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Article Dans Une Revue European Respiratory Journal Année : 2018

In-depth hemodynamic phenotyping of pulmonary hypertension due to left heart disease

Résumé

The commonest cause of pulmonary hypertension (PH) is left heart disease (LHD). The current classification system for definitions of PH-LHD is under review. We therefore performed prospective in-depth invasive hemodynamic phenotyping in order to assess the site of increased pulmonary vascular resistance (PVR) in PH-LHD subsets.Based on pulmonary artery occlusion waveforms yielding an estimate of the effective capillary pressure (P c' ), we partitioned PVR in larger arterial (R up , upstream resistance) and small arterial plus venous components (R ds , downstream resistance). In the case of small vessel disease, R up decreases and R ds increases. Inhaled nitric oxide (iNO) testing was used to assess acute vasoreactivity.Right ventricular (RV) afterload (PVR, pulmonary arterial compliance and effective arterial elastance) was significantly higher in combined post- and pre-capillary PH (Cpc-PH, n=35) than in isolated post-capillary PH (Ipc-PH, n=20). RV afterload decreased during iNO in Cpc-PH and idiopathic pulmonary arterial hypertension (iPAH, n=31), but remained unchanged in Ipc-PH. R up was similar in Cpc-PH (66.8±10.8%) and iPAH (65.0±12.2%, p=0.530) suggesting small vessel disease, but significantly higher in Ipc-PH (96.5±4.5%, p<0.001) suggesting upstream transmission of elevated left atrial pressures (LAP).RV afterload is driven by elevated LAP in Ipc-PH and is further increased by elevated small vessel resistance in Cpc-PH. Cpc-PH is responsive to iNO. Our data support current definitions of PH-LHD subsets.
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Dates et versions

hal-01790382 , version 1 (30-04-2020)

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Christian Gerges, Mario Gerges, Pierre Fesler, Anna Maria Pistritto, Nicholas Konowitz, et al.. In-depth hemodynamic phenotyping of pulmonary hypertension due to left heart disease. European Respiratory Journal, 2018, ⟨10.1183/13993003.00067-2018⟩. ⟨hal-01790382⟩
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