Wave Intensity Analysis Provides Novel Insights Into Pulmonary Arterial Hypertension and Chronic Thromboembolic Pulmonary Hypertension

Publikation: Forskning - peer reviewTidsskriftartikel

DOI

  • Junjing Su
  • Charlotte Manisty
    Charlotte Manisty
  • Kim H Parker
    Kim H ParkerDepartment of Bioengineering, Imperial College London, London, United Kingdom.
  • Ulf Simonsen
  • Jens Erik Nielsen-Kudsk
  • Soren Mellemkjaer
    Soren Mellemkjaer
  • Susan Connolly
    Susan ConnollyDepartment of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom.
  • P Boon Lim
    P Boon LimDepartment of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom.
  • Zachary I Whinnett
    Zachary I WhinnettDepartment of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom.
  • Iqbal S Malik
    Iqbal S MalikDepartment of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom.
  • Geoffrey Watson
    Geoffrey WatsonNIHR Cardiovascular BRU Royal Brompton Hospital & National Heart and Lung Institute, Imperial College London, London, United Kingdom.
  • Justin E Davies
    Justin E DaviesDepartment of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom.
  • Simon Gibbs
    Simon GibbsDepartment of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom.
  • Alun D Hughes
    Alun D Hughes1 Aarhus University Hospital, Department of Cardiology and Aarhus University Institute of Clinical Medicine, Denmark. 2 Aarhus University, Institute of Clinical Medicine, Denmark. 3 University College London, Institute of Cardiovascular Science, United Kingdom.
  • Luke Howard
    Luke HowardDepartment of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom.

BACKGROUND: In contrast to systemic hypertension, the significance of arterial waves in pulmonary hypertension (PH) is not well understood. We hypothesized that arterial wave energy and wave reflection are augmented in PH and that wave behavior differs between patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH).

METHODS AND RESULTS: Right heart catheterization was performed using a pressure and Doppler flow sensor-tipped catheter to obtain simultaneous pressure and flow velocity measurements in the pulmonary artery. Wave intensity analysis was subsequently applied to the acquired data. Ten control participants, 11 patients with PAH, and 10 patients with CTEPH were studied. Wave speed and wave power were significantly greater in PH patients compared with controls, indicating increased arterial stiffness and right ventricular work, respectively. The ratio of wave power to mean right ventricular power was lower in PAH patients than CTEPH patients and controls. Wave reflection index in PH patients (PAH: ≈25%; CTEPH: ≈30%) was significantly greater compared with controls (≈4%), indicating downstream vascular impedance mismatch. Although wave speed was significantly correlated to disease severity, wave reflection indexes of patients with mildly and severely elevated pulmonary pressures were similar.

CONCLUSIONS: Wave reflection in the pulmonary artery increased in PH and was unrelated to severity, suggesting that vascular impedance mismatch occurs early in the development of pulmonary vascular disease. The lower wave power fraction in PAH compared with CTEPH indicates differences in the intrinsic and/or extrinsic ventricular load between the 2 diseases.

OriginalsprogEngelsk
TidsskriftJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
Vol/bind6
Tidsskriftsnummer11
ISSN2047-9980
DOI
StatusUdgivet - 31 okt. 2017

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