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2.
Med Hypotheses ; 147: 110483, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33444904

RESUMO

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is causing the current pandemic of coronavirus disease 2019 (COVID-19) that have killed over one million people worldwide so far. To date, over forty million people have officially been identified to be infected with this virus with less than 3% death rate. Since many more people are expected to have been infected with this virus without the official diagnosis, the number of people who have recovered from the SARS-CoV-2 infection should be substantial. Given the large number of people recovered from either the mild SARS-CoV-2 infection or more severe COVID-19 conditions, it is critical to understand the long-term consequences of the infection by this virus. Our histological evaluations revealed that patients died of COVID-19 exhibited thickened pulmonary vascular walls, one important hallmark of pulmonary arterial hypertension (PAH). By contrast, such pulmonary vascular remodeling lesions were not found in patients died of SARS-CoV-1 during the 2002-2004 SARS outbreak or due to the infection by H1N1 influenza. The advancement in the treatment for the human immunodeficiency virus (HIV) infection has been remarkable that HIV-infected individuals now live for a long time, in turn revealing that these individuals become susceptible to developing PAH, a fatal condition. We herein hypothesize that SARS-CoV-2 is another virus that is capable to triggering the increased susceptibility of infected individuals to developing PAH in the future. Given the large number of people being infected with SARS-CoV-2 during this pandemic and that most people recover from severe, mild or asymptomatic conditions, it is imperative to generate scientific information on how the health of recovered individuals may be affected long-term. PAH is one lethal consequence that should be considered and needs to be monitored. This may also foster the research on developing therapeutic agents to prevent PAH, which has not so far been successful.


Assuntos
/complicações , Hipertensão Arterial Pulmonar/complicações , Animais , /virologia , Comorbidade , Surtos de Doenças , Suscetibilidade a Doenças , Endotélio Vascular/patologia , Humanos , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/complicações , Pulmão/virologia , Modelos Teóricos , Ucrânia/epidemiologia
3.
BMC Surg ; 21(1): 3, 2021 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-33397333

RESUMO

BACKGROUND: We aimed to explore the relationship between the neutrophil to lymphocyte ratio (NLR) and the early clinical outcomes in children with congenital heart disease (CHD) associated with pulmonary arterial hypertension (PAH) after cardiac surgery. METHODS: A retrospective observational study involving 190 children from January 2013 to August 2019 was conducted. Perioperative clinical and biochemical data were collected. RESULTS: We found that pre-operative NLR was significantly correlated with AST, STB, CR and UA (P < 0.05), while post-operative NLR was significantly correlated with ALT, AST, BUN (P < 0.05). Increased post-operative neutrophil count and NLR as well as decreased lymphocyte count could be observed after cardiac surgery (P < 0.05). Level of pre-operative NLR was significantly correlated with mechanical ventilation time, ICU stay time and total length of stay (P < 0.05), while level of post-operative NLR was only significantly correlated to the first two (P < 0.05). By using ROC curve analysis, relevant areas under the curve for predicting prolonged mechanical ventilation time beyond 24 h, 48 h and 72 h by NLR were statistically significant (P < 0.05). CONCLUSION: For patients with CHD-PAH, NLR was closely related to early post-operative complications and clinical outcomes, and could act as a novel marker to predict the occurrence of prolonged mechanical ventilation.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Cardiopatias Congênitas/cirurgia , Linfócitos/patologia , Neutrófilos/patologia , Hipertensão Arterial Pulmonar/cirurgia , Biomarcadores/sangue , Criança , Feminino , Cardiopatias Congênitas/sangue , Cardiopatias Congênitas/complicações , Humanos , Contagem de Linfócitos , Masculino , Período Pré-Operatório , Prognóstico , Hipertensão Arterial Pulmonar/sangue , Hipertensão Arterial Pulmonar/complicações , Estudos Retrospectivos , Volume Sistólico , Função Ventricular Esquerda
4.
J Cardiothorac Surg ; 15(1): 136, 2020 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-32527284

RESUMO

Transposition of the great arteries (TGA) and interruption of the aortic arch (IAA) are uncommon congenital heart diseases. The association between TGA and IAA is rare. The aim of this study is to present a case with combined TGA and IAA, who underwent the primary repair and review the literature with similar cases. The one-month-old patient was admitted with tachypnea and cyanosis. Delayed diagnosis was caused due to the absence of prenatal examination. Echocardiography and computed tomography angiography confirmed TGA with anterior-posterior-oriented great arteries, wide patent ductus arteriosus, type B IAA, ventricular septal defect (VSD) and pulmonary arterial hypertension. The patient underwent a single-stage primary surgical repair process leading to VSD closure, reconstruction of the aortic arch and arterial switch operation in October 2019. The patient is doing well at a 3-month follow-up post-surgery. The echocardiogram suggests a normal systolic function of the ventricles and trivial regurgitation for both aortic and pulmonary valves. CONCLUSIONS: The single-stage repair with VSD closure, reconstruction of aortic arch and arterial switch operation might be an applicable approach for most of the patients with combined TGA and IAA. Long term follow-up is required as a high re-intervention rate for recurrent coarctation, supravalvular aortic stenosis, neoaortic valve regurgitation, obstruction of the right heart system and coronary stenosis has been reported.


Assuntos
Aorta Torácica/anormalidades , Aorta Torácica/cirurgia , Permeabilidade do Canal Arterial/cirurgia , Comunicação Interventricular/cirurgia , Transposição dos Grandes Vasos/cirurgia , Transposição das Grandes Artérias , Humanos , Lactente , Masculino , Hipertensão Arterial Pulmonar/complicações , Valva Pulmonar
8.
Pediatr Cardiol ; 41(7): 1334-1339, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32468125

RESUMO

This study investigated the efficacy and safety of intravenous treprostinil during the perioperative period in infants with non-restrictive ventricular septal defect (VSD) and severe pulmonary arterial hypertension (PAH) undergoing surgical VSD repair. This was a retrospective study. There were 79 infants with non-restrictive VSD and severe PAH receiving surgical treatment from January to December 2019 in our cardiac center. The patients were divided into the treprostinil group and control group according to whether intravenous treprostinil was used during the perioperative period. There were no significant differences in the preoperative characteristics, including age, sex, weight, ventricular size, or preoperative pulmonary artery pressure, between the two groups. Although the pulmonary artery pressure in both groups was significantly lower postoperatively than preoperatively, the postoperative pulmonary artery systolic pressure was significantly lower in group T than in group C. The postoperative mechanical ventilation time, ICU stay, and hospital stay in group T were shorter than those in group C. Treprostinil can be used effectively and safely to reduce the perioperative pulmonary artery pressure in infants with non-restrictive VSD and severe PAH undergoing surgical VSD repair.


Assuntos
Anti-Hipertensivos/administração & dosagem , Epoprostenol/análogos & derivados , Comunicação Interventricular/tratamento farmacológico , Comunicação Interventricular/cirurgia , Hipertensão Arterial Pulmonar/tratamento farmacológico , Administração Intravenosa , Anti-Hipertensivos/efeitos adversos , Epoprostenol/administração & dosagem , Epoprostenol/efeitos adversos , Feminino , Comunicação Interventricular/complicações , Ventrículos do Coração/fisiopatologia , Humanos , Lactente , Tempo de Internação , Masculino , Período Perioperatório , Hipertensão Arterial Pulmonar/complicações , Hipertensão Arterial Pulmonar/cirurgia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
9.
J Cardiothorac Surg ; 15(1): 105, 2020 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-32434521

RESUMO

BACKGROUND: Surgical closure of atrial septal defect (ASD) is contraindicated in the condition with severe pulmonary arterial hypertension (PAH), whereas ASD closure in an effective intervention to normalize the structure and function of the right heart after previously experiencing volume overload due to shunting from the defect. This study aimed to evaluate normalization of the right heart and emergence of PAH after surgical closure of ASD. METHODS: This retrospective study was carried out in 45 patients over 18 years who had undergone surgical closure of ASD. The study has the aim to evaluate the morphological and functional parameters before and after the surgical approach and the preoperative factors that influenced the development of pulmonary arterial hypertension (PAP) after the ASD closure. RESULTS: The majority of subjects were female (73.3%) although there were no significant differences between males and females from the various parameters. The average of mPAP in the group that experienced PAH was higher than non-PAH group after ASD closure (p = 0.019, 31.23 ± 12.70 mmHg vs 24.07 ± 13.08 mmHg). Significant differences were found in the Right Atrium (RA) dimension, Right Ventricle (RV) dimension, Tricuspid Regurgitation Velocity (TRV) and Tricuspid Annular Plane Systolic Excursion (TAPSE) between before and at 6 months after ASD closure (p = 0.000, p = 0.000, p = 0.000, p = 000, respectively). The sensitivity of the predictive model to estimate PAH at 6 months after surgical closure of ASD was 58%, with a specificity of 62.5%. CONCLUSION: Structural and functional normalization of the right heart occurs at 6 months after surgical closure of ASD with the decrease of RA and RV dimensions and improvement from tricuspid regurgitation. Emergence of PAH after ASD closure was influenced by higher mPAP before surgical approach.


Assuntos
Comunicação Interatrial/cirurgia , Hipertensão Arterial Pulmonar/diagnóstico , Adulto , Ecocardiografia , Feminino , Comunicação Interatrial/complicações , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/fisiopatologia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Complicações Pós-Operatórias/fisiopatologia , Hipertensão Arterial Pulmonar/complicações , Hipertensão Arterial Pulmonar/diagnóstico por imagem , Hipertensão Arterial Pulmonar/fisiopatologia , Estudos Retrospectivos , Sensibilidade e Especificidade , Insuficiência da Valva Tricúspide/etiologia , Adulto Jovem
10.
PLoS One ; 15(4): e0227775, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32294102

RESUMO

BACKGROUND: Pulmonary arterial hypertension (PAH) is frequently complicated by sleep disordered breathing (SDB), and previous studies have largely focused on hypoxemic SDB. Even though nocturnal hypercapnia was shown to exacerbate pulmonary hypertension, the clinical significance of nocturnal hypercapnia among PAH patients has been scarcely investigated. METHOD: Seventeen patients with PAH were identified from 246 consecutive patients referred to Kyoto University Hospital for the evaluation of lung transplant registration from January 2010 to December 2017. Included in this study were 13 patients whose nocturnal transcutaneous carbon dioxide partial pressure (PtcCO2) monitoring data were available. Nocturnal hypercapnia was diagnosed according to the guidelines of the American Academy of Sleep Medicine. Associations of nocturnal PtcCO2 measurements with clinical features, the findings of right heart catheterization and pulmonary function parameters were evaluated. RESULTS: Nocturnal hypercapnia was diagnosed in six patients (46.2%), while no patient had daytime hypercapnia. Of note, nocturnal hypercapnia was found for 5 out of 6 patients with idiopathic PAH (83.3%). Mean nocturnal PtcCO2 levels correlated negatively with the percentage of predicted total lung capacity (TLC), and positively with cardiac output and cardiac index. CONCLUSION: Nocturnal hypercapnia was prevalent among advanced PAH patients who were waiting for lung transplantation, and associated with %TLC. Nocturnal hypercapnia was associated with the increase in cardiac output, which might potentially worsen pulmonary hypertension especially during sleep. Further studies are needed to investigate hemodynamics during sleep and to clarify whether nocturnal hypercapnia can be a therapeutic target for PAH patients.


Assuntos
Dióxido de Carbono/sangue , Hipertensão Pulmonar Primária Familiar/complicações , Hipercapnia/epidemiologia , Hipertensão Arterial Pulmonar/complicações , Síndromes da Apneia do Sono/epidemiologia , Adolescente , Adulto , Criança , Hipertensão Pulmonar Primária Familiar/sangue , Hipertensão Pulmonar Primária Familiar/cirurgia , Feminino , Humanos , Hipercapnia/sangue , Hipercapnia/diagnóstico , Hipercapnia/etiologia , Japão/epidemiologia , Transplante de Pulmão , Masculino , Pessoa de Meia-Idade , Polissonografia , Prevalência , Hipertensão Arterial Pulmonar/diagnóstico , Hipertensão Arterial Pulmonar/cirurgia , Estudos Retrospectivos , Índice de Gravidade de Doença , Síndromes da Apneia do Sono/sangue , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/etiologia , Listas de Espera , Adulto Jovem
11.
Pediatrics ; 145(5)2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32269136

RESUMO

Systemic sclerosis sine scleroderma (ssSSc) is a rare variant of systemic sclerosis, with only one pediatric case reported in the medical literature to date. Pulmonary arterial hypertension as the presenting feature of ssSSc is extremely rare, even in adults, and so far has never been reported in children. We report, for the first time, a case of pediatric ssSSc in a 3-year-old girl, who presented with interstitial lung disease and pulmonary hypertension. The patient was prescribed early aggressive pulmonary vasodilators combined with anti-inflammatory medications. The clinical response was good, and her current condition at 12 years of age is remarkable, considering the high mortality rates reported in adults. We underscore the importance of early aggressive treatment in future cases of similar presentation.


Assuntos
Hipertensão Arterial Pulmonar/complicações , Hipertensão Arterial Pulmonar/diagnóstico por imagem , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/diagnóstico por imagem , Cateterismo Cardíaco/métodos , Criança , Pré-Escolar , Feminino , Humanos , Hipertensão Arterial Pulmonar/terapia , Escleroderma Sistêmico/terapia
12.
Rev Mal Respir ; 37(3): 222-234, 2020 Mar.
Artigo em Francês | MEDLINE | ID: mdl-32199735

RESUMO

INTRODUCTION: Pulmonary hypertension (PH) is a life-threatening haemodynamic condition associated with many disorders. In pulmonary arterial hypertension (PAH) and chronic thrombo-embolic pulmonary hypertension, several treatments acting against pulmonary endothelial dysfunction have been shown to be effective. Exposure to cigarette smoke leads to endothelial dysfunction which is comparable to that observed in patients with PAH. The main objective was to investigate the difference in the haemodynamic changes during exercise in patients under specific treatment, from diagnosis (T0) to the first reassessment visit with a right heart catheterisation (T1), between those exposed or not exposed to cigarette smoke. MATERIALS AND METHODS: Between January 2002 and December 2018, all patients under specific treatment for PAH or chronic thromboembolic PH who underwent supine submaximal exercise assessment at T0 and T1 in our institution were asked specific questions about tobacco smoking. RESULTS: Overall (n=109), difference in mean isoflow mPAP was 19.0±15.4mmHg in patients exposed to tobacco smoke versus 21.3±16.6mmHg in unexposed patients (P=0.59). Median survival in exposed group was 83 months while in the unexposed group, median survival was 100 months (P=0.099). DISCUSSION: Our study did not show any significant difference in terms of haemodynamic changes during exercise between a group of patients under specific PH treatment exposed to cigarette smoke and a group unexposed. Endothelial dysfunction induced by smoke exposure does not appear to have a major impact on the response to the specific PH treatment.


Assuntos
Fumar Cigarros/efeitos adversos , Exercício Físico/fisiologia , Hemodinâmica/efeitos dos fármacos , Exposição Ocupacional/efeitos adversos , Hipertensão Arterial Pulmonar/terapia , Fumaça/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Fumar Cigarros/epidemiologia , Feminino , Hemodinâmica/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/estatística & dados numéricos , Hipertensão Arterial Pulmonar/complicações , Hipertensão Arterial Pulmonar/epidemiologia , Hipertensão Arterial Pulmonar/fisiopatologia , Estudos Retrospectivos , Fumar Tabaco/efeitos adversos , Fumar Tabaco/epidemiologia , Adulto Jovem
13.
PLoS One ; 15(2): e0229409, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32109943

RESUMO

The microRNA miR-1 is an important regulator of muscle phenotype including cardiac muscle. Down-regulation of miR-1 has been shown to occur in left ventricular hypertrophy but its contribution to right ventricular hypertrophy in pulmonary arterial hypertension are not known. Previous studies have suggested that miR-1 may suppress transforming growth factor-beta (TGF-ß) signalling, an important pro-hypertrophic pathway but only indirect mechanisms of regulation have been identified. We identified the TGF-ß type 1 receptor (TGF-ßR1) as a putative miR-1 target. We therefore hypothesized that miR-1 and TGF-ßR1 expression would be inversely correlated in hypertrophying right ventricle of rats with pulmonary arterial hypertension and that miR-1 would inhibit TGF-ß signalling by targeting TGF-ßR1 expression. Quantification of miR-1 and TGF-ßR1 in rats treated with monocrotaline to induce pulmonary arterial hypertension showed appropriate changes in miR-1 and TGF-ßR1 expression in the hypertrophying right ventricle. A miR-1-mimic reduced enhanced green fluorescent protein expression from a reporter vector containing the TGF-ßR1 3'- untranslated region and knocked down endogenous TGF-ßR1. Lastly, miR-1 reduced TGF-ß activation of a (mothers against decapentaplegic homolog) SMAD2/3-dependent reporter. Taken together, these data suggest that miR-1 targets TGF-ßR1 and reduces TGF-ß signalling, so a reduction in miR-1 expression may increase TGF-ß signalling and contribute to cardiac hypertrophy.


Assuntos
Cardiomegalia/patologia , Regulação da Expressão Gênica , Hipertrofia Ventricular Direita/patologia , MicroRNAs/genética , Hipertensão Arterial Pulmonar/complicações , Receptor do Fator de Crescimento Transformador beta Tipo I/metabolismo , Animais , Cardiomegalia/etiologia , Cardiomegalia/metabolismo , Hipertrofia Ventricular Direita/etiologia , Hipertrofia Ventricular Direita/metabolismo , Masculino , Ratos , Ratos Sprague-Dawley , Receptor do Fator de Crescimento Transformador beta Tipo I/genética
14.
Arch Cardiovasc Dis ; 113(1): 70-84, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31924541

RESUMO

Pulmonary arterial hypertension is a progressive and lethal cardiopulmonary disease. The rise in right ventricular afterload leads to right ventricular hypertrophy and failure. Right ventricular failure is the most important prognostic factor for morbidity and mortality in pulmonary arterial hypertension or pulmonary hypertension caused by left heart diseases. Surprisingly, the right ventricle is not targeted by pulmonary arterial hypertension-specific therapies. The current profound lack of basic understanding of pulmonary arterial hypertension-related right ventricular remodelling can explain, at least in part, this paradox. The physiology and haemodynamic function of the right ventricle in the normal state differ considerably from those of the left ventricle, and the known mechanisms of left ventricular dysfunction cannot be generalized to right ventricular dysfunction. Ion channel activities and calcium homeostasis tightly regulate cardiac function, and their dysfunction contributes to the pathogenesis of cardiac diseases. This review focuses on the ion channels (potassium, calcium) and intracellular calcium handling remodelling involved in right ventricular hypertrophy and dysfunction caused by pulmonary arterial hypertension.


Assuntos
Acoplamento Excitação-Contração , Ventrículos do Coração/fisiopatologia , Hipertrofia Ventricular Direita/etiologia , Contração Miocárdica , Hipertensão Arterial Pulmonar/complicações , Disfunção Ventricular Direita/etiologia , Função Ventricular Direita , Remodelação Ventricular , Potenciais de Ação , Animais , Pressão Arterial , Cálcio/metabolismo , Modelos Animais de Doenças , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/metabolismo , Insuficiência Cardíaca/fisiopatologia , Frequência Cardíaca , Ventrículos do Coração/metabolismo , Humanos , Hipertrofia Ventricular Direita/metabolismo , Hipertrofia Ventricular Direita/fisiopatologia , Potássio/metabolismo , Prognóstico , Hipertensão Arterial Pulmonar/metabolismo , Hipertensão Arterial Pulmonar/fisiopatologia , Artéria Pulmonar/fisiopatologia , Fatores de Risco , Pesquisa Médica Translacional , Disfunção Ventricular Direita/metabolismo , Disfunção Ventricular Direita/fisiopatologia
15.
Cardiovasc J Afr ; 31(4): 75-80, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31544202

RESUMO

BACKGROUND: Pulmonary arterial hypertension (PAH) is a haemodynamic and pathophysiological condition with restricted flow through the pulmonary arterial circulation. In pulmonary hypertension, right ventricular hypertrophy and diastolic dysfunction can lead to an increase in atrial strain, fibrosis and dilation, which cause inhomogeneous atrial conduction. Interlead variation in P-wave duration is called P-wave dispersion (PwD), which is an electrocardiographic parameter that can be used to predict atrial arrhythmias. Our aim was to investigate the relationship between PwD, functional capacity, and invasive and non-invasive haemodynamic parameters of patients diagnosed with PAH. METHODS: Between 2015 and 2017 we enrolled 33 patients admitted to our in-patient clinic and diagnosed with PAH, and 32 healthy individuals for the control group. Details of these patients at the time of diagnosis were analysed, including gender, age, physical examination, electrocardiogram (ECG), echocardiography, six-minute walk test distance (6MWD), haemodynamic parameters and blood tests for biochemical markers that are correlated with clinical severity. Statistical analyses were performed using SPSS version 20.0 (SPSS Inc, Chicago, Illinois, USA). Statistical significance was taken as p < 0.05. RESULTS: In the forward stepwise multiple linear regression analysis, PwD and mean pulmonary artery pressure determined by right heart catheterisation were independently related to the functional capacity tested by the 6MWD (p < 0.02 and p < 0.01, respectively). CONCLUSIONS: PwD can easily be calculated from a surface ECG to indirectly estimate the functional status and prognosis of the patient with PAH.


Assuntos
Potenciais de Ação , Função do Átrio Direito , Remodelamento Atrial , Eletrocardiografia , Frequência Cardíaca , Hipertrofia Ventricular Direita/diagnóstico , Hipertensão Arterial Pulmonar/diagnóstico , Disfunção Ventricular Direita/diagnóstico , Adulto , Idoso , Pressão Arterial , Cateterismo Cardíaco , Estudos de Casos e Controles , Ecocardiografia , Tolerância ao Exercício , Feminino , Humanos , Hipertrofia Ventricular Direita/etiologia , Hipertrofia Ventricular Direita/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Hipertensão Arterial Pulmonar/complicações , Hipertensão Arterial Pulmonar/fisiopatologia , Artéria Pulmonar/fisiopatologia , Fatores de Tempo , Disfunção Ventricular Direita/etiologia , Disfunção Ventricular Direita/fisiopatologia , Função Ventricular Direita , Teste de Caminhada , Adulto Jovem
18.
Eur J Ophthalmol ; 30(3): 579-585, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-30773051

RESUMO

OBJECTIVE: To evaluate the potential utility of perfusion density measurements to discriminate patients with arterial hypertension by cardiovascular risk category. METHODS: In this cross-sectional study, one eye per subject was evaluated (N = 73). The study cohort was divided into three groups according to the clinical criteria established by the European Guidelines for Arterial Hypertension: 26 controls, 24 patients with low cardiovascular risk, and 23 patients with very high cardiovascular risk. All patients were examined using RS-3000 Advance optical coherence tomography angiography to analyze macular and peripapillary perfusion density. RESULTS: There were no differences among the three risk groups by sex or age. Decreased macular perfusion density was found at the level of the superficial and deep plexuses (p ⩽ 0.047). No differences were observed in peripapillary perfusion density (p = 0.18). CONCLUSION: Optical coherence tomography angiography can detect changes in macular perfusion density in patients with hypertension and high cardiovascular risk and might represent a supportive imaging method in the evaluation of the cardiovascular risk in hypertensive patients.


Assuntos
Retinopatia Hipertensiva/diagnóstico , Hipertensão Arterial Pulmonar/complicações , Vasos Retinianos/patologia , Idoso , Estudos Transversais , Feminino , Angiofluoresceinografia/métodos , Humanos , Retinopatia Hipertensiva/etiologia , Retinopatia Hipertensiva/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Células Ganglionares da Retina/patologia , Tomografia de Coerência Óptica/métodos
19.
Int J Cardiovasc Imaging ; 36(4): 577-584, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31853819

RESUMO

To explore the value of right ventricular (RV) parameters detected by three-dimensional echocardiography (3DE) in risk stratification in pulmonary arterial hypertension (PAH) patients. We prospectively recruited 130 pulmonary hypertension patients from National Center for Cardiovascular Diseases, Fuwai Hospital. Each participant was performed a transthoracic echocardiography and 3DE parameters were measured using an off-line software (4D RV Function 2.0, TomTec). Patients were classified into low, intermediate-high risk group based on 2015 ESC Guidelines. A total of 91 PAH patients (34 ± 12 years old, 25 males) were enrolled, among which, 42 were classified into low risk group, while 49 were intermediate-high risk group. Compared with low-risk patients, those with intermediate-high risk had significantly larger 3DE-RV volumes, worse ejection fraction (EF) and tricuspid annular plane systolic excursion, and decreased longitudinal strain (LS). Receive operating characteristic curves illustrated all the 3DE parameters were able to predict intermediate-high risk stratification, especially 3D-RVEF (area under curve, 0.82, 95% CI 0.73-0.91, P < 0.001). And 3D-RVEF < 26.39% had a 81.6% sensibility and 73.8% specificity to predict intermediate-high risk stratification. Univariate and multivariate Logistic regression analyses identified 3D-RV end-diastolic (OR 1.02, 95% CI 1.01-1.03, P = 0.002) and end-systolic (OR 1.03, 95% CI 1.01-1.04, P < 0.001) volumes, 3D-RVEF (OR 0.82, 95% CI 0.75-0.90, P < 0.001) and LS of free wall (OR 1.17, 95% CI 1.05-1.31, P = 0.005) as independent predictors of intermediate-high risk stratification. In conclusion, RV volumes, EF and free wall strain detected by 3DE were independent predictors of intermediate-high risk stratification in PAH patients, among which, RVEF showed the best predictive capacity.


Assuntos
Ecocardiografia Tridimensional , Hipertensão Arterial Pulmonar/diagnóstico por imagem , Volume Sistólico , Disfunção Ventricular Direita/diagnóstico por imagem , Função Ventricular Direita , Adulto , Pressão Arterial , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Hipertensão Arterial Pulmonar/complicações , Hipertensão Arterial Pulmonar/fisiopatologia , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/fisiopatologia , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco , Disfunção Ventricular Direita/etiologia , Disfunção Ventricular Direita/fisiopatologia , Adulto Jovem
20.
Am J Pathol ; 190(1): 48-56, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31839145

RESUMO

Kv11.1 potassium channels are essential for heart repolarization. Prescription medication that blocks Kv11.1 channels lengthens the ventricular action potential and causes cardiac arrhythmias. Surprisingly little is known about the Kv11.1 channel expression and function in the lung tissue. Here we report that Kv11.1 channels were abundantly expressed in the large pulmonary arteries (PAs) of healthy lung tissues from humans and rats. Kv11.1 channel expression was increased in the lungs of humans affected by chronic obstructive pulmonary disease-associated pulmonary hypertension and in the lungs of rats with pulmonary arterial hypertension (PAH). In healthy lung tissues from humans and rats, Kv11.1 channels were confined to the large PAs. In humans with chronic obstructive pulmonary disease-associated pulmonary hypertension and in rats with PAH, Kv11.1 channels were expressed in both the large and small PAs. The increase in Kv11.1 channel expression closely followed the time-course of the development of pulmonary vascular remodeling in PAH rats. Treatment of PAH rats with dofetilide, an Kv11.1 channel blocker approved by the US Food and Drug Administration for use in the treatment of arrythmia, inhibited PAH-associated pulmonary vascular remodeling. Taken together, the findings from this study uncovered a novel role of Kv11.1 channels in lung function and their potential as new drug targets in the treatment of pulmonary hypertension. The protective effect of dofetilide raises the possibility of repurposing this antiarrhythmic drug for the treatment of patients with pulmonary hypertension.


Assuntos
Arritmias Cardíacas/prevenção & controle , Canal de Potássio ERG1/antagonistas & inibidores , Músculo Liso Vascular/efeitos dos fármacos , Fenetilaminas/farmacologia , Bloqueadores dos Canais de Potássio/farmacologia , Hipertensão Arterial Pulmonar/complicações , Sulfonamidas/farmacologia , Remodelação Vascular/efeitos dos fármacos , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/patologia , Estudos de Casos e Controles , Canal de Potássio ERG1/metabolismo , Feminino , Seguimentos , Humanos , Masculino , Músculo Liso Vascular/metabolismo , Músculo Liso Vascular/patologia , Prognóstico , Hipertensão Arterial Pulmonar/metabolismo , Hipertensão Arterial Pulmonar/patologia , Ratos Sprague-Dawley
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