Evaluation of Pulmonary Artery Stiffness in Pulmonary Hypertension With Cardiac Magnetic Resonance
Javier Sanz, MD*,*,
Mbabazi Kariisa, MPH*, ,
Santo Dellegrottaglie, MD, PhD*, ,
Susanna Prat-González, MD*,
Mario J. Garcia, MD, FACC*,
Valentin Fuster, MD, PhD, FACC*,
Sanjay Rajagopalan, MD, FACC*,
* Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, New York
Davis Heart and Lung Research Institute, Ohio State University, Columbus, Ohio
A. De Gasperis Department of Cardiology and Cardiac Surgery, Niguarda-Ca' Granda Hospital, Milan, Italy
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Figure 1 Indexes of PA Stiffness According to Patient Subgroups
Median values and interquartile ranges (error bars) for pulmonary artery pulsatility (A), compliance (B), capacitance (C), distensibility (D), elastic modulus (E), and stiffness index β (F) in the different patient subgroups. *p < 0.05 in comparison with patients with no pulmonary hypertension (PH). p < 0.05 in comparison with patients with exercise-induced pulmonary hypertension (EIPH). PA = pulmonary artery.
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Figure 2 Relationship Between sPAP and PA Stiffness
Regression analysis of the relationships between systolic pulmonary artery pressure (sPAP) and pulmonary artery pulsatility (A), compliance (B), capacitance (C), distensibility (D), elastic modulus (E), and stiffness index β (F). Brown circles = patients with no PH; orange circles = patients with EIPH; red circles = patients with PH at rest. Abbreviations as in Figure 1.
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Figure 3 Diagnostic Ability of PA Pulsatility for the Presence of PH
The receiver-operating characteristic curve of the ability of PA pulsatility to detect mean PA pressure (at rest) >25 mm Hg. AUC = area under the curve; CI = confidence interval; other abbreviations as in Figure 1.
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Figure 4 Proposed Role of Increased PA Stiffness in the Development and Progression of PH
In early disease stages (top half), poorly identified factors that may include abnormal shear stress or endothelial injury alter PA elastic properties. This leads to increased pulse pressure (PP) and favors the development of overt PH. Elevated distending pressures result in PA dilation, causing further stiffening and shear stress abnormalities and establishing a positive feedback cycle of disease progression. The bottom half of the figure represents a cross-section of the pulmonary trunk. Initially, the PA has normal size and preserved elastic properties. In early stages, such as EIPH, there is increased stiffness of the PA wall. In advanced stages (PH at rest), stiffness continues to increase and the PA dilates. Abbreviations as in Figure 1.
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