Epidemiology and Pathophysiology of Chronic Thromboembolic Pulmonary
                        Hypertension: Risk Factors and Mechanisms

Medrek, Sarah; Safdar, Zeenat

doi:10.14797/mdcj-12-4-195

Cited by 9 publications

(4 citation statements)

References 47 publications

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“…More importantly, RVEF had a reinforced value in assessing disease severity because of the relation to cardiac index, 6MWD, and NT-proBNP. In line with our findings, a previous study reported that an increase in the RV/LV diameter ratio and high B-type natriuretic peptide levels were predictive of CTEPH development ( 15 ).…”

Section: Discussionsupporting

confidence: 93%

Right Ventricular Function Predicts Adverse Clinical Outcomes in Patients With Chronic Thromboembolic Pulmonary Hypertension: A Three-Dimensional Echocardiographic Study

Liang

Guo

et al. 2021

Front. Med.

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Background: Right ventricular (RV) function plays a vital role in the prognosis of patients with chronic thromboembolic pulmonary hypertension (CTEPH). We used new machine learning (ML)-based fully automated software to quantify RV function using three-dimensional echocardiography (3DE) to predict adverse clinical outcomes in CTEPH patients.Methods: A total of 151 consecutive CTEPH patients were registered in this prospective study between April 2015 and July 2019. New ML-based methods were used for data management, and quantitative analysis of RV volume and ejection fraction (RVEF) was performed offline. RV structural and functional parameters were recorded using 3DE. CTEPH was diagnosed using right heart catheterization, and 62 patients underwent cardiac magnetic resonance to assess right heart function. Adverse clinical outcomes were defined as PH-related hospitalization with hemoptysis or increased RV failure, including conditions requiring balloon pulmonary angioplasty or pulmonary endarterectomy, as well as death.Results: The median follow-up time was 19.7 months (interquartile range, 0.5–54 months). Among the 151 CTEPH patients, 72 experienced adverse clinical outcomes. Multivariate Cox proportional-hazard analysis showed that ML-based 3DE analysis of RVEF was a predictor of adverse clinical outcomes (hazard ratio, 1.576; 95% confidence interval (CI), 1.046~2.372; P = 0.030).Conclusions: The new ML-based 3DE algorithm is a promising technique for rapid 3D quantification of RV function in CTEPH patients.

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Section: Discussionsupporting

confidence: 93%

Right Ventricular Function Predicts Adverse Clinical Outcomes in Patients With Chronic Thromboembolic Pulmonary Hypertension: A Three-Dimensional Echocardiographic Study

Liang

Guo

et al. 2021

Front. Med.

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“…Fibrinolysis is the initial stage of thrombus breakdown, followed by an inflammatory response that recruits neutrophils to continue decomposition. In the meanwhile, monocytes and endothelial progenitor cells are also recruited to promote clot reorganization and angiogenesis ( Medrek and Safdar, 2016 ). Studies have demonstrated impairment in fibrinolytic system and deficiency in fibrin in the patients with CTEPH ( Yan et al, 2019 ).…”

Section: Specific Pathogenic Mechanisms For Chronic Thromboembolic Pulmonary Hypertensionmentioning

confidence: 99%

In situ Pulmonary Artery Thrombosis: A Previously Overlooked Disease

Cao

Geng

et al. 2021

Front. Pharmacol.

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Pulmonary thromboembolism (PTE) is the third leading cause of death in cardiovascular diseases. PTE is believed to be caused by thrombi detached from deep veins of lower extremities. The thrombi travel with systemic circulation to the lung and block pulmonary arteries, leading to sudden disruption of hemodynamics and blood gas exchange. However, this concept has recently been challenged by accumulating evidence demonstrating that de novo thrombosis may be formed in pulmonary arteries without deep venous thrombosis. On the other hand, chronic thromboembolic pulmonary hypertension (CTEPH), a subtype of pulmonary hypertension, could have different pathogenesis than traditional PTE. Therefore, this article summarized and compared the risk factors, the common and specific pathogenic mechanisms underlying PTE, in situ pulmonary artery thrombosis, and CTEPH at molecular and cellular levels, and suggested the therapeutic strategies to these diseases, aiming to facilitate understanding of pathogenesis, differential diagnosis, and precision therapeutics of the three pulmonary artery thrombotic diseases.

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“…Direct-acting oral anticoagulants can be divided into two classes: direct thrombin inhibitors (dabigatran) and direct factor Xa inhibitors (apixaban, edoxaban, and rivaroxaban). Despite the use of anticoagulants, approximately 25 to 50% of DVT patients develop PTS and about 5% of patients suffering from an unresolved PE develop chronic thromboembolic pulmonary hypertension (CTEPH) as a late complication (179).…”

Section: Current Therapies and Future Perspectivesmentioning

confidence: 99%

Fibrinolysis and Inflammation in Venous Thrombus Resolution

et al. 2019

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Clinical observations and accumulating laboratory evidence support a complex interplay between coagulation, inflammation, innate immunity and fibrinolysis in venous thromboembolism (VTE). VTE, which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), and the subsequent complications of post-thrombotic syndrome (PTS), are significant causes of morbidity and mortality in patients. Clinical risk factors for VTE include cancer, major trauma, surgery, sepsis, inflammatory bowel disease, paralysis, prolonged periods of immobility, and aging. Abnormalities in venous blood flow or stasis initiates the activation of endothelial cells, and in concert with platelets, neutrophils and monocytes, propagates VTE in an intact vein. In addition, inflammatory cells play crucial roles in thrombus recanalization and restoration of blood flow via fibrinolysis and vascular remodeling. Faster resolution of the thrombus is key for improved disease prognosis. While in the clinical setting, anticoagulation therapy is successful in preventing propagation of venous thrombi, current therapies are not designed to inhibit inflammation, which can lead to the development of PTS. Animal models of DVT have provided many insights into the molecular and cellular mechanisms involved in the formation, propagation, and resolution of venous thrombi as well as the roles of key components of the fibrinolytic system in these processes. Here, we review the recent advances in our understanding of fibrinolysis and inflammation in the resolution of VTE.

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Epidemiology and Pathophysiology of Chronic Thromboembolic Pulmonary Hypertension: Risk Factors and Mechanisms

Cited by 9 publications

References 47 publications

Right Ventricular Function Predicts Adverse Clinical Outcomes in Patients With Chronic Thromboembolic Pulmonary Hypertension: A Three-Dimensional Echocardiographic Study

Right Ventricular Function Predicts Adverse Clinical Outcomes in Patients With Chronic Thromboembolic Pulmonary Hypertension: A Three-Dimensional Echocardiographic Study

In situ Pulmonary Artery Thrombosis: A Previously Overlooked Disease

Fibrinolysis and Inflammation in Venous Thrombus Resolution

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