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      Recent advancements in pulmonary arterial hypertension and right heart failure research: overview of selected abstracts from ATS2020 and emerging COVID-19 research

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          Abstract

          Each year the American Thoracic Society (ATS) Conference brings together scientists who conduct basic, translational and clinical research to present on the recent advances in the field of respirology. Due to the Coronavirus Disease of 2019 (COVID-19) pandemic, the ATS2020 Conference was held online in a series of virtual meetings. In this review, we focus on the breakthroughs in pulmonary hypertension research. We have selected 11 of the best basic science abstracts which were presented at the ATS2020 Assembly on Pulmonary Circulation mini-symposium “What’s New in Pulmonary Arterial Hypertension (PAH) and Right Ventricular (RV) Signaling: Lessons from the Best Abstracts,” reflecting the current state of the art and associated challenges in PH. Particular emphasis is placed on understanding the mechanisms underlying RV failure, the regulation of inflammation, and the novel therapeutic targets that emerged from preclinical research. The pathologic interactions between pulmonary hypertension, right ventricular function and COVID-19 are also discussed.

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          Most cited references89

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          Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes.

          The effects of empagliflozin, an inhibitor of sodium-glucose cotransporter 2, in addition to standard care, on cardiovascular morbidity and mortality in patients with type 2 diabetes at high cardiovascular risk are not known.
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            2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT).

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              Haemodynamic definitions and updated clinical classification of pulmonary hypertension

              Since the 1st World Symposium on Pulmonary Hypertension (WSPH) in 1973, pulmonary hypertension (PH) has been arbitrarily defined as mean pulmonary arterial pressure (mPAP) ≥25 mmHg at rest, measured by right heart catheterisation. Recent data from normal subjects has shown that normal mPAP was 14.0±3.3 mmHg. Two standard deviations above this mean value would suggest mPAP >20 mmHg as above the upper limit of normal (above the 97.5th percentile). This definition is no longer arbitrary, but based on a scientific approach. However, this abnormal elevation of mPAP is not sufficient to define pulmonary vascular disease as it can be due to an increase in cardiac output or pulmonary arterial wedge pressure. Thus, this 6th WSPH Task Force proposes to include pulmonary vascular resistance ≥3 Wood Units in the definition of all forms of pre-capillary PH associated with mPAP >20 mmHg. Prospective trials are required to determine whether this PH population might benefit from specific management. Regarding clinical classification, the main Task Force changes were the inclusion in group 1 of a subgroup “pulmonary arterial hypertension (PAH) long-term responders to calcium channel blockers”, due to the specific prognostic and management of these patients, and a subgroup “PAH with overt features of venous/capillaries (pulmonary veno-occlusive disease/pulmonary capillary haemangiomatosis) involvement”, due to evidence suggesting a continuum between arterial, capillary and vein involvement in PAH.
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                Author and article information

                Journal
                Pulm Circ
                Pulm Circ
                PUL
                sppul
                Pulmonary Circulation
                SAGE Publications (Sage UK: London, England )
                2045-8932
                2045-8940
                19 August 2021
                Jul-Sep 2021
                : 11
                : 3
                : 20458940211037274
                Affiliations
                [1 ]Pulmonary Hypertension Research Group, Centre de Recherche de l'Institut Universitaire de Cardiologie et Pneumologie de Quebec City, Quebec, Canada
                [2 ]Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
                [3 ]Department of Anesthesiology and Perioperative Medicine, Division of Molecular Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
                [4 ]Division of Translational and Regenerative Medicine, University of Arizona, Tucson, AZ, USA
                [5 ]Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, and Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
                Author notes
                [*]Fancois Potus, Pulmonary Hypertension Research Group, Centre de Recherche de l'Institut Universitaire de Cardiologie et Pneumologie de Quebec, 2725 chemin Sainte Foy, G1V4G5, Quebec, QC, Canada. Email: francois.potus@ 123456CRIUCPq.ulaval.ca Yen-Chun Lai, Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University School of Medicine 980 W. Walnut St. R3 C412, Indianapolis, IN 46202, USA. Email: yelai@ 123456iu.edu
                Author information
                https://orcid.org/0000-0001-8036-3079
                https://orcid.org/0000-0002-4703-5708
                Article
                10.1177_20458940211037274
                10.1177/20458940211037274
                8381443
                ae86e43c-051e-4201-890a-65f4df2ff56d
                © The Author(s) 2021

                Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 21 June 2021
                : 15 July 2021
                Funding
                Funded by: Vitalant and the Hemophilia Center of Western Pennsylvania;
                Funded by: Gilead Sciences Research Scholars Program in Pulmonary Arterial Hypertension;
                Funded by: American Heart Association, FundRef https://doi.org/10.13039/100000968;
                Award ID: 18IPA34170257
                Award ID: 19CDA34660173
                Award ID: 19CDA34730039
                Funded by: National Institutes of Health, FundRef https://doi.org/10.13039/100000002;
                Award ID: 5K08HL141995-03
                Award ID: R01HL142638
                Award ID: R01HL148712-01
                Funded by: ABRC New Investigator Award ;
                Award ID: ABRC/ADHS18-198871
                Funded by: Actelion Entelligence Young Investigator Award;
                Categories
                Review Article
                Custom metadata
                July-September 2021
                ts2

                Respiratory medicine
                translational research,pulmonary hypertension,covid-19,ats,basic science research

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