Impact of Pulmonary Endarterectomy on Pulmonary Arterial Wave Propagation and Reservoir Function

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  • Junjing Su, NEURODIN; Department of Biomedicine; Aarhus University; Aarhus, Denmark; Neuroimmunology of Degenerative Diseases group; Department of Biomedicine; Aarhus University; Aarhus, Denmark.
  • ,
  • Alun D Hughes, Institute of Cardiovascular Science, University College London , London , United Kingdom.
  • ,
  • Ulf Simonsen
  • Jens Erik Nielsen-Kudsk
  • Kim H Parker, Department of Bioengineering, Imperial College London, London, United Kingdom.
  • ,
  • Luke S Howard, IVF Unit, Hammersmith Hospital, London, United Kingdom.
  • ,
  • Soren Mellemkjaer

High wave speed and large wave reflection in the pulmonary artery have previously been reported in patients with chronic thromboembolic pulmonary hypertension (CTEPH). We assessed the impact of pulmonary endarterectomy (PEA) on pulmonary arterial wave propagation and reservoir function in CTEPH patients. Right heart catheterization was performed using a combined pressure and Doppler flow sensor tipped guidewire to obtain simultaneous pressure and flow velocity measurements in the pulmonary artery in eight CTEPH patients before and 3 months after PEA. Wave intensity and reservoir-excess pressure analyses were then performed. Following PEA, mean pulmonary arterial pressure (PAPm, ~49 versus ~32 mmHg), pulmonary vascular resistance (PVR, ~11.1 versus ~5.1 Wood Units) and wave speed (~16.5 versus ~8.1 m/s), i.e. local arterial stiffness, markedly decreased. The changes in the intensity of the reflected arterial wave and wave reflection index (pre: ~28%; post: ~22%) were small and post-PEA patients with and without residual pulmonary hypertension (i.e. PAPm ≥25 mmHg) had similar wave reflection index (~20 versus ~23%). The reservoir and excess pressure decreased post-PEA and the changes were associated with improved right ventricular afterload, function and size. In conclusion, while PVR and arterial stiffness decreased substantially following PEA, large wave reflection persisted, even in patients without residual pulmonary hypertension, indicating lack of improvement in vascular impedance mismatch. This may continue to affect the optimal ventriculo-arterial interaction and further studies are warranted to determine whether this contributes to persistent symptoms in some patients.

TidsskriftA J P: Heart and Circulatory Physiology (Online)
StatusE-pub ahead of print - 21 jun. 2019

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