Endothelial cell ferroptosis mediates monocrotaline-induced pulmonary hypertension in rats by modulating NLRP3 inflammasome activation

Evaluating The Association Of Endothelial Function And Pulmonary Pressures In Suspected PH

The following is a summary of "Endothelial function correlates with pulmonary pressures in subjects with clinically suspected pulmonary hypertension," published in the June 2024 issue of Cardiology by Correale et al.

Pulmonary hypertension (PH) often involves impaired blood flow dynamics in the lungs.

Researchers conducted retrospective research to verify any association between blood vessel expansion during flow-mediated dilation (FMD) and hemodynamic parameters at right heart catheterization (RHC) in patients with suspected PH.

They enrolled consecutive outpatients suspected of PH. The endothelial function was assessed using FMD and derived hemodynamic parameters (pulmonary artery parameters [PAP] and pulmonary vascular resistances [PVR]) by using RHC in all patients.

The results showed that 95 consecutive patients with suspected PH were included in the study. The average age was 63 years (SD 13 years), and 58% were male. FMD values showed a significant negative correlation with systolic PAP (r= -0.21, P=0.078). In multivariable analysis with age, gender, TAPSE, peak-TVR, and FMD, FMD remained significantly correlated with systolic PAP (B=-47, P=0.02). Patients grouped by median peak TRV and FMD levels showed progressively higher systolic PAP, mean PAP, and PVR (P for trend<0.001 for all).  

Investigators concluded that in patients suspected of having PH, FMD values inversely correlated with systolic PAP. When combined with peak TRV levels, FMD was predictive of higher systolic and mean PAP and increased PVR.

Source: ajconline.Org/article/S0002-9149(24)00454-5/abstract#%20

PAH Risk Scoring Systems Can Also Predict Survival In Pulmonary Hypertension

Risk stratification scoring systems designed for pulmonary arterial hypertension (PAH) that include 3 or 4 strata can also predict survival in patients with non-PAH pulmonary hypertension (PH), according to study findings published in Chest.

Researchers assessed whether risk scores originally developed for PAH had prognostic value in pulmonary hypertension groups 1 to 4. Toward that end, the researchers compared how well several major 3- and 4-strata PAH risk scoring systems predicted PH survival in patients who enrolled in the Pulmonary Vascular Research Institute (PVRI) GoDeep meta-registry.

Patients included for analysis had a right heart catheter-confirmed PH diagnosis from a participating PH expert center and were at least 18 years of age at diagnosis. The analysis included the REVEAL Lite 2 risk score, the REVEAL 2.0 risk score, the European Society of Cardiology (ESC)/European Respiratory Society (ERS) 2022 risk score, and the COMPERA registry 3-/4-strata risk scores.

The PVRI GoDeep meta-registry had 27,070 patients on October 16, 2023, including 8565 incident and treatment-naïve patients in 15 PH centers. Among the cohort, 3537(41%) patients were diagnosed with group 1 PH, 1807 (21%) had group 2 PH, 1635 (19%) had group 3 PH, and 1586 (19%) patients had group 4 PH. Their median age was 65 (range, 52-74) years, and 39% were male. The median pulmonary arterial pressure was 42 (range, 33-52) mm Hg, and the median pulmonary vascular resistance was 7 (range, 4-11) WU.

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This comprehensive study with real-world data from 15 PH centers substantially extends our understanding of the predictive power of PAH-designed risk scores, including their potential application in PH patients beyond the PAH group.

All the risk scores predicted survival for patients with incident PH. The REVEAL scores were significantly better than the ESC/ERS risk 2022 score and compared favorably to the COMPERA registry 3-strata risk score. Among patients with REVEAL Lite 2.0 score of 6 or less, the overall 1-, 3-, and 5-year survival rates were 93%, 78%, and 66%, respectively, including patients in all PH groups. Those with higher scores had a significantly worse prognoses.

In univariate Cox regression analysis, significantly increased hazard ratios were confirmed for each point increase in REVEAL 2.0 and REVEAL Lite 2, compared with patients with a total score of 6 points or less. The COMPERA registry 4-strata risk score was able to discriminate between intermediate-low and intermediate-high risk patients and significantly outperformed the ESC/ERS risk 2022 score.

In PH group-based analyses, all included risk scores predicted survival in PH groups 1 to 4. The ESC/ERS 2022 risk score had an uneven distribution with strong predominance of the intermediate risk score group for the 4 PH groups. The COMPERA 4-strata risk score discriminated intermediate-low and intermediate-high patients in all groups. REVEAL scores C-indices in a continuous scoring system were the highest for each individual PH group.

PAH-designed 3- and 4-strata risk scores had predictive power in each subgroup, with strong discrimination of the continuous REVEAL scores and efficacy of the 4-strata risk score to discriminate between intermediate-low and intermediate-high cohorts.

Similar results were observed when dichotomizing the overall PH cohort and each PH group for severe vs nonsevere PH (PVR ≥5 WU and PVR <5 WU).

Limitations include the retrospective study design, the ability to perform only limited subgroup analyses, and possible selection bias.

"This comprehensive study with real-world data from 15 PH centers substantially extends our understanding of the predictive power of PAH-designed risk scores, including their potential application in PH patients beyond the PAH group," the investigators stated.

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors' disclosures.

This article originally appeared on Pulmonology Advisor

Measuring Blood Vessel Function In Arm May Help Predict PH: Study

Measuring blood vessel function in the arm in a noninvasive way can help predict pulmonary hypertension (PH) when combined with certain heart measurements, a study has found.

The study, "Endothelial Function Correlates With Pulmonary Pressures in Subjects With Clinically Suspected Pulmonary Hypertension," was published in The American Journal of Cardiology.

PH occurs when blood pressure in the pulmonary arteries that carry blood from the heart to the lungs is too high. This increased pressure can lead to serious problems, such as heart failure. To understand PH better, it's important to study how blood flows through these arteries.

In PH, blood flow is impaired, which means higher pressure in the pulmonary arteries (PAP) and increased pulmonary vascular resistance (PVR). Researchers in Italy wanted to see if there was a link between the health of the endothelial cells that make up the blood vessel linings and these measurements.

To test this, they used a test called flow-mediated dilation (FMD), which checks how well the artery in the arm expands when blood flow increases.

The study included 95 patients suspected of having PH, who were a mean age of 63 years and 58% of them were male. Each patient underwent FMD and right-sided heart catheterization to measure blood pressure in the heart and lungs, including PAP and PVR. The catheterization is an invasive procedure that provides precise measurements.

As blood vessel health worsens, pressure in pulmonary arteries increases

Results showed that lower FMD values, indicating poorer blood vessel health, were linked to higher systolic PAP. This means that as blood vessel health worsens, the pressure in the pulmonary arteries increases. The link with PVR was less clear.

Further analysis, taking into account factors such as age, sex, and other heart function measurements, confirmed that FMD is a significant predictor of systolic PAP. This means that even when considering these other factors, FMD remains an important indicator.

The study also grouped patients based on their FMD and another measurement called peak tricuspid regurgitation velocity (TRV). Patients with both impaired FMD and peak TRV had the highest systolic PAP, mean PAP, and PVR levels. This trend suggests that combining these two measurements can better predict PH.

The study found poorer blood vessel health, as measured by FMD, is linked to higher pulmonary artery pressure in patients with suspected PH. Combining FMD with peak TRV provides a useful, noninvasive way to predict the severity of PH, which can help in its diagnosis and treatment.

"The assessment of endothelial function by FMD is relatively simple, feasible, cheap, and noninvasive, thus possibly representing an innovative tool for the clinical screening of patients with suspected PH," the scientists wrote.

"Future studies are needed to ascertain whether FMD may represent a possible useful tool for risk stratification, treatment, and outcome modification in [pulmonary arterial hypertension]," they added.

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