Contemporary prevalence of pulmonary arterial hypertension in adult congenital heart disease following the updated clinical classification

Riel, Annelieke C.M.J. van; Schuuring, Mark J.; Hessen, Irene D. van; Zwinderman, A.H.; Cozijnsen, Luc; Reichert, Constant L.A.; Hoorntje, Jan C.A.; Wagenaar, Lodewijk J.; Post, Marco C.; Dijk, Arie P.J. van; Hoendermis, Elke S.; Mulder, Barbara J.M.; Bouma, Berto J.

doi:10.1016/j.ijcard.2014.04.072

Cited by 122 publications

(81 citation statements)

References 39 publications

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“…Pulmonary hypertension (PH) deserves special attention because it is common in CHD, 119 its pathogenesis is likely to be different from PH secondary to acquired HF, 120 and it is an important contributor to posttransplantation morbidity and mortality. In ACHD patients, a pulmonary vascular resistance (PVR) exceeding 4 Wood units was associated with greater perioperative mortality risk (20%), but there was no difference in long-term survival based on pretransplantation PVR.…”

Section: Pulmonary Vascular Resistancementioning

confidence: 99%

Transplantation and Mechanical Circulatory Support in Congenital Heart Disease

Ross¹,

Law²,

Book³

et al. 2016

Circulation

123

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Section: Pulmonary Vascular Resistancementioning

confidence: 99%

Transplantation and Mechanical Circulatory Support in Congenital Heart Disease

Ross¹,

Law²,

Book³

et al. 2016

Circulation

123

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“…The recently reported incidence of pulmonary hypertension in adult patients with CHD is approximately 3.2%. 20 Patients with pulmonary hypertension might be advised against pregnancy, so they were underrepresented in both the CARPREG study (0.50%, 3 in 599 deliveries) 11 and the ZAHARA study (0.31%, 4 in 1,302 deliveries). 5 The incidence of pulmonary hypertension in our study was much higher (11.9%, 32 in 268 deliveries), possibly because most of these pregnancies were in the early years of our study and pre-pregnancy counseling was not provided at that time.…”

Section: Pregnancy Outcomesmentioning

confidence: 99%

Comparison of 3 Risk Estimation Methods for Predicting Cardiac Outcomes in Pregnant Women With Congenital Heart Disease

Shih

Chen

et al. 2015

Circ J

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“…None of these symptoms are very specific. These are exactly the same complaints expressed by patients with left heart disease, or other types of lung disease; they also happen to be the most common causes of PAH (14). Based on the dosages reported in the 1970s, only severely addicted cocaine abusers would seem to ingest enough levamisole to be at risk.…”

Section: Discussionmentioning

confidence: 75%

“…Humans also occasionally abuse aminorex (11) and an association between aminorex abuse and PAH has long been suspected (12). In 2012, our group published a case report demonstrating that humans are capable of the same conversion as horses (13), Although the kinetics of this conversion are only now being clarified (14,15). The fact that this conversion occurs at all raises the possibility that levamisole administration might, ultimately, result in human PAH.…”

Section: Contextmentioning

confidence: 99%

Levamisole, Aminorex, and Pulmonary Arterial Hypertension: A Review

Karch¹,

Vaiano²,

Bertol³

2015

Razavi Int J Med

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Context: An epidemic of aminorex-associated pulmonary arterial hypertension (PAH), resulting in multiple fatalities, occurred in the 1970s ending only after the drug was removed from the market. In 2009, when it was found that horses de-wormed with the anthelmintic levamisole, metabolized that drug to aminorex, the same drug that caused the 1970s outbreak of PAH. The discovery would not have been cause for concern except to horseracing enthusiasts, who feared horse doping. However, at about the same time the relationship between levamisole and aminorex was discovered, cocaine cartels began adulterating cocaine with levamisole. The rationale for adulterating cocaine with levamisole remains to be established. The purpose of this short review article is to discuss possible reasons for levamisole contamination, new discoveries about the human pharmacokinetics of aminorex, and the possible relationship between aminorex and pulmonary arterial hypertension in man. Evidence acquisition: Medline contents, as well as estimates published by the U.S. drug enforcement agency (DEA), US state department, and the European monitoring center for drugs and drug abuse (EMCDDA) were reviewed and relevant articles retrieved. There is uniform agreement among the various monitoring agencies analyzed.Results: Approximately 70 percent of the U.S. cocaine supply and 40 percent of the European cocaine supply is contaminated with levamisole. Aminorex has the same binding affinities for serotonin and other neurotransmitters as amphetamine. As serotonin is considered to be an important factor in the development of PAH, the possibility of another epidemic of aminorex-induced PAH, this time among cocaine abusers, seems real, and threatening. Conclusions:The results of the first human pharmacokinetic studies of aminorex were first characterized in 2013. The results suggest that while humans could produce aminorex from levamisole, they probably do not convert very much. Even though cases of PAH have been reported in cocaine users, the latest pharmacokinetic studies suggest that very little aminorex is actually produced from the ingested levamisole, probably not enough to cause PAH. However, since both cocaine and aminorex can cause PAH the situation remains unclear. the lack of a clear answer is partially the development of an insidious pulmonary hypertension, producing subtle and non-specific symptoms in its early stages.

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Contemporary prevalence of pulmonary arterial hypertension in adult congenital heart disease following the updated clinical classification

Cited by 122 publications

References 39 publications

Transplantation and Mechanical Circulatory Support in Congenital Heart Disease

Transplantation and Mechanical Circulatory Support in Congenital Heart Disease

Comparison of 3 Risk Estimation Methods for Predicting Cardiac Outcomes in Pregnant Women With Congenital Heart Disease

Levamisole, Aminorex, and Pulmonary Arterial Hypertension: A Review

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