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

Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Kim H. Parker¹  Junjing Su²  Ulf Simonsen²  Jens Erik Nielsen‐Kudsk³  Soren Mellemkjaer³  Charlotte Manisty⁴  Luke Howard⁵  Susan Connolly⁵  Iqbal S. Malik⁵  Simon Gibbs⁵  Geoffrey Watson⁵  Justin E. Davies⁵  Alun D. Hughes⁵  P. Boon Lim⁵  Zachary I. Whinnett⁵ 

[1] Department of Bioengineering, Imperial College London, London, United Kingdom;Department of Biomedicine, Aarhus University, Aarhus C, Denmark;Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark;Institute of Cardiovascular Science, University College London, London, United Kingdom;National Heart and Lung Institute Imperial College London, London, United Kingdom;

关键词: pulmonary artery;    pulmonary hypertension;    pulse wave velocity;    wave intensity;   

DOI  :  10.1161/JAHA.117.006679

来源: DOAJ

【 摘 要 】

BackgroundIn 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 ResultsRight 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. ConclusionsWave 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.

【 授权许可】

Unknown