RT Journal Article
SR Electronic
T1 The isobaric pulmonary arterial compliance in pulmonary hypertension
JF ERJ Open Research
JO erjor
FD European Respiratory Society
SP 00941-2020
DO 10.1183/23120541.00941-2020
A1 Denis Chemla
A1 Emmanuelle Berthelot
A1 Jason Weatherald
A1 Edmund M. T. Lau
A1 Laurent Savale
A1 Antoine Beurnier
A1 David Montani
A1 Olivier Sitbon
A1 Pierre Attal
A1 David Boulate
A1 Patrick Assayag
A1 Marc Humbert
A1 Philippe Hervé
YR 2021
UL http://openres.ersjournals.com/content/early/2021/02/04/23120541.00941-2020.abstract
AB 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.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.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 matterConflict 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 COIConflict 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.