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  1. Article ; Online: Basement Membrane Extracellular Matrix Proteins in Pulmonary Vascular and Right Ventricular Remodeling in Pulmonary Hypertension.

    Ambade, Anjira S / Hassoun, Paul M / Damico, Rachel L

    American journal of respiratory cell and molecular biology

    2021  Volume 65, Issue 3, Page(s) 245–258

    Abstract: The extracellular matrix (ECM), a highly organized network of structural and nonstructural proteins, plays a pivotal role in cellular and tissue homeostasis. Changes in the ECM are critical for normal tissue repair, whereas dysregulation contributes to ... ...

    Abstract The extracellular matrix (ECM), a highly organized network of structural and nonstructural proteins, plays a pivotal role in cellular and tissue homeostasis. Changes in the ECM are critical for normal tissue repair, whereas dysregulation contributes to aberrant tissue remodeling. Pulmonary arterial hypertension is a severe disorder of the pulmonary vasculature characterized by pathologic remodeling of the pulmonary vasculature and right ventricle, increased production and deposition of structural and nonstructural proteins, and altered expression of ECM growth factors and proteases. Furthermore, ECM remodeling plays a significant role in disease progression, as several dynamic changes in its composition, quantity, and organization are documented in both humans and animal models of disease. These ECM changes impact vascular cell biology and affect proliferation of resident cells. Furthermore, ECM components determine the tissue architecture of the pulmonary and myocardial vasculature as well as the myocardium itself and provide mechanical stability crucial for tissue homeostasis. However, little is known about the basement membrane (BM), a specialized, self-assembled conglomerate of ECM proteins, during remodeling. In the vasculature, the BM is in close physical association with the vascular endothelium and smooth muscle cells. While in the myocardium, each cardiomyocyte is enclosed by a BM that serves as the interface between cardiomyocytes and the surrounding interstitial matrix. In this review, we provide a brief overview on the current state of knowledge of the BM and its ECM composition and their impact on pulmonary vascular remodeling and right ventricle dysfunction and failure in pulmonary arterial hypertension.
    MeSH term(s) Animals ; Basement Membrane/metabolism ; Basement Membrane/pathology ; Cell Proliferation ; Endothelium, Vascular/metabolism ; Endothelium, Vascular/pathology ; Extracellular Matrix Proteins/metabolism ; Humans ; Hypertension, Pulmonary/metabolism ; Hypertension, Pulmonary/pathology ; Myocytes, Cardiac/metabolism ; Myocytes, Cardiac/pathology ; Myocytes, Smooth Muscle/metabolism ; Myocytes, Smooth Muscle/pathology ; Vascular Remodeling ; Ventricular Remodeling
    Chemical Substances Extracellular Matrix Proteins
    Language English
    Publishing date 2021-06-12
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 1025960-0
    ISSN 1535-4989 ; 1044-1549
    ISSN (online) 1535-4989
    ISSN 1044-1549
    DOI 10.1165/rcmb.2021-0091TR
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. 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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  3. Article: Quantifying 4D flow cardiovascular magnetic resonance vortices in patients with pulmonary hypertension: A pilot study.

    Borhani, Ali / Porter, Kristin K / Umair, Muhammad / Chu, Linda C / Mathai, Stephen C / Kolb, Todd M / Damico, Rachel L / Hassoun, Paul M / Kamel, Ihab R / Zimmerman, Stefan L

    Pulmonary circulation

    2023  Volume 13, Issue 4, Page(s) e12298

    Abstract: In this 4D flow cardiovascular magnetic resonance (CMR) study, vortical blood flow in the main pulmonary artery (MPA) is quantified using circulation (ᴦ), a metric used in fluid dynamics to quantify the rotational components of flow. Circulation (ᴦ) is a ...

    Abstract In this 4D flow cardiovascular magnetic resonance (CMR) study, vortical blood flow in the main pulmonary artery (MPA) is quantified using circulation (ᴦ), a metric used in fluid dynamics to quantify the rotational components of flow. Circulation (ᴦ) is a 4D flow CMR metric that quantifies the vortical blood flow pattern in the MPA of patients with pulmonary hypertension (PH), distinguishes them from healthy controls, and shows high correlation with invasive markers of PH severity.
    Language English
    Publishing date 2023-10-18
    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/pul2.12298
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  4. Article: Spatial and temporal resolution of metabolic dysregulation in the Sugen hypoxia model of pulmonary hypertension.

    Simpson, Catherine E / Ambade, Anjira S / Harlan, Robert / Roux, Aurelie / Graham, David / Klauer, Neal / Tuhy, Tijana / Kolb, Todd M / Suresh, Karthik / Hassoun, Paul M / Damico, Rachel L

    Pulmonary circulation

    2023  Volume 13, Issue 3, Page(s) e12260

    Abstract: Although PAH is partially attributed to disordered metabolism, previous human studies have mostly examined circulating metabolites at a single time point, potentially overlooking crucial disease biology. Current knowledge gaps include an understanding of ...

    Abstract Although PAH is partially attributed to disordered metabolism, previous human studies have mostly examined circulating metabolites at a single time point, potentially overlooking crucial disease biology. Current knowledge gaps include an understanding of temporal changes that occur within and across relevant tissues, and whether observed metabolic changes might contribute to disease pathobiology. We utilized targeted tissue metabolomics in the Sugen hypoxia (SuHx) rodent model to investigate tissue-specific metabolic relationships with pulmonary hypertensive features over time using regression modeling and time-series analysis. Our hypotheses were that some metabolic changes would precede phenotypic changes, and that examining metabolic interactions across heart, lung, and liver tissues would yield insight into interconnected metabolic mechanisms. To support the relevance of our findings, we sought to establish links between SuHx tissue metabolomics and human PAH -omics data using bioinformatic predictions. Metabolic differences between and within tissue types were evident by Day 7 postinduction, demonstrating distinct tissue-specific metabolism in experimental pulmonary hypertension. Various metabolites demonstrated significant tissue-specific associations with hemodynamics and RV remodeling. Individual metabolite profiles were dynamic, and some metabolic shifts temporally preceded the emergence of overt pulmonary hypertension and RV remodeling. Metabolic interactions were observed such that abundance of several liver metabolites modulated lung and RV metabolite-phenotype relationships. Taken all together, regression analyses, pathway analyses and time-series analyses implicated aspartate and glutamate signaling and transport, glycine homeostasis, lung nucleotide abundance, and oxidative stress as relevant to early PAH pathobiology. These findings offer valuable insights into potential targets for early intervention in PAH.
    Language English
    Publishing date 2023-07-02
    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/pul2.12260
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Metabolomic Differences in Connective Tissue Disease-Associated Versus Idiopathic Pulmonary Arterial Hypertension in the PVDOMICS Cohort.

    Simpson, Catherine E / Hemnes, Anna R / Griffiths, Megan / Grunig, Gabriele / Tang, W H Wilson / Garcia, Joe G N / Barnard, John / Comhair, Suzy A / Damico, Rachel L / Mathai, Stephen C / Hassoun, Paul M

    Arthritis & rheumatology (Hoboken, N.J.)

    2023  Volume 75, Issue 12, Page(s) 2240–2251

    Abstract: Objective: Patients with connective tissue disease-associated pulmonary arterial hypertension (CTD-PAH) experience worse survival and derive less benefit from pulmonary vasodilator therapies than patients with idiopathic PAH (IPAH). We sought to ... ...

    Abstract Objective: Patients with connective tissue disease-associated pulmonary arterial hypertension (CTD-PAH) experience worse survival and derive less benefit from pulmonary vasodilator therapies than patients with idiopathic PAH (IPAH). We sought to identify differential metabolism in patients with CTD-PAH versus patients with IPAH that might underlie these observed clinical differences.
    Methods: Adult participants with CTD-PAH (n = 141) and IPAH (n = 165) from the Pulmonary Vascular Disease Phenomics (PVDOMICS) study were included. Detailed clinical phenotyping was performed at cohort enrollment, including broad-based global metabolomic profiling of plasma samples. Participants were followed prospectively for ascertainment of outcomes. Supervised and unsupervised machine learning algorithms and regression models were used to compare CTD-PAH versus IPAH metabolomic profiles and to measure metabolite-phenotype associations and interactions. Gradients across the pulmonary circulation were assessed using paired mixed venous and wedged samples in a subset of 115 participants.
    Results: Metabolomic profiles distinguished CTD-PAH from IPAH, with patients with CTD-PAH demonstrating aberrant lipid metabolism with lower circulating levels of sex steroid hormones and higher free fatty acids (FAs) and FA intermediates. Acylcholines were taken up by the right ventricular-pulmonary vascular (RV-PV) circulation, particularly in CTD-PAH, while free FAs and acylcarnitines were released. In both PAH subtypes, dysregulated lipid metabolites, among others, were associated with hemodynamic and RV measurements and with transplant-free survival.
    Conclusions: CTD-PAH is characterized by aberrant lipid metabolism that may signal shifted metabolic substrate utilization. Abnormalities in RV-PV FA metabolism may imply a reduced capacity for mitochondrial beta oxidation within the diseased pulmonary circulation.
    MeSH term(s) Adult ; Humans ; Familial Primary Pulmonary Hypertension ; Hypertension, Pulmonary/complications ; Phenomics ; Vasodilator Agents/therapeutic use ; Pulmonary Arterial Hypertension/complications ; Connective Tissue Diseases/complications
    Chemical Substances Vasodilator Agents
    Language English
    Publishing date 2023-10-30
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 2756371-6
    ISSN 2326-5205 ; 2326-5191
    ISSN (online) 2326-5205
    ISSN 2326-5191
    DOI 10.1002/art.42632
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  6. Article ; Online: SU5416 does not attenuate early RV angiogenesis in the murine chronic hypoxia PH model.

    Peloquin, Grace L / Johnston, Laura / Damarla, Mahendra / Damico, Rachel L / Hassoun, Paul M / Kolb, Todd M

    Respiratory research

    2019  Volume 20, Issue 1, Page(s) 123

    Abstract: Background: Right ventricular (RV) angiogenesis has been associated with adaptive myocardial remodeling in pulmonary hypertension (PH), though molecular regulators are poorly defined. Endothelial cell VEGFR-2 is considered a "master regulator" of ... ...

    Abstract Background: Right ventricular (RV) angiogenesis has been associated with adaptive myocardial remodeling in pulmonary hypertension (PH), though molecular regulators are poorly defined. Endothelial cell VEGFR-2 is considered a "master regulator" of angiogenesis in other models, and the small molecule VEGF receptor tyrosine kinase inhibitor SU5416 is commonly used to generate PH in rodents. We hypothesized that SU5416, through direct effects on cardiac endothelial cell VEGFR-2, would attenuate RV angiogenesis in a murine model of PH.
    Methods: C57 BL/6 mice were exposed to chronic hypoxia (CH-PH) to generate PH and stimulate RV angiogenesis. SU5416 (20 mg/kg) or vehicle were administered at the start of the CH exposure, and weekly thereafter. Angiogenesis was measured after one week of CH-PH using a combination of unbiased stereological measurements and flow cytometry-based quantification of myocardial endothelial cell proliferation. In complementary experiments, primary cardiac endothelial cells from C57 BL/6 mice were exposed to recombinant VEGF (50 ng/mL) or grown on Matrigel in the presence of SU5416 (5 μM) or vehicle.
    Result: SU5416 directly inhibited VEGF-mediated ERK phosphorylation, cell proliferation, and Kdr transcription, but not Matrigel tube formation in primary murine cardiac endothelial cells in vitro. SU5416 did not inhibit CH-PH induced RV angiogenesis, endothelial cell proliferation, or RV hypertrophy in vivo, despite significantly altering the expression profile of genes involved in angiogenesis.
    Conclusions: These findings demonstrate that SU5416 directly inhibited VEGF-induced proliferation of murine cardiac endothelial cells but does not attenuate CH-PH induced RV angiogenesis or myocardial remodeling in vivo.
    MeSH term(s) Angiogenesis Inhibitors/pharmacology ; Angiogenesis Inhibitors/therapeutic use ; Animals ; Chronic Disease ; Heart Ventricles/drug effects ; Heart Ventricles/pathology ; Hypertension, Pulmonary/drug therapy ; Hypertension, Pulmonary/pathology ; Hypoxia/drug therapy ; Hypoxia/pathology ; Indoles/pharmacology ; Indoles/therapeutic use ; Male ; Mice ; Mice, Inbred C57BL ; Neovascularization, Pathologic/drug therapy ; Neovascularization, Pathologic/pathology ; Pyrroles/pharmacology ; Pyrroles/therapeutic use
    Chemical Substances Angiogenesis Inhibitors ; Indoles ; Pyrroles ; Semaxinib (71IA9S35AJ)
    Language English
    Publishing date 2019-06-17
    Publishing country England
    Document type Journal Article
    ZDB-ID 2041675-1
    ISSN 1465-993X ; 1465-993X
    ISSN (online) 1465-993X
    ISSN 1465-993X
    DOI 10.1186/s12931-019-1079-x
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  7. Article ; Online: Metabolic profiling of in vivo right ventricular function and exercise performance in pulmonary arterial hypertension.

    Simpson, Catherine E / Coursen, Julie / Hsu, Steven / Gough, Ethan K / Harlan, Robert / Roux, Aurelie / Aja, Susan / Graham, David / Kauffman, Matthew / Suresh, Karthik / Tedford, Ryan J / Kolb, Todd M / Mathai, Stephen C / Hassoun, Paul M / Damico, Rachel L

    American journal of physiology. Lung cellular and molecular physiology

    2023  Volume 324, Issue 6, Page(s) L836–L848

    Abstract: Right ventricular (RV) adaptation is the principal determinant of outcomes in pulmonary arterial hypertension (PAH), however, RV function is challenging to assess. RV responses to hemodynamic stressors are particularly difficult to interrogate without ... ...

    Abstract Right ventricular (RV) adaptation is the principal determinant of outcomes in pulmonary arterial hypertension (PAH), however, RV function is challenging to assess. RV responses to hemodynamic stressors are particularly difficult to interrogate without invasive testing. This study sought to identify metabolomic markers of in vivo right ventricular function and exercise performance in PAH. Consecutive subjects with PAH (
    MeSH term(s) Humans ; Pulmonary Arterial Hypertension ; Natriuretic Peptide, Brain ; Ventricular Function, Right/physiology ; Kynurenine ; Familial Primary Pulmonary Hypertension ; Biomarkers ; Arginine ; Ventricular Dysfunction, Right
    Chemical Substances Natriuretic Peptide, Brain (114471-18-0) ; Kynurenine (343-65-7) ; Biomarkers ; Arginine (94ZLA3W45F)
    Language English
    Publishing date 2023-04-18
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
    ZDB-ID 1013184-x
    ISSN 1522-1504 ; 1040-0605
    ISSN (online) 1522-1504
    ISSN 1040-0605
    DOI 10.1152/ajplung.00003.2023
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  8. Article ; Online: Improved Survival for Patients with Systemic Sclerosis-associated Pulmonary Arterial Hypertension: The Johns Hopkins Registry.

    Hassan, Hussein J / Naranjo, Mario / Ayoub, Nour / Housten, Traci / Hsu, Steven / Balasubramanian, Aparna / Simpson, Catherine E / Damico, Rachel L / Mathai, Stephen C / Kolb, Todd M / Hassoun, Paul M

    American journal of respiratory and critical care medicine

    2022  Volume 207, Issue 3, Page(s) 312–322

    Abstract: Rationale: ...

    Abstract Rationale:
    MeSH term(s) Humans ; Pulmonary Arterial Hypertension/therapy ; Pulmonary Arterial Hypertension/complications ; Hypertension, Pulmonary/etiology ; Hypertension, Pulmonary/therapy ; Hypertension, Pulmonary/diagnosis ; Scleroderma, Systemic/complications ; Familial Primary Pulmonary Hypertension/complications ; Registries
    Language English
    Publishing date 2022-09-26
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 1180953-x
    ISSN 1535-4970 ; 0003-0805 ; 1073-449X
    ISSN (online) 1535-4970
    ISSN 0003-0805 ; 1073-449X
    DOI 10.1164/rccm.202204-0731OC
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  9. Article: Risk Stratification of Patients with Pulmonary Arterial Hypertension: The Role of Echocardiography.

    Mercurio, Valentina / Hassan, Hussein J / Naranjo, Mario / Cuomo, Alessandra / Mazurek, Jeremy A / Forfia, Paul R / Balasubramanian, Aparna / Simpson, Catherine E / Damico, Rachel L / Kolb, Todd M / Mathai, Stephen C / Hsu, Steven / Mukherjee, Monica / Hassoun, Paul M

    Journal of clinical medicine

    2022  Volume 11, Issue 14

    Abstract: Background: Given the morbidity and mortality associated with pulmonary arterial hypertension (PAH), risk stratification approaches that guide therapeutic management have been previously employed. However, most patients remain in the intermediate-risk ... ...

    Abstract Background: Given the morbidity and mortality associated with pulmonary arterial hypertension (PAH), risk stratification approaches that guide therapeutic management have been previously employed. However, most patients remain in the intermediate-risk category despite initial therapy. Herein, we sought to determine whether echocardiographic parameters could improve the risk stratification of intermediate-risk patients. Methods: Prevalent PAH patients previously enrolled in observational studies at 3 pulmonary hypertension centers were included in this study. A validated PAH risk stratification approach was used to stratify patients into low-, intermediate-, and high-risk groups. Right ventricular echocardiographic parameters were used to further stratify intermediate-risk patients into intermediate-low- and intermediate-high-risk groups based on transplant-free survival. Results: From a total of 146 patients included in our study, 38 patients died over a median follow-up of 2.5 years. Patients with intermediate-/high-risk had worse echocardiographic parameters. Tricuspid annular plane systolic excursion (TAPSE) and the degree of tricuspid regurgitation (TR) were highly associated with survival (p < 0.01, p = 0.04, respectively) and were subsequently used to further stratify intermediate-risk patients. Among intermediate-risk patients, survival was worse for patients with TAPSE < 19 mm compared to those with TAPSE ≥ 19 mm (estimated one-year survival 74% vs. 96%, p < 0.01) and for patients with moderate/severe TR compared to those with no/trace/mild TR (estimated one-year survival 70% vs. 93%, p < 0.01). Furthermore, among intermediate-risk patients, those with both TAPSE < 19 mm and moderate/severe TR had an estimated one-year survival (56%) similar to that of high-risk patients (56%), and those with both TAPSE ≥ 19 mm and no/trace/mild TR had an estimated one-year survival (97%) similar to that of low-risk patients (95%). Conclusions: Echocardiography, a routinely performed, non-invasive imaging modality, plays a pivotal role in discriminating distinct survival phenotypes among prevalent intermediate-risk PAH patients using TAPSE and degree of TR. This can potentially help guide subsequent therapy.
    Language English
    Publishing date 2022-07-12
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2662592-1
    ISSN 2077-0383
    ISSN 2077-0383
    DOI 10.3390/jcm11144034
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  10. Article: Ventricular mass discriminates pulmonary arterial hypertension as redefined at the Sixth World Symposium on Pulmonary Hypertension.

    Simpson, Catherine E / Kolb, Todd M / Hsu, Steven / Zimmerman, Stefan L / Corona-Villalobos, Celia P / Mathai, Stephen C / Damico, Rachel L / Hassoun, Paul M

    Pulmonary circulation

    2022  Volume 12, Issue 1, Page(s) e12005

    Abstract: Cardiac magnetic resonance (CMR) measures of right ventricular (RV) mass, volumes, and function have diagnostic and prognostic value in pulmonary arterial hypertension (PAH). We hypothesized that RV mass-based metrics would discriminate incident PAH as ... ...

    Abstract Cardiac magnetic resonance (CMR) measures of right ventricular (RV) mass, volumes, and function have diagnostic and prognostic value in pulmonary arterial hypertension (PAH). We hypothesized that RV mass-based metrics would discriminate incident PAH as redefined by the lower mean pulmonary arterial pressure (mPAP) threshold of >20 mmHg at the Sixth World Symposium on Pulmonary Hypertension (6th WSPH). Eighty-nine subjects with suspected PAH underwent CMR imaging, including 64 subjects with systemic sclerosis (SSc). CMR metrics, including RV and left ventricular (LV) mass, were measured. All subjects underwent right heart catheterization (RHC) for assessment of hemodynamics within 48 h of CMR. Using generalized linear models, associations between CMR metrics and PAH were assessed, the best subset of CMR variables for predicting PAH were identified, and relationships between mass-based metrics, hemodynamics, and other predictive CMR metrics were examined. Fifty-nine subjects met 6th WSPH criteria for PAH. RV mass metrics, including ventricular mass index (VMI), demonstrated the greatest magnitude difference between subjects with versus without PAH. Overall and in SSc, VMI and RV mass measured by CMR were among the most predictive variables discriminating PAH at RHC, with areas under the receiver operating characteristic curve 0.86 and 0.83. respectively. VMI increased linearly with pulmonary vascular resistance and with mPAP in PAH, including in lower ranges of mPAP associated with mild PAH. VMI ≥ 0.37 yielded a positive predictive value of 90% for discriminating PAH. RV mass metrics measured by CMR, including VMI, discriminate incident, treatment-naïve PAH as defined by 6th WSPH criteria.
    Language English
    Publishing date 2022-01-18
    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/pul2.12005
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