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. 2018 Aug;28(8):3464-3472.
doi: 10.1007/s00330-018-5346-x. Epub 2018 Feb 27.

Pulmonary Arterial Stiffening in COPD and Its Implications for Right Ventricular Remodelling

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Free PMC article

Pulmonary Arterial Stiffening in COPD and Its Implications for Right Ventricular Remodelling

Jonathan R Weir-McCall et al. Eur Radiol. .
Free PMC article

Abstract

Background: Pulmonary pulse wave velocity (PWV) allows the non-invasive measurement of pulmonary arterial stiffening, but has not previously been assessed in COPD. The aim of the current study was to assess PWV in COPD and its association with right ventricular (RV) remodelling.

Methods: Fifty-eight participants with COPD underwent pulmonary function tests, 6-min walk test and cardiac MRI, while 21 healthy controls (HCs) underwent cardiac MRI. Thirty-two COPD patients underwent a follow-up MRI to assess for longitudinal changes in RV metrics. Cardiac MRI was used to quantify RV mass, volumes and PWV. Differences in continuous variables between the COPD and HC groups was tested using an independent t-test, and associations between PWV and right ventricular parameters was examined using Pearson's correlation coefficient.

Results: Those with COPD had reduced pulsatility (COPD (mean±SD):24.88±8.84% vs. HC:30.55±11.28%, p=0.021), pulmonary acceleration time (COPD:104.0±22.9ms vs. HC: 128.1±32.2ms, p<0.001), higher PWV (COPD:2.62±1.29ms-1 vs. HC:1.78±0.72ms-1, p=0.001), lower RV end diastolic volume (COPD:53.6±11.1ml vs. HC:59.9±13.0ml, p=0.037) and RV stroke volume (COPD:31.9±6.9ml/m2 vs. HC:37.1±6.2ml/m2, p=0.003) with no difference in mass (p=0.53). PWV was not associated with right ventricular parameters.

Conclusions: While pulmonary vascular remodelling is present in COPD, cardiac remodelling favours reduced filling rather than increased afterload. Treatment of obstructive lung disease may have greater effect on cardiac function than treatment of pulmonary vascular disease in most COPD patients KEY POINTS: • Pulmonary pulse wave velocity (PWV) is elevated in COPD. • Pulmonary PWV is not associated with right ventricular remodelling. • Right ventricular remodelling is more in keeping with that of reduced filling.

Keywords: Heart ventricles; Magnetic resonance imaging; Pulmonary arteries; Pulmonary disease, chronic obstructive; Pulse-wave analysis.

Conflict of interest statement

Guarantor

The scientific guarantor of this publication is Jonathan Weir-McCall.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• case-control

• performed at one institution

Figures

Fig. 1
Fig. 1
Calculation of pulse wave velocity, pulmonary acceleration time and pulmonary pulsatility. Magnitude (A) and phase (B) images of the main pulmonary artery from which flow (C) and area (D) data are acquired from which the pulse wave velocity is derived. A zoomed in period from early systole (E) demonstrates the calculation of the pulmonary acceleration time (∆t). Cine images of the main pulmonary artery at end diastole (F) and end systole (G) are used to calculate pulmonary pulsatility
Fig. 2
Fig. 2
Bar (representing the mean) and dot (representing the individual participants) plot of the change in right ventricular mass from baseline to follow-up examination

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