In Vivo Diagnosis of Pulmonary Atherosclerosis

Kravitz, Kevin D.; Scharf, Gerald R.; Chandrasekaran, Krishnaswamy

doi:10.1378/chest.106.2.632

Cited by 5 publications

(7 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The higher blood pressure in the systemic arteries is currently the most widely accepted explanation for their preferential predisposition to atherosclerotic lesion development in comparison to pulmonary arteries (6,7). The 'pressure hypothesis' is also supported by the findings of pulmonary arterial lesions in the presence of pulmonary hypertension (5,8). Certain studies have reported lesions reminiscent of atherosclerotic plaques in the pulmonary arteries of patients with pulmonary hypertension (5,8,9,28).…”

Section: Discussionmentioning

confidence: 87%

“…The 'pressure hypothesis' is also supported by the findings of pulmonary arterial lesions in the presence of pulmonary hypertension (5,8). Certain studies have reported lesions reminiscent of atherosclerotic plaques in the pulmonary arteries of patients with pulmonary hypertension (5,8,9,28). However, systemic atherosclerosis frequently affects people with normal blood pressure, indicating the involvement of factors other than high blood pressure in the etiopathogenesis.…”

Section: Discussionmentioning

confidence: 87%

“…A notable exception to atherosclerotic involvement exists in the pulmonary circulation. Studies of atherosclerosis of pulmonary arteries are anecdotal, although not unknown (2)(3)(4)(5). Traditionally, this higher susceptibility of systemic arteries to atherogenesis relative to pulmonary arteries has been attributed to higher hydrodynamic forces in the former (6,7).…”

Section: Introductionmentioning

confidence: 99%

“…Traditionally, this higher susceptibility of systemic arteries to atherogenesis relative to pulmonary arteries has been attributed to higher hydrodynamic forces in the former (6,7). When pulmonary arterial pressure is elevated, complex angiopathic lesions develop in the pulmonary arteries that have sometimes been found to resemble systemic atherosclerosis (5,8,9). However, the arterial lesions in pulmonary hypertension are very different from atherosclerotic plaques in their distribution and histopathology (9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Association of increased lipid peroxide levels in the aorta in comparison to the pulmonary artery with the presence of coronary artery disease

Malik

2016

Biomedical Reports

View full text Add to dashboard Cite

Abstract. Atherosclerosis predominantly affects systemic arteries as compared to pulmonary arteries; however, the reasons for this differential predilection are not clear. Oxidative damage caused by free radicals is a key initiating event in atherogenesis and the lungs are able to produce large quantities of free radicals even under physiological conditions. The present study investigated whether pulmonary venous blood reaching the aorta contained greater quantities of lipid peroxides, a marker of oxidative stress, compared to the pulmonary artery. Aortic and pulmonary artery blood samples were collected at the time of cardiac catheterization from 45 consecutive patients (38% female) without acute coronary event and free of other medical disorders, who were scheduled to undergo coronary angiography for anginal chest pain. Lipid peroxides were measured in terms of malondialdehyde (MDA). MDA levels were significantly higher in the aorta compared to the pulmonary artery (4.93±1.97 vs. 3.36±1.14 nmol/ml; P<0.001); the difference was significant in patients with angiographic coronary artery disease (CAD) (P<0.001) compared to the patients without CAD (P=0.071). Higher aortic MDA levels were associated with the presence of CAD even following adjustment for major risk factors. The results of the present study demonstrate that aortic blood contains significantly greater levels of lipid peroxides compared to pulmonary artery. This differential oxidative stress between systemic and pulmonary arteries could provide a mechanistic explanation for their difference in the propensity to develop atherosclerosis.

show abstract

Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Association of increased lipid peroxide levels in the aorta in comparison to the pulmonary artery with the presence of coronary artery disease

Malik

2016

Biomedical Reports

View full text Add to dashboard Cite

show abstract

“…29 Helical CT scans and MR angiography were available in some of our COPD patients with CPA lesions. The presence of some CPA abnormality was in most cases confirmed by both CT and MR angiography, but the lesions were less evident by these techniques than by TEE.…”

Section: Russo Et Al Pulmonary Artery Lesions In Copdmentioning

confidence: 99%

Central Pulmonary Artery Lesions in Chronic Obstructive Pulmonary Disease

et al. 1999

View full text Add to dashboard Cite

Background-In patients with acute pulmonary embolism, transesophageal echocardiography (TEE) often reveals presumably thrombotic lesions within the central pulmonary arteries (CPAs). These CPA lesions, when found in patients with primary pulmonary hypertension, have been attributed to in situ thrombosis or atherosclerosis. We hypothesized that similar CPA lesions may also develop in patients with chronic obstructive pulmonary disease (COPD) in the absence of pulmonary embolism. Methods and Results-We examined by TEE 25 patients with COPD and 27 control patients with left heart disease. None of the patients had previous pulmonary embolism or ileofemoral and popliteal vein thrombosis. By use of TEE, CPA lesions were found in 12 COPD patients (48%) and 2 control patients (7.4%) (PϽ0.01). When CPA lesions were subdivided into types 1 (protruding and mobile) and 2 (wall-adherent), type 1 lesions proved to be uncommon, being found within the pulmonary trunk in 12% and 3.7% of COPD and control patients, respectively (PϭNS). Conversely, type 2 lesions, which were always localized in the right pulmonary artery, were frequent in COPD patients (36%) and rare in control patients (3.7%) (PϽ0.01). When available, helical CT and MR angiography confirmed TEE findings, supporting an atherosclerotic origin of type 2 lesions, which were different from typical thrombotic lesions. FEV 1 /FVC ratio, RV/TLC ratio, PaO 2 , hematocrit value, and pulmonary artery systolic pressure were not significantly different in COPD patients with and without CPA lesions. At TEE, however, COPD patients with CPA lesions showed a larger size of the main and right pulmonary arteries. Conclusions-TEE often reveals CPA lesions in stable patients with COPD even in the absence of significant pulmonary hypertension and not in close relation with the severity of pulmonary dysfunction.

show abstract

In vivo tomographic assessment of the heart and blood vessels with intravascular ultrasound

Görge¹,

Baumgart

et al. 1998

Basic Research in Cardiology

View full text Add to dashboard Cite

Intravascular ultrasound (IVUS) has emerged from being a research tool to becoming an intrinsic part of modern invasive cardiology mainly due to imaging micro anatomy in vivo. For the first time, it is possible to base therapeutic decisions not only on lumenograms but also on vessel wall assessment. IVUS has both diagnostic and intervention associated potential. The diagnostic strength of IVUS is its ability to describe compensatory coronary artery enlargement as a response to arteriosclerosis, to assess intermediate lesions, and to reveal occult left main stem disease and angiographically "silent" arteriosclerosis. The intervention associated potential of IVUS is the optimal device selection, i.e., rotablators in calcified lesions or atherectomy devices in large plaque burden. The effects of PTCA on vessel wall morphology can be studied in great detail and the effect on luminal gain can be assessed. Several groups have shown that the residual plaque area ("plaque burden") even after angiographically successful PTCA still lies in the range of 60%. A significant reduction in this number may influence long-term outcome after PTCA. Minimal luminal area and residual plaque area after PTCA seem to be indicators of restenosis, while the presence or absence of dissections seems to be less predictive. The main mechanism of restenosis after PTCA is vessel shrinkage, not intimal hyperplasia. Intravascular monitoring of stent expansion led to high-pressure stent deployment with a significant increase in post-procedural luminal diameters and the ability to withhold anticoagulation in patients with optimal stent deployment. In pulmonary and aortic diseases, IVUS contributed significantly to the understanding of aortic dissection and pulmonary hypertension. Additionally, with intracardiac ultrasound left and right ventricular function can be assessed. Intracardiac ultrasound has gained clinical usefulness for guiding transcatheter ablation in patients with conduction system abnormalities. In the future, integrated devices, such as balloons on IVUS catheters, steerable catheters, integrated flow and pressure transducers, tissue characterization, and 0.018" IVUS guide wire will further enhance the usefulness of IVUS.

show abstract

In Vivo Diagnosis of Pulmonary Atherosclerosis

Cited by 5 publications

References 10 publications

Association of increased lipid peroxide levels in the aorta in comparison to the pulmonary artery with the presence of coronary artery disease

Association of increased lipid peroxide levels in the aorta in comparison to the pulmonary artery with the presence of coronary artery disease

Central Pulmonary Artery Lesions in Chronic Obstructive Pulmonary Disease

In vivo tomographic assessment of the heart and blood vessels with intravascular ultrasound

Contact Info

Product

Resources

About