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dc.contributorVall d'Hebron Barcelona Hospital Campus
dc.contributor.authorGrignola, Juan C.
dc.contributor.authorDomingo Ribas, Enric
dc.contributor.authorLópez Meseguer, Manuel
dc.contributor.authorTrujillo, Pedro
dc.contributor.authorBravo Masgoret, Carles
dc.contributor.authorPérez Hoyos, Santiago
dc.contributor.authorRomán Broto, Antonio
dc.date.accessioned2021-12-27T13:18:13Z
dc.date.available2021-12-27T13:18:13Z
dc.date.issued2021-05
dc.identifier.citationGrignola JC, Domingo E, López-Meseguer M, Trujillo P, Bravo C, Pérez-Hoyos S, et al. Pulmonary Arterial Remodeling Is Related to the Risk Stratification and Right Ventricular-Pulmonary Arterial Coupling in Patients With Pulmonary Arterial Hypertension. Front Physiol. 2021 May;12:631326.
dc.identifier.issn1664-042X
dc.identifier.urihttp://hdl.handle.net/11351/6734
dc.descriptionIntravascular ultrasound; Pulmonary arterial hypertension; Risk stratification
dc.description.abstractBackground: Pulmonary arterial (PA) stiffness has an essential contribution to the right ventricular (RV) failure pathogenesis. A comprehensive and multiparameter risk assessment allows predicting mortality and guiding treatment decisions in PA hypertension (PAH). We characterize PA remodeling with intravascular ultrasound (IVUS) in prevalent and stable patients with PAH according to the ESC/ERS risk table and analyze the RV-PA coupling consequences. Methods: Ten control subjects and 20 prevalent PAH adult patients underwent right heart catheterization (RHC) with simultaneous IVUS study. We estimated cardiac index (CI), pulmonary vascular resistance, and compliance (PVR, PAC) by standard formulas. From IVUS and RHC data, PA diameter, wall thickness/luminal diameter ratio, and indexes of stiffness (pulsatility, compliance, distensibility, incremental elastic modulus - Einc-, and the stiffness index β) were measured. We evaluated RV-PA coupling by the ratio of tricuspid annular plane systolic excursion to systolic pulmonary arterial pressure (TAPSE/sPAP). The individual average risk was calculated by assigning a score of 1 (low-risk -LR-), 2 (intermediate-risk -IR-), and 3 (high-risk -HR-) for each of seven variables (functional class, six-minute walking test, brain natriuretic peptide, right atrial area and pressure, CI, and PA oxygen saturation) and rounding the average value to the nearest integer. Results: All PA segments interrogated showed increased vessel diameter, wall cross-sectional area (WCSA), and stiffness in patients with PAH compared to control subjects. 45% corresponded to LR, and 55% corresponded to IR PAH patients. The different measurements of PA stiffness showed significant correlations with TAPSE/sPAP (r = 0.6 to 0.76) in PAH patients. The IR group had higher PA stiffness and lower relative WCSA than LR patients (P < 0.05), and it is associated with a lower PAC and TAPSE/sPAP (P < 0.05). Conclusion: In prevalent PAH patients, the severity of proximal PA remodeling is related to the risk stratification and associated with PAC and RV-PA coupling impairment beyond the indirect effect of the mean PA pressure. The concomitant assessment of IVUS and hemodynamic parameters at diagnosis and follow-up of PAH patients could be a feasible and safe tool for risk stratification and treatment response of the PA vasculopathy during serial hemodynamic measurements.
dc.language.isoeng
dc.publisherFrontiers Media
dc.relation.ispartofseriesFrontiers in Physiology;12
dc.rightsAttribution 4.0 International
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.sourceScientia
dc.subjectHipertensió pulmonar - Diagnòstic
dc.subjectRiscos per a la salut - Avaluació
dc.subjectEcocardiografia
dc.subject.meshHypertension, Pulmonary
dc.subject.mesh/diagnosis
dc.subject.meshRisk Assessment
dc.subject.meshUltrasonography, Interventional
dc.titlePulmonary Arterial Remodeling Is Related to the Risk Stratification and Right Ventricular-Pulmonary Arterial Coupling in Patients With Pulmonary Arterial Hypertension
dc.typeinfo:eu-repo/semantics/article
dc.identifier.doi10.3389/fphys.2021.631326
dc.subject.decshipertensión pulmonar
dc.subject.decs/diagnóstico
dc.subject.decsevaluación de riesgos
dc.subject.decsecografía intervencionista
dc.relation.publishversionhttps://doi.org/10.3389/fphys.2021.631326
dc.type.versioninfo:eu-repo/semantics/publishedVersion
dc.audienceProfessionals
dc.contributor.organismesInstitut Català de la Salut
dc.contributor.authoraffiliation[Grignola JC] Pathophysiology Department, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay. [Domingo E] Àrea del Cor, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Departament de Fisiologia, Escola de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain. [López-Meseguer M, Bravo C, Roman A] Servei de Pneumologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Ciberes, IS Carlos III, Madrid, Spain. [Trujillo P] Centro Cardiovascular Universitario, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay. [Pérez-Hoyos S] Unitat d’Estadística, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain
dc.identifier.pmid34012405
dc.identifier.wos000651062200001
dc.rights.accessrightsinfo:eu-repo/semantics/openAccess


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