Pulmonary Circulation最新文献_第2页

Delta-like ligand 4 inhibitor drug treatment induces pulmonary hypertension in cancer clinical trials. 在癌症临床试验中，Delta 样配体 4 抑制剂药物治疗会诱发肺动脉高压。

IF 2.2 4区医学

Pulmonary Circulation Pub Date : 2024-11-08 eCollection Date: 2024-10-01 DOI: 10.1002/pul2.12450

Casandra E Besse, Nolan M Winicki, Cristian Puerta, Moises Hernandez, Jason X-J Yuan, Patricia A Thistlethwaite

引用次数: 0

Quantitative pulmonary perfusion in acute pulmonary embolism and chronic thromboembolic pulmonary hypertension. 急性肺栓塞和慢性血栓栓塞性肺动脉高压的定量肺灌注。

IF 2.2 4区医学

Pulmonary Circulation Pub Date : 2024-11-08 eCollection Date: 2024-10-01 DOI: 10.1002/pul2.12445

Jacob V Hansen, Mette W Poulsen, Jens E Nielsen-Kudsk, Mannudeep K Kalra, Mads D Lyhne, Asger Andersen

{"title":"Quantitative pulmonary perfusion in acute pulmonary embolism and chronic thromboembolic pulmonary hypertension.","authors":"Jacob V Hansen, Mette W Poulsen, Jens E Nielsen-Kudsk, Mannudeep K Kalra, Mads D Lyhne, Asger Andersen","doi":"10.1002/pul2.12445","DOIUrl":"https://doi.org/10.1002/pul2.12445","url":null,"abstract":"Current methods for quantifying perfusion from computed tomography pulmonary angiography (CTPA) often rely on semi-quantitative scoring systems and requires an experienced evaluator. Few studies report on absolute quantitative variables derived from the images, and the methods are varied with mixed results. Dual-energy CTPA (DE-CTPA) enables automatic quantification of lung and lobar perfusion with minimal user interaction by utilizing machine learning based software. We aimed to evaluate differences in DE-CTPA derived quantitative perfusion variables between patients with acute pulmonary embolism (PE) and chronic thromboembolic pulmonary hypertension (CTEPH). This retrospective, single-center, observational study included 162 adult patients diagnosed with PE (n = 81) or CTEPH (n = 81) and scanned using dual-energy CT between 2020 and 2023. Mann-Whitney U tests and permutational analysis of variance (PERMANOVA) were used for comparative analyses. We found whole lung perfusion blood volume to be lower (p < 0.001) in PE patients (median 3399 mL [2554, 4284]) than in CTEPH patients (median 4094 mL [3397, 4818]). The same was observed at single lung and lobar level. PERMANOVA encompassing all perfusion variables showed a difference between the two groups (F-statistic = 13.3, p = 0.002). Utilizing logistic regression, right and left lower lobe perfusion blood volume showed some ability to differentiate between PE and CTEPH with area under the receiver operation characteristics curve values of 0.71 (95% CI: 0.56; 0.84) and 0.72 (95% CI: 0.56; 0.86). Pulmonary perfusion is lower in patients with PE than patients with CTEPH, highlighted by differences in DECT-derived perfusion blood volume. Quantitative perfusion variables might be useful to differentiate between the two diseases.","PeriodicalId":20927,"journal":{"name":"Pulmonary Circulation","volume":"14 4","pages":"e12445"},"PeriodicalIF":2.2,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11544464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142626981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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

Comorbidity profiles and pulmonary embolism risk assessment: Leveraging the Charlson Comorbidity Index for improved prognostication in a national data set. 合并症概况和肺栓塞风险评估：利用 Charlson 生病指数改进全国数据集的预后。

IF 2.2 4区医学

Pulmonary Circulation Pub Date : 2024-11-07 eCollection Date: 2024-10-01 DOI: 10.1002/pul2.70010

Truong-An Ho, Ka U Lio, Palakkumar Patel, Yichen Wang, Hammad Arshad, Si Li, Parth Rali

{"title":"Comorbidity profiles and pulmonary embolism risk assessment: Leveraging the Charlson Comorbidity Index for improved prognostication in a national data set.","authors":"Truong-An Ho, Ka U Lio, Palakkumar Patel, Yichen Wang, Hammad Arshad, Si Li, Parth Rali","doi":"10.1002/pul2.70010","DOIUrl":"https://doi.org/10.1002/pul2.70010","url":null,"abstract":"Current risk assessment of pulmonary embolism (PE) stratifies patients based on hemodynamic stability, clinical parameters of severity, right ventricular dysfunction and cardiac injury but fails to integrate a wide variety of comorbid conditions. The Charlson Comorbidity Index (CCI) predicts mortality based on patients' diseases and provides a system to quantify disease burden. The National Inpatient Sample (NIS) database (2016-2018) was used to identify patients with PE and calculate CCI score groups of 0, 1-2, 3-5, and ≥6 and stratify them by outcome. Of 561,625 patients with PE, 176,460 (31.4%) had CCI score of 0, 223,870 (39.8%) had CCI of 1-2, 102,305 (18.2%) had CCI of 3-5, and 58,990 (10.5%) had CCI ≥ 6. Higher CCI scores were associated with increased mortality: CCI 1-2 (adjusted odds ratio [aOR] 2.09), CCI 3-5 (aOR 3.12), CCI ≥ 6 (aOR 5.44) compared to CCI 0, along with stepwise increases in shock and mechanical ventilation with each increase in CCI score group. CCI scores ≥3 had increased length of stay (1.4-1.72 days) and increased total hospital costs ($3651-$4265) compared to CCI0. Patients with CCI ≥ 3 were less likely to receive systemic thrombolysis, catheter directed thrombolysis and mechanical thrombectomy. Acute PE in patients with elevated comorbidity scores is associated with higher morbidity and mortality, increased hospital resource utilization, and decreased usage of advanced therapies in a large cohort reflective of patients across the United States. Integration of comorbidities in risk assessment profiles identifies patients with higher short-term mortality which may guide management strategy.","PeriodicalId":20927,"journal":{"name":"Pulmonary Circulation","volume":"14 4","pages":"e70010"},"PeriodicalIF":2.2,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11541855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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

Hemodynamic markers independent of pulmonary capillary wedge pressure can discriminate between pre and postcapillary exercise-induced pulmonary hypertension. 独立于肺毛细血管楔压的血流动力学指标可区分毛细血管运动前和运动后诱发的肺动脉高压。

IF 2.2 4区医学

Pulmonary Circulation Pub Date : 2024-11-06 eCollection Date: 2024-10-01 DOI: 10.1002/pul2.70002

Margaret Montovano, Paul J Scheel, Ilton M Cubero Salazar, Paul M Hassoun, Ryan J Tedford, Steven Hsu

引用次数: 0

Extracorporeal membrane oxygenation (ECMO) support for children with pulmonary hypertension: A single-institutional experience of outcomes. 为肺动脉高压患儿提供体外膜肺氧合（ECMO）支持：单一机构的成果经验。

IF 2.2 4区医学

Pulmonary Circulation Pub Date : 2024-10-25 eCollection Date: 2024-10-01 DOI: 10.1002/pul2.12442

Christopher Nemeh, Nicholas Schmoke, William Patten, Eunice Clark, Yeu S Wu, Pengchen Wang, Paul Kurlansky, William Middlesworth, Eva W Cheung, Erika B Rosenzweig

{"title":"Extracorporeal membrane oxygenation (ECMO) support for children with pulmonary hypertension: A single-institutional experience of outcomes.","authors":"Christopher Nemeh, Nicholas Schmoke, William Patten, Eunice Clark, Yeu S Wu, Pengchen Wang, Paul Kurlansky, William Middlesworth, Eva W Cheung, Erika B Rosenzweig","doi":"10.1002/pul2.12442","DOIUrl":"10.1002/pul2.12442","url":null,"abstract":"Pediatric pulmonary arterial hypertension (PAH) can present with a wide spectrum of disease severity. Pulmonary hypertension (PH) crises can lead to acute decompensation requiring extracorporeal membrane oxygenation (ECMO) support, including extracorporeal cardiopulmonary resuscitation (eCPR). We evaluated outcomes for pediatric PH patients requiring ECMO. A single-institution retrospective review of pediatric PAH patients with World Symposium on PH (WSPH) groups 1 and 3 requiring ECMO cannulation from 2010 through 2022 (n = 20) was performed. Primary outcome was survival to hospital discharge. Secondary outcomes were survival to decannulation and 1-year survival. Of 20 ECMO patients, 16 (80%) survived to decannulation and 8 (40%) survived to discharge and 1 year follow up. Of three patients who had two ECMO runs; none survived. There were five patients who had eCPR for the first run; one survived to discharge. The univariate logistic regression model showed that venovenous ECMO was associated with better survival to hospital discharge than venoarterial ECMO, (OR: 0.12, 95% CI: 0.01-0.86, p = 0.046). PH medications (administered before, during, or after ECMO) were not associated with survival to discharge. For children with decompensated PAH requiring ECMO, mortality rate is high, and management is challenging. While VA ECMO is the main configuration for decompensated PH, VV ECMO could be considered if there is adequate ventricular function, presence of a systemic to pulmonary shunt, or an intercurrent treatable illness to improve survival to discharge. A multidisciplinary approach with requisite expertise should be utilized on a case-by-case basis until more reliable data is available to predict outcomes.","PeriodicalId":20927,"journal":{"name":"Pulmonary Circulation","volume":"14 4","pages":"e12442"},"PeriodicalIF":2.2,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11502935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142506831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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

Transcriptome analyses reveal common immune system dysregulation in PAH patients and Kcnk3-deficient rats. 转录组分析揭示了 PAH 患者和 Kcnk3 基因缺陷大鼠的共同免疫系统失调。

IF 2.2 4区医学

Pulmonary Circulation Pub Date : 2024-10-23 eCollection Date: 2024-10-01 DOI: 10.1002/pul2.12434

Grégoire Ruffenach, Hélène Le Ribeuz, Mary Dutheil, Kristell El Jekmek, Florent Dumont, Anaïs Saint-Martin Willer, Marc Humbert, Véronique Capuano, Lejla Medzikovic, Mansoureh Eghbali, David Montani, Fabrice Antigny

{"title":"Transcriptome analyses reveal common immune system dysregulation in PAH patients and Kcnk3-deficient rats.","authors":"Grégoire Ruffenach, Hélène Le Ribeuz, Mary Dutheil, Kristell El Jekmek, Florent Dumont, Anaïs Saint-Martin Willer, Marc Humbert, Véronique Capuano, Lejla Medzikovic, Mansoureh Eghbali, David Montani, Fabrice Antigny","doi":"10.1002/pul2.12434","DOIUrl":"https://doi.org/10.1002/pul2.12434","url":null,"abstract":"Pulmonary arterial hypertension (PAH) is a severe disease caused by progressive distal pulmonary artery obstruction. One cause of PAH are loss-of-function mutations in the potassium channel subfamily K member 3 (KCNK3). KCNK3 encodes a two-pore domain potassium channel, which is crucial for pulmonary circulation homeostasis. However, our understanding of the pathophysiological mechanisms underlying KCNK3 dysfunction in PAH is still incomplete. Taking advantage of unique Kcnk3-deficient rats, we analyzed the transcriptomic changes in the lungs from homozygous Kcnk3-deficient rats and wild-type (WT) littermates and compared them to PAH patient transcriptomic data. Transcriptome analysis of lung tissue obtained from WT and Kcnk3-deficient rats identified 1915 down- or upregulated genes. In addition, despite limited similarities at the gene level, we found a strong common signature at the pathway level in PAH patients and Kcnk3-deficient rat lungs, especially for immune response. Using the dysregulated genes involved in the immune response, we identified Spleen Associated Tyrosine Kinase (SYK), a significantly downregulated gene in human PAH patients and Kcnk3-deficient rats, as a hub gene. Our data suggests that the altered immune system response observed in PAH patients may be partly explained by KCNK3 dysfunction through the alteration of SYK expression.","PeriodicalId":20927,"journal":{"name":"Pulmonary Circulation","volume":"14 4","pages":"e12434"},"PeriodicalIF":2.2,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11497494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142516595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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

Non-invasive surrogates for right Ventricular-Pulmonary arterial coupling: a systematic review and Meta-Analysis. 右心室-肺动脉耦合的非侵入性替代物：系统回顾和元分析。

IF 2.2 4区医学

Pulmonary Circulation Pub Date : 2024-10-21 eCollection Date: 2024-10-01 DOI: 10.1002/pul2.70004

Jem M Golbin, Neehal Shukla, Neil Nero, Maxwell A Hockstein, Adriano R Tonelli, Matthew T Siuba

{"title":"Non-invasive surrogates for right Ventricular-Pulmonary arterial coupling: a systematic review and Meta-Analysis.","authors":"Jem M Golbin, Neehal Shukla, Neil Nero, Maxwell A Hockstein, Adriano R Tonelli, Matthew T Siuba","doi":"10.1002/pul2.70004","DOIUrl":"https://doi.org/10.1002/pul2.70004","url":null,"abstract":"Right ventricle-pulmonary artery (RV-PA) coupling describes the energetic relationship between RV contractility and its afterload. The gold standard for assessment of this relationship requires invasive pressure-volume (PV) loop measurements. Non-invasive surrogates of RV-PA coupling have been developed, such as the echocardiographic tricuspid annular plane systolic excursion to pulmonary artery systolic pressure ratio (TAPSE/PASP), but their performance has not been systematically assessed. We sought to assess performance of TAPSE/PASP ratio compared to PV loop-defined RV-PA coupling. A systematic search was conducted. Studies were included if PV loop derived RV-PA coupling metrics were compared to echocardiographic or magnetic resonance imaging surrogates. We conducted a meta-analysis of TAPSE/PASP correlation to PV loop-defined RV-PA coupling. 1452 studies were identified in the initial search, of which ten met inclusion criteria. Five studies allowed for pooled analysis of TAPSE/PASP to Ees/Ea correlation (r = 0.52, 95% confidence interval 0.36-0.65). There was moderate heterogeneity across the pooled studies. Despite the common use of Non-invasive surrogates of RV-PA coupling, there is only moderate correlation with gold standard measurements. These metrics do not inform on the individual components of RV-PA coupling, limiting their use in the management of patients with RV dysfunction.","PeriodicalId":20927,"journal":{"name":"Pulmonary Circulation","volume":"14 4","pages":"e70004"},"PeriodicalIF":2.2,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11493845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142506832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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

Congruency between clinician-assessed risk and calculated risk of 1-year mortality in patients with pulmonary arterial hypertension: A retrospective chart review. 肺动脉高压患者临床医生评估的风险与计算的 1 年死亡风险之间的一致性：回顾性病历

IF 2.2 4区医学

Pulmonary Circulation Pub Date : 2024-10-18 eCollection Date: 2024-10-01 DOI: 10.1002/pul2.12455

Amresh Raina, Margaret R Sketch, Benjamin Wu, Meredith Broderick, Oksana A Shlobin

{"title":"Congruency between clinician-assessed risk and calculated risk of 1-year mortality in patients with pulmonary arterial hypertension: A retrospective chart review.","authors":"Amresh Raina, Margaret R Sketch, Benjamin Wu, Meredith Broderick, Oksana A Shlobin","doi":"10.1002/pul2.12455","DOIUrl":"10.1002/pul2.12455","url":null,"abstract":"The objective of this analysis was to compare clinician-based and formally calculated risk assessments by REVEAL Lite 2 and COMPERA 2.0 and to characterize parenteral prostacyclin utilization within 90 days of baseline in high-risk patients. A multisite, double-blind, retrospective chart review of patients with pulmonary arterial hypertension (PAH) was conducted with an index period of January 2014-March 2017. Patients were categorized into the \"any PAH medication\" or \"prostacyclin-enriched\" cohort based on latest PAH medication initiated within the index period. Clinicians classified the patient's 1-year mortality risk as \"low,\" \"intermediate,\" or \"high\" based on their clinical assessment. REVEAL Lite 2 and COMPERA 2.0 scores were independently calculated. Risk assessment congruency was evaluated. Parenteral prostacyclin use was evaluated within 90 days of baseline. Thirty-two clinicians participated and abstracted data for 299 patients with PAH. At baseline, mean patient age was 52 years, 6-min walk distance was 226 m, and most patients were WHO functional class II or III. Half of the patients (53%) were classified by clinician assessment as intermediate risk, while most were classified as high risk by REVEAL Lite 2 (59%) and intermediate-high risk by COMPERA 2.0 (52%). Parenteral prostascyclins were underutilized in high-risk patients, and not initiated in a timely fashion. Clinician-assessed risk category was incongruent with tool-based risk assessments in 40%-54% of patients with PAH, suggesting an underestimation of the patient's risk category by clinician gestalt. Additionally, there was a lack of timely prostacyclin initiation for patients with PAH stratified as high-risk by either tool.","PeriodicalId":20927,"journal":{"name":"Pulmonary Circulation","volume":"14 4","pages":"e12455"},"PeriodicalIF":2.2,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11487335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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

Barriers to and facilitators of physical activity in pediatric pulmonary hypertension. 小儿肺动脉高压患者进行体育锻炼的障碍和促进因素。

IF 2.2 4区医学

Pulmonary Circulation Pub Date : 2024-10-16 eCollection Date: 2024-10-01 DOI: 10.1002/pul2.70000

Catherine M Avitabile, Caroline O'Brien, Divya Dureja, Dana Albizem, Jena Mota, Melissa Xanthopoulos, Babette S Zemel, Peter F Cronholm

{"title":"Barriers to and facilitators of physical activity in pediatric pulmonary hypertension.","authors":"Catherine M Avitabile, Caroline O'Brien, Divya Dureja, Dana Albizem, Jena Mota, Melissa Xanthopoulos, Babette S Zemel, Peter F Cronholm","doi":"10.1002/pul2.70000","DOIUrl":"https://doi.org/10.1002/pul2.70000","url":null,"abstract":"Therapeutic exercise has not been widely adopted in pediatric pulmonary hypertension (PH), despite adult data supporting its safety and efficacy. While physical limitations may prevent children with PH from participating in physical activity, other barriers to and facilitators of physical activity are unknown. Youth ages 8-18 years with World Symposium of PH diagnostic Groups 1-4, functional class I or II, and ambulatory status were prospectively enrolled in a cross-sectional study including separate 30-min participant and caregiver interviews regarding attitudes toward physical activity and a proposed exercise intervention in pediatric PH. Interview questions were guided by Social Cognitive Theory and explored autonomy, self-confidence, and self-efficacy. Interviews were transcribed, coded, and analyzed using an iterative process to determine themes and patterns. Demographics and relevant PH condition-specific data were abstracted from the medical record. Thirty PH participant/caregiver dyads were interviewed. Facilitators of physical activity included enjoyment/interest in the activity, socialization, incentivization, and feelings of safety and normalcy. Barriers to physical activity included lack of interest, fear/anxiety, and self-consciousness. Findings were similar in children and adults. Participants rarely reported restriction of activity by caregivers or medical providers. Attitudes toward engagement in a proposed exercise program were generally positive and reflected personal experiences with physical activity. Monitored exercise interventions that focus on patients' interests, cultivate confidence, respect limitations, and acknowledge the need for extrinsic incentivization may have benefits in pediatric PH. Future trials should test the impact of these characteristics on patient wellbeing and clinical outcomes.","PeriodicalId":20927,"journal":{"name":"Pulmonary Circulation","volume":"14 4","pages":"e70000"},"PeriodicalIF":2.2,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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

Prostacyclin pathway vasodilators in patients with chronic thromboembolic pulmonary hypertension (CTEPH): A systemic review and meta-analysis of randomized controlled trials. 慢性血栓栓塞性肺动脉高压（CTEPH）患者的前列环素通路血管扩张剂：随机对照试验的系统回顾和荟萃分析。

IF 2.2 4区医学

Pulmonary Circulation Pub Date : 2024-10-16 eCollection Date: 2024-10-01 DOI: 10.1002/pul2.70001

Weijun Li, Xingxue Pang, Jun Chen, Xiaoxia Ren, Huaibing Zhao, Xu Wang, Ning Zhao, Dayi Hu, Zhongyi Jin

{"title":"Prostacyclin pathway vasodilators in patients with chronic thromboembolic pulmonary hypertension (CTEPH): A systemic review and meta-analysis of randomized controlled trials.","authors":"Weijun Li, Xingxue Pang, Jun Chen, Xiaoxia Ren, Huaibing Zhao, Xu Wang, Ning Zhao, Dayi Hu, Zhongyi Jin","doi":"10.1002/pul2.70001","DOIUrl":"https://doi.org/10.1002/pul2.70001","url":null,"abstract":"Although surgical and interventional therapy has emerged as the primary treatment for patients with chronic thromboembolic pulmonary hypertension (CTEPH), there remains a subset of patients who need medication therapy. This study aimed to evaluate the efficacy and safety outcomes of prostacyclin pathway vasodilators, providing further insight for clinical decision-making. A literature search was conducted in PubMed, Embase, and CENTRAL databases from inception to December 2023. Literature screening and quality assessment were carried out with the Cochrane Risk of Bias Tool. Data analysis was conducted using RevMan 5.4 software. We included 6 randomized controlled trials with 387 patients. Prostacyclin pathway vasodilators demonstrated a significant improvement in PVR (-125.26 dynes·sec·cm-5, 95%CI: -219.29 to -31.23, Z = 2.61, and p < 0.009), RAP (-0.78 mmHg, 95%CI: -1.52 to -0.04, Z = 2.06, and p = 0.04), cardiac index (0.62, 95%CI: 0.54 to 0.69, Z = 16.13, and p < 0.00001), and the number of patients showing improvement in WHO functional class (3.86, 95%CI: 1,92 to 7.77, Z = 3.79, and p = 0.0002) compared to controls, moreover, a trend towards improvement was observed in mPAP, 6MWD, and NT-proBNP. Regarding the safety endpoints, no significant difference was found in both groups in terms of serious adverse events and all-cause deaths. The prostacyclin pathway vasodilators present therapeutic potential for CTEPH patients with inoperable or persistent/recurrent PH after PEA/BPA primarily characterized by distal small-vessel and microvasculopathy. However, the current clinical evidence remains insufficient and controversial, necessitating further validation.","PeriodicalId":20927,"journal":{"name":"Pulmonary Circulation","volume":"14 4","pages":"e70001"},"PeriodicalIF":2.2,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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