The Experts below are selected from a list of 9459 Experts worldwide ranked by ideXlab platform
Marco Guazzi - One of the best experts on this subject based on the ideXlab platform.
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endothelial dysfunction and Lung Capillary injury in cardiovascular diseases
Progress in Cardiovascular Diseases, 2015Co-Authors: Marco Guazzi, Shane A Phillips, Ross Arena, Carl J LavieAbstract:Cardiac dysfunction of both systolic and diastolic origins leads to increased left atrial pressure, Lung Capillary injury and increased resistance to gas transfer. Acutely, pressure-induced trauma disrupts the endothelial and alveolar anatomical configuration and definitively causes an impairment of cellular pathways involved in fluid-flux regulation and gas exchange efficiency, a process well identified as stress failure of the alveolar-Capillary membrane. In chronic heart failure (HF), additional stimuli other than pressure may trigger the true remodeling process of capillaries and small arteries characterized by endothelial dysfunction, proliferation of myofibroblasts, fibrosis and extracellular matrix deposition. In parallel there is a loss of alveolar gas diffusion properties due to the increased path from air to blood (thickening of extracellular matrix) and loss of fine molecular mechanism involved in fluid reabsorption and clearance. Deleterious changes in gas transfer not only reflect the underlying Lung tissue damage but also portend independent prognostic information and may play a role in the pathogenesis of exercise limitation and ventilatory abnormalities observed in these patients. Few currently approved treatments for chronic HF have the potential to positively affect structural remodeling of the Lung Capillary network; angiotensin-converting enzyme inhibitors are one of the few currently established options. Recently, more attention has been paid to novel therapies specifically targeting the nitric oxide pathway as a suitable target to improve endothelial function and permeability as well as alveolar gas exchange properties.
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abstract 15309 impaired gas diffusion and rv to pulmonary circulation uncoupling limit exercise performance in heart failure patients
Circulation, 2014Co-Authors: Valentina Labate, Francesco Bandera, Greta Generati, Marta Pellegrino, Eleonora Alfonzetti, Marco GuazziAbstract:Introduction: In heart failure (HF) patients, an altered gasdiffusing capacity for carbon monoxide (DLCO) is a marker of Lung Capillary injury that bears relevant clinical and prognostic information. It is unknown whether right heart-pulmonary circulation (RH-PC) uncoupling abnormalities and gas diffusion are linked and may become synergic in causing exercise limitation and ventilation inefficiency. Methods: 17 HF patients (mean age 64±11; male 75%; NYHA II-III; mean left ventricular (LV) ejection fraction 34±9%) underwent DLCO measurements with assessment of membrane component (DM) an Capillary blood volume (Vc) and underwent to maximal cardiopulmonary exercise testing (CPET, tilt-ergometer,personalized ramp protocol) combined with Echo-Doppler assessment of right ventricular function by assessing tricuspid annular peak systolic excursion (TAPSE) and pulmonary systolic pressure (PASP). Results: Patients exhibited an abnormal gas diffusion (mean DLCO 17±3.9 ml/min/mmHg) with depressed alveolar-Capillary membrane diffusing capacity (DM) component (mean 23.4±6.8 ml/min/mmHg) and elevated Capillary volume (mean 111.2±64 ml) along with significant functional limitation (mean peak VO2 12.5±3.7 ml/kg/min) and ventilatory inefficiency(mean VE/VCO2 slope: 34.4±6.9 and mean end-tidal of CO2 mean 32.1±5.2 mmHg). Significant correlations were found between DM, TAPSE/PASP relationship, peak VO2 and VE/VCO2 slope at peak exercise (figure). Conclusions: Our findings show a link between the RV-PC uncoupling with gas diffusion abnormalities suggesting that interventions aimed at targeting the functional performance in HF population have to ideally combine amodulatory effect on both the alveolar-Capillary gas diffusion capacity and right heart function. ![][1] [1]: /embed/graphic-1.gif
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pulmonary hypertension with left sided heart disease
Nature Reviews Cardiology, 2010Co-Authors: Marco Guazzi, Ross ArenaAbstract:Pulmonary hypertension (PH) with left-sided heart disease is defined, according to the latest Venice classification, as a Group 2 PH, which includes left-sided ventricular or atrial disease, and left-sided valvular diseases. These conditions are all associated with increased left ventricular filling pressure. Although PH with left-sided heart disease is a common entity, and long-term follow-up trials have provided firm recognition that development of left-sided PH carries a poor outcome, available data on incidence, pathophysiology, and therapy are sparse. Mitral stenosis was reported as the most frequent cause of PH several decades ago, but PH with left-sided heart disease is now usually caused by systemic hypertension and ischemic heart disease. In patients with these conditions, PH develops as a consequence of impaired left ventricular relaxation and distensibility. Chronic sustained elevation of cardiogenic blood pressure in pulmonary capillaries leads to a cascade of untoward retrograde anatomical and functional effects that represent specific targets for therapeutic intervention. The pathophysiological and clinical importance of the hemodynamic consequences of left-sided heart disease, starting with Lung Capillary injury and leading to right ventricular overload and failure, are discussed in this Review, focusing on PH as an evolving contributor to heart failure that may be amenable to novel interventions.
Ross Arena - One of the best experts on this subject based on the ideXlab platform.
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endothelial dysfunction and Lung Capillary injury in cardiovascular diseases
Progress in Cardiovascular Diseases, 2015Co-Authors: Marco Guazzi, Shane A Phillips, Ross Arena, Carl J LavieAbstract:Cardiac dysfunction of both systolic and diastolic origins leads to increased left atrial pressure, Lung Capillary injury and increased resistance to gas transfer. Acutely, pressure-induced trauma disrupts the endothelial and alveolar anatomical configuration and definitively causes an impairment of cellular pathways involved in fluid-flux regulation and gas exchange efficiency, a process well identified as stress failure of the alveolar-Capillary membrane. In chronic heart failure (HF), additional stimuli other than pressure may trigger the true remodeling process of capillaries and small arteries characterized by endothelial dysfunction, proliferation of myofibroblasts, fibrosis and extracellular matrix deposition. In parallel there is a loss of alveolar gas diffusion properties due to the increased path from air to blood (thickening of extracellular matrix) and loss of fine molecular mechanism involved in fluid reabsorption and clearance. Deleterious changes in gas transfer not only reflect the underlying Lung tissue damage but also portend independent prognostic information and may play a role in the pathogenesis of exercise limitation and ventilatory abnormalities observed in these patients. Few currently approved treatments for chronic HF have the potential to positively affect structural remodeling of the Lung Capillary network; angiotensin-converting enzyme inhibitors are one of the few currently established options. Recently, more attention has been paid to novel therapies specifically targeting the nitric oxide pathway as a suitable target to improve endothelial function and permeability as well as alveolar gas exchange properties.
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pulmonary hypertension with left sided heart disease
Nature Reviews Cardiology, 2010Co-Authors: Marco Guazzi, Ross ArenaAbstract:Pulmonary hypertension (PH) with left-sided heart disease is defined, according to the latest Venice classification, as a Group 2 PH, which includes left-sided ventricular or atrial disease, and left-sided valvular diseases. These conditions are all associated with increased left ventricular filling pressure. Although PH with left-sided heart disease is a common entity, and long-term follow-up trials have provided firm recognition that development of left-sided PH carries a poor outcome, available data on incidence, pathophysiology, and therapy are sparse. Mitral stenosis was reported as the most frequent cause of PH several decades ago, but PH with left-sided heart disease is now usually caused by systemic hypertension and ischemic heart disease. In patients with these conditions, PH develops as a consequence of impaired left ventricular relaxation and distensibility. Chronic sustained elevation of cardiogenic blood pressure in pulmonary capillaries leads to a cascade of untoward retrograde anatomical and functional effects that represent specific targets for therapeutic intervention. The pathophysiological and clinical importance of the hemodynamic consequences of left-sided heart disease, starting with Lung Capillary injury and leading to right ventricular overload and failure, are discussed in this Review, focusing on PH as an evolving contributor to heart failure that may be amenable to novel interventions.
Gerald Simonneau - One of the best experts on this subject based on the ideXlab platform.
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Lung Capillary blood volume and membrane diffusion in preCapillary pulmonary hypertension
Journal of Heart and Lung Transplantation, 2016Co-Authors: Laurent Godinas, David Montani, David Amar, Xavier Jais, Olivier Sitbon, Gerald Simonneau, Laurent Savale, Mitja Jevnikar, Marc Humbert, Pierantonio LavenezianaAbstract:Background Combined diffusion capacity of the Lung for carbon monoxide (DLco) and nitric oxide (DLno) measurements allow for the estimation of pulmonary Capillary blood volume (Vc) and alveolar membrane diffusion (Dm). The clinical usefulness of these measurements in pulmonary hypertension (PH) is unclear. Methods Combined DLco and DLno were measured in 290 consecutive patients with preCapillary PH (pulmonary arterial hypertension (PAH), n = 153; pulmonary veno-occlusive disease (PVOD), n = 33; and chronic thromboembolic pulmonary hypertension (CTEPH), n = 104). Clinical correlates of Vc and Dm were assessed in a sub-group of PAH patients without comorbidities. Results PVOD patients compared with PAH and CTEPH patients displayed the lowest values of Vc (29.4 ± 16.8 ml vs 56.3 ± 26.5 ml vs 56.9 ± 26.2 ml, p p p Conclusions PVOD patients display higher values of the DLno/DLco ratio compared with PAH and CTEPH, suggesting proportionally greater reduction in Vc relative to Dm. However, partitioning of diffusion failed to be more clinically relevant than conventional DLco for detection of PVOD.
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Lung Capillary blood volume and membrane diffusion in preCapillary pulmonary hypertension
Journal of Heart and Lung Transplantation, 2016Co-Authors: Laurent Godinas, David Montani, David Amar, Xavier Jais, Olivier Sitbon, Gerald Simonneau, Edmund M T Lau, Laurent Savale, Mitja Jevnikar, Marc HumbertAbstract:Background Combined diffusion capacity of the Lung for carbon monoxide (DLco) and nitric oxide (DLno) measurements allow for the estimation of pulmonary Capillary blood volume (Vc) and alveolar membrane diffusion (Dm). The clinical usefulness of these measurements in pulmonary hypertension (PH) is unclear. Methods Combined DLco and DLno were measured in 290 consecutive patients with preCapillary PH (pulmonary arterial hypertension (PAH), n = 153; pulmonary veno-occlusive disease (PVOD), n = 33; and chronic thromboembolic pulmonary hypertension (CTEPH), n = 104). Clinical correlates of Vc and Dm were assessed in a sub-group of PAH patients without comorbidities. Results PVOD patients compared with PAH and CTEPH patients displayed the lowest values of Vc (29.4 ± 16.8 ml vs 56.3 ± 26.5 ml vs 56.9 ± 26.2 ml, p p p Conclusions PVOD patients display higher values of the DLno/DLco ratio compared with PAH and CTEPH, suggesting proportionally greater reduction in Vc relative to Dm. However, partitioning of diffusion failed to be more clinically relevant than conventional DLco for detection of PVOD.
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Lung Capillary blood volume and membrane diffusion in ph
European Respiratory Journal, 2014Co-Authors: Laurent Godinas, David Montani, Pierantonio Laveneziana, David Amar, Abdel Belguendouz, Mourad Sarni, Xavier Jais, Barbara Girerd, Olivier Sitbon, Gerald SimonneauAbstract:Combined Lung diffusion of carbon monoxide (DLCO) and nitric oxide (DLNO) measurement has a potential ability to assess pulmonary Capillary blood volume (Vc) disturbances. Usefullness of DLNO measurement and its derivatives is still controversial in pulmonary hypertension. To evaluate its potential role, we restrospectively reviewed the combined values of DLCO and DLNO in 120 well-characterized consecutive patients with pulmonary hypertension. Patients were divided in three groups: pulmonary hypertension (PAH) (n=64), pulmonary veno-occlusive disease (PVOD) (n=14) and chronic thrombo-embolic pulmonary hypertension (CTEPH) (n=42). Measurements of DLNO, DLCO, membrane diffusing capacity (Dm) and Vc were measured during a single breath maneuver. An ANOVA or a Kruskal-Wallis statistical test were used to compare groups. We found a significant difference between patients with PVOD and with PAH or CTEPH for DLNO, DLCO, Dm and Vc. DLNO/DLCO ratio was not different between groups (non statistically significant trend for an increased ratio in PVOD). We conclude that DLNO measurement alone or in combination could help to determine subtype of pulmonary hypertension and needs further attention. View this table: DLNO, DLCO, Dm and Vc values
Laurent Godinas - One of the best experts on this subject based on the ideXlab platform.
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Lung Capillary blood volume and membrane diffusion in preCapillary pulmonary hypertension
Journal of Heart and Lung Transplantation, 2016Co-Authors: Laurent Godinas, David Montani, David Amar, Xavier Jais, Olivier Sitbon, Gerald Simonneau, Laurent Savale, Mitja Jevnikar, Marc Humbert, Pierantonio LavenezianaAbstract:Background Combined diffusion capacity of the Lung for carbon monoxide (DLco) and nitric oxide (DLno) measurements allow for the estimation of pulmonary Capillary blood volume (Vc) and alveolar membrane diffusion (Dm). The clinical usefulness of these measurements in pulmonary hypertension (PH) is unclear. Methods Combined DLco and DLno were measured in 290 consecutive patients with preCapillary PH (pulmonary arterial hypertension (PAH), n = 153; pulmonary veno-occlusive disease (PVOD), n = 33; and chronic thromboembolic pulmonary hypertension (CTEPH), n = 104). Clinical correlates of Vc and Dm were assessed in a sub-group of PAH patients without comorbidities. Results PVOD patients compared with PAH and CTEPH patients displayed the lowest values of Vc (29.4 ± 16.8 ml vs 56.3 ± 26.5 ml vs 56.9 ± 26.2 ml, p p p Conclusions PVOD patients display higher values of the DLno/DLco ratio compared with PAH and CTEPH, suggesting proportionally greater reduction in Vc relative to Dm. However, partitioning of diffusion failed to be more clinically relevant than conventional DLco for detection of PVOD.
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Lung Capillary blood volume and membrane diffusion in preCapillary pulmonary hypertension
Journal of Heart and Lung Transplantation, 2016Co-Authors: Laurent Godinas, David Montani, David Amar, Xavier Jais, Olivier Sitbon, Gerald Simonneau, Edmund M T Lau, Laurent Savale, Mitja Jevnikar, Marc HumbertAbstract:Background Combined diffusion capacity of the Lung for carbon monoxide (DLco) and nitric oxide (DLno) measurements allow for the estimation of pulmonary Capillary blood volume (Vc) and alveolar membrane diffusion (Dm). The clinical usefulness of these measurements in pulmonary hypertension (PH) is unclear. Methods Combined DLco and DLno were measured in 290 consecutive patients with preCapillary PH (pulmonary arterial hypertension (PAH), n = 153; pulmonary veno-occlusive disease (PVOD), n = 33; and chronic thromboembolic pulmonary hypertension (CTEPH), n = 104). Clinical correlates of Vc and Dm were assessed in a sub-group of PAH patients without comorbidities. Results PVOD patients compared with PAH and CTEPH patients displayed the lowest values of Vc (29.4 ± 16.8 ml vs 56.3 ± 26.5 ml vs 56.9 ± 26.2 ml, p p p Conclusions PVOD patients display higher values of the DLno/DLco ratio compared with PAH and CTEPH, suggesting proportionally greater reduction in Vc relative to Dm. However, partitioning of diffusion failed to be more clinically relevant than conventional DLco for detection of PVOD.
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Lung Capillary blood volume and membrane diffusion in ph
European Respiratory Journal, 2014Co-Authors: Laurent Godinas, David Montani, Pierantonio Laveneziana, David Amar, Abdel Belguendouz, Mourad Sarni, Xavier Jais, Barbara Girerd, Olivier Sitbon, Gerald SimonneauAbstract:Combined Lung diffusion of carbon monoxide (DLCO) and nitric oxide (DLNO) measurement has a potential ability to assess pulmonary Capillary blood volume (Vc) disturbances. Usefullness of DLNO measurement and its derivatives is still controversial in pulmonary hypertension. To evaluate its potential role, we restrospectively reviewed the combined values of DLCO and DLNO in 120 well-characterized consecutive patients with pulmonary hypertension. Patients were divided in three groups: pulmonary hypertension (PAH) (n=64), pulmonary veno-occlusive disease (PVOD) (n=14) and chronic thrombo-embolic pulmonary hypertension (CTEPH) (n=42). Measurements of DLNO, DLCO, membrane diffusing capacity (Dm) and Vc were measured during a single breath maneuver. An ANOVA or a Kruskal-Wallis statistical test were used to compare groups. We found a significant difference between patients with PVOD and with PAH or CTEPH for DLNO, DLCO, Dm and Vc. DLNO/DLCO ratio was not different between groups (non statistically significant trend for an increased ratio in PVOD). We conclude that DLNO measurement alone or in combination could help to determine subtype of pulmonary hypertension and needs further attention. View this table: DLNO, DLCO, Dm and Vc values
Pierantonio Laveneziana - One of the best experts on this subject based on the ideXlab platform.
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Lung Capillary blood volume and membrane diffusion in preCapillary pulmonary hypertension
Journal of Heart and Lung Transplantation, 2016Co-Authors: Laurent Godinas, David Montani, David Amar, Xavier Jais, Olivier Sitbon, Gerald Simonneau, Laurent Savale, Mitja Jevnikar, Marc Humbert, Pierantonio LavenezianaAbstract:Background Combined diffusion capacity of the Lung for carbon monoxide (DLco) and nitric oxide (DLno) measurements allow for the estimation of pulmonary Capillary blood volume (Vc) and alveolar membrane diffusion (Dm). The clinical usefulness of these measurements in pulmonary hypertension (PH) is unclear. Methods Combined DLco and DLno were measured in 290 consecutive patients with preCapillary PH (pulmonary arterial hypertension (PAH), n = 153; pulmonary veno-occlusive disease (PVOD), n = 33; and chronic thromboembolic pulmonary hypertension (CTEPH), n = 104). Clinical correlates of Vc and Dm were assessed in a sub-group of PAH patients without comorbidities. Results PVOD patients compared with PAH and CTEPH patients displayed the lowest values of Vc (29.4 ± 16.8 ml vs 56.3 ± 26.5 ml vs 56.9 ± 26.2 ml, p p p Conclusions PVOD patients display higher values of the DLno/DLco ratio compared with PAH and CTEPH, suggesting proportionally greater reduction in Vc relative to Dm. However, partitioning of diffusion failed to be more clinically relevant than conventional DLco for detection of PVOD.
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Lung Capillary blood volume and membrane diffusion in ph
European Respiratory Journal, 2014Co-Authors: Laurent Godinas, David Montani, Pierantonio Laveneziana, David Amar, Abdel Belguendouz, Mourad Sarni, Xavier Jais, Barbara Girerd, Olivier Sitbon, Gerald SimonneauAbstract:Combined Lung diffusion of carbon monoxide (DLCO) and nitric oxide (DLNO) measurement has a potential ability to assess pulmonary Capillary blood volume (Vc) disturbances. Usefullness of DLNO measurement and its derivatives is still controversial in pulmonary hypertension. To evaluate its potential role, we restrospectively reviewed the combined values of DLCO and DLNO in 120 well-characterized consecutive patients with pulmonary hypertension. Patients were divided in three groups: pulmonary hypertension (PAH) (n=64), pulmonary veno-occlusive disease (PVOD) (n=14) and chronic thrombo-embolic pulmonary hypertension (CTEPH) (n=42). Measurements of DLNO, DLCO, membrane diffusing capacity (Dm) and Vc were measured during a single breath maneuver. An ANOVA or a Kruskal-Wallis statistical test were used to compare groups. We found a significant difference between patients with PVOD and with PAH or CTEPH for DLNO, DLCO, Dm and Vc. DLNO/DLCO ratio was not different between groups (non statistically significant trend for an increased ratio in PVOD). We conclude that DLNO measurement alone or in combination could help to determine subtype of pulmonary hypertension and needs further attention. View this table: DLNO, DLCO, Dm and Vc values
