Hostname: page-component-848d4c4894-wg55d Total loading time: 0 Render date: 2024-06-10T11:07:22.207Z Has data issue: false hasContentIssue false
  • English
  • Français

Pulmonary arterial compliance in patients of CHD with increased pulmonary blood flow

Published online by Cambridge University Press:  03 November 2022

Mrigank Choubey Open the ORCID record for Mrigank Choubey [Opens in a new window] ,
Shyam S. Kothari ,
Saurabh K. Gupta Open the ORCID record for Saurabh K. Gupta [Opens in a new window] ,
Sivasubramanian Ramakrishnan  and
Anita Saxena
Mrigank Choubey
Affiliation:
Cardiology, All India Institute of Medical Sciences, New Delhi, India
Shyam S. Kothari*
Affiliation:
Cardiology, All India Institute of Medical Sciences, New Delhi, India
Saurabh K. Gupta
Affiliation:
Cardiology, All India Institute of Medical Sciences, New Delhi, India
Sivasubramanian Ramakrishnan
Affiliation:
Cardiology, All India Institute of Medical Sciences, New Delhi, India
Anita Saxena
Affiliation:
Cardiology, All India Institute of Medical Sciences, New Delhi, India
*
Author for correspondence: Dr. Shyam Sunder Kothari DM, FACC, Professor and Head, Department of Cardiology, Cardio-thoracic Centre, All India Institute of Medical Sciences, New Delhi – 110029, India. E-mail: kothariss100@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Pulmonary arterial compliance, the dynamic component of pulmonary vasculature, remains inadequately studied in patients with left to right shunts. We sought to study the pulmonary arterial compliance in patients with left to right shunt lesions and its utility in clinical decision-making.

Materials and methods:

In this single-centre retrospective study, we reviewed cardiac catheterisation data of consecutive patients of left to right shunt lesions catheterised over one year. In addition to the various other parameters, pulmonary arterial compliance was calculated, as indexed pulmonary flow (Qpi) / (Heart rate × pulse pressure in the pulmonary artery). RC time was also calculated, as the product of pulmonary arterial compliance and pulmonary vascular resistance index. Patients were divided into “operable,” “borderline,” and “inoperable” based on the decision of the treating team, and the pulmonary arterial compliance values were evaluated in these groups to study if it can be utilised to refine the operability decision.

Results:

298 patients (Median age 16 years, 56% <18 years) with various acyanotic shunt lesions were included. Overall, the pulmonary arterial compliance varied with Qpi, pulmonary artery mean pressure, and pulmonary vascular resistance index, but did not vary with age, type of lesion, or transpulmonary gradients. The median pulmonary arterial compliance in patients with normal pulmonary artery pressure (Mean pulmonary artery pressure less than 20 mmHg) was 4.1 ml/mmHg/m2 (IQR 3.2). The median pulmonary arterial compliance for operable patients was 2.67 ml/mmHg/m2 (IQR 2.2). Median pulmonary arterial compliance was significantly lower in both inoperable (0.52 ml/mmHg/m2, IQR 0.34) and borderline (0.80 ml/mmHg/m2, IQR 0.36) groups when compared to operable patients (p < 0.001). A pulmonary arterial compliance value lower than 1.18 ml/mmHg/m2 identified inoperable patients with high sensitivity and specificity (95%, AUC 0.99). However, in borderline cases, assessment by this value did not agree with empirical clinical assessment.

The median RC time for the entire study population was 0.47 S (IQR 0.30). RC time in operable patients was significantly lower than that in the inoperable patients (Median 0.40 IQR 0.23 in operable, 0.73 0.25 in inoperable patients (p < 0.001).

Conclusions:

Addition of pulmonary arterial compliance to the routine haemodynamic assessment of patients with shunt lesions may improve our understanding of the pulmonary circulation and may have clinical utility.

Keywords

Pulmonary arterial complianceoperabilityleft to right shunt lesionsshunt physiology
Type
Original Article
Information
Cardiology in the Young , Volume 33 , Issue 10 , October 2023 , pp. 1889 - 1895
Check for updates
Copyright
© The Author(s), 2022. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Milnor, WR, Jose, AD, McGaff, CJ. Pulmonary vascular volume, resistance, and compliance in man. Circulation [Internet] 1960; 22: 130–137.CrossRefGoogle ScholarPubMed
van der Feen, DE, Bartelds, B, de Boer, RA, Berger, RMF. Assessment of reversibility in pulmonary arterial hypertension and congenital heart disease. Heart 2019; 105: 276–282.CrossRefGoogle ScholarPubMed
Lopes, AA, Oleary, PW. Measurement, interpretation and use of haemodynamic parameters in pulmonary hypertension associated with congenital cardiac disease. Cardiol Young. 2009; 19: 431–435.CrossRefGoogle ScholarPubMed
Slife, DM, Latham, RD, Sipkema, P, Westerhof, N. Pulmonary arterial compliance at rest and exercise in normal humans. Am J Physiol - Hear Circ Physiol 1990; 258: 27–26.Google ScholarPubMed
Basnet, NB, Awa, S, Hishi, T, Yanagisawa, M. Pulmonary arterial compliance in children with atrial and ventricular septal defect. Heart Vessels. 2000; 15: 61–69.CrossRefGoogle ScholarPubMed
Reuben, SR. Compliance of the human pulmonary arterial system in disease. Circ Res. 1971; 29: 40–50.CrossRefGoogle ScholarPubMed
Kirby, BJ. Pulmonary artery compliance in pulmonary heart disease. Progr Resp Res 1975; 9: 254–260.CrossRefGoogle Scholar
LaFarge, CG, Miettinen, OS. The estimation of oxygen consumption. Cardiovasc Res [Internet] 1970; 4: 23–30.CrossRefGoogle ScholarPubMed
Lopes, AA, Barst, RJ, Haworth, SG, et al. Repair of congenital heart disease with associated pulmonary hypertension in children: what are the minimal investigative procedures? Consensus statement from the Congenital Heart Disease and Pediatric Task Forces, Pulmonary Vascular Research Institute (PVRI). Pulm Circ [Internet] 2014; 4: 330–341.CrossRefGoogle ScholarPubMed
Yin, FCP, Liu, Z, Brin, KP. Estimation of Arterial Compliance. In Ventricular/Vascular Coupling. Springer New York, New York, NY, 1987: 384–398.10.1007/978-1-4613-8634-6_16CrossRefGoogle Scholar
Liu, Z, Brin, KP, Yin, FC. Estimation of total arterial compliance: an improved method and evaluation of current methods. Am J Physiol Circ Physiol 1986; 251: H588–600.CrossRefGoogle ScholarPubMed
Lankhaar, JW, Westerhof, N, Faes, TJC, et al. Pulmonary vascular resistance and compliance stay inversely related during treatment of pulmonary hypertension. Eur Heart J. 2008; 29: 1688–1695.10.1093/eurheartj/ehn103CrossRefGoogle ScholarPubMed
Stergiopulos, N, Meister, JJ, Westerhof, N. Simple and accurate way for estimating total and segmental arterial compliance: the pulse pressure method. Ann Biomed Eng 1994; 22: 392–397.CrossRefGoogle ScholarPubMed
Saouti, N, Westerhof, N, Postmus, PE, Vonk-Noordegraaf, A. The arterial load in pulmonary hypertension. Eur Respir Rev. 2010; 19: 197–203.CrossRefGoogle ScholarPubMed
Ghio, S, Schirinzi, S, Pica, S. Pulmonary arterial compliance: how and why should we measure it? Glob Cardiol Sci Pract 2015; 2015: 58.CrossRefGoogle Scholar
Stergiopulos, N, Meister, JJ, Westerhof, N. Evaluation of methods for estimation of total arterial compliance. Am J Physiol - Hear Circ Physiol [Internet] 1995; 268: H1540–8. DOI 10.1152/ajpheart.1995.268.4.H1540 CrossRefGoogle ScholarPubMed
Saouti, N, Westerhof, N, Postmus, PE, Vonk-Noordegraaf, A. The arterial load in pulmonary hypertension. Eur Respir Rev 2010; 19: 197–203.CrossRefGoogle ScholarPubMed
Tedford, RJ. Determinants of right ventricular afterload (2013 Grover Conference series). Pulm Circ. 2014; 4: 211–219.CrossRefGoogle ScholarPubMed
Vanden Eynden, F, Bové, T, Chirade, ML, Van Nooten, G, Segers, P. Measuring pulmonary arterial compliance: mission impossible? Insights from a novel in vivo continuous-flow based experimental model. Pulm Circ 2018; 8: 1–12.CrossRefGoogle ScholarPubMed
Iwaya, Y, Muneuchi, J, Sugitani, Y, Watanabe, M. Pulmonary vascular resistance and compliance in pulmonary blood flow alterations in children with congenital heart disease. Heart Vessels 2022; 37: 1283–1289.CrossRefGoogle ScholarPubMed
Randall, OS, van den Bos, GC, Westerhof, N. Systemic compliance: does it play a role in the genesis of essential hypertension? Cardiovasc Res 1984; 18: 455–462.CrossRefGoogle ScholarPubMed
Galiè, N, Channick, RN, Frantz, RP, et al. Risk stratification and medical therapy of pulmonary arterial hypertension. Eur Respir J 2019; 53: 1801889. DOI 10.1183/13993003.01889-2018.CrossRefGoogle ScholarPubMed
Palecek, T, Jansa, P, Ambroz, D, et al. Are pulmonary artery pulsatility indexes able to differentiate chronic pulmonary thromboembolism from pulmonary arterial hypertension? An echocardiographic and catheterization study. Heart Vessels 2011; 26: 176–182.CrossRefGoogle ScholarPubMed
Kussmaul, WG, Altschuler, JA, Matthai, WH, Laskey, WK. Right ventricular-vascular interaction in congestive heart failure. Importance of low-frequency impedance. Circulation 1993; 88: 1010–1015.CrossRefGoogle ScholarPubMed
Dragu, R, Rispler, S, Habib, M, et al. Pulmonary arterial capacitance in patients with heart failure and reactive pulmonary hypertension. Eur J Heart Fail 2015; 17: 74–80.CrossRefGoogle ScholarPubMed
Mahapatra, S, Nishimura, RA, Sorajja, P, Cha, S, McGoon, MD. Relationship of pulmonary arterial capacitance and mortality in idiopathic pulmonary arterial hypertension. J Am Coll Cardiol. 2006; 47: 799–803.CrossRefGoogle ScholarPubMed
Naeije, R, Delcroix, M. Is the time constant of the pulmonary circulation truly constant? Eur Respir J 2014; 43: 1541–1542.CrossRefGoogle ScholarPubMed
Supplementary material: File

Choubey et al. supplementary material

Tables S1-S2 and Figures S1-S2

Download Choubey et al. supplementary material(File)
File 1 MB