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Exercise induced pulmonary hypertension

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https://www.readbyqxmd.com/read/29167228/contribution-of-impaired-parasympathetic-activity-to-right-ventricular-dysfunction-and-pulmonary-vascular-remodeling-in-pulmonary-arterial-hypertension
#1
Denielli da Silva Gonçalves Bos, Cathelijne 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 Dorfmuller, 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 -Beneficial effects of parasympathetic stimulation have been reported in left heart failure, however, 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 PAH-patients, and the potential therapeutic effects of pyridostigmine (PYR), an oral drug stimulating the parasympathetic activity through acetylcholinesterase (AchE) inhibition, in experimental pulmonary hypertension (PH)...
November 22, 2017: Circulation
https://www.readbyqxmd.com/read/29167118/exercise-facilitates-early-recognition-of-cardiac-and-vascular-remodeling-in-chronic-thrombo-embolic-pulmonary-hypertension-in-a-novel-cteph-swine-model
#2
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-N(ω)-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
https://www.readbyqxmd.com/read/29127236/structural-and-functional-changes-of-the-pulmonary-vasculature-after-hypoxia-exposure-in-the-neonatal-period-a-new-swine-model-of-pulmonary-vascular-disease
#3
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
https://www.readbyqxmd.com/read/29098626/micrornas-mediate-beneficial-effects-of-exercise-in-heart
#4
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
https://www.readbyqxmd.com/read/29047079/molecular-basis-of-nitrative-stress-in-the-pathogenesis-of-pulmonary-hypertension
#5
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
https://www.readbyqxmd.com/read/29046979/medical-management-of-pulmonary-hypertension-with-unclear-and-or-multifactorial-mechanisms-group-5-is-there-a-role-for-pulmonary-arterial-hypertension-medications
#6
REVIEW
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
https://www.readbyqxmd.com/read/29029950/survival-of-idiopathic-pulmonary-arterial-hypertension-patients-in-the-modern-era-in-australia-and-new-zealand
#7
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
https://www.readbyqxmd.com/read/29025748/compromised-cerebrovascular-regulation-and-cerebral-oxygenation-in-pulmonary-arterial-hypertension
#8
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
https://www.readbyqxmd.com/read/29023250/biomechanical-determinants-of-right-ventricular-failure-in-pulmonary-hypertension
#9
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
https://www.readbyqxmd.com/read/29022270/exercise-training-in-pulmonary-hypertension-and-right-heart-failure-insights-from-pre-clinical-studies
#10
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
https://www.readbyqxmd.com/read/28937582/design-of-the-exercise-mri-evaluation-of-hiv-pulmonary-arterial-hypertension-longitudinal-determinants-exhalted-trial
#11
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
https://www.readbyqxmd.com/read/28935040/cardiopulmonary-exercise-testing-what-is-its-value
#12
REVIEW
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
https://www.readbyqxmd.com/read/28882941/anomalous-left-anterior-descending-artery-arising-from-the-pulmonary-trunk-a-rare-cause-of-angina
#13
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
https://www.readbyqxmd.com/read/28821335/symptoms-are-more-useful-than-echocardiography-in-patient-selection-for%C3%A2-pulmonary-endarterectomy
#14
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
https://www.readbyqxmd.com/read/28680584/use-of-thermodilution-cardiac-output-overestimates-diagnoses-of-exercise-induced-pulmonary-hypertension
#15
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
https://www.readbyqxmd.com/read/28596298/sex-differences-in-pulmonary-vascular-control-focus-on-the-nitric-oxide-pathway
#16
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
https://www.readbyqxmd.com/read/28590298/diagnostic-and-prognostic-implications-of-exercise-treadmill-and-rest-first-pass-radionuclide-angiography-in-patients-with-pulmonary-hypertension
#17
Yen-Wen Wu, Pei-Ying Hsu, Yen-Hung Lin, Mei-Fang Cheng, Chi-Lun Ko, Yih-Hwen Huang, Ruoh-Fang Yen, Jin-Shing Chen, Jou-Wei Lin, Hsao-Hsun Hsu
PURPOSE: Pulmonary hypertension (PH) is characterized by abnormally increased pulmonary vascular pressure, leading to deteriorated right ventricular function and premature death. Pulmonary mean transit time (PMTT) and biventricular function response to exercise in first-pass radionuclide angiography (FP-RNA) may provide early detection and timely disease monitoring of PH. This study aimed to investigate the diagnostic and prognostic values of this imaging modality in PH patients. METHODS: Left and right ventricular ejection fraction (LVEF/RVEF) and PMTT at rest and immediately after exercise treadmill test were measured by FP-RNA in 77 consecutive patients with clinical presentations suggestive of PH (aged 46 ± 15 years, 33 men), mostly with symptoms of unexplained progressive dyspnea...
September 2017: Clinical Nuclear Medicine
https://www.readbyqxmd.com/read/28566298/colchicine-depolymerizes-microtubules-increases-junctophilin-2-and-improves-right-ventricular-function-in-experimental-pulmonary-arterial-hypertension
#18
Kurt W Prins, Lian Tian, Danchen Wu, Thenappan Thenappan, Joseph M Metzger, Stephen L Archer
BACKGROUND: Pulmonary arterial hypertension (PAH) is a lethal disease characterized by obstructive pulmonary vascular remodeling and right ventricular (RV) dysfunction. Although RV function predicts outcomes in PAH, mechanisms of RV dysfunction are poorly understood, and RV-targeted therapies are lacking. We hypothesized that in PAH, abnormal microtubular structure in RV cardiomyocytes impairs RV function by reducing junctophilin-2 (JPH2) expression, resulting in t-tubule derangements...
May 31, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28560534/exercise-testing-and-stress-imaging-in-aortic-valve-disease
#19
REVIEW
Luc A Pierard, Raluca Dulgheru
Aortic valve disease and especially aortic stenosis (AS) is a growing cardiac pathology. Aortic valve replacement (AVR) is still the only treatment with proven benefit on survival in symptomatic patients and in patients with a left ventricular ejection fraction (LVEF) <50%. The benefit of prophylactic AVR in asymptomatic patients is still unproven. Once symptoms develop, the prognosis worsens. Exercise testing has emerged as a tool to unmask the "pseudo-asymptomatic" patients with AS (those without self-reporting symptoms), to link "exercise induced dyspnea" more confidently and more objectively to aortic valve disease and to allow for a safe "watchful waiting strategy" in "pseudo-symptomatic" patients (those with dyspnea unrelated to aortic valve disease)...
July 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28287506/assessment-of-pulmonary-capillary-blood-volume-membrane-diffusing-capacity-and-intrapulmonary-arteriovenous-anastomoses-during-exercise
#20
Vincent Tedjasaputra, Sean van Diepen, Sophie É Collins, Wade M Michaelchuk, Michael K Stickland
Exercise is a stress to the pulmonary vasculature. With incremental exercise, the pulmonary diffusing capacity (DLCO) must increase to meet the increased oxygen demand; otherwise, a diffusion limitation may occur. The increase in DLCO with exercise is due to increased capillary blood volume (Vc) and membrane diffusing capacity (Dm). Vc and Dm increase secondary to the recruitment and distension of pulmonary capillaries, increasing the surface area for gas exchange and decreasing pulmonary vascular resistance, thereby attenuating the increase in pulmonary arterial pressure...
February 20, 2017: Journal of Visualized Experiments: JoVE
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