Persistent abnormalities in pulmonary arterial compliance after heart transplantation in patients with combined post-capillary and pre-capillary pulmonary hypertension

Ghio, Stefano; Pica, Silvia; Temporelli, Pier Luigi; Boffini, Massimo; Rinaldi, Mauro; Raineri, Claudia; Pistono, Massimo; Totaro, Rossana; Guida, Stefania; Visconti, Luigi Oltrona

doi:10.1371/journal.pone.0188383

Cited by 15 publications

(13 citation statements)

References 23 publications

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“…23,26,27 The results of the present study are in line with previous studies as we found resting LV-filling and RV-filling pressures within the normal range in most patients. Studies of invasive haemodynamics demonstrate that resting LV and RV filling pressures tend to normalize in most HTx patients during the first months after surgery, whereas pulmonary arterial compliance remains reduced.…”

Section: Discussionsupporting

confidence: 92%

“…Studies of invasive haemodynamics demonstrate that resting LV and RV filling pressures tend to normalize in most HTx patients during the first months after surgery, whereas pulmonary arterial compliance remains reduced. 23,26,27 The results of the present study are in line with previous studies as we found resting LV-filling and RV-filling pressures within the normal range in most patients. However, the haemodynamic response to exercise is clearly abnormal in HTx patients.…”

Section: Discussionsupporting

confidence: 92%

“…12 This documented inability to increase CI adequately during exercise might be attributable to several factors such as impaired ventricular contractile reserve, 28,29 an inadequate stroke volume reserve coupled with chronotropic incompetence, 30,31 increased afterload, 32 and RV dysfunction. 27 However, in long-term patients, as seen in the present study, the most likely causes of graft dysfunction are microvascular and macrovascular CAV and myocardial fibrosis. 11,12 The distinct differences in haemodynamics at peak exercise between HTx patients and healthy controls emphasize that assessment of invasive haemodynamics during resting conditions falls short as a measure of systolic and diastolic graft performance.…”

Section: Discussionsupporting

confidence: 46%

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Prognostic value of exercise myocardial deformation and haemodynamics in long‐term heart‐transplanted patients

et al. 2019

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Aims The study evaluated exercise left ventricular global longitudinal strain (LVGLS) and invasive haemodynamics for major adverse cardiac events (MACE) prediction in heart‐transplanted (HTx) patients. Methods and results The study comprised 74 stable consecutive HTx patients who were followed at the Department of Cardiology, Aarhus University Hospital, Denmark, from August 2013 to January 2017. All patients were transplanted a minimum of 12 months before study entry and were included at the time of their routine annual coronary angiography. A symptom‐limited haemodynamic exercise test with simultaneous echocardiographic study was performed. The primary endpoint was MACE during follow‐up defined as heart failure hospitalization, treated rejection episodes, coronary event, or cardiac death. The median time since transplant was 5 years [1:12] and the median follow‐up was 1095 days [391;1506]. Thirty patients (41%) experienced MACE during follow‐up. Patients who suffered MACE had an impaired resting and peak exercise systolic function in form of a lower LV ejection fraction (Rest: 56 ± 12% vs. 65 ± 7%, P < 0.001; Peak 64 ± 13% vs. 72 ± 6%, P < 0.01) and LVGLS (Rest: 13 ± 4% vs. 16 ± 2%, P < 0.01; Peak: 15 ± 6% vs. 20 ± 4%, P = 0.0001) than patients without MACE episodes. In contrast, resting diastolic filling patterns were comparable between patients suffering from MACE and patients without MACE. At rest, pulmonary capillary wedge pressure (mPCWP) and cardiac index did not predict MACE, whereas increased right atrial pressure (mRAP) was associated with increased MACE risk. Patients with peak exercise mPCWP >23 mmHg [hazard ratio (HR) 2.5, 95% confidence interval (CI): 1.2–5.4], cardiac index <5.9 L/min/m2 (HR 2.7, 95% CI: 1.0–6.3), or mRAP >13 mmHg (HR 2.7, 95% CI: 1.1–6.3) had increased MACE risk. Patients with exercise‐induced LVGLS increase <3.5% and peak exercise cardiac index <5.9 L/min/m2 [HR 6.1 (95% CI: 2.2–17.1)] or mPCWP >23 mmHg [HR 6.1 (95% CI: 2.1–17.5)] or mRAP >13 mmHg [HR 7.5 (95% CI: 2.3–23.9)] had the highest MACE risk. Conclusions Resting haemodynamic parameters were poor MACE predictors in long‐term HTx patients. In contrast, peak exercise mPCWP, mRAP, and CI were significant MACE predictors. LVGLS both at rest and during exercise were significant MACE predictors, and the combined model with peak exercise LVGLS and peak exercise mPCWP, mRAP, and CI clearly identified high‐risk HTx patients in relation cardiovascular endpoints independently of time since HTx.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 46%

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Prognostic value of exercise myocardial deformation and haemodynamics in long‐term heart‐transplanted patients

et al. 2019

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“…The second mechanism is pulmonary arterial vasoconstriction and remodelling associated with increased pulmonary vascular resistances (PVR) partly due to an imbalance between a decreased nitric oxide (NO) availability and an increased endothelin expression, as described in the ‘mitral lung’ . In this case, reversibility of PH is uncertain, even after restoring normal left‐heart haemodynamics …”

Section: Introductionmentioning

confidence: 99%

“…14 In this case, reversibility of PH is uncertain, even after restoring normal left-heart haemodynamics. 15 Chronic PH induces right ventricular (RV) remodelling and might lead to RV failure, which has been shown to be an important prognostic factor in HF. 10,[16][17][18][19] At the late stage of HF, an elevated PVR has been considered a contraindication to heart transplantation as it may induce RV graft failure.…”

Section: Introductionmentioning

confidence: 99%

Pulmonary hypertension in chronic heart failure: definitions, advances, and unanswered issues

et al. 2018

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Pulmonary hypertension (PH) is a common and severe complication of heart failure (HF). Consequently, HF is the leading cause of PH. For many years, specialists have attempted to better understand the pathophysiology of PH in HF, to define its prevalence and its impact on prognosis in order to improve the therapeutic management of these patients. Nowadays, despite the recent guidelines published on the subject, several points remain unclear or debated, and until now, no study has demonstrated the efficacy of any treatment. The aim of this review is to report the evolution of the concepts on post‐capillary PH (diagnosis, prevalence, prognosis, and therapeutics). The main issues are raised, focusing especially on the link between structural alterations and haemodynamic abnormalities, to discuss the possible reasons for treatment failures and future potential targets.

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Pulmonary arterial compliance is a useful predictor of pulmonary vascular disease in congenital heart disease

et al. 2018

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Histopathological assessment of the pulmonary arteries is crucial to determine the surgical indications in patients with congenital heart disease (CHD) and intractable pulmonary vascular disease (PVD). We aimed to clarify whether pulmonary hemodynamic parameters can predict PVD in patients with CHD and pulmonary arterial hypertension (PAH) We performed histopathological evaluations of lung specimens and cardiac catheterizations in 27 patients with CHD-PAH. We divided these patients into the patients with and without PVD, and compared pulmonary hemodynamic parameters including pulmonary arterial compliance (Cp) between two groups. Age at lung biopsy was 4 (2-7) months. There were 16 patients with trisomy 21. Cardiac diagnosis included ventricular septal defect in 16, atrial septal defect in 5, atrioventricular septal defect in 4, and others in 2. There were 11 patients with histopathologically proven PVD (Heath-Edwards classification grade ≥ 3 in 5; the index of PVD ≥ 1.1 in 3; extremely thickened media in 6; hypoplasia of the pulmonary arteries in 3). Cp in the patients with PVD was significantly lower than that in patients without PVD (0.99 [0.74-1.42] vs 1.56 [1.45-1.88], p = 0.0047), although there was no significant difference in the ratio of systemic to pulmonary blood flow, pulmonary arterial pressure, and resistance between two groups. A Cp cutoff value of < 1.22 ml/mmHg m as a predictor of PVD yielded a sensitivity and a specificity of 93% and 64%, respectively. Pulmonary arterial compliance can be a predictor of PVD among patients with CHD-PAH.

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Persistent abnormalities in pulmonary arterial compliance after heart transplantation in patients with combined post-capillary and pre-capillary pulmonary hypertension

Cited by 15 publications

References 23 publications

Prognostic value of exercise myocardial deformation and haemodynamics in long‐term heart‐transplanted patients

Prognostic value of exercise myocardial deformation and haemodynamics in long‐term heart‐transplanted patients

Pulmonary hypertension in chronic heart failure: definitions, advances, and unanswered issues

Pulmonary arterial compliance is a useful predictor of pulmonary vascular disease in congenital heart disease

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