Global Pulmonary Vascular Remodeling in Pulmonary Hypertension Associated With Heart Failure and Preserved or Reduced Ejection Fraction
Authors' conclusion
In HF, PH is associated with global pulmonary vascular remodeling, but the severity of PH correlates most strongly with venous and small IV intimal thickening, similar to the pattern observed in PVOD.
Study context
- Population
- Patients with heart failure (HF) (preserved or reduced EF) and pulmonary hypertension (PH), with lung specimens from autopsy or surgery4,949 arteries, 7630 veins, 2168 indeterminate vessels (IV)
- Participants
- 108 / 12 / 17
- Comparison
- HF-PH vs normal controls vs pulmonary veno-occlusive disease (PVOD)
- HF-PHn = 108
- Controln = 12reference
- PVODn = 17
- Outcome
- Pulmonary vascular remodeling (arterial % medial thickness; % intimal thickness of arteries, veins and small indeterminate vessels) and its association with PASP
Methodological detailsautopsy and surgical lung specimens, quantitative histomorphometry
- Autopsy and surgical lung specimens
- Quantitative histomorphometry
Main finding
As reported in the abstract
Pulmonary vascular remodeling (average %)
| Group | Arterial % medial thickness | Arterial %IT | Venous %IT | IV %IT |
|---|---|---|---|---|
| Control | 6.9 | 4.9 | 14.0 | 10.6 |
| HF-PH | 11.0 | 14.9 | 24.9 | 25.8 |
| PVOD | 15.0 | 31.1 | 43.9 | 50.0 |
Arterial % medial thickness
Control6.9
HF-PH11.0
PVOD15.0
Arterial %IT
Control4.9
HF-PH14.9
PVOD31.1
Venous %IT
Control14.0
HF-PH24.9
PVOD43.9
IV %IT
Control10.6
HF-PH25.8
PVOD50.0
- HF-PH vs Control: P < 0.0001 — higher in HF-PH, all measures
- HF-PH vs PVOD: P ≤ 0.005 — lower in HF-PH, all measures
- PASP correlation with arterial % medial thickness
- r=0.41
- PASP correlation with arterial %IT
- r=0.35
- PASP correlation with venous %IT
- r=0.49
- PASP correlation with IV %IT
- r=0.55
Further findings
Median, mm Hg
| Outcome | HF-PH | Control | PVOD | |
|---|---|---|---|---|
| PASP | 59 (IQR 50–70) | Not reported in the abstract | 91 (IQR 82–103) | Control: not reported in the abstract |
Transpulmonary gradient vs remodeling (right heart catheterization subset: 30 HF-PH, 14 PVOD)
- Similar associations, numerically stronger for venous and IV %IT
HF-PH with RV dysfunction
- PASP slightly higher but pulmonary vascular remodeling not more severe
Diffusing capacity of the lungs
- Remodeling severity associated with reduced diffusing capacity
Original publication
Global Pulmonary Vascular Remodeling in Pulmonary Hypertension Associated With Heart Failure and Preserved or Reduced Ejection Fraction. Circulation. Published 15 December 2017. doi:10.
Summarised from the published abstract; every number is checked against it