Pulmonary arterial stiffening in COPD and its implications for right ventricular remodelling

作者：Weir McCall Jonathan R; Liu Shiu Cheong Patrick S K; Struthers Allan D; Lipworth Brian J; Houston J Graeme^*

来源：European Radiology, 2018, 28(8): 3464-3472.

DOI：10.1007/s00330-018-5346-x

• Magnetic resonance imaging
• Pulmonary arteries
• Heart ventricles
• Pulse-wave analysis
• Pulmonary disease
• chronic obstructive

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.
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.
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/m(2) vs. HC:37.1 +/- 6.2ml/m(2), p=0.003) with no difference in mass (p=0.53). PWV was not associated with right ventricular parameters.
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
aEuro cent Pulmonary pulse wave velocity (PWV) is elevated in COPD.
aEuro cent Pulmonary PWV is not associated with right ventricular remodelling.
aEuro cent Right ventricular remodelling is more in keeping with that of reduced filling.

• 出版日期2018-8