Purpose of review With the establishment of vasodilator therapy as a mainstay of treatment for pulmonary arterial hypertension (PAH), new therapeutic approaches are needed to prevent the development of the vasculopathy associated with this disease. Many studies are currently underway to investigate nonvasodilator treatment options. Recent findings Modulation of bone morphogenic protein receptor type 2 (BMPR2) signaling with sotatercept showed promising results in phase 2 studies. Rituximab, an anti-CD20 monoclonal antibody, showed some signal for beneficial effect in patients with scleroderma-associated PAH. Studies evaluating agents including tocilizumab, selonsertib, bardoxolone, 10-nitro-9(E)-enoic acid (CXA-10) and intravenous iron have not shown acceptable efficacy in treating PAH. Summary Pharmacologic approaches for the treatment of PAH include altering of transforming growth factor β/BMPR2 signaling, proliferation via growth factors, immune response, oxidative stress, estrogen signaling, metabolism, and neurohormonal modulation. Other treatment modalities including pulmonary artery nerve denervation, stem cell therapy, and inter-atrial shunt formation are also being explored.
Objective: Cardiovascular (CV) diseases and cancer constitute the main causes of contemporary death reasons. CV prevention in patients with colon cancer enable implementation of more effective, life-saving oncological treatment and might prevent distant CV mortality in cancer survivors. Unfortunately, available data shows that prevention actions are rarely undertaken in oncological patients compared to patients without cancer. The aim of the planned study is developing a model cardiooncological care programme,ON-CARDIO” in patients with colon cancer emphasizing the role of telemedicine and prevention. In particular the study is aiming at: The assessment if telemedical care programme,ON-CARDIO” implementation will result in obtaining the cardiooncological prevention goals Determining the type and demand on cardiooncological interventions using the,ON-CARDIO” programme The assessment of implemented cardiooncological interventions on control level of cardiovascular risk factors and frequency of cardiological complications in patients with colon cancer The assessment of heart rhythm disorders frequency and their relationship with oncological therapy using ECG telemonitoring with AliveCor Kardia Mobile application Assessing the influence of oncological therapy in colon cancer on blood pressure level, left ventricle function, cardiac arrhythmia and potential signs of ischemia Determining the influence of applied cardiooncological interventions on biochemistry parameters (NT-proBNP, troponin, CRP, HbA1c, lipid panel) Results: The programme is planned to be started this year, so far no results are available. The research hypothesis assumes that implementation of intensive, complex cardiooncological care using the model telemedical care programme,ON-CARDIO” will influence on achieving the cardiooncological prevention goals, contribute to early detection of cardiological complications occurring along with oncological therapy and will serve as a prototype for building similar systems in other cancer diseases. Conclusions: The above described project constitutes original, authorial idea, so far in medical literature there are no available data in this field. This programme for the first time will provide significant contribution and new knowledge concerning the role of telemedicine and cardiooncological prevention in patients with colon cancer characterized by similar risk profile as in CV diseases, which may subsequently lead to improvement of their prognosis.
Chronic thromboembolic pulmonary hypertension (CTEPH) occurs when thromboemboli travel to the pulmonary vasculature, fail to resolve, and cause elevated pulmonary arterial pressure. Untreated, this disease leads to progressive right heart failure and death. It develops in approximately 1% to 5% of patients who suffer an acute pulmonary embolism (PE) and has an overall incidence of 3 to 30 per million in the general population. While it is not entirely evident why most but not all people are able to clear this clot burden, there are known risk factors for the development of CTEPH. These include signs of right heart strain at the time of incident PE, inherited coagulopathies, inflammatory conditions, hypothyroidism, and a history of splenectomy. Since CTEPH can be treated both surgically and medically, it is critical to understand the pathophysiology of the disease so affected patients can be identified and diagnosed appropriately.
Pulmonary arterial hypertension (PAH) is a chronic progressive disease that leads to right heart failure and death. Pulmonary arterial capacitance (PAC), defined as stroke volume divided by the pulmonary pulse pressure, has been identified as a prognostic factor in PAH. The impact of changes in PAC over time, however, is unclear. We evaluated changes in PAC over time to determine if such changes predicted transplant-free survival. A single-center retrospective study of consecutive group 1 PAH patients who had two or more right heart catheterizations (RHC) between January 2007 and June 2016 was undertaken. Hemodynamic data, clinical data, and outcomes were collected. Univariate and multivariate Cox proportional-hazards modelling to identify the contribution of risk factors for a composite outcome of death or lung transplantation was done. Mixed-effects logistic regression was performed to investigate the association between the change in PAC value over time and the composite outcome. A P value < 0.05 was considered significant. In total, 109 consecutive patients with a total of 300 RHC data were identified. PAC correlated inversely with functional status ( P < 0.001) and inversely with pulmonary vascular resistance ( P < 0.001). PAC values increased with the addition of new PAH-specific medications. Mixed effects logistic regression modeling using longitudinal data showed that a decrease in PAC over the study period was associated with increased mortality and transplantation (adjusted P = 0.039) over the study period. Change in PAC was a better predictor of outcome over the study period than baseline PAC or changes in other hemodynamic or clinical parameters. Decreases in PAC were predictive of increased mortality or transplantation in patients with group 1 PAH. There was a trend towards increased PAC in response to the addition of a PAH-specific medication. Our data support the use of PAC as a therapeutic target in PAH.
