The isobaric pulmonary arterial compliance in pulmonary hypertension
- Denis Chemla1,2,3,
- Emmanuelle Berthelot2,4,
- Jason Weatherald5,
- Edmund M. T. Lau6,
- Laurent Savale2,3,7,
- Antoine Beurnier1,4,
- David Montani2,3,
- Olivier Sitbon2,3,
- Pierre Attal1,
- David Boulate1,
- Patrick Assayag2,3,4,8,
- Marc Humbert2,3,7 and
- Philippe Hervé3,9
- 1Service d'explorations fonctionnelles multidisciplinaires bi-site Antoine Béclère - Kremlin Bicêtre, GHU Paris Sud, AP-HP, Le Kremlin-Bicêtre, France
- 2Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- 3INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France
- 4Service de cardiologie, GHU Paris Sud, AP-HP, Le Kremlin-Bicêtre, France
- 5Department of Medicine, Division of Respirology, University of Calgary, and Libin Cardiovascular Institute, Calgary, Alberta, Canada
- 6Department of Respiratory Medicine, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
- 7Service de Pneumologie, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
- 8Department of Otolaryngology-Head and Neck Surgery, Shaare-Zedek Medical Center and Hebrew University Medical School, Jerusalem, Israel
- 9Departement de Chirurgie Thoracique, Vasculaire et de Transplantation Pulmonaire, Hopital Marie Lannelongue, Le Plessis Robinson, France
- Pr Denis CHEMLA, MD, Service des Explorations Fonctionnelles - Broca 4 Hôpital de Bicêtre, 78 rue du Général Leclerc, 94 275 Le Kremlin Bicêtre, France. E-mail: denis.chemla{at}aphp.fr
Abstract
Pulmonary hypertension (PH) is associated with stiffening of pulmonary arteries which increases right ventricular pulsatile loading. High pulmonary artery wedge pressure (PAWP) in postcapillary PH (Pc-PH) further decreases PA compliance (PAC) at a given pulmonary vascular resistance (PVR) compared to precapillary PH, thus responsible for a higher total arterial load. In all other vascular beds, arterial compliance is considered as mainly determined by the distending pressure, due to non-linear stress-strain behaviour of arteries. We tested the applicability, advantages and drawbacks of two comparison methods of PAC depending on the level of mean PA pressure mPAP (isobaric PAC) or PVR.
Right heart catheterisation data including PAC (stroke volume/pulse pressure) were obtained in 112Pc-PH (of whom 61 had combined postcapillary and precapillary PH) and 719 idiopathic pulmonary arterial hypertension (iPAH).
PAC could be compared over the same mPAP range (25–66 mmHg) in 792/831 patients (95.3%) and over the same PVR range (3–10.7 WU) in only 520/831 patients (62.6%). The main assumption underlying comparisons at a given PVR was not verified as the PVR×PAC product (RC-time) was not constant but on the contrary more variable than mPAP. In the 788/831 (94.8%) patients studied over the same PAC range (0.62–6.5 mL·mmHg−1), PVR and thus total arterial load tended to be higher in iPAH.
Our study favours comparing PAC at fixed mPAP level (isobaric PAC) rather than at fixed PVR. A reappraisal of the effects of PAWP on the pulsatile and total arterial load put on the right heart is needed, and this point deserves further studies.
Footnotes
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Conflict of interest: Chemla has nothing to disclose.
Conflict of interest: Berthelot has None.
Conflict of interest: Dr. Weatherald reports grants, personal fees and non-financial support from Janssen Inc., grants, personal fees and non-financial support from Actelion, personal fees and non-financial support from Bayer, personal fees from Novartis, outside the submitted work; .
Conflict of interest: Dr. Lau has nothing to disclose.
Conflict of interest: Dr. Savale reports grants, personal fees and non-financial support from Actelion, personal fees and non-financial support from MSD, personal fees and non-financial support from Bayer, grants, personal fees and non-financial support from GSK, outside the submitted work; .
Conflict of interest: Beurnier has No COI to disclose in the subject matter
Conflict of interest: Dr. MONTANI reports grants and personal fees from Actelion, grants and personal fees from Bayer, personal fees from GSK, personal fees from Pfizer, grants, personal fees and non-financial support from MSD, personal fees from Chiesi, personal fees from Boerhinger, non-financial support from Acceleron, outside the submitted work; .
Conflict of interest: Dr. SITBON reports grants, personal fees and non-financial support from Actelion Pharmaceuticals, personal fees and non-financial support from Bayer, grants from GlaxoSmithKline, grants, personal fees and non-financial support from Merck, personal fees from Ferrer, personal fees from Gossamer Bio, personal fees from Acceleron, outside the submitted work; .
Conflict of interest: Attal has No COI
Conflict of interest: Dr. Boulate has nothing to disclose.
Conflict of interest: Dr. Assayag has nothing to disclose.
Conflict of interest: Dr. Humbert reports personal fees from Acceleron, grants and personal fees from Actelion, grants and personal fees from Bayer, personal fees from GSK, personal fees from Merck, personal fees from Novartis, personal fees from Astrazeneca, personal fees from Sanofi, outside the submitted work.
Conflict of interest: Hervé has No COI to disclose.
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- Received February 1, 2021.
- Accepted February 1, 2021.
- ©The authors 2021
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