Shizuo Hanya1, Kengo Yoshii2, Motoaki Sugawara3. 1. Faculty of Health Sciences, Kinjo University Graduate School, Hakusan, Ishikawa, Japan. 2. Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan. 3. Tokyo Women's Medical College, Tokyo, Japan.
Abstract
Objectives: Although pulmonary hypertension (PH) caused by left heart disease (PH-LHD) is more common in PH, little is known about its properties of pulmonary artery (PA) in PH-LHD. The purpose of this study was to measure pulmonary regional pulse wave velocity (PWV) and to quantify the magnitude of reflected waves in patients with PH-LHD by the analysis of the pressure-velocity loops (PU-loop). Methods: High-fidelity PA pressure (Pm) and PA velocity (Vm) were measured in 11 subjects with PH-LHD (mean Pm>25 mmHg), 1 subject with atrial septal defect (ASD) without PH and 12 control subjects, using multisensor catheters. PWV was calculated as the slope of the initial part of the PU-loop in early systole. The similarity in the shapes of the pressure and flow velocity waveforms over one PU-loop was quantified as the magnitude of reflected wave by calculating the standard error of the estimate (Sy/x) from linear regression analysis between Pm and corresponding Vm. PWV and Sy/x during a Valsalva maneuver (VM) were also assessed in nine control subjects. Results: The contour of PU-loop was so characteristic between control and PH-LHD. Max. PWV (349 cm/s) was recorded in PH-LHD and min. PWV (111 cm/s) was recorded in ASD. VM increased Pm (12 [7-15] mmHg vs. 50 [18-110] mmHg; p=0.009) and PWV (200 [148-238] cm/s vs. 260 [192-306] cm/s; p=0.009) significantly without significant increase of Sy/x (19.6 [12.7-28.9]% vs. 28.2 [19.3-40.7]%; p=0.079). Although Sy/x was significantly higher in PH-LHD than in control and ASD (31.0 [14.3-36.3]% vs. 17.5 [8.4-28.9]%; p=0.009, ASD: 18.2%) , no significant difference was found in PWV between PH-LHD and control (269 [159-349] cm/s vs. 203 [154-289] cm/s; p=0.089). Conclusions: 1) The magnitude of wave reflection was elevated in PH-LHD significantly as compared with control and ASD. 2) Despite the significant increase in PA-PWV caused by abrupt elevation in Pm during VM in control, chronic elevation in Pm did not increase PA-PWV in PH-LHD significantly. It was hypothesized that the PA constituted a self-regulating system for maintaining the arterial stiffness stable against the chronic elevation in Pm in PH-LHD by a remodeling of increasing proximal pulmonary arterial crosssectional area gradually, which was compatible with the Moens-Korteweg equation. The PU-loop could provide a new simple and conventional method for assessing the pulmonary arterial properties, clinically. (This is a translation of J Jpn Coll Angiol 2016; 56: 45-53.).
Objectives: Although pulmonary hypertension (PH) caused by left heart disease (PH-LHD) is more common in PH, little is known about its properties of pulmonary artery (PA) in PH-LHD. The purpose of this study was to measure pulmonary regional pulse wave velocity (PWV) and to quantify the magnitude of reflected waves in patients with PH-LHD by the analysis of the pressure-velocity loops (PU-loop). Methods: High-fidelity PA pressure (Pm) and PA velocity (Vm) were measured in 11 subjects with PH-LHD (mean Pm>25 mmHg), 1 subject with atrial septal defect (ASD) without PH and 12 control subjects, using multisensor catheters. PWV was calculated as the slope of the initial part of the PU-loop in early systole. The similarity in the shapes of the pressure and flow velocity waveforms over one PU-loop was quantified as the magnitude of reflected wave by calculating the standard error of the estimate (Sy/x) from linear regression analysis between Pm and corresponding Vm. PWV and Sy/x during a Valsalva maneuver (VM) were also assessed in nine control subjects. Results: The contour of PU-loop was so characteristic between control and PH-LHD. Max. PWV (349 cm/s) was recorded in PH-LHD and min. PWV (111 cm/s) was recorded in ASD. VM increased Pm (12 [7-15] mmHg vs. 50 [18-110] mmHg; p=0.009) and PWV (200 [148-238] cm/s vs. 260 [192-306] cm/s; p=0.009) significantly without significant increase of Sy/x (19.6 [12.7-28.9]% vs. 28.2 [19.3-40.7]%; p=0.079). Although Sy/x was significantly higher in PH-LHD than in control and ASD (31.0 [14.3-36.3]% vs. 17.5 [8.4-28.9]%; p=0.009, ASD: 18.2%) , no significant difference was found in PWV between PH-LHD and control (269 [159-349] cm/s vs. 203 [154-289] cm/s; p=0.089). Conclusions: 1) The magnitude of wave reflection was elevated in PH-LHD significantly as compared with control and ASD. 2) Despite the significant increase in PA-PWV caused by abrupt elevation in Pm during VM in control, chronic elevation in Pm did not increase PA-PWV in PH-LHD significantly. It was hypothesized that the PA constituted a self-regulating system for maintaining the arterial stiffness stable against the chronic elevation in Pm in PH-LHD by a remodeling of increasing proximal pulmonary arterial crosssectional area gradually, which was compatible with the Moens-Korteweg equation. The PU-loop could provide a new simple and conventional method for assessing the pulmonary arterial properties, clinically. (This is a translation of J Jpn Coll Angiol 2016; 56: 45-53.).
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