Assessment of Right Ventricular-Pulmonary Arterial Coupling in Schistosomiasis-Associated Pulmonary Arterial Hypertension

Обзор

Pulmonary Arterial Hypertension is a progressive and potentially fatal cardiopulmonary disorder characterized by remodeling of the pulmonary vasculature, progressive elevation of pulmonary vascular resistance (PVR), and eventual right ventricular (RV) failure. According to the 2022 European Society of Cardiology/European Respiratory Society (ESC/ERS) guidelines, pulmonary hypertension is currently defined hemodynamically by a mean pulmonary arterial pressure (mPAP) \>20 mmHg measured by right heart catheterization, while pulmonary arterial hypertension is additionally characterized by pulmonary arterial wedge pressure (PAWP) ≤15 mmHg and PVR \>2 Wood units. Schistosomiasis-associated pulmonary arterial hypertension (Sch-PAH) is classified within Group 1 PAH and represents one of the most important causes of PAH in endemic regions, particularly in developing countries such as Egypt and Brazil. Schistosomiasis is considered the second most prevalent parasitic disease worldwide after malaria, affecting more than 200 million individuals globally. Chronic hepatosplenic schistosomiasis may lead to porto-systemic shunting, allowing parasite eggs to embolize into the pulmonary circulation, triggering chronic inflammation, endothelial dysfunction, and pulmonary vascular remodeling. The pathological changes observed in Sch-PAH resemble those seen in idiopathic PAH, including medial hypertrophy, intimal fibrosis, and plexiform lesions. However, several studies suggest that patients with Sch-PAH may exhibit better long-term survival compared with idiopathic PAH despite comparable pulmonary hemodynamic impairment. The mechanisms underlying this relatively favorable prognosis remain incompletely understood. Right ventricular adaptation to increased afterload is currently recognized as one of the principal determinants of prognosis in PAH.

Вмешательства

• Процедура right heart catheterization for measure pulmonary artery pressure
  right heart catheterization for measure pulmonary artery pressure Through swan ganz catheter

Первичные конечные точки

• Right ventricular-pulmonary arterial coupling quantified by the TAPSE/PASP ratio measured by transthoracic echocardiography at baseline [Срок оценки: 1 year]

Критерии участия

Критерии включения

• All patients above 18 year diagnosed with schistozomiasis through history of exposure , serology , positive stool antigens ,Symmers' periportal fibrosis (the "clay pipe-stem" appearance) or Splenomegaly and suspected pulmonary hypertension through Probability Score" approach based on the 2022 ESC/ERS

Критерии исключения

• All patients below 18 years old.
• Left ventricular systolic or diastolic dysfunction.
• Significant left-sided valvular heart disease.
• severe chronic lung disease such as, Chronic obstructive pulmonary disease (COPD) ---- GOLD 4 and severe Interstitial lung disease (ILD).
• Chronic Thromboembolic Pulmonary Hypertension.
• Congenital heart diseases.
• Severe hepatic or renal impairment unrelated to schistosomiasis.
• Hemodynamically unstable patients.
• Poor echocardiographic window preventing adequate RV assessment.
• Active infection or acute systemic illness.
• Refusal to participate in the study.
• Significant arrhythmias affecting hemodynamic assessment (e.g., uncontrolled atrial fibrillation).
• Previous heart or lung transplantation.
• Pregnancy.

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Не применимо

Модель

Одна группа

Маскирование

Открытое

Основная цель

Лечение

Центры проведения

Египет · 1 центр

• Mansoura university hospitals — Al Mansurah

Публикации

• Blanca-Jover E, Contreras-Chova F, Jerez-Calero A, Uberos-Fernandez J, Perez-Lara L. Congenital Heart Disease and Pulmonary Arterial Hypertension: Current Perspectives. Rev Cardiovasc Med. 2026 Mar 20;27(3):48337. doi: 10.31083/RCM48337. eCollection 2026 Mar. PMID 41923748
• Lee SY, Jung HO, Kim KA, Oh GC, Jung MH, Youn JC, Chung WB, Youn HJ. Impact of the New Definition on the Prognosis of Patients With Pulmonary Hypertension Compared to the Classic Definition. Korean Circ J. 2025 Nov;55(11):984-997. doi: 10.4070/kcj.2024.0416. Epub 2025 Jul 1. PMID 40736381
• Gupfert M, Weber L, Haager PK, Baier P, Kopp S, Rigger J, Chronis J, Gerhard M, Rickli H, Maeder MT. Impact of Right Heart Catheterization and the 2022 ESC/ERS Definition of Pulmonary Hypertension in Patients With Mitral Regurgitation Undergoing Valve Repair/Replacement. Pulm Circ. 2026 Feb 12;16(1):e70265. doi: 10.1002/pul2.70265. eCollection 2026 Jan. PMID 41695275
• Soliman YMA, El-Kassas M, ElAziz AA, Mousa MS, Hasswa MK, Magdy S, Elkorashy R. Clinical and hemodynamic evaluation of schistosomiasis-associated pulmonary arterial hypertension from Egyptian pulmonary hypertension centers: epidemiology, risk factors, and survival determinants. Sci Rep. 2026 Mar 21;16(1):9668. doi: 10.1038/s41598-026-41412-7. PMID 41865030

Идентификаторы

NCT: NCT07707193 · Sohag-Med--26-6-4 MD

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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