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Exercise induced pulmonary hypertension

Mark R de Jong, Annemiek F Hoogerwaard, Ahmet Adiyaman, Jaap Jan J Smit, Anand R Ramdat Misier, Jan-Evert Heeg, Boudewijn A A M van Hasselt, Isabelle C Van Gelder, Harry J G M Crijns, Ignacio Fernández Lozano, Jorge E Toquero Ramos, F Javier Alzueta, Borja Ibañez, José M Rubio, Fernando Arribas, José M Porres Aracama, Josep Brugada, Lluís Mont, Arif Elvan
BACKGROUND: Hypertension is an important, modifiable risk factor for the development of atrial fibrillation (AF). Even after pulmonary vein isolation (PVI), 20-40% experience recurrent AF. Animal studies have shown that renal denervation (RDN) reduces AF inducibility. One clinical study with important limitations suggested that RDN additional to PVI could reduce recurrent AF. OBJECTIVE: The goal of this multicenter randomized controlled study is to investigate whether RDN added to PVI reduces AF recurrence...
February 27, 2018: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Robert Naeije, Rajeev Saggar, David Badesch, Sanjay Rajagopalan, Luna Gargani, Franz Rischard, Francesco Ferrara, Alberto M Marra, Michele D'Alto, Todd M Bull, Rajan Saggar, Ekkehard Grünig, Eduardo Bossone
Exercise stress testing of the pulmonary circulation for the diagnosis of latent or early stage pulmonary hypertension is gaining acceptance. There is emerging consensus to define exercise-induced pulmonary hypertension by a mean pulmonary artery pressure higher than 30 mmHg at a cardiac output of less than 10 L/min and a total pulmonary vascular resistance higher than 3 Wood units at maximum exercise, in the absence of pulmonary hypertension at rest. Exercise-induced pulmonary hypertension has been reported in association with a bone morphogenetic receptor-2 gene mutation, in systemic sclerosis, in left heart conditions, in chronic lung diseases and in chronic pulmonary thrombo-embolism...
January 27, 2018: Chest
Steven Hsu, Kristen M Kokkonen-Simon, Jonathan A Kirk, Todd M Kolb, Rachel L Damico, Stephen C Mathai, Monica Mukherjee, Ami A Shah, Fredrick M Wigley, Kenneth B Margulies, Paul M Hassoun, Marc K Halushka, Ryan J Tedford, David A Kass
Background -Patients with systemic sclerosis-associated pulmonary arterial hypertension (SSc-PAH) have a far worse prognosis than those with idiopathic PAH (IPAH). In the intact heart, SSc-PAH exhibits depressed rest and reserve right ventricular (RV) contractility as compared to IPAH. We tested whether this disparity involves underlying differences in myofilament function. Methods -Cardiac myocytes were isolated from RV septal endomyocardial biopsies from patients with SSc-PAH, IPAH, or SSc with exertional dyspnea but no resting PAH (SSc-d); control RV septal tissue was obtained from non-diseased donor hearts (6-7/group)...
January 19, 2018: Circulation
Sherin Hassan M Mehani, Heba Ahmed A Abdeen
[Purpose] Ventilatory limitation is a common problem in patients with chronic heart failure and pulmonary hypertension. Excess ventilation may arise from augmented ventilatory drive, over activity of chemoreceptors and muscle ergoreceptors, or premature onset of lactic acidosis. Exertional dyspnea can cause limitations in the activities of daily living and as a result, reduced quality of life for these patients. The aim of the present study was to evaluate the effect of cardiopulmonary rehabilitation program on ventilatory efficiency for these patients...
October 2017: Journal of Physical Therapy Science
Denielli da Silva Gonçalves Bós, Cathelijne E E Van Der Bruggen, Kondababu Kurakula, Xiao-Qing Sun, Karina R Casali, Adenauer G Casali, Nina Rol, Robert Szulcek, Cris Dos Remedios, Christophe Guignabert, Ly Tu, Peter Dorfmüller, Marc Humbert, Paul J M Wijnker, Diederik W D Kuster, Jolanda van der Velden, Marie-José Goumans, Harm-Jan Bogaard, Anton Vonk-Noordegraaf, Frances S de Man, M Louis Handoko
BACKGROUND: The beneficial effects of parasympathetic stimulation have been reported in left heart failure, but whether it would be beneficial for pulmonary arterial hypertension (PAH) remains to be explored. Here, we investigated the relationship between parasympathetic activity and right ventricular (RV) function in patients with PAH, and the potential therapeutic effects of pyridostigmine (PYR), an oral drug stimulating the parasympathetic activity through acetylcholinesterase inhibition, in experimental pulmonary hypertension (PH)...
February 27, 2018: Circulation
Kelly Stam, Richard W B van Duin, Andre Uitterdijk, Zongye Cai, Dirk J Duncker, Daphne Merkus
Chronic thrombo-embolic pulmonary hypertension (CTEPH) develops in 4% of patients after pulmonary embolism and is accompanied by an impaired exercise tolerance, which is ascribed to the increased right ventricular (RV) afterload and a ventilation/perfusion (V/Q) mismatch in the lungs. This study investigated changes in arterial PO2 and hemodynamics in response to graded treadmill exercise during development and progression of CTEPH in a swine model. Swine were chronically instrumented and received multiple pulmonary embolisms by (i) microsphere infusion (Spheres) over five weeks, (ii) endothelial dysfunction by administration of eNOS inhibitor L-Nω-Nitroarginine methyl ester (LNAME) during seven weeks, (iii) combined pulmonary embolisms and endothelial dysfunction (LNAME+Spheres), or (iv) served as sham-operated controls (Sham)...
November 22, 2017: American Journal of Physiology. Heart and Circulatory Physiology
Daphne P M de Wijs-Meijler, Richard W B van Duin, Dirk J Duncker, Urs Scherrer, Claudio Sartori, Irwin K M Reiss, Daphne Merkus
Pulmonary vascular disease (PVD) represents an underestimated and increasing clinical burden in the neonatal period, but also later in life, when exercise-tolerance is decreased. Animal models performing long-term follow-up after a perinatal insult are lacking. This study aimed to develop and characterize a neonatal swine model with hypoxia-induced PVD, during long-term follow-up after re-exposure to normoxia, and to investigate the exercise response in this model. Piglets were exposed to a normoxic (N=10) or hypoxic environment (N=9) for four weeks...
November 10, 2017: American Journal of Physiology. Heart and Circulatory Physiology
Yihua Bei, Lichan Tao, Dragos Cretoiu, Sanda Maria Cretoiu, Junjie Xiao
MicroRNAs (miRNAs, miRs), a group of small non-coding RNAs, repress gene expressions at posttranscriptional level in most cases and are involved in cardiovascular physiology and disease pathogenesis. Increasing evidence has proved that miRNAs are potential regulators of exercise induced cardiac growth and mediate the benefits of exercise in a variety of cardiovascular diseases. In this chapter, we will review the regulatory effects of miRNAs in cardiac adaptations to exercise, and summarize their cardioprotective effects against myocardial infarction, ischemia/reperfusion injury, heart failure, diabetic cardiomyopathy, atherosclerosis, hypertension, and pulmonary hypertension...
2017: Advances in Experimental Medicine and Biology
Colin E Evans, You-Yang Zhao
Pulmonary hypertension (PH) is a lung vascular disease with marked increases in pulmonary vascular resistance and pulmonary artery pressure (>25 mmHg at rest). In PH patients, increases in pulmonary vascular resistance lead to impaired cardiac output and reduced exercise tolerance. If untreated, PH progresses to right heart failure and premature lethality. The mechanisms that control the pathogenesis of PH are incompletely understood, but evidence from human and animal studies implicate nitrative stress in the development of PH...
2017: Advances in Experimental Medicine and Biology
Jason Weatherald, Laurent Savale, Marc Humbert
PURPOSE OF REVIEW: The purpose of this review was to outline the mechanisms and to review recent literature on pulmonary arterial hypertension (PAH) medications in group 5 pulmonary hypertension (PH). RECENT FINDINGS: The first steps in management are to understand the mechanisms and hemodynamic profile and to exclude chronic thromboembolic disease. Recent studies in the past 5 years have found that PAH medications may improve hemodynamics in patients with pre-capillary pulmonary hypertension due to sarcoidosis, pulmonary Langerhans cell histiocytosis, lymphangioleiomyomatosis, and myeloproliferative disorders with dasatinib-induced PH...
October 18, 2017: Current Hypertension Reports
Geoff Strange, Edmund M Lau, Eleni Giannoulatou, Carolyn Corrigan, Eugene Kotlyar, Fiona Kermeen, Trevor Williams, David S Celermajer, Nathan Dwyer, Helen Whitford, Jeremy P Wrobel, John Feenstra, Melanie Lavender, Kenneth Whyte, Nicholas Collins, Peter Steele, Susanna Proudman, Vivek Thakkar, Dominic Keating, Anne Keogh
BACKGROUND: Epidemiology and treatment strategies continue to evolve in pulmonary arterial hypertension (PAH). We sought to define the characteristics and survival of patients with idiopathic, heritable and drug-induced PAH in the current management era. METHODS: Consecutive cases of idiopathic, heritable and drug-induced PAH were prospectively enrolled into an Australian and New Zealand Registry. RESULTS: Between January 2012 and December 2016, a total of 220 incident cases were enrolled (mean age 57...
September 20, 2017: Heart, Lung & Circulation
Simon Malenfant, Patrice Brassard, Myriam Paquette, Olivier Le Blanc, Audrey Chouinard, Valérie Nadeau, Philip D Allan, Yu-Chieh Tzeng, Sébastien Simard, Sébastien Bonnet, Steeve Provencher
BACKGROUND: Functional cerebrovascular regulatory mechanisms are important for maintaining constant cerebral blood flow and oxygen supply in heathy individuals and are altered in heart failure. We aim to examine whether pulmonary arterial hypertension (PAH) is associated with abnormal cerebrovascular regulation and lower cerebral oxygenation and their physiological and clinical consequences. METHODS AND RESULTS: Resting mean flow velocity in the middle cerebral artery mean flow velocity in the middle cerebral artery (MCAvmean); transcranial Doppler), cerebral pressure-flow relationship (assessed at rest and during squat-stand maneuvers; analyzed using transfer function analysis), cerebrovascular reactivity to CO2, and central chemoreflex were assessed in 11 patients with PAH and 11 matched healthy controls...
October 12, 2017: Journal of the American Heart Association
Francesco Scardulla, Diego Bellavia, Patrizio Vitulo, Giuseppe Romano, Chiara Mina, Giovanni Gentile, Francesco Clemenza, Salvatore Pasta
Pulmonary hypertension (PH) is a disease characterized by progressive adverse remodeling of the distal pulmonary arteries, resulting in elevated pulmonary vascular resistance and load pressure on the right ventricle (RV), ultimately leading to RV failure. Invasive hemodynamic testing is the gold standard for diagnosing PH and guiding patient therapy. We hypothesized that lumped-parameter and biventricular finite-element (FE) modeling may lead to noninvasive predictions of both PH-related hemodynamic and biomechanical parameters that induce PH...
October 18, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Daniel Moreira-Gonçalves, Rita Ferreira-Nogueira, Mário Santos, Ana Filipa Silva, Rita Ferreira, Adelino Leite-Moreira, José Alberto Duarte, Tiago Henriques-Coelho
Exercise training (ExT) is widely used for the prevention and treatment of several chronic cardiovascular diseases. However, only recently it started to be recognized as safe and beneficial in pulmonary arterial hypertension. Despite the consistency of its favorable effects on exercise tolerance and quality of life, the mechanisms underlying these meaningful clinical improvements remain unclear. Current studies emphasize the exercise-induced changes on skeletal muscle but the impact of ExT at the level of the pulmonary circulation and right ventricle should not be overlooked...
2017: Advances in Experimental Medicine and Biology
Mohamad Amer Alaiti, Aditya Goud, Gautam Ramani, Sashwatee Bagchi, Sadeer Al-Kindi, Steven Sawicki, Christopher Longenecker, Trevor Jenkins, David Pauza, Myung Park, Grace McComsey, Orlando Simonetti, Brian Hoit, Sanjay Rajagopalan
BACKGROUND: Pulmonary arterial hypertension (PAH) is a potentially serious cause of dyspnea and exercise limitation in patients with HIV infection. In this trial, we propose using exercise MRI in conjunction with cardiopulmonary testing to delineate PAH from other causes of cardiovascular dysfunction, identify individuals with exercise-induced PAH who are at high risk of developing resting PAH, and provide longitudinal estimates of progression of PAH and right ventricular function. METHODS: In this prospective observational study, HIV patients with dyspnea and exercise limitation in the absence of identifiable causes and those who meet the inclusion criteria will be enrolled based on resting pulmonary artery pressure (≤ or >40 mmHg) on a screening echocardiogram and exercise limitation on the Modified Medical Research Council dyspnea scale...
September 20, 2017: Journal of Cardiovascular Medicine
Marco Guazzi, Francesco Bandera, Cemal Ozemek, David Systrom, Ross Arena
Compared with traditional exercise tests, cardiopulmonary exercise testing (CPET) provides a thorough assessment of exercise integrative physiology involving the pulmonary, cardiovascular, muscular, and cellular oxidative systems. Due to the prognostic ability of key variables, CPET applications in cardiology have grown impressively to include all forms of exercise intolerance, with a predominant focus on heart failure with reduced or with preserved ejection fraction. As impaired cardiac output and peripheral oxygen diffusion are the main determinants of the abnormal functional response in cardiac patients, invasive CPET has gained new popularity, especially for diagnosing early heart failure with preserved ejection fraction and exercise-induced pulmonary hypertension...
September 26, 2017: Journal of the American College of Cardiology
Abdalla Ibrahim, Stephen P Power, Peter Kelly
A 60-year-old man with a medical history of hypertension and dyslipidaemia presented to our rapid access chest pain clinic with a 2-month history of chest pain on exertion. An exercise stress test was arranged, which showed electrical evidence of inducible ischaemia. Subsequently, a coronary angiogram revealed an anomalous left anterior descending artery arising from the main pulmonary artery that received grade 3 collaterals from a large right coronary artery arising from the aorta. The circumflex arises from the right coronary sinus with a retroaortic course and provided collaterals to the anomalous left anterior descending artery...
September 7, 2017: BMJ Case Reports
Laura Donahoe, Rachel Vanderlaan, John Thenganatt, Karen McRae, Anastasia Bykova, Jakov Moric, John Granton, Marc de Perrot
BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) is still largely underdiagnosed in the general population. Although transthoracic echocardiogram (TTE) is recommended to screen for CTEPH, it may not detect patients with chronic thromboembolic disease (CTED) and mild or exercise-induced pulmonary hypertension (PH) who could also benefit from pulmonary endarterectomy (PEA). METHODS: All patients referred to our CTEPH program with persistent mismatched perfusion defects on ventilation-perfusion (VQ) scan between January 2005 and June 2015 were divided into three groups according to TTE and right heart catheterization (RHC) as follows: (1) typical CTEPH group (PH on RHC and TTE), (2) TTE-negative (neg) CTEPH group (PH on RHC, but not TTE), or (3) CTED group (no PH on RHC and TTE)...
October 2017: Annals of Thoracic Surgery
Steven Hsu, Samuel B Brusca, Parker S Rhodes, Todd M Kolb, Stephen C Mathai, Ryan J Tedford
Two new definitions of exercise-induced pulmonary hypertension (EIPH) have emerged. Both rely on measuring cardiac output (CO), yet this remains unstandardized. In our cohort of patients undergoing invasive cardiopulmonary exercise testing, we found that using thermodilution CO rather than direct Fick CO led to a significant excess of EIPH diagnoses.
March 2017: Pulmonary Circulation
Daphne P M de Wijs-Meijler, A H Jan Danser, Irwin K M Reiss, Dirk J Duncker, Daphne Merkus
Although the incidence of pulmonary hypertension is higher in females, the severity and prognosis of pulmonary vascular disease in both neonates and adults have been shown to be worse in male subjects. Studies of sex differences in pulmonary hypertension have mainly focused on the role of sex hormones. However, the contribution of sex differences in terms of vascular signaling pathways regulating pulmonary vascular function remains incompletely understood. Consequently, we investigated pulmonary vascular function of male and female swine in vivo, both at rest and during exercise, and in isolated small pulmonary arteries in vitro, with a particular focus on the NO-cGMP-PDE5 pathway...
June 2017: Physiological Reports
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