Pulmonary vascular remodeling in pulmonary hypertension due to chronic heart failure.
Pulmonary hypertension (PHT) associated with chronic heart failure (CHF) is a risk factor of right ventricular failure after heart transplantation (HT). Our aim was to study pulmonary vascular changes in patients with CHF and to assess any correlation with haemodynamic data.


METHODS
We studied 17 HT recipients with preoperative CHF who died shortly after HT. Preoperative haemodynamic information was obtained immediately before HT. Vascular lesions in muscular arteries were assessed by linear morphometry. Haemodynamic data were correlated with the morphologic changes.


RESULTS
Mean transpulmonary gradient (TPG) was 8.9+/-4.5 mm Hg and pulmonary vascular resistance (PVR) was 2.25+/-1.34 Wu. According to the threshold for at-risk PHT (TPG>12 mm Hg or PVR>2.5 Wu), six patients had at-risk PHT. Medial thickness was 23.82+/-7.23% in patients with at-risk PHT and 17.16+/-3.24% in patients without at-risk PHT (p=0.018).


CONCLUSIONS
Medial hypertrophy of muscular pulmonary arteries is more common and severe than expected in patients with CHF, even in patients without at-risk PHT. This structural change could explain why PHT, even in range of values not excluding HT, is a risk factor for right ventricular failure after HT and influences post-HT haemodynamic behaviour.
Delgado
Juan F
JF
Heart Failure and Transplant Unit, Hospital Doce de Octubre, Avenida de Córdoba sn, Km 5,400. 28041 Madrid, Spain. jdelgado.hdoc@salud.madrid.org
Conde
Esther
E
Sánchez
Violeta
V
López-Ríos
Fernando
F
Gómez-Sánchez
Miguel A
MA
Escribano
Pilar
P
Sotelo
Teresa
T
Gómez de la Cámara
Agustín
A
Cortina
José
J
de la Calzada
Carlos S
CS
D000328:Adult; D002423:Cause of Death; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006333:Heart Failure / Q000150:complications / Q000401:mortality / Q000473:pathology*; D016027:Heart Transplantation / Q000379:methods / Q000401:mortality*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D011300:Preoperative Care; D011336:Probability; D011651:Pulmonary Artery / Q000473:pathology* / Q000503:physiopathology; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000401:mortality*