Cargando…
Pulmonary Arterial Remodeling Is Related to the Risk Stratification and Right Ventricular-Pulmonary Arterial Coupling in Patients With Pulmonary Arterial Hypertension
BACKGROUND: Pulmonary arterial (PA) stiffness has an essential contribution to the right ventricular (RV) failure pathogenesis. A comprehensive and multiparameter risk assessment allows predicting mortality and guiding treatment decisions in PA hypertension (PAH). We characterize PA remodeling with...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8126681/ https://www.ncbi.nlm.nih.gov/pubmed/34012405 http://dx.doi.org/10.3389/fphys.2021.631326 |
_version_ | 1783693811872956416 |
---|---|
author | Grignola, Juan C. Domingo, Enric López-Meseguer, Manuel Trujillo, Pedro Bravo, Carlos Pérez-Hoyos, Santiago Roman, Antonio |
author_facet | Grignola, Juan C. Domingo, Enric López-Meseguer, Manuel Trujillo, Pedro Bravo, Carlos Pérez-Hoyos, Santiago Roman, Antonio |
author_sort | Grignola, Juan C. |
collection | PubMed |
description | BACKGROUND: Pulmonary arterial (PA) stiffness has an essential contribution to the right ventricular (RV) failure pathogenesis. A comprehensive and multiparameter risk assessment allows predicting mortality and guiding treatment decisions in PA hypertension (PAH). We characterize PA remodeling with intravascular ultrasound (IVUS) in prevalent and stable patients with PAH according to the ESC/ERS risk table and analyze the RV-PA coupling consequences. METHODS: Ten control subjects and 20 prevalent PAH adult patients underwent right heart catheterization (RHC) with simultaneous IVUS study. We estimated cardiac index (CI), pulmonary vascular resistance, and compliance (PVR, PAC) by standard formulas. From IVUS and RHC data, PA diameter, wall thickness/luminal diameter ratio, and indexes of stiffness (pulsatility, compliance, distensibility, incremental elastic modulus - Einc-, and the stiffness index β) were measured. We evaluated RV-PA coupling by the ratio of tricuspid annular plane systolic excursion to systolic pulmonary arterial pressure (TAPSE/sPAP). The individual average risk was calculated by assigning a score of 1 (low-risk -LR-), 2 (intermediate-risk -IR-), and 3 (high-risk -HR-) for each of seven variables (functional class, six-minute walking test, brain natriuretic peptide, right atrial area and pressure, CI, and PA oxygen saturation) and rounding the average value to the nearest integer. RESULTS: All PA segments interrogated showed increased vessel diameter, wall cross-sectional area (WCSA), and stiffness in patients with PAH compared to control subjects. 45% corresponded to LR, and 55% corresponded to IR PAH patients. The different measurements of PA stiffness showed significant correlations with TAPSE/sPAP (r = 0.6 to 0.76) in PAH patients. The IR group had higher PA stiffness and lower relative WCSA than LR patients (P < 0.05), and it is associated with a lower PAC and TAPSE/sPAP (P < 0.05). CONCLUSION: In prevalent PAH patients, the severity of proximal PA remodeling is related to the risk stratification and associated with PAC and RV-PA coupling impairment beyond the indirect effect of the mean PA pressure. The concomitant assessment of IVUS and hemodynamic parameters at diagnosis and follow-up of PAH patients could be a feasible and safe tool for risk stratification and treatment response of the PA vasculopathy during serial hemodynamic measurements. |
format | Online Article Text |
id | pubmed-8126681 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-81266812021-05-18 Pulmonary Arterial Remodeling Is Related to the Risk Stratification and Right Ventricular-Pulmonary Arterial Coupling in Patients With Pulmonary Arterial Hypertension Grignola, Juan C. Domingo, Enric López-Meseguer, Manuel Trujillo, Pedro Bravo, Carlos Pérez-Hoyos, Santiago Roman, Antonio Front Physiol Physiology BACKGROUND: Pulmonary arterial (PA) stiffness has an essential contribution to the right ventricular (RV) failure pathogenesis. A comprehensive and multiparameter risk assessment allows predicting mortality and guiding treatment decisions in PA hypertension (PAH). We characterize PA remodeling with intravascular ultrasound (IVUS) in prevalent and stable patients with PAH according to the ESC/ERS risk table and analyze the RV-PA coupling consequences. METHODS: Ten control subjects and 20 prevalent PAH adult patients underwent right heart catheterization (RHC) with simultaneous IVUS study. We estimated cardiac index (CI), pulmonary vascular resistance, and compliance (PVR, PAC) by standard formulas. From IVUS and RHC data, PA diameter, wall thickness/luminal diameter ratio, and indexes of stiffness (pulsatility, compliance, distensibility, incremental elastic modulus - Einc-, and the stiffness index β) were measured. We evaluated RV-PA coupling by the ratio of tricuspid annular plane systolic excursion to systolic pulmonary arterial pressure (TAPSE/sPAP). The individual average risk was calculated by assigning a score of 1 (low-risk -LR-), 2 (intermediate-risk -IR-), and 3 (high-risk -HR-) for each of seven variables (functional class, six-minute walking test, brain natriuretic peptide, right atrial area and pressure, CI, and PA oxygen saturation) and rounding the average value to the nearest integer. RESULTS: All PA segments interrogated showed increased vessel diameter, wall cross-sectional area (WCSA), and stiffness in patients with PAH compared to control subjects. 45% corresponded to LR, and 55% corresponded to IR PAH patients. The different measurements of PA stiffness showed significant correlations with TAPSE/sPAP (r = 0.6 to 0.76) in PAH patients. The IR group had higher PA stiffness and lower relative WCSA than LR patients (P < 0.05), and it is associated with a lower PAC and TAPSE/sPAP (P < 0.05). CONCLUSION: In prevalent PAH patients, the severity of proximal PA remodeling is related to the risk stratification and associated with PAC and RV-PA coupling impairment beyond the indirect effect of the mean PA pressure. The concomitant assessment of IVUS and hemodynamic parameters at diagnosis and follow-up of PAH patients could be a feasible and safe tool for risk stratification and treatment response of the PA vasculopathy during serial hemodynamic measurements. Frontiers Media S.A. 2021-05-03 /pmc/articles/PMC8126681/ /pubmed/34012405 http://dx.doi.org/10.3389/fphys.2021.631326 Text en Copyright © 2021 Grignola, Domingo, López-Meseguer, Trujillo, Bravo, Pérez-Hoyos and Roman. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Physiology Grignola, Juan C. Domingo, Enric López-Meseguer, Manuel Trujillo, Pedro Bravo, Carlos Pérez-Hoyos, Santiago Roman, Antonio Pulmonary Arterial Remodeling Is Related to the Risk Stratification and Right Ventricular-Pulmonary Arterial Coupling in Patients With Pulmonary Arterial Hypertension |
title | Pulmonary Arterial Remodeling Is Related to the Risk Stratification and Right Ventricular-Pulmonary Arterial Coupling in Patients With Pulmonary Arterial Hypertension |
title_full | Pulmonary Arterial Remodeling Is Related to the Risk Stratification and Right Ventricular-Pulmonary Arterial Coupling in Patients With Pulmonary Arterial Hypertension |
title_fullStr | Pulmonary Arterial Remodeling Is Related to the Risk Stratification and Right Ventricular-Pulmonary Arterial Coupling in Patients With Pulmonary Arterial Hypertension |
title_full_unstemmed | Pulmonary Arterial Remodeling Is Related to the Risk Stratification and Right Ventricular-Pulmonary Arterial Coupling in Patients With Pulmonary Arterial Hypertension |
title_short | Pulmonary Arterial Remodeling Is Related to the Risk Stratification and Right Ventricular-Pulmonary Arterial Coupling in Patients With Pulmonary Arterial Hypertension |
title_sort | pulmonary arterial remodeling is related to the risk stratification and right ventricular-pulmonary arterial coupling in patients with pulmonary arterial hypertension |
topic | Physiology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8126681/ https://www.ncbi.nlm.nih.gov/pubmed/34012405 http://dx.doi.org/10.3389/fphys.2021.631326 |
work_keys_str_mv | AT grignolajuanc pulmonaryarterialremodelingisrelatedtotheriskstratificationandrightventricularpulmonaryarterialcouplinginpatientswithpulmonaryarterialhypertension AT domingoenric pulmonaryarterialremodelingisrelatedtotheriskstratificationandrightventricularpulmonaryarterialcouplinginpatientswithpulmonaryarterialhypertension AT lopezmeseguermanuel pulmonaryarterialremodelingisrelatedtotheriskstratificationandrightventricularpulmonaryarterialcouplinginpatientswithpulmonaryarterialhypertension AT trujillopedro pulmonaryarterialremodelingisrelatedtotheriskstratificationandrightventricularpulmonaryarterialcouplinginpatientswithpulmonaryarterialhypertension AT bravocarlos pulmonaryarterialremodelingisrelatedtotheriskstratificationandrightventricularpulmonaryarterialcouplinginpatientswithpulmonaryarterialhypertension AT perezhoyossantiago pulmonaryarterialremodelingisrelatedtotheriskstratificationandrightventricularpulmonaryarterialcouplinginpatientswithpulmonaryarterialhypertension AT romanantonio pulmonaryarterialremodelingisrelatedtotheriskstratificationandrightventricularpulmonaryarterialcouplinginpatientswithpulmonaryarterialhypertension |