Noninvasively Assessed Pulmonary Artery Stiffness Predicts Mortality in Pulmonary Arterial Hypertension

Gan, C. Tji-Joong; Lankhaar, Jan-Willem; Westerhof, Nico; Marcus, J. Tim; Becker, Annemarie; Twisk, Jos W. R.; Boonstra, Anco; Postmus, Pieter E.; Vonk‐Noordegraaf, Anton

doi:10.1378/chest.07-1246

Cited by 351 publications

(312 citation statements)

References 25 publications

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“…Pulmonary hypertension is associated with proximal PA distension and reduced distensibility 12. Indices of proximal PA distensibility or stiffness quantified by echocardiography,13, 14 computed tomography angiography,15 and magnetic resonance imaging12, 16, 17, 18, 19 are attractive noninvasive indices of PH in humans.…”

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confidence: 99%

“…Indices of proximal PA distensibility or stiffness quantified by echocardiography,13, 14 computed tomography angiography,15 and magnetic resonance imaging12, 16, 17, 18, 19 are attractive noninvasive indices of PH in humans. These indices correlate with “gold standard” invasive measurements of pulmonary vascular resistance and PA pressure,14, 15, 18 are reliable and early noninvasive indicators of PH (even when only exercised‐induced PH is present),16, 18 predict mortality,12, 17, 18 and help predict acute drug responsiveness 19. Recently, a right pulmonary artery distensibility (RPAD) index quantified by echocardiography, essentially a shortening fraction of the right PA, was evaluated in dogs affected with heartworm disease and various degrees of PH 6.…”

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confidence: 99%

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Diagnostic Value of Right Pulmonary Artery Distensibility Index in Dogs with Pulmonary Hypertension: Comparison with Doppler Echocardiographic Estimates of Pulmonary Arterial Pressure

Visser

Johnson

et al. 2016

Veterinary Internal Medicne

109

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BackgroundNoninvasive diagnosis of pulmonary hypertension (PH) primarily relies upon Doppler echocardiography of tricuspid regurgitation (TR). However, TR might be absent or difficult to measure.Hypothesis/ObjectivesTo determine the diagnostic value of right pulmonary artery distensibility (RPAD) index for prediction of Doppler‐derived estimates of pulmonary artery (PA) pressure compared to other indices of PH in dogs.AnimalsSixty‐nine client‐owned dogs with TR.MethodsProspective observational study. Dogs were allocated to groups according to TR pressure gradient (TRPG): TRPG <36 mmHg (control, n = 22), TRPG 36–50 (n = 16), TRPG 50–75 (n = 14) and TRPG >75 mmHg (n = 17). Right pulmonary artery distensibility index, acceleration time to peak PA flow (AT), AT: ejection time of PA flow (AT:ET) and main PA size: aorta size (MPA:Ao) were calculated in each dog.ResultsRight pulmonary artery distensibility index demonstrated the strongest correlation (r = −0.90; P < .0001) to TRPG followed by MPA:Ao (r = 0.78; P < .0001), AT (r = −0.69; P < .0001) and AT:ET (r = −0.68; P < .0001). RPAD index possessed the most accurate cutoff (<29.5%; Sensitivity [Sn] 0.84, Specificity [Sp] 0.95) to predict TRPG >50 mmHg compared to AT (<53.9 ms; Sn 0.74, Sp 0.87), AT:ET (<0.30; Sn 0.61, Sp 0.97) and MPA:Ao (>1.04; Sn 0.94, Sp 0.74). All intra‐ and interobserver measurement variabilities exhibited coefficients of variation ≤13%.Conclusions and Clinical ImportanceRight pulmonary artery distensibility index is an accurate predictor of TRPG and should be particularly useful if TR is absent or difficult to measure.

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confidence: 99%

mentioning

confidence: 99%

Diagnostic Value of Right Pulmonary Artery Distensibility Index in Dogs with Pulmonary Hypertension: Comparison with Doppler Echocardiographic Estimates of Pulmonary Arterial Pressure

Visser

Johnson

et al. 2016

Veterinary Internal Medicne

109

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“…PWV has been studied as a noninvasive measure of PA stiffness 8, 29, 30, 31. A major difficulty in measuring PWV is related to the change in the shape of pressure and flow waves with distance that makes it difficult to assign a single value that is definitive for the entire wave.…”

Section: Discussionmentioning

confidence: 99%

“…Application of PWV to PA is further complicated by PA anatomical features because of its short distance and curvature, and a need for a high temporal resolution CMR 32. Except studies measuring PWV in normal subjects,30, 31 other studies involving PWV and analysis of RV CMR indexes were performed in patients with advanced PAH with overall much higher values of mean pulmonary artery pressure and PVR, thus limiting its clinical use 8, 29, 33, 34. The latter is also true for studies applying the dynamic contrast–enhanced magnetic resonance imaging in pulmonary vascular system in patients with advanced PAH 35, 36.…”

Section: Discussionmentioning

confidence: 99%

Novel Noninvasive Assessment of Pulmonary Arterial Stiffness Using Velocity Transfer Function

Gupta

Sharifov

Lloyd

et al. 2018

JAHA

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BackgroundPulmonary artery (PA) stiffness is associated with increased pulmonary vascular resistance (PVR). PA stiffness is accurately described by invasive PA impedance because it considers pulsatile blood flow through elastic PAs. We hypothesized that PA stiffness and impedance could be evaluated noninvasively by PA velocity transfer function (VTF), calculated as a ratio of the frequency spectra of output/input mean velocity profiles in PAs.Methods and ResultsIn 20 participants (55±19 years, 14 women) undergoing clinically indicated right‐sided heart catheterization, comprehensive phase‐contrast and cine‐cardiac magnetic resonance imaging was performed to calculate PA VTF, along with right ventricular mass and function. PA impedance was measured as a ratio of frequency spectra of invasive PA pressure and echocardiographically derived PA flow waveforms. Mean PA pressure was 29.5±13.6 mm Hg, and PVR was 3.5±2.8 Wood units. A mixed‐effects model showed VTF was significantly associated with PA impedance independent of elevation in pulmonary capillary wedge pressure (P=0.005). The mean of higher frequency moduli of VTF correlated with PVR (ρ=0.63; P=0.003) and discriminated subjects with low (n=10) versus elevated PVR (≥2.5 Wood units, n=10), with an area under the curve of 0.95, similar to discrimination by impedance (area under the curve=0.93). VTF had a strong inverse association with right ventricular ejection fraction (ρ=−0.73; P<0.001) and a significant positive correlation with right ventricular mass index (ρ=0.51; P=0.02).Conclusions VTF, a novel right ventricular–PA axis coupling parameter, is a surrogate for PA impedance with the potential to assess PA stiffness and elevation in PVR noninvasively and reliably using cardiac magnetic resonance imaging.

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“…Distensibility, compliance, stiffness, and RAC require an area or diameter measurement, which in humans4, 5 and in an animal models of pulmonary hypertension6 are measured by the gold standard of MRI. Only the first three require an invasive pressure measurement, which is typically obtained by right heart catheterization 4, 5.…”

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confidence: 99%

Letter to the Editor

Kellihan

Chesler

2016

Veterinary Internal Medicne

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Noninvasively Assessed Pulmonary Artery Stiffness Predicts Mortality in Pulmonary Arterial Hypertension

Cited by 351 publications

References 25 publications

Diagnostic Value of Right Pulmonary Artery Distensibility Index in Dogs with Pulmonary Hypertension: Comparison with Doppler Echocardiographic Estimates of Pulmonary Arterial Pressure

Diagnostic Value of Right Pulmonary Artery Distensibility Index in Dogs with Pulmonary Hypertension: Comparison with Doppler Echocardiographic Estimates of Pulmonary Arterial Pressure

Novel Noninvasive Assessment of Pulmonary Arterial Stiffness Using Velocity Transfer Function

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