Letter by Frumkin Regarding Article, "Dramatically Improved Severe Pulmonary Arterial Hypertension Caused by Qing-Dai (Chinese Herbal Drug) for Ulcerative Colitis."

Frumkin, Lyn R.

doi:10.1536/ihj.23-281

Int. Heart J.

2023

DOI: 10.1536/ihj.23-281

|View full text |Cite

Letter by Frumkin Regarding Article, "Dramatically Improved Severe Pulmonary Arterial Hypertension Caused by Qing-Dai (Chinese Herbal Drug) for Ulcerative Colitis."

Lyn R. Frumkin

Help me understand this report

Search citation statements

Order By: Relevance

Paper Sections

Select...

Citation Types

Supporting

Mentioning

Contrasting

Year Published

2023

2024

Publication Types

Select...

Article2

Relationship

Self Cite0

Independent2

Authors

Journals

Cited by 2 publications

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

Definition, classification and diagnosis of pulmonary hypertension

Kovacs,

Bartolome,

Denton

et al. 2024

Eur Respir J

View full text Add to dashboard Cite

Pulmonary hypertension (PH) is a haemodynamic condition characterised by elevation of mean pulmonary arterial pressure (mPAP) >20 mmHg, assessed by right heart catheterisation. Pulmonary arterial wedge pressure (PAWP) and pulmonary vascular resistance (PVR) distinguish pre-capillary PH (PAWP ≤15 mmHg, PVR >2 Wood Units (WU)), isolated post-capillary PH (PAWP >15 mmHg, PVR ≤2 WU) and combined post- and pre-capillary PH (PAWP >15 mmHg, PVR >2 WU). Exercise PH is a haemodynamic condition describing a normal mPAP at rest with an abnormal increase of mPAP during exercise, defined as a mPAP/cardiac output slope >3 mmHg/L/min between rest and exercise. The core structure of the clinical classification of PH has been retained, including the five major groups. However, some changes are presented herewith, such as the re-introduction of “long-term responders to calcium channel blockers” as a subgroup of idiopathic pulmonary arterial hypertension, the addition of subgroups in group 2 PH and the differentiation of group 3 PH subgroups based on pulmonary diseases instead of functional abnormalities. Mitomycin-C and carfilzomib have been added to the list of drugs with “definite association” with PAH. For diagnosis of PH, we propose a stepwise approach with the main aim of discerning those patients who need to be referred to a PH centre and who should undergo invasive haemodynamic assessment. In case of high probability of severe pulmonary vascular disease, especially if there are signs of right heart failure, a fast-track referral to a PH centre is recommended at any point during the clinical workup.

show abstract

Definition, classification and diagnosis of pulmonary hypertension

Kovacs,

Bartolome,

Denton

et al. 2024

Eur Respir J

View full text Add to dashboard Cite

show abstract

Response to the Letter by Frumkin Regarding the Article, "Dramatically Improved Severe Pulmonary Arterial Hypertension Caused by Qing-Dai (Chinese Herbal Drug) for Ulcerative Colitis"

Kubota,

Imai,

Okuyama

et al. 2023

Int. Heart J.

View full text Add to dashboard Cite

We deeply thank Dr. Frumkin for the comments on our case report. 1) We completely agree with Dr. Frumkin that drug and toxin-induced pulmonary arterial hypertension (PAH) according to the guidelines should be classified to be associated with "indigo naturalis (Chinese herb Qing-Dai)" administration instead of "indirubin (Chinese herb Qing-Dai)". As Dr. Frumkin pointed out, Qing-Dai comprises various ingredients and its formulation widely varies depending on where and by whom it is prescribed. Thus, determining which ingredients are more associated with PAH could be difficult. In our case, the Qing-Dai that the patient received was prescribed by a specific clinic. 2) However, indigo naturalis itself is a substance commonly available as a dye used for jeans and other clothing materials. In Asian countries, some patients with ulcerative colitis (UC) could purchase indigo naturalis on the Internet and self-administer it. Since these indigo naturalis formulations are not sold as drugs, currently regulating their use under the Pharmaceutical Affairs Law is difficult. Therefore, there is a need to more clearly warn patients with UC and physicians that indigo naturalis or Qing-Dai could pose a risk of causing PAH.

show abstract

scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.

Contact Info

customersupport@researchsolutions.com

10624 S. Eastern Ave., Ste. A-614

Henderson, NV 89052, USA

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Blog Terms and Conditions API Terms Privacy Policy Contact Cookie Preferences Do Not Sell or Share My Personal Information

Made with 💙 for researchers

Part of the Research Solutions Family.

Letter by Frumkin Regarding Article, "Dramatically Improved Severe Pulmonary Arterial Hypertension Caused by Qing-Dai (Chinese Herbal Drug) for Ulcerative Colitis."

Cited by 2 publications

References 14 publications

Definition, classification and diagnosis of pulmonary hypertension

Definition, classification and diagnosis of pulmonary hypertension

Response to the Letter by Frumkin Regarding the Article, "Dramatically Improved Severe Pulmonary Arterial Hypertension Caused by Qing-Dai (Chinese Herbal Drug) for Ulcerative Colitis"

Contact Info

Product

Resources

About