Right ventricle remodeling in chronic thromboembolic pulmonary hypertension

Liu, Jixiang; Yang, Peiran; Tian, Han; Zhen, Kaiyuan; McCabe, Colm; Zhao, Lan; Zhai, Zhenguo

doi:10.2478/jtim-2022-0027

Cited by 14 publications

(11 citation statements)

References 88 publications

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“…Our approach yielded simulation results with excellent agreement with measured data and estimated pulmonary arterial stiffness, TAWSS, and OSI distribution in both baseline and CTEPH. Pulmonary arterial stiffness can drive upstream (i.e., right ventricular (Liu et al 2022 )) and downstream (i.e., pulmonary capillary (Wang and Chesler 2011 )) remodeling to accelerate disease progression. Moreover, changes in WSS are relevant to the growth or dissolution of thrombi (Sakariassen et al 2015 ).…”

Section: Discussionmentioning

confidence: 99%

Subject-specific one-dimensional fluid dynamics model of chronic thromboembolic pulmonary hypertension

Kachabi,

Colebank,

Chesler

2023

Biomech Model Mechanobiol

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Chronic thromboembolic pulmonary hypertension (CTEPH) develops due to the accumulation of blood clots in the lung vasculature that obstructs flow and increases pressure. The mechanobiological factors that drive progression of CTEPH are not understood, in part because mechanical and hemodynamic changes in the small pulmonary arteries due to CTEPH are not easily measurable. Using previously published hemodynamic measurements and imaging from a large animal model of CTEPH, we applied a subject-specific one-dimensional (1D) computational fluid dynamic (CFD) approach to investigate the impact of CTEPH on pulmonary artery stiffening, time-averaged wall shear stress (TAWSS), and oscillatory shear index (OSI) in extralobar (main, right, and left) pulmonary arteries and intralobar (distal to the extralobar) arteries. Our results demonstrate that CTEPH increases pulmonary artery wall stiffness and decreases TAWSS in extralobar and intralobar arteries. Moreover, CTEPH increases the percentage of the intralobar arterial network with both low TAWSS and high OSI, quantified by the novel parameter $$\varphi$$ φ , which is related to thrombogenicity. Our analysis reveals a strong positive correlation between increases in mean pulmonary artery pressure (mPAP) and $$\varphi$$ φ from baseline to CTEPH in individual subjects, which supports the suggestion that increased $$\varphi$$ φ drives disease severity. This subject-specific experimental–computational framework shows potential as a predictor of the impact of CTEPH on pulmonary arterial hemodynamics and pulmonary vascular mechanics. By leveraging advanced modeling techniques and calibrated model parameters, we predict spatial distributions of flow and pressure, from which we can compute potential physiomarkers of disease progression. Ultimately, this approach can lead to more spatially targeted interventions that address the needs of individual CTEPH patients.

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Section: Discussionmentioning

confidence: 99%

Subject-specific one-dimensional fluid dynamics model of chronic thromboembolic pulmonary hypertension

Kachabi,

Colebank,

Chesler

2023

Biomech Model Mechanobiol

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“…Ultrasound (US) has been demonstrated to be precise, dependable, not involve exposure to ionizing radiation, has high repeatability for measuring muscle quantity in different populations and is available at the bedside. [7][8][9][10] Importantly, ultrasound offers extremely strong reliability and repeatability when performed by ultrasonographers who received formal training [ICC (intraclass correlation coefficient) of 0.97-0.99 for muscle thickness parameter]. 11 Skeletal muscle dysfunction in COPD patients can manifest as abnormal muscle mass of the lower extremities.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound Assessment of the Rectus Femoris in Patients with Chronic Obstructive Pulmonary Disease Predicts Sarcopenia

Deng¹,

Yan²,

Tong³

et al. 2022

COPD

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Purpose Sarcopenia, an age-related loss of skeletal muscle mass and function, is frequent in patients with chronic obstructive pulmonary disease (COPD) and is linked to a poor prognosis. The diagnosis of sarcopenia requires specific equipment and is inconvenient to introduce into clinical practice. Ultrasound is an innovative method to assess muscle quantity. The objective of this research was to evaluate the use of ultrasound for prospectively screening for sarcopenia in COPD patients. Patients and Methods A total of 235 stable patients with COPD were included in this observational study and divided into development and validation sets. The Asian Working Group for Sarcopenia standards were used to define sarcopenia. The thickness (RF thick ) and cross-sectional area (RF csa ) of the rectus femoris were measured using ultrasound. Receiver operating characteristic curve analysis of RF thick and RF csa was used to predict sarcopenia. Nomogram models were constructed based on RF thick , RF csa , age and body mass index to identify sarcopenia. Results Sarcopenia was present in 83 (35.32%) patients. Patients with sarcopenia had advanced age, decreased pulmonary function, decreased physical function and poor clinical outcomes. RF thick and RF csa showed good predictive ability for sarcopenia in the development and validation sets. The nomogram based on RF thick and RF csa could detect sarcopenia in COPD patients, and all had significant predictive performance in the development and validation sets. The calibration plot showed good agreement between the nomogram predictions and actual observations. Conclusion The ultrasound measurement of the rectus femoris has potential for the clinical assessment of sarcopenia in patients with COPD.

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“…Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive pulmonary vascular disease caused by single or recurrent pulmonary thromboembolism, leading to elevated pulmonary vascular resistance and maladaptive right ventricular failure ( 1 – 3 ). Removal of organized thrombotic materials and neointima by pulmonary endarterectomy (PEA) is the gold standard therapy for operable CTEPH ( 4 ), conferring a 3-year survival rate of up to 89% in operated patients ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

Clinical features and metabolic reprogramming of atherosclerotic lesions in patients with chronic thromboembolic pulmonary hypertension

Liu

Chang

Zhang

et al. 2022

Front. Cardiovasc. Med.

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BackgroundChronic thromboembolic pulmonary hypertension (CTEPH) patients may present with atherosclerotic lesions in their pulmonary arteries, but their clinical characteristics remain unclear. The metabolic pathways associated with the atherosclerotic lesions may explain their occurrence and have implications for interventions, but they have not been investigated.MethodsWe collected pulmonary endarterectomy (PEA) samples of CTEPH patients from December 2016 to August 2021. Following a detailed pathological examination of the PEA specimen, the patients were divided into those with and without lesions, and age- and sex matching were performed subsequently using propensity score matching (n = 25 each). Metabolomic profiling was used to investigate the metabolites of the proximal lesions in the PEA specimens.ResultsIn our study population, 27.2% of all PEA specimens were found to contain atherosclerotic lesions. CTEPH patients with atherosclerotic lesions were more likely to have a history of symptomatic embolism and had a longer timespan between embolism and surgery, whereas the classic risk factors of systemic and coronary circulation could not distinguish CTEPH patients with or without atherosclerotic lesions. Metabolomic profiling revealed that the formation of atherosclerotic lesions in CTEPH was closely related to altered glycine, serine, and threonine metabolic axes, possibly involved in cellular senescence, energy metabolism, and a proinflammatory microenvironment.ConclusionThe occurrence of atherosclerotic lesions in the pulmonary arteries of CTEPH was associated with symptomatic thromboembolic history and prolonged disease duration. The results revealed a new link between atherosclerotic lesions and aberrant amino acid metabolism in the context of CTEPH for the first time. This study has characterized the clinical and metabolic profiles of this distinct group of CTEPH patients, providing new insights into disease pathogenesis and potential interventions.

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Right ventricle remodeling in chronic thromboembolic pulmonary hypertension

Cited by 14 publications

References 88 publications

Subject-specific one-dimensional fluid dynamics model of chronic thromboembolic pulmonary hypertension

Subject-specific one-dimensional fluid dynamics model of chronic thromboembolic pulmonary hypertension

Ultrasound Assessment of the Rectus Femoris in Patients with Chronic Obstructive Pulmonary Disease Predicts Sarcopenia

Clinical features and metabolic reprogramming of atherosclerotic lesions in patients with chronic thromboembolic pulmonary hypertension

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