Atrial flutter regression in HIV-associated pulmonary arterial hypertension after treatment with bosentan

Pulmonary arterial hypertension (PAH) is a rare condition characterized by an increase in pulmonary arterial resistance leading to right heart failure and death. Arrhythmias are a growing problem in PAH; therefore, maintenance of sinus rhythm is considered to be an important treatment aim in these patients. We described the case of a 46-year-old woman with HIV-associated pulmonary arterial hypertension who developed atrial flutter. After treatment with bosentan, it was observed a significant improvement in clinical and haemodynamic parameters. In addition, the AFL, which had previously persisted to both antiarrhythmic drug therapy and electrical stimulation, and had recurred after transthoracic electrical cardioversion, disappeared in absence of any antiarrhythmic drug. Though the precise factors responsible for supraventricular arrhythmogenesis are still largely obscure, it is likely that initiation and maintenance of AFL may depend on all the conditions that can lead to increase in right atrial pressure, size, and wall stress, such as PAH. In our case, bosentan reduced both mean pulmonary artery pressure (mPAP) value and right heart chambers pressures. Therefore, it is conceivable that with the anatomical substrate needed for the maintenance of AFL being disappeared, sinus rhythm was restored.</p

Impact of Foods and Dietary Supplements Containing Hydroxycinnamic Acids on Cardiometabolic Biomarkers: A Systematic Review to Explore Inter-Individual Variability

Plant-based diets rich in bioactive compounds such as polyphenols have been shown to positively modulate the risk of cardiometabolic (CM) diseases. The inter-individual variability in the response to these bioactives may affect the findings. This systematic review aimed to summarize findings from existing randomized clinical trials (RCTs) evaluating the effect of hydroxycinnamic acids (HCAs) on markers of CM health in humans. Literature searches were performed in PubMed and the Web of Science. RCTs on acute and chronic supplementation of HCA-rich foods/extracts on CM biomarkers were included. Forty-four RCTs (21 acute and 23 chronic) met inclusion criteria. Comparisons were made between RCTs, including assessments based on population health status. Of the 44 RCTs, only seven performed analyses on a factor exploring inter-individual response to HCA consumption. Results demonstrated that health status is a potentially important effect modifier as RCTs with higher baseline cholesterol, blood pressure and glycaemia demonstrated greater overall effectiveness, which was also found in studies where specific subgroup analyses were performed. Thus, the effect of HCAs on CM risk factors may be greater in individuals at higher CM risk, although future studies in these populations are needed, including those on other potential determinants of inter-individual variability. PROSPERO, registration number CRD42016050790

Exhaled and arterial levels of endothelin-1 are increased and correlate with pulmonary systolic pressure in COPD with pulmonary hypertension

BACKGROUND: Endothelin-1 (ET-1) and Nitric Oxide (NO) are crucial mediators for establishing pulmonary artery hypertension (PAH). We tested the hypothesis that their imbalance might also occur in COPD patients with PAH. METHODS: The aims of the study were to measure exhaled breath condensate (EBC) and circulating levels of ET-1, as well as exhaled NO (FENO) levels by, respectively, a specific enzyme immunoassay kit, and by chemiluminescence analysis in 3 groups of subjects: COPD with PAH (12), COPD only (36), and healthy individuals (15). In order to evaluate pulmonary-artery systolic pressure (PaPs), all COPD patients underwent Echo-Doppler assessment. RESULTS: Significantly increased exhaled and circulating levels of ET-1 were found in COPD with PAH compared to both COPD (p < 0.0001) only, and healthy controls (p < 0.0001). In COPD with PAH, linear regression analysis showed good correlation between ET-1 in EBC and PaPs (r = 0.621; p = 0.031), and between arterial levels of ET-1 and PaPs (r = 0.648; p = 0.022), while arterial levels of ET-1 inversely correlated with FEV1%, (r = -0.59, p = 0.043), and PaPs negatively correlated to PaO2 (r = -0.618; p = 0.032). Significantly reduced levels of FENO were found in COPD associated with PAH, compared to COPD only (22.92 +/- 11.38 vs.35.07 +/- 17.53 ppb; p = 0.03). Thus, we observed an imbalanced output in the breath between ET-1 and NO, as expression of pulmonary endothelium and epithelium impairment, in COPD with PAH compared to COPD only. Whether this imbalance is an early cause or result of PAH due to COPD is still unknown and deserves further investigations

Using PaCO2 values to grade obesity-hypoventilation syndrome severity: a retrospective study

Background: To date, an important aspect that has still not been clarified is the assessment of OHS severity. The purpose of this retrospective study was to evaluate whether grading OHS severity according to PaCO2 values may be useful in order to provide a more definite characterization and targeted management of patients. In this regard, baseline anthropometric and sleep polygraphic characteristics, treatment options, and follow up outcomes, were compared between OHS patients with different degree of severity (as assessed according to PaCO2 values). Methods: Patients were classified into three groups, according to PaCO2 values: 1) mild (46 mmHg ≤ PaCO2 ≤ 50 mmHg), moderate (51 mmHg ≤ PaCO2 ≤ 55 mmHg), severe (PaCO2 ≥ 56 mmHg). Therefore, differences among the groups in terms of baseline anthropometric, and sleep polygraphic characteristics, treatment modalities and follow up outcomes were retrospectively evaluated. Results: Patients with more severe degree of hypercapnia were assessed to have increased BMI and bicarbonate levels, worse diurnal and nocturnal hypoxemia, and a more severe impairment in pulmonary mechanics compared to milder OHS. CPAP responders rate significantly decreased from mild to severe OHS. After follow up, daytime sleepiness (as measure by the ESS), PaO2, and PaCO2 significantly improved with PAP therapy in all three groups. Discussion and Conclusions: Classification of OHS severity according to PaCO2 levels may be useful to provide a more defined characterization and, consequently, a more targeted management of OHS patients. Further studies are needed to confirm our findings

Predictive value of exercise testing in pulmonary arterial hypertension

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Exercise to predict outcome in idiopathic vs associated pulmonary arterial hypertension.

We tested the ability of exercise testing to predict not only survival but also time to clinical worsening in idiopathic versus associated pulmonary arterial hypertension (PAH).Hundred thirty-six patients with PAH (85 idiopathic and 51 with associated conditions), underwent cardiopulmonary exercise testing and a 6-minute walk test. Death or transplantation, and clinical worsening events were recorded.Thirty-two patients died and 4 had lung transplantation. At univariate analysis, PAH patients survival was associated with oxygen uptake (VO2) at peak exercise and at anaerobic threshold, ventilatory equivalent for CO2 (VEVCO2) at anaerobic threshold (at), VE/VCO2slope and distance walked. Time to clinical worsening was associated with peakVO2 and VO2at, VEVCO2at, end-tidal CO2 partial pressure measured at anaerobic threshold, peakO2 pulse, increase in O2pulse and distance walked. At multivariable analysis, distance walked and VEVCO2at predicted survival, and only peakVO2 predicted time to clinical worsening. The ROC curve-derived cut-off values were 305 m for the 6-min walk distance, 54 for VEVCO2at and 11.6 mL·Kg(-1).min for peakVO2. In the subgroup of associated PAH, no variable independently predicted survival or clinical worsening.We conclude several exercise variables predict survival and clinical stability in idiopathic PAH. Exercise variables are less accurate predictors of outcome in associated PAH.JOURNAL ARTICLESCOPUS: ar.jinfo:eu-repo/semantics/publishe

Hyperventilation in patients with pulmonary arterial hypertension is related to increased chemosensitivity

[Publication Page: A6224]info:eu-repo/semantics/nonPublishe

Exercise testing to predict outcome in idiopathic versus

We tested the ability of exercise testing to predict not only survival but also time to clinical worsening in idiopathic versus associated pulmonary arterial hypertension (PAH).Hundred thirty-six patients with PAH (85 idiopathic and 51 with associated conditions), underwent cardiopulmonary exercise testing and a 6-minute walk test. Death or transplantation, and clinical worsening events were recorded.Thirty-two patients died and 4 had lung transplantation. At univariate analysis, PAH patients survival was associated with oxygen uptake (VO2) at peak exercise and at anaerobic threshold, ventilatory equivalent for CO2 (VEVCO2) at anaerobic threshold (at), VE/VCO2slope and distance walked. Time to clinical worsening was associated with peakVO2 and VO2at, VEVCO2at, end-tidal CO2 partial pressure measured at anaerobic threshold, peakO2 pulse, increase in O2pulse and distance walked. At multivariable analysis, distance walked and VEVCO2at predicted survival, and only peakVO2 predicted time to clinical worsening. The ROC curve-derived cut-off values were 305 m for the 6-min walk distance, 54 for VEVCO2at and 11.6 mL·Kg(-1).min for peakVO2. In the subgroup of associated PAH, no variable independently predicted survival or clinical worsening.We conclude several exercise variables predict survival and clinical stability in idiopathic PAH. Exercise variables are less accurate predictors of outcome in associated PAH.JOURNAL ARTICLESCOPUS: ar.jinfo:eu-repo/semantics/publishe

Human cytomegalovirus infection in an as yet unexplored at-risk category of subjects: elderly subjects facing acute ischemic stroke

Background: Human cytomegalovirus (HCMV) is an important opportunistic pathogen leading to severe diseases in “at-risk” categories of individuals upon the symptomatic reactivation of the virus belonging to specific genotypes. In this respect, it has been postulated that envelope glycoproteins (g) N and O could have a key role as virulence factors, most likely in combined patterns. Several data is accumulating about HCMV reactivations in non-immunocompromised adults with critical illness that may impair clinical outcomes. The interplay between HCMV and immune surveillance is also supposed to become more vulnerable in advanced age; here, subclinical reactivations may drive expanded anti-HCMV immune responses. Accordingly, it is reasonable to expect cases of HCMV reactivation in elderly patients facing an acute life-threatening disease such as ischemic stroke. Materials/methods: We have performed an observational prospective study in a cohort of 105 elderly patients admitted to the Stroke Care Units of Parma University-Hospital for major acute ischemic stroke. Plasma samples from patients tested positive for anti-HCMV IgG, collected at 10±2 days from hospital admission, were analyzed for the presence of viral DNA by Real-Time PCR; gN and gO genotyping was performed by RFLP in case of positive DNAemia. Results: HCMV DNA was detected in the range of few hundred copies/mL in 11.7% of the analyzed samples. The gN and gO genotypes were characterized in 77.7% of the positive samples for HCMVDNAemia. In particular, the gN3 genotype was found to predominate (57.1%); with regard to gO, the recurrent genotypes were gO1 (57.1%) and gO2 (42.9%). Furthermore, these data suggest that combined gN3-gO1 and gN3-gO2 genotypes could be the recurring virulence factor patterns associated with viral DNAemia. Conclusions: This study focused for the first time on the role of HCMV infection in acute ischemic stroke. Overall, the results suggest that HCMV tends to escape immune surveillance in some elderly patients in this clinical setting. The quite low viral genome copies could be associated with localized, rather systemic, viral reactivations and involved specific HCMV envelope genotype combinations. The impact of these data will be evaluated with respect to clinical outcomes and HCMV-specific T cell responses of the studied population