01 September 2020

Pulmonary Circulation: September featured articles

Impact of SARS-CoV-2 pandemic on pulmonary hypertension out-patient clinics in Germany: a multi-centre study

Abstract

Pulmonary hypertension is frequently underdiagnosed, and referral is delayed with subsequent impact on outcomes. During the SARS-CoV-2 pandemic, restrictions on daily life and changes in hospitals' daily routine care were introduced in Germany. This multi-centre study provides evidence for a negative influence of these restrictions on patient care in pulmonary hypertension expert referral centres.

Impact of the updated hemodynamic definitions on diagnosis rates of pulmonary hypertension

Abstract

We evaluated whether updated pulmonary hypertension definitive criteria proposed in sixth World Symposium on Pulmonary Hypertension had an impact on diagnosis of overall pulmonary hypertension and pre-capillary and combined pre- and post-capillary phenotypes as compared to those in European Society of Cardiology/European Respiratory Society 2015 pulmonary hypertension Guidelines. Study group comprised the retrospectively evaluated 1300 patients (age 53.1 ± 18.8 years, female 807, 62.1%) who underwent right heart catheterization with different indications between 2006 and 2018. Mean pulmonary arterial pressure ≥25 mmHg (European Society of Cardiology) and PAMP (mean pulmonary arterial pressure) >20 mmHg (World Symposium on Pulmonary Hypertension) right heart catheterization definitions criteria were used, respectively. For pre-capillary pulmonary hypertension, pulmonary artery wedge pressure ≤15 mmHg and pulmonary vascular resistance ≥3 Wood units criteria were included in the both definitions. Normal mean pulmonary arterial pressure (È

Exercise right heart catheterization before and after balloon pulmonary angioplasty in inoperable patients with chronic thromboembolic pulmonary hypertension

Background

Balloon pulmonary angioplasty is an evolving, interventional treatment option for inoperable patients with chronic thromboembolic pulmonary hypertension (CTEPH). Pulmonary hypertension at rest as well as exercise capacity is considered to be relevant outcome parameters. The aim of the present study was to determine whether measurement of pulmonary hemodynamics during exercise before and six months after balloon pulmonary angioplasty have an added value.

Endothelial PDGF-mediated Activation of Smooth Muscle PDGF Receptors in Pulmonary Arterial Hypertension

Abstract

Platelet-derived growth factor (PDGF) is one of the major growth factors found in human and mammalian serum and tissues. Abnormal activation of PDGF signaling pathway through PDGF receptors (PDGFR) may contribute to the development and progression of pulmonary vascular remodeling and obliterative vascular lesions in patients with pulmonary arterial hypertension (PAH). In this study, we examined the expression of PDGFR isoforms in pulmonary arterial smooth muscle (PASMC) and endothelial (PAEC) cells and investigated whether PDGF secreted from PASMC or PAEC promotes PASMC proliferation. Our results showed that the protein expression of PDGFRα and PDGFRβ in PASMC was upregulated in patients with idiopathic PAH (IPAH) compared to normal subjects. PDGF activated PDGFRα and PDGFRβ in PASMC, as determined by phosphorylation of PDGFRα and PDGFRβ. The PDGF-mediated activation of PDGFRα/PDGFRβ was enhanced in IPAH-PASMC compared to normal cells. Expression level of PDGF-AA and PDGF-BB was greater in the conditioned media collected from IPAH-PAEC than from normal PAEC. Furthermore, incubation of IPAH-PASMC with conditioned culture media from normal PAEC induced more PDGFRα activation than in normal PASMC. Accordingly, the conditioned media from IPAH-PAEC resulted in more PASMC proliferation than the media from normal PAEC. These data indicate that a) the expression and activity of PDGFR are increased in IPAH-PASMC compared to normal PASMC, and b) PAEC from IPAH patients secret higher level of PDGF than PAEC from normal subjects. The enhanced secretion (and production) of PDGF from IPAH-PAEC and upregulated PDGFR expression (and function) in IPAH-PASMC may contribute to enhancing PDGF/PDGFR-associated pulmonary vascular remodeling in PAH.

Impact of SARS-CoV-2 pandemic on pulmonary hypertension out-patient clinics in Germany: a multi-centre study

Abstract

Pulmonary hypertension is frequently underdiagnosed, and referral is delayed with subsequent impact on outcomes. During the SARS-CoV-2 pandemic, restrictions on daily life and changes in hospitals' daily routine care were introduced in Germany. This multi-centre study provides evidence for a negative influence of these restrictions on patient care in pulmonary hypertension expert referral centres.


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