Pulmonary vascular disease & thromboembolism
Microvascular Disease in Chronic Thromboembolic Pulmonary Hypertension: Hemodynamic Phenotyping and Histomorphometric Assessment
Authors' conclusion
Pulmonary artery occlusion waveform analysis with estimation of Rup seems to be a valuable technique for assessing the degree of small-vessel disease and postoperative outcome after PEA in chronic thromboembolic pulmonary hypertension.
Study context
- Population
- Patients with chronic thromboembolic pulmonary hypertension undergoing pulmonary endarterectomy (PEA)biopsies in 49
- Participants
- 90 patients
- Outcome
- Persistent PH after PEA and survival, predicted by upstream resistance (Rup) from pulmonary artery occlusion waveforms
Methodological detailshistological validation (lung wedge biopsies)
- Histological validation (lung wedge biopsies)
Main finding
As reported in the abstract
OR for persistent PH (95% CI)P value
Rup (per 10%)
0.40(0.23–0.69)
P = 0.001Per 10%, as printed
- Rup (per 10%)
- HR for survival 0.03 (95% CI 0.00–0.33); P = 0.004
Observational data: associations, not effects.
Further findings
Correlation of Rup with histology
- Rup vs arterial %MT, nonobstructed territories (r)
- −0.72, P<0.001
- Rup vs arterial %IT, nonobstructed territories (r)
- −0.62, P<0.001
- Rup vs venous %IT, obstructed territories (r)
- −0.44, P=0.024
Histology in persistent pulmonary hypertension (PH) and nonsurvivors
- Arterial %MT and %IT (nonobstructed) and venous %IT (obstructed) significantly increased in persistent PH and nonsurvivors
Original publication
Microvascular Disease in Chronic Thromboembolic Pulmonary Hypertension: Hemodynamic Phenotyping and Histomorphometric Assessment. Circulation. Published 3 January 2020. doi:10.
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