1887
Volume 2015, Issue 4
  • ISSN: 2305-7823
  • EISSN:

Abstract

The pulmonary circulation is a high-flow/low-pressure system, coupled with a flow generator chamber–the right ventricle–, which is relatively unable to tolerate increases in afterload. A right heart catheterization, using a fluid-filled, balloon-tipped Swan-Ganz catheter allows the measurement of all hemodynamic parameters characterizing the pulmonary circulation: the inflow pressure, an acceptable estimate the outflow pressure, and the pulmonary blood flow. However, the study of the pulmonary circulation as a continuous flow system is an oversimplification and a thorough evaluation of the pulmonary circulation requires a correct understanding of the load that the pulmonary vascular bed imposes on the right ventricle, which includes static and dynamic components. This is critical to assess the prognosis of patients with pulmonary hypertension or with heart failure.

Pulmonary compliance is a measure of arterial distensibility and, either alone or in combination with pulmonary vascular resistance, gives clinicians the possibility of a good prognostic stratification of patients with heart failure or with pulmonary hypertension. The measurement of pulmonary arterial compliance should be included in the routine clinical evaluation of such patients.

Loading

Article metrics loading...

/content/journals/10.5339/gcsp.2015.58
2015-11-28
2020-07-13
Loading full text...

Full text loading...

/deliver/fulltext/gcsp/2015/4/gcsp.2015.58.html?itemId=/content/journals/10.5339/gcsp.2015.58&mimeType=html&fmt=ahah

References

  1. Naeije R. Physiology of the pulmonary circulation and the right heart. Curr Hypertens Rep. 2013; 15::623631.
    [Google Scholar]
  2. Voelkel NF, Quaife RA, Leinwand LA, Barst RJ, McGoon MD, Meldrum DR, Dupuis J, Long CS, Rubin LJ, Smart FW, Suzuki YJ, Gladwin M, Denholm EM, Gail DB. National Heart, Lung, and Blood Institute Working Group on Cellular and Molecular Mechanisms of Right Heart Failure . Right ventricular function and failure: Report of a National Heart, Lung, and Blood Institute working group on cellular and molecular mechanisms of right heart failure. Circulation. 2006; 114::18831891.
    [Google Scholar]
  3. Swan HJ, Ganz W, Forrester J, Marcus H, Diamond G, Chonette D. Catheterization of the heart in man with use of a flow-directed catheter. N Engl J Med. 1970; 283::447451.
    [Google Scholar]
  4. McDonald's blood flow in arteries. In: Nichols WWO'Rourke MF, eds. Theoretical, Experimental and Clinical Principles. 5th edition. London: Hodder Arnold 2005.
    [Google Scholar]
  5. Frank O. The basic shape of the arterial pulse. First treatise: Mathematical analysis. 1889. J Mol Cell Cardiol. 1990; 22::255277.
    [Google Scholar]
  6. Saouti N, Westerhof N, Postmus PE, Vonk-Noordegraaf A. The arterial load in pulmonary hypertension. Eur Respir Rev. 2010; 19::197203.
    [Google Scholar]
  7. Janicki JS, Weber KT, Likoff MJ, Fishman AP. The pressure-flow response of the pulmonary circulation in patients with heart failure and pulmonary vascular disease. Circulation. 1985; 72::12701278.
    [Google Scholar]
  8. Chemla D, Castelain V, Hervé P, Lecarpentier Y, Brimioulle S. Haemodynamic evaluation of pulmonary hypertension. Eur Respir J. 2002; 20::13141331.
    [Google Scholar]
  9. O'Rourke MF. Vascular impedance in studies of arterial and cardiac function. Physiol Review. 1982; 62::570623.
    [Google Scholar]
  10. Wang Z, Chesler NC. Pulmonary vascular wall stiffness: An important contributor to the increased right ventricular afterload with pulmonary hypertension. Pulm Circ. 2011; 1::212223.
    [Google Scholar]
  11. Lankhaar JW, Noordegraaf AV, Marcus JT. A computed method for non invasive MRI assessment of pulmonary arterial hypertension. J Appl Physiol. 2004; 97::794795.
    [Google Scholar]
  12. Sanz J, Kariisa M, Dellegrottaglie S, Prat-González S, Garcia MJ, Fuster V, Rajagopalan S. Evaluation of pulmonary artery stiffness in pulmonary hypertension with cardiac magnetic resonance. JACC Cardiovasc Imaging. 2009; 2::286295.
    [Google Scholar]
  13. Lankhaar JW, Westerhof N, Faes TJ, Gan CT, Marques KM, Boonstra A, van den Berg FG, Postmus PE, Vonk-Noordegraaf A. Pulmonary vascular resistance and compliance stay inversely related during treatment of pulmonary hypertension. Eur Heart J. 2008; 29::16881695.
    [Google Scholar]
  14. Reuben SR. Compliance of the pulmonary arterial system in disease. Circ Res. 1971; 29::4050.
    [Google Scholar]
  15. Gan CT, Lankhaar JW, Westerhof N, Marcus JT, Becker A, Twisk JW, Boonstra A, Postmus PE, Vonk-Noordegraaf A. Noninvasively assessed pulmonary artery stiffness predicts mortality in pulmonary hypertension. Chest. 2007; 132::19061912.
    [Google Scholar]
  16. Saouti N, Westerhof N, Helderman F, Marcus JT, Stergiopulos N, Westerhof BE, Boonstra A, Postmus PE, Vonk-Noordegraaf A. RC-time constant of single lung equals that of both lungs together: A study in chronic thromboembolic pulmonary hypertension. Am J Physiol Heart Circ Physiol. 2009; 297::H2154H2160.
    [Google Scholar]
  17. Tedford RJ, Hassoun PM, Mathai SC, Girgis RE, Russell SD, Thiemann DR, Cingolani OH, Mudd JO, Borlaug BA, Redfield MM, Lederer DJ, Kass DA. Pulmonary capillary wedge pressure augments right ventricular pulsatile loading. Circulation. 2012; 125::289297.
    [Google Scholar]
  18. Tedford RJ. Determinants of right ventricular afterload (2013 Grover conference series). Pulmonary Circulation. 2014; 4:2:211219. doi:10.1086/676020 .
    [Google Scholar]
  19. Pietra GG, Capron F, Stewart S, Leone O, Humbert M, Robbins IM, Reid LM, Tuder RM. Pathologic assessment of vasculopathies in pulmonary hypertension. J Am Coll Cardiol. 2004; 43:Suppl. 12:25S32S.
    [Google Scholar]
  20. Humbert M, Morrell NW, Archer SL, Stenmark KR, MacLean MR, Lang IM, Christman BW, Weir EK, Eickelberg O, Voelkel NF, Rabinovitch M. Cellular and molecular pathobiology of pulmonary arterial hypertension. J Am Coll Cardiol. 2004; 43:Suppl. 12:13S124.
    [Google Scholar]
  21. D'Alonzo GE, Barst RJ, Ayres SM, Bergofsky EH, Brundage BH, Detre KM, Fishman AP, Goldring RM, Groves BM, Kernis JT, Levy PS, Pietra GG, Reid LM, Reeves JT, Rich S, Vreim CE, Williams GW, Wu M. Survival in patients with primary pulmonary hypertension. Results from a national prospective registry. Ann Intern Med. 1991; 115::343349.
    [Google Scholar]
  22. Brimioulle S, Naeije R, Vachiéry JL. Feasibility of routine pulmonary arterial impedance measurements in pulmonary hypertension. Chest. 2004; 125::21212128.
    [Google Scholar]
  23. Hunter KS, Lee PF, Lanning CJ, Ivy DD, Kirby KS, Claussen LR, Chan KC, Shandas R. Pulmonary vascular input impedance is a combined measure of pulmonary vascular resistance and stiffness and predicts clinical outcomes better than pulmonary vascular resistance alone in pediatric patients with pulmonary hypertension. Am Heart J. 2008; 155::166174.
    [Google Scholar]
  24. 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::799803.
    [Google Scholar]
  25. Mahapatra S, Nishimura RA, Oh JK, McGoon MD. The prognostic value of pulmonary vascular capacitance determined by Doppler echocardiography in patients with pulmonary arterial hypertension. J Am Soc Echocardiogr. 2006; 19::10451050.
    [Google Scholar]
  26. Lankhaar JW, Westerhof N, Faes TJ, Marques KM, Marcus JT, Postmus PE, Vonk-Noordegraaf A. Quantification of right ventricular afterload in patients with and without pulmonary hypertension. Am J Physiol Heart Circ Physiol. 2006; 291::H1731H1737.
    [Google Scholar]
  27. Domanski MJ, Mitchell GF, Norman JE, Exner DV, Pitt B, Pfeffer MA. Independent prognostic information provided by sphygmomanometrically determined pulse pressure and mean arterial pressure in patients with left ventricular dysfunction. J Am Coll Cardiol. 1999; 33::951958.
    [Google Scholar]
  28. Bonapace S, Rossi A, Cicoira M, Franceschini L, Golia G, Zanolla L, Marino P, Zardini P. Aortic distensibility independently affects exercise tolerance in patients with dilated cardiomyopathy. Circulation. 2003; 107::16031608.
    [Google Scholar]
  29. Miller WL, Grill DE, Borlaug BA. Clinical features, hemodynamics, and outcomes of pulmonary hypertension due to chronic heart failure with reduced ejection fraction. J Am Coll Cardiol HF. 2013; 1::290299.
    [Google Scholar]
  30. Dupont M, Mullens W, Skouri HN, Abrahams Z, Wu Y, Taylor DO, Starling RC, Tang WH. Prognostic role of pulmonary arterial capacitance in advanced heart failure. Circ Heart Fail. 2012; 5::778785.
    [Google Scholar]
  31. Pellegrini P, Rossi A, Pasotti M, Raineri C, Cicoira M, Bonapace S, Dini FL, Temporelli PL, Vassanelli C, Vanderpool R, Naeije R, Ghio S. Prognostic relevance of pulmonary arterial compliance in patients with chronic heart failure. Chest. 2014; 145::10641070.
    [Google Scholar]
  32. Delgado JF, Conde E, Sánchez V, López-Ríos F, Gómez-Sánchez MA, Escribano P, Sotelo T, Gómez de la Cámara A, Cortina J, de la Calzada CS. Pulmonary vascular remodeling in pulmonary hypertension due to chronic heart failure. Eur J Heart Fail. 2005; 7::10111016.
    [Google Scholar]
  33. Nakayama Y, Nakanishi N, Hayashi T, Nagaya N, Sakamaki F, Satoh N, Ohya H, Kyotani S. Pulmonary artery reflection for differentially diagnosing primary pulmonary hypertension and chronic pulmonary thromboembolism. J Am Coll Cardiol. 2001; 38::214218.
    [Google Scholar]
  34. Castelain V, Hervé P, Lecarpentier Y, Duroux P, Simonneau G, Chemla D. Pulmonary artery pulse pressure and wave reflection in chronic pulmonary thromboembolism and primary pulmonary hypertension. J Am Coll Cardiol. 2001; 37::10851092.
    [Google Scholar]
  35. Pagnamenta A, Vanderpool R, Brimioulle S, Naeije R. Proximal pulmonary arterial obstruction decreases the time constant of the pulmonary circulation and increases right ventricular afterload. J Appl Physiol. 2013; 114::15861592.
    [Google Scholar]
  36. MacKenzie Ross RV, Toshner MR, Soon E, Naeije R, Pepke-Zaba J. Decreased time constant of the pulmonary circulation in chronic thromboembolic pulmonary hypertension. Am J Physiol Heart Circ Physiol. 2013; 305::H259H264.
    [Google Scholar]
  37. Mayer E, Jenkins D, Lindner J, D'Armini A, Kloek J, Meyns B, Ilkjaer LB, Klepetko W, Delcroix M, Lang I, Pepke-Zaba J, Simonneau G, Dartevelle P. Surgical management and outcome of patients with chronic thromboembolic pulmonary hypertension: Results from an international prospective registry. J Thorac Cardiovasc Surg. 2011; 141::702710.
    [Google Scholar]
  38. Madani MM, Auger WR, Pretorius V, Sakakibara N, Kerr KM, Kim NH, Fedullo PF, Jamieson SW. Pulmonary endarterectomy: Recent changes in a single institution's experience of more than 2.700 patients. Ann Thorac Surg. 2012; 94::97103.
    [Google Scholar]
  39. Corsico AG, D'Armini AM, Cerveri I, Klersy C, Ansaldo E, Niniano R, Gatto E, Monterosso C, Morsolini M, Nicolardi S, Tramontin C, Pozzi E, Viganò M. Long-term outcome after pulmonary endarterectomy. Am J Respir Crit Care Med. 2008; 178::419424.
    [Google Scholar]
  40. Bonderman D, Martischnig AM, Vonbank K, Nikfardjam M, Meyer B, Heinz G, Klepetko W, Naeije R, Lang IM. Right ventricular load at exercise is a cause of persistent exercise limitation in patients with normal resting pulmonary vascular resistance after pulmonary endarterectomy. Chest. 2011; 139::122127.
    [Google Scholar]
  41. Ghio S, Morsolini M, Corsico A, Klersy C, Mattiucci G, Raineri C, Scelsi L, Vistarini N, D'Armini AM. Pulmonary arterial compliance and exercise capacity after pulmonary endarterectomy. Eur Respir J. 2014; 43::14031409.
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.5339/gcsp.2015.58
Loading
/content/journals/10.5339/gcsp.2015.58
Loading

Data & Media loading...

  • Article Type: Review Article
Keyword(s): pulmonary arterial compliance and pulmonary circulation
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error