Prevelance of Pulmonary Atherosclerosis in Patients With Chronic Thromboembolic Pulmonary Hypertension

Abstract

Conjunctive:The aim of our study was to determine the prevalence of pulmonary atherosclerosis in patients with Chronic Thromboembolic Pulmonary Hypertension (CTEPH) who underwent Pulmonary Endarterectomy (PEA). Methods:One hundred twenty-eight patients with CTEPH who underwent PEA included in our study. Pathologic examination performed to the excised chronic thromboembolic material for the presence of atherosclerosis.Results: Pathologic specimens of 65 patients (50.8%) displayed atherosclerosis in our study. There were no evident differences between the group with pulmonary atherosclerosis and group without pulmonary atherosclerosis regarding the prevalence of smoking, hypertension, diabetes, hypercholesterolemia, high sensitive CRP (hsCRP) and the neutrophile-lymphocyte ratio (N/L ratio). Conclusions:Pulmonary atherosclerosis seems to be a common finding in patients with CTEPH. Based on this observation it might be suggested that pathophysiological association exists between venous thromboembolism and atherosclerosis.

Clinical features and metabolic reprogramming of atherosclerotic lesions in patients with chronic thromboembolic pulmonary hypertension

“…It is well known that the major pulmonary artery and its branches are rarely affected by atherosclerotic lesions due to their relatively low blood pressure and high flow ( 12 ). In contrast, during the development of PH, atherosclerotic lesions may occur in the main pulmonary artery ( 9 , 12 , 23 ). Atherosclerotic lesions in the pulmonary vascular bed have also been noted in pulmonary arterial hypertension, revealed by autopsy, possibly as a result of shear stress-induced endothelial injury and subsequent inflammation ( 24 , 25 ).…”

“…In general, four major pathological alterations are observed within the specimens from PEA, including neointima formation, atherosclerotic lesions, thrombosis, and recanalization ( 7 ). Macrophage-derived foam cells and cholesterol clefts are found in the atherosclerotic lesions in CTEPH ( 7 , 9 ). However, it remains uncertain whether the traditional cardiovascular risk factors and the thromboembolus-derived atherosclerotic lesions in CTEPH are clinically related ( 10 , 11 ).…”

“…Atherosclerotic lesions do not develop in pulmonary arteries under the normal environment of low pressure and high flow, but they may form during the development of PH ( 9 , 12 ). Atherosclerotic lesions were found in approximately 30% of CTEPH cases ( 7 , 13 ).…”

Characterization of atherosclerotic plaques in blood vessels with low oxygenated blood and blood pressure (Pulmonary trunk): role of growth differentiation factor-15 (GDF-15)

“…In a similar way, low level of oxygen in the blood may contribute to the pathogenesis of various diseases of the vascular wall [ 28 ]. In this context, atherosclerosis in the pulmonary arteries, its branches, and after pulmonary hypertension are rarely affected by atherosclerosis and are not common in human [ 54 , 55 ]. Most recently it has been shown that pulmonary artery calcification was significantly greater in patients with suspicion of stable angina pectoris compared to healthy control by using quantitative 18F-sodium fluoride positron emission tomography/computed tomography (NaF-PET/CT), a method that has been most recently suggested to be of clinical use in the early detection of pulmonary artery atherosclerosis [ 56 ].…”

Interplay of Low-Density Lipoprotein Receptors, LRPs, and Lipoproteins in Pulmonary Hypertension

“…Humans with LDLR loss-of-function mutations (ie, familial hypercholesterolemia) do not typically develop PAH. Nonetheless, pulmonary arterial atherosclerosis has been observed in adult patients with chronic obstructive pulmonary disease (COPD) or chronic thromboembolic PH ( 35 , 36 , 37 , 38 ). Both LDL and HDL were reported to be dysfunctional in PAH ( 39 ).…”