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Article ; Online: The Acute Effects of Prostacyclin on Right Ventricular Contractility and Pulmonary Artery Coupling.

Vanderpool, Rebecca R / Insel, Michael / Kubba, Saad / Rischard, Franz P

American journal of respiratory and critical care medicine

2023 Volume 207, Issue 8, Page(s) 1100–1102

MeSH term(s)	Humans ; Epoprostenol/pharmacology ; Pulmonary Artery ; Hypertension, Pulmonary/drug therapy ; Pulmonary Circulation ; Prostaglandins I/pharmacology ; Ventricular Function, Right ; Ventricular Dysfunction, Right ; Myocardial Contraction
Chemical Substances	Epoprostenol (DCR9Z582X0) ; Prostaglandins I
Language	English
Publishing date	2023-01-23
Publishing country	United States
Document type	Letter ; Research Support, Non-U.S. Gov't ; Comment
ZDB-ID	1180953-x
ISSN	1535-4970 ; 0003-0805 ; 1073-449X
ISSN (online)	1535-4970
ISSN	0003-0805 ; 1073-449X
DOI	10.1164/rccm.202210-1861LE
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Article ; Online: iCPET Calculator: A Web-Based Application to Standardize the Calculation of Alpha Distensibility in Patients With Pulmonary Arterial Hypertension.

Elliott, Jordan / Menakuru, Nainika / Martin, Kellan Juliet / Rahaghi, Farbod Nicholas / Rischard, Franz P / Vanderpool, Rebecca R

Journal of the American Heart Association

2023 Volume 12, Issue 20, Page(s) e029667

Abstract: Background Pulmonary vascular distensibility associates with right ventricular function and clinical outcomes in patients with unexplained dyspnea and pulmonary hypertension. Alpha distensibility coefficient is determined from a nonlinear fit to ... ...

Abstract	Background Pulmonary vascular distensibility associates with right ventricular function and clinical outcomes in patients with unexplained dyspnea and pulmonary hypertension. Alpha distensibility coefficient is determined from a nonlinear fit to multipoint pressure-flow plots. Study aims were to (1) create and test a user-friendly tool to standardize analysis of exercise hemodynamics including distensibility, and (2) investigate changes in distensibility following treatment in patients with pulmonary arterial hypertension. Methods and Results Participants with an exercise right heart catherization were retrospectively identified from the University of Arizona Pulmonary Hypertension (UA PH) registry and split into a pulmonary arterial hypertension group, a comparator group, and a control group. Right ventricular function was quantified using the coupling ratio and diastolic stiffness. Prototypes of the invasive cardiopulmonary exercise testing (iCPET) calculator were developed using Matlab, Python, and RShiny to analyze exercise hemodynamics and alpha distensibility coefficient, α (%/mm Hg) from multipoint pressure flow plots. Interclass correlation coefficients were calculated for interplatform and interobserver variability in alpha. No significant bias in the intraplatform (Matlab versus RShiny; intraclass correlation coefficient: 0.996) or interobserver (intraclass correlation coefficient: 0.982) comparison of alpha values. Afterload significantly decreased (
MeSH term(s)	Humans ; Pulmonary Arterial Hypertension ; Hypertension, Pulmonary/diagnostic imaging ; Hypertension, Pulmonary/complications ; Retrospective Studies ; Exercise Test/methods ; Familial Primary Pulmonary Hypertension ; Internet ; Ventricular Function, Right ; Pulmonary Artery/diagnostic imaging ; Ventricular Dysfunction, Right
Language	English
Publishing date	2023-10-10
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2653953-6
ISSN	2047-9980 ; 2047-9980
ISSN (online)	2047-9980
ISSN	2047-9980
DOI	10.1161/JAHA.123.029667
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Article ; Online: Looking backwards: is it time to assess veno-atrial interactions in pulmonary arterial hypertension?

Pugliese, Steven / Vanderpool, Rebecca R

The European respiratory journal

2019 Volume 54, Issue 4

MeSH term(s)	Atrial Fibrillation ; Familial Primary Pulmonary Hypertension ; Heart Atria ; Humans ; Pulmonary Arterial Hypertension ; Pulmonary Veno-Occlusive Disease
Language	English
Publishing date	2019-10-17
Publishing country	England
Document type	Editorial ; Comment
ZDB-ID	639359-7
ISSN	1399-3003 ; 0903-1936
ISSN (online)	1399-3003
ISSN	0903-1936
DOI	10.1183/13993003.01598-2019
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Article ; Online: Hematocrit-corrected Pulmonary Vascular Resistance.

Vanderpool, Rebecca R / Naeije, Robert

American journal of respiratory and critical care medicine

2018 Volume 198, Issue 3, Page(s) 305–309

MeSH term(s)	Anemia, Sickle Cell/physiopathology ; Hematocrit ; Humans ; Hypertension, Pulmonary/complications ; Hypertension, Pulmonary/physiopathology ; Polycythemia/complications ; Polycythemia/physiopathology ; Pulmonary Artery/physiopathology ; Vascular Resistance/physiology
Language	English
Publishing date	2018-05-06
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1180953-x
ISSN	1535-4970 ; 0003-0805 ; 1073-449X
ISSN (online)	1535-4970
ISSN	0003-0805 ; 1073-449X
DOI	10.1164/rccm.201801-0081PP
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Article ; Online: Advanced hemodynamic and cluster analysis for identifying novel RV function subphenotypes in patients with pulmonary hypertension.

Janowski, Alexandra M / Ravellette, Keeley S / Insel, Michael / Garcia, Joe G N / Rischard, Franz P / Vanderpool, Rebecca R

The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation

2023 Volume 43, Issue 5, Page(s) 755–770

Abstract: Background: Quantifying right ventricular (RV) function is important to describe the pathophysiology of in pulmonary hypertension (PH). Current phenotyping strategies in PH rely on few invasive hemodynamic parameters to quantify RV dysfunction severity. ...

Abstract	Background: Quantifying right ventricular (RV) function is important to describe the pathophysiology of in pulmonary hypertension (PH). Current phenotyping strategies in PH rely on few invasive hemodynamic parameters to quantify RV dysfunction severity. The aim of this study was to identify novel RV phenotypes using unsupervised clustering methods on advanced hemodynamic features of RV function. Methods: Participants were identified from the University of Arizona Pulmonary Hypertension Registry (n = 190). RV-pulmonary artery coupling (Ees/Ea), RV systolic (Ees), and diastolic function (Eed) were quantified from stored RV pressure waveforms. Consensus clustering analysis with bootstrapping was used to identify the optimal clustering method. Pearson correlation analysis was used to reduce collinearity between variables. RV cluster subphenotypes were characterized using clinical data and compared to pulmonary vascular resistance (PVR) quintiles. Results: Five distinct RV clusters (C1-C5) with distinct RV subphenotypes were identified using k-medoids with a Pearson distance matrix. Clusters 1 and 2 both have low diastolic stiffness (Eed) and afterload (Ea) but RV-PA coupling (Ees/Ea) is decreased in C2. Intermediate cluster (C3) has a similar Ees/Ea as C2 but with higher PA pressure and afterload. Clusters C4 and C5 have increased Eed and Ea but C5 has a significant decrease in Ees/Ea. Cardiac output was high in C3 distinct from the other clusters. In the PVR quintiles, contractility increased and stroke volume decreased as a function of increased afterload. World Symposium PH classifications were distributed across clusters and PVR quintiles. Conclusions: RV-centric phenotyping offers an opportunity for a more precise-medicine-based management approach.
MeSH term(s)	Humans ; Hypertension, Pulmonary/physiopathology ; Hypertension, Pulmonary/diagnosis ; Hypertension, Pulmonary/classification ; Male ; Female ; Phenotype ; Middle Aged ; Hemodynamics/physiology ; Cluster Analysis ; Ventricular Dysfunction, Right/physiopathology ; Ventricular Function, Right/physiology ; Registries ; Aged
Language	English
Publishing date	2023-12-21
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	1062522-7
ISSN	1557-3117 ; 1053-2498
ISSN (online)	1557-3117
ISSN	1053-2498
DOI	10.1016/j.healun.2023.12.009
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Article ; Online: Progress in Pulmonary Hypertension with Left Heart Failure. Beyond New Definitions and Acronyms.

Vanderpool, Rebecca R / Naeije, Robert

American journal of respiratory and critical care medicine

2015 Volume 192, Issue 10, Page(s) 1152–1154

MeSH term(s)	Female ; Heart Failure/epidemiology ; Humans ; Hypertension, Pulmonary/epidemiology ; Male ; Pulmonary Heart Disease/epidemiology ; Ventricular Dysfunction, Left/epidemiology ; Ventricular Dysfunction, Right/epidemiology
Language	English
Publishing date	2015-11-15
Publishing country	United States
Document type	Comment ; Editorial
ZDB-ID	1180953-x
ISSN	1535-4970 ; 0003-0805 ; 1073-449X
ISSN (online)	1535-4970
ISSN	0003-0805 ; 1073-449X
DOI	10.1164/rccm.201507-1509ED
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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: The Right Ventricular-Pulmonary Arterial Coupling and Diastolic Function Response to Therapy in Pulmonary Arterial Hypertension.

Vanderpool, Rebecca R / Hunter, Kendall S / Insel, Michael / Garcia, Joe G N / Bedrick, Edward J / Tedford, Ryan J / Rischard, Franz P

Chest

2021 Volume 161, Issue 4, Page(s) 1048–1059

Abstract: Background: Multiparametric risk assessment is used in pulmonary arterial hypertension (PAH) to target therapy. However, this strategy is imperfect because most patients remain at intermediate or high risk after initial treatment, with low risk being ... ...

Abstract	Background: Multiparametric risk assessment is used in pulmonary arterial hypertension (PAH) to target therapy. However, this strategy is imperfect because most patients remain at intermediate or high risk after initial treatment, with low risk being the goal. Metrics of right ventricular (RV) adaptation are promising tools that may help refine our therapeutic strategy. Research question: Does RV adaptation predict therapeutic response over time? Study design and methods: We evaluated 52 incident treatment-naive patients with advanced PAH by catheterization and cardiac imaging longitudinally at baseline, follow-up 1 (∼3 months), and follow-up 2 (∼18 months). All patients received goal-directed therapy with parenteral treprostinil and/or combination therapy with treatment escalation if functional class I or II was not achieved. On the basis of their therapeutic response, patients were evaluated at follow-up 1 as nonresponders (died) or as responders, and again at follow-up 2 as super-responders (low risk) or partial responders (high/intermediate risk). Multiparametric risk was based on a simplified European Respiratory Society/European Society of Cardiology guideline score. RV adaptation was evaluated with the single-beat coupling ratio (Ees/Ea) and diastolic function with diastolic elastance (Eed). Data are expressed as mean ± SD or as OR (95% CI). Results: Nine patients (17%) were nonresponders. PAH-directed therapy improved the European Respiratory Society low-risk score from 1 (2%) at baseline to 23 (55%) at follow-up 2. Ees/Ea at presentation was nonsignificantly higher in responders (0.9 ± 0.4) vs nonresponders (0.6 ± 0.4; P = .09) but could not be used to predict super-responder status at follow-up 2 (OR, 1.40 [95% CI, 0.28-7.0]; P = .84). Baseline RV ejection fraction and change in Eed were successfully used to predict super-responder status at follow-up 2 (OR, 1.15 [95% CI, 1.0-1.27]; P = .009 and OR, 0.29 [95% CI, 0.86-0.96]; P = .04, respectively). Interpretation: In patients with advanced PAH, RV-pulmonary arterial coupling could not discriminate irreversible RV failure (nonresponders) at presentation but showed a late trend to improvement by follow-up 2. Early change in Eed and baseline RV ejection fraction were the best predictors of therapeutic response.
MeSH term(s)	Familial Primary Pulmonary Hypertension ; Heart Murmurs ; Humans ; Hypertension, Pulmonary ; Prospective Studies ; Pulmonary Arterial Hypertension/drug therapy ; Pulmonary Artery ; Ventricular Dysfunction, Right ; Ventricular Function, Right
Language	English
Publishing date	2021-10-09
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1032552-9
ISSN	1931-3543 ; 0012-3692
ISSN (online)	1931-3543
ISSN	0012-3692
DOI	10.1016/j.chest.2021.09.040
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Article ; Online: Right ventricular load and contractility in HIV-associated pulmonary hypertension.

Rajaratnam, Arun / Rehman, Sofiya / Sharma, Prerna / Singh, Vikas K / Saul, Melissa / Vanderpool, Rebecca R / Gladwin, Mark T / Simon, Marc A / Morris, Alison

PloS one

2021 Volume 16, Issue 2, Page(s) e0243274

Abstract: Background: People living with human immunodeficiency virus (PLWH) are at risk of developing pulmonary hypertension (PH) and right ventricular (RV) dysfunction, but understanding of the relationship of RV function to afterload (RV-PA coupling) is ... ...

Abstract	Background: People living with human immunodeficiency virus (PLWH) are at risk of developing pulmonary hypertension (PH) and right ventricular (RV) dysfunction, but understanding of the relationship of RV function to afterload (RV-PA coupling) is limited. We evaluated the clinical and hemodynamic characteristics of human immunodeficiency virus (HIV)-associated PH. Methods: We performed a retrospective review of patients with a diagnosis of HIV undergoing right heart catheterization (RHC) from 2000-2016 in a tertiary care center. Inclusion criteria were diagnosis of HIV, age ≥ 18 years and availability of RHC data. PH was classified as either pulmonary arterial hypertension (PAH; mean pulmonary arterial pressure [mPAP] ≥ 25mmHg with pulmonary artery wedge pressure [PAWP] ≤ 15mmHg) or pulmonary venous hypertension (PVH; mPAP ≥ 25mmHg with PAWP > 15). We collected demographics, CD4 cell count, HIV viral load, RHC and echocardiographic data. The single beat method was used to calculate RV-PA coupling from RHC. Results: Sixty-two PLWH with a clinical likelihood for PH underwent RHC. Thirty-two (52%) met PH criteria (15 with PAH, 17 with PVH). Average time from diagnosis of HIV to diagnosis of PH was 11 years. Eleven of 15 individuals with PAH were on antiretroviral therapy (ART) while all 17 patients with PVH were on ART. Compared to PLWH without PH, those with PH had an increased likelihood of having a detectable HIV viral load and lower CD4 cell counts. PLWH with PAH or PVH had increased RV afterload with normal RV contractility, and preserved RV-PA coupling. Conclusion: PLWH with PH (PAH or PVH) were more likely to have a detectable HIV viral load and lower CD4 count at the time of RHC. PLWH with PAH or PVH had increased RV afterload, normal RV contractility, with preserved RV-PA coupling suggestive of an early onset, mild, and compensated form of PH. These results should be confirmed in larger studies.
MeSH term(s)	Adult ; Cardiac Catheterization ; Female ; HIV/isolation & purification ; HIV Infections/complications ; HIV Infections/diagnosis ; HIV Infections/physiopathology ; HIV Infections/virology ; Humans ; Hypertension, Pulmonary/diagnosis ; Hypertension, Pulmonary/etiology ; Hypertension, Pulmonary/physiopathology ; Hypertension, Pulmonary/virology ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Myocardial Contraction ; Pulmonary Arterial Hypertension/diagnosis ; Pulmonary Arterial Hypertension/etiology ; Pulmonary Arterial Hypertension/physiopathology ; Pulmonary Arterial Hypertension/virology ; Retrospective Studies ; Ventricular Dysfunction, Right/diagnosis ; Ventricular Dysfunction, Right/etiology ; Ventricular Dysfunction, Right/physiopathology ; Ventricular Dysfunction, Right/virology ; Viral Load
Language	English
Publishing date	2021-02-23
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0243274
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Article: Targeting L-arginine-nitric oxide-cGMP pathway in pulmonary arterial hypertension.

Tang, Haiyang / Vanderpool, Rebecca R / Wang, Jian / Yuan, Jason X-J

Pulmonary circulation

2017 Volume 7, Issue 3, Page(s) 569–571

Language	English
Publishing date	2017-09-14
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	10.1177/2045893217728261
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