Future perspective in diabetic patients with pre- and post-capillary pulmonary hypertension

Luongo, Federico; Miotti, Cristiano; Scoccia, Gianmarco; Papa, Silvia; Manzi, Giovanna; Cedrone, Nadia; Toto, Federica; Malerba, Claudia; Papa, G; Caputo, Annalisa; Manguso, Giulia; Adamo, F; Vizza, Carmine Dario; Badagliacca, Roberto

doi:10.1007/s10741-021-10208-4

Cited by 3 publications

(3 citation statements)

References 115 publications

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“…1 Diabetes mellitus type 2 is associated with worse right ventricular function and survival. 20 , 21 , 22 Hypertension, diabetes, obesity, and COPD are associated with a decreased 6MWD. 23 Furthermore, comorbidities can complicate the evaluation of disease progression and therapeutic response.…”

Section: Discussionmentioning

confidence: 99%

“…Elderly patients present with more comorbidities such as ischemic heart disease, systemic hypertension, atrial fibrillation, diabetes mellitus, and hypothyroidism which could limit their prognosis compared with younger patients 1 . Diabetes mellitus type 2 is associated with worse right ventricular function and survival 20–22 . Hypertension, diabetes, obesity, and COPD are associated with a decreased 6MWD 23 .…”

Section: Discussionmentioning

confidence: 99%

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The evolution of survival of pulmonary arterial hypertension over 15 years

et al. 2022

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The prognosis of pulmonary arterial hypertension (PAH) remains dismal. Over the years, multiple therapeutic advances have been introduced. This study evaluates the evolution of PAH survival over the past 15 years. We included 293 consecutive adult patients diagnosed with PAH between 2005 and 2019 (median age: 61.8 years, 70.3% female). Patients were divided into three cohorts based on the time of diagnosis: 2005–2009, 2010–2014, and 2015–2019 (2005–2009: n = 56; 2010–2014: n = 111; 2015–2019: n = 126). Transplant‐free survival was measured from the date of right heart catheterization until patients reached the composite endpoint of lung transplant or death. Multivariable cox‐pulmonary hypertension regression was used to study the effect of the time of diagnosis. The final cox model was fitted in both younger and older patients to evaluate the difference between these groups. During a median follow‐up time of 4.1 (interquartile range: 2.2–7.3) years, 9 patients underwent lung transplantation and 151 patients died. The median overall transplant‐free survival was 6.2 (5.5–8.0) years. Patients older than 56 years at baseline who were diagnosed in 2005–2009 showed better survival compared to patients diagnosed in 2010–2014 and 2015–2019 with an adjusted hazard ratio of, respectively, 2.12 (1.11–4.03) and 2.83 (1.41–5.69). Patients younger than 56 years showed neither an improved nor deteriorated survival over time. In conclusion, survival in patients with PAH did not improve over time, despite more available therapeutic options. This might be partly due to the changed demographic characteristics of the PAH patients and a still important diagnostic delay.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The evolution of survival of pulmonary arterial hypertension over 15 years

et al. 2022

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“… 126 CAV1 mutations are also associated with lipid disorders such as type 2 diabetes, 127 which itself has been shown to be an independent risk factor for PH. 128 Previous studies have shown that diabetes may cause defects in the mechanotransduction of arterial SMCs via alterations in ECM composition, which lead to increased stiffness and decreased arteriolar compliance. 129 Other comorbidities of Cpc‐PH, such as obesity and age, have also been shown to alter mechanotransduction in ECs and SMCs.…”

Section: Bridging the Knowledge Gaps: Directions For Future Workmentioning

confidence: 99%

Biomechanical and Mechanobiological Drivers of the Transition From PostCapillary Pulmonary Hypertension to Combined Pre−/PostCapillary Pulmonary Hypertension

Allen

Frye

Ramanathan

et al. 2023

JAHA

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Combined pre−/postcapillary pulmonary hypertension (Cpc‐PH), a complication of left heart failure, is associated with higher mortality rates than isolated postcapillary pulmonary hypertension alone. Currently, knowledge gaps persist on the mechanisms responsible for the progression of isolated postcapillary pulmonary hypertension (Ipc‐PH) to Cpc‐PH. Here, we review the biomechanical and mechanobiological impact of left heart failure on pulmonary circulation, including mechanotransduction of these pathological forces, which lead to altered biological signaling and detrimental remodeling, driving the progression to Cpc‐PH. We focus on pathologically increased cyclic stretch and decreased wall shear stress; mechanotransduction by endothelial cells, smooth muscle cells, and pulmonary arterial fibroblasts; and signaling‐stimulated remodeling of the pulmonary veins, capillaries, and arteries that propel the transition from Ipc‐PH to Cpc‐PH. Identifying biomechanical and mechanobiological mechanisms of Cpc‐PH progression may highlight potential pharmacologic avenues to prevent right heart failure and subsequent mortality.

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An update on diabetes spectrum in heart failure: current evidence and potential therapeutic applications

Palazzuoli

Savarese

2022

Heart Fail Rev

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Future perspective in diabetic patients with pre- and post-capillary pulmonary hypertension

Cited by 3 publications

References 115 publications

The evolution of survival of pulmonary arterial hypertension over 15 years

The evolution of survival of pulmonary arterial hypertension over 15 years

Biomechanical and Mechanobiological Drivers of the Transition From PostCapillary Pulmonary Hypertension to Combined Pre−/PostCapillary Pulmonary Hypertension

An update on diabetes spectrum in heart failure: current evidence and potential therapeutic applications

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