scholarly journals The Role of Hyperglycemia and Insulin Resistance in the Development and Progression of Pulmonary Arterial Hypertension

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Daniel Grinnan ◽  
Grant Farr ◽  
Adam Fox ◽  
Lori Sweeney

Pulmonary hypertension is a progressive disorder which often leads to right ventricular failure and death. While the existing classification system for pulmonary hypertension does not account for the impact of diabetes mellitus, evidence is emerging that suggests that diabetes is associated with pulmonary hypertension and that diabetes modifies the course of pulmonary hypertension. There is also growing radiographic, hemodynamic, biochemical, and pathologic data supporting an association between diabetes and pulmonary hypertension. More robust epidemiologic studies are needed to confirm an association between diabetes and pulmonary hypertension and to show that diabetes is a disease modifier in pulmonary hypertension. In addition, evaluating the effects of glucose control in animals with pulmonary hypertension and diabetes (as well as in humans) is warranted.

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Tanyeri ◽  
B Keskin ◽  
O Y Akbal ◽  
A Hakgor ◽  
A Karagoz ◽  
...  

Abstract Background and aim In this study we evaluated the impact of the updated pulmonary hypertension (PH) definitive criteria proposed in 6th World PH Symposium (WSPH) on numbers and frequencies of and pre- versus post-capillary PH as compared to those in European Society of Cardiology (ESC) 2015 PH Guidelines. Methods Study group comprised the retrospectively evaluated 1299 patients (pts) (age 53.1±18.8 years, female 807, 62.1%) who underwent right heart catheterisation (RHC) with different indications between 2006 and 2018. For ESC and WSPH PH definitions, pulmonary arterial mean pressure (PAMP) ≥25 mmHg (definition-A) and PAMP >20 mmHg (definition-B) RHC criteria were used, respectively. For pre-capillary PH definitions, pulmonary artery wedge pressure (PAWP) ≤15 mmHg and pulmonary vascular resistance (PVR) ≥3 Wood units criteria were included in the both definitions. Results In RHC assessments, PAMP ≥25 mmHg and >20 mmHg were noted in 891 (68.6%) and 1051 (80.9%) of overall pts, respectively. Moreover, pre-capillary PH was diagnosed in 284 (21.8%) and 298 (22.9%) with definition-A and B, respectively. Although updated WSPH definition was associated with a net 12.3% and a relative 18% increase in the overall PH diagnosis, net and relative changes in the frequency of the pre-capillary PH were only 1% and 4.9%. Increase in the overall PH with updated WSPH criterias compared to previous ESC definitions was associated with increase in the number of pre-capillary PH (n=298, 22.9%) but not in the overall frequency of post-capillary PH (688, 52.9%). Because PVR was the product of the transpulmonary gradient (PAMP minus PAWP) divided by cardiac output, this measure was found to keep specificity for distinction between pre- versus post-capillary PH even after lowering thetreshold diagnostic for PAMP from 25 to 20 mmHg. Conclusions Although updated WSPH definition was associated with net 12.3% and relative 18% increase in the overall PH diagnosis, its impact on frequencies of pre- versus post-capillary PH within overall PH population was negligible.These seem to be due to critical role of PVR ensuring specificity in pre-capillary PH diagnosis even after lowering the definitive PAMP treshold to 20 mmHg.


2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
W Serra ◽  
L M Marangoni ◽  
M G Goldoni ◽  
A C Chetta

Abstract In Pulmonary Hypertension (PH), the development of dilatation and right ventricular failure (RV) are signs of accelerated progression of the disease resulting in an increased risk of cardiac death, and right ventricular failure. Even the non-invasive assessment of the systolic blood pressure pulmonary artery (PAPs) by well-established doppler echocardiography, this does not give us a measure of ventriculo-pulmonary interaction. Some studies have shown the potential use of echocardiography to indirectly evaluate the PVR and the pulmonary outflow acceleration time (ACTPO), it should be a good correlated indirect measure. To have a measure of the ventriculo-pulmonary interaction, we used a parameter that contained information related to pulmonary pressure and a parameter that was an indicator of pulmonary vascular resistance. We have therefore called it PAPS / ACTPO ratio [strength / surface unit] / [time]. We wanted to study this parameter in apparently healthy subjects to code the normal range. From January 2017 to December 2017, we have studied 60 normal patients subjecting them to a complete two-dimensional echocardiographic / Doppler evaluation of the right function and hemodynamics. Echocardiographic imaging was performed using a Philips IE33 and a 3.5 MHz transducer (Philips Medical Systems, Andover, MA). We planned to evaluate this parameter in patients with Pulmonary Hypertension associated with systemic sclerosis. Statistical analysis. To test the diagnostic power of variables, ROC curves were extrapolated. AUC and cut-off point (max sensitivity + specificity) were also calculated. Pair of variables were correlated by using Pearson’s test. Significance was always set at 0.05. IBM SPSS 25.0 (IBM, Amork, NY) was always used for all the statistical tests. PAPs/ACTpo ratio was measured by two echocardiographers blinded to the clinical data in order to assess interobserver variability Results In normal subjects we found a mean PAPS / ACTPO ratio of 0.26, indicator of an optimal pulmonary arterial ventricle coupling. The first data derived from the only 19 patient analysis shows that those presenting pre-capillary pulmonary hypertension to cardiac catheterization have a PAPS/ACTPO ratio of 0.40 ± 0.05 . Interobserver variability was lower than 5% Conclusion PAPS / ACTPO ratio may be an indicator of pulmonary arterial ventricle coupling. Table 1 PAPs/Act PAPs NYHA 24m Tapse (mm) Act (msc) PVR WUmm/Hg.min.L CAT dx PAPs PAPs/Act R value ,877 ,491 -,076 -,901 ,820 ,795 Sig ,000 ,033 ,757 ,000 ,000 ,000 19 19 19 19 19 19 18 Statistical analysis


2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Feik ◽  
E Berghausen ◽  
M Zierden ◽  
E Hirsch ◽  
S Baldus ◽  
...  

Abstract Introduction Pulmonary hypertension (PH) is a pulmonary vascular disease that is associated with unacceptably high morbidity and mortality. PH is characterized by chronically increased pulmonary arterial pressure, increased pulmonary vascular resistance and right ventricular (RV) dysfunction and hypertrophy. Underlying mechanisms include increased proliferation and reduced apoptosis of both vascular smooth muscle cells (SMC) and endothelial cells (EC), as well as dysregulated immune responses. We have previously shown that class IA phosphatidylinositol-3-kinase (PI3K) isoforms, activated via receptor tyrosine kinases, are critically involved in the pathogenesis of PH. However, recent findings suggest that the class IB isoform PI3Kγ, which is activated downstream of G protein coupled receptors, is also important. It has been shown that PI3Kγ is involved in numerous processes that promote both vascular remodelling and maladaptive cardiac hypertrophy, including leukocyte recruitment, expression of proinflammatory chemokines and cytokines, as well as SMC and EC proliferation and survival. Therefore, the aim of our study was to investigate the role of PI3Kγ in the pathogenesis of PH. Methods The impact of PI3Kγ on the pathogenesis of PH was analysed in vivo using mice expressing a catalytically inactive form of PI3Kγ (PI3KγKD/KD) in the hypoxia-induced mouse model of PH. Mice were kept at 10%O2 (HOX) for 21 days or left under normoxic conditions (NOX). Subsequently, systolic right ventricular pressure (RVSP) was measured with a pressure catheter. RV hypertrophy was expressed as the ratio of RV weight to left ventricular + septum weight. Migration and proliferation of human pulmonary arterial SMC (hPASMC) as well as EC (hMVEC) were analysed using a PI3Kγ isoform-specific inhibitor (AS605240 [0.1; 0.3; 1μM]). Chemotaxis was determined by means of a modified Boyden chamber, and proliferation was quantified by a Bromodeoxyuridine (BrdU) incorporation assay. Results Whereas PI3Kγ inactivation had no effect on NOX animals, hypoxia led to increased RVSP and RV hypertrophy in WT animals (34.67±2.02 mmHg; 0.38±0.087) which were unexpectedly further increased in PI3KγKD/KD mice (37.67±1.3 mmHg, p=0.0104 vs. HOX WT; 0.47±0.06, p=0.0155 vs. HOX WT). Heart rate and systemic blood pressure remained unchanged. Inhibition of PI3Kγ by means of AS605240 did not affect proliferation of hPASMC and hMVEC, induced by multiple stimuli (FCS [10%], PDGF-BB [30ng/ml], or CXCL12 [100ng/ml], VEGF [50ng/ml]), respectively. However, FCS-induced migration of these cells was significantly reduced by AS605240 [0.3μM] (p<0.05). Conclusion Contrary to our expectations, the results show that kinase inactivation of PI3Kγ was not able to attenuate the pathogenesis of PH, but surprisingly led to a significant increase without critically changing cellular responses of SMC and EC. Therefore, our results indicate an unexpected protective effect of PI3Kγ on PH. Funding Acknowledgement Type of funding source: None


2021 ◽  
Vol 23 (1) ◽  
pp. 379
Author(s):  
Myo Htet ◽  
Jane. E. Nally ◽  
Patricia. E. Martin ◽  
Yvonne Dempsie

Pulmonary hypertension is a serious clinical condition characterised by increased pulmonary arterial pressure. This can lead to right ventricular failure which can be fatal. Connexins are gap junction-forming membrane proteins which serve to exchange small molecules of less than 1 kD between cells. Connexins can also form hemi-channels connecting the intracellular and extracellular environments. Hemi-channels can mediate adenosine triphosphate release and are involved in autocrine and paracrine signalling. Recently, our group and others have identified evidence that connexin-mediated signalling may be involved in the pathogenesis of pulmonary hypertension. In this review, we discuss the evidence that dysregulated connexin-mediated signalling is associated with pulmonary hypertension.


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