The ischemia and pulmonary hypertension involved in APE can induce an increase in serum levels of cytokines and chemokines, including tumor necrosis factor-alpha (TNFα), interleukin (IL)-1β, IL-8, CX3CR1, CXCRL1, brain natriuretic peptide (BNP), troponin T (TnT) and D-dimer (D2D) (Zagorski et al., 2003; Wang et al., 2013; Wang et al., 2014; Zhang et al., 2017; Shi et al., 2018). Here, TNF is linked to pulmonary arterial hypertension.