Echocardiographic Evaluation of Pulmonary Artery Distensibility

Pasierski, Tomasz; Starling, Randall; Binkley, Philip F.; Pearson, Anthony C.

doi:10.1378/chest.103.4.1080

Cited by 28 publications

(28 citation statements)

References 12 publications

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“…The present data are in line with a number of earlier observations, obtained both in vitro and in vivo [9,10]. PASIERSKI et al [12], however, employing the conventional ultrasound M-mode technique for measuring vessel diameter, found that the elastic modulus (the ratio of pulmonary arterial pressure to vessel wall strain) was independent of age, and was related only to pulmonary arterial pressure. It is a common finding that pulmonary artery distensibility is reduced in patients with pulmonary hypertension [17,18].…”

Section: Influence Of Agesupporting

confidence: 93%

“…It is a common finding that pulmonary artery distensibility is reduced in patients with pulmonary hypertension [17,18]. In the study of PASIERSKI et al [12] MPAP ranged 15±56 mmHg, with most of the patients being hypertensive, suggesting that the effect of age on pulmonary artery stiffness was overwhelmed by the dominating influence of pulmonary artery pressure.…”

Section: Influence Of Agementioning

confidence: 96%

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confidence: 95%

“…The age dependence of pulmonary arterial wall distensibility is another controversial issue. Although in vitro studies have shown that the pulmonary arterial wall stiffens with age [9,10], in vivo studies have produced equivocal results; a negative correlation between pulmonary compliance and age was reported in one study [11] but no such relation was found in another [12].In view of the above uncertainties, the relationship between Dst and Ddyn of the right main pulmonary artery and its age dependence was studied. Ddyn was determined from the pressure/diameter relationship during the cardiac cycle, whereas static (or, rather, quasistatic) distensibility was determined using changes in mean pulmonary artery pressure (MPAP) and diameter during physical exercise.…”

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Assessment of the viscosity of the pulmonary artery wall

et al. 2000

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Large artery wall viscosity reduces the efficiency of heart/vessel coupling. The aim of the present study was to assess pulmonary artery wall viscosity through comparison of the static (Dst) and dynamic distensibility (Ddyn) of the vessel wall.Right pulmonary artery pressure and diameter was measured in 13 patients and eight healthy volunteers. Ddyn was calculated as the relative change in end-diastolic diameter induced by the pressure pulse, and Dst as the relative change in mean diameter induced by the change in mean pressure during steady-state exercise.Dst The arterial wall responds to stress through both elastic and viscous behaviour, the former being related to the elastin and the latter to the collagen and smooth muscle content of the vessel wall [1,2]. During systole, the elastic behaviour of the arterial wall allows its diameter to increase proportionally to pressure; in the case of a purely elastic arterial wall, the total amount of energy stored would be released during diastole. In reality, however, part of the energy that corresponds to viscous deformation is dissipated within the arterial wall. Wall viscosity reduces the efficiency of heart/vessel coupling, and may place extra load on the ventricle [3].Wall viscosity is responsible for the difference that exists between the static (Dst) and dynamic distensibility (Ddyn) of a given vessel [1,2,4,5]. Under static conditions, the change in diameter in response to a given change in distending pressure is determined only by the elastic properties of the vessel wall. Under dynamic conditions, however, when changes in pressure are pulsatile and the time available for distension is limited, wall viscosity impedes distension, resulting in less change in diameter for the same change in pressure [6]. The greater the wall viscosity, the greater the difference between Dst and Ddyn. Dst has been found to be considerably higher than Ddyn in systemic arteries, the difference being accounted for by wall viscosity [1,2,4,5].Information on pulmonary artery wall viscosity is limited and controversial. In the perfused dog lungs, the slope of the static curve relating volume to pressure (i.e. lung compliance) was found to be 1.5 times steeper than that of the dynamic curve [7], indicating considerable vessel wall viscosity. In humans, no direct comparison of Dst and Ddyn of the pulmonary artery has been made, but the close similarity of pressure and diameter curves recorded from the pulmonary artery has been taken as a sign of low vessel wall viscosity [8]. The age dependence of pulmonary arterial wall distensibility is another controversial issue. Although in vitro studies have shown that the pulmonary arterial wall stiffens with age [9,10], in vivo studies have produced equivocal results; a negative correlation between pulmonary compliance and age was reported in one study [11] but no such relation was found in another [12].In view of the above uncertainties, the relationship between Dst and Ddyn of the right main pulmonary artery and its age dependence was ...

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Section: Influence Of Agesupporting

confidence: 93%

Section: Influence Of Agementioning

confidence: 96%

mentioning

confidence: 95%

mentioning

confidence: 98%

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Assessment of the viscosity of the pulmonary artery wall

et al. 2000

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“…Indices of proximal PA distensibility or stiffness quantified by echocardiography,13, 14 computed tomography angiography,15 and magnetic resonance imaging12, 16, 17, 18, 19 are attractive noninvasive indices of PH in humans. These indices correlate with “gold standard” invasive measurements of pulmonary vascular resistance and PA pressure,14, 15, 18 are reliable and early noninvasive indicators of PH (even when only exercised‐induced PH is present),16, 18 predict mortality,12, 17, 18 and help predict acute drug responsiveness 19. Recently, a right pulmonary artery distensibility (RPAD) index quantified by echocardiography, essentially a shortening fraction of the right PA, was evaluated in dogs affected with heartworm disease and various degrees of PH 6.…”

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confidence: 99%

Diagnostic Value of Right Pulmonary Artery Distensibility Index in Dogs with Pulmonary Hypertension: Comparison with Doppler Echocardiographic Estimates of Pulmonary Arterial Pressure

Visser

Johnson

et al. 2016

Veterinary Internal Medicne

109

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BackgroundNoninvasive diagnosis of pulmonary hypertension (PH) primarily relies upon Doppler echocardiography of tricuspid regurgitation (TR). However, TR might be absent or difficult to measure.Hypothesis/ObjectivesTo determine the diagnostic value of right pulmonary artery distensibility (RPAD) index for prediction of Doppler‐derived estimates of pulmonary artery (PA) pressure compared to other indices of PH in dogs.AnimalsSixty‐nine client‐owned dogs with TR.MethodsProspective observational study. Dogs were allocated to groups according to TR pressure gradient (TRPG): TRPG <36 mmHg (control, n = 22), TRPG 36–50 (n = 16), TRPG 50–75 (n = 14) and TRPG >75 mmHg (n = 17). Right pulmonary artery distensibility index, acceleration time to peak PA flow (AT), AT: ejection time of PA flow (AT:ET) and main PA size: aorta size (MPA:Ao) were calculated in each dog.ResultsRight pulmonary artery distensibility index demonstrated the strongest correlation (r = −0.90; P < .0001) to TRPG followed by MPA:Ao (r = 0.78; P < .0001), AT (r = −0.69; P < .0001) and AT:ET (r = −0.68; P < .0001). RPAD index possessed the most accurate cutoff (<29.5%; Sensitivity [Sn] 0.84, Specificity [Sp] 0.95) to predict TRPG >50 mmHg compared to AT (<53.9 ms; Sn 0.74, Sp 0.87), AT:ET (<0.30; Sn 0.61, Sp 0.97) and MPA:Ao (>1.04; Sn 0.94, Sp 0.74). All intra‐ and interobserver measurement variabilities exhibited coefficients of variation ≤13%.Conclusions and Clinical ImportanceRight pulmonary artery distensibility index is an accurate predictor of TRPG and should be particularly useful if TR is absent or difficult to measure.

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