Pulmonary vascular resistance and compliance stay inversely related during treatment of pulmonary hypertension

Lankhaar, Jan-Willem; Westerhof, Nico; Faes, T.J.C.; Gan, C. Tji-Joong; Marques, Koen M.; Boonstra, Anco; Berg, F.G. van den; Postmus, Pieter E.; Vonk‐Noordegraaf, Anton

doi:10.1093/eurheartj/ehn103

Cited by 249 publications

(212 citation statements)

References 19 publications

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“…Our data show that nitrite improves Cpa but not PVR. If we assume a fixed inverse hyperbolic relationship between Cpa and PVR (30,31), then hemodynamic response to nitrite can only occur in those patients who fall along the upper portion of the shoulder of the resistance-compliance curve. This portion of the resistance-compliance curve is where large changes in compliance can occur with little change in resistance, e.g., PH-HFpEF patients.…”

Section: Discussionmentioning

confidence: 99%

“…We first compared the distribution of study outcome variables between the 3 patient groups (WHO Groups 1, 2, and 3) before aerosolized sodium nitrite intervention using the nonparametric Kruskal-Wallis test. To test the effect of aerosolized sodium nitrite on hemodynamic parameters at all time points relative to baseline (15,30,45, and 60 minutes after dose 1; and 15, 30, 45 and 60 minutes after dose 2), a linear mixed-effect model was used. In this model, the effect of treatment on hemodynamics (15-60 minutes after dose) was compared with baseline values.…”

Section: Methodsmentioning

confidence: 99%

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Acute hemodynamic effects of inhaled sodium nitrite in pulmonary hypertension associated with heart failure with preserved ejection fraction

Simon

Vanderpool²,

Nouraie³

et al. 2016

JCI Insight

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Acute hemodynamic effects of inhaled sodium nitrite in pulmonary hypertension associated with heart failure with preserved ejection fraction

Simon

Vanderpool²,

Nouraie³

et al. 2016

JCI Insight

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“…These patients eventually die due to RV failure. Diagnosing decreased distensibility could help to identify CTEPH patients who may benefit from thrombectomy by reducing RV afterload (105).…”

Section: Ct Diagnosis Of Ctephmentioning

confidence: 99%

The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism

Doğan

A²,

Geleijins³

et al. 2015

Diagn Interv Radiol

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A cute pulmonary embolism (PE) is the third most common cardiovascular condition, after coronary artery disease and stroke (1). Due to lack of specific sets of symptoms that accurately predict or exclude the diagnosis of acute PE, the diagnosis strongly relies on noninvasive imaging techniques. Diagnostic strategies for evaluating PE have undergone important changes over the past decades (2). Due to rapid technical advances in speed and spatial resolution, the utility of computed tomography (CT) angiography has been recognized in vascular imaging. Particularly, after the development of multidetector row CT in 1998 (3), CT pulmonary angiography (CTPA) has become the imaging method of choice in the diagnosis of acute PE (4). CTPA has advantages over conventional invasive X-ray pulmonary angiography and nuclear ventilation-perfusion (V/Q) imaging. CT is a widely available, fast and noninvasive technique, has the capability to directly visualize emboli, and may provide alternative diagnoses (4).Despite adequate diagnosis and anticoagulant therapy, death rate after a diagnosis of acute PE is still 8%-15% (5, 6). The prognosis of acute PE mainly depends on residual pulmonary circulation and the severity of right ventricular (RV) dysfunction (7). Recent studies have shown that CT permits the assessment of acute right-sided heart failure. Furthermore, CT can predict adverse clinical outcome by using the RV/left ventricular (LV) diameter ratio (8, 9) or RV ejection fraction in patients with PE (10).The aim of this review is to discuss the developments of CT in PE diagnosis, and to analyze the added value of CT in estimating PE severity and prognosis. Furthermore, CT findings of chronic thromboembolic pulmonary arterial hypertension (CTEPH) as a complication of acute PE will be discussed. CT developments in PE diagnosisHistorically, pulmonary angiography and nuclear planar V/Q-imaging were the main imaging methods used for diagnosing PE. Both methods have recognized limitations. Pulmonary angiography has previously been regarded as reference standard, but the method CHEST IMAGING REVIEW ABSTRACT Pulmonary embolism (PE) is a potentially life threatening condition requiring adequate diagnosis and treatment. Computed tomography pulmonary angiography (CTPA) is excellent for including and excluding PE, therefore CT is the first-choice diagnostic imaging technique in patients suspected of having acute PE. Due to its wide availability and low invasiveness, CTPA tends to be overused. Correct implementation of clinical decision rules in diagnostic workup for PE improves adequate use of CT. Also, CT adds prognostic value by evaluating right ventricular (RV) function. CT-assessed RV dysfunction and to lesser extent central emboli location predicts PE-related mortality in normotensive and hypotensive patients, while PE embolic obstruction index has limited prognostic value. Simple RV/left ventricular (LV) diameter ratio measures >1.0 already predict risk for adverse outcome, whereas ratios <1.0 can safely exclude adverse outcome. Con...

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“…Their results support the concept that a subgroup of patients with exercise-induced pulmonary hypertension (and normal rest haemodynamics) does exist and may correspond to a intermediate step within the progressive process through which an individual develops PAH, passing from normal rest haemodynamics to established rest PAH. The same concept has been recently brought up [35], based on magnetic resonance imaging studies performed by LANKHAAR et al [36], demonstrating that arterial compliance and resistance remains inversely related during the course of PAH, thus suggesting that increased arterial stiffness and, therefore, reduced compliance, may be the most important mechanical phenomenon at early phases in PAH development. TOLLE et al [34], however, believe that dynamic pulmonary vasoconstriction and not decreased compliance is the main mechanism related to exerciseinduced PAH.…”

mentioning

confidence: 71%

Trends in pulmonary arterial hypertension

Souza¹,

Jardim²

2009

Eur Respir Rev

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Pulmonary vascular resistance and compliance stay inversely related during treatment of pulmonary hypertension

Abstract: During therapy for PH, R and C remain inversely related. Therefore, changes in both R and C better explain changes in cardiac index than either of them alone. Not only resistance but also compliance plays a prominent role in PH especially in an early stage of the disease.

Cited by 249 publications

References 19 publications

Acute hemodynamic effects of inhaled sodium nitrite in pulmonary hypertension associated with heart failure with preserved ejection fraction

Acute hemodynamic effects of inhaled sodium nitrite in pulmonary hypertension associated with heart failure with preserved ejection fraction

The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism

Trends in pulmonary arterial hypertension

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