Abstract 15874: In vivo Assessment of Pulmonary Arterial Vasculopathy by Intravascular ultrasound in Patients Evaluated for Lung Transplantation
The aim is to assess pulmonary arterial vasculopathy in patients with chronic respiratory failure evaluated pre-lung transplantation , by intravascular ultrasound (IVUS) in medium sized pulmonary arteries, and to compare it to pulmonary arterial hypertension (PAH) and healthy controls.
We studied 102 patients: 17 group 1, COPD without pulmonary hypertension (PH),6 females, 60±4 years; 17 group 2 COPD and PH, 4 females, 59±3 years; 21 group 3 interstitial lung disease (ILD) without PH,11 females, 60±4 years; 19 group 4 with ILD and PH, 6 females, 60±4 years; 18 group 5 PAH NYHA 2-3, 14 females, 53± 14 years; 10 group 6, healthy controls, 6 females, 51± 5 years. PH was defined as mean pulmonary artery pressure (PAPm)>25 mmHg. Patients were submitted to heart catheterization, and IVUS in medium sized elastic PA ( 2-3 mm diameter) of inferior lobes. Studied variables were: PAPm, cardiac output(CO) pulmonary vascular resistance (PVR) , IVUS PA wall fibrosis, IVUS pulsatility (IVUSp) and elastic modulus (EM). Arterial pulsatility was estimated by IVUS: (systolic-diastolic lumen area/diastolic lumen area) x 100. PA stiffness was assessed by the EM (pulse pressure/IVUSp).
Ages were similar in all groups. As expected in group 6 all variables were clearly different from the other groups. PA fibrosis was higher in COPD vs ILD (21.46±6.2, 16.84±6.7 P 0.003). EM was lower in COPD vs ILD (89.1±54.6, 126.12±77, P 0.02). No differences in IVUSp between COPD and ILD (24.11±11.9, 24.85±15.5, P 0.82). Table shows the main variables classifying patients with COPD and ILD depending on the presence of PH.
Patients with severe chronic respiratory failure, either with or without PH, suffered from a severe pulmonary arterial vasculopathy with high degree of structural and functional wall remodeling similar to that of PAH patients. Patients with ILD had greater PA stiffness than COPD.
- © 2013 by American Heart Association, Inc.