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The roles of Circulating Cytokines and right ventricular adaptation in pre-capillary pulmonary Hypertension
Csósza Györgyi
KÁROLY RÁCZ CONSERVATIVE MEDICINE PROGRAM
Dr. Reusz György
SE Pulmonológiai Klinika tanterme
2025-06-23 14:00:00
Pulmonology
Dr. Losonczy György
Dr. Lázár Zsófia
Dr. Nagy Anikó Ilona
Dr. Piróth Zsolt
Dr. Zima Endre
Dr. Cseprekál Orsolya
Dr. Paróczai Dóra
The deterioration of RV function determines the survival of patients with pre-capillary pulmonary hypertension. RV adaptation to the increased pulmonary vascular pressure shows great individual variability, however, the process is not fully understood, and its assessment needs better tools. Several cytokines have been implicated to influence myocardial adaptation in PH, but their association to clinical measures is not known. Right ventricular stroke work index, a calculated parameter, has been previously proposed to assess RV work, but its use for clinical practice should be better characterized. We found that RVSWI correlates with PVR in patients with PAH and CTEPH, and it might be a potential marker to capture the adaptive and maladaptive phases of RV adaptation. Importantly, a decreased RVSWI value at diagnosis can predict an unfavourable therapeutic response to initial pulmonary vasodilator therapies in PAH and CTEPH, suggesting that this parameter might aid decision-making in patient management. Furthermore, we showed that comorbidities with known negative effects on the function of the left ventricle, are also associated with decreased RV function in PAH, as assessed by RVSWI. The increased concentration of serum apelin, a molecule with a potent positive inotropic effect, can identify patients with PAH, CTEPH and PH due to lung diseases at the diagnosis, and is positively related to disease severity and RV function. IL22RA2 has been recently described to be involved in RV adaption in PAH, and we found that its elevated blood concentration is linked with less severe PH, and a better RV function. Furthermore, serum VEGF concentrations might be suitable to follow the clinical improvement of patients. Overall, our findings highlight that the hemodynamic parameter of RVSWI and the circulating biomarkers of apelin and IL22RA2 hold potential clinical values in the assessment of cardiac function in pre-capillary PH.