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Expert Rev Respir Med. 2016 Feb;10(2):235-40. doi: 10.1586/17476348.2016.1116389. Epub 2015 Nov 27.

Cardiovascular risk in pulmonary alveolar proteinosis.

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a 2nd Pulmonary Department , "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens , Athens , Greece.
b 2nd Critical Care Department, Pulmonary Hypertension Clinic , "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens , Athens , Greece.
c 7th Pulmonary Department and Asthma Center , Athens Chest Hospital , Athens , Greece.
d Hauner Children's University Hospital , Ludwig-Maximilians University, German Center for Lung Research , Munich , Germany.


We hypothesized that cardiovascular events and/or indices of cardiac dysfunction may be increased in pulmonary alveolar proteinosis (PAP). Systemic and pulmonary arterial hypertension, arrhythmias, pulmonary embolism, stroke and ischemic heart attack were reported. Patients underwent serum anti-GM-CSF antibodies, disease severity score (DSS), Doppler transthoracic echocardiograph, glucose, thyroid hormones, lipids, troponin and pro-Brain natriuretic peptide (BNP) examination. Thirteen patients (8 female) were studied, median age of 47. Pro-BNP inversely related to DLCO% and TLC%; troponin directly related to DSS, age, P(A-a)O2, left atrium-, left ventricle-end-diastole diameter and BMI. On multiple regression analysis DSS was the only parameter significantly and strongly related with troponin (R(2) = 0.776, p = 0.007). No cardiovascular event was reported during follow-up. In PAP cardiovascular risk indices relate to lung disease severity. Therefore, PAP patients could be at increased risk for cardiovascular events. Quantitation of its magnitude and potential links to lungs' physiologic derangement will be addressed in future studies.


Pulmonary alveolar proteinosis; autoimmune pulmonary alveolar proteinosis; cardiovascular events; disease severity; inhaled GM-CSF; pro-BNP; pulmonary arterial hypertension; serum lipids; troponin

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