Document Detail

Occlusion pressure analysis role in partitioning of pulmonary vascular resistance in CTEPH.
MedLine Citation:
PMID:  22362857     Owner:  NLM     Status:  MEDLINE    
Flow-directed pulmonary artery occlusion is posited to enable partitioning of vascular resistance into small and large vessels. As such it may have a role in assessment for pulmonary endarterectomy. To test if the occlusion technique distinguished small from large vessel disease we studied 59 subjects with chronic thromboembolic pulmonary hypertension (CTEPH), idiopathic pulmonary arterial hypertension (IPAH), and connective tissue disease (CTD)-associated PAH. At right heart catheterisation, occlusion pressures were recorded. With fitting of the pressure decay curve, pulmonary vascular resistance was partitioned into downstream (small vessels) and upstream (large vessels, Rup). 47 patients completed the study; 14 operable CTEPH, 15 inoperable CTEPH, 13 idiopathic or CTD-PAH and five post-operative CTEPH. There was a significant difference in mean Rup in the proximal operable CTEPH group 87.3 (95% CI 84.1-90.5); inoperable CTEPH mean 75.8 (95% CI 66.76-84.73), p=0.048; and IPAH/CTD, mean 77.1 (95% CI 71.86-82.33), p=0.003. Receiver operating characteristic curves to distinguish operable from inoperable CTEPH demonstrated an area under the curve of 0.75, p=0.0001. A cut-off of 79.3 gave 100% sensitivity (95% CI 73.5-100%) but 57.1% specificity (95% CI 28.9-82.3%). In a subgroup analysis of multiple lobar sampling there was demonstrable heterogeneity. Rup is significantly increased in operable proximal CTEPH compared with non-operable distal CTEPH and IPAH/CTD-PAH. Rup variability in patients with CTEPH and PAH is suggestive of pathophysiological heterogeneity.
Mark Toshner; Jay Suntharalingam; Pierre Fesler; Elaine Soon; Karen K Sheares; David Jenkins; Paul White; Nicholas W Morrell; Robert Naeije; Joanna Pepke-Zaba
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-02-23
Journal Detail:
Title:  The European respiratory journal     Volume:  40     ISSN:  1399-3003     ISO Abbreviation:  Eur. Respir. J.     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-09-03     Completed Date:  2013-02-04     Revised Date:  2013-05-23    
Medline Journal Info:
Nlm Unique ID:  8803460     Medline TA:  Eur Respir J     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  612-7     Citation Subset:  IM    
University of Cambridge, UK.
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MeSH Terms
Cardiac Catheterization
Chronic Disease
Connective Tissue Diseases / diagnosis,  physiopathology
Hypertension, Pulmonary / diagnosis,  physiopathology*,  surgery
Middle Aged
Patient Selection
Pulmonary Artery / physiopathology,  surgery
Pulmonary Embolism / diagnosis,  physiopathology*,  surgery
ROC Curve
Vascular Resistance / physiology*

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