title: In situ expression of Bcl-2 in pulmonary artery endothelial cells associates with pulmonary arterial hypertension relative to heart failure with preserved ejection fraction.
abstract: We have previously reported that pulmonary artery endothelial cells (PAECs) can be harvested from the tips of discarded Swan-Ganz catheters after right heart catheterization (RHC). In this study, we tested the hypothesis that the existence of an antiapoptotic phenotype in PAECs obtained during RHC is a distinctive feature of pulmonary arterial hypertension (PAH; World Health Organization group 1) and might be used to differentiate PAH from other etiologies of pulmonary hypertension. Specifically, we developed a flow cytometry-based measure of Bcl-2 activity, referred to as the normalized endothelial Bcl-2 index (NEBI). We report that higher NEBI values are associated with PAH to the exclusion of heart failure with preserved ejection fraction (HFpEF) and that this simple diagnostic measurement is capable of differentiating PAH from HFpEF without presenting addition risk to the patient. If validated in a larger, multicenter study, the NEBI has the potential to assist physicians in the selection of appropriate therapeutic interventions in the common and dangerous scenario wherein patients present a clinical and hemodynamic phenotype that makes it difficult to confidently differentiate between PAH and HFpEF.
authors.affiliation: Cardiovascular Institute, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
authors.forename: Raymond L
authors.initials: RL
authors.lastname: Benza
authors.affiliation: Cardiovascular Institute, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
authors.forename: Gretchen
authors.initials: G
authors.lastname: Williams
authors.affiliation: Cardiovascular Institute, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
authors.forename: Changgong
authors.initials: C
authors.lastname: Wu
authors.affiliation: Autoimmunity Institute, Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
authors.forename: Kelly J
authors.initials: KJ
authors.lastname: Shields
authors.affiliation: Cardiovascular Institute, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
authors.forename: Amresh
authors.initials: A
authors.lastname: Raina
authors.affiliation: Cardiovascular Institute, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Murali
authors.affiliation: Cardiovascular Institute, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Passineau
keywords: Bcl-2; diagnostics; endothelial cells; heart failure with preserved ejection fraction; pulmonary arterial hypertension; pulmonary artery; right heart catheterization