Limits...
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

2D Strain analysis of the RV in a patient with severe PAH during a vasodilatory test. Measurement of deformation parameters of the RV, as in this case employing longitudinal strain, appears as a very attractive alternative for the evaluation of systolic function. However, validation of these parameters in large populations of patients with PAH is desirable before its use at the clinical routine. Left panel shows the measurements in the regions of interest (free wall and septum). Right upper panel shows the quantitative curves of longitudinal strain over time. Right lower panel shows the parametric quantitation in a colour scale of the different segments analysed.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2682922&req=5

Figure 5: 2D Strain analysis of the RV in a patient with severe PAH during a vasodilatory test. Measurement of deformation parameters of the RV, as in this case employing longitudinal strain, appears as a very attractive alternative for the evaluation of systolic function. However, validation of these parameters in large populations of patients with PAH is desirable before its use at the clinical routine. Left panel shows the measurements in the regions of interest (free wall and septum). Right upper panel shows the quantitative curves of longitudinal strain over time. Right lower panel shows the parametric quantitation in a colour scale of the different segments analysed.

Mentions: Another promising tool for right ventricular assessment is tissue doppler imaging techniques, but at present, data are relatively scarce and variability of results are still too high to rely only in this method for right ventricular function analysis in pulmonary hypertension (Fig. 4). However some studies have already reported normal range of mechanical variables in Doppler imaging studies [42], have shown evidence of interventricular dyssynchrony in pulmonary hypertension [43] and have related these variables to serum levels of brain natriuretic peptide [44]. In addition even some variables, such as apical strain rate (Fig. 5), have been correlated with pulmonary artery pressures [45].


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)

2D Strain analysis of the RV in a patient with severe PAH during a vasodilatory test. Measurement of deformation parameters of the RV, as in this case employing longitudinal strain, appears as a very attractive alternative for the evaluation of systolic function. However, validation of these parameters in large populations of patients with PAH is desirable before its use at the clinical routine. Left panel shows the measurements in the regions of interest (free wall and septum). Right upper panel shows the quantitative curves of longitudinal strain over time. Right lower panel shows the parametric quantitation in a colour scale of the different segments analysed.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: 2D Strain analysis of the RV in a patient with severe PAH during a vasodilatory test. Measurement of deformation parameters of the RV, as in this case employing longitudinal strain, appears as a very attractive alternative for the evaluation of systolic function. However, validation of these parameters in large populations of patients with PAH is desirable before its use at the clinical routine. Left panel shows the measurements in the regions of interest (free wall and septum). Right upper panel shows the quantitative curves of longitudinal strain over time. Right lower panel shows the parametric quantitation in a colour scale of the different segments analysed.
Mentions: Another promising tool for right ventricular assessment is tissue doppler imaging techniques, but at present, data are relatively scarce and variability of results are still too high to rely only in this method for right ventricular function analysis in pulmonary hypertension (Fig. 4). However some studies have already reported normal range of mechanical variables in Doppler imaging studies [42], have shown evidence of interventricular dyssynchrony in pulmonary hypertension [43] and have related these variables to serum levels of brain natriuretic peptide [44]. In addition even some variables, such as apical strain rate (Fig. 5), have been correlated with pulmonary artery pressures [45].

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