Acute absolute vasodilatation is associated with a lower vascular wall stiffness in pulmonary arterial hypertension

Juan C. Grignola, Enric Domingo, Rio Aguilar, Manuel Vázquez, Manuel López-Messeguer, Carlos Bravo, Antonio Roman

Research output: Contribution to journalArticleResearchpeer-review

9 Citations (Scopus)

Abstract

Background: Acute vasoreactivity testing (VT) is considered mandatory in the diagnostic work-up of patients with pulmonary arterial hypertension (PAH). We studied the relation between the acute absolute arterial vasodilatation and the severity of vascular remodeling estimated by intravascular ultrasound (IVUS) in patients with idiopathic PAH. Methods: Simultaneous right heart catheterization and IVUS of the pulmonary artery (PA) were performed both in basal conditions and during short-term intravenous epoprostenol infusion in nineteen idiopathic PAH patients. Pulmonary vascular resistance (PVRi) and capacitance indexes (stroke volume/pulse pressure, Cp), were calculated. Local pulsatility was estimated by IVUS (IVUSp) (systolic-diastolic lumen area / diastolic lumen area × 100; sA-dA / dA) and PA stiffness was assessed by the elastic modulus (E: pulse pressure/IVUSp). Results: Epoprostenol infusion (11 ± 2 ng/kg/min) determined a real vasodilatation (increment of dA > 10%) in six patients. This vasodilation group presented on average significantly higher cardiac index, stroke volume index and Cp, and lower PVRi and IVUSp (P < 0.05), with a lower E (P = 0.08). Three patients were responders according to the actual criteria, but only one showed a real vasodilator response. Baseline E below the median value (≤ 190 mm Hg) was able to differentiate patients with an acute vasodilator response (sensibility 83%, specificity 73%, area under ROC 0.81; P < 0.05). Neither E nor vasodilator response is correlated with delta mean PA pressure and PVRi. Conclusions: Patients with higher IVUSp and lesser E displayed an absolute PA vasodilation during VT with epoprostenol. The patients with a positive VT according to actual criteria do not necessarily have a real vasodilatation on intravascular ultrasound. © 2011 Elsevier Ireland Ltd.
Original languageEnglish
Pages (from-to)227-231
JournalInternational Journal of Cardiology
Volume164
Issue number2
DOIs
Publication statusPublished - 5 Apr 2013

Keywords

  • Acute vasoreactivity test
  • IVUS
  • Pulmonary artery stiffness
  • Pulmonary hypertension

Fingerprint Dive into the research topics of 'Acute absolute vasodilatation is associated with a lower vascular wall stiffness in pulmonary arterial hypertension'. Together they form a unique fingerprint.

  • Cite this

    Grignola, J. C., Domingo, E., Aguilar, R., Vázquez, M., López-Messeguer, M., Bravo, C., & Roman, A. (2013). Acute absolute vasodilatation is associated with a lower vascular wall stiffness in pulmonary arterial hypertension. International Journal of Cardiology, 164(2), 227-231. https://doi.org/10.1016/j.ijcard.2011.07.020