Artery Research

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Volume 20, Issue C, December 2017, Pages 60 - 61

5.5 IMPACT OF PULMONARY ENDARTERECTOMY ON PULMONARY ARTERIAL WAVE PROPAGATION AND RESERVOIR FUNCTION

Authors
Junjing Su1, 2, Alun Hughes3, 2, Ulf Simonsen1, Jens Erik Nielsen-Kudsk4, Kim Parker5, Luke Howard2, Søren Mellemkjaer4
1Department of Biomedicine, Aarhus University, Denmark
2National Heart and Lung Institute, Imperial College London, UK
3Institute of Cardiovascular Science, University College London, UK
4Department of Cardiology, Aarhus University Hospital, Denmark
5Department of Bioengineering, Imperial College London, UK
Available Online 6 December 2017.
DOI
10.1016/j.artres.2017.10.051How to use a DOI?
Abstract

Background: Recent studies have demonstrated distinctive arterial wave characteristics in patients with chronic thromboembolic pulmonary hypertension (CTEPH)1. Therefore, we aimed to assess the impact of pulmonary endarterectomy (PEA) on pulmonary arterial wave propagation and reservoir function in CTEPH patients.

Methods: Right heart catheterization was performed using a 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 analyses2 were subsequently applied to the acquired data and the diastolic pressure decay time was estimated.

Results: Following PEA, mean pulmonary pressure (49 ± 10 mmHg versus 32 ± 13 mmHg), pulmonary vascular resistance (PVR) and wave speed, i.e. local arterial stiffness, significantly improved. However, there were no significant changes in arterial wave energy and wave reflection index (29.3 % [11.4–41.4 %] versus 21.2 % [16.2 – 25.9 %] post-PEA), even in patients with normalized pulmonary pressure. The RC-time (product of PVR and compliance) decreased post-PEA. Furthermore, the reservoir pressure related to arterial compliance, excess pressure caused by arterial waves and asymptotic pressure at which the flow would cease significantly decreased post-PEA and the changes were associated with improved right ventricular afterload, function and size.

Conclusion: Large wave reflection persisted post-PEA indicating lack of normalization of vascular impedance mismatch. Decreased RC-time suggests structural damage to the pulmonary vasculature. Wave intensity and reservoir-excess pressure analysis may be used as an additional assessment of the hemodynamic outcomes following PEA.

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This is an open access article distributed under the CC BY-NC license.

References

1.MA Quail, DS Knight, JA Steeden, L Taelman, S Moledina, AM Taylor, et al., Noninvasive pulmonary artery wave intensity analysis in pulmonary hypertension, Am J Physiol Heart Circ Physiol, Vol. 308, No. 12, 15 June 2015, pp. H1603-H1611.
2.KH Parker, Arterial reservoir pressure, subservient to the McDonald lecture, Artery 13, Artery Res, Vol. 7, No. 3–4, September 2013, pp. 171-85.
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Journal
Artery Research
Volume-Issue
20 - C
Pages
60 - 61
Publication Date
2017/12/06
ISSN (Online)
1876-4401
ISSN (Print)
1872-9312
DOI
10.1016/j.artres.2017.10.051How to use a DOI?
Open Access
This is an open access article distributed under the CC BY-NC license.

Cite this article

risenwbib
TY  - JOUR
AU  - Junjing Su
AU  - Alun Hughes
AU  - Ulf Simonsen
AU  - Jens Erik Nielsen-Kudsk
AU  - Kim Parker
AU  - Luke Howard
AU  - Søren Mellemkjaer
PY  - 2017
DA  - 2017/12/06
TI  - 5.5 IMPACT OF PULMONARY ENDARTERECTOMY ON PULMONARY ARTERIAL WAVE PROPAGATION AND RESERVOIR FUNCTION
JO  - Artery Research
SP  - 60
EP  - 61
VL  - 20
IS  - C
SN  - 1876-4401
UR  - https://doi.org/10.1016/j.artres.2017.10.051
DO  - 10.1016/j.artres.2017.10.051
ID  - Su2017
ER  -