Abstract
Simple SummaryPulmonary hypertension (PH) remains a fatal disease, despite the advances in disease-specific therapies. This may be because the assessment of pulmonary hemodynamics in PH has not been established. Recently, several studies have reported that the pulmonary arterial wave reflection (PAWR) might influence the right ventricular afterload and could provide additional information regarding the severity and progression of PH. However, the pathophysiology of PAWR has some unclear points particularly in the case of acute pulmonary embolism (APE). The objective of this study was to investigate, for the first time, the characteristics of PAWR in a dog model of APE using dual-tipped sensor wire. From the result of the present study, after dogs developed PH by injections of dextran microsphere, PAWR was increased significantly along with the pulmonary vascular resistance (PVR) and reduced after vasodilator administration. In addition, PAWR was significantly correlated with PVR and right ventricular fractional area of change (FAC). These results indicating that PAWR may be useful as a new evaluation method in PH and may detect changes related to right ventricular afterload earlier than pulmonary artery pressure (PAP).Pulmonary hypertension (PH) is a complex syndrome that has been frequently diagnosed in dogs and humans and can be detected by Doppler echocardiography and invasive catheterization. Recently, PAWR attracts much attention as a noninvasive approach for the early detection of PH. The present study aims to investigate the PAWR changes in acute pulmonary embolism (APE) and highlight the response of PAWR variables to vasodilator therapy in dogs. For this purpose, anesthesia and catheterization were performed in 6 Beagle dogs. After that, APE was experimentally conducted by Dextran microsphere administration, followed by vasodilator (Nitroprusside; 1μg/kg/min/IV) administration. The hemodynamics, echocardiography, PVR and PAWR variables were evaluated at the baseline, after APE and after administration of nitroprusside. The result showed a significant increase in PVR, PAP, tricuspid regurgitation (TR) as well as PAWR variables following APE induction compared with the baseline (p < 0.05). Vasodilation caused by administration of nitroprusside reduced the mean atrial pressure, PVR and PAWR parameters. There were a significant correlation and linear regression between PAWR indices and PVR as well as right ventricular function parameters. In conclusion, PAWR is not only correlated with PVR but also the right ventricular function parameter, which indicates that PAWR may be useful as a new evaluation method in PH, considering that PAWR can assess both right ventricular afterload and right ventricular function.
Highlights
Pulmonary hypertension (PH) is a refractory disease that causes right heart failure due to an increase in the pulmonary artery pressure (PAP) and right ventricular afterload [1,2].In dogs, PH has been recognized as a clinical syndrome for many years, but the routine accurate clinical diagnosis has been enhanced with the widespread usage of Doppler echocardiography in the clinical setting
This study investigated the characteristics of pulmonary arterial wave reflection (PAWR) through experimental induction of acute pulmonary embolism (APE) in dogs and measuring the PAWR before and after administration of vasodilator
We investigated the changes of hemodynamics, echocardiographic and PAWR variables after administration of nitroprusside as a vasodilator
Summary
Pulmonary hypertension (PH) is a refractory disease that causes right heart failure due to an increase in the pulmonary artery pressure (PAP) and right ventricular afterload [1,2].In dogs, PH has been recognized as a clinical syndrome for many years, but the routine accurate clinical diagnosis has been enhanced with the widespread usage of Doppler echocardiography in the clinical setting. Pulmonary hypertension (PH) is a refractory disease that causes right heart failure due to an increase in the pulmonary artery pressure (PAP) and right ventricular afterload [1,2]. PH is a multifactorial problem that has been categorized into six groups in dogs based on the disease origin, including pulmonary arterial hypertension, left side heart disease, respiratory disease, pulmonary thromboembolism, parasitic disease and multifactorial or with unclear mechanisms [3]. It is considered that the prognosis of PH often be affected when the right ventricular function is reduced by an increase in the afterload [4,5]. The severity of PH is affected by PVR and PAP and by vascular impedance, pulmonary arterial wave reflection (PAWR) and right ventricular function
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