Predictors of poor outcome in patients with pulmonary arterial hypertension: A single center study

Stepnowska, Emilia; Lewicka, Ewa; Dąbrowska−Kugacka, Alicja; Daniłowicz‐Szymanowicz, Ludmiła; Zagożdżon, Paweł; Kamiński, Rafał; Lewicka-Potocka, Zuzanna; Miękus, Paweł; Kozłowski, Dariusz; Potocki, Wojciech; Raczak, Grzegorz

doi:10.1371/journal.pone.0193245

Cited by 12 publications

(9 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, we wanted to explore if, combining information from TTE with other non-invasive variables into a multivariate model, we would be able to predict prognostic results of RHC without actually performing it. It should be emphasized that many of non-invasive parameters have proven prognostic value both in PAH and CTEPH [8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Prediction of Prognostic Hemodynamic Indices in Pulmonary Hypertension Using Non-Invasive Parameters

Mańczak¹,

Kurzyna²,

Piłka³

et al. 2020

Diagnostics

View full text Add to dashboard Cite

Effective targeted therapy of pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) requires regular risk stratification. Among many prognostic parameters, three hemodynamic indices: right atrial pressure, cardiac index, and mixed venous saturation are considered critically important for correct risk classification. All of them are measured invasively and require right heart catheterization (RHC). The study was aimed to verify assumption that a model based on non-invasive parameters is able to predict hemodynamic profile described by the mentioned invasive indices. A group of 330 patients with pulmonary hypertension was used for the selection of the best predictors from the set of 17 functional, biochemical, and echocardiographic parameters. Multivariable logistic regression models for the prediction of low-risk and high-risk profiles were created. The cut-off points were determined and subsequent validation of the models was conducted prospectively on another group of 136 patients. The ROC curve analysis showed the very good discrimination power of the models (AUC 0.80–0.99) in the prediction of the hemodynamic profile in the total validation group and subgroups: PAH and CTEPH. The models indicated the risk profiles with moderate sensitivity (57–60%) and high specificity (87–93%). The method enables estimation of the hemodynamic indices when RHC cannot be performed.

show abstract

Section: Introductionmentioning

confidence: 99%

Prediction of Prognostic Hemodynamic Indices in Pulmonary Hypertension Using Non-Invasive Parameters

Mańczak¹,

Kurzyna²,

Piłka³

et al. 2020

Diagnostics

View full text Add to dashboard Cite

show abstract

“…Brain natriuretic peptide (BNP) is an established and widely used clinical parameter for heart function and failure, and ventricular remodelling. While BNP was shown being a prognostic marker in PAH [27], others ruled out the NT-proBNP response to exercise as a disease severity assessment marker of PAH [28]. No significant upregulation of BNP was detectable in the RV due to the application of different diets (Fig.…”

Section: Resultsmentioning

confidence: 99%

Pulmonary arterial remodelling by deficiency of peroxisome proliferator-activated receptor-γ in murine vascular smooth muscle cells occurs independently of obesity-related pulmonary hypertension

et al. 2019

View full text Add to dashboard Cite

Background Obesity is associated with cardiovascular complications, including pulmonary hypertension (PH). Reports suggest that peroxisome proliferator-activated receptor-γ (PPARγ) has direct action in preventing vascular remodelling in PH. Here we dissected the specific role of high-fat-diet (HFD)-induced obesity and vascular smooth muscle cell (VSMC)-PPARγ for remodelling of small pulmonary arteries. Methods Wild-type (WT) and VSMC-specific PPARγ-knockout (Sm Pparγ −/− ) mice were fed a low-fat-diet (LFD, 10% kcal from fat) or HFD (60% kcal from fat) for 24 weeks. Mice were metabolically phenotyped (e.g. weight development, insulin/glucose tolerance) at the beginning, and after 12 and 24 weeks, respectively. At 24 weeks additionally pulmonary pressure, heart structure, pulmonary vascular muscularization together with gene and protein expression in heart and lung tissues were determined. Results HFD increased right ventricular systolic pressure (RVSP) to a similar extent in WT and Sm Pparγ −/− mice. HFD decreased glucose tolerance and insulin sensitivity in both WT and Sm Pparγ −/− mice. Importantly, the increase in RVSP correlated with the degree of insulin resistance. However, VSMC-PPARγ deficiency increased pulmonary vascular muscularization independently of the diet-induced rise in RVSP. This increase was associated with elevated expression of early growth response protein 1 in heart and osteopontin in lung tissue. Conclusions Here we demonstrate a correlation of insulin resistance and pulmonary pressure. Further, deficiency of PPARγ in VSMCs diet-independently leads to increased pulmonary vascular muscularization.

show abstract

“…The current standard of medical care consists of periodic ambulatory clinic visits with testing including echocardiography, exercise testing, and monitoring for arrhythmia. While these tests provide useful information about cardiac function, they neither correlate with overall debility; nor do they adequately predict risk of future adverse events [36][37][38][39]. Knowing that debilitating morbidities are not limited to only specific cardiac conditions, the intention of this study was to develop a broad based, generalizable clinical measure of infirmity for children and adolescents with cardiac disease.…”

Section: Discussionmentioning

confidence: 99%

Translation of the Frailty Paradigm from Older Adults to Children with Cardiac Disease

et al. 2020

View full text Add to dashboard Cite

Children and adolescents with cardiac disease (CCD) have significant morbidity and lower quality of life. However, there are no broadly applicable tools similar to the frailty score as described in the elderly, to define functional phenotype in terms of physical capability and psychosocial wellbeing in CCD. The purpose of this study is to investigate the domains of the frailty in CCD. We prospectively recruited CCD (8-17.5 years old, 70% single ventricle, 27% heart failure, 12% pulmonary hypertension; NYHA classes I, II and III) and age and gender matched healthy controls (total n = 56; CCD n = 34, controls n = 22; age 12.6 ± 2.6 years; 39.3% female). We measured the five domains of frailty: slowness, weakness, exhaustion, body composition and physical activity using developmentally appropriate methods. Age and gender-based population norms were used to obtain Z scores and percentiles for each measurement. Two-tailed t-tests were used to compare the two groups. The CCD group performed significantly worse in all five domains of frailty compared to healthy controls. Slowness: 6-min walk test with Z score −3.

show abstract

Predictors of poor outcome in patients with pulmonary arterial hypertension: A single center study

Cited by 12 publications

References 37 publications

Prediction of Prognostic Hemodynamic Indices in Pulmonary Hypertension Using Non-Invasive Parameters

Prediction of Prognostic Hemodynamic Indices in Pulmonary Hypertension Using Non-Invasive Parameters

Pulmonary arterial remodelling by deficiency of peroxisome proliferator-activated receptor-γ in murine vascular smooth muscle cells occurs independently of obesity-related pulmonary hypertension

Translation of the Frailty Paradigm from Older Adults to Children with Cardiac Disease

Contact Info

Product

Resources

About