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New concepts in the invasive and non invasive evaluation of remodelling of the right ventricle and pulmonary vasculature in pulmonary arterial hypertension.

Domingo E, Aguilar R, López-Meseguer M, Teixidó G, Vazquez M, Roman A - Open Respir Med J (2009)

Bottom Line: Histopathology of PAH is founded on structural modifications on the vascular wall of small pulmonary arteries characterized by thickening of all its layers.In addition current progress in Echo Doppler technique will quantify right ventricular function with parameters independent of loading conditions and not requiring volumetric approximations of the complex geometry of the right ventricle.This would allow the in vivo study of right ventricular and pulmonary artery remodelling in PAH.

View Article: PubMed Central - PubMed

Affiliation: Cardiology Department, Hospital Universitari Vall Hebron, Barcelona, Spain.

ABSTRACT
Pulmonary arterial hypertension (PAH) is a rare fatal disease defined as a sustained elevation of pulmonary arterial pressure to more than 25 mmHg at rest, with a mean pulmonary-capillary wedge pressure and left ventricular enddiastolic pressure of less than 15 mmHg at rest. Histopathology of PAH is founded on structural modifications on the vascular wall of small pulmonary arteries characterized by thickening of all its layers. These changes, named as vascular remodelling, include vascular proliferation, fibrosis, and vessel obstruction. In clinical practice the diagnosis of PAH relies on measurements of pulmonary vascular pressure and cardiac output, and calculation of pulmonary vascular resistances. Direct evaluation of pulmonary vascular structure is not routinely performed in pulmonary hypertension since current imaging techniques are limited and since little is known about the relationship between structural changes and functional characteristics of the pulmonary vasculature. Intravascular ultrasound studies in patients with pulmonary hypertension have shown a thicker middle layer, increased wall-thickness ratio and diminished pulsatility than in control patients. Optical Coherence Tomography, a new high resolution imaging modality that has proven its superiority over intravascular ultrasound (IVUS) for the detection and characterization of coronary atherosclerotic plaque composition, may potentially be a useful technique for the in vivo study of the pulmonary arterial wall. In addition current progress in Echo Doppler technique will quantify right ventricular function with parameters independent of loading conditions and not requiring volumetric approximations of the complex geometry of the right ventricle. This would allow the in vivo study of right ventricular and pulmonary artery remodelling in PAH.

No MeSH data available.


Related in: MedlinePlus

Image of IVUS of a pulmonary artery in a patient with Pulmonary Arterial Hypertension. Calculation of amount of fibrosis of the arterial wall.
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Figure 1: Image of IVUS of a pulmonary artery in a patient with Pulmonary Arterial Hypertension. Calculation of amount of fibrosis of the arterial wall.

Mentions: Direct evaluation of pulmonary vascular structure is not routinely performed in pulmonary hypertension since current imaging techniques are limited and since little is known about the relationship between structural changes and functional characteristics of the pulmonary vasculature. Intravascular ultrasound studies in patients with pulmonary hypertension have shown a thicker middle layer, increased wall-thickness ratio (Fig. 1) and diminished pulsatility than in control patients [23,24]. However vasoreactivity to nitric oxyde, oxygen or epoprostenol does not appear to correlate with structural assessment of pulmonary vascular wall by intravascular ultrasound (IVUS) [23, 24]. IVUS provides combined morphological and functional evaluation of the elastic pulmonary vessels of patients with pulmonary hypertension and allows direct assessment of the acute changes induced in the pulmonary vessel wall dynamics by epoprostenol. The exploration is safe, and can be undertaken at the same time of cardiac catheterization. In addition there is an association between impaired pulmonary artery functional state as determined by IVUS and mortality at follow-up. However larger series are needed to determine the exact prognostic value of this technique in the setting of pulmonary hypertension [23].


New concepts in the invasive and non invasive evaluation of remodelling of the right ventricle and pulmonary vasculature in pulmonary arterial hypertension.

Domingo E, Aguilar R, López-Meseguer M, Teixidó G, Vazquez M, Roman A - Open Respir Med J (2009)

Image of IVUS of a pulmonary artery in a patient with Pulmonary Arterial Hypertension. Calculation of amount of fibrosis of the arterial wall.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2682922&req=5

Figure 1: Image of IVUS of a pulmonary artery in a patient with Pulmonary Arterial Hypertension. Calculation of amount of fibrosis of the arterial wall.
Mentions: Direct evaluation of pulmonary vascular structure is not routinely performed in pulmonary hypertension since current imaging techniques are limited and since little is known about the relationship between structural changes and functional characteristics of the pulmonary vasculature. Intravascular ultrasound studies in patients with pulmonary hypertension have shown a thicker middle layer, increased wall-thickness ratio (Fig. 1) and diminished pulsatility than in control patients [23,24]. However vasoreactivity to nitric oxyde, oxygen or epoprostenol does not appear to correlate with structural assessment of pulmonary vascular wall by intravascular ultrasound (IVUS) [23, 24]. IVUS provides combined morphological and functional evaluation of the elastic pulmonary vessels of patients with pulmonary hypertension and allows direct assessment of the acute changes induced in the pulmonary vessel wall dynamics by epoprostenol. The exploration is safe, and can be undertaken at the same time of cardiac catheterization. In addition there is an association between impaired pulmonary artery functional state as determined by IVUS and mortality at follow-up. However larger series are needed to determine the exact prognostic value of this technique in the setting of pulmonary hypertension [23].

Bottom Line: Histopathology of PAH is founded on structural modifications on the vascular wall of small pulmonary arteries characterized by thickening of all its layers.In addition current progress in Echo Doppler technique will quantify right ventricular function with parameters independent of loading conditions and not requiring volumetric approximations of the complex geometry of the right ventricle.This would allow the in vivo study of right ventricular and pulmonary artery remodelling in PAH.

View Article: PubMed Central - PubMed

Affiliation: Cardiology Department, Hospital Universitari Vall Hebron, Barcelona, Spain.

ABSTRACT
Pulmonary arterial hypertension (PAH) is a rare fatal disease defined as a sustained elevation of pulmonary arterial pressure to more than 25 mmHg at rest, with a mean pulmonary-capillary wedge pressure and left ventricular enddiastolic pressure of less than 15 mmHg at rest. Histopathology of PAH is founded on structural modifications on the vascular wall of small pulmonary arteries characterized by thickening of all its layers. These changes, named as vascular remodelling, include vascular proliferation, fibrosis, and vessel obstruction. In clinical practice the diagnosis of PAH relies on measurements of pulmonary vascular pressure and cardiac output, and calculation of pulmonary vascular resistances. Direct evaluation of pulmonary vascular structure is not routinely performed in pulmonary hypertension since current imaging techniques are limited and since little is known about the relationship between structural changes and functional characteristics of the pulmonary vasculature. Intravascular ultrasound studies in patients with pulmonary hypertension have shown a thicker middle layer, increased wall-thickness ratio and diminished pulsatility than in control patients. Optical Coherence Tomography, a new high resolution imaging modality that has proven its superiority over intravascular ultrasound (IVUS) for the detection and characterization of coronary atherosclerotic plaque composition, may potentially be a useful technique for the in vivo study of the pulmonary arterial wall. In addition current progress in Echo Doppler technique will quantify right ventricular function with parameters independent of loading conditions and not requiring volumetric approximations of the complex geometry of the right ventricle. This would allow the in vivo study of right ventricular and pulmonary artery remodelling in PAH.

No MeSH data available.


Related in: MedlinePlus