Background: Pulmonary hypertension (PH) is a chronic and complex condition, requiring consistent management and education. The widespread use of smartphones has opened possibilities for mobile health apps to support both patients and health care professionals in monitoring and managing PH more effectively. Objective: This study aimed to identify and assess the quality of free smartphone apps for PH targeted at either patients or health care professionals. Methods: A systematic search was conducted on freely available apps for patients with PH and health care professionals, accessed from a Spanish IP address, on Android (Google Play) and iOS (App Store) platforms. Searches were performed in October 2022 and 2023. Apps were independently analyzed by two reviewers, focusing on general characteristics. Quality assessment was based on the Mobile Application Rating Scale (MARS) framework, and Mann-Whitney U tests compared mean MARS scores against specific variables. Results: In the overall study, 21 apps were identified. In the 2022 search, 19 apps were listed (9 iOS, 7 Android, 3 available on both platforms). In the subsequent 2023 search, 16 apps were identified (6 Android, 7 iOS, 3 available on both platforms). Of those identified in 2022, 14 remained available in 2023, with only 7 updated since 2022. In addition, 12 apps targeted patients or the general population, while 9 targeted health care professionals; none involved patients in the development or design. Conversely, 13 apps involving health care professionals were identified. There were 10 apps that received pharmaceutical industry funding. The primary goal for 81% (17/21) of the apps was to disseminate general information about PH. The overall mean MARS quality was acceptable in 2022 and 2023, with mean ratings of 3.1 (SD 0.6) and 3.3 (SD 0.5), respectively. The functionality category achieved the highest scores in both years, indicating ease of use and intuitive navigation. In contrast, the subjective quality domain consistently received the lowest ratings in the MARS assessment across both years. None of the apps underwent clinical testing themselves; however, 2 incorporated tools or algorithms derived from trials. The overall quality of iOS apps statistically outperformed that of Android apps in both years (P<.05). Furthermore, the involvement of health care professionals in app development was associated with enhanced quality, a trend observed in both years (P=.003 for both years). Conclusions: This review of mobile health apps for PH reveals their emergent development stage, with generally acceptable quality but lacking refinement. It highlights the critical role of health care professionals in app development, as they contribute significantly to quality and reliability. Despite this, a notable stagnation in app quality and functionality improvement over 2 years points to a need for continuous innovation and clinical validation for effective clinical integration. This research advocates for future app developers to actively engage with health care professionals, integrate patient insights, and mandate rigorous clinical validation for PH management.

Background: The pathogenesis of chronic thromboembolic pulmonary hypertension (CTEPH) involves a multifaceted interplay of factors, including incomplete thrombus resolution, endothelial dysfunction, and vascular remodeling. Recent studies have highlighted the role of extracellular vesicles (EVs) in vascular diseases, suggesting their potential involvement in CTEPH progression. This study aims to investigate the role of EVs from various cellular sources in the development of CTEPH. Methods: An experimental study was conducted using 11 male three-month-old Large-White pigs. The EVs of endothelial origin (EEVs; CD146+), leukocyte-derived EVs (LEVs; CD45+, CD44+), and consistent with mesenchymal-origin EVs (CD90+, CD105+) were quantified. Measurements were taken at baseline, after the first embolization, and prior to each subsequent weekly embolization. Embolizations were repeated until chronic pulmonary hypertension (PH) was generated. Based on these findings, a clinical case-control study was performed involving nine patients previously diagnosed with CTEPH and 18 patients with pulmonary embolism who did not develop CTEPH after two years of follow-up. Results: The experimental study, consistent with the mesenchymal-origin EVs, exhibited a progressive decrease below baseline levels; LEVs decreased after PH was established, while EEVs remained elevated throughout the study. Subsequently, in the clinical case-control study, CD45+ LEVs emerged as a significant association of CTEPH, with an odds ratio (OR) of 21.25 (95% CI: 1.91–236.00; p = 0.013). Conclusions: Inflammation involving LEVs and EEVs plays a crucial role in sustaining the vascular alterations leading to pulmonary vasculature remodeling in CTEPH.

Introduction: Chronic thromboembolic pulmonary hypertension (CTEPH) is generated after one or repited pulmonary embolism (PE). Objectives: To study the relationship between the levels of microvesicles (MVs) and hemodynamic changes on mean pulmonary arterial pressures (mPAP) from PE to CTEPH. Methods: Experimental procedures were performed in large white pigs. Acute PE was generated by pulmonary embolization with polydextrane-microspheres with a diameter of 300 μm, pre-capillary PH was obtained by repeated microsphere embolizations. Next, we carried out a case-control study with 9 patients with CTEPH and 18 with PE without CTEPH. We measured total MVs, endothelial (EMVs), leukocytes (LMVs) and mesenchymal origin by flow cytometry. U-Mann Whitney, Friedman and Spearman9s coefficient were applied according to analysis. Results: The animal model achieved to increase mPAP after an acute embolism (p=0.02) and after repeat embolisms (p=0.034) reproducing the hemodynamic features seen in the patients. Negative correlations were found between EMVs and mPAP after repeated embolisms (Rho: -0.886, p=0.019) and between LMVs and mPAP in an acute embolism (Rho: -0.986, p<0.001). Positive correlation was shown between mPAP after an acute embolism and CD90+CD105+Mvs measured after repeated embolisms (Rho: 832, p=0.040). In patients, MVs in CTEPH group are higher than in PE (p=0.046). EMVs decreased in the most severe patients while LMVs increased in these patients. Conclusions: Inverse relationship between EMVs levels and mPAP suggests a lack of endothelial reserve in the experimental model and in the most severe patients.

BACKGROUND Pulmonary hypertension (PH), is a chronic and complex condition, requiring consistent management and education. The widespread use of smartphones has opened possibilities for mobile health apps to support both patients and healthcare professionals in monitoring and managing PH more effectively. OBJECTIVE The review aimed to identify and assess the quality of free smartphone apps for PH targeted at both patients and healthcare professionals. METHODS A systematic search was conducted on freely available apps for PH patients and healthcare professionals, accessed from a Spain IP address, on Android (Google Play) and iOS (App Store) platforms. Searches were performed in October 2022 and 2023. Apps were independently analysed by two reviewers, focusing on general characteristics. Quality assessment was based on the Mobile Application Rating Scale (MARS) framework, and Mann-Whitney U tests compared mean MARS scores against specific variables. RESULTS In the overall study, 21 apps were identified. In the 2022 search, 19 apps were listed (9 iOS, 7 Android, 3 available on both platforms). In the subsequent 2023 search, 16 apps were identified (6 Android, 7 iOS, 3 available on both platforms). Of those identified in 2022, 14 remained available in 2023, with only 6 updated since 2022. Twelve apps targeted patients/general population, while 9 targeted healthcare professionals; none involved patients in the development or design. Conversely, 13 apps involving healthcare professionals were identified. Ten apps received pharmaceutical industry funding. The apps primary goals for 81% were to disseminate general information about PH. The overall MARS quality was acceptable in 2022 and 2023, rated at 2.9 (0.6) and 3.0 (0.5), respectively. The functionality category achieved the highest scores in both years, indicating ease of use and intuitive navigation. In contrast, the subjective quality domain consistently received the lowest ratings in the MARS assessment across both years. None of the apps underwent clinical testing themselves however, two incorporated tools/algorithms derived from trials. The overall quality of iOS applications statistically outperformed that of Android applications in both years (p<0.05). Furthermore, the involvement of healthcare professionals in app development was associated with enhanced quality, a trend observed in both years (p<0.05). CONCLUSIONS This review of mHealth apps for PH reveals their emergent development stage, with generally acceptable quality but lacking refinement. It highlights the critical role of healthcare professionals in app development, contributing significantly to their quality and reliability. Despite this, a notable stagnation in app quality and functionality improvement over two years points to a need for continuous innovation and clinical validation for effective clinical integration. Conclusively, this research advocates for future app developers to engage with healthcare professionals actively, integrate patient insights, and mandate rigorous clinical validation for PH management.