Pulmonary vasodilator therapies are of no benefit in pulmonary hypertension due to left heart disease: A meta-analysis

Cao, Jacob; Wales, K.; Cordina, Rachael; Lau, Edmund; Celermajer, David S.

doi:10.1016/j.ijcard.2018.09.043

Cited by 27 publications

(17 citation statements)

References 29 publications

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“…Accurate diagnosis of PAH and careful patient selection is critical. For example, trials of pulmonary vasodilator drugs in patients with pulmonary hypertension (PH) secondary to left heart and lung diseases have not shown benefit and revealed the potential for harmful side effects [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Pharmacological Treatment of Pulmonary Arterial Hypertension in Australia: Current Trends and Challenges

Anderson

Lavender

Lau

et al. 2020

Heart, Lung and Circulation

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Section: Introductionmentioning

confidence: 99%

Pharmacological Treatment of Pulmonary Arterial Hypertension in Australia: Current Trends and Challenges

Anderson

Lavender

Lau

et al. 2020

Heart, Lung and Circulation

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“…Jacob Y Cao et al., in their SR and meta-analysis, assessed the effects of all types of advanced therapy in group 2 PH, 30 including one study in patients with VHD. They also included two non-invasive studies, one of them using Udenafil.…”

Section: Discussionmentioning

confidence: 99%

Targeted therapy with phosphodiesterase 5 inhibitors in patients with pulmonary hypertension due to heart failure and elevated pulmonary vascular resistance: a systematic review

2020

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Pulmonary Hypertension due to left heart disease is the most common type of Pulmonary Hypertension. Morbidity and mortality significantly increase once Pulmonary Hypertension is present. Treatment is aimed toward optimizing the underlying condition. Targeted therapy has been evaluated in small studies with mixed results. The goal of this systematic review is to identify the possible benefit and safety of Phosphodiesterase 5 inhibitors in Pulmonary Hypertension due to left heart disease with elevated pulmonary vascular resistance, diagnosed by right heart catheterization. Electronic searches using MEDLINE/PREMEDLINE, EMBASE, and The Cochrane Library were searched on 21 October 2018. Randomized clinical trials comparing Phosphodiesterase 5 inhibitors versus placebo in patients with proven Pulmonary Hypertension by right heart catheterization secondary to left heart disease (both heart failure with reduced ejection fraction and with preserved ejection fraction) and reported pulmonary vascular resistance were included. We identified 436 potentially relevant studies. After reviewing the titles and abstracts to exclude irrelevant articles, five randomized clinical trials were considered for the study. Sildenafil was well tolerated among all studies. Sildenafil was found to improve hemodynamics, exercise capacity, and quality of life in patients with elevated pulmonary vascular resistance. Phosphodiesterase 5 inhibitors therapy in patients with proven Pulmonary Hypertension due to left heart disease and elevated pulmonary vascular resistance by right heart catheterization may improve the quality of life, exercise capacity, and pulmonary hemodynamics. Further prospective randomized controlled studies are needed to confirm.

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“…IPAH may lead to increased PVR, progressive right ventricular dysfunction, right heart failure, and early mortality. The symptoms of IPAH are non-specific, including fatigue, weakness, shortness of breath, angina, and syncope, usually induced by exertion (1,3,4). Although the cause of IPAH is unclear, some cases are familial and caused by gene defects, or mutations, such as BMPR2 (5), SMAD8 (6), ALK1 (7), and BMPR1B (8) and so on.…”

Section: Introductionmentioning

confidence: 99%

Identification of Potential Biomarkers and Immune Infiltration Characteristics in Idiopathic Pulmonary Arterial Hypertension Using Bioinformatics Analysis

Zeng

Liu

Zhang

2021

Front. Cardiovasc. Med.

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Objectives: Idiopathic pulmonary arterial hypertension (IPAH) is a rare but severe lung disorder, which may lead to heart failure and early mortality. However, little is known about the etiology of IPAH. Thus, the present study aimed to establish the differentially expressed genes (DEGs) between IPAH and normal tissues, which may serve as potential prognostic markers in IPAH. Furthermore, we utilized a versatile computational method, CIBERSORT to identify immune cell infiltration characteristics in IPAH.Materials and Methods: The GSE117261 and GSE48149 datasets were obtained from the Gene Expression Omnibus database. The GSE117261 dataset was adopted to screen DEGs between IPAH and the control groups with the criterion of |log2 fold change| ≥ 1, adjusted P < 0.05, and to further explore their potential biological functions via Gene Ontology analysis, Kyoto Encyclopedia of Genes and Genomes Pathway analysis, and Gene Set Enrichment Analysis. Moreover, the support vector machine (SVM)-recursive feature elimination and the least absolute shrinkage and selection operator regression model were performed jointly to identify the best potential biomarkers. Then we built a regression model based on these selected variables. The GSE48149 dataset was used as a validation cohort to appraise the diagnostic efficacy of the SVM classifier by receiver operating characteristic (ROC) analysis. Finally, immune infiltration was explored by CIBERSORT in IPAH. We further analyzed the correlation between potential biomarkers and immune cells.Results: In total, 75 DEGs were identified; 40 were downregulated, and 35 genes were upregulated. Functional enrichment analysis found a significantly enrichment in heme binding, inflammation, chemokines, cytokine activity, and abnormal glycometabolism. HBB, RNASE2, S100A9, and IL1R2 were identified as the best potential biomarkers with an area under the ROC curve (AUC) of 1 (95%CI = 0.937–1.000, specificity = 100%, sensitivity = 100%) in the discovery cohort and 1(95%CI = 0.805–1.000, specificity = 100%, sensitivity = 100%) in the validation cohort. Moreover, immune infiltration analysis by CIBERSORT showed a higher level of CD8+ T cells, resting memory CD4+ T cells, gamma delta T cells, M1 macrophages, resting mast cells, as well as a lower level of naïve CD4+ T cells, monocytes, M0 macrophages, activated mast cells, and neutrophils in IPAH compared with the control group. In addition, HBB, RNASE2, S100A9, and IL1R2 were correlated with immune cells.Conclusion:HBB, RNASE2, S100A9, and IL1R2 were identified as potential biomarkers to discriminate IPAH from the control. There was an obvious difference in immune infiltration between patient with IPAH and normal groups.

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Pulmonary vasodilator therapies are of no benefit in pulmonary hypertension due to left heart disease: A meta-analysis

Cited by 27 publications

References 29 publications

Pharmacological Treatment of Pulmonary Arterial Hypertension in Australia: Current Trends and Challenges

Pharmacological Treatment of Pulmonary Arterial Hypertension in Australia: Current Trends and Challenges

Targeted therapy with phosphodiesterase 5 inhibitors in patients with pulmonary hypertension due to heart failure and elevated pulmonary vascular resistance: a systematic review

Identification of Potential Biomarkers and Immune Infiltration Characteristics in Idiopathic Pulmonary Arterial Hypertension Using Bioinformatics Analysis

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