Role of prostacyclin in pulmonary hypertension

Date of Acceptance: 11/12/2014 This is an open access article distributed under the terms of the Creative Commons Attribution license CC BY-4.0, which permits unrestricted use, distribution and reproduction in any medium, provided the original work is properly cited.Prostacyclin is a powerful cardioprotective hormone released by the endothelium of all blood vessels. Prostacyclin exists in equilibrium with other vasoactive hormones and a disturbance in the balance of these factors leads to cardiovascular disease including pulmonary arterial hypertension. Since it’s discovery in the 1980s concerted efforts have been made to make the best therapeutic utility of prostacyclin, particularly in the treatment of pulmonary arterial hypertension. This has centred on working out the detailed pharmacology of prostacyclin and then synthesising new molecules based on its structure that are more stable or more easily tolerated. In addition, newer molecules have been developed that are not analogues of prostacyclin but that target the receptors that prostacyclin activates. Prostacyclin and related drugs have without doubt revolutionised the treatment and management of pulmonary arterial hypertension but are seriously limited by side effects within the systemic circulation. With the dawn of nanomedicine and targeted drug or stem cell delivery systems it will, in the very near future, be possible to make new formulations of prostacyclin that can evade the systemic circulation allowing for safe delivery to the pulmonary vessels. In this way, the full therapeutic potential of prostacyclin can be realised opening the possibility that pulmonary arterial hypertension will become, if not curable, a chronic manageable disease that is no longer fatal. This review discusses these and other issues relating to prostacyclin and its use in pulmonary arterial hypertensionPeer reviewedFinal Published versio

Clinical cardiac electrophysiologic evaluation of the positive inotropic agent, DPI 201-106

DPI 201-106 is a new positive inotropic agent. The cardiac electrophysiology of 16 patients was studied before and during DPI 201-106 administration (loading dose of intravenous DPI 201-106, 1·8 mg kg−1 h−1 administered over 10 min, followed by a maintenance dose of 0·2 mg kg−1 h−1). DPI 201-106 had no effect on the sinus node. The AH interval during fixed-rate atrial pacing became prolonged during DPI 201-106 infusion. There was a significant prolongation of the QT interval [QT (corrected), 417 ± 22 to 502 ± 35 ms, P<0·05; QT (atrial pacing at 600 ms), 374 ±17 to 419 ± 23 ms, P<0·05; QT (ventricular pacing at 600 ms), 409 ± 37 to 449 ± 30 ms, P<0·05]. The ventricular effective refractory period significantly prolonged during DPI 201-106 administration (242 ± 21 to 287 ± 56 ms, P < 0·05), but the supernormal-period duration decreased. The atrial effective refractory period was shortened in four patients and prolonged in one (261 ± 67 to 240 ± 53 ms, NS). The corrected atrial repolarization time (PTac) shortened significantly during DPI 210-106 infusion (479 ± 26 to 445 ± 22 ms at 20 min of the maintenance dose, P<0·05). Atrial fibrillation was initiated in five patients during DPI infusion, but no ventricular arrhythmia was provoked. These findings suggest that DPI 201-106 has novel differential electrophysiological effects on atria and ventricle

New people, new publisher, and new perspectives

As we begin our sixth year of publishing Pulmonary Circulation, we are excited about several new developments. First, we welcome two new Deputy Editors to the editorial leadership team: Kurt R. Stenmark, MD, and Irene M. Lang, MD

Cardiopulmonary disease as sequelae of long-term COVID-19: Current perspectives and challenges

COVID-19 infection primarily targets the lungs, which in severe cases progresses to cytokine storm, acute respiratory distress syndrome, multiorgan dysfunction, and shock. Survivors are now presenting evidence of cardiopulmonary sequelae such as persistent right ventricular dysfunction, chronic thrombosis, lung fibrosis, and pulmonary hypertension. This review will summarize the current knowledge on long-term cardiopulmonary sequelae of COVID-19 and provide a framework for approaching the diagnosis and management of these entities. We will also identify research priorities to address areas of uncertainty and improve the quality of care provided to these patients

RETROSPECTIVE EFFICACY ANALYSIS OF ACUTE VASOREACTIVE TEST AS A CRITERIA FOR SURGERY IN CHILDREN WITH INBORN LEFT-TO-RIGHT BLOOD SHUNTING AND PULMONARY ARTERIAL HYPERTENSION

Aim. Retrospective analysis of efficacy of the acute vasoreactive test (AVRT) as a criteria for operability of children with inborn left-to-right blood shunting complicated by pulmonary arterial hypertension (IRLBS-PAH), by an experience of one center.Material and methods. Retrospective analysis of the data of right heart chambers catheterization and echocardiographic study from 29 case histories of BS-PAH patients during 2012-2016. Results of AVRT are interpreted by modified Barst criteria (decline of pulmonary vascular resistance index, PVRI, and relation of PVRI to the index of systemic vascular resistance, SVR more than 20%, and the and PVRI &lt;6 Wood units/m2 in PVR/SVR &lt;0,3). In accordance with the results of AVRT, patients were selected to two main groups: group 1 — children with positive response, group 2 — children with negative response. After correction of the inborn defect in bith groups, following assessment of cardiovascular system condition was done by echocardiographical study in one week and one month. Metrics of echocardiography data was indexed. For the defect of interventricular septum (DIVS), indexation of the size was done via the relation to aortic root diameter, that was measured in parasternal position, longitudinal axis. Systolic pressure in the right ventricle was measured by the velocity of tricuspid regurgitation, measured in apical four-chamber position. Mean values with the standard deviation and p-values were calculated in R studio 2017 software, v.1.0.153.Results. Among 29 patients, girls to boys relation was 4,8:1. Mean age 6,0±4,9 y. o. For group 1: median of DIVS 1,4 with the value of additional shunting 9,93±9,39 mm, baseline systolic pressure in the right ventricle (SPRV) 57,96±20,16 mmHg, in one month after surgery 38,96±14,16 mmHg. No complications registered. In the second group, median DIVS 0,4 with additional shunting 3,3±0 mm. Baseline SPRV 66,05±17,27 mmHg, with the decline in one month after transcatheter closure to 57,4±17,35 mmHg. During the early post-surgery period, in 2 patients of group 2 there was pulmonary crisis, treated with inhalatory iloprost. Conclusion. Acute vasoreactive test is effective criteria of operability assessment of inborn left-to-right blood shunting, complicated by pulmonary arterial hypertension, in pediatrics