Chest
Clinical InvestigationsPulmonary VasculatureIntravascular Ultrasound Assessment of Pulmonary Vascular Disease in Patients With Pulmonary Hypertension
Section snippets
Study Population
The study population consisted of 30 patients (10 men and 20 women) ranging in age from 33 to 73 years (mean, 54 years) who had suspected primary or secondary PH and were undergoing cardiac catheterization. The causes for PH were the following: severe left ventricular dysfunction (8 patients); mitral valve stenosis (16 patients); mitroaortic valvular disease (3 patients); Eisenmenger syndrome (1 patient); CREST (ie, calcinosis, Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly, and
Hemodynamic Data
The baseline values for PASP and mean PA pressure ranged from 21 to 136 mm Hg (mean [± SD], 49 ± 22) and from 13 to 85 mm Hg (33 ± 14), respectively. Pulmonary vascular resistance (PVR) and indexed PVR were 3.4 ± 3.3 Wood units (WU) (range, 0.4 to 16.3 WU) and 5.5 ± 4.7 WU × m2 (range, 0.8 to 22.4 WU × m2), respectively.
IVUS Measurements
We were able to perform the IVUS examination in all patients without complication (Fig 1). An average of two lobes were assessed per patient. The upper and lower lobes both were
Assessment of the Pulmonary Circulation Using IVUS and Correlations With Hemodynamic Abnormalities
The use of IVUS imaging allowed for the in vivo identification of regional differences in pulmonary vascular abnormalities found in patients with PH. Greater vascular wall hypertrophy already had been demonstrated in the lower lobes by histopathology,2 a finding attributed to the higher hydrostatic pressure chronically present in these segments with the patient in the upright posture. In contrast, there was no difference in IVUS indexes between the right and left lungs, demonstrating the
Conclusion
IVUS brings additional useful information to the evaluation of patients with PH. IVUS confirms in vivo the in vitro observation of greater vascular hypertrophy in the more dependent regions of the lung. IVUS-derived indexes correlate with classic hemodynamic indexes of PH and with two biochemical markers of PH, plasma ET-1 levels and reduced ET-1 clearance. Additional studies are necessary to determine whether the structural information derived from IVUS may help in the evaluation of the
Acknowledgment
The authors thank Joanne Vincent and Nathalie Ruel for their technical assistance, and Suzanne Taillefer for her help in the preparation of the manuscript.
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Supported by the Fonds de la Recherche en Santé du Québec, the Medical Research Council of Canada, the Quebec Heart and Stroke Foundation, the CAFIR of the University of Montreal, and the Fonds de Recherche de l’Institut de Cardiologie de Montréal.