Pulmonary Vascular Distensibility and Early Pulmonary Vascular Remodeling in Pulmonary Hypertension

Singh, Inderjit; Oliveira, R.; Naeije, Robert; Rahaghi, F.N.; Oldham, William M.; Systrom, David; Waxman, Aaron

doi:10.1016/j.chest.2019.04.111

Cited by 40 publications

(50 citation statements)

References 29 publications

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“…PA distensibility is one of several measures of PA stiffness and reflects the degree of vascular remodelling as the percent increase in pulmonary vessel diameter in relation to the increase in pressure [ 74 , 96 , 100 ]. It is a strong prognostic marker [ 74 ] and has been associated with RV pulmonary arterial uncoupling in patients with unexplained exercise intolerance and normal resting echocardiography results [ 101 ].…”

Section: Estimates Of Mean Pulmonary Pressure and Pulmonary Resistancmentioning

confidence: 99%

Cardiac Magnetic Resonance Imaging in Pulmonary Arterial Hypertension: Ready for Clinical Practice and Guidelines?

Kjellström

Lindholm

Ostenfeld

2020

Curr Heart Fail Rep

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Purpose of Review Pulmonary arterial hypertension (PAH) is a progressive disease with high mortality. A greater understanding of the physiology and function of the cardiovascular system in PAH will help improve survival. This review covers the latest advances within cardiovascular magnetic resonance imaging (CMR) regarding diagnosis, evaluation of treatment, and prognostication of patients with PAH. Recent Findings New CMR measures that have been proven relevant in PAH include measures of ventricular and atrial volumes and function, tissue characterization, pulmonary artery velocities, and arterio-ventricular coupling. Summary CMR markers carry prognostic information relevant for clinical care such as treatment response and thereby can affect survival. Future research should investigate if CMR, as a non-invasive method, can improve existing measures or even provide new and better measures in the diagnosis, evaluation of treatment, and determination of prognosis of PAH.

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Section: Estimates Of Mean Pulmonary Pressure and Pulmonary Resistancmentioning

confidence: 99%

Cardiac Magnetic Resonance Imaging in Pulmonary Arterial Hypertension: Ready for Clinical Practice and Guidelines?

Kjellström

Lindholm

Ostenfeld

2020

Curr Heart Fail Rep

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“…The distensibility factor a has been shown to be higher in pre-menopausal women and lower in aging adults, 19 lower in young adult men of Sub-Saharan African ascendance 20 lower with chronic but not acute hypoxic exposure 2,21 or diesel exhaust exposure, 22 and lower in adolescents born by in vitro fertilization. 14 The a factor has been reported to be decreased in patients with borderline hypertension, 23 early or latent pulmonary vascular disease, 5,24 and heart failure. 6,24 A decreased pulmonary vascular distensibility results in higher PA pressures during exercise, which may be associated with insufficient RV function adaptation, RV-PA uncoupling and decreased aerobic exercise capacity, in healthy subjects 19,25 and more so in heart failure patients.…”

Section: Discussionmentioning

confidence: 99%

“…14 The a factor has been reported to be decreased in patients with borderline hypertension, 23 early or latent pulmonary vascular disease, 5,24 and heart failure. 6,24 A decreased pulmonary vascular distensibility results in higher PA pressures during exercise, which may be associated with insufficient RV function adaptation, RV-PA uncoupling and decreased aerobic exercise capacity, in healthy subjects 19,25 and more so in heart failure patients. 6,24 In this study, the pulmonary circulation was more distensible in adolescents compared to adults.…”

Section: Discussionmentioning

confidence: 99%

“…6,24 A decreased pulmonary vascular distensibility results in higher PA pressures during exercise, which may be associated with insufficient RV function adaptation, RV-PA uncoupling and decreased aerobic exercise capacity, in healthy subjects 19,25 and more so in heart failure patients. 6,24 In this study, the pulmonary circulation was more distensible in adolescents compared to adults. Even though this was associated with a better RV-PA coupling as assessed by TAPSE/ PASP and S'/PASP ratios, aerobic exercise measured by VO 2 max corrected for body weight was not different.…”

Section: Discussionmentioning

confidence: 99%

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Exercise stress echocardiography of the pulmonary circulation and right ventricular-arterial coupling in healthy adolescents

Forton

Motoji

Caravita

et al. 2020

European Heart Journal - Cardiovascular Imaging

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Aims To explore the effects of age and sex in adolescents vs. young or middle-aged adults on pulmonary vascular function and right ventricular-arterial (RV-PA) coupling as assessed by exercise stress echocardiography. Methods and results Forty healthy adolescents aged 12–15 years were compared with 40 young adults aged 17–22 years and 40 middle-aged adults aged 30–50 years. Sex distribution was equal in the three groups. All the subjects underwent an exercise stress echocardiography. A pulmonary vascular distensibility coefficient α was determined from multipoint pulmonary vascular pressure–flow relationships. RV-PA coupling was assessed by the tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure (PASP) ratio, who has been previously validated by invasive study. While cardiac index and mean PAP were not different, adolescents compared to young and middle-aged adults, respectively had higher pulmonary vascular distensibility coefficients α (1.60 ± 0.31%/mmHg vs. 1.39 ± 0.29%/mmHg vs. 1.20 ± 0.35%/mmHg, P < 0.00001). Adolescents and young adults compared to middle-aged adults, respectively had higher TAPSE/PASP ratios at rest (1.24 ± 0.18 mm/mmHg and 1.22 ± 0.17 mm/mmHg vs. 1.07 ± 0.18 mm/mmHg, P < 0.008) and during exercise (0.86 ± 0.24, 0.80 ± 0.15 and 0.72 ± 0.15 mm/mmHg, P < 0.04). The TAPSE/PASP ratio decreased with exercise. There were no sex differences in α or TAPSE/PASP. Conclusion Compared to adults, adolescents present with a sex-independent more distensible pulmonary circulation. Resting and exercise RV-PA coupling is decreased in middle-aged adults.

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“…15 On this subject, a decrease in the pulmonary vascular distensibility or an increase in the PVR can be associated with an impaired aerobic exercise capacity and RVpulmonary arterial uncoupling. 16 In this issue of the European Journal of Preventive Cardiology, Domenech-Ximenos et al 17 evaluated the ventricular remodelling induced by endurance exercise together with pulmonary function in 93 athletes between 20 and 45 years of age and highly trained (minimum of 12 hours a week in the last 5 years). The authors also analysed their results based on sex differences and compared their findings with a control population of 72 age and sex-matched individuals.…”

mentioning

confidence: 99%

Cardiovascular magnetic resonance to evaluate cardiopulmonary remodelling in endurance athletes: can we predict adaptation to exercise?

Rodríguez-Palomares

2019

Eur J Prev Cardiolog

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Pulmonary Vascular Distensibility and Early Pulmonary Vascular Remodeling in Pulmonary Hypertension

Cited by 40 publications

References 29 publications

Cardiac Magnetic Resonance Imaging in Pulmonary Arterial Hypertension: Ready for Clinical Practice and Guidelines?

Cardiac Magnetic Resonance Imaging in Pulmonary Arterial Hypertension: Ready for Clinical Practice and Guidelines?

Exercise stress echocardiography of the pulmonary circulation and right ventricular-arterial coupling in healthy adolescents

Cardiovascular magnetic resonance to evaluate cardiopulmonary remodelling in endurance athletes: can we predict adaptation to exercise?

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