Purpose Pulmonary venous hypertension (PVH) with preserved systolic left ventricular ejection fraction is an established comorbidity in chronic obstructive pulmonary disease, COPD. PVH is characterized by mPAP ≥25mmHg and PCWP >15mmHg. Vascular morphological changes in PVH remain unclear. Methods and Materials A retrospective analysis of 33 patients with COPD/emphysema lung transplanted at Rigshospitalet, Denmark (1991-2010) was performed. PVH was diagnosed with right heart catheterization. Patients were stratified into two groups: (1) transpulmonary gradient (TPG) ≤12mmHg (passive PVH) and (2) TPG >12mmHg (“out of proportion” PVH). Arterial lesions were graded (1-6) according to a modified Heath and Edwards (HE) scale, and venous lesions as grade 0 : no venous vascular involvement, grade 1 : intimal fibrosis, medial hypertrophy and arterialization, and grade 2 : grade1 with >50% lumen reduction and/or aneurysmatic dilatation, secondary lumina, venolitis, fibrinoid necrosis or thrombosis. Results The mean age at evaluation was 55±6 years (73% women). All patients had NYHA functional class III-IV with FEV 1 22±7% and total lung capacity 116±21% of predicted. All had preserved left systolic ventricular function. Group I : n=16 (81% women), age 56±6 years, mPAP 28.4.2±2.8mmHg, PCWP 19.4±3.2mmHg. Mean TPG was 9.0±2.2 and median HE grading was 1 (range 0-2) with medial hypertrophy of muscular pulmonary arteries and muscularization of pulmonary arterioles. Median venous grade was 1 (range 0-2) with intimal fibrosis, medial hypertrophy and arterialization. Group II : n=17 (65% women), age 54±5 years, mPAP 37.1±6.2mmHg, PCWP 17.9±1.7mmHg, TPG 19.1±6.2 mmHg. Median HE grading was 0 (range 0-2). Median venous grade was 1 (range 0-2). Conclusions Although no difference in grades between patients with “out-of proportion” or passive PVH were observed, PVH appears to induce significant myofibroblast proliferation in both pulmonary arteries and veins.
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