Impact of Severe Pulmonary Arterial Hypertension on the Left Heart and Prognostic Implications

Kishiki, Kanako; Singh, Amita; Narang, Akhil; Gomberg‐Maitland, Mardi; Goyal, Neha; Maffessanti, Francesco; Besser, Stephanie; Mor‐Avi, Victor; Lang, Roberto M.; Addetia, Karima

doi:10.1016/j.echo.2019.05.008

Cited by 28 publications

(28 citation statements)

References 17 publications

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“…[2][3][4] Current treatment strategies for this disorder are palliative and do not significantly improve longterm survival. [5][6][7] Therefore, new therapies' plan is urgent to be…”

mentioning

confidence: 99%

Bioinformatic analysis and validation of microRNA‐508‐3p as a protective predictor by targeting NR4A3/MEK axis in pulmonary arterial hypertension

Chen

Fen

et al. 2021

J Cellular Molecular Medi

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Pulmonary arterial hypertension (PAH) is a cure-resist and chronic disease with enigmatic molecular mechanisms. 1 The aetiopathogenesis of PAH chiefly characterized by proliferation, migration, anti-apoptosis or phenotype switches of pulmonary artery smooth muscle cell (PASMC), and leading to an abnormal elevation in pulmonary arterial pressure. [2][3][4] Current treatment strategies for this disorder are palliative and do not significantly improve longterm survival. [5][6][7] Therefore, new therapies' plan is urgent to be

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“…[2][3][4] Current treatment strategies for this disorder are palliative and do not significantly improve longterm survival. [5][6][7] Therefore, new therapies' plan is urgent to be…”

mentioning

confidence: 99%

Bioinformatic analysis and validation of microRNA‐508‐3p as a protective predictor by targeting NR4A3/MEK axis in pulmonary arterial hypertension

Chen

Fen

et al. 2021

J Cellular Molecular Medi

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“…Recently, Kishiki et al reported that patients with PAH had LV dysfunction, detected as reduced GLS-LV and LV diastolic dysfunction, in addition to right heart dysfunction, and the LV dysfunction was strongly associated with mortality. 15 They also reported that the LS was impaired in both septal and non-septal LV segments. This result suggests that the LV dysfunction was caused not only by interventricular effect due to RV pressure and/or volume overload but also by other factors that affect the LV function in patients with PAH.…”

Section: Discussionmentioning

confidence: 97%

Increased Arterial Stiffness in Chronic Thromboembolic Pulmonary Hypertension Was Improved with Riociguat and Balloon Pulmonary Angioplasty: A Case Report

Sato¹,

Shimizu²,

Ito³

et al. 2021

IMCRJ

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Background:The role of arterial stiffness in the pathophysiology of chronic thromboembolic pulmonary hypertension (CTEPH) is unclear. The cardio-ankle vascular index (CAVI) is a novel arterial stiffness index reflecting stiffness of the arterial tree from the origin of the aorta to the ankle, independent from blood pressure at the time of measurement. CAVI reflects functional stiffness, due to smooth muscle cell contraction or relaxation, and organic stiffness, due to atherosclerosis. Here, we report the case of a patient with an increased CAVI due to CTEPH and the improvement after riociguat administration and balloon pulmonary angioplasty (BPA). Case Presentation: A 65-year-old man suffered from dyspnea on exertion, and he was diagnosed with distal CTEPH. The mean pulmonary artery pressure (mPAP) was 51 mmHg, and the initial CAVI was 10.0, which is high for patient's age. In addition to right ventricular dysfunction, left ventricular dysfunction was observed as reduced global longitudinal strain (GLS-LV). After riociguat administration, CAVI decreased to 9.1 and GLS-LV improved from −10.3% to −17.3%, although pulmonary hypertension remained (mPAP 41 mmHg). Subsequently, a total of five BPA sessions were performed. Six months after the final BPA, mPAP decreased to 19 mmHg and GLS-LV improved to 19.3%. The patient was symptom free and his 6-minute walk distance improved from 322 m to 510 m. CAVI markedly decreased to 5.8, which is extremely low for his age. Conclusion: These observations suggested that arterial stiffness as measured by CAVI was increased in CTEPH, potentially deteriorating cardiac function because of enhanced afterload. The mechanism of the increase of CAVI in this case of CTEPH was obscure; however, riociguat administration and BPA might improve the pathophysiology of CTEPH partly by decreasing CAVI.

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“…However, when the LVEF is normal, newer work has shown LV global longitudinal strain is independently associated with death in addition to right-sided heart abnormalities. 19 In addition to routine assessment of RV strain, consideration should be given to following LV strain as well.…”

Section: Impact On the Left Ventriclementioning

confidence: 99%

The Future of Imaging in Pulmonary Hypertension: Better Assessment of Structure, Function, and Flow

Narang

Freed

2019

Advances in Pulmonary Hypertension

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Cardiovascular imaging is essential in the evaluation and management of patients with pulmonary hypertension. Echocardiography and magnetic resonance imaging, in particular, provide basic measurements of pulmonary pressure and right ventricular function, but current technology allows for a much more comprehensive assessment. Many of these advancements have the potential to enhance risk stratification and provide additional phenotypic data that may strengthen or alter the therapeutic approach. This review will highlight multiple novel techniques from various imaging modalities and how this information can be applied in clinical practice.

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Impact of Severe Pulmonary Arterial Hypertension on the Left Heart and Prognostic Implications

Cited by 28 publications

References 17 publications

Bioinformatic analysis and validation of microRNA‐508‐3p as a protective predictor by targeting NR4A3/MEK axis in pulmonary arterial hypertension

Bioinformatic analysis and validation of microRNA‐508‐3p as a protective predictor by targeting NR4A3/MEK axis in pulmonary arterial hypertension

Increased Arterial Stiffness in Chronic Thromboembolic Pulmonary Hypertension Was Improved with Riociguat and Balloon Pulmonary Angioplasty: A Case Report

The Future of Imaging in Pulmonary Hypertension: Better Assessment of Structure, Function, and Flow

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