Current Opinion in Pulmonary Medicine最新文献_第3页

Important negative trials in pulmonary hypertension. 肺动脉高压的重要阴性试验。

IF 2.8 3区医学

Current Opinion in Pulmonary Medicine Pub Date : 2025-09-01 Epub Date: 2025-07-07 DOI: 10.1097/MCP.0000000000001198

Sarah Cullivan, Lucy McCourt, Sean Gaine

引用次数: 0

The fluid challenge for identification of pulmonary hypertension associated with left heart disease. 鉴别左心相关肺动脉高压的液体挑战

IF 2.8 3区医学

Current Opinion in Pulmonary Medicine Pub Date : 2025-09-01 Epub Date: 2025-07-04 DOI: 10.1097/MCP.0000000000001189

Michele D'Alto, Andrea Vergara, Antonio Orlando, Robert Naeije

{"title":"The fluid challenge for identification of pulmonary hypertension associated with left heart disease.","authors":"Michele D'Alto, Andrea Vergara, Antonio Orlando, Robert Naeije","doi":"10.1097/MCP.0000000000001189","DOIUrl":"10.1097/MCP.0000000000001189","url":null,"abstract":"Purpose of review: Left heart disease (LHD) is the commonest cause of pulmonary hypertension (PH). The differential diagnosis between PH associated with LHD (PH-LHD) and pulmonary arterial hypertension (PAH) may be difficult. PH associated with LHD is causally related to chronically increased pulmonary artery wedge pressure (PAWP). However, PAWP may be \"falsely\" normal or high-normal at the time of diagnostic right heart catheterization.Recent findings: Updated guidelines for step-by-step diagnosis of PAH and LHD leave nevertheless a proportion of patients with PH and diagnostic uncertainty. In these patients, several studies have shown that a PAWP >18 mmHg after a rapid infusion of 500 ml saline is associated with a high likelihood of LHD. Evidence has been accumulated that patients with PH, cardiovascular risk factors and a high-normal PAWP should have LHD excluded by a fluid challenge. Preliminary studies suggest that the test may be performed noninvasively by combining Doppler echocardiography and lung ultrasound showing respectively a ratio of trans-mitral flow E wave to mitral annulus tissue velocity e' (E/e') ≥12 and ≥5 B-lines.Summary: A fluid challenge has a place in the step-by-step diagnostic work-up of patients referred for PH for the differential diagnosis between PH-LHD and PAH.","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":"31 5","pages":"464-469"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Precision medicine in pulmonary hypertension: how close are we today? 精准医学治疗肺动脉高压：我们离目标还有多远？

IF 2.8 3区医学

Current Opinion in Pulmonary Medicine Pub Date : 2025-09-01 Epub Date: 2025-07-07 DOI: 10.1097/MCP.0000000000001195

Bradley A Maron

{"title":"Precision medicine in pulmonary hypertension: how close are we today?","authors":"Bradley A Maron","doi":"10.1097/MCP.0000000000001195","DOIUrl":"10.1097/MCP.0000000000001195","url":null,"abstract":"Purpose of review: Pulmonary hypertension (PH) is a specific but heterogeneous disease defined foremost by elevated pulmonary artery pressure, typically occurring due to pulmonary vascular fibroproliferative, plexigenic, or thrombotic remodelling. The heterogenous clinical and pathobiological basis of PH poses challenges and opportunities for optimizing treatment alignment to individual patients.Recent findings: Advancing precision medicine through personalized treatment pathways in PH is particularly timely owing to persistent morbidity and shortened lifespan reported for patients despite an expanding armamentarium of pharmacotherapeutics, particularly for pulmonary arterial hypertension. Accomplishing this goal successfully has benefited from efforts that optimize clinical phenotyping, establishing reticulotypes that represent the phenotypic consequences of functionally essential pathogenic molecular events, and build greater insight on treatment response variability observed in randomized clinical trials.Summary: Although as a scientific field PH remains early in the precision medicine journey, wider availability and lower cost of high throughput -omics platforms, and increasingly sophisticated analytical methodologies introduces optimism that clinically actionable strategies that improve patient-treatment alignment can be realized in the near-term.","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"429-436"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Unraveling mechanistic insights through interstitial lung disease multiomics. 通过间质性肺病多组学揭示机制见解。

IF 2.8 3区医学

Current Opinion in Pulmonary Medicine Pub Date : 2025-09-01 Epub Date: 2025-07-07 DOI: 10.1097/MCP.0000000000001192

Aravind A Menon, Auyon J Ghosh

{"title":"Unraveling mechanistic insights through interstitial lung disease multiomics.","authors":"Aravind A Menon, Auyon J Ghosh","doi":"10.1097/MCP.0000000000001192","DOIUrl":"10.1097/MCP.0000000000001192","url":null,"abstract":"Purpose of review: Interstitial lung disease (ILD) and consequent pulmonary fibrosis are associated with significant morbidity and mortality with limited treatment options. There are more than 200 different etiologies that can lead to ILD. As a result, diagnostic accuracy and delay, prognostication, and treatment responses are still rife with challenges. The integration of bioinformatics with clinical practice is gaining momentum, evolving from a research tool to a practical resource with potential applications at the bedside. Work in this field has opened avenues into the pursuit of precision medicine in ILD.Recent findings: Across various 'omics-based technologies, numerous studies highlight the potential of using molecular data to disentangle the complex processes that lead to pulmonary fibrosis. Recent studies point toward integrating signals across domains to filter out noise and identify true signals. However, there is still a need for functional work to connect the high-dimensional signals to the biology underlying pulmonary fibrosis.Summary: Pursuing a multiomic approach across multiple domains in ILD holds promise for better biomarkers, clinical trial enrichment, and developing a deeper understanding of disease pathology.","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"512-517"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

PROMs in sarcoidosis - what to use for systemic disease and individual organs and why? 结节病中的PROMs -用于全身性疾病和单个器官，为什么？

IF 2.8 3区医学

Current Opinion in Pulmonary Medicine Pub Date : 2025-09-01 Epub Date: 2025-07-15 DOI: 10.1097/MCP.0000000000001203

Claudia Ravaglia

{"title":"PROMs in sarcoidosis - what to use for systemic disease and individual organs and why?","authors":"Claudia Ravaglia","doi":"10.1097/MCP.0000000000001203","DOIUrl":"10.1097/MCP.0000000000001203","url":null,"abstract":"Purpose of review: This review provides a critical evaluation of patient-reported outcome measures (PROMs) in sarcoidosis, focusing on their use in assessing systemic disease and organ-specific involvement. We aim to summarize current tools, identify evidence gaps, and explore the evolving role of PROMs in both clinical research and practice.Recent findings: generic instruments such as the SF-36, EQ-5D, and PROMIS have been widely applied in sarcoidosis cohorts, yet their lack of disease specificity limits their interpretability and responsiveness. Sarcoidosis-specific tools [including the Sarcoidosis Health Questionnaire (SHQ), the King's Sarcoidosis Questionnaire (KSQ), and the Fatigue Assessment Scale (FAS)] offer greater construct validity and capture symptoms more relevant to patient experience. On the other hand, PROMs for cardiac, neurologic, ocular, and hepatic involvement remain underdeveloped. PROMs are increasingly incorporated into clinical trials but are rarely used in routine care, partly due to challenges in implementation, interpretation, and integration into workflows. Technological innovations such as computer-adaptive testing and ePROMs offer promising solutions.Summary: PROMs are essential for capturing the subjective burden of sarcoidosis, particularly in domains poorly reflected by physiologic measures. Further work is needed to expand validation across phenotypes, develop organ-specific tools, and embed PROMs into clinical decision-making and regulatory frameworks.","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"540-546"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Sex differences in pulmonary (arterial) hypertension: does it matter? 肺动脉高压的性别差异：重要吗？

IF 2.8 3区医学

Current Opinion in Pulmonary Medicine Pub Date : 2025-09-01 Epub Date: 2025-07-23 DOI: 10.1097/MCP.0000000000001197

Corey E Ventetuolo, Alexis E Sherman-Roe

{"title":"Sex differences in pulmonary (arterial) hypertension: does it matter?","authors":"Corey E Ventetuolo, Alexis E Sherman-Roe","doi":"10.1097/MCP.0000000000001197","DOIUrl":"10.1097/MCP.0000000000001197","url":null,"abstract":"Purpose of review: This review synthesizes the current prevailing theories behind the 'sex paradox' or 'sex puzzle' in pulmonary arterial hypertension (PAH), a disease marked by sexual dimorphism. To a lesser extent, we also review sex differences in other forms of pulmonary hypertension.Recent findings: Although more females than males develop PAH worldwide, female sex is associated with improved right ventricular (RV) function and survival. We review the role of sex chromosomes and sex hormones and their relationships to genomic and epigenetic regulation, immune function, and RV function, sex-based differences in therapeutic response and social determinants of health and intersectionality with gender in PAH pathobiology, prevalence and outcomes. We include experimental studies and observational human data that have led to the study of sex hormone modulation as a treatment strategy in PAH, with recently completed clinical trials. In addition, we explore potential future directions to help understand the mechanisms that underpin sex biases in pulmonary vascular disease, as well as those that may inform potential therapeutic targets.Summary: Survival in PAH depends on RV function, and females have improved survival despite increased prevalence for reasons that remain unclear. While knowledge gaps remain, recent advancements offer promise and many future directions.","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":"31 5","pages":"411-428"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12331139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pulmonary veno-occlusive disease: a paradigm of diagnosis and therapeutic challenges in pulmonary hypertension. 肺静脉闭塞性疾病：肺动脉高压的诊断和治疗挑战的范例。

IF 2.8 3区医学

Current Opinion in Pulmonary Medicine Pub Date : 2025-09-01 Epub Date: 2025-06-05 DOI: 10.1097/MCP.0000000000001184

Benoit Aguado, Julien Grynblat, Brandon Budhram, Maria-Rosa Ghigna, Athenaïs Boucly, Fabrice Antigny, Xavier Jaïs, Olivier Sitbon, Laurent Savale, Marc Humbert, David Montani

{"title":"Pulmonary veno-occlusive disease: a paradigm of diagnosis and therapeutic challenges in pulmonary hypertension.","authors":"Benoit Aguado, Julien Grynblat, Brandon Budhram, Maria-Rosa Ghigna, Athenaïs Boucly, Fabrice Antigny, Xavier Jaïs, Olivier Sitbon, Laurent Savale, Marc Humbert, David Montani","doi":"10.1097/MCP.0000000000001184","DOIUrl":"10.1097/MCP.0000000000001184","url":null,"abstract":"Purpose of review: Pulmonary veno-occlusive disease (PVOD) is a rare and life-threatening form of precapillary pulmonary hypertension. This review aims to outline its genetic and environmental risk factors, highlight key diagnostic challenges, and discuss current treatment options.Recent findings: PVOD can occur sporadically or as a hereditary autosomal recessive condition with biallelic eukaryotic translation initiation factor 2 alpha kinase 4 ( EIF2AK4) mutations, leading to nearly complete disease penetrance. Known risk factors include specific drug/toxin and environmental exposures, such as mitomycin C and trichloroethylene, respectively. PVOD is characterized by progressive pulmonary venous and capillary remodelling, severe hypoxemia, and right ventricular failure. Diagnosis remains difficult due to overlapping features with pulmonary arterial hypertension (PAH), but high-resolution computed tomography (HRCT) findings, low lung diffusion capacity for carbon monoxide (DLCO), and genetic testing can aid differentiation. Initiation of PAH-approved drugs in patients with PVOD requires careful consideration due to limited evidence of long-term clinical benefits and the high risk of developing pulmonary oedema in this population. Lung transplantation remains the only curative treatment, with posttransplant survival rates comparable to idiopathic PAH.Summary: PVOD is a progressive and fatal disease requiring early recognition and specific management. Due to its poor prognosis and lack of effective medical therapies, early referral for lung transplantation is crucial. Advances in genetic and molecular research may lead to novel treatment strategies.","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"443-455"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Echocardiographic evaluation of the pulmonary circulation and right ventricular functional unit during exercise and its clinical value. 运动时肺循环和右心室功能单位的超声心动图评价及其临床价值。

IF 2.8 3区医学

Current Opinion in Pulmonary Medicine Pub Date : 2025-09-01 Epub Date: 2025-07-23 DOI: 10.1097/MCP.0000000000001186

Teresa John, Tall Roschinsky, Philipp Douschan

{"title":"Echocardiographic evaluation of the pulmonary circulation and right ventricular functional unit during exercise and its clinical value.","authors":"Teresa John, Tall Roschinsky, Philipp Douschan","doi":"10.1097/MCP.0000000000001186","DOIUrl":"10.1097/MCP.0000000000001186","url":null,"abstract":"Purpose of review: In this review, we provide an overview of the echocardiographic evaluation of the pulmonary circulation - right ventricular functional unit during exercise and its clinical value.Recent findings: An increased understanding on the physiological response of pulmonary hemodynamics during exercise and evidence of the impact of an abnormal mean pulmonary arterial pressure (mPAP)/cardiac output (CO) slope on survival led to the reintroduction of exercise pulmonary hypertension (EPH), defined as a mPAP/CO slope >3 mmHg/l/min, in the current European Society of Cardiology/European Respiratory Society (ESC/ERS) guidelines for pulmonary hypertension. Additionally, noninvasive exercise echocardiography may enable easy and readily available assessment of pulmonary exercise hemodynamics.Summary: Impaired pulmonary exercise hemodynamics are considered early hemodynamic signs of cardiopulmonary disease. In order to diagnose EPH, exercise right heart catheterization (RHC) is needed, which is invasive, highly cost- and staff intensive and reserved to expert centers. Noninvasive surrogates derived from exercise echocardiography might be an appropriate alternative to invasive RHC.","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"456-463"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144689469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

New therapeutic options in sarcoidosis. 结节病的新治疗选择。

IF 2.8 3区医学

Current Opinion in Pulmonary Medicine Pub Date : 2025-09-01 Epub Date: 2025-07-07 DOI: 10.1097/MCP.0000000000001196

Hilario Nunes, Raphael Hindré, Florence Jeny

{"title":"New therapeutic options in sarcoidosis.","authors":"Hilario Nunes, Raphael Hindré, Florence Jeny","doi":"10.1097/MCP.0000000000001196","DOIUrl":"10.1097/MCP.0000000000001196","url":null,"abstract":"Purpose of review: Corticosteroids remain the cornerstone of sarcoidosis treatment but are associated with significant toxicities and impaired quality of life. Second-line and third-line treatments include hydroxychloroquine or immunosuppressants (methotrexate, azathioprine, leflunomide and mycophenolate mofetil), and anti-TNF-α agents (infliximab and adalimumab), respectively. The latest identification of significant key cellular pathways in sarcoidosis pathogenesis has led to the development of new therapeutic strategies described in this review.Recent findings: JAK inhibitors, mainly tofacitinib, exhibited encouraging results in case reports, small retrospective series, and two prospective open-label trials for skin and pulmonary sarcoidosis. mTOR inhibitors demonstrated efficacity in one cross-over study on skin involvement. Promising findings were obtained with efzofitimod, an inhibitor of neuropilin-2 receptor, in a pilot study on pulmonary sarcoidosis, which needs to be confirmed. Other drugs with potentially relevant mechanisms of action have been used in case reports or small series or are under investigation: CTLA-4 inhibitors, IL-6 inhibitors, NLRP3 inflammasome inhibitors, GM-CSF inhibitors, PDE-4 inhibitors, and statins. There is very little data available on antifibrotic agents for fibrotic pulmonary sarcoidosis.Summary: Despite many challenges, well designed studies are warranted to investigate new therapeutic options in sarcoidosis, particularly in patients with refractory forms or unacceptable side-effects with third-line treatment.","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"560-570"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Artificial intelligence in cardiac sarcoidosis: ECG, Echo, CPET and MRI. 人工智能在心脏结节病中的应用：心电图、超声、CPET和MRI。

IF 2.8 3区医学

Current Opinion in Pulmonary Medicine Pub Date : 2025-09-01 Epub Date: 2025-07-07 DOI: 10.1097/MCP.0000000000001193

Wilfred Ifeanyi Umeojiako, Thomas Lüscher, Rakesh Sharma

{"title":"Artificial intelligence in cardiac sarcoidosis: ECG, Echo, CPET and MRI.","authors":"Wilfred Ifeanyi Umeojiako, Thomas Lüscher, Rakesh Sharma","doi":"10.1097/MCP.0000000000001193","DOIUrl":"10.1097/MCP.0000000000001193","url":null,"abstract":"Purpose of review: Cardiac sarcoidosis is a form of inflammatory cardiomyopathy that varies in its clinical presentation. It is associated with significant clinical complications such as high-degree atrioventricular block, ventricular tachycardia, heart failure and sudden cardiac death. It is challenging to diagnose clinically, and its increasing detection rate may represent increasing awareness of the disease by clinicians as well as a rising incidence. Prompt diagnosis and risk stratification reduces morbidity and mortality from cardiac sarcoidosis. Noninvasive diagnostic modalities such as ECG, echocardiography, PET/computed tomography (PET/CT) and cardiac MRI (cMRI) are increasingly playing important roles in cardiac sarcoidosis diagnosis. Artificial intelligence driven applications are increasingly being applied to these diagnostic modalities to improve the detection of cardiac sarcoidosis.Recent findings: Review of the recent literature suggests artificial intelligence based algorithms in PET/CT and cMRIs can predict cardiac sarcoidosis as accurately as trained experts, however, there are few published studies on artificial intelligence based algorithms in ECG and echocardiography.Summary: The impressive advances in artificial intelligence have the potential to transform patient screening in cardiac sarcoidosis, aid prompt diagnosis and appropriate risk stratification and change clinical practice.","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"534-539"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0