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Article ; Online: Pulmonary Embolism Center of Excellence: Putting It All Together.

Visovatti, Scott H

Interventional cardiology clinics

2023 Volume 12, Issue 3, Page(s) 393–398

Abstract: Center of excellence (COE) designations are generally used to identify programs with expertise in a specific area of medicine. Meeting criteria for a COE may result in advantages including improved clinical outcomes, marketing advantages, and improved ... ...

Abstract	Center of excellence (COE) designations are generally used to identify programs with expertise in a specific area of medicine. Meeting criteria for a COE may result in advantages including improved clinical outcomes, marketing advantages, and improved financial performance. However, criteria for COE designations are highly variable, and they are granted by a wide variety of entities. The diagnosis and treatment of both acute pulmonary emboli and chronic thromboembolic pulmonary hypertension are disciplines that require multidisciplinary expertise, highly coordinated care, specialized technology and advanced skillsets gained through high patient volumes.
MeSH term(s)	Humans ; Chronic Disease ; Risk Factors ; Pulmonary Embolism/diagnosis ; Pulmonary Embolism/therapy ; Hypertension, Pulmonary/diagnosis ; Angioplasty, Balloon
Language	English
Publishing date	2023-04-28
Publishing country	Netherlands
Document type	Journal Article ; Review
ISSN	2211-7466
ISSN (online)	2211-7466
DOI	10.1016/j.iccl.2023.03.006
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Article ; Online: Status and Future Directions for Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Disease With and Without Pulmonary Hypertension: A Scientific Statement From the American Heart Association.

Aggarwal, Vikas / Giri, Jay / Visovatti, Scott H / Mahmud, Ehtisham / Matsubara, Hiromi / Madani, Michael / Rogers, Frances / Gopalan, Deepa / Rosenfield, Kenneth / McLaughlin, Vallerie V

Circulation

2024 Volume 149, Issue 15, Page(s) e1090–e1107

Abstract: Balloon pulmonary angioplasty continues to gain traction as a treatment option for patients with chronic thromboembolic pulmonary disease with and without pulmonary hypertension. Recent European Society of Cardiology guidelines on pulmonary hypertension ... ...

Abstract	Balloon pulmonary angioplasty continues to gain traction as a treatment option for patients with chronic thromboembolic pulmonary disease with and without pulmonary hypertension. Recent European Society of Cardiology guidelines on pulmonary hypertension now give balloon pulmonary angioplasty a Class 1 recommendation for inoperable and residual chronic thromboembolic pulmonary hypertension. Not surprisingly, chronic thromboembolic pulmonary hypertension centers are rapidly initiating balloon pulmonary angioplasty programs. However, we need a comprehensive, expert consensus document outlining critical concepts, including identifying necessary personnel and expertise, criteria for patient selection, and a standardized approach to preprocedural planning and establishing criteria for evaluating procedural efficacy and safety. Given this lack of standards, the balloon pulmonary angioplasty skill set is learned through peer-to-peer contact and training. This document is a state-of-the-art, comprehensive statement from key thought leaders to address this gap in the current clinical practice of balloon pulmonary angioplasty. We summarize the current status of the procedure and provide a consensus opinion on the role of balloon pulmonary angioplasty in the overall care of patients with chronic thromboembolic pulmonary disease with and without pulmonary hypertension. We also identify knowledge gaps, provide guidance for new centers interested in initiating balloon pulmonary angioplasty programs, and highlight future directions and research needs for this emerging therapy.
MeSH term(s)	Humans ; Hypertension, Pulmonary/diagnosis ; Hypertension, Pulmonary/etiology ; Hypertension, Pulmonary/therapy ; Pulmonary Embolism/complications ; Pulmonary Embolism/therapy ; American Heart Association ; Chronic Disease ; Angioplasty, Balloon ; Pulmonary Artery ; Thromboembolism ; Endarterectomy
Language	English
Publishing date	2024-03-07
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	80099-5
ISSN	1524-4539 ; 0009-7322 ; 0069-4193 ; 0065-8499
ISSN (online)	1524-4539
ISSN	0009-7322 ; 0069-4193 ; 0065-8499
DOI	10.1161/CIR.0000000000001197
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Article ; Online: Aberrant Long-Chain Fatty Acid Metabolism Associated with Evolving Systemic Sclerosis-Associated Pulmonary Arterial Hypertension.

Coursen, Julie C / Tuhy, Tijana / Naranjo, Mario / Woods, Adrianne / Hummers, Laura K / Shah, Ami A / Suresh, Karthik / Visovatti, Scott H / Mathai, Stephen C / Hassoun, Paul M / Damico, Rachel L / Simpson, Catherine E

American journal of physiology. Lung cellular and molecular physiology

2024

Abstract: We sought to investigate differential metabolism in patients with systemic sclerosis (SSc) who develop pulmonary arterial hypertension (PAH) versus those who do not, as a method of identifying potential disease biomarkers. In a nested case-control design, ...

Abstract	We sought to investigate differential metabolism in patients with systemic sclerosis (SSc) who develop pulmonary arterial hypertension (PAH) versus those who do not, as a method of identifying potential disease biomarkers. In a nested case-control design, serum metabolites were assayed in SSc subjects who developed right heart catheterization-confirmed PAH (n=22) while under surveillance in a longitudinal cohort from Johns Hopkins, then compared to metabolites assayed in matched SSc patients who did not develop PAH (n=22). Serum samples were collected at "proximate" (within 12 months) and "distant" (within 1-5 years) time points relative to PAH diagnosis. Metabolites were identified using liquid chromatography-mass spectroscopy (LC-MS). An LC-MS dataset from SSc subjects with either mildly elevated pulmonary pressures or overt PAH from the University of Michigan was compared. Differentially abundant metabolites were tested as predictors of PAH in two additional validation SSc cohorts. Long-chain fatty acid metabolism (LCFA) consistently differed in SSc-PAH versus SSc without PH. LCFA metabolites discriminated SSc-PAH patients with mildly elevated pressures in the Michigan cohort and predicted SSc-PAH up to two years prior to clinical diagnosis in the Hopkins cohort. Acylcholines containing LCFA residues and linoleic acid metabolites were most important for discriminating SSc-PAH. Combinations of acylcholines and linoleic acid metabolites provided good discrimination of SSc-PAH across cohorts. Aberrant lipid metabolism is observed throughout the evolution of PAH in SSc. Lipidomic signatures of abnormal LCFA metabolism distinguish SSc-PAH patients from those without PH, including prior to clinical diagnosis and in mild disease.
Language	English
Publishing date	2024-04-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	1013184-x
ISSN	1522-1504 ; 1040-0605
ISSN (online)	1522-1504
ISSN	1040-0605
DOI	10.1152/ajplung.00057.2024
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Zs.A 2749: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)

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Article ; Online: Risk Stratification in Pulmonary Arterial Hypertension: Perhaps Simple Is Not Best?

Fauvel, Charles / White, R James / Vanderpool, Rebecca R / Badagliacca, Roberto / Tobore, Tobore / Rahman, Mohammad / Vizza, Carmine Dario / Lin, Shili / Everett, Allen D / Visovatti, Scott H / Benza, Raymond L

Chest

2023 Volume 165, Issue 2, Page(s) 431–436

MeSH term(s)	Humans ; Pulmonary Arterial Hypertension ; Familial Primary Pulmonary Hypertension ; Risk Assessment
Language	English
Publishing date	2023-09-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	1032552-9
ISSN	1931-3543 ; 0012-3692
ISSN (online)	1931-3543
ISSN	0012-3692
DOI	10.1016/j.chest.2023.09.005
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Article ; Online: Periprocedural Complications With Balloon Pulmonary Angioplasty: Analysis of Global Studies.

Jain, Nishant / Sheikh, Muhammad A / Bajaj, Divyansh / Townsend, Whitney / Krasuski, Richard / Secemsky, Eric / Chatterjee, Saurav / Moles, Victor / Agarwal, Prachi P / Haft, Jonathan / Visovatti, Scott H / Cascino, Thomas M / Rosenfield, Kenneth / Nallamothu, Brahmajee K / Mclaughlin, Vallerie V / Aggarwal, Vikas

JACC. Cardiovascular interventions

2023 Volume 16, Issue 8, Page(s) 976–983

Abstract: Background: Balloon pulmonary angioplasty (BPA) was introduced as a treatment modality for patients with inoperable, medically refractory chronic thromboembolic pulmonary hypertension decades ago; however, reports of high rates of pulmonary vascular ... ...

Abstract	Background: Balloon pulmonary angioplasty (BPA) was introduced as a treatment modality for patients with inoperable, medically refractory chronic thromboembolic pulmonary hypertension decades ago; however, reports of high rates of pulmonary vascular injury have led to considerable refinement in procedural technique. Objectives: The authors sought to better understand the evolution of BPA procedure-related complications over time. Methods: The authors conducted a systematic review of original articles published by pulmonary hypertension centers globally and performed a pooled cohort analysis of procedure-related outcomes with BPA. Results: This systematic review identified 26 published articles from 18 countries worldwide from 2013 to 2022. A total of 1,714 patients underwent 7,561 total BPA procedures with an average follow up of 7.3 months. From the first period (2013-2017) to the second period (2018-2022), the cumulative incidence of hemoptysis/vascular injury decreased from 14.1% (474/3,351) to 7.7% (233/3,029) (P < 0.01); lung injury/reperfusion edema decreased from 11.3% (377/3,351) to 1.4% (57/3,943) (P < 0.01); invasive mechanical ventilation decreased from 0.7% (23/3,195) to 0.1% (4/3,062) (P < 0.01); and mortality decreased from 2.0% (13/636) to 0.8% (8/1,071) (P < 0.01). Conclusions: Procedure-related complications with BPA, including hemoptysis/vascular injury, lung injury/reperfusion edema, mechanical ventilation, and death, were less common in the second period (2018-2022), compared with first period (2013-2017), likely from refinement in patient and lesion selection and procedural technique over time.
MeSH term(s)	Humans ; Pulmonary Artery/diagnostic imaging ; Hypertension, Pulmonary ; Pulmonary Embolism/diagnostic imaging ; Pulmonary Embolism/therapy ; Pulmonary Embolism/complications ; Hemoptysis/complications ; Lung Injury/complications ; Vascular System Injuries/etiology ; Treatment Outcome ; Angioplasty, Balloon/adverse effects ; Angioplasty, Balloon/methods ; Pulmonary Edema/etiology ; Edema/etiology ; Chronic Disease
Language	English
Publishing date	2023-03-22
Publishing country	United States
Document type	Systematic Review ; Journal Article
ZDB-ID	2452157-7
ISSN	1876-7605 ; 1936-8798
ISSN (online)	1876-7605
ISSN	1936-8798
DOI	10.1016/j.jcin.2023.01.361
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Article ; Online: Physical activity and quality of life in patients with pulmonary hypertension.

Cascino, Thomas M / McLaughlin, Vallerie V / Richardson, Caroline R / Behbahani-Nejad, Nilofar / Moles, Victor M / Visovatti, Scott H / Jackson, Elizabeth A

The European respiratory journal

2019 Volume 53, Issue 6

MeSH term(s)	Aged ; Exercise ; Exercise Therapy ; Female ; Humans ; Hypertension, Pulmonary/therapy ; Linear Models ; Male ; Middle Aged ; Prospective Studies ; Quality of Life ; Walk Test
Language	English
Publishing date	2019-06-20
Publishing country	England
Document type	Letter ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	639359-7
ISSN	1399-3003 ; 0903-1936
ISSN (online)	1399-3003
ISSN	0903-1936
DOI	10.1183/13993003.00028-2019
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Article ; Online: Fatty acid metabolism promotes TRPV4 activity in lung microvascular endothelial cells in pulmonary arterial hypertension.

American journal of physiology. Lung cellular and molecular physiology

2024 Volume 326, Issue 3, Page(s) L252–L265

Abstract: Pulmonary arterial hypertension (PAH) is a morbid disease characterized by significant lung endothelial cell (EC) dysfunction. Prior work has shown that microvascular endothelial cells (MVECs) isolated from animals with experimental PAH and patients with ...

Abstract	Pulmonary arterial hypertension (PAH) is a morbid disease characterized by significant lung endothelial cell (EC) dysfunction. Prior work has shown that microvascular endothelial cells (MVECs) isolated from animals with experimental PAH and patients with PAH exhibit significant abnormalities in metabolism and calcium signaling. With regards to metabolism, we and others have shown evidence of increased aerobic glycolysis and evidence of increased utilization of alternate fuel sources (such as fatty acids) in PAH EC. In the realm of calcium signaling, our prior work linked increased activity of the transient receptor potential vanilloid-4 (TRPV4) channel to increased proliferation of MVECs isolated from the Sugen/Hypoxia rat model of PAH (SuHx-MVECs). However, the relationship between metabolic shifts and calcium abnormalities was not clear. Specifically, whether shifts in metabolism were responsible for increasing TRPV4 channel activity in SuHx-MVECs was not known. In this study, using human data, serum samples from SuHx rats, and SuHx-MVECs, we describe the consequences of increased MVEC fatty acid oxidation in PAH. In human samples, we observed an increase in long-chain fatty acid levels that was associated with PAH severity. Next, using SuHx rats and SuHx-MVECs, we observed increased intracellular levels of lipids. We also show that increasing intracellular lipid content increases TRPV4 activity, whereas inhibiting fatty acid oxidation normalizes basal calcium levels in SuHx-MVECs. By exploring the fate of fatty acid-derived carbons, we observed that the metabolite linking increased intracellular lipids to TRPV4 activity was β-hydroxybutyrate (BOHB), a product of fatty acid oxidation. Finally, we show that BOHB supplementation alone is sufficient to sensitize the TRPV4 channel in rat and mouse MVECs. Returning to humans, we observe a transpulmonary BOHB gradient in human patients with PAH. Thus, we establish a link between fatty acid oxidation, BOHB production, and TRPV4 activity in MVECs in PAH. These data provide new insight into metabolic regulation of calcium signaling in lung MVECs in PAH.
MeSH term(s)	Animals ; Humans ; Mice ; Rats ; Antineoplastic Agents ; Calcium/metabolism ; Endothelial Cells/metabolism ; Familial Primary Pulmonary Hypertension/metabolism ; Fatty Acids/metabolism ; Lipids ; Lung/metabolism ; Pulmonary Arterial Hypertension/metabolism ; TRPV Cation Channels/metabolism
Chemical Substances	Antineoplastic Agents ; Calcium (SY7Q814VUP) ; Fatty Acids ; Lipids ; TRPV Cation Channels ; TRPV4 protein, human ; Trpv4 protein, rat ; Trpv4 protein, mouse
Language	English
Publishing date	2024-01-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	1013184-x
ISSN	1522-1504 ; 1040-0605
ISSN (online)	1522-1504
ISSN	1040-0605
DOI	10.1152/ajplung.00199.2023
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Article ; Online: Right atrial strain is predictive of clinical outcomes and invasive hemodynamic data in group 1 pulmonary arterial hypertension.

Bhave, Nicole M / Visovatti, Scott H / Kulick, Brian / Kolias, Theodore J / McLaughlin, Vallerie V

The international journal of cardiovascular imaging

2017 Volume 33, Issue 6, Page(s) 847–855

Abstract: Transthoracic echocardiography (TTE) is a practical and widely used tool for risk stratification in pulmonary arterial hypertension (PAH). We hypothesized that right atrial (RA) reservoir function, represented by peak RA systolic strain, correlates with ... ...

Abstract	Transthoracic echocardiography (TTE) is a practical and widely used tool for risk stratification in pulmonary arterial hypertension (PAH). We hypothesized that right atrial (RA) reservoir function, represented by peak RA systolic strain, correlates with invasive hemodynamic measurements and clinical outcomes in PAH. Patients with group 1 PAH who had TTE within 6 months of index PAH clinic visit and right heart catheterization were included in this retrospective study. Peak RA strain in the 2D apical 4-chamber view was measured with speckle-tracking software. The primary endpoint was a composite of prostacyclin initiation, lung transplantation, and death. RA strain was also measured in healthy control subjects. Among the 37 patients studied, 25 (68%) met the primary endpoint. RA strain was significantly lower among patients who met the primary endpoint than among those who did not (mean 20% vs. 33%, P = 0.002). Strain was lower in PAH patients than in controls (mean 24% vs. 35%, P = 0.0001). RA strain correlated negatively with hemodynamic data including RA pressure (R = -0.31), mean pulmonary arterial pressure (R = -0.33), and pulmonary vascular resistance (R = -0.39), and positively with cardiac index (R = 0.44). In receiver operating characteristic analysis to distinguish between patients meeting the primary endpoint and event-free survivors, RA strain was not significantly different from RA volume, right ventricular (RV) fractional area change, RV basal diameter, or right ventricular systolic pressure (area under the curve 0.82, 0.81, 0.83, 0.86, and 0.97, respectively). Our results demonstrate that RA strain is predictive of clinical outcomes in PAH. Further research is needed to determine if RA strain is independently associated with outcomes in this population.
Language	English
Publishing date	2017-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	2055311-0
ISSN	1875-8312 ; 1573-0743 ; 1569-5794 ; 0167-9899
ISSN (online)	1875-8312 ; 1573-0743
ISSN	1569-5794 ; 0167-9899
DOI	10.1007/s10554-017-1081-7
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Article: Transpulmonary amino acid metabolism in the sugen hypoxia model of pulmonary hypertension.

Philip, Nicolas / Pi, Hongyang / Gadkari, Mahin / Yun, Xin / Huetsch, John / Zhang, Cissy / Harlan, Robert / Roux, Aurelie / Graham, David / Shimoda, Larissa / Le, Anne / Visovatti, Scott / Leary, Peter J / Gharib, Sina A / Simpson, Catherine / Santhanam, Lakshmi / Steppan, Jochen / Suresh, Karthik

Pulmonary circulation

2023 Volume 13, Issue 1, Page(s) e12205

Abstract: In pulmonary artery hypertension (PAH), emerging evidence suggests that metabolic abnormalities may be contributing to cellular dysfunction in PAH. Metabolic abnormalities such as glycolytic shift have been observed intracellularly in several cell types ... ...

Abstract	In pulmonary artery hypertension (PAH), emerging evidence suggests that metabolic abnormalities may be contributing to cellular dysfunction in PAH. Metabolic abnormalities such as glycolytic shift have been observed intracellularly in several cell types in PAH, including microvacular endothelial cells (MVECs). Concurrently, metabolomics of human PAH samples has also revealed a variety of metabolic abnormalities; however the relationship between the intracellular metabolic abnormalities and the serum metabolome in PAH remains under investigation. In this study, we utilize the sugen/hypoxia (SuHx) rodent model of PAH to examine the RV, LV and MVEC intracellular metabolome (using targeted metabolomics) in normoxic and SuHx rats. We additionally validate key findings from our metabolomics experiments with data obtained from cell culture of normoxic and SuHx MVECs, as well as metabolomics of human serum samples from two different PAH patient cohorts. Taken together, our data, spanning rat serum, human serum and primary isolated rat MVECs reveal that: (1) key classes of amino acids (specifically, branched chain amino acids-BCAA) are lower in the pre-capillary (i.e., RV) serum of SuHx rats (and humans); (2) intracellular amino acid levels (in particular BCAAs) are increased in SuHx-MVECs; (3) there may be secretion rather than utilization of amino acids across the pulmonary microvasculature in PAH and (4) an oxidized glutathione gradient is present across the pulmonary vasculature, suggesting a novel fate for increased glutamine uptake (i.e., as a source of glutathione). in MVECs in PAH. In summary, these data reveal new insight into the shifts in amino acid metabolism occurring across the pulmonary circulation in PAH.
Language	English
Publishing date	2023-03-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2638089-4
ISSN	2045-8940 ; 2045-8932
ISSN (online)	2045-8940
ISSN	2045-8932
DOI	10.1002/pul2.12205
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Article: Barriers to physical activity in patients with pulmonary hypertension.

Cascino, Thomas M / McLaughlin, Vallerie V / Richardson, Caroline R / Behbahani-Nejad, Nilofar / Moles, Victor M / Visovatti, Scott H / Jackson, Elizabeth A

Pulmonary circulation

2018 Volume 9, Issue 2, Page(s) 2045894019847895

Abstract: Patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) have low levels of physical activity (PA). Increased PA has health benefits including improved quality of life. This study aimed to identify ... ...

Abstract	Patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) have low levels of physical activity (PA). Increased PA has health benefits including improved quality of life. This study aimed to identify patient-perceived barriers to PA that correlate with objectively measured PA in this population. We performed a cross-sectional survey of 40 patients with PAH and CTEPH. Participants rated how often 15 barriers interfere with being physically active on a 5-point Likert Scale. The primary outcome measure was PA quantified using the Fitbit Zip activity tracker for two weeks. The primary independent variables were the 15 barriers and a summary score (total average barriers). Separate multivariable linear regressions were performed to assess the association between the 15 barriers and the summary score and PA adjusting for age, sex, and PAH etiology. Of the participants, 85% (34/40) had valid step counts and were included. Of these 34, 85% (n = 29) were female and 91% (n = 31) had PAH. The median (interquartile range [IQR]) number of daily steps was 3913 (2309-6313). The barriers endorsed most strongly were lack of self-discipline, lack of energy, and lack of interest. In the multivariable analysis, a 1-unit increase in perceived lack of interest, lack of enjoyment, and lack of skills was associated with a significant decrease in step counts of -1414 steps (95% confidence interval [CI] = (-2580 - -248), -1458 steps (-2404 - -511), and -1533 steps (-2910 - -156), respectively. Counseling and interventions aimed at increasing PA in patients with PAH should address interest, enjoyment, and skill development.
Language	English
Publishing date	2018-11-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	2638089-4
ISSN	2045-8940 ; 2045-8932
ISSN (online)	2045-8940
ISSN	2045-8932
DOI	10.1177/2045894019847895
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