title: Nitric oxide and pulmonary arterial pressures in pulmonary hypertension.
abstract: Decreased production of vasodilator substances such as nitric oxide (NO) has been proposed as important in development of pulmonary arterial hypertension (PAH). We hypothesize that NO measured over time serves as a non invasive marker of severity of PAH and response to therapy. We prospectively and serially measured exhaled NO and carbon monoxide (CO), a vasodilator and anti-inflammatory product of heme oxygenases, in 17 PAH patients in conjunction with hemodynamic parameters over 2 years. Although pulmonary artery pressures and NO were similar in all patients at entry to the study, NO increased in the 12 individuals who survived to complete the study, and correlated with change in pulmonary artery pressures. In contrast, CO did not change or correlate with hemodynamic parameters. Investigation of NO-oxidant reaction products in PAH in comparison to controls suggests that NO synthesis is impaired in the lung and that reactive oxygen species may be involved in the pathophysiology of pulmonary hypertension. Endogenous NO is inversely related to pulmonary artery pressure in PAH, with successful therapy of PAH associated with increase in NO.
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
authors.forename: Roberto F
authors.initials: RF
authors.lastname: Machado
authors.forename: Medha-Vini
authors.initials: MV
authors.lastname: Londhe Nerkar
authors.forename: Raed A
authors.initials: RA
authors.lastname: Dweik
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hammel
authors.forename: Allison
authors.initials: A
authors.lastname: Janocha
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Pyle
authors.forename: Daniel
authors.initials: D
authors.lastname: Laskowski
authors.forename: Constance
authors.initials: C
authors.lastname: Jennings
authors.forename: Alejandro C
authors.initials: AC
authors.lastname: Arroliga
authors.forename: Serpil C
authors.initials: SC
authors.lastname: Erzurum
mesh_terms: D001794:Blood Pressure / Q000502:physiology*; D002248:Carbon Monoxide / Q000378:metabolism; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000378:metabolism* / Q000503:physiopathology* / Q000628:therapy; D008875:Middle Aged; D009569:Nitric Oxide / Q000378:metabolism*; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000378:metabolism* / Q000503:physiopathology*; D013997:Time Factors
chemical_list: D009569:Nitric Oxide; D002248:Carbon Monoxide