Pulmonary Arterial Remodeling Is Related to the Risk Stratification and Right Ventricular-Pulmonary Arterial Coupling in Patients With Pulmonary Arterial Hypertension
Grignola, Juan C. (Universidad de la República (Uruguai))
Domingo Ribas, Enric (Universitat Autònoma de Barcelona. Departament de Medicina)
López-Meseguer, Manuel (Hospital Universitari Vall d'Hebron)
Trujillo, Pedro (Universidad de la República (Uruguai))
Bravo Masgoret, Carles (Hospital Universitari Vall d'Hebron)
Pérez-Hoyos, Santiago (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Roman, Antonio (Hospital Universitari Vall d'Hebron)

Data:	2021
Resum:	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. 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. 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). 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.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Pulmonary arterial stiffness ; Right ventricular-arterial coupling ; Pulmonary arterial hypertension ; Intravascular ultrasound ; Risk stratification
Publicat a:	Frontiers in physiology, Vol. 12 (may 2021) , ISSN 1664-042X

DOI: 10.3389/fphys.2021.631326
PMID: 34012405

13 p, 1.3 MB

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