Assessment of Patients with Pulmonary Hypertension

McNeil, Keith

doi:10.1159/000158546

Cited by 2 publications

(1 citation statement)

References 4 publications

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“…However, similar to others we found that a subgroup of COPD patients (12%) presents with out-of-proportion elevated pulmonary artery pressure (>40 mm Hg) similar to the features seen in (idiopathic) PAH [1,5,6,24]. In this group, we found a marked overrepresentation of the 5HTT long allelic variant (L).…”

Section: Discussionsupporting

confidence: 88%

Genetic Polymorphisms of the Serotonin Transporter, but Not the 2a Receptor or Nitric Oxide Synthetase, Are Associated with Pulmonary Hypertension in Chronic Obstructive Pulmonary Disease

et al. 2009

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Background: Pulmonary hypertension (PH) is prognosti- cally important in chronic obstructive pulmonary disease (COPD). Since PH only weakly correlates with hypoxemia, other factors must play a role. Objective: To investigate whether polymorphisms of the serotonin transporter (5HTT), serotonin-2a receptor (5HTR2a) and endothelial nitric oxide synthetase (eNOS) are related to PH in COPD. Methods: In 59 COPD patients who underwent right heart catheterization, 6-min walking distance, NYHA functional class, pulmonary function tests, blood gases and 5HTT, 5HTR2a and eNOS (4ab and T298C) polymorphisms were determined. Results: Forty-nine COPD patients in NYHA functional class III–IV were included. Ten were excluded due to comorbid causes of PH (mainly chronic thromboembolic). PH (mPAP ≧25 mm Hg) was present in 55% and usually mild, but out of proportion (mPAP ≧40 mm Hg) in 12%. Patients with PH had significantly higher frequencies of the 5HTT-L-allele (52%) compared to individuals without PH (36%), and LL homozygote patients had more severe PH. In patients with out-of-proportion PH, the L-allelic frequency was even 75%. We found no association of 5HTR2a and eNOS polymorphism with PH in COPD. Conclusions: In this COPD cohort we confirm that PH is frequent and usually mild, but out of proportion in a subgroup. We found a significant association of the L-allelic variant of 5HTT with PH overall and especially in out-of-proportion PH. These findings may point towards a role of the serotonin system in COPD-PH and warrant further studies.

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Section: Discussionsupporting

confidence: 88%

Genetic Polymorphisms of the Serotonin Transporter, but Not the 2a Receptor or Nitric Oxide Synthetase, Are Associated with Pulmonary Hypertension in Chronic Obstructive Pulmonary Disease

et al. 2009

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Chronic thromboembolic pulmonary hypertension

Opitz¹,

Ulrich²

2018

Swiss Med Wkly

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Chronicthromboembolic pulmonary hypertension (CTEPH) is a potentially fatal disease, which may occur as a rare complication after acute pulmonary embolism, although the exact epidemiology of CTEPH is unknown. The mechanisms involved in nonresolution of thrombotic material and scarring of large and/or small pulmonary arteries are unknown; some risk factors have been identified. To date, CTEPH is still underdiagnosed and undertreated. The cardinal symptom of CTEPH is dyspnoea on exertion, but diagnosis is challenging owing to nonspecific symptoms. Right heart catheterisation is mandatory for the diagnosis of pulmonary hypertension, followed by several imaging methods including besides ventilation/perfusion scan, computed tomography pulmonary angiography and conventional angiography. Operability assessment by a multidisciplinary team is crucial for the management in all CTEPH patients, as pulmonary endarterectomy (PEA) remains the only curative treatment of choice. PEA leads to substantial improvement of haemodynamics, symptoms, and life expectancy enabling many patients to lead unrestricted lives under sole anticoagulation therapy. For inoperable patients or those with disease not amenable to surgery, medical therapy or balloon angioplasty are emerging treatment options. Owing to the complexity of CTEPH, the diagnosis and treatment of CTEPH patients is reserved exclusively to experienced CTEPH centres.

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Assessment of Patients with Pulmonary Hypertension

Cited by 2 publications

References 4 publications

Genetic Polymorphisms of the Serotonin Transporter, but Not the 2a Receptor or Nitric Oxide Synthetase, Are Associated with Pulmonary Hypertension in Chronic Obstructive Pulmonary Disease

Genetic Polymorphisms of the Serotonin Transporter, but Not the 2a Receptor or Nitric Oxide Synthetase, Are Associated with Pulmonary Hypertension in Chronic Obstructive Pulmonary Disease

Chronic thromboembolic pulmonary hypertension

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