Masafumi Fukumitsu1, Toru Kawada2, Shuji Shimizu2, Michael J Turner2, Kazunori Uemura2, Masaru Sugimachi3. 1. Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka 565-8565, Japan; Department of Artificial Organ Medicine, Faculty of Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan. Electronic address: mfuku@ncvc.go.jp. 2. Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka 565-8565, Japan. 3. Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka 565-8565, Japan; Department of Artificial Organ Medicine, Faculty of Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan.
Abstract
BACKGROUND: Wave reflection is enhanced in patients with pulmonary arterial hypertension (PAH), which may be derived from a mismatch of pulmonary artery (PA) impedance between proximal and distal sites of arteries. Whether enhanced wave reflection correlates with histological remodeling remains unknown, partly because lung biopsy is not clinically recommended for PAH patients due to substantial risks of mortality and morbidity. METHODS: Pulmonary hypertension was induced by SU5416 injection and 3-week hypoxic exposure (SuHx-PH) in rats, and hemodynamic and histological examinations were performed at 4weeks (SuHx-PH4W) and 8weeks (SuHx-PH8W) after SU5416 injection (n=7 each). Two groups of age-matched normal rats were also analyzed (n=7 each). Using an elastic tube with a 3-element Windkessel model, PA impedance was parameterized as pulmonary artery compliance (CP), peripheral resistance (RP), characteristic impedance (ZC), and transmission time (TD) in conducting arteries. Wave reflection was quantified as reflection gain at 0 Hz (Γgain) in the frequency domain, and as the ratio of peak backward pressure to peak forward pressure (KB/F) in the time domain. RESULTS: The SuHx-PH groups demonstrated increased RP and ZC, and decreased CP and TD compared with normal groups. Γgain and KB/F were significantly higher in the SuHx-PH8W group than in the SuHx-PH4W group, and correlated strongly with a histological index of vascular wall thickening (R2=0.839, P<0.001 for Γgain and R2=0.775, P<0.001 for KB/F). CONCLUSIONS: Enhanced wave reflection caused by abnormal PA impedance correlates with histological remodeling, and may have a diagnostic value in clinical staging of PAH.
BACKGROUND: Wave reflection is enhanced in patients with pulmonary arterial hypertension (PAH), which may be derived from a mismatch of pulmonary artery (PA) impedance between proximal and distal sites of arteries. Whether enhanced wave reflection correlates with histological remodeling remains unknown, partly because lung biopsy is not clinically recommended for PAH patients due to substantial risks of mortality and morbidity. METHODS: Pulmonary hypertension was induced by SU5416 injection and 3-week hypoxic exposure (SuHx-PH) in rats, and hemodynamic and histological examinations were performed at 4weeks (SuHx-PH4W) and 8weeks (SuHx-PH8W) after SU5416 injection (n=7 each). Two groups of age-matched normal rats were also analyzed (n=7 each). Using an elastic tube with a 3-element Windkessel model, PA impedance was parameterized as pulmonary artery compliance (CP), peripheral resistance (RP), characteristic impedance (ZC), and transmission time (TD) in conducting arteries. Wave reflection was quantified as reflection gain at 0 Hz (Γgain) in the frequency domain, and as the ratio of peak backward pressure to peak forward pressure (KB/F) in the time domain. RESULTS: The SuHx-PH groups demonstrated increased RP and ZC, and decreased CP and TD compared with normal groups. Γgain and KB/F were significantly higher in the SuHx-PH8W group than in the SuHx-PH4W group, and correlated strongly with a histological index of vascular wall thickening (R2=0.839, P<0.001 for Γgain and R2=0.775, P<0.001 for KB/F). CONCLUSIONS: Enhanced wave reflection caused by abnormal PA impedance correlates with histological remodeling, and may have a diagnostic value in clinical staging of PAH.