![]() Several of these microRNAs regulate transcripts that drive cardiac remodeling and pulmonary arterial hypertension and are now emerging as epigenetic pulmonary arterial hypertension biomarkers and targets for therapy. We identified for the first time in human disease (pulmonary arterial hypertension) trans-right–ventricle and transpulmonary microRNA gradients in blood plasma. The differential microRNA-concentrations correlated with prognostic hemodynamic variables (pulmonary vascular resistance, tricuspid annular plane systolic excursion, etc.). Between-group comparison revealed miR-29a-3p, miR-26a-5p, miR-590-5p, and miR-200c-3p as upregulated in pulmonary arterial hypertension-superior vena cava and miR-99a-5p as downregulated in pulmonary arterial hypertension–pulmonary artery. Measurements and Main Results:Īnalysis of differential concentrations (false discovery rate < 0.05) revealed two trans-right–ventricle microRNA gradients (pulmonary artery vs superior vena cava): miR-193a-5p (step-up in pulmonary arterial hypertension and step-down in control) and miR-423-5p (step-down in pulmonary arterial hypertension and step-up in control) and two transpulmonary microRNA gradients (ascending aorta vs pulmonary artery): miR-26b-5p (step-down only in control) and miR-331-3p (step-up only in pulmonary arterial hypertension). Standard pulmonary arterial hypertension treatment. Nine nonpulmonary arterial hypertension controls included as follows: mild/moderate left ventricular outflow tract obstruction (7), mediastinal teratoma (1), portal vein stenosis (1). Twelve pulmonary arterial hypertension patients included as follows: idiopathic pulmonary arterial hypertension (5), pulmonary arterial hypertension (2), pulmonary arterial hypertension-repaired congenital heart disease (4), portopulmonary pulmonary hypertension (1). ![]() Setting:Ĭhildren’s hospital at a medical school. Prospective blood collection during cardiac catheterization from the superior vena cava, pulmonary artery, and ascending aorta in 12 children with pulmonary arterial hypertension and nine matched nonpulmonary arterial hypertension controls, followed by an unbiased quantitative polymerase chain reaction array screen for 754 microRNAs in plasma. Measurement of transpulmonary pressure assists in spirometry in availing for calculation of static lung compliance.We investigated whether concentrations of circulating microRNAs differ across the hypertensive right ventricle and pulmonary circulation, and correlate with hemodynamic/echocardiographic variables in patients with pulmonary arterial hypertension versus nonpulmonary arterial hypertension controls. The intrapleural pressure is estimated by measuring the pressure inside a balloon placed in the esophagus. The alveolar pressure is estimated by measuring the pressure in the airways while holding one's breath. Transpulmonary pressure can be measured by placing pressure transducers. Lung volume at any given pressure during inhalation is more than the lung volume at any given pressure during exhalation. The transpulmonary pressure vs volume curve of inhalation (usually plotted as volume as a function of pressure) is different from that of exhalation, the difference being described as hysteresis. For a given lung volume, the transpulmonary pressure is equal and opposite to the elastic recoil pressure of the lung. Under physiological conditions the transpulmonary pressure is always positive intrapleural pressure is always negative and relatively large, while alveolar pressure moves from slightly negative to slightly positive as a person breathes. Download scientific diagram Changes in pulmonary vascular resistance (PVR) (A), transpulmonary pressure gradient (TPG) (B), diastolic pressure gradient. If 'transpulmonary pressure' = 0 (alveolar pressure = intrapleural pressure), such as when the lungs are removed from the chest cavity or air enters the intrapleural space (a pneumothorax), the lungs collapse as a result of their inherent elastic recoil. Since atmospheric pressure is relatively constant, pressure in the lungs must be higher or lower than atmospheric pressure for air to flow between the atmosphere and the alveoli. Where P tp is transpulmonary pressure, P alv is alveolar pressure, and P ip is intrapleural pressure. ![]() During human ventilation, air flows because of pressure gradients. Transpulmonary pressure is the difference between the alveolar pressure and the intrapleural pressure in the pleural cavity. ![]()
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