Occlusion pressure analysis role in partitioning of pulmonary vascular resistance in CTEPH.

The European Respiratory Journal
Mark ToshnerJoanna Pepke-Zaba

Abstract

Flow-directed pulmonary artery occlusion is posited to enable partitioning of vascular resistance into small and large vessels. As such it may have a role in assessment for pulmonary endarterectomy. To test if the occlusion technique distinguished small from large vessel disease we studied 59 subjects with chronic thromboembolic pulmonary hypertension (CTEPH), idiopathic pulmonary arterial hypertension (IPAH), and connective tissue disease (CTD)-associated PAH. At right heart catheterisation, occlusion pressures were recorded. With fitting of the pressure decay curve, pulmonary vascular resistance was partitioned into downstream (small vessels) and upstream (large vessels, Rup). 47 patients completed the study; 14 operable CTEPH, 15 inoperable CTEPH, 13 idiopathic or CTD-PAH and five post-operative CTEPH. There was a significant difference in mean Rup in the proximal operable CTEPH group 87.3 (95% CI 84.1-90.5); inoperable CTEPH mean 75.8 (95% CI 66.76-84.73), p=0.048; and IPAH/CTD, mean 77.1 (95% CI 71.86-82.33), p=0.003. Receiver operating characteristic curves to distinguish operable from inoperable CTEPH demonstrated an area under the curve of 0.75, p=0.0001. A cut-off of 79.3 gave 100% sensitivity (95% CI 73.5-100%) but 57...Continue Reading

Citations

Oct 8, 2013·Current Hypertension Reports·Robert Naeije
Nov 26, 2013·Clinics in Chest Medicine·Peter S MarshallWilliam R Auger
Jan 27, 2015·Pulmonary Circulation·Christian GergesIrene M Lang
Aug 19, 2014·The Journal of Thoracic and Cardiovascular Surgery·Andrea M D'ArminiRoberto Dore
Jan 10, 2014·Circulation Journal : Official Journal of the Japanese Circulation Society·Norikazu Yamada
Apr 14, 2016·Expert Review of Respiratory Medicine·Stefan GuthEckhard Mayer
Sep 12, 2016·Respirology : Official Journal of the Asian Pacific Society of Respirology·Rika SudaKoichiro Tatsumi
Aug 6, 2014·Circulation·Irene Marthe Lang, Michael Madani
Mar 31, 2018·The European Respiratory Journal·Christian GergesIrene M Lang
Jul 14, 2020·Current Opinion in Pulmonary Medicine·Vikramjit S Khangoora, Oksana A Shlobin
Dec 19, 2020·The European Respiratory Journal·Marion DelcroixGérald Simonneau

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