In Vivo Assessment of Pulmonary Arterial Wall Fibrosis by Intravascular Optical Coherence Tomography in Pulmonary Arterial Hypertension: A New Prognostic Marker of Adverse Clinical Follow-Up§

Enric Domingo*, 1, 2, Juan C Grignola 3, Rio Aguilar 2, María Angeles Montero 4, Christian Arredondo 1, Manuel Vázquez 1, Manuel López-Messeguer 5, Carlos Bravo 5, Nadia Bouteldja 1, Cristina Hidalgo 1, Antonio Roman 5
1 Area del Cor, Hospital Universitari Vall d’Hebron, Spain
2 Dept Fisiología Universitat Autonoma Barcelona, Spain
3 Dept de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
4 Servei de Anatomia Patológica, Hospital Universitari Vall d’Hebron, Spain
5 Servei de Pneumologia i CIBERES, Hospital Universitari Vall d’Hebron, Spain

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© 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 ( 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 d’Hebron, Pg Vall d’Hebron 119-129, 08035, Barcelona, Spain; Tel: (+34) 93 2746155; Fax: (+34) 93 2746001; E-mail:
§ This study was presented in part in the Scientific Session of the American Heart Association (AHA), Nov 12-16th. Orlando, FL; USA. A9223. Circulation 124 (21, Suppl): A9223; 2011.



The aim is to correlate pulmonary arterial (PA) remodeling estimated by PA fibrosis in PA hypertension (PAH) with clinical follow-up. Histology of PA specimens is also performed.


19 patients, aged 54±16 (4 men), functional class II-III were studied with right heart catheterization, PA Intravascular Ultrasound and optical coherence tomography (OCT) in inferior lobe segment. PA wall fibrosis was obtained by OCT ( area of fibrosis/PA cross sectional area × 100). Patients follow-up was blind to OCT. Events were defined as mortality, lung transplantation, need of intravenous prostaglandins or onset of right ventricular failure.


OCT measurements showed high intra- and interobserver agreement. There was a good correlation between OCT and histology in PA fibrosis from explanted lungs. Area of fibrosis was 1.4±0.8 mm2, % fibrosis was 22.3±8. Follow-up was 3.5 years (2.5-4.5). OCT %Fib was significantly correlated with PA capacitance (r=-0.536) and with pulmonary vascular rsistance (r=0.55). Patients were divided according to the median value of PA fibrosis. There were 10 patients with a high (≥ 22%) and 9 with a low fibrosis (<22%). Events occurred in 6 (1 death, 1 lung transplantation, 2 intravenous prostaglandins, 2 right heart failure) out of 10 patients with high and in 0 out of 9 patients with low fibrosis (p<0.01).


In PAH, the severity of PA remodeling assessed by OCT wall fibrosis was significantly predictive of severely unfavorable clinical outcome. In vivo assessment of pulmonary arterial wall fibrosis by intravascular OCT in PAH is a promising new prognostic marker of adverse clinical outcome.

Keywords: Catheterization, pulmonary heart disease, prognosis, remodeling..