14 January 2022

This week in PVD

Obstructive sleep apnea-COPD overlap syndrome common, linked with poor outcomes

Obstructive sleep apnea and COPD overlap syndrome is common and is associated with worse outcomes, poorer quality of life and a higher prevalence of comorbidities such as diabetes and hypertension compared with COPD only, researchers reported.

“Our study suggests that OSA is common in patients with COPD in pulmonary outpatient clinics, and pulmonologists should ... consider screening for OSA symptoms in these patients,” Pan Zhang, MD, from the department of control and prevention of chronic noncommunicable diseases at Xuzhou Center for Disease Control and Prevention in Jiangsu, China, and colleagues wrote in BMC Pulmonary Medicine.

The cross-sectional study included 842 patients with COPD (mean age, 63 years; 28% women) in the Xuzhou area in eastern China who were treated from December 2018 to December 2019. Researchers evaluated the modified Medical Research Council (MRC) Dyspnea Scale, Epworth Sleepiness Scale, COPD Assessment Test, Hospital Anxiety and Depression Scale, Charlson Comorbidity Index and STOP-Bang questionnaire for all patients and performed spirometry and overnight polysomnography.

In total, 66% of patients had obstructive sleep apnea, which was defined as apnea-hypopnea index of five or more events per hour.

Study finds potential therapeutic target in piezo1 ion channel

The levels of Piezo1, an ion channel that senses membrane tension in cells, was found to be increased in the lung blood vessels of patients with idiopathic pulmonary arterial hypertension (PAH) and in animal models of pulmonary hypertension (PH), a study says.

Research showed that these higher levels trigger certain signaling pathways in pulmonary arterial endothelial cells (PAECs) which line lung blood vessels. This may stimulate the contraction and uncontrolled growth of pulmonary artery smooth muscle cells (PASMCs), ultimately promoting the development of PAH.

Compounds that target the activity of Piezo1 in lung vessels could potentially be used to treat pulmonary hypertension, researchers say.

The study, “Endothelial upregulation of mechanosensitive channel Piezo1 in pulmonary hypertension,” was published in the American Journal of Physiology-Cell Physiology.

When blood flows through the lung arteries, it causes mechanical stretching and constant stress. In PH, this may be exacerbated because even more blood accumulates in the lung vessels, causing a prolonged mechanical stretch of the lung vessel walls.

In hypertension and inflammation, a process called osmotic stretch can cause PAECs and PASMCs to swell and produce pressure on cell membranes. Ion channels, such as Piezo1, have the ability to sense cell membrane stretch and promote the influx of calcium ions into the cell and stimulate signaling pathways.

However, information is lacking about the role of Piezo channels in lung blood vessels and whether they contribute to the progression of PAH and PH. To address this, a team of researchers from the U.S. and China based at the University of California and University of Arizona College of Medicine sought to evaluate the production and function of Piezo1 in pulmonary cells from patients with PAH and animal models of PH.

Linking COPD severity with emphysema phenotypes identified Via CT

Panlobular emphysema (PLE) is associated with more chronic obstructive pulmonary disease (COPD) symptom burden, greater airflow obstruction, greater extent of emphysema, and higher systemic inflammation, according to a study published in Respiratory Medicine.

Understanding phenotypic patterns in COPD and associating them with clinical course and outcomes of the disease can help to guide therapy for clinicians and predict prognosis. Chest computed tomography (CT) has become routine in clinical research on COPD, and recent studies show an association of CT data with treatable traits. In the current study, researchers aimed to describe CT findings in 83 patients with COPD to better understand emphysema phenotypes and determine associations with clinical parameters including lung function, inflammatory markers, and quality of life. An expert radiologist reviewed historic chest CT scans and scored them for emphysema subtype, extent, and distribution.

CTEPH study ties lung arterial obstruction to airflow obstruction

Increased lung arterial obstruction is significantly associated with greater airflow obstruction in people with chronic thromboembolic pulmonary hypertension (CTEPH) and without a smoking history, a study shows.

Notably, airflow obstruction, reflected by a reduced ability to exhale quickly, was lessened with reduced arterial obstruction and improved blood flow following pulmonary thromboendarterectomy, or PEA — CTEPH’s mainstay treatment, a surgery to remove blood clots from major blood vessels in the lungs.

These findings suggest that blood vessel and flow changes seen in CTEPH patients may contribute to airflow obstruction.

Larger studies are needed to confirm this association and clarify its underlying mechanisms, the researchers noted.

The study, “Vascular involvement in chronic thromboembolic pulmonary hypertension is associated with spirometry obstructive impairment,” was published in the journal BMC Pulmonary Medicine.

CTEPH is a rare type of pulmonary hypertension (PH) caused by blood clots in the lung arteries, which increase their blood pressure, force the heart to work hard to pump blood, and cause exercise-induced shortness of breath.

In standard lung tests, these patients often show patterns of airflow obstruction, even in the absence of a smoking history (a known contributor). A previous study showed that CTEPH patients tended to have a low FEV1 relative to healthy people.

Does multiorgan FCU reduce hospital stay in patients with cardiopulmonary symptoms?

Multiorgan focused clinical ultrasonography (FCU) assessment for patients admitted to the hospital with cardiopulmonary symptoms did not reduce hospitalization stay by at least 24 hours, according to a study published in JAMA Network Open.

For the clinical trial (Australian New Zealand Clinical Trials Registry Identifier:

ACTRN12618001442291), researchers enrolled patients (N=248) who were admitted to the Royal Melbourne Hospital in Australia with cardiopulmonary conditions between 2018 and 2019. Cardiopulmonary conditions included: acute coronary syndrome, acute decompensated heart failure (ADHF), asthmatic crisis, cardiac valve disease, cardiogenic syncope, exacerbated chronic obstructive pulmonary disease (COPD), interstitial pulmonary disease, pericardial effusion, pleural effusion, pneumonia, pulmonary embolism, or undifferentiated dyspnea. Patients were randomly assigned 1:1 to receive FCU of the heart, lung, and lower extremity (n=124) or usual care (n=124) and were assessed for hospital stay and outcomes.

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