guasch, Tanvi Nayak, Mihir John, Abd Abdelhrahman, Anas Ahmed, Harrison W Farber, Nicholas S Hill

Pulmonary artery wedge pressure is a crucial measurement for differentiating between hemodynamic categories of pulmonary hypertension (PH), particularly Groups 1 and 2. In this prospective study, we analyzed the diagnostic utility of checking wedge oxygen saturation to confirm wedge position during right heart catheterization in patients referred for PH.

肺动脉楔压是区分肺动脉高压(PH)血流动力学类型的关键指标,特别是1组和2组。在这项前瞻性研究中,我们分析了在转介PH患者的右心导管插入术中检查楔形血氧饱和度以确定楔形位置的诊断效用。
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引用次数: 0
A Systematic Literature Review Exploring the Efficacy and Safety of Tadalafil and Sildenafil in Pulmonary Arterial Hypertension. 系统性文献综述探讨他达拉非和西地那非治疗肺动脉高压的疗效和安全性。
IF 2.5 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-11-27 eCollection Date: 2025-10-01 DOI: 10.1002/pul2.70212
Rajan Saggar, Nora Rahhali, Assunta Senatore, Marinella Sandros, David Lopez, Gabriela Gomez Rendon, Ambar Khan, Ellie Boulton, Anna Bobrowska, Sandeep Sahay

Pulmonary Arterial Hypertension (PAH) is a rare, chronic and progressive disease affecting the heart and lungs. Endothelin receptor antagonist (ERA) + phosphodiesterase type 5 inhibitor (PDE5i) treatment is recommended for all PAH patients. The two approved PDE5is are tadalafil and sildenafil. To determine the efficacy and safety outcomes for tadalafil and sildenafil as monotherapies or in combination with ERAs for treating PAH, from randomized controlled trials (RCTs) and real-world evidence studies (RWEs) identified by a systematic literature review (SLR). MEDLINE, Embase and Cochrane Libraries were searched in May 2024. Relevant outcomes included 6-min walk distance (6MWD), pulmonary vascular resistance (PVR) and safety. This report includes studies where patients were treated with either sildenafil or tadalafil. Fifteen RCTs and three RWEs investigated tadalafil (tadalafil 40 mg or 20 mg once daily) or sildenafil (20 mg three times a day). Mean 6MWD change from baseline (CFB) in patients receiving tadalafil or sildenafil monotherapy were comparable, however, in combination with an ERA, tadalafil may be more effective. Generally, there was more data for tadalafil + ERAs, showing marked improvement in mean PVR CFB, compared with patients receiving sildenafil. Conclusions on safety were limited. Risk of bias in RCTs was generally low but moderate in RWEs. Two studies reported patients who switched from sildenafil to tadalafil treatment, treatment transition was feasible. Although comparable when used as monotherapy, this qualitative analysis suggests that tadalafil + ERA combination therapy may have more favorable 6MWD improvements than sildenafil + ERA combination therapy.

肺动脉高压(PAH)是一种罕见的影响心脏和肺部的慢性进行性疾病。所有PAH患者推荐使用内皮素受体拮抗剂(ERA) +磷酸二酯酶5型抑制剂(PDE5i)治疗。批准的两种pde5药物是他达拉非和西地那非。通过系统文献综述(SLR)确定随机对照试验(rct)和真实世界证据研究(RWEs),以确定他达拉非和西地那非单独治疗或与ERAs联合治疗PAH的疗效和安全性。2024年5月检索MEDLINE、Embase和Cochrane图书馆。相关指标包括6分钟步行距离(6MWD)、肺血管阻力(PVR)和安全性。该报告包括用西地那非或他达拉非治疗患者的研究。15项随机对照试验和3项随机对照试验研究了他达拉非(他达拉非40毫克或20毫克,每日1次)或西地那非(20毫克,每日3次)。接受他达拉非或西地那非单药治疗的患者从基线的平均6MWD变化(CFB)是相当的,然而,与ERA联合,他达拉非可能更有效。总的来说,他达拉非+ ERAs的数据更多,与接受西地那非的患者相比,平均PVR CFB有显著改善。关于安全性的结论有限。rct的偏倚风险一般较低,而RWEs的偏倚风险中等。两项研究报告了从西地那非转为他达拉非治疗的患者,治疗过渡是可行的。虽然作为单药使用时具有可比性,但本定性分析表明,他达拉非+ ERA联合治疗可能比西地那非+ ERA联合治疗具有更有利的6MWD改善。
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引用次数: 0
Progressive Pericardial Effusions (PEF) in Patients With Pulmonary Arterial Hypertension (PAH) Taking Sotatercept-Association With Pre-Existing Pericardial Effusion. 肺动脉高压(PAH)患者的进行性心包积液(PEF)与先前存在的心包积液相关。
IF 2.5 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-11-26 eCollection Date: 2025-10-01 DOI: 10.1002/pul2.70215
Hilamber Subba, Tapan H Mehta, John Gilboy, Jacob Gelman, Rachel Cutting, Kellie Ramsdell, Heidi Roy, Joel A Wirth

Pericardial effusion (PEF) in PAH may be a marker of worsening disease or associated with autoimmune conditions. Sotatercept was not initially reported as associated with the development or progression of PEF. We describe PAH patients taking sotatercept who were found to have new or worsening PEF and examine associated comorbidities.

PAH患者心包积液(PEF)可能是疾病恶化或与自身免疫性疾病相关的标志。sotaterept最初未被报道与PEF的发生或进展相关。我们描述了服用索特西普的PAH患者,他们被发现有新的或恶化的PEF,并检查了相关的合并症。
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引用次数: 0
Initial Experience of Multipurpose Mechanical Aspiration System for Acute High-Risk Pulmonary Embolism: A Prospective Multi-Center Case Series. 多用途机械抽吸系统治疗急性高危肺栓塞的初步经验:前瞻性多中心病例系列。
IF 2.5 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-11-25 eCollection Date: 2025-10-01 DOI: 10.1002/pul2.70206
GuangMing Tan, Timothy Ho Him Kam, Edbert Cheuk Yin Lai, Esmond Yan Hang Fong, Jake Yin Kei Yeung, Bryan Ping-Yen Yan

High-risk acute pulmonary embolism (PE) is associated with significant in-hospital mortality. Large-Bore Mechanical Thrombectomy (LBMT) is a treatment option for acute PE, but data on its efficacy in high-risk PE was limited. This prospective case series reported the outcomes of 14 patients with high-risk PE treated using a novel multipurpose mechanical aspiration system (MMAS). Most patients were in hemodynamic decompensation, requiring inotropic or mechanical circulatory support. The mean procedural time was 73.5 ± 39.2 min. Complete procedural success was achieved in 78.6% of the cases, while two patients required bailout therapies. The mean pulmonary arterial pressure decreased by 27.2%, and the right-ventricle/left-ventricle ratio normalized in 85.7% of patients. The primary endpoint-in-hospital mortality-was 0%, while the major bleeding rate was 27.2%. These findings suggest that MMAS is a safe and effective intervention for acute high-risk PE.

高风险急性肺栓塞(PE)与显著的住院死亡率相关。大口径机械取栓术(LBMT)是急性PE的一种治疗选择,但其在高危PE中的疗效数据有限。本前瞻性病例系列报道了14例高风险PE患者使用新型多用途机械抽吸系统(MMAS)治疗的结果。大多数患者血流动力学失代偿,需要肌力或机械循环支持。平均手术时间73.5±39.2 min。78.6%的病例手术完全成功,2例患者需要紧急救助治疗。平均肺动脉压下降27.2%,85.7%的患者右心室/左心室比值恢复正常。主要终点住院死亡率为0%,而大出血率为27.2%。这些发现表明MMAS是一种安全有效的干预急性高危PE的方法。
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引用次数: 0
Why Is Pulmonary Endarterectomy Underused in Japan? Epidemiology, Genetics, and a Practical Operability Framework. 为什么肺内膜切除术在日本应用不足?流行病学,遗传学和实际可操作性框架。
IF 2.5 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-11-25 eCollection Date: 2025-10-01 DOI: 10.1002/pul2.70213
Masayuki Nishiyama, Takayuki Okada, Hiroyasu Tsukaguchi, Tadaaki Koyama

Chronic thromboembolic pulmonary hypertension (CTEPH) is a complication of pulmonary embolism that is characterized by chronic obstruction of pulmonary arteries because of organized thrombi. Pulmonary endarterectomy (PEA) is the primary treatment of choice for CTEPH, which aims to clear the pulmonary arteries as completely as possible to decrease right ventricular afterload, thereby improving pulmonary hypertension (PH). PEA is a complex surgical procedure involving cardiopulmonary bypass and deep hypothermic circulatory arrest. Although it provides excellent outcomes, it is associated with frequent complications, including lung reperfusion injury, endobronchial hemorrhage, and persistent PH. Therefore, patients with CTEPH need to be referred to specialized centers. Germany performs approximately 150 PEA procedures annually. However, in Japan, the availability of PEA facilities is limited. The present study aims to delineate the differences in CTEPH management between Japan and Germany, evaluate the underlying reasons for the limited implementation of PEA in Japan, and underscore the need for specialized assessment and referral of patients who are eligible for PEA. The limited utilization of PEA in Japan appears to be attributable not to underestimation of the procedure itself, but rather to anatomical and institutional constraints.

慢性血栓栓塞性肺动脉高压(CTEPH)是肺栓塞的一种并发症,其特征是有组织血栓导致肺动脉慢性阻塞。肺动脉内膜切除术(PEA)是CTEPH的主要治疗选择,其目的是尽可能完全清除肺动脉,减少右心室后负荷,从而改善肺动脉高压(PH)。PEA是一项复杂的外科手术,包括体外循环和深度低温循环停搏。虽然它提供了良好的结果,但它与常见的并发症相关,包括肺再灌注损伤、支气管内出血和持续的ph。因此,CTEPH患者需要转诊到专门的中心。德国每年实施大约150例PEA手术。然而,在日本,PEA设施的可用性有限。本研究旨在描述日本和德国在CTEPH管理方面的差异,评估日本实施PEA有限的潜在原因,并强调对符合PEA条件的患者进行专门评估和转诊的必要性。在日本,PEA的有限利用似乎不是由于对程序本身的低估,而是由于解剖学和体制上的限制。
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引用次数: 0
Why Wait for Sick People to Get Sicker? The Paradox of the Treatment of Patients With Pulmonary Arterial Hypertension. 为什么要等病人病情加重?肺动脉高压患者治疗的悖论。
IF 2.5 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-11-20 eCollection Date: 2025-10-01 DOI: 10.1002/pul2.70202
Mauricio Orozco-Levi, Vinicio A de Jesús Pérez, Tomas Pulido, Angie Pabón-Quezada, Philip Morisky, Rafael Conde-Camacho, Alba Ramírez-Sarmiento

Pulmonary arterial hypertension (PAH) is a chronic, progressive, and ultimately life-threatening disease characterized by vascular remodeling and increasing pulmonary vascular resistance. Despite significant advances in diagnostic tools and therapeutic strategies, clinical intervention often begins only when patients become symptomatic-typically at New York Heart Association (NYHA) functional class II or higher. Paradoxically, while early detection of PAH is strongly encouraged to preempt irreversible vascular, cardiac, and multisystem damage, treatment remains largely restricted to those already exhibiting symptoms. Patients in NYHA class I, though experiencing pathophysiological progression, are systematically excluded from approved pharmacological therapies. This disjunction represents not only a clinical and ethical conundrum but also a conceptual paradox: why invest in early diagnosis if early treatment is withheld? Emerging evidence on various chronic diseases, including cancer, infectious diseases like HIV and hepatitis, and even other cardiovascular diseases, underscores the benefits of initiating treatment before the onset of symptoms. In contrast, the current approach to PAH inadvertently promotes a nihilistic "wait and see" policy, exposing asymptomatic patients to preventable deterioration. Herein, we call for a reassessment of clinical guidelines, regulatory frameworks, and access policies with the goal of better aligning them with the biological realities of PAH. While we advocate for a paradigm shift toward the inclusion of NYHA class I patients in treatment strategies, we explicitly acknowledge the current limitations of the evidence base and emphasize the need for ongoing, high-quality research including counterarguments and the practical challenges of early treatments.

肺动脉高压(PAH)是一种慢性、进行性、最终危及生命的疾病,其特征是血管重构和肺血管阻力增加。尽管诊断工具和治疗策略取得了重大进展,但临床干预往往只有在患者出现症状时才开始——通常是在纽约心脏协会(NYHA)功能II级或更高时。矛盾的是,虽然强烈鼓励早期检测多环芳烃以预防不可逆的血管、心脏和多系统损伤,但治疗仍然主要局限于已经出现症状的患者。NYHA I级患者虽然经历了病理生理进展,但系统地排除在批准的药物治疗之外。这种脱节不仅代表了一个临床和伦理难题,也代表了一个概念上的悖论:如果拒绝早期治疗,为什么要投资于早期诊断?关于各种慢性疾病,包括癌症、艾滋病毒和肝炎等传染病,甚至其他心血管疾病的新证据,强调了在症状出现之前开始治疗的好处。相比之下,目前治疗多环芳烃的方法无意中促进了一种虚无主义的“观望”政策,使无症状患者暴露于可预防的恶化之中。在此,我们呼吁重新评估临床指南、监管框架和准入政策,以更好地使其与多环芳烃的生物学现实保持一致。虽然我们提倡将NYHA I类患者纳入治疗策略的范式转变,但我们明确承认目前证据基础的局限性,并强调需要进行持续的高质量研究,包括反驳和早期治疗的实际挑战。
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引用次数: 0
Altered Arginine Metabolism in Children Undergoing Fontan Palliation: A Prospective Cohort Study. Fontan姑息期儿童精氨酸代谢改变:一项前瞻性队列研究。
IF 2.5 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-11-19 eCollection Date: 2025-10-01 DOI: 10.1002/pul2.70211
Benjamin S Frank, Sierra Niemiec, Ludmila Khailova, Christopher A Mancuso, Tanner Lehmann, Gareth J Morgan, Michael V DiMaria, Carmen C Sucharov, Jelena Klawitter, Jesse A Davidson

Children with single ventricle heart disease (SVHD) demonstrate decreased arginine/NO metabolism following Stage 2 (Glenn) palliation, associated with poor postoperative outcomes. It is unknown if arginine dysregulation persists at Stage 3 (Fontan). The purpose of this study is to quantify circulating arginine metabolites in children undergoing Fontan palliation for SVHD to evaluate the relationship between metabolite concentrations and outcomes. Prospective cohort study of children undergoing Fontan operation (n = 82) and similar age healthy controls (n = 49). We measured circulating arginine metabolites pre- and post-op by tandem mass spectrometry. Postoperative outcomes included length of stay (LOS) and pleural drainage. Pre-op cases showed lower arginine, argininosuccinate, cysteine, NMMA, higher glutathione, and lower arginine/ADMA, arginine/citrulline, and arginine/ornithine ratios compared to controls. Post-op cases experienced progressively decreasing citrulline concentration and higher arginine/ADMA, arginine/citrulline, and arginine/ornithine ratios compared to pre-op. In uncorrected analysis, postoperative decreased citrulline level (31.4% and 33.9% longer LOS for 50% decrease in [citrulline] at 2 and 24 h, respectively) was associated with longer LOS. Decreased arginine/ADMA and arginine/ornithine ratios were significantly associated with longer LOS and greater pleural drainage. Arginine metabolism is altered in children with SVHD in both the pre- and post-Stage 3 period. Patients with greater postoperative derangements, including lower arginine/ADMA and arginine/ornithine ratios, experienced more morbidity. We speculate that alterations in arginine metabolism may be a modifiable risk factor for adverse post-Stage 3 outcomes in SVHD.

患有单心室心脏病(SVHD)的儿童在第2期(Glenn)缓解后表现出精氨酸/NO代谢下降,与术后预后不良相关。目前尚不清楚精氨酸失调是否在第3期持续存在(Fontan)。本研究的目的是量化接受Fontan姑息治疗的SVHD儿童的循环精氨酸代谢物,以评估代谢物浓度与预后之间的关系。接受Fontan手术的儿童(n = 82)和年龄相近的健康对照(n = 49)的前瞻性队列研究。我们用串联质谱法测量手术前后的循环精氨酸代谢物。术后结果包括住院时间(LOS)和胸膜引流。术前病例显示较低的精氨酸、精氨酸琥珀酸盐、半胱氨酸、NMMA、较高的谷胱甘肽、较低的精氨酸/ADMA、精氨酸/瓜氨酸和精氨酸/鸟氨酸比率。与术前相比,术后病例瓜氨酸浓度逐渐降低,精氨酸/ADMA、精氨酸/瓜氨酸和精氨酸/鸟氨酸比值较高。在未经校正的分析中,术后瓜氨酸水平降低(2和24小时[瓜氨酸]降低50%,使LOS延长31.4%和33.9%)与LOS延长相关。精氨酸/ADMA和精氨酸/鸟氨酸比值的降低与更长的LOS和更大的胸膜引流显著相关。SVHD患儿的精氨酸代谢在3期前后均发生改变。术后紊乱程度较高的患者,包括精氨酸/ADMA和精氨酸/鸟氨酸比例较低的患者,发病率更高。我们推测精氨酸代谢的改变可能是SVHD患者3期后不良结局的一个可改变的危险因素。
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引用次数: 0
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Pulmonary Circulation
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