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Pulmonary Circulation[JOURNAL]

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Knowledge Gaps and Controversies on Cardiopulmonary Exercise Testing in the Assessment of Pulmonary Vascular Disease: An Official Statement of the Pulmonary Vascular Research Institute Exercise and Right Ventricular Function Task Force.

Waxman AB, Babu A, Badagliacca R … +18 more , Ferreira E, George P, Guazzi M, Howard L, Kim D, Kovacs G, Kubba S, Langleben D, McCabe C, Menezes T, Oliveira R, Orfanos S, Singh I, Systrom D, Tedford R, Vanderpool R, Vizza CD, Rischard FP

Pulm Circ · 2026 Jan · PMID 41586300 · Full text

Exercise testing has long been essential for evaluating diagnosis, prognosis, and functional status in pulmonary hypertension (PH). Recent advances have clarified its role in defining reference values and prognostic mark... Exercise testing has long been essential for evaluating diagnosis, prognosis, and functional status in pulmonary hypertension (PH). Recent advances have clarified its role in defining reference values and prognostic markers. Nonetheless, substantial knowledge gaps persist regarding the implementation of invasive cardiopulmonary exercise testing (iCPET) and its potential to inform pathophysiology and therapeutic decision-making. This statement addresses the knowledge gaps that hinder the application of iCPET and exercise right heart catheterization (RHC) in the assessment of PH. We present research priorities and scenarios in which these tests may clarify drug mechanisms and support PH subphenotyping. An international, multidisciplinary task force of cardiology and pulmonology experts reviewed the literature and formulated consensus recommendations through iterative discussions.

Refractory Peripheral Pulmonary Stenosis and Severe Pulmonary Arterial Hypertension Associated With a Loss-of-Function Variant in .

Steffes LC, Adamson GT, Dunn KE … +1 more , Feinstein JA

Pulm Circ · 2026 Jan · PMID 41574350 · Full text

We report a novel genetic variant in a patient with treatment-resistant peripheral pulmonary artery stenosis (PPS) and progressive pulmonary arterial hypertension (PAH). A premature infant was diagnosed with bilateral PP... We report a novel genetic variant in a patient with treatment-resistant peripheral pulmonary artery stenosis (PPS) and progressive pulmonary arterial hypertension (PAH). A premature infant was diagnosed with bilateral PPS requiring multiple surgical reconstructions and interventional procedures with refractory proximal stenoses. Despite adequate anatomic repair preserving nearly all right lung segments, the child developed progressive PAH with elevated pressures in preserved segments out of proportion to residual obstruction. Genetic evaluation revealed a heterozygous variant in , a critical regulator of VEGF signaling essential for pulmonary vascular development and homeostasis. We propose that haploinsufficiency could disrupt endothelial function during development, leading to aberrant vascular patterning. This dysfunction may lead to PPS and ongoing endothelial dysfunction contributing to PAH. This represents a potential novel genetic cause of PPS with PAH, expanding the understanding of critical regulators in pulmonary vascular development and pathology. Comprehensive genetic evaluation in treatment-resistant pulmonary vascular disease may identify novel mechanisms and eventually guide personalized therapeutic approaches through enhanced genotype-phenotype correlation.

Resistin-Like Molecule Beta Participates in Calcium Regulation Via Direct Interaction With CaSR and a PLC-IPR-Dependent Mechanism in Hypoxia-Induced Pulmonary Hypertension.

Liu G, Tian H, Tan J … +3 more , Liu Y, Xing Y, Dai A

Pulm Circ · 2026 Jan · PMID 41574349 · Full text

The proliferation of pulmonary artery smooth muscle cells (PASMCs) is a key mechanism in hypoxic pulmonary hypertension (HPH). Resistin-like Molecule Beta (RELM-β) promotes the hypoxia-induced proliferation of PASMCs, an... The proliferation of pulmonary artery smooth muscle cells (PASMCs) is a key mechanism in hypoxic pulmonary hypertension (HPH). Resistin-like Molecule Beta (RELM-β) promotes the hypoxia-induced proliferation of PASMCs, and calcium ions (Ca²⁺) play an important role in cell proliferation. However, the mechanism by which RELM-β regulates Ca²⁺ and the pathogenesis of HPH remain unclear. We established a RELM-β-knockout (RELM-β) model and assessed the mechanism by which RELM-β affects Ca regulation, cell proliferation, and pulmonary haemodynamics. In the rat HPH model and hypoxia-treated PASMCs, the expression of RELM-β was increased, which led to changes in pulmonary haemodynamics (elevated right ventricular systolic pressure [RVSP], right ventricular hypertrophy, and pulmonary artery thickening) and PASMC proliferation. Conversely, after RELM-β knockout, the opposite effects were observed. RELM-β regulated the intracellular Ca²⁺ concentration ([Ca²⁺]) through the Phospholipase C-Inositol 1,4,5-Trisphosphate Receptor (PLC-IPR) pathway, which promoted the release of intracellular Ca²⁺ and its binding to calcium-sensing receptor (CaSR), ultimately increasing store-operated calcium entry (SOCE) and extracellular Ca²⁺ influx and promoting PASMC proliferation. RELM-β, which is a cytokine-like growth factor, plays a role in the proliferation of PASMCs and the promotion of HPH.

Relationship of Pulmonary Artery to Aorta Ratio With Pulmonary Vascular Resistance, Compliance, and Outcomes in COPD and Interstitial Lung Disease in PVDOMICS.

Jankowich MD, Borgia M, Lempel J … +5 more , Desanti E, Renapurkar R, Morrison AR, Choudhary G, Rounds SI

Pulm Circ · 2026 Jan · PMID 41567752 · Full text

Noninvasive imaging markers may be helpful in identifying higher-risk patients with various lung diseases. Pulmonary artery to aorta ratio (PA/A ratio) on computed tomography (CT) is an indicator of pulmonary hypertensio... Noninvasive imaging markers may be helpful in identifying higher-risk patients with various lung diseases. Pulmonary artery to aorta ratio (PA/A ratio) on computed tomography (CT) is an indicator of pulmonary hypertension, but its relationship with other hemodynamic, imaging, and physiologic measurements, functional status, and outcomes requires further investigation. We set out to determine if the PA/A ratio is related to components of right ventricular (RV) afterload (pulmonary vascular resistance (PVR), PA compliance), lung diffusion capacity, radiographic emphysema, or honeycombing on chest CT, six-minute-walk distance, and transplant-free survival in COPD and/or interstitial lung disease (ILD). Data including PA/A ratio, hemodynamics, imaging, physiologic measurements, and survival in Redefining Pulmonary Hypertension through Pulmonary Vascular Disease Phenomics (PVDOMICS) cohort participants with COPD, ILD, or both were analyzed in regression and survival models to determine the association between PA/A ratio and various outcomes. We found that PA/A ratio analyzed as a continuous variable or dichotomized (> 0.9 vs. ≤ 0.9) was associated with higher PVR and lower PA compliance in fully adjusted models. Having either a PA/A ratio > 0.9 or a more elevated PVR was associated with worse transplant-free survival, while PA compliance was not associated with survival. PVR did not appear to mediate the relationship of PA/A ratio with survival. PA/A ratio did not correlate with six-minute walk distance or presence of emphysema or honeycombing, but was related to lower lung diffusion capacity. In conclusion, PA/A ratio on CT is related to aspects of RV afterload and to survival in COPD and ILD.

Methamphetamine-Associated Pulmonary Arterial Hypertension: Impact, Mechanisms, and a Framework for Management.

Sood N, Weerasekare J, Zhyvylo I … +2 more , Goncharova EA, De Marco T

Pulm Circ · 2026 Jan · PMID 41567751 · Full text

Methamphetamine-associated pulmonary arterial hypertension (Meth-PAH) is an increasingly prevalent but understudied subtype of Group 1 pulmonary arterial hypertension (PAH). While most prevalent in the Western United Sta... Methamphetamine-associated pulmonary arterial hypertension (Meth-PAH) is an increasingly prevalent but understudied subtype of Group 1 pulmonary arterial hypertension (PAH). While most prevalent in the Western United States, its reach continues to expand with the evolving global methamphetamine epidemic. Despite its designation as a definite cause of PAH, there are no standardized diagnostic criteria or treatment guidelines specific to Meth-PAH. This review summarizes its epidemiology, proposed pathophysiology, clinical management, and treatment challenges. We outline a pragmatic approach to Meth-PAH, emphasizing structured screening for substance use, initiation of oral PAH-specific therapies regardless of abstinence, and therapy escalation based on adherence and serial risk assessment. Key knowledge gaps include Meth-PAH pathophysiology, performance of risk stratification tools, and the safety and efficacy of PAH therapies in patients with ongoing use. A multidisciplinary approach is needed to address both Meth-PAH and methamphetamine use disorder to improve outcomes in this high-risk, stigmatized population.

Effect of Early Versus Late Catheter-Directed Intervention on Clinical Outcomes in Acute Pulmonary Embolism: A Systematic Review and Meta-Analysis.

Abouelmagd AA, Abofrekha B, Al Zoubi BM … +7 more , Gowaily I, Mady MH, Heiba AH, Manasrah A, Elshahat M, Turkmani M, Abuelazm M

Pulm Circ · 2026 Jan · PMID 41561191 · Full text

Catheter-directed intervention (CDI) in patients presenting with pulmonary embolism (PE) is suggested to improve in-hospital outcomes. We aimed to compare the effect of early versus late initiation of CDI on in-hospital... Catheter-directed intervention (CDI) in patients presenting with pulmonary embolism (PE) is suggested to improve in-hospital outcomes. We aimed to compare the effect of early versus late initiation of CDI on in-hospital outcomes. A systematic review and meta-analysis were conducted according to PRISMA guidelines. A comprehensive search of PubMed, Scopus, Web of Science, and Embase databases was performed from inception to May 2025. Data extraction was conducted independently by multiple reviewers. Statistical analysis was performed using R software version 4.3.2, and odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) were combined using a random-effects model. Six studies, including 53,472 patients, were included. Early intervention before 24 h significantly reduced mortality (OR 0.61, 95% CI [0.44-0.84]; ² = 0%). Moreover, Early intervention before 24 h significantly reduced the all-cause readmission in patients with acute PE (OR = 0.81 (95% CI: [0.73, 0.89];  = 0%). There was no significant difference in risk of major bleeding in early vs late intervention (OR = 0.82; 95% CI: [0.48, 1.39];  = 69.3%). Also, early intervention before 24 h significantly reduced the length of hospital stay (LOS) (MD = -3.11 days (95% CI: [-4.33, -1.89]; ² = 0%). This meta-analysis showed that early CDI, particularly within 24 h of presentation, is associated with a significant reduction in both mortality and all-cause readmission in patients with acute PE, without increasing the risk of bleeding. These findings support the concept of "time-is-myocardium" and reinforce the need for structured protocols that enable early therapeutic intervention. Further randomized controlled trials are needed to confirm these findings and to establish the optimal timing for this potentially life-saving therapy.

Subcutaneous Treprostinil in PH Associated With Left Heart Disease or Chronic Lung Disease.

Sadushi-Koliçi R, Alajbegovic L, Gojic V … +6 more , Skoro-Sajer N, Campean I, Shafran I, Mörtl D, Gerges C, Lang IM

Pulm Circ · 2026 Jan · PMID 41555851 · Full text

Pulmonary hypertension (PH) associated with left heart disease (LHD-PH) and pulmonary hypertension associated with chronic lung disease (CLD-PH) are the most common PH subtypes but lack effective treatments. In a prospec... Pulmonary hypertension (PH) associated with left heart disease (LHD-PH) and pulmonary hypertension associated with chronic lung disease (CLD-PH) are the most common PH subtypes but lack effective treatments. In a prospective cohort study, 90 patients (39 LHD-PH, 51 CLD-PH) with severe disease [pulmonary vascular resistance (PVR) > 5 Wood units and recent right heart failure (RHF)] were treated with subcutaneous Treprostinil (scTRE). Clinical, echocardiographic, and hemodynamic parameters were assessed at baseline and at 12 months; survival was tracked for 5 years. In LHD-PH and CLD-PH patients at 12 months, 6-min walking distance (6MWD) improved by 88 m [64;112] and 52 m [22;89], respectively, World Health Organisation functional class (WHO FC) improved in 77% and 78% of patients and mean pulmonary artery pressure (mPAP) decreased by 5.78 mmHg and 9.05 mmHg, respectively. Tricuspid annular plane systolic excursion/systolic pulmonary artery pressure (TAPSE/sPAP) ratio improved in patients with CLD-PH. Median scTRE dose at 12 months was 30 ng/kg/min. Overall survival at 5 years was 38.6% in LHD-PH group and 49.7% in CLD-PH group. Patients with baseline pulmonary arterial wedge pressure (PAWP) < 12 mmHg had better outcomes. Open-label scTRE was associated with a spectrum of clinically relevant benefits in a select group of LHD-PH and CLD-PH patients recently hospitalized for RV failure and was well tolerated.

Prognostic Value of Acute Vasoreactivity in Chronic Thromboembolic Pulmonary Hypertension.

Uphus JAG, Hu JR, Huang S … +8 more , Hofbauer TM, Panzenboeck A, Sadushi-Kolici R, Shafran I, Skoro-Sajer N, Gerges C, Brittain E, Lang IM

Pulm Circ · 2026 Jan · PMID 41555850 · Full text

Vasoreactivity, which refers to the reduction of mean pulmonary arterial pressure in response to inhaled vasodilators, is a well-established metric for prognostication and treatment selection in patients with pulmonary a... Vasoreactivity, which refers to the reduction of mean pulmonary arterial pressure in response to inhaled vasodilators, is a well-established metric for prognostication and treatment selection in patients with pulmonary arterial hypertension. However, the role of vasoreactivity in chronic thromboembolic pulmonary hypertension is less studied. We investigated whether vasoreactivity at time of diagnosis carries prognostic value in all patients with chronic thromboembolic pulmonary hypertension, and how it relates to the effect of long-term pulmonary vasodilator treatments. Patients diagnosed with CTEPH were prospectively subjected to 40 ppm inhaled nitric oxide testing at the diagnostic right heart catheterization. Classic (acute decrease of mean pulmonary arterial pressure > 10 mmHg to a level below 40 mmHg,  = 25), absolute (acute decrease of by 10 mmHg,  = 47) and percent (acute decrease by 10%,  = 129, all with maintained cardiac output) definitions of vasoreactivity were examined in retrospect. The relationship between each definition and transplantation-free survival was assessed with Cox regression models adjusted for baseline mPAP, age, sex, and WHO functional class. Patients ( = 325) were observed over a median of 5.5 years (interquartile range 2.6-9.2). Vasoreactivity, by the percent definition, was associated with significantly improved adjusted 5-year transplantation-free survival (hazard ratio = 0.61, 95% confidence interval 0.38-0.97,  = 0.036). Among not operated patients (n = 174, 53.5%), vasodilator PH medications were associated with improved survival in vasoresponders (hazard ratio = 0.46, 95% confidence interval 0.22-0.96,  = 0.04), but had no impact on survival in non-vasoresponders (hazard ratio = 0.67, 95% confidence interval 0.36-1.24,  = 0.20). Vasoreactivity at baseline catheterization carries prognostic value in CTEPH.

Supplemental Oxygen Decreases Cardiac Effort in Pulmonary Arterial Hypertension.

Norton K, Gyawali B, Haight D … +2 more , James White R, Lachant D

Pulm Circ · 2026 Jan · PMID 41555849 · Full text

In this single-blind, crossover pilot study, supplemental oxygen at 2 L/min during 6-min walk test reduced Cardiac Effort in patients with pulmonary arterial hypertension, while 6-min walk distance remained unchanged. Th... In this single-blind, crossover pilot study, supplemental oxygen at 2 L/min during 6-min walk test reduced Cardiac Effort in patients with pulmonary arterial hypertension, while 6-min walk distance remained unchanged. This decrease suggests improved physiology for an unchanged workload. Continuous electrocardiogram heart rate monitoring adds considerable value to the 6-min walk.

From Clusters to Outcomes: Machine Learning-Based Phenotyping in Intermediate-High-Risk Acute Pulmonary Embolism.

Kultursay B, Kaymaz C, Tokgoz HC … +17 more , Karacam M, Keskin B, Tanyeri S, Hakgor A, Mutlu D, Bulus C, Sirma D, Atici SZ, Kibar M, Cicek SN, Vezir A, Erdem C, Bayram Z, Kulahcioglu S, Sekban A, Tanboga IH, Ozdemir N

Pulm Circ · 2026 Jan · PMID 41555848 · Full text

Intermediate-high-risk (IHR) pulmonary embolism (PE) represents a heterogeneous group in whom guideline-based criteria may insufficiently capture biologic and hemodynamic variability relevant to early deterioration. Data... Intermediate-high-risk (IHR) pulmonary embolism (PE) represents a heterogeneous group in whom guideline-based criteria may insufficiently capture biologic and hemodynamic variability relevant to early deterioration. Data-driven phenotyping may improve risk stratification and support individualized decisions regarding reperfusion therapy. In this retrospective cohort study (2012-2025), 553 guideline-defined IHR PE patients were analyzed using unsupervised machine learning. Thirty-six demographic, clinical, laboratory, echocardiographic, and CT variables were standardized and encoded as appropriate for clustering. Multiple algorithms were compared, and the optimal model was selected using silhouette width and stability metrics. Clinical characteristics, imaging findings, treatment patterns, and outcomes were compared across phenotypes. The primary outcome was in-hospital mortality; secondary outcome was all-cause long-term mortality. Multivariable logistic regression and Cox models assessed associations with outcomes, and pre-post-treatment changes were evaluated. Two phenotypes were identified using the k-prototypes algorithm (silhouette width = 0.697). Cluster 1 (RV-failure phenotype;  = 360) exhibited younger age, lower systolic blood pressure, more severe RV dysfunction, higher thrombotic burden, and lower baseline TAPSE/PASP ratios. Cluster 2 (comorbidity-dominant phenotype;  = 193) comprised older patients with more cardiovascular/metabolic comorbidities but relatively preserved hemodynamics. In-hospital mortality was 6.0% overall and lower in Cluster 2 (3.6% vs. 7.2%); Cluster 2 remained independently associated with reduced early mortality (OR: 0.43; 95% CI: 0.19-0.98). The CDT-cluster interaction term was not statistically significant. Both phenotypes demonstrated significant improvements in RV function after reperfusion, with greater gains-including TAPSE/PASP-in Cluster 1. Over a median follow-up of 73.2 months, long-term mortality did not differ significantly between phenotypes (log-rank  = 0.11). Unsupervised ML revealed two clinically meaningful IHR PE phenotypes with divergent early risk but comparable long-term outcomes. These findings suggest that phenotype-based assessment may refine risk stratification and help guide individualized decisions regarding CDT and other reperfusion strategies in acute PE.

Beta-3 Adrenoreceptor Agonist Mirabegron Improves Right Ventricular Function in a Rat Monocrotaline-Induced Pulmonary Hypertension Model.

Mendes-Ferreira P, Tielemans B, Wagenaar A … +11 more , Bouzin C, Adão R, Pokreisz P, De Mulder D, Leite-Moreira A, Brás-Silva C, Balligand JL, Dessy C, Delcroix M, Quarck R, Belge C

Pulm Circ · 2026 Jan · PMID 41532037 · Full text

Considering the beta-3 adrenoceptor agonist, mirabegron, may display vasodilator and cardioprotective properties, we investigated the therapeutic potential of mirabegron in monocrotaline-induced pulmonary hypertension in... Considering the beta-3 adrenoceptor agonist, mirabegron, may display vasodilator and cardioprotective properties, we investigated the therapeutic potential of mirabegron in monocrotaline-induced pulmonary hypertension in rats. High-dose mirabegron improved right ventricular function, and endothelium-dependent relaxation in isolated rat pulmonary arteries, suggesting that mirabegron may be beneficial in pulmonary arterial hypertension.

Cerebral Tissue Pulmonary Embolism Masquerading as Primary Graft Dysfunction After Lung Transplantation.

Izhakian S, Heching M, Fridel L … +3 more , Rosengarten D, Kramer MR, Shtraichman O

Pulm Circ · 2026 Jan · PMID 41532036 · Full text

Early graft dysfunction following lung transplantation is commonly attributed to primary graft dysfunction (PGD). However, other rare etiologies may present with similar clinical and radiologic features. We report a uniq... Early graft dysfunction following lung transplantation is commonly attributed to primary graft dysfunction (PGD). However, other rare etiologies may present with similar clinical and radiologic features. We report a unique case of a 58-year-old male with idiopathic pulmonary fibrosis who underwent bilateral lung transplantation. The donor was a young adult with traumatic brain injury. Within hours post-transplant, the recipient developed severe hypoxemia and diffuse infiltrates on chest imaging, consistent with Grade 3 PGD. Despite supportive therapy, there was limited improvement. Histopathological examination of transbronchial biopsies revealed cerebral cortical neurons and glial tissue embedded in the pulmonary vasculature, confirming cerebral tissue embolism. This case highlights cerebral tissue pulmonary embolism as an under-recognized cause of early allograft dysfunction. Clinicians should consider donor-derived embolic events, particularly in trauma-related donors, in the differential diagnosis of PGD-like presentations.

Comparison of the Efficacy and Safety of Sutureless Technique Versus Conventional Surgery in the Initial Treatment of Total Anomalous Pulmonary Venous Connection: A Systematic Review and Meta-Analysis.

Shen L, Ding N, Liu H … +4 more , Yi H, Zhang J, Zhao G, Li Z

Pulm Circ · 2026 Jan · PMID 41522630 · Full text

Total anomalous pulmonary venous connection (TAPVC) is a rare but life-threatening congenital heart defect that requires surgical correction. The sutureless technique has been developed as an alternative to conventional... Total anomalous pulmonary venous connection (TAPVC) is a rare but life-threatening congenital heart defect that requires surgical correction. The sutureless technique has been developed as an alternative to conventional repair to minimize postoperative complications. This meta-analysis evaluates and compares the efficacy and safety of the two surgical approaches. A comprehensive literature search was conducted in PubMed, EMBASE, the Cochrane Library, and major Chinese databases for studies published between January 2010 and December 2024. Five retrospective comparative studies including a total of 1,327 patients met the inclusion criteria. Data were analyzed using RevMan version 5.4. Primary outcome measures included the incidence of postoperative pulmonary venous obstruction (PVO), reoperation due to PVO, total postoperative mortality, and late mortality. A random-effects model was applied to all analyses to account for anticipated clinical heterogeneity. A subgroup analysis based on TAPVC anatomical type was also performed. The meta-analysis demonstrated that the sutureless technique was associated with a significantly lower postoperative PVO rate (Odds Ratio [OR] = 0.46; 95% Confidence Interval [CI]: 0.28-0.77;  = 0.047) and a reduced reoperation rate due to PVO (OR = 0.25; 95% CI: 0.08-0.77;  = 0.049) compared with conventional surgery. Subgroup analysis indicated that the reduction in postoperative PVO was most evident among patients with infracardiac-type TAPVC. No statistically significant differences were observed in total postoperative mortality (OR = 0.66; 95% CI: 0.35-1.24;  > 0.05) or late mortality (OR = 0.37; 95% CI: 0.13-1.06;  > 0.05). Across all outcomes, heterogeneity was low to moderate (I² < 50%). Major limitations of this study include the retrospective design of all included studies, small sample sizes for certain analyses, variability in study methodology, and possible publication bias. The sutureless technique appears to be a safe and effective alternative to conventional surgery for primary TAPVC repair. It significantly reduces postoperative PVO and the need for reoperation, with the greatest benefit observed in high-risk subtypes such as infracardiac TAPVC. However, given that all available evidence is derived from retrospective studies of moderate quality, further large-scale prospective investigations are required to validate these findings and assess long-term outcomes.

Echinacoside Improves Pulmonary Vascular Remodeling by Regulating the L- and T-Type Ca Channels in the Prevention and Treatment of Pulmonary Hypertension.

Zhao Y, Wang J, Qiao Y … +8 more , Gai X, Hu J, Wang H, Xia Q, Hu Q, Li Z, Li C, Bi H

Pulm Circ · 2026 Jan · PMID 41522629 · Full text

The typical pathology of pulmonary hypertension (PH) is characterized by pulmonary vasoconstriction and irreversible pulmonary vascular remodeling. Vascular remodeling is the process of structural changes and cellular re... The typical pathology of pulmonary hypertension (PH) is characterized by pulmonary vasoconstriction and irreversible pulmonary vascular remodeling. Vascular remodeling is the process of structural changes and cellular rearrangement of blood vessels due to injury and is a significant factor in conditions such as PH. Echinacoside (ECH) is a phenylethanol glycoside from Tibetan herbs, and our previous study found that ECH modulated calcium channels on pulmonary artery smooth muscle cells (PASMCs) and improved pulmonary vasoconstriction. To investigate the role of ECH in improving pulmonary vascular remodeling in PH, we constructed hypoxia-induced hypoxic pulmonary hypertension (HPH) and MCT-induced pulmonary arterial hypertension (PAH) models. Transcriptomic analysis revealed significant enrichment of Cav1.2, Cav3.2, and PKC/MAPK signaling pathways in PAH rats. ECH effectively inhibited Cav1.2 and Cav3.2 protein and mRNA expression, as well as the phosphorylation levels of PKC/MAPK, in HPH and PAH. In addition, ECH effectively reduced mean pulmonary artery pressure (mPAP) and right ventricular hypertrophy index (RVHI) and improved pulmonary vascular remodeling in HPH and PAH rats. In short, we found that ECH improved pulmonary vascular remodeling by modulating Cav1.2 and Cav3.2/PKC/MAPK pathways. Furthermore, this improvement was effective in both HPH and PAH.

Global Resource Disparities Between Pulmonary Hypertension Centers: Results From the International Survey by the PVRI IDDI Access to Care Workstream.

Prisco SZ, Kantorovich A, Liu Y … +7 more , Sahay S, Bernardo R, Balasubramanian V, Raj JU, Golden G, Rischard F, PVRI Innovative Drug Development Initiative Access to Care Workstream

Pulm Circ · 2026 Jan · PMID 41510145 · Full text

There is a limited understanding of how pulmonary hypertension (PH) patients are managed worldwide. The Pulmonary Vascular Research Institute (PVRI) Innovative Drug Discovery Initiative (IDDI) global survey attempted to... There is a limited understanding of how pulmonary hypertension (PH) patients are managed worldwide. The Pulmonary Vascular Research Institute (PVRI) Innovative Drug Discovery Initiative (IDDI) global survey attempted to obtain insights into access to PH care in diverse international regions to pave future action plans. Responses from 151 centers (19.9% from Europe, 3.9% Middle East, 6% South Asia, 17.9% East Asia, 2% Sub-Saharan Africa, 31.8% Latin America, and 18.5% North America) were received. Most respondents had access to electrocardiography, echocardiography, and right heart catheterization but less availability to pulmonary function tests, ventilation/perfusion scans, and genetic testing. Phosphodiesterase type 5 (PDE-5) inhibitors were available in almost all centers but there was limited access to oral, inhaled, and parenteral prostacyclin therapy, riociguat, and selexipag. Cluster analysis of middle-high- and high income countries demonstrated significant variability in PH care delivery and disparities in therapeutic resources across the three clusters. The most common limitations identified that contribute to delayed PH diagnosis were insufficient financial resources, insufficient staff, and limited time. Survey respondents requested access to webinars with content experts (45%), access to content experts for consultation and review of complex cases via video chat (55%), resources to attend a conference (67.5%), and provision of a mentorship program (33.1%) along with greater availability of medications, remote conference access, clinical trial availability, and increased advocacy for patients. Survey results suggest significant disparities across the globe. Further research is needed to understand access to PH care and therapies in non-expert/academic centers and regional disparities within countries.

My First Step Into the Pulmonary Circulation World.

Voelkel NF

Pulm Circ · 2025 Oct · PMID 41473697 · Full text

Abstract loading — click title to view on PubMed.

Splenectomy Increases CTEPH Risk and Modifies Clinical Features of Acute Pulmonary Embolism.

White D, Locke BW, Scarpato BM … +3 more , Cirulis MM, Raif K, Dodson MW

Pulm Circ · 2026 Jan · PMID 41472662 · Full text

Chronic thromboembolic pulmonary hypertension (CTEPH) is due to unresolved pulmonary embolism (PE), however the pathophysiology of how PE evolves into CTEPH is unclear. Study of populations of acute PE patients at increa... Chronic thromboembolic pulmonary hypertension (CTEPH) is due to unresolved pulmonary embolism (PE), however the pathophysiology of how PE evolves into CTEPH is unclear. Study of populations of acute PE patients at increased risk for CTEPH, such as those with prior splenectomy, may clarify the mechanisms driving transition from acute PE to CTEPH. In this study, we examined the relationship between acute PE, CTEPH and splenectomy in two observational cohorts. In the first, we compared the frequency of splenectomy among groups of patients with CTEPH, PE, and no PE. In the second, we compare clinical features of acute PE presentation in hospitalized patients with or without a prior splenectomy. We find that a history of splenectomy is significantly more frequent in patients with CTEPH than in patients with PE (OR 4.3, 95% CI 1.5-12.6). This association remained when we compared CTEPH patients to PE patients without a provoking factor for PE (OR 5.3, 95% CI 1.7-16.9), a population that is at increased risk of developing CTEPH. Patients with acute PE and prior splenectomy were more likely to present with subacute symptoms, more likely to have a distal location of PE, and less likely to have deep venous thrombosis (DVT) than were non-splenectomized acute PE patients. Thus, prior splenectomy appears to modify some clinical features of acute PE. We hypothesize that the difference in clinical features of PE that are observed in the context of prior splenectomy are relevant to the increased risk of CTEPH observed in this population.

Leveraging Vascular Over Ventricular Ratios in Observational Chronic Thromboembolic Pulmonary Hypertension and Acute Pulmonary Embolism Cohorts to Decode Clot Chronicity on Computed Tomography Angiography.

Larson J, Khorasani S, Laurenzo S … +6 more , Chiu S, Malaisrie SC, Schimmel D, Rahaghi F, Cuttica M, Mylvaganam R

Pulm Circ · 2025 Oct · PMID 41459318 · Full text

This study evaluates the utility of CT-derived PA/A and RV/LV ratios in distinguishing surgically accessible CTEPH from acute PE and negative controls. Unlike the RV/LV ratio, PA/A ratio was significantly higher in CTEPH... This study evaluates the utility of CT-derived PA/A and RV/LV ratios in distinguishing surgically accessible CTEPH from acute PE and negative controls. Unlike the RV/LV ratio, PA/A ratio was significantly higher in CTEPH patients compared to low and intermediate/high-risk acute PE cohorts, indicating its utility as a marker of clot chronicity.

Pulmonary Hypertension Associated With Sickle Cell Disease and Schistosomiasis.

Mickael C, Kabwe JC, Fonseca Balladares D … +15 more , Bai AS, Nolan K, Lee MH, Kumar R, Hilton JF, Phiri J, Musonda T, Tuscan K, Sanders L, Stenmark KR, Buehler PW, Sinkala E, Irwin DC, Mazimba S, Graham BB

Pulm Circ · 2025 Oct · PMID 41438844 · Full text

Schistosomiasis and sickle cell disease (SCD) both cause pulmonary hypertension (PH). We identified a subject with sickle cell trait and hepatosplenic schistosomiasis, who on right heart catheterization had PH, but due t... Schistosomiasis and sickle cell disease (SCD) both cause pulmonary hypertension (PH). We identified a subject with sickle cell trait and hepatosplenic schistosomiasis, who on right heart catheterization had PH, but due to high cardiac output. In a pre-clinical model, we found SCD mice were protected from developing schistosomiasis-induced PH.

The Discovery of Inhaled Prostanoids for Pulmonary Hypertension.

Seeger W

Pulm Circ · 2025 Oct · PMID 41426514 · Full text

Abstract loading — click title to view on PubMed.

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