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Impact of pulmonary endarterectomy on pulmonary arterial wave propagation and reservoir function

Su, J; Hughes, AD; Simonsen, U; Nielsen-Kudsk, JE; Parker, KH; Howard, LS; Mellemkjaer, S; (2019) Impact of pulmonary endarterectomy on pulmonary arterial wave propagation and reservoir function. American Journal of Physiology: Heart and Circulatory Physiology , 317 (3) H505-H516. 10.1152/ajpheart.00181.2019. Green open access

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Abstract

High wave speed and large wave reflection in the pulmonary artery have previously been reported in patients with chronic thromboembolic pulmonary hypertension (CTEPH). We assessed the impact of pulmonary endarterectomy (PEA) on pulmonary arterial wave propagation and reservoir function in CTEPH patients. Right heart catheterization was performed using a combined pressure and Doppler flow sensor tipped guidewire to obtain simultaneous pressure and flow velocity measurements in the pulmonary artery in eight CTEPH patients before and 3 months after PEA. Wave intensity and reservoir-excess pressure analyses were then performed. Following PEA, mean pulmonary arterial pressure (PAPm, ~49 versus ~32 mmHg), pulmonary vascular resistance (PVR, ~11.1 versus ~5.1 Wood Units) and wave speed (~16.5 versus ~8.1 m/s), i.e. local arterial stiffness, markedly decreased. The changes in the intensity of the reflected arterial wave and wave reflection index (pre: ~28%; post: ~22%) were small and post-PEA patients with and without residual pulmonary hypertension (i.e. PAPm ≥25 mmHg) had similar wave reflection index (~20 versus ~23%). The reservoir and excess pressure decreased post-PEA and the changes were associated with improved right ventricular afterload, function and size. In conclusion, while PVR and arterial stiffness decreased substantially following PEA, large wave reflection persisted, even in patients without residual pulmonary hypertension, indicating lack of improvement in vascular impedance mismatch. This may continue to affect the optimal ventriculo-arterial interaction and further studies are warranted to determine whether this contributes to persistent symptoms in some patients.

Type: Article
Title: Impact of pulmonary endarterectomy on pulmonary arterial wave propagation and reservoir function
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1152/ajpheart.00181.2019
Publisher version: https://doi.org/10.1152/ajpheart.00181.2019
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: arterial stiffness, pulmonary endarterectomy, pulmonary hypertension, wave intensity analysis, wave reflection
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Population Science and Experimental Medicine
URI: https://discovery.ucl.ac.uk/id/eprint/10077200
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