title: Risk factors for hemoptysis in idiopathic and hereditary pulmonary arterial hypertension.
abstract: BACKGROUND
  When hemoptysis complicates pulmonary arterial hypertension (PAH), it is assumed to result from bronchial artery hypertrophy. In heritable PAH, the most common mutation is in the BMPR2 gene, which regulates growth, differentiation and apoptosis of mesenchymal cells. The aim of this study is to determine the relationship in PAH between the occurrence of hemoptysis, and disease progression, bronchial artery hypertrophy, pulmonary artery dilation and BMPR2 mutations.
  
  
  METHODS
  129 IPAH patients underwent baseline pulmonary imaging (CT angio or MRI) and repeated right-sided heart catheterization. Gene mutations were assessed in a subset of patients.
  
  
  RESULTS
  Hemoptysis was associated with a greater presence of hypertrophic bronchial arteries and more rapid hemodynamic deterioration. The presence of a BMPR2 mutation did not predispose to the development of hemoptysis, but was associated with a greater number of hypertrophic bronchial arteries and a worse baseline hemodynamic profile.
  
  
  CONCLUSIONS
  Hemoptysis in PAH is associated with bronchial artery hypertrophy and faster disease progression. Although the presence of a BMPR2 mutation did not correlate with a greater incidence of hemoptysis in our patient cohort, its association with worse hemodynamics and a trend of greater bronchial arterial hypertrophy may increase the risk of hemoptysis.
authors.affiliation: Pulmonology Department, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Darryl
authors.initials: D
authors.lastname: Tio
authors.forename: Edward
authors.initials: E
authors.lastname: Leter
authors.forename: Bart
authors.initials: B
authors.lastname: Boerrigter
authors.forename: Anco
authors.initials: A
authors.lastname: Boonstra
authors.forename: Anton
authors.initials: A
authors.lastname: Vonk-Noordegraaf
authors.forename: Harm Jan
authors.initials: HJ
authors.lastname: Bogaard
mesh_terms: D052006:Bone Morphogenetic Protein Receptors, Type II / Q000235:genetics*; D001981:Bronchial Arteries / Q000473:pathology*; D006328:Cardiac Catheterization; D006439:Hemodynamics; D006469:Hemoptysis / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000235:genetics* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D011651:Pulmonary Artery / Q000473:pathology*; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
chemical_list: C498218:BMPR2 protein, human; D052006:Bone Morphogenetic Protein Receptors, Type II