RESEARCH ARTICLE


New Concepts in the Invasive and Non Invasive Evaluation of Remodelling of the Right Ventricle and Pulmonary Vasculature in Pulmonary Arterial Hypertension



Enric Domingo*, 1, 3, Rio Aguilar1, Manuel López-Meseguer2, Gisela Teixidó1, Manuel Vazquez1, Antonio Roman2
1 Cardiology Department, Hospital Universitari Vall Hebron, Barcelona, Spain
2 Pneumology Department, Hospital Universitari Vall Hebron, CIBERES, Universitat Autonoma Barcelona, Spain
3 Physiology Department, Medical College, Universitat Autonoma Barcelona, Spain


Article Metrics

CrossRef Citations:
0
Total Statistics:

Full-Text HTML Views: 706
Abstract HTML Views: 540
PDF Downloads: 222
Total Views/Downloads: 1468
Unique Statistics:

Full-Text HTML Views: 266
Abstract HTML Views: 267
PDF Downloads: 137
Total Views/Downloads: 670



© Domingo et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Cardiology Department, Hospital Universitari Vall Hebron, P, Vall Hebron 119-129, 08035, Barcelona, Spain; Tel: 34-93-2746155; E-mail: edrcg@hotmail.com


Abstract

Pulmonary arterial hypertension (PAH) is a rare fatal disease defined as a sustained elevation of pulmonary arterial pressure to more than 25 mmHg at rest, with a mean pulmonary-capillary wedge pressure and left ventricular enddiastolic pressure of less than 15 mmHg at rest. Histopathology of PAH is founded on structural modifications on the vascular wall of small pulmonary arteries characterized by thickening of all its layers. These changes, named as vascular remodelling, include vascular proliferation, fibrosis, and vessel obstruction. In clinical practice the diagnosis of PAH relies on measurements of pulmonary vascular pressure and cardiac output, and calculation of pulmonary vascular resistances. Direct evaluation of pulmonary vascular structure is not routinely performed in pulmonary hypertension since current imaging techniques are limited and since little is known about the relationship between structural changes and functional characteristics of the pulmonary vasculature. Intravascular ultrasound studies in patients with pulmonary hypertension have shown a thicker middle layer, increased wall-thickness ratio and diminished pulsatility than in control patients. Optical Coherence Tomography, a new high resolution imaging modality that has proven its superiority over intravascular ultrasound (IVUS) for the detection and characterization of coronary atherosclerotic plaque composition, may potentially be a useful technique for the in vivo study of the pulmonary arterial wall. In addition current progress in Echo Doppler technique will quantify right ventricular function with parameters independent of loading conditions and not requiring volumetric approximations of the complex geometry of the right ventricle. This would allow the in vivo study of right ventricular and pulmonary artery remodelling in PAH.